Darlow Smithson Productions (United Kingdom)

Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task. Twenty-five PwPD (70.52years±7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps. After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline ( P <0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months. These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD. for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465 ).

We present a case report of a first-trimester pregnant individual with chronic pain on chronic opioid therapy who successfully cross-titrated from full-μ agonist opioid to buprenorphine without causing significant withdrawal symptoms. A 37-year-old gravida 1, para 0 woman with chronic pain on opioid therapy successfully completed a 6-week cross-titration from 120 morphine equivalent dose to buprenorphine in her first trimester without affecting pain scores, functional capacity, withdrawal symptoms except for mild nausea and insomnia, or adverse perinatal outcomes. After increasing her buprenorphine in the second trimester, at 38 weeks, she bore a healthy neonate without eliciting signs of neonatal abstinence syndrome while on a stable buprenorphine dose. The American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine agree that pregnant patients with chronic pain should avoid or minimize opioids. For patients on chronic opioid therapy unable to minimize opioid use during pregnancy, it is unclear whether to continue their chronic opioid therapy or transition to other medications, including buprenorphine. This case demonstrated how one pregnant person with chronic pain on opioid therapy but not meeting diagnostic criteria for opioid use disorder safely transitioned from full-μ agonist opioids to buprenorphine without precipitating withdrawal or adverse perinatal outcomes. Cross-titration could be similarly performed for a pregnant patient with untreated opioid use disorder. In addition, the used cross-titration schedule and the rationale are provided.

A scenario is presented in which an engineer in the field finds that there is a problem with the system specifications and a symmetric finite impulse response (FIR) filter in the software does not do the job; it needs reduced passband ripple or, maybe, more stopband attenuation. We present a simple method for transforming an FIR filter into one with better passband and stopband characteristics, while maintaining phase linearity. While filter sharpening may not be used often, it does have its place in an engineer's toolbox. An optimal filter has a shorter impulse response than a sharpened filter with the same passband and stopband ripple, and thus is more computationally efficient. However, filter sharpening can be used whenever a given filter response cannot be modified, such as a software code that makes use of an unchangeable filter subroutine. The scenario described is hypothetical, but all practicing engineers have been in situations where a problem needs to be solved without the full arsenal of normal design tools. Filter sharpening could be used when improved filtering is needed, but insufficient ROM space is available to store more filter coefficients, or as a way to reduce ROM requirements. In addition, in some hardware applications using filter ASICs, it may be easier to add additional chips to a design than it is to design a new ASIC.