Neck manipulation is commonly used in the management of some musculoskeletal disorders to reduce pain and improve movement. There is, however, little understanding about the underlying mechanism. Recent research has alluded to a neurophysiological mechanism mediated through supraspinal pathways in the central nervous system, that may alter motor activity. The purpose of this study was to determine the effect of neck manipulation on the excitability of cortical motoneurons by means of activating corticospinal pathways to the flexor carpi radialis (FCR) muscle in an active motor system using the transcranial magnetic stimulation (TMS) technique.Motor evoked potentials (MEPs) were elicited by TMS and recorded in 20 normal subjects using established procedures. The peak-to-peak amplitude of MEPs were measured both before and after C6/7 manipulation and before and after neck positioning. Both interventions were applied to the normal subjects in random order on two different days. MEPs were recorded immediately after the intervention, then seven minutes and 14 minutes later to assess the time course of the effect. Five neck pain subjects participated in the manipulation experiments. The effects of manipulation, resulting in joint cavitation, were also explored. Two trials were undertaken before the intervention and these served as control measures. MEP data was represented in two ways. Firstly, 40 MEPs were averaged over 120 seconds; secondly, 15 MEPs were average over 60 seconds. A percentage change calculation was used to express the data relative to the baseline. Alterations in cortical excitability before and after manipulation were analysed by repeated measure analysis of variance (ANOVA) on the MEP data, and percentage change scores.Cortical neurons projecting to FCR were significantly facilitated up to 60 seconds after the manipulation of the non-painful segment, relative to baseline values and the positioning control. A small but significant latent increase in excitability was also observed 15 minutes after manipulation. The response to manipulation of the painful cervical segment was significantly different from that of the non-painful segment. When manipulation of the painful segment did not result in joint cavitation, an inhibitory effect was observed. In contrast, however, cortical motoneurons were facilitated when joint cavitation was associated with manipulation.In conclusion, motor activity is enhanced with neck manipulation when cortical motoneuron excitability is measured by TMS in human subjects performing a voluntary contraction. This may explain the clinically observed improvement in spinal motion and motor control with spinal manipulation. Further, joint cavitation may be important in signifying the success of the joint manipulation. The excitatory effect on cortical motoneurons is probably mediated through a transcortical pathway by means of the activation of muscle afferents with the manipulative thrust.These findings assist in understanding the neurophysiological mechanism underlying the effect of spinal manipulation.

<p>Abstract</p><p>The purpose of this study was to investigate if physical training on swissball could minimize the pain in back and neck. Two employers where interviewed about physical training and health, to see if their labourers needed physical training. Twelve labourers with sedentary work participated in the study for six weeks. Half group of twelve where active during the same period while other half where inactive. Twelve VAS-scale handled out before and after exercise to give a result. The result show that the majority of active persons got less pain in back and neck after physical exercise on swissball. The majority of inactive persons got more pain.</p>

Using an existing data set comprised of 368 individuals newly diagnosed with cancers of the head and neck, we investigated the predictive validity of the Head and Neck Patient Symptom Checklist (HNSC) by comparing scores on the HNSC to scores on the Patient-Generated Symptom Global Assessment (PG-SGA), and by examining the ability of HNSC scores and four demographic variables to predict dietary intake, weight loss, and functional capacity. HNSC sensitivity (0.79 0.98), specificity (0.99 1.00), positive predictive value (92% 100%), and negative predictive value (94% - 100%) were excellent. Pain, loss of appetite and difficulty swallowing predicted 82% of reduced dietary intake. Advanced tumor stage, loss of appetite and difficulty swallowing predicted 79% of weight loss. Loss of appetite, difficulty swallowing, feeling full and lack of energy predicted 78% of reduced functional capacity. The HNSC appears to be valid and could aid with early symptom identification, intervention and improved outcomes.

Whiplash injuries occur in automotive crashes and may cause long term health issues such as headache, neck pain, and visual and auditory disturbance. Whiplash-Associated Disorders are very costly and can impair the quality of human lives. Most studies focus on whiplash injuries that occur in neutral position head postures, although there is some evidence in the literature that non-neutral head posture can significantly increase the persistence of symptoms on patients. Crash dummies have limited biofidelity particularly for out-of-position scenarios and the current neck injury criteria were not derived for situations at which the head motion is not through the sagittal plane. Therefore Finite Element Methods provide an important tool that can be used to predict injury in different impact scenarios. The Finite Element model which was used for this study was previously developed at the University of Waterloo representing a 50th percentile male. The model had been previously validated at the segment level in extension, flexion, tension, and axial rotation. The full cervical spine model was validated in frontal and rear impact as well as tension. Since the final validation of the model, the ligament properties of the upper cervical spine and the muscle implementations had been improved to enhance the biofidelity of the model. To further improve the model, the addition of laxities to the ligaments of the upper cervical spine was studied. Several studies were performed based on the experiments in the literature to determine appropriate laxities for the upper cervical spine model. First, the laxities of -2 to 4 mm on all the ligaments were studied on the segment level of the model to find their effect on the failure force and displacement to failure in extension, flexion, tension, and axial rotation. The model development then went through a series of iterations in order to achieve laxity values that satisfied the failure force and displacement to failure reported in the literature for the four loading cases. Finally the laxities were used on a full cervical spine model and tested in physiological range of motion in extension, flexion, axial rotation, and lateral bending. The laxities were optimized using an iterative process. The results of this study provided laxity values that were acceptable in both segments level failure study and full cervical spine physiological range of motion study. The model was also validated against literature in impact scenarios. Using a cadaver experiment of 7 g rear impact, the global kinematics of the cervical spine was verified against the literature. The model provided good agreement with the head kinematics and relative rotations between the vertebrae for the cadaver tests. An 8 g rear impact cadaver test was used to validate the ligament strains and disc shear strains. For the anterior longitudinal ligament, the capsular ligament, and the disc shear strains, the model results were within one standard deviation of the literature in the majority of cervical spine regions that were reported. The model was also validated against volunteer low severity rear impact to verify the active musculature in the cervical spine. The head kinematics was generally within the boundaries that were reported by the literature. The model was compared to an experiment that used cadavers to investigate non-neutral rear impact scenarios. This experiment used cables and springs to replicate the passive behaviour of the musculature. The model showed good agreement with the extension and axial rotation results in both head kinematics and relative vertebrae rotations. The flexion and lateral bending results were not similar to the experimental data; attributed to the difference in muscle implementation between the two models. A total of 24 simulations were completed to find the effect of impact severity, axial rotation, and muscle activations on ligament strains during out-of-position rear impacts. The results illustrated that in general, ligament strains increased with the severity of impact and decreased with muscle activation. In out-of-position scenarios, the strains increased in some of the ligaments. An increase to the ligament strain as a result of non-neutral posture was mostly visible in the capsular ligaments of the upper cervical spine. The alar ligament and the apical ligaments of the upper cervical spine may fail in out-of-position at high rear impact scenarios. Recommendations for future work on the cervical spine Finite Element model includes the validation of the musculature and the usage of the muscles to rotate the head to a desired position to improve the biofidelity of the model and the results in out-of-position rear impacts. Further optimization of the laxities of the upper cervical spine can increase the biofidelity in this region. The modeling of the vertebral arteries into the FE model can help investigate whether out-of-position can increase the chance of injury of this region. The effect of flexion, extension, lateral bending, and their combination with axial rotation and the study of frontal and side impacts can be helpful in design of safer headrests for vehicles.

Bone quality and the conditions that affect it make up a large field of study. One specific area of interest is the loss in bone strength during exposure to microgravity. The femoral neck (FN) region in particular is an important region of study since a FN failure has such a detrimental effect on mobility. The objective of this study was to characterize the effects of microgravity and recovery on the FN in the adult male hindlimb unloaded (HU) rat model. This was done through peripheral quantitative computed tomography (pQCT), mechanical testing in two different loading conditions, and estimated strength indices. Adult male Sprague-Dawley rats (6-mo) were grouped into baseline (BL), ambulatory cage control (CC) and hindlimb unloaded (HU); HU and CC animals were further divided into sub-groups (n=15 each): HU euthanized after 28 days of suspension, and HU euthanized after 28, 56, and 84 days of recovery with CC groups being euthanized at each of these time points. The excised right and left femoral necks were both scanned ex vivo using pQCT. Quasi-static mechanical testing was performed with the right femurs positioned vertically and the left femurs positioned laterally at a -10 degree angle. A series of strength indices was used to attempt to predict the mechanical testing results, including a compression index, a bending index and an alternative combination of the two. HU exposure led to 6.3 percent lower bone mineral content (BMC), compared to BL and 7.8 percent lower total volumetric bone mineral density (vBMD) at the FN. The vertical or axial loading showed a 17.1 percent drop in mechanical strength due to HU exposure. The lateral loading test revealed a 5.4 percent drop in strength, showing that HU had a greater effect on the axial loading configuration. Also, after just 28 days of recovery, the axial loading test revealed a complete recovery of strength. None of the strength indexes completely predicted the mechanical behavior of the FN. In the right femur, the combined index had the highest correlation with an R value of 0.94. The bending strength index had the highest correlation in the left lateral testing with an R value of 0.98. However, in all the cases, the strength indexes failed to predict the mechanical behavior at all the time points. In general, the strength indexes provide valuable input, but fail to replace mechanical testing.

The purpose of this study is to evaluate the health related quality of life (QoL) of head and neck cancer (HNC) patients with cancer-free survival after treatment and to investigate the factors correlated with their health-related QoL. The European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30) questionnaire and the EORTC head and neck cancer-specific questionnaire (QLQ H&N-35) were self-administered by all participating patients. Sociodemographic data were collected using a questionnaire specifically designed for the study and through the medical chart reviewed. The patients who have been treated radiotherapy in our department of radiation oncology were invited to participate Health-related quality of life was assessed 3 months or later after completion of radiotherapy. Data relating to sociodemographic factors, disease characteristics and treatment factors of HNC survivors were analyzed. A total of 141 head and neck cancer patients completed the questionnaires. After data analysis, the results are described as follows: In the results of EORTC QLQ-C30 questionnaire, the score of ¡§global health status¡¨ is 69.34. Most of the patient could maintain good functional quality of life. ¡§Fatigue¡¨ is the most impaired symptom score in the patient. In the results of EORTC QLQ-H&N35, the three head and neck specific symptom scores indicating the most impaired in QOL were ¡§Weight loss¡¨, ¡§Nutrition supplements¡¨ and ¡§dry mouth¡¨. After analysis through the multiple regression model, we found sex, age, tumor subsite, radiotherapy technique and surgery were the independent factors significantly correlated with the QoL scales This study is helpful for us to understand the QoL status and the factors affecting the QoL for patients with head and neck cancer after radiotherapy.

Introduction: Current treatment recommendations for advanced SCCHN include the use of combined modality therapy (e.g., radiation plus chemotherapy/biologic therapy). The new biologic agent, cetuximab, is considered a primary cost driver for SCCHN management. Cetuximab’s impact, however, has not been factored into SCCHN cost estimates; furthermore, costs have not been delineated for diagnostic, treatment, and end-of-life segments of advanced SCCHN management. We aim to characterize SCCHN segmented and overall costs, before and after cetuximab’s approval. Methods: This was a retrospective analysis of the PharMetrics Choice database. Patients >20 years of age with ICD-9-CM codes suggestive of advanced SCCHN diagnosed between 3/1/2003 and 3/1/2008 were included. Patients were divided into cohorts by diagnosis date: “pre-biologic” and “post-biologic.” Descriptive statistics were used to summarize patient characteristics, monthly and total medical costs, and cost drivers. The Mann-Whitney U test was used to compare costs between segments and cohorts; whereas, least squares regression was used to ascertain the impact of covariates. Results: A total of 365 patients met study criteria. Patients were predominately male (78%), with a median age of 57 years. Median monthly costs were: diagnosis ($2,199), treatment ($4,161), end-of-life ($6,614), and total ($4,167). Total direct medical costs were primarily driven by outpatient costs (23%). Patient age and length of follow-up had a significant impact on total costs, with older age associated with lower costs. When treatment segment was isolated, median monthly costs were lower in the “pre-biologic” as compared to the “post-biologic” era ($3,301 vs. $4,381, p=0.0024); biologic therapy accounted for 4.2% of total cost in the study period. In those patients experiencing all segments of care (“benchmark group”), median monthly costs were: diagnosis ($1,733), treatment ($8,265), end-of-life ($6,614), and total ($7,817). There were no significant differences in monthly medical costs between cohorts for the benchmark group. Conclusions: Median total cost exceeded $4,000/month for SCCHN patients; treatment and end-of-life segments incurred higher costs. Outpatient costs were the biggest cost-driver. Median monthly cost for the treatment segment increased by approximately $1,000 following cetuximab’s approval; however, this difference dissipated when the analysis was limited to those patients who experienced all segments of care. / text

published_or_final_version / Surgery / Master / Master of Philosophy

published_or_final_version / Surgery / Master / Master of Philosophy

Kaklo ir viršutinės galūnės skausmai yra plačiai paplitę tarp biuro darbuotojų. Tai šiuolaikinių biurų darbuotojų problema: kasmet daugėja ��monių, kurie didelę darbo dienos dalį praleidžia prie kompiuterio, daugėja ir tų, kurie skundžiasi kaklo bei viršutinės galūnės ir galvos skausmais. Darbo tikslas. Nustatyti kineziterapijos poveikį, mažinant galvos, kaklo ir viršutinės galūnės skausmus biuro darbuotojams. Taikyti metodai. Pirminės darbuotojų apklausos metu buvo apklausti 68 darbuotojai, didžiąją dienos dalį dirbantys kompiuteriu. Buvo atrinkti 25 darbuotojai (moterys), kurie sutiko dalyvauti antrajame tyrimo etape. Beveik visi jautė galvos, kaklo, pečių lanko skausmus. Tiriamosioms (n=25) buvo taikomi KT pratimai, laikomasi ilgų bei trumpų poilsio pertraukėlių, paaiškintos pagrindinės taisyklingos sėdėsenos taisyklės. Po 12 savaičių buvo vykdomas antrasis tyrimo etapas. Jo metu buvo pakartotinai apklausiami darbuotojai ir atliekami judesių amplitudės matavimai, vertinama raumenų jėgos dinamika bei pusiausvyra. Anketa buvo paruošta remiantis modifikuota Aberdeen skausmo skale, Borg CR10 skale, Vernono kaklo negalios indekso skale. Rezultatai. Tyrimo rezultatai parodė, jog iš (n=25) apklaustų darbuotojų prieš kineziterapiją skausmą jautė 92% tiriamųjų. Dažniausiai pasitaikantys buvo galvos, kaklo ir viršutinės žasto dalies skausmai. Po 12 savaičių KT taikymo, sėdėsenos korekcijos bei optimalaus darbo ir poilsio rėžimo laikymosi, pastebimas žymus galvos, kaklo ir rankos... [toliau žr. visą tekstą] / Neck and upper limb pain is frequently reported by computer workers. It is becoming a common problem as more people are using computers and so more and more people are complaining of pain in the neck and upper limbs, and headaches. Aims: To identify the efficacy of physiotherapy in order to relieve headache, chronic neck and shoulder pain. This research programme was concerned with people that spend the largest part of their working day using computers. Methods: The present study was designed to quantify the typical level of pain, and then to test the efficacy of physiotherapy intervention. Sixty eight workers answered the questionnaire. Only twenty five computer workers were asked to partcipate in the study, all of whom had reported headaches and had frequent or long standing neck and upper limb symptoms. Participants were asked to fill out a modified questionnaire detailing their pain before the intervention and after. The range of various neck and arm movements of the participants were then measured using goniometry and the results recorded. The group was then taught various exercises and required to take regular breaks for 12 weeks. Results: The pain was found to have been effectively relieved. Physical exercise intervention resulted in a statistically significant (p<0,05) decrease in the intensity of headaches and neck pain (from 92% to 48%). The increase in the the range of mobility and static balanse signicantly improved (p<0,05). Conclusion: Although physiotherapy is... [to full text]