Frontiers in Pain Research

Background: Chronic pain is a multidimensional condition that often persists despite conventional treatment and adversely affects multiple domains of daily life. Music listening has emerged as a promising non-pharmacological intervention, with accumulating evidence supporting its beneficial effects on pain and associated psychological outcomes. However, despite growing evidence of efficacy, the translation of music listening into routine clinical practice remains limited, partly because intervention reporting has received comparatively little attention. Objective: To evaluate the effectiveness of music listening interventions for chronic pain and systematically assess the methodological quality and completeness of intervention reporting to identify barriers to reproducibility and clinical implementation. Methods: Systematic searches were conducted in PubMed, Cochrane Library, CINAHL, and Web of Science through June 2025, with no date restrictions on publication. Randomized controlled trials involving adults with chronic pain receiving music listening interventions were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias. Intervention reporting was evaluated using the TIDieR checklist, and a random-effects meta-analysis was performed for pain intensity outcomes. Results: Ten RCTs involving 538 participants were included. Music listening interventions varied substantially in delivery, duration, and music selection procedures, reflecting considerable heterogeneity in intervention design. Most studies reported significant improvements in pain and psychological outcomes. Meta-analysis of eight trials (10 effect estimates), demonstrated a moderate reduction in pain intensity (SMD = -0.53, 95% CI: -0.96 to -0.11, p = 0.014; I2 = 76.2%). Although intervention rationale and procedures were generally well described, reporting of intervention modifications, treatment fidelity, and adherence was frequently incomplete. These reporting deficiencies may compromise reproducibility and limit translation into clinical practice. Conclusions: Music listening appears to be a safe, accessible, and scalable non-pharmacological intervention for chronic pain management, with benefits extending beyond pain reduction to psychological wellbeing, quality of life, and functioning. However, incomplete reporting of key intervention components may limit reproducibility and hinder clinical implementation. Future trials should adopt standardized and transparent reporting standards to facilitate implementation into clinical practice.

Background: Whether a patient's pain improved after emergency department (ED) treatment is read from the record to benchmark EDs, compare drugs, and label research outcomes. It is interpretable only if a post-treatment score is recorded, appropriately timed, and chosen by a fixed rule; its stability across these choices is unknown. Methods: Retrospective measurement study of adult headache visits in a de-identified ED database (MIMIC-IV-ED, 2011-2019). Among treated visits, we quantified reassessment completeness by time window, estimated meaningful relief (a reduction of at least 2 points) under score-selection rules and missing-data assumptions, tested whether reassessment was predictable at treatment, and compared headache with other painful presentations. Results: Among 19,501 visits (15,273 patients), 13,682 (70.2%) were treated. A post-treatment pain score appeared at any time for 77.1% (95% CI, 76.4 to 77.8), but within 2 hours of the analgesic for only 47.9% and within 1 hour for 27.5%. Meaningful relief was 66.9% using the first post-treatment score but 81.0% and 83.4% using the last or lowest score; it was 67.5% under inverse-probability weighting and could be bounded only between 51.8% and 74.4%. Whether a score was recorded was weakly predictable at treatment (area under the curve, 0.566) and unrelated to baseline pain. Completeness was similar across headache strata and comparator painful presentations. In an independent ED (MC-MED, a different EHR), the score-selection effect replicated: relief rose from 71.1% (first) to 80.6% (last) and 83.4% (lowest). Conclusions: Documented pain relief after ED headache treatment was not a stable outcome: it varied with the reassessment window and score-selection rule, was not point-identified for unreassessed patients, and behaved like other painful ED presentations. Programs and research that use documented relief should prespecify the reassessment window, score-selection rule, completeness denominator, and a missing-data range, and favor protocol-timed reassessment.

Myofascial pain syndrome (MPS) is a major cause of chronic neck pain, with tissue ischemia implicated as a contributing factor. This prospective, single-arm interventional study evaluated the analgesic effect of ultrasound-guided fascia hydrorelease (US-FHR) performed around arteries supplying the neck in patients with chronic neck MPS. Thirteen adults (median age 53.0 years; 38.5% female) underwent US-FHR targeting the perivascular fascia of either the transverse cervical or dorsal scapular artery using 2 mL of normal saline. Pain intensity was assessed by visual analog scale (VAS) at rest and during movement; disability by the 5-item Pain Disability Index, Japanese version (PDI-5-J); and arterial blood flow volume before and after the procedure. The primary outcome, pain VAS during movement, decreased from 49.0 mm (interquartile range [IQR], 44.5-64.0) at baseline to 22.0 mm (IQR, 14.5-31.5) at 15 min and 22.0 mm (IQR, 14.0-34.0) at 1 week (Hodges&-Lehmann median difference, 30.5 mm [95% CI, 24.5 to 36.5] and 28.5 mm [95% CI, 18.5 to 37.0]; both P < 0.001). Pain VAS at rest improved from 21.0 mm (IQR, 13.0-43.5) to 8.0 mm at 15 min and 1 week (median difference, 14.5 mm [95% CI, 9.0 to 24.0; P = 0.001] and 13.5 mm [95% CI, 6.0 to 21.0; P = 0.007]). PDI-5-J decreased from 17.0 (IQR, 10.5-23.0) to 13.0 (IQR, 4.0-17.5) at 1 week (median difference, 5 [95% CI, 2 to 8; P = 0.004]). Blood flow volume increased from 11.2 mL/min (IQR, 4.5-14.4) to 17.2 mL/min (IQR, 6.1-23.7) immediately after US-FHR (median difference, +4.1 mL/min [95% CI, +2.5 to +8.9; P = 0.001]), although transient. One patient experienced transient bleeding that was promptly controlled. In this single-arm feasibility study, US-FHR around the target artery was simple and safe to perform and was associated with reduced neck pain. Because the study lacked a control group, these preliminary findings should be regarded as hypothesis-generating and require confirmation in controlled trials; they may also inform the future evaluation of MPS in other anatomical regions. Trial registration: UMIN Clinical Trials Registry, UMIN000053612.

Background: Shared decision-making (SDM) is a key component in patient-centered care for people consulting health care due to chronic musculoskeletal pain, including subacromial pain syndrome (SAPS). Limited research has explored how patients, relatives, and healthcare professionals perceive the content and delivery of SDM for managing SAPS in primary care. Thus, this study aims to explore stakeholder perspectives on the content, delivery, and contextual requirements for a context-specific SDM intervention for SAPS, and to identify shared challenges and co-develop ideas to inform intervention development. Methods: We conducted three separate future workshops (patients/relatives, physiotherapists/chiropractors, and general practitioners), each consisting of structured critique, fantasy, and implementation phases. A rapid preliminary analysis of workshop data was followed by semi-structured stakeholder interviews to validate, challenge, or elaborate the findings. All data were analysed thematically using an iterative, reflexive approach. Results: Twenty-eight participants took part across three workshops: patients/relatives (n = 10), physiotherapists/chiropractors (n = 12), and general practitioners (n = 6). Six additional stakeholders provided inputs via subsequent interviews (three physiotherapists, one patient, one relative and one GP). Thematic analysis identified 20 themes and 59 sub-themes, which were refined into two overarching categories: (1) shared barriers to SDM in SAPS care, including diagnostic uncertainty, fragmented clinical care pathways, time constraints, and decision fatigue; and (2) stakeholder visions for future SDM interventions, emphasising continuity, tailored communication tools, and supportive digital ecosystems. Conclusion: Based on stakeholder input, SDM in SAPS care may consider integrating dynamic, integrated systems that account for diagnostic ambiguity, contextual constraints, and varying patient capacities. These findings provide an actionable foundation for co-developing and piloting a context specific SDM intervention for primary care.

Background: Deep brain stimulation (DBS) is a widely used therapy for neurologic and psychiatric disorders. Conventional DBS delivers highly regular stimulation patterns that suppress pathological activity but can induce stimulation-related side effects, limiting the therapeutic window. Introducing controlled temporal variability through stochastic pulse timing may represent an alternative programming dimension to improve tolerability while preserving clinical benefit. Methods: An adult in their 60's with bilateral Vim DBS underwent evaluation of tonic, pink-noise, and white-noise stimulation patterns delivered through his chronically implanted Boston Scientific Genus system using the Chronos research platform. We assessed tremor and stimulation-induced side effects using accelerometry, spiral drawing tasks, standardized speech recordings, and patient-reported paresthesias. Results: Pink noise stimulation preserved meaningful tremor suppression while improving tolerability compared with conventional tonic 130 Hz stimulation. Under tonic stimulation, dysarthria and paresthesias were prominent at 2.0 mA, narrowing the usable therapeutic window. In contrast, pink noise maintained tremor control across the same amplitude range with reduced side-effect burden. White noise stimulation demonstrated intermediate effects, providing improved tolerability relative to tonic stimulation but less tremor suppression than pink noise. Findings were consistent across accelerometry and functional drawing tasks. Conclusion: This study provides first-in-human evidence that temporally structured stochastic pulse timing can preserve therapeutic benefit while expanding the tolerable stimulation range relative to tonic DBS. These findings suggest that temporal structure represents a clinically meaningful programming dimension that may broaden the DBS therapeutic window using software based updates to existing hardware. Further evaluation in larger cohorts is warranted

Background: Gait impairment is common among people with multiple sclerosis (PwMS) and is an important marker of disease progression. However, gait assessments typically require in-person evaluations. Objective: To describe the pose-estimation-based method for estimating spatiotemporal gait parameters from a single consumer-grade video, and evaluate the feasibility of home video collection by PwMS. Methods: In a single-center longitudinal digital phenotyping study, ambulatory adults with MS completed a standardized walking task recorded in the frontal plane. Pose estimation (MediaPipe Pose, Ultralytics) and custom scripts were used to estimate gait parameters from videos. Participants were invited to record walking videos at home using personal devices. Adoption and technical feasibility were evaluated across two home video data acquisition phases, with iterative protocol refinements. Results: The in-clinic study included 132 participants; 55 contributed home videos. In Phase I, while home video adoption was low (45% [30/66]), 87% [26/30] uploaded [&ge;]1 video of sufficient quality for gait analysis. After protocol refinements, 100% [25/25] uploaded [&ge;]1 high-quality video. Overall, high-quality frontal-plane videos were obtained at similar rates at home (92% [97/105]) and in-clinic (91% [423/467]). Conclusions: Home walking videos can feasibly be collected by PwMS to estimate gait parameters, providing an accessible approach for remote gait monitoring.

There is growing interest and need for non-invasive stimulation approaches for the treatment of Parkinson's disease (PD) and other neurological conditions. Pilot studies indicate that vibrotactile stimulation on the fingertips may reduce PD motor symptoms (Pfeifer et al., 2021; Syrkin-Nikolau et al., 2018). PD motor symptoms (e.g., rigidity, bradykinesia) are correlated with exaggerated beta power in the subthalamic nucleus (STN), where neurons are excessively synchronized (Brown 2003; Kuhn et al., 2006; Neumann et al., 2016; Yin et al., 2021), but the effect of vibrotactile stimulation on the STN has not been determined. Here, in 12 PD participants in the OFF deep brain stimulation (DBS) and OFF medication state, we investigated how unilateral vibrotactile stimulation applied to the fingertips affects local field potential (LFP) power in STN. We used a within-participants design to expose each participant to a treatment stimulation pattern, termed randomized vibrotactile stimulation (RVS), and a control stimulation pattern, with the order randomized and with intermittent acquisition of STN LFP. RVS yielded a modest but statistically significant 12% (SEM 4.6%) reduction in mean normalized STN beta power and a 48% (SEM 19%) reduction in peak beta power compared to the DBS-off baseline condition and was significantly different when compared to our control stimulus. Furthermore, we identified a biomarker in STN beta power that predicts which participants may benefit from RVS. We observed that participants that exhibited prominent beta peaks had stronger reductions in mean beta power (17% reduction, SEM 6.1%) and peak beta power (55% reduction, SEM 10%). Regressing against the magnitude of the peak in beta provides a moderate prediction of change in mean and peak beta power due to RVS (R2 = 0.58 for mean and 0.52 for peak). We then used our observations to construct a computational model where beta peaks in a simulated STN varied from prominent to diminished. We found that the efficacy of randomized treatments was dependent on the magnitude of beta peaking, mirroring our clinical findings, and showing that RVS may act by reducing intra-neuronal synaptic strengths in STN. Despite robust changes in STN LFP in our study population, we did not observe a significant change in motor symptoms. These results suggest that peripheral vibrotactile stimulation can reduce STN beta power and motivate additional studies to investigate its long-term effects on motor symptoms across a large population of participants.

Background/Objectives: This systematic review examines how different mechanisms of Traumatic Brain Injury (TBI) influence post-injury functional independence and aims to clarify whether recovery patterns vary by injury type. A total of 105 studies (n = 59,621) involving adults with TBI were synthesized. These findings can guide clinicians and researchers in predicting outcomes and effectively customizing rehabilitation plans. Methods: A review following PRISMA standards analyzed English-language studies published from 1975 to 2025, assessed functional outcomes using the Functional Independence Measure (FIM) or the Glasgow Outcome Scale-Extended (GOSE), converted them to z-scores, and aggregated them via a random-effects model with inverse-variance weighting to demonstrate their relevance. Results: Recreational TBIs show the highest functional independence (z = +1.77), followed by MVAs (z = +1.56), with falls (z = +0.70) and assault-related TBIs (z = -0.12) showing moderate outcomes, and TBIs with penetrating trauma (z = -1.15) indicating the most adverse results. Conclusions: TBI mechanisms appear to meaningfully influence long-term post-injury functional independence. Highlighting this can inspire clinicians and researchers to trust these insights to improve prognosis and rehabilitation strategies, underscoring their crucial role in advancing patient care.

Background: Transition timing to post-acute rehabilitation after ischemic stroke is heavily influenced by non-clinical factors, introducing potential systemic disparities in care access. We evaluated the association between insurance payor status and acute hospital length of stay (LOS) prior to inpatient rehabilitation discharge among critically ill stroke patients. Methods: Using the MIMIC-IV database, we identified ICU-admitted adults with ischemic stroke discharged to inpatient rehabilitation (n=1,285). The primary outcome was hospital LOS prior to rehab transfer. Multivariable log-transformed linear regression evaluated the association with insurance payor (Medicare, private, other/unknown; reference: Medicaid), adjusting for demographics, diagnostic-code counts (medical complexity), and ICU LOS (acute illness severity). Results: Median hospital LOS before rehab discharge was longest for Medicaid patients (13.2 days) compared with private insurance (11.0 days) and Medicare (9.5 days). In the adjusted model, Medicare insurance was associated with a significantly shorter transition time to inpatient rehabilitation, corresponding to a 13.5% shorter acute hospital stay (adjusted LOS ratio 0.87; 95% CI: 0.79-0.96; p=0.005) relative to Medicaid. Private insurance demonstrated a descriptive trend toward shorter LOS that did not achieve statistical significance (adjusted LOS ratio 0.93; 95% CI: 0.84-1.02; p=0.122). Other and unknown payor categories showed no significant differences. Conclusions: Insurance payor status serves as an independent predictor of acute care transition timing for stroke patients requiring inpatient rehabilitation. The prolonged acute stays observed among Medicaid beneficiaries suggest significant non-clinical, administrative bottlenecks in post-acute placement, underscoring the critical need for standardized, streamlined insurance approval pathways to ensure equitable neurological recovery.

Background/Objectives: Traumatic Brain Injuries (TBIs) affect more than 50 million individuals worldwide each year. Approximately 90% of individuals survive and experience persistent motor, cognitive, and emotional deficits, substantially contributing to a reduced quality of life and a global economic burden. TBI mechanisms are a foundational determinant of long-term recovery. The objective of this study was to examine long-term trends in functional locomotion ability over extended follow-up durations (>10 years) across distinct TBI mechanisms. The researchers hypothesized that TBIs caused by falls or violent mechanisms would be associated with poorer functional locomotor abilities and, subsequently, lower item scores than those sustained through automotive or recreational activities. Methods: Data were obtained from the Traumatic Brain Injury Model Systems (TBIMS) database at Craig Hospital in Englewood, Colorado, the largest longitudinal TBI data repository in the world. Functional locomotion was assessed using the Functional Independence Measure (FIM) Locomotion item as the primary outcome measure. To enhance measurement precision and ensure interval-level scaling, raw FIM scores were converted into logit-based estimates of latent functional ability using Rasch modeling. Longitudinal changes of these Rasch-transformed scores were analyzed using linear mixed-effects regression, accounting for individual-level variability and unbalanced follow-up data. Results: The findings demonstrated a clinically meaningful decline in functional ability among individuals with TBIs from violent mechanisms, particularly assault-related injuries and gunshot wounds, which were associated with chronic medical complications and limited functional independence. Conversely, TBIs from bicycling, unclassified vehicular incidents, and winter sports showed significant positive estimates, possibly reflecting higher premorbid physical fitness. Motor vehicle, motorcycle, pedestrian, and fall-related TBIs demonstrated steep early gains, followed by a period of recovery stabilization and plateau. In contrast, violence-related mechanisms were characterized by consistently low median scores, with minimal long-term improvement. Falls, gymnastics, track & field, and water sports did not exhibit meaningful changes in the context of the primary hypothesis. Conclusions: TBI mechanisms play a vital role in shaping long-term functional locomotion outcomes, with violence-related TBIs associated with poorer long-term functional independence. The results have clinically important implications, supporting earlier identification of high-risk populations and the development of targeted rehabilitation strategies during periods of heightened neuroplasticity. Rasch analysis integrated with linear mixed-effects modeling yields a robust analytic framework that uncovers subtle but meaningful differences in recovery trajectories across TBI mechanisms.

Introduction: Acute compartment syndrome (ACS) is a limb-threatening complication of extremity trauma that requires timely diagnosis to prevent irreversible muscle and nerve injury. Current diagnostic methods are invasive, intermittent, and operator-dependent. We evaluated the feasibility of a novel, Bluetooth-enabled electrical impedance myography (EIM) device (mAlert, Myolex, Inc., Brookline, MA, USA) for continuous, noninvasive detection of ACS-related tissue changes. Methods: Ten Yorkshire swine underwent anterior tibial compartment monitoring using three ACS models: albumin infusion (ALB, n=3), femoral artery and vein ligation (LIG, n=3), and combined albumin infusion plus ligation (ALB+LIG, n=4). Resistance (R), reactance (X), and phase (P) were measured every minute across 1 to 199 kHz alongside continuous intra-compartmental pressure (ICP) monitoring. Group differences in normalized impedance trends were evaluated using the Kruskal Wallis test with Dunn post hoc correction. As a proof-of-concept human study, nine healthy volunteers wore the device for up to five days to assess electrode durability and signal stability. Tissue ischemia was validated using pimonidazole immunohistochemistry. Results: ALB infusion produced progressive, frequency-dependent decreases in R, X, and P, whereas LIG produced consistent increases in R and X across frequencies. The ALB+LIG model generated mixed responses, reflecting the competing effects of edema and ischemia. Normalized phase slopes differed significantly among groups (H=6.14, p=0.046), with post hoc testing showing significant divergence between the ALB and LIG models (p=0.041). Control limbs remained stable throughout monitoring. Pimonidazole staining confirmed hypoxic injury in the intervention limb. In the human pilot study, three participants completed five days of monitoring, demonstrating sustained signal acquisition, while electrode degradation limited data collection in the remaining participants. Conclusions: This preliminary feasibility study demonstrates that wearable EIM can continuously detect model-specific physiological changes associated with ACS in a large-animal model. These findings support further development and clinical evaluation of wearable EIM as a non-invasive monitoring technology for early ACS detection in trauma patients.

Transcranial photobiomodulation (PBM) is an emerging non-invasive brain stimulation method that is thought to increase neural metabolism by stimulating ATP production by the mitochondria. However, the mechanisms of action and the effects on the human brain are still unclear. In the present study, we investigated the potential of this method to enhance Blood Oxygen Level Dependent (BOLD) responses during the execution of a motor task in young and aged participants. Sixty young and aged participants were included in this single-blinded, sham-controlled, randomised, crossover study. They underwent an fMRI recording before and after 24-min stimulation with a 80-LEDs helmet emitting transcranially red and near infrared light. Post vs Pre BOLD signal was compared between PBM and SHAM, in each group. At baseline, aged participants showed reduced BOLD signal compared to young ones, in key regions of the sensorimotor processing, principally the left primary motor cortex and striatum. Transcranial PBM did not have a real impact in the young group. However in aged participants it increased BOLD signal in some regions that were underactivated compared to the young group at baseline. In particular, regional analysis showed increased BOLD response in the left primary motor cortex, and right dorsal and ventral premotor regions and striatum. These results suggest that transcranial PBM can increase fMRI BOLD activity in the task-related regions, particularly in aged subjects. Further research are needed to distinguish neural from vascular effects in transcranial PBM.

Background/Objectives: Traumatic Brain Injuries (TBIs) often cause profound functional impairments, yet the influence of TBI mechanisms on stair-climbing functional independence over extended timelines remains poorly understood. This study assesses whether Rasch-transformed FIM Stairs scores varied by TBI mechanism over follow-ups spanning 10 years or more. Methods: Data from the TBI Model Systems database were analyzed. The original 30,768 data entries were reduced to 6,226, corresponding to individuals with at least 10 years of data. Functional Independence Measure Stairs data were transformed to logit units via Rasch analysis before being evaluated with a linear mixed-effects regression, incorporating TBI mechanisms, age, follow-up time, and their interactions, with random effects accounting for the participant ID and pre-injury residence location. Results: TBI mechanisms meaningfully shape very long-term stair-climbing. Gunshot wounds and pedestrian-related accidents are associated with poorer performances, whereas motorcycles, bicycles, unclassified vehicular accidents, winter sports, other sports, and fall-related TBIs demonstrated relatively better function. Age, follow-up time, and their interaction also reached significance. Conclusions: Stair-climbing recovery trajectories over extended time significantly vary by TBI mechanism, with individuals with TBIs from gunshots and pedestrian-related accidents showing the most unfavorable recoveries. These findings support the development of mechanism-specific prognostic guidance and individualized rehabilitation strategies, thereby encouraging tailored approaches to improve outcomes.

Spontaneous activity in primary sensory neurons has been implicated in neuropathic symptoms, yet its earliest origins and immediate functional consequences remain incompletely understood. This gap is especially consequential in chemotherapy-induced peripheral neuropathy (CIPN), where sensory toxicities commonly limit effective cancer treatment. Using in vivo recordings in rats, we show that a single dose of oxaliplatin (OX) induces spontaneous firing within 24 h across touch and proprioceptive low-threshold mechanoreceptor (LTMR) afferents. Spontaneous firing consistently originated distally in peripheral axons and was accompanied by enhanced responses to mechanical stimulation, identifying LTMR sensory endings as the earliest source of spontaneous firing and a common site for spontaneous and stimulus-evoked hyperexcitability. OX also induced early structural abnormalities at sensory endings; however, SF+ LTMRs retained mechanosensory response profiles, indicating that spontaneous firing can emerge within otherwise functional sensory endings. Although coincident spontaneous and stimulus-evoked activity distorted encoding in individual LTMRs, these effects had little impact on population LTMR responses or motor behavior relying on mechanosensory feedback. Together, these findings identify sensory endings as an early target of OX neurotoxicity and demonstrate that spontaneous firing spanning multiple tactile and proprioceptive LTMR submodalities can coexist with largely preserved sensory function, indicating that even broad engagement across mechanosensory pathways is insufficient to disrupt all LTMR-dependent functions. These observations indicate that abnormal afferent activity initiated at sensory endings may be sufficient to engage sensory pathways underlying some paresthetic symptoms while leaving others largely unaffected, whereas progression to chronic neuropathic symptoms may require subsequent recruitment of the dorsal root ganglion.

Effective modulation of cortical-subcortical motor circuits is essential for post-stroke recovery, yet progress has been constrained by the absence of non-invasive tools capable of precisely targeting deep brain structures. In this pilot proof of concept study, we explored the feasibility and preliminary neuromodulatory effects of a 12-minute transcranial focused ultrasound (tFUS) protocol targeting the ipsilesional ventral lateral posterior (VLp) thalamus in ischemic stroke patients. Six individuals with upper-limb hemiparesis received individualized, neuronavigation-guided tFUS. Sensorimotor tracking performance improved signiffcantly after a single session. Concurrent EEG revealed reversible beta-power suppression over the ipsilesional motor cortex and enhanced theta-phase synchronization in frontoparietal networks, both of which were associated with behavioral gains. Resting-state fMRI indicated rebalancing of inter-hemispheric motor networks. These preliminary ffndings suggest that thalamic tFUS can modulate both local and networklevel neural activity and is associated with immediate functional improvement, highlighting its potential as a feasible neuromodulation approach for deep motor circuit engagement in post-stroke rehabilitation.

Purpose: The purpose of this study was to identify subgroups of talkers with Parkinsons disease (PD) with shared tongue, lip, and jaw articulatory amplitude behaviors. The study also sought to identify demographic and clinical features that can distinguish the identified kinematic subgroups. Methods: 53 talkers with PD and 54 controls participated. Articulatory amplitudes of the tongue, lip, and jaw were measured during a paragraph reading task using three-dimensional electromagnetic articulography. Amplitude performance profiles of the tongue, lip, and jaw were established for each talker with PD by referencing their performance to that of controls. These profiles were submitted to a hierarchical cluster analysis to identify kinematic-based subgroups. Amplitude performances were compared across subgroups to determine between-group patterns. Demographic and clinical features (e.g., age, sex, disease duration, selected perceptual speech characteristics, dysarthria severity) were compared across the identified kinematic subgroups. Results: Four main kinematic subgroups with differing amplitude performance profiles were identified. One subgroup exhibited normal to mildly exaggerated or mildly reduced amplitudes and was labeled preclinical subgroup (n = 16). Three subgroups exhibited pronounced amplitude reductions of either the tongue (n = 10), the tongue and lips (n = 12), or the tongue, lips, and jaw (n = 10). In addition, there were five talkers with PD whose performance profiles did not align with the identified four subgroups. Their performance was characterized by either pronounced amplitude exaggerations or mildly reduced jaw and lip amplitudes and exaggerated tongue amplitudes. None of the demographic or clinical features differed significantly between the main four subgroups. Conclusion: Findings suggest that the extent to which hypokinesia manifests within the articulatory subsystem can vary in talkers with PD. Longitudinal studies are needed to determine if these subgroups represent different stages of disease progression or distinctly different manifestations of the disease within the articulatory subsystem.

Background: Motor disturbances are common in neurologic and neurodegenerative syndromes. A standard motor speed and dexterity measure is the finger tapping test (FTT). The FTT has traditionally been administered in clinic using a mechanical FTT, limiting accessibility and early motor change quantification. This study assessed the validity of a smartphone app-based FTT, which may expand access and enable more frequent testing. Methods: The cohort was diagnostically diverse, including participants with frontotemporal dementia (FTD), progressive supranuclear palsy (PSP), corticobasal syndrome, primary progressive aphasia, multiple sclerosis, and clinically unimpaired controls. Participants completed a 20-second ALLFTD Mobile App (mApp)-FTT with each hand. Tapping speed metrics were extracted. Participants completed the gold-standard mechanical FTT, a neurologist-administered finger tapping exam, the PSP Rating Scale (PSPRS) and the Unified Parkinson`s Disease Rating Scale (UPDRS). Correlations assessed mApp-FTT and mechanical FTT relationships; regressions evaluated associations with neurologist-rated finger tapping impairment, PSPRS and UPDRS, adjusting for age and sex. Results: The mApp-FTT showed moderate-to-strong correlations with the mechanical FTT (dominant: r=0.63, p<0.001; non-dominant: r=0.55, p<0.001). Taps per second were associated with PSPRS motor severity (dominant hand: std. {beta}=-0.59, 95% CI [-0.91, -0.27], p<0.001) and the UPDRS (dominant hand: std. {beta}=-0.41, 95% CI [-0.82, 0.00], p=0.049). Flight time was modestly associated with neurologist-rated finger tapping impairment (dominant hand: std. {beta}=0.15, 95% CI [0.00, 0.29], p=0.044). Conclusion: These findings support mApp-FTT validity as a measure of motor function across neurodegenerative conditions. Validation in longitudinal and unsupervised remote settings is warranted to understand scalability and evaluate change over time.

Background To build a clinically translatable neonatal seizure detection algorithm using amplitude-integrated electroencephalography (aEEG) and compressed spectral array (CSA). Methods Using a public dataset of annotated neonatal EEGs, features of the aEEG and CSA were extracted from the left and right centroparietal electrodes. These features were then used to train and test three machine learning classifiers, Random Forest (RF), Support Vector Machines (SVM), and Artificial Neural Networks (ANN). Results The trained RF, SVM, and ANN classifiers had areas under the curve (AUC) of 0.80, 0.69, and 0.79 for capturing seizure time periods and an average accuracy of 0.91, 0.90, and 0.92 respectively for capturing seizure and non-seizure time periods. Median accuracy scores were higher among patients without hypoxic-ischemic encephalopathy (HIE; median = 1 for all three classifiers) than HIE patients (median = 0.92, 0.93, 0.93). Conclusion A clinically interpretable aEEG-CSA algorithm is feasible for neonatal seizure detection by extracting standard EEG features and coupling these features with a supervised ML classifier.

Effective postoperative pain control is essential following laparoscopic cholecystectomy, yet the analgesic value of a standardised 150 mg preoperative dose of pregabalin has not been clearly established. This systematic review and meta-analysis synthesised evidence from seven randomised controlled trials published between 2008 and 2025 to evaluate the efficacy and safety of pregabalin when administered before surgery. Four trials reported 24-hour postoperative pain scores, and pooled analysis demonstrated that pregabalin significantly reduced pain compared with control (SMD = 0.80 lower; 95% CI, 1.42 to 0.18 lower; p = 0.01), although statistical heterogeneity was high (I-squared = 81%). Pregabalin also produced notable reductions in opioid consumption, including fentanyl (SMD = 1.24 lower; p = 0.002) and tramadol (SMD = 4.21 lower; p = 0.002), again with considerable variability across studies. Sedation was slightly increased but did not reach statistical significance, and there were no significant differences in postoperative nausea, vomiting, or headache. Sensitivity analyses supported the stability of these findings. Overall, the results indicate that a single 150 mg preoperative dose of pregabalin meaningfully reduces postoperative pain and opioid requirements following laparoscopic cholecystectomy while maintaining an acceptable safety profile, supporting its use as part of a multimodal analgesic strategy.

Background and Purpose- Prehospital large-vessel occlusion (LVO) scales identify severe stroke syndromes but may not distinguish LVO from intracerebral hemorrhage (ICH). We aimed to prospectively validate the PreICH scale, with the primary diagnostic objective of differentiating ICH from confirmed LVO, and to explore whether additional hemorrhage-oriented variables could refine its performance. Methods- We conducted a prospective observational study of consecutive stroke-code activations evaluated before neuroimaging by a vascular neurologist. PreICH was calculated prospectively. Patients with calculable PreICH and valid final diagnosis were included. The primary diagnostic cohort comprised confirmed LVO and ICH. Secondary cohorts included ischemic stroke versus ICH and the overall stroke-code cohort, including stroke mimics. Multivariable NIHSS-adjusted models identified variables associated with ICH. A modified PreICH score (mPreICH) was derived post hoc and evaluated as exploratory apparent performance. Results- Among 1012 screened activations, 982 patients were analyzed: 597 ischemic strokes, 91 ICH, and 294 stroke mimics. The LVO-versus-ICH cohort included 144 LVO and 91 ICH. NIHSS and RACE were higher in ICH than in ischemic stroke, but did not differ between LVO and ICH (NIHSS, 13 [IQR, 7-20] versus 15 [5-23], P=0.300; RACE, 5 [2-8] versus 6 [2-8], P=0.435). In the LVO-versus-ICH cohort, PreICH showed an AUC of 0.758 (95% CI, 0.696-0.820), whereas RACE did not discriminate LVO from ICH (AUC, 0.530 [95% CI, 0.453-0.607]). The exploratory mPreICH showed apparent AUCs of 0.835 (95% CI, 0.785-0.884) for ischemic stroke versus ICH and 0.798 (95% CI, 0.740-0.856) for LVO versus ICH. Conclusions- In this prospective stroke-code cohort, severity-based scales distinguished ICH from the overall ischemic stroke population but showed limited ability to differentiate LVO from ICH. An exploratory modified PreICH scale incorporating additional hemorrhage-oriented variables improved apparent discriminative performance, including in the LVO-versus-ICH setting. External validation is required before potential implementation in prehospital decision-making.