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This paper will go through an attempt to predict vital data namely BPM and pulse interval of human being. Study involves data set produced with a total of 83 subjects spread across various categories by age group and BMI ratio. A specialized device fabricated for this purpose designed on a development board divided in two layers of printed circuit board based on Atmega328p microcontroller enables the collection of data using a pulse sensor. The machine learning algorithm running on the device saves encoded data files and produces calculation based on the previous data saved. Thus, the accuracy improves after every data sample obtained enabling the device with experience-based learning. The system makes use of a few mathematical equations on the dataset obtained for each category and is successfully able to predict BPM and pulse interval more than 70% times for age group 21 to 25 involving proportionate subjects according to BMI ratio with a database of 140 samples for each parameter taken from 70 subjects; predict BPM more than 50% times and pulse interval more than 30% times for age group 51 to 55 also involving proportionate subjects according to BMI ratio with a database of 26 samples for each parameter taken from 13 subjects while subjects were sitting or standing idle represented by the class “Regular”.

Text Neck Syndrome is repeated stress injury to the neck, or it is a pain encountered in the neck due to excessive usage of handheld devices for a prolonged period. In this paper, we have used the Microsoft Kinect sensor to create the dataset for normal and abnormal sitting postures by obtaining 3D skeletal coordinates of people. Features are extracted from the data collected from the Kinect sensor data based on the various parameters like Minkowski distance, Euclidean distance, Manhattan distance, etc. Then we have applied different machine learning algorithms, namely, K-nearest neighbours, Random forest, Support vector machine, Logistic and Linear Regression, to classify them. The performance of various algorithms is analysed. The best testing accuracy achieved is 92.85% by using Random Forest and Support Vector Machine algorithms.

Lower limb flexibility is known to be decreased in those living in mountainous areas, and musculoskeletal growth is often influenced by lifestyle factors. The purpose of this study was to determine the relationship between the means of transportation to school and lower limb musculoskeletal function and low back pain.During routine medical examinations conducted in two cities in a prefecture in 2016, a questionnaire was administered. The parents of 15,259 students who attended elementary school answered questions evaluating the following parameters: (1) anteflexion limit in the standing posture, (2) crouching failure, (3) one leg standing failure, (4) low back pain during lumbar extension, (5) lower limb alignment abnormalities, and (6) flat foot. Students were divided into a walking commuting group (13,569 students) and a vehicle commuting group (1690 students), and findings were compared between the two groups using chi-square tests.In the walking and vehicle commuting groups, anteflexion limit in the standing posture was present in 23.3% and 26.1% of students, respectively (p = 0.013). Crouching failure was present in 4.6% and 7.3% of students (p 0.001); one leg standing failure in 5.3% and 8.5% of students (p 0.001); low back pain in 5.0% and 7.1% of students (p 0.001); positive leg alignment abnormalities in 7.3% and 8.0% of students (p = 0.260); and flat foot in 7.4% and 8.7% of students (p = 0.067), respectively. Significant differences were observed in all four of the failure measures. No significant differences were observed in the two methods evaluating morphological abnormalities.The decreased walking duration and increased sitting duration associated with vehicle commuting had little effect on lower limb morphology but could induce lower limb dysfunction and low-back pain in children. Thus, supplemental walking should be instated for children who commute by car.

Summary Kinesio taping (KT) is a popular intervention among the physiotherapists since it facilitates the reduction of pain and improvement of activities. However, there is little evidence about the therapeutic application of KT in pregnant women. A 33-year-old woman with a history of one term normal vaginal delivery referred to us at the 26th weeks of her second pregnancy. Almost 2 months before her referral, she experienced constant pain in the legs, ankles, and lumbar. The patient also reported burning sensation and sweating in the sole of her feet and sleep disturbance. She had a painful functional impairment that made walking, standing, sitting, and personal activities difficult. The patient did not take any sedatives during pregnancy. Therefore, KT was applied to the lower thoracic region for 5 days at three times. The Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) were utilized to assess pain-related disability in the patient. After KT application, both VAS and ODI scores showed a significant decrease. Furthermore, she reported a remarkable improvement in her walking ability, feet sweating, and sleep disturbance. The present case report explained the use of KT on the lower thoracic spine in a patient suffering from low back and leg pains, as well as burning sensation and sweating of the sole of feet during pregnancy. The results revealed an improvement in patient symptoms, which may be due to the application of KT on the lower thoracic region. It seemed that her symptoms were due to pregnancy-induced physiologic changes in the body and sympathetic nervous system (SNS) disorder. Based on this study, it can be concluded that KT is a safe and inexpensive technique that can be used as a complementary therapy of low back and leg pains and SNS disorder in pregnant women.

Sedentary behavior (SB) and physical activity (PA) are important risk factors of cardiovascular disease morbidity and mortality. In addition to increasing the amount of moderate-to-vigorous PA (MVPA), the current PA guidelines recommend that adults should reduce SB, or any waking activity performed while sitting, reclining, or lying, with low energy expenditure. While mounting evidence has emphasized the benefits of increasing MVPA, little has focused on the effect of SB on health. Therefore, this review discusses the pathophysiological effects of SB and the potential physiological benefits of reducing/breaking up SB at the levels below the current guidelines for PA. Such knowledge is important, given that the majority of the United States population performs insufficient or no MVPA and is at high risk of being negatively impacted by SB. Interventions targeting sedentary time, such as breaking up SB by standing and moving, may be safe, feasible, and applicable to execute daily for a wide range of the population. This review also discusses the importance of monitoring SB in the era of the coronavirus disease 2019 (COVID-19) pandemic and the clinical implications of sitting less and moving more.

Background Emergency nurses are at higher risk than the average worker of experiencing lumbar pain. This is the first study to undertake real time monitoring to quantify lumbar movements of nurses working in the emergency department (ED). Methods Emergency nurses at a single Australian ED were recruited for a prospective observational case study. Participants worked in four discrete clinical areas of the ED; In-charge, triage, resuscitation, and cubicles. Data collected included participant demographics, lumbar pain pre- and post-shift, and real-time recording of lumbar movements. Results Sixty-two nurses participated. There were statistically significant differences in time spent standing (p = 0.005), sitting (p ≤ 0.001) and in locomotion (moving) (p ≤ 0.001) when compared by clinical role. Triage nurses spent over half their shift sitting, had the most sustained (> 30 s) flexions (60+ degrees) and had a median of 4 periods of uninterrupted sitting (10−30 mins) per shift. Conclusions Differences in movement demands were identified based on various clinical roles in the ED. Triage was associated with greater periods of uninterrupted sitting and with greater degrees of sustained flexion, both of which are predictors for back pain. This study provides foundation evidence that triage may not be the most appropriate location for staff returning from back injury.

Objective The aim of this study was to examine lymphatic diameters in lower limbs of healthy volunteers in different body positions using lymphatic ultrasound examinations. Methods Thirty-five healthy volunteers participated in this study. Those who had a history of varicose veins in the leg, deep venous thrombosis, or surgery on their legs or abdomen were excluded. We measured the vertical width of the lymphatics with a 33 MHz linear ultrasound probe, at 20 cm above the knee (thigh) and 10 cm below the knee (lower leg). First, the participants were placed supine, then sitting, and then standing. We performed lymphatic ultrasound examinations in each body position. The Student t test was used to compare lymphatic vessel diameters in the supine, sitting, and standing positions. The significance level was set at .05. Results Among 35 healthy volunteers, 17 were men and 18 were women. Mean age was 30.9 (range, 23-55) years. The mean body mass index was 21.3 kg/m2 (range, 29.0-16.1 kg/m2). We could not detect lymphatic vessels in 1 thigh and 3 lower legs, leaving 69 thighs and 67 lower legs for evaluation. In the thigh, the mean lymphatic diameters in the supine and standing positions were 0.154 mm and 0.150 mm, respectively, which were not significantly different. In the lower leg, the mean lymphatic diameters in the supine, sitting, and standing positions were 0.160 mm, 0.163 mm, and 0.164 mm, respectively, which were not significantly different. In the thigh, the mean lymphatic diameter in the supine position was larger in the men (0.17 mm) than in the women (0.14 mm) (P = .022). Similarly, in the lower leg, the mean lymphatic diameter in the supine position was greater in the men (0.19 mm) than in the women (0.14 mm) (P = .0044). There was no correlation between the supine lymphatic diameters and the age or body mass index of the participants. Conclusions In healthy legs, lymphatic diameters do not change with body positioning. Supine lymphatic vessel diameters are greater in men than in women.

Coronavirus disease-2019 (COVID-19) has a profound impact on the health care system worldwide. In the COVID-19 pandemic, hospitals are required to halt elective surgeries and procedures for preventing nosocomial infections and saving medical resources. In these situations, emergency procedures are required for life-threatening cardiovascular diseases such as acute coronary syndrome and cardiogenic shock. To prevent the spread of COVID-19, a social distance is essentially required. In ordinary percutaneous coronary intervention (PCI), operators manipulate the devices standing at the patient's tableside during the whole procedure, which may involve a certain risk of exposure to patients with COVID-19. A robotic-assisted PCI (R-PCI) allows operators to manipulate devices remotely, sitting at a cockpit located several meters away from the patient, and in addition, the assistant can be at the foot of the bed, much further from the access site. R-PCI can help to minimize the radiation exposure and the amount of person-to-person contact, and consequently may reduce the risk for the exposure to the virus., Graphical abstract Image, graphical abstract

Purpose Our objective was to estimate the impact of the absence of Out-of-Bed (OoB) mobilization during intensive care unit (ICU) stay among patients ≥70 years on their long-term autonomy. Methods We conducted an ancillary study of the multicenter FRAGIREA study, including patients aged over 70 years, admitted to ICU for more than 48 h. We excluded the patients who died before day 180, who were lost to follow-up, and for whom the baseline autonomy (ADL) score was not available. Patients were classified into the OoB or non-OoB-mobilization group, and the impact of OoB mobilization on the decreased 6-month autonomy was estimated. Results Among the 548 patients of the FRAGIREA cohort, 276 were included in the present study. Among them, 226 had OoB mobilization and 50 did not. 220/276 (80%) patients experienced the transfer to chair as rehabilitation therapy, passive mobilization and transfer to upright sitting were also frequently performed. A decrease in the 6-month autonomy was observed for 63 (23%) patients. After the elimination of potential confounders, non-OoB-mobilization patients had a greater risk of 6-month decreased autonomy (aOR 2.43 [1.18; 4.98]). Conclusions Mobilization during the ICU stay of elderly ICU patient survivors was associated with a lower decreased autonomy at 6 months.

BACKGROUND/PURPOSE This retrospective study aimed to determine which factors, such as cognition, motor recovery, swallowing function, and bladder and bowel functions, significantly predicted independence in the activities of daily living (ADL) at hospital discharge in a domestic population of patients experiencing post-acute stroke who received in-hospital rehabilitation. METHODS We reviewed medical records that were retrieved from the Integrated Medical Database, National Taiwan University Hospital (NTUH-iMD) of 3000 patients who suffered from stroke and were admitted to NTUH from 2014 to 2017. The main outcome measure was independence in the basic ADL (modified Barthel index [mBI]) at discharge. Regression analyses were used to identify prognostic factors for the basic ADL (mBI). RESULTS The total mBI improved from 40.7 ± 33.0 to 63.1 ± 34.1 in eligible 2538 patients during their hospital stay. The baseline daily activity function (R2 change = 0.042) was the most important prognostic factor associated with independence at discharge, followed by dependence in sitting up (R2 change = 0.014), impaired sitting balance (R2 change = 0.010), the Brunnstrom stage of hemiplegic lower limb (R2 change = 0.006), and the presence of bladder incontinence (R2 change = 0.006) assessed by physician upon rehabilitation admission (R2 = 0.53, p

Older adults may be subject to prolonged bedrest during hospitalization for acute cardiovascular disease, which can contribute to poor functional outcomes posthospitalization. Our objective was to describe mobility status in hospitalized older adults with acute cardiovascular disease.Patients aged ≥ 60 years old in the cardiac intensive care unit and cardiovascular ward at a tertiary care academic centre in Montréal, Québec were prospectively enrolled from April 2019 to March 2020. Activity levels were measured with the ActiGraph GT9X Link 3-axis accelerometer (ActiGraph, Pensacola, FL). Sedentary was defined as lying in bed or in a sitting position. Health-related quality of life (HRQOL) was measured with the Short-Form 36 (SF-36) questionnaire by telephone at 1 month posthospitalization. The primary outcome was percentage of sedentary time during hospitalization.There were 35 patients included in the analysis (75.7 ± 6.9 years old; 45.7% female; 22.9% ischemic heart disease; 20.0% heart failure). Patients spent 91.2% ± 5.5 in a sedentary position during their hospital stay. Mean steps per minute were 1.0 ± 1.2, and mean kcals consumed per day were 116.6 ± 124.5. In the multivariable analysis, a higher percentage of sedentary time and lower steps per minute were each associated with lower total SF-36 scores at 1-month posthospitalization (bothOlder adults with acute cardiovascular disease may be sedentary for a large part of their hospital stay. Increased sedentary time is associated with worse self-reported posthospital HRQOL. Future studies are needed to determine whether interventions to increase activity during hospitalization improve posthospital HRQOL and functional outcomes.Les personnes âgées hospitalisées en raison d’une maladie cardiovasculaire en phase aiguë peuvent être sujettes à un alitement prolongé qui peut contribuer à des résultats fonctionnels médiocres après l’hospitalisation. Notre objectif était de décrire l’état de mobilité des personnes âgées hospitalisées en raison d’une maladie cardiovasculaire en phase aiguë.Nous avons inscrit de façon prospective les patients de ≥ 60 ans de l’unité des soins intensifs cardiaques et de l’unité de cardiologie d’un centre universitaire de soins tertiaires à Montréal, au Québec, d’avril 2019 à mars 2020. Nous avons mesuré les niveaux d’activité physique à l’aide de l’accéléromètre ActiGraph GT9X Link 3-axis (ActiGraph, Pensacola, Floride, É.-U.). Nous avons défini la sédentarité par le fait d’être couché au lit ou en position assise. Nous avons mesuré la qualité de vie liée à la santé (QVLS) à l’aide du questionnaire SF-36 (Short Form-36) par téléphone un mois après l’hospitalisation. Le critère de jugement principal était le pourcentage de temps sédentaire durant l’hospitalisation.Dans l’analyse, on comptait 35 patients (75,7 ± 6,9 ans; 45,7 % de femmes; 22,9 % atteints d’une cardiopathie ischémique; 20,0 % atteints d’insuffisance cardiaque). Les patients passaient 91,2 % ± 5,5 en position sédentaire durant leur séjour à l’hôpital. Les pas moyens par minute étaient de 1,0 ± 1,2, et les kcal moyennes consommées par jour étaient de 116,6 ± 124,5. Dans l’analyse multivariée, un pourcentage plus élevé de temps sédentaire et un nombre inférieur de pas par minute étaient chacun associés à des scores totaux plus faibles au SF-36 un mois après l’hospitalisation (Les personnes âgées atteintes d’une maladie cardiovasculaire en phase aiguë se retrouvent sédentaires pendant une grande partie de leur séjour à l’hôpital. L’augmentation du temps sédentaire est associée à une plus mauvaise QVLS après l’hospitalisation selon les personnes âgées interrogées. Des études ultérieures sont nécessaires pour déterminer si les interventions pour accroître l’activité physique durant l’hospitalisation améliorent la QVLS et les résultats fonctionnels après l’hospitalisation.

An 89-year-old woman was admitted to our hospital for subacute onset of right upper and lower limb weakness and was diagnosed with acute cerebral infarction. During rehabilitation, close observation revealed that her oxygen saturation decreased in the sitting position and improved in the recumbent position without any subjective symptoms of dyspnea. Transthoracic and transesophageal echocardiography and cardiac catheterization revealed a large patent foramen ovale with an atrial septal aneurysm with right-to-left shunting through the defect, and she was diagnosed with platypnea-orthodeoxia syndrome. Her right hemiplegia caused the trunk to collapse, so the patient slumped when in sitting position, and the trunk tilted to the right forward, resulting in an increased right-to-left shunt. Her peripheral capillary oxygen saturation improved in the upright sitting position supported by therapists. This case suggests that right hemiplegia may exacerbate the symptoms of platypnea-orthodeoxia syndrome.

Background Children with Down Syndrome (DS) present with neuromuscular disturbances leading to delayed developmental milestones, poor quality of movement and poor balance. The aim of this study is to discuss the role of trunk muscle strength in the functional performance of children with DS. Methodology 28 children were recruited in the study, 14 with DS and 14 age and gender-matched controls. Trunk muscle strength, reaching ability and balance were assessed using a Handheld Dynamometer, Modified Functional Reach test and Pediatric Balance Scale, respectively. Results Children with DS present with poorer trunk muscle strength, reaching ability and balance as compared to typically developing (TD) children. There was a positive correlation between trunk muscle strength and lateral reaching in children with DS. A strong to moderate correlation was observed between the trunk muscle strength and balance in children with DS. Discussion Children with DS demonstrated a significantly weak trunk muscle groups. Lateral reaching distance is reduced due to the poor proximal control and they present with near-normal forward reach distance attributed to compensation using the lower trunk muscles. They exhibit poor balance in the components that require a small base of support. Conclusion Children with DS exhibit weak trunk muscles along with lesser reaching distance and poor balance. Also, trunk muscle strength influences lateral reaching ability. Trunk muscle strength, mainly trunk extensors impacted functional balance in sitting, standing and while performing transfers.

To evaluate the predictive value of intraoperative neuromonitoring (IONM) in brainstem cavernous malformation (BSCM) surgery.Surgically treated patients with BSCM were included. All patients received IONM consisting of motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs). Neurologic examination was conducted preoperatively and at discharge and follow-up3 months after BSCM removal. Demographic, radiographic, and clinical features were assessed. Study end points were new motor or somatosensory deficits and functional disability.A total of 62 patients were included. MEP decrease was associated with new motor deficits at discharge (P = 0.022), and SSEP decrease was associated with new somatosensory deficits at discharge (P0.001) and follow-up (P0.001). Sensitivity and specificity values for MEPs (discharge: 31% and 93%; follow-up: 33% and 91%) and SSEPs (discharge: 82% and 80%; follow-up: 85% and 79%) were calculated, respectively. Receiver operating characteristic analyses with area under the curve (AUC) metrics revealed acceptable performance of MEPs (AUC, 0.75; P = 0.022) and SSEPs (AUC, 0.72; P = 0.004) in predicting early deficits. Intraoperative decrease of MEPs (P = 0.047) and SSEPs (P = 0.017) was associated with early functional disability. Surgery-related subdural air accumulation impaired IONM reliability in predicting early (P = 0.048) and long-term (P = 0.013) deficits.Established IONM warning criteria may be valid for BSCM removal. However, surgical approaches in the sitting position significantly limit the predictive value of IONM, to some extent because of intraoperative pneumocephalus.

Automated vehicles are an emerging technology that operate with differing levels of automatic control (SAE levels). The current study explored participants’ acceptance of a conditional (Level 3) automated vehicle (AV) before and after riding as a passenger for 10 min on open, public roads in uncontrolled traffic. Additionally, participants were asked to rate the riskiness (perceived risk) of a variety of vehicle maneuvers, such as turning, accelerating, and braking when approaching an intersection. We predicted that participants would report higher acceptance ratings and lower perceived risk ratings after experiencing the AV compared to pre-trip ratings. Further, we predicted that participants riding in the front-passenger seat would report higher ratings for risk compared to participants sitting in the rear-passenger or rear-driver seats. Sixty participants from South-East Queensland, Australia (aged 21–82 years; Mage = 45.78; 23 female) took part in the study. Compared to pre-trip responses, participants reported statistically higher ratings for acceptance, as well as statistically lower ratings for perceived risk with respect to specific vehicle maneuvers performed while in automated mode. Differences were detected between seats for perceived risk, but these results were less clear. Increases in acceptance and decreases in risk were also detected as the number of false hazards detected by the vehicle increased. Overall, these findings suggest that acceptance towards AVs may increase, and expectations of risk related to AV maneuvers may decrease, after participants have experienced the vehicles firsthand, on an open, public road in an uncontrolled traffic environment.

Purpose This study aimed to directly compare different measurement scenarios using a supplemental radiation exposure measurement data set. Materials and methods Two sets of measurement scenarios comparing different body postures, such as standing and chair sitting positions, and different measurement directions, such as anterior and posterior directions, were assessed for radiation dose rate variations in this study at the Tokyo Medical Center, Japan. The estimated precaution time for holding children in the spoon position while sitting was also calculated. Results Different radiation dose rate measurement scenarios showed different variation tendencies. Radiation dose rate measurement showed higher mean values of measured radiation dose tendency in the standing position than in the sitting positions. The measurement from the anterior direction showed a slightly lower tendency than that from the posterior direction. Assuming a dose limit of 1 mSv, the precaution time calculated for children being held in the spoon position for a certain duration every day was 51.5 (range, 12.5–152.2) minutes. Conclusions Our study presented a supplemental radiation exposure measurement data set and directly compared different measurement scenarios. Several trends in radiation exposure variations were found in the measurement scenarios at different body postures and different measurement directions. Our study data set could be a useful source of concrete information regarding radiation safety and contribute to the review and revision of public guidance in the future.

Highlights • Unexplained dizziness in the elderly may result from cerebral small vessel disease. • Dizzy elderly patients differed from controls in EEG power when standing. • EEG power when standing correlated with subjective (perceived) instability., Objective To examine the hypothesis that small vessel disease disrupts postural networks in older adults with unexplained dizziness in the elderly (UDE). Methods Simultaneous electroencephalography and postural sway measurements were undertaken in upright, eyes closed standing, and sitting postures (as baseline) in 19 younger adults, 33 older controls and 36 older patients with UDE. Older adults underwent magnetic resonance imaging to determine whole brain white matter hyperintensity volumes, a measure of small vessel disease. Linear regression was used to estimate the effect of instability on electroencephalographic power and connectivity. Results Ageing increased theta and alpha desynchronisation on standing. In older controls, delta and gamma power increased, and theta and alpha power reduced with instability. Dizzy older patients had higher white matter hyperintensity volumes and more theta desynchronisation during periods of instability. White matter hyperintensity volume and delta power during periods of instability were correlated, positively in controls but negatively in dizzy older patients. Delta power correlated with subjective dizziness and instability. Conclusions Neural resource demands of postural control increase with age, particularly in patients with UDE, driven by small vessel disease. Significance EEG correlates of postural control saturate in older adults with UDE, offering a neuro-physiological basis to this common syndrome.

Made available in DSpace on 2022-04-28T19:41:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-11-01 Background: The evidence on the association between sedentary behaviour and depression in adolescence is mixed. We aimed to investigate the association between mentally-active and mentally-passive sedentary behaviours at 11 years (11y) and depressive symptoms at 14y, and to examine potential mediators. Methods: UK Millennium Cohort Study data were used (n=7,124; 49% boys). At 11y, participants self-reported frequency of mentally-passive (listening to music, internet use) and mentally-active sedentary behaviours (reading, playing electronic games). Additional parental-reported behaviours (mentally-passive: TV viewing; mentally-active: homework) were summed with self-reported behaviours to represent continuous indicators of mentally-active and mentally-passive sedentary behaviour. Depressive symptoms were assessed (at 11y and 14y) using the short-version of Mood and Feelings Questionnaire. Body mass index (BMI), mentally-passive sedentary behaviour and cognition at 14y were examined as potential mediators. Linear regression models were adjusted for confounders and stratified by sex. Subsequent mediation analyses reporting e-values were used to assess unmeasured confounding. Results: Among girls, mentally-passive sedentary behaviour at 11y was associated with later depressive symptoms (14y) [β:0.089 (95%CI:0.055-0.122), e-value:1.32]. This association was mediated by BMI [5.6% (95%CI:4.1%–8.6%)] and mentally-passive sedentary behaviour [105.6% (95%CI:79.6%–156.7%)]. No associations were observed in boys or between mentally-active sedentary behaviour and later depressive symptoms. Limitations: The parental report of behaviours and the assessment of mediators and outcome in the same wave are the main limitations. Conclusion: Future interventions aiming to improve mental health among girls could aim to reduce mentally-passive sedentary behaviour in early teens and could target potential mediators including BMI. MRC Epidemiology Unit and Centre for Diet and Activity Research (CEDAR) School of Clinical Medicine Institute of Metabolic Science Cambridge Biomedical Campus University of Cambridge Department of Physical Education Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP) Food & Mood Centre Centre for Innovation in Mental and Physical Health and Clinical Treatment School of Medicine Faculty of Health Deakin University Department of Psychological Medicine Institute of Psychiatry Psychology and Neuroscience King's College London, De Crespigny Park Maudsley NHS Foundation Trust Department of Physical Education Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP)

Patients with DISH are susceptible to spinal fractures and subsequent neurological impairment, including after minor trauma. However, DISH is often asymptomatic and fractures may have minimal symptoms, which may lead to delayed diagnosis. The purpose of this study was to identify risk factors for delayed diagnosis of spinal fractures in patients with diffuse idiopathic skeletal hyperostosis (DISH).The subjects were 285 patients with DISH surgically treated at 18 medical centers from 2005 to 2015. Cause of injury, imaging findings, neurological status at the times of injury and first hospital examination, and the time from injury to diagnosis were recorded. A delayed diagnosis was defined as that made24 h after injury.Main causes of injury were minor trauma due to a fall from a standing or sitting position (51%) and high-energy trauma due to a fall from a high place (29%) or a traffic accident (12%). Delayed diagnosis occurred in 115 patients (40%; 35 females, 80 males; mean age 76.0 ± 10.4 years), while 170 (60%; 29 females, 141 males; mean age 74.6 ± 12.8 years) had early diagnosis. Delayed group had a significantly higher rate of minor trauma (n = 73, 63% vs. n = 73, 43%), significantly more Frankel grade E (intact neurological status) cases at the time of injury (n = 79, 69% vs. n = 73, 43%), and greater deterioration of Frankel grade from injury to diagnosis (34% vs. 8%, p 0.01). In multivariate analysis, a minor trauma fall (OR 2.08; P 0.05) and Frankel grade E at the time of injury (OR 2.29; P 0.01) were significantly associated with delayed diagnosis.In patients with DISH, it is important to keep in mind the possibility of spinal fracture, even in a situation in which patient sustained only minor trauma and shows no neurological deficit. This is because delayed diagnosis of spinal fracture can cause subsequent neurological deterioration.

Background Mechanosensitivity changes and trigger points in the infraspinatus muscle are associated with several painful conditions of the upper limb. The aim of this study was to assess the effect of different postures of the upper quadrant on the pressure pain threshold (PPT) of the infraspinatus muscle. Methods This was an observational, cross-sectional study. Fifty-four subjects with and without shoulder pain (Asymptomatic subjects = 27, mean age 26.9 ± 4.92 years, BMI 23.73 ± 3.87), (symptomatic subjects = 27, mean age 27.6 ± 3.68 years, BMI 24.35 ± 3.86) were evaluated with a pressure algometer on the infraspinatus muscle belly, in four different positions of the upper quadrant: rest position (P1), passive scapular retraction position (P2), cervical contralateral inclination position (P3), and suprascapular nerve provocation position (P4). The assessed side was randomly chosen and all measurements were taken in sitting position. Results No differences were observed between groups. The within-group analysis showed differences for both factors: “Positions” (F = 69.91; p = 0.001) and the interaction “Positions^Group” (F = 3.36; p = 0.02). The pairwise post-hoc analysis showed differences for the retracted position (P2) compared to others P1 (p = 0.001), P3 (p = 0.001), and P4 (p = 0.001), with higher PPT results achieved on the retracted position. Differences between P4 vs. P1 (p = 0.03) were also observed, with higher values for P4. Conclusion Placing the scapular girdle in a passive scapular retraction position significantly reduces the pressure sensitivity at the infraspinatus muscle. Physiotherapists can take into account these results when assessing and treating patients with upper quadrant pain syndromes.

High returns to college lead to intense competition among high-school students for places at elite universities. In this paper, I study an unanticipated effect of a high-school curriculum reform in China in the 2000s. In this context, students in the last cohort under the old curriculum were faced with an unexpectedly increased pressure associated with higher costs of retaking the College Entrance Exam due to the curriculum switch; I confirm this pattern by demonstrating a sharply declining number of exam retakers in the year when the curriculum was changed. I then study the impact of this increased cost and the associated higher pressure on household educational investments as well as long-run outcomes of students. The empirical results show that households with students exposed to a higher cost of retaking the exam invested more in children’s education for a better chance on their first sitting. Further evidence indicates that being in the last cohort under the old curriculum reduced students’ subjective wellbeing and led to more pessimism in the long run.

A non-invasive, no radiation, out-of-hospital automated system is proposed to identify low arch integrated in the design and manufacturing of personalized orthoses using parametric modelling. The aim of the design process is to integrate assistive technology with assessment and prevent low arch progressing to a more serious case - flatfoot. In the automated procedure, we developed an assessment method including reliable thresholds of foot type classification and test protocol to reduce interferences due to preceding activities, an automation to translate scanned data into parametric design for orthotic customization, finite element model evaluating effectiveness of the personalized design, and a personalized comparative test to evaluate the long-term improvement of foot arch shape. Our low arch threshold established by subject-specific 3D models reduced the misclassification rate from 55%, as previously reported to 6.9%. Individuals who engaged in sedentary activity (i.e. sitting) had the greater change in arch height compared to active activity (i.e. standing and walking), which is more likely to affect the obtained measure. Therefore, a test protocol now states that participants are not allowed to sit over 100 min prior the measurement to reduce such interference. We have proposed and tested an automated algorithm to translate scanned data including seven foot's parameters into customised parametric design of the insert. The method decreases the required time of orthotic computer-aided design from over 3 h to less than 2 min. A finite element analysis procedure was additionally developed to assess the performance of geometries and material of designed orthotic based on the distribution of plantar pressure and internal stress. The personalized comparative assessment based on midfoot contact area was carried out periodically for follow-up and the orthotic could be re-designed if necessary. The proposed automated procedure develops a pre-screening system to distinguish low arch and provide preventatives before it becomes symptomatic. Furthermore, non-symptom flatfoot can be detected at early stages and referred to medics for further diagnosis or treatment.

Background & aims Whether the frequency of interruptions to sitting time involving simple resistance activities (SRAs), compared to uninterrupted sitting, differentially affected 22 h glycemic control in adults with medication-controlled type 2 diabetes (T2D). Methods & results Twenty-four participants (13 men; mean ± SD age 62 ± 8 years) completed three 8 h laboratory conditions: SIT: uninterrupted sitting; SRA3: sitting interrupted with 3 min of SRAs every 30 min; and, SRA6: sitting interrupted with 6 min of SRAs every 60 min. Flash glucose monitors assessed glycemic control over a 22 h period. No differences were observed between conditions for overall 22 h glycemic control as measured by AUCtotal, mean glucose and time in hyperglycemia. During the 3.5 h post-lunch period, mean glucose was significantly lower during SRA6 (10.1 mmol·L−1, 95%CI 9.2, 11.0) compared to SIT (11.1 mmol·L−1, 95%CI 10.2, 12.0; P = 0.006). Post-lunch iAUCnet was significantly lower during SRA6 (6.2 mmol·h·L−1, 95%CI 3.3, 9.1) compared to SIT (9.9 mmol·h·L−1, 95%CI 7.0, 12.9; P = 0.003). During the post-lunch period, compared to SIT (2.2 h, 95%CI 1.7, 2.6), time in hyperglycemia was significantly lower during SRA6 (1.5 h, 95%CI 1.0, 1.9, P = 0.001). Nocturnal mean glucose was significantly lower following the SRA3 condition (7.6 mmol·L−1, 95%CI 7.1, 8.1) compared to SIT (8.1 mmol·L−1, 95%CI 7.6, 8.7, P = 0.024). Conclusions With standardized total activity time, less-frequent active interruptions to sitting may acutely improve glycemic control; while more-frequent interruptions may be beneficial for nocturnal glucose in those with medication-controlled T2D.

Background and aims Capsule endoscopy (CE) interpretation requires the review of many thousands of images, with lesions often limited to just a few frames. In this study we aim to determine whether lesion detection declines according to the number of capsule videos read. Methods 32 participants, 16 of which were novices (NR) and 16 experienced (ER) capsule readers took part in this prospective evaluation study. Participants read six capsule cases with a variety of lesions, in a randomly assigned order during a single sitting. Psychomotor Vigilance Tests and Fatigue Scores were recorded prior to commencing and then after every two capsules read. Changes in lesion detection and measures of fatigue were assessed across the duration of the study. Results Mean agreement with the predefined lesions was 48.3% (SD:16.1), and 21.3% (SD:15.1) for the experienced and novice readers respectively. Lesion detection declined amongst experienced reader after the first study (p = 0.01), but remained stable after subsequent capsules read, while NR accuracy was unaffected by capsule numbers read. Objective measures of fatigue did not correlate with reading accuracy. Conclusion This study demonstrates that reader accuracy declines after reading just one capsule study. Subjective and objective measures of fatigue were not sufficient to predict the onset of the effects of fatigue.

Made available in DSpace on 2022-05-01T05:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-07-01 Background: The aim of this study was to determine whether muscle strength of the lower limb and trunk during the acute phase after stroke are predictors of motor function and disability 90 days after hospital discharge. Methods: This prospective study used a nonconcurrent design to evaluate stroke patients at two time points: a) first 72 h: hip abduction and ankle dorsiflexion (HAAD) score, trunk sitting control, clinical evaluation, demographic profile, and stroke severity using the National Institutes of Health Stroke Scale (NIHSS); b) 90 days after hospital discharge: modified Rankin scale (mRS). The participants were divided into two groups: good outcome (mRS 0–2) and worse outcome (mRS>2), and the differences between them were assessed statistically. Clinical and demographic variables were included in the multiple logistic regression analysis. The ROC curve was used to illustrate the clinical sensitivity and specificity of the HAAD score cutoff for the outcomes. Results: Thirty-seven patients were included: 16 with mRS≤2 and 21 with mRS>2. Patients in the worse outcome group were older (p = 0.02) and presented with higher NIHSS scores (p = 0.002), lower HAAD scores (p < 0.001), higher pain sensation (p = 0.04), greater altered perception (p = 0.008), and no trunk control in the sitting position (p = 0.004). A lower HAAD score (OR = 0.09; 95%CI: 0.14–0.53; p < 0.001) and the absence of trunk control in the sitting position (OR = 0.55; 95%CI:0.54–0.95; p < 0.001) were associated with unsatisfactory outcomes. Conclusion: A HAAD score

Recent trials and meta-analysis have indicated that complete revascularization (CR) of multivessel coronary disease is beneficial in patients with ST-segment elevation myocardial infarction (STEMI) compared to culprit-only intervention. However, the optimal timing of CR remains unclear. We aimed to analyze the optimal timing of CR in patients with STEMI and multivessel disease by performing an updated network meta-analysis using the recent largest randomized controlled trial. PUBMED and EMBASE were searched through October 2020 to identify randomized controlled trials comparing CR and culprit-only revascularization. A random-effect network meta-analysis comparing three arms (same-sitting [during the index procedure] CR versus staged CR versus culprit-only) and 4 arms (same-sitting CR versus staged CR [in-hospital] versus staged CR [out-hospital] versus culprit-only) were performed. Eleven studies with a total of 7,015 patients were included in our analysis. There was no significant difference in major adverse cardiovascular event (MACE) (HR 0.82, 95% CI 0.64-1.05), cardiovascular death (HR 0.69, 95%CI 0.35-1.33), myocardial infarction (HR 0.66, 95%CI 0.37-1.16), and revascularization (HR 1.05, 95%CI 0.70-1.58) between same-sitting CR and staged CR. When staged CR was further divided into staged CR during the hospitalization and after discharge, there was no significant difference in these outcomes between staged CR (in-hospital) and staged CR (out-hospital). In conclusion, in patients with multivessel disease presenting with STEMI, complete revascularization at any timing, including same-sitting, staged in-hospital, and staged out-hospital, may have similar benefits.

To determine the reliability of the Thai version of International Physical Activity Questionnaire Short Form (IPAQ-SF) in Chronic Obstructive Pulmonary Disease (COPD) patients.A cross sectional study was carried out in COPD subjects at Chiang Dao hospital, Chiang Mai, Thailand in June and July 2019. COPD subjects were asked to complete the Thai version of the IPAQ-SF. Calculations for each level of activity were carried out separately (vigorous activity, moderate activity, walking, and sitting). This was carried out twice with an interval of four weeks between visits. The test-retest reliability of the IPAQ was assessed using the intraclass correlation (ICC) with a 95% confidence interval (CI). Cohen's kappa coefficient and percentage agreement were used to test the repeatability of the physical activity classification between the two visits.Sixty COPD subjects (50% male), with a mean age of 71.2 ± 7.7 years were included. The least reliability was established for sitting time (ICC = 0.439; 95%CI; 0.212, 0.621, p-value 0.001) and the greatest for the total physical activity (ICC = 0.837; 95%CI; 0.741, 0.899, p-value 0.001). The Kappa statistic was 0.433 with a 95%CI; 0.237, 0.639, p-value0.001 and the percentage agreement of the physical activity classification between the two visits was 66.7%.The test-retest reliability was adequate for vigorous activity and total physical activity. Although there are concerns about the agreement for classification of physical activity, the IPAQ-SF may be a useful if not definitive tool for assessing physical activity in COPD.

Trunk rotations are important functional movements which form the foundations of human motion pattern, especially in the functions of walking and running. They prevent the functional impairments and structural lesions resulting from axial overloading in static positions such as sitting.The aim of the study was to assess the influence of rotational movement training exercises on the abdominal muscle thickness and spinal mobility range.Randomized controlled trial.The study involved 73 individuals aged 18-45. The subjects were randomly divided into two groups. The study group (TG) comprised 40 people who performed rotational movement exercises over the period of 4 weeks (16 training sessions). In the control group (CG) the training was not applied. Changes in the thickness of selected abdominal muscles on ultrasound imaging were evaluated, as well as trunk mobility, based on the trunk lateral flexion test.The analysis of the obtained data has demonstrated a statistically significant increase in the thickness of the abdominal internal (IO) (p 0.05) and external oblique muscles (EO) (p 0.001) in the study group (TG) between measurements I and II, and measurements I and III. A similar increase in the thickness was found in the summation measurement of TrA + IO + EO. Bilateral increase in the trunk lateral flexion range in the frontal plane has also been noted.Rotational movement training of the trunk leads to an increase in the thickness of the abdominal oblique muscles. Rotational movement exercise training increases trunk mobility in the frontal plane.

Platypnea-orthodeoxia syndrome (POS) is a rare condition where patients suffer from dyspnea and reduced oxygenation while in the sitting position. A 69-year-old man initially experienced dyspnea and hypoxemia in the sitting position after developing hemiplegia and postural instability secondary to a cerebral hemorrhage, but the symptoms improved in the supine position. Transesophageal echocardiography revealed a patent foramen ovale (PFO). In the sitting or semi-Fowler position, increased right-left shunt was observed using Swan-Ganz catheterization and pulmonary perfusion scintigraphy. The PFO closure was performed, which obliterated dyspnea and hypoxemia in the sitting position. In POS associated with PFO, comprehensive pre-operative evaluation using multi-modality tests in different postural settings critically delineates the etiology that guides appropriate treatment strategy.

Introduction Treatment of complex upper end tibial fractures has always been a challenge to orthopaedic surgeons. Though the roentgenogram results are satisfactory, the clinical and functional outcomes especially in terms of squatting/cross-leg sitting after long term follow-up are little known. Hence, we have done this study with a primary aim to assess the clinico-radiological and functional outcomes after operative fixation (mostly by locking plates) in complex upper end tibial fractures and a secondary aim to analyze correlation between functional outcome scores/range of motion (ROM) and the ability to squat & sit cross-legged in post-operative period. Materials and methods This prospective study included a total of 33 patients who were mainly treated with locking plates. In the follow-up, patients were assessed clinico-radiologically and outcome measurements were determined using the Tegner-Lysholm (T-L) Knee Score. Patients were categorized according to their ability to squat/sit cross-legged and a subgroup analysis was performed by comparing mean ROM and T-L score in each group. Results Majority of patients were in young and adult age group with a male to female ratio of 4.5:1. The average age was 42.39 ±14.64 years. Road traffic accident was the most common mode of injury. Average time interval between injury and surgery was 5.8±4.4 days. All the fractures united by 5-9 months. Mean ROM and T-L score at last follow-up were 120.94°±13.63° and 88.12±7.24 respectively. Average shortening, varus and valgus deformity were 0.43±0.09 cm, 2.12°±0.62° and 1.06°±0.45° respectively. 14 patients (42.42%) were able to squat and 15 (45.45%) were able to sit cross-legged postoperatively. Upon subgroup analysis, difference of mean ROM in those who could squat/sit cross-legged was found statistically significant (p≤0.05), however the difference in mean functional scores was not significant (p≥0.05). Conclusion Complex upper tibial fractures are a difficult entity to deal with. Anatomical locking plates take care of the alignment, articular congruity as well as ligamentous balancing thus giving good mid-term outcomes after ORIF/MIPO. However, applicability of the present functional outcome scores in assessing squatting/cross leg sitting remains doubtful. More weightage needs to be given to these activities to evaluate the outcome in South Asian population.

Objectives To examine associations of active school commuting (ASC) with time spent in physical activity (PA) and sedentary behaviour (SB) among adolescents. Design Cross-sectional study. Methods Global School-based Student Health Survey data from 277,833 adolescents aged 11–17 years (48.9% girls), collected during 2007–2016, were analysed. Adolescents were asked how many days per week they walked or bicycled to and from school, were physically active, and how much time they spent sitting on a typical day. ASC was defined as ≥3 days/week, meeting PA recommendations as ≥60 min/day, high SB as leisure-time sitting ≥3 h/day. Multilevel logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of the association estimates. Results Adolescents who used ASC ≥ 3 days/week had over double the odds of meeting PA recommendations (OR: 2.06, 95% CI: 2.01–2.12), after adjusting for a set of covariates. Adolescents who reported ASC ≥ 3 days/week had 17% lower odds of reporting high SB (0.83, 0.81−0.85). The estimated OR of ASC and PA was 2.57 (2.31–2.86) in low-income and 1.84 (1.75–1.94) in high-income countries. Adolescents with ASC ≥ 3 days/week had 22% lower odds of reporting high SB in African and Eastern Mediterranean regions (0.78, 0.73−0.84 and 0.75−0.82, respectively). Country-wise estimates of the associations are presented. Conclusions ASC is strongly and positively associated with PA recommendations and moderately with lower SB in adolescents. These estimates vary across WHO regions and by country’s income. Promoting ASC has the potential to promote active lifestyle among adolescents around the globe.

Mindfulness-Based Stress Reduction (MBSR) offers comprehensive instruction to clients in three forms of meditation: the body scan, sitting meditation, and gentle hatha yoga. Clinical experience suggests that participants may express a preference for one mode of practice over others. However, little research has addressed this question or explored participants’ experience of nonspecific factors such as group discussion and teacher personality. In this paper, we aimed to shed light on these open questions in two ways. First, we present quantitative and qualitative post-test data from a nonclinical sample of 181 participants who completed course evaluation forms at the end of an 8-week MBSR program. Second, we share clinical insights and lessons learned over several years teaching MBSR in a community-based program. On evaluation forms, participants reported meaningful improvements in well-being following MBSR and evaluated the nonspecific elements of the course as highly useful. Although they rated all three forms of meditation as beneficial, there was a preference for the body scan and sitting meditation over yoga, and for audio-guided over self-guided practice. Qualitative feedback reflected themes related to learning different forms of meditation, developing an independent practice, meditating with a group, adding additional sessions, and appreciation for the course. Survey findings, taken together with existing research and clinical impressions, support recommendations to address participant preconceptions about the different forms of meditation, encourage meditation practice without audio guides, pay attention to the level of individual participation, discuss how to carve out time to meditate, and promote participants’ development of an ongoing meditation practice. We illustrate these points with case examples and clinical vignettes.

Objective Assessment of sitting has been challenging and nuances in the length of sitting are often missed. Methods The present study assessed total, short and prolonged sitting time, and number of breaks from sitting, and their association with anxiety, depression, and health-related quality of life (HRQoL). Adults (M=59.1 years) in three studies (n=1,574) wore the activPAL accelerometer (thigh) to obtain a measure of sitting, and the Actigraph accelerometer (hip) for estimating moderate-to-vigorous physical activity (MVPA). Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and HRQoL using the EQ-5D-5L (for health state and utility scores). Generalised linear modelling tested associations. Results Total and prolonged sitting were associated with higher depression [total: β = 0.132 (0.010, 0.254); prolonged: β = 0.178 (0.053, 0.304)] and worse HRQoL health state scores [(total: β = -0.985 (-1.471, -0.499); prolonged: β = -0.834 (-1.301, -0.367)] and utility scores [(total: β = -0.008 (-0.012, -0.003); prolonged: β = -0.008 (-0.012, -0.004)], after controlling for covariates. MVPA was associated with better HRQoL health state and utility scores [health state: β =0.554 (0.187, 0.922); utility: β = 0.001 (0.001, 0.002)]. Total and prolonged sitting were associated with a 14% increased odds of being in the borderline/abnormal category for depression. No interactions were observed between MVPA status (active vs. inactive) and total or prolonged sitting. Anxiety was unrelated to any sitting variable. Conclusion Device-based measures of both total and prolonged sitting time were associated with depression and health-related quality of life, but not anxiety.

Background Sensorimotor control of axial segments, which develops during childhood and is not mature until adolescence, is essential for the development of balance control during motor activities. Children with cerebral palsy (CP) have deficits in postural control when standing or walking, including less stabilization of the head and trunk which could affect postural control. Research question Is dynamic stabilization of axial segments during an unstable sitting task deficient in children with CP compared to typically developing children? Is this deficit correlated with the deficit of postural control during standing? Method Seventeen children with CP (GMFCS I-II) and 17 typically-developing children from 6 to 12 years old were rated on the Trunk Control Measurement Scale (TCMS). In addition, posturography was evaluated in participants while they maintained their balance in stable sitting, unstable sitting, and quiet standing, under “eyes open” and “eyes closed” conditions. In sitting tasks, the participants had to remain stable while being prevented from using the lower and upper limbs (i.e. to ensure the involvement of axial segments alone). Results Children with CP compared to TD children had significantly larger surface area, mean velocity and RMS values of CoP displacements measured during the unstable sitting task and the standing task, under both “eyes open” and “eyes closed” conditions. No significant group effects were observed during the stable sitting task. The TCMS total score was significantly lower, indicating trunk postural deficit, in the CP group than in the TD group and was significantly correlated with postural variables in the sitting and standing tasks. Significance Children with CP indeed have a specific impairment in the postural control of axial segments. Since the postural control of axial segments is important for standing and walking, its impairment should be taken into account in rehabilitation programs for children with CP.

Camptocormia is an involuntary flexion between 15-45° of the thoracolumbar spine when standing, walking or sitting, which disappears completely in the supine position. Is associated to Parkinson's disease and other neurodegenerative conditions, being its physiopatology unknown. We report three cases of atypical anti-psychotic induced camptocormia.

Management of socket fit is challenging for people using lower-limb prostheses because of residual limb volume fluctuation throughout the day. Releasing socket pressures during sitting (partial doffing) may help users increase their limb volume after they have undergone volume loss earlier in the day. The purpose of this research was to develop and evaluate a system to allow for quick and easy locking pin and socket panel release during sitting and relock upon standing. The system was to allow the partial doff tether length to be custom set for each user, accomplish release and relock in less than 2.0 s each, require only one hand, and require a finger push force comparable to a push button on a phone. A motor-driven release/relock system (240 g build weight) housed within the socket adjusts locking pin tether length, and an instrumented ratcheting dial adjusts socket panel position. Three participants with a trans-tibial amputation operated the system properly using one hand. For a partial doff, users preferred a tether length between 5 and 6 cm. All users executed release within 1.5 s and relock within 1.5 s.

Objective To compare the prefrontal cortex (PFC) activation and task performance during single- and dual-task conditions between typically developing (TD) children and children with hemiplegic cerebral palsy (HCP). Design A prospective, comparative design. Setting Research laboratory. Participants Participants (N=21) included 12 TD children (age, 6.0±1.1y) and 9 children with HCP (age, 7.2±3.1). Interventions Not applicable. Main Outcome Measures PFC activation was assessed by measuring the concentration of oxygenated hemoglobin while the children performed a shape-matching task with their more affected arm while sitting on a stable (single task) vs dynamic surface (dual task). The task performance was assessed with the total number of shapes matched, dual-task cost, and reaction time (RT). Results For both conditions, the children with HCP exhibited greater PFC activation, matched a fewer shapes, and had slower RT than the TD children. These differences were accentuated during the dual-task condition and the dual-task cost was greater. An increase in the PFC activation during the dual-task condition was tightly correlated with a higher dual-task cost in children with HCP (r=0.77, P=.01). Conclusions Children with HCP appear to have a heightened amount of PFC activity while performing a dual task. The greater cortical activity may be a result of the finite attentional resources that are shared between both the motor as well as cognitive demands of the task. The cognitive-motor interference is likely exacerbated in children with HCP because of the structural and functional brain changes as a result of an insult to the developing brain.

Background The functional anatomy of the osteoarthritic hip joint in the sagittal plane has not been defined. The purpose of this study was to define the functional anatomy of the hip using clinical and radiographic analyses. Methods 320 hips had preoperative standing and sitting lateral spine-pelvis-hip X-rays. Radiographic pelvic measurements were pelvic incidence (PI) and sacral slope (SS), and hip measurements were anteinclination (AI) and pelvic femoral angle (PFA). Pelvic tilt (PT) was calculated as PI-SS. A triangle model was created from the clinical data that illustrates the functional motion of the hip during postural changes from standing to sitting. Results Pelvic motion was coordinated with hip motion, even with spinopelvic imbalance and stiffness. Pelvic motion (ΔSS) varied for all 5 types of imbalance, but pelvic motion (ΔSS) and acetabular motion (ΔAI) changed with a 1:1 ratio and inversely with femoral motion (ΔPFA) with a 1:1 ratio. The triangle model showed similar results with ΔSS, ΔPT, and ΔAI changing in a 1:1:1 ratio, and femur motion inversely changing with a 1:1 ratio. Conclusion The functional anatomy of the hip joint can be visually illustrated using a triangle model. Pelvic angles SS, PT, and AI change in unison, whereas femoral motion (ΔPFA) changes inversely with pelvic motion (ΔSS) in a 1:1 ratio. This coordinated mobility explains the limitations of the Lewinnek safe zone, which include only the acetabulum.

Introduction Pusher syndrome is characterised by the patient pushing towards the hemiparetic side with the contralateral side, in a sitting position, standing and during movement, surpassing the gravitational mean line, which produces inappropriate adjustment and postural control. Objective To determine the effectiveness of physiotherapy treatment in post-stroke pusher syndrome and to extract guidelines for its correct identification and interdisciplinary approach. Method A systematic review was carried out (2000–2019), using the specialised databases MEDLINE, Scopus, PEDro and Web of Science. The descriptors used in the search strategies were “pusher syndrome”, “pushing behaviour”, “controversial pushing”, treatment, “physical therapy”, physiotherapy. Results Although the evidence is still limited, the intensive intervention of Physiotherapy in the patient with pusher syndrome post-stroke seems to improve the clinical symptoms in terms of severity and postural control. Among the different forms of treatment, training through visual feedback seems to be effective, especially using the Nintendo Wii balance platform. Conclusion An individualised physiotherapeutic intervention with each patient is necessary to facilitate and guide the most effective motor strategies, work synergies between the members of the interdisciplinary team are essential (with specific guidelines on transfers and functional activities between sessions) to ensure continuity of care that guarantees achievements are maintained.

The bedridden and physically disabled person is unable to move from their bed and they need a caretaker to take care of them or to assist them in this work. They are in the situation of spending more money on the caretaker. Thus, a design solution is proposed to help bedridden patients in their defecation activities. This design helps people, by giving them ease to pass their excreta by sitting on a specially designed bed. The control of the machine lies with the person lying on the bed. On switching ON the machine, the headrest rises and the leg rest lowers. This gives a sitting comfortable position for the patient to carry out the defecation. Along with that movement, the door on the bed opens and the basin set-up fixed under the cot moves sideward till it covers the bed opening. After the completion of the process, the person confirms and makes the next move by pressing the actuation button. When it is pressed, the flush is done and the waste is then transferred to the outlet which is connected to the toilet drainage. The machine has an inlet where the water supply enters the basin. After the flushing of the toilet, a forced water supply from the machine sprays the water to clean the patient’s back. The whole mechanisms are to be controlled by an Arduino controller board and limit switches.

Background Poor standing posture has been reported in women with larger breasts, increasing the risk of back pain. Whilst breast reduction surgery can improve posture, conservative measures such as special bras may offer short or long-term relief of symptoms without surgical intervention. Research question This study aimed to utilise a multi-study intervention to investigate the short and long-term kinematic effects of wearing a posture bra. Methods Study one utilised biomechanics and physiotherapy expertise to modify the design of a prototype bra to improve posture and breast kinematics; resulting in a second-generation posture bra. To test this bra, 24 females were randomly assigned to control and intervention groups. The control group wore their everyday bra; the intervention group wore the generation 2 posture bra in place of their everyday bra for three months. Pre and post intervention, posture (spine curvature, scapula position, whole body alignment) and breast kinematics were assessed during sitting, standing and walking. Short-term effects of the posture bra were compared to an everyday bra and no bra (study two), whilst the long-term effects were compared using the no bra condition (study three). Results Biomechanical intervention improved posture and breast kinematics in a prototype posture bra resulting in a second-generation prototype. Pre-intervention, the generation 2 posture bra significantly improved scapula retraction by 6° during both sitting and standing, but also increased deviation of whole body alignment compared to everyday bra and no bra conditions. During walking the posture bra reduced breast motion by 17 % compared to the everyday bra. Following the three-month wearer intervention, scapula depression significantly improved in the intervention group. Significance A biomechanically informed posture bra was able to effectively support the breasts and improve scapula position without compromising spinal curvature, reducing the risk of musculoskeletal pain associated with poor posture.

Schools serve as the ideal location for implementing interventions to increase physical activity (PA) as children spend most of their day in the school setting. As adolescents become more and more sedentary and obesity statistics become more dire, efforts to increase physical literacy and PA should be heightened. Physical literacy is the ability for a child to understand the movement of their body and how it can be manipulated to increase activity for recreation or sports movement. When physical literacy is paired with school-based multi-component programs, children are more likely to make a behavior change. As educators know, children are more likely to make a behavior change when mastery of content is achieved, and the lesson is tailored to their needs. Even small changes, like moving a little more or adding an additional serving of vegetables to the diet, can make a profound impact. In the current review we discuss: 1) the state of PA within school systems; 2) provide a rationale for why school systems fail to meet said guidelines; and 3) suggest how guidelines can eventually be achieved through the promotion of physical literacy and effective school-based multi component programs.

The aim of the study was to investigate mental and physical health as well as living conditions and lifestyle habits in the adult general population in spring 2020 and one year into the COVID-19 pandemic in Sweden comparing results from two cross-sectional studies carried out in February-May 2020 and 2021. The study population comprises 2,273 persons in 2020 and 2,216 persons in 2021 who responded to the national public health survey sent to random population samples in one county in Sweden. The age group was 16–84 years, and the response rates were 45% and 44%, respectively. Differences in living conditions (economic difficulties, social support and worrying about losing one's job), lifestyle habits (physical activity, daily smoking, sitting duration and alcohol use), and health (self-rated health, pain in shoulders or neck, sleeping difficulties, anxiety or worry, and obesity) between years 2020 and 2021 were analysed using multiple binary logistic regression in men and women, adjusting for age group and educational level. Very few statistically significant differences were observed between 2020 and 2021 regarding living conditions, lifestyle factors and health. The main finding was that the prevalence of anxiety and worry increased among women. Surveillance of the long-term public health consequences of the pandemic in the general population using robust data and methods, is important for planning and targeting preventive activities.

Background Acromegaly patients have a very high incidence of difficult endotracheal intubation. The Modified Mallampatti grading (MMPG) in the sitting position is a common test performed preoperatively to predict difficult intubation. It has been suggested that supine MMPG is possibly a better predictor of difficult tracheal intubation (DTI) rather than the sitting MMPG in normal individuals. Objective We wanted to determine if the supine MMPG had a better diagnostic accuracy than the sitting MMPG in predicting DTI in acromegaly patients. Methods This was a single-centre prospective observational study conducted in 70 adult acromegaly patients undergoing pituitary adenoma surgery requiring general anaesthesia and endotracheal intubation. MMPG in the sitting position was recorded during the pre-anaesthesia consultation. An independent observer recorded the MMPG in the supine position and the ease of intubation prior to surgery. The diagnostic performance of the MMPG for the prediction of DTI was evaluated in the sitting and supine positions through the area under the receiver operating characteristic (ROC) curve. The Naguib score was also calculated and its ability to predict DTI was tested. Results Thirty-five patients (50%) out of a total of 70 patients had difficult tracheal intubation. The area under the ROC curve for MMPG in supine position 0.708 (0.587–0.810) was greater than that for the MMPG in the sitting position 0.616 (0.492–0.729) ; p = 0.0146∗). Conclusion MMPG performed in the supine position was possibly a superior predictor of difficult tracheal intubation in adult acromegaly patients compared with MMPG performed in the sitting position.

The characteristics of typical posterior canal-benign paroxysmal positional vertigo-canalolithiasis (P-BPPV-Can) are well known. We found 10 patients with a new variant of P-BPPV-Can: Reverse (Rev)-P-BPPV-Can. The characteristics and pathophysiology of Rev-P-BPPV-Can are discussed.For 4 years and 9 months, 10 patients with Rev-P-BPPV-Can (9 women and 1 man; mean age: 73 years) visited our clinic. Within the same period, 268 patients with unilateral typical P-BPPV-Can were treated. During the Dix-Hallpike and Epley maneuvers, nystagmus was recorded using an infrared charge-coupled device camera mounted on a pair of spectacles.The patients exhibited entirely opposite direction of nystagmus from typical P-BPPV-Can in both the Dix-Hallpike head position and upright sitting position. The patients had typical characteristics of nystagmus due to canalolithiasis, such as latency, duration of1 min, linear-torsional nystagmus, and fatigability. Rev-P-BPPV-Can appeared after the Epley maneuver for typical P-BPPV-Can; in other patients, Rev-P-BPPV-Can changed to typical P-BPPV-Can. The affected sides of Rev-P-BPPV-Can were decided by those of typical P-BPPV-Can.Canalolithiasis in the non-ampullary distal portion of the posterior semicircular canal may be a potential pathophysiology of Rev-P-BPPV-Can. The Epley maneuver has little effect for treating Rev-P-BPPV-Can, but spontaneous transition to typical P-BPPV-Can or spontaneous recovery is expected.

Spinal cord injury (SCI) often results in loss of the ability to keep the trunk erect and stable while seated. Functional neuromuscular stimulation (FNS) can cause muscles paralyzed by SCI to contract and assist with trunk stability. We have extended the results of a previously reported threshold-based controller for restoring upright posture using FNS in the sagittal plane to more challenging displacements of the trunk in the coronal plane. The system was applied to five individuals with mid-thoracic or higher SCI, and in all cases the control system successfully restored upright sitting. The potential of the control system to maintain posture in forward-sideways (diagonal) directions was also tested in three of the subjects. In all cases, the controller successfully restored posture to erect. Clinically, these results imply that a simple, threshold based control scheme can restore upright sitting from forward, lateral or diagonal leaning without a chest strap; and that removal of barriers to upper extremity interaction with the surrounding environment could potentially allow objects to be more readily retrieved from around the wheelchair. Technical performance of the system was assessed in terms of three variables: response time, recovery time and percent maximum deviation from erect. Overall response and recovery times varied widely among subjects in the coronal plane (415±213 ms and 1381±883 ms, respectively) and in the diagonal planes (530±230 ms and 1800±820 ms, respectively). Average response time was significantly lower (p 0.05) than the recovery time in all cases. The percent maximum deviation from erect was of the order of 40% or less for 9 out of 10 cases in the coronal plane and 5 out of 6 cases in diagonal directions.

Background Behavioral observations support clinical in-depth phenotyping but phenotyping and pattern recognition are affected by training background. As Attention Deficit Hyperactivity Disorder, Restless Legs syndrome/Willis Ekbom disease and medication induced activation syndromes (including increased irritability and/or akathisia), present with hyperactive-behaviors with hyper-arousability and/or hypermotor-restlessness (H-behaviors), we first developed a non-interpretative, neutral pictogram-guided phenotyping language (PG-PL) for describing body-segment movements during sitting. Methodology & results The PG-PL was applied for annotating 12 1-min sitting-videos (inter-observer agreements >85%->97%) and these manual annotations were used as a ground truth to develop an automated algorithm using OpenPose, which locates skeletal landmarks in 2D video. We evaluated the algorithm's performance against the ground truth by computing the area under the receiver operator curve (>0.79 for the legs, arms, and feet, but 0.65 for the head). While our pixel displacement algorithm performed well for the legs, arms, and feet, it predicted head motion less well, indicating the need for further investigations. Conclusion This first automated analysis algorithm allows to start the discussion about distinct phenotypical characteristics of H-behaviors during structured behavioral observations and may support differential diagnostic considerations via in-depth phenotyping of sitting behaviors and, in consequence, of better treatment concepts.

Purpose This work aims to validate new 6D couch features and their implementation for seated radiotherapy in RayStation (RS) treatment planning system (TPS). Materials and methods In RS TPS, new 6D couch features are (i) chair support device, (ii) patient treatment option of “Sitting: face towards the front of the chair”, and (iii) patient support pitch and roll capabilities. The validation of pitch and roll was performed by comparing TPS generated DRRs with planar x-rays. Dosimetric tests through measurement by 2D ion chamber array were performed for beams created with varied scanning and treatment orientation and 6D couch rotations. For the implementation of 6D couch features for treatments in a seated position, the TPS and oncology information system (Mosaiq) settings are described for a commercial chair. An end-to-end test using an anthropomorphic phantom was performed to test the complete workflow from simulation to treatment delivery. Results The 6D couch features were found to have a consistent implementation that met IEC 61712 standard. The DRRs were found to have an acceptable agreement with planar x-rays based on visual inspection. For dose map comparison between measured and calculated, the gamma index analysis for all the beams was >95% at a 3% dose-difference and 3 mm distance-to-agreement tolerances. For an end-to end-testing, the phantom was successfully set up at isocenter in the seated position and treatment was delivered. Conclusions Chair-based treatments in a seated position can be implemented in RayStation through the use of newly released 6D couch features.

Physical inactivity is a well-established risk factor for cardiovascular disease (CVD) incidence and mortality. In the last decade, there is also emerging evidence of the role of sedentary behaviors (sitting) as a risk factor for CVD. Therefore, there is increasing interest in understanding the independent and joint effects of physical activity and sedentary behavior on CVD risk. Higher levels of moderate-to-vigorous physical activity and less time spent in sedentary behavior are associated with a decreased risk of CVD. There is also preliminary evidence that higher levels of light-intensity physical activity are associated with lower all-cause mortality rates; however, the cardio-protective effects of light-intensity physical activity are yet to be determined. The results from several studies have demonstrated that the effects of sedentary behavior on CVD risk is more pronounced among individuals who are physically inactive, compared to those who are more active. Further, high levels (60–75 min per day) of moderate-to-vigorous physical activity appear to eliminate the increased risk of CVD associated with excessive sedentary behavior. Replacing sedentary behavior with any intensity of physical activity will produce health benefits; however, the greatest benefits occur when replacing sedentary behavior with moderate-to-vigorous intensity physical activity.

The aim of this study was to examine the relationships between isometric handgrip (HG) strength and isokinetic strength data of the glenohumeral rotator muscles. Twelve (Female = 50%) Brazilian Sitting Volleyball (SV) national team players volunteered. Measures of maximal grip strength were obtained by a HG dynamometer Jamar® and isokinetic measures of peak torque (PT) and total work (TW) during shoulder rotations movements were obtained with a Biodex isokinetic dynamometer at speed of 60°/s and 180°/s. Pearson correlation coefficients between isometric HG and isokinetic strength data ranged between 0.23 and 0.72 for the PT and between 0.3 and 0.76 for the isokinetic TW. Results presented positive relationships between HG isometric strength and isokinetic strength of external rotators of the shoulder in SV players. We can suggest that in the absence of isokinetic dynamometers, HG isometric strength measurements could be used to measure strength levels of the external rotator muscles of elite SV players’ shoulder, particularly in the TW values.