Sensor-based assessments in medical practice and rehabilitation include the measurement of physiological signals such as EEG, EMG, ECG, heart rate, and NIRS, and the recording of movement kinematics and interaction forces. Such measurements are commonly employed in clinics with the aim of assessing patients\' pathologies, but so far some of them have found full exploitation mainly for research purposes. In fact, even though the data they allow to gather may shed light on physiopathology and mechanisms underlying motor recovery in rehabilitation, their practical use in the clinical environment is mainly devoted to research studies, with a very reduced impact on clinical practice. This is especially the case for muscle synergies, a well-known method for the evaluation of motor control in neuroscience based on multichannel EMG recordings. In this paper, considering neuromotor rehabilitation as one of the most important scenarios for exploiting novel methods to assess motor control, the main challenges and future perspectives for the standard clinical adoption of muscle synergy analysis are reported and critically discussed.

BACKGROUND: Autoimmune encephalitis (AE) poses significant challenges in clinical management, requiring effective monitoring tools for therapeutic success and relapse detection. This study aims to assess the Clinical Assessment Scale in Autoimmune Encephalitis (CASE) as compared to the modified Rankin scale (mRS) in evaluating AE patients and to determine the real-world adoption of the CASE score.
METHODS: A retrospective cohort study was conducted on 20 AE patients, assessing clinical data including symptomatology, diagnostic findings, and therapeutic regimens. Furthermore, we performed a systematic review on the test performance criteria and the real-world use of the CASE score.
RESULTS: The CASE score showed a higher sensitivity in detecting clinical changes compared to the mRS, with a significant correlation between the two scales throughout the disease course (r = 0.85, p < 0.01). A systematic review of 150 articles revealed widespread adoption of the CASE score, especially in Asian populations, demonstrating high reliability and internal consistency.
CONCLUSIONS: Despite limitations such as retrospective design and small sample size, our findings underscore the CASE score\'s utility in both clinical practice and research settings. The CASE score emerges as a valuable tool for monitoring AE patients, offering improved sensitivity over existing scales like the mRS. Further validation studies in diverse populations are warranted to establish its broader applicability and inform future therapeutic interventions.

The physician\'s perspective on clinical assessment skills by nurses in psychiatry: A case study Abstract: Background: People with a mental and physical illness receive less good somatic care compared to the general population. Patients in psychiatry receive better medical care when nurses have in-depth medical expertise. Therefore, in a psychiatric institution in Switzerland in 2017, the Clinical Assessment and Decision Making (CADM) by nurses was implemented. Aim: The aim of the study was to investigate how physicians and senior psychologists experience the implementation of CADM by nurses in order to derive recommendations on how to optimize the collaboration and promote a sustainable establishment. Methods: An embedded single case study was used, and the data analysis was based on grounded theory strategies by Charmaz. Semi-structured expert interviews (n = 11) and open unstructured observations were conducted in a psychiatric institution in Switzerland. Results: The results showed nine relevant aspects regarding collaboration and CADM by nurses: \"Strengths\", \"Weaknesses\", \"Risks\", \"Opportunities\", \"Expectations\", \"Challenges\", \"Benefits\", \"Competencies of CADM nurses\" and \"Wishes for the future\". Conclusions: The physicians and senior psychologists considered the CADM by nurses as an added value for the interprofessional team and for the patients. Lack of clarity regarding the scope of responsibilities, role definitions and possible applications made the implementation of CADM difficult.
Zusammenfassung: Hintergrund: Menschen mit einer psychischen und somatischen Erkrankung erhalten eine weniger gute somatische Versorgung im Vergleich zur Bevölkerung ohne psychische Erkrankung. Um die Versorgungsqualität zu erhöhen, wurde in einer psychiatrischen Institution in der Schweiz 2017 das Clinical Assessment und Decision Making (CADM) durch Pflegende eingeführt. Ziel: Ziel der Studie war es, zu untersuchen, wie Ärzt_innen und leitende Psycholog_innen die Durchführung des CADM durch Pflegende erleben. Dies, um daraus Empfehlungen abzuleiten, wie die Zusammenarbeit optimiert und eine nachhaltige Etablierung des CADM gefördert werden kann. Methode: Eine Embedded Single Case Study wurde angewandt, die Datenanalyse orientierte sich an den Strategien der Grounded Theory nach Charmaz. Es fanden semistrukturierte Expert_inneninterviews (n = 11) und offene unstrukturierte Beobachtungen in einer Psychiatrie in der Schweiz statt. Ergebnisse: Die Ergebnisse zeigten neun relevante Bereiche, welche die Zusammenarbeit und das CADM durch Pflegende betreffen: „Stärken“, „Schwächen“, „Risiken“, „Chancen“, „Erwartungen“, „Herausforderungen“, „Nutzen“, „Kompetenzen der CADM Pflegenden“ und „Wünsche für die Zukunft“. Schlussfolgerungen: Die Ärzt_innen und leitenden Psycholog_innen erachteten das CADM durch Pflegende als Mehrwert für das interprofessionelle Team und die Patient_innen. Unklarheiten in Bezug auf den Verantwortungsbereich, Rollendefinitionen und Einsatzmöglichkeiten erschwerten die Implementation des CADM.

BACKGROUND: Case presentation assessment is common in both medicine and dentistry and is known under various names depending on the country and institution. It relates mainly to aspects of diagnosis and treatment planning and is considered highly authentic and useful. The COVID-19 pandemic necessitated the movement of this assessment from face-to-face to online. The aim of this investigation was to explore the students\' impressions of the two different examination modalities. With this information, a decision on future diets of this examination can be made to accommodate the students\' perspectives.
METHODS: Quantitative and qualitative data were gathered using an online, self-administered survey.
RESULTS: The students were split 50/50 regarding which assessment modality they preferred. Overall, they considered the online examination to be fair, and the majority agreed that the online format allowed them to display their knowledge as well as face-to-face.
CONCLUSIONS: The delivery of case presentation examination is possible online. An online case presentation is a fair, useful, and authentic assessment that is appropriate to the needs of the faculty and students. Satisfaction with the two possible methods of conducting this assessment suggests it would be reasonable to conduct this examination online in the future.

This Letter to the Editor is a response to Broyan and colleagues who recently published a Case Report presenting data on 28 patients in the United States who identified kratom as their primary substance of use and who were subsequently induced on buprenorphine/naloxone for a reported diagnosis of kratom use disorder. We applaud the authors for helping to advance the science on kratom and recognize the difficulties in conducting kratom-related clinical assessment and research. However, a number of inconsistences and generalizations were identified in this Case Report, which also lacked some critical context. Importantly, such inconsistencies and generalizations can be observed throughout kratom-specific case reports. We feel this is now an important opportunity to highlight these issues that are present in the Broyan and colleagues Case report but emphasize that they are not unique to it. We do this with the hope that by acknowledging these issues it can help inform editors, clinicians, and researchers who may not be familiar with kratom and, as a result of this unfamiliarity, may inadvertently present findings in a manner that could confuse readers and even misinform clinical researchers and practitioners.

OBJECTIVE: To confirm what impairments are present in runners with Achilles tendinopathy (AT) and explore the variance of AT severity in an adequately powered study.
METHODS: Case-control study.
METHODS: Two private physiotherapy clinics in Australia and Spain.
METHODS: Forty-four recreational male runners with AT and 44 healthy controls matched by age, height, and weight.
METHODS: Demographics, activity (IPAQ-SF), pain and function (VISA-A), pain during hopping (Hop pain VAS), hopping duration, psychological factors (TSK-11, PASS20), and physical tests regarding lower-limb maximal strength and endurance.
RESULTS: Body mass index (BMI), activity, VISA-A, pain, and duration of hopping, TSK-11, PASS20, standing heel raise to failure, seated heel raise and leg extension 6RM, hip extension and abduction isometric torque were significantly different between groups (P < 0.05) with varied effect sizes (V = 0.22, d range = 0.05-4.18). 46% of AT severity variance was explained by higher BMI (β = -0.41; p = 0.001), weaker leg curl 6RM (β = 0.32; p = 0.009), and higher pain during hopping (β = -0.43; p = 0.001).
CONCLUSIONS: Runners with AT had lower activity levels, lower soleus strength, and were less tall. BMI, pain during hopping, and leg curl strength explained condition severity. This information, identified with clinically applicable tools, may guide clinical assessment, and inform intervention development.

Temporomandibular disorder (TMD) perturbs the tongue motor control and consequently impairs oral function, but strength training reduces this impairment. However, tongue motor control is widely reduced to a matter of strength.
To investigate the accuracy of the tongue placement as a measure of tongue motor control in patients with TMD compared with age- and sex-matched healthy participants.
This proof-of-concept case-control study was prospective, observational, and part of the TMIQ study (NCT04102306). After pointing against a wood stick while maintaining the tongue as sharp as possible, the examinator drew the contour of the tongue print on the wood stick, which was then scanned for image analyses to compute the area for each participant using ImageJ.
A total of 94 participants were included, all patients with TMD (n = 47) diagnosed with myalgia, 61% with intra-articular joint disorder accordingly to the DC/TMD. The median (IQR) tongue print area was 117 (111) mm2 for the TMD group and 93.5 (76.2) mm2 for the control group (V = 352, p = .04) and the median [95% confidence interval] difference was 25.4 [1.3; 51.0] mm². Overlapping of the 95% confidence intervals of the area evidenced no significant difference between the categories of the DC/TMD. The corrected each area-total correlation (r = .24) suggests a reasonably homogenous thus valid measure.
The results suggest that TMD impairs the motor control of the tongue. Therefore, the sharpest tongue pointing test may constitute a simple and accessible clinical tool to assess the accuracy of tongue placement in TMD patients. The study was registered on ClinicalTrial.gov with identification number NCT04102306.

Tears of the medial collateral ligament of the knee are common and often managed non-operatively [1]. Grade 3 tears that fail to heal are often treated with surgical repair through an open incision on the medial aspect of the knee. Many other ligament injuries of the knee are now managed with arthroscopic surgery. This has not yet been described for medial collateral ligament injuries of the knee. We describe a new arthroscopically assisted technique for MCL repair after grade III injury which avoids some of these complications.

Determining the validity of data during clinical neuropsychological assessment is crucial for proper interpretation, and extensive literature has emphasized myriad methods of doing so in diverse samples. However, little research has considered noncredible presentation in persons with multiple sclerosis (pwMS). PwMS often experience one or more factors known to impact validity of data, including major neurocognitive impairment, psychological distress/psychogenic interference, and secondary gain. This case series aimed to illustrate the potential relationships between these factors and performance validity testing in pwMS. Six cases from an IRB-approved database containing pwMS referred for neuropsychological assessment at a large, academic medical center involving at least one of the above-stated factors were identified. Backgrounds, neuropsychological test data, and clinical considerations for each were reviewed. Interestingly, no pwMS diagnosed with major neurocognitive impairment was found to have noncredible performance, nor was any patient with noncredible performance in the absence of notable psychological distress. Given the variability of noncredible performance and multiplicity of factors affecting performance validity in pwMS, clinicians are strongly encouraged to consider psychometrically appropriate methods for evaluating validity of cognitive data in pwMS. Additional research aiming to elucidate base rates of, mechanisms begetting, and methods for assessing noncredible performance in pwMS is imperative.

BACKGROUND: The long case is a traditional method of clinical assessment which has fallen out of favour in certain contexts, primarily due to psychometric concerns. This study explored the long case\'s educational impact, an aspect which has been neglected in previous research.
METHODS: Three focus groups of medical students (20 in total) and semi-structured interviews of six examiners were conducted. Cook and Lineberry\'s framework for exploring educational impact was used as a sensitising tool during thematic analysis of the data.
RESULTS: Participants described the long case and its scoring as having influence on student learning. Engaging in the activity of a long case had an essential role in fostering students\' clinical skills and served as a powerful driving force for them to spend time with patients. The long case was seen as authentic, and the only assessment to promote a holistic approach to patients. Students had concerns about inter-case variability, but there was general consensus that the long case was valuable, with allocation of marks being an important motivator for students.
CONCLUSIONS: This study offers a unique focus on the traditional long case\'s educational consequences; the extent of its positive impact would support its place within a program of assessment.