Understanding macrographia in children with autism spectrum disorders

It has been consistently reported that children with autism spectrum disorders (ASD) show considerable handwriting difficulties, specifically relating to accurate and consistent letter formation, and maintaining appropriate letter size. The aim of this study was to investigate the underlying factors that contribute to these difficulties, specifically relating to motor control. We examined the integrity of fundamental handwriting movements and contributions of neuromotor noise in 26 children with ASD aged 8–13 years (IQ > 75), and 17 typically developing controls. Children wrote a series of four cursive letter l's using a graphics tablet and stylus. Children with ASD had significantly larger stroke height and width, more variable movement trajectory, and higher movement velocities. The absolute level of neuromotor noise in the velocity profiles, as measured by power spectral density analysis, was significantly higher in children with ASD; relatively higher neuromotor noise was found in bands >3 Hz. Our findings suggest that significant instability of fundamental handwriting movements, in combination with atypical biomechanical strategies, contribute to larger and less consistent handwriting in children with ASD.     

Consideration of treatment fidelity to improve manual therapy research

Objectives: The purpose of this paper was to define treatment fidelity, review its use in health care research and suggest how it may be utilized in manual therapy research to improve the reliability and validity of the literature.

Results: We offer an outline and a table of how manual therapy research may benefit from the concept of treatment fidelity.

Discussion: While treatment fidelity is a newer concept, and has not been integrated into Physical Therapy or Manual Therapy research, when utilized, it can have positive effects on the reliability and validity of the techniques we evaluate.     

Delaying forelimb responses by microstimulation of macaque V1

Electrical microstimulation of macaque V1 has previously been shown to delay saccadic eye movements made to a punctate visual target placed in the receptive field of the stimulated neurons. It remains unclear whether this delay effect is specific to the oculomotor system or whether the effect can be demonstrated in the skeletomotor system as well. To address this question, a rhesus monkey was trained to depress a left or right lever with its respective hand in response to a visual target presented in the left or right hemifield. On 50% of trials, a 100 ms train of stimulation consisting of 100 μA, 0.2-ms anode-first pulses was delivered to the neurons before the onset of the visual target. Stimulation of V1 delayed the execution of the lever response when the visual target was positioned within the receptive field of the stimulated neurons. We suggest that the delay effect induced by microstimulation of V1 is largely due to a disruption of the visual signal as it is transmitted along the geniculostriate pathway.     

Specificity of practice results from differences in movement planning strategies

Withdrawing visual feedback after practice of a manual aiming task results in a severe decrease in aiming accuracy. This decrease in accuracy is such that participants are often less accurate than controls who are beginning practice of the task without visual feedback. These results have been interpreted as evidence that motor learning is specific to the sources of afferent information optimizing performance, because it could be processed at the exclusion of other sources of afferent information. The goal of the present study was to test this hypothesis. To reach our goal we evaluated whether online visual feedback prevented kinesthetic information to be used for: (1) eliminating movement anisotropy resulting from difference in limb inertia when aiming in different directions and (2) creating an internal model of limb mechanics. Participants practiced a manual aiming task with or without visual feedback and with knowledge of results. After this acquisition phase, participants performed two transfer tests. The first transfer test was performed without visual feedback and/or knowledge of results. The second transfer test was similar to the first one but participants initiated their movements from a different starting base. The results showed strong specificity effects in that withdrawing visual feedback resulted in large pointing bias and variability. However, the results of the two transfer tests showed that the processing of visual feedback did not prevent the processing of kinesthetic information used to eliminate movement anisotropy or to create an internal model of limb mechanics. Rather, specificity of practice effects resulted from participants using the same motor plan in transfer as they did in acquisition even though they had no longer access to visual feedback to modulate their movement online. These results indicate that during acquisition participants adopted different movement planning strategies depending on the source of afferent information available.     

Comparison between Weightbearing-CT semiautomatic and manual measurements in Hallux Valgus

BackgroundRadiographic measurements are an essential tool to determine the appropriate surgical treatment and outcome for Hallux Valgus (HV). HV deformity is best evaluated by weight-bearing computed tomography (WBCT).The objective was (1) to assess the reliability of WBCT computer-assisted semi-automatic imaging measurements in HV, (2) to compare semi-automatic with manual measurements in the setting of an HV, and (3) to compare semi-automatic measurements between HV and control group.MethodsIn this retrospective IRB (ID# 201904825) approved study, we assessed patients with hallux valgus deformity. The sample size calculation was based on the hallux valgus angle (HVA). Thus to obtain the 0.8 power, including 26 feet with HV in this study, was necessary. Our control group consisted of 19 feet from 19 patients without HV. Raw multiplanar data was evaluated using software CubeVue®. In the axial plane, hallux valgus angle (HVA), intermetatarsal angle (IMA), and interphalangeal angle (IPA) were measured. The semiautomatic 3D measurements were performed using the Bonelogic®Software. Inter-rater reliabilities were performed using ICC. Agreement between methods was tested using the Bland-Altman plots. The difference between Patologic and Control cases using semi-automatic measurements was assessed with the Wilcoxon signed-rank test. Alpha risk was set to 5% (α = 0.05). P ≤ 0.05 were considered significant.ResultsReliabilities utilizing ICC were over 0.80 for WBCT manual measurements and WBCT semi-automatic readings. Inter and intraobserver agreement for Manual and Semi-automatic WBCT measurements demonstrated excellent reliability.ConclusionsSemi-automatic measurements are reproducible and comparable to measurements performed manually. The software differentiated pathological from non-pathological conditions when subjected to semi-automatic measurements. The development of advanced semi-automatic segmentation software with minimal user intervention is essential for the establishment of big data and can be integrated into clinical practice, facilitating decision-making.     

Manual versus digital aspiration for first-line treatment of primary spontaneous pneumothorax. The AMVADI study: a randomized clinical trial

IntroductionThe effectiveness of needle aspiration in the initial treatment of primary spontaneous pneumothorax has been widely studied. The objective of this research was to compare digital with manual aspiration in a randomized clinical trial.MethodsWe designed a blinded parallel-group randomized clinical trial with a 1:1 allocation ratio. The clinical trial is reported in line with the guidelines of the CONSORT group. The primary outcome variables were immediate success and hospital admission, while the secondary outcome measures were relapse, re-admission and need for surgery, and length of hospital stay. A satisfaction survey was also carried out among clinicians who perform these 2 types of aspiration.ResultsA total of 67 patients were included in the study (n = 36, control group; n = 31, experimental group) with no losses to follow-up. In both groups, 58% of procedures were immediately successful, avoiding hospital admission. No differences were found in rates of relapse, re-admission, need for surgery, or length of hospital stay. Overall, 80% of clinicians who performed aspiration preferred the digital system, and this preference rose to 100% among clinicians who performed more than 5 procedures a year.ConclusionsBoth manual and digital aspiration provide good immediate results avoiding hospital admission, while digital drainage is preferred by clinicians responsible for first-line treatment of pneumothorax.     

Providing Patient Mobilization With a Mobility Technician Improves Staff Efficiency and Constrains Cost in Primary Total Hip Arthroplasty

BackgroundMobility technicians (MTs) demonstrate value in constraining the cost of total joint replacement procedures. MTs are certified medical assistants with specialized ambulation/gait training who work under the direction of the nursing staff to meet patient mobilization demands in hospital wards. This study analyzed their impact on primary total hip arthroplasty (THA).MethodsData were retrospectively reviewed from both the time before and the time after MTs were introduced to the hospital for demographic information (ie, age, gender, race, and payer) and clinical measures (ie, length of stay and discharge disposition). The control group was treated and mobilized according to standard physical therapy and nursing staff protocols. Study group subjects had access to the MTs at the direction of their registered nurse. Included subjects underwent a primary THA procedure for arthritic conditions or hip fractures, or for conversion from a previous hip surgery. Excluded were subjects who underwent procedures for revision, bilateral, or hip resurfacing procedures.ResultsThe study and control groups included 542 and 1297 subjects, respectively. They shared a median length of stay of 2 days (P = .121). More study group subjects were discharged home than were their control group counterparts (91.51%-87.43%, P = .012). Cost analysis revealed an annual savings of $119,794.50 in total first post-acute care (ie, the period spent at a patient’s initial discharge disposition level) costs to the institution. Therefore, MTs would need to successfully treat only 5 patients annually to recoup a savings equivalent to their salary.ConclusionMTs support the recovery of THA patients in the hospital, in turn optimizing their discharge disposition. Institutions may experience a financial benefit in a bundled payment system, in which avoiding costly rehab facilities may result in savings over the episode.     

Tai chi for enhanced inpatient mobilization: A feasibility study

ObjectiveTo determine whether utilizing beginner, video-guided tai chi and qigong classes as an adjunct to physical therapy to enhance mobilization among hospitalized patients is feasible and acceptable.DesignSingle-arm feasibility study over a 15½-week period.SettingThree medical-surgical units at one hospital.InterventionsSmall-group video-guided beginner-level tai chi and qigong classes supervised by physical therapists occurred three times a week.Main outcome measuresThe primary outcome was weekly class attendance. Secondary outcomes included patient and staff satisfaction, collected by surveys and semi-structured interviews. Process measures included class duration. Balancing measures included falls.ResultsOne-hundred and fifty-seven patients were referred for recruitment, 45 gave informed consent, and 38 patients attended at least one class. The number of weekly class attendees increased during the study period. Based on first-class experience, 68% (26/38) of patients reported enjoying the class “quite a bit” or “extremely,” 66% (25/38) of patients reported feeling “more mobile” afterward, and 76% (29/38) of patients agreed that the class made them more comfortable going home. Average class duration was 29 minutes. Zero falls occurred during or immediately following class.ConclusionsVideo-guided tai chi and qigong classes are feasible and well-received at our hospital. Future studies of the impact on preserving mobility and function or reducing length of stay are of interest.     

Editorial comment: variables affecting the presence of mesenchymal stromal cells in the peripheral blood and their relationship with apheresis product

Paediatric haematology began to establish itself as a speciality in the UK just over 60 years ago. In that time, clinical trials involving all the specialist centres in the country, and based on scientific advances, have dramatically improved the outlook for children with a range of malignant and non-malignant disorders, but particularly acute leukaemia. As in many specialties, multidisciplinary teams have played a major role in delivering these advances. With these structures in place at a national level, perhaps, of all specialities, paediatric haematology is poised to benefit from the new developments in precision medicine, gene editing and immunotherapy.