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OBJECTIVES:To investigate changes in the Japanese version of the Vertigo Symptom Scale-short form (VSS-sf) scores and to determine the minimal important change (MIC) in participants with subacute infratentorial stroke. DESIGN:Multicenter prospective longitudinal study. SETTING:Inpatient rehabilitation units across 5 neurosurgical hospitals. PARTICIPANTS:A total of 74 inpatients with first-ever subacute infratentorial stroke. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:The VSS-sf, gaze nystagmus, and nausea were assessed at baseline (within 7d to 3mo after stroke onset), 2 weeks, and 4 weeks. At follow-up assessments, the Global Rating of Change (GRC) scale was used by both the participant and the therapist to rate dizziness improvement at rest and during movement. MIC was estimated using receiver operating characteristic curve analysis based on GRC thresholds. RESULTS:VSS-sf scores significantly decreased over time, indicating symptom improvement. The correlation between VSS-sf change scores and GRC met the acceptable threshold at 4 weeks. The MIC was 4.00 points at rest (95% confidence interval, 4.00-6.00; sensitivity=0.56, specificity=0.93, area under the curve=0.73) and 6.00 points during movement (95% confidence interval, 4.00-9.07; sensitivity=0.68, specificity=0.83, area under the curve=0.76). CONCLUSIONS:To our knowledge, this is the first study to establish the clinical course and MIC of the VSS-sf in patients with subacute infratentorial stroke. The findings demonstrate that vertigo and dizziness improve over 4 weeks. A change of ≥4 points at rest or ≥6 points during movement represents meaningful improvement, providing useful benchmarks for clinical evaluation.
The flexor digitorum brevis (FDB) is a key intrinsic foot muscle that contributes not only to toe flexion but also to energy absorption and generation during bipedal locomotion in humans. Despite its functional importance, the homology among hominid species and morphological alterations during evolution in each species of the FDB remain insufficiently understood. A more detailed morphological analysis, particularly a comparative analysis of origin sites and innervation, is necessary to clarify the homology of FDB among hominids. In this comparative anatomical study, the feet of eight humans, three chimpanzees, and three orangutans were analysed. In humans, the FDB typically originates from the calcaneal tuberosity and plantar aponeurosis and is innervated by the medial plantar nerve (MPN). However, in one case, dual innervation from both the medial and lateral plantar nerves (LPNs) was observed. The accessory muscle belly from the flexor digitorum longus tendon, found in four human cases, was inserted variably into digits IV and/or V, similar to the FDB tendon, and was innervated by the MPN in all cases. In chimpanzees, the FDB originates from two sites, the calcaneus and flexor digitorum tibialis (FDT) tendon, both innervated by the MPN in all cases. In one orangutan specimen, the FDB was divided into two bellies originating from the calcaneus: one inserted into digit II and was innervated by the MPN, while the other merged with the flexor digitorum fibularis tendon to digit III and received dual innervation from both the medial and LPNs. In another orangutan case, the FDB originated from the calcaneus as a single muscle inserted into digits II-IV and was innervated by the MPN, with the accessory belly from the FDT tendon innervated by the LPN. The third orangutan case showed a single FDB into digits II-IV innervated by the MPN and dual innervation of the muscle belly originating from the FDT tendon via the medial and LPNs. These findings suggest that the dual-origin sites and innervation of the FDB, which was previously considered a variation in humans, may be a common morphological feature shared by hominids. The combination of dual-origin sites and innervation accounts for the greater diversity of the muscle compared with those with a single origin site or innervation. The characteristics in humans may be consistent with the morphological alterations of the foot, which are adaptations to habitual bipedal locomotion, such as a robust and posteroinferiorly elongated calcaneal tuberosity and a medial shift of the functional foot axis.
BACKGROUND:Knee braces are often prescribed for individuals with anterior cruciate ligament-deficient knees. Although rigid functional knee braces are limited to certain contact sports, soft knee braces can be used in almost all sports. However, few studies have investigated the restraining effect of soft knee braces. We developed an elastomeric knee brace with anatomical straps and no rigid hinges to improve its suitability for athletic use. This study aimed to investigate the restraining force of the elastomeric brace and compare it with that of functional and soft braces. METHODS:A custom-made anterior displacement knee model was used. The restraining force of the elastomeric, functional, and soft braces against 20 mm of anterior tibial displacement was measured in five sets of five repetitions using a tensile testing machine directly connected to the knee model. FINDINGS:The elastomeric knee brace demonstrated a higher restraining force at all displacements than the functional and soft knee braces, particularly in the initial phase (0-10 mm). The decrease in the restraining force over repeated trials was less pronounced at 5- and 10-mm displacements, indicating that the elastomeric knee brace maintained a more stable restraining force. INTERPRETATION:The developed elastomeric knee brace exerted a higher restraining force against anterior tibial displacement than the functional and soft knee braces, and this restraining effect was maintained even after repeated use.
