Clinical Test Scores Research Articles

Investigating the Relationship Between Kinesiophobia, Catastrophizing, Pain Intensity, Disability, and Gait Performance in Chronic Neck Pain

Introduction: There is little evidence regarding the relationship between gait performance and psychological factors in people with chronic neck pain. This study evaluates gait performance in patients with neck pain and explores the relationship between gait performance and kinesiophobia, pain catastrophizing, pain intensity, and disability. Materials and Methods: A cross-sectional study was conducted on 34 patients with chronic neck pain and 29 age- and sex-matched controls were recruited for this study. The participants performed timed up-and-go (TUG), and 10-m walk tests (TMW) with and without head-turning tests. The associations between clinical gait tests, kinesiophobia (Tampa scale of kinesiophobia (TSK), pain catastrophizing scale, pain intensity (visual analog scale), and disability (neck disability index) were assessed. Results: People with neck pain had significant differences in the TUG, and TMW with and without head-turning tests compared to controls (P<0.01). Kinesiophobia and pain catastrophism were significantly correlated with TMW tests (r range=0.45 to 0.71, and 0.40 to 0.47, respectively). Pain intensity and disability were not correlated with gait tests. Conclusion: The gait performance, as represented by TUG and TMWs test scores, altered in patients with chronic neck pain in comparison controls. Fear of motion and pain catastrophizing thoughts correlated with clinical gait test scores.

Postural control behavior in women with dizziness

Vestibular dysfunctions normally manifest as dizziness, which is characterized by a subjective body balance disturbance. The present study aimed to analyze the influence of women’s self-perception of the level of dizziness on their postural behavior. This cross-sectional research was conducted with women 30 years old or more with a complaint of dizziness for at least three months. Anthropometric data were collected, as well as information on the level of dizziness and static postural control assessment (both with eyes open and closed). The descriptive and inferential analyses of the data were carried out with the SPSS 23.0 software. The clinical test scores were submitted to the Kolmogorov-Smirnov normality test and Student’s t-test for independent samples. The sample comprised 59 women, mean age 69.05 (±13.77) years. Regarding intensity, 37.2% had mild dizziness, 32.2% had moderate dizziness, and 30.5% had severe dizziness. The balance motor control pattern identified a lower limb prevalence on the total sway surface of the elliptic area both with eyes open (p = 0.012) and closed (p = 0.024), as well as anteroposterior sway with eyes open in the group with severe dizziness (p = 0.041). The self-perception of the level of dizziness influenced these women’s postural behavior.

Application of online to offline teaching mode in the training of non-anesthesiology residents in the department of anesthesiology: a randomized, controlled trial.

To explore the effect of applying the online to offline teaching mode in the training of non-anesthesiology residents in department of anesthesiology. The randomized controlled trial was performed on non-anesthesiology residents from Affiliated Jiangning Hospital of Nanjing Medical University. All selected residents were randomly divided into the traditional teaching group (Group T) and the online to offline teaching group (Group O) by the random number table method. Traditional teaching mode was used in Group T, while the online to offline teaching mode was used in Group O. The training period lasted for two months. At the end of the training, theoretical and clinical skills were assessed for all residents, and students' satisfaction scores on teaching were investigated from the aspects of teaching mode, stimulating learning interest, improving learning process and teaching satisfaction. The teaching efficiency was compared and analyzed in the two groups. In total, 39 cases in Group O and 38 cases in Group T were included in the statistical analysis. Compared with Group T, theory test scores, clinical skills test scores, and overall scores improved significantly in Group O (82.2 ± 8.1 vs. 91.3 ± 7.6; 85.1 ± 4.7 vs. 93.3 ± 5.4 and 83.4 ± 6.4 vs. 92.1 ± 6.7, respectively, p < 0.01). Compared with Group T, scores on teaching mode, stimulating learning interest, improving learning process and teaching satisfaction were higher in Group O (81.1 ± 6.9 vs. 93.7 ± 5.2; 83.6 ± 5.8 vs. 91.6 ± 6.4; 82.4 ± 5.3 vs. 90.9 ± 4.8 and 82.1 ± 5.9 vs. 92.1 ± 5.5, respectively, p < 0.01). The online to offline teaching mode can improve the level of professional theory and clinical skill operation, and teaching satisfaction of the non-anesthesiology residents in department of anesthesiology, thus improving the teaching effectiveness.

Using Serial Trichotomization to Determine Fitness to Drive in Medically At-Risk Drivers.

Clinical tests that identify fit and unfit drivers with 100% sensitivity and specificity would reduce uncertainty and improve efficiency of occupational therapists performing comprehensive driving evaluations (CDEs). To examine whether serial trichotomization of clinical tests predicts pass-fail outcomes with 100% sensitivity and specificity in a sample of medically at-risk drivers and in drivers with and without cognitive impairment (CI) referred for a CDE. Retrospective data collection and analysis of scores on the Montreal Cognitive Assessment; Trail Making Test, Part A and Part B; and the Useful Field of View® Subtests 1 to 3 and outcomes on the CDE (pass-fail or indeterminate requiring lessons and retesting). Receiver operating characteristic curves of clinical tests were performed to determine 100% sensitivity and specificity cut points in predicting CDE outcomes. Clinical tests were arranged in order from most to least predictive to identify pass-fail and indeterminate outcomes. A driving assessment clinic. Among 142 medically at-risk drivers (M age = 69.2 yr, SD = 14.1), 66 with CI, 46 passed and 39 failed the CDE; 57 were indeterminate. On-road pass-fail outcomes. Together, the six clinical tests predicted 62 pass and 49 fail outcomes in the total sample; 21 pass and 34 fail outcomes in participants with CI; and 58 pass and 14 fail outcomes in participants without CI. Serial trichotomization of clinical tests increases the accuracy of making informed decisions and reduces the number of drivers undergoing unnecessary on-road assessments. Plain-Language Summary: Clinical tests and their cut points that identify fit and unfit drivers vary substantially across settings and research studies. Serial trichotomization is one method that could help control for this variation by combining clinical test scores showing 100% sensitivity and specificity to identify pass (fit drivers) and fail outcomes (unfit drivers) and to reduce the number of drivers undergoing unnecessary on-road assessments.

Examining Eye Tracking Metrics and Cognitive Function in Post-Stroke Individuals: A Comparison of Visual Searching Tasks between Those with and without Cognitive Impairment

Introduction: After a stroke, individuals commonly experience visual problems and impaired cognitive function, which can significantly impact their daily lives. In addition to visual neglect and hemianopia, stroke survivors often have difficulties with visual search tasks. Researchers are increasingly interested in using eye tracking technology to study cognitive processing and determine whether eye tracking metrics can be used to screen and assess cognitive impairment in patients with neurological disorders. As such, assessing these areas and understanding their relationship is crucial for effective stroke rehabilitation. Methods: We enrolled 60 stroke patients in this study and evaluated their eye tracking performance and cognitive function through a series of tests. Subsequently, we divided the subjects into two groups based on their scores on the HK-MoCA test, with scores below 21 out of 30 indicating cognitive impairment. We then compared the eye tracking metrics between the two groups and identified any significant differences that existed. Spearman correlation analysis was conducted to explore the relationship between clinical test scores and eye tracking metrics. Moreover, we employed a Mann-Whitney U test to compare eye tracking metrics between groups with and without cognitive impairment. Results: Our results revealed significant correlations between various eye tracking metrics and cognitive tests (p ≤ 0.001–0.041). Furthermore, the group without cognitive impairment demonstrated higher saccade velocity, gaze path velocity, and shorter time to target than the group with cognitive impairment (p ≤ 0.001–0.040). Receiver operating characteristic curve analyses were performed, and the optimal cut-off values for gaze path velocity and saccade velocity were 329.665 (px/s) (sensitivity = 0.80, specificity = 0.533) and 2.150 (px/ms) (sensitivity = 0.733, specificity = 0.633), respectively. Conclusions: Our findings indicate a significant correlation between eye tracking metrics and cognitive test scores. Furthermore, the group with cognitive impairment exhibited a significant difference in these metrics, and a cut-off value was identified to predict whether a client was experiencing cognitive impairment.

Microstructure abnormalities of the diffusion quantities in children with attention-deficit/hyperactivity disorder: an AFQ and TBSS study.

To explore the specific alterations of white matter microstructure in children with attention-deficit/hyperactivity disorder (ADHD) by automated fiber quantification (AFQ) and tract-based spatial statistics (TBSS), and to analyze the correlation between white matter abnormality and impairment of executive function. In this prospective study, a total of twenty-seven patients diagnosed with ADHD (20 males, 7 females; mean age of 8.89 ± 1.67 years) and twenty-two healthy control (HC) individuals (11 males, 11 females, mean age of 9.82 ± 2.13 years) were included. All participants were scanned with diffusion kurtosis imaging (DKI) and assessed for executive functions. AFQ and TBSS analysis methods were used to investigate the white matter fiber impairment of ADHD patients, respectively. Axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD) and fractional anisotropy (FA) of 17 fiber properties were calculated using the AFQ. The mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), mean diffusivity (MDDKI), axial diffusivity (ADDKI), radial diffusivity (RDDKI) and fractional anisotropy (FADKI) of DKI and AD, RD, MD, and FA of diffusion tensor imaging (DTI) assessed the integrity of the white matter based on TBSS. Partial correlation analyses were conducted to evaluate the correlation between white matter abnormalities and clinical test scores in ADHD while taking age, gender, and education years into account. The analyses were all family-wise error rate (FWE) corrected. ADHD patients performed worse on the Behavior Rating Inventory of Executive Function (BRIEF) test (p < 0.05). Minor variances existed in gender and age between ADHD and HC, but these variances did not yield statistically significant distinctions. There were no significant differences in TBSS for DKI and DTI parameters (p > 0.05, TFCE-corrected). Compared to HC volunteers, the mean AD value of right cingulum bundle (CB_R) fiber tract showed a significantly higher level in ADHD patients following the correction of FWE. As a result of the point-wise comparison between groups, significant alterations (FWE correction, p < 0.05) were mainly located in AD (nodes 36-38, nodes 83-97) and MD (nodes 92-95) of CB_R. There was no significant correlation between white matter diffusion parameters and clinical test scores in ADHD while taking age, gender, and education years into account. The AFQ method can detect ADHD white matter abnormalities in a specific location with greater sensitivity, and the CB_R played a critical role. Our findings may be helpful in further studying the relationship between focal white matter abnormalities and ADHD.

Machine learning-based prediction of longitudinal cognitive decline in early Parkinson’s disease using multimodal features

Patients with Parkinson’s Disease (PD) often suffer from cognitive decline. Accurate prediction of cognitive decline is essential for early treatment of at-risk patients. The aim of this study was to develop and evaluate a multimodal machine learning model for the prediction of continuous cognitive decline in patients with early PD. We included 213 PD patients from the Parkinson’s Progression Markers Initiative (PPMI) database. Machine learning was used to predict change in Montreal Cognitive Assessment (MoCA) score using the difference between baseline and 4-years follow-up data as outcome. Input features were categorized into four sets: clinical test scores, cerebrospinal fluid (CSF) biomarkers, brain volumes, and genetic variants. All combinations of input feature sets were added to a basic model, which consisted of demographics and baseline cognition. An iterative scheme using RReliefF-based feature ranking and support vector regression in combination with tenfold cross validation was used to determine the optimal number of predictive features and to evaluate model performance for each combination of input feature sets. Our best performing model consisted of a combination of the basic model, clinical test scores and CSF-based biomarkers. This model had 12 features, which included baseline cognition, CSF phosphorylated tau, CSF total tau, CSF amyloid-beta1-42, geriatric depression scale (GDS) scores, and anxiety scores. Interestingly, many of the predictive features in our model have previously been associated with Alzheimer’s disease, showing the importance of assessing Alzheimer’s disease pathology in patients with Parkinson’s disease.

Migraine Treatment Using Erenumab: Can Lead to a Cognitive and Psychological Qualitative Improvement?

Migraine is one of the most disabling disorders in the world, associated with poor quality of life. Migraine prevention strategies have increasingly evolved since monoclonal antibodies against the calcitonin gene-related peptide (CGRP), or its receptor, were identified. CGRP is the ideal target of monoclonal antibodies (mAbs). In particular, erenumab is the mAb that has shown good therapeutic efficacy in reducing pain intensity and having high tolerability. In this study, we aimed to investigate the efficacy of erenumab on both cognitive performance and psychological well-being. This was a pilot study with a retrospective design that included 14 subjects (2 males and 12 females), with a mean age of 52.29 ± 9.62, who attended the Headache and Migraine outpatient clinic of the IRCCS Centro Neurolesi Bonino-Pulejo of Messina. The evaluation consisted of measuring cognitive and psychological functioning. Comparing clinical and psychometric test scores between baseline and follow-up, we found a significant improvement in both cognitive performance and quality of life. We also observed a decrease in migraine disability. Our findings have shown improvements in global cognitive performance and quality of life in migraine patients taking erenumab.

Serum Vitamin D Levels and Dry Eye Disease in Postmenopausal Women: A Case-Control Study at a Tertiary Care Center in Rural Haryana.

Despite the high prevalence of Vitamin-D insufficiency and high susceptibility to dry eye disease (DED) in postmenopausal women (PMW), correlation between DED and Vitamin D has not been explored in PMW in any Indian study. To explore the correlation between serum Vitamin D levels in PMW with and without DED, in a hospital-based population in rural Haryana. Subjective (ocular surface disease index [OSDI] questionnaire) and objective clinical tests were undertaken for DED diagnosis. 25(OH) Vitamin D was measured in serum using enzyme-linked immunosorbent assay; insufficient (10-30 ng/ml) and deficient (<10 ng/ml). Descriptive statistics were analyzed by mean ± standard deviation for continuous and frequencies for the categorical variables; Student's t-test used to find out mean difference in Vitamin D levels; P < 0.05 was considered statistically significant. One hundred and forty PMW (60.1 ± 5.32 years) were included; Group-A (Controls; no DED; n: 70); Group-B (Cases; DED diagnosed by OSDI scores; n: 70); Subgroup-B1 (clinical tests negative; n: 30) and B2 (clinical tests positive; n: 40). There was no statistically significant difference in OSDI scores between B1 and B2. Significantly lower mean Vitamin D levels were found in cases (14.36 ± 4.08 ng/ml) as compared to controls (19.19 ± 6.4 ng/ml) (P = 0.001) and in B2 (13.15 ± 3.51 ng/ml) as compared to B1 (15.57 ± 4.66 ng/ml) (P = 0.01). There were significantly low levels of Vitamin-D in clinically established DED. Evaluating Vitamin D levels as a part of the dry eye workup in PMW is recommended. OSDI scores were not aligned with the clinical test scores; questionnaire-based tests alone may not be sufficient for diagnosing DED.

A Preliminary Investigation of Mobile Respiratory Function Testing in Western Australian Communities

Although underutilized, spirometry is essential in the diagnosis and management of chronic obstructive pulmonary disease (COPD) and asthma. This study aimed to investigate a mobile (i.e., transportable) lung function testing (LFT) services in two metropolitan and two rural clinics in Western Australia. Individuals attending a mobile LFT clinic in 2021 were invited to complete questionnaires at baseline and after 6–8 weeks. Questionnaires were completed by 59/74 (79.7%) respondents (mean age 62.5 ± 14.2 years); most were female (35/59; 59.3%). A history of asthma was reported in 50.9% (30/59) and COPD in 18.6% (11/59) of respondents [13.6% (8/59) reported both]. At baseline, most (22/30; 73.3%) had asthma control test scores ≤19 (mean 16.6; range 8.0–25.0); at follow-up, 16/31 (51.6%) had scores ≤19 (mean score 18.0; range 6.0–25.0). Of the 11 diagnosed with COPD at baseline, the mean Clinical COPD Questionnaire and COPD assessment test scores were greater at follow-up (1.9 vs. 2.3; and: 10.3 vs. 14.7 respectively), reflecting worsening disease. Most participants (57/59; 96.6%) were satisfied with the LFT experience. The role of mobile LFT services to optimize the diagnosis and management of chronic lung disease and to minimize patient burden requires further investigation to improve short term patient outcomes.

Relationship between Cross-Sectional Area and Function of Core Muscles: An MRI Study

Background Particular attention has been paid to the core muscles because they serve as a muscular corset that works as a unit to stabilize the body and spine. Training programs for improving core stability often target improving core strength and endurance. Increased muscle size is also an expected effect of training programs. However, the relationship between core muscle cross-sectional area (CSA) and strength, stability, and clinical core test scores has not been identified. Purpose To investigate the relationship between core muscle CSA and muscle functions (strength, endurance, and stability). Study design A cross-sectional study Methods Fifty healthy participants (24 men, 26 women) participated in this study. The CSA of core muscle was measured using MRI. Maximal isometric trunk flexor strength, endurance, the score of double leg loading test were used to measure core muscle function. The relationship between core muscle CSA and muscle function was examined by Pearson’s correlation coefficient and Spearman rho correlation coefficient. Results Maximal isometric trunk flexor strength and side bridge strength were positively correlated with core muscle CSA. The isometric endurance test scores also showed a positive correlation with core muscle CSA except for the score of trunk flexor endurance test. Conclusions Only core strength showed moderate to excellent correlation with core muscle CSA. These findings indicate that core training to achieve muscle hypertrophy could lead to improved core strength but not core endurance.

Biomechanical Analysis Suggests Myosuit Reduces Knee Extensor Demand during Level and Incline Gait.

An FDA-approved soft wearable robot, the Myosuit, which was designed to provide hip and knee extension torque has recently been commercialized. While studies have reported reductions in metabolic costs, increased gait speeds, and improvements in clinical test scores, a comprehensive analysis of electromyography (EMG) signals and joint kinematics is warranted because the recruitment of appropriate muscle groups during physiological movement patterns facilitates effective motor learning. Here, we compared the lower limb joint kinematics and EMG patterns while wearing the Myosuit with that of unassisted conditions when performing level overground and incline treadmill gait. The level overground gait sessions (seven healthy subjects) were performed at self-selected speeds and the incline treadmill gait sessions (four healthy subjects) were performed at 2, 3, 4, and 5 km/h. In order to evaluate how the user is assisted, we conducted a biomechanical analysis according to the three major gait tasks: weight acceptance (WA), single-limb support, and limb advancement. The results from the gait sessions suggest that Myosuit not only well preserves the users’ natural patterns, but more importantly reduce knee extensor demand during the WA phase for both level and incline gait.

Dementia-related user-based collaborative filtering for imputing missing data and generating a reliability scale on clinical test scores.

Medical doctors may struggle to diagnose dementia, particularly when clinical test scores are missing or incorrect. In case of any doubts, both morphometrics and demographics are crucial when examining dementia in medicine. This study aims to impute and verify clinical test scores with brain MRI analysis and additional demographics, thereby proposing a decision support system that improves diagnosis and prognosis in an easy-to-understand manner. Therefore, we impute the missing clinical test score values by unsupervised dementia-related user-based collaborative filtering to minimize errors. By analyzing succession rates, we propose a reliability scale that can be utilized for the consistency of existing clinical test scores. The complete base of 816 ADNI1-screening samples was processed, and a hybrid set of 603 features was handled. Moreover, the detailed parameters in use, such as the best neighborhood and input features were evaluated for further comparative analysis. Overall, certain collaborative filtering configurations outperformed alternative state-of-the-art imputation techniques. The imputation system and reliability scale based on the proposed methodology are promising for supporting the clinical tests.

Training Emergency Department Residents in the Management of Postpartum Hemorrhage: Comparison of Two Approaches [A183

INTRODUCTION: Postpartum hemorrhage (PPH) is a major contributor to maternal mortality, accounting for 15% of all maternal deaths in the United States. Mortality and morbidity from PPH can be prevented with recognition and rapid intervention. The emergency department (ED) is the first place where women with postpartum hemorrhage present, particularly in areas where obstetric care is limited. Maternity care deserts are defined as counties without a hospital offering obstetric care and no obstetric providers. A total of 34.9% of the counties in the United Sates qualify as maternity care deserts, accounting for 146,451 births. It is critical that ED physicians be trained in the management of PPH. METHODS: The study design is a blinded randomized control trial. Thirty ED residents from Yale New Haven Hospital enrolled completed a pre-intervention survey assessing their baseline knowledge and confidence in managing PPH. Residents received a lecture on the management of PPH. Participants were then randomized into a group that received no further intervention and a group that participated in a simulation and debriefing. One week later, the residents’ clinical skills were evaluated in a simulation and repeated the survey. Clinical skills evaluation and survey test scores of the two groups were compared using t test. Covariates were analyzed by linear regression. RESULTS: All participants improved their knowledge and confidence regardless of the method used. Simulation did not appear to confer additional benefit. CONCLUSION: This study demonstrated that through delivery of a curriculum, we can improve the confidence and the knowledge of ED residents in the management of PPH.

Docosahexaenoic and Eicosapentaenoic Intervention Modifies Plasma and Erythrocyte Omega-3 Fatty Acid Profiles But Not the Clinical Course of Children With Autism Spectrum Disorder: A Randomized Control Trial.

BackgroundThe pathogenesis of autism spectrum disorder (ASD) is under investigation and one of the main alterations relates to the metabolic and inflammatory system dysfunctions. Indeed, based on a possible deficit of omega-3 fatty acids (FAs) of patients with ASD and looking for an anti-inflammatory effect, dietary supplements with omega-3 fatty acids have been proposed. We aimed to evaluate differences in plasma and erythrocyte FA profiles and plasma cytokines in patients with infantile ASD after supplementation with docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids or placebo and both compared at baseline with a reference healthy group.MethodsA double-blind, randomized placebo-controlled intervention with DHA/EPA for 6 months was carried out in 54 children between 2 and 6 years diagnosed with ASD. They were selected and randomly assigned into two groups: 19 children received 800 mg/day of DHA and 25 mg/day of EPA, or placebo. In addition, another reference group of 59 healthy children of the same age was included. Plasma lipids and cytokines, and FA profiles in plasma and erythrocytes were measured at baseline and after 6 months of treatment in ASD children, and at baseline in the reference group.ResultsThere were no differences in demographic, anthropometric characteristics, and omega-3 intake between the healthy reference group and the ASD children at baseline. Children with ASD showed the higher plasma percentages of palmitic acid and total saturated FA and lower total omega-6 polyunsaturated FA (PUFA) compared with healthy children. An increased level of DHA and reduced EPA level in erythrocytes were detected in the ASD group vs. the reference group. After 6 months of treatment, the ASD group that received DHA enriched product significantly increased the plasma and erythrocyte percentages of DHA, but no differences were observed in the clinical test scores and other parameters as plasma cytokines between the two groups of ASD related to the intervention.ConclusionSpanish children with ASD exhibit an appropriate omega-3 FA status in plasma and erythrocytes. Neither a clinical improvement of ASD children nor a better anti-inflammatory or fatty acid state has been found after an intervention with DHA/EPA for 6 months. So, the prescription of n-3 LC-PUFA and other dietary supplements in ASD should be only indicated after a confirmed alteration of FA metabolism or omega-3 LC-PUFA deficiency evaluated by specific erythrocyte FA.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT03620097].

Converging evidence of impaired brain function in systemic lupus erythematosus: changes in perfusion dynamics and intrinsic functional connectivity.

Τhe study examined changes in hemodynamics and functional connectivity in patients with systemic lupus erythematosus (SLE) with or without neuropsychiatric manifestations. Participants were 44 patients with neuropsychiatric SLE (NPSLE), 20 SLE patients without such manifestations (non-NPSLE), and 35 healthy controls. Resting-state functional MRI (rs-fMRI) was used to obtain whole-brain maps of (a) perfusion dynamics derived through time shift analysis (TSA), (b) regional functional connectivity (intrinsic connectivity contrast (ICC) coefficients), and (c) hemodynamic-connectivity coupling. Group differences were assessed through independent samples t-tests, and correlations of rs-fMRI indices with clinical variables and neuropsychological test scores were, also, computed. Compared to HC, NPSLE patients demonstrated intrinsic hypoconnectivity of anterior Default Mode Network (DMN) and hyperconnectivity of posterior DMN components. These changes were paralleled by elevated hemodynamic lag. In NPSLE, cognitive performance was positively related to higher intrinsic connectivity in these regions, and to higher connectivity-hemodynamic coupling in posterior DMN components. Uncoupling between hemodynamics and connectivity in the posterior DMN was associated with worse task performance. Non-NPSLE patients displayed hyperconnectivity in posterior DMN and sensorimotor regions paralleled by relatively increased hemodynamic lag. Adaptation of regional brain function to hemodynamic changes in NPSLE may involve locally decreased or locally increased intrinsic connectivity (which can be beneficial for cognitive function). This process may also involve elevated coupling of hemodynamics with functional connectivity (beneficial for cognitive performance) or uncoupling, which may be detrimental for the cognitive skills of NPSLE patients.

Kinematic evaluation and reliability assessment of the Nine Hole Peg Test for manual dexterity

BackgroundThe Nine Hole Peg Test (NHPT) is one of the most frequently used tools to assess manual dexterity. However, no kinematic parameters are provided to describe the quality of the motor performance, since time is the only score. PurposeTo investigate test-retest and intra-rater reliability, correlation with clinical test score, and discriminant validity of kinematic indexes during NHPT. Study DesignA clinical measurement study. MethodsTwenty-five healthy right-handed volunteers performed the NHPT. An experienced physiotherapist administered two sessions at a 6-hour interval with two trials for dominant and non-dominant upper limbs. An optoelectronic system was used to detect NHPT performance, which was divided into nine consecutive peg-grasp, peg-transfer, peg-in-hole, hand-return phases, and one final removing phase. Outcome measures were total and single phases times, normalized jerk, mean, peak and time-to-peak of velocity, curvature index during peg-grasp and hand-return phases, and trunk 3D displacement. The statistical analysis included Intraclass Correlation Coefficients (ICCs) for test-retest and intra-rater reliability, Pearson's coefficients for correlation with the NHPT score, and paired t-tests for discriminant validity. ResultsTest-retest reliability was excellent for trunk rotation (ICC: 0.91) and good to moderate for the other indexes (ICCs: 0.89-0.61). Intra-rater reliability was excellent for total and removing times (ICCs: 0.91 and 0.94) and good to moderate for the other indexes (ICCs: 0.84-0.66), except for trunk inclination (ICC: 0.37). NHPT phases, normalized jerk, mean velocity, peak of velocity, time-to-peak and curvature index correlated with total time (r-score: 0.8-0.3). NHPT phases and most kinematic indexes discriminated the dominant from non-dominant upper limb, with the greatest effect size for normalized jerk during hand-return (d = 1.16). ConclusionsKinematic indexes during NHPT can be considered for manual dexterity assessment. These indexes may allow for the detection of kinematic changes responsible for NHPT score variations in healthy subjects or patients with upper limb impairments.

Data-driven staging of genetic frontotemporal dementia using multi-modal MRI.

Frontotemporal dementia in genetic forms is highly heterogeneous and begins many years to prior symptom onset, complicating disease understanding and treatment development. Unifying methods to stage the disease during both the presymptomatic and symptomatic phases are needed for the development of clinical trials outcomes. Here we used the contrastive trajectory inference (cTI), an unsupervised machine learning algorithm that analyzes temporal patterns in high‐dimensional large‐scale population datasets to obtain individual scores of disease stage. We used cross‐sectional MRI data (gray matter density, T1/T2 ratio as a proxy for myelin content, resting‐state functional amplitude, gray matter fractional anisotropy, and mean diffusivity) from 383 gene carriers (269 presymptomatic and 115 symptomatic) and a control group of 253 noncarriers in the Genetic Frontotemporal Dementia Initiative. We compared the cTI‐obtained disease scores to the estimated years to onset (age—mean age of onset in relatives), clinical, and neuropsychological test scores. The cTI based disease scores were correlated with all clinical and neuropsychological tests (measuring behavioral symptoms, attention, memory, language, and executive functions), with the highest contribution coming from mean diffusivity. Mean cTI scores were higher in the presymptomatic carriers than controls, indicating that the method may capture subtle pre‐dementia cerebral changes, although this change was not replicated in a subset of subjects with complete data. This study provides a proof of concept that cTI can identify data‐driven disease stages in a heterogeneous sample combining different mutations and disease stages of genetic FTD using only MRI metrics.

Does a Lower Limb Balance Test after Anterior Cruciate Ligament Reconstruction Have a Significant Correlation with Postoperative Clinical Score, Stability, and Functional Performance Test?

Lower limb balance ability is reduced after anterior cruciate ligament reconstruction (ACLR). However, the recovery of balance based on functional test scores after ACLR is not known because the correlation between balance and clinical scores remains unclear. We aimed to analyze the correlation between lower limb balance assessed by functional test and clinical knee test scores after ACLR. We evaluated lower limb balance using the anterior-posterior stability index (APSI) of the Biodex Balance System (BBS). Patients underwent clinical tests to evaluate the knee, including the Tegner activity score, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, and KT-2000 arthrometer measurement, hamstring per quadriceps muscle strength ratio at 60°/sec (HQ ratio), and functional performance tests (single-leg hop and single-leg vertical jump tests) 1 year after ACLR. We used a paired t-test to compare continuous preoperative and postoperative variables and Pearson's correlation coefficient to determine the relationship between BBS-APSI and clinical scores. Forty-eight patients (35 men and 13 women; mean age, 28.9 ± 8.3 years) were included. The follow-up period and BBS-APSI were 12.4 ± 2.0 months and 0.9 ± 0.4, respectively. Tegner activity score, IKDC subjective score, Lysholm score, and KT-2000 arthrometer measurement improved significantly postoperatively (p < 0.001). BBS-APSI was correlated with the Tegner activity score (r = -0.335, p = 0.020), IKDC subjective score (r = -0.301, p = 0.037), Lysholm score (r = -0.323, p = 0.025), single-leg hop test results (r = -0.300, p = 0.038), and single-leg vertical jump test results (r = -0.336, p = 0.019). There was no correlation between KT-2000 arthrometer measurement and HQ ratio. BBS-APSI was correlated with functional performance test scores after ACLR, rendering the BBS-APSI as a useful assessment tool to evaluate postoperative functional recovery. Continuously improving balance after ACLR could be useful for functional recovery after surgery.

Data‐driven staging and subtyping of genetic frontotemporal dementia using multi‐modal MRI

AbstractBackgroundFrontotemporal dementia is a highly heterogeneous disorder and neurodegeneration begins years prior to symptom onset, complicating disease understanding and treatment. Here we used an unsupervised machine learning algorithm to identify disease sub‐trajectories in genetic frontotemporal dementia.MethodThe contrastive trajectory inference (cTI, available at neuropm‐lab.com/neuropm‐box.html) is a method to analyze temporal patterns in multi‐dimensional populational datasets, consisting of unsupervised feature selection, contrastive prinicipal component analysis and subject ordering to obtain individual disease severity scores and distinct subtypes. We applied the cTI to cross‐sectional MRI data (gray matter density, T1/T2 ratio, fALFF, gray matter fractional ansiotrophy and mean diffusivity) from 383 gene carriers (269 presymptomatic and 115 symptomatic) from the GENFI study (148 with C9orf72 expansions, 169 with GRN mutations, and 67 with MAPT mutations) and a control group of 253 non‐carriers. The cTI was applied to all modalities in combination and individually. We compared the obtained disease severity scores to the estimated years to onset (EYO; age ‐ mean age of onset in relatives), clinical, and neuropsychological test scores. cTI subtypes were compared to genetic variants, as gene variants have specific pathology and group‐level differences in neuroimaging.ResultThe cTI identified disease severity scores were significantly correlated with all clinical and neuropsychiatric tests (measuring behavioural symptoms, attention, memory, language, and executive function) for all modalities, in combination and individually, and for the EYO for all modalities except mean diffusivity. The combination of all modalities provided the best overall results (CBI: r = 0.581, p &lt; 0.001; EYO: r = 0.321, p &lt; 0.001) (figure 1). Among individual modalities, gray matter density performed best (CBI: r = 0.475, p &lt; 0.001; EYO: r = 0.286, p &lt; 0.001). The cTI did not recover the three genetic variants, instead assigning most gene carriers (&gt; 80%) to subtype 1 (figure 2). The cTI distinguished non‐carriers from carriers (87% of non‐carriers are in subtype 2).ConclusionThe cTI can identify disease severity in a heterogeneous sample of genetic FTD using only neuroimaging metrics. It is unable to uncover genetic variants, suggesting that genetic variants may have similar neuroimaging features at early presymptomatic stages.