EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review.

Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.

Abnormal cortical asymmetry as a target for neuromodulation in neuropsychiatric disorders: A narrative review and concept proposal.

Recent advances in knowledge relating to the organization of neural circuitry in the human brain have increased understanding of disorders involving brain circuit asymmetry. These asymmetries, which can be measured and identified utilizing EEG and LORETA analysis techniques, may be a factor in mental disorders. New treatments involving non-invasive brain stimulation (NIBS), including trans-cranial magnetic stimulation, direct current stimulation and vagal nerve stimulation, have emerged in recent years. We propose that EEG identification of circuit asymmetry geometries can direct non-invasive brain stimulation more specifically for treatments of mental disorders. We describe as a narrative review new NIBS therapies that have been developed and delivered, and suggest that they are proving effective in certain patient groups. A brief narrative of influence of classical and operant conditioning of neurofeedback on EEG coherence, phase, abnormalities and Loreta's significance is provided. We also discuss the role of Heart rate variability and biofeedback in influencing EEG co-relates. Clinical evidence is at an early stage, but the basic science evidence and early case studies suggest that this may be a promising new modality for treating mental disorders and merits further research.

Adherence to clinical practice guidelines among three primary contact professions: a best evidence synthesis of the literature for the management of acute and subacute low back pain.

AIM: To determine adherence to clinical practice guidelines in the medical, physiotherapy and chiropractic professions for acute and subacute mechanical low back pain through best-evidence synthesis of the healthcare literature. METHODS: A structured best-evidence synthesis of the relevant literature through a literature search of relevant databases for peer-reviewed papers on adherence to clinical practice guidelines from 1995 to 2013. Inclusion of papers was based on selection criteria and appraisal by two reviewers who independently applied a modified Downs & Black appraisal tool. The appraised papers were summarized in tabular form and analysed by the authors. RESULTS: The literature search retrieved 23 potentially relevant papers that were evaluated for methodological quality, of which 11 studies met the inclusion criteria. The main finding was that no profession in the study consistently attained an overall high concordance rating. Of the three professions examined, 73% of chiropractors adhered to current clinical practice guidelines, followed by physiotherapists (62%) and then medical practitioners (52%). CONCLUSIONS: This review showed that quality papers in this area of research are very limited. Notwithstanding, chiropractors appear to adhere to clinical practice guidelines more so than physiotherapists and medical practitioners, although there is scope for improvement across all three professions.

OBJECTIF: Évaluer la conformité, dans les professions médicale, de physiothérapie et de chiropratique, avec les directives de pratique clinique en ce qui concerne la lombalgie mécanique aiguë et subaiguë par une synthèse des données probantes de la documentation sur les soins de santé. MÉTHODOLOGIE: Une synthèse structurée des données probantes provenant de la documentation pertinente, par une recherche des bases de données des publications examinées par les pairs sur le respect des directives de pratique clinique entre 1995 et 2013. Le choix des publications a été fait selon des critères de sélection et des évaluations distinctes par deux examinateurs qui ont utilisé l'outil d'évaluation Downs & Black modifié. Les documents d'évaluation ont été résumés en tableaux et ont été analysés par les auteurs. RÉSULTATS: La recherche des documents a extrait 23 publications potentiellement pertinentes qui ont été examinées pour leur qualité méthodologique, et dont 11 satisfaisaient les critères de sélection. La principale conclusion était qu'aucune des professions à l'étude n'a atteint de façon consistante un taux global élevé de concordance. Parmi les trois professions à l'étude, 73 % des chiropraticiens respectaient les directives de pratique clinique, suivis par les physiothérapeutes (62 %), et les médecins (52 %). CONCLUSIONS: Cette étude a démontré la rareté des publications de qualité dans ce domaine de recherche. Cela dit, les chiropraticiens semblent respecter les directives de pratique clinique plus que les physiothérapeutes et les médecins, bien qu'il y ait des possibilités d'amélioration dans les trois professions.

Hand-held dynamometry correlation with the gold standard isokinetic dynamometry: a systematic review.

OBJECTIVE: To examine the current evidence regarding the reliability and validity of hand-held dynamometry for assessment of muscle strength in the clinical setting. DATA SOURCES: A search was conducted of the following databases: Cochrane, MEDLINE, PubMed, PEDro, OTseeker, Index to Chiropractic Literature (ICL), and MANTIS, from inception until January 29, 2010. STUDY SELECTION: The MeSH subject heading "muscle strength dynamometer" was searched, in isolation and in combination with the text word phrases "hand-held dynamometer" and "isokinetic." Four hundred fifty-four different studies met this search and were reviewed for possible inclusion. DATA EXTRACTION: Two independent reviewers assessed the quality of the included manuscripts. The PEDro data collection system was used in conjunction with the Cochrane Diagnostic Test Accuracy Description. A third reviewer was used when there was disagreement between the primary reviewers. DATA SYNTHESIS: Seventeen manuscripts met the inclusion criteria for this review, with a total of 19 studies (2 of the manuscripts involved 2 separate studies) that compared hand-held dynamometry with an identified reference standard (isokinetic muscle strength testing). The results demonstrated minimal differences between hand-held dynamometry and isokinetic testing. CONCLUSIONS: Considering hand-held dynamometry's ease of use, portability, cost, and compact size, compared with isokinetic devices this instrument can be regarded as a reliable and valid instrument for muscle strength assessment in a clinical setting.

Conservative therapy for Complex Regional Pain Syndrome Type I in a paediatric patient: a case study.

Complex regional pain syndrome (CRPS) is a term that describes a variety of chronic pain conditions that are believed to result from dysfunction in the central or peripheral nervous systems. Typical features include dramatic changes in the colour and temperature of the skin over the affected limb or body part, accompanied by an intense pain which is out of proportion to the injury thought responsible. Skin sensitivity, sweating, and swelling are also commonly involved. This case study presents subjective reports of changes in pain and extremity weight bearing capacity in an 8 year-old child with Chronic Region Pain Syndrome Type I. The changes reported occurred over a 12 week conservative course of treatment which included manipulation, nutritional supplementation and rehabilitation. The patient was able to regain full control of her legs and full weight bearing after 3 weeks of treatment.

Radiographic anomalies that may alter chiropractic intervention strategies found in a New Zealand population.

OBJECTIVE: To provide occurrence rates for anomalies discovered on radiographs in patients seeking chiropractic care. METHODS: One thousand four random patient files dated between 1997 and 2001 were obtained from the records of the outpatient clinic at the New Zealand College of Chiropractic. In cases in which radiographs were taken, the radiographic reports were analyzed by the authors for the presence of a number of anomalies. RESULTS: Eight hundred forty-seven full-spine radiographs were included in the study. Anomalies were found in 68% of patients who had radiographs taken. The 5 most frequently occurring anomalies in descending order were degenerative joint disease (23.8%), posterior ponticle (13.6%), soft tissue abnormalities (13.5%), transitional segments (9.8%), and spondylolisthesis (7.8%). Other noteworthy occurrences because of their generalized status as absolute contraindications to adjustment are fracture (6.6%), malignant tumor (0.8%-3.1%), abdominal aortic aneurysm (0.8%) and atlantoaxial instability (0.6%). CONCLUSION: A large percentage of patients presenting for chiropractic care have anomalies present on spinal radiographs. Further research and analysis is necessary to investigate the risk-verses-benefit ratio of spinal radiographs for chiropractic patients.