658 research outputs found
Spinal pain and postural sway. Is there a relationship?
No full textPostural stability is an important component in maintaining upright stance and balance during normal daily movements and activities. Postural stability is also an important factor in the elderly where balance disability may increase the risk of falls and subsequent injury. In sport, problems with balance may lead to serious injuries. Thus, postural stability has important implications in rehabilitation and sports.
Many different methods exist today for assessing postural sway. Centre of pressure (COP) evaluation is a frequently used method of measuring this stability and gain insights into potential pathological mechanisms e.g. in association with pain. This is possible as the COP signal is proportional to ankle torque, a combination of descending motor commands as well as mechanical properties of the musculature around.
Over the last decades, postural sway has been most commonly evaluated by using spatial measures such as sway distance, velocity and area traversed based upon sequential locations of the COP in the plane of the force platform. However, despite its common usage, important clinical aspects of the COP measurements such as its potential suitability for clinical monitoring purposes in pain patients remained unaddressed. Several literature reviews were conducted that identified relevant gaps in current knowledge to focus our research.
This led to the following primary research questions:
a) Can a best evidence experimental setup be identified that is suitable for spinal pain sufferers?
b) Is there a relationship between pain intensity and the COP excursions?
c) Are there alterations in postural sway associated with diminishing pain?
Based on a systematic review of the literature the following experimental protocol was developed: Three measurements of 90sec each were conducted in bipedal narrow stance with closed eyes at a sampling frequency of 100Hz. We selected the COP parameters 90% circle diameter as a descriptor of sway area and mean sway velocity as it has shown its discriminative value for various pain conditions.
The prospective part of this thesis was preceded by pilot studies that confirmed the excellent reliability of the selected experimental setup for mean sway velocity in antero-posterior (AP) and the medio-lateral (ML) direction (ICC2,k 0.85-0.89, 95% CI 0.63-0.97, SEM 0.66-0.78) and 90% circle diameter (ICC2,k 0.80, 95% CI 0.54-0.94, SEM 0.89). Later on, very similar values were observed for sway data obtained from the symptomatic groups.
The experimental setup was found to be safe and a sub-sample of predominantly low back pain patients (n=20) reported no difficulties complying with the postural tasks involved. Furthermore, no effects of learning or fatigue could be demonstrated in 10 healthy individuals either during inter-session (10 consecutive measurements) or intra-session (three times 3 measurements at 2-3 day intervals). No adverse incidents associated with the measurements occurred in approximately 1500 measurements.
By enrolling age matched healthy individuals as a control group (n=77), reference values for the included COP parameters were established to which all subsequent data obtained from symptomatic individuals could be compared.
A total of 210 patients were enrolled subdivided into three groups for non-specific neck, mid back and low back pain. A physical examination was conducted for all pain sufferers, who were asked to rate their pain intensity on a NRS-11 scale. The associated disability was assessed by means of the Disability Rating Index. Depending on the reported severity of their complaint, the symptomatic individuals were subdivided into seven pain intensity groups (NRS 2-8) for each of the painful regions: low back (n=77, n=11/group), mid back (n=63, n=9/group) and neck (n=70, n=10/group).
The symptomatic participants exhibited greater postural sway than healthy controls. As a general trend, a statistically significant increase was reached beginning at about NRS score 4 for all three pain regions. Depending on the COP parameter and painful region, significant differences between individual NRS levels were reached about every 2-3 NRS levels.
Significant differences in COP excursions between mid back, low back and neck pain sufferers could be identified. However, in the light of the expected inter-subject variability in pain perception as well as the low number of participants per NRS group this conclusion warrants caution.
A major finding from a univariate regression analysis was a linear relationship between pain intensity and the COP parameters (p<0.001) for all painful regions, while a multivariate regression analysis showed that other variables such as age, gender, height, weight and BMI did not have a statistically significant effect on postural sway.
This close relationship was maintained even with diminishing pain levels after a course of manual therapy treatments conducted in a group of low back (n=38) and neck pain patients (n=36). In this instance three measurements and interventions were performed at 3-4 day intervals. With few exceptions, the follow-up COP measures in connection with specific pain intensities did not show a significant difference in postural sway compared to reference values for identical NRS levels at baseline.
In addition, a similar linear relationship between pain intensity, the COP sway parameters and the patient's disability ratings was identified for all painful regions.
At the same time, a clear trend towards predominant sway in the medio-lateral direction was observed with increasing pain intensities, until 70% of sway occurred in ML direction at NRS score 8. In comparison, healthy controls showed a nearly equal sway distribution between AP (52%) and ML (48%) direction.
In the absence of learning effects, the reduced COP excursions with decreasing NRS scores in subacute and chronic pain sufferers further suggests that pain interference rather than long-term neuro-physiological adaptations (such as central sensitization) are the primary causative factor for increased sway.
Our findings may have clinical implications for COP measures in patients with significant pain. These include routine sway analyses as an objective outcome measure during the rehabilitation and treatment process. It also stresses the importance of an initial focus on pain regulation rather than proprioceptive training
Is there a relationship between pain intensity and postural sway in patients with non-specific low back pain?
No full textBackground
Increased center of pressure excursions are well documented in patients suffering from non-specific low back pain, whereby the altered postural sway includes both higher mean sway velocities and larger sway area. No investigation has been conducted to evaluate a relationship between pain intensity and postural sway in adults (aged 50 or less) with non-specific low back pain.
Methods
Seventy-seven patients with non-specific low back pain and a matching number of healthy controls were enrolled. Center of pressure parameters were measured by three static bipedal standing tasks of 90sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11), an equal number of patients (n=11) was enrolled per pain score.
Results
Generally, our results confirmed increased postural instability in pain sufferers compared to healthy controls. In addition, regression analysis revealed a significant and linear increase in postural sway with higher pain ratings for all included COP parameters. Statistically significant changes in mean sway velocity in antero-posterior and medio lateral direction and sway area were reached with an incremental change in NRS scores of two to three points.
Conclusions
COP mean velocity and sway area are closely related to self-reported pain scores. This relationship may be of clinical use as an objective monitoring tool for patients under treatment or rehabilitation
Pain relief is associated with decreasing postural sway in patients with non-specific low back pain
No full textBackground
Increased postural sway is well documented in patients suffering from non-specific low back pain, whereby a linear relationship between higher pain intensities and increasing postural sway has been described. No investigation has been conducted to evaluate whether this relationship is maintained if pain levels change in adults with non-specific low back pain.
Methods
Thirty-eight patients with non-specific low back pain and a matching number of healthy controls were enrolled. Postural sway was measured by three identical static bipedal standing tasks of 90 sec duration with eyes closed in narrow stance on a firm surface. The perceived pain intensity was assessed by a numeric rating scale (NRS-11). The patients received three manual interventions (e.g. manipulation, mobilization or soft tissue techniques) at 3-4 day intervals, postural sway measures were obtained at each occasion.
Results
A clinically relevant decrease of four NRS scores in associated with manual interventions correlated with a significant decrease in postural sway. In contrast, if no clinically relevant change in intensity occurred ([less than or equal to]1 level), postural sway remained similar compared to baseline. The postural sway measures obtained at follow-up sessions 2 and 3 associated with specific NRS level showed no significant differences compared to reference values for the same pain score.
Conclusions
Alterations in self-reported pain intensities are closely related to changes in postural sway. The previously reported linear relationship between the two variables is maintained as pain levels change. Pain interference appears responsible for the altered sway in pain sufferers. This underlines the clinical use of sway measures as an objective monitoring tool during treatment or rehabilitation
Concept Mapping as a Follow-Up Strategy for Learning From Texts: Can the Acquisition of Knowledge and Skills be Fostered by Prompts?
No full textConcept mapping is a learning strategy that fosters meaningful learning. This study (N = 112 students, mean age: 17.20) investigated the benefits of cognitive and/or metacognitive prompts on learning outcomes when learning by concept mapping. Participants who were prompted during concept mapping achieved a significantly better learning outcome. However, mixed prompts were not more beneficial than solely cognitive or metacognitive prompts. Apparently, the availability of prompts per se fostered a more systematic learning behavior. However, as the results of a follow-up test without prompts showed, prompting learners once was not sufficient to help learners to continue to successfully use this learning technique on their own
Does postural sway change in association with manual therapeutic interventions? A review of the literature
No full textStudy design
Literature Review
Objectives
The objective of this literature review was to determine if postural sway changes in association with manual therapeutic interventions and to investigate whether any changes occur in healthy individuals or in association with pain intensity.
Summary of Background data
Improving postural stability has been proposed as a goal of manual therapeutic interventions. So far, no literature review has addressed whether there is supportive evidence for this and if so, what factors may be associated or causative for observed sway alterations.
Search methods
Seven online databases (PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, ScienceDirect and the Cochrane library) were systematically searched followed by a manual search of the retrieved papers.
Selection criteria
Studies comparing postural sway derived from bipedal force plate measurements in association with a manual therapeutic intervention, ideally compared to a control group.
Data collection and analysis
Two reviewers independently screened titles and abstracts for relevance, conducted the data extraction and the risk of bias assessment which was conducted using the RTI item bank. A descriptive analysis was conducted as the heterogeneous study designs prevented pooling of data.
Results
Nine studies of varying methodological quality met the inclusion criteria. No direct comparison of data across the studies was possible. There was no evidence that manual interventions lead to a change in postural sway in healthy individuals regardless of the body regions addressed by the intervention. There was some indication that postural sway may change at follow-up measurements in pain sufferers; however, this may be due to variations in pain intensity rather than resulting from the intervention itself.
Conclusions
There is no conclusive scientific evidence that manual therapeutic interventions may exhibit any immediate or long-term effect on COP excursions. Any changes in sway may be attributable to decreases in pain intensity
Messung und Beurteilung von Ruhe- und Störschallpegeln in Hörprüfkabinen
No full textDurch aktuelle nationale und internationale Bestrebungen zur Vereinheitlichung audiologischer Methoden nimmt die Einhaltung von Normen einen immer höheren Stellenwert ein. Die technischen Anforderungen an den Einsatz medizinischer Messgeräte und deren Umgebungsbedingungen sind in einer Reihe von einschlägigen Vorschriften festgeschrieben. Insbesondere die messtechnische Überprüfung der akustischen Eignung von Hörprüfräumen bzw. -kabinen ist sowohl in apparativer als auch methodischer Hinsicht eine Herausforderung. In dieser Arbeit werden die aktuellen Anforderungen an akustische Umgebungsbedingungen zur Durchführung ton- und sprachaudiometrischer Messungen vorgestellt und ein geeignetes Verfahren zur normgerechten messtechnischen Überprüfung anhand von zwei Beispielen aus der Praxis beschrieben. Nach der Beurteilung der Messergebnisse unter Berücksichtigung der einschlägigen Vorschriften werden Bewertungsmöglichkeiten zur zweckmäßigen Eignung dieser Räumlichkeiten diskutiert.Current national and international efforts toward standardization have increased the importance of adhering to norms and regulations. Technical requirements for medical measurement devices and their operating conditions are specified in relevant norms. The measurement based inspection of premises used for audiometry has posed special challenges in terms of measurement technique and methodology. This work presents current norms of acoustic environments for pure tone and speech audiometry. Additionally we describe a method of norm compliant technical verification of these demands under real world conditions. Measurements made via this method are described and discussed. We also give possible methods of assessing the eligibility of premises based on these measurements
Crackin' the code of post-race: post-1980s novels and post-race discourses
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Comunicação e Expressão, Programa de Pós-Graduação em Inglês: Estudos Linguísticos e Literários, Florianópolis, 2013.Abstract : The last decades has seen a shift in racial thought in the U.S. The discourses vary from the statement that the U.S. has moved beyond race to the post-racial neoliberalist discourse in which 'essential' identities are fragments of a social past and its continuance has the function of renewing race and racism. As these discourses gain ground in the U.S. society, the issue of fighting racism becomes more slippery. The present investigation analyzes the meanings attached to the rebirth of novels that deals with the concept of passing for white in this period and its relation with the fragmentation of the color line. More specifically, the aim of this dissertation is to unveil the forms through which No Telephone to Heaven, Caucasia, and The Girl Who Fell from the Sky respond to the discourses of racial liberalism and Critical Realism. Drawing upon Santiago?s concept of in-betweenness and Butler's concept of performativity, this dissertation sought to analyze the novels chosen as rich sources of insight about the changing racial thought in the U.S.As últimas décadas registraram uma mudança no pensamento racial nos Estados Unidos. Os discursos variam da afirmação de que os Estados Unidos transcendeu a questão racial ao discurso neoliberalista pós-racial que considera identidades 'essenciais' como fragmentos de um passado social e sua continuação apenas renova os conceitos de raça e racismo. A medida que esses discursos se tornam dominantes nos Estados Unidos, a questão do combate ao racismo se torna mais incerta. A presente investigação analisa os significados ligados ao reaparecimento de romances que lidam com o conceito de 'passar por branco' neste período e sua relação com a fragmentação da ?color line?. Mais especificamente, o objetivo deste estudo é investigar a forma que No Telephone to Heaven, Caucasia, and The Girl Who Fell from the Sky respondem aos discursos de liberalismo racial e Realismo Crítico. Com base no conceito de ?entre-lugar? de Santiago e o conceito de performatividade de Butler, esta tese procurou analisar as novelas escolhidas como fontes ricas de compreensão do pensamento racial nos Estados Unidos
Cyber – libertär?Nach dem 11. September
No full textDer Beitrag von Alexander Roßnagel („Freiheit im Cyberspace” [1]) ist als Erwiderung auf meinen Beitrag („Der Staat im Cyberspace” [2]) der begrüßenswerte Beginn einer Diskussion – welche überfällig ist und nicht bald zur Ruhe kommen sollte
Investigation of cap-independent translation in neuronal differentiation
No full textInitiation der Translation ist ein komplexer und stark regulierter Prozess, bei dem Ribosomen die mRNA binden. Die überwiegende Mehrheit eukaryotischer mRNAs wird durch einen 5‘-Cap-abhängigen Mechanismus translatiert. Dazu bindet der eIF4F-Proteinkomplex die mRNA an der 5'-Cap-Struktur, um weitere eIFs und die kleine ribosomale Untereinheit zu rekrutieren, welche dann die 5'UTR von 5'- in 3'-Richtung bis zu einem Startcodon scannt. Anschließend trifft die große ribosomale Untereinheit dazu und die Proteinsynthese beginnt.
Darüber hinaus kann die Translation durch IRES, interne ribosomale Eintrittsstellen, vermittelt werden, welche das Ribosom unabhängig von Cap und 5‘-Ende zum Startcodon rekrutieren. Die zelluläre IRES-vermittelte Translation gilt als ineffizient unter physiologischen Bedingungen, wird aber durch Stress aktiviert. Da die Regulation dieses Mechanismus weitaus unbekannt ist, haben wir die zelluläre, Cap-unabhängige Translationsinitiation untersucht. Dafür haben wir eine embryonale Stammzelllinie generiert, welche eine dominant-negative Mutante von 4E-BP1 exprimiert. 4E-BP1 bindet das 5‘-Cap-bindende Protein, sodass eIF4F nicht am 5'-Cap andocken kann. Wir haben das Proteom während der Überexpression von 4E-BP1 und der neuronalen Differenzierung bestimmt, um Translationsdynamiken systemisch zu erfassen. Gene mit verminderter Sensitivität für die Cap-abhängige Translation wurden so identifiziert und in bicistronischen Reporter-Assays getestet. Nach strenger Validierung wurde eine Cap-unabhängig translatierte mRNA, Pqbp1, entdeckt.
Der zweite Teil dieser Studie untersuchte die Cap-unabhängige Translation einer circRNA, welche keine freien Enden hat und daher per IRES translatiert werden muss. Wir konnten bestätigen, dass circMbl in vitro translatiert wird und konnten so innerhalb eines Kooperationsprojekts zu der Erkenntnis beitragen, dass circRNAs im Fliegengehirn translatiert werden.Translation initiation is a complex and highly regulated process which involves the assembly of an elongation competent ribosome on the mRNA. The vast majority of eukaryotic mRNAs is translated by a canonical cap-dependent mechanism. This requires the eIF4F protein complex to bind the mRNA at the 5’-cap to recruit further eIFs and the small ribosomal subunit which then scans the 5’UTR in 5’ to 3’ direction until a start codon is encountered. Afterwards the large ribosomal subunit joins and protein synthesis begins.
Besides that, translation of mRNAs can be mediated by IRESs, internal ribosome entry sites, which recruit the ribosome in a cap and 5’-end-independent manner to the start codon. Such cellular IRES-mediated translation is thought to be inefficient under physiological conditions but activated during stress. As the regulation of this mechanism is not well understood, we aimed to elucidate cellular cap-independent translation events. Therefore, we generated a mouse embryonic stem cell line with inducible overexpression of a dominant negative mutant of 4E-BP1. 4E-BP1 sequesters the cap-binding protein eIF4E so that the eIF4F protein complex fails to assemble at the 5’-cap. We performed shotgun proteomics during 4E‑BP1 overexpression and neuronal differentiation to globally monitor translation dynamics. Genes with reduced sensitivity for cap-dependent translation were identified and tested for internal translation initiation in bicistronic reporter assays. After stringent validation one cap-independently translated mRNA, Pqbp1, was discovered.
The second part of this study investigated cap-independent translation initiation on a circRNA, which by nature lacks free ends and thus requires IRES-mediated translation. We could show that circMbl is translated in vitro and thus contributed to the scientific evidence for the translation of circRNAs in fly brain, which was studied in a collaboration project
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