Exploration Of Muscle Motor Control To Guide Botox Injections For Runner’s Dystonia
Bibliographic record
Abstract
HISTORY: The patient (female, age 44) was diagnosed with runner’s dystonia (RD) of the right lower extremity (LE) in April 2022. RLE heel whip emerged in 2016 during a race. Notable medical history includes severe traumatic brain injury at age 4 and from 2017-2021: abdominal muscle diastasis (DRAM) postpartum, PT treatment of DRAM, abdominoplasty to correct DRAM and steroid injection for mild right hip dysplasia. Botox injection to R tensor fascia lata received in July 2022 did not resolve RD symptoms, which has increased in severity and now impact walking and cycling. PHYSICAL EXAMINATION: The patient completed the following tests in June 2023 to guide future Botox interventions: Lower Extremity Functional Scale (LEFS), LE strength and coordination, upper (UMN) and lower motor neuron (LMN) screen, McGill’s torso muscular endurance test battery for endurance, and treadmill running gait analysis with bilateral surface electromyography (EMG) of the medial gastrocnemius, tibialis anterior, biceps femoris, and gluteus maximus. Neuromuscular effort was calculated as the time duration spent in, above, and below the activation measured during maximum voluntary contraction during the stance phase of running. DIFFERENTIAL DIAGNOSIS: Genetic testing ruled out Parkinson's-related diseases. MRI and EMG screening ruled out multiple sclerosis. TEST AND RESULTS: UMN/LMN screen was negative. LEFS score = 70/80. Mild gross strength deficits in right hip external rotators, hip abductors, and ankle plantarflexors as compared with left. McGills’s test confirmed low endurance of back extensors. Neuromuscular effort of tibialis anterior and gluteus maximus during running was greater in right compared with left. FINAL WORKING DIAGNOSIS: The patient meets the following RD clinical assessment criteria: task specificity, first onset of symptoms during running, inconsistent orthopedic examination, negative UMN/LMN exam, absence of pain, and excessive muscle activation observed with EMG. TREATMENT AND OUTCOMES: The patient agreed to back extensor and hip muscle strengthening exercises. Abnormal running gait mechanics may benefit from biofeedback gait retraining due to muscular imbalances resulting in poor motor control. Botox injections could be explored, but risks, benefits and patient preference must be considered.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".