Estimation of Vertical Ground Reaction Force during Single-leg Landing Using Two-dimensional Video Images and Pose Estimation Artificial Intelligence.

OBJECTIVE: Assessment of the vertical ground reaction force (VGRF) during landing tasks is crucial for physical therapy in sports. The purpose of this study was to determine whether the VGRF during a single-leg landing can be estimated from a two-dimensional (2D) video image and pose estimation artificial intelligence (AI). METHODS: Eighteen healthy male participants (age: 23.0 ± 1.6 years) performed a single-leg landing task from a 30-cm height. The VGRF was measured using a force plate and estimated using center of mass (COM) position data from a 2D video image with pose estimation AI (2D-AI) and three-dimensional optical motion capture (3D-Mocap). The measured and estimated peak VGRFs were compared using a paired t-test and Pearson's correlation coefficient. The absolute errors of the peak VGRF were also compared between the two estimations. RESULTS: No significant difference in the peak VGRF was found between the force plate measured VGRF and the 2D-AI or 3D-Mocap estimated VGRF (force plate: 3.37 ± 0.42 body weight [BW], 2D-AI: 3.32 ± 0.42 BW, 3D-Mocap: 3.50 ± 0.42 BW). There was no significant difference in the absolute error of the peak VGRF between the 2D-AI and 3D-Mocap estimations (2D-AI: 0.20 ± 0.16 BW, 3D-Mocap: 0.13 ± 0.09 BW, P = 0.163). The measured peak VGRF was significantly correlated with the estimated peak by 2D-AI (R = 0.835, P <0.001). CONCLUSION: The results of this study indicate that peak VGRF estimation using 2D video images and pose estimation AI is useful for the clinical assessment of single-leg landing.

Relationship between onset of trunk muscle activities and pelvic kinematics in individuals with and without chronic low back pain.

BACKGROUND: Lumbopelvic movement patterns during prone hip extension has been proposed as a clinical screening method for trunk muscle dysfunction in patients with chronic low back pain (CLBP). However, correlations between trunk muscle onset and pelvic kinematics have not been investigated. OBJECTIVE: To examine the correlation between trunk muscle onset and pelvic kinematics during prone hip extension in participants with CLBP. METHODS: Fifteen patients with CLBP and 15 healthy individuals participated. We evaluated the muscle activities of the lumbar multifidus, the longissimus, and the semitendinosus via electromyogram and the displacement angles of the pelvic tilt, oblique and rotation. RESULTS: The onset of the multifidus at the ipsilateral side of hip extension was significantly delayed in the patients with CLBP compared to the control group (P< 0.001). The onset of the ipsilateral multifidus in the control group was significantly correlated with increased anterior pelvic tilt angle (P= 0.019, r= 0.597), whereas no significant correlation was observed in the CLBP group (P= 0.810, r=-0.068). CONCLUSION: The results suggest that pelvic kinematics during prone hip extension does not predict the delayed trunk muscle onset in patients with CLBP.

The relationship between joint kinematic patterns during single-leg drop landing and perceived instability in individuals with chronic ankle instability.

BACKGROUND: Perceived instability is a primary symptom among individuals with chronic ankle instability. However, the relationship between joint kinematics during landing remains unclear. Therefore, we investigated the relationships between landing kinematics and perceived instability in individuals with chronic ankle instability. METHODS: In 32 individuals with chronic ankle instability, we recorded ankle, knee, and hip joint angles during a single-leg drop landing. Joint angle waveforms during 200 ms before and after initial contact were summarized into single values using two methods: peak joint angles and principal component scores via principal component analysis. Using Spearman's rank correlation coefficient (ρ), we examined the relationships of peak joint angles and principal component scores with the Cumberland Ankle Instability Tool score, with a lower score indicating a greater perceived instability (α = 0.05). FINDINGS: The second principal component scores of ankle angle in the horizontal and sagittal planes significantly correlated with the Cumberland Ankle Instability Tool score (Horizontal: ρ = 0.507, P = 0.003; Sagittal: ρ = -0.359, P = 0.044). These scores indicated the differences in the magnitude of angles before and after landing. Significant correlations indicated a greater perceived instability correlated with smaller internal rotation and plantarflexion before landing and smaller external rotation and dorsiflexion after landing. In contrast, no peak joint angles correlated with the Cumberland Ankle Instability Tool score (P > 0.05). INTERPRETATION: In individuals with chronic ankle instability, ankle movements during landing associated with perceived instability may be a protective strategy before landing and potentially cause ankle instability after landing.

Trunk Muscle Activity and Ratio of Local Muscle to Global Muscle Activity during Supine Bridge Exercises under Unstable Conditions in Young Participants with and without Chronic Low Back Pain.

Core exercises on an unstable surface increase trunk muscle activity, especially for local muscle groups. Therefore, there is a possibility that exercises on an unstable surface would be effective in the rehabilitation of non-specific chronic low back pain (NSCLBP). The present study assessed trunk muscle activities during bridge exercise on the floor and two kinds of unstable surfaces, i.e., a balance ball and the BOSU, for individuals with and without NSCLBP. This study enrolled 17 and 18 young participants with and without NSCLBP, respectively. In the balance ball condition, both groups showed a significant increase in erector spinae activity compared to the floor condition, and the increase in activity was significantly greater in the NSCLBP group than in the control group (p = 0.038). On the other hand, neither group showed significant changes in trunk muscle activities in the BOSU condition compared to those in the floor condition. The control group showed a significant increase in internal oblique/transversus abdominis activity under the balance ball condition (p = 0.020), whereas there were no significant changes in these muscle activities between the balance ball and floor conditions in the NSCLBP group. The present study showed that participants with NSCLBP significantly increased muscle activity of the erector spinae, one of the global back muscles, on the balance ball in spite of small effects on muscle activity of the internal oblique/transversus abdominis, which is one of the local abdominal muscles. Therefore, attention should be paid to the application of bridge exercises on the balance ball for individuals with NSCLBP.

Effect of suspensory strategy on balance recovery after lateral perturbation.

Postural stability is essential for performing daily activities and preventing falls, whereby suspensory strategy with knee flexion may play a role in postural control. However, the contribution of the suspensory strategy for postural control during sudden lateral perturbation remains unclear. We aimed to determine how suspensory strategy contributed to postural adjustment during sudden perturbation in the lateral direction and what knee flexion setting maximized its effect. Eighteen healthy young adults (10 male and 8 female) participated in this study. Kinematic data during lateral perturbation at three velocities (7, 15, and 20 cm/s) were collected under three knee flexion angle conditions (0°, 15°, and 65°) using motion capture technology. Postural adjustments to the external perturbation were assessed by four parameters related to the temporal aspects of the center of mass (COM): reaction time, peak displacement/time and reversal time, and minimum value of the margin of stability (minimum-MOS). Our results showed that the COM height before the perturbation significantly lowered with increasing knee flexion angle. The COM reaction times for low and mid perturbation velocities were delayed at 65° of knee flexion compared to 0° and 15°, and the COM reversal times were significantly shorter at 65° of knee flexion than at 0° and 15° across all perturbation velocities. The minimum-MOS at the high-velocity of perturbation was significantly smaller at 65° of knee flexion than at 0° and 15°. In conclusion, the adoption of a suspensory strategy with slight knee flexion induced enhanced stability during sudden external and lateral perturbations. However, excessive knee flexion induced instability.

Global validation of data-assimilative electron ring current nowcast for space weather applications.

The hazardous plasma environment surrounding Earth poses risks to satellites due to internal charging and surface charging effects. Accurate predictions of these risks are crucial for minimizing damage and preparing for system failures of satellites. To forecast the plasma environment, it is essential to know the current state of the system, as the accuracy of the forecast depends on the accuracy of the initial condition of the forecast. In this study, we use data assimilation techniques to combine observational data and model predictions, and present the first global validation of a data-assimilative electron ring current nowcast during a geomagnetic storm. By assimilating measurements from one satellite and validating the results against another satellite in a different magnetic local time sector, we assess the global response and effectiveness of the data assimilation technique for space weather applications. Using this method, we found that the simulation accuracy can be drastically improved at times when observations are available while eliminating almost all of the bias previously present in the model. These findings contribute to the construction of improved operational models in estimating surface charging risks and providing realistic 'source' populations for radiation belt simulations.

The Comet Interceptor Mission.

Here we describe the novel, multi-point Comet Interceptor mission. It is dedicated to the exploration of a little-processed long-period comet, possibly entering the inner Solar System for the first time, or to encounter an interstellar object originating at another star. The objectives of the mission are to address the following questions: What are the surface composition, shape, morphology, and structure of the target object? What is the composition of the gas and dust in the coma, its connection to the nucleus, and the nature of its interaction with the solar wind? The mission was proposed to the European Space Agency in 2018, and formally adopted by the agency in June 2022, for launch in 2029 together with the Ariel mission. Comet Interceptor will take advantage of the opportunity presented by ESA's F-Class call for fast, flexible, low-cost missions to which it was proposed. The call required a launch to a halo orbit around the Sun-Earth L2 point. The mission can take advantage of this placement to wait for the discovery of a suitable comet reachable with its minimum ΔV capability of 600 ms-1. Comet Interceptor will be unique in encountering and studying, at a nominal closest approach distance of 1000 km, a comet that represents a near-pristine sample of material from the formation of the Solar System. It will also add a capability that no previous cometary mission has had, which is to deploy two sub-probes - B1, provided by the Japanese space agency, JAXA, and B2 - that will follow different trajectories through the coma. While the main probe passes at a nominal 1000 km distance, probes B1 and B2 will follow different chords through the coma at distances of 850 km and 400 km, respectively. The result will be unique, simultaneous, spatially resolved information of the 3-dimensional properties of the target comet and its interaction with the space environment. We present the mission's science background leading to these objectives, as well as an overview of the scientific instruments, mission design, and schedule.

Hip and knee kinematics, center of pressure position, and ground reaction force are associated with Achilles tendon force during jump landing.

PURPOSE: Jump-landing exercises are often performed during the rehabilitation of Achilles tendon (AT) injuries. However, the factors that affect the AT force (ATF) during landing are unclear. This study aimed to determine the kinematics and ground reaction force (GRF) variables associated with the peak ATF during a drop vertical jump (DVJ). METHODS: The landing phase of DVJ was evaluated in 101 healthy participants (46 males, age: 21.2 ± 1.4 years old) using a three-dimensional motion analysis system with two force plates. ATF was estimated from the ankle flexion angle and moment. Univariate and multivariate regression analyses were performed with the peak ATF as the dependent variable. The vertical GRF (VGRF), center of pressure (COP), forward trunk leaning, hip/knee/ankle joint angles at peak ATF, and sex were used as independent variables. RESULTS: In the univariate regression analysis, larger VGRF (ß = 0.813), more anterior COP position (ß = 0.214), smaller knee flexion (ß = -0.251) and adduction (ß = -0.252), smaller hip flexion (ß = -0.407), smaller forward trunk lean (ß = -0.492), and male sex (ß = -0.282) were significantly associated with a larger peak ATF. Multivariate analysis revealed that larger VGRF (ß = 1.018), more anterior COP position (ß = 0.320), a larger knee (ß = 0.442), and smaller hip flexion (ß = -0.205) were associated with the larger peak ATF. CONCLUSIONS: The VGRF, COP position, and knee and hip flexion were independently associated with ATF. Modifying these factors may be useful in managing tendon loading during jump-landing exercises.

Acute effects of static and dynamic stretching for ankle plantar flexors on postural control during the single-leg standing task.

Static stretching (SS) and dynamic stretching (DS) are widely used as warm-ups before sports. However, whether stretching affects postural control remains unclear. We compared the effects of SS and DS on the plantar flexors and postural control during single-leg standing. Fifteen healthy young participants performed SS, DS, or no stretching (control). The stretch condition consisted of four sets lasting 30 s each. The control condition was a rest with standing for 210 s. Center of pressure (COP) displacement was measured using a force plate before and after each intervention to assess postural control during the single-leg standing task. The COP area, COP velocity, and anteroposterior (COPAP) and mediolateral (COPML) range were calculated. DS significantly decreased in the COPML range (21.5 ± 4.1 to 19.0 ± 2.5 mm; P = 0.02), COP velocity (33.8 ± 7.6 to 29.8 ± 6.5 mm/s; P < 0.01), and COP area (498.6 ± 148.3 to 393.3 ± 101.1 mm2; P < 0.01), whereas SS did not change in the COP parameters (COP area 457.2 ± 108.3 to 477.8 ± 106.1 mm2, P = .49; COP velocity 31.2 ± 4.2 to 30.7 ± 5.8 mm/s, P = 0.60; COPAP 25.4 ± 3.1 to 25.3 ± 3.2 mm, P = 0.02; COPML 20.7 ± 3.3 to 21.1 ± 2.5 mm, P = 0.94). Therefore, DS of the plantar flexors enhances postural control during single-leg standing and may be effective for both injury prevention and performance enhancement.

Validity of AI-Based Gait Analysis for Simultaneous Measurement of Bilateral Lower Limb Kinematics Using a Single Video Camera.

Accuracy validation of gait analysis using pose estimation with artificial intelligence (AI) remains inadequate, particularly in objective assessments of absolute error and similarity of waveform patterns. This study aimed to clarify objective measures for absolute error and waveform pattern similarity in gait analysis using pose estimation AI (OpenPose). Additionally, we investigated the feasibility of simultaneous measuring both lower limbs using a single camera from one side. We compared motion analysis data from pose estimation AI using video footage that was synchronized with a three-dimensional motion analysis device. The comparisons involved mean absolute error (MAE) and the coefficient of multiple correlation (CMC) to compare the waveform pattern similarity. The MAE ranged from 2.3 to 3.1° on the camera side and from 3.1 to 4.1° on the opposite side, with slightly higher accuracy on the camera side. Moreover, the CMC ranged from 0.936 to 0.994 on the camera side and from 0.890 to 0.988 on the opposite side, indicating a "very good to excellent" waveform similarity. Gait analysis using a single camera revealed that the precision on both sides was sufficiently robust for clinical evaluation, while measurement accuracy was slightly superior on the camera side.

Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder.

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited renal disease characterized by the bilateral development of multiple cysts in the kidneys. Pain management is a clinically important issue, especially because approximately 60% of patients with ADPKD experience chronic pain related to hemorrhage from renal cysts, which significantly reduces their daily life. The cystic fibrosis transmembrane conductance regulator, the molecule responsible for cyst formation in ADPKD, is also the cause of cystic fibrosis. Since attention deficit hyperactivity disorder (ADHD) is known to occur frequently in conjunction with cystic fibrosis, ADPKD may be associated with ADHD. However, to our knowledge, no study has investigated 1) ADHD or autism spectrum disorder (ASD) as comorbidities with ADPKD, 2) the effects of ADHD medications on chronic pain in ADPKD, or 3) cerebral blood flow corresponding to guanfacine (GF) or methylphenidate (MP) treatment for chronic pain. We report the case of a 15-year-old girl with ADPKD, who had chronic back pain associated with ADPKD and had to withdraw from high school because the pain interfered with her daily life. Although she took antihypertensive medications to prevent bleeding, they did not provide adequate blood pressure control. The patient was referred to a child psychiatrist and diagnosed with ASD; however, the pain did not improve. Subsequently, she was referred to our pain center. The diagnosis of ADHD was confirmed and treatment with ADHD medications was initiated. Monotherapy with MP, atomoxetine, and GF resulted in hypertension and hypotension as side effects; however, a combination of MP 18 mg and GF 4 mg provided pain relief and moderate blood pressure control, and the patient was able to go on to college. During the course of treatment, there was an improvement in the distribution of cerebral blood flow in the prefrontal and insular cortices. Confirmation of an ADHD diagnosis comorbid with ASD enabled the use of ADHD medications. The combination of MP and GF improved chronic back pain and high blood pressure due to ADPKD and cerebral blood flow. Screening for ADHD is important in the treatment of ADPKD.

Change in sensory integration and regularity of postural sway with the suspensory strategy during static standing balance.

Background and aim: The suspensory strategy, a method for controlling postural balance in the vertical direction of the center of mass (COM), is considered by the elderly as a means of balance control. The vertical COM control might alter the sensory integration and regularity of postural sway, which in turn impacts balance. However, to date, this was not confirmed. Thus, this study aimed at investigating the influence of the suspensory strategy achieved through knee flexion on the static standing balance. Methods: Nineteen participants were monitored at knee flexion angles of 0°, 15°, and 65°. Time-frequency analysis and sample entropy were employed to analyze the COM data. Time-frequency analysis was utilized to assess the energy content across various frequency bands and corresponding percentage of energy within each frequency band. The outcomes of time-frequency are hypothesized to reflect the balance-related sensory input and sensory weights. Sample entropy was applied to evaluate the regularity of the COM displacement patterns. Results: Knee flexion led to a decreased COM height. The highest energy content was observed at 65° knee flexion, in contrast with the lowest energy observed at 0° in both the anterior-posterior (AP) and medial-lateral (ML) directions. Additionally, the ultra-low-frequency band was more pronounced at 65° than that at 0° or 15° in the ML direction. Furthermore, the COM amplitudes were notably higher at 65° than those at 0° and 15° in the AP and ML directions, respectively. The sample entropy values were lower at 65° and 15° than those at 0° in the ML direction, with the lowest value observed at 65° in the vertical direction. Conclusion: The suspensory strategy could enhance the sensory input and cause sensory reweighting, culminating in a more regular balance control. Such suspensory strategy-induced postural control modifications may potentially provide balance benefits for people with declining balance-related sensory, central processing, and musculoskeletal system functions.

Factors associated with persistent pain in college athletes with a history of lateral ankle sprain.

OBJECTIVES: To determine the factors associated with and prevalence of persistent pain in college athletes with chronic ankle instability (CAI) and with previous lateral ankle sprain (LAS) without CAI. DESIGN: Cross-Sectional Study. SETTING: Online survey at one university. PARTICIPANTS: Of the 385 respondents surveyed online, 140 were identified as having experienced at least one LAS (CAI group: 69, coper group: 24, LAS group not classified as either: 47). MAIN OUTCOME MEASURES: Factors associated with the presence of pain during activities of daily living (ADL) and sports were identified using multivariate logistic regression analyses. Independent variables were demographics, injury characteristics, the Identification of Functional Ankle Instability (IdFAI) score, the Foot and Ankle Ability Measure Sports (FAAM-Sports) and ADL subscales, and the Tampa Scale for Kinesiophobia-11 score. RESULTS: The prevalence of pain during ADL and sports in the three groups was 16.7%-42.0% and 33.3%-56.5%, respectively. FAAM-Sports and IdFAI score were significantly associated with pain during ADL and sports in the CAI group (odd ratio: 0.923 and 1.145), respectively. No significant pain-related factors were found in the coper and LAS groups. CONCLUSIONS: Lower self-reported function and greater perceived ankle instability may be important factors in pain management in athletes with CAI.

Case report: Atomoxetine improves chronic pain with comorbid post-traumatic stress disorder and attention deficit hyperactivity disorder.

Background: It is known that patients reporting chronic pain often experience trauma or post-traumatic stress disorder (PTSD) and tend to be more difficult to treat. Attention deficit hyperactivity disorder (ADHD), a neurodevelopmental disorder, is frequently associated with chronic pain. Furthermore, patients diagnosed with ADHD are more likely to encounter trauma and develop PTSD because of their inattentive and impulsive tendencies. There are reports stating that atomoxetine (ATX), a selective noradrenaline reuptake inhibitor for ADHD, is effective in patients diagnosed with PTSD and ADHD. However, there have been no reports on cases of comorbid PTSD and ADHD with chronic pain, and ATX's potential in improving chronic pain coexisting PTSD. Furthermore, no reports have evaluated patient cerebral blood flow in conjunction with the course of treatment with ATX for chronic pain. Case report: In this study, we reported a case where ATX improved chronic pain with PTSD and improved cerebral blood flow. The patient was a 56-year-old woman exhibiting chronic pain with PTSD, resulting from 6 years of severe domestic violence from her common-law husband. She had no history of ADHD diagnosis, but through aggressive screening, comorbid ADHD was diagnosed. When treated with ATX, there were significant improvements in her pain, quality of life, anxiety, depression, catastrophic thoughts, and cerebral blood flow. As a result, she could resume work after 11 years. Conclusion: The study showed that chronic pain with PTSD may be comorbid with ADHD. Moreover, we found that ATX can improve chronic pain with PTSD and cerebral blood flow. Aggressive screening of ADHD is important because once the diagnosis of comorbidity is confirmed, an ideal ADHD treatment can be selected. Therefore, based on the results of this study, ATX may be a candidate for treatment for cases of chronic pain with PTSD and ADHD.

Interlimb Asymmetry in Knee Extension Moment During Double-Leg Squatting Is Associated With Persistent Quadriceps Weakness After ACL Reconstruction.

Background: Although double-leg squatting is less dynamic and places less demand on the quadriceps compared with landing tasks, the relationship between double-leg squatting biomechanics and persistent quadriceps weakness after anterior cruciate ligament reconstruction (ACLR) is unknown. Purpose: To clarify the relationships between asymmetries in quadriceps strength and lower limb biomechanics during double-leg squatting >1 year after ACLR. Study Design: Controlled laboratory study. Methods: A total of 26 participants (5.5 ± 3.8 years after ACLR) were enrolled. The limb symmetry index (LSI) of isokinetic quadriceps strength was used to divide participants into the high-quadriceps (HQ) group (LSI ≥90%; n = 18) and the low-quadriceps (LQ) group (LSI <90%; n = 8). The knee, hip, and ankle extension moment (relative to body weight and support moment [sum of knee, hip, and ankle moments]) and vertical ground-reaction force during double-leg squatting were analyzed using 3-dimensional motion analysis. The association of quadriceps strength and biomechanical variables was tested using 2-way analysis of variance and univariate regression analysis. Results: A significant group-by-limb interaction was found for the peak knee extension moment and the ratios of knee and hip extension moment to support moment (P < .001, P = .015 and P < .001, respectively). The LQ group showed a significantly smaller peak knee extension moment and knee to support moment ratio but a larger hip to support moment ratio in the involved limb than in the uninvolved limb (95% CIs: knee extension moment, -0.273 to -0.088 N·m/kg; knee to support moment ratio, -10.7% to -2.2%; hip to support moment ratio, 3.2% to 8.5%). No interlimb difference was found for the HQ group. The LSI of quadriceps strength was significantly associated with the LSI of peak knee extension moment (R2 = 0.183), knee to support moment ratio (R2 = 0.256), and hip to support moment ratio (R2 = 0.233). The mean maximum isokinetic quadriceps strength and peak knee extension moment during squatting on the involved limb of the LQ group were 2.40 ± 0.39 and 0.90 ± 0.16 N·m/kg, respectively. Conclusion: Asymmetrical biomechanics during double-leg squatting was associated with persistent quadriceps weakness after ACLR. The LQ group had reduced knee extensor moment on the involved side during squatting despite loading at approximately half the maximum strength. Clinical Relevance: Quadriceps strengthening exercises, together with interventions to improve neuromuscular control, may reduce asymmetrical biomechanics during double-leg squatting.

Trunk Muscle Activities during Ergometer Rowing in Rowers with and without Low Back Pain.

This study aimed to determine the differences in trunk muscle activity during rowing at maximal effort between rowers with and without low back pain (LBP). Ten rowers with LBP and 12 rowers without LBP were enrolled in this study. All rowers performed a 500-m trial using a rowing ergometer at maximal effort. The amplitudes of the activities of the thoracic erector spinae (TES), lumbar erector spinae (LES), latissimus dorsi (LD), rectus abdominis (RA), and external oblique (EO) muscles were analyzed using a wireless surface electromyography (EMG) system. EMG data at each stroke were converted into 10-time series data by recording averages at every 10% in the 100% stroke cycle and normalized by maximum voluntary isometric contraction in each muscle. Two-way repeated measures analysis of variance was performed. Significant interactions were found in the activities of the TES and LES (P < 0.001 and P = 0.047, respectively). In the post hoc test, the TES activity in the LBP group was significantly higher than that in the control group at the 10% to 20% and 20% to 30% stroke cycles (P = 0.013 and P = 0.007, respectively). The LES activity in the LBP group was significantly higher than that in the control group at the 0% to 10% stroke cycle (P < 0.001). There was a main group effect on the LD activity, with significantly higher activity in the LBP group than in the control group (P = 0.023). There were no significant interactions or main effects in the EO and RA activities between the groups. The present study showed that rowers with LBP compared with those without LBP exhibited significantly higher TES, LES, and LD muscle activities. This indicates that rowers with LBP exhibit excessive back muscle activity during rowing under maximal effort.

Improvement in persistent idiopathic facial pain with comorbid ADHD using the combination of a dopamine system stabilizer and psychostimulant: A case report.

Key Clinical Message: Persistent idiopathic facial pain (PIFP) and attention-deficit/hyperactivity disorder (ADHD) may coexist and can be improved with ADHD medications. Thus, clinicians should screen for ADHD by a multidisciplinary approach when treating PIFP and differentiate between other odontogenic disorders. Abstract: We report a case of a woman with persistent idiopathic facial pain (PIFP) and attention-deficit/hyperactivity disorder (ADHD) that markedly improved with the administration of a combination of aripiprazole (APZ) and methylphenidate (MP) treatment. Screening for ADHD and administration of APZ and/or MP may be considered in treating PIFP.

Case report: Remission of chronic low back pain and oral dysesthesia comorbid with attention deficit/hyperactivity disorder by treatment with atomoxetine and pramipexole.

Introduction: Oral dysesthesia is a disease characterized by pain and/or abnormal sensations in the oral region, without any organic abnormality. Its symptoms include pain, and it is considered to be a disorder associated with idiopathic oral-facial pain. It is also known that idiopathic oral-facial pain tends to coexist with chronic musculoskeletal pain, including low back pain, even before its onset. Such coexisting idiopathic pain conditions are also called chronic overlapping pain conditions (COPCs). In general, COPCs are often refractory to treatment. Recently, it has been reported that attention deficit hyperactivity disorder (ADHD) is associated with many COPCs, such as pain in the facial and lower back regions and so on. However, there are no reports of (1) ADHD as a comorbidity with oral dysesthesia (OD) or (2) of the therapeutic effects of ADHD medications or dopamine agonists on low back pain and OD or an (3) evaluation of cerebral blood flow over time after treatment with these medications for OD and low back pain. Case Presentation: In this study, we report the case of an 80-year-old man with OD and chronic low back pain that persisted for more than 25 years. His OD and chronic back pain were refractory to standard treatment, prevented him from continuing work, and tended to be exacerbated by conflicts in his relationship with his son. In recent years, ADHD has often been found to be comorbid with chronic pain, and ADHD medications have been reported to improve chronic pain as well. The patient was confirmed to have undiagnosed ADHD and was treated with the ADHD medication atomoxetine and dopamine agonist pramipexole, which dramatically improved his OD, chronic back pain, and cognitive function. Furthermore, along the course of treatment, there was improvement in cerebral blood flow in his prefrontal cortex, which was thought to reflect improved function in the region. Consequently, he was able to resume work and improve his family relationships. Conclusion: Therefore, in the cases of ODs and COPCs, screening for ADHD and, if ADHD is diagnosed, ADHD medications or dopamine agonists may be considered.

Repetitive pitching decreases the elbow valgus stability provided by the flexor-pronator mass: the effects of repetitive pitching on elbow valgus stability.

BACKGROUND: Baseball pitching induces a large elbow valgus load, stressing the ulnar collateral ligament (UCL). Flexor-pronator mass (FPM) contraction contributes to valgus stability; however, repetitive baseball pitching may weaken the FPM contractile function. The present study investigated the effects of repetitive baseball pitching on the medial valgus stability measured using ultrasonography. We hypothesized that repetitive pitching would decrease elbow valgus stability. METHODS: This was a controlled laboratory study. Fifteen young male baseball players at the collegiate level (age: 23.0 ± 1.4 years) were enrolled. The medial elbow joint space was measured using ultrasonography (B-mode, 12-MHz linear array transducer) in the following three conditions: at rest (unloaded), under 3 kg valgus load (loaded), and under valgus load with maximal grip contraction to activate FPM (loaded-contracted). All measurements were performed before and after the pitching tasks, which comprised five sets of 20 pitches. Two-way repeated-measures analysis of variance was applied to determine changes in the medial elbow joint space. The post hoc test with Bonferroni adjustment was applied to assess the changes within the time and condition. RESULTS: The medial elbow joint space was significantly greater under the loaded than the unloaded and loaded-contracted conditions both before and after pitching (P < .001). In the loaded-contracted condition, the medial elbow joint space significantly increased after repetitive baseball pitching (P < .001). CONCLUSIONS: The results of the present study indicated that repetitive baseball pitching reduced the elbow valgus stability. This reduction could be attributed to the decreased FPM contractile function. Insufficient contraction may increase the tensile load on the UCL with pitching. FPM contraction plays a role in narrowing the medial elbow joint space; however, repetitive baseball pitching reduced the elbow valgus stability. It has been suggested that sufficient rest and recovery of the FPM function are required to reduce the UCL injury risk.

Subsequent Jumping Increases the Knee and Hip Abduction Moment, Trunk Lateral Tilt, and Trunk Rotation Motion During Single-Leg Landing in Female Individuals.

Single-leg landings with or without subsequent jumping are frequently used to evaluate landing biomechanics. The purpose of this study was to investigate the effects of subsequent jumping on the external knee abduction moment and trunk and hip biomechanics during single-leg landing. Thirty young adult female participants performed a single-leg drop vertical jumping (SDVJ; landing with subsequent jumping) and single-leg drop landing (SDL; landing without subsequent jumping). Trunk, hip, and knee biomechanics were evaluated using a 3-dimensional motion analysis system. The peak knee abduction moment was significantly larger during SDVJ than during SDL (SDVJ 0.08 [0.10] N·m·kg-1·m-1, SDL 0.05 [0.10] N·m·kg-1·m-1, P = .002). The trunk lateral tilt and rotation angles toward the support-leg side and external hip abduction moment were significantly larger during SDVJ than during SDL (P < .05). The difference in the peak hip abduction moment between SDVJ and SDL predicted the difference in the peak knee abduction moment (P = .003, R2 = .252). Landing tasks with subsequent jumping would have advantages for evaluating trunk and hip control as well as knee abduction moment. In particular, evaluating hip abduction moment may be important because of its association with the knee abduction moment.