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BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the most common developmental spine disorder among children. It is characterized by a lateral deviation of the spine that gives rise to the distinctive "S" or "C" shaped bending of the spine. The Lin School of Lingnan Region (LSLR), one of the prominent schools for bare-handed orthopaedic manipulation in southern China, provides preliminary evidences that the orthopaedic manipulation techniques help to correct deviations of the spine. Previous research found that Orthopaedic Manipulation Techniques of LSLR (OMT-LSLR) could reduce the Cobb's angles in patients with AIS. Therefore, the current study aims to investigate the effectiveness and safety of the OMT-LSLR in treating teenagers with AIS. METHODS: In this participant-and-assessor-blinded randomized controlled clinical trial, 50 participants identified AIS without surgical indications will be recruited and randomized into two groups to receive physiotherapy scoliosis-specific exercises training with either orthopaedic manipulation or sham manipulation treatment for 16 weeks, followed by post-treatment visits at week 24. Primary outcome measure is the change of Scoliosis Research Society-22 (SRS-22) questionnaire score. Secondary outcome measures include Traditional Chinese version of Spinal Appearance Questionnaire (TC-SAQ) score, Italian Spine Youth Quality of Life (ISYQOL) score, the change of Cobb's angle measured by Xray, and the change of Cobb's angle, spinal rotation and muscle volume measured by three-dimensional (3D) ultrasound. The trial will be conducted at the Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre in Hong Kong (CUHK-CMSCTRC). DISCUSSION: The results of this study will establish comprehensive clinical evidence about the efficacy and safety of the Orthopaedic Manipulation Techniques of the Lin School of Lingnan Region in the Treatment of Adolescent Idiopathic Scoliosis. One of the characteristics of this trial is that it is a participant-and-assessor-blinded randomized controlled clinical trial with sham manipulation. The study would also apply three-dimensional (3D) ultrasound technology to investigate the relationship between the change of the muscle volume and the spinal curve. TRIAL REGISTRATION: The trial is registered on ClinicalTrials.gov (Identifier: NCT05639023 ) on December 6, 2022.
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Escoliose , Criança , Humanos , Adolescente , Escoliose/terapia , Escoliose/cirurgia , Manipulação Ortopédica , Qualidade de Vida , Coluna Vertebral , Terapia por Exercício/métodos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To summarize the reliability and validity of ultrasonography in evaluating the stiffness, excursion, stiffness, or strain rate of diaphragm, intercostals and abdominal muscles in healthy or non-hospitalized individuals. LITERATURE SEARCH: PubMed, Embase, SPORTDiscus, CINAHL and Cochrane Library were searched from inception to May 30, 2022. STUDY SELECTION CRITERIA: Case-control, cross-sectional, and longitudinal studies were included if they investigated the reliability or validity of various ultrasonography technologies (e.g., brightness-mode, motion-mode, shear wave elastography) in measuring the thickness, excursion, stiffness, or strain rate of any respiratory muscles. DATA SYNTHESIS: Relevant data were summarized based on healthy and different patient populations. The methodological quality by different checklist depending on study design. The quality of evidence of each psychometric property was graded by the Grading of Recommendations, Assessment, Development and Evaluations, respectively. RESULTS: This review included 24 studies with 787 healthy or non-hospitalized individuals (e.g., lower back pain (LBP), adolescent idiopathic scoliosis (AIS), and chronic obstructive pulmonary disease (COPD)). Both inspiratory (diaphragm and intercostal muscles) and expiratory muscles (abdominal muscles) were investigated. Moderate-quality evidence supported sufficient (intra-class correlation coefficient > 0.7) within-day intra-rater reliability of B-mode ultrasonography in measuring right diaphragmatic thickness among people with LBP, sufficient between-day intra-rater reliability of M-mode ultrasonography in measuring right diaphragmatic excursion in non-hospitalized individuals. The quality of evidence for all other measurement properties in various populations was low or very low. High-quality evidence supported sufficient positive correlations between diaphragm excursion and forced expiratory volume in the first second or forced vital capacity (r > = 0.3) in healthy individuals. CONCLUSIONS: Despite the reported sufficient reliability and validity of using ultrasonography to assess the thickness, excursion, stiffness, and strain rate of respiratory muscles in non-hospitalized individuals, further large-scale studies are warranted to improve the quality of evidence regarding using ultrasonography for these measurements in clinical practice. Researchers should establish their own reliability before using various types of ultrasonography to evaluate respiratory muscle functions. TRIAL REGISTRATION: PROSPERO NO. CRD42022322945.
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Músculos Intercostais , Músculos Respiratórios , Humanos , Adolescente , Reprodutibilidade dos Testes , Estudos Transversais , UltrassonografiaRESUMO
PURPOSE: Although it is evident that some patients with adolescent idiopathic scoliosis (AIS) have proprioceptive deficit in peripheral joints, knowledge on the proprioceptive function of the deformed spine is limited. Nonetheless, spinal proprioception in AIS may be affected three-dimensionally, prior studies only focussed on evaluating peripheral proprioception in single plane. Therefore, this study aimed to develop a novel spinal proprioception assessment using three-dimensional motion analysis in patients with AIS. METHODS: Participants were included if they had a primary diagnosis of AIS who did not receive or failed conservative treatments. Three trunk repositioning tests involving flexion-extension, lateral-flexion, and axial-rotation were conducted. A three-dimensional kinematics of the trunk was used as the outcome measures. The proprioceptive acuity was quantified by the repositioning error. The intra-examiner and test-retest reliability were analysed by the intraclass correlation coefficient (ICC). RESULTS: Fifty-nine patients with AIS were recruited. Regarding the trunk flexion-extension test, the single measure ICC showed moderate reliability (0.46) and the average measures ICC demonstrated good reliability (0.72). As for the trunk lateral-flexion test, the reliability of single measure and average measures ICC was moderate (0.44) and good (0.70) reliability, respectively. For the trunk axial-rotation test, the single measure ICC indicated fair reliability (0.32), while the average measures ICC showed moderate reliability (0.59). CONCLUSION: This is the first study to evaluate the reliability of novel three-dimensional spinal proprioception assessments in patients with AIS. The trunk flexion-extension repositioning test may be preferable clinical test given its highest reliability.
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Cifose , Escoliose , Humanos , Adolescente , Escoliose/diagnóstico , Reprodutibilidade dos Testes , Coluna Vertebral , PropriocepçãoRESUMO
BACKGROUND: Authentic assessment and effective feedback are among various strategies that promote learning in the assessment process. These strategies are commonly used during clinical placements. However, they are rarely implemented in the didactic portion of physiotherapy education despite the benefits this type of assessment may bring to achieving students' learning and outcome. METHODS: This mixed method study investigated how an authentic continuous assessment coupled with rubrics facilitated physiotherapy students' learning process in a real-life complex skill of exercise prescription and instruction. The study also explored the relationship between different activities in the Learning Management System (LMS) and learning outcomes. Qualitative data was collected using a focus group and an analysis of discussion forum posts. Quantitative data included various information from a questionnaire, the LMS and assessment score. RESULTS: Thematic analyses from the focus group and discussion forum posts suggest that students used a cyclical self-regulated learning process as a result of authentic task design and rubrics for feedback facilitation. Interestingly, the discussion forum access was found to be moderately and significantly correlated with assessment score by Spearman's rank correlation (ρ = 0.59, p < 0.01), while the students did not find the discussion forum useful. CONCLUSIONS: Overall results suggest the promotion of self-regulated learning in this authentic continuous assessment. The roles and goals of each authentic task within the assessment should be made explicit in order to raise cognitive awareness of benefits.
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Bacharelado em Enfermagem , Estudantes de Enfermagem , Humanos , Aprendizagem , Pesquisa em Educação em Enfermagem , Modalidades de FisioterapiaRESUMO
BACKGROUND: The recovery of locomotion is greatly prioritized, and neuromodulation has been emerging as a promising approach in recent times. STUDY DESIGN: Single-subject research design. SETTINGS: A laboratory at The Hong Kong Polytechnic University. OBJECTIVES: To investigate the effects of augmenting activity-based therapy (ABT) to transcutaneous electrical spinal cord stimulation (TSCS) on enhancing specific lower limb muscle strength and improving locomotor ability in an individual with chronic incomplete spinal cord injury (iSCI). METHODS: An individual with iSCI underwent two phases of treatment, ABT alone followed by combined ABT+TSCS, each for a period of 10 weeks. The TSCS stimulated T10-T11 and T12-L1 segments with a frequency of 30 Hz at an intensity between 105 mA and 130 mA. Manual muscle testing, 6 min walk test (6MWT), and surface electromyography (EMG) responses of specific lower limb muscles were measured. Additionally, spasticity and sensorimotor examinations were conducted every two weeks, while pain tolerance was recorded after each treatment session. RESULTS: After the ABT+TSCS treatment, there was an increase in overall muscle strength grading (from 1.8 ± 0.3 to 2.2 ± 0.6 out of 5.0). The 6MWT showed a greater increase in walking distance (3.5 m to 10 m) after combined treatment than ABT alone. In addition, the EMG response of the anterior rectus femoris, biceps femoris, medial gastrocnemius, and tibialis anterior after ABT+TSCS increased more than after ABT alone. The spasticity grade was reduced (from 0.8 ± 0.7 to 0.5 ± 0.6) whereas the average lower limb motor score increased from 17 to 23 points. No adverse effects were reported. CONCLUSIONS: ABT+TSCS increased the target-specific lower limb muscle strength and walking ability more than ABT alone in an individual with chronic iSCI.
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Objectives: To assess the effectiveness of auricular acupressure (AA) in managing pain and disability in individuals with chronic musculoskeletal pain. Materials and Methods: A systematic search on six electronic databases was performed from their inception to May 7, 2023, to identified relevant randomized controlled trials (RCTs). Two independent reviewers screened the abstracts and full texts, extracted data, and assessed risk of bias using RoB 2. The primary outcomes were pain intensity and disability. The secondary outcomes were pain pressure thresholds, pain catastrophizing level, and fear avoidance beliefs. A random-effects model was used for meta-analyses. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation. Sensitivity analyses were conducted after removing low-quality papers. Results: Of 633 identified records, six studies involving 496 participants were included. All included studies compared the effectiveness of AA with sham controls in treating various chronic musculoskeletal pain. Four meta-analyses were conducted to compare the effectiveness of AA with sham controls. Low-quality evidence supported that AA had a large effect size on postintervention subjective pain reduction (standardized mean difference [SMD] = -0.95; 95% confidence interval [CI]: -1.36 to -0.54; p = 0.00; I2 = 52.61%); moderate-quality evidence substantiated that AA had a large effect size on enhancing postintervention pressure pain threshold (SMD = -0.55; 95% CI: -0.88 to -0.23; p = 0.00; I2 = 0%). There was low-quality evidence that AA had a large effect on reducing postintervention disability (SMD = -0.68; 95% CI: -1.24 to -0.12; p = 0.02; I2 = 51.33%). Our sensitivity analysis reaffirmed the same conclusion regarding pain reduction immediately after the intervention. Fourteen participants reported minimal adverse events, including soreness, tenderness, irritation, and redness, which disappeared within 1-7 days. Discussion: Our systematic review revealed that AA significantly improved pain, pressure pain thresholds, and disability in individuals with various chronic musculoskeletal pain conditions immediately post-treatment compared with sham treatment. Given the paucity of studies and inconsistent protocols, future RCTs are warranted to evaluate the effectiveness of AA in people with chronic musculoskeletal pain at a longer follow-up with detailed protocols, which allows researchers and clinicians to optimize AA intervention. Conclusion: AA has immediate post-treatment benefits for chronic musculoskeletal pain, whereas its effects at the 1- or 6-month follow-up remain uncertain.
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OBJECTIVE: We aimed to assess the reliability of quantifying psoas major (PM) and quadratus lumborum (QL) stiffness with ultrasound shear wave elastography (SWE), and to explore the effects of gender and physical activity on muscle stiffness. METHODS: Fifty-two healthy participants (18-32 y) were recruited. To determine reliability, 29 of them underwent repeated SWE measurements of PM and QL stiffness by an operator on the same day. The intra-class correlation coefficients (ICC3,1), standard error of measurement (SEM) and minimal detectable change with 95% confidence interval (MDC95) were calculated. The rest participants underwent a single measurement. Two-way MANCOVA was conducted for the effects of gender and physical activity on muscle stiffness. RESULTS: The observed reliability for PM (ICC3,1 = 0.89-0.92) and QL (ICC3,1 = 0.79-0.82) were good-to-excellent and good, respectively. The SEM (kPa) was 0.79-1.03 and 1.23-1.28, and the MDC95 (kPa) was 2.20-2.85 and 3.41-3.56 for PM and QL, respectively. After BMI adjustment, both gender (PM: F = 10.15, p = 0.003; QL: F = 18.07, p < 0.001) and activity level (PM: F = 5.90, p = 0.005; QL: F = 6.33, p = 0.004) influenced muscle stiffness. The female and inactive groups exhibited higher stiffness in both muscles. CONCLUSION: SWE is reliable for quantifying the stiffness of PM and QL. Female and physical inactivity may elevate PM and QL stiffness, underscoring the importance of accounting for these factors in muscle stiffness investigations. Larger prospective studies are needed to further elucidate their effects.
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Músculos do Dorso , Técnicas de Imagem por Elasticidade , Humanos , Feminino , Reprodutibilidade dos Testes , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/fisiologia , Exercício FísicoRESUMO
Trunk stability is crucial for people with trunk paralysis resulting from spinal cord injuries (SCI), as it plays a significant role in performing daily life activities and preventing from fall-related accidents. Traditional therapy used assistive methods or seating modifications to provide passive assistance while restricting their daily functionality. The recent emergence of neuromodulation techniques has been reported as an alternative therapy that could improve trunk and sitting functions following SCI. The aim of this review was to provide a broad perspective on the existing studies using neuromodulation techniques and identify their potentials in terms of trunk recovery for people with SCI. Five databases were searched (PubMed, Embase, Science Direct, Medline-Ovid, and Web of Science) from inception to December 31, 2022 to identify relevant studies. A total of 21 studies, involving 117 participants with SCI, were included in this review. According to these studies, neuromodulation significantly improved the reaching ability, restored trunk stability and seated posture, increased sitting balance, as well as elevated activity of trunk and back muscles, which were considered early predictors of trunk recovery after SCI. However, there is limited evidence regarding neuromodulation techniques on the improvement of trunk and sitting functions. Therefore, future large-scale randomized controlled trials are warranted to validate these preliminary findings.
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INTRODUCTION: Work-related musculoskeletal disorders (WMSDs) are recognized as a leading cause of nonfatal injuries in construction, but no review of existing studies has systematically analyzed and visualized the trends of WMSDs among construction workers. The current science mapping-based review summarized research published between 2000 and 2021 related to WMSDs among construction workers through co-word, co-author, and citation analysis. METHOD: A total of 63 bibliographic records retrieved from the Scopus database were analyzed. RESULTS: The results identified influential authors with high impacts in this research domain. Moreover, the results indicated that MSDs, ergonomics, and construction not only had the highest occurrence of been studied, but also the highest impact in terms of total link strength. In addition, the most significant contributions to research relating to WMSDs among construction workers have originated primarily from the United States, Hong Kong, and Canada. Furthermore, a follow-up in-depth qualitative discussion was conducted to focus on summarizing mainstream research topics, identifying existing research gaps, and proposing directions for future studies. CONCLUSIONS: This review provides an in-depth understanding of related research on WMSDs among construction workers and proposes the emerging trends in this research field.
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Indústria da Construção , Doenças Musculoesqueléticas , Doenças Profissionais , Humanos , Estados Unidos , Fatores de Risco , Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/etiologia , Ergonomia , Hong Kong , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , PrevalênciaRESUMO
Spinal cord injuries (SCI) can result in sensory and motor dysfunctions, which were long considered permanent. Recent advancement in electrical neuromodulation has been proven to restore sensorimotor function in people with SCI. These stimulation protocols, however, were mostly invasive, expensive, and difficult to implement. In this study, transcutaneous electrical stimulation (tES) was used to restore over-ground walking of an individual with 21 years of chronic paralysis from a cervical SCI. After a total of 66 weeks of rehabilitation training with tES, which included standing, functional reaching, reclined sit-up, treadmill walking, and active biking, significant improvement in lower-limb volitional movements and overall light touch sensation were shown as measured by the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) score. By the end of the study, the participant could walk in a 4-m walking test with the aid of a walking frame and ankle-foot orthoses. The successful sensorimotor recovery of our study participant sheds light on the future of non-invasive neuromodulation treatment for SCI paralysis.
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Falls are a prevalent cause of injury among older people. While some wearable inertial measurement unit (IMU) sensor-based systems have been widely investigated for fall risk assessment, their reliability, validity, and identification ability in community-dwelling older people remain unclear. Therefore, this study evaluated the performance of a commercially available IMU sensor-based fall risk assessment system among 20 community-dwelling older recurrent fallers (with a history of ≥2 falls in the past 12 months) and 20 community-dwelling older non-fallers (no history of falls in the past 12 months), together with applying the clinical scale of the Mini-Balance Evaluation Systems Test (Mini-BESTest). The results show that the IMU sensor-based system exhibited a significant moderate to excellent test-retest reliability (ICC = 0.838, p < 0.001), an acceptable level of internal consistency reliability (Spearman's rho = 0.471, p = 0.002), an acceptable convergent validity (Cronbach's α = 0.712), and an area under the curve (AUC) value of 0.590 for the IMU sensor-based receiver-operating characteristic (ROC) curve. The findings suggest that while the evaluated IMU sensor-based system exhibited good reliability and acceptable validity, it might not be able to fully identify the recurrent fallers and non-fallers in a community-dwelling older population. Further system optimization is still needed.
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Acidentes por Quedas , Equilíbrio Postural , Humanos , Idoso , Reprodutibilidade dos Testes , Medição de Risco/métodos , Curva ROCRESUMO
OBJECTIVE: To explore the incidence of musculoskeletal injuries in elite able-bodied and wheelchair foil fencers. DESIGN: A 3-year prospective cohort study of sport injuries during 2006-2009. SETTING: A sample of elite able-bodied fencers (AFs) and wheelchair fencers (WFs) from the Hong Kong National Squad. PARTICIPANTS: A total of 14 wheelchair and 10 able-bodied elite fencers completed the 3-year study. METHODS: Monthly interviews with fencers to collect data related to their injuries. MAIN OUTCOME MEASURES: The incidence rate and relative risk of injury were analyzed among able-bodied and WFs with different trunk control ability. RESULTS: Wheelchair fencers had higher overall injury incidence rate (3.9/1000 hours) than AFs (2.4/1000 hours). Wheelchair fencers with poor trunk control were more vulnerable to injuries (4.9/1000 hours) than those with good trunk control (3.0/1000 hours). Upper extremity injuries were predominant in WFs (73.8%), with elbow (32.6%) and shoulder strain (15.8%) being the most common injuries. Lower extremity injuries were predominant in AFs (69.4%), with muscle strain over knee and thigh region (22.6%), ankle sprain (14.5%), and knee sprain (11.3%) being the leading injuries. CONCLUSIONS: Results of this pilot study highlighted the distinct injury incidence between the 2 different fencer groups. Larg-scale epidemiologic and biomechanical studies are warranted to improve the understanding of fencing injuries to develop specific injury prevention/rehabilitation programs.
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Traumatismos em Atletas/epidemiologia , Sistema Musculoesquelético/lesões , Cadeiras de Rodas , Adulto , Atletas , Feminino , Humanos , Incidência , Extremidade Inferior/lesões , Masculino , Projetos Piloto , Estudos Prospectivos , Fatores de Risco , Entorses e Distensões/epidemiologia , Extremidade Superior/lesões , Adulto JovemRESUMO
Levodopa therapy is the standard pharmacological treatment for Parkinson's disease (PD). However, after an initial period of significant benefit, the effects of levodopa begin to wear off. This results in a reduction in the effect duration and the development of motor complications. We describe the case of a 69-year-old woman presented with a 3-year history of lower back pain and progressive left leg weakness. One year prior to referral for neurological assessment, the patient first noted progressive leg weakness and insufficient strength to rise from a chair. The diagnosis of PD was made after excluding potential neurological disorders. The patient was initially started on oral levodopa, which improved her motor symptoms considerably during the first year. However, dose adjustment and combined pharmacological strategies failed to sufficiently control motor symptoms during the subsequent year. The patient experienced declines in gait ability, clumsiness in the left limbs, and difficulty in performing housework. The patient then sought chiropractic attention. Gait rehabilitation was the major goal in the treatment program for this patient, with the impression of motor complications of PD. The intervention consisted of spinal manipulation, intermittent motorized traction of the lumbar segments, and gait training programs. Following 3 months of the intervention, the patient demonstrated increased muscle strength and improved gait characteristics, as depicted by a gait cyclogram and vertical ground reaction force graphing. The current report illustrates that a multicomponent chiropractic approach may be used as an additional measure to mitigate gait decline in PD patients.
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The sacroiliac joint (SIJ) is designed primarily for stability with minute motions. SIJ dysfunction refers to improper movement of the SIJs. Diagnosis and evaluation of SIJ dysfunction are difficult, with use of physical maneuvers and image-guided anesthetic injection. This case report describes a 47-year-old female who experienced right buttock pain and painful limp for approximately 2 months. Standing radiographs revealed inflammatory sclerosis surrounding the right SIJ. Physical examination found tenderness over the right SIJ and positive results in provocation (the distraction, compression, and thigh thrust) tests, compatible with right SIJ dysfunction. Her pain was resolved and gait performance was retrieved following 6-month program of combined thoracolumbar manipulation and rehabilitation exercises. Unexpectedly, change in pelvic incidence (PI) angles was noticed on follow-up radiograph. PI remains more or less fixed throughout adult life since the mobility of the SIJs is considered negligible. The current presentation is designed to explore the significance of PI change. The PI disparity unfolds the possibility of recognizing SIJ dysfunction based on consecutive radiographs.
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Chronic orchialgia can be the result of pathological processes of the scrotal contents or stem from non-intrascrotal structures. Successful pain management depends on identifying the source of localized or referred pain. This is a case report of a 39-year-old male sports coach who presented with low back pain, right orchialgia, and sciatica refractory to conservative management. Magnetic resonance (MR) imaging revealed disc protrusion at L3/L4 and L4/L5 levels. Positive outcomes in relieving back and testicular pain were obtained after a total of 30 chiropractic sessions over a 9-week period. The evidence of the subjective improvement was corroborated by regression of the herniated discs documented on the repeat MR imaging. While chronic orchialgia is not an uncommon problem for men of all ages, it has seldom been described in association with lumbar discogenic disease. The current study provided preliminary support for a link between orchialgia and lumbar disc herniation. Chiropractic manipulation had provided a mechanistic alleviation of noxious lumbar stimuli, leading to symptomatic and functional improvements.
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Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Dor Lombar , Adulto , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/terapia , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , MasculinoRESUMO
Cervicogenic dizziness (CGD) is a syndrome of neck pain accompanied by a false sensation of unsteadiness and dizziness due to neck pathology. An 11-year-old girl presented with neck pain and dizziness for four months. According to the patient's statement, her complaints were likely related to the prolonged smartphone use for texting. Sagittal radiograph showed cervical kyphosis, anterior wedging of several vertebrae, and mild anterolisthesis of C2 on C3 and C3 on C4. These findings might be present in as physiological variants in children. However, continuous static stress in the minor variants could aggravate biomechanical problems, such as cervicogenic dizziness. After ruling out other neurological or vestibular problems, a multicomponent approach consisted of thermal ultrasound therapy, cervical manipulation, and intermittent motorized cervicothoracic traction to release cervical complaints. Three months later, the patient reported a resolution of neck pain and dizziness. At 12-month follow-up, all radiographic metrics showed improvement, including restoration of cervical alignment and lordotic curvature. The immature growing cervical spine has unique anatomic, physiologic and biomechanical features. A static neck flexion can lead to typical injury patterns seen in this age group. This article aims to raise awareness of the potential harms of excessive smartphone use by children.
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Rheumatoid arthritis (RA) is an autoimmune disease that affects the synovial tissue which lines joints and tendons. The craniocervical junction is made up exclusively of synovial joints and ligaments and especially vulnerable to the inflammatory process of RA. The chronic inflammation of RA leads to loss of ligamentous restriction and erosion of the bony structures and results in craniocervical instability (CCI). This is a case report of an 80-year-old woman who had been diagnosed with seropositive RA two decades ago presented with head dropping and losing balance while walking for several months. Radiographic images of the cervical spine showed RA-related features of instability in the form of atlantoaxial instability, cranial settling and subaxial subluxation. Since physical therapy and acupuncture previously failed to provide a substantial, long-lasting outcome, the patient sought chiropractic care for her condition. The chiropractic regimen consisted of upper thoracic spine mobilization/adjustment, electrical muscle stimulation of the cervical extensors, home exercises and neck bracing. She regained substantial neck muscle strength, gaze angle and walking balance following a 4-month chiropractic treatment, although cervical kyphosis persisted. The current study aims to provide basic knowledge of CCI associated with RA and ability to modify a treatment program to accommodate the needs of patients with coexisting red flags.
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Gua sha is a traditional healing technique that aims to create petechiae on the skin for a believed therapeutic benefit. Natural healings are mostly based on repeated observations and anecdotal information. Hypothetical model for healing does not always fit the modern understanding. Yet, the mechanisms underlying Gua Sha have not been empirically established. Contemporary scientific research can now explain some events of traditional therapies that were once a mystery. It is assumed that Gua Sha therapy can serve as a mechanical signal to enhance the immune surveillance function of the skin during the natural resolving of the petechiae, through which scraping may result in therapeutic benefits. The current review, without judging the past hypothetical model, attempts to interpret the experience of the ancient healings in terms of contemporary views and concepts.
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Parkinson's disease (PD) is a progressive neurological disorder with cardinal motor features of tremor, bradykinesia, muscle rigidity, impaired gait and posture. Muscular pain or arthralgia is a common non-motor symptom in PD. The PD-related pain is probably attributed to a combination of altered posture, abnormal muscle tone, and truncal dystonia. A 59-year-old male taxi-driver with PD treated with levodopa for 18 months complained of progressive low back pain and gait difficulties that prevented him from normal activities in the past 2 months. Magnetic resonance imaging showed degenerative disc disease with multiple levels of bulging discs in the lumbar spine. After 35 chiropractic sessions, there was a significant improvement in various aspects of well-being, including pain resolution measured by a numeric rating scale, physical and mental improvement measured by the Parkinson's Disease Questionnaire, gait stability depicted by gait cyclogram, and better postural alignment and stability assessed by radiographic parameters. The current study may serve as an example of spinal manipulation showing the potential to address gait and posture problems associated with pain in a patient with PD. Aging changes in the muscles, bones and joints may accompany PD. Although PD itself is an incurable neurodegenerative disease, functional capacity of the musculoskeletal system can be enhanced by different types of manual therapy, by means of improving muscle strength, joint mobility, and postural balance. The actual duration in sustaining improved outcomes following a course of manipulative intervention remains to be determined.
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Traditional discipline-specific training has limitations in facilitating inter-professional communication and collaboration. To address this issue, two local universities in Hong Kong launched an interprofessional team-based learning program to allow the undergraduate healthcare students to form teams and experience collaborative problem-solving. This study aimed to evaluate the experiences of nursing and physiotherapy undergraduates following interprofessional learning activities. Twenty-seven 3rd-year nursing and physiotherapy undergraduates were recruited through purposive sampling. Semi-structured interviews were conducted, and written feedback was solicited until data saturation was achieved. An inductive thematic analysis was used for the data, and each theme was mutually exclusive. The findings revealed the positive experiences of the students with this interprofessional learning activity. Three main themes emerged: (1) the process of interprofessional learning; (2) profession-related outcomes of interprofessional learning; and (3) patient-related outcomes of interprofessional learning. The study indicated that interprofessional team-based learning activities enhanced learning experiences of the students through interactive learning with other healthcare students. Experiences of relationships that are trustful and complementary allow students to develop confidence in knowledge transfer and in interprofessional collaboration, as well as in providing a holistic patient-centered care. These findings substantiate the importance and value of interprofessional learning in healthcare education.