Balance Difficulties Research Articles

Mycolicibacterium fortuitum (Mycobacterium fortuitum) complex infection in a captive Soccoro dove (Zenaida graysoni)

Mycobacteriosis caused by Mycolicibacterium fortuitum (formely Mycobacterium fortuitum) occurs all over the world and has been reported in mammals, reptiles, amphibians, and, most often, in fish. M. fortuitum mycobacteriosis in animals is usually fatal, especially in captive species. Cases in companion animals usually do not end in death, especially if the etiological agent has been isolated and the antibiotics susceptibility profile of the strain has been determined. This case study presents mycobacteriosis in a Socorro dove (Zenaida graysoni). The bird showed serious chronic signs from the central nervous system, such as balance disorders and difficulties staying on the perch. The necropsy revealed numerous irregularly sized foci of beige-yellow necrosis penetrating the liver, especially in the liver parenchyma and on the surface of this organ. Microbiological examination identified the cultured strain as the M. fortuitum complex. The mycobacterial infection with M. fortuitum in the Soccoro dove at the zoo had primarily a zoonotic aspect. Both the zoo staff and visitors were exposed to potential infection. Secondly, the occurrence of fatal mycobacteriosis in a bird species that no longer occurs in the wild could have ruined the efforts to keep this species alive in captivity.

Problems Associated with Persisting Primitive Reflex in Healthy School-going Children

Introduction: Primitive reflexes, originating in the brainstem, develop in utero and vanish within six months post-birth, aiding infant motor milestones. Integration relies on cortical maturation inhibiting them via basal ganglia pathways. Persistence may indicate neurological issues lead to motor, balance, and learning difficulties. Aim: This scoping review explored the persistence of primitive reflexes and determined the problems associated with their persistence in healthy school-going children. Materials and Methods: A total of 3988 full-text published articles were identified from PubMed, Ovid-SP and Physiotherapy Evidence Database (PEDro) from 2004-2024 year. Only full text prevalence/ incidence and observational studies on children between 4-12 years are included. After duplicate deletion 3614 articles were left at abstract level, finally 63 full text articles related to research topic were further analysed and only nine articles were included in review for analysis. Results: Within group analysis for both experimental groups were found to be statistically significant for Rectus femoris and Vastus Lateralis muscles whereas between group analysis revealed general power training group to offer statistically significant improvement with p-value <0.05. Conclusion: Majority of articles show that persistence of ATNR (Asymmetrical Tonic Neck Reflex) reflex shows neurological impairments like attention and reading difficulties while persistence of spinal galant may lead to scoliosis. In articles assessing the persistence of all primitive reflexes like ATNR/STNR (Symmetrical Tonic Neck Reflex)/TLR (Tonic Labyrinthine Reflex) may cause gait impairments and development delay. Boys exhibit higher reflex activity and attention deficits, correlating with diminished reading proficiency, emphasising the link between neuromotor maturity and academic achievement. The prevalence of primary reflexes like ATNR and TLR in preschoolers, impact attention, neuromotor development and gait. Early detection of persisting primitive reflex, and managing them with reflex integration therapy in children can help mitigate neurological development delay

Türkiye'deki Öğrencilerin Nöroşirürji ve Diğer Uzmanlık Kariyer Tercihlerinin Karşılaştırılması

Aim: This study aimed to investigate the thoughts of medical faculty students in Türkiye about neurosurgery and the reasons for the low neurosurgery exam results. Methods: Between 2014 and 2021, the lowest and highest the Examination for Specialty in Medicine (ESM) scores of eight hundred students who started neurosurgery residency in 14 exam periods in Türkiye were determined. The scores of the other 39 specialties in the same exams were also determined, and they were compared with neurosurgery scores. Eight quotas for Aerospace Medicine and Medical Ecology and Hydroclimatology with insufficient data were excluded from the study. One hundred eighty-nine quotas and scores for military health services and ninety-three for international students were excluded as their scores are calculated differently. Moreover, in the 2022-2023 academic year, a survey was conducted with the students of 12 medical faculties in all geographical regions in Türkiye. 3590 students participated in the study. Participants answered 11 questions about career choices and neurosurgery. Results: The mean neurosurgery ESM score was 53.3±1.31. It was seen that 21.8% (n=223) of the 1023 neurosurgery quotas were not preferred. The ranking of neurosurgery scores for ESM was between 29th and 36th among 40 specialties. The average scores of neurosurgery in metropolitan city faculties were significantly higher than in other university hospitals and institutional hospitals (p = 0,008, p = 0,002; respectively). The average age of 3590 students who answered all questions in the survey was 22.4. 44% were women (n=1578), and 56% were men (n=2012). Students were less interested in surgical specialties in their senior year (p=0.004). While those considering a career in neurosurgery were 22.3% in the first two years, this rate decreased to 6.3% in the last two years (p<0.001). The rate of those who wanted residency programs in metropolitan cities was 90.5%. University hospitals were preferred more than training and research hospitals affiliated with the Ministry of Health in all branches (p=0.039). Three-quarters of the students had negative opinions about the neurosurgery specialty. Conclusions: The reasons why neurosurgery is a less favored specialty are financial gain, negative thoughts about work-life balance and course difficulty. To get more successful students to choose neurosurgery, the successful students in the first grades should be targeted, and neurosurgery should be well introduced.

Where is my hand? Proprioceptive disturbances in posterior cortical atrophy and typical Alzheimer’s disease

AbstractBackgroundPosterior cortical atrophy (PCA) is a neurodegenerative syndrome most commonly caused by Alzheimer’s disease (AD) pathology. PCA is often considered the canonical ‘visual dementia’, characterised by the progressive loss of visual and posterior cortical functions corresponding to parieto‐occipital and occipito‐temporal atrophy. However, patient reports of difficulties finding sleeves of clothes, transferring between postures and determining heading direction imply non‐visual disturbances, consistent with the multisensory role of the posterior parietal cortex. Such reports raise questions regarding AD clinical heterogeneity, representing a substantial challenge to patients' independence and management of PCA and typical AD (tAD).MethodPatient (total n = 39; PCA n = 23; tAD n = 16) and control (n = 19) participants repeatedly reached to a proprioceptive target (their non‐dominant thumb) (Fig.A) with and without vision and tactile feedback (n = 40 trials per participant). The target was positioned passively behind a screen apparatus at five positions using an adjustable foam handrest. The primary outcome measure was absolute (medio‐lateral) error determined using whole‐body motion capture data (Fig.B).ResultAbsolute error was greater without than with vision across groups. However, the effect of removing vision on absolute error was smallest in the control group (estimated mean error with vision [95%CI]: 15mm [6,25]; without vision: 23mm [14,32]), greatest in PCA (with vision: 39mm [30,49]; without vision: 76mm [67,86]) and intermediate in the tAD group (with vision: 26mm [16,37]; without vision: 49mm [39,60]) (vision‐by‐group interaction: p<.001; Fig.C). For ∼5% of trials, absolute error exceeded 200mm in PCA and 120mm in tAD participants (Fig.B; control range: 0.01‐80mm). There was no evidence of an effect of tactile feedback in any group.The effect of target location differed between groups (location‐by‐group interaction: p<.001). Patient reaching errors were particularly apparent under postures where the target arm crossed the body midline (e.g. left arm in right hemispace); this effect was notably evident in the PCA group even with available vision (Fig.C).ConclusionFindings emphasise disturbed spatial awareness in PCA and tAD in the absence of vision, consistent with diminished body position sense‐ proprioception ‐ which may be mediated centrally through posterior parietal vulnerability. Findings suggest implications for assessment and management of disabling dressing, mobility, navigation and balance difficulties.

Imbalance and gait impairment in Parkinson's disease: discussing postural instability and ataxia.

Gait and balance difficulties pose significant clinical challenges in Parkinson's disease (PD). The impairment of physiological mechanisms responsible for maintaining natural orthostatism plays a central role in the pathophysiology of postural instability observed in PD. In addition to the well-known rigidity and abnormalities in muscles and joints, various brain regions involved in the regulation of posture, balance, and gait, such as the basal ganglia, cerebellum, and brainstem regions like the pontine peduncle nucleus, are affected in individuals with PD. The recognition of the cerebellum's role in PD has been increasingly acknowledged. Cortical areas and their connections are associated with freezing of gait, a type of frontal lobe ataxia commonly observed in PD. Furthermore, impairments in the peripheral nervous system, including those caused by levodopatherapy, can contribute to gait impairment and imbalance in PD patients. Consequently, individuals with PD may exhibit frontal ataxia, sensory ataxia, and even cerebellar ataxia as underlying causes of gait disturbances and imbalance, starting from the early stages of the disease. The complex interplay between dysfunctional brain regions, impaired cortical connections, and peripheral nervous system abnormalities contributes to the multifaceted nature of gait and balance difficulties in PD. Understanding the intricate mechanisms is crucial for the development of effective therapeutic approaches targeting these specific deficits in PD.

Is Posterior Cruciate Ligament Needle Pie-Crusting Safe and Effective in Balancing Cruciate-Retained Total Knee Arthroplasty? A Comparative Study

BackgroundThere is still debate over whether to sacrifice the posterior cruciate ligament (PCL) during total knee arthroplasty (TKA). Several studies reported the costs and benefits of each approach regarding technical difficulties in PCL balancing and postoperation complications. In this study, we aimed to evaluate PCL needling as a safe method for balancing the cruciate-retained TKA (CR-TKA). MethodsIn this comparative study, 120 patients underwent CR-TKA and were divided into 2 groups. Fifty-four patients with an acceptable PCL tightness were included in group A, and 66 cases with a tight PCL were included in group B. In group B, needle pie-crusting of the PCL was performed instead of releasing the PCL from its insertions as the standard procedure. The participants' functional outcomes, pain severity, knee range of motion, and PCL laxity were evaluated during multiple follow-ups in 3 years postoperatively. ResultsThe participants' age, weight, and body mass index did not differ between the 2 groups. The mean age of the patients was 69 ± 5.9 years. The functional outcomes and range of motion of the patients in the 2 groups significantly improved after the operation compared to the preoperative status, but the postoperative score was not significantly different between groups (P > .05). Clinical examinations were normal in all patients in both groups in all follow-up stages. ConclusionsPCL balancing is a time-consuming yet essential step for the outcome of CR-TKA and patient satisfaction. PCL needling technique shows promising results and a few complications for PCL balancing in CR-TKA.

NCMP-07. HEADACHE PRESENTATION AND MANAGEMENT IN VON HIPPEL-LINDAU (VHL)-ASSOCIATED HEMANGIOBLASTOMAS

Abstract BACKGROUND Hemangioblastomas are the most common brain tumors among patients with Von Hippel-Lindau (VHL) disease. Common characteristics of these benign tumors, such as tumor growth, peritumoral edema, and cystic expansion, may lead to neurologic morbidity and/or mortality. Thus, early diagnosis based on symptom presentation and appropriate treatment is paramount to VHL-associated hemangioblastoma management. METHODS We conducted a systematic review of PubMed, Scopus, Cochrane, Embase, and Web of Science databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified studies reporting pre-diagnostic symptoms and post-diagnostic treatments among patients with VHL-associated hemangioblastomas. RESULTS Data from 150 patients were analyzed. The average age at presentation was 35.3 years (range: 18-75) and 52.7% of patients were female. Headache was the most common presenting symptom (73.3%). Other presenting symptoms included balance or gait disturbances (42%), ataxia (41.3%), nausea (24.3%), emesis (24.3%), dysmetria (15.5%), swallowing difficulties (11.3%), and singultus (10.7%). Anatomically, 98.7% of tumors were in the posterior fossa, specifically 69% in the cerebellum and 30% in the brainstem. Approximately 62.8% of patients had tumor associated cysts. A majority of the patients (98.7%) underwent gross-total resection of the tumor and cyst drainage as needed. Other common treatments included radiotherapy, gamma-knife surgery, and ventriculoperitoneal shunt placement. CONCLUSION Patients with VHL-associated hemangioblastomas commonly presented with headaches, balance or gait difficulties, and ataxia. Tumors were generally found in the posterior fossa and were associated with cysts. Gross-total resection was the main treatment offered to patients with these tumors.

Work stressors, work-family conflict, parents’ depressive symptoms and perceived parental concern for their children’s mental health during COVID-19 in Canada: a cross-sectional analysis

BackgroundWork-related stressors and work-family conflict are important social determinants of mental health. While the impact of these stressors on parents’ mental health is well documented, we know comparatively less about their impact on children’s mental health. Furthermore, though the COVID-19 pandemic has significantly altered these stressors, particularly with the increase in teleworking, major knowledge gaps persist regarding the association between parents’ stressors and perceived parental concern for their children’s mental health during the COVID-19 pandemic. Based on the stress contagion perspective, this study tests (1) the mediating role of parents’ depressive symptoms with parental concern for their children’s mental health, and (2) whether these associations vary depending on whether parents had the opportunity to engage in telework.MethodsA path analysis was performed from a cross-sectional analytic sample of 780 employed parents in the province of Quebec (Canada). The same model was then stratified by teleworking opportunity. The model’s indirect associations were obtained by the bootstrap bias-corrected method with 1,000 replications.ResultsThe results show that the stressors of work-to-family conflict, increased difficulties in work-family balance since the COVID-19 pandemic, irregular schedules, low esteem derived from work, and job insecurity were all indirectly associated with an increase in parental concern for their children’s mental health through increased parents’ depressive symptoms. However, some associations differ depending on teleworking status. The indirect associations involving increased difficulties in work-family balance since the COVID-19 pandemic as well as irregular work schedules were observed only in the teleworking group.ConclusionsThis study fills a gap in research on the association between the work-family interface and parental concern for their children’s mental health during the COVID-19 pandemic. It highlights the importance of concerted and cohesive action between child health policies and those regarding work and work-family balance to prevent work-related psychosocial risks, particularly considering the post pandemic expanded and persistent reliance on teleworking.

Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

Effectiveness of Transcutaneous Electrical Nerve Stimulations Oral Exercise in Hypo Salivation Among Type II Diabetic Patients Over Submandibular Glands

This study was conducted to improve the patient's oral function, especially dry mouth (xerostomia) and infection. The aim of this study is to analyse the effectiveness of transcutaneous electrical nerve stimulation vs. oral exercise in reducing hypo salivation among type II diabetic patients over the submandibular glands. The secretion of saliva is critical for oral health, digestion, prevention of infections, and the healing process. Hypo salivation is defined as a decrease in saliva in the mouth. It is the most common type II diabetic problem among adults and older people. It is estimated to occur in 10 of every 35 adults. Because of hypo salivation, Type II diabetic adults may experience infection, cavities, soreness, ulcers, a decrease in taste sensation, and difficulty in water balance. Hypo salivation leads to many complications that make the condition of the diabetic patient even worse. Hence, there is a wide need for treatment techniques to be searched for, and they must be applicable to all communities. There are various therapies to improve the salivary rate, but there is a need to analyse the technique that gives better outcomes with a short intervention with easy accessibility. The materials and method of this study follow a simple method and are evidenced with a noninvasive diagnostic tool. Saliometry by the low-spitting method was used to measure the salivary flow rate. The methodology was a comparative study design with a pre-post-test. Samples were selected from 40 volunteers based on inclusion criteria. Group A: Transcutaneous Electrical Nerve Stimulation, 8 sessions, 20 minutes each, twice a week for 4 weeks. Group B: Oral exercise, 16 sessions, 2 minutes each, in 3 sets for 4 weeks. At the end of 30 days of sessions, the salivary flow rate has increased from 0.36 to 1.03 ml/min and the SD from 0.12 to 0.91 for Group A, and from 0.34 to 0.56 ml/min and the SD from 0.2 to 0.4. The result concludes that both groups showed improvement, while group A, which received transcutaneous electrical nerve stimulation, was comparatively better than group B, which received oral exercise

Regional recruitment and differential behavior of motor units during postural control in older adults.

Aging is associated with neuromuscular system changes that may have implications for the recruitment and firing behaviors of motor units (MUs). In previous studies, we observed that young adults recruit subpopulations of triceps surae MUs during tasks that involved leaning in five directions: common units that were active during different leaning directions and unique units that were active in only one leaning direction. Furthermore, the MU subpopulation firing behaviors [average firing rate (AFR), coefficient of variation (CoVISI), and intermittent firing] modulated with leaning direction. The purpose of this study was to examine whether older adults exhibited this regional recruitment of MUs and firing behaviors. Seventeen older adults (aged 74.8 ± 5.3 yr) stood on a force platform and maintained their center of pressure leaning in five directions. High-density surface electromyography recordings from the triceps surae were decomposed into single MU action potentials. A MU tracking analysis identified groups of MUs as being common or unique across the leaning directions. Although leaning in different directions did not affect the AFR and CoVISI of common units (P > 0.05), the unique units responded to the leaning directions by increasing AFR and CoVISI, albeit modestly (F = 18.51, P < 0.001). The unique units increased their intermittency with forward leaning (F = 9.22, P = 0.003). The mediolateral barycenter positions of MU activity in both subpopulations were found in similar locations for all leaning directions (P > 0.05). These neuromuscular changes may contribute to the reduced balance performance seen in older adults.NEW & NOTEWORTHY In this study, we observed differences in motor unit recruitment and firing behaviors of distinct subpopulations of motor units in the older adult triceps surae muscle from those observed in the young adult. Our results suggest that the older adult central nervous system may partially lose the ability to regionally recruit and differentially control motor units. This finding may be an underlying cause of balance difficulties in older adults during directionally challenging leaning tasks.

Objective Difficulty-Skill Balance Impacts Perceived Balance but Not Behaviour: A Test of Flow and Self-Determination Theory Predictions

Flow and self-determination theory predict that game difficulty in balance with player skill maximises enjoyment and engagement, mediated by attentive absorption or competence. Yet recent evidence and methodological concerns are challenging this view, and key theoretical predictions have remained untested, importantly which objective difficulty-skill ratio is perceived as most balanced. To test these, we ran a preregistered study (n=309) using a Go-like 2-player game with an AI opponent, randomly assigning players to one of three objective difficulty-skill ratios (AI plays to win, draw, or lose) over five matches. The AI successfully manipulated objective balance, with the draw condition perceived as most balanced. However, balance did not impact play behaviour, nor did we find the predicted uniform 'inverted-U' between balance and positive play experiences. Importantly, we found both theories too underspecified to severely test. We conclude that balance and competence likely matter less for behavioural engagement than commonly held. We propose alternative factors such as player appraisals, novelty, and progress, and debate the value and challenges of theory-testing work in games HCI.

Redefining Hypotension in Older Adults: Implications for the Prevention of Age Related Cognitive Decline

Chronically low blood pressure in older adults is associated with significantly increased long-term risks of dementia and all-cause mortality risk. Yet low blood pressure is generally not treated until an individual begins to experience the acute symptoms arising from very low cerebral perfusion. However, these acute symptoms, such as dizziness, balance difficulty, syncope, increased fall occurrence, vision impairment, and nausea, begin to occur only at very low blood pressure levels, such that mean arterial pressure levels as low as 65mmHg are often considered to be of limited concern. If the long-term consequences of chronic low blood pressure are to be prevented, an alternative approach to defining what constitutes too low a blood pressure for older adults, i.e. hypotension, will be required. Cognitive aging is a significant health concern for many older adults as it has significant impact on quality of life, and is widely considered a precursor to dementia. Here, we utilize an FDA cleared computer aided cognitive assessment tool to identify the relationship between resting brachial blood pressure in the upright seated position, and cognitive function in a convenience sample of independently living older adult men and women. We observed that resting diastolic blood pressure is significantly and positively correlated with cognitive function in adults over the age of 60 years. Specifically, cognitive performance was found to be significantly impaired for diastolic blood pressure levels below approximately 80 mmHg. Diastolic blood pressures (DBP) below 80 mmHg in older adults have consistently been shown to increase the risk of dementia as well as all-cause mortality, but the influence of below normal DBP on quality of life (QoL) in older adults has not been extensively addressed. The present work shows that adults over age 60, with a DBP below 80 mmHg, are significantly more likely to demonstrate mild to moderate cognitive impairment, and correspondingly, the associated impacts on QoL. These results lead to the suggestion that maintenance of diastolic blood in older adults in the 80-90 mmHg range will not only improve quality of life in this population, but may also provide substantial clinical benefit in terms of preventing, or reversing, age-related cognitive decline.

Effect of work from home and employee mental health through mediating role of workaholism and work-family balance.

The current global outbreak caused by COVID-19 has produced a unique situation with severe health and financial consequences. The fast and quick global impact called for an immediate response. A key public health action was the decision to amend the law to allow employees to work from home (WFH) whenever it was possible. In response to public health restrictions to stop the spread of COVID-19, organizations quickly switched to WFH without fully comprehending the effects of continued WFH on mental and physical health. Working from anywhere and at any time has made the separation between business and personal life more difficult. These modifications may cause employees' workdays to be longer and to experience greater work-life conflict. Overwork and work addiction provide a greater risk to the public's health and can harm various facets of mental and physical health, such as depression, anxiety, and sleep difficulties. There hasn't been much research on the underlying processes that link workaholism to poor mental health, especially among Indian academics. There is a rise in the number of people who are worried about their mental health in academic settings. The primary purpose of this study is to determine whether academicians in India can potentially have a healthy work-family balance, which may mitigate the negative impacts of workaholism and poor mental health especially due to the Work from Home system. A population-based study was conducted on academicians (n = 456) at private and public universities in Delhi NCR, India. Workaholism, work-family balance, and mental health difficulties were all measured using self-reported scales in the study. By using path analysis, the proposed mediation model was evaluated. The survey responses had an accuracy rate of 80%. Based on the conceptual research framework, PLS-SEM path modeling is used to find the causal connection between the indicators and latent components. The findings indicated that workaholism has been associated with mental health in two different ways: directly and through work-family balance. The path analysis found a statistically significant relationship between work from home and mental health through workaholism and work-family balance. Increased levels of anxiety, depression, stress, headaches, exhaustion, and reduced job satisfaction were some of the mental health consequences of Work from Home. This study provides real-world guidance to human resource managers on how to prioritize composite-level interventions at all levels of the university to create highly satisfied employees, provide a good working environment, and improve employees' mental health. Many researches have been done on the relationship between work-from-home and employee mental health, but relatively few have looked at how work-life balance and workaholism play a role in how work-from-home affects employees' mental health. This study fills a need in the academic and practitioner literature by investigating the relationship between work-from-home from home and employee mental health as well as the mediating function of work-family balance and workaholism with regard to Indian higher education institutions.

Selective Tibial Neurotomy for Spastic Equinovarus Foot: Operative Technique.

Spastic equinovarus foot (SEF) is a common complication of stroke and other upper motor neuron injuries. It is characterized by a plantigrade and inverted foot, often with toe curling, causing significant disability from pain, gait, and balance difficulties. Management includes physical therapy, antispasticity drugs, orthoses, chemical neurolysis, or botulinum toxin, all of which may be insufficient, sedating, or transient. Selective tibial neurotomy (STN) provides a surgical option that is effective and long-lasting. Our goal is to provide a concise description of our technique for performing the STN for treatment of SEF. We discuss the standard posterior approach with surgical variations used by other groups and a medial approach, should the posterior approach be insufficient. A posterior leg approach allows access to the tibial nerve and its branches to the bilateral gastrocnemius muscles, soleus, posterior tibialis, and extrinsic toe flexors. A medial approach is used if the toe flexors cannot be accessed sufficiently from the posterior approach. Nerve branch targets identified by preoperative functional assessment are carefully exposed and fully neurolysed distally to identify all terminal branches to each muscle of interest before neurotomy. The STN is a powerful tool for treating SEF, with an immediate and lasting effect. Approximately 80% of the target muscle should be denervated to ensure long-term efficacy while maintaining adequate function of the muscle through collateral innervation. The STN is a safe and effective outpatient procedure that can be performed by an experienced nerve surgeon to improve balance and ambulation and reduce pain for patients with SEF. Large clinical trials are necessary to further establish this underutilized procedure in the United States.

Age, cognitive task, and arm position differently affect muscle synergy recruitment but have similar effects on walking balance.

Age modifies walking balance and neuromuscular control. Cognitive and postural constraints can increase walking balance difficulty and magnify age-related differences. However, how such challenges affect neuromuscular control remains unknown. We determined the effects of age, cognitive task, and arm position on neuromuscular control of walking balance. Young (YA) and older adults (OA) walked on a 6-cm wide beam with and without arm crossing and a cognitive task. Walking balance was quantified by the distance walked on the beam. We also computed step speed, margin of stability, and cognitive errors. Neuromuscular control was determined through muscle synergies extracted from 13 right leg and trunk muscles. We analyzed neuromuscular complexity by the number of synergies and the variance accounted for by the first synergy, coactivity by the number of significantly active muscles in each synergy, and efficiency by the sum of the activation of each significantly active muscle in each synergy. OA vs. YA walked a 14% shorter distance, made 12 times more cognitive errors, and showed less complex and efficient neuromuscular control. Cognitive task reduced walking balance mainly in OA. Decreases in step speed and margin of stability, along with increased muscle synergy coactivity and reduced efficiency were observed in both age groups. Arm-crossing also reduced walking balance mostly in OA, but step speed decreased mainly in YA, in whom the margin of stability increased. Arm-crossing reduced the complexity of synergies. Age, cognitive task, and arm position affect differently muscle synergy recruitment but have similar effects on walking balance.

The Effect of Vitamin D, B12, and Folic Acid Supplements in Relieving Major Depressive Symptoms, General Anxiety Disorder among Adults and Adolescents - A Systemic Article Review

Depression and anxiety disordersare a heterogeneous disorders and are thought to develop as a result of complex interactions between genetic and environmental Factors.(1) Vitamin D deficiency is the most common cause of Osteomalacia among adults and adolescents with its associated classical symptoms such as bones pain, muscle weakness which may affect productivity, daily activates, school and work absence and mood. Vitamin B12 deficiency causes complex hematological and neurological signs and symptoms as easy fatigability, lethargy, pallor, ictrous, paresthesia, difficulty of balance or loss of proprioception and neuropsychiatric symptoms may be presented in severe cases. Vitamin B9 deficiency is a rare condition causes complex hematological signs and symptoms as easy fatigability, lethargy, pallor, ictrous, symptoms may be presented in severe cases. Aim of the study: To review articles studying the relationship between Vitamin D deficiency and/ or vitamin B12 deficiency, and/or B9 deficiency levels and supplements in relieving major depression (MDD) and general anxiety disorder (GAD) symptoms.

Managing Idiopathic Normal Pressure Hydrocephalus: Need for a Change of Mindset

Idiopathic normal pressure hydrocephalus (iNPH) refers to a complex brain disorder characterized by ventricular enlargement and the classic Hakim's triad of gait and balance difficulties, urinary incontinence, and cognitive impairment. It predominantly affects older patients in the absence of an identified cause. As the elderly population continues to increase, iNPH becomes a growing concern in the complex spectrum of neuro-geriatric care, with significant socio-economic implications. However, unlike other well-structured management approaches for neurodegenerative disorders, the management of iNPH remains largely uncodified, leading to suboptimal care in many cases. In this article, we highlighted the challenges of current practice and identify key points for an optimal structuration of care for iNPH. Adopting a global approach to iNPH could facilitate a progressive shift in mindset, moving away from solely aiming to cure an isolated neurological disease with uncertain outcomes to providing comprehensive care that focuses on improving the daily life of frail patients with complex neurodegenerative burdens, using tailored goals.

An alternately optimized generative adversarial network with texture and content constraints for deformable registration of 3D ultrasound images

Objective. 3D ultrasound non-rigid registration is significant for intraoperative motion compensation. Nevertheless, distorted textures in the registered image due to the poor image quality and low signal-to-noise ratio of ultrasound images reduce the accuracy and efficiency of the existing methods. Approach. A novel 3D ultrasound non-rigid registration objective function with texture and content constraints in both image space and multiscale feature space based on an unsupervised generative adversarial network based registration framework is proposed to eliminate distorted textures. A similarity metric in the image space is formulated based on combining self-structural constraint with intensity to strengthen the robustness to abnormal intensity change compared with common intensity-based metrics. The proposed framework takes two discriminators as feature extractors to formulate the texture and content similarity between the registered image and the fixed image in the multiscale feature space respectively. A distinctive alternating training strategy is established to jointly optimize the combination of various similarity loss functions to overcome the difficulty and instability of training convergence and balance the training of generator and discriminators. Main results. Compared with five registration methods, the proposed method is evaluated both with small and large deformations, and achieves the best registration accuracy with average target registration error of 1.089 mm and 2.139 mm in cases of small and large deformations, respectively. The performance on peak signal to noise ratio (PSNR) and structural similarity (SSIM) also proves the effective constraints on distorted textures of the proposed method (PSNR is 31.693 dB and SSIM is 0.9 in the case of small deformation; PSNR is 28.177 dB and SSIM is 0.853 in the case of large deformation). Significance. The proposed 3D ultrasound non-rigid registration method based on texture and content constraints with the distinctive alternating training strategy can eliminate the distorted textures with improving the registration accuracy.

Late adult-onset Niemann Pick type C (NPC): An “atypical” typical presentation at the age of 62

We report a 67-year-old woman with a 5-year history of progressive walking and balance difficulties with near-fall episodes. Gradually she also developed fine motor and speech problems that progressively impacted her communication. Swallowing function was unremarkable, and there was no history of choking episodes in the past. She had an uneventful neonatal period, with normal psychomotor development and unremarkable family history. Past medical history was positive for status post-cholecystectomy, hypertriglyceridemia, gastric bypass surgery (obesity) and mild obstructive sleep apnea. There was no history of hypertension, hypercholesterolemia or diabetes. Patient quitted smoking >5 years ago (23 packs/y).