ABSTRACTHuman handedness has long been classified in binary terms, yet such categorical distinctions increasingly appear at odds with both conceptual and empirical advances in psychological research. This commentary examines some of the challenges facing laterality researchers in reconceptualizing handedness. First, it considers the practical tension involved in measuring handedness as a continuous variable: though this affords greater precision it imposes a time and attentional burden on participants, particularly in studies where handedness is not a primary interest. Second, it explores how technology is changing handedness, with the decline of handwriting and the rise of bimanual digital devices challenging the validity of the most commonly used short measure of handedness: writing hand. Third, it argues that rather than abandoning categorical classification altogether, researchers could consider a more nuanced model that offers greater ability to distinguish differences in handedness than binary conceptualizations, whilst still retaining the intuitive benefits and ease of measurement of the categorical approach. By refining how we categorize handedness rather than abandoning categorization altogether, researchers can recognize both the complexity of the construct and the realities of empirical work.
Objective
Loss of hand function following spinal cord injury (SCI) severely impacts independence and quality of life. Restoring volitional hand control in individuals with SCI remains a critical challenge, addressed using different approaches, including physiotherapy, occupational therapy, and assistive technologies such as neuroprostheses and robotic systems. This study aimed to develop and evaluate an easy-to-setup and user-friendly EMG system for decoding attempted hand and finger movements in individuals with SCI.

Approach
We implemented an EMG decoding system for hand opening/closing (2 classes) and single-finger flexion (3 classes) attempts, using a fast-donning 32-channel dry EMG sleeve integrated with a seamless deep-learning LSTM-based decoding pipeline. Eight people with different classifications of SCI tested the system over two sessions while receiving real-time feedback through a virtual hand interface. 

Main results
The system achieved high online accuracy for hand open-close discrimination across all subjects (mean 92.5%), and an accuracy that was consistently above chance for single-finger flexion classification (mean 74.2%), with a greater error observed for more nuanced movements in participants with higher motor impairment. Performance plateaued quickly over time, indicating that user learning to not play a relevant role within the limited number of sessions performed. 

Significance
These findings demonstrate that our system allows good online decoding of different hand and finger movements in people with SCI. The approach supports pathways toward intuitive, digit-level control of neuroprostheses and robotic devices, with strong potential for clinical translation due to its quick setup and ease of use.
Background/Objectives: Hand phlegmons are rapidly progressive bacterial soft-tissue infections that may lead to severe functional impairment, repeated surgical interventions, and prolonged hospitalization if diagnosis and treatment are delayed. Although Gram-positive skin flora are considered the predominant pathogens, microbiological findings and clinical severity may vary considerably depending on the extent of infection and host factors. Methods: This single-center retrospective study analyzed 100 patients surgically treated for hand phlegmons at a university hospital between 2020 and 2025. Clinical data included demographics, portal of entry, microbiological findings, inflammatory markers, antibiotic therapy, number of surgical procedures, and length of hospital stay. Pathogens were classified according to Gram stain characteristics, and statistical analyses were performed using nonparametric methods and correlation analyses. Results: The cohort consisted of 69 male and 31 female patients with a mean age of 50.5 ± 20.9 years. Mean hospital stay was 12.9 days (range 1-77), and patients underwent an average of 2.18 surgical procedures (range 0-11). Wounds and bite injuries represented the most common portals of entry, although many cases lacked a clearly identifiable cause. Microbiological cultures were negative in 62% of cases. Among positive cultures, Gram-positive organisms predominated (84.2%), with Staphylococcus aureus and Streptococcus pyogenes representing the most frequent pathogens. MRSA was detected in three patients and was associated with significantly more surgical procedures (p = 0.04) and a tendency toward prolonged hospitalization. Admission CRP levels differed significantly according to Gram stain classification (p = 0.008) and correlated positively with both length of hospital stay (r = 0.431, p < 0.001) and number of surgical interventions (r = 0.272, p = 0.006). Patients with microbiologically confirmed infections required significantly more operative procedures than patients without pathogen detection (p < 0.001). Empiric antibiotic therapy primarily consisted of ampicillin/sulbactam, cefuroxime, and clindamycin, followed by oral therapy with amoxicillin-clavulanate or clindamycin. Conclusions: Hand phlegmons remain clinically challenging infections characterized by heterogeneous presentation, frequent culture-negative findings, and substantial surgical burden. Gram-positive pathogens continue to predominate, while resistant organisms such as MRSA may be associated with more complex clinical courses. Elevated inflammatory markers at admission correlate with prolonged hospitalization and increased operative requirements, suggesting their potential value as indicators of disease severity. Early diagnosis, prompt surgical debridement, and individualized antimicrobial therapy remain essential for infection control and preservation of hand function.
This report describes a case in which orthotic therapy and the reversed application of a knitted hand function enhancement glove (Nigirukun®) were used to treat an intrinsic-plus-like movement pattern persisting after recovery from wrist drop secondary to radial nerve palsy. The patient was a man in his 20s who developed radial nerve palsy after a traffic accident. Although wrist drop and sensory disturbance improved during recovery, an intrinsic-plus-like movement pattern characterized by metacarpophalangeal joint flexion with proximal and distal interphalangeal joint extension persisted in the left hand, resulting in difficulty in grasping objects, particularly with the ring and little fingers. The intrinsic tightness test showed no evidence of structural shortening, suggesting that abnormal movement was mainly related to a fixed motor control strategy associated with intrinsic muscle overactivity. Initial treatment consisted of thermotherapy, range-of-motion exercises, and orthotic therapy designed to maintain the interphalangeal joints in flexion. To modify the flexion onset pattern during grasping, a knitted hand function enhancement glove was applied in a reversed orientation to assist interphalangeal joint flexion during the early phase of grasping, thereby reducing intrinsic muscle-dominant activation. Immediately after the introduction of the reversed glove, the patient reported improved ease of grasping, accompanied by increases in grip strength and active motion indices. By hospital day 59, total passive motion showed little change; however, improvements in finger flexor strength, active movement measures, and patient-reported outcomes were observed, suggesting that functional recovery may have been related more to changes in motor strategy than to structural joint changes. These findings suggest that the reversed use of a knitted hand function enhancement glove may support sensorimotor re-education and facilitate the relearning of coordinated flexion patterns in daily activities.
Outcome assessment after claw hand correction is inconsistent, with prior reports relying on heterogeneous combinations of joint-angle measurements, photographs, grip testing, and qualitative functional grading. We developed the Contralateral Hand Function Score (CHFS), a simple contralateral hand-referenced composite measure, and evaluated its reproducibility and construct validity. We performed a retrospective study of 51 patients who underwent surgical correction of claw hand between 2009 and 2025. CHFS was calculated as the mean of three equally weighted domains-motion, strength, and function-each expressed as a percentage of the contralateral normal hand. A separate modifier system (CHFS-M) recorded claw-specific contextual determinants of residual impairment but was not included in score calculation. Validation included interobserver reproducibility, interdomain coherence, and predefined known-group comparisons. Cohort characteristics, outcome distribution, and validation metrics were summarized from the study dataset. Mean age was 41.8 ± 12.6 years and mean follow-up was 18.6 ± 7.2 months. Mean CHFS was 66.2 ± 18.4%, with 24% excellent, 55% good, and 21% poor outcomes. Interobserver reproducibility was excellent for the final CHFS (intraclass correlation coefficient, 0.994) and for all component domains (>0.97). Cronbach's alpha was 0.984 for the three domains and 0.932 for the function subitems. CHFS differed significantly by claw type, contracture status, and surgical technique. The most frequent contextual determinants were diminished workspace (42%), arch reversal (38%), thumb pinch deficit (34%), and flexor digitorum profundus weakness (30%). CHFS is a simple, reproducible, and clinically interpretable outcome measure for claw hand correction. It provides a practical contralateral-referenced summary of recovery, whereas CHFS-M improves clinical interpretation by documenting residual contextual deficits not captured by the composite score alone. Therapeutic Level IV.
Infections of the hand are encountered across emergency medicine, primary care, and surgical practice, and their outcomes depend heavily on early recognition. The complex anatomy of the hand, with its multiple fascial planes, tendon sheaths, and confined spaces, allows infection to spread rapidly and produce lasting functional impairment when treatment is delayed. This pictorial review presents a series of clinically important hand infections drawn from the archive of a board-certified hand surgeon, spanning common superficial conditions to uncommon but limb-threatening deep-space, articular, and osseous disease. For each entity, we summarize characteristic clinical features, useful diagnostic and imaging findings, likely causative organisms, and initial management, illustrated with representative clinical photographs and imaging. By organizing these conditions across tissue planes, the review offers a practical, pattern-based reference that clinicians can use at the point of care to triage urgency, select empiric therapy, and identify patients who require early referral or operative intervention.
Grip strength (GS) is a crucial indicator of hand function; however, its reliable assessment in individuals with severe hand dysfunction remains a clinical challenge. This study evaluated the intra-rater reliability of GS and grip pressure (GP) using the Jamar dynamometer and a modified sphygmomanometer (ModSp) in patients with complex bilateral hand dysfunction. Secondary objectives included determining the correlation between the instruments and exploring patient preferences. Fifty-two individuals with severe bilateral hand dysfunction due to systemic sclerosis were assessed as a representative model. A standardized measurement protocol was followed for both instruments. Intra-rater reliability was analyzed using intraclass correlation coefficients (ICCs), and linear regression was used to derive conversion formulas. Patient preferences were recorded using standardized open-ended questions and analyzed via thematic content analysis. Both instruments demonstrated excellent ICCs (0.96-0.98). Strong positive correlations were found between instrument scores (r = 0.88-0.91, p < 0.001), and regression models explained 78-82% of the variance. However, Bland-Altman analysis revealed systematic bias and relatively wide limits of agreement, indicating the methods are not interchangeable. Regarding preferences, 69.2% of participants favored the ModSp, citing greater comfort, better adaptation to deformities, and reduced pain during grasp, while 17.3% preferred the Jamar dynamometer and 13.5% reported no preference. The Jamar and ModSp devices demonstrated excellent intra-rater reliability for grip assessment in severe hand dysfunction. While strongly correlated, they are not directly interchangeable for precise monitoring. The ModSp offers a practical, patient-centered alternative when standard dynamometry is hindered by physical constraints.
Cerebral palsy (CP) is a leading cause of long-term disability for children in Vietnam and across the world, affecting both gross and fine motor skills as well as daily independence. Intensive therapy has been shown to significantly improve motor outcomes. Moreover, parental involvement in therapy contributes positively to child development. Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) is a structured intervention that targets motor function of the upper and lower extremities through intensive, goal-directed practice. This study aims to evaluate the effectiveness of a parent-delivered HABIT-ILE programme in young children with CP in Vietnam, using a randomised controlled trial comparing onsite and online groups of intervention. A total of 48 children aged 2-6 years diagnosed with bilateral CP will be randomly assigned to one of two intervention groups: parent-delivered HABIT-ILE conducted either in a rehabilitation centre or at home. Participants will be paired based on their age and functional levels using the Gross Motor Function Classification System Expanded and Revised and the (mini-)Manual Ability Classification System before randomisation. Each group will receive an identical 50-hour intervention over 2 weeks, delivered by parents under the supervision of HABIT-ILE experts. Primary outcomes include the Gross Motor Function Measure-66 and the Melbourne Assessment 2. Secondary outcomes will consist of Vietnamese versions of the West-African version of the ACTIVLIM-CP questionnaire, Paediatric Evaluation of Disability Inventory, Canadian Occupational Performance Measure and parental quality of life with World Health Organization Quality of Life Brief Version questionnaire. Assessments will occur twice at baseline with 2 weeks in between (T0 and T1), postintervention (T2, 2 weeks after T1) and 3-month follow-up (T3). A 2 (group)×4 (time) repeated-measures analysis of variance will be used to analyse the data ETHICS AND DISSEMINATION: The study has been approved by the Ethics Committee in Biomedical Research at the University of Medicine and Pharmacy at Ho Chi Minh City (Approval No. 726/HĐĐĐ-ĐHYD, issued on 13 June 2024). NCT06593158.
This study aims to compare upper extremity muscle thickness, hand grip strength, manual dexterity, and cognitive functions in elderly individuals living in the community and nursing homes. A total of 85 older adults with similar demographic characteristics, aged 65-80 years, 39 living in nursing homes and 46 community-dwelling older adults, were included in a cross-sectional study. Hand grip strength (HGS) was assessed via the Jamar hand dynamometer, and pinch strength was assessed via the Jamar digital pinch gauge. The Purdue Pegboard Test (PPT) was used to assess manual dexterity, and the Stroop T-Bag Test was used to assess cognitive function. In addition, upper extremity muscle thickness was assessed via ultrasonography. The forearm, biceps brachii, triceps brachii and deltoid muscle thicknesses were lower in elderly people living in nursing homes than in adults living in the community (p < 0.05). HGS and pinch strength were greater in adults living in the community than in adults living in nursing homes (p < 0.05). The total PPT score was higher in adults living in the community than in adults living in nursing homes (p < 0.05). The MOCA score and Stroop test composite score of elderly individuals living in nursing homes were worse than those of adults living in the community (p < 0.05). In this study, older adults living in nursing homes were observed to have lower upper extremity muscle thickness, handgrip strength, pinch strength, manual dexterity, and cognitive performance compared with community-dwelling older adults. This may be related to differences in living conditions, social resources, and environmental factors between the two groups. These findings suggest that maintaining upper extremity muscle thickness and strength, manual dexterity, and cognitive functions may be important for older adults living in nursing homes.
Allergic inflammation, such as allergic asthma, allergic rhinitis, and atopic dermatitis, shares many pathogenic hallmarks, including inappropriate activation of type 2 immune responses, tissue barrier dysfunction, and disruption of local homeostasis. Due to their remarkable plasticity and tissue adaptability, macrophages are crucial effector cells of the innate immune system that play complex, context-dependent dual roles in allergic inflammation. On the one hand, macrophages are implicated in the persistence of chronic inflammation, thereby boosting Th2 cell recruitment, eosinophil infiltration, antigen processing, chemokine secretion, inflammatory mediator release, and tissue remodeling. On the other hand, they promote the resolution of inflammation by triggering barrier repair, producing anti-inflammatory mediators including TGF-β and IL-10, and phagocytosing apoptotic cells. Recent single-cell transcriptomic and functional studies have demonstrated that macrophages are dynamically distributed along an activation continuum rather than merely fitting into the traditional M1/M2 polarization. Functional states are determined by cellular origin, illness stage, tissue niche, and complex regulatory networks. For macrophages implicated in airway inflammation and remodeling, non-IgE-dependent nasal neurogenic reflexes, skin barrier disruption, itch neuroimmune circuits, and inflammation resolution, distinct barrier tissues-such as the lung, nasal mucosa, and skin-show notable tissue specificity. The pathogenic and preventive functions of macrophages in allergic inflammation are systematically summarized in this review, which also emphasizes a continuous spectrum of macrophage activation and incorporates interactions among metabolic reprogramming, pyroptosis, epigenetic control, and trained immunity. Given the dynamic and microenvironment-dependent nature of macrophage function, future treatment approaches need to shift from broad anti-inflammatory therapies to precision reprogramming that is stage-specific and tissue-tuned. During the start and amplification stages of inflammation, therapeutic strategies should target pathogenic M2a-like programs, chemokine networks, monocyte recruitment, and excessive pyroptotic responses. On the other hand, M2b/M2c and pro-resolving macrophage-mediated efferocytosis, immunological tolerance, and tissue healing should be the focus of tactics in the resolution and repair stages. Furthermore, the management of allergic diseases may shift from empirical anti-inflammatory therapy to mechanism-guided precision interventions through patient stratification based on single-cell omics, spatial omics, and macrophage-associated biomarkers.
Aging is associated with declines in muscle strength, yet after menopause the relative rate of decline is greater in females than males. Whether sex hormones are predictive of strength across the lifespan and with aging is largely unknown. This study assessed the impact of sex hormone concentrations and menopause hormone therapy (MHT) on muscle strength in aging. Hand grip strength, sex hormone concentrations (total testosterone, bioavailable testosterone (FAI), estradiol, bioavailable estradiol (FEI)), and history of female MHT use were extracted or calculated from the National Health and Nutrition Examination Survey (NHANES) for 4,330 participants (2,194 females). Males were 36-40% stronger than females throughout adulthood. One-year averages of total testosterone (r=0.48, p<0.01), FAI (r=0.86, p<0.001), and FEI (r=0.71, p<0.001) were associated with strength in males. All hormones were correlated with strength in females, with estradiol (r=0.81, p<0.001) and FEI correlations (r=0.82, p<0.001) the strongest. Multiple linear regressions demonstrated that the FAI was a predictor of strength, while total testosterone was not, in both males and females and that estradiol and FEI were indicative of female strength in later adulthood. Hand grip strength in older females with a history of MHT use was 1.9kg greater than those with no MHT history (p<0.01) and this advantage widened with age (2.4% at 60 yrs to 14.3% at ≥80 yrs). This study strongly suggests (1) age-related declines in endogenous sex hormones, particularly bioavailable hormones, contribute to strength reductions with aging; and (2) MHT may have the potential to offset meaningful strength reductions with advanced aging.
Chronic right ventricular (RV) pacing (RVP) causes pacing-induced cardiomyopathy (PICM) in only a small number of patients. We evaluated ECG correlates of (i) PICM and (ii) response to cardiac resynchronization therapy (CRT) upgrade. We conducted a retrospective case-control study by including all CRT upgrades for PICM (LVEF <50%) at our center between 2014 and 2018. Controls were patients with ≥5 ECGs all demonstrating RVP over ≥2 years and all echocardiographic LVEF ≥50%. Root-summed-squared (3D) ECG was obtained from reconstructed vectorcardiographic X-Y-Z leads. Predictors of PICM and CRT response were assessed as area under ROC curve (AUC) for pre-CRT and Δ (post-CRT - pre-CRT) ECG intervals and QRS voltage-time-integrals (VTI). We included 104 patients with CRT upgrade for PICM (age 73.7 ± 10.5 years, female 29.1%, QRS duration 167.8 ± 25.2 ms, LVEF 28.8 ± 8.0%, ΔLVEF 13.8 ± 10.3%) and 178 controls without PICM (age 73.2 ± 14.9 years, female 52.8%, QRS duration 144.0 ± 20.9 ms, LVEF 56.7 ± 5.2%). PICM was best identified by VTIQRS-3D (AUC 0.851; VTIQRS-3D ≥ 80 μVs sensitivity 87.5%, specificity 63.5%), VTIQRS-Y (0.846), and QRS duration (0.775). CRT response (LVEF increase ≥10% at 3-12 months) occurred in 73/104 (70.2%) patients. Lack of CRT response was best predicted by longer pre-CRT QRS duration (AUC 0.640; QRS duration ≥180 ms sensitivity 45.2%, specificity 83.6%), and less ΔVTIQRS-3D (0.609) and ΔVTIQRS-X (0.608). In patients with chronic RVP, VTIQRS-3D ≥ 80 μVs can be used as a screening test for echocardiographic confirmation of PICM. RV-paced QRS duration >180 ms, on the other hand, identifies those who may not respond to CRT upgrade.
Cervical cancer (CC) is a main malignancy affecting women globally, with a high mortality rate. Chemoradiotherapy resistance is a significant factor in determining treatment outcomes, and prognostic biomarkers are essential for the appropriate selection of therapeutic strategies. This study aimed to identify gene expression signatures that may allow for follow-up treatment response in CC patients. Samples of non-stem CC cells selected by Fluorescence-activated Cell Sorting from 21 Responders and 10 Non-responder patients, who attended the Mario Penna Institute (Belo Horizonte-Brazil) from August 2017 to May 2018, and submitted to Next-generation RNA sequencing, were analyzed to evaluate differential gene expression profiles between both groups. Machine Learning and statistical analyses were performed to identify a signature related to clinical outcomes. 2670 Differentially expressed genes (DEGs) with log2FoldChange ≤ -1 or ≥ 1 and adjusted p-value ≤ 0.05 were found. Of these, 1591 were protein-coding, but only 8 were considered relevant based on machine-learning and statistical analyses for classifying treatment response. However, only PNMA3 and ZIK1 were markedly upregulated in non-responder patients. Among the genes upregulated in Responder patients, only ATF4 and ATP1B3 were identified by machine-learning analysis. On the other hand, only ATF4, PNMA3, and ZIK1 were associated in network interactions, more specifically to apoptosis pathways, and the differential expression of ATF4 and PNMA3 occurred exclusively in cervical cancer non-stem cells, in the presence of ZIK1. We propose that upregulation of PNMA3 and downregulation of ATF4, specifically in cervical cancer non-stem cells, is associated with upregulation of ZIK1 and with resistance to apoptosis and chemoradiotherapy. Therefore, suggesting that these genes may serve as potential signatures for CC prognosis.
Fully covered self-expandable metallic stents (FCSEMSs) are used widely for the preoperative biliary drainage of pancreatic cancer because of their low recurrent biliary obstruction (RBO) rates. On the other hand, concerns about non-RBO adverse events (AEs), such as pancreatitis, have led to ongoing debate over the optimal stent. Therefore, this study aimed to clarify the clinical outcomes of preoperative biliary drainage using plastic stents (PSs) and FCSEMSs for patients with pancreatic cancer undergoing neoadjuvant chemotherapy (NAC). This study retrospectively reviewed consecutive patients (between June 2012 and September 2024) who underwent NAC following biliary drainage using either PSs or FCSEMSs and who were followed up until the decision for or against a surgical resection was made. Forty-seven patients were included (PS, n=33; FCSEMS, n=14). The RBO rate was not significantly different (39% vs. 7.1%, p=0.081), whereas the time to RBO was significantly longer in the FCSEMS group (126 days vs. not reached, p=0.046). Non-RBO AEs were observed more frequently in the FCSEMS group (15% vs. 43%, p=0.061). The rate of overall AEs, including RBO and non-RBO AEs, was similar between the two groups (45% vs. 43%, p=1.000). Subgroup analysis between the PS ≥10 Fr (n=27) and FCSEMS groups showed no significant differences. Large-diameter PSs may be an alternative in selected patients at high risk of non-RBO AEs, including post-ERCP pancreatitis, but attention should be paid to the risk of RBO.
The clinical management of osteosarcoma faces critical challenges, including postoperative recurrence and metastasis of residual tumor cells, chemotherapy resistance, and impaired self-repair capacity due to extensive bone defects following tumor resection. Herein, we develop a novel functionalized 3D-printed scaffold with NIR-II responsiveness (BGS/I-LDH@MgO2), designed to simultaneously address the dual needs of inhibiting osteosarcoma recurrence and promoting bone regeneration. This scaffold consists of 3D-printed bioactive glass scaffold (BGS) and MgO2-modified ZnAl-layered double hydroxides (ZnAl-LDHs) intercalated with 5-iodo-isophthalic acid (I-IPA). Under NIR-II irradiation, the scaffold effectively triggers a photodynamic therapy (PDT) effect to eliminate osteosarcoma cells. Notably, the incorporation of MgO2 enables oxygen release within the tumor microenvironment, alleviating hypoxia and enhancing PDT efficacy for superior antitumor performance. Furthermore, the degradation of ZnAl-LDHs and MgO2 releases Mg2+ and Zn2+ ions and generates a mildly alkaline microenvironment, which collectively facilitate the osteogenic differentiation of bone marrow mesenchymal stem cells and accelerate the process of bone healing. This functionalized 3D-printed scaffold demonstrates excellent anti-tumor and osteogenic properties, showing great promise for the treatment of osteosarcoma-associated bone defects.
Idiopathic frozen shoulder is a disabling condition characterized by pain and restricted range of motion, often evaluated using patient-reported outcome measures such as the Disabilities of the Arm, Shoulder and Hand (DASH) score. However, the clinical interpretation of DASH changes remains unclear without defined thresholds for meaningful improvement. While the minimal detectable change (MDC) has been established for various musculoskeletal conditions, poor data exist for patients with frozen shoulder treated with focal extracorporeal shock wave therapy (f-ESWT). This study aims to address this gap. Our primary aim was to establish the MDC of the DASH score in this population. Secondary goals included: (1) identifying the MDC values for Constant-Murley Score (CMS) (2) evaluating the patients' improvement over time; and (3) studying treatment influence outcomes over time. The primary hypothesis was that a clinically meaningful MDC for the DASH score can be identified in patients with idiopathic frozen shoulder treated with f-ESWT, and that this threshold would be consistent with or slightly higher than values reported in other upper limb disorders. A prospective cohort of 94 patients with idiopathic frozen shoulder treated with f-ESWT was analyzed, with 77 patients completing 12-month follow-up. Inclusion criteria required clinical diagnosis and intact rotator cuff. Outcomes included DASH, CMS, and VAS scores assessed at baseline, end of treatment, and at 2-, 6-, and 12-month follow-ups. Subgroup analysis evaluated early (<3 months) versus delayed treatment. Significant improvements were observed in all outcome measures over time (p < 0.001). DASH scores decreased significantly from baseline to all follow-ups, with continued improvement up to 12 months. The MDC for DASH scored 18.3. The MDC of CMS was 18.9. Patients treated within 3 months showed significantly better DASH scores at 2 months (p = 0.034). No complications were reported. This study establishes clinically relevant MDC thresholds for DASH in idiopathic frozen shoulder treated with f-ESWT, supporting its use as a meaningful outcome measure. The findings align with previous literature in upper limb disorders but suggest slightly higher thresholds, likely due to greater baseline disability in this population. Early treatment may enhance recovery, emphasizing the importance of timely intervention. These results provide valuable benchmarks for clinical interpretation and trial design, although limitations include reliance on distribution-based methods and absence of a control group. II; prospective cohort study.
To compare the midterm clinical and radiographic outcomes of extracorporeal shockwave therapy (ESWT) and ultrasound-guided needling (UGN) in symptomatic calcific tendinitis of the rotator cuff (RCCT). This study is a follow-up of a randomized controlled trial. Eighty-two patients with shoulder complaints due to RCCT (>5 mm in size, Gärtner type I-II) persisting >4 months despite nonoperative treatment, including a subacromial corticosteroid injection, were allocated to ESWT (4 sessions of high-energy ESWT) or UGN (single ultrasound-guided puncture and lavage using two 17-gauge needles). Outcomes at 5 years were the Constant-Murley Score (CMS), Disabilities of the Arm, Shoulder, and Hand questionnaire, and visual analog scale for pain. Radiographs were used to evaluate the size, location, morphology, and recurrence of the deposits. The minimum follow-up in this study was 5 years (mean 6.8 ± 1.1 years; range 60-106 months). Sixty-seven (82%) of the original 82 patients were included (43 females; 64%, mean age 51.8 ± 9.0 years). Baseline CMS was 67.4 ± 12.5. At 5 years, the mean CMS was 94.4 ± 6.4 and 93.3 ± 13.6 for ESWT and UGN, respectively (P = .67). Ninety-four percent of both groups achieved the minimal clinically important difference threshold value for CMS. Additional treatment was received by 42% and 26% of ESWT and UGN, respectively (P = .17). No recurrence of calcific deposits was found in treated tendons. New deposits in a different rotator cuff tendon were observed in 15% of UGN patients. Patients with RCCT treated with ESWT and UGN show excellent midterm clinical and radiographic outcomes, with most achieving clinically important difference threshold values without significant intergroup differences. Both treatment groups showed high rates of additional treatments with the potential of underpowered analysis. Level II, randomized controlled trial.
To provide a comprehensive summary of the existing literature that describes treatment options for post-concussion sleep disturbances in children and adults. Studies have shown that 30%-70% of individuals who sustain a concussion develop a post-injury sleep disturbance. The presence of sleep disturbance contributes to prolonged recovery from concussion and poorer long-term outcomes. Thus, identifying effective treatments for post-concussion sleep disturbances is essential to reduce the burden of persisting post-concussion symptoms. Scoping review. A systematic literature search was conducted in MEDLINE, Embase, CINAHL, Web of Science, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts, then full-text articles against the inclusion and exclusion criteria. Primary studies that investigated at least 1 treatment for post-concussion sleep disturbances were included. Of the 3660 articles yielded from the initial search, 19 were included in this review. The most commonly studied intervention was CBT (n = 3), followed by blue-light therapy (n = 2), photobiomodulation (n = 2), and melatonin (n = 2). Other treatments included an educational intervention, trauma-focused psychotherapy, 2 novel forms of psychotherapy, acoustic neuromodulation, multisensory integration therapy, gabapentin, hand self-shiatsu, interdisciplinary rehabilitation, and music therapy. The most common study design was a randomized controlled trial (n = 8, 42%). Over half of the studies (n = 13, 68%) used pre-existing validated scoring tools as subjective measures of sleep. Only 4 studies were conducted exclusively in children 18 years and younger. This review supports current guidelines that recommend CBT as a first-line therapy for post-concussion sleep disturbances. However, higher-quality evidence is needed before other interventions should be incorporated into routine practice, particularly for children. Future research should consider the impact of other post-concussion symptoms on adherence to sleep-promoting therapies.
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To evaluate the effect of pulley system exercises combined with conventional therapy on upper-limb function in children with hemiplegic CP. A randomized controlled trial was conducted with 32 children aged 3-7 years with hemiplegic CP. Participants were allocated to an intervention group (A) receiving pulley system exercises alongside conventional therapy or a control group (B) receiving conventional therapy alone. Outcomes measured pre- and post-intervention included the Assisting Hand Assessment (AHA), Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), and isometric muscle strength. Both groups improved significantly, but the intervention group showed significantly greater gains in bimanual performance, motor coordination, and muscle strength compared to controls (P<0.01). Incorporating structured pulley system exercises with conventional therapy significantly enhances upper-limb function in children with hemiplegic CP. This affordable, adaptable approach may optimize rehabilitation outcomes by delivering high-repetition, progressively loaded, task-specific practice.