Posture modulates the sensitivity of the H-reflex.

The effect of body posture on the human soleus H-reflex via electrical stimulation of the tibial nerve at the popliteal fossa was studied. All parameters that may influence the reflex were controlled stringently. H-reflexes were elicited in three different body postures while keeping the level of background muscle activation to a minimum. The H-reflex curve relative to the M-wave curve did not change significantly in any of the body postures. However, the maximal H-reflex amplitude significantly increased in the prone position compared with the sitting (p = 0.02) and standing positions (p = 0.01). The background level of electrical activity of the soleus muscle did not significantly change during varying body postures. Together, these findings indicate that the effectiveness of the spindle primary afferent synapse on the soleus motor neuron pool changes significantly in prone position as compared to sitting and standing positions. Given that we have controlled the confounding factors excluding the head position relative to the gravity and the receptors that may be differentially activated at varying body postures such as the proprioceptors, it is concluded that the tonic activity from these receptors may presynaptically interfere with the effectiveness of the spindle primary afferent synapses on the soleus motor neurons.

Classification of short and long term mild traumatic brain injury using computerized eye tracking.

Accurate, and objective diagnosis of brain injury remains challenging. This study evaluated useability and reliability of computerized eye-tracker assessments (CEAs) designed to assess oculomotor function, visual attention/processing, and selective attention in recent mild traumatic brain injury (mTBI), persistent post-concussion syndrome (PPCS), and controls. Tests included egocentric localisation, fixation-stability, smooth-pursuit, saccades, Stroop, and the vestibulo-ocular reflex (VOR). Thirty-five healthy adults performed the CEA battery twice to assess useability and test-retest reliability. In separate experiments, CEA data from 55 healthy, 20 mTBI, and 40 PPCS adults were used to train a machine learning model to categorize participants into control, mTBI, or PPCS classes. Intraclass correlation coefficients demonstrated moderate (ICC > .50) to excellent (ICC > .98) reliability (p < .05) and satisfactory CEA compliance. Machine learning modelling categorizing participants into groups of control, mTBI, and PPCS performed reasonably (balanced accuracy control: 0.83, mTBI: 0.66, and PPCS: 0.76, AUC-ROC: 0.82). Key outcomes were the VOR (gaze stability), fixation (vertical error), and pursuit (total error, vertical gain, and number of saccades). The CEA battery was reliable and able to differentiate healthy, mTBI, and PPCS patients reasonably well. While promising, the diagnostic model accuracy should be improved with a larger training dataset before use in clinical environments.

Investigating the effects of chiropractic care on resting-state EEG of MCI patients.

Introduction: Mild cognitive impairment (MCI) is a stage between health and dementia, with various symptoms including memory, language, and visuospatial impairment. Chiropractic, a manual therapy that seeks to improve the function of the body and spine, has been shown to affect sensorimotor processing, multimodal sensory processing, and mental processing tasks. Methods: In this paper, the effect of chiropractic intervention on Electroencephalogram (EEG) signals in patients with mild cognitive impairment was investigated. EEG signals from two groups of patients with mild cognitive impairment (n = 13 people in each group) were recorded pre- and post-control and chiropractic intervention. A comparison of relative power was done with the support vector machine (SVM) method and non-parametric cluster-based permutation test showing the two groups could be separately identified with high accuracy. Results: The highest accuracy was obtained in beta2 (25-35 Hz) and theta (4-8 Hz) bands. A comparison of different brain areas with the SVM method showed that the intervention had a greater effect on frontal areas. Also, interhemispheric coherence in all regions increased significantly after the intervention. The results of the Wilcoxon test showed that intrahemispheric coherence changes in frontal-occipital, frontal-temporal and right temporal-occipital regions were significantly different in two groups. Discussion: Comparison of the results obtained from chiropractic intervention and previous studies shows that chiropractic intervention can have a positive effect on MCI disease and using this method may slow down the progression of mild cognitive impairment to Alzheimer's disease.

Measuring the Quality of the OSCE in a Chiropractic Programme: A Review of Metrics and Recommendations.

OBJECTIVES: The Objective Structured Clinical Examination (OSCE) is a commonly used assessment of clinical skill, and ensuring the quality and reliability in OSCEs is a complex, and on-going process. This paper discusses scoring schemas and reviews checklists and global rating scales (GRS) for marking. Also detailed are post-examination quality assurance metrics tailored to smaller cohorts, with an illustrative dataset. METHODS: A deidentified OSCE dataset, from stations with both a checklist and GRS, of 24 examinees from a 2021 cohort was assessed using the following metrics: Cut-scores or pass-rates, number-of-failures, R2, inter-grade discrimination, and between-group-variation. The results were used to inform a set of implementable recommendations to improve future OSCEs. RESULTS: For most stations the calculated cut-score calculated was higher than the traditional pass of 50% (58.9.8-68.4%). Number-of-failures were low for traditional pass rates and cuts-scores (0.00-16.7%), excepting Lab Analysis where number-of-failures was 50.0%. R2 values ranged from 0.67-0.97, but proportion of total variance was high (67.3-95.9). These data suggest there were potential missed teaching concepts, that station marking was open to examiner interpretation, and there were inconsistencies in examiner marking.Recommendations included increasing checklist detail and using a weighted marking scale, separating some stations into dichotomous and key-feature checklists, using GRSs specific to each station, and reviewing all future OSCEs with the metrics described to guide refinements. CONCLUSIONS: The analysis used revealed several potential issues with the OSCE assessment. These findings informed recommendations to improve the quality of future examinations.

Differences in learning retention and experience of augmented reality notes compared to traditional paper notes in a chiropractic technique course: A randomized trial.

OBJECTIVE: To investigate if a written guide or augmented reality (AR) guide improves free recall of diversified chiropractic adjusting technique and to capture participants' impressions of the study in a poststudy questionnaire. METHODS: Thirty-eight chiropractic students were evaluated for diversified listing (a nomenclature denoting vertebral malposition and correction) recall, pre-AR and post-AR, or written guide review. The vertebral segments used were C7 and T6. Two randomized groups reviewed an original course written guide (n = 18) or a new AR guide (n = 20). A Wilcoxon-Mann-Whitney (C7) and t test (T6) compared group differences in reevaluation scores. A poststudy questionnaire was given to capture participants' impressions of the study. RESULTS: Both groups showed no significant differences in free recall scores after reviewing the guides for C7 or T6. The poststudy questionnaire suggested a number of strategies could be used to improve current teaching material such as more detail in the written guides and organizing content into smaller blocks. CONCLUSION: Use of an AR or written guide does not seem to change participants' free recall ability when used to review diversified technique listings. The poststudy questionnaire was useful to identify strategies to improve currently used teaching material.

Clinical testing of mild traumatic brain injury using computerised eye-tracking tests.

Traumatic brain injury (TBI) refers to the alteration of typical brain function that occurs following a blow to the head. Even a mild case of traumatic brain injury (mTBI) can lead to long-term impairment, so accurate and timely detection is vital. Visual symptoms are common following mTBI, so while it may seem to fall outside their typical scope of practice, optometrists are ideally qualified to assess the visual impacts and help with the diagnosis of mTBI. Given that mTBI is challenging to objectively diagnose and has no universally accepted diagnostic criteria, clinicians can lack confidence in diagnosing mTBI, and be hesitant in becoming involved in the management of such patients. The development of easily quantifiable techniques using eye tracking as an objective diagnostic tool provides practitioners with an easier pathway into the field, assigning numerical values to parameters which are difficult to assess using conventional optometric tests. As this evolving technology becomes increasingly integrated into optometric clinical settings, the potential for it to identify deficits accurately and reliably in patients following mTBI, and to monitor both their recovery and the effectiveness of potential treatments will increase. This paper provides an overview of clinical tests, relevant to optometrists, that can uncover oculomotor, attentional, and exteroceptive deficits following a mTBI, so that an optometrist with an interest in eye tracking can play a role in the detection and monitoring of mTBI symptoms.

The Effects of Spinal Manipulation on Oculomotor Control in Children with Attention Deficit Hyperactivity Disorder: A Pilot and Feasibility Study.

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent, chronic neurodevelopmental disorder that affects oculomotor (eye movement) control. Dysfunctional oculomotor control may result in reading or educational difficulties. This randomized controlled crossover study sought to investigate the feasibility of a larger scale trial and effects of a single session of spinal manipulation on oculomotor control in children with ADHD. Thirty children participated in the study and were randomized into either control-first or spinal manipulation first groups. The results indicate that the trial was feasible. Secondary outcomes showed that there was a significant decrease in reading time after the spinal manipulation intervention compared to the control intervention. Future studies of the effects of spinal manipulation on oculomotor control in children with ADHD are suggested.

Differences in learning retention when teaching a manual motor skill with a visual vs written instructional aide.

OBJECTIVE:: This study aimed to determine if a written or visual teaching aid influenced learning retention when teaching a manual motor skill. METHODS:: Seventy chiropractic students who had completed an upper cervical specific chiropractic technique course were evaluated for technique-specific recall before and after a review using either a visual teaching aid or a written guide. Two randomized groups reviewed original course-written guides ( n = 33) or new visual teaching aids ( n = 37). Repeated-measures analysis of variance and post hoc t tests compared group differences in reevaluation scores. RESULTS:: Performance of both groups improved postintervention ( F[1, 68] = 182.56, p < .001). However, the visual teaching aid group improved more than the written guide group ( F[1, 68] = 4.66, p = .03). The visual teaching aid group percentage score improved by 24.4% (SD ± 12.3%, p < .01); the written guide group improved by 17.7% (SD ± 13.7%; p < .01). CONCLUSION:: The mean learning retention improved in both the visual and the written teaching guide groups, but there was greater improvement in the visual aid group. This study suggests that visual teaching aids may be more useful than written guides when students attempt to recall information related to learning a manual motor skill.

Analysis of the chief complaints of older patients seeking chiropractic care at a teaching clinic and potential implications for clinical education.

OBJECTIVE:: To describe the chief complaints of people older than 65 years who seek chiropractic care at a chiropractic teaching clinic and assess the case mix available at the clinic. METHODS:: One hundred patient files were included in this study. Patient files were included if the patient was older than 65 years when he or she initiated care at the teaching clinic. Data on age, sex, and chief complaints were recorded. RESULTS:: Of the patients included in this study, 55% were female. The mean age of patients was 69.5 years, with an age range of 65-88 years. The most common chief complaint was low back pain, with 45% of patients reporting this as their chief complaint. The second most prevalent complaint was neck pain, followed by patients seeking care with no presenting complaints (14%) and patients with extremity complaints (8%). Groin pain, hip pain, balance problems, headaches, and visceral complaints were also reported. CONCLUSION:: The most common reasons that older patients presented for chiropractic care were for back and neck pain. The case mix was considered similar to practices in the country.