International Hypnosis Research Institute - Massage Therapy

Evaluation of Applied Kinesiology meridian techniques by means of surface electromyography (sEMG)

Sat, 28 Aug 2010 11:10:00 -0500

Full Title: Evaluation of Applied Kinesiology meridian techniques by means of surface electromyography (sEMG): demonstration of the regulatory influence of antique acupuncture points BACKGROUND: The use of Applied Kinesiology techniques based on manual muscle tests relies on the relationship between muscles and acupuncture meridians. Applied Kinesiology detects body dysfunctions based on changes in muscle tone. Muscle tonification or inhibition within the test setting can be achieved with selected acupoints. These acupoints belong to either the same meridian or related meridians. The aim of this study is to analyze muscle sedation and tonification by means of surface electromyography. METHODS: Manual muscle tests were carried out using standard Applied Kinesiology (AK) techniques. The investigation included basic AK procedures such as sedation and tonification with specific acupoints. The sedation and tonification acupoints were selected from related meridians according to the Five Elements. The tonification effect of these acupoints was also tested while interfering effects were induced by manual stimulation of scars. The effects of selective neural therapy, i.e. individually tested and selected anesthetic agent, for the treatment of scars were also studied. The characteristics of muscle action were documented by surface electromyographys (sEMG). RESULTS: The sEMG data showed a diminution of signal intensity when sedation was used. Graded sedation resulted in a graded diminution of signal amplitude. Graded increase in signal amplitude was observed when antique acupuncture points were used for tonification. The tactile stretch stimulus of scars localized in meridian-independent places produced diminution of signal intensity on a reference muscle, similar to sedation. These changes, however, were not corrected by tonification acupoints. Correction of these interferences was achieved by lesion specific neural therapy with local anesthetics. CONCLUSION: We demonstrated the central working principles, i.e. sedation and tonification, of Applied Kinesiology through the use of specific acupoints that have an influence on manual muscle tests. Sedation decreases RMS signal in sEMG, whereas tonification increases it. Interfering stimuli from scars were corrected by selective neural therapy. Chin Med. 2009 May 29;4:9. Moncayo R, Moncayo H. WOMED, Innsbruck, Austria. anmeldung@womed.at

A randomized trial of massage therapy after heart surgery

Fri, 27 Aug 2010 11:06:00 -0500

OBJECTIVES: To determine whether massage therapy improves postoperative mood, pain, anxiety, and physiologic measurements; shortens hospital stay; and decreases occurrence of atrial fibrillation. METHODS: Two hundred fifty-two adults undergoing cardiac surgery were randomized to usual postoperative care (n=126) or usual care plus two massages (n=126). Assessments of mood, depression, anxiety, pain, physiologic status, cardiac rhythm, and hospital length of stay were completed. Logistic and linear regressions were performed. RESULTS: Preoperative pain, mood, and affective state scores were positively associated with postoperative scores; however, there were no postoperative differences between groups for any measures (P=.11 to .93). There were no differences in physiologic variables except lower postoperative blood pressure after massage (P = .01). Postoperative atrial fibrillation occurrence (P = .6) and median postoperative hospital length of stay (P = .4) were similar between groups. CONCLUSION: Massage therapy is feasible in cardiac surgical patients; however, it does not yield therapeutic benefit. Nevertheless, it should be a patient-selected and -paid option. Heart Lung. 2009 Nov-Dec;38(6):480-90. Epub 2009 Jun 28. Albert NM, Gillinov AM, Lytle BW, Feng J, Cwynar R, Blackstone EH. Nursing Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.

Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive...

Fri, 20 Aug 2010 10:44:00 -0500

Full Title: Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures Objectives: (1) To assess the efficacy of a 20 minute massage therapy session on pain, anxiety, and tension in patients before an invasive cardiovascular procedure. (2) To assess overall patient satisfaction with the massage therapy. (3) To evaluate the feasibility of integrating massage therapy into preprocedural practices. Experimental pretest-posttest design using random assignment. Medical cardiology progressive care units at a Midwestern Academic Medical Center. Patients (N=130) undergoing invasive cardiovascular procedures. The intervention group received 20 minutes of hands on massage at least 30 minutes before an invasive cardiovascular procedure. Control group patients received standard preprocedural care. Visual analogue scales were used to collect verbal numeric responses measuring pain, anxiety, and tension pre- and postprocedure. The differences between pre- and postprocedure scores were compared between the massage and standard therapy groups using the Mann-Whitney Wilcoxon's test. Scores for pain, anxiety, and tension scores were identified along with an increase in satisfaction for patients who received a 20-minute massage before procedure compared with those receiving standard care. This pilot study showed that massage can be incorporated into medical cardiovascular units' preprocedural practice and adds validity to prior massage studies. Prog Cardiovasc Nurs. 2009 Dec;24(4):155-61. Wentworth LJ, Briese LJ, Timimi FK, Sanvick CL, Bartel DC, Cutshall SM, Tilbury RT, Lennon R, Bauer BA. Department of Nursing Administration, Mayo Clinic, Rochester, MN 55905, USA. wentworth.laura@mayo.edu

Depression, mood, stress, and Th1/Th2 immune balance in primary breast cancer patients...

Fri, 13 Aug 2010 10:42:00 -0500

Full Title: Depression, mood, stress, and Th1/Th2 immune balance in primary breast cancer patients undergoing classical massage therapy PURPOSE: Cancer patients frequently suffer from psychological comorbidities such as depression and elevated stress. Previous studies could demonstrate that cancer patients benefit from massage therapy on the physical and psychological level. This pilot study investigates the effects of massage on depression, mood, perceived stress, and the Th1/Th2 ratio in breast cancer patients. METHODS: Thirty-four breast cancer patients were randomly assigned to a massage group (n = 17) and a control group (n = 17). Patients of the massage group received two 30-min classical massages per week for 5 weeks. At baseline, at the end of the intervention period, and 6 weeks after the end of intervention, patients of both groups completed the Perceived Stress Questionnaire (PSQ), the Patient Health Questionnaire (PHQ), and the Berlin Mood Questionnaire (BFS) and blood was withdrawn for determining cytokine concentrations and the Th1/Th2 ratio. RESULTS: Twenty-nine patients were included in the statistical analysis. Depression (PHQ) and anxious depression (BSF) were significantly reduced immediately after massage compared to the control group. Stress (PSQ) and elevated mood (BSF) did not show significant alterations after massage therapy. Changes of cytokine concentrations and Th1/Th2 ratio were insignificant as well, although there was a slight shift towards Th1 in the massage group over time. CONCLUSIONS: Massage therapy is an efficient treatment for reducing depression in breast cancer patients. Insignificant results concerning immunological parameters, stress, and mood indicate that further research is needed to determine psychological and immunological changes under massage therapy. Support Care Cancer. 2010 Jul 20. Krohn M, Listing M, Tjahjono G, Reisshauer A, Peters E, Klapp BF, Rauchfuss M. Department of Psychosomatics and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany, michaela.krohn@charite.de.

Back massage therapy promotes psychological relaxation and an increase in...

Fri, 06 Aug 2010 10:23:00 -0500

Full Title: Back massage therapy promotes psychological relaxation and an increase in salivary chromogranin A release Massage therapy promotes psychosocial relaxation, reduces stress and has been reported to improve the immune function. As such, massage therapy is currently used in palliative care for the relief of anxiety and pain. Although psychosocial status has been evaluated using subjective psychological tests, such as State-Trait Anxiety Inventory (STAI), subjective psychological tests are of limited value if the subjects fail to report reliably. Salivary biomarkers have been recently suggested as useful objective markers for assessing psychosocial status. To determine whether salivary biomarkers are useful objective indices for assessing the effects of back massage on the mental status of 25 young healthy female volunteers, we measured heart rate and salivary biomarkers (alpha-amylase activity, cortisol, and chromogranin A) and assessed the STAI score before and after the back massage. Back massage significantly reduced the heart rate and STAI; however, salivary amylase and cortisol levels did not change. In contrast, the level of salivary chromogranin A significantly increased. We therefore conclude that changes in the salivary biomarkers tested here may not indicate changes in psychological status following massage therapy. However, the increase in chromogranin A release may contribute to the immunologically beneficial effects of massage therapy as chromogranin A has antibacterial and antifungal activity. J Anesth. 2010 Aug 5.Noto Y, Kudo M, Hirota K. Department of Nursing, Hirosaki University Graduate School of Health Sciences, Hirosaki, 036-8563, Japan.

Massage therapy improves neurodevelopment outcome at two years corrected age for...

Sat, 31 Jul 2010 12:21:00 -0500

Full Title: Massage therapy improves neurodevelopment outcome at two years corrected age for very low birth weight infants BACKGROUND: Long term effects of massage therapy in very preterm newborns infants are still to be described. Few studies evaluated neurodevelopment just at six months, and included late preterm infants. OBJECTIVE: To study the effect of massage therapy on neurodevelopment of very low birth weight infants at two years corrected age. STUDY DESIGN: Newborns with birth weight between >or= 750 and

Differences in practitioners' proficiency affect the effectiveness of massage therapy...

Sat, 24 Jul 2010 12:20:00 -0500

Full Title: Differences in practitioners' proficiency affect the effectiveness of massage therapy on physical and psychological states OBJECTIVE: An examination was made of how differences in the proficiency of massage practitioners had different physical and psychological effects on clients. METHOD: Eight healthy 50-year-old females, suffering from chronic neck and shoulder stiffness, were recruited and four interventions were conducted: three 40-minute massage therapy interventions, one each by a freshman and a sophomore student studying massage therapy, and one by their instructor, and one rest on the massage table. Visual analogue scale score for muscle stiffness in the neck and shoulder, state anxiety score, and salivary cortisol concentration levels and secretory immunoglobulin A, were measured pre- and post- interventions. RESULTS: Visual analogue scale of neck and shoulder stiffness after massage by the instructor was significantly lower than that after the other interventions, and the score of state anxiety was lower than that after resting. (c) 2009 Elsevier Ltd. All rights reserved. J Bodyw Mov Ther. 2010 Jul;14(3):239-44. Epub 2009 Feb 20. Donoyama N, Shibasaki M. Course of Acupuncture and Moxibustion, Department of Health, Faculty of Health Sciences, Tsukuba University of Technology, 4-12-7, Kasuga, Tsukuba 305-8521, Ibaraki, Japan. donoyama@k.tsukuba-tech.ac.jp

Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study

Sat, 17 Jul 2010 12:19:00 -0500

Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Cardiac surgery patients undergo long procedures and commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects of massage therapy for alleviation of pain, tension, and anxiety, we studied the efficacy and feasibility of massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study (massage, n=62; control, n=51). Patients receiving massage therapy had significantly decreased pain, anxiety, and tension. Patients were highly satisfied with the intervention, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important component of the healing experience for patients after cardiovascular surgery. Copyright 2009 Elsevier Ltd. All rights reserved. Complement Ther Clin Pract. 2010 May;16(2):70-5. Epub 2009 Jul 14. Bauer BA, Cutshall SM, Wentworth LJ, Engen D, Messner PK, Wood CM, Brekke KM, Kelly RF, Sundt TM 3rd. Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. bauer.brent@mayo.edu

Itching, pain, and anxiety levels are reduced with massage therapy in burned adolescents

Sat, 10 Jul 2010 12:18:00 -0500

Burn can be among the most severe physical and psychologic traumas a person may face. Patients with burns commonly have severe itching and pain. Severe itching has also been associated with anxiety, sleep disturbance, and disruption of daily living activities. The addition of complementary treatments to standard care may lead to improved pain management and may offer a safer approach for reducing pain and procedural anxiety for patients with burns. The authors conducted an experimental study to examine whether the effects of massage therapy reduced burned adolescents' pain, itching, and anxiety levels. Sixty-three adolescents were enrolled in this study shortly after admission (mean days = 3 +/- 0.48) at a burn unit in a large university hospital from February 2008 to June 2009. The measures including the pain, itching, and state anxiety were collected on the first and last days of the 5-week study period. The participants had an average age of 14.07 +/- 1.78 years and came usually from the lower socioeconomic strata. The authors observed that massage therapy reduced all these measures from the first to the last day of this study (P < .001). In most cultures, massage treatments are used to alleviate a wide range of symptoms. Although health professionals agree on the use of nonpharmacologic method for patients with burns, these applications are not yet common. J Burn Care Res. 2010 May-Jun;31(3):429-32. Parlak Gürol A, Polat S, Akçay MN. Department of Pediatric Nursing, Faculty of Health Sciences, Atatürk University, Erzurum, Turkey.

Massage therapy for people with HIV/AIDS

Sat, 03 Jul 2010 12:58:00 -0500

BACKGROUND: Infection with human immunodeficency virus (HIV) and acquired immunodeficency syndrome (AIDS) is a pandemic that has affected millions of people globally. Although major research and clinical initiatives are addressing prevention and cure strategies, issues of quality of life for survivors have received less attention. Massage therapy is proposed to have a positive effect on quality of life and may also have a positive effect on immune function through stress mediation. OBJECTIVES: The objective of this systematic review was to examine the safety and effectiveness of massage therapy on quality of life, pain and immune system parameters in people living with HIV/AIDS. SEARCH STRATEGY: A comprehensive search strategy was devised incorporating appropriate terms for HIV/AIDS, randomised controlled trials (RCTs), massage therapy and the pertinent measures of benefit. All electronic databases identified were searched in November 2008, including Cochrane Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, SCIENCE CITATION INDEX, AIDSLINE, AIDSearch, CINAHL, HEALTHSTAR, PsycLIT, AMED, Current Contents, AMI, NLM GATEWAY, LILACS, IndMed, SOCIOFILE, SCI, SSCI, ERIC and DAI. We also reviewed relevant published and unpublished conference abstracts and proceedings andscrutinised reference lists from pertinent journals. There were no language or date restrictions. SELECTION CRITERIA: Studies were identified by two reviewers based on trial design (RCTs) and participants (ie, people of any age with HIV/AIDS, at any stage of the disease) who had undergone an intervention that included massage therapy for the identified aims of improving quality of life and activity and participation levels, improving immune function, reducing pain and improving other physiological or psychological impairments. DATA COLLECTION AND ANALYSIS: Two reviewers independently identified included studies and extracted relevant data. Two other reviewers independently reviewed the included studies for risk of bias. All data and risk of bias judgements were entered into Revman (v5) and meta-analyses were conducted where appropriate. MAIN RESULTS: Twelve papers were identified, from which four were included. The remaining eight papers were excluded predominantly due to inappropriate methodology. The four included studies were highly clinically heterogenous, investigating a range of age groups (ie, children, adolescents and adults) across the disease spectrum from early HIV through late-stage AIDS. The settings were either community or palliative care, and the outcome measures were a combination of quality of life and immunological function. The trials were judged to be at moderate risk of bias mostly because of incomplete reporting. For quality of life measures, the studies reported that massage therapy in combination with other modalities, such as meditation and stress reduction, are superior to massage therapy alone or to the other modalities alone. The quality of life domains with significant effect sizes included self-reported reduced use of health care resources, improvement in self-perceived spiritual quality of life and improvement in total quality of life scores. One study also reported positive changes in immune function, in particular CD4+ cell count and natural killer cell counts, due to massage therapy, and one study reported no difference between people given massage therapy and controls in immune parameters. Adverse or harmful effects were not well reported. AUTHORS' CONCLUSIONS: There is some evidence to support the use of massage therapy to improve quality of life for people living with HIV/AIDS (PLWHA), particularly in combination with other stress-management modalities, and that massage therapy may have a positive effect on immunological function. The trials are small, however, and at moderate risk of bias. Further studies are needed using larger sample sizes and rigorous design/reporting before massage therapy can be strongly recommended for PLWHA. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007502. Hillier SL, Louw Q, Morris L, Uwimana J, Statham S. Centre for Allied Health Evidence, University of South Australia (City East), North Terrace, Adelaide, SA, Australia, 5000.

Treatment effects of massage therapy in depressed people: a meta-analysis

Mon, 31 May 2010 12:33:00 -0500

OBJECTIVE: To systematically investigate the treatment effects of massage therapy in depressed people by incorporating data from recent studies. DATA SOURCES: A meta-analysis of randomized controlled trials (RCTs) of massage therapy in depressed people was conducted using published studies from PubMed, EMBASE, PsycINFO, and CINAHL electronic database from inception until July 2008. The terms used for the search were derived from medical subheading term (MeSH) massage combined with MeSH depression. Hand searching was also checked for bibliographies of relevant articles. Retrieval articles were constrained to RCTs/clinical trials and human subjects. No language restrictions were imposed. STUDY SELECTION: We included 17 studies containing 786 persons from 246 retrieved references. Trials with other intervention, combined therapy, and massage on infants or pregnant women were excluded. DATA EXTRACTION: Two reviewers independently performed initial screen and assessed quality indicators by Jadad scale. Data were extracted on publication year, participant characteristics, and outcomes by another single reviewer. DATA SYNTHESIS: All trials showed positive effect of massage therapy on depressed people. Seventeen RCTs were of moderate quality, with a mean quality score of 6.4 (SD = 0.85). The pooled standardized mean difference in fixed- and random-effects models were 0.76 (95% CI, 0.61-0.91) and 0.73 (95% CI, 0.52-0.93), respectively. Both indicated significant effectiveness in the treatment group compared with the control group. The variance between these studies revealed possible heterogeneity (tau(2) = 0.06, Cochran chi(2)(16) = 25.77, P = .06). CONCLUSIONS: Massage therapy is significantly associated with alleviated depressive symptoms. However, standardized protocols of massage therapy, various depression rating scales, and target populations in further studies are suggested. © Copyright 2010 Physicians Postgraduate Press, Inc. J Clin Psychiatry. 2010 Mar 23. Hou WH, Chiang PT, Hsu TY, Chiu SY, Yen YC. Department of Physical Medicine and Rehabilitation, Kaohsiung, Taiwan.

Itching, Pain, and Anxiety Levels Are Reduced With Massage Therapy...

Tue, 25 May 2010 12:31:00 -0500

Full Title: Itching, Pain, and Anxiety Levels Are Reduced With Massage Therapy in Adolescent Having Burn Burn, a person may face, is one of the statuses, which can be a most severe physical and psychologic trauma. Patients with burns commonly have severe itching and pain. Severe itching has also been associated with the anxiety, sleep disturbance, and disruption of daily living activities. The addition of complementary treatments to standard care may lead to a greater pain management and may offer a safer approach for reducing pain and procedural anxiety for patients with burns. The authors conducted an experimental study to examine whether the effects of massage therapy reduced burned adolescents' pain, itching, and anxiety levels. Sixty-three adolescents were enrolled in this study shortly after admission (mean days = 3 +/- 0.48) at a burn unit in a large university hospital from February 2008 to June 2009. The measures including the pain, itching, and state anxiety were collected on the first and last days of the 5-week study period. The participants had an average age of 14.07 +/- 1.78 years and came usually from the lower socioeconomic strata. The authors observed that massage therapy reduced all these measures from the first to the last day of this study (P < .001). In most cultures, massage treatment are used to alleviate a wide range of symptoms. Although health professionals agree on the use of nonpharmacologic method for patients with burns, these applications are not yet common. J Burn Care Res. 2010 Mar 31. Parlak A, Polat S, Nuran Akçay M. From the *Department of Pediatric Nursing, Faculty of Health Sciences, Atatürk University, Erzurum; daggerDepartment of Pediatric Nursing, Bozok University, School of Health, Yozgat; and double daggerDepartment of General Surgery, Medical Faculty, Atatürk University, Erzurum, Turkey.

The efficacy of classical massage on stress perception and cortisol...

Tue, 18 May 2010 12:29:00 -0500

The efficacy of classical massage on stress perception and cortisol following primary treatment of breast cancer To investigate the efficacy of classical massage on stress perception and mood disturbances, 34 women diagnosed with primary breast cancer were randomized into an intervention or control group. For a period of 5 weeks, the intervention group (n = 17) received biweekly 30-min classical massages. The control group (n = 17) received no additional treatment to their routine health care. The Perceived Stress Questionnaire (PSQ) and the Berlin Mood Questionnaire (BSF) were used and the patients' blood was collected at baseline (T1), at the end of the intervention period (T2), and 6 weeks after T2 (T3). Compared with control group, women in the intervention group reported significantly lower mood disturbances, especially for anger (p = 0.048), anxious depression (p = 0.03) at T2, and tiredness at T3 (p = 0.01). No group differences were found in PSQ scales, cortisol and serotonin concentrations at T2 and T3. However, perceived stress and cortisol serum levels (p = 0.03) were significantly reduced after massage therapy (T2) compared with baseline in the intervention group. Further research is needed to validate our findings. Arch Womens Ment Health. 2010 Apr;13(2):165-73. Epub 2010 Feb 19. Listing M, Krohn M, Liezmann C, Kim I, Reisshauer A, Peters E, Klapp BF, Rauchfuss M. Center for Internal Medicine and Dermatology, Department of Psychosomatics and Psychotherapy Berlin, Charité-Universitätsmedizin Berlin, Luisenstr. 13a, Berlin, Germany. miriam.listing@charite.de

Comparison between massage and music therapies to relieve the severity...

Tue, 11 May 2010 12:18:00 -0500

Full Title: Comparison between massage and music therapies to relieve the severity of labor pain BACKGROUND: During labor, women experience a high level of intense, stressful and steady pain that may negatively affect both mothers and neonates. Painkillers have previously been used for childbearing women, but nowadays, owing to some well-known limitations and serious side effects, nonpharmacologic methods such as massage and music therapies are being broadly recommended. The present clinical trial was conducted to compare the effects of massage and music therapies on the severity of labor pain in the Ilam province of western Iran. MATERIALS & METHODS: Overall, 101 primigravidae who were hospitalized for vaginal delivery were recruited and randomly stratified into two groups of either massage (n = 51) or music (n = 50) therapies. Pain was measured using the visual analog scale and the two groups were compared in terms of pain severity before and after the interventions. RESULTS: Mothers in the massage therapy group had a lower level of pain compared with those in the music therapy group (p = 0.009). A significant difference was observed between the two groups in terms of pain severity after intervention (p = 0.01). Agonizing, or most severe, labor pain was significantly relieved after massage therapy (p = 0.001). CONCLUSION: Massage therapy was an effective method for reducing and relieving labor pain compared with music therapy and can be clinically recommended as an alternative, safe and affordable method of pain relief where using either pharmacological or nonpharmacological methods are optional. Womens Health (Lond Engl). 2010 May;6(3):377-81. Taghinejad H, Delpisheh A, Suhrabi Z. Ilam University of Medical Sciences, Ilam, Iran.

Massage therapy for fibromyalgia symptoms

Sat, 24 Apr 2010 12:22:00 -0500

Massage therapy is widely used by patients with fibromyalgia seeking symptom relief. We performed a review of all available studies with an emphasis on randomized controlled trials to determine whether massage therapy can be a viable treatment of fibromyalgia symptoms. Extensive narrative review. PubMed, PsychInfo, CINAHL, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2009) were searched for the key words "massage", "massotherapy", "self-massage", "soft tissue manipulation", "soft tissue mobilization", "complementary medicine", "fibromyalgia" "fibrositis", and "myofascial pain". No language restrictions were imposed. The reference lists of all articles retrieved in full were also searched. The effects of massage on fibromyalgia symptoms have been examined in two single-arm studies and six randomized controlled trials. All reviewed studies showed short-term benefits of massage, and only one single-arm study demonstrated long-term benefits. All reviewed studies had methodological problems. The existing literature provides modest support for use of massage therapy in treating fibromyalgia. Additional rigorous research is needed in order to establish massage therapy as a safe and effective intervention for fibromyalgia. In massage therapy of fibromyalgia, we suggest that massage will be painless, its intensity should be increased gradually from session to session, in accordance with patient's symptoms; and the sessions should be performed at least 1-2 times a week. Rheumatol Int. 2010 Mar 20. Kalichman L. Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 84105, Israel, kleonid@bgu.ac.il.