Hemiparetic Research Articles

Differences in gray matter atrophy and functional connectivity between motor subtypes of Parkinson's disease.

Parkinson's disease (PD) patients with postural gait abnormalities exhibit poorer motor function scores, more severe non-motor symptoms, faster cognitive function deterioration, and a less favorable response to drugs and surgery compared to PD patients with tremor. This discrepancy is believed to be associated with more pronounced gray matter atrophy and abnormal functional connectivity. To investigate the distinctive pathological mechanisms between PD subtypes, we examined gray matter volume (GMV) and functional connectivity in patients with Parkinson's disease presenting with postural instability/gait difficulty (PD-PIGD), patients with tremor-dominant Parkinson's disease (PD-TD), and healthy controls. Voxel-based morphometry (VBM) of T1-weighted images was conducted to compare GMV among 64 PD-PIGD patients, 44 PD-TD patients, and 32 controls. Subsequently, functional connectivity within regions showing reduced GMV was compared across the groups. We analyzed whether differences among the groups were associated with clinical characteristics and neuroimaging biomarkers using partial correlation and binary logistic regression. Our comparison between PD-PIGD and PD-TD patients revealed a link between PD-PIGD and more extensive frontotemporal atrophy, potentially indicating increased basal ganglia activity accompanied by decreased cerebellum activity. Furthermore, in addition to the smaller GMV in the left middle temporal gyrus, the increased functional connectivity between this brain region and the right caudate was also the independent risk factor for PD-PIGD. In addition, we compared brain network connectivity between the PIGD and TD subtypes, using an independent component analysis (ICA). We found that Compared to PD-TD, PD-PIGD patients showed an enhanced sensorimotor network (SMN) around the left supplementary motor area. These findings suggest that severe gray matter atrophy and abnormal functional connectivity and brain networks may serve as pathophysiological mechanisms distinguishing PD-PIGD patients from other subtypes.

Ứng dụng tiêm Botulinum Neurotoxin dưới hướng dẫn của siêu âm và điện cơ trong điều trị loạn trương lực cơ cổ: Ca lâm sàng

Dystonia is a movement disorder characterized by persistent or intermittent muscle contractions, involuntary, creating repetitive and/or abnormal postures and movements. Dystonic movements result in characteristic twisting or tremor patterns. Dystonia often begins or worsens with intentional movements, combined with excessive muscle activation. Dystonia is classified according to the affected body regions: focal dystonia, segmental dystonia, multifocal dystonia, hemidystonia, and generalized dystonia. Anterocollis is a type of cervical dystonia, caused by persistent, repetitive contractions of neck muscle groups, leading to excessive neck flexion. Anterocollis is described in the context of movement disorders in Parkinson’s syndrome (Parkinson’s disease, multiple system atrophy, etc.). Treatment of dystonia is primarily symptomatic: medications, Botulinum Neurotoxin (BoNT) injections, surgery, and physical therapy. Among these, BoNT injections are considered the first choice for focal or segmental dystonia.Botulinum Neurotoxin acts at the neuromuscular junction, leading to muscle paralysis. BoNT injections require injection equipment, surface disinfection, and determination of the injection site based on clinical landmarks. Some deep and difficult injections require specialized techniques such as electromyography (EMG) and ultrasound. In the case of anterocollis, BoNT is often applied to both superficial and deep muscles. To achieve effectiveness and limit complications during and after injection, practitioners often use combined EMG and ultrasound techniques. We present a clinical case to illustrate the value of using BoNT injections under the simultaneous guidance of EMG and ultrasound in treating anterocollis at the Neurology Department of Hanoi Medical University Hospital.

Occurrence of Body Posture Abnormalities in Overweight and Obese Children Aged 5-6 Years-Pilot Study.

The study aimed to assess the occurrence of body posture disorders and their changes under the influence of a physioprophylactic program in children depending on body weight. In the examined children, the general and segmental body composition and body posture were determined using a physiotherapeutic assessment based on the Kasperczyk method. Mass, overall, and segmental body composition were determined using the bioelectrical impedance method using a TANITA body composition analyzer. The study group of 76 children was divided due to body weight disorders into Group I (n = 51), in which BMI and fat mass values were within the normative limits for age and gender, and Group II (n = 19), comprising children whose body weight exceeded the norm and/or fat mass exceeded normative values. The examined children underwent a physioprophylactic. The program was conducted by qualified physiotherapists for 12 weeks, once a week for 30 min. The therapeutic program was focused on physioprevention of being overweight and the correction of body posture. A distal distribution of fat mass was observed in the examined group. Asymmetry in the sagittal plane was found in 35% of children. No statistically significant differences were found in the presence of asymmetry in the sagittal plane between the groups. No statistically significant differences were found in the occurrence of posture irregularities between the groups. There were no changes in the weight and body posture of the examined children under the influence of the physiotherapy program. The lack of correlation in the examined group between body weight and posture irregularities in 5-6-year-olds may suggest the acquisition of posture defects as a consequence of the persistence of overweight or obesity.

The Relationship Between Postural Torticollis Abnormalities and Plagiocephaly on the Early Motor Development Milestones of Lying and Rolling Activities in Infants: A Retrospective Study

ABSTRACT The study examined how neck muscle imbalance and plagiocephaly affect the lying and rolling activities in 118 infants aged 4 to 6 months with postural torticollis. Outcome measures included age, sex, cervical movement, and plagiocephaly severity. Neck muscle function was assessed with the Muscle Function Scale (MFS), and infant motor abilities in lying and rolling were evaluated through the corresponding dimensions of the Gross Motor Function Measure (GMFM). Multiple regression analysis showed that a better MFS score of the affected neck was significantly associated with improved lying and rolling activities in the GMFM (p < .01), and importantly, the interaction between the plagiocephaly and the MFS scores of the affected neck muscle in these activities was found to be significant (p < .05). These results highlight the need for early intervention in infants with torticollis to address muscle imbalance and plagiocephaly, crucial for early motor development (KCT0008367).

Towards an explanation for 'unexplained' dizziness in older people.

Subjective unsteadiness or dizziness, usually without increase in body sway, is common in older people. The absence of mechanistic understanding of such symptoms renders clinical management difficult. Here, we explore the mechanisms behind such idiopathic dizziness (ID), focusing on postural control abnormalities. Thirty patients with ID and 30 age-matched controls stood on a moving platform. Platform oscillations were randomly delivered at different velocities (from 0 to 0.2m/s). Markers of postural control, including objective sway (trunk sway path, recorded via a sensor attached to vertebrae C7), stepping responses, subjective instability and anxiety ratings were obtained. MRI scans were available for correlations with levels of cerebral small vessel disease in 28 patients and 24 controls. We observed a significant relationship between objective and subjective instability in all groups. The slope of this fit was significantly steeper for patients than controls, indicating greater perceived instability for the same body sway. Stepwise linear regression showed that the slopes of this objective-subjective instability relationship were best explained by concerns about falling (Falls Efficacy Scale-International), clinical physical functioning (Short Physical Performance Battery) and, to some degree, by neuroimaging markers of cerebral small vessel disease. In addition, patients had a reduced stepping threshold, suggesting an overly cautious postural response. The distorted perception of instability and subtle impairments in balance control, including abnormal and overly cautious stepping responses, underlies the emergence of ID. It appears to relate to changes in postural performance, psychological functioning and disruption of postural brain networks associated with cerebral small vessel disease.

The Morbid Impact of Environmental Toxins on the Human Nervous System: Dystonia Nexus with Organic Solvents, Pesticides, and Heavy Metals

Dystonia is a neurological disorder characterized by involuntary muscle contractions that lead to abnormal movements and postures. This review examines environmental toxins and their etiology and pathogenesis of dystonia. Environmental toxins – organic solvents, pesticides, and heavy metals – disrupt neural pathways and neurotransmitter functions, contributing to the development of dystonia. These toxins induce neurotoxicity through mechanisms involving oxidative stress, inflammatory responses, and interference with neurotransmitter synthesis and release. Organic solvents disrupt neuronal membrane integrity and neurotransmission, while pesticides impair neurotransmitter synthesis and receptor function. Heavy metals alter ion channel function, promote oxidative stress, and trigger inflammatory responses, causing neuronal damage. Diagnosing dystonia requires a thorough medical history, neurological examination, lab work, and specialized tests, including imaging and genetic testing. Treatment strategies focus on symptom management by identifying and eliminating the source of environmental toxin exposure and medications (e.g., dopaminergic agents, anticholinergics, GABAergic agents, and BOTOX injections). These strategies are complemented by physical therapy, nutritional support, regulating monitoring and follow-up, and education and counseling.

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.

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.

Assessment of Animal Welfare at an Exotic Animal Fair in Poland: A Focus on the Quality of Exhibition Containers for Reptiles and Amphibians.

Given the growing number of events involving exotic animals, it is crucial to prioritize the well-being of the animals involved. This study aims to evaluate the quality of animal presentation at a selected fair in Poland and assess the level of animal welfare evident in the exhibition boxes, contributing to the ongoing dialogue on this important issue. The evaluators used a five-point Likert scale and a Yes/No system to analyze the living conditions during the fair, including the size of containers, presence of substrate, and environmental enrichment. They also assessed the occurrence of visual abnormal postures and behaviors to gauge the overall level of welfare. To ensure the reliability and consistency of the data and minimize potential bias, each evaluator repeated the rating process three times, with a three-week interval between each session. An average value was then calculated for each aspect. A total of 818 animals were present at the fair, with 688 being reptiles (84.11%) and 130 being amphibians (15.89%). This study revealed that the provision of substrate scored higher for reptiles compared to amphibians, while the size of containers for amphibians received higher ratings than those for reptiles. Visual abnormalities in posture and behavior were more common in reptiles than in amphibians. Display containers for snakes received the lowest ratings and showed more visual abnormalities in posture and behavior, raising concerns about their welfare. Despite the presence of environmental enrichment, the overall level of animal welfare was assessed as being medium/low. Pearson's correlation coefficient indicated good reliability among the evaluators during the assessment process, with most assessments showing values > 0.8. Despite existing regulations for exhibitors, neglect remains prevalent. These findings highlight the potential negative impact of animal exposure at fairs on animal welfare. Display containers were often inadequately sized for the animals, particularly for snakes, chameleons, monitor lizards, and salamanders.

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.

Upper Extremity Motor Performance among Spastic Quadriplegic Cerebral Palsy Patients with and without Head Control

Background: Cerebral Palsy refers to chronic abnormalities of movement and posture resulting from non-progressive disruptions in the developing fetus or immature brain. A key component of overcoming activity restriction is head control, which is essential for locomotor abilities and motor activities including grasping and sitting. Objective: To determine upper extremity motor performance among spastic quadriplegic cerebral palsy patients, with and without head control. Methods: A comparative cross-sectional study with 35 participants was conducted to investigate the interplay between head control and upper extremity function in children with spastic quadriplegic cerebral palsy. Two groups were formed based on the presence or absence of head control. Inclusion criteria comprised of both genders aged 1.09-10.02 with spastic quadriplegic CP, excluding those with contractures, botulin toxin injections, orthopedic surgery, or serious medical problem/seizures. Data entry and descriptive statistical analysis were conducted using Statistical Package for Social Sciences (SPSS) version 26. Results:There was a statistically significant difference between the groups, one including participants with control and other without it as the P value is &lt;0.017. The group A, with head control, showed higher values of QUEST; therefore, showed significant correspondence. Conclusion: The study found a significant positive relationship between head control and upper extremity function in children with spastic quadriplegic cerebral palsy.

Clinical characteristics and surgical outcomes in patients with superior oblique muscle palsy: a retrospective study on 1057 patients

BackgroundTo evaluate the clinical findings of patients with SOP who underwent surgery.MethodsThis historical cohort study was performed on 1057 SOP patients managed with surgery in Farabi Hospital, Iran, from 2011 to 2022.ResultsThere were 990 (93.7%) patients with unilateral SOP with the mean age of 21.8 ± 14.8 years. Of these, 715 patients (72.2%) were diagnosed with congenital SOP, and 275 patients (27.8%) had acquired SOP (P < 0.001). In contrast, 67 (6.3%) patients were diagnosed with bilateral SOP, with the mean age of 19.4 ± 15.6 years. Among these, 18 cases exhibited the masked type. The mean angle of vertical deviation in primary position at far in unilateral and bilateral cases was 15.6 ± 8.3 and 13.3 ± 9.1 △, respectively (P < 0.001). In unilateral cases, abnormal head posture (AHP) was detected in 847 (85.5%) patients and 12 (1.2%) had paradoxical AHP. Amblyopia was found in 89 (9.9%) unilateral and 7 (10.3%) bilateral cases. Solitary inferior oblique myectomy, was the most common surgery in both unilateral (n = 756, 77.1%) and bilateral (n = 35, 52.2%) patients. The second surgery was performed for 84 (8.6%) unilateral and 33 (49.3%) bilateral cases (P < 0.001). The prevalence of amblyopia and the mean angle of horizontal deviation were significantly higher in patients who needed more than one surgery (all P < 0.05).ConclusionCongenital SOP was more than twice as frequent as acquired SOP and about 90% of unilateral and 50% of bilateral cases were managed with one surgery. Amblyopia and significant horizontal deviation were the most important factors for reoperation.Trial registrationThe Institutional Review Board approval was obtained from the Tehran University of Medical Sciences (IR.TUMS.FNM.REC.1400.012) and this study adhered to the tenets of the Declaration of Helsinki and HIPAA.

Explicit training through neurodevelopmental therapy improves tone and postural control in hemiplegic stroke-A Systematic review protocol

Introduction Hemiplegia is the common term used to describe a multitude of clinical problems associated with a stroke. Hemiplegic stroke accounts for 70-85% of all first strokes. Trunk stability is impaired due to hypertonia and weakness in hemiplegia. Impaired trunk control leads to gait and postural abnormalities which if left untreated causes permanent disability in hemiplegics. Objective To investigate the scope of research on the benefits of explicit training using Neurodevelopmental Therapy (NDT) for enhancing tone and postural control in subjects with hemiplegic stroke. Methods In order to adhere to established protocols of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, the systematic review will be carried out to find pertinent studies published up to the search date, and a thorough search strategy will be applied across popular electronic databases including PubMed/Medline, Scopus, and Cochrane Library. This systematic review methodology has been registered in PROSPERO for rigorous and transparent dissemination of study search, synthesis, and analysis. Discussion As the motor impairments due to abnormal tone and postural impairment in hemiplegic stroke substantially impact a stroke survivor’s quality of life, this study will provide a thorough and methodical approach to synthesize and report the merits and demerits on the effectiveness of NDT in enhancing tone and postural control, considering the potential variability in interventions and outcomes, and the methodological rigor of particular studies. The review also intends to provide significant insights for clinicians, researchers, and policymakers by critically analysing and summarizing the present state of research in this domain. This will facilitate evidence-based decision-making in rehabilitation techniques for patients with hemiplegic stroke. Systematic Review Registration number CRD42023476137

Health-Related Quality of Life in Romanian Patients with Dystonia: An Exploratory Study.

Background/Objectives: Dystonia is a neurological movement disorder characterized by involuntary muscle contractions that lead to abnormal movements and postures; it has a major impact on patients' health-related quality of life (HRQoL). The aim of this study was to examine the HRQoL of Romanian patients with dystonia using the EQ-5D-5L instrument. Methods: Responses to the EQ-5D-5L and the visual analogue scale (VAS) were collected alongside demographic and clinical characteristics. Health profiles were analyzed via the metrics of the EQ-5D-5L, severity levels, and age groups. Using Shannon's indexes, we calculated informativity both for patients' health profile as a whole and each individual dimension. Level sum scores (LSS) of the EQ-5D-5L were calculated and compared with scores from the EQ-5D-5L index and VAS. The HRQoL measures were analyzed through demographic and clinical characteristics. Descriptive statistics, Spearman correlation, and non-parametric tests (Mann-Whitney U or Kruskall-Wallis H) were used. The level of agreement between HRQoL measures was assessed using their intraclass correlation coefficient (ICC) and Bland-Altman plots. Results: A sample of 90 patients was used, around 75.6% of whom were female patients, and the mean age at the beginning of the survey was 58.7 years. The proportion of patients reporting "no problems" in all five dimensions was 10%. The highest frequency reported was "no problems" in self-care (66%), followed by "no problems" in mobility (41%). Shannon index and Shannon evenness index values showed higher informativity for pain/discomfort (2.07 and 0.89, respectively) and minimal informativity for self-care (1.59 and 0.68, respectively). The mean EQ-5D-5L index, LSS, and VAS scores were 0.74 (SD = 0.26), 0.70 (SD = 0.24), and 0.61 (SD = 0.21), respectively. The Spearman correlations between HRQoL measures were higher than 0.60. The agreement between the EQ-5D-5L index and LSS values was excellent (ICC = 0.970, 95% CI = 0.934-0.984); the agreement was poor-to-good between the EQ-5D-5L index and VAS scores (ICC = 683, 95% CI = 0.388-0.820), and moderate-to-good between the LSS and VAS scores (ICC = 0.789, 95% CI = 0.593-0.862). Conclusions: Our results support the utilization of the EQ-5D-5L instrument in assessing the HRQoL of dystonia patients, and empirical results suggest that the EQ-5D-5L index and LSS measure may be used interchangeably. The findings from this study highlight that HRQoL is complex in patients with dystonia, particularly across different age groups.

Does botulinum toxin affect psycho-social aspects in dystonia?

Dystonia is a movement disorder in which sustained muscle contractions give rise to abnormal postures or involuntary movements. It is a disabling and disfiguring disorder that affects activities of daily living and gives people a bizarre appearance often associated with psychological morbidity, embarrassment and social avoidance. Intramuscular injection of botulinum toxin (BoNT) is the most effective treatment for motor symptoms in focal dystonia, but little is known about its impact on the psycho-social dimension. The main aim of this study was to evaluate psycho-social changes in patients with focal dystonia after starting BoNT treatment using self-reported scales. The Beck Depression Inventory (BDI-II), the 36-Item Short Form Health Survey (SF-36), the Body Uneasiness Test (BUT), the State-Trait Anxiety Inventory (STAI) and the Visual Analogue Scale (VAS) assessing body self-image, satisfaction with physical aspects, social avoidance, self-reported depression, and self-distress were completed by 11 patients with dystonia and 9 patients with hyperhidrosis as a control group before BoNT (T0). VAS was then performed after four weeks (T1) to assess whether BoNT induced changes in the psychosocial dimension. Our results showed that only depressive symptoms and rumination about body defects improved in patients with dystonia after BoNT treatment, while improvement in self-distress and satisfaction with physical aspects was also found in hyperhidrosis. Individuals with hyperhidrosis experience poorer psychological well-being and suffer from higher levels of distress compared to dystonic patients. This suggests that individuals with this disabling condition are more vulnerable to social impact than dystonic patients.

Prevalence of Upper Extremity Pain among Tabla Players working in Islamabad/Rawalpindi

Background: Upper extremity pain is a significant concern among musicians, particularly those involved in repetitive and high-stress activities such as playing the tabla. This study aims to assess the prevalence and risk factors of upper extremity pain and associated functional disabilities in tabla players based in Islamabad and Rawalpindi. Objective: To determine the prevalence of upper extremity pain and functional disability among tabla players and to identify associated risk factors. Methods: A cross-sectional descriptive survey was conducted at music schools, academies, and churches in Islamabad and Rawalpindi. The study spanned five months from June 23, 2023, following the approval of the synopsis. A sample size of 100 male tabla players aged 19-38 years, with at least two years of playing experience and a minimum of two practice sessions per week, was selected using a non-probability convenient sampling technique. Data collection tools included the Visual Analogue Scale (VAS) for pain assessment and the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire for evaluating functional limitations. Participants with a history of upper extremity diseases, surgical history, trauma, or congenital deformities were excluded. Descriptive analysis was performed using SPSS version 25, with frequencies, percentages, and p-values calculated to determine statistical significance. Results: Among the participants, 40% were aged 19-23 years, 26% were aged 24-28 years, 31% were aged 29-33 years, and 3% were aged 34-38 years. The prevalence of upper extremity pain was 89%, and functional disability was 88%. Pain levels varied with playing hours per week: 11% reported no pain, 16% had mild pain, 67% experienced moderate pain, and 6% had severe pain. Functional disability scores were similarly distributed across playing hours, with 11% reporting no disability, 16% mild disability, 67% moderate disability, and 6% severe disability. The relationship between playing hours and both VAS and DASH scores was statistically significant (p-values 0.045 and 0.032, respectively). Conclusion: The study revealed a high prevalence of upper extremity pain and functional disability among tabla players, significantly impacting their quality of life. Key risk factors included repetitive movements, abnormal posture, prolonged practice hours, poor technique, age, and gender. These findings underscore the need for preventive strategies and targeted interventions to reduce musculoskeletal disorders in this population.

Correlation of Foot Posture Index and Years of Experience in Nurses with Ankle and Pain

This study aims to determine the correlation between the foot posture index and the years of experience of nurses having foot and ankle pain. Nurses spend a great deal of time on their feet. Due to long standing and unequal weight shifting on the foot the plantar arches become stiff or less flexible. This leads to have deformed or abnormal foot posture. Therefore, by using foot posture index we’re going to assess the foot posture of the nurses and then correlate them with their years of experience.

Incidence and predictors of postural abnormalities in Parkinson's disease: a PPMI cohort study.

Axial postural abnormalities (PA) are invalidating symptoms of Parkinson's disease (PD). Risk factors for PA are unknown. We sought to evaluate PA incidence and risk factors over the first 4-6years of PD. We included 441 PD patients from the Parkinson's Progression Markers Initiative (PPMI) cohort with data at diagnosis and after 4-year follow-up. PA was defined according to a posture item ≥ 2 at the Movement Disorder Society-sponsored-revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) in Off therapeutic condition. The Kruskal-Wallis test was used to compare characteristics of patients without PA ('no-PA'), with PA at disease onset ('baseline-PA'), and PA developed during follow-up ('develop-PA'). To identify predictors of PA development, univariate and multivariate Cox regression analyses were performed considering demographic, clinical and therapeutic variables. 10.9% of patients showed PA at baseline and 23.7% developed PA within the first 4-6years since diagnosis. Older age, malignant phenotype, higher MDS-UPDRS part III, Hoehn & Yahr, and dysautonomia (SCOPA-AUT) score, and lower levels of physical activity were predictors of PA development at the univariate analysis. Older age (Hazard ratio [HR] per year: 1.041) and higher MDS-UPDRS part III score (HR per point: 1.035) survived as PA development predictors in the multivariate analysis. PPMI cohort data show that > 30% of PD patients present PA within the first 4-6years of disease. Older age at onset and higher motor burden are associated with a higher risk for PA development. The protective role of physical activity merits to be further investigated.

When Vaping Isn't Actually Safer: A Death From Toxic Alcohol Contaminated Vape Juice.

Vape juice is a diluent for e-cigarette active ingredients, nicotine or tetrahydrocannabinol (THC). Lack of strict regulation in vape juice production is a concern as ingredients and their concentrations may vary widely from the labeling.A 43-year-old woman was transported via ambulance to the hospital after ingesting homemade vape juice, presenting unresponsive with decerebrate posturing. She reportedly made a tincture combining a vape juice purchased online (containing "ethylene glycol") and THC for "endometriosis-related pain relief." Laboratory evaluation revealed anion gap metabolic acidosis, elevated serum lactate, and high serum osmolality. Urine fluoresced under Wood's lamp, and fomepizole was administered as an ethylene glycol antidote, but she expired the following afternoon. Clinical serum toxicology results returned after death revealed 235 mg/dL of methanol, and no ethylene glycol.Autopsy findings included ischemic changes of the gastrointestinal tract and cerebral edema with herniation. Postmortem toxicology performed on hospital admission blood revealed methanol (220 mg/dL), propylene glycol (59 mg/dL), Δ-9 THC and metabolites, and medications administered during hospitalization. The medical examiner determined the cause of death to be methanol and propylene glycol toxicity.To our knowledge, this is the first report of accidental death from ingestion of vape juice contaminated with toxic alcohol.

Spinal cord stimulation for postural abnormalities in Parkinson’s disease: 1-year prospective pilot study

BackgroundPostural abnormalities (PA) are common in the advanced stages of Parkinson’s disease (PD), but effective therapies are lacking. A few studies suggested that spinal cord stimulation (SCS) could be a potential therapy whereas its effect is still uncertain. We aimed to investigate whether SCS had potential for benefiting PD patients with PA.MethodsT8-12 SCS was operated on six PD patients with PA and all patients were followed for one year. Evaluations were made before and after SCS. Moreover, three patients were tested separately with SCS on-state and off-state to confirm the efficacy of SCS.ResultsImprovements in lateral trunk flexion degree, anterior thoracolumbar flexion degree and motor function were found after SCS. The improvements diminished while SCS was turned off.ConclusionsLower thoracic SCS may be effective for improving PA in PD patients, but further studies are needed to confirm this conclusion.Trial registrationChinese Clinical Trial Registry, ChiCTR1900024326, Registered on 6th July 2019; https://www.chictr.org.cn/showproj.aspx?proj=40835.