Effectiveness of Non-Pharmacological Therapy on Physical Symptoms in Patients With Persistent Concussion Symptoms: A Systematic Review.

This systematic review provides a comprehensive overview on the effectiveness of rehabilitation on physical symptoms in patients of all ages with persistent concussion symptoms. PubMed, MEDLINE®, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched from January 1, 2012 to September 1, 2023 using terms related to physical post-concussion symptoms. Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network (SIGN) and the Quality Assessment Tool. The Grading of Recommendations Assessment, Development, and Evaluation system was applied to rate the quality of evidence. Thirty-two articles were included. Preliminary evidence suggests that transcranial magnetic stimulation improves symptoms in adults, specifically headaches. Young adults reported a significant decrease in physical symptoms following sub-symptom aerobic training as well as cervical spine manual therapy. Tentatively, adults demonstrated improvements in headache symptoms following neurofeedback sessions, and progressive muscle relaxation resulted in a decrease in monthly headaches. Multimodal therapy in adults produced significant change in physical symptoms when compared with usual care. However, no further reduction in physical symptoms was observed when adult patients received a program of care that afforded cervicovestibular rehabilitation with symptom-limited exercise compared with a symptom-limited exercise program alone. Cognitive behavioral therapy demonstrated inconsistent findings for its effects on physical symptoms, specifically headaches. Veterans had a significant change in post-concussive symptoms, specifically headaches, following 3-month use of an interactive smartphone application as compared with standard care. Finally, in a pediatric population, the use of melatonin did not produce any changes in physical persistent concussion symptoms as compared with placebo. Preliminary evidence suggests that various forms of rehabilitative therapies can improve persistent physical concussive symptoms. However, given the methodological limitations in the majority of trials, the results need to be interpreted with caution.

Real world evidence of improved attention and cognition during physical therapy paired with neuromodulation: a brain vital signs study.

Background: Non-invasive neuromodulation using translingual neurostimulation (TLNS) has been shown to advance rehabilitation outcomes, particularly when paired with physical therapy (PT). Together with motor gains, patient-reported observations of incidental improvements in cognitive function have been noted. Both studies in healthy individuals and case reports in clinical populations have linked TLNS to improvements in attention-related cognitive processes. We investigated if the use of combined TLNS/PT would translate to changes in objective neurophysiological cognitive measures in a real-world clinical sample of patients from two separate rehabilitation clinics. Methods: Brain vital signs were derived from event-related potentials (ERPs), specifically auditory sensation (N100), basic attention (P300), and cognitive processing (N400). Additional analyses explored the attention-related N200 response given prior evidence of attention effects from TLNS/PT. The real-world patient sample included a diverse clinical group spanning from mild-to-moderate traumatic brain injury (TBI), stroke, Multiple Sclerosis (MS), Parkinson's Disease (PD), and other neurological conditions. Patient data were also acquired from a standard clinical measure of cognition for comparison. Results: Results showed significant N100 variation between baseline and endpoint following TLNS/PT treatment, with further examination showing condition-specific significant improvements in attention processing (i.e., N100 and N200). Additionally, CogBAT composite scores increased significantly from baseline to endpoint. Discussion: The current study highlighted real-world neuromodulation improvements in neurophysiological correlates of attention. Overall, the real-world findings support the concept of neuromodulation-related improvements extending beyond physical therapy to include potential attention benefits for cognitive rehabilitation.

The SE-AssessWrist for robot-aided assessment of wrist stiffness and range of motion: Development and experimental validation.

INTRODUCTION: Physical human-robot interaction offers a compelling platform for assessing recovery from neurological injury; however, robots currently used for assessment have typically been designed for the requirements of rehabilitation, not assessment. In this work, we present the design, control, and experimental validation of the SE-AssessWrist, which extends the capabilities of prior robotic devices to include complete wrist range of motion assessment in addition to stiffness evaluation. METHODS: The SE-AssessWrist uses a Bowden cable-based transmission in conjunction with series elastic actuation to increase device range of motion while not sacrificing torque output. Experimental validation of robot-aided wrist range of motion and stiffness assessment was carried out with five able-bodied individuals. RESULTS: The SE-AssessWrist achieves the desired maximum wrist range of motion, while having sufficient position and zero force control performance for wrist biomechanical assessment. Measurements of two-degree-of-freedom wrist range of motion and stiffness envelopes revealed that the axis of greatest range of motion and least stiffness were oblique to the conventional anatomical axes, and approximately parallel to each other. CONCLUSIONS: Such an assessment could be beneficial in the clinic, where standard clinical measures of recovery after neurological injury are subjective, labor intensive, and graded on an ordinal scale.

Importance of Wrist Movement Direction in Performing Activities of Daily Living Efficiently.

The wrist is an essential component in performing the activities of daily living (ADLs) associated with a high quality of life. After a neurological disorder, motor function of the hand and wrist can be affected, reducing quality of life. Many experiments have illustrated that more wrist flexion/extension is required than radial/ulnar deviation when performing ADLs; however, how this result translates to efficiency in performing ADLs has not been investigated. Motivated by clinical assessment during neurorehabilitation, in this paper we investigate with able-bodied participants how performing tasks representative of the Jebsen-Taylor Hand Function Test are impacted when a splint constrains the user to a single rotational degree of freedom of the wrist. Twenty participants enrolled in the study, performing five tasks under five conditions, including constraint to pure flexion/extension and radial/ulnar deviation. The importance of wrist movement direction in performing ADLs efficiently found in this study could shape clinical wrist rehabilitation paradigms and wrist rehabilitation robot designs.

Suspected trigeminal nerve neuropathy causing persistent idiopathic facial pain: a report of four cases.

Persistent idiopathic facial pain is often a disabling condition for patients. Due to a lack of agreed upon diagnostic criteria and varied symptomatology, the diagnosis of persistent idiopathic facial pain is elusive and remains one of exclusion. It is typically described as a unilateral, deep, poorly localized pain in the territory of the trigeminal nerve, however there are a number of case reports that describe bilateral symptoms. Unlike trigeminal neuralgia, the condition encompasses a wider distribution that does not conform or relate to a specific dermatome. In addition, the pain is typically continuous, with no periods of remission and there are no signs or symptoms suggestive of autonomic involvement. Reports documenting the response to various conservative treatments for persistent idiopathic facial pain have been widely variable likely due to the heterogeneity of the condition. Four cases of persistent idiopathic facial pain due to suspected trigeminal nerve neuropathy and their management are presented. A specific form of targeted, manual, instrument-assisted, intra-oral vibration therapy appeared to provide relief in the four cases described.

La douleur faciale idiopathique persistante est souvent une condition invalidante pour les patients. En raison de l'absence de critères diagnostiques convenus et d'une symptomatologie variée, le diagnostic de douleur faciale idiopathique persistante est difficile à établir et demeure un diagnostic d'exclusion. On décrit généralement la douleur comme étant unilatérale, profonde et mal localisée dans la région du nerf trijumeau, mais il existe un certain nombre de rapports de cas qui décrivent des symptômes bilatéraux. Contrairement à la névralgie faciale, l'affection englobe une distribution plus large qui n'est pas conforme ou liée à un dermatome précis. De plus, la douleur est généralement continue, sans période de rémission et il n'y a aucun signe ou symptôme suggérant une atteinte du système nerveux autonome. Les rapports documentant la réponse à divers traitements conservateurs utilisés pour la douleur faciale idiopathique persistante ont été très variables, probablement en raison de l'hétérogénéité de l'affection. Quatre cas de douleur faciale idiopathique persistante due à un soupçon de neuropathie du nerf trijumeau et leur prise en charge sont présentés. Dans les quatre cas décrits, une forme spécifique de thérapie par vibration ciblée, intraorale, manuelle, appuyée par des instruments, a semblé apporter un soulagement.

Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial.

OBJECTIVE: It is hypothesised that cervical manipulation may increase the risk of cerebrovascular accidents. We aimed to determine whether cervical spine manipulation is associated with changes in vertebral artery and cerebrovascular haemodynamics measured with MRI compared with neutral neck position and maximum neck rotation in patients with chronic neck pain. SETTING: The Imaging Research Centre at St. Joseph's Hospital in Hamilton, Ontario, Canada. PARTICIPANTS: Twenty patients were included. The mean age was 32 years (SD ±12.5), mean neck pain duration was 5.3 years (SD ±5.7) and mean neck disability index score was 13/50 (SD ±6.4). INTERVENTIONS: Following baseline measurement of cerebrovascular haemodynamics, we randomised participants to: (1) maximal neck rotation followed by cervical manipulation or (2) cervical manipulation followed by maximal neck rotation. The primary outcome, vertebral arteries and cerebral haemodynamics, was measured after each intervention and was obtained by measuring three-dimensional T1-weighted high-resolution anatomical images, arterial spin labelling and phase-contrast flow encoded MRI. Our secondary outcome was functional connectivity within the default mode network measured with resting state functional MRI. RESULTS: Compared with neutral neck position, we found a significant change in contralateral blood flow following maximal neck rotation. There was also a significant change in contralateral vertebral artery blood velocity following maximal neck rotation and cervical manipulation. We found no significant changes within the cerebral haemodynamics following cervical manipulation or maximal neck rotation. However, we observed significant increases in functional connectivity in the posterior cerebrum and cerebellum (resting state MRI) after manipulation and maximum rotation. CONCLUSION: Our results are in accordance with previous work, which has shown a decrease in blood flow and velocity in the contralateral vertebral artery with head rotation. This may explain why we also observed a decrease in blood velocity with manipulation because it involves neck rotation. Our work is the first to show that cervical manipulation does not result in brain perfusion changes compared with a neutral neck position or maximal neck rotation. The changes observed were found to not be clinically meaningful and suggests that cervical manipulation may not increase the risk of cerebrovascular events through a haemodynamic mechanism. TRIAL REGISTRATION NUMBER: NCT02667821.

A four year prospective study of injuries in elite Ontario youth provincial and national soccer players during training and matchplay.

INTRODUCTION: With over 200 million amateur players worldwide, soccer is one of the most popular and internationally recognized sports today. By understanding how and why soccer injuries occur we hope to reduce prevalent injuries amongst elite soccer athletes. METHODS: Via a prospective cohort, we examined both male and female soccer players eligible to train with the Ontario Soccer Association provincial program between the ages of 13 to 17 during the period of October 10, 2008 and April 20, 2012. Data collection occurred during all player exposures to potential injury. Exposures occurred at the Soccer Centre, Ontario Training grounds and various other venues on multiple playing surfaces. RESULTS: A total number of 733 injuries were recorded. Muscle strain, pull or tightness was responsible for 45.6% of all injuries and ranked as the most prevalent injury. DISCUSSION: As anticipated, the highest injury reported was muscular strain, which warrants more suitable preventive programs aimed at strengthening and properly warming up the players' muscles.

INTRODUCTION: Avec plus de 200 millions de joueurs amateurs dans le monde, le soccer est aujourd'hui l'un des sports les plus populaires et internationalement reconnus. En comprenant comment et pourquoi se produisent les blessures dans le soccer, nous espérons réduire les blessures répandues parmi ses athlètes d'élite. MÉTHODOLOGIE: Du 10 octobre 2008 au 20 avril 2012, nous avons étudié une cohorte prospective de joueurs et de joueuses de soccer de 13 à 17 ans qui s'entraînaient dans le cadre du programme provincial de l'Ontario Soccer Association. Nous avons recueilli des données à toutes les occasions de risques de blessures pour les joueurs, à savoir au Centre de soccer, sur les terrains d'entraînement de l'Ontario et divers autres lieux sur différentes surfaces de jeu. RÉSULTATS: On a enregistré un total de 733 blessures. Le claquage ou la raideur musculaire comptait pour 45,6 % de toutes les blessures et se classait parmi la blessure la plus répandue. DISCUSSION: Comme prévu, la blessure la plus fréquemment signalée était le claquage musculaire. Pour l'éviter, il faut mettre sur pied des programmes de prévention plus appropriés visant au renforcement et à l'échauffement adéquat des muscles des joueurs.