A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early cardiac echocardiography

Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI) in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. Stanford type A aortic dissection, rarely may mimic myocardial infarction. We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. Prognostic implications of early diagnosis applying transthoracic echocardiography (TTE) are described

Short-term effects of manual therapy plus capacitive and resistive electric transfer therapy in individuals with chronic non-specific low back pain : a randomized clinical trial study

Background and Objectives: Chronic non-specific low back pain (CNSLBP) is defined as back pain that lasts longer than 12 weeks. Capacitive and resistive electric transfer (TECAR) therapy utilizes radiant energy to generate endogenous heat and is widely used for the treatment of chronic musculoskeletal pain. The aim of this study was to investigate the efficacy of manual therapy (MT) program combined with TECAR therapy in individuals with CNSLBP. Materials and Methods: Sixty adults with CNSLBP were randomly divided equally into three groups. The first group followed an MT protocol in the lumbar region (MT group), the second group followed the same MT protocol combined with TECAR therapy (MT + TECAR group) using a conventional capacitive electrode as well as a special resistive electrode bracelet, and the third group (control group) received no treatment. Both intervention programs included six treatments over two weeks. Pain in the last 24 h with the Numeric Pain Rating Scale (NPRS), functional ability with the Roland–Morris Disability Questionnaire (RMDQ), pressure pain threshold (PPT) in the lumbar region with pressure algometry, and mobility of the lumbo-pelvic region through fingertip-to-floor distance (FFD) test were evaluated before and after the intervention period with a one-month follow-up. Analysis of variance with repeated measures was applied. Results: In the NPRS score, both intervention groups showed statistically significant differences compared to the control group both during the second week and the one-month follow-up (p 0.05). Conclusions: The application of an MT protocol with TECAR therapy appeared more effective than conventional MT as well as compared to the control group in reducing pain and disability and improving PPT in individuals with CNSLBP. No further improvement was noted in the mobility of the lumbo-pelvic region by adding TECAR to the MT intervention

The effectiveness of pain neuroscience/neurophysiology education in patients with chronic low back pain

Background: Non-Specific Chronic Low Back Pain (NSCLBP) persists for more than 12 weeks. Manual therapy (MT), recommended for NSCLBP, demonstrates short-term efficacy. Pain Neuroscience/Neurophysiology Education (PNE) teaches patients to modify their pain perception through explanations, metaphors, and examples, focusing on brain reeducation. Motivational Interviewing (MI) enhances movement toward behavior change, encouraging patients to actively participate in treatment and avoid indecision. Both PNE and MI approach the multidimensional nature of chronic pain from different perspectives but can be combined for effective management. Objective: The purpose of this doctoral thesis was to examine the impact of adding PNE with integrated MI to a manual therapy program on pain intensity, pain perception, functional ability, kinesiophobia, catastrophizing and low back performance in adults with NSCLBP. Method: Sixty adults with NSCLBP participated in the study and were randomly assigned to three groups of 20 participants each (two intervention groups and one control group). The first group (MT group) followed a four-week manual therapy program. The second group followed the same manual therapy program combined with PNE with integrated MI (MT+PNE/MI group). Finally, the third group (control) followed a general home-based exercise program. Pain intensity in the last 24 hours was assessed using the Numeric Pain Rating Scale (NPRS), pain perception through Pressure Pain Threshold (PPT) in the lumbar region with a digital algometer, functional ability with the Greek version of the Roland-Morris Disability Questionnaire (RMDQ), kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), catastrophizing with the Pain Catastrophizing Scale (PCS), and low back performance with the Back Performance Scale (BPS). Assessments were conducted before the intervention, at the 4th week (after the completion of the intervention), and six months after the end of the intervention. Descriptive analysis and frequency analysis were performed to present the participants' demographic characteristics. Additionally, a two-way analysis of variance with repeated measures was applied for result analysis, with the level of statistical significance set at p < 0.05. Results - Discussion: According to the results, both intervention groups showed statistically significant differences compared to the control group, at both the fourth-week assessment and the six-month follow-up, as evidenced by NPRS and RMDQ scores, as well as the total values of tested PPTs (p < 0.05). Moreover, statistically significant differences between the two intervention groups were observed, with the MT+PNE/MI group showing statistically greater improvement at both time points (fourth week and six-month follow-up) (p < 0.05). Regarding TSK and PCS scores at the fourth week, statistically significant differences were observed between the two intervention groups and the control group, as well as between the two intervention groups themselves (p < 0.05). However, at the six-month follow-up, statistically significant differences were found only between the MT+PNE/MI group and the other two groups, with the MT+PNE/MI group showing significant improvements (p < 0.05). In relation to BPS, both intervention groups exhibited statistically significant differences compared to the control group at the fourth week, without significant differences between the two intervention groups. However, at the six-month follow-up, significant differences were observed between the MT+PNE/MI group and the other two groups (p < 0.05), with MT+PNE/MI demonstrating greater improvement. Conclusions: In conclusion, the addition of PNE with integrated MI further improved the positive effects of the MT program in all measured parameters. The combined application of MT+PNE/MI seemed to lead to greater improvements compared to the isolated application of MT, and these improvements were sustained over a longer duration. The short-term and long-term positive effects observed in the participants of the MT+PNE/MI group are likely attributed to the application of PNE with integrated MI, contributing to increased treatment effectiveness. More studies are needed in the future to explore the optimal dosage of the combination of MT with PNE/MI.Υπόβαθρο: Ο χρόνιος οσφυϊκός πόνος μη ειδικής αιτιολογίας (Non-Specific Chronic Low Back Pain, NSCLBP) χαρακτηρίζεται από διάρκεια συμπτωμάτων μεγαλύτερη των 12 εβδομάδων. Η δια χειρός τεχνικές (Manual Therapy, MT) που εφαρμόζονται στα πλαίσια της φυσικοθεραπευτικής παρέμβασης, προτείνονται για την αντιμετώπιση του NSCLBP. Έρευνες έχουν δείξει ότι το MT μπορεί να βελτιώσει σημαντικά την κλινική εικόνα των ασθενών με NSCLBP βραχυπρόθεσμα. Η εκπαίδευση στη νευροφυσιολογία του πόνου (Pain Neuroscience/Neurophysiology Education, PNE) αποτελεί μια μέθοδο μέσω της οποίας ο ασθενής διδάσκεται να τροποποιεί την αντίληψή του για τον πόνο μέσω εξηγήσεων, μεταφορών, και παραδειγμάτων οι οποίες στοχεύουν στην επανεκπαίδευση του εγκεφάλου. Η παρακινητική συνέντευξη (Motivational Interviewing, MI) αποτελεί μια γνωστική θεραπεία που βασίζεται στο βιοψυχοκοινωνικό μοντέλο υγείας και έχει ως στόχο της να εισάγει αλλαγές στη συμπεριφορά του ασθενή παρακινώντας τον να συμμετάσχει ενεργά στη θεραπεία έτσι ώστε να αποφύγει την αναποφασιστικότητα. Τόσο το PNE όσο και το MI προσεγγίζουν από διαφορετικές πτυχές την πολυεπίπεδη φύση του χρόνου πόνου. Ωστόσο, μπορούν να εφαρμοστούν συνδυαστικά για την αντιμετώπισή του. Σκοπός: Σκοπός της διδακτορικής διατριβής ήταν να εξεταστεί η επίδραση της προσθήκης PNE με ενσωματωμένο ΜΙ σε ένα πρόγραμμα MT στην ένταση του πόνου, στον ουδό πόνου πίεσης, στη λειτουργική ικανότητα, στην κινησιοφοβία, στην καταστροφολογία και στην λειτουργική επίδοση της οσφύος σε ενήλικες με NSCLBP. Μέθοδος: Εξήντα ενήλικες με NSCLBP συμμετείχαν στην συγκεκριμένη έρευνα. Οι συμμετέχοντες χωρίστηκαν τυχαία σε τρεις ομάδες των 20 συμμετεχόντων η κάθε μία (δύο ομάδες παρέμβασης και μία ελέγχου). Η μία ομάδα (ομάδα MT) ακολούθησε ένα πρόγραμμα φυσικοθεραπευτικής αποκατάστασης MT διάρκειας τεσσάρων εβδομάδων. Η δεύτερη ομάδα ακολούθησε το ίδιο πρόγραμμα MT σε συνδυασμό με PNE με ενσωματωμένο MI (ομάδα MT+PNE/MI). Τέλος, η τρίτη ομάδα (ομάδα ελέγχου) ακολούθησε ένα γενικό πρόγραμμα ασκήσεων για το σπίτι. Η ένταση του πόνου τις τελευταίες 24 ώρες με την αριθμητική κλίμακα πόνου (Numeric Pain Rating Scale, NPRS), ο ουδός πόνου πίεσης (Pressure Pain Threshold, PPT) στην περιοχή της οσφύος με ψηφιακό αλγόμετρο, η λειτουργική ικανότητα με την ελληνική έκδοση του ερωτηματολογίου Roland-Morris (Roland-Morris disability questionnaire, RMDQ), η κινησιοφοβία με την κλίμακα κινησιοφοβίας Tampa (Tampa Scale for Kinesiophobia, TSK), η καταστροφολογία με την κλίμακα καταστροφολογίας του πόνου (Pain Catastrophizing Scale, PCS) και η λειτουργική επίδοση της οσφύος με τη λειτουργική δοκιμασία Back Performance Scale (BPS) αξιολογήθηκαν πριν την παρέμβαση, την 4η εβδομάδα (μετά την ολοκλήρωση της παρέμβασης) και έξι μήνες μετά το τέλος της παρέμβασης. Για την ανάλυση των αποτελεσμάτων πραγματοποιήθηκε περιγραφική ανάλυση και ανάλυση συχνοτήτων για την παρουσίαση των δημογραφικών χαρακτηριστικών των συμμετεχόντων. Επίσης εφαρμόστηκε ανάλυση διακύμανσης δύο παραγόντων (two-way analysis of variance, ANOVA) με επαναλαμβανόμενες μετρήσεις. Το επίπεδο στατιστικής σημαντικότητας τέθηκε στο p < 0.05. Αποτελέσματα - Συζήτηση: Σύμφωνα με τα αποτελέσματα και οι δύο ομάδες παρέμβασης παρουσίασαν στατιστικά σημαντικές διαφορές σε σύγκριση με την ομάδα ελέγχου τόσο στην αξιολόγηση της τέταρτης εβδομάδας όσο και στον εξάμηνο επανέλεγχο, όπως προέκυψε από τα στα σκορ του NPRS και του RMDQ, καθώς και από τις τιμές των του συνόλου των PPTs που εξετάστηκαν (p < 0,05). Επιπλέον, παρατηρήθηκαν στατιστικά σημαντικές διαφορές μεταξύ των δύο ομάδων παρέμβασης, με τη βελτίωση στην ομάδα MT+PNE/MI να είναι στατιστικά μεγαλύτερη και στις δύο χρονικές στιγμές (τέταρτη εβδομάδα και εξάμηνος επανέλεγχος) (p < 0,05). Σχετικά με τα σκορ TSK και PCS στην τέταρτη εβδομάδα, παρατηρήθηκαν στατιστικά σημαντικές διαφορές μεταξύ των δύο ομάδων παρέμβασης σε σύγκριση με την ομάδα ελέγχου, καθώς και των δύο ομάδων παρέμβασης μεταξύ τους (p < 0,05). Ωστόσο, κατά τον εξάμηνο επανέλεγχο, στατιστικά σημαντικές διαφορές παρατηρήθηκαν μόνο μεταξύ της ομάδας MT+PNE/MI και των άλλων δύο ομάδων, με την ομάδα MT+PNE/MI να επιδεικνύει σημαντικές βελτιώσεις (p < 0,05). Σχετικά με το BPS, και οι δύο ομάδες παρέμβασης παρουσίασαν στατιστικά σημαντικές διαφορές σε σύγκριση με την ομάδα ελέγχου την τέταρτη εβδομάδα, χωρίς σημαντικές διαφορές μεταξύ των δύο ομάδων παρέμβασης. Ωστόσο, κατά τον εξάμηνο επανέλεγχο, υπήρχαν σημαντικές διαφορές μεταξύ της ομάδας MT+PNE/MI και των άλλων δύο ομάδων (p < 0,05), με την ομάδα MT+PNE/MI να επιδεικνύει μεγαλύτερη βελτίωση. Συμπεράσματα: Συμπερασματικά η προσθήκη της PNE με ενσωματωμένο ΜΙ βελτίωσε περαιτέρω τα θετικά αποτελέσματα του προγράμματος ΜΤ σε όλα τα μετρήσιμα μεγέθη που εξετάστηκαν. Η συνδυαστική εφαρμογή του MT+PNE/MI φάνηκε να οδηγεί σε μεγαλύτερες βελτιώσεις σε σύγκριση με την μεμονωμένη εφαρμογή της παρέμβασης MT, ενώ αυτές οι βελτιώσεις διατηρήθηκαν και για μεγαλύτερο χρονικό διάστημα. Τα βραχυπρόθεσμα και μακροπρόθεσμα θετικά αποτελέσματα που παρατηρήθηκαν στους συμμετέχοντες της ομάδας MT+PNE/MI πιθανόν να οφείλονται στην εφαρμογή του PNE με ενσωματωμένο MI, η οποία συνέβαλε στην αύξηση της αποτελεσματικότητας της θεραπείας. Περισσότερες μελέτες θα πρέπει να διεξαχθούν στο μέλλον προκειμένου να διερευνηθεί η βέλτιστη δοσολογία του συνδυασμού του ΜΤ με το PNE/MI

Effects of Manual Therapy Plus Pain Neuroscience Education with Integrated Motivational Interviewing in Individuals with Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial Study

Background and Objectives: Chronic non-specific low back pain (CNLBP) persists beyond 12 weeks. Manual therapy recommended for CNLBP demonstrates short-term efficacy. Pain Neuroscience Education (PNE) teaches patients to modify pain perception through explanations, metaphors, and examples, targeting brain re-education. Motivational Interviewing (MI) enhances motivation for behavioral change, steering patients away from ambivalence and uncertainty. These approaches collectively address the multifaceted nature of CNLBP for effective management. The aim of this study was to investigate a manual therapy intervention combined with PNE with MI on pain, pressure pain threshold (PPT), disability, kinesiophobia, catastrophizing, and low back functional ability in individuals experiencing CNLBP. Materials and Methods: Sixty adults with CNLBP were randomly divided into three equal groups (each n = 20). The first group received manual therapy and PNE with integrated MI (combined therapy group), the second group underwent only manual therapy (manual therapy group), and the third group followed a general exercise program at home (control group). Pain in the last 24 h was assessed using the Numeric Pain Rating Scale (NPRS), functional ability with the Roland–Morris Disability Questionnaire (RMDQ), PPT in the lumbar region through pressure algometry, kinesiophobia with the Tampa Scale for Kinesiophobia (TSK), catastrophizing with the Pain Catastrophizing Scale (PCS), and performance using the Back Performance Scale (BPS) at baseline, in the fourth week, and six months post-intervention. Results: Statistically significant differences between the intervention groups and the control group were found in both the fourth-week measurement and the six-month follow-up, as evident in the NPRS and RMDQ scores, as well as in the total values of tested PPTs (p p p p p Conclusions: The addition of PNE with integrated MI enhanced the positive effects of a manual therapy intervention in all outcome measures. The combination of manual therapy plus PNE with integrated MI appeared to provide greater improvements compared to the isolated application of manual therapy, and these improvements also lasted longer. These short- and long-term positive effects are likely attributed to the combination of PNE with integrated MI, which contributed to increasing the effectiveness of the treatment. Further studies are required to investigate the optimum dosage of manual therapy and PNE with integrated MI in individuals with CNLBP

Hemodynamic Responses to a Handgrip Exercise Session, with and without Blood Flow Restriction, in Healthy Volunteers

Exercising at submaximal intensity with a hand dynamometer causes mild hemodynamic adaptations that can improve cardiovascular function. However, hemodynamic responses and fatigue have not been adequately studied in an isometric exercise protocol combined with blood flow restriction (BFR). Our study aimed to examine and compare acute hemodynamic responses and muscle fatigue after an isometric exercise session using a handgrip dynamometer, with and without BFR. Twelve volunteers performed the exercise protocol, with and without BFR, at random, with the BFR pressure set at 140 mmHg. Arterial blood pressure (BP), heart rate (HR), oxygen saturation (SpO2), and muscle fatigue were measured before, during, and 15 min after the completion of the exercise session. Without BFR, we noticed a slight, albeit statistically insignificant, HR increase. The variations found in systolic and diastolic pressure were small and statistically insignificant. Furthermore, blood oxygen saturation (SpO2) did not change significantly. Significantly higher levels of fatigue were found in exercise with BFR, compared to without BFR, at the end of each set of isometric contractions. In conclusion, a handgrip exercise session with mild BFR does not alter the acute hemodynamic responses to exercise in healthy volunteers. However, it results in higher muscle fatigue compared to that experienced after exercise without BFR

Recording of Falls in Elderly Fallers in Northern Greece and Evaluation of Aging Health-Related Factors and Environmental Safety Associated with Falls: A Cross-Sectional Study

Background. Elderly falls constitute a global problem with huge social and economic aspects. Fall risk factors are both intrinsic (physical and psychological) and extrinsic (related with environmental safety). Aim. To record both intrinsic and extrinsic risk factors and their correlation in elderly fallers in order to suggest specific guidelines for their medical care and environmental modification inside and outside the home. Method. The study involved 150 elderly fallers (median age 70 (67-74)), who completed a record containing information on known risk factors related to their health status, as well as information on the conditions and causes that led to the fall. Each fall was considered an independent event, while measurements were performed regarding balance, strength, their functional ability, and the fear of a possible fall. Descriptive analysis and frequency analysis were used to record the health and activity status of the participants as well as the fall-related environmental factors. Severity of each fall event across a variety of locations was examined using the Kruskal-Wallis one-way analysis of variance. Multiple linear regression was applied to examine the effect of the mean values of functional tests and medical records on the number of fall events. Results. In the span of 12 months, a total of 304 fall events were recorded. Regarding location, 77.6% occurred indoors; more frequent were the bedroom (28.6%) and the bathroom (28%). The interior stairs (10.5%), the kitchen (4.9%), and the living room (3.3%) were the less frequent locations. Concerning danger, falling on the interior stairs caused the longest hospitalization, followed by the kitchen and the bathroom. Extrinsic factors that led to both indoor and outdoor falls were the administration of psychotropic medication, poor space ergonomics, lack of basic safety standards, and poor lighting conditions. Vision problems and dizziness resulted in more falls than other intrinsic factors. Furthermore, reduced performance in the FICSIT-4 test and the 30-Second Chair Stand Test, as well as high scores in the CONFbal–GREEK questionnaire and the Short FES-I, shows a linear relationship with an increased number of falls. Conclusions. Ergonomic interventions can help prevent indoor elderly falls. Poor construction and lack of adequate lighting mainly cause outdoor falls. Regular eye examinations, management of vertigo, improvement of the balance and strength of the lower limbs, and reduction of fear of impending falls are the intrinsic factors that help prevent falls the most

NeuroSuitUp: System Architecture and Validation of a Motor Rehabilitation Wearable Robotics and Serious Game Platform

Background: This article presents the system architecture and validation of the NeuroSuitUp body–machine interface (BMI). The platform consists of wearable robotics jacket and gloves in combination with a serious game application for self-paced neurorehabilitation in spinal cord injury and chronic stroke. Methods: The wearable robotics implement a sensor layer, to approximate kinematic chain segment orientation, and an actuation layer. Sensors consist of commercial magnetic, angular rate and gravity (MARG), surface electromyography (sEMG), and flex sensors, while actuation is achieved through electrical muscle stimulation (EMS) and pneumatic actuators. On-board electronics connect to a Robot Operating System environment-based parser/controller and to a Unity-based live avatar representation game. BMI subsystems validation was performed using exercises through a Stereoscopic camera Computer Vision approach for the jacket and through multiple grip activities for the glove. Ten healthy subjects participated in system validation trials, performing three arm and three hand exercises (each 10 motor task trials) and completing user experience questionnaires. Results: Acceptable correlation was observed in 23/30 arm exercises performed with the jacket. No significant differences in glove sensor data during actuation state were observed. No difficulty to use, discomfort, or negative robotics perception were reported. Conclusions: Subsequent design improvements will implement additional absolute orientation sensors, MARG/EMG based biofeedback to the game, improved immersion through Augmented Reality and improvements towards system robustness

Neurorehabilitation Through Synergistic Man-Machine Interfaces Promoting Dormant Neuroplasticity in Spinal Cord Injury: Protocol for a Nonrandomized Controlled Trial

Background: Spinal cord injury (SCI) constitutes a major sociomedical problem, impacting approximately 0.32-0.64 million people each year worldwide; particularly, it impacts young individuals, causing long-term, often irreversible disability. While effective rehabilitation of patients with SCI remains a significant challenge, novel neural engineering technologies have emerged to target and promote dormant neuroplasticity in the central nervous system. Objective: This study aims to develop, pilot test, and optimize a platform based on multiple immersive man-machine interfaces offering rich feedback, including (1) visual motor imagery training under high-density electroencephalographic recording, (2) mountable robotic arms controlled with a wireless brain-computer interface (BCI), (3) a body-machine interface (BMI) consisting of wearable robotics jacket and gloves in combination with a serious game (SG) application, and (4) an augmented reality module. The platform will be used to validate a self-paced neurorehabilitation intervention and to study cortical activity in chronic complete and incomplete SCI at the cervical spine. Methods: A 3-phase pilot study (clinical trial) was designed to evaluate the NeuroSuitUp platform, including patients with chronic cervical SCI with complete and incomplete injury aged over 14 years and age-/sex-matched healthy participants. Outcome measures include BCI control and performance in the BMI-SG module, as well as improvement of functional independence, while also monitoring neuropsychological parameters such as kinesthetic imagery, motivation, self-esteem, depression and anxiety, mental effort, discomfort, and perception of robotics. Participant enrollment into the main clinical trial is estimated to begin in January 2023 and end by December 2023. Results: A preliminary analysis of collected data during pilot testing of BMI-SG by healthy participants showed that the platform was easy to use, caused no discomfort, and the robotics were perceived positively by the participants. Analysis of results from the main clinical trial will begin as recruitment progresses and findings from the complete analysis of results are expected in early 2024. Conclusions: Chronic SCI is characterized by irreversible disability impacting functional independence. NeuroSuitUp could provide a valuable complementary platform for training in immersive rehabilitation methods to promote dormant neural plasticity