The effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness: A systematic review.

Background: Dizziness is a non-specific term used by patients to describe several symptoms ranging from true vertigo, light headedness, disorientation or sense of imbalance. Vestibular rehabilitation (VR) is a specific form of exercise-based therapy programme aimed at alleviating the primary and secondary problems of a vestibular pathology. The aim of this study was to investigate the effectiveness of exercise-based vestibular rehabilitation in adult patients with chronic dizziness. Methods: The following five databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE, PubMed, the Physiotherapy Evidence Database (PEDro) and Scopus (Elsevier). Two investigators independently reviewed all articles and a systematic review of literature was performed using the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The articles were included if they met the following inclusion criteria: (1) randomised controlled trial, (2) people with chronic dizziness, (3) adults aged 18 or over, (4) exercise-based VR, (5) VR exercises compared with sham or usual care, non-treatment or placebo and (6) only studies published full text in English. Results: The initial search identified 304 articles, four of which met the criteria for analysis. All studies involved some form of vestibular rehabilitation, including vestibular compensation, vestibular adaptation and substitution exercises. These exercises were compared with usual medical care (three studies) or placebo eye exercise (one study). The Vertigo Symptom Scale was the most commonly used outcome measure to assess subjective perception of symptoms of dizziness (three studies). According to the PEDro scale, three studies were considered to be of high quality, and one was rated as fair.  Conclusions: This review suggests that exercise-based vestibular rehabilitation shows benefits for adult patients with chronic dizziness with regard to improvement in the vertigo symptom scale, fall risk, balance and emotional status.

Religious anti-gay prejudice as a predictor of mental health, abuse, and substance use.

Anti-gay, or homonegative, prejudice is generally considered harmful to the wellbeing of sexual minority individuals. However, the origins or nature of such prejudice may vary. Despite a sizable body of literature suggesting homonegative prejudice is frequently religious-based, the psychological impact of exposure to religious anti-gay prejudice remains largely undetermined. Addressing this research gap, the authors examined whether opposition to same-sex sexuality on religious grounds predicted detrimental outcomes among same- and both-sex attracted individuals, as well as their heterosexual counterparts. A nationwide U.S. sample of 1600 individuals-recruited using contemporary online crowd-sourcing techniques designed to limit selection bias-completed a novel inventory assessing interpersonal exposure to religious (as well as nonreligious) homonegative disapproval. Outcome variables assessed included a number of clinically relevant measures spanning general mental health, social support, suicidality, abuse, and substance use. Analyses revealed that greater exposure to religious anti-gay prejudice predicted higher levels of anxiety, stress, and shame; more instances of physical and verbal abuse; and more problematic alcohol use. Furthermore, while sexual minority individuals tended to fare more poorly than their heterosexual counterparts on almost every outcome measure assessed, homonegative prejudice predicted poorer outcomes among all respondents regardless of their sexual orientation or religious identification. Hence, results are among the first to demonstrate that anti-gay religious exposure is associated with substantial threats to wellbeing, and that such effects may be observed beyond religious sexual minorities. Overall, findings imply that homonegative religious social conditions may be of broader health and mental health concern than is conventionally recognized. (PsycINFO Database Record

When Chronic Pain Is Not "Chronic Pain": Lessons From 3 Decades of Pain.

The current move in physical therapy toward the biopsychosocial management of chronic pain has led some interpreters to call for a less hands-on approach, as awareness of central sensitization leads to specific management trends and a move away from pathoanatomical considerations. The authors of this Viewpoint suggest that no approach, no matter how vocal and evangelistic its followers, would likely be any more certain than what preceded it. This Viewpoint poses the question, why, when we (as a profession) appear (according to the new physical therapy gurus) to have been so wrong before, do we appear to believe that we are right this time? J Orthop Sports Phys Ther 2017;47(8):515-517. doi:10.2519/jospt.2017.0606.

Sex and the sinner: comparing religious and nonreligious same-sex attracted adults on internalized homonegativity and distress.

Homonegative prejudice has long been connected with poor psychological outcomes. These have often been purported to include internalized homonegativity (IH), an outcome regarded as especially detrimental given its association with a large number of adverse mental health correlates. Given the evidence that homonegative prejudice often prevails most strongly within many mainstream religious contexts, the current study examined whether religious lesbian, gay, and bisexual (LGB) individuals would possess higher levels of internalized homonegativity than their nonreligious, and formerly religious, LGB counterparts. To test this hypothesis, Christian, formerly Christian, and nonreligious Australian LGB respondents (N = 579), recruited through social media platforms and a diverse range of community groups, completed an online survey assessing IH; religion-sexuality distress; religious and familial homonegativity; sense of self; and outness. Ordinal logistic regressions revealed that Christian LGB respondents possessed significantly more IH than nonreligious respondents. Furthermore, perceiving greater homonegativity in one's religious and familial environments predicted higher levels of distress and IH among Christians specifically. Despite having apostatized, former Christians still reported greater religion-sexuality distress than nonreligious individuals, suggesting that the psychological effects of homonegative religious environments are potentially enduring. Across all respondents, IH was also greater for males, those who were less "out," and those who possessed a weaker sense of self. Findings generally support the premise that religious homonegativity places LGB Christians at additional psychological risk, with particular regard to IH and religion-sexuality identity conflict, and that both personal and interpersonal characteristics may exacerbate this risk.

Cervical Spondylotic Myelopathy presenting as mechanical neck pain: a case report.

Cervical Spondylotic Myelopathy (CSM) is the most common type of myelopathy in adults over 55 years of age. In the early stages symptoms may include local neck pain and stiffness that might mimic the presentation of non-specific mechanical neck pain (NSMNP). The patient was a 79 year old male, who complained of eight weeks of neck pain. He had been referred for physiotherapy by his family physician with a diagnosis of NSMNP. Initial presentation was consistent with the referral, but further assessment by the physiotherapist revealed findings suggestive of CSM. He was referred for an urgent cervical MRI scan, which revealed myelomalacic changes at C3/4 due to spondylotic changes. The patient was unsuitable for manual therapy intervention and was referred to a spinal orthopaedic surgeon who performed a posterior decompression and stabilisation at C3-C5, 2 months after the initial presentation. This case report highlights the importance of considering CSM in adults over 55 years of age presenting with NSMNP, particularly as the prevalence of both increases with age. It demonstrates the need for health professionals to carry out detailed examination where CSM may be a potential differential diagnosis. Outcomes are less favourable for patients over the age of 70, therefore an urgent surgical opinion was required for this patient. Deterioration of symptoms whilst he awaited surgery demonstrates how missed diagnosis may lead to possible long term spinal cord damage, with potential medico-legal concerns for the therapist.

Or cues knowledge of alternatives: evidence from priming.

Recent research has determined that word meanings can instantly influence the meaning and distribution of other words in the sentence. Here, we manipulated basic carrier sentences with the disjunction or linking two nouns that were either filling the same thematic role or not, and were either semantically related or not. Though previous research has shown that one word can prime a semantically related word even in a sentential context, we predicted that if or cues knowledge about contextually-relevant alternatives, priming for semantic relatives will only obtain when those words also fill the same thematic role. These predictions were confirmed, as self-paced reading times of the second alternative in the sentence were faster only when the two alternatives shared the same thematic role and semantic category, suggesting that disjunction words like or function similarly to verbs, which cue knowledge about expected argument structure and sense depending on sentential context. The relevance of these findings for basic reasoning phenomena (i.e., the subadditivity effect) is also discussed.

Vascular profiling: should manual therapists take blood pressure?

Risk assessment of the cervical spine prior to manual therapy interventions is currently a contentious topic, highlighted by recent suggestions in the medical press (http://www.bmj.com/content/344/bmj.e3679), that manipulative therapy should be abandoned because of the perceived risk. This paper addresses the issue of manual therapists using blood pressure measurement as an aid to clinical reasoning and decision making. The authors' use a case series of three neuromusculoskeletal presentations, which support the contention that blood pressure recording can prove to be an appropriate objective test for assessment prior to manual therapy interventions. Furthermore, it is suggested that blood pressure testing may provide direction for risk assessment and/or the management of patients across all populations and age groups as part of a holistic 'vascular profiling' approach to clinical reasoning and decision making.

Validation of the Abbreviated Westmead Post-traumatic Amnesia Scale: a brief measure to identify acute cognitive impairment in mild traumatic brain injury.

OBJECTIVE: To validate the use of the Abbreviated Westmead Post-traumatic Amnesia Scale (A-WPTAS) in the assessment of acute cognitive impairment in mild traumatic brain injury (mTBI). METHODS: Data previously collected from 82 mTBI and 88 control participants using the Revised Westmead Post-traumatic Amnesia Scale (R-WPTAS) was converted to A-WPTAS scores and pass/fail classifications were calculated for both scales. RESULTS: The proportion of failures on the R-WPTAS and the A-WPTAS did not differ and a similar number of mTBIs were classified on each. For mTBIs the relationship between the independent memory test and a pass/fail classification was the same for both scales. Bivariate logistic regressions revealed that mTBIs, relative to controls, were around 8 times more likely to fail the assessment (R-WPTAS: 95% CI: 3.70-18.87; A-WPTAS: 95% CI: 3.70-20.14). As verbal learning improved the likelihood of failure was reduced. Greater education was associated with a decreased likelihood of failure. The relationship between education and a fail performance was not sustained when education was adjusted for the effect of age, prior mTBI, blood alcohol level, injury status, verbal learning, and morphine administration. CONCLUSIONS: The A-WPTAS is a valid measure. The A-WPTAS may reduce the risk of failing to classify patients with mTBI by identifying and documenting acute cognitive impairment.

Composite measures quantify households' obesogenic potential and adolescents' risk behaviors.

OBJECTIVE: The aims of this study were to generate composite measures quantifying a household's obesogenic potential and to examine the relationship of the composite variables with older children's eating, physical activity (PA), and small screen recreation. METHODS: Data were from surveys with 1685 child-parent pairs in which the child was in grade 6, 8, or 10 (mean age: 14 years). Composite measures of the obesogenic household environment were generated from 11 measures using nonlinear principal components analysis. Associations between the composite measures and the children's healthy and unhealthy food intake, PA, and screen time were tested (adjusting for demographic characteristics). RESULTS: Two scales were generated: (1) obesogenic control, which clustered together factors that mitigate risk; and (2) obesogenic risk. Higher scores on the control scale were associated with higher adolescent intake of healthy foods, lower intake of unhealthy foods, higher PA, and less screen time. Higher scores on the risk scale were associated with lower adolescent intake of healthy foods, higher intake of unhealthy foods, lower PA, and more screen time. There were significant 2-way interactions between the scales for soft drink consumption and PA. CONCLUSIONS: Household obesogenic potential may be quantified as 2 factors reflecting cumulative risk and control practices. These factors have both additive associations with obesogenic behaviors and, in some cases, modify each other, suggesting that a healthy home environment requires attention to both. Health promotion messages could incorporate these 2 different but interacting factors that parents can use to modify the obesogenic potential of their household.

The prospective course of postconcussion syndrome: the role of mild traumatic brain injury.

OBJECTIVE: To investigate whether postconcussion syndrome (PCS) represents long-term sequelae associated with mild traumatic brain injury (mTBI). METHODS: Prospective consecutive admissions to a Level 1 trauma hospital were assessed a mean 4.9 days and again 106.2 days post-injury. The final sample comprised 62 mTBI and 58 nonbrain injured trauma controls (TC). Change or lack of change in individual PCS-like symptoms and PCS was examined. Multilevel logistic regression was used to analyze whether mTBI predicts 3-month PCS (Time 2; T2); whether predictors of PCS (within 14 days of injury, Time 1; T1) predict 3-month PCS, and how change in these predictors from T1 to T2 were associated with change in PCS status. Variables included demographic, injury-related, financial incentives, neuropsychological, and psychiatric disorder. RESULTS: MTBI did not predict PCS. PCS was comparable (T1: mTBI: 40.3%, TC: 50.0%; T2: mTBI: 46.8%, TC: 48.3%). At T2, 38.6% were new cases of PCS; between 30.8% and 86.2% reported either a new or more frequent symptom. A pre-injury depressive or anxiety disorder (OR = 2.99, 95% CI [1.38, 6.45]), and acute posttraumatic stress (OR = 1.05, 95% CI [1.00, 1.00]) were early markers of PCS, regardless of mTBI. An interaction between time and posttraumatic stress disorder (PTSD) suggested the relationship between the severity of PTSD symptoms and PCS strengthened over time (OR = 2.66, 95% CI [1.08, 6.55]). Pain was related to PCS. Females were more likely than males to have PCS. CONCLUSION: The data suggest the phenomenon of PCS in trauma patients does not show an association with mTBI.

The role of the anterior lateral eyes in the vision-based behaviour of jumping spiders.

Jumping spiders, or salticids, sample their environment using a combination of two types of eyes. The forward-facing pair of 'principal' eyes have narrow fields of view, but exceptional spatial resolution, while the two or three pairs of 'secondary' eyes have wide fields of view and function especially well as motion analysers. Motion detected by the secondary eyes may elicit an orienting response, whereupon the object of interest is examined further using the high-acuity principal eyes. The anterior lateral (AL) eyes are particularly interesting, as they are the only forward-facing pair of secondary eyes. In this study, we aimed to determine characteristics of stimuli that elicit orienting responses mediated by the AL eyes. After covering all eyes except the AL eyes, we measured orienting responses to dot stimuli that varied in size and contrast, and moved at different speeds. We found that all stimulus parameters had significant effects on orientation propensity. When tethered flies were used as prey, we found that visual information from the AL eyes alone was sufficient to elicit stalking behaviour. These results suggest that, in terms of overall visual processing, the relevance of spatial vision in the AL eyes has been underestimated in the literature. Our results also show that female spiders are significantly more responsive than males. We found that hunger caused similar increases in orientation propensity in the two sexes, but females responded more often than males both when sated and when hungry. A higher propensity by females to orient toward moving objects may be related to females tending to experience higher nutritional demands than males.

Cervical arterial dysfunction: knowledge and reasoning for manual physical therapists.

SYNOPSIS: This clinical commentary provides evidence-based information regarding adverse cerebrovascular events in the context of manual therapy assessment and management of the cervical spine. Its aim is to facilitate clinical decision making during diagnosis and treatment of patients presenting to the therapist with cervicocranial pain. Rather than focusing on a traditional view of premanipulative testing as the cornerstone for decision making, we present information concerning the clinical presentation of specific vascular conditions. Additionally, we discuss the assessment and management of musculoskeletal pain in the presence of risk factors for cerebrovascular accident. It is proposed that vascular "red flag" presentations mimic neuromusculoskeletal cervicocranial syndromes. Invariably, the 2 conditions coexist. This reasoning presupposes that some patients who have poor clinical outcomes, or a serious adverse response to treatment, may be those who actually present with undiagnosed vascular pathology. We use 2 case reports to demonstrate how incorporating vascular knowledge into clinical reasoning processes may influence clinical decision making. LEVEL OF EVIDENCE: Level 5.

The impact of postnatal and concurrent maternal depression on child behaviour during the early school years.

BACKGROUND: This prospective study explores the ongoing impact of early and subsequent maternal depression on offspring behaviour in the early school years. METHODS: Seventy five mothers recruited into a longitudinal study were assessed for symptoms of depression when their children were 4, 12 and 15 months, 4 years and later when the children were 6-8 years of age. Mothers, fathers, and school teachers were asked to report on children's internalising and externalising behaviour problems. RESULTS: Exposure to maternal depression during the first postpartum year was related to mother reports of child internalising and externalising problems in the early school years. Although depression in the first year predicted later internalising problems, effects for externalising behaviour problems were mediated by concurrent depression. Relations between concurrent maternal depression and externalising problems were confirmed by teacher ratings. Interestingly, the severity of symptoms at four months was significantly correlated with behaviour problems seven years later. LIMITATIONS: Attrition over successive study contacts and therefore limited statistical power is acknowledged. Findings may be a conservative estimate of associations between maternal depression and later child behaviour problems. Also, the high prevalence of depressive symptomatology in the population from which the sample was drawn may limit the generalisability of results. CONCLUSIONS: Findings confirm the importance of early identification and treatment for mothers with postnatal depression, given the likelihood of ongoing depression and relations with later child behaviour problems. From a practical point, severity of early symptoms may be a reliable index of those mothers and children at greatest risk.

Cervical arterial dysfunction and manual therapy: a critical literature review to inform professional practice.

An abundance of literature has attempted to provide insight into the association between cervical spine manual therapy and cervical artery dysfunction leading to cerebral ischaemic events. Additionally, specific guidelines have been developed to assist manual therapists in clinical decision-making. Despite this, there remains a lack of agreement within the profession on many issues. This paper presents a critical, re-examination of relevant literature with the aim of providing a contemporary, evidence-informed review of key areas regarding the neurovascular risks of cervical spine manual therapy. From a consideration of case reviews and surveys, haemodynamic principles, and blood flow studies, the authors suggest that: (1) it is currently impossible to meaningfully estimate the size of the risk of post-treatment complications; (2) existing testing procedures have limited clinical utility; and (3) a consideration of the association between pre-existing vascular risk factors, combined with a system based approach to cervical arterial haemodynamics (inclusive of the carotid system), may assist manual therapists in identifying at-risk patients.

Manual therapy and cervical arterial dysfunction, directions for the future: a clinical perspective.

This paper offers a contemporary, evidence-based perspective on the issue of adverse neurovascular events related to cervical spine manual therapy. The purpose of this perspective is to challenge traditional thought and practice and to recognize areas where practice and research should develop. By considering the themes presented in this paper, the clinician can broaden his or her approach to neurovascular assessment in line with contemporary evidence and thought. We present information based on clinically relevant questions. The nature of vertebrobasilar insufficiency and the utility of pre-treatment testing are examined in light of contemporary evidence. In addition, we report on internal carotid artery pathology, and the significance of appreciating atherosclerosis in clinical decision-making. These later two areas are not commonly recognized within manual therapy literature, and we suggest that their importance to differential diagnosis of head and neck pain, as well as estimating treatment related risk, is paramount. We propose that the term cervical arterial dysfunction is more appropriate than classically used nomenclature. This term refers more accurately and completely to the range of pathologies at different anatomical sites that manual therapists treating patients with head and neck pain are likely to encounter. Finally, we present a brief review of the medico-legal status pertaining to this area. Although this is English law-related, the themes derived from this section are of interest to all manual therapists.

Assessment of repeated displays: a test of possible mechanisms.

Many animals signal their resource holding potential (RHP) to deter competitors from engaging them in potentially costly fights. Studies of this opponent assessment function have generated important insights into signal design and evolution. In the case of sounds, rate of production is often a salient feature. We used digital video playback to conduct analogous experiments exploring the importance of temporal variation in visual signals. Our study focused on the push-up display of male Jacky dragons Amphibolurus muricatus, an Australian agamid lizard. This stereotyped movement-based signal is commonly performed during male-male contests. A previous study has shown that Jacky dragons responses are influenced by the overall display rate of a video conspecific. We built upon this finding by investigating the effect of short-term variation in display rate. Each playback sequence varied systematically across a different combination of display parameters, while keeping the total number of push-ups constant. Other potential cues, such as morphology and the characteristics of individual motor patterns, were precisely controlled. The aggressive signalling and locomotor behaviour of subject males varied significantly between sequences. Most notably, performance of throat expansions, a typical agamid threat posture, was suppressed by video sequences with temporal clumping of displays. These results show that lizards are sensitive to differences in the temporal fine structure of display sequences and suggest that display concentration is an important assessment cue.

Psychological adjustment among partners of women at high risk of developing breast/ovarian cancer.

PURPOSE: The aim of the current research was to characterize psychological adjustment among partners of women at high risk of developing breast/ovarian cancer and to explore the relationship between women's and partners' adjustment. METHODS: A study of 95 unaffected at-risk women and 95 partners was carried out using mailed, self-administered questionnaires with validated measures of psychological outcome. RESULTS: Elevated levels of distress were noted in up to 10% of partners. High monitoring coping style and greater perceived breast cancer risk for their wife were associated with higher distress levels for partners. However, communicating openly with their wife and the occurrence of a recent cancer-related event in the woman's family were related to lower distress for partners. Partners' cancer-specific distress was positively related to their wives' distress. CONCLUSION: Among partners with elevated levels of distress, the ability to provide effective support to the at-risk women and participate appropriately in their decision making may be compromised. These partners are likely to benefit from targeted clinical interventions designed to reduce their distress levels. The findings emphasize the importance of considering partners of at-risk women in service provision and highlight the need for partners to obtain information and support specifically tailored to their needs.

Cervical arterial dysfunction assessment and manual therapy.

In this paper, we present a clinical overview of cervical arterial dysfunction (CAD) for manual therapists who treat patients presenting with cervical pain and headache syndromes. An overview of vertebrobasilar arterial insufficiency (VBI) is given, with reference to assessment procedures recommended by commonly used guidelines. We suggest that the evidence supporting contemporary practice is limited and present a more holistic, evidence-based approach to considering CAD. This approach considers typical pain patterns and clinical progressions of both vertebrobasilar, and internal carotid arterial pathologies. Attention to the risk factors and pathomechanics of arterial dysfunction is also given. We suggest that consideration of the information provided in this Masterclass will enhance the manual therapist's clinical reasoning with regard to differential diagnosis of cervical pain syndromes, and prediction of serious adverse reactions to treatment.

Low blood lead levels do not appear to be further reduced by dietary supplements.

OBJECTIVE: Our objective was to evaluate the association of dietary intakes of selected micronutrients and blood lead (PbB) concentrations in female adults and in children. DESIGN: With longitudinal monitoring, we measured daily intakes of the micronutrients calcium, magnesium, sodium, potassium, barium, strontium, phosphorus, zinc, iron (limited data), and copper from 6-day duplicate diets (2-13 collections per individual) and PbB concentrations. Participants were three groups of females of child-bearing age (one cohort consisting of 21 pregnant subjects and 15 nonpregnant controls, a second cohort of nine pregnant migrants), and one group of 10 children 6-11 years of age. RESULTS: Mean PbB concentrations were <5 microg/dL. A mixed linear model that included only group and time accounted for 5.9% of the variance of the PbB measurements; neither the effect of time nor the effect of group was significant. The model containing all of the micronutrients (except iron, for which there was a great deal of missing data), along with time and group, accounted for approximately 9.2% of the variance of PbB; this increase was not statistically significant. There was, however, a significant association of PbB with phosphorus, magnesium, and copper when all micronutrients were included in the statistical analysis, perhaps reflecting a synergistic effect. CONCLUSIONS: In contrast to most previous studies, we found no statistically significant relationships between the PbB concentrations and micronutrient intake. In adults and older children with low PbB concentrations and minimal exposure to Pb, micronutrient supplementation is probably unnecessary.