Application of computer stabilometric technologies with biofeedback in patients with lumbosacral pain

Author(s):  
Vladislav V. Andreev ◽  
Yuri Kambulatovich Kodzaev

Introduction. Low back pain is one of the most common sufferings of modern humans. In developed countries, such manifestations are a serious medical and economic problem. Lumbosacral pain in many cases is caused by the occurrence of somatic dysfunction of the bones of the pelvis and sacrum. The main methods of treatment are prescribing drug therapy and non-drug treatment. Today, osteopathic techniques are highly effective for the diagnosis and correction of somatic dysfunctions of the pelvic region. Such treatment in patients with pain in the lower back helps to reduce pain and restore the functional state of patients. Equally important are computer technologies with biofeedback (BFB) with the possibility of effective correction of proprioceptive innervation and muscle-tonic syndromes. The stabilometric platform allows you to register the parameters of the static-dynamic function of support and balance maintenance. The resulting changes in the position of the sacrum and pelvic bones create a distortion of proprioceptive somatosensory afferentation, postural tonic reflexes of the axial skeleton and limbs are blocked, the sequence of activation of the motor units of the locomotor apparatus is disrupted, the mechanisms for maintaining support and walking change. The aim — to study the effectiveness of using a stabiloplatform with biofeedback in the diagnostic mode of coordinating and static-dynamic disorders in patients with somatic dysfunctions of the pelvic and sacral bones in a training mode in combination with osteopathic correction for pain in the lumbosacral region. Materials and methods. In a prospective controlled study in patients with lumbosacral pain with somatic dysfunctions of the pelvic bones, the results of treatment were analyzed in 66 patients aged 23–56 years. Diagnosis of dysfunctions of the iliac bones was carried out according to the generally accepted rules of osteopathic examination — osteopathic examination and determination of the position of bone landmarks. The observed patients were divided into groups and subgroups depending on the type of dysfunction. The main group consisted of patients with clinical and osteopathic signs of somatic dysfunctions of the pubic bone and ilium. The patients were followed up for 14 days. The observation and treatment program included: osteopathic correction of diagnosed somatic dysfunction and stabilometric examination (3 control points) with a training regimen (3 sessions). Stabilometric testing was carried out at the stage of diagnosis and selection of patients for inclusion in the study. Re-examination was carried out 14 days after the moment of treatment. The clinical effect was compared with the results of stabilometric tests. In addition, the intensity of the pain syndrome and the severity of muscle-tonic reactions were analyzed. According to the results of the test regime, the stability in the «eyes open» and «eyes closed» modes was assessed. Results. A decrease in the intensity of pain is achieved, normalization of the balance in axial parameters with an improvement in the function of coordination of movements is noted. The Romberg coefficient decreases most significantly in somatic dysfunctions of the iliac bones in the position of anterior rotation without a significant difference in lateralization: on the right, a decrease from 570 ± 12% to 295 ± 23% and on the left from 550 ± 22 to 260 ± 25% (p <0.05). Conclusion. In the event of somatic dysfunctions of the pelvic bones with lumbosacralgia, the combined use of osteopathic correction and physiotherapy exercises on a stabiloplatform in a training mode with biofeedback has a significant effect. The training regimen promotes pain regression in acute and chronic pain. The best results have been achieved in patients with dysfunction in the anterior rotation of the ilium. Stabilometric testing in the diagnostic mode allows you to obtain objective data on the nature of imbalance and imbalance. The training regime ensures the achievement of a therapeutic result in 3 sessions and can be used in inpatient and outpatient conditions of medical institutions.

2021 ◽  
pp. 52-65
Author(s):  
V. V. Andreev ◽  
A. I. Sychev

Introduction. Somatic dysfunctions of the pelvic and sacral bones are one of the most common causes of lumbosacral pain with impaired spine statics, functional disorders of internal organs and other manifestations. Remote symptoms include torsional dural dysfunctions. Distortion of proprioceptive somatosensory afferentation blocks postural tonic reflexes of the axial skeleton and extremities, disrupts the sequence of activation of motor units of the locomotion system, changes the mechanisms for providing support and walking. Osteopathic correction of somatic dysfunctions in the region improves the condition of patients, however, in some cases, it is not possible to achieve complete regression of the identified syndromes. One of the effective corrective methods are computer technologies with the registration of the parameters of the static-dynamic function of support and maintaining balance. The possibilities of restoring reflex mechanisms can be obtained using computer stabilometry with a biofeedback program (BFB). Testing was carried out at the stage of diagnosis and follow-up: at the stage of screening, immediately after the treatment session, and 14 days after the moment of treatment. The clinical effect was compared with the results of stabilometric testing. The training sessions were carried out after registering the statokinesiogram.The aim of the research was to study the possibilities of using a stabiloplatform with BFB in in the mode of diagnosis of coordination and static-dynamic disorders of the axial skeleton in patients with various types of somatic dysfunctions of the pelvic bones and in the training mode together with the osteopathic correction of the somatic dysfunctions identified in patients.Materials and methods. In a prospective controlled study, the results of examination and treatment of 66 patients aged 23–56 years (median — 33) were analyzed, including 36 women and 39 men with somatic dysfunctions of the pelvic bones. In the main group, clinical and osteopathic signs of somatic dysfunctions of the pubic bone and ilium were revealed. The observation was carried out for 14 days. Osteopathic treatment of the corresponding type of dysfunction and stabilometric examination (3 control points) and training (3 sessions) were performed. Among the analyzed clinical manifestations, the intensity of pain syndrome and muscle-tonic reactions was taken into account. According to the results of the stabilometry, stability (RC) was assessed in the «eyes open» and «eyes closed» modes. The primary checkpoint is the start of observation and the correction procedure. Stage control after 7 days and the final observation point — 14 days. In total, 3–4 osteopathic sessions were carried out, stabilometric control was the screening stage, before and after the session, observation after 14 days from the last session.Results. There was detected decrease in pain intensity, normalization of axial balance and coordination of movements. The most significant was the decrease in the Romberg coefficient in patients with dysfunction of the iliac bones in the anterior rotation, regardless of the side: dynamics on the right: decrease from 570±12 to 295±23 % and on the left from 550±22 to 260±25 % (p<0,05).Conclusion. The combined use of osteopathic correction and physiotherapy exercises on a stabiloplatform in a training mode with BFB promotes regression of neurological and clinical symptoms, which is confirmed by all diagnostic methods used in the study — clinical neurological, clinical osteopathic, stabilometric with BFB. The best results were achieved in patients with somatic dysfunction anterior rotation of the ilium. The use of a stabiloplatform with BFB in the diagnostic mode allows obtaining objective data on the nature of the imbalance and balance disorders. The training regime contributes to the achievement of a therapeutic result in a short time (3 sessions) and can be used in inpatient and outpatient conditions of medical institutions.


2018 ◽  
Vol 4 ◽  
pp. 3-13
Author(s):  
Yuriy Dumanskiy ◽  
Oleksandr Bondar ◽  
Oleksandr Tkachenko ◽  
Evhenii Stoliachuk ◽  
Vasilii Ermakov

In recent years, breast cancer (BC) is the most common cancer pathology and the most common cause of disability among women in developed countries. Finding the most effective ways of interaction between the patient and the doctor creates the preconditions for the necessary analysis of the treatment process from an objective and subjective point of view. Therefore, an important indicator to be taken into account is the quality of life of a patient. To compare the indicators of a comprehensive assessment of the quality of life of patients to the adverse locally advanced forms (LA) of breast cancer before and after systemic intravenous polychemotherapy (SPCTx) and selective endolymphatic polychemotherapy (ELPCTx) in neoadjuvant mode. The study was conducted on the basis of a random analysis of outpatient cards from 112 patients with LA BC T4A-DN0-3M0 who received a comprehensive antitumor treatment on the basis of the Donetsk regional antitumor center and the University Clinic of the Odessa National Medical University from 2000 to 2017, which was proposed a questionnaire at various stages of preoperative treatment. The first (control) group consisted of 65 patients (58 %) with inoperable forms of LA BC, which was performed in neoadjuvant mode by SPCTx. The second (study group) included 47 patients (42 %) with inoperable forms of LA BC, which was performed as a neoadjuvant course ELPCTx. According to the integral indicators of quality of life and quality of health between patients in the control and study groups, there was no statistically significant difference. In a detailed analysis of the indicators of symptomatic scales, the difference between the groups did not exceed the critical. Based on the results of a study conducted among patients receiving endolymphatic chemotherapy in a neoadjuvant mode, the subjective evaluations of treatment in absolute numbers have better reference values without statistical superiority. The study of the integrative indicator of quality of life and its discrete elements is an ergonomic and economical means of heuristic assessment of the health of patients in order to further develop more rational and convenient ways of solving urgent issues of modern oncology by increasing compliance and finding a compromise between the physician and the patient.


2020 ◽  
Vol 16 ◽  
Author(s):  
Neerja Thukral ◽  
Jaspreet Kaur ◽  
Manoj Malik

Background: Peripheral neuropathy is a major and chronic complication of diabetes mellitus affecting more than 50% of patients suffering from diabetes. There is involvement of both large and small diameter nerve fibres leading to altered somatosensory and motor sensations, thereby causing impaired balance and postural instability. Objective: To assess the effects of exercises on posture and balance in patients suffering from diabetes mellitus. Method: Mean changes in Timed Up and Go test(TUGT), Berg Balance Scale and Postural Sway with eyes open and eyes closed on Balance System were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Eighteen randomized controlled trials met the selection criteria and were included in the study. All the studies ranked high on PEDro Rating scale. Risk of bias was assessed by Cochrane collaboration tool of risk of bias. Included studies had low risk of bias. Sixteen RCT’s were included for the meta-analysis. Result: Results of meta-analysis showed that there was statistically significant improvement in TUGT with p≤ 0.05 and substantial heterogeneity (I 2 = 84%, p < 0.00001) in experimental group as compared to control group. There was statistically significant difference in Berg Balance Scale scores and heterogeneity of I 2 = 62%, p < 0.00001 and significant changes in postural stability (eyes open heterogeneity of I 2 = 100%, p =0.01 and eyes closed, heteogeneity I 2 = 0%, p =0.01). Sensitivity analysis causes change in heterogeneity. Conclusion: It can be concluded that various exercises like balance training, core stability, Tai-Chi, proprioceptive training etc. have a significant effect in improving balance and posture in diabetic neuropathy.


Author(s):  
Philip J. Johnson ◽  
Sofi Dhanaraj ◽  
Sarah Berhane ◽  
Laura Bonnett ◽  
Yuk Ting Ma

Abstract Background The neutrophil–lymphocyte ratio (NLR), a presumed measure of the balance between neutrophil-associated pro-tumour inflammation and lymphocyte-dependent antitumour immune function, has been suggested as a prognostic factor for several cancers, including hepatocellular carcinoma (HCC). Methods In this study, a prospectively accrued cohort of 781 patients (493 HCC and 288 chronic liver disease (CLD) without HCC) were followed-up for more than 6 years. NLR levels between HCC and CLD patients were compared, and the effect of baseline NLR on overall survival amongst HCC patients was assessed via multivariable Cox regression analysis. Results On entry into the study (‘baseline’), there was no clinically significant difference in the NLR values between CLD and HCC patients. Amongst HCC patients, NLR levels closest to last visit/death were significantly higher compared to baseline. Multivariable Cox regression analysis showed that NLR was an independent prognostic factor, even after adjustment for the HCC stage. Conclusion NLR is a significant independent factor influencing survival in HCC patients, hence offering an additional dimension in prognostic models.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
James Atampiiga Avoka ◽  
Elvis J. Dun-Dery ◽  
Issah Seidu ◽  
Armel N. E. Abou ◽  
Paul Twene ◽  
...  

Abstract Background Rotavirus is considered the main causal factor of severe gastroenteritis among infants and children globally. The association with severe rotavirus infection is mostly worse among the least developed countries, mainly due to inadequate access to medical care and poverty. This study was conducted to determine the seasonal effects in respect of diarrhea cases in children, the association between diarrhea cases and Rota2 vaccine in the Fanteakwa District of the Eastern Region of Ghana. Methods The study compares monthly diarrhea cases against children vaccinated with Rota2 extracted from DHIMS2 spanning May 2012 to December 2017 in Fanteakwa District. A univariate association between diarrhea cases and children vaccinated with Rota 2 was conducted using the R-software version 3.4.4 with the use of forecast, tseries and TSAPred. Pearson Correlation coefficient was also computed between monthly diarrhea cases and Rota 2 as well as lagged values of Rota 2 and Diarrhea cases. Results The study shows that February recorded the highest average number of diarrhea cases (172) over the period 2012 to 2017 with a standard deviation of 59. However, a one-way analysis of variance shows a significant difference amongst the monthly averages with an F-statistic of 0.042 and P-value of 0.064. It is observed that the correlations between each of the Rota2 doses and the lagged cases are positive, showing higher Rota2 doses a month ago ((Xt − 1),0.346 to0.735), two months ago ((Xt − 2),0.383 to 0.746), three months ago ((Xt − 3), 0.330 to 0.737) and four months ago ((Xt − 4), 0.236 to 0.723) are associated with lower diarrhea cases. The results also show that an increase in the previous two month’s Rota2 figures by 100 is associated with a significant decrease in the currently expected diarrhea cases by approximately 36. Conclusion Seasonal variations exist in the occurrence of diarrhea in children, with January recording the highest number of diarrhea cases (172). There is a relationship between episodes of diarrhea in children and Rota2 (p-value = 0.064); thus, the more children are vaccinated with Rota2, the less diarrhea cases are recorded. Diarrhea cases in Fanteakwa district are generally low, except 2013 and 2016 where the cases are higher than the rest of the other years.


2021 ◽  
pp. 073563312110272
Author(s):  
Neila Chettaoui ◽  
Ayman Atia ◽  
Med Salim Bouhlel

Embodied learning pedagogy highlights the interconnections between the brain, body, and the concrete environment. As a teaching method, it provides means of engaging the physical body in multimodal learning experiences to develop the students’ cognitive process. Based on this perspective, several research studies introduced different interaction modalities to support the implementation of an embodied learning environment. One such case is the use of tangible user interfaces and motion-based technologies. This paper evaluates the impacts of motion-based, tangible-based, and multimodal interaction merging between tangible interfaces and motion-based technology on improving students’ learning performance. A controlled study was performed at a primary school with 36 participants (aged 7 to 9), to evaluate the educational potential of embodied interaction modalities compared to tablet-based learning. The results highlighted a significant difference in the learning gains between all groups, as determined by one-way ANOVA [F (3,32) = 6.32, p = .017], in favor of the multimodal learning interface. Findings revealed that a multimodal learning interface supporting richer embodied interaction that took advantage of affording the power of body movements and manipulation of physical objects might improve students’ understanding of abstract concepts in educational contexts.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 499.2-500
Author(s):  
A. De Diego Sola ◽  
M. Vaamonde Lorenzo ◽  
A. Castiella Eguzkiza ◽  
M. J. Sánchez Iturri ◽  
N. Alcorta Lorenzo ◽  
...  

Background:Despite therapeutic advances in recent years, methotrexate (MTX) remains the gold standard for the treatment of rheumatoid arthritis (RA). Among the side effects that have been blamed on it are liver fibrosis (LF) and cirrhosis, although late studies have failed to show such a relation1,2. The only validated test in the diagnosis of LF is biopsy. Given the relevance of MTX in the treatment of RA, it is important to evaluate non-invasive diagnostic options for LF such as transitional elastography (FibroScan, FS).Objectives:To evaluate the percentage of LF in RA patients treated with MTX. Secondly, to assess the correlation between altered liver function, RA activity, and LF. To determine whether dose and/or duration of treatment with MTX may affect the development of LF in such patients.Methods:We did a prospective study between February 2019 and January 2020. Patients affected of RA treated with MTX were included. Patients with basal liver disease (hepatitis B, hepatitis C and steatohepatitis), alcohol consumption, type I diabetes mellitus, chronic renal failure, heart failure, obesity and concomitant treatment with leflunomide or antiretrovirals were excluded. Demographic, clinical, analytical and therapeutic variables were collected. Liver fibrosis was assessed by FS in kilopascals (kpa) and using the APRI score. RA activity was assessed by DAS28 score. Continuous variables are described with mean and standard deviation (SD), and qualitative variables are shown with absolute value and percentage. Spearman’s and Mann-Whitney’s U tests were used for the bivariate analysis.Results:Fifty patients were included (Table 1 and 2). Of these, 38 were women (76%) with mean age of 61.8 years (SD 11.7) and mean RA evolution time of 13.7 years (SD 8.2). The mean DAS28 at the visit was 2.39 (SD 1.1). The FS showed an average of 4.8 kpa (SD 2). The mean duration of treatment with MTX was 85.8 months (SD 93.3) and that of AD-MTX was 5414.6mg (SD 5011). Patients were divided into those with DA-MTX greater than 4000mg (21, 42%) and less than 4000mg (29, 58%) and no significant differences were found in terms of LF in FS (p 0.637) or APRI scale (p 0.806). No significant differences were found in terms of treatment duration either. Six patients (12%) had elevated aspartate aminotransferase (AST) and 9 (18%) had elevated alanine aminotransferase (ALT). No significant difference was found in FS values in relation to ALT, but it was with elevated AST (p 0.021). Similarly, differences were found in APRI based on AST (p 0.045). Metabolic syndrome was collected in 4 patients (8%) without significant differences with FS or APRI values. There were no significant differences in LF depending on gamma-glutamyl transpeptidase (GGT) values.Conclusion:FS and APRI score are useful for the determination of LF in RA patients treated with MTX. There is no evidence of a relationship between AD-MTX and LF by FS or APRI. AST values may be related to the presence of fibrosis as determined by FS or APRI. and the presence of the metabolic syndrome are not.References:[1]G.L. Erre, et al. Methotrexate therapy is not associated with increased liver stiffness and significant liver fibrosis in rheumatoid arthritis patients: A cross-sectional controlled study with real-time two-dimensional shear wave elastography. European Journal of Internal Medicine 69 (2019) 57–63. Internet.[2]R. Conway et al. Risk of liver injury among methotrexate users: a meta-analysis of randomised controlled trials. Semin Arthritis Rheum 2015 Oct;45(2):156–62. Internet.Disclosure of Interests:None declared


2016 ◽  
Vol 18 (2) ◽  
pp. 203-213 ◽  
Author(s):  
Supattra Sroypetch ◽  
Neil Carr ◽  
Tara Duncan

This paper examines host and backpacker perceptions of the environmental impacts of backpacker tourism on local communities in less-developed countries. The discussion is based on data collected in 2011 via surveys and interviews with host and backpacker populations in the Yasawa Islands of Fiji. The results suggest that there is a significant difference between the perceptions of hosts and their guests towards the environmental impacts of backpacker tourism. Backpackers believe that they generate a higher extent of negative environmental impacts on the destination than those perceived by their hosts. This study broadens the understanding of the impacts of backpacker tourism from dual perspectives – both the hosts and guests.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jesse Dawson ◽  
Theresa J Kimberley ◽  
Gerard E Francisco ◽  
Patricia Smith ◽  
Steven C Cramer ◽  
...  

Introduction: Vagus Nerve Stimulation (VNS) paired with rehabilitation induces movement specific plasticity in rat motor cortex and improves forepaw function in a rat ischemic model compared to rehabilitation alone. A 20 subject first-in-human study in the UK indicated acceptable safety and feasibility of this approach in patients with arm weakness after stroke and showed a significant difference in favour of VNS paired with rehabilitation in the per-protocol analysis (Upper Extremity Fugl Meyer difference of 9.6 points for VNS vs. 3.0 Control; p = 0.038). We conducted a new, double-blind sham controlled study to further assess this technique. Methods: Subjects with chronic moderate to severe upper extremity hemiparesis secondary to ischemic stroke (Upper Extremity Fugl Meyer (UEFM) 20-50) were enrolled at four sites (3 US, 1 UK). After baseline assessments subjects were implanted with a vagus nerve stimulation device if all eligibility criteria were met. Following implantation, randomization was made to either paired VNS (1/2 second, 30 Hz., 0.8 mA, 100 uS stimulation with task-specific movement) or sham control (stimulation only on first 5 movements). All received the same intensive and task-specific rehabilitation and had 18 treatment sessions (2-hourly, 3 times a week for 6-weeks, approximately 50 repetitions per task and 300 to 400 repetition movements per session). Outcomes were assessed on the first and 30 th day following completion of the 6-week therapy course. Results: Sixteen patients (8 female) were implanted (8 VNS, 8 Control). Mean age (SD) was 63.2(6.9), with an average (SD) of 21.7 months (12.9) post stroke. One study related serious adverse event was reported (a wound infection that resolved with IV antibiotics). Blinded results (change in UEFM, WMFT, and UEFM responders for both groups) will be available and presented. Conclusions: A pivotal study of VNS paired with rehabilitation movements will be justified if preliminary results are confirmed.


PEDIATRICS ◽  
1960 ◽  
Vol 25 (5) ◽  
pp. 742-747
Author(s):  
Robert J. Haggerty ◽  
Mohsen Ziai

A controlled study of the treatment of bacterial meningitis with single and multiple, potentially antagonistic antimicrobial drugs was undertaken. Sixty-five patients received a single and 71 received several drugs in combination. The two groups were generally comparable. There was no significant difference in the results: that is antagonism could not be demonstrated in this clinical study. It seems reasonable to recommend that, in patients over 1 month of age with acute primary bacterial meningitis in whom an etiologic agent cannot be promptly identified, the use of multiple drugs aimed at the three most likely organisms (pneumococcus, meningococcus, H. influenzae) can be employed without danger of clinically apparent antagonism.


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