Scapula Dyskinesis

Scapular dyskinesis is any alteration of its static position or kinematics during movements in the shoulder joint. The correct scapula orientation is associated with the tone of the muscles attached to it. The prevalence of scapular dyskinesis is high among patients with subacromial impingement syndrome, partial rotator cuff tears, shoulder joint instability and SLAP injuries. Scapular dyskinesis can be caused by a whole range of factors, including upper cross syndrome and postural adaptations predisposing to it, neurological disorders. However, instrumental diagnosis of scapular dyskinesis is difficult, which makes the use of clinical tests the main method of its detection. In this lecture, the etiology of scapular dyskinesis, classification, diagnostic tests and treatment methods are analyzed in detail. The detection of scapular dyskinesis and its type determination in patients with shoulder joint pathologies allows us to form an optimal rehabilitation therapy protocol, including techniques of myofascial release, passive and active stretching of spasmodic and training of weak muscle groups aimed at correcting postural disorders, pathology of the scapulohumeral rhythm, restoration of the glenohumeral joint normal biomechanics.

Effectiveness of Therapy for the Treatment of Accommodative Insufficiency: An Open Pilot Study

Background: To evaluate improvements in clinical measures and symptoms in children and young adults with accommodative insufficiency in an open trial of office-based vergence and accommodative therapy. Methods: Major eligibility requirements included ages 9 to 30 years and amplitude of accommodation (AA) ≥2 diopters (D) below Hoffstetter’s minimum. Participants completed 8 weekly, 1-hour sessions of office-based vergence and accommodative therapy. Therapy procedures followed the Convergence Insufficiency Treatment Trial (CITT) therapy protocol with emphasis on accommodative procedures. Clinical measures of accommodation and symptoms (Convergence Insufficiency Symptom Survey [CISS]) were assessed at baseline and after therapy. Results were evaluated using the Student’s t test and Kruskal-Wallis test. Repeatability of CISS scores at baseline was assessed using Bland Altman 95% Limits of Agreement (LoA) and Interclass Correlation Coefficient (ICC). Results: Eighteen participants (mean age 17.4 ± 8.0 years) were enrolled; sixteen completed the study. The mean AA improved significantly from 5.5D OD and OS at baseline to 12.4D OD and 12.8D OS at outcome (p<0.001). Mean monocular accommodative facility (AF) also increased significantly in both eyes from 6.6 cycles per min (cpm) OD and 7.4cpm OS at baseline to 14.2cpm OD and OS at outcome (p≤0.0009). Amplitude-scaled monocular AF also showed significant improvements (p≤0.034 for both). Mean CISS score improved 10.50 points (p=0.0003). Significantly greater improvements in AA were observed in children (9.0D) than in adults (4.3D) in the right eye (p=0.007 for both comparisons). Conversely mean improvement in CISS score was significantly greater in adults than in children (p=0.039). Repeated CISS scores differed by, on average,1.47 points (95% limits of agreement:-5.19, 8.13; p=0.12). The ICC was 0.95 with a 95% confidence interval of 0.87 to 0.98. Conclusion: Eight weekly sessions of office-based accommodative vergence therapy combined with homebased- reinforcement therapy resulted in improvements of symptoms and clinical measures of accommodation in children and young adults with accommodative insufficiency.

The Effects of the Flash Technique Compared to Those of an Abbreviated Eye Movement Desensitization and Reprocessing Therapy Protocol on the Emotionality and Vividness of Aversive Memories

Introduction: The Flash technique is a novel intervention aimed at rapidly decreasing the subjective disturbance of an aversive memory, thereby serving as a potential way of treating post-traumatic stress disorder (PTSD). The protocol is used to stimulate clients to engage in positive imagery while being discouraged to actively recollect the targeted disturbing memory. Previous research into the Flash technique’s efficacy shows promising results, yet controlled studies are lacking.Objectives: To test the efficacy of the Flash technique, it was compared to an abbreviated eye movement desensitization and reprocessing (EMDR) therapy protocol in a controlled experimental setting. We hypothesized that the Flash technique would lead to a larger decrease in the emotionality and vividness of an aversive autobiographical memory when compared to EMDR therapy. Our second hypothesis was that the procedure of the Flash technique would be evaluated more pleasant by its receiver.Method: The sample consisted of 60 non-clinical participants (mean age = 25.28 years; 73.33% female) who were able to recall an aversive autobiographical memory. They were randomized to either the Flash technique or the EMDR therapy condition. Measurements consisted of emotionality and vividness-ratings pre and post intervention, and at 1-week follow-up.Results: Bayesian analyses showed no differences between Flash and EMDR to the extent to which the emotionality and vividness of their memory was reduced. Afterward, the Flash technique was rated more pleasant than EMDR.Conclusion: The results support the claim that the Flash technique might be used as a brief and efficacious intervention for individuals suffering from disturbing memories. Although the results suggest that its efficacy does not differ from EMDR, the Flash technique seems to yield similar outcomes in a more pleasant way. Further research into its working mechanisms and in a clinical sample is required.

Pulmonary tuberculosis and COVID-19 coinfection: A new medical challenge

Radiological findings in chest radiography and respiratory symptomatology represent a great challenge of interpretation during the COVID-19 (Coronavirus Disease 2019) pandemic, as their patterns can generate uncertainty at the time of diagnosis. This case highlights the importance in achieving an adequate correlation between diagnostic imaging and the clinical picture. We present a male adult who was admitted for 8 days of respiratory symptoms. Management with steroids was initiated according to the RECOVERY (Randomized Evaluation of COVID-19 Therapy) protocol and later confirmation of SARS-CoV-2 infection was received. In the following weeks, he deteriorated slowly and progressively clinically, without reaching respiratory failure. Imaging showed a thick-walled cavitation in the right lower lobe. Tuberculosis was suspected and confirmed. The uniqueness of this case of COVID-19 coinfection in a patient with undiagnosed tuberculosis, represents a diagnostic and clinical management challenge, where the proper interpretation of chest radiology is a fundamental tool.

An MRD-stratified pediatric protocol is as deliverable in adolescents and young adults as children with ALL

Pediatric regimens have improved outcomes in adolescent and young adult (AYA) acute lymphoblastic leukemia (ALL). However, results remain inferior to children with ALL. The ALLG ALL06 study (anzctr.org.au/ACTRN12611000814976) was designed to assess whether a pediatric ALL regimen (ANZCHOG Study 8) could be administered to patients aged 15-39 years in a comparable time frame to children as assessed by the proportion of patients completing induction/consolidation and commencing the next phase of therapy - protocol M or high risk (HR) treatment - by day 94. Minimal residual disease (MRD) response stratified patients to HR treatment and transplantation. From 2012 to 2018, 86 patients were enrolled; 82 were eligible. Median age was 22 (range, 16-38) years. Induction/consolidation was equally deliverable in ALL06 as in Study 8. In ALL06, 41.5% (95%CI, 30.7-52.9) commenced protocol M or HR therapy by day 94 vs 39.3% in Study 8 (p=0.77). Median time to protocol M/HR treatment was 96 (IQR, 87.5-103) days in ALL06 vs 98 days in Study 8 (p=0.80). Induction mortality was 3.6%. With median follow up of 44 (1-96) months, estimated 3-year disease free survival (DFS) was 72.8% (95%CI, 62.8-82.7) and estimated 3-year overall survival (OS) was 74.9% (95%CI, 65.3-84.5%). End induction/consolidation MRD negativity rate was 58.6%. Body mass index (BMI) ≥30 and day 79 MRD positivity were associated with poorer DFS and OS. Pediatric therapy was safe and as deliverable in AYA patients as children with ALL. Intolerance of pediatric ALL induction/consolidation is not a major contributor to inferior outcomes in AYA ALL.