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IntroductionAcute pain levels following orthopaedic injury (eg, fracture) are a predictor of the onset of chronic pain, which affects nearly 50% of fracture patients and impairs functional recovery. Among current pharmacological treatments for acute pain, non-steroidal anti-inflammatory drugs have been associated with delayed bone healing, while opioids inhibit effective bone remodelling, increase the risk of pseudarthrosis and carry a high risk of addiction. In light of this, the development of new pain treatments is essential. Cannabidiol (CBD), a non-addictive and non-psychotropic cannabis component stands out as a potential therapeutic agent, given its analgesic and anti-inflammatory properties as well as its potential benefits for bone healing. This randomised controlled trial aims to investigate the effect of acute CBD treatment, compared with placebo, on patients’ self-reported pain, inflammation and well-being following a fracture injury.Methods and analysisThis is a triple-blind, randomised, placebo-controlled clinical trial. A total of 225 adults aged 18–70 years, who have suffered a long bone fracture and were treated at the Hôpital du Sacré-Coeur de Montréal, will be randomly assigned within 1 week to one of three treatment arms (25 mg or 50 mg of CBD or placebo) for 1 month. The primary outcome will be the difference in the pain score between groups at 1-month follow-up. Secondary outcomes will include measures of persistent pain, inflammation, opioid usage, quality of life, sleep quality, depression, anxiety, cognition and orthopaedic function. Data will be collected at baseline, 1-month and 3-month follow-ups.Ethics and disseminationThis study obtained a Health Canada licence for use of cannabis products. It has also been approved by Health Canada and the Research Ethics Board of the CIUSSS du Nord-de-l’Île-de-Montréal (Project ID 2025-2105). The findings will be published in a peer-reviewed journal and presented at local, national and international conferences. The trial’s results will be made publicly available on the ClinicalTrials.gov database.Trial registration number NCT06448923.

IntroductionTherapeutic interventions for disorders of consciousness lack consistency; evidence supports non-invasive brain stimulation, but few studies assess neuromodulation in acute-to-subacute brain-injured patients. This study aims to validate the feasibility and assess the effect of a multi-session transcranial alternating current stimulation (tACS) intervention in subacute brain-injured patients on recovery of consciousness, related brain oscillations and brain network dynamics.Methods and analysesThe study is comprised of two phases: a validation phase (n=12) and a randomised controlled trial (n=138). Both phases will be conducted in medically stable brain-injured adult patients (traumatic brain injury and hypoxic-ischaemic encephalopathy), with a Glasgow Coma Scale score ≤12 after continuous sedation withdrawal. Recruitment will occur at the intensive care unit of a Level 1 Trauma Centre in Montreal, Quebec, Canada. The intervention includes a 20 min 10 Hz tACS at 1 mA intensity or a sham session over parieto-occipital cortical sites, repeated over five consecutive days. The current’s frequency targets alpha brain oscillations (8–13 Hz), known to be associated with consciousness. Resting-state electroencephalogram (EEG) will be recorded four times daily for five consecutive days: pre and post-intervention, at 60 and 120 min post-tACS. Two additional recordings will be included: 24 hours and 1-week post-protocol. Multimodal measures (blood samples, pupillometry, behavioural consciousness assessments (Coma Recovery Scale-revised), actigraphy measures) will be acquired from baseline up to 1 week after the stimulation. EEG signal analysis will focus on the alpha bandwidth (8–13 Hz) using spectral and functional network analyses. Phone assessments at 3, 6 and 12 months post-tACS, will measure long-term functional recovery, quality of life and caregivers’ burden.Ethics and disseminationEthical approval for this study has been granted by the Research Ethics Board of the CIUSSS du Nord-de-l’Île-de-Montréal (Project ID 2021–2279). The findings of this two-phase study will be submitted for publication in a peer-reviewed academic journal and submitted for presentation at conferences. The trial’s results will be published on a public trial registry database (ClinicalTrials.gov).Trial registration number NCT05833568.

This study aimed to use a data-driven approach to identify individualized speed thresholds to characterize running demands and athlete workload during games and practices in skill and linemen football players. Data were recorded from wearable sensors over 28 sessions from 30 male Canadian varsity football athletes, resulting in a total of 287 performances analyzed, including 137 games and 150 practices, using a global positioning system. Speed zones were identified for each performance by fitting a 5-dimensional Gaussian mixture model (GMM) corresponding to 5 running intensity zones from minimal (zone 1) to maximal (zone 5). Skill players had significantly higher (p < 0.001) speed thresholds, percentage of time spent, and distance covered in maximal intensity zones compared to linemen. The distance covered in game settings was significantly higher (p < 0.001) compared to practices. This study highlighted the use of individualized speed thresholds to determine running intensity and athlete workloads for American and Canadian football athletes, as well as compare running performances between practice and game scenarios. This approach can be used to monitor physical workload in athletes with respect to their tactical positions during practices and games, and to ensure that athletes are adequately trained to meet in-game physical demands.

ObjectivesThis study aimed to investigate cortical excitability differences in the primary motor cortex (M1) hand representation between individuals with temporomandibular disorders (TMD) and healthy controls. We assessed resting motor thresholds, motor-evoked potentials (MEPs), intracortical inhibition, and intracortical facilitation and explored potential associations with clinical and psychosocial characteristics in the TMD group.Materials and methodsWe recruited 36 female participants with TMD and 17 pain-free controls. Transcranial magnetic stimulation (TMS) was used to assess M1 cortical excitability. Correlations between clinical and psychosocial factors and cortical excitability measures were also evaluated.ResultsPatients with TMD showed significantly higher intracortical facilitation at 12 ms (z = 1.98, p = 0.048) and 15 ms (z = 2.65, p = 0.008) when compared to controls. Correlations revealed associations between intracortical facilitation and pain interference, sleep quality, depressive symptoms, and pain catastrophizing in the TMD group.ConclusionsFemales with TMD exhibit heightened motor cortex intracortical facilitation in the hand representation, potentially indicating altered cortical excitability beyond the motor face area. This suggests a role for cortical excitability in TMD pathophysiology, influenced by psychosocial factors.Clinical relevanceUnderstanding cortical excitability in TMD may inform targeted interventions. Psychosocial variables may play a role in cortical excitability, emphasizing the multidimensional nature of TMD-related pain. Further research is needed to confirm and expand upon these findings, with potential implications for the management of TMD and related pain conditions.

Introduction Approximately 50% (between 16–74%) of adults with Parkinson’s disease (PD) show excessive daytime sleepiness. Besides its important role for vision, light conveys a powerful stimulating signal for alertness and cognition. Recent research has demonstrated that the blue part of light spectrum is the most efficient in enhancing vigilance and cognitive performance in young and older healthy individuals, thanks to a specific photoreception system within the eye which is particularly sensitive to blue wavelength. The aim of this pilot study was to compare the effects of blue-enriched light exposure (BL) and red-light placebo exposure (RL) on psychomotor vigilance and cognitive performance in adults with PD. Methods Sixteen participants with idiopathic PD (64.0±5.5 yrs, 6 women, Hoehn and Yahr status: 2) completed a brief neuropsychological assessment to exclude dementia, self-reported questionnaires and a complete eye examination in screening visits. The one-day experimental procedure included 1.25 h period of baseline dim-light exposition, followed by two light conditions presented in a counterbalanced design and separated by 15 minutes in dim-light: 1.25 h of BL at 959lux and 1.25 h of placebo RL condition at 472lux. Both light conditions were delivered by Luminette®. Data were normalized according to baseline dim-light evaluation. Mixed analyses of variance (2 light conditions X 2 orders) were performed to compare performance on an auditory psychomotor vigilance task (A-PVT) and an auditory 2-back cognitive tasks (A-2-back) during light exposure. Results We observed no significant effect of light conditions, orders and no interaction on reaction time (RT) and number of correct answers for the A-2-Back task. Furthermore, there was no significant difference between BL and RL on A-PVT performance including median RT, shift in optimum RT (i.e.,mean RT from fastest 10% RT), and duration of response in the lapse domain (i.e.,mean RT from slowest 10% RT). Conclusion These preliminary results do not support the notion that blue-enriched white light exposure is more efficient than red light exposure to stimulate psychomotor vigilance and cognitive performance in adults with PD. Next steps of analyses will compare the effects of BL and RL on subjective sleepiness and EEG cortical activation in the same population. Support (if any) CIHC & QPN

PurposeSubconcussive head impacts during contact sports are challenging to identify and their consequences remain elusive. Impaired autonomic nervous system responses involving altered cardiac dynamics have been reported following mild traumatic brain injury but remain underexplored in contact sports. This study monitored online effects of head impact exposure on athletes’ cardiovascular function during a Varsity Canadian football season.MethodsHeart rate recovery (HRR) segments (n=225) were extracted from 11 skill players (median [IQR] age: 23 [2] years; body mass index: 26 [1] kg/m²) equipped with two wearable sensors recording accelerations, heart rate, velocity, estimated metabolic energy expenditure, and fast head acceleration events (HAE). The heart signal derivative was used to detect HRR segments which were then matched with the number and intensity of HAE previously sustained during the game.ResultsFollowing a single HAE above 40 g, the median HRR (ΔHR/Δt=0.461 bpm/s, n=23 segments) decreased of 19% (p=0.005) compared to segments prior to the event (ΔHR/Δt=0.569 bpm/s, n=182 segments). This reduction was also observed with HAE as low as 20 g (0.474 bpm/s, n=42 segments; 30% reduction; p= 4.30e-08, figure 1). These were neither correlated with metabolic energy expenditure (R²=0.009, p=0.541) nor with peak running velocity reached before HAE (R²=4e-04, p=0.896).Abstract 83 Figure 1Heart rate recovery rates for segments binned by upper bounds for peak linear acceleration of 10 g (i.e., no head acceleration event – HAE –, leftmost), up to 20 g (second box), up to 30 g (third box), up to 40 g (fourth box) and 40 g and up (last box on the right). Significance test: Kruskal-Wallis rank sum test relative to the «no impacts» sample, thresholds: * = 0.05, ** = 0.01, *** = 0.001[Figure omitted. See PDF]ConclusionThis demonstrates a possible direct relationship between HAE starting at 20 g and disturbed cardiac response. Given the repetitive nature of subconcussive hits beyond this ≥ 20g threshold, there is an urgent need to investigate whether or how altered heart rate kinetics could influence severity of head injury in contact sports.

Crucial clinical decisions in the acute-to-subacute stages of severe traumatic brain injury (sTBI) are mostly based on neurological exams and behavioral assessments. Although electroencephalography (EEG)-derived indices of consciousness show prognostic potential, their effectiveness in tracking individual recovery over time remains unclear. This study characterizes the longitudinal recovery of consciousness following sTBI, tracking EEG spectral power, and aperiodic exponent markers, considering sex, etiology, and age. Four medically stable, non-sedated sTBI patients were recruited 7–26 days post-injury, based on etiology (sTBI), age (M=30 years, SD=1.41 years), lesion severity (diffuse axonal injury). Behavioral responsiveness was assessed daily using the Coma Recovery Scale-Revised (CRS-R), alongside 5-min resting-state EEG for 6 days, with an additional recording a week later. Changes in power spectral distribution and the aperiodic component were observed over time, even within similar diagnostic categories. The aperiodic component exhibited a similar improvement trajectory to behavioral responsiveness, with a progressive flattening of the EEG slope in two individuals who recovered consciousness. In contrast, individuals whose CRS-R category remained static showed inconsistent fluctuations in the aperiodic component over time. Improvements in CRS-R scores were accompanied by changes in absolute power for theta, alpha, and beta frequency bands. However, the “ABCD” and Maximum Frequency Peak frameworks showed limitations and inconsistencies when compared to behavioral outcomes. This longitudinal within-subject design captured neurophysiological changes along patient-specific recovery trajectories, revealing substantial fluctuations within individual EEG markers, despite controlling for typical confounds like etiology, age, lesion severity, and sex. Combining spectral power and the aperiodic exponent may support the development of more dynamic and reliable markers to track changes in brain activity associated with consciousness recovery, potentially improving diagnostic accuracy, outcome prediction, and therapeutic interventions. Ethical approval for this study has been given by the Research Ethics Board of the CIUSSS du Nord-de-l’Île-de-Montréal (Project ID 2021-2279).

This paper presents a complete hardware and software pipeline for real-time speech enhancement in noisy and reverberant conditions. The device consists of a microphone array and a camera mounted on eyeglasses, connected to an embedded system that enhances speech and plays back the audio in headphones, with a latency of maximum 120 msec. The proposed approach relies on face detection, tracking and verification to enhance the speech of a target speaker using a beamformer and a postfiltering neural network. Results demonstrate the feasibility of the approach, and opens the door to the exploration and validation of a wide range of beamformer and speech enhancement methods for real-time speech enhancement.