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BACKGROUND: Grooving evidence suggests that patients could have Direct Access (DA) to physiotherapy. It represents a new model of care, which might lead to improve patients' health status and decrease cost services for healthcare compared with a secondary care referral pathway. The aim of this study is to explore the evidence regarding feasibility, effectiveness, costs, safety and patient satisfaction through DA compared to other organizational models. METHODS: A systematic review was carried out through MEDLINE, CINAHL, and EMBASE databases from their inceptions until March 2018 using keywords related with DA. All articles in English, Italian or Polish comparing the modality of DA with any other organizational modality were included. Two reviewers independently selected eligible studies, extracted the data, and assessed methodological quality using the Newcastle-Ottawa Scale for cohort studies. RESULTS: 1593 articles were initially identified, and thirteen studies met the inclusion criteria. The mean NOS score for study quality was 6.4 ± 1.4 out of a possible total score of nine points. Patients impairments and health care status, were similar through all studies. DA showed less number of physiotherapy treatments, visits to physician, imaging performed and required fewer non-steroidal anti-inflammatory drugs and secondary care. Patients were more satisfied with the service in comparison to the group referred by the physician. and costs per subject were lower. DA patients were younger, with a higher level of education; mostly, they presented a less severe clinical condition and a more acute pathologies related to the spine. No harms were reported. Only one study assessed the clinical safety of the DA. CONCLUSION: The findings suggest that DA to physiotherapy is feasible considering the clinical and economic point of view. However, more research is still needed due to the low evidence of the reviewed studies and to explore the clinical safety of DA.

MRI was performed in seven patients with presumed central pontine and extrapontine myelinolysis. The underlying diseases were diabetes, lung cancer, Wilson disease, trauma, alcoholism, renal insufficiency and hemodialysis. CPM was found in four cases (in two of them extrapontine lesions were considered as resulting from Wilson disease), CPM and EPM in three patients. The localization of extrapontine changes included cerebellum, cerebral peduncles, caudate and lentiform nuclei, internal capsules, white matter and cortex of the cerebrum.

A major problem in neurorehabilitation is the lack of objective outcomes to measure movement quality. Movement quality features, such as coordination and stability, are essential for everyday motor actions. These features allow reacting to continuously changing environment or to resist external perturbations. Neurological disorders affect movement quality, leading to functionally impaired movements. Recent findings suggest that the central nervous system organizes motor elements (eg, muscles, joints, fingers) into task-specific ensembles to stabilize motor tasks performance. A method to quantify this feature has been previously developed based on the uncontrolled manifold (UCM) hypothesis. UCM quantifies movement quality in a spatial-temporal domain using intertrial analysis of covariation between motor elements. In this point-of-view article, we first describe major obstacles (eg, the need for group analysis) that interfere with UCM application in clinical settings. Then, we propose a process of quantifying movement quality for a single individual with a novel use of bootstrapping simulations and UCM analysis. Finally, we reanalyze previously published data from individuals with neurological disorders performing a wide range of motor tasks, that is, multi-digit pressing and postural balance tasks. Our method allows one to assess motor quality impairments in a single individual and to detect clinically important motor behavior changes. Our solution may be incorporated into a clinical setting to assess sensorimotor impairments, evaluate the effects of specific neurological treatments, or track movement quality recovery over time. We also recommended the proposed solution to be used jointly with a typical statistical analysis of UCM parameters in cohort studies.

Uniparentally-inherited markers on mitochondrial DNA (mtDNA) and the non-recombining regions of the Y chromosome (NRY), have been used for the past 30 years to investigate the history of humans from a maternal and paternal perspective. Researchers have preferred mtDNA due to its abundance in the cells, and comparatively high substitution rate. Conversely, the NRY is less susceptible to back mutations and saturation, and is potentially more informative than mtDNA owing to its longer sequence length. However, due to comparatively poor NRY coverage via shotgun sequencing, and the relatively low and biased representation of Y-chromosome variants on capture assays such as the 1240 k, ancient DNA studies often fail to utilize the unique perspective that the NRY can yield. Here we introduce a new DNA enrichment assay, coined YMCA (Y-mappable capture assay), that targets the "mappable" regions of the NRY. We show that compared to low-coverage shotgun sequencing and 1240 k capture, YMCA significantly improves the mean coverage and number of sites covered on the NRY, increasing the number of Y-haplogroup informative SNPs, and allowing for the identification of previously undiscovered variants. To illustrate the power of YMCA, we show that the analysis of ancient Y-chromosome lineages can help to resolve Y-chromosomal haplogroups. As a case study, we focus on H2, a haplogroup associated with a critical event in European human history: the Neolithic transition. By disentangling the evolutionary history of this haplogroup, we further elucidate the two separate paths by which early farmers expanded from Anatolia and the Near East to western Europe., Open Access funding enabled and organized by Projekt DEAL. This study was funded by the Max Planck Society, the French (ANR) and German (DFG) Research Foundations under the INTERACT project (ANR-17-FRAL-0010, DFG-HA-5407/4-1, 2018-2021) to M.R. and W.H., the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program under Grant agreement no. 771234-PALEoRIDER to W.H., the award Praemium Academiae of the Czech Academy of Sciences to M.E. and the project RVO 67985912 of the Institute of Archaeology of the Czech Academy of Sciences, Prague to M.S.

The aim of this study was to investigate the reliability and validity of the Trunk Control Measurement Scale (TCMS) among children with cerebral palsy (CP) who were living in Tanzania. Two physiotherapy trainees, each blinded to the other’s test findings, independently administered the TCMS to 38 children with CP (16 female; M age = 7.2, SD = 4.8 years) twice over sessions separated by a 30-day interval. We assessed internal consistency and intra/inter-rater reliability using Cronbach’s alpha and the Intraclass Correlation Coefficient (ICC), respectively. We examined measurement error through Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC). We assessed construct validity with Spearman's correlation coefficient between the TCMS and both the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). We found a frank floor effect. Internal consistency (α = 0.945) and reliability indices were excellent for the total scale (ICC for intra-rater reliability = 0.985, inter- reliability = 0.997) and for each sub-scale score. We found low values of SEM (1.7 points) and MDC (4.8 points). Construct validity was supported by moderate and strong correlations between the TCMS and the GMFCS and MACS in this sample. We conclude that the psychometric properties of the TMCS support its clinical and research use for youth with CP in low-income settings.

The authors used two analyses developed within the framework of the uncontrolled manifold hypothesis to quantify multimuscle synergies during voluntary body sway: analysis of intertrial variance and analysis of motor equivalence with respect to the center of pressure (COP) trajectory. Participants performed voluntary sway tasks in the anteroposterior direction at 0.33 and 0.66Hz. Muscle groups were identified in the space of muscle activations and used as elemental variables in the synergy analyses. Changing mechanical and vision feedback–based constraints led to significant changes in indices of sway performance such as COP deviations in the uninstructed, mediolateral direction and indices of spontaneous postural sway. In contrast, there were no significant effects on synergy indices. These findings show that the neural control of performance and of its stability may involve different control variables and neurophysiological structures. There were strong correlations between the indices of motor equivalence and those computed using the intercycle variance analysis. This result is potentially important for studies of patients with movement disorders who may be unable to perform multiple trials (cycles) at any given task, making analysis of motor equivalence of single trials a viable alternative to explore changes in stability of actions

We explored unintentional drifts in voluntary whole-body sway tasks following the removal of visual feedback. The main hypothesis was that the unintentional drifts were produced by drifts of referent coordinates for salient performance variables. Young healthy subjects stood quietly on a force platform and also performed voluntary body sway at 0.5 Hz both in the anterio-posterior and medio-lateral directions. Visual feedback on the center of pressure (COP) coordinate was provided and then turned off. During quiet stance trials, the subjects matched the initial COP coordinate with a target shifted by 3 cm anterior, posterior, left, or right from the coordinate during natural standing and activated the right tibialis anterior to 30% of its maximal voluntary contraction. During cyclical voluntary sway task, the nominal sway amplitude was always 4 cm while the midpoint was at one of the four mentioned locations. Removing visual feedback caused COP drifts during quiet stance trials that were consistent across trials performed by a subject but could be in opposite directions across subjects; there was a consistent drop in the activation level of tibialis anterior. During voluntary body sway, removing visual feedback caused a consistent increase in the voluntary sway amplitude and a drift of the midpoint that was consistent within but not across subjects. Motor equivalent and non-motor equivalent inter-cycle motion components were quantified within the space of muscle groups (muscle modes) under visual feedback and at the end of the period without visual feedback. Throughout the trial, there were large motor equivalent motion components, and they increased over the period without visual feedback. The results corroborate the idea that referent coordinate drifts at different levels of the control hierarchy can lead to unintentional drifts in performance. It suggests that directions of COP drifts are defined by two main factors, drift of the body referent coordinate toward the actual coordinate (that can lead to fall) and an opposite drift to ensure body motion to a safer location. Analysis of motor equivalence suggests that postural stability is not compromised during unintentional drifts in performance in contrast to earlier studies of multi-finger tasks. This may be due to the vital importance of postural stability for everyday actions. This is a post-peer-review, pre-copyedit version of an article published in [Experimental Brain Research]. The final authenticated version is available online at: https://doi.org/10.1007/s00221-017-4972-x