Classifying Changes in Amputee Gait following Physiotherapy Using Machine Learning and Continuous Inertial Sensor Signals.

Wearable sensors allow for the objective analysis of gait and motion both in and outside the clinical setting. However, it remains a challenge to apply such systems to highly diverse patient populations, including individuals with lower-limb amputations (LLA) that present with unique gait deviations and rehabilitation goals. This paper presents the development of a novel method using continuous gyroscope data from a single inertial sensor for person-specific classification of gait changes from a physiotherapist-led gait training session. Gyroscope data at the thigh were collected using a wearable gait analysis system for five LLA before, during, and after completing a gait training session. Data from able-bodied participants receiving no intervention were also collected. Models using dynamic time warping (DTW) and Euclidean distance in combination with the nearest neighbor classifier were applied to the gyroscope data to classify the pre- and post-training gait. The model achieved an accuracy of 98.65% ± 0.69 (Euclidean) and 98.98% ± 0.83 (DTW) on pre-training and 95.45% ± 6.20 (Euclidean) and 94.18% ± 5.77 (DTW) on post-training data across the participants whose gait changed significantly during their session. This study provides preliminary evidence that continuous angular velocity data from a single gyroscope could be used to assess changes in amputee gait. This supports future research and the development of wearable gait analysis and feedback systems that are adaptable to a broad range of mobility impairments.

Visuoauditory Associative Memory Established with Cholecystokinin Under Anesthesia Is Retrieved in Behavioral Contexts.

Plastic change in neuronal connectivity is the foundation of memory encoding. It is not clear whether the changes during anesthesia can alter subsequent behavior. Here, we demonstrated that in male rodents under anesthesia, a visual stimulus (VS) was associated with electrical stimulation of the auditory cortex or natural auditory stimulus in the presence of cholecystokinin (CCK), which guided the animals' behavior in a two-choice auditory task. Auditory neurons became responsive to the VS after the pairings. Moreover, high-frequency stimulation of axon terminals of entorhinal CCK neurons in the auditory cortex enabled LTP of the visual response in the auditory cortex. Such pairing during anesthesia also generated VS-induced freezing in an auditory fear conditioning task. Finally, we verified that direct inputs from the entorhinal CCK neurons and the visual cortex enabled the above neural plasticity in the auditory cortex. Our findings suggest that CCK-enabled visuoauditory association during anesthesia can be translated to the subsequent behavior action.SIGNIFICANCE STATEMENT Our study provides strong evidence for the hypothesis that cholecystokinin plays an essential role in the formation of cross-modal associative memory. Moreover, we demonstrated that an entorhinal-neocortical circuit underlies such neural plasticity, which will be helpful to understand the mechanisms of memory formation and retrieval in the brain.

Changes on Tendon Stiffness and Clinical Outcomes in Athletes Are Associated With Patellar Tendinopathy After Eccentric Exercise.

OBJECTIVE: Eccentric exercise is commonly used as a form of loading exercise for individuals with patellar tendinopathy. This study investigated the change of mechanical properties and clinical outcomes and their interrelationships after a 12-week single-legged decline-board exercise with and without extracorporeal shockwave therapy (ESWT). DESIGN: Randomized controlled trial. SETTING: Outpatient clinic of a university. PARTICIPANTS: Thirty-four male in-season athletes with patellar tendinopathy for more than 3 months were randomized into exercise and combined groups. INTERVENTIONS: The exercise group received a 12-week single-legged decline-squat exercise, and the combined group performed an identical exercise program in addition to a weekly session of ESWT in the initial 6 weeks. MAIN OUTCOME MEASURES: Tendon stiffness and strain were examined using ultrasonography and dynamometry. Visual analog scale and Victoria Institute of Sports Assessment-patella (VISA-p) score were used to assess pain and dysfunction. These parameters were measured at preintervention and postintervention. RESULTS: Significant time effect but no significant group effect on the outcome measures; significant reduction in tendon stiffness (P = 0.02) and increase in tendon strain (P = 0.00); and reduction of intensity of pain (P = 0.00) and dysfunction (P = 0.00) were observed. Significant correlations between changes in tendon stiffness and VISA-p score (ρ = -0.58, P = 0.05); alteration in tendon strain, pain intensity (ρ = -0.63, P = 0.03); and VISA-p score (ρ = 0.60, P = 0.04) were detected after the exercise program. CONCLUSIONS: Eccentric exercise-induced modulation on tendon mechanical properties and clinical symptoms are associated in athletes with patellar tendinopathy.

Decreasing Fear of Falling in Chronic Stroke Survivors Through Cognitive Behavior Therapy and Task-Oriented Training.

Background and Purpose- Research has shown that balance training is effective for reducing the fear of falling in individuals with a history of stroke. In this study, we evaluated (1) whether cognitive behavior therapy could augment the beneficial effects of task-oriented balance training (TOBT) in reducing the fear of falling in chronic stroke survivors and (2) whether it could, in turn, reduce fear-avoidance behavior and improve related health outcomes. Methods- Eighty-nine cognitively intact subjects with mildly impaired balance ability were randomized into the following 2 groups that underwent 90-minutes interventions 2 days per week for 8 weeks: (1) cognitive behavior therapy + TOBT or (2) general health education + TOBT (control). The primary outcome was the fear of falling, and the secondary outcomes were fear-avoidance behavior, balance, fall risk, independent daily living, community integration, and health-related quality of life. The outcomes were assessed at baseline, after 4 and 8 weeks of intervention, and 3 and 12 months after completing the intervention. Results- Eighty-two subjects completed the intervention and follow-up assessments. From postintervention to 12 months after completing the intervention, the cognitive behavior therapy + TOBT participants reported greater reduction in the fear of falling and fear-avoidance behavior and greater improvements in balance and independent daily living than the general health education + TOBT participants. Conclusions- Cognitive behavior therapy should be considered as an adjuvant therapy to standard physiotherapy for cognitively intact individuals with a history of stroke. Clinical Trial Registration- URL: https://clinicaltrials.gov. Unique identifier: NCT02937532.

Brief exposure to intense turbulence induces a sustained life-history shift in echinoids.

In coastal ecosystems, attributes of fluid motion can prompt animal larvae to rise or sink in the water column and to select microhabitats within which they attach and commit to a benthic existence. In echinoid (sea urchin and sand dollar) larvae living along wave-exposed shorelines, intense turbulence characteristic of surf zones can cause individuals to undergo an abrupt life-history shift characterized by precocious entry into competence - the stage at which larvae will settle and complete metamorphosis in response to local cues. However, the mechanistic details of this turbulence-triggered onset of competence remain poorly defined. Here, we evaluate in a series of laboratory experiments the time course of this turbulence effect, both the rapidity with which it initiates and whether it perdures. We found that larvae become competent with turbulence exposures as brief as 30 s, with longer exposures inducing a greater proportion of larvae to become competent. Intriguingly, larvae can remember such exposures for a protracted period (at least 24 h), a pattern reminiscent of long-term potentiation. Turbulence also induces short-term behavioral responses that last less than 30 min, including cessation of swimming, that facilitate sinking and thus contact of echinoid larvae with the substratum. Together, these results yield a novel perspective on how larvae find their way to suitable adult habitat at the critical settlement transition, and also open new experimental opportunities to elucidate the mechanisms by which planktonic animals respond to fluid motion.

Cognitive behavioural therapy for fear of falling and balance among older people: a systematic review and meta-analysis.

BACKGROUND: fear of falling is prevalent among older people and associated with various health outcomes. A growing number of studies have examined the effects of interventions designed to reduce the fear of falling and improve balance among older people, yet our current understanding is restricted to physiological interventions. Psychological interventions such as cognitive behavioural therapy (CBT) have not been reviewed and meta-analysed. OBJECTIVE: to perform a systematic review and meta-analysis evaluating the effects of CBT on reducing fear of falling and enhancing balance in community-dwelling older people. METHOD: randomised controlled trials (RCTs) addressing fear of falling and balance were identified through searches of six electronic databases, concurrent registered clinical trials, forward citation and reference lists of three previous systematic reviews. RESULTS: a total of six trials involving 1,626 participants were identified. Four studies used group-based interventions and two adopted individual intervention. Intervention period ranged from 4 to 20 weeks, and the number and duration of face-to-face contact varied. Core components of the CBT intervention included cognitive restructuring, personal goal setting and promotion of physical activities. The risk of bias was low across the included studies. Our analysis suggests that CBT interventions have significant immediate and retention effects up to 12 months on reducing fear of falling, and 6 months post-intervention effect on enhancing balance. CONCLUSIONS: CBT appears to be effective in reducing fear of falling and improving balance among older people. Future researches to investigate the use of CBT on reducing fear of falling and improving balance are warranted.

The effect of whole body vibration training on quadriceps voluntary activation level of people with age-related muscle loss (sarcopenia): a randomized pilot study.

BACKGROUND: Whole body vibration was an effective training for improving muscle performance. The purpose of this study was to explore the effects of 12-week whole-body vibration training program on voluntary activation of quadriceps muscles of older people with age-related muscle loss (sarcopenia). METHODS: Twelve community dwelling seniors with age-related muscle loss were randomly allocated into whole body vibration training group and control group. The training lasted for 12 weeks. Twitch interpolation were conducted to examine the voluntary activation of quadriceps at pre- and post-intervention. RESULTS: Although there was no significant difference between whole body vibration training group and control group on the absolute values of the interpolated twitch ratio after 12 weeks of training. The changed values of ratio (Post minus Pre) were significantly different between the two groups (p = 0.044). CONCLUSIONS: The voluntary activation of quadriceps muscles of older people with age-related muscle loss was facilitated after 12 weeks of WBV training with 40 Hz × 4 mm × 360 s. Considering the small sample size of this study, it may only provide a piece of evidence that WBV is effective for facilitating the central motor drive in seniors with age-related muscle loss. More subjects are needed to confirm the present finding. TRIAL REGISTRATION: ISRCTN63583948 , registered on 16th January 2017, retrospectively registered.

Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis.

OBJECTIVE: To evaluate (1) the effectiveness of transcutaneous electrical nerve stimulation (TENS) at improving lower extremity motor recovery in stroke survivors and (2) the optimal stimulation parameters for TENS. REVIEW METHODS: A systematic search was conducted for studies published up to October 2017 using eight electronic databases (CINAHL, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PEDro, PubMed and Web of Science). Randomized controlled trials that evaluated the effectiveness of the application of TENS at improving lower extremity motor recovery in stroke survivors were assessed for inclusion. Outcomes of interest included plantar flexor spasticity, muscle strength, walking capacity and balance. RESULTS: In all, 11 studies met the inclusion criteria which involved 439 stroke survivors. The meta-analysis showed that TENS improved walking capacity, as measured by either gait speed or the Timed Up and Go Test (Hedges' g = 0.392; 95% confidence interval (CI) = 0.178 to 0.606) compared to the placebo or no-treatment control groups. TENS also reduced paretic plantar flexor spasticity, as measured using the Modified Ashworth Scale and Composite Spasticity Scale (Hedges' g = -0.884; 95% CI = -1.140 to -0.625). The effect of TENS on walking capacity in studies involving 60 minutes per sessions was significant (Hedges' g = 0.468; 95% CI = 0.201-0.734) but not in study with shorter sessions (20 or 30 minutes) (Hedges' g = 0.254; 95% CI = -0.106-0.614). CONCLUSION: The results support the use of repeated applications of TENS as an adjunct therapy for improving walking capacity and reducing spasticity in stroke survivors.

Optimal frequency/time combination of whole body vibration training for developing physical performance of people with sarcopenia: a randomized controlled trial.

OBJECTIVE: To determine whether frequency and exposure time to whole body vibration influenced its effects on physical performance in seniors with sarcopenia. DESIGN: Randomized controlled trial Setting: A university sports training laboratory. SUBJECTS: Eighty community dwelling seniors with sarcopenia were recruited. INTERVENTIONS: Participants were randomly divided into 4 groups, namely, low-frequency (LG: 20Hz x 720s), medium-frequency (MG: 40Hz x 360s), high-frequency (HG: 60Hz x 240s) and control (CG: no extra training) for 12 weeks of whole body vibration training and 12 weeks of follow-up. MAIN MEASURES: Assessments were done at baseline, mid-intervention, post-intervention, mid-follow-up, and final follow-up for five-repetition sit-to-stand, 10-meter walking test with self-preferred speed and timed-up-and-go test. RESULTS: There was significant time × group interaction effect in timed-up-and-go test (F12, 304 = 3.333, effect size = 0.116, p < 0.001). Between-group differences in percentage change from baseline were significant between medium-frequency group and control group on all outcome variables after 12-week whole body vibration training (Five-repetition sit-to-stand test: 10.46 ± 2.28 (-16.12%), p = 0.008; 10-meter walking test: 1.05 ± 0.16 (11.18%), p = 0.04; Timed-up-and-go test: 11.32 ± 1.72 (-15.08%), p = 0.001). CONCLUSION: With the total number of vibrations controlled, the combination of 40Hz and 360s of whole body vibration has the best outcome on physical performance of people with sarcopenia.

An investigation of the psychometric properties of the Chinese (Cantonese) version of Subjective Index of Physical and Social Outcome (SIPSO).

OBJECTIVE: The objectives of this study were 1) to translate and make cultural adaptations to the English version of the SIPSO questionnaire to create a Chinese (Cantonese) version, 2) evaluate the internal consistency, test-retest reliability the C-SIPSO questionnaire, and 3) compare the SIPSO-C scores of stroke survivors with different demographic characteristics to establish the discriminant validity of the questionnaire Design: Translation of questionnaire, cross sectional study. SETTING: University-based clinical research laboratory. Subjects Community-dwelling chronic stroke survivors. INTERVENTIONS: Not applicable. MAIN MEASURES: Subjective Index of Physical and Social Outcome, Geriatric Depression Scale, 10-metre Walk test. RESULTS: Two bilingual professional translators translated the SIPSO questionnaire independently. An expert panel comprising five registered physiotherapists verified the content validity of the final version (C-SIPSO). C-SIPSO demonstrated good internal consistency (Cronbach's α = 0.83) and excellent test-retest reliability (ICC3,1 = 0.866) in ninety-two community dwelling chronic stroke survivors. Stroke survivors scored higher than 10 in the Geriatric Depression Scale ( U = 555.0, P < 0.001) and with the comfortable walking speed lower than 0.8ms-1 ( U = 726.5; P = 0.012) scored significantly lower on SIPSO-C. CONCLUSION: SIPSO-C is a reliable instrument that can be used to measure the level of community integration in community-dwelling stroke survivors in Hong Kong and southern China. Stroke survivors who were at high risk of minor depression and with limited community ambulation ability demonstrated a lower level of community integration as measured with SIPSO-C.

Effect of Leg Selection on the Berg Balance Scale Scores of Hemiparetic Stroke Survivors: A Cross-Sectional Study.

OBJECTIVE: To examine whether selection of the nonparetic or paretic leg as the weight-bearing leg in item 13 (standing unsupported one foot in front) and item 14 (standing on one leg) of the Berg Balance Scale (BBS) influences the item scores, and thus the total score. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation laboratory. PARTICIPANTS: Community-dwelling people (N=63, aged ≥50y) with chronic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: BBS. RESULTS: The 4 BBS total scores ranged from 48.4 to 50.7. The total score was significantly lower when a participant was asked to step forward with the nonparetic leg in item 13, and stand on the paretic leg in item 14. Fewer participants received a maximum score with the BBS1 formulation than the others. In addition, the correlations with walking speed and Activities-specific Balance Confidence Scale scores were greatest with the BBS1 score. CONCLUSIONS: Our findings suggest that BBS1 was the most challenging formulation for our participants; this might serve to minimize the ceiling effect of the BBS. These findings provide a rationale for amending the BBS administration guidelines with the BBS1 formulation.

Fear Avoidance Behavior, Not Walking Endurance, Predicts the Community Reintegration of Community-Dwelling Stroke Survivors.

OBJECTIVE: To examine the contribution of walking endurance, subjective balance confidence, and fear avoidance behavior to community reintegration among community-dwelling stroke survivors. DESIGN: Cross-sectional study. SETTING: University-based rehabilitation center. PARTICIPANTS: Patients with chronic stroke (N=57) aged ≥50 years. INTERVENTIONS: None. MAIN OUTCOME MEASURE: The Chinese version of the Community Integration Measure (CIM). RESULTS: Our correlation analyses revealed that fear avoidance behavior as measured by the Chinese version of the Survey of Activities and Fear of Falling in the Elderly (SAFE) scores had the highest significant negative correlation with CIM scores among all the variables tested. Our regression analyses also revealed that walking endurance and subjective balance confidence were not significant predictors of CIM scores. Based on scores on the number of falls in the previous 6 months, Chinese version of the Geriatric Depression Scale scores, distance covered in the 6-minute walk test, and Chinese versions of the Activities-specific Balance Confidence Scale scores and SAFE scores, our final regression model predicted 49.7% of the variance in the Chinese version of the CIM scores. CONCLUSIONS: The levels of walking endurance and subjective balance confidence are not significant predictors of community reintegration of community-dwelling stroke survivors but the fear avoidance behavior. Future studies addressing fear avoidance behavior is clearly warranted for stroke rehabilitation.

Acute effects of whole-body vibration on trunk muscle functioning in young healthy adults.

The purpose of this study was to explore the immediate effects of different frequencies of whole-body vibration (WBV) on the performance of trunk muscles of healthy young adults. A group of 30 healthy subjects (15 men; 15 women; age, 26.8 ± 3.74 years; body mass index, 21.9 ± 1.802) participated in the study. Each subject received 3 sessions of vibration exercise with different exercise parameters with frequencies of 25 Hz and 40 Hz and sham stimulation in a random order on different days. Before and after each WBV exercise session, subjects were assessed for trunk muscle strength/endurance tests and trunk proprioception tests. There was a significant increase in trunk extensor strength (p ≤ 0.05) after low-frequency (25 Hz) WBV exercise, but high-frequency (40 Hz) vibration exercise had resulted in a significant decrease in trunk extensor endurance (p ≤ 0.05). Statistical gender difference (p = 0.04) was found for trunk extensor endurance with lower WBV training. No change was noted in the trunk proprioception with different frequencies of WBV. In conclusions, the immediate response of the body to WBV was different for low and high frequencies. Low-frequency vibration enhanced trunk extensor strength, but high-frequency vibration would decrease endurance of the trunk extensor muscles. Males are more sensitive than females in trunk extensor endurance for lower frequency WBV exposure. These results indicated that short-term WBV with low frequency was effective to improve trunk extensor strength in healthy adults, and that could be helpful for relevant activities of trunk extensor performing and preventing sport injury.

In vivo and ex vivo approaches to studying the biomechanical properties of healing wounds in rat skin.

An evaluation of wound mechanics is crucial in reflecting the wound healing status. The present study examined the biomechanical properties of healing rat skin wounds in vivo and ex vivo. Thirty male Sprague-Dawley rats, each with a 6 mm full-thickness circular punch biopsied wound at both posterior hind limbs were used. The mechanical stiffness at both the central and margins of the wound was measured repeatedly in five rats over the same wound sites to monitor the longitudinal changes over time of before wounding, and on days 0, 3, 7, 10, 14, and 21 after wounding in vivo by using an optical coherence tomography-based air-jet indentation system. Five rats were euthanized at each time point, and the biomechanical properties of the wound tissues were assessed ex vivo using a tensiometer. At the central wound bed region, the stiffness measured by the air-jet system increased significantly from day 0 (17.2%), peaked at day 7 (208.3%), and then decreased progressively until day 21 (40.2%) as compared with baseline prewounding status. The biomechanical parameters of the skin wound samples measured by the tensiometer showed a marked reduction upon wounding, then increased with time (all p < 0.05). On day 21, the ultimate tensile strength of the skin wound tissue approached 50% of the normal skin; while the stiffness of tissue recovered at a faster rate, reaching 97% of its prewounded state. Our results suggested that it took less time for healing wound tissues to recover their stiffness than their maximal strength in rat skin. The stiffness of wound tissues measured by air-jet could be an indicator for monitoring wound healing and contraction.

Convolutional Neural Network for Estimating Spatiotemporal and Kinematic Gait Parameters using a Single Inertial Sensor.

Lower limb disability severely impacts gait, thus requiring clinical interventions. Inertial sensor systems offer the potential for objective monitoring and assessment of gait in and out of the clinic. However, it is imperative such systems are capable of measuring important gait parameters while being minimally obtrusive (requiring few sensors). This work used convolutional neural networks to estimate a set of six spatiotemporal and kinematic gait parameters based on raw inertial sensor data. This differs from previous work which either was limited to spatiotemporal parameters or required conventional strap-down integration techniques to estimate kinematic parameters. Additionally, we investigated a data segmentation method which does not rely on gait event detection, further supporting its applicability in real-world settings.Preliminary results demonstrate our model achieved high accuracy on a mix of spatiotemporal and kinematic gait parameters, either meeting or exceeding benchmarks based on literature. We achieved 0.04 ± 0.03 mean absolute error for stance-time symmetry ratio and an absolute error of 4.78 ± 4.78, 4.50 ± 4.33, and 6.47 ± 7.37cm for right and left step length and stride length, respectively. Lastly, errors for knee and hip ranges of motion were 2.31 ± 4.20 and 1.73 ± 1.93°, respectively. The results suggest that machine learning can be a useful tool for long-term monitoring of gait using a single inertial sensor to estimate measures of gait quality.

Colorectal Cancer Presenting as Sacral Pain at a Chiropractic Clinic.

This case report describes a diagnosis of spinal pain secondary to metastatic colon cancer, highlighting the need for close monitoring and an interdisciplinary approach for this cohort. An 82-year-old female presented with acute exacerbation of chronic low back pain with a rating of 7/10. She had a history of stage III colon cancer diagnosed 17 years previously and was currently in remission. Red flags included worsening pain after four days of oral analgesics and a history of cancer. Imaging revealed an osteolytic L5 vertebral lesion with endplate disruption, consistent with metastasis. She was urgently referred to an oncologist who ordered chemotherapy and radiotherapy. The metastatic spread of malignancy to the spine can manifest as new or progressive back pain and requires prompt diagnosis and management. Magnetic resonance imaging is recommended for the detection of osseous lesions and spinal cord compression. The case report serves as an educational tool for chiropractors in recognizing and managing spinal metastasis. By sharing this case report, healthcare professionals can learn from the experiences and challenges faced during the patient's care and apply that knowledge to their practice.

Undiagnosed Osteoporotic Vertebral Fractures in an Octogenarian During the Coronavirus Disease Pandemic.

Osteoporotic vertebral fractures are frequently misdiagnosed or under-recognized in the older population, leading to disease progression and reduced quality of life. This case of an 87-year-old woman with acute back pain highlights the importance of early diagnosis and management of fragility fractures. During the coronavirus disease (COVID-19) pandemic, patients with a history of well-managed osteoporosis experienced worsening symptoms of vertebral collapse due to activity limitations and prolonged immobilization. The initial diagnosis of spinal stenosis delayed appropriate treatment for four months. Serial magnetic resonance imaging revealed compression fractures at L1 and L3, and a dual-energy x-ray absorptiometry scan showed osteoporosis with a T-score of -3.2. Pharmacological therapy, including bisphosphonates, was initiated. A comprehensive rehabilitation program with a multidisciplinary approach, with bracing, and lifestyle changes helped stabilize the spine, reduce pain, and maximized function. Her condition improved with close monitoring and guidance during home exercises. This case exemplifies the necessity of a precise and timely diagnosis of osteoporotic vertebral fractures to initiate management and mitigate disease progression.

A Central Slip Injury in a Professional Basketball Player.

Hand injuries are extremely prevalent in sports such as ball sports. Delayed diagnosis or improperly managed injuries have the potential to prolong the athlete's return to the competition and permanently damage their abilities. We report the case of a 35-year-old male professional basketball player who presented to a chiropractor with pain and swelling of the right fifth finger two days after a basketball game. The injury occurred when a player passed the basketball and the ball hit his fifth finger "head-on". Examination revealed enlargement of the middle joint of the right fifth finger and a boutonniere deformity. He was diagnosed with a central slip injury using magnetic resonance imaging (MRI). Since there are no standard treatment guidelines for central slip injuries, multi-model chiropractic therapy was applied to the injury and adjacent sites. The patient returned to the game by the end of the third week and fully recovered within six weeks. Chiropractors must understand how to best guide athletes' clinical management of these injuries, given the inherent need for immediate and complete recovery.

Thyroid Cancer Presenting as Neck Pain at a Chiropractic Clinic.

We report an unusual case of metastatic papillary thyroid carcinoma presenting with progressive neck pain in a 58-year-old female with known bilateral thyroid nodules. Despite initial benign ultrasonographic findings and trials of conservative therapy for over 2 months, the patient's anterior neck pain and unremitting symptoms prompted concern regarding an underlying orthopedic condition. She sought chiropractic consultation, and MRI revealed pathologic vertebral fractures. Biopsy of the thyroid and vertebral bone lesions demonstrated metastatic thyroid carcinoma. The patient was diagnosed with papillary thyroid cancer. The early detection of metastatic disease is critical for optimizing oncological treatment and outcomes. This case highlights the importance of close follow-up when the initial workup or management fails, consideration of sinister pathologies in high-risk patients, and a multidisciplinary approach to complex conditions. It provides an important reminder not to attribute unresolved symptoms to benign causes without serial re-evaluation, especially in patients with known risks, such as thyroid disease. A high index of suspicion and openness to atypical disease presentations is fundamental to avoid missed opportunities for diagnosis and prompt treatment.

Pediatric Text Neck Syndrome.

Text neck syndrome is a growing concern in the pediatric population due to the increased use of mobile devices and screens, potentially leading to long-lasting musculoskeletal issues. This case report presents a six-year-old boy with a one-month history of cephalgia and cervicalgia, who initially received insufficient care. After nine months of chiropractic intervention, the patient reported significant improvements in pain relief, neck mobility, and neurological symptoms, supported by radiographic findings. This report emphasizes the importance of early recognition and intervention in pediatric patients, as well as the role of ergonomics, exercise, and proper smartphone usage habits in preventing text neck and maintaining spinal health.