Reliability and validity of knee valgus angle calculation at single-leg drop landing by posture estimation using machine learning.

Background: The consensus on anterior cruciate ligament (ACL) injury prevention involves the suppression of dynamic knee valgus (DKV). The gold standard for evaluating the DKV includes three-dimensional motion analysis systems; however, these are expensive and cannot be used to evaluate all athletes. Markerless motion-capture systems and joint angle calculations using posture estimation have been reported. However, there have been no reports on the reliability and validity of DKV calculations using posture estimation. Research question: This study aimed to clarify the reliability and validity of DKV calculation using posture estimation. Methods: Fifteen participants performed 10 single-leg jump landings from a height of 20 cm, and the knee joint angle was calculated using joint points measured using machine learning (MediaPipe Pose) and motion-capture systems (VICON MX). Two types of angle calculation methods were used: absolute value and change from the initial ground contact (IC). Intra- and inter-rater reliabilities were examined using intraclass correlation coefficients, and concurrent validity was examined using Pearson's correlation coefficients. To examine intra-examiner reliability, we performed single-leg jump landings at intervals of ≥3 days. Results: The calculation by MediaPipe Pose was significantly higher than that by the 3-D motion analysis systems (p < 0.05, error range 18.83-19.68°), and there was no main effect of knee valgus angle or time on the excursion angle from IC (p > 0.05). No significant concurrent validity was found in the absolute value, which was significantly correlated with the change in IC. Although the inter-rater reliability of the absolute value was low, the change in IC showed good reliability and concurrent validity. Significance: The results of this research suggest that the DKV calculation by pose estimation using machine learning is practical, with normalization by the angle at IC.

Anterior talofibular ligament footprint dimension measured using three-dimensional magnetic resonance imaging.

OBJECTIVE: Knowledge of footprint anatomy is essential for ankle anterior talofibular ligament repair and reconstruction. We aimed to determine the intra- and inter-rater measurement reliability of the anterior talofibular ligament footprint dimension using three-dimensional MRI. METHODS: MRI images of 20 ankles with intact ligaments, including 11 with a single bundle and nine with double-bundle ligaments, were analyzed. Imaging was performed using a 3.0-Tesla MRI. Isotropic three-dimensional proton density-weighted images with a voxel size of 0.6 mm were obtained. The fibular and talar footprints were manually segmented using image processing software to create three-dimensional ligament footprints. The lengths, widths, and areas of each sample were measured. A certified orthopedic surgeon and a senior orthopedic fellow performed the measurements twice at 6-week intervals. The intra- and inter-rater differences in the measurements were calculated. RESULTS: The length, width, and area of the single-bundle fibular footprint were 8.7 mm, 5.4 mm, and 37.4 mm2, respectively. Those of the talar footprint were 8.4 mm, 4.3 mm, and 30.1 mm2, respectively. The inferior bundle of the double-bundle ligament was significantly smaller than the single and superior bundles (p < 0.001). No differences were observed between intra-rater measurements by either rater, with maximum differences of 0.7 mm, 0.5, and 1.7 mm2, in length, width, and area, respectively. The maximum inter-rater measurement differences were 1.9 mm, 0.5, and 2.4 mm2, respectively. CONCLUSION: Measurements of the anterior talofibular ligament dimensions using three-dimensional MRI were sufficiently reliable. This measurement method provides in vivo quantitative data on ligament footprint anatomy.

Changed resting-state connectivity of anterior insular cortex affects subjective pain reduction after knee arthroplasty: A longitudinal study.

The mechanism of chronic knee osteoarthritis (OA) pain and postoperative pain due to knee arthroplasty has not been elucidated. This could be involved neuroplasticity in brain connectivity. To clarify the mechanism of chronic knee OA pain and postoperative pain, we examined the relationship between resting-state functional connectivity (rs-FC) and clinical measurements in knee OA before and after knee arthroplasty, focusing on rs-FCs with the anterior insular cortex (aIC) as the key region. Fifteen patients with knee OA underwent resting-state functional magnetic resonance imaging and clinical measurements shortly before and 6 months after knee arthroplasty, and 15 age- and sex-matched control patients underwent an identical protocol. Seed-to-voxel analysis was performed to compare the clinical measurements and changed rs-FCs, using the aIC as a seed region, between the preoperative and postoperative patients, as well as between the operative and control patients. In preoperative patients, rs-FCs of the aIC to the OFC, frontal pole, subcallosal area, and medial frontal cortex increased compared with those of the control patients. The strength of rs-FC between the left aIC and right OFC decreased before and after knee arthroplasty. The decrease in rs-FC between the left aIC and right OFC was associated with decreased subjective pain score. Our study showed a correlation between longitudinally changed rs-FC and clinical measurement before and after knee arthroplasty. Rs-FC between the aIC and OFC have the potential to elucidate the mechanisms of knee OA pain and postoperative pain due to knee arthroplasty.

Continuous local antibiotic perfusion for deep infection of the foot and ankle.

BACKGROUND: This study aimed to report the outcome of deep infections of the foot and ankle, which are among the most challenging orthopedic conditions to treat, after continuous local antibiotic perfusion. METHODS: Eleven patients with deep foot and ankle infections were treated with continuous local antibiotic perfusion between January 2019 and March 2024. After surgical debridement, we performed continuous perfusion of high concentrations of gentamicin (60 mg/50 ml) directly into the infected bone and soft tissue for two weeks using bone marrow needles and double-lumen tubes. Patient characteristics, infection relapse, and adverse events were investigated. RESULTS: The mean age of the patients was 53 years (range 12-79 years), with six males and five females. The infections were controlled without additional surgeries in ten patients with a mean follow-up of 40 months (12-62 months). Two patients developed a fungal infection, of which one required an additional debridement surgery, and the other was treated with oral antifungal medication. No adverse events occurred due to high-concentration gentamicin. CONCLUSIONS: Short-term infection control was achieved using continuous local antibiotic perfusion; thus, it can be a treatment option for deep infections of the foot and ankle.

Time course of biomechanics during jump landing before and after two different fatigue tasks.

Objective: Muscle fatigue contributes to anterior cruciate ligament (ACL) injuries, with increased knee and hip abduction observed during fatigue. However, there have been no reports revealing the differences between fatigue tasks or the duration of these changes. In this study, we conducted single-leg drop landings before and after hip and knee fatigue tasks to elucidate the changes in lower limb biomechanics over time. Methods: Twenty-two male participants performed single-leg drop landings before, immediately after, and 5, 10, and 15 min after fatigue tasks involving isokinetic hip abduction/adduction (hip fatigue task [HFT]) and knee extension/flexion (knee fatigue task [KFT]). Hip and knee kinematic and kinetic data were collected using a three-dimensional motion analysis device and two force plates. A two-way ANOVA was performed with both the fatigue task (HFT and KFT) and time point (Time 1 to Time 4) as factors, and the main effects and interactions were calculated. Results: The knee adduction angle after the HFT was significantly greater than that after KFT immediately following the fatigue task. The knee flexion moment was significantly lower in the KFT, whereas the knee adduction and internal rotation moments were significantly higher in the HFT immediately after the fatigue task. Conclusion: This study revealed distinct kinematic and kinetic changes specific to each fatigue task, particularly in the frontal plane for hip joint tasks and the sagittal plane for knee joint tasks. These findings could assist in the development of ACL injury prevention programs tailored to the functional improvement and exercise capacity of each joint.

Long-Term Rehabilitation Therapy Is Effective for Physical Function in a Patient With Amyloid Light Chain Amyloidosis Complicated by Nephrotic Syndrome: A Case Report and Literature Review.

We report on the rehabilitation of a patient with amyloid light chain (AL) amyloidosis complicated by nephrotic syndrome. Various symptoms produced by AL amyloidosis, including nephrotic syndrome, complicate rehabilitation therapy. In this case report, long-term physical therapy was initiated prior to autologous peripheral blood stem cell transplantation owing to the risk of further decline in physical function due to decreased mobility and physical activity. Patients were instructed on how to perform home exercise therapy. Furthermore, compliance was monitored using a checklist and regular face-to-face feedback. There was no increase in skeletal muscle mass, but improvements in grip strength, lower extremity muscle strength, and phase angle were observed after 24 weeks of physical therapy. Despite the absence of partial remission (urinary protein level of 3.5 g/gCre or higher), nephrotic syndrome demonstrated a trend toward improvement. Since the effectiveness of physical therapy in such patients has not yet been fully established, this report suggests that long-term rehabilitation therapy for physical function in patients with nephrotic syndrome complicated by persistent proteinuria may be effective.

Analysis of the suprahyoid muscles during tongue elevation: High-density surface electromyography as a novel tool for swallowing-related muscle assessment.

BACKGROUND: High-density surface electromyography (HD-sEMG) has enabled non-invasive analysis of motor unit (MU) activity and recruitment, but its application to swallowing-related muscles is limited. OBJECTIVE: We aimed to investigate the utility of HD-sEMG for quantitatively evaluating the MU recruitment characteristics of the suprahyoid muscles during tongue elevation. METHODS: We measured the sEMG activity of the suprahyoid muscles of healthy participants during tongue elevation using HD-sEMG. Maximum voluntary contraction (MVC) was measured, followed by data collection during sustained and ramp-up tasks to capture suprahyoid muscle activity. Changes in the temporal/spatial MU recruitment patterns within individual suprahyoid muscles were analysed. RESULTS: This study enrolled 16 healthy young adults (mean age: 27.8 ± 5.3 years; eight males and eight females). Increasing muscle force corresponded to a decrease in modified entropy and correlation coefficient and an increase in the coefficient of variation. No significant differences were observed between male and female participants. CONCLUSION: The results of this study, consistent with those observed in other muscles, such as the vastus lateralis muscle, suggest that HD-sEMG is a valuable and reliable tool for quantitatively evaluating MU recruitment in the suprahyoid muscles. This measurement technique holds promise for novel assessments of swallowing function.

Temporal validation of a clinical prediction rule for distinguishing locomotive syndromes in community-dwelling older adults: A cross-sectional study from the DETECt-L study.

Objectives: Clinical prediction rules are used to discriminate patients with locomotive syndrome and may enable early detection. This study aimed to validate the clinical predictive rules for locomotive syndrome in community-dwelling older adults. Methods: We assessed the clinical prediction rules for locomotive syndrome in a cross-sectional setting. The age, sex, and body mass index of participants were recorded. Five physical function tests-grip strength, single-leg standing time, timed up-and-go test, and preferred and maximum walking speeds-were measured as predictive factors. Three previously developed clinical prediction models for determining the severity of locomotive syndrome were assessed using a decision tree analysis. To assess validity, the sensitivity, specificity, likelihood ratio, and post-test probability of the clinical prediction rules were calculated using receiver operating characteristic curve analysis for each model. Results: Overall, 280 older adults were included (240 women; mean age, 74.8 ± 5.2 years), and 232 (82.9%), 68 (24.3%), and 28 (10.0%) participants had locomotive syndrome stages ≥ 1, ≥ 2, and = 3, respectively. The areas under the receiver operating characteristics curves were 0.701, 0.709, and 0.603, in models 1, 2, and 3, respectively. The accuracies of models 1 and 2 were moderate. Conclusions: These findings indicate that the models are reliable for community-dwelling older adults.

Cervical percutaneous interferential current stimulation improves citric acid cough tests in patients with Parkinson's disease on medication.

Aspiration pneumonia is the leading cause of death in patients with Parkinson's disease. The incidence of silent aspiration is high in such patients owing to decreased pharyngeal and laryngeal sensation; thus, interventions for this condition may help prevent pneumonia. In this single-arm, open-label study, we used a cervical percutaneous interferential current stimulation device to activate pharyngeal and laryngeal sensory nerves. We evaluated its effectiveness in patients with Hoehn-Yahr stages 2-4 Parkinson's disease. The primary endpoint was the proportion of patients with a normal cough reflex after consuming 1% citric acid at the end of the intervention compared with baseline measurements. In total, 25 patients received neck percutaneous interferential current stimulation for 20 min twice weekly for 8 weeks. Afterward, the proportion of patients with a normal cough reflex after 1% citric acid consumption increased significantly (p = 0.001), whereas other indicators, such as tongue pressure, peak expiratory flow, and penetration or aspiration during videofluoroscopic examination, remained unchanged. A longer duration of illness, higher Unified Parkinson's Disease Rating Scale total scores, and higher levodopa equivalent daily doses were significantly associated with improved cough test outcomes. Hence, cervical percutaneous interferential current stimulation significantly improved cough reflexes and may improve silent aspiration. Trial Registration: Japan Registry of Clinical Trials, jRCTs062220013, first registered 09/05/2022.

Differences in lower-limb biomechanics during single-leg landing considering two peripheral fatigue tasks.

Dynamic knee valgus (DKV) occurs during landing after a fatigue task involving the lower extremity. However, the manner in which different peripheral fatigue tasks affect DKV remains unknown. In this study, we investigated the DKV via electromyography during single-leg landing considering the hip-joint fatigue task (HFT) and knee-joint fatigue task (KFT) performed by healthy men. We recruited 16 healthy male participants who performed a single-leg jump-landing motion from a height of 20 cm before and after an isokinetic hip abduction/adduction task (HFT) and knee extension/flexion task (KFT). Three-dimensional motion analysis systems were attached to the left gluteus medius and quadriceps, and surface electromyography was used to analyze the lower limb kinematics, kinetics, and muscle activity. The primary effects and interactions of the task and fatigue were identified based on the two-way repeated-measures analysis of variance. The results of the average angle during landing indicated that DKV occurs in KFT, whereas HFT applies external forces that adduct and internally rotate the knee at peak vertical ground reaction force (vGRF). Furthermore, both KFT and HFT exhibited an increase in muscle activity in the quadriceps. The analysis revealed that the occurrence of DKV varies depending on the peripheral fatigue task, and the effects on average DKV during landing and DKV at peak vGRF vary depending on the peripheral fatigue task.

Functional electrostimulation therapy for vastus medialis decreases the varus thrust during gait.

[Purpose] This study aimed to investigate whether modification of vastus medialis activity can delay the varus thrust. [Participants and Methods] Ten participants (Kellgren-Laurence grades I: n=2, II: n=6, and III: n=2) diagnosed with knee osteoarthritis were enrolled. The intervention involved free walking on a 10-m walkway at any speed after donning a functional electrical stimulation set to contract the vastus medialis before heel contact. Using a Vicon Nexus ground reaction force meter and a wireless electromyograph DELSYS, varus thrust, maximal knee extension angle, maximal knee adduction moment, and vastus medialis onset time were assessed both before and after intervention. [Results] A significant difference in varus thrust was detected from before to after the intervention (2.7 ± 1.1° vs. 2.2 ± 1.3°). Both the vastus medialis activation time (-0.06 ± 0.09 vs. -0.21 ± 0.1) and the knee-joint extension angle (8.7 ± 5.1° vs. 5.5 ± 5.9°) decreased following intervention, whereas the knee adduction moment significantly increased (0.50 ± 0.20° vs 0.56 ± 0.18°). [Conclusion] Wearing the functional electrical stimulation set caused the vastus medialis to act earlier in response to heel strike, thereby improving the knee-joint extension angle and suppressing varus thrust.

Advanced liver fibrosis is associated with decreased gait speed in older patients with chronic liver disease.

This study investigated whether the progression of liver fibrosis affects the prevalence of sarcopenia and incidence of decreased gait speed in older patients with chronic liver disease (CLD). Patients with CLD aged ≥ 60 years were classified into low, intermediate, and high fibrosis 4 (FIB-4) index groups according to the degree of liver fibrosis. The prevalence of sarcopenia and incidence of decreased gait speed (< 1.0 m/s) were compared among the three groups. Logistic regression analysis was performed to investigate factors affecting the risk of decreased gait speed. No significant difference was observed in the prevalence of sarcopenia among the three groups, but the incidence of decreased gait speed significantly differed (p = 0.029). When analyzed individually, a significant difference in decreased gait speed incidence was observed between the high and low FIB-4 index groups (p = 0.014). In logistic regression analysis, the progression of liver fibrosis (odds ratio: 1.32, 95% confidence interval: 1.13-1.55) and lower extremity muscle strength (LEMS) (odds ratio: 0.92, 95% confidence interval: 0.88-0.97) were significantly associated with decreased gait speed. As liver fibrosis progresses in older patients with CLD, it becomes important to focus on not only skeletal muscle mass and grip strength, but also gait speed and LEMS.

A Novel Surgical Technique Using a Hockey Stick-Like Guided Knife to Go Through the Eyes of a Needle for Trigger Finger.

Trigger finger surgery is primarily managed with open surgery accompanied by 10-14 days of postoperative recovery, which may interrupt activities of daily living. In the past, we attempted to perform percutaneous surgery by inserting a hockey stick-shaped guide knife through a scalpel incision several millimeters long. Sometimes, we encounter difficult cases wherein triggering does not disappear despite repeated attempts to release the A1 pulley through the small incision, thus forcing us to extend the incision. As a result, the postoperative recovery is sometimes prolonged. We describe our experience using a novel percutaneous procedure in which a guide knife was inserted through one or two 20-gauge needle holes, instead of a scalpel skin incision, to release the A1 pulley. We describe a new method that minimizes skin and soft tissue damage and reliably shortens posttreatment recovery.

Association between motor symptoms of Parkinson's disease and swallowing disorders.

BACKGROUND: Parkinson's disease (PD) presents with motor symptoms that hinder physical activity. This study aimed to thoroughly investigate swallowing dysfunction in patients with PD using videofluoroscopy (VF) and the Movement Disorder Society (MDS)-Unified PD Rating Scale (UPDRS) sub-scores. METHODS: This study was part of an intervention project to evaluate the effectiveness of cervical percutaneous interferential current stimulation in patients with Hoehn and Yahr stages 2-4 PD. Baseline data, including swallowing-related indicators such as VF, were obtained and compared to the MDS-UPDRS sub-scores including rigidity, tremor, postural instability/gait difficulty, and limb scores. RESULTS: Twenty-seven patients were included in this study. In the VF analysis, laryngeal penetration/aspiration, oral cavity residue, epiglottic vallecular residue, and pharyngeal residue were observed with remarkable frequency. The multivariate analysis revealed that the mean rigidity score of UPDRS was an independent and significantly correlated factor with laryngeal penetration/aspiration during the ingestion of 10 mL of water (odds ratio 1.294, 95% confidence interval 1.035-1.617; p = 0.024). CONCLUSION: This study revealed a correlation between muscle rigidity and laryngeal penetration or aspiration risk. The detailed comparative analysis of various individual PD symptoms and swallowing disorders was substantial, which enabled early detection of the risk of swallowing disorder and the implementation of appropriate measures. TRIAL REGISTRATION NUMBER: jRCTs062220013.

Variability in sonographic anterior drawer test measurements of the ankle: Experienced versus beginner examiners.

BACKGROUND: This study aimed to clarify the variability in the measurements of stress sonography of the ankle and determine the effects of examiner experience on the measurements. METHODS: Twenty examiners (10 experienced and 10 beginners) were included in the study. Each examiner performed stress ultrasonography on a patient with a chronic anterior talofibular ligament injury and a patient with an intact ligament using the reverse anterior drawer method. Changes in ligament length before versus after stress were determined. The same 20 examiners performed ultrasonography on two other patients with an injured or intact ATFL using the anterior drawer method. The length change values and variance were compared between the groups using t-tests and F-tests. RESULTS: Using the reverse anterior drawer method, the change in the anterior talofibular ligament length was 3.3 mm (range, 2.2-4.8 mm) in the experienced group and 2.7 mm (0.0-4.1 mm) in the beginner group for the ligament injured patient. The length changes for the patient with intact anterior talofibular ligament were 0.5 mm (0.1-0.9 mm) and 0.4 mm (-0.1-1.5 mm) in the experienced and beginner groups, respectively. There were no significant intergroup differences in measurement amount (P = 0.37) or variance (P = 0.72). Similarly, using the anterior drawer method, no significant differences between the groups were found in measurement amount or variance. CONCLUSION: The quantitative evaluation of stress sonography of the ankle was variable regardless of examiner experience or stress method, particularly in patients with an anterior talofibular ligament injury. The amount of variability appeared to be unacceptably large for clinical application. Our study results highlight the need for technical standardization.

Swallowing Exercise Evaluated Using High-Density Surface Electromyography in Patients with Head and Neck Cancer: Supplementary Analysis of an Exploratory Phase II Trial.

Background and Objectives: Muscle strength evaluation using high-density surface electromyography (HD-sEMG) was recently developed for the detailed analysis of the motor unit (MU). Detection of the spatial distribution of sEMG can detect changes in MU recruitment patterns resulting from muscle-strengthening exercises. We conducted a prospective study in 2022 to evaluate the safety and feasibility of transcutaneous electrical sensory stimulation (TESS) therapy using an interferential current device (IFCD) in patients with head and neck squamous cell carcinoma (HNSCC) undergoing chemoradiotherapy (CRT), and reported the safety and feasibility of TESS. We evaluated the efficacy of swallowing exercises in patients with HNSCC undergoing CRT and determined the significance of sEMG in evaluating swallowing function. Materials and Methods: In this supplementary study, the patients performed muscle-strengthening exercises five days a week. The association of the effects of the exercises with body mass index, skeletal muscle mass index, HD-sEMG, tongue muscle strength, and tongue pressure were evaluated. Results: We found significant correlations between the rate of weight loss and skeletal muscle mass index reduction and the rate of change in the recruitment of the MU of the suprahyoid muscle group measured using HD-sEMG. Conclusions: We believe that nutritional supplementation is necessary in addition to muscle strengthening during CRT.

Efficacy of neuromuscular electrical stimulation for thoracic and abdominal surgery: A systematic review and meta-analysis.

This systematic review and meta-analysis examined the efficacy of neuromuscular electrical stimulation (NMES) on lower limb muscle strength and health-related quality of life (HR-QOL) after thoracic and abdominal surgery. We searched the Cochrane Central Register of Controlled Trials, MEDLINE via PubMed, Excerpta Medica Database via Elsevier, Physiotherapy Evidence Database, Cumulative Index to Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform via their dedicated search portal, and ClinicalTrials.gov on November 2021 and updated in April 2023 to identify randomized controlled trials that examined the effects of NMES after thoracic and abdominal surgery. The primary outcomes were lower limb muscle strength, HR-QOL, and adverse events. We used the Cochrane Risk of Bias Tool and the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the certainty of evidence. A total of 18 randomized control trials involving 915 participants, including 10 on cardiovascular surgery, two on pulmonary surgery, five on digestive system surgery, and one on other surgery, were included. NMES slightly increased lower limb muscle strength and adverse events in cardiovascular surgery. Adverse events (hypotension, pain, and muscle discomfort) occurred in seven patients. HR-QOL was measured in two studies on cardiovascular surgery, but these were not pooled due to concept heterogeneity. Overall, NMES slightly increases lower limb muscle strength after cardiovascular surgery without serious adverse events. However, higher-quality randomized control trials in thoracic and abdominal surgeries are needed.

Detailed findings of videofluoroscopic examination among patients with Parkinson's disease on the effect of cervical percutaneous interferential current stimulation.

Introduction: Parkinson's disease (PD) leads to various types of swallowing disorders. We investigated the effect of cervical percutaneous interferential current stimulation on dysphagia. By conducting detailed qualitative and quantitative analysis of videofluoroscopic examination, we aimed to understand dysphagia in patients with PD and investigate its effects on swallowing function. Methods: Patients received cervical percutaneous interferential current stimulation for 20 min twice a week for 8 weeks. In this exploratory study, we evaluated aspiration/laryngeal penetration, oral cavity residue, vallecular residue, and pharyngeal residue. In addition, we performed temporal analysis. Results: Twenty-five patients were completely evaluated. At baseline, the proportions of laryngeal penetration/aspiration, oral cavity residue, epiglottic vallecula residue, and pharyngeal residue were 40.0, 88.0, 72.0, 60.0, and 16.0%, respectively. Conversely, pharyngeal transit time, laryngeal elevation delay time, pharyngeal delay time, and swallowing reflex delay were nearly within the normal ranges. Cervical percutaneous interferential current sensory stimulation improved only oral cavity residue at the end of the intervention, from 88.0 to 56.0%. Discussion: Patients with PD demonstrated remarkably high frequencies of residues in the oral and pharyngeal regions. The usefulness of cervical interferential current stimulation was partially demonstrated for oral cavity residue. Considering that PD exhibits diverse symptoms, further accumulation of cases and knowledge is warranted. Trial registration: jRCTs062220013.

Relationship of Chronic Ankle Instability With Foot Alignment and Dynamic Postural Stability in Adolescent Competitive Athletes.

Background: Competitive adolescent athletes should be aware of the early signs of chronic ankle instability (CAI) and the connection between the condition and performance. Purpose: To investigate whether CAI is related to foot alignment and morphology as well as dynamic postural stability after a jump landing among adolescent competitive athletes with and without a history of a lateral ankle sprain and CAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Between July 2020 and August 2021, adolescent competitive athletes (N = 85; n = 49 boys; n = 36 girls) were classified into 3 groups using Cumberland Ankle Instability Tool (CAIT) scores: healthy athletes (n = 55), coper athletes (n = 19), and athletes with CAI (n = 11). Results of foot alignment assessments involving the leg-heel angle (LHA) and navicular height, intrinsic foot muscle morphology, dynamic postural stability index (DPSI), and other parameters were compared among the 3 groups. The relationship between the CAIT score and the LHA and dynamic postural stability and instability were examined using multiple linear regression. Results: Compared with the healthy group, the CAI group had a significantly greater LHA (8.73°± 3.22° vs 6.09°± 3.26°; P < .05), higher DPSI (0.336 ± 0.046 vs 0.298 ± 0.035), and higher vertical stability index (0.303 ± 0.048 vs 0.264 ± 0.037; P < .05 for all). Multiple regression analysis showed that the LHA (ß = -0.228; P = .033) and DPSI (ß = -0.240; P = .025) were significantly associated with the CAIT score . Conclusion: Valgus rearfoot alignment and poorer dynamic postural control were associated with CAI among adolescent athletes.

Swallowing sound index analysis using electronic stethoscope and artificial intelligence for patients with Parkinson's disease.

BACKGROUND AND PURPOSE: Several noninvasive tools assess swallowing disorders, including electronic stethoscope artificial intelligence (AI) analysis for remote diagnosis, with the potential for telemedicine. This study investigated the swallowing sound index in patients with Parkinson's disease (PD). METHODS: This single-arm, open-label trial assessed the impact of cervical percutaneous interferential current stimulation on swallowing in patients with PD classified as Hoehn-Yahr stages 2-4. Stimulation was conducted for 8 weeks. Baseline data were used to examine the link between the swallowing sound index and indicators such as videofluoroscopy (VF). Furthermore, we examined changes in the swallowing sound index after the intervention. RESULTS: Twenty-five patients were included. The swallowing sound index in patients with PD was higher than that in those with amyotrophic lateral sclerosis but considerably lower than that in healthy controls. The number of patients with normal EAT-10 scores positively correlated with the swallowing sound index, whereas elevated C-reactive protein levels were negatively correlated with the swallowing sound index. However, the index displayed no correlation with other indicators, including the VF results. Despite the intervention, the index remained unchanged throughout the study. CONCLUSION: In patients with PD, a decrease in the swallowing sound index suggests a potential association between swallowing disorders and the risk of aspiration pneumonia. TRIAL REGISTRATION NUMBER: jRCTs062220013.