Physical Medicine / OMM
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/30823
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Browsing Physical Medicine / OMM by Author "Lee, Yein"
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Item Atypical Presentation of Focal Dystonia in Female Bassoonist: A Case Study(2022) Taqvi, Samar; Lee, YeinBackground: Focal dystonia is a disorder characterized by sustained or intermittent muscle contractions causing abnormal or repetitive movements. Musicians dystonia is focal task-specific dystonia (FTSD) elicited in professional musicians during instrumental playing. Approximately 1% of all professional musicians develop musician's dystonia. Demographically, male musicians tend to be affected more than women, with a male: female ratio of 4:1. Embouchure dystonia falls under the category of FTSD that affects the jaw or tongue in musicians that play woodwind instruments such as oboe, clarinet, bassoon, and flute. The purpose of this case study is to highlight an unusual presentation of focal dystonia. Case Information: We present this case of a 74-year-old female bassoonist with a clinical presentation of jaw weakness and tremor. The patient reported that the symptoms only occurred when she played her instrument. The patient's past medical history includes TMJ and rheumatoid arthritis. Physical exam findings revealed a contraction of the muscles of facial expression accompanied by small tremor-like movements of the chin when playing the bassoon. EMG/NCS studies were ordered along with MRI, which incidentally showed vestibular schwannoma. Although unrelated to the patient's symptoms, a referral was made to otolaryngology. With normal EMG results, a trial of propranolol was initiated with a concern of possible essential tremor, but patient failed to respond to the medicine. Due to the task-specific nature of the patient's symptoms, occurring only when she plays, we initiated a multidisciplinary treatment plan for focal dystonia. The patient was referred to a speech-language pathologist, and we started several home exercises to help with the movement disorder. In addition, the patient was suggested to start movement-based therapies such as the Alexander technique, yoga, and Feldenkrais. The patient was also offered counseling to help her process this serious diagnosis that can dramatically affect a musician's career. The patient also had significant joint and myofascial pain which was treated with osteopathic manipulative treatment and trigger point injections. Conclusions: This case presents an embouchure dystonia that is atypical. Our patient did not fit the typical clinical picture of young, male musician complaining of unwanted movements. While task specific, her movements mimicked essential tremor at times, not to mention other rheumatologic and musculoskeletal conditions such as degenerative joint disease and myofascial pain that contributed to the chief complaint. With the incidental findings of vestibular schwannoma, her diagnostic process was complicated as well. This case highlights the importance of including FTSD on the differential for any musician that presents to the clinic with a complaint of unwanted movements, weakness or tremor regardless of past medical history, age, and gender. Although unclear at initial presentation, with careful history, physical examination, and appropriate diagnostic tests, our team was able to arrive at the correct diagnosis and initiate appropriate treatment.Item Designing a Sustainable in-Clinic Protocol to Expand Postural Stability Data Collection(2022) Dinh, Mai; Kennedy, Shawn; Gupta, Sanya; Nayak, Rajesh; Mason, David; Lee, Yein; Patterson, RitaPurpose: Assessing postural stability may help to predict fall risk and aid in understanding underlying mechanisms of injuries due to falls. Several studies have compared postural stability in different populations of patients; however, the age, gender, race, health conditions, and the number of participants were limited. To answer clinical questions on the relationship between postural stability and fall risk, it is necessary to expand the dataset by including minority and vulnerable populations. The objective of this study is to design a sustainable clinic research data collection protocol to better understand fall risk in the diverse minority populations surrounding the HSC community and provide clinicians with sway information on their patients. Methods: Sustainable data collection protocol: Third-year medical students rotating in OMM clinic collected sway data for one half day during their month-long rotation. Data collectors were presented a video demo of the protocol and a didactic video on balance and falls before collecting data. Medical assistants in the clinic brought patients to students before the appointment time or when the patient's physician was seeing another patient, to avoid delays in clinic schedule. The total time for data collection is approximately two minutes. Postural sway data: Postural sway was evaluated in patients seen in the Osteopathic Manipulated Medicine (OMM) clinic at the University of North Texas Health Science Center between 6/7/2021 and 12/21/2021. Patients who were cane or wheelchair-dependent and children less than 65 lbs. were excluded. Patients took off their shoes and put on shoe covers. Patients then stood on footprints attached to the Bertec Force Plate (Bertec Columbus, Ohio). Patients were asked to stand straight, hands by their sides, body facing toward and looking at a target in front of them for 10 seconds with their eyes open. The same procedure was repeated with their eyes closed. Three trials of each condition were performed. A rest period of three seconds took place between each trial. Measurements of Mean Center of Gravity Sway Velocity were collected. Postural sway data was retrospectively analyzed from the clinic data collection (UNTHSC IRB# 2013-102). Results: 701 postural sway measurements were collected on a total of 511 patients between 06/07/2021 and 12/21/2021. Conclusion: As a result of creating a sustainable data collecting model by incorporating third-year medical students in their rotations as data collectors, 701 postural sway measurements were obtained in approximately seven months. This achievement was possible due to the continuous improvement of the protocol with the collaboration of clinic staff and physicians to ensure data collection incorporates smoothly into the natural flow of the clinic. Future steps: One next step is to allow treatment providers secure access to their patient's data so they can discuss changes in sway during clinic visits. Another is to partner with artificial intelligence experts to form algorithms to analyze the data on diverse patient populations to assist clinicians in clinical assessments/treatments and possibly provide fall prediction alerts.Item Determining optimal wearable sensor location for detection of differences in younger versus older adults.(2022) Panchal, Olivia; Lee, Yein; Moudy, SarahObjectives: Previous studies have assessed the efficacy of wearable sensors in detecting differences between younger and older adults or non-fallers and fallers as a means for predicting fall risk in these populations. Numerous combinations of variables (e.g., acceleration, step length, stride duration, and harmonic ratio) have been measured using various sensor locations (e.g., iliac crest, sacrum, dorsal foot, femur, and shin). Currently, there is no consensus among researchers regarding the ideal sensor location for detecting significant differences in these variables between either younger and older adults or non-fallers and fallers. Therefore, the purpose of this study was to determine if common fall risk variables are able to detect differences in relatively healthy younger and older adults as a means for earlier-onset fall risk detection and determine optimal sensor location to make these measurements easier in a clinical setting. We hypothesized that older adults would demonstrate decreased average range of acceleration and the sacrum would be the optimal sensor location for detecting differences in acceleration because of its close proximity to the center of mass. Design: 12 participants voluntarily enrolled and were divided into 2 groups based on age (18-35 and >60 years). Subjects performed a 2-minute treadmill walking task at a self-selected habitual pace. Wearable sensors were placed on the sacrum, lateral femur, and anterior tibia bilaterally. Sensors measured linear acceleration in the anteroposterior (AP), mediolateral (ML), and vertical (V) directions. The average range of acceleration across 10 gait cycles was calculated for each subject. Results: No significant differences in acceleration were found between groups in the AP and V directions for sensors placed at the sacrum (p≥0.317) and lateral femur (p≥0.054) or in any direction for sensors placed at the anterior tibia (p≥0.395). ML acceleration was significantly decreased in the older adults group at the sacrum (Younger=8.83±1.05 m/s2, Older=7.09±1.09 m/s2; p=0.034) and the right lateral femur (Younger=37.58±17.00 m/s2, Older=27.33±4.85 m/s2; p=0.017). Conclusion: With the exception of ML acceleration, acceleration was not found to be significantly different between groups. Significant differences in ML acceleration measured at the sacrum and lateral femur are consistent with previous studies. Compared to AP and V acceleration, hip sway during walking as measured by ML acceleration is more prominent and easier to detect in a clinical setting. Greater side-to-side sway could correlate with instability and thus, an increased risk of falls. Therefore, ML acceleration may be an important variable to focus on in future studies emphasizing earlier fall risk detection in healthy adults. The results suggest sacrum and lateral thigh (rather than anterior tibia) sensors would be more advantageous at detecting differences in acceleration in such studies.Item How "in tune" are musicians to their musculoskeletal problems? A survey of dancers, instrumentalists, and vocal performers.(2022) Colucci, Patricia; Lee, Yein; Roop, Katrina; Passmore, CynthiaRAD Abstract Submission How "in tune" are musicians to their musculoskeletal problems? A survey of dancers, instrumentalists, and vocal performers. Purpose This is an ongoing survey of dancers, instrumentalists, and vocal performers connected with University of North Texas Health Science Center Performing Arts Medicine Clinic (UNTHSC PAMC.) The study's goal was to study the injuries, illnesses, prior treatments, self-care habits, and the effectiveness of osteopathic manipulative treatment (OMT) when addressing the musculoskeletal injuries of the performers. Methods A survey consisting of 33 quantitative and qualitative questions was created using Qualtrics and granted IRB approval (IRB 1504435-3.) The survey gathered information about the duration and frequency of practices and performances for dancers, vocal performers, brass, string, percussion, and woodwind instrumentalists. Surveys were distributed and collected through the internet and a mobile platform. Information regarding the survey was disseminated through social media and word of mouth. Data was gathered from Qualtrics and analyzed. Performers were asked specifics of their practice schedule, if break time is allotted, and about performer injuries and treatments pursued. If a participant received OMT, he or she was asked about its impact on their return to performance. Those surveyed also reported the amount of cardiovascular exercise and resistance and flexibility training they do in a week. Every person surveyed was asked about the impact coronavirus disease 2019 (COVID-19) has made on their performance. Results At this time, of 58 respondents, and 42 instrumentalists were selected for initial analysis. These instrumentalists are primarily White, highly educated, 30 years of age, and have typically played 13 years (range 5 - 66 years). Preliminary results revealed that 75% of instrumentalists report practicing 5 hours or more per week. Additionally, 66% of instrumentalists play with pain, most reportedly in the jaw, anterior neck, and upper/middle back. The instrumentalist demonstrated a high level of technical language when describing their injuries. The survey reported frequent break times and using a variety of at-home modalities to treat their pain, while 78% reported less than four hours of cardiovascular activity per week. There were eight subjects who responded to questions regarding OMT. Of those responses, three responded that OMT has decreased or improved pain, four responded that OMT had reduced time away from performances, and three reported OMT had enhanced sound quality. Conclusions The current findings support the already known high prevalence of musculoskeletal injuries amongst instrumentalists. Many musicians were significantly aware of their medical problems, as evidenced by the highly technical description of their various musculoskeletal diagnoses. While they demonstrated trying many different self-care and treatment modalities for their injuries and illnesses, the survey shows musicians dedicate little time to physical activity. Due to a lack of responses, the significance of OMT on musculoskeletal injuries of the performers remains to be seen.