Potential mechanisms for osteopathic manipulative treatment to alleviate migraine-like pain in female rats.

Introduction: Migraines are the leading cause of disability in the United States, and the use of non-pharmaceutical treatments like osteopathic manipulative treatment (OMT) has shown promise. Despite its potential, the lack of mechanistic understanding has hindered widespread adoption. This study aims to investigate the efficacy of OMT in treating acute migraines and unravel its underlying mechanisms of action. Methods: Female rats were subjected to a "two-hit" approach to induce migraine-like pain. This involved bilateral injections of Complete Freund's Adjuvant (CFA) into the trapezius muscle (1st hit) followed by exposure to Umbellulone, a human migraine trigger, on Day 6 post-CFA (2nd hit). Soft tissue and articulatory techniques were applied to the cervical region for acute abortive or repeated prophylactic treatment. Cutaneous allodynia and trigeminal system activation were assessed through behavioral tests and immunohistochemical staining. Results: Following Umbellulone inhalation, CFA-primed rats exhibited periorbital and hind paw allodynia. Immediate application of OMT after Umbellulone inhalation as an abortive treatment partially alleviated cutaneous allodynia. With OMT applied thrice as a prophylactic measure, complete suppression of tactile hypersensitivity was observed. Prophylactic OMT also prevented the increase of c-fos signals in the trigeminal nucleus caudalis and the elevation of calcitonin gene-related peptide expression in trigeminal ganglia induced by CFA and Umbellulone exposure at 2 h post-inhalation. Discussion: These findings provide mechanistic insights into OMT's migraine-relief potential and underscore its viability as a non-pharmacological avenue for managing migraines.

We Are Still Here: Living with HIV in the UK.

In this article we highlight a number of the ongoing challenges faced by people living with HIV in the UK today (2021). Based on in-depth interviews with 23 respondents drawn from a range of ages, backgrounds and walks of life, we offer an insight into deeply personal experiences of what it means to have HIV. We demonstrate the degree to which, 40 years on from the formal emergence of the HIV pandemic, stigma and related structural violence remain both extremely present and extraordinarily debilitating. In essence, social responses to HIV remain mired in a past age.

Design and Implementation of an Instrumented Data Glove that measures Kinematics and Dynamics of Human Hand.

Human hands are versatile biomechanical architectures that can perform simple movements such as grasping to complicated movements such as playing a musical instrument. Such extremely dependable and useful parts of the human body can be debilitated due to movement disorders such as Parkinson's disease, stroke, spinal cord injury, multiple sclerosis and cerebral palsy. In such cases, precisely measuring the residual or abnormal hand function becomes a critical assessment to help clinicians and physical therapists in diagnosis, treatment and in prescribing appropriate prosthetics or rehabilitation therapies. The current methodologies used to measure abnormal or residual hand function are either paperbased scales that are prone to human error or expensive motion tracking systems. The cost and complexity restrict the usability of these methods in clinical environments. In this paper we present a low-cost instrumented glove that can measure kinematics and dynamics of human hand, by leveraging the recent advances in 3D printing technologies and flexible sensors.

Lateralization and Model Transference in a Bilateral Cursor Task.

Post-stroke rehabilitation, occupational and physical therapy, and training for use of assistive prosthetics leverages our current understanding of bilateral motor control to better train individuals. In this study, we examine upper limb lateralization and model transference using a bimanual joystick cursor task with orthogonal controls. Two groups of healthy subjects are recruited into a 2-session study spaced seven days apart. One group uses their left and right hands to control cursor position and rotation respectively, while the other uses their right and left hands. The groups switch control methods in the second session, and a rotational perturbation is applied to the positional controls in the latter half of each session. We find agreement with current lateralization theories when comparing robustness to feedforward perturbations in feedback and feedforward measures. We find no evidence of a transferable model after seven days, and evidence that the brain does not synchronize task completion between the hands.

HERCULES: A Three Degree-of-Freedom Pneumatic Upper Limb Exoskeleton for Stroke Rehabilitation.

This paper outlines the construction, current state, and future goals of HERCULES, a three degree-of-freedom (DoF) pneumatically actuated exoskeleton for stroke rehabilitation. The exoskeleton arm is capable of joint-angle control at the elbow in flexion and extension, at the shoulder in flexion and extension, and at the shoulder in abduction and adduction. In the near future we plan to embed kinematic synergies into the control system architecture of this arm to gain dexterous and near-natural movements.Clinical Relevance- This device can be used as an upper limb rehabilitation testbed for individuals with complete or partial upper limb paralysis. In the future, this system can be used to train individuals on synergy-based rehabilitation protocols.

Myoelectric Control of a Soft Hand Exoskeleton Using Kinematic Synergies.

Soft hand exoskeletons offer a lightweight, low-profile alternative to rigid rehabilitative robotic systems, enabling their use to restore activities of daily living (ADL) in those with hand paresis due to stroke or other conditions. The hand exoskeleton with embedded synergies (HEXOES) is a soft cable-driven hand exoskeleton capable of independently actuating and sensing 10 degrees of freedom (DoF) of the hand. Control of the 10 DoF exoskeleton is dimensionally reduced using three manually defined synergies in software corresponding to thumb, index, and 3-finger flexion and extension. In this paper, five healthy subjects control HEXOES using a neural network which decodes synergy weights from contralateral electromyography (EMG) activity. The three synergies are manipulated in real time to grasp and lift 15 ADL objects of various sizes and weights. The neural network's training and validation mean squared error, object grasp time, and grasp success rate were measured for five healthy subjects. The final training error of the neural network was 4.8 ± 1.8% averaged across subjects and tasks, with 8.3 ± 3.4% validation error. The time to reach, grasp, and lift an object was 11.15 ± 4.35 s on average, with an average success rate of 66.7% across all objects. The complete system demonstrates real time use of biosignals and machine learning to allow subjects to operate kinematic synergies to grasp objects using a wearable hand exoskeleton. Future work and applications are further discussed, including possible design improvements and enrollment of individuals with stroke.

An economic analysis of a contingency model utilising vaccination for the control of equine influenza in a non-endemic country.

BACKGROUND: Equine influenza (EI) is an infectious respiratory disease of horses that has never been reported in New Zealand (NZ). However, the 2007 EI outbreak in Australia, previously EI free, spurred the NZ government and stakeholders into evaluating alternative EI control strategies in order to economically justify any future decision to eradicate or manage EI. To build on the policy debate, this paper presents an epinomic (epidemiologic and economic) modelling approach to evaluate alternative control strategies. An epidemiologic model to determine how alternative EI control strategies influence the distribution of EI. Model results were then input into a cost-benefit analysis framework, to identify the return and feasibility of alternative EI eradication strategies in NZ. METHODS: The article explores nine alternative eradication scenarios and two baseline strategies. The alternative scenarios consisted of three vaccination strategies (suppressive, protective or targeted) starting at three time points to reflect the commercial breeding-cycle. These alternatives were compared to two breeding-cycle adjusted baselines: movement restriction in the breeding season (August to January) or non-breeding season (February to July). The economic loss parameters were incursion response, impact to the commercial racing industry (breeding, sales and racing), horse morbidity and mortality, and compensation to industry participants. RESULTS AND CONCLUSIONS: Results suggest that the economic viability of the EI eradication programme is dependent on when within the breeding-cycle the EI outbreak occurs. If an outbreak were to occur, the return on each dollar invested for protective or suppressive vaccination strategies would be between NZD$3.67 to NZD$4.89 and between NZD$3.08 to NZD$3.50 in the breeding and non-breeding seasons, respectively. Therefore, protective or suppressive vaccination strategies could be prioritised, regardless of season. As multiple industry stakeholders benefit from these strategies, the study will enable policy development and to better formulate a user-pays eradication programme.

Decoding Synergy-Based Hand Movements using Electroencephalography.

In this paper, scalp electroencephalographic (EEG) signals were recorded from 10 subjects during hand grasping. Six objects that span different grasp types were used. Grasp kinematics were recorded using CyberGlove. From a training subset of the data, kinematic synergies were determined and their reconstruction weights in these grasps were calculated. EEG features (power spectral densities in four low and high frequency bands) were trained on kinematic synergy weights using multivariate linear regression. Using this model, kinematics from testing subset of data were decoded from EEG with 3-fold cross validation. Results are compared to chance level to determine if reconstruction weights are related to EEG features. Results indicate that EEG features can decode synergy-based movement generation. Study implications and future implementations were discussed.

Elaborating the Human Aspect of the NIST Framework for Cyber-Physical Systems.

The National Institute of Standards and Technology (NIST) has developed a Framework for Cyber-Physical Systems (CPS Framework) that supports system engineering analysis, design, development, operation, validation and assurance of CPS. Cyber-physical systems (CPS) comprise interacting digital, analog, physical, and human components engineered for function through integrated physics and logic. For instance, a city implementing an advanced traffic management system including real-time predictive analytics and adaptation/optimization must consider all aspects of such a CPS system of systems' functioning and integrations with other systems, including interactions with humans. One Aspect (or grouping of stakeholder concerns) of the CPS Framework is the Human Aspect. NIST is engaging HFES in a panel discussion to elaborate Human Aspect concerns, especially relevant constructs, measures, methods, and tools.

Towards a wearable hand exoskeleton with embedded synergies.

Numerous hand exoskeletons have been proposed in the literature with the aim of assisting or rehabilitating victims of stroke, brain/spinal cord injury, or other causes of hand paralysis. In this paper a new 3D printed soft hand exoskeleton, HEXOES (Hand Exoskeleton with Embedded Synergies), is introduced and mechanically characterized. Metacarpophalangeal (MCP) and proximal interphalangeal/interphalangeal (PIP/IP) joints had measured maximum flexion angles of 53.7 ± 16.9° and 39.9 ± 13.4°, respectively; and maximum MCP and PIP angular velocities of 94.5 ± 41.9 degrees/s and 74.6 ± 67.3 degrees/s, respectively. These estimates indicate that the mechanical design has range of motion and angular velocity characteristics that meet the requirements for synergy-based control. When coupled with the proposed control loop, HEXOES can be used in the future as a test-bed for synergy-based clinical hand rehabilitation.

Hand Grasping Synergies As Biometrics.

Recently, the need for more secure identity verification systems has driven researchers to explore other sources of biometrics. This includes iris patterns, palm print, hand geometry, facial recognition, and movement patterns (hand motion, gait, and eye movements). Identity verification systems may benefit from the complexity of human movement that integrates multiple levels of control (neural, muscular, and kinematic). Using principal component analysis, we extracted spatiotemporal hand synergies (movement synergies) from an object grasping dataset to explore their use as a potential biometric. These movement synergies are in the form of joint angular velocity profiles of 10 joints. We explored the effect of joint type, digit, number of objects, and grasp type. In its best configuration, movement synergies achieved an equal error rate of 8.19%. While movement synergies can be integrated into an identity verification system with motion capture ability, we also explored a camera-ready version of hand synergies-postural synergies. In this proof of concept system, postural synergies performed well, but only when specific postures were chosen. Based on these results, hand synergies show promise as a potential biometric that can be combined with other hand-based biometrics for improved security.

Synergy Repetition Training versus Task Repetition Training in Acquiring New Skill.

Traditionally, repetitive practice of a task is used to learn a new skill, exhibiting as immediately improved performance. Research suggests, however, that a more experience-based rather than exposure-based training protocol may allow for better transference of the skill to related tasks. In synergy-based motor control theory, fundamental motor skills, such as hand grasping, are represented with a synergy subspace that captures essential motor patterns. In this study, we propose that motor-skill learning through synergy-based mechanisms may provide advantages over traditional task repetition learning. A new task was designed to highlight the range of motion and dexterity of the human hand. Two separate training strategies were tested in healthy subjects: task repetition training and synergy training versus a control. All three groups showed improvements when retested on the same task. When tested on a similar, but different set of tasks, only the synergy group showed improvements in accuracy (9.27% increase) compared to the repetition (3.24% decline) and control (3.22% decline) groups. A kinematic analysis revealed that although joint angular peak velocities decreased, timing benefits stemmed from the initial feed-forward portion of the task (reaction time). Accuracy improvements may have derived from general improved coordination among the four involved fingers. These preliminary results warrant further investigation of synergy-based motor training in healthy individuals, as well as in individuals undergoing hand-based rehabilitative therapy.

Low-Dimensional Synergistic Representation of Bilateral Reaching Movements.

Kinematic and neuromuscular synergies have been found in numerous aspects of human motion. This study aims to determine how effectively kinematic synergies in bilateral upper arm movements can be used to replicate complex activities of daily living (ADL) tasks using a sparse optimization algorithm. Ten right-handed subjects executed 18 rapid and 11 natural-paced ADL tasks requiring bimanual coordination while sitting at a table. A position tracking system was used to track the subjects' arms in space, and angular velocities over time for shoulder abduction, shoulder flexion, shoulder internal rotation, and elbow flexion for each arm were computed. Principal component analysis (PCA) was used to generate kinematic synergies from the rapid-paced task set for each subject. The first three synergies accounted for 80.3 ± 3.8% of variance, while the first eight accounted for 94.8 ± 0.85%. The first and second synergies appeared to encode symmetric reaching motions which were highly correlated across subjects. The first three synergies were correlated between left and right arms within subjects, whereas synergies four through eight were not, indicating asymmetries between left and right arms in only the higher order synergies. The synergies were then used to reconstruct each natural-paced task using the l1-norm minimization algorithm. Temporal dilations of the synergies were introduced in order to model the temporal scaling of movement patterns achieved by the cerebellum and basal ganglia as reported previously in the literature. Reconstruction error was reduced by introducing synergy dilations, and cumulative recruitment of several synergies was significantly reduced in the first 10% of training task time by introducing temporal dilations. The outcomes of this work could open new scenarios for the applications of postural synergies to the control of robotic systems, with potential applications in rehabilitation. These synergies not only help in providing near-natural control but also provide simplified strategies for design and control of artificial limbs. Potential applications of these bilateral synergies were discussed and future directions were proposed.

QAPD: an integrated system to quantify symptoms of Parkinson's disease.

The complex prevalence of Parkinson's disease (PD) symptoms has pushed research towards assessment tools that can assist in their quantification. There remains a need for a system capable of measuring symptoms during various tasks at multiple motor levels (kinematics and electromyography). In this paper, we present the development and initial validation of a quantitative assessment tool for Parkinson's disease (QAPD), a system designed to assist researchers and clinicians in the study of PD. The system integrates motion tracking, data gloves, and electromyography to collect movement related data from multiple body parts. As part of the system, a custom MATLAB® based toolbox has been designed to quantify bradykinesia, tremor, micrographia, and muscle rigidity using both standard and contemporary data analysis techniques. We believe this system can be a useful assessment tool to assist clinicians and researchers in diagnosing and estimating movement dysfunction in individuals with PD.

Effect of visual and tactile feedback on kinematic synergies in the grasping hand.

The human hand uses a combination of feedforward and feedback mechanisms to accomplish high degree of freedom in grasp control efficiently. In this study, we used a synergy-based control model to determine the effect of sensory feedback on kinematic synergies in the grasping hand. Ten subjects performed two types of grasps: one that included feedback (real) and one without feedback (memory-guided), at two different speeds (rapid and natural). Kinematic synergies were extracted from rapid real and rapid memory-guided grasps using principal component analysis. Synergies extracted from memory-guided grasps revealed greater preservation of natural inter-finger relationships than those found in corresponding synergies extracted from real grasps. Reconstruction of natural real and natural memory-guided grasps was used to test performance and generalizability of synergies. A temporal analysis of reconstruction patterns revealed the differing contribution of individual synergies in real grasps versus memory-guided grasps. Finally, the results showed that memory-guided synergies could not reconstruct real grasps as accurately as real synergies could reconstruct memory-guided grasps. These results demonstrate how visual and tactile feedback affects a closed-loop synergy-based motor control system.

Web-based technical assistance and training to promote community tobacco control policy change.

In 1998 the tobacco industry was released of claims that provided monetary relief for states. A significant expansion of tobacco control activity in many states created a need to develop local capacity. Technical assistance and training for new and experienced staff became a significant challenge for tobacco control leadership. In Colorado, this challenge was addressed in part through the development of a technical assistance and training Web site designed for local tobacco control staff and coalition members. Researchers, technical Web site development specialists, state health agency, and state tobacco control coalition staff collaborated to develop, promote, and test the efficacy of this Web site. The work group embodied a range of skills including tobacco control, Web site technical development, marketing, training, and project management. Persistent marketing, updating of Web site content, and institutionalizing it as a principal source of information and training were key to use by community coalition members.