In the human face, the muscles and joints that generate movement have different properties. Whereas the jaw is a conventional condyle joint, the facial musculature has neither distinct origin nor insertion points, and the muscles do not contain muscle spindle proprioceptors. This current study aims to compare the proprioceptive ability at the orofacial muscles with that of the temporomandibular joint (TMJ) in 21 neuro-typical people aged between 18 and 65 years. A novel psychophysical task was devised for use with both structures that involved a fixed 30.5 mm start separation followed by closure onto stimuli of 5, 6, 7, 8 mm diameter. The mean proprioceptive score when using the lips was 0.84 compared to 0.79 at the jaw (p < 0.001), and response error was lower by 0.1 mm. The greater accuracy in discrimination of lip movement is significant because, unlike the muscles controlling the TMJ, the orbicularis oris muscle controlling the lips inserts on to connective tissue and other muscle, and contains no muscle spindles, implying a different more effective, proprioceptive mechanism. Additionally, unlike the lack of correlation previously observed between joints in the upper and lower limbs, at the face the scores from performing the task with the two different structures were significantly correlated (r = 0.5, p = 0.018). These data extend the understanding of proprioception being correlated for the same left and right joints and correlated within the same structure (e.g. ankle dorsiflexion and inversion), to include use-dependant proprioception, with performance in different structures being correlated through extended coordinated use. At the lips and jaw, it is likely that this arises from extensive coordinated use. This informs clinical assessment and suggests a potential for coordinated post-injury training of the lips and jaw, as well as having the potential to predict premorbid function via measurement of the uninjured structure, when monitoring progress and setting clinical rehabilitation goals.
Background: Self-regulatory mental fatigue (SRF) is commonly experienced after sustained mental and physical effort that requires people to self-regulate behavior, emotion, and movement. Its occurrence suggests that attempts at conscious self-control cause depletion of an exhaustible resource and could lead to decreased quantity and quality of exercises during physical therapy (PT). Patients typically experience fatigue during PT treatment following musculoskeletal or neurological injury, however, SRF has never been applied to PT although there is a strong theoretical link.Objectives: This paper aims to critically appraise the evidence and introduce the concept of SRF to PT rehabilitation of musculoskeletal and neurological conditions. Objectives are to review the current evidence linking SRF to motor control and learning of rehabilitation exercises, links to other allied health areas; to examine the role of emotional suppression on SRF and how it affects performance of PT exercises; and to review the evidence concerning potential techniques for clinicians to offset or promote recovery from SRF. Major findings: Self-regulatory mental fatigue is a robust concept as shown by the volume of research in the area. However, variable methodology and the novelty of the concept to PT reduce the strength of the body of evidence. Research suggests a theoretical link between SRF and reduced quality and quantity of PT exercise. Self-regulatory mental fatigue can be induced during motor learning and by psychosocial costs of musculoskeletal and neurological conditions. Good-quality evidence indicates that techniques such as quotas and implementation intentions could prove useful clinical tools to decrease the effects of SRF during PT treatment. Glucose mouth rinse or ingestion is supported by the literature but is not a clinically sustainable treatment for SRF. Conclusions: There is a theoretical link between SRF and decreased quality and quantity of therapeutic exercise. In order to decrease the effects of SRF this review suggests strategies such as quotas, implementation intentions, rest periods, and glucose supplementation.
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