Modulacija soleusnega refleksa H z vajami za orofacialno področje, vrat ter ramenski obroč ali žvečenjem

Magdič, Marša

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Title:	Modulacija soleusnega refleksa H z vajami za orofacialno področje, vrat ter ramenski obroč ali žvečenjem
Authors:	ID Magdič, Marša (Author) ID Fekonja, Anita (Mentor) More about this mentor... ID Holobar, Aleš (Comentor) ID Vogrin, Matjaž (Comentor)
Files:	DOK_Magdic_Marsa_2026.pdf (3,99 MB) MD5: 69EB7C12CBF7CB0B22E8E98E1CAEEB5A
Language:	Slovenian
Work type:	Dissertation
Typology:	2.08 - Doctoral Dissertation
Organization:	MF - Faculty of Medicine
Abstract:	Doktorska disertacija obravnava soodvisnost orofacialne in vratne muskulature in nevralnega sistema ter izhaja iz predpostavke, da imajo lahko lokalizirane aktivnosti, kot je stiskanje zob, sistemski vpliv na spinalno vzdražnost. Čeprav je znano, da imajo raztezne vaje tako krajevne kot oddaljene učinke, ostaja specifičen vpliv raztezanja orofacialnih mišic premalo raziskan. Ta študija preučuje učinke dveh intervencij, in sicer serije 25 razteznih in mobilizacijskih vaj, usmerjenih na vratne in orofacialne mišice (Vadba), ter žvečenja šestih žvečilnih gumijev šest minut (Žvečenje), na soleusni refleks H in presinaptično inhibicijo. V raziskavi je sodelovalo deset prostovoljcev (povprečna starost: 28,75 ± 9 let), pri katerih so bile meritve refleksa H zabeležene s pomočjo površinske večkanalne elektromiografije (HDsEMG) pred in po vsaki intervenciji. Iz nepogojenih in pogojenih refleksov H so bili pridobljeni latenca (HLAT), trajanje (HDUR), amplituda od vrha do vrha (HP2P, D1PSP) ter amplituda pozitivnega vrha (HPOS). Za preučevanje mehanizmov presinaptične inhibicije D1 je bilo izračunano razmerje (D1PSP/HP2P) med pogojenim (D1PSP) in nepogojenim (HP2P) refleksom H. Dodatno so bili analizirani prispevki posameznih motoričnih enot (ME), pri čemer je bilo kategoriziranih 8400 proženj 376 različnih motoričnih enot glede na prag proženja. Po intervenciji Vadba sta se HP2P in HPOS zmanjšala, HDUR pa se je značilno povečal, medtem ko intervencija Žvečenje na te parametre ni imela vpliva. Razmerje D1PSP/HP2P je ostalo nespremenjeno, kar nakazuje, da opaženo zmanjšanje HP2P ni posledica mehanizmov presinaptične inhibicije. Analiza posameznih motoričnih enot je potrdila ugotovitve refleksa H. Rezultati študije nakazujejo, da lahko raztezne in mobilizacijske vaje, usmerjene na vratno in orofacialno področje, zmanjšajo nevromišično vzdražnost, kar odpira možnosti za nefarmakološko obvladovanje stanj, povezanih s prekomerno vzdražnostjo motoričnih nevronov, ter prispeva k splošni sprostitvi telesa. Za celovito razumevanje lokalnih procesov ter ovrednotenje učinkov obeh intervencij smo s pomočjo miotonometrije kvantificirali biomehanske in viskoelastične lastnosti masetra ter zgornjega dela mišice trapezius. Miotonometrija je objektivna, neinvazivna in neboleča metoda, ki je zlasti primerna za občutljive predele, kot je obraz. Pred in po vsaki intervenciji smo z ročnim miotonometrom ocenili mehanične in viskoelastične lastnosti (tonus, togost, dekrement, relaksacija in lezenje) obeh mišic. Pri masetru sta se po intervenciji Vadba znatno povečala togost (14,46 %, p < 0,001) in tonus (7,03 %, p < 0,001), medtem ko sta se po intervenciji Žvečenje zmanjšala (–8,82 %, p < 0,001; –5,53 %, p < 0,001). Poleg tega sta se lezenje in relaksacija masetra zmanjšali po intervenciji Vadba (–9,71 %, p < 0,001; –11,36 %, p < 0,001) in povečali po intervenciji Žvečenje (9,68 %, p < 0,001; 9,98 %, p < 0,001). V zgornjem delu mišice trapezius se je tonus pomembno zmanjšal tako po intervenciji Vadba (–7,65 %, p < 0,001) kot po Žvečenje (–1,06 %, p = 0,003), medtem ko se je relaksacija po obeh intervencijah pomembno povečala (Vadba: 1,78 %, p < 0,001; Žvečenje: 2,82 %, p < 0,001). Dekrement zgornjega dela mišice trapezius se je po intervenciji Vadba zmanjšal (–11,57 %, p < 0,001), po intervenciji Žvečenje pa ostal nespremenjen. Miotonometrični izsledki te študije kažejo na zapleteno lokalno interakcijo med biomehanskimi in viskoelastičnimi lastnostmi masetra in zgornjega dela mišice trapezius po vadbi in žvečenju. Ti rezultati poudarjajo pomen previdnosti pri predpostavljanju rezultatov takšnih intervencij in potrebo po nadaljnjih raziskavah s ciljem razumevanja in raziskovanja morebitnih terapevtskih učinkov vadbe pri disfunkcijah ramen in vratu.
Keywords:	Raztezanje, oddaljen učinek, večkanalni površinski elektromiogram (HDsEMG), miotonometrija
Place of publishing:	Maribor
Publisher:	[M. Magdič]
Year of publishing:	2026
PID:	20.500.12556/DKUM-93895
UDC:	616.314-089.23(043.3)
COBISS.SI-ID:	274639363
Publication date in DKUM:	09.04.2026
Views:	183
Downloads:	12
Metadata:
Categories:	MF
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Licences

License:	CC BY-NC-ND 4.0, Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International

Link:	http://creativecommons.org/licenses/by-nc-nd/4.0/
Description:	The most restrictive Creative Commons license. This only allows people to download and share the work for no commercial gain and for no other purposes.
Licensing start date:	25.07.2025

Secondary language

Language:	English
Title:	Modulation of soleus H reflex by orofacial, neck and shoulder girdle exercises or by chewing
Abstract:	In this doctoral dissertation, we are addressing the interconnected nature of orofacial, neck musculature, and the neural system suggests that localised activities, such as teeth clenching, can influence remote spinal excitability. While stretching exercises are known to have both local and remote effects, the specific impact of orofacial muscle stretching remains underexplored. This study investigates the effects of two interventions: a series of 25 stretching and mobility exercises targeting the neck and orofacial muscles (Exercises), and chewing six chewing gums for six minutes (Chewing), on the soleus H-reflex and D1 presynaptic inhibition. Ten volunteers (mean age: 28.75 ± 9 years) participated, with H-reflex measurements collected using high-density electromyography (HDsEMG) before and after each intervention. Latency (HLAT), duration (HDUR) peak-to-peak (HP2P, D1PSP) and positive peak (HPOS) amplitudes were extracted from unconditioned and conditioned H-reflexes. The ratio (D1PSP /HP2P) between conditioned (D1PSP) and unconditioned (HP2P) H-reflex was calculated to study the D1 presynaptic inhibition mechanisms. Additionally, single motor unit (MU) contributions were analysed, with 8400 firings from 376 distinct MUs categorised by firing threshold. HP2P, HPOS decreased and HDUR was significantly increased after the Exercise intervention, while the Chewing intervention had no effect on these parameters. The D1PSP /HP2P ratio remained unchanged, suggesting that the observed drop in HP2P is not mediated by presynaptic inhibition mechanisms. Single MU analysis corroborated the H-reflex findings. The results of this study suggest that stretching and mobility exercises targeting the neck and orofacial region can reduce neuromuscular excitability, offering potential for non-pharmacological management of conditions associated with motoneuron hyperexcitability and general whole-body relaxation. For a comprehensive understanding of local processes and an evaluation of the effects of both interventions, we quantified the biomechanical and viscoelastic properties of the masseter and the upper portion of the trapezius muscle using myotonometry. Myotonometry provides an objective non-invasive, pain-free assessment of these muscle properties, making it particularly useful for sensitive areas like the face. The masseter and upper trapezius mechanical and viscoelastic properties (Tone, Stiffness, Decrement, Relaxation Time, and Creep) were assessed before and after each intervention using a handheld myotonometric device. The masseter muscle showed a significant increase in Stiffness (14.46 %, p < 0.001) and Tone (7.03 %, p < 0.001) following the Exercise intervention, while both decreased after the Chewing intervention (−8.82 %, p < 0.001; −5.53 %, p < 0.001, respectively). Additionally, Creep and Relaxation in the masseter muscle decreased after Exercise (−9.71 %, p < 0.001; −11.36 %, p < 0.001) but increased following Chewing (9.68 %, p < 0.001; 9.98 %, p < 0.001). In the upper trapezius muscle, Tone significantly decreased after both Exercise (−7.65 %, p < 0.001) and Chewing (−1.06 %, p = 0.003), while Relaxation increased significantly following both interventions (Exercise: 1.78 %, p < 0.001; Chewing: 2.82 %, p < 0.001). The upper trapezius muscle's Decrement decreased after Exercise (−11.57 %, p < 0.001) but remained unchanged following the Chewing intervention. The myotonometric findings of this study suggest a complex local interplay between tone, biomechanical and viscoelastic properties of the masseter and trapezius muscles after the Exercise and Chewing interventions. These results highlight the importance of caution when assuming on the outcomes of such intervention and the need for further research to fully understand and explore the potential therapeutic effects of these exercises on shoulder and neck dysfunctions.
Keywords:	Stretching, remote effect, high-density EMG, exercise, interventional study, myotonometry

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