Rehabilitation Targets Research Articles

Test–retest reliability and validity in lower limb proprioception tests using image capture technique in healthy adults

BackgroundProprioceptive assessments in clinical practice remain confined to ordinal scales, with a lack of ratio scales. Quantitative proprioception assessments such as threshold to detect passive motion (TDPM) and joint position sense (JPS) help determine the severity of functional impairments and evaluate treatment efficacy. However, their clinical introduction remains challenging due to the extensive and costly equipment required for their measurement.PurposeTo investigate the test–retest reliability and validity in the simplified TDPM and JPS using 14 image capture techniques in targeting hip, knee, and ankle joints.MethodsThis study included 16 volunteers. The measurements were conducted in individual rehabilitation rooms located within the wards of our hospital. Examiners measured a total of 12 TDPM and JPS, including hip, knee, and ankle joints, each performed three times. Moreover, the multi-joint TDPM, distinguished into lower limb flexion and extension patterns, was additionally performed. These measurements were repeated 1 week later. In statistical analysis, the test–retest reliability and construct validity were evaluated using intraclass correlation coefficients (ICC) and Spearman’s rank correlation coefficients.ResultsThe TDPM, multi-joint TDPM, and JPS (variable data; VE) demonstrated moderate reliability across all tested movement directions (TDPM: ICC 0.52–0.70, limits of agreement [LOA] < 10°; multi-joint TDPM: ICC 0.64–0.73, LOA < 10°; JPS: ICC 0.55–0.78, LOA < 10°). No significant correlation was observed between these tests.ConclusionsTDPM and JPS using image capture techniques can reliably measure proprioception and serve as independent tests to evaluate different aspects of proprioception. These findings contribute to future studies aimed at introducing quantitative proprioception tests into clinical practice and facilitating clinical decision-making for rehabilitation targeting proprioceptive impairment.

Depenalization of Drug Abuse Criminal Act as a Humanist Criminal Law Policy

The purpose of this research is to analyze and evaluate ratio legis of criminal sanctions against perpetrators of narcotics abuse and policy reformulation of humanist sanction arrangements against narcotics abusers in the future. This research is a legal research that uses statutory and conceptual approaches. The results of study; (1) ratio legis of providing criminal sanctions against narcotics abusers as referred to in Act Number 35 Year 2009 concerning Narcotics is that the formers of the Act still adhere to the retrebutive paradigm. The target of rehabilitation is only limited to victims of drug abuse, not drug abusers; (2) the policy reformulation of sanctions against drug abusers in the future is no longer using criminal law means. The means used are non-penal means that remove criminal sanctions and replace them with rehabilitation measures.

Short-term changes in brain networks and cognition in children with frontal lobe lesions treated solely with neurosurgical procedures

Intracranial lesions in children often have good prognoses, allowing long-term survival. Cognitive functions, crucial for life quality, need more attention. Previous research has focused on adults, with pediatric studies limited by varied lesions and complex treatments. This study aims to evaluate cognitive and brain network changes in children with frontal lobe lesions, which significantly impact cognitive function, using a before-and-after comparison. The study enrolled 20 children with frontal lesions who underwent fMRI and cognitive tests before and after surgery, with only surgical treatment initially. Brain network changes were evaluated using functional metrics, and cognitive shifts were measured through test scores. Correlations were analyzed to explore brain mechanisms behind cognitive changes. Additionally, 20 healthy children underwent the same assessments for baseline data. Preliminary evidence of cognitive recovery, notably in social cognition, was observed about three months post-surgery, potentially linked to increased functional connectivity between the right lingual gyrus and right middle temporal gyrus. Children with frontal lobe lesions have demonstrated short-term postoperative cognitive improvement and associated reorganization and repair of brain networks, though this capacity for repair may diminish over time. This underscores the importance of timely rehabilitation interventions. This study offers unique insights into cognitive neuroscience and potential rehabilitation targets.

Post-COVID cognitive impairments: targets of neuropsychological rehabilitation

BACKGROUND: At the moment, a large number of scientific studies are devoted to the topic of post-COVID cognitive disorders, as well as to the study of the neurological and psychiatric consequences of COVID-19. However, the issues of describing the cognitive profile that is pathognomonic for a post-COVID patient, as well as the treatment and neurocorrection of emerging disorders are considered extremely rarely. AIM: The aim of this study is to compile a cognitive profile of a post-COVID patient and identify targets for neuropsychological rehabilitation. MATERIALS AND METHODS: A complete neuropsychological examination was carried out on 50 patients who had suffered moderate or mild COVID-19 no more than six months ago from the time of research. Used: MoCA test, clock drawing test, verbal association technique, FAB, G. Head test, test for understanding comparative constructions, “barrel and box” test, symbol-numeric coding test, asthenia rating scale (MFI-20), Hospital scale anxiety and depression. RESULTS: According to the results of screening scales, patients scored borderline between normal and mild (subjective) cognitive decline. No impairments in operational auditory-verbal and visual memory were detected. Low performance in the symbolic-numeric coding technique was revealed, combined with a deterioration in the understanding of logical-grammatical structures. These same scales have a direct correlation with the general level of cognitive integrity. High rates of anxiety and asthenia and low rates of depression were revealed. CONCLUSIONS: This cohort of patients was found to have mild cognitive deficits. A decrease in neurodynamic parameters and a violation of quasi-spatial concepts come to the fore. There are high rates of anxiety and asthenia with the leading mental component of asthenia, against the background of preserved motivation and low rates of depression. The targets of neurocorrection for these patients are: stability of attention, fluency of speech, speed of thinking, quasi-spatial concepts.

A Randomized Feasibility Study of Rehabilitation Targeting Upper Extremity Function and Participation Using Hippotherapy and the Equine Environment for Children with Cerebral Palsy and Autism Spectrum Disorder.

Introduction: Children with upper extremity neuromotor impairments often have decreased participation in life activities. Hippotherapy and rehabilitation in the equine environment might be effective in targeting participation, given the community context and natural activity involvement. This randomized controlled feasibility trial assessed recruitment, retention, treatment fidelity, and acceptability of rehabilitation using hippotherapy and the equine environment, targeting upper extremity function and participation for children with neuromotor impairments to inform a larger trial. Methods: This 6-month trial occurred in Ohio, June-December 2021. Participants were 6-17 years old with upper extremity neuromotor impairment (and primary diagnosis of cerebral palsy and/or autism). Participants were randomized into treatment or waitlist control using REDCap. Treatment was 16 h (4 h/week/4 weeks) of rehabilitation using hippotherapy and the equine environment. Control participants completed a 4-week waiting period, then received the treatment. Recruitment, screening, enrollment, attendance, and retention were tracked. Nonblinded assessments of body structures and functions, activity, and participation were administered pre- and postcontrol and treatment. Assessment measure completion, treatment fidelity, and acceptability were recorded. Results: Twenty-six participants were screened between July and October 2021; 77% (20/26) met inclusion criteria; 70% (14/20) enrolled and randomized: 6 control and 8 treatment. Two withdrew after randomization and one was excluded for fear of horses. In total, n = 5 control and n = 6 treatment completed initial assessment. Retention was 80% (4/5) control and 83% (5/6) treatment, just below the a priori criteria (85%). Assessment measure completion was variable (77%-100%) and replacement of some should be considered before advancing to a clinical trial. Treatment fidelity and acceptability were moderate to high. There were no adverse events from study participation. Conclusions: Results demonstrated preliminary evidence of fidelity and acceptability of rehabilitation using hippotherapy and the equine environment for children with upper extremity neuromotor impairments. Some changes should be made to improve enrollment, retention, and outcome measure completion before advancing to a definitive trial. Trial registration: ClinicalTrials.gov identifier: NCT0653068. Trial funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Foundation for Physical Therapy Research, American Academy of Cerebral Palsy and Developmental Medicine, and Pedal With Pete Foundation.

Allied rehabilitation using caregiver-mediated exercises combined with telerehabilitation for stroke (ARMed4Stroke): A randomised controlled trial

Objective To assess the added value of caregiver-mediated exercises combined with telerehabilitation in addition to usual care compared to usual care alone on the self-reported mobility outcome after subacute stroke. Design Multicentre, observer-blinded, parallel randomised controlled trial. An off-site researcher allocated treatments using minimisation. Setting Four rehabilitation centres in the Netherlands. Participants Forty-one patient–caregiver dyads within 3 months poststroke. Intervention Eight-week blended care program with caregiver-mediated mobility exercises for 2.5 h per week supported by telerehabilitation and four face-to-face sessions in addition to usual care. Main measures Self-reported mobility domain of the Stroke Impact Scale postintervention. Secondary outcomes were functional outcome, dyads’ psychosocial wellbeing, care transition to the community postintervention and after 6 months. Results Forty-one dyads (21 intervention, 20 control) were randomised, and 37 (N = 18; N = 19) were analysed following intention-to-treat. The Stroke Impact Scale mobility was not significantly different between groups postintervention (B 0.8, 95% CI –6.8–8.5, p = 0.826). The secondary outcomes, namely, (a) caregivers’ quality of life postintervention (p = 0.013), (b) caregivers’ symptoms of depression postintervention (p = 0.025), and (c) independence in leisurely activities at 6 months (p = 0.024), showed significant benefits in favour of caregiver-mediated exercises with telerehabilitation. A significant difference favouring controls was found in self-reported muscle strength at 6 months (p = 0.002). Conclusions Caregiver-mediated exercises combined with telerehabilitation yielded no differential effect on our primary outcome self-reported mobility. Although the trial is underpowered, current findings are in line with previous trials. Future studies should further explore beneficial effects of caregiver involvement in stroke rehabilitation targeting psychosocial wellbeing.

Neighborhood Deprivation and Recovery Following Traumatic Brain Injury Among Older Adults.

Understanding the extent to which neighborhood impacts recovery following traumatic brain injury (TBI) among older adults could spur targeting of rehabilitation and other services to those living in more disadvantaged areas. The objective of the present study was to determine the extent to which neighborhood disadvantage influences recovery following TBI among older adults. In this retrospective cohort study, the Area Deprivation Index (ADI) was used to assess neighborhood deprivation by linking it to 9-digit beneficiary zip codes. We used national-level rankings to divide the cohort into the top 10% (highest neighborhood disadvantage), middle 11-90%, and bottom 10% (lowest neighborhood disadvantage). Recovery was operationalized as days at home, calculated by subtracting days spent in a care environment or deceased from monthly follow-up over the year post-TBI. Among 13,747 Medicare beneficiaries with TBI, 1713 (12.7%) were in the lowest decile of ADI rankings and 1030 (7.6%) were in the highest decile of ADI rankings. Following covariate adjustment, beneficiaries in neighborhoods with greatest disadvantage [rate ratio (RtR) 0.96; 95% confidence interval (CI) 0.94, 0.98] and beneficiaries in middle ADI percentiles (RtR 0.98; 95% CI 0.97, 0.99) had fewer days at home per month compared to beneficiaries in neighborhoods with lowest disadvantage. This study provides evidence that neighborhood is associated with recovery from TBI among older adults and highlights days at home as a recovery metric that is responsive to differences in neighborhood disadvantage.

Clinicians’ Attitudes, Perspectives, and Clinical Practices on Gait Retraining After Anterior Cruciate Ligament Reconstruction

Introduction: It has been shown that 45%–85% of patients with anterior cruciate ligament reconstruction (ACLR) will have early-onset arthritis within 10–12 years following surgery. Over the past two decades, the amount of literature regarding ACLR, gait maladaptations after ACLR and their potential link to early-onset arthritis, and rehabilitation techniques has grown exponentially; however, long-term patient outcomes remain modest. Methods: To evaluate current clinicians’ attitudes, perspectives, and clinical practice approach for rehabilitation of patients following ACLR, a survey questionnaire was designed using the Delphi technique. Results: Of the 263 respondents, 84.4% (n = 226) reported that they believed gait training to be “Very” or “Extremely Important.” However, only 35.7% (n = 94) reported objectively measuring gait during ACLR rehabilitation. Of the total respondents, only 6.8% (n = 18) assessed gait during rehabilitation using two-dimensional or three-dimensional motion capture technologies. Discussion: Our results suggest that while gait evaluation was perceived as important, most respondents did not objectively measure gait metrics as a clinical outcome during ACLR rehabilitation. These findings provide a prospective rehabilitation target to potentially mitigate a known risk factor of early-onset arthritis (gait maladaptations) in individuals following ACLR.

Significance of Neurotransmitters in Cerebral Ischemia: Understanding the Role of Serotonin, Dopamine, Glutamate, and GABA in Stroke Recovery and Treatment.

Brain ischemia occurs following heart failure, thromboembolism, and atherosclerosis, and it is characterized by the disturbance of blood flow resulting from the blockage of blood vessels. After a series of studies, it is deduced that various changes occur following stroke, including neural death and changes in plasticity. Studies have reported that neurotransmitters tend to change following a stroke. These changes that occur surrounding the infarct area following a stroke can be considered new therapeutic targets for stroke rehabilitation. Although various studies have reported that different neurotransmitters have a promising role in either the progression or the rehabilitation following stroke, they have not found any pharmacological interventions to help the previous rehabilitation therapeutics. Phytocompounds also offer potential therapeutic benefits in stroke management due to their antioxidative and anti-inflammatory properties. This article aimed to compile recent advancements in neurotransmitter research related to ischemia and explore the potential use of neurotransmitter agonists/antagonists in ischemic conditions to identify potential drug candidates for treating the severe and prolonged stages of stroke in the future.

Contralateral cutaneous reflex modulation during gait in individuals with and without chronic ankle instability

IntroductionChronic ankle instability (CAI), a common seqeula to ankle injury is characterized by a variety of sensorimotor deficits extending beyond the previously injured limb. Cutaneous reflexes have been identified as a potential contributor to these functional limitations with recent studies identifying alterations in reflex patterns following sural nerve stimulation among those with CAI. To date, no studies have measured cutaneous reflexes of the unaffected limb in this population, therefore, the objective of this study was to measure contralateral cutaneous reflexes during gait in individuals with unilateral CAI and healthy controls. MethodsMuscle activity of 6 lower limb muscles was measured in nineteen participants while receiving random, non-noxious sural nerve stimulations during a walking task. ResultsControl reflex patterns were generally well-aligned with previous literature while CAI patterns varied from controls in several muscles throughout the gait cycle. Namely, a lack of lateral gastrocnemius facilitation during late stance and medial gastrocnemius inhibition at midstance. Additionally, a lack of significant BF facilitation throughout contralateral swing was noted. These results indicate reflex alterations extend beyond the affected limb in those with unilateral CAI indicating changes at the spinal level following lateral ankle sprains (LAS). Considering the symptom variability in CAI, the lack of significant reflexes exhibited by the CAI group may be due to increased variability in motor output between subjects or between stimulation trials. ConclusionsThese findings highlight the importance of identifying reflex alterations arising from LAS and subsequently treating these limitations through rehabilitation targeting systemic neural pathways rather than local deficits.

Palliative Rehabilitation in Patients with Cancer: Definitions, Structures, Processes and Outcomes.

This review examines the literature on palliative rehabilitation for patients with advanced cancer, focusing on definitions, structures, processes, and outcomes. Palliative cancer rehabilitation targets comfort and functional improvement for patients with limited rehabilitation potential across various settings. The palliative cancer rehabilitation team, typically led by a physician, coordinates symptom management and referrals to rehabilitation and other allied healthcare professionals as needed. The outcomes of palliative cancer rehabilitation varied widely by goals, settings, and interventions. Studies in hospice settings generally reported improved symptom control; inpatient rehabilitation had mixed functional outcomes; and outpatient palliative rehabilitation may contribute to enhanced functional and symptom outcomes, especially among patients with higher baseline function. Palliative cancer rehabilitation emphasizes a collaborative approach that integrates palliative care with rehabilitation interventions, aiming to enhance quality of life and address diverse patient needs. Further research and standardization are necessary to realize its full potential.

Early auditory processing abnormalities alter individual learning trajectories and sensitivity to computerized cognitive training in schizophrenia.

Auditory system plasticity is a promising target for neuromodulation, cognitive rehabilitation and therapeutic development in schizophrenia (SZ). Auditory-based targeted cognitive training (TCT) is a 'bottom up' intervention designed to enhance the speed and accuracy of auditory information processing, which has been shown to improve neurocognition in certain SZ patients. However, the dynamics of TCT learning as a function of training exercises and their impact on neurocognitive functioning and therapeutic outcomes are unknown. Forty subjects (SZ, n = 21; healthy subjects (HS), n = 19) underwent comprehensive clinical, cognitive, and auditory assessments, including measurements of auditory processing speed (APS) at baseline and after 1-h of TCT. SZ patients additionally completed 30-hours of TCT and repeated assessments ~10-12 weeks later. SZ patients were deficient in APS at baseline (d = 0.96, p < 0.005) relative to HS. After 1-h of TCT, analyses revealed significant main effects of diagnosis (d = 1.75, p = 0.002) and time (d = 1.04, p < 0.001), and a diagnosis × time interaction (d = 0.85, p = 0.02) on APS. APS learning effects were robust after 1-h in SZ patients (d = 1.47, p < 0.001) and persisted throughout the 30-h of training. Baseline APS was associated with verbal learning gains after 30-h of TCT (r = 0.51, p = 0.02) in SZ. TCT learning metrics may have prognostic utility and aid in the prospective identification of individuals likely to benefit from TCT. Future experimental medicine studies may advance predictive algorithms that enhance TCT-related clinical, cognitive and functional outcomes.

Health-related quality of life measures in patients undergoing decompressive craniectomy for severe traumatic brain injury: a 6-year follow-up analysis

Purpose We aimed to assess the long-term neurological outcomes and the functionality and QoL in patients undergoing decompressive craniectomy for severe traumatic brain injury, respectively. Materials and methods Among the 120 patients who underwent decompressive craniectomy for severe TBI between 2002 and 2007, 101 were included based on the inclusion criteria. Long-term follow-up results (minimum 3 years) were available for 22 patients. The outcomes were assessed using the Glasgow Outcome Scale (GOS) and the functionality and HRQoL were assessed using the Short Form-36 (SF-36) (v2) and Quality of Life After Brain Injury (QoLIBRI) questionnaires. Results Among the patients with severe TBI, 62 (61.4%) died and 39 (38.6%) were discharged to either home or a physical therapy facility. Eleven of the thirty-nine patients could not be reached and were excluded from the final analysis. The mean GOS of the remaining 28 patients was 4.14 ± 0.8 after 6.46 ± 1.64 years of follow-up. The HRQoL was assessed in 22 of the 28 patients. The HRQoL scores were lower in patients with TBI than in healthy controls. Furthermore, there was a significant difference in the HRQoL scores in patients with improved GOS scores than in those with unimproved GOS scores. Conclusions Health-related outcome scores could help clinicians understand the requirements of survivors of severe TBI to create a realistic rehabilitation target for them. QoLIBRI served as a good way of communication in these subjects.

A novel referral strategy to enhance the enrollment of patients with heart failure in cardiac rehabilitation: A feasibility study.

Rehabilitation targeting patients with cardiac conditions are evident and acknowledged in clinical guidelines. However, participation rates remain suboptimal, with only 50% of all patients with cardiac conditions participating in these programs across Europe. Considering the well-documented effects of rehabilitation, increasing the referral rate to cardiac rehabilitation would be desirable. This study aimed to evaluate the feasibility of a novel referral strategy that could potentially enhance enrollment in cardiac rehabilitation for patients with heart failure. This prospective feasibility study incorporating both quantitative and qualitative methods was conducted in an outpatient heart failure clinic and a municipal health care center. 106 patients with heart failure were referred to the heart failure clinic from September 2021 through July 2022. A 15-20 min face-to-face physiotherapy consultation was incorporated into usual care, evaluating patients' habitual and actual level of functioning, disability, and physical activity and assessing their potential need and motivation for cardiac rehabilitation. Three predefined quantitative feasibility outcomes: reach, referral rate, and data completeness were assessed. Additionally, semi-structured interviews explored acceptability among patients and health care professionals at the municipal health care center and the hospital. Finally, the potential effect was assessed based on the enrollment rate. Physiotherapy consultations were offered to 86% of eligible patients; of these, 52% were referred to cardiac rehabilitation. Ninety-one percent data completeness was achieved. The intervention was well-accepted by patients and health care professionals. The enrollment rate reached 79%. The novel referral strategy proved feasible concerning reach and data completeness, although the referral rate suggested that further refinements are required before a full-scale trial. The novel referral strategy was well-accepted, and enrollment rate approached an acceptable level.

Individuals with a ventral hernia who report moderate to high fear have worse functional performance than those with low fear

PurposeVentral hernia repairs (VHR) are performed to restore the integrity of the abdominal wall. Fear of movement, or kinesiophobia, may develop in patients with ventral hernia due to pain and functional impairments, however it has not yet been objectively measured in this patient population. The purpose of this study was to test the hypothesis that in patients with ventral hernia awaiting surgical repair, higher levels of kinesiophobia would be associated with poorer mobility, abdominal core function, and quality of life.MethodsSeventy-seven participants scheduled for ventral hernia repair were enrolled as part of an ongoing randomized controlled trial (NCT05142618). The Tampa Scale of Kinesiophobia (TSK-11) is an 11-item questionnaire that asks about fear of movement and physical activity restriction. Participants were split into groups based on their TSK-11 score (minimal, low, moderate to high). Primary outcome measures included the five-time sit-to-stand (5xSTS), Quiet Unstable Sitting Test (QUeST), and the Hernia-Related Quality-of-Life (HerQLeS) survey. A one-way ANOVA with a Bonferroni correction compared QUeST, 5xSTS, and HerQLes results between groups.ResultsGroups were significantly different on 5xSTS (minimal: 11.4 ± 2.6 s, low: 13.8 ± 3.1 s, moderate to high: 17.8 ± 9.8 s; p = 0.001) and HerQLes (minimal: 58.0 ± 27.8, low: 49.4 ± 22.0, moderate to high: 30.6 ± 25.3; p = 0.003) but not QUeST (minimal: − 2.8 ± 2.5, low: − 6.8 ± 10.0, moderate to high: − 5.5 ± 5.0; p = 0.16).ConclusionIndividuals with moderate to high kinesiophobia have worse pre-operative performance-based (5xSTS) and self-reported (HerQLes) function and quality of life than those with minimal and low kinesiophobia. Future research should examine the influence of kinesiophobia on post-operative outcomes as it may be a potent target for rehabilitation.

Anterior pelvic tilt increases hamstring strain and is a key factor to target for injury prevention and rehabilitation.

Hamstring muscle strain injury is very common in sports involving high-speed running. Hamstring muscles originate from the ischial tuberosity and thus pelvic position may influence hamstring strain during different sports movements like sprinting, but this has only been evaluated by indirect methods. This study tested the hypothesis that a change in anterior pelvic tilt causes elongation of the overall hamstring complex and disproportionately elongates proximal relative to distal muscle regions. Seven fresh-frozen specimens (full lower limb with pelvis and lumbar spine) were used for this in vitro study. Specimens were dissected to enable visualization of the hamstring muscles and then fixed into a custom-made testing bench that allowed controlled movement of the pelvis over a fixed femur and tibia. Nine markers were inserted into the hamstring muscles to allow intra- and intermuscle difference measurements. Then, six different anterior pelvic angles were used to measure the difference in hamstring muscle lengthening through a three-dimensional reconstruction system based on stereoscopic machine vision technology. An increase in anterior pelvic tilt produced a significant non-uniform increase in tissue elongation in all regions of the three hamstring muscles (semitendinosus, semimembranosus [SMB] and biceps femoris long head), which was greater in the proximal (>1 cm every 5°) compared to the distal region (≈0.4 cm every 5°). At the proximal hamstring region, SMB showed significantly greater length changes compared to conjoint tendons with nonstatistically significant elongation differences between muscles at the distal region. Considering the results of the study, the pelvis segment will likely play a fundamental role as a strain regulator of hamstring muscles. These results will have an impact on injury rehabilitation and prevention processes of hamstring injuries, as well as optimize future musculoskeletal models and avoid potential underestimation of the hamstring muscle-tendon complex lengthening during high-speed running. N/A.

Transthoracic Ultrasound Improves Cardiac Function in Mice.

Cardiac dysfunction is a severe complication that is associated with an increased risk of mortality in multiple diseases. Cardioprotection solution that has been researched is the electrical stimulation of the vagus nerve to exert cardio protection. This method has been shown to reduce the systemic inflammatory response and maintain the immune homeostasis of the heart. However, the invasive procedure of electrode implantation poses a risk of nerve or fiber damage. Here, we propose transthoracic ultrasound stimulation (US) of the vagus nerve to alleviate cardiac dysfunction caused by lipopolysaccharide (LPS). We developed a noninvasive transthoracic US system and exposed anesthetized mice to ultrasound protocol or sham stimulation 24 h after LPS treatment. Results showed that daily heart targeting US for 4 days significantly increased left ventricular systolic function ( p = 0.01) and improved ejection fraction ( p = 0.03) and shortening fraction ( p = 0.04). Furthermore, US significantly reduced inflammation cytokines, including IL-6 ( p = 0.03) and IL- 1β ( p = 0.04). In addition, cervical vagotomy abrogated the effect of US, suggesting the involvement of the vagus nerve's anti-inflammatory effect. Finally, the same ultrasound treatment but for a longer period (14 days) also significantly increased cardiac function in naturally aged mice. Collectively, these findings suggest the potential of transthoracic US as a possible novel noninvasive approach in the context of cardiac dysfunction with reduced systolic function and provide new targets for rehabilitation of peripheral organ function.

Dynamic joint stiffness in individuals with femoroacetabular impingement syndrome pre- and post-hip arthroscopy

BackgroundPatients with hip-related pain often fail to return to their desired level of activity following hip arthroscopy. Lasting biomechanics alterations may be one potential explanation. Dynamic joint stiffness assesses the mechanistic controls of the lower limb during high impact movements, and thus, may provide valuable clinical targets to improving movement and optimizing return to activity after surgery. MethodsTwenty-five participants (13 females) with hip-related pain underwent 3D motion capture during a drop jump task before surgery and six months post-operatively. Nineteen healthy controls (9 females) were collected for comparison. Sagittal plane dynamic joint stiffness was calculated during the initial landing phase. Baseline and 6-month dynamic joint stiffness data were compared 1) between males and females with hip-related pain and 2) between individuals with hip-related pain and controls using Wilcoxon Signed-Rank and Mann Whitney U tests. Sexes were analyzed separately. FindingsFrom baseline to 6 months post-operatively, females with hip-related pain demonstrated decreased dynamic ankle stiffness (2.26 Nm/deg. [0.61] to 1.84 Nm/deg. [0.43]) (p = .005) and males with hip-related pain demonstrated increased dynamic hip stiffness (2.73 [0.90] to 3.88 [1.73]) (p = .013). There were no differences in dynamic stiffness at any joint between individuals with hip-related pain at either timepoint when compared to controls (p ≥ .099). InterpretationFemales and males with hip-related pain may demonstrate unique changes in dynamic joint stiffness after surgery, indicating return to activity may follow different trajectories for each sex. Additional work should examine the relationship between hip joint stiffness and treatment outcomes and identify additional movement-related rehabilitation targets.

The Unseen Strain: Investigating the Awareness of Rhinoplasty Surgeons Regarding Their Spine Health.

Musculoskeletal pain is a common occupational health problem among surgeons that can affect work productivity and quality of life. The aim of the study was to investigate the prevalence and causes of back pain among rhinoplasty surgeons, evaluate their routine practice, and identify unique risk factors. A further goal was to measure functional disabilities with the Total Disability Index (TDI) questionnaire. A structured online questionnaire was distributed to plastic surgeons performing rhinoplasty internationally. The questionnaire comprised sections on biodata, routine practice posture, length of practice, surgical duration, and the history of surgery or hospitalization related to these issues. In the second part of the survey, participants were asked to complete the TDI questionnaire. The prevalence of back pain was reported by 93.6% of surgeons, with low back pain being the most common (76.7%). The average pain intensity for low back pain was 44.8 ± 26.8. The mean TDI score was calculated as 31 ± 12.1, with 58.2% of surgeons experiencing mild to moderate disability. Significant associations were found between musculoskeletal pain severity and disability index and factors such as BMI, exercise, years of rhinoplasty practice, number of surgeries performed per week, and average procedure length. Interestingly, only 16.4% of rhinoplasty surgeons had previous ergonomic training or education. Musculoskeletal issues related to the spine are prevalent among rhinoplasty surgeons. It is imperative to educate surgeons about this underestimated health problem, provide proper physical rehabilitation targeting ergonomic concerns, and make changes to current practices to address this issue effectively.

Pain catastrophizing levels differentiate between common diseases with pain: HIV, fibromyalgia, complex regional pain syndrome, and breast cancer survivors.

Pain catastrophizing is a core psychological factor determining pain experience. We addressed the question of whether patients with different pain syndromes group into different pain catastrophizing phenotypes. A total of 727 patients with chronic pain associated with four primary syndromes: Breast cancer (BC) survivors (n = 400), fibromyalgia (FM, n = 52), complex regional pain syndrome (CRPS, n = 155), and HIV (n = 120) were first studied for differences in levels of pain catastrophizing (Pain Catastrophizing Scale, PCS) and pain intensity by analysis of variance. Subsequently, individual scores of the PCS subscales "rumination", "magnification," and "helplessness" from the pooled cohorts were submitted to multivariate k-means clustering to explore subgroups. Three clusters defined by the level of catastrophizing were identified. The "low catastrophizing" cluster (n = 377) included most of the BC patients (71.0%) and the "moderate catastrophizing" cluster (n = 256) most of the FM patients (61.5%). HIV (31.9%) and CRPS (44.7%) patients were over-represented in the "high catastrophizing" cluster (n = 94) with the highest catastrophizing tendencies in all dimensions. These patients reported more helplessness than the patients in the two other clusters. The primary syndrome causing the pain has an impact on self-reported pain-related catastrophizing. Helplessness is a predominant feature in HIV and CRPS patients and therefore an important target in pain rehabilitation.