Comparing in-clinic versus telehealth for vestibular physical therapy.

BACKGROUND: Vestibular rehabilitation (VR) is a commonly employed treatment method for disorders of dizziness and imbalance. Access to a clinic for rehabilitation appointments can be challenging for a person experiencing dizziness. Telehealth may offer a comparable alternative to clinic-based VR for some patients. OBJECTIVE: The objective of this study was to determine the efficacy of telehealth-based VR compared to traditional clinic-based VR, as measured with the Dizziness Handicapped Inventory (DHI) in a retrospective sample of patients with vestibular conditions. METHODS: This is a retrospective, multi-institutional review from May 2020 to January 2021. Three study groups were analyzed: a telehealth group, a hybrid group, and a clinic based control group. Treatment efficacy was measured using the DHI. A repeated measures ANCOVA was performed to compare changes between the groups and across timepoints. RESULTS: The repeated measures ANCOVA was not significant for the interaction of groups (control, telehealth, and hybrid) by time (pre and post) (p > 0.05). However, there was a significant main effect for time (pre and post) (p < 0.05). Specifically, all groups improved DHI scores from pre to post treatment with mean differences of control: 31.85 points, telehealth: 18.75 points, and hybrid: 21.45 points. CONCLUSION: Findings showed that in-clinic, telehealth, and hybrid groups demonstrated a decrease in DHI scores, indicating self-reported improvements in the impact of dizziness on daily life. Continued research is recommended to explore the efficacy of using telehealth in assessing and treating vestibular conditions.

Will Men Use Novel Male Contraceptive Methods and Will Women Trust Them? A Systematic Review.

Novel male contraceptives have been in development for almost as long as female methods, yet there are no products available on the market. Hormonal approaches tested clinically to date include the use of oral, injectable, implant and transdermal methods. The study of attitudes toward male contraception has been inconsistent and there have been no systematic reviews drawing these data together. We conducted a systematic review of the available evidence for male and female acceptability of novel male contraception. We identified 32 studies and present a narrative synthesis of quantitative data and a thematic synthesis of qualitative data. In novel drug trials, the proportion of male participants willing to use a male contraceptive ranged from 34.0% to as high as 82.3%. In studies regarding hypothetical drugs, male willingness to use ranged from 13.6% to 83.0%. High proportions of women (42.8%-94.0%) reported willingness to use a novel male method in both hypothetical studies and actual drug trials. In qualitative studies, both men and women expressed the desire to share responsibility for contraception. There is consistent interest among both men and women in novel male contraceptive methods and willingness to use them. The systematic review was registered with PROSPERO: CRD42020173281.

Transfacial transmandibular approach to the masticator space: Excision of odontogenic myxoma arising from the mandibular condyle.

Odontogenic myxomas are an uncommon benign odontogenic tumor that can present with a wide variety of symptomatology depending on location and potentially be locally destructive. The present case describes a 66-year-old female who presented with left lower facial paresthesia, left aural fullness and hearing loss. She was found to have an odontogenic myxoma that involved the condylar head and extended into the masticator space. In this report we detail our surgical approach utilizing a preauricular transfacial transmandibular approach to the masticator space. In addition, we will discuss various approaches to the masticator space and infratemporal fossa along with considerations on how to manage facial nerve paralysis, facial contour deformities, and post-operative rehabilitation for permanent unilateral condylar head disarticulation.

Cervical & thoracic manipulations: Acute effects upon pain pressure threshold and self-reported pain in experimentally induced shoulder pain.

BACKGROUND: Emerging evidence suggests that cervical and thoracic joint manipulations may be advocated in treating patients with shoulder pain. OBJECTIVES: To determine the acute effects of cervical, cervicothoracic, and thoracic joint manipulations on outcomes of self-reported pain and pain pressure threshold in experimentally induced shoulder pain. DESIGN: Repeated measures. METHODS: Twenty (20) healthy volunteers were tested on two sessions. Session 1 consisted on baseline assessment of pain pressure threshold testing over the infraspinatus bilaterally and self-reported shoulder pain using the shoulder pain and disability index (SPADI) pain scale. An isokinetic exercise protocol was used to induce delayed onset muscle soreness. In session 2 (24-48 h later), all variables were reassessed before and immediately after a combination of cervical, cervicothoracic and thoracic manipulations. RESULTS: SPADI pain scale scores were significantly different between time points (p < 0.001): the exercise protocol significantly increased reported pain [mean increase 14.1, p < 0.001] while the manipulation significantly decreased reported pain (mean decrease 5.60, p < 0.001)) although pain remained higher than baseline levels. Pain pressure threshold differences were also found between time points (p = 0.001): manipulation significantly increased pain threshold bilaterally (p < 0.001) similar to baseline levels. CONCLUSIONS: Cervical, cervicothoracic, and thoracic joint manipulations acutely increased pain pressure threshold and decreased self-reported shoulder pain in participants with experimentally induced shoulder pain. Physiotherapists may consider the combination of such techniques to achieve short-term hypoalgesic effects and facilitate the application of more active interventions.

Epichloë uncinata Infection and Loline Content Protect Festulolium Grasses From Crickets (Orthoptera: Gryllidae).

Experiments with artificial diets demonstrated that black field cricket (Teleogryllus commodus (Walker)) and Lepidogryllus sp. were highly responsive to presence of lolines in their diet-quantities of diet consumed declined exponentially with increasing loline concentration. Amount consumed by black field cricket and Lepidogryllus sp. on diet containing 5,600 µg/g lolines was only 8 and 2% relative to those on loline-free diet, respectively. Additional experiments with Festulolium seeds demonstrated that both cricket species predated heavily on endophyte-free seed but largely avoided Epichloë uncinata-infected seed. By 12 h, black field cricket had destroyed 98.8% of endophyte-free but only 24.8% of E. uncinata-infected, loline-containing seed. By 36 h, Lepidogryllus sp. crickets had destroyed 40% of endophyte-free but had not fed on E. uncinata-infected, loline-containing seed. Glasshouse experiments demonstrated this aversion to lolines greatly reduces the damage potential of black field cricket in E. uncinata-infected Festulolium. When microswards were sown with E. uncinata-infected Festulolium, seedling numbers were reduced 25-26%, and yields 29-40%, by black field crickets relative to microswards sown without insect infestation. This contrasts with 70-78% reduction in seedling numbers and 67-80% reduction in yields in microswards sown to either endophyte-free Festulolium, endophyte-free perennial ryegrass, or Epichloë festucae var. lolii-infected Festulolium. Yields of mature E. uncinata-infected Festulolium plants were not adversely affected by black field crickets, irrespective of the presence of the endophyte-free standard Festulolium sown as a companion. In contrast, yields of endophyte-free Festulolium, endophyte-free perennial ryegrass, and E. festucae var. lolii-infected Festulolium plants were reduced by 56-61% by crickets.

Delayed olfactory ensheathing cell transplants reduce nociception after dorsal root injury.

Injury to cervical dorsal roots mimics the deafferentation component of brachial plexus injury in humans, with intractable neuropathic pain in the deafferented limb being a common consequence. Such lesions are generally not amenable to surgical repair. The use of olfactory ensheathing cells (OECs) for dorsal root repair, via acute transplantation, has been successful in several studies. From a clinical point of view, delayed transplantation of OECs would provide a more realistic timeframe for repair. In this study we investigated the effect of delayed OEC transplantation on functional recovery of skilled forepaw movements and amelioration of neuropathic pain, using a C7 and C8 dorsal root injury rat model previously established in our lab. We found that OEC transplantation to the dorsal horn 1 week after root injury effectively attenuated neuropathic disturbances associated with dorsal root injury, including spontaneous pain behavior, tactile allodynia and thermal hyperalgesia. The sensory controls of complex, goal-oriented skilled reaching and ladder walking, however, were not improved by delayed OEC transplantation. We did not detect any significant influence of transplanted OECs on injury-induced central reorganisation and afferent sprouting. The anti-nociceptive effect mediated by OEC transplants may therefore be explained by alternative mechanisms such as modification of inflammation and astrogliosis. The significant effect of OEC transplants in mitigating neuropathic pain may be clinically useful in intractable pain syndromes arising from deafferentation. This article is part of a Special Issue entitled: Understanding olfactory ensheathing glia and their prospect for nervous system repair.

Effects of human OEC-derived cell transplants in rodent spinal cord contusion injury.

Numerous reports indicate that rodent olfactory ensheathing cells (OECs) assist in spinal cord repair and clinical trials have been undertaken using autologous transplantation of human olfactory ensheathing cells (hOECs) as a treatment for spinal cord injury. However, there are few studies investigating the efficacy of hOECs in animal models of spinal cord injury. In this study hOECs were derived from biopsies of human olfactory mucosa, purified by culture in a serum-free medium containing neurotrophin-3, genetically labelled with EGFP, and stored frozen. These hOEC-derived cells were thawed and transplanted into the spinal cord injury site 7 days after a moderate contusion injury of the spinal cord at thoracic level T10 in the athymic rat. Six weeks later the animals receiving the hOEC-derived transplants had greater functional improvement in their hindlimbs than controls, assessed using open field (BBB scale) and horizontal rung walking tests. Histological analysis demonstrated beneficial effects of hOEC-derived cell transplantation: reductions in the volume of the lesion and the cavities within the lesion. The transplanted cells were located at the periphery of the lesion where they integrated with GFAP-positive astrocytes resulting in a significant reduction of GFAP staining intensity adjacent to the lesion. Although their mechanism of action is unclear we conclude that hOEC-derived cell transplants improved functional recovery after transplantation into the contused spinal cord, probably by modulating inflammatory responses and reducing secondary damage to the cord.