Gait impairment in cervical spondylotic myelopathy: Analysis, impact on function, and effect of surgical intervention

Chest pain is one of the most frequent complaints in medical settings, yet more than half of cases have no detectable cause. Once a cardiac cause has been excluded, patients are typically discharged with a label of non-cardiac chest pain (NCCP). Patients with NCCP have been shown to have poor outcomes in terms of continued symptoms, distress, and continuing concern about heart disease. In addition, NCCP represents a significant burden to health services. The aetiology and management of NCCP is under-researched and poorly understood. This study sought to examine the predictors of persistent pain and health service use for patients in whom a cardiac diagnosis had been excluded. It also sought to explore how patients interpreted their symptoms in the context of normal test results, and the impact of their experiences with health services on these interpretations. A mixed-methods design was adopted. A prospective cohort study was initially conducted with 145 participants with chest pain who attended exercise stress testing and had normal test results. At one-year follow-up, 69% reported continued pain. In addition, nearly half of participants had returned to their general practitioner and one in ten had attended the emergency department for the investigation of chest pain. In logistic regression analyses, the variables heartburn, pain precipitated by movement, cardiac anxiety, illness perceptions, and lack of communication about test results were predictive of persistent chest pain. When participants with continued chest pain were categorised into persistent healthcare users and non-persistent healthcare users, these variables were predominantly associated with participants with persistent health service use for chest pain. In addition, a number of psychological variables including anxiety and depression distinguished the persistent service users. Employment appeared to be a protective factor against persistent pain and related service use. A small sample of participants from this cohort was interviewed in a qualitative study informed by the principles of Interpretative Phenomenological Analysis (IPA). Analysis revealed three predominant themes: 1) the disempowerment of normal test results; 2) limbo - the inner struggle of negating and relating to potential causes; and 3) the inadequacy of healthcare to validate and care for symptoms. The dynamic, complex process of interpreting symptoms and deciding whether to seek healthcare was illuminated. The results indicate that interventions targeting the assessment of a potential gastro-oesophageal or musculoskeletal cause and the reduction of cardiac anxiety are likely to improve outcomes in these patients. Improved communication with patients is also indicated. Psychological factors appear to drive persistent service use and interventions targeting these are likely to reduce medical costs. Patients with NCCP are not a homogenous patient group and an individualised, stepped-care approach to management appears to be warranted

Normalisation method can affect gluteus medius electromyography results during weight bearing exercises in people with hip osteoarthritis (OA): a case control study.

Surface electromyography (sEMG) is used to assess muscle activation during therapeutic exercise, but data are significantly affected by inter-individual variability and requires normalisation of the sEMG signal to enable comparison between individuals. The purpose of this study was to compare two normalisation methods, a maximal method (maximum voluntary isometric contraction (MVIC)) and non-maximal peak dynamic method (PDM), on gluteus medius (GMed) activation using sEMG during three weight-bearing exercises in people with hip osteoarthritis (OA) and healthy controls. Thirteen people with hip OA and 20 controls performed three exercises (Squat, Step-Up, Step-Down). Average root-mean squared EMG amplitude based on MVIC and PDM normalisation was compared between groups for both involved and uninvolved hips using Mann-Whitney tests. Using MVIC normalisation, significantly higher normalised GMed EMG amplitudes were found in the OA group during all Step-up and down exercises on the involved side (p=0.02-0.001) and most of the Step exercises on the uninvolved side (p=0.03-0.04), but not the Squat (p\u3e0.05), compared to controls. Using PDM normalisation, significant between-group differences occurred only for Ascending Squat (p=0.03) on the involved side. MVIC normalisation demonstrated higher inter-trial relative reliability (ICCs=0.78-0.99) than PDM (ICCs=0.37-0.84), but poorer absolute reliability using Standard Error of Measurement. Normalisation method can significantly affect interpretation of EMG amplitudes. Although MVIC-normalised amplitudes were more sensitive to differences between groups, there was greater variability using this method, which raises concerns regarding validity. Interpretation of EMG data is strongly influenced by the normalisation method used, and this should be considered when applying EMG results to clinical populations

Associations between gait kinematics, gross motor function and physical activity among young people with cerebral palsy: A cross sectional study

INTRODUCTION: The aim of this study was to investigate the association between gait parameters, gross motor function and physical activity (PA) in young people with cerebral palsy (CP). METHODS: Thirty-eight adolescents aged between 10–19 years with spastic CP in GMFCS levels I-III (mean [standard deviation] age 13.7 [2.4] yr; 53%female) were included in this cross-sectional study. Hip, knee and ankle joint excursion and stance time was assessed using 3D gait analysis. Self-selected walking speed was assessed during a timed 10 m overground walk and treadmill walking. Gross motor function was assessed using dimensions D and E of the Gross Motor Function Measure (GMFM-66). Moderate-to-vigorous PA, light PA and step-count were assessed using an accelerometer. Linear regression was used to examine associations. RESULTS: After adjusting for age, sex and GMFCS level, percentage stance time was associated with dimension E of the GMFM-66 (β= –0.29, 95%CI –0.54 to –0.05). There was no evidence that any other gait parameters were associated with GMFM-66 dimensions D or E. There was also no evidence that gait parameters or GMFM-66 dimensions D or E were associated with step-count or time in PA after adjusting for age, sex and GMFCS level. DISCUSSION: The findings provide an insight into the complexity of the relationship between gait quality or ability at the impairment level, function as measured in a controlled environment, and the performance of habitual PA, which is essential for health among children with CP

Dissecting the Links Between Cerebellum and Dystonia

Dystonia is a common movement disorder characterized by sustained muscle contractions. These contractions generate twisting and repetitive movements or typical abnormal postures, often exacerbated by voluntary movement. Dystonia can affect almost all the voluntary muscles. For several decades, the discussion on the pathogenesis has been focused on basal ganglia circuits, especially striatal networks. So far, although dystonia has been observed in some forms of ataxia such as dominant ataxias, the link between the cerebellum and dystonia has remained unclear. Recent human studies and experimental data mainly in rodents show that the cerebellum circuitry could also be a key player in the pathogenesis of some forms of dystonia. In particular, studies based on behavioral adaptation paradigm shed light on the links between dystonia and cerebellum. The spectrum of movement disorders in which the cerebellum is implicated is continuously expanding, and manipulation of cerebellar circuits might even emerge as a candidate therapy in the coming years.SCOPUS: ed.jinfo:eu-repo/semantics/publishe

Dissecting the Links Between Cerebellum and Dystonia

Dystonia is a common movement disorder characterized by sustained muscle contractions. These contractions generate twisting and repetitive movements or typical abnormal postures, often exacerbated by voluntary movement. Dystonia can affect almost all the voluntary muscles. For several decades, the discussion on the pathogenesis has been focused on basal ganglia circuits, especially striatal networks. So far, although dystonia has been observed in some forms of ataxia such as dominant ataxias, the link between the cerebellum and dystonia has remained unclear. Recent human studies and experimental data mainly in rodents show that the cerebellum circuitry could also be a key player in the pathogenesis of some forms of dystonia. In particular, studies based on behavioral adaptation paradigm shed light on the links between dystonia and cerebellum. The spectrum of movement disorders in which the cerebellum is implicated is continuously expanding, and manipulation of cerebellar circuits might even emerge as a candidate therapy in the coming years.SCOPUS: ed.jinfo:eu-repo/semantics/publishe

Rehabilitation needs of people with brain tumours in Ireland: "Brain-Restore"

Action research study of rehabilitation needs of people with brain tumours</p

Identifying the top 10 priorities of adolescents with a physical disability regarding participation in physical activity: A Delphi study

Aim: To establish consensus among adolescents with a physical disability regarding their priorities for enhancing participation in physical activity and help inform the design of future interventions for participation in physical activity. Method: We conducted a national multi‐round Delphi study involving adolescents with a physical disability aged 13 to 17 years. Round 1 of the initial survey consisted of open‐ended questions. Free‐text responses were then analysed thematically, creating items categorized according to the family of participation‐related constructs (fPRC). In round 2, participants rated the perceived importance of these items using a 5‐point Likert scale. The top 10 priorities were constructed from the highest‐ranked items. Results: One hundred and sixteen participants (mean age = 14 years 7 months, range = 13–17 years; 66 males; 58 with cerebral palsy; 43 wheelchair users) completed round 1; 108 items were included in round 2. Fifty‐eight items were rated as either ‘important’ or ‘really important’ by 70% of participants. The top 10 priorities were rated as important or really important by 82% to 94% of participants with a mean Likert score of 4.40 (range = 4.25–4.63). Seven of the top 10 priorities were related to the environmental context of the fPRC. The other three were related to involvement and the related concept of preference. Interpretation: The priorities identified will help inform future physical activity interventions for adolescents with a physical disability

Duration of symptoms before diagnosis in degenerative cervical myelopathy: protocol for a systematic review

Review question / Objective: The aim of this systematic review is to describe and measure the duration of symptoms prior to diagnosis of DCM, as reported in primary studies of people with this condition, with a view to informing further research on diagnostic delay. To this end, the systematic review will focus on the primary question: What is the typical duration of symptoms prior to diagnosis in people with Degenerative Cervical Myelopathy?  Condition being studied: DCM represents a collection of pathological entities including spondylosis, degenerative disk disease, ossification of the posterior longitudinal ligament (OPLL), and ossification of the ligamentum flavum which individually, or in combination, cause compression of the cervical spinal cord, resulting in a clinical syndrome typified by gait imbalance, loss of hand dexterity and sphincter dysfunction (Tetreault et al., 2015a). It is the most common cause of spinal cord dysfunction in adults worldwide (KalsiRyan et al, 2013).  INPLASY registration number:  This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 22 June 2021 and was last updated on 22 June 2021 (registration number INPLASY202160079)</p