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Background: This study aimed to analyse the effects of a plank-based strength training programme on muscle activation in patients with long COVID., Subjects and Methods: Case series study that included patients with long COVID who participated in a 12-week trunk and pelvic muscle strength training programme. Clinical variables and the modified fatigue impact scale (MFIS) were used to assess fatigue levels. Percentage of muscle activation during a core muscle plank was measured via surface electromyography. Pre- and post-intervention results were compared using the Wilcoxon signed-rank test and evaluated with Cohen's D effect size (ES)., Results: Twenty-one subjects participated in the study; 81% female, mean age 47.5 years (range: 28-55 years), and median duration of symptoms 21 months (range: 5-24 months); 90.5% of the participants experienced fatigue (MFIS score = 38). Muscle activation during plank exercises improved across all muscles after the intervention, with significant increases in the left (p = 0.011, medium ES) and right external oblique (p =0.039, small ES) muscles and the right latissimus dorsi muscle (p = 0.039, small ES). Additionally, significant reductions in fatigue were observed in the total MFIS score (p = 0.004, medium ES) and in the physical (p < 0.001, large ES) and psychosocial subscales (p = 0.033, small ES)., Conclusions: Results suggest that a plank-based strength training programme may be effective in enhancing trunk and pelvic muscle activation in individuals with long COVID.

Abstract: A high-riding jugular bulb can complicate standard otologic and neurotologic approaches and must be taken into account during surgical planning., Competing Interests: M.-E.N. discloses that he is a shareholder of the following companies: 3M, Amgen, Pfizer, Johnson & Johnson, Kimberly Clark, Medtronic, and Nestle. P.W.G. discloses that he is a shareholder of the following companies: Amgen, Eli Lily, Medtronic, Merck, Novartis, Pfizer, and Roche. The remaining authors disclose no conflicts of interest., (Copyright © 2024, Otology & Neurotology, Inc.)

Many behaviors require the coordinated actions of somatic and autonomic functions. However, the underlying mechanisms remain elusive. By opto-stimulating different populations of descending spinal projecting neurons (SPNs) in anesthetized mice, we show that stimulation of excitatory SPNs in the rostral ventromedial medulla (rVMM) resulted in a simultaneous increase in somatomotor and sympathetic activities. Conversely, opto-stimulation of rVMM inhibitory SPNs decreased both activities. Anatomically, these SPNs innervate both sympathetic preganglionic neurons and motor-related regions in the spinal cord. Fiber-photometry recording indicated that the activities of rVMM SPNs correlate with different levels of muscle and sympathetic tone during distinct arousal states. Inhibiting rVMM excitatory SPNs reduced basal muscle and sympathetic tone, impairing locomotion initiation and high-speed performance. In contrast, silencing the inhibitory population abolished muscle atonia and sympathetic hypoactivity during rapid eye movement (REM) sleep. Together, these results identify rVMM SPNs as descending spinal projecting pathways controlling the tone of both the somatomotor and sympathetic systems., Competing Interests: Declaration of interests Z.H. is a co-founder of Rugen and Myrobalan and an advisor of Axonis., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To report the largest case series of isolated malleus fractures with systematic review to characterize the disease's presentation and natural history, and provide suggestions for management., Data Sources: PubMed, Embase, Cochrane Library., Review Methods: Retrospective cohort study was performed on 12 patients with isolated malleus fractures. History, physical exam, pre- and post-treatment audiograms, and imaging were obtained. Systematic review of the literature was performed., Results: Including the cases herein, 58 isolated malleus fractures were identified, the majority of which were published in the 21st century. Mean time to presentation after injury was 34.4 months. Most common etiology was external auditory canal (EAC) manipulation. Physical exam and imaging did not identify any abnormality at presentation in 16% and 21% of cases, respectively. The majority of fractures involved the manubrium. Air-bone gap (ABG) at initial presentation ranged from 16 to 26 dB, and was greater at higher frequencies. Thirty-six cases underwent surgery. ABG improvement was greater at all frequencies for those who underwent surgery. Final ABG was significantly less than initial ABG at nearly every frequency for those who underwent surgery (p < 0.05), while not at any frequency for those who were observed., Conclusions: Isolated malleus fractures may occur more often than historical data suggests, and are perhaps underdiagnosed. Abrupt removal of a finger from the EAC with pain and hearing loss is nearly pathognomonic. Conductive hearing loss with ABG greater at higher frequencies is most often observed. Observation is unlikely to produce spontaneous improvements in hearing, while surgery demonstrates reliable decreases in ABG. Laryngoscope, 134:1032-1041, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system. Gait abnormalities, such as altered joint kinematics, are common in people with MS (pwMS). Traditional clinical gait assessments may not detect subtle kinematic alterations, but advances in motion capture technology and analysis methods, such as statistical parametric mapping (SPM), offer more detailed assessments. The aim of this study was to compare the lower-limb joint kinematics during gait between pwMS and healthy controls using SPM analysis. Methods: A cross-sectional study was conducted involving pwMS and healthy controls. A three-dimensional motion capture system was used to obtain the kinematic parameters of the more affected lower limb (MALL) and less affected lower limb (LALL), which were compared using the SPM analysis. Results: The study included 10 pwMS with mild disability (EDSS ≤ 3) and 10 healthy controls. The results showed no differences in spatiotemporal parameters. However, significant differences were observed in the kinematics of the lower-limb joints using SPM. In pwMS, compared to healthy controls, there was a higher anterior pelvis tilt (MALL, p = 0.047), reduced pelvis elevation (MALL, p = 0.024; LALL, p = 0.044), reduced pelvis descent (MALL, p = 0.033; LALL, p = 0.022), reduced hip extension during pre-swing (MALL, p = 0.049), increased hip flexion during terminal swing (MALL, p = 0.046), reduced knee flexion (MALL, p = 0.04; LALL, p < 0.001), and reduced range of motion in ankle plantarflexion (MALL, p = 0.048). Conclusions : pwMS with mild disability exhibit specific kinematic abnormalities during gait. SPM analysis can detect alterations in the kinematic parameters of gait in pwMS with mild disability.

Objective: To report a case of alternobaric facial palsy (AFP) with a hyperpneumatized temporal bone and to review the relevant literature in order to propose a new facet of AFP pathogenesis., Methods: A patient with a hyperpneumatized temporal bone was found to have recurrent episodes of facial palsy associated with air travel. Systematic review of PubMed, Cochrane Library, and Embase characterized all articles related to transient facial palsy associated with altitude changes or diving with a focus on demographics and imaging findings., Results: A 25 year-old male was referred for recurrent facial palsy associated with commercial air travel. Imaging demonstrated a hyperpneumatized and well-aerated temporal bone. Total air cell volume was calculated to be 8.59 cc on the affected side. A systematic review of the literature identified 49 cases of AFP. Mean age was 34 years old and 80% were male. Twelve cases had imaging of the temporal bone for evaluation, of which 85% demonstrated at least 1 area of hyperpneumatization. Hyperpneumatization was most frequently encountered in the mastoid, zygomatic root, and inferior petrous apex., Conclusion: Hyperpneumatization of the temporal bone is critical to AFP etiology as it predicts higher middle ear pressure, if atmospheric pressure changes cannot be equilibrated, via reduced efficacy of normal tympanic membrane pressure buffering. This hypothesis helps to better account for the rarity of the condition and male preponderance.

Background: Significant complications of diabetes include pain and the loss of sensation in peripheral limbs. Pain management of diabetic symmetric peripheral neuropathy (DSPN) remains challenging. This study reports on utilizing pulsed electromagnetic field therapy (PEMF) to reduce pain and improve skin perfusion pressure (SPP) in subjects with DSPN., Methods: A randomized, sham-controlled, double-blind, clinical trial was conducted on subjects afflicted with foot pain associated with DSPN. Following informed consent, 182 subjects with diabetes and confirmed DSPN were entered into the trial for a period of 18 weeks. Subjects were randomized into active PEMF treatment or nonactive sham and instructed to treat to their feet for 30 minutes, twice daily and report daily pain scores. Some patients in the active arm experienced a transient low field strength notification (LFSN) due to improper pad placement during treatment. Skin perfusion pressure measurements were also collected at two and seven weeks to assess peripheral arterial disease effects via measurement of local microcirculatory flow and blood pressure., Results: Patients in the active arm who did not receive an LFSN experienced a clinically significant 30% reduction in pain from baseline compared to sham ( P < .05). Though not statistically significant, SPP in the active group trended toward improvement compared to sham., Conclusions: Pulsed electromagnetic field therapy appears effective as a nonpharmacological means for reduction of pain associated with diabetic peripheral neuropathy and holds promise for improvement of vascular physiology in microcirculatory dysfunction associated with diabetic peripheral arterial disease., Competing Interests: Declaration of Conflicting InterestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Erica E. Tassone is a full-time employee of Regenesis Biomedical Inc., Jeffrey C. Page is a member of the medical advisory board of Regenesis Biomedical Inc., Marvin J. Slepian is a member of the board of directors of Regenesis Biomedical Inc.

Background: Alterations in mental functions are among the most frequent manifestations of stroke that have a direct impact on the patient's functionality. The objective of this study was to analyze the relationship of sociodemographic variables with the executive functions (EFs) of participants with right middle cerebral artery (MCA) stroke., Methods: A cross-sectional observational case-control study was conducted at the State Center for Brain Damage in Madrid, Spain. Fifty-eight subjects were recruited and divided into two groups. Each participant was administered the following: the FIM+FAM Functional Assessment Measure, the Lawton and Brody scale, The Trail-Making Test, the Zoo Map Test and the Hanoi Tower., Results: Statistically significant differences ( p < 0.05) were identified between participants with ischemic stroke and control in functional and EF functions, as well as between participants with hemorrhagic stroke and control. No statistically significant differences were found in the experimental group between subjects who had sustained ischemic and hemorrhagic stroke. No significant associations were identified between the variables age, gender and education level in relation to functionality and executive functions ( p > 0.05) in people with stroke., Conclusion: People who have suffered a right cerebral artery stroke have deficiencies in the EFS, resulting in poorer performance of the activity of daily living, compared to healthy subjects of the same age, gender and education level. In the correlational analysis of the stroke participants, no significant associations were identified between the variables gender, age and education level in relation to functionality and EF.

Objectives: To determine the incidence and impact of monopolar cautery use in a cohort of pediatric cochlear implant (CI) users., Study Design: Case series from a retrospective chart review and a systematic review of the literature., Setting: Tertiary academic referral center., Methods: CI patient charts from 2012 to 2021 were reviewed from a single pediatric hospital system to determine if monopolar cautery was used during a subsequent surgical procedure. In addition, a systematic review of the literature was performed to identify additional, relevant patients. Postoperative CI function was the primary outcome measure., Results: In total, 190 patients underwent a surgical procedure following cochlear implantation in a single pediatric hospital system. Fifteen patients (7.9%) and 17 distinct surgical procedures were identified in which monopolar cautery was used. Seven of these 17 cases (41.2%) involved the head and neck, and 10 were performed below the clavicles. No patients experienced a device failure or a decline in CI performance following surgery. A systematic review identified an additional 4 patients who underwent a surgery that used monopolar cautery following cochlear implantation, and no change in CI function was identified., Conclusions: The present study adds additional support to the notion that monopolar cautery does not necessarily injure CI functionality. While the most risk adverse strategy when planning a surgical procedure for a CI patient is to avoid monopolar cautery use altogether, the use of cautery should not immediately be associated with implant dysfunction., (© 2022 American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Objective: Assess clinical evolution and health-related quality of life at three months after discharge in patients who were admitted and diagnosed with COVID-19 pneumonia, evaluated by the Rehabilitation Service and received physiotherapy in Fuenlabrada Hospital., Methods: Data were collected from 59 patients, separating those who were assessed in ICU (41 patients) from those assessed in the hospital ward (18). Data were obtained from their Electronic Medical Record, and a telephone interview was performed three months after their discharge. Data about their clinical progress during their hospitalization, after discharge, over the next months and their condition at the time of the interview is analyzed. Patients were asked to assess the quality of the physiotherapy received and to answer the SF-36 health-related quality of life questionnaire., Results: These patients had the worst progress of the COVID pneumonia among all patients hospitalized in our hospital, but they had a good functional recovery with the inpatient physiotherapy received, which was positively rated. After three months, 84% have persistent symptoms, with the most common being dyspnoea, fatigue and anxiety/depression, and score worse in the SF-36 questionnaire than the reference population., Conclusions: Most patients who require rehabilitation during their COVID pneumonia admission have persistent symptoms and perceive a deterioration in their health-related quality of life after three months of discharge., (Copyright © 2021 Sociedad Española de Rehabilitación y Medicina Física. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Botulinum toxin A is the first-line treatment for localised spasticity. However, the economic impact of this treatment is not fully known. This study aimed to describe the real costs of botulinum toxin A for the treatment of adult patients with spasticity at a spasticity clinic pertaining to a rehabilitation service, over a period of one year., Methods: We retrospectively reviewed all medical procedures carried out during the year 2017. We collected data on the type of toxin used (incobotulinumtoxin A, onabotulinumtoxin A, or Abobotulinumtoxin A), the number of units injected, the anatomical region, and the time elapsed between infiltrations. The costs of medication and indirect costs, such as staff and consumables, were also calculated., Results: This is the first study to describe the real costs of botulinum toxin treatment of spasticity in adult patients in Spain. In 2017, 510 infiltration procedures were performed in 164 patients. The total cost of treating spasticity in our service was 116 789.70. The mean annual cost per patient was 603.64 for onabotulinumtoxin A, 642.69 for abobotulinumtoxin A, and 707.59 for incobotulinumtoxin A., Conclusions: Our economic study of real clinical practice is consistent with the theoretical models published in the literature. The different characteristics of each toxin and the inability to establish an equivalence between the units of each drug prevents us from directly comparing these costs., (Copyright © 2021. Published by Elsevier España, S.L.U.)

Introduction: Motor Imagery techniques may be used as a complement to the recovery of motor sequelae after a stroke, as during the evocation of a movement the activation of neuronal circuits involved in the actual execution of the movement occurs., Patients and Methods: A simple-blind randomized controlled trial was conducted. A total of 38 patients were randomly assigned to a study group. Both groups performed, for four weeks, five weekly sessions of neurorehabilitation and three weekly sessions of experimental or control intervention, respectively.The experimental group training the recognition of laterality, while the control group the recognition of body parts. Participants were evaluated pre and post intervention with posturography parameters -Sway area (AREA), Sway path length (LONG), difference in weigthload between lower limbs (DIFLOAD)-, the Berg Balance scale (BBS), the Barthel Index (BI), the Time Up and Go Test (TUG), the Functional Ambulation Categories (FAC), and the quality-of-life scale for stroke (ECVI-38)., Results: After performing the intragroup analysis, statistical significance was obtained for AREA (p < 0.001), LONG (p = 0.04), DIFLOAD (p = 0.02), BBS (p < 0.001), BI (p < 0.001), FAC (p < 0.001), and ECVI-38 (p < 0.001) in the experimental group; and for DIFLOAD (p = 0.01), BBS (p = 0.001), BI (p = 0.001), TUG (p = 0.04), FAC (p = 0.03), and ECVI-38 (p = 0.003) in the control group. In the intergroup analysis, statistical significance was obtained for AREA (p = 0.03), BBS (p = 0.03), FAC (p = 0.02) and ECVI-38 (p = 0.002) at postintervention time., Conclusions: Combined use of physical rehabilitation and recognition of laterality through implicit motor imagery tasks, improves balance and functions related to postural control in subacute stroke patients.

Background: There is a paucity of literature regarding rock climbing footwear. Rock climbers anecdotally voice numerous complaints regarding their current footwear. In an effort to improve existing rock-climbing footwear, implementation of a survey tool assessing the attitudes and practices of rock climbers was undertaken., Methods: A Web-based survey was developed to assess the demographics, attitudes, and practices of individuals active in rock climbing, with a focus on footwear., Results: Forty-five of the 417 respondents were male and 55% were female. The average years climbing was 7, with a majority of respondents in the 18- to 34-year-old category. The majority climbed 5 to 10 hours/week. Eighty percent identified as intermediate or advanced climbers. Climbing shoes were an average of 0.83 size smaller than the climber's street shoes. The more elite the climber, the greater the mismatch. Overall satisfaction with current rock-climbing shoes was 88%; however, as the age of climber and number of years of participation increased, the level of satisfaction decreased. The most frequently reported problems with shoes included inconsistent sizing between brands and poor heel fit. The most commonly reported locations of pain were the toes and heel., Conclusions: The authors concluded the following: 1) a surprisingly high satisfaction with current rock-climbing shoes was reported; 2) the difference in size between climbing shoes and street shoes was less than expected; 3) more shoe fitting problems were experienced by those with the most experience in climbing and those who spend the most time climbing; 4) the most common locations for experiencing pain were the toes and the posterior heel or Achilles tendon; 5) higher than expected satisfaction levels with climbing shoes contrasted with the very high number of specific complaints and recommendations for improvement; and 6) because of the increasing popularity of rock climbing, foot care providers should learn about the various types of climbing and the shoe gear needs that result therefrom.

This study aimed to evaluate walking in multiple sclerosis (MS) patients with mild disability. A case control study with 8 mild disability MS patients and 10 controls was conducted. This study analyzed spatiotemporal, kinematic, and kinetic parameters. We also analyzed the timing of these parameters, as a percentage of the gait cycle. The MS patients and controls walked with a similar gait pattern. However, there were differences in the timing of the biomechanical parameters. The timing of toe-off was at 62-63% of gait cycle in MS subjects while in controls it was at 59.94% ( p = 0.009 to 0.027 vs. to controls). The peak of knee flexion during swing was at 74-76% of gait cycle in MS subjects while in controls was at 72% ( p = 0.027 to 0.034). While the peak of ankle dorsiflexion during stance occurred at 48-50% in MS subjects, while in controls it was at 46% ( p = 0.001 to 0.009), and the peak of plantar flexion during pre-swing was at 66% in MS subjects vs. 64% in controls ( p = 0.001). At the kinetic pattern, the first peak of the vertical ground reaction force occurred at 14% of gait cycle in controls while in MS patients it was at 17-20% ( p = 0.012 to 0.021). MS subjects with mild disability walked with similar spatiotemporal parameters, joint angles and moments compared to controls. However, our results suggest that those changed the temporal occurrences, expressed as percentage of the gait cycle, of the kinematic and kinetic parameters.

Introduction: Audiovestibular toxicity secondary to immunotherapy has only rarely been reported in the literature. Herein, we examine our experience diagnosing and managing audiovestibular immune-related adverse events (irAEs) in patients undergoing immunotherapy., Methods: Four patients who experienced irAEs were included. Demographics, immunotherapy regimen, diagnostic tests, treatment, and outcomes were recorded in a retrospective chart review., Results: The cases of three patients with metastatic melanoma and one patient with metastatic renal cell carcinoma are presented. Hearing loss and tinnitus were the most common presenting symptoms. Immune checkpoint inhibitors (ICIs) were implicated in three cases and T-cell therapy in one case. Two of three patients (67%) treated with steroids had substantial improvements in hearing., Conclusions: Audiovestibular irAEs are a rare complication of immunotherapy. Suspicion for symptoms including hearing loss, tinnitus, and/or vertigo should prompt an expedient referral to the otolaryngologist for evaluation, as symptoms may improve with corticosteroid use. Hearing and/or vestibular deficits can have a substantial impact on the quality of life for affected patients, but rehabilitation options do exist., Competing Interests: Conflict of Interest: Marc-Elie Nader: Stock ownership in 3M, Amgen, Cardinal Health, Johnson & Johnson, Medtronic, and Pfizer. Paul W. Gidley: Stock ownership in Amgen, Eli Lily, Merck, Medtronic, and Pfizer. Joshua C. Page: None.

This study evaluates the effects of a rehabilitation program based on reflex locomotion therapy (RLT) on balance, gait, and fatigue in patients with multiple sclerosis (MS). Twenty-three patients diagnosed with MS participated in this study. Reversal design was carried out. The assessment tools included the Berg Balance Scale (BBS), the Performance Oriented Mobility Assessment (POMA), the Fatigue Severity Scale (FSS) and the instrumental analysis of the gait recorded by Vicon Motion System ® . We analyzed spatio-temporal parameters and kinematic variables of the hip, knee, and ankle joints. Additionally, the Client Satisfaction Questionnaire (CSQ-8) was administrated. We did find a significant improvement in balance and gait tools after the RLT period. Regarding instrumental analysis, the statistical analysis of spatio-temporal parameters showed a significant improvement in stride length, double support, and velocity after the RLT period. Concerning kinematic parameters, the analysis showed improvements in hip and knee range of motion (ROM) after RLT period. RLT could improve gait and balance in patients with MS. The patients reported a high level of satisfaction with the therapy received.

Objective: To determine recurrence patterns in patients with head and neck cancers requiring facial nerve sacrifice and to determine the optimal management of the positive proximal facial nerve margin., Study Design: Case series with chart review., Setting: Tertiary care center., Patients: One hundred fifty-five patients with head and neck malignancies who underwent sacrifice of the facial nerve between March 1, 1999 and October 31, 2020. Demographics, preoperative facial nerve function, prior oncologic treatment, histologic type, operative details, adjuvant treatment, recurrence patterns, and overall survival were reviewed., Main Outcome Measures: Recurrence rates and recurrence location., Results: Thirteen patients (8%) had positive proximal margins on final pathologic evaluation. Six of 13 (46%) experienced disease recurrence. No disease recurred proximally along the facial nerve. The recurrence rate was 26% for negative proximal facial nerve margins. Segments of the facial nerve biopsied included: extratemporally (n = 78), at the stylomastoid foramen (36), mastoid segment (22), second genu (7), tympanic (6), geniculate (3), labyrinthine (1), and IAC (2). Median patient follow-up was 30.3 months., Conclusions: Our data suggest that a conservative approach to a positive proximal facial nerve margin is optimal with respect to operative planning, patient morbidity, and disease recurrence patterns. Recurrence proximally along the facial nerve is an exceedingly rare event and the necessity of biopsy proximal to the geniculate ganglion, and in some cases even to the second genu, is called into question., (Copyright © 2021, Otology & Neurotology, Inc.)