The effect of a modified elastic band orthosis on gait and balance in stroke survivors.

BACKGROUND: Gait is crucial for independent living for stroke survivors and assistive devices have been developed to support gait performance. Ankle foot orthosis (AFOs) are commonly provided to stroke survivors to prevent foot drop during walking. However, previous studies have reported limitations of AFOs including them being too heavy, creating skin irritation, and being a stigma of disability. OBJECTIVE: The purpose was to compare the gait and balance improvement between elastic band orthosis (EBOs) and AFOs. STUDY DESIGN: Experimental study design. METHODS: The AFOs and EBOs were provided to 17 stroke survivors, and changes in gait and balance were assessed compared to barefoot (control). Gait spatiotemporal parameters were measured using the zebris-FDM-Rehawalk® system, and balance ability was evaluated using the time up and go test (TUG). Satisfaction with the EBOs was determined using the Quebec user evaluation of satisfaction with assistive technology (QUEST2.0) questionnaire. RESULTS: The EBO showed significant differences in; gait speed, cadence, stride length, stride time, step length unaffected side, stance phase and swing phase on the affected side, and pre-swing on the unaffected side, and balance performance (TUG) (p<0.05) when compared to the AFO and control conditions. The participants were quite satisfied with the EBOs with QUEST2.0 scores greater than 4 out of 5. CONCLUSIONS: EBOs could be provided to stroke survivors given their acceptability and properties to improve gait and balance. The EBO used in this study offered clinically important improvements in gait and balance when compare to AFO and control conditions, and could mitigate against some of the limitations reported in the use of AFOs in stroke survivors.

Knowledge and Perceptions about COVID-19 among Thai Classical Dancers in Thailand: An Online Cross-Sectional Survey.

The prevention and control of the spread of COVID-19 has become a major challenge and concern globally. Since the COVID-19 pandemic is still ongoing, sufficient knowledge and practices of people toward COVID-19 is necessary. Thai classical dancers are one of the groups affected by the pandemic. Health literacy in dancers has been shown to be crucial for their health and performance. Hence, this study aimed to assess Thai classical dancers' knowledge and perception about COVID-19. A cross-sectional 25-item online survey was conducted between March and October 2021. Content validity was performed through the index of Item-Objective Congruence (IOC). Descriptive statistics were applied to represent Thai classical dancer characteristics, knowledge, and perception. The Thai version of the questionnaire had 2 modified items and 2 additional items from the original questionnaire, and the IOC was 1.0. Of the 323 participants who completed the survey, most had adequate knowledge about COVID-19, while 23.84% correctly answered about symptoms of severe COVID-19. Thai classical dancers showed a good perception on COVID-19 prevention and control. Basic understanding about COVID-19 among Thai classical dancers based on their available resources is important. Hence, providing more valid sources of information and health literacy to Thai classical dancers should be considered. More studies on COVID-19 in other dancers should also be explored.

Greater Star Excursion Balance Test Performance in Thai Khon Masked Dancers Versus Nondancers.

The Khon masked dance drama is an authentic Thai classical performance that has been handed down for centuries. The performance has many unique choreographic patterns that are typical of the Southeast Asian performing arts. The Thai Khon masked dance consists of a combination of balance control and limb movement in different rhythms. The grace and beauty of Khon performances are dependent on the precision of the limb movement's curve, angle, and specific position. The connection between balance control and body movements during performance is crucial. The purpose of this study was to compare postural control between Thai Khon masked dancers and nondancers and explore bilateral asymmetry in postural control during single leg standing between the dominant and non -dominant legs using the Star Excursion Balance Test (SEBT). Thai Khon masked dancers (n = 25) and nondancers (n = 25) were asked to identify their dominant leg and perform the SEBT using both legs. The reaching distances in different directions from the SEBT were converted to a normalized distance for comparison. A mixed model ANOVA and t-test were applied to determine the differences between directions in both the dominant and non-dominant legs. The interaction between dancer and nondancer groups was also verified .The results showed that dancers performed better on SEBT than nondancers in all directions (p < 0.05). In conclusion, Thai Khon masked dancers demonstrated a superior ability to maintain dynamic postural control during the SEBT. When considering all directions together, the dominant side was not a factor that affected postural control during the SEBT. This study adds further supporting evidence that Khon masked dance training improves dynamic balance control and can possibly be applied as a recreational exercise to promote balance performance .

Anatomical variants identified on chest computed tomography of 1000+ COVID-19 patients from an open-access dataset.

Chest computed tomography (CT) has been the preferred imaging modality during the pandemic owing to its sensitivity in detecting COVID-19 infections. Recently, a large number of COVID-19 imaging datasets have been deposited in public databases, leading to rapid advances in COVID-19 research. However, the application of these datasets beyond COVID-19-related research has been little explored. The authors believe that they could be used in anatomical research to elucidate the link between anatomy and disease and to study disease-related alterations to normal anatomy. Therefore, the present study was designed to investigate the prevalence of six well-known anatomical variants in the thorax using open-access CT images obtained from over 1000 Iranian COVID-19 patients aged between 6 and 89 years (60.9% male and 39.1% female). In brief, we found that the azygos lobe, tracheal bronchus, and cardiac bronchus were present in 0.8%, 0.2%, and 0% of the patients, respectively. Variations of the sternum, including sternal foramen, episternal ossicles, and sternalis muscle, were observed in 9.6%, 2.9%, and 1.5%, respectively. We believe anatomists could benefit from using open-access datasets as raw materials for research because these datasets are freely accessible and are abundant, though further research is needed to evaluate the uses of other datasets from different body regions and imaging modalities. Radiologists should also be aware of these common anatomical variants when examining lung CTs, especially since the use of this imaging modality has increased during the pandemic.

Noise Exposures Causing Hearing Loss Generate Proteotoxic Stress and Activate the Proteostasis Network.

Exposure to excessive sound causes noise-induced hearing loss through complex mechanisms and represents a common and unmet neurological condition. We investigate how noise insults affect the cochlea with proteomics and functional assays. Quantitative proteomics reveals that exposure to loud noise causes proteotoxicity. We identify and confirm hundreds of proteins that accumulate, including cytoskeletal proteins, and several nodes of the proteostasis network. Transcriptomic analysis reveals that a subset of the genes encoding these proteins also increases acutely after noise exposure, including numerous proteasome subunits. Global cochlear protein ubiquitylation levels build up after exposure to excess noise, and we map numerous posttranslationally modified lysines residues. Several collagen proteins decrease in abundance, and Col9a1 specifically localizes to pillar cell heads. After two weeks of recovery, the cochlea selectively elevates the abundance of the protein synthesis machinery. We report that overstimulation of the auditory system drives a robust cochlear proteotoxic stress response.

Effects of melatonin on severe crush spinal cord injury-induced reactive astrocyte and scar formation.

The present work aimed at analyzing the effects of melatonin on scar formation after spinal cord injury (SCI). Upregulation of reactive astrocyte under SCI pathological conditions has been presented in several studies. It has been proved that the crucial factor in triggering this upregulation is proinflammatory cytokines. Moreover, scar formation is an important barrier to axonal regeneration through the lesion area. Melatonin plays an important role in reducing inflammation, but its effects on scar formation in the injured spinal cord remain unknown. Hence, we used the model of severe crush injury in mice to investigate the effects of melatonin on scar formation. Mice were randomly separated into four groups; SCI, SCI+Melatonin 1 (single dose), SCI+Melatonin 14 (14 daily doses), and control. Melatonin was administered by intraperitoneal injection (10 mg/kg) after injury. Immunohistochemical analysis, Western blot, and behavioral evaluation were used to explore the effects of melatonin after SCI for 14 days. The melatonin-treated mice presented higher expression of neuronal markers (P < 0.001). Remarkably, the inflammatory response appeared to be greatly reduced in the SCI+Melatonin 14 group (P < 0.001), which also displayed less scar formation (P < 0.05). These findings suggest that melatonin inhibits scar formation by acting on inflammatory cytokines after SCI. Overall, our results suggest that melatonin is a promising treatment strategy after SCI that deserves further investigation. © 2016 Wiley Periodicals, Inc.

Comparison of Balance Performance Between Thai Classical Dancers and Non-Dancers.

Thai classical dance is a traditional dramatic art, the technique of which has many features in common with South East Asian performing art. The choreographic patterns consist of various forms of balance control together with limb movements in slow rhythm. The grace and beauty of the dancer are dependent on how well the limb movements curve and angle. The relationship of whole body proportion and balance control in various patterns of support base is also important. The purpose of this study was to compare balance abilities between Thai classical dancers and non-dancers in different balance conditions. Twenty-five Thai classical dancers and 25 non-dancers performed the modified Sensory Organization Test (mSOT) and were further challenged by adding dynamic head tilts (DHTs) in four different directions during mSOT. Mixed model ANOVA was applied to determine the equilibrium score in each balance condition and also the interaction between dancer and non-dancer groups. It was found that Thai classical dancers achieved better equilibrium scores in all mSOT conditions except the least challenging one. Moreover, additional multitask conditions (mSOT+DHT) were revealed to profoundly affect differences between dancers and controls. In conclusion, Thai classical dancers demonstrated a better ability to maintain postural stability during different challenging postural tests. This information suggests various ways of putting the practice of Thai classical dance to use in the future.

Biomedical and clinical promises of human pluripotent stem cells for neurological disorders.

Neurological disorders are characterized by the chronic and progressive loss of neuronal structures and functions. There is a variability of the onsets and causes of clinical manifestations. Cell therapy has brought a new concept to overcome brain diseases, but the advancement of this therapy is limited by the demands of specialized neurons. Human pluripotent stem cells (hPSCs) have been promised as a renewable resource for generating human neurons for both laboratory and clinical purposes. By the modulations of appropriate signalling pathways, desired neuron subtypes can be obtained, and induced pluripotent stem cells (iPSCs) provide genetically matched neurons for treating patients. These hPSC-derived neurons can also be used for disease modeling and drug screening. Since the most urgent problem today in transplantation is the lack of suitable donor organs and tissues, the derivation of neural progenitor cells from hPSCs has opened a new avenue for regenerative medicine. In this review, we summarize the recent reports that show how to generate neural derivatives from hPSCs, and discuss the current evidence of using these cells in animal studies. We also highlight the possibilities and concerns of translating these hPSC-derived neurons for biomedical and clinical uses in order to fight against neurological disorders.

Restoration of auditory evoked responses by human ES-cell-derived otic progenitors.

Deafness is a condition with a high prevalence worldwide, produced primarily by the loss of the sensory hair cells and their associated spiral ganglion neurons (SGNs). Of all the forms of deafness, auditory neuropathy is of particular concern. This condition, defined primarily by damage to the SGNs with relative preservation of the hair cells, is responsible for a substantial proportion of patients with hearing impairment. Although the loss of hair cells can be circumvented partially by a cochlear implant, no routine treatment is available for sensory neuron loss, as poor innervation limits the prospective performance of an implant. Using stem cells to recover the damaged sensory circuitry is a potential therapeutic strategy. Here we present a protocol to induce differentiation from human embryonic stem cells (hESCs) using signals involved in the initial specification of the otic placode. We obtained two types of otic progenitors able to differentiate in vitro into hair-cell-like cells and auditory neurons that display expected electrophysiological properties. Moreover, when transplanted into an auditory neuropathy model, otic neuroprogenitors engraft, differentiate and significantly improve auditory-evoked response thresholds. These results should stimulate further research into the development of a cell-based therapy for deafness.

Stem cell based therapy in the inner ear: appropriate donor cell types and routes for transplantation.

Losing one of our main sensory systems such as hearing can have devastating consequences in the way we interact with the world. The main problem lies in the fact that the critical sensory cells, the auditory neurons and hair cells located in the cochlea are only generated during development and, when damaged, cannot be replaced. The options currently available to treat this condition are very limited, and are mostly represented by prosthetic devices such as hearing aids and cochlear implants. There is a clear need for a therapeutic breakthrough that will help the millions of people affected, and the advances in stem cell technologies are offering a glimmer of hope for this affliction. Although still at a very early stage, a growing bulk of literature is being produced attempting to pave the path for a stem cell-based therapy for deafness. From the many variables to bear in mind when developing this approach, two appear to be of paramount importance. First, different cell types are potentially to be used, all of them having advantages and disadvantages. Second, in order to target such a small and secluded organ as the cochlea, difficult surgical techniques are to be used, some of which still need to be developed. The present article will aim to present the most recent advances of the field, focussing on these two critical issues.

The existence of opioid receptors in the cochlea of guinea pigs.

Several independent investigations have demonstrated the presence of opioid peptides in the inner ear organ of Corti and in particular in the efferent nerve fibers innervating the cochlear hair cells. However, the precise innervation pattern of opioid fibers remains to be investigated. In the present study the expression of opioid receptors and their peptides is demonstrated in young adult guinea pig cochlea. Opioid receptors are mainly expressed in hair cells of the organ of Corti and in inner and outer spiral bundles with different characteristics for each type of receptor. Co-localization studies were employed to compare the distribution of mu-, delta- and kappa-opioid receptors and their respective peptides, beta-endorphin, leu-enkephalin and dynorphin. Additionally, immunostaining of synaptophysin was used in this study to identify the presynaptic site. Immunoreactivity for enkephalin and dynorphin was found in the organ of Corti. Leu-enkephalin was co-localized with synaptophysin prominently in the inner spiral bundle (ISB). Dynorphin was co-localized with synaptophysin in both inner and outer spiral bundles. Delta-opioid receptor was most prominently co-localized with its peptide in the ISB bundle. Kappa-opioid receptor was seemingly present with dynorphin in both inner and outer spiral bundles. The co-staining of both peptides and receptors with synaptophysin in the same areas suggests that some of the opioid receptors may act as auto-receptors. The results provide further evidence that opioids may function as neurotransmitters or neuromodulators in the cochlea establishing the basis for further electrophysiological and pharmacological investigations to understand better the roles of the opioid system in auditory function.

Opioid modulation of GABA release in the rat inferior colliculus.

BACKGROUND: The inferior colliculus, which receives almost all ascending and descending auditory signals, plays a crucial role in the processing of auditory information. While the majority of the recorded activities in the inferior colliculus are attributed to GABAergic and glutamatergic signalling, other neurotransmitter systems are expressed in this brain area including opiate peptides and their receptors which may play a modulatory role in neuronal communication. RESULTS: Using a perfusion protocol we demonstrate that morphine can inhibit KCl-induced release of [3H]GABA from rat inferior colliculus slices. DAMGO ([D-Ala(2), N-Me-Phe(4), Gly(5)-ol]-enkephalin) but not DADLE ([D-Ala2, D-Leu5]-enkephalin or U69593 has the same effect as morphine indicating that micro rather than delta or kappa opioid receptors mediate this action. [3H]GABA release was diminished by 16%, and this was not altered by the protein kinase C inhibitor bisindolylmaleimide I. Immunostaining of inferior colliculus cryosections shows extensive staining for glutamic acid decarboxylase, more limited staining for micro opiate receptors and relatively few neurons co-stained for both proteins. CONCLUSION: The results suggest that micro-opioid receptor ligands can modify neurotransmitter release in a sub population of GABAergic neurons of the inferior colliculus. This could have important physiological implications in the processing of hearing information and/or other functions attributed to the inferior colliculus such as audiogenic seizures and aversive behaviour.

The presence of opioid receptors in rat inner ear.

Opioid peptides have been identified in the inner ear but relatively little information is available about the expression and distribution of their receptors. The aim of the present study was therefore to identify and localize the mu (MOR), delta (DOR) and kappa (KOR) opioid receptor subtypes within the rat cochlea. The expression of these opioid receptor subtypes was determined by reverse transcriptase-polymerase chain reaction followed by nested polymerase chain reaction analysis. Amplification of RNAs from rat cerebral cortex (positive control) and rat cochlea with MOR, DOR and KOR primers resulted in products of the predicted lengths, 564, 356 and 276 bp, respectively. Restriction digestion confirmed the identity of these products. All three receptor subtypes were identified in the cochlea and further characterized by immunocytochemistry. DOR and KOR immunoreactivity was found in inner and outer hair cells, bipolar cells of the spiral ganglion and interdental cells of the limbus. In contrast, no MOR immunoreactivity was observed in the inner and outer hair cells, and interdental cells. All three types of receptor fibers were also detected in the bipolar cells and nerve fibers within the spiral ganglion. In addition, MOR- and KOR-containing nerve fibers were observed in the limbus. These findings are the first report of the presence of all three classical opioid receptors in the inner ear and suggest that these receptors may have both presynaptic and postsynaptic roles.