Spinal cord injury etiology, severity, and care in East Asia: a cross-sectional analysis of the International Spinal Cord Society Database Project.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To evaluate etiologic factors associated with spinal cord injury (SCI) severity and to identify predictive factors of reduction in SCI severity in six countries. SETTING: SCI centers in Bangladesh, India, Malaysia, Nepal, Sri Lanka, and Thailand. METHODS: Data from centers collected between October 2015 and February 2021 were analyzed using descriptive statistics and logistic regression. RESULTS: Among 2634 individuals, the leading cause of SCIs was falls (n = 1410, 54%); most occurred from ≥1 meter (n = 1078). Most single-level neurological injuries occurred in the thoracic region (n = 977, 39%). Greater than half of SCIs (n = 1423, 54%) were graded American Spinal Injury Association Impairment Scale (AIS) A. Thoracic SCIs accounted for 53% (n = 757) of all one-level AIS A SCIs. The percentage of thoracic SCIs graded AIS A (78%) was significantly higher than high cervical (52%), low cervical (48%), lumbar (24%), and sacral (31%) SCIs (p < 0.001). Regression analyses isolated predictive factors both of SCI severity and inpatient improvement. Four factors predicted severity: age, neurological level, etiology, and country of residence. Four factors predicted improvement: age, neurological level, AIS grade on intake, and country of residence. CONCLUSIONS: Findings can be used by healthcare providers and public health agencies in these countries to inform the public of the risk of SCI due to falls. Future studies should examine the social and occupational milieux of falls. Country-to-country comparisons of prehospital and inpatient care are also justified. Fall prevention policies can encourage the use of safety equipment when performing tasks at heights ≥1 meter.

The Synchronous Application of Yoga and Myofascial Release Therapy for Musculoskeletal Pain: A Case Report.

Introduction: Musculoskeletal (MSK) pain is common and costly, and conventional care is often inadequate for pain resolution. Although evidence supports movement and manual therapy treatments, the benefits of the synchronous application of these two therapies are sparsely documented and poorly understood. Case presentation: A 40-year-old female presented to a chiropractic practice within a large multispecialty clinic with chronic right-sided thoracolumbar and posterior ribcage, abdominal wall, and anterior hip pain, despite extensive medical workup and multifaceted treatment. Intervention description: Initial chiropractic treatment entailed manual therapy and yoga-based home exercise prescription. Outcome measures during the first two months of treatment fluctuated erratically. In an effort to facilitate at-home yoga practice and to bolster the patient's self-efficacy, myofascial release therapy was combined synchronously with in-clinic yoga practice ("yoga release therapy", YRT). Outcomes: The shift in treatment to YRT was associated with improvements measured on the Patient-Reported Outcomes Measurement Information System (PROMIS) instrument, including: pain rating (50 - 20), pain interference (60 - 47), sleep disturbance (54 - 37), anxiety (46 - 42), fatigue (57 - 43), physical function (32 - 51), and social function (44 - 65). Conclusion: These outcomes indicate a potential role for YRT in an integrative approach to managing MSK pain. They justify prospective research to validate YRT's efficacy and explore its mechanisms.

Physical clinical care and artificial-intelligence-guided core resistance training improve endurance and patient-reported outcomes in subjects with lower back pain.

BACKGROUND: Low back pain is an extremely prevalent issue with an extensive impact, ranging from decreased quality of life to lost years of productivity. Many interventions have been developed to alleviate chronic lower back pain, yet it remains a widespread problem. The objective of this study was to examine the role of artificial intelligence guided resistance training relative to clinical variables in subjects experiencing lower back pain. METHODS: 69 out of 108 enrolled and 92 accrued subjects completed the 8-week intervention. Subjects were randomized into four groups (Control, Training, Clinical, or Combined). The Training cohort received supervised artificial-intelligence-guided core-focused resistance training while the Clinical group received clinical care. The Combined group received both clinical care and artificial-intelligence-guided training and the Control group received no treatment. Participants were evaluated using functional testing and patient-reported outcomes at baseline, 4 weeks, and 8 weeks. FINDINGS: In the clinical tests, the Clinical and Combined cohorts showed increased total time for isometric extensor endurance and the Clinical cohort increased total distance traveled in the 6-min walk test at 8 weeks. The Training, Clinical, and Combined groups showed improvements in Patient-reported outcomes after 8 weeks. Most of the significant improvements were only seen at the 8-week evaluation for both the clinical evaluations and Patient-reported outcomes. The Control group did not show significant improvements in any outcome measures. INTERPRETATION: The present data indicate that core-focused interventions, including artificial-intelligence-guided moderate-resistance exercise, can increase objective functional outcomes and patient satisfaction using Patient-reported outcomes in individuals with lower back pain.

Low back pain does not predict unemployment in a U.S. refugee population: A retrospective cohort study.

Background: Unemployment can limit host-community integration for refugees. Poor health is a leading cause of unemployment among refugees in the U.S. This study assesses whether low back pain (LBP) is predictive of unemployment among a group of refugees in the U.S. Methods: Electronic medical record data were collected for a total of 3,183 refugee patients. General patient characteristics (sex, age, home country, need for English interpretation, tobacco use, and illicit drug use), employment status, and mental illness and LBP diagnoses were studied. Descriptive and logistic regression analyses were used to explore relationships between LBP and unemployment. Results: Of the 12 home countries considered, seven were represented by >40 patients: Somalia (n=1696), Sudan/South Sudan (n=460), Bosnia and Herzegovina (n=280), Iraq (n=266), Ethiopia (n=261), Ukraine (n=72), and Syria (n=60). Nearly a quarter of Iraqi patients suffered from LBP as did approximately 15% of Somali, Syrian, Ethiopian, and Sudanese patients. Nearly half of Iraqi patients were unemployed, as were greater than 30% of Somali, Sudanese, Ukrainian, and Ethiopian patients. A statistically significantly higher percentage of unemployed patients suffered from LBP (17.9%) than employed patients (13.6%) (p=0.003). However, on regression analysis, LBP was not predictive of unemployment (OR: 1.12, p=0.336). Instead, predictive variables included: a patient-reported need for an English interpreter (OR: 3.35, p<.001), female sex (OR: 1.49, p<.001), mental illness (OR: 1.82, p<.001), and illicit drug use (OR: 1.92, p=0.032). Conclusions: Contrary to findings from multiple studies implicating LBP as a leading cause of unemployment in high-income countries, a diagnosis of LBP does not predict unemployment for this group of refugees in the U.S. This finding illuminates a novel dimension of the healthy immigrant effect and indicates a divergent perception of the relationship between LBP and work in the refugee population as compared to non-refugee populations studied in North America and Europe. Further investigation of refugees' perceptions of LBP in relation to work is indicated.

The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States.

BACKGROUND: Spine related disorders entail biological (somatic), psychological, and social factors. Though biological factors are often emphasized, psychosocial considerations may not be receiving proper attention in the chiropractic field. Chiropractors treat spine complaints and therefore should be trained in the full spectrum of the biopsychosocial model. This study examines the use of psychosocial related terminology in United States doctor of chiropractic program (DCP) curricula, the Council on Chiropractic Education (CCE) standards, and the National Board of Chiropractic Examiners (NBCE) test plans. METHODS: Nineteen academic course catalogs, CCE curricular standards and meta-competencies, and NBCE test plans were studied. Terms containing "psycho", "soci", "mental", "econom", "cultur", "emotion", "determinant", "public", "communit", "neighbor", "behav", or "cognitive" were identified in each document. Frequency of use, context of use, thematic categorization, and percentage of use compared to overall content were calculated and described. RESULTS: 'Public' is the most commonly used psychosocial related term in DCP curricula. 'Determinant' was used in 1 DCP curriculum. The number of courses with psychosocial related terminology in course titles and course descriptions ranged from 1 to 5 and 3 to 12, respectively. Most terms are found in clinical skills, special populations, and other miscellaneous courses, with fewer terms found in psychology and public health courses. Terminology use in course titles and descriptions compared to overall content ranges from 3.40 to 14.86%. CCE uses terminology 17 times across 5 (out of 8) total meta-competencies. NBCE includes terminology in test plans I and II, but not III or IV. CONCLUSIONS: Despite evidence suggesting the influential role of psychosocial factors in determinants of health and healthcare delivery, these factors are poorly reflected in United States DCP curricula. This underappreciation is further evidenced by the lack of representation of psychosocial terminology in NBCE parts III and IV test plans. The reasons for this are theoretical; lack of clarity or enforcement of CCE meta-competencies may contribute.

The Manchurian candidate: chiropractors as propagators of neoliberalism in health care.

The rise of neoliberalism has influenced the health care sector, including the chiropractic profession. The neoliberal infiltration of market justice behavior is in direct conflict with the fiduciary agreement to serve the public good before self-interests and has compromised the chiropractor, who now may act as an agent of neoliberalism in health care. The purpose of this paper is to present an overview of the impact of neoliberalism on the chiropractic profession and provide recommendations for a professional philosophical shift from a market justice model to a communal and social justice model.

The role of the locus coeruleus in mediating the attentional blink: a neurocomputational theory.

The attentional blink refers to the transient impairment in perceiving the 2nd of 2 targets presented in close temporal proximity. In this article, the authors propose a neurobiological mechanism for this effect. The authors extend a recently developed computational model of the potentiating influence of the locus coeruleus-norepinephrine system on information processing and hypothesize that a refractoriness in the function of this system may account for the attentional blink. The model accurately simulates the time course of the attentional blink, including Lag 1 sparing. The theory also offers an account of the close relationship of the attentional blink to the electrophysiological P3 component. The authors report results from two behavioral experiments that support a critical prediction of their theory regarding the time course of Lag 1 sparing. Finally, the relationship between the authors' neurocomputational theory and existing cognitive theories of the attentional blink is discussed.

Simplified dynamics in a model of noradrenergic modulation of cognitive performance.

Neurophysiological work in monkeys has shown that changes in tonic and stimulus-induced activity in the noradrenergic brainstem nucleus locus coeruleus (LC) are tightly correlated with fluctuations in behavioral performance in a visual discrimination task. Simulation work suggests transitions between observed modes of LC activity may be mediated by changes in the level of coherent firing among individual LC neurons. We have simplified this simulation by abstracting the LC to a simple, excitable system in two variables modeled after the FitzHugh-Nagumo relaxation oscillator. This abstracted LC simulates population-level dynamics of the nucleus relevant to its influence on behavior. Coherence within the nucleus was simulated as a single parameter which amplified external input to the abstracted LC while attenuating tonic, uncorrelated activity. Simulated results captured LC dynamics and their relationship with behavior observed in monkeys. Behavior was further simulated over a range of potential LC states not, as yet, directly observed. These results suggest a reverse sigmoidal relationship between false alarm rate and coherence, and a more complex, non-monotonic relationship between response time and coherence.