Physical therapy management of pediatric and adolescent neck pain: a call to action

Abstract

Background: Neck pain is reported to be as high as 40% in adolescents and can be a precursor to developing adult persistent neck pain.

Objectives: To identify and review literature on physical therapy management of pediatric and adolescent neck pain.

Methods: A sensitive search strategy adhered to PRISMA guidelines. Our systematic review used the databases PubMed, CINAHL, and Embase including articles published from inception to May 2019. For the article to be included, it had to meet the following criteria: (a) age under 18?years old; (b) musculoskeletal neck pain; (c) any intervention or treatment provided by physical therapists; (d) English language; (e) any outcome measure that reported disability, function, or pain; (f) any and all published literature: randomized controlled trials (RCTs), systematic reviews, cohort studies, case reports, editorials, and commentaries.

Results: Our comprehensive search yielded 5,115 articles and two studies met eligibility. Both articles were written by the same author group. The articles investigated the effect of pain neuroscience education (PNE) plus deep neck muscle strengthening in twenty-one students ages 15-18?years old with chronic idiopathic neck pain. The results concluded there may be some benefit to PNE plus deep neck flexor and extensor strength.

Conclusions: The main finding of this systematic review is the paucity of published research on physical therapy management of pediatric and adolescent neck pain. Our systematic review serves as a call to action for physical therapists to perform further research in order to provide the best evidence-based care for this population.     

A centromere satellite concomitant with extensive karyotypic diversity across the Peromyscus genus defies predictions of molecular drive

A common feature of eukaryotic centromeres is the presence of large tracts of tandemly arranged repeats, known as satellite DNA. However, these centromeric repeats appear to experience rapid evolution under forces such as molecular drive and centromere drive, seemingly without consequence to the integrity of the centromere. Moreover, blocks of heterochromatin within the karyotype, including the centromere, are hotspots for chromosome rearrangements that may drive speciation events by contributing to reproductive isolation. However, the relationship between the evolution of heterochromatic sequences and the karyotypic dynamics of these regions remains largely unknown. Here, we show that a single conserved satellite DNA sequence in the order Rodentia of the genus Peromyscus localizes to recurrent sites of chromosome rearrangements and heterochromatic amplifications. Peromyscine species display several unique features of chromosome evolution compared to other Rodentia, including stable maintenance of a strict chromosome number of 48 among all known species in the absence of any detectable interchromosomal rearrangements. Rather, the diverse karyotypes of Peromyscine species are due to intrachromosomal variation in blocks of repeated DNA content. Despite wide variation in the copy number and location of repeat blocks among different species, we find that a single satellite monomer maintains a conserved sequence and homogenized tandem repeat structure, defying predictions of molecular drive. The conservation of this satellite monomer results in common, abundant, and large blocks of chromatin that are homologous among chromosomes within one species and among diverged species. Thus, such a conserved repeat may have facilitated the retention of polymorphic chromosome variants within individuals and intrachromosomal rearrangements between species—both factors that have previously been hypothesized to contribute towards the extremely wide range of ecological adaptations that this genus exhibits.

     

An innovative advance to increase the use of the vaccine information statement

Because many physicians do not use the Vaccine Information Statement (VIS), we created a revised statement that would alert the physician to the need to use the VIS. Even though the Centers for Disease Control (CDC) coordinated this evaluation, both the CDC and most of the State Board of Medical Examiners did not support this revision of the VIS. Despite the disinterest of the vast majority of the State Board of Medical Examiners, we would recommend that this updated VIS be implemented immediately to educate our society on the information in the VIS.     

Wild-type and A315T mutant TDP-43 exert differential neurotoxicity in a Drosophila model of ALS

The RNA-binding protein TDP-43 has been linked to amyotrophic lateral sclerosis (ALS) both as a causative locus and as a marker of pathology. With several missense mutations being identified within TDP-43, efforts have been directed towards generating animal models of ALS in mouse, zebrafish, Drosophila and worms. Previous loss of function and overexpression studies have shown that alterations in TDP-43 dosage recapitulate hallmark features of ALS pathology, including neuronal loss and locomotor dysfunction. Here we report a direct in vivo comparison between wild-type and A315T mutant TDP-43 overexpression in Drosophila neurons. We found that when expressed at comparable levels, wild-type TDP-43 exerts more severe effects on neuromuscular junction architecture, viability and motor neuron loss compared with the A315T allele. A subset of these differences can be compensated by higher levels of A315T expression, indicating a direct correlation between dosage and neurotoxic phenotypes. Interestingly, larval locomotion is the sole parameter that is more affected by the A315T allele than wild-type TDP-43. RNA interference and genetic interaction experiments indicate that TDP-43 overexpression mimics a loss-of-function phenotype and suggest a dominant-negative effect. Furthermore, we show that neuronal apoptosis does not require the cytoplasmic localization of TDP-43 and that its neurotoxicity is modulated by the proteasome, the HSP70 chaperone and the apoptosis pathway. Taken together, our findings provide novel insights into the phenotypic consequences of the A315T TDP-43 missense mutation and suggest that studies of individual mutations are critical for elucidating the molecular mechanisms of ALS and related neurodegenerative disorders.     

The impact of behavioural screening on intervention outcomes in a randomised,controlled multiple behaviour intervention trial

Background  

With an increasing research focus on multiple health behaviour change interventions, a methodological issue requiring further investigation is whether or not to employ pre-trial behavioural screening to exclude participants who are achieving a pre-specified level of one or more behaviours. Behavioural screening can be used to direct limited resources to participants most in need of a behaviour change intervention; but may reduce the representativeness of the sample and limit comparability with trials that do not employ pre-trial behavioural screening. Furthermore, the impact of this type of screening on intervention participation and intervention effects is unknown.     

Effect of waiting time on substance abuse treatment completion in pregnant women

Although substance abuse treatment is associated with improved maternal and neonatal outcomes, pregnant women may be at increased risk of attrition. To explore the hypothesis that shorter waiting time for treatment is associated with increased completion, we analyzed all pregnant treatment admissions and discharges in the Treatment Episode Data Set—Discharges. There were 10,661 pregnant admissions in 2006. The effect of waiting time on treatment completion was modified by treatment setting. Immediate entry into ambulatory treatment, where most pregnant women are treated, was significantly associated with completion (odds ratio = 1.27, 95% confidence interval = 1.14-1.41). Criminal justice referral and a high school education were identified as completion predictors in all treatment settings. Waiting time impacts treatment completion in pregnant women. Resources need to be directed to ensure immediate access to treatment, particularly in the ambulatory setting.     

Enhanced heroin self-administration and distinct dopamine adaptations in female rats

Increasing evidence suggests that females are more vulnerable to the harmful effects of drugs of abuse, including opioids. Additionally, rates of heroin-related deaths substantially increased in females from 1999 to 2017 [1], underscoring the need to evaluate sex differences in heroin vulnerability. Moreover, the neurobiological substrates underlying sexually dimorphic responding to heroin are not fully defined. Thus, we evaluated male and female Long Evans rats on acquisition, dose-responsiveness, and seeking for heroin self-administration (SA) as well as using a long access model to assess escalation of intake at low and high doses of heroin, 0.025 and 0.1 mg/kg/inf, respectively. We paired this with ex vivo fast-scan cyclic voltammetry (FSCV) in the medial nucleus accumbens (NAc) shell and quantification of mu-opioid receptor (MOR) protein in the ventral tegmental area (VTA) and NAc. While males and females had similar heroin SA acquisition rates, females displayed increased responding and intake across doses, seeking for heroin, and escalation on long access. However, we found that males and females had similar expression levels of MORs in the VTA and NAc, regardless of heroin exposure. FSCV results revealed that heroin exposure did not change single-pulse elicited dopamine release, but caused an increase in dopamine transporter activity in both males and females compared to their naïve counterparts. Phasic-like stimulations elicited robust increases in dopamine release in heroin-exposed females compared to heroin-naïve females, with no differences seen in males. Together, our results suggest that differential adaptations of dopamine terminals may underlie the increased heroin SA behaviors seen in females.Subject terms: Reward, Addiction