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Background: Balance impairment is a frequent cause of morbidity and mortality in people with Parkinson’s disease (PD). As opposed to the effects of appendicular motor symptoms, the effects of Levodopa on balance impairment in idiopathic PD are less clear. Objective: To review the literature on the effects of oral Levodopa on clinical balance test performance, posturography, step initiation, and responses to perturbation in people with idiopathic PD (PwPD). Methods: A systematic search of three scientific databases (Pubmed, Embase, and Web of Science) was conducted in accordance with PRISMA guidelines. For the pilot meta-analysis, standardized mean differences with 95% confidence intervals were calculated using an inverse variance random effects model. Data not suitable for implementation in the meta-analysis (missing means or standard deviations, and non-independent outcomes) were analyzed narratively. Results: A total of 2772 unique studies were retrieved, of which 18 met the eligibility criteria and were analyzed, including data of 710 idiopathic PwPD. Levodopa had a significant positive effect on the Berg Balance Scale, the Push and Release test, and jerk and frequency parameters during posturography. In contrast, some significant negative effects on velocity-based sway parameters were found during posturography and step initiation. However, Levodopa had no significant effect on most step initiation- and all perturbation parameters. Conclusion: The effects of Levodopa on balance in PwPD vary depending on the outcome parameters and patient inclusion criteria. A systematic approach with well-defined outcome parameters, and prespecified, sensitive and reliable tests is needed in future studies to unravel the effects of oral Levodopa on balance.

Objective Falls can be highly debilitating and have an important negative impact on the quality of life of patients with Parkinson's disease (PD). The aim of this systematic review and meta-analysis is to provide an up-to-date overview of the prevalence of ≥1 fall and ≥2 falls in idiopathic PD. Data Sources MEDLINE, Web of Science, Embase and Cinahl databases were systematically searched until 04 July 2022 for prospective studies reporting fall prevalence in persons with idiopathic PD. Methods Pooled prevalence rates with 95% confidence intervals (CIs) were computed using random-effects models. Heterogeneity among studies was assessed using the I2 statistic. Results A total of 54 studies (7546 participants) were included, and random-effects meta-analysis yielded a pooled proportional fall rate of 0.48 (95% CI [0.43–0.52], I2 = 93%, 46 studies, 6874 participants) for classification 1 (≥1 fall) and a pooled proportional fall rate of 0.32 (95% CI [0.27–0.37], I2 = 78%, 31 studies, 5672 participants) for classification 2 (≥2 falls). Subgroup analysis on the classification of falls, and length and method of monitoring falls did not reveal significant differences and did not reduce between-study variability. Conclusion Pooled estimates suggest that one in two persons with PD fall at least once, and one in three fall at least twice within the registered time period. Substantial variability remains after pooling fall prevalence rates according to the length and method of monitoring. Therefore, no recommendations can be made concerning these methodological aspects. Future research on falls in PD is encouraged to implement best practice recommendations to monitor and report fall data.

OBJECTIVE: To examine the interrater reliability and agreement of a pain mechanisms-based classification for patients with nonspecific neck pain (NSNP). METHODS: Design – Observational, cross-sectional reliability study with a simultaneous examiner design. Setting: University hospital-based outpatient physical therapy clinic. Participants: A random sample of 48 patients, aged between 18 and 75 years old, with a primary complaint of neck pain was included. Interventions: Subjects underwent a standardized subjective and clinical examination, performed by 1 experienced physical therapist. Two assessors independently classified the participants’ NSNP on 3 main outcome measures. Main outcome measures: The Cohen kappa, percent agreement, and 95% confidence intervals (CIs) were calculated to determine the interrater reliability for (1) the predominant pain mechanism; (2) the predominant pain pattern; and (3) the predominant dysfunction pattern (DP). RESULTS: There was almost perfect agreement between the 2 physical therapists’ judgements on the predominant pain mechanism, kappa = .84 (95% CI, .65–1.00), p

Background Nonspecific low back pain (NSLBP) is a common problem. Attempts have been made to classify NSLBP patients into homogenous subgroups. Classification systems based on identifying the underlying mechanism(s) driving the disorder are clinically useful to guide specific interventions. Objective To establish consensus among experts regarding clinical criteria suggestive of a dominance of ‘articular’, ‘myofascial’, ‘neural’, ‘central’, and ‘sensorimotor control’ dysfunction patterns (DPs) in NSLBP patients. Study design A 2-phase sequential design of a focus group and Delphi-study. Methods A focus group with 10 academic experts was organized to elaborate on the different DPs discernible in LBP patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 DPs resulting from the focus group. Results Fifteen musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating LBP patients completed the Delphi-survey. Respectively, 34 (response rate, 100.0%), 20 (58.8%) and 15 (44.12%) respondents replied to rounds 1, 2 and 3. Twenty-two ‘articular’, 20 ‘myofascial’, 21 ‘neural’, 18 ‘central’ and 11 ‘sensorimotor control’ criteria reached a predefined ≥80% consensus level. For example, after round 2, 85.0% of the Delphi-experts agreed to identify ‘referred pain below the knee’ as a subjective examination criterion suggestive for a predominant ‘neural DP’. Conclusion These indicators suggestive of a clinical dominance of the proposed DPs could help clinicians to assess and diagnose NSLBP patients. Future reliability and validity testing is needed to determine how these criteria may help to improve physical therapy outcome for NSLBP patients.

Low back pain is a major problem involving high medical costs, therefore effective prevention strategies are essential. Stabilization exercises seem to facilitate the neuromuscular control of the lumbar spine and may be useful in prevention programs. To investigate whether specific lumbar stabilization training has an effect on muscle recruitment patterns in a healthy population, in the present study 30 subjects were recruited to perform two types of testing exercises, i.e. bridging exercises and exercises in four-point kneeling, both before and after training. Surface electromyographic data of different abdominal and back muscles were obtained. After training, analysis of the relative muscle activity levels (percentage of maximal voluntary isometric contraction) showed a higher activity of the local (segmental-stabilizing) abdominal muscles, but not of the local back muscles; minimal changes in global (torque-producing) muscle activity also occurred. Analysis of the local/global relative muscle activity ratios revealed higher ratios during all exercises after training, although not all differences were significant. These results indicate that muscle recruitment patterns can be changed in healthy subjects by means of a training program that focuses on neuromuscular control. Additional studies are needed to evaluate this type of training as a prevention strategy.

Objectives To investigate the electromyographic (EMG) trunk muscle activity during a low-load instrumented axial rotation exercise (Tergumed) and the relevance of increasing resistance. Setting Evaluation was done in a training centre in a university hospital. Participants Thirty healthy subjects without musculoskeletal or neuromuscular complaints. Main outcome measures The normalized (as a percentage of maximal voluntary isometric contractions (MVIC)) EMG activity of 14 abdominal and back muscles were investigated during dynamic trunk rotation exertions at 30%, 50% and 70% of maximum mean force (MMF). Results During the low-load (30% MMF) rotation exercise, the internal abdominal oblique muscle reached activity levels of 30% of MVIC. All the examined back muscles and the external abdominal obliques reached activity levels of 60% of MVIC. Increasing the resistance during seated axial rotation, created significantly higher relative muscle activity levels for all trunk muscles. Conclusions The results of the present study indicate that increasing resistance to 50% and 70% MMF during seated axial rotation in a Tergumed training device consistently created higher relative activity levels in all trunk muscles. In the vulnerable spine undergoing rehabilitation the results suggest that training at 30% MMF may be sufficient.

The purpose of this study was to examine the repeatability and reproducibility of the different tests of a clinical test battery evaluating the components of functional spinal stability: postural control (sway velocity data), proprioception (repositioning error), and muscle activation (electromyographic data).A total of 28 healthy volunteers participated in this study: 14 in the repeatability study and 14 in the reproducibility study. Each subject was tested three times, with an interval of 1 wk between the test sessions. The intraclass correlation coefficients and the standard error of the measurements as a percentage of the grand mean were calculated.The intraclass correlation coefficients for both the repeatability and the reproducibility evaluation showed good to excellent reliability for all variables (intraclass correlation coefficient, 0.60-0.98). The standard error of the measurements as a percentage of the grand mean ranged from 0.004 to 19.94.The functional clinical test battery investigated in this study proved to be a reliable tool in the assessment of healthy subjects. The evaluation of postural control, proprioception, and muscle activity (coordination, stabilization, maximal voluntary isometric contraction, endurance, and flexion-relaxation) showed good to excellent repeatability and reproducibility. Further analysis of the reliability of these variables in a clinical setting, particularly in patients with low back pain, seems appropriate.

Background No consensus exists on how rehabilitation programs for lumbar discectomy patients with persistent complaints after surgery should be composed. A better understanding of normal and abnormal postoperative trunk muscle condition might help direct the treatment goals. Methods A three-dimensional CT scan of the lumbar spine was obtained in 18 symptomatic and 18 asymptomatic patients who had undergone a lumbar discectomy 42 months to 83 months (median 63 months) previously. The psoas muscle (PS), the paraspinal muscle mass (PA) and the multifidus muscle (MF) were outlined at the L3, L4 and L5 level. Of these muscles, fat free Cross Sectional Area (CSA) and fat CSA were determined. CSA of the lumbar erector spinae (LES = longissimus thoracis + iliocostalis lumborum) was calculated by subtracting MF CSA from PA CSA. Mean muscle CSA of the left and right sides was calculated at each level. To normalize the data for interpersonal comparison, the mean CSA was divided by the CSA of the L3 vertebral body (mCSA = normalized fat-free muscle CSA; fCSA = normalized fat CSA). Differences in CSA between the pain group and the pain free group were examined using a General Linear Model (GLM). Three levels were examined to investigate the possible role of the level of operation. Results In lumbar discectomy patients with pain, the mCSA of the MF was significantly smaller than in pain-free subjects (p = 0.009) independently of the level. The mCSA of the LES was significantly smaller in pain patients, but only on the L3 slice (p = 0.018). No significant difference in mCSA of the PS was found between pain patients and pain-free patients (p = 0.462). The fCSA of the MF (p = 0.186) and of the LES (p = 0.256) were not significantly different between both populations. However, the fCSA of the PS was significantly larger in pain patients than in pain-free patients. (p = 0.012). The level of operation was never a significant factor. Conclusions CT comparison of MF, LES and PS muscle condition between lumbar discectomy patients without pain and patients with protracted postoperative pain showed a smaller fat-free muscle CSA of the MF at all levels examined, a smaller fat- free muscle CSA of the LES at the L3 level, and more fat in the PS in patients with pain. The level of operation was not found to be of importance. The present results suggest a general lumbar muscle dysfunction in the pain group, in particular of the deep stabilizing muscle system.

Background Trunk bridging exercises are often used as therapeutic exercises for lumbopelvic stabilization. These exercises focus on the retraining of muscle coordination patterns in which optimal ratios between local segmental stabilizing and global torque producing muscle activity are assumed to be essential. However, a description of such ratios is lacking. The purpose of this study was to investigate both relative (as a percentage of maximal voluntary isometric contraction) muscle activity levels and ratios of local to global muscle activity, during bridging stabilization exercises. Methods Thirty healthy university students (15 men, 15 women) with a mean age of 19.6 year volunteered to perform 3 bridging exercises (single bridging, ball bridge and unilateral bridging). The surface electromyographic activity of different trunk muscles was evaluated on both sides. Results During all bridging exercises, the ratio of the internal oblique to the rectus abdominis was very high due to minimal relative activity of the rectus abdominis. In general, the ratio of the internal/external abdominal oblique activity was about 1. However, during the unilateral bridging exercise, the ipsilateral internal/external abdominal oblique activity ratio was 2.79 as a consequence of the significant higher relative activity of the internal oblique compared to the external oblique. The relative muscle activity and the ratios of the back muscles demonstrated similar activity levels for all back muscles, resulting in ratios about 1. Conclusion Both the minimal relative activity of the rectus abdominis and the high internal oblique to the rectus abdominis activity ratio reported in the present study are in accordance with results of other trunk stabilization exercises. The relative muscle activity and the ratio of the abdominal obliques seem to alter depending on the task and the presumable need for stability. The findings concerning the relative muscle activity and the ratios of the back muscles support the assumption that during these bridging exercises, all back muscles contribute in a similar way to control spine positions and movements in a healthy population.

Stabilization exercises are intended to optimize function of the muscles that are believed to govern trunk stability. Debate exists whether certain muscles are more important than others in optimally performing these exercises. Thirty healthy volunteers were asked to perform three frequently prescribed stabilization exercises in four-point kneeling. The electromyographic activity of different trunk and hip muscles was evaluated. Average amplitudes obtained during the exercises were normalized to the amplitude in maximal voluntary contraction (% MVIC). During all three exercises, the highest relative muscle activity levels (> 20% MVIC) were consistently found in the ipsilateral lumbar multifidus and gluteus maximus. During both the single leg extension (exercise 1) and the leg and arm extension exercise (exercise 2) the contralateral internal oblique and ipsilateral external oblique reached high levels (> 20%MVIC). During exercise 2 there were also high relative activity levels of the ipsilateral lumbar part and the contralateral thoracic part of the iliocostalis lumborum and the contralateral lumbar multifidus. During the leg and arm extension exercise with contralateral hip flexion (exercise 3) there were high relative muscle activity levels of all back muscles, except for the latissimus dorsi muscle. The lowest relative muscle activity levels (

Although progressive resistance training of trunk muscles on devices is very common, today, the effects of increasing resistance on trunk muscle activity during dynamic extension and flexion movements on training devices have not been reported yet. Thirty healthy subjects participated in maximal isometric and submaximal dynamic (at 30%, 50% and 70% of maximum mean torque (MMT)) extension and flexion exercises on Tergumed lumbar training devices. The normalized (as a percentage of maximal voluntary isometric contractions (MVIC)) electromyographic activity of 16 abdominal and back muscles was investigated. The results of the present study indicated that in general, with increasing resistance from 30% MMT to 50% MMT and 70% MMT, the activity of all back muscles during the extension exercises and the activity of all abdominal muscles during the flexion exercises increased significantly. To train strength (>60% of MVIC), low intensities (30% and 50% MMT) appeared sufficient to affect the back muscles, but for the abdominals higher resistance (70% MMT) was required. In contrast to the other back muscles, the lumbar multifidus demonstrated high activity levels during both the extension and the flexion exercises. As the lumbar multifidus is demonstrated to be an important muscle in segmental stabilization of the lumbar spine, this finding may help in understanding the efficacy of rehabilitation programs using specific training devices.

Main problem: Previous studies have demonstrated that sciatica patients have poorer postural control than healthy controls and that postural control remains unchanged 3 months after lumbar discectomy in sciatica patients. The aims of the current study were to investigate whether static balance control recovers in pain-free discectomy patients long-term after lumbar discectomy. Next is to determine whether static balance responses of asymptomatic and symptomatic lumbar discectomy patients differed from each other and from healthy controls. In addition, the influence of the extent of disc resection (unilateral/bilateral removal) and the side of operation on static balance control were investigated. Methods: Fifteen pain-free lumbar discectomy patients, 23 lumbar discectomy patients with residual pain and 72 controls performed unilateral stance tasks with eyes open and eyes closed on a force plate were taken up for the investigation. Three repetitions of a 10 s unilateral stance test were performed on each leg. Postural sway was determined. Patients were divided into three age groups. Results: In the eyes open condition, there was no significant difference between postural sway of pain-free lumbar discectomy patients and controls (P=0.68), whereas balance of patients with pain was significantly worse than in controls (P=0.003). In the eyes closed condition, the sway in both groups of lumbar discectomy patients was significantly worse than in controls (pain-free P=0.009/painful P

In this article part of the forebrain of the bank vole ( Clethrionomys glareolus ) is presented in stereotaxic coordinates. The stereotaxic procedure was performed as follows. With the vole’s head mounted in a stereotaxic adaptor, internal reference tracks were made with a 0.5-mm diameter microdialysis cannula and India ink, 2 mm in front and 2.6 mm behind the skull landmark bregma. Brains were fixed for 72 h in 4% commercial formaldehyde in sodiumcacodylate buffer containing 1% CaCl 2 . To determine shrinkage they were weighed before and after fixation. After embedding in paraffin they were sectioned at 25 μm and stained with Nissl. Photomicrographs were taken from the brain of one animal while its frontal (antero-posterior) coordinates of five neural structures were compared with those of 12 other voles. Variability was also checked in lateral and vertical directions at frontal level −1.0 mm (relative to bregma). The results show that the distance between the two skull landmarks bregma and lambda correlates significantly and negatively with the antero-posterior position of each of the brain areas. On the basis of these results an equation is proposed to improve accuracy in locating neural structures that deviate due to biological variability.

Background Illicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood. Methods Fourteen mixed-gender focus groups of either African American or Latino/a drug users (N = 95) discussed barriers to HCV testing and treatment. Themes were identified through content analysis of focus group discussions. Results Many drug users were tested for HCV in settings where they were receiving care. Outside of these settings, most were unaware of voluntary test sites. After testing HCV positive, drug users reported not receiving clear messages regarding the meaning of a positive HCV test, the impact of HCV infection, or appropriate next steps including HCV clinical evaluations. Many drug users perceived treatment as unimportant because they lacked symptoms, healthcare providers minimized the severity of the diagnosis, or providers did not recommend treatment. Mistrust of the motivations of healthcare providers was cited as a barrier to pursuing treatment. Social networks or social interactions were a source of HCV-related information and were influential in shaping drug users perceptions of treatment and its utility. Conclusion Drug users perceived a paucity of settings for self-initiated HCV testing and poor provider-patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.