Head Position Research Articles

Variations in Cortical Oxygenation by Near-Infrared Spectroscopy According to Head Position after Acute Stroke: The Preliminary Findings of an Observational Study.

Background: After ischemic stroke, there is no general consensus on the optimal position for the head of patients in the acute phase. This observational study aimed to measure the variations in cortical oxygenation using noninvasive functional near-infrared spectroscopy (fNIRS) at different degrees of head positioning on a bed. Methods: Consecutive ischemic stroke patients aged 18 years or older with anterior circulation ischemic stroke within 48 h of symptom onset who could safely assume different positions on a bed were included. A 48-channel fNIRS system was placed in the bilateral sensorimotor cortex. Then, the bed of each patient was moved into four consecutive positions: (1) seated (90° angle between the head and bed surface); (2) lying at 30°; (3) seated again (90°); and (4) lying flat (0°). Each position was maintained for 90 s; the test was conducted 48 h after stroke onset and after 5 ± 1 days. The variations in oxygenated hemoglobin in the global brain surface and for each hemisphere were recorded and compared. Results: Twenty-one patients were included (males, n = 11; age, 79 ± 9 years; ASPECTS, 8 ± 2). When evaluating the affected side, the median oxygenation was significantly greater in the lying-flat (0°) and 30° positions than in the 90° position (p < 0.001 for both comparisons). No significant differences between the supine position and the 30° position were found, although oxygenation was slightly lower in the 30° position than in the supine position (p = 0.063). No differences were observed when comparing recanalized and nonrecanalized patients separately or according to stroke severity. The evaluation conducted 5 days after the stroke confirmed the previous data, with a significant difference in oxygenation at 0° and 30° compared to 90°. Conclusions: This preliminary study suggested that there are no substantial differences in brain oxygenation between the lying-flat head position and the 30° laying position.

Registration of jaw centric relation with different deprogramming devices

BACKGROUND: There are several methods to register jaw centric relation for diagnosis and therapy of dysfunctional disorders of the temporomandibular joint. However, there is insufficient information in the literature regarding the choice of the optimal way to determine this indicator. AIM: To compare different methods for recording jaw centric relation according to the data of the computed tomography of temporomandibular joint. MATERIALS AND METHODS: The study includes participants with increased abrasion of hard tooth tissues and symptoms of musculoskeletal dysfunction of the temporomandibular joint. The main group (80 people) has been recorded jaw centric relation using deprogramming devices (Lucia jig — 1stsubgroup, Kois deprogrammer — 2ndsubgroup, sheet calibrator — 3rd subgroup, deprogrammer in combination with M. Rocаbado kinesiotherapy elements — 4th subgroup). The control group included 20 participants, who had not had deprogramming before registration of jaw centric relation. The results were monitored using computed tomography of temporomandibular joint and subsequent assessment of the sizes of the TMG articular gap in the coronary and sagittal sections at 3 stages of the study: diagnostic, after registration of jaws central relation and prosthetic treatment and 6 months after prosthetic rehabilitation. Since there were no more than 50 observations in each group, the Shapiro–Wilk W-test was used to verify compliance with the norm. RESULTS: According to the data obtained, the parameters of the temporomandibular joint gap have changed in the main group of the 1th subgroup, where indicators are approaching the physiological norm (98% of cases). In the 2ndsubgroup, 90% of the participants show a tendency to conform to the physiological norm. The exception is 10% of the participants with no tendency of improvement. The smaller part (75%) of the participants of the 3rd subgroup observed compliance of the parameters of the articular gap with the criteria of the norm. The dimensions of the anterior part of the articular gap of the temporomandibular joint exceed the dimensions of the distal part, which indicates the anterior position of the temporomandibular joint. Some patients in this group (25%) showed no positive results of computed tomography measurements after jaws centric relation registration. In the 4th subgroup, the patients returned to normal values (100% of the cases). The positive effect of prosthetic treatment and restoration of the position of the articular heads of the temporomandibular joint were obtained in 45 % of the participants in the control group. However, in 55% of the participants the location of the articular gap of the temporomandibular joint did not improve. CONCLUSIONS: Lucia jig in combination with the M. Rokabado’s complex of cranial-postural kinesiotherapy is the most effective method to register jaw centric relation within this study. The remaining methods are also applied among prosthetic dentists and gnathologists. However, in each clinical situation, it is necessary to consider temporomandibular joint pathology indications, type and degree of severity as well as the technical and financial capacity of both doctor and patient.

Rare Case of Klippel Feil Syndrome Associated with Mirror Movements

Klippel Feil Syndrome (KFS) is a multisystem disorder with the typical clinical trial of short neck, restriction of headand neck movements and low posterior hairline and associated with anomalies of the urogenital, musculoskeletal, neurological andcardiovascular systems. Here is a case report of a young boy with history of abnormal head and upper limbs movements alongwith repeated bowing of head since the age of 6 months. He also had frequent falls with repeated minor trauma to the face.Antenatal and peripartum period was uneventful and child had no neonatal complications with normal development. Onexamination the child had abnormal head position with bowing, short neck and low hair line. Musculoskeletal system examinationrevealed decreased range of passive movements at cervical spine extension and lateral flexion with no focal neurological deficits.Further examination revealed Mirror movements (synkinesis) in the upper limbs. Mirror movements are the involuntarymovements of one body part that mirror intentional movements on the opposite side. Other Systemic examinations were normal.CT Cervical spine showed fusion of the upper three cervical vertebrae and the child was diagnosed as a case of klippel feil syndrometype 2 presenting with mirror movements. This rare case of klippel feil syndrome is being presented with the aim that such casesshould be detected and treated at an early stage to reduce the cosmetic &amp; social stigma to the patient and parents. This casereport also gives a brief overview of associated features of KFS along with its management.

Persistent Depression of the Lambda Site with Progressive Skull Deformity May Be a Sign of Suture Closure: Case Series and Pathologic Consideration

Back groundFlat head syndrome (FHS) sometimes occurs when a baby maintains the same head position during the first several months of life causing a skull deformity. FHS usually improves with time and natural growth, however, some shows aggravation against conservative treatment. We reviewed pathologically proved early closure of skull suture that may have seen secondary to FHS. MethodsThe clinical and radiological findings of the patients who showed progressive skull deformity resembling FHS were retrospectively reviewed. All the patients underwent surgical treatment and pathological specimens were obtained. ResultsThe detected patients included two 5-month-old infants and one 1-year-old infant. The formers were conservatively treated without any obvious premature suture closure on computed tomography (CT), and later developed progressive tower-like skull deformities. The infants were diagnosed with possible premature fusion of Lambda site and underwent removal around lambda depression (LD). The latter showed evident sagittal suture closure on CT with digital markings, and was diagnosed with increased intracranial pressure and underwent cranioplasty of posterior expansion. Histopathological specimens obtained from the patients’ resected sutures showed irregularly narrowed suture structure with ossification and fibrous tissue proliferation within them, supporting the diagnosis of premature closure of the sagittal sutures. Their postoperative courses were uneventful, and their skull deformities subsequently improved. ConclusionsConservative therapy-resistant progressive occipital skull deformity with LD may be a sign of early suture closure, even if CT does not show obvious suture closure. The findings are helpful for early diagnosis and might lead to minimal invasive surgery if needed.

Transcutaneous Transmission of Light of Photobiomodulation Therapy Wavelengths at 808 nm, 915 nm, 975 nm, and 1064 nm to the Spinal Canal of Cadaver Dogs

This study compared the transcutaneous target level irradiances from the thoracic to lumbar segments of the interior spinal canal in three cadaver dogs, measured for light at four wavelengths (808 nm, 915 nm, 975 nm, and 1064 nm), common in photobiomodulation therapy (PBMT). Intra-spinal irradiances at nine sites spanning approximately 8 cm in length were measured using a flexible intra-spinal probe under surface application of continuous-wave (CW) light with powers ranging from 0.5 W to 2 W. Surface illumination was applied using an acupuncture treatment head in three modes: non-contact with skin removed, non-contact with skin intact, and contact with skin intact. During surface application, the treatment head was positioned over the spinal canal near the 13th vertebrae (T13, surface site 1), and approximately 4 cm (surface site 5) and 8 cm (surface site 9) caudal to T13. At each position of the treatment head, the light was multiplexed among the four wavelengths at the same power setting. In all three modes of surface application, the target level irradiance at the 1064 nm wavelength was significantly greater than that at the other three wavelengths (p ≤ 0.0017). At a surface irradiance of ~157 mW/cm2, corresponding to 0.5 W light applied with the treatment head directly in contact with the skin, the intra-spinal irradiance at 1064 nm reached 0.137 ± 0.095 mW/cm2. Obtaining a dosage of PBMT-associative wavelengths of this magnitude at the level of the spinal canal may guide focused research into the transcutaneous applicability of PBMT for spinal cord injuries.

Asymmetry of the Subjective Visual Vertical in Patients With Unilateral Peripheral Vestibular Deficit.

Perception of verticality is clinically assessed using the subjective visual vertical (SVV), a test of the otolith system that consists of aligning a bar on the gravitational vertical in darkness. Patients with acute unilateral vestibulopathy (AUVP) show a systematic SVV bias toward the affected side, whichever the side of line orientation. Whether SVV estimates are symmetrical has not been investigated. This study included 10 patients with AUVP (vestibular neuritis) and 10 with BPPV (posterior semicircular canal). SVV measurements were made at two preset angles of line orientation (15° and 30°) toward the ipsilateral and contralateral sides, relative to the affected side. The results showed asymmetrical SVV estimates in the AUVP group, with significantly greater SVV errors for ipsilateral than contralateral line orientation, as well as for the preset angle of 30° compared to 15°. SVV estimates were significantly lower in patients with BPPV who also exhibited SVV asymmetry. SVV estimates remained unchanged just after the maneuver and were normalized some days later or after supplementary maneuvers. SVV asymmetry should be routinely considered in the clinic. We recommend individually assessing ipsilateral and contralateral SVV and using at least two preset angles. This allows for a better assessment and diagnosis of otolith organ imbalance that can trigger chronic instability and dizziness. The contribution of neck afferents related to head position in space seems to be the main source of SVV asymmetry.

Changes in lateral standing posture following orthognathic surgery: a cohort study

Altering neuromuscular and musculoskeletal relationships also affects standing body posture, particularly in the head and neck areas. This prospective cohort study assessed the effects of orthognathic surgery on head posture in the lateral standing view. Thirty-one patients who underwent single-jaw orthognathic mandibular surgery were included. The patients underwent lateral cephalometric and photographic evaluations of their natural habitual posture before and 6 months after surgery. The craniovertebral angle and Frankfort angle (Frankfort horizontal line to true horizontal line angle) were determined and measured using MB-Ruler software. Mandibular positional changes were also measured by superimposing lateral cephalograms and recording changes in the menton point in the vertical and horizontal planes. All data were analysed by paired t-test. The craniovertebral angle increased significantly in patients with Class II malocclusion (P = 0.001) and decreased significantly in Class III patients (P = 0.004). Furthermore, the Frankfort angle was significantly increased in both Class II (P = 0.005) and Class III (P = 0.012) patients. The tendency towards forward head posture decreased in patients with Class II malocclusion, and the lateral neck posture improved. Conversely, a slight but significant tendency towards a forward head posture was observed in Class III patients after surgery. Furthermore, the natural head position changed in both study groups, leading to a more upright head posture.

Effect of Backward Walking on Treadmill with Inclination in Individuals with Forward Head Posture: A Comparative Study

Abstract Background: Forward head posture (FHP) is one of the most common postural abnormalities found in undergraduates (18–30 years), with a prevalence rate of 73%. If the cervical spine is held in a protracted position, such as hyperextension of the upper cervical spine (C1-C3) and flexion of the lower cervical spine (C4-C7), it can cause changes in head posture, eventually leading to FHP. Aims: This study aimed to determine the effect of backward walking (BW) on the surface and on treadmill with inclination in individuals with FHP. Objectives: The objective of this study was to compare the effect of surface BW and BW on treadmill with inclination on the craniovertebral angle (CVA) and gait outcomes in individuals with FHP. Materials and Methods: Sixty-two participants were recruited and randomly assigned to the surface BW group (n = 31) and BW on treadmill with inclination (n = 31). Participants fulfilled the pre- and postassessment with a 2 weeks (three times per week) intervention of BW in conjunction with conventional exercises. The CVA was measured using Markus Bader ruler software. Gait outcomes were assessed using Neurocom Balance Master, walk across component was selected. Results: The present study implemented statistical tests such as paired t-test and unpaired t-test for the recorded data. Conclusion: BW has shown a significant difference in the CVA and some components of gait outcomes in within the group analysis, whereas in between the group analysis, there is a significant difference in some gait outcomes.

Altered body balance and plantar pressure distribution in young adults with forward head posture

BackgroundForward head posture (FHP), a common postural issue, affects balance and may be linked to altered muscle activity and cervical spine alignment. This study investigated the impact of FHP on static balance and plantar pressure distribution in adults. We hypothesized that FHP would be associated with poorer balance and altered pressure distribution. MethodsThis case-control study investigated the impact of FHP on static balance and plantar pressure distribution in adults (n = 52). Participants were categorized based on craniovertebral angle (CVA), into FHP (CVA <47°) and control (CVA ≥47°) groups. Static balance was assessed using a NeuroCom® Balance Manager System, evaluating parameters like center of gravity sway and directional control. Plantar pressure distribution was measured with an Emed Pedobarography system during walking, analyzing maximum force, peak pressure, and contact area. ResultsParticipants with FHP showed poorer balance with eyes closed on foam compared to the control group. Additionally, the FHP group exhibited lower total maximum force and altered force distribution in both feet during walking. Correlations suggested that higher CVA degrees were associated with decreased balance and altered plantar pressure distribution. Despite, linear regression analyses revealed no significant predictive relationships between CVA and specific balance measures, it showed significant associations with several plantar pressure distribution parameters, including total maximum force exerted on both feet, maximum force on the forefoot, and peak pressure on the hindfoot. ConclusionThese findings suggest that FHP may influence balance and plantar pressure distribution, with a potentially stronger effect on plantar pressure than balance parameters.

IMU Data-Driven and PCA-Based Approach to Establish Quantifiable and Practically Applicable Measures for V2 Technique Elements in Cross-Country Skiing.

Quantifying movement coordination in cross-country (XC) skiing, specifically the technique with its elemental forms, is challenging. Particularly, this applies when trying to establish a bidirectional transfer between scientific theory and practical experts' knowledge as expressed, for example, in ski instruction curricula. The objective of this study was to translate 14 curricula-informed distinct elements of the V2 ski-skating technique (horizontal and vertical posture, lateral tilt, head position, upper body rotation, arm swing, shoulder abduction, elbow flexion, hand and leg distance, plantar flexion, ski set-down, leg push-off, and gliding phase) into plausible, valid and applicable measures to make the technique training process more quantifiable and scientifically grounded. Inertial measurement unit (IMU) data of 10 highly experienced XC skiers who demonstrated the technique elements by two extreme forms each (e.g., anterior versus posterior positioning for the horizontal posture) were recorded. Element-specific principal component analyses (PCAs)-driven by the variance produced by the technique extremes-resulted in movement components that express quantifiable measures of the underlying technique elements. Ten measures were found to be sensitive in distinguishing between the inputted extreme variations using statistical parametric mapping (SPM), whereas for four elements the SPM did not detect differences (lateral tilt, plantar flexion, ski set-down, and leg push-off). Applicability of the established technique measures was determined based on quantifying individual techniques through them. The study introduces a novel approach to quantitatively assess V2 ski-skating technique, which might help to enhance technique feedback and bridge the communication gap that often exists between practitioners and scientists.

At-Risk Tackling Techniques and Effectiveness in English Premiership Rugby.

Head-down tackling has been associated with higher rates of head and neck injuries and less successful tackles compared with head-up tackling in American football. In rugby, head and neck injuries have been associated with tackling, with the tackler's head positioned in front of the ball carrier. To assess the success and risks of tackling techniques used in the English Rugby Premiership matches. Cross-sectional study; Level of evidence, 3. Three reviewers analyzed 1000 consecutive solo defensive tackling attempts during the 2022 to 2023 season in 6 English Rugby Premiership matches. Slow-motion replays were used to analyze the success of the tackling attempt in terms of head angulation (head up vs head down), head position relative to the offensive player's waist at point of contact, and tackling method (inside shoulder, arm, head across the bow, and head-to-head). The chi-square test or Fisher exact test was used to analyze categorical data, and the 2-tailed Student t test or the Mann-Whitney U test was used to analyze continuous data. The mean interrater reliabilities for analyzing the tackles were good across all groups (κ = 0.715). Head-up and head-down tackling occurred in 848 tackle attempts (84.8%) and 152 tackle attempts (15.2%), respectively. Head-up tackles were successful in 80.7% of the tackle attempts compared with 71.1% of the head-down tackle attempts (P = .0072). Tackles made at or above the waist were successful in 80.7% of the tackle attempts compared with 73.1% of tackles below the waist (P = .0193). The inside-shoulder technique had the highest successful tackle rate at 90.8%, compared with 44.2% with the arm technique (P < .0001) and 72.4% with the head-across-the-bow technique (P < .0001). The inside-shoulder technique resulted in head-up tackling in 84.8% of players compared with 59.8% with the head-across-the-bow technique (P < .0001) and 94.9% with arm tackling (P = .0001). There were 4 recorded injuries to the tackler: 2 neck injuries, 1 shoulder injury, and 1 wrist/hand injury. Head-up tackling, tackles made at or above the level of the offensive player's waist, and inside-shoulder tackling were found to be more efficient in producing successful tackles. The head-down, tackling below the waist, and head-across-the-bow techniques were associated with poor tackling and lower success rates.

Reliable Landmarks for Common Femoral Artery Cannulation: Femoral Head or Inguinal Skin Crease?

Context: Angiography catheterization through the femoral artery (FA) carries risks of vascular complications. The optimal site for puncture is above the common FA bifurcation (CFAB) and below the inferior epigastric artery. Aims: This study aims to assess the relationship of the inguinal skin crease with the position of the femoral head and the CFAB. Settings: From March 2014 to March 2015, this study was conducted in a single center. Materials and Methods: Patients above 18 years were eligible for coronary angiography through the trans-FA. The FA cannulation was carried out using an 18G needle. A contrast medium was injected to visualize the common FA (CFA), the CFAB, and the inferior epigastric artery. A reference point was placed tangent to the inguinal skin crease. Results: There were 185 patients, with a mean age of 61.47 ± 8.95 years, and 53.2% were men. CFAB was inferior to the midline of the femoral head in 94.6% of patients and, in relation to the inguinal skin crease, was inferior, equal, and superior in about one-third of patients; the position of the inguinal skin crease was inferior to the midline of the femoral head in 98.1%. The position of the inferior epigastric artery was superior to the femoral head in all patients. There was no significant difference based on gender or body mass index comparison. Conclusions: Because femoral head fluoroscopy is less commonly used as a landmark for a puncture during FA cannulation, the inguinal skin crease may be an applicable point for CFA puncture.

Structural design of a novel rotary platform 3D printer

Abstract Stair-stepping defects in 3D printing processes can be caused by various reasons, such as the quality of the printing material, the position of the print head, printing speed, printing temperature, and so on. To improve the issue of stair-stepping effects in thin-walled revolving parts during the 3D printing process, this project aims to design a 3D printer that enables the print head to move in the X, Y, and Z axes while the heated bed platform can rotate. This will significantly reduce the stair-stepping effect’s impact and greatly enhance the printing’s quality and accuracy.

Computer vision-guided open-source active commutator for neural imaging in freely behaving animals.

Recently developed miniaturized neural recording devices that can monitor and perturb neural activity in freely behaving animals have significantly expanded our knowledge of neural underpinning of complex behaviors. Most miniaturized neural interfaces require a wired connection for external power and data acquisition systems. The wires are required to be commutated through a slip ring to accommodate for twisting of the wire or tether and alleviate torsional stresses. The increased trend toward long-term continuous neural recordings has spurred efforts to realize active commutators that can sense the torsional stress and actively rotate the slip ring to alleviate torsional stresses. Current solutions however require the addition of sensing modules. Here, we report on an active translating commutator that uses computer vision (CV) algorithms on behavioral imaging videos captured during the experiment to track the animal's position and heading direction in real time and uses this information to control the translation and rotation of a slip ring commutator to accommodate for accumulated mouse heading orientation changes and position. The CV-guided active commutator has been extensively tested in three separate behavioral contexts. We show reliable cortex-wide imaging in a mouse in an open field with a miniaturized wide-field cortical imaging device. Active commutation resulted in no changes to measured neurophysiological signals. The active commutator is fully open source, can be assembled using readily available off-the-shelf components, and is compatible with a wide variety of miniaturized neurophotonic and neurophysiology devices.

Craniomaxillofacial landmarks detection in CT scans with limited labeled data via semi-supervised learning

BackgroundThree-dimensional cephalometric analysis is crucial in craniomaxillofacial assessment, with landmarks detection in craniomaxillofacial (CMF) CT scans being a key component. However, creating robust deep learning models for this task typically requires extensive CMF CT datasets annotated by experienced medical professionals, a process that is time-consuming and labor-intensive. Conversely, acquiring large volume of unlabeled CMF CT data is relatively straightforward. Thus, semi-supervised learning (SSL), leveraging limited labeled data supplemented by sufficient unlabeled dataset, could be a viable solution to this challenge. MethodWe developed an SSL model, named CephaloMatch, based on a strong-weak perturbation consistency framework. The proposed SSL model incorporates a head position rectification technique through coarse detection to enhance consistency between labeled and unlabeled datasets and a multilayers perturbation method which is employed to expand the perturbation space. The proposed SSL model was assessed using 362 CMF CT scans, divided into a training set (60 scans), a validation set (14 scans), and an unlabeled set (288 scans). ResultThe proposed SSL model attained a detection error of 1.60 ± 0.87 mm, significantly surpassing the performance of conventional fully supervised learning model (1.94 ± 1.12 mm). Notably, the proposed SSL model achieved equivalent detection accuracy (1.91 ± 1.00 mm) with only half the labeled dataset, compared to the fully supervised learning model. ConclusionsThe proposed SSL model demonstrated exceptional performance in landmarks detection using a limited labeled CMF CT dataset, significantly reducing the workload of medical professionals and enhances the accuracy of 3D cephalometric analysis.

Comparing Muscle Activity and Onset Time of Cervical and Thoracoscapular Muscles during Shoulder Flexion and Abduction in Individuals with and without Forward Head Posture

Comparing Muscle Activity and Onset Time of Cervical and Thoracoscapular Muscles during Shoulder Flexion and Abduction in Individuals with and without Forward Head Posture

Assessment of the Relationship between Antero-Posterior Dental Malocclusions, Body Posture Abnormalities and Selected Static Foot Parameters in Adults.

Objectives: This study aimed to find if a relationship exists between antero-posterior malocclusions and the level of musculoskeletal disorders in adults, including body posture and static foot analysis. Methods: In all, 420 participants were recruited through convenience sampling (Kraków University students and patients of a local dentist's practice). Following general medical interviews, dental examinations and consideration of inclusion and exclusion criteria, 90 healthy volunteers (ages 19-35) were enrolled and assigned to three groups (n = 30) based on occlusion type (Angle's molar Class I, II or III). The research procedure involved occlusion and temporomandibular disorder assessment conducted by a dental specialist. Comprehensive morphological measurements of body asymmetry were performed using the Videography 2D package and FreeSTEP software, which calculated the parameters determined from anterior, posterior and lateral projection photos. Foot loading distribution was analyzed using the FreeMED baropodometric platform. Results: Significant differences were demonstrated in the positioning of the head, cervical and lumbar spine in the sagittal plane among individuals with the analyzed occlusal classes (p < 0.05). Individuals with Angle's Class II exhibited significantly greater forward head positions and greater depths of cervical and lumbar lordosis compared with individuals with Class III or Class I. Those with overbites had higher forefoot loading. The Class III individuals exhibited greater L-R displacement, indicating a larger angle of displacement of the centers of the right and left feet relative to the lower edge of the measurement platform, suggesting pelvic rotation. Conclusions: An inclination for concurrent occurrences of malocclusions and posture deviations in the sagittal plane was observed. An interdisciplinary approach involving dentistry and physiotherapy specialists which utilizes tools for comprehensive posture assessment is crucial for diagnosing and treating such conditions.

Effect of topical brinzolamide on visual function and waveform in patients of infantile nystagmus syndrome: A randomized control trial.

To evaluate the effect of topical carbonic anhydrase inhibitor (brinzolamide) versus placebo on visual function and waveforms in infantile nystagmus syndrome (INS). Prospective, placebo-controlled, double-blind, cross-over study. Setting- A tertiary eye care center. Patients- Cases of idiopathic INS with and without abnormal head posture aged ≥10 years who had not received previous treatment for nystagmus. Intervention- Patients were randomized into two groups. Group 1 was given placebo for 3 months, and after a washout period of 7 days started on topical brinzolamide for the next 3 months. In group 2, the order was reversed. The drops were administered topically three times (every 8 hours) in both eyes. Outcome measure- Binocular best corrected visual acuity (BCVA) using the ETDRS chart, eXpanded nystagmus acuity function (NAFX) score and INS waveforms obtained from eye movement recordings, intraocular pressure (IOP) by Goldmann applanation tonometer, near stereopsis by TNO stereo test, and change in abnormal head posture before and after intervention in the null position. A total of 29 cases completed the study (23 with abnormal head posture; 6 without abnormal head posture). While brinzolamide shows improvement in visual acuity and NAFX score in idiopathic INS, its clinical significance needs further evidence.

Reliability of scapular position and periscapular muscle strength tests in healthy subjects with forward neck and rounded shoulder posture

BACKGROUND: People with forward head posture (FHP) and rounded shoulder posture (RSP) may experience shifts in scapular position and alterations in the strength of the muscles surrounding the scapula. Therefore, a reliable scapula position and scapula muscle strength test are required to identified scapula problem and provided appropriate intervention programs. OBJECTIVE: This study aimed to determine the reliability of scapular position measurements obtained using a modified digital inclinometer and palpation meter, as well as muscle strength using a hand-held dynamometer (HHD) in individuals with FHP and RSP. METHODS: Thirty healthy subjects underwent scapular position tests (upward rotation, anterior tilt, depression, and protraction) and strength tests of periscapular muscles (serratus anterior, upper trapezius, middle trapezius, and lower trapezius) on both the dominant and non-dominant sides. The reliability of the measurements was confirmed by computing the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal clinically important difference (MCID). Test and re-tests were conducted over a period of one week and actual values for each measurement were also obtained and assessed. RESULTS: The ICC ranged from 0.802 to 0.935 for the scapular position tests and from 0.808 to 0.949 for muscle strength tests on the dominant and non-dominant sides. For scapular position tests, SEM values ranged from 0.3 cm to 0.6 cm (protraction and depression), from 1.0∘ to 1.7∘ (upward rotation and anterior tilt) and MCID values ranged from 0.7 cm to 1.6 cm (protraction and depression), from 2.8∘ to 4.7∘ (upward rotation and anterior tilt). Regarding muscle strength tests, SEM and MCID values were in the range 14.4N–27.3N and 39.9N–75.7N, respectively. CONCLUSIONS: Scapular position and periscapular muscle strength can be reproducibly measured in healthy subjects individuals with FHP and RSP. These instruments can hence be recommended for evaluating these functional traits in subjects with FHP and RSP.

A trans-generation conundrum with implications in rehabilitation programs – what factors influence non-specific back pain in children?

Back pain in children and adolescents is one of the most frequent reasons for seeing a medical specialist worldwide. Many factors have been incriminated when it comes to influencing the appearance of non-specific back pain in children as well as in adults. For the younger population, some of the culprits seem to be sitting for long periods, us-ing harmful postural patterns, a forward head posture determined by incorrect positioning during prolonged studying hours, and carrying a too-heavy backpack, but do they really influence non-specific back pain in children? These ques-tions are valid for all generations and countries. This paper aimed to review the published literature to determine whether the factors mentioned above, sitting in mismatched school furniture, carrying heavy backpacks, and forward head posture, influence the incidence of non-specific back pain in children and whether there are any data or differences between the general population and Roma-nian students. For this purpose, we conducted database research using the keywords “non-specific back pain in chil-dren, sitting, school furniture, forward head posture, backpack carrying” and various combinations of these terms, which returned 37 eligible articles for this paper in PubMed - Center for Biotechnology Information (NCBI) and Sci-enceDirect. There was no time limit on the researched articles, and they had to refer to the pediatric population, be open-access and in extenso articles, and be written in English, French, or Spanish. After analyzing the results from these articles, the conclusion is that there is no evident or spe-cific connection between non-specific back pain in pediatric populations and harmful posture patterns while sitting or carrying a backpack. Also, more multicentered research using fewer variables and more objective measurement instruments is needed. Keywords: non-specific back pain in children, sitting, bad posture, school furniture, forward head posture, back-pack carrying