BACKGROUND: Differential diagnosis is a hot topic in physical therapy, especially for those working in a direct access setting dealing with neck pain and its associated disorders. All international guidelines agree in recommending to first rule out non-musculoskeletal pathologies as the cause of signs and symptoms in the patient. Although the autonomic nervous system (ANS) has a crucial role and is also involved in pain conditions, coverage of it in neuroscience textbooks and educational programmes is limited and most healthcare professionals are unfamiliar with it. Although autonomic conditions are benign in nature, they are clinically of great importance as they may be a 'red flag' warning of an injury along the sympathetic pathway. Therefore, sound knowledge of the ANS system is essential for clinicians.OBJECTIVE: To develop physical therapists' knowledge of and confidence in understanding cervical ANS function and dysfunction, thus enhancing clinical reasoning skills and the pattern recognition process, and performing and interpreting objective examinations.METHODS: This master class provides an introductory guide and essential knowledge to facilitate clinicians to understand cervical autonomic dysfunctions and their clinical evaluation. The optimal referral method is also handled.CONCLUSIONS: Gaining knowledge and understanding of the ANS, its function, its dysfunction, and the related clinical manifestations is likely to lead to a decision-making process driven by 'science and conscience'. This will empower physical therapists to be aware of subtle clues that may be offered by patients during the interview and history intake leading to the appropriate physical examination and triage.
DOCUMENT
Abstract: Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.
DOCUMENT
In de afgelopen jaren groeide het besef dat veel inwoners die een beroep doen op de publieke dienstverlening de nodige stress en zorgen ervaren. Werkloosheid, hoge schulden of problemen in de opvoeding kunnen eraan bijdragen dat het leven van mensen meer vraagt dan zij aankunnen. Het besef dat chronische stress een wissel trekt op het functioneren heeft een groeiende groep publieke dienstverleners geïnspireerd om in de ondersteuning die zij inwoners bieden, (meer) rekening te houden met de doorwerking van de stress op gedrag. Dat een aanhoudend stroom van zorgen verklaart waarom inwoners die hulp nodig hebben te vaak niet in staat blijken om de processtappen te zetten die van hen worden gevraagd: stukken aanleveren, geen afspraken missen, solliciteren, rondkomen van weekgeld, et cetera. Een van de belangrijkste middelen voor professionals om inwoners te motiveren en te ondersteunen de processtappen toch te zetten is het gesprek. Veel professionals (en hun management) hebben de neiging om vooral aandacht te besteden aan de inhoud van die gesprekken. Een verkenning van studies naar de impact van inrichting op ervaren stress leert dat ook de inrichting van een gebouw kan bijdragen aan stress-sensitieve dienstverlening. Op verzoek van de gemeente Utrecht en in nauwe samenwerking met Studio Sociaal Centraal heeft het lectoraat Schulden en Incasso een literatuurverkenning uitgevoerd om de gemeente Utrecht en andere uitvoerders van publieke dienstverlening op weg te helpen bij het inrichten van ontmoetingsruimten voor professionals die uitvoering geven aan onder meer de schuldhulpverlening, re-integratie, Wmo, jeugdhulpverlening en jeugdgezondheidszorg.
DOCUMENT
The objective of this study is to investigate the heart rate (HR) accuracy measured at the wrist with the photoplethysmography (PPG) technique with a Fitbit Charge 2 (Fitbit Inc) in wheelchair users with spinal cord injury, how the activity intensity affects the HR accuracy, and whether this HR accuracy is affected by lesion level.
MULTIFILE
Background: Sexual deviance is regarded as an important risk factor for sexual offending. However, little is known about the development of deviant sexual interests. The transfer of arousal between emotions, i.e., excitation transfer, could attribute sexual salience to stimuli that would otherwise not be sexual in nature. As such, excitation transfer could contribute to the very beginning of unusual or deviant sexual interests. The current protocol proposes a study to investigate to what extent excitation transfer occurs, i.e., to what extent genital and subjective sexual arousal to sexual stimuli is higher in an emotional state than in a neutral state. Following a prior pilot study, several adjustments were made to the study protocol, including a stronger emotional manipulation by using 360-degree film clips and the inclusion of a larger and more sexually diverse sample. Methods: We will recruit 50 adult male volunteers with diverse sexual interests. We will induce sexual arousal in four different emotional states (aggression/dominance, endearment, fear, disgust) and a neutral state. Sexual arousal will be measured genitally using penile plethysmography and subjectively via self-report. Using paired samples t-tests, sexual arousal in the emotional states will be compared with sexual arousal in the neutral state. Discussion: We aim to show that arousal in response to emotional stimuli that are initially nonsexual in nature, can enhance sexual arousal. These findings have potentially important implications for the development of unusual and/or deviant sexual interests and possibly for the treatment of such sexual deviant interests in people who have committed sexual offenses.
DOCUMENT
Background Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. Methodology In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth. Findings The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. Conclusion By listening to women’s experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers’ wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.
DOCUMENT
Comparisons of visual perception, response-selection, and response-execution performance were made between Type 2 diabetes mellitus patients and a matched nondiabetic control group. 10 well-controlled male patients with Type 2 diabetes without diabetic complications (M age 58 yr.) and an age and IQ-matched non-diabetic control group consisting of 13 male healthy volunteers (M age 57 yr.) were included. Significant differences were found only between the two groups on response-selection performance, which concerns the selection and preparation of an appropriate motor action.
DOCUMENT
Music interventions are used for stress reduction in a variety of settings because of the positive effects of music listening on both physiological arousal (e.g., heart rate, blood pressure, and hormonal levels) and psychological stress experiences (e.g., restlessness, anxiety, and nervousness). To summarize the growing body of empirical research, two multilevel meta-analyses of 104 RCTs, containing 327 effect sizes and 9,617 participants, were performed to assess the strength of the effects of music interventions on both physiological and psychological stress-related outcomes, and to test the potential moderators of the intervention effects. Results showed that music interventions had an overall significant effect on stress reduction in both physiological (d = .380) and psychological (d = .545) outcomes. Further, moderator analyses showed that the type of outcome assessment moderated the effects of music interventions on stress-related outcomes. Larger effects were found on heart rate (d = .456), compared to blood pressure (d = .343) and hormone levels (d = .349). Implications for stress-reducing music interventions are discussed.
DOCUMENT
Music interventions are used for stress reduction in a variety of settings because of the positive effects of music listening on both physiological arousal (e.g., heart rate, blood pressure, and hormonal levels) and psychological stress experiences (e.g., restlessness, anxiety, and nervousness). To summarize the growing body of empirical research, two multilevel meta-analyses of 104 RCTs, containing 327 effect sizes and 9,617 participants, were performed to assess the strength of the effects of music interventions on both physiological and psychological stress-related outcomes, and to test the potential moderators of the intervention effects. Results showed that music interventions had an overall significant effect on stress reduction in both physiological (d = .380) and psychological (d = .545) outcomes. Further, moderator analyses showed that the type of outcome assessment moderated the effects of music interventions on stress-related outcomes. Larger effects were found on heart rate (d = .456), compared to blood pressure (d = .343) and hormone levels (d = .349). Implications for stress-reducing music interventions are discussed.
DOCUMENT
Recent advancements in mobile sensing and wearable technologies create new opportunities to improve our understanding of how people experience their environment. This understanding can inform urban design decisions. Currently, an important urban design issue is the adaptation of infrastructure to increasing cycle and e-bike use. Using data collected from 12 cyclists on a cycle highway between two municipalities in The Netherlands, we coupled location and wearable emotion data at a high spatiotemporal resolution to model and examine relationships between cyclists' emotional arousal (operationalized as skin conductance responses) and visual stimuli from the environment (operationalized as extent of visible land cover type). We specifically took a within-participants multilevel modeling approach to determine relationships between different types of viewable land cover area and emotional arousal, while controlling for speed, direction, distance to roads, and directional change. Surprisingly, our model suggests ride segments with views of larger natural, recreational, agricultural, and forested areas were more emotionally arousing for participants. Conversely, segments with views of larger developed areas were less arousing. The presented methodological framework, spatial-emotional analyses, and findings from multilevel modeling provide new opportunities for spatial, data-driven approaches to portable sensing and urban planning research. Furthermore, our findings have implications for design of infrastructure to optimize cycling experiences.
MULTIFILE
