Tag: pubmed

J Neural Eng. 2021 Nov 15. doi: 10.1088/1741-2552/ac39b8. Online ahead of print.

ABSTRACT

OBJECTIVE: Brain-Computer Interfaces (BCI) with Functional Electrical Stimulation (FES) as a feedback device might promote neuroplasticity and hence improve motor function. Novel findings suggested that neuroplasticity could be possible in people with multiple sclerosis (pwMS). This preliminary study explores the effects of using a BCI-FES in therapeutic intervention, as an emerging methodology for gait rehabilitation in pwMS.

APPROACH: People with relapsing-remitting, primary progressive or secondary progressive MS were evaluated with the inclusion criteria to enroll the 9 participants required by the statistically computed sample size. Each patient trained with a BCI-FES during 24 sessions distributed in 8 weeks. The effects were evaluated on gait speed (Timed 25 Foot Walk), walking ability (12-item Multiple Sclerosis Walking Scale), quality of life measures, the true positive rate as the BCI-FES performance metric and the event-related desynchronization onset latency of the sensorimotor rhythms.

MAIN RESULTS: Seven patients completed the therapeutic intervention. A statistically and clinically significant post-treatment improvement was observed in gait speed, as a result of a reduction in the time to walk 25 feet (-1.99 s, p=0.018), and walking ability (-31.25 score points, p=0.028). The true positive rate showed a statistically significant improvement (+15.87 score points, p=0.018). An earlier event-related desynchronization onset latency (-180ms) after treatment was found.

SIGNIFICANCE: This is the first study that explored gait rehabilitation using BCI-FES in pwMS. The results showed improvement in gait which might have been promoted by changes in functional brain connections involved in sensorimotor rhythm modulation. Although more studies with a larger sample size and control group are required to validate the efficacy of this approach, these results suggest that BCI-FES technology could have a positive effect on MS gait rehabilitation.

PMID:34781272 | DOI:10.1088/1741-2552/ac39b8

Psychoneuroendocrinology. 2021 Oct 28;135:105576. doi: 10.1016/j.psyneuen.2021.105576. Online ahead of print.

ABSTRACT

PURPOSE: The acute state of anorexia nervosa (AN) is accompanied by increased peripheral concentrations of brain-derived damage markers indicative of ongoing neural and glial damage processes. Although these findings correspond with well-documented structural brain changes in the disorder, it remains unclear whether abnormal levels of brain-derived damage markers persist after long-term weight-recovery from AN.

METHODS: To address this question, we used single-molecule array (Simoa) technology to measure serum levels of neurofilament light (NF-L), tau protein and glial fibrillary acidic protein (GFAP) in a group of 55 long-term weight-recovered women with a history of AN (recAN) and 55 age-matched healthy controls. Strict exclusion criteria allowed us to control for confounds present in previous studies including most importantly neurological conditions.

RESULTS: We found not only no group differences but also statistical evidence for equal damage marker levels between groups using Bayesian hypothesis testing.

CONCLUSION: These results provide evidence for the absence of neuronal and glial damage processes after long-term weight-recovery from AN. Together, our findings are indicative of complete normalization following long-term weight restoration provide hope that recovery from AN halts neuronal damage processes and support the need to test potential candidates for therapeutic interventions including pharmacological neuroprotection.

PMID:34781223 | DOI:10.1016/j.psyneuen.2021.105576

Clin Neurol Neurosurg. 2021 Nov 10;211:107022. doi: 10.1016/j.clineuro.2021.107022. Online ahead of print.

ABSTRACT

OBJECTIVE: There is limited evidence on the use of antiplatelet therapy (APT) to reduce the risk and morbidity of cerebral aneurysmal rupture. This analysis retrospectively assessed APT use in patients presenting to our institution with aneurysmal subarachnoid hemorrhage (aSAH).

METHODS: We evaluated the records of 186 patients over 7 years of retrospective data from our tertiary care center and an existing database of patients with aSAH. A total of 18 cases with patients on APT and 168 patients not on APT (controls) were identified. Primary outcomes measured were clinical grade (Hunt and Hess score), radiographic grade (Fisher score), and presence of delayed cerebral ischemia (DCI). Secondary outcomes were modified Rankin score at discharge and at 3 months. DCI from cerebral vasospasm was defined as the occurrence of focal neurological impairment or a decrease in at least 2 points on the Glasgow Coma Scale. Logistic regression models were generated.

RESULTS: We found that APT use did not appear to lead to statistically significant differences in initial presentation, including Hunt-Hess score and Fisher grade (2.91 vs 3.06, p = 0.66, and 3.23 vs 3.22, p = 0.96 respectively). In addition, APT use was not associated with increased rates of delayed cerebral ischemia (DCI) (OR 0.27 p = 0.12). Our analysis showed that increased Hunt Hess score and the presence of DCI are both associated with increased mRS at 90 days (OR 2.32 p < 0.001; OR 2.91 p = 0.002).

CONCLUSION: The patients in this retrospective observational study did not demonstrate worse outcomes from their aSAH despite APT therapy. Larger prospective studies should be performed to see if this relationship holds and if decreased rates of DCI can be observed.

PMID:34781219 | DOI:10.1016/j.clineuro.2021.107022

Clin Neurol Neurosurg. 2021 Nov 6;211:107020. doi: 10.1016/j.clineuro.2021.107020. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to evaluate the functional recovery of stroke patients with orophyaryngeal dysphagia after treatment with traditional swallowing therapy (TST), neuromuscular electrical stimulation (NMES), and kinesiology taping (KT), by using clinical swallowing assessments and objective fiberoptic endoscopic evaluation of swallowing (FEES).

METHODS: A total of 37 patients were randomized in three groups: those who received TST and NMES as Group 1 (n:12), those who received both TST and KT as Group 2 (n:13), and those who received TST, NMES, and KT together as Group 3 (n:12). Patients were evaluated before treatment, after treatment, and three months after treatment onset with bedside water-swallow test, Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), penetration-aspiration scale (PAS), and National Institute of Health-Swallow Safety Scale (NIH-SSS). FOIS, PAS, and NIS-SSS were completed according to results of fiberoptic endoscopic evaluation of swallowing (FEES).

RESULTS: A statistically significant decrease was observed in bedside water-swallow test, EAT-10, PAS, and NIH-SSS scores in all treatment groups 5 weeks and 3 months after treatment onset compared to pre-treatment scores (p < 0.05). There was a statistically significant increase in FOIS scores 5 weeks and 3 months after treatment compared to pretreatment scores in all treatment groups (p < 0.05). When the pre-treatment, 3-week, and 5-month swallow scale scores of all groups were compared, there was no significant different difference in terms of bedside water-swallow test, EAT-10, FOIS, PAS, or NIH-SSS scores (p > 0.05).

CONCLUSION: According to the results of our study, KT is a new option in the treatment of stroke-related dysphagia, is an effective treatment approach and its efficacy is maintained throughout long-term follow-up.

PMID:34781221 | DOI:10.1016/j.clineuro.2021.107020

Nurs Open. 2021 Nov 15. doi: 10.1002/nop2.1091. Online ahead of print.

ABSTRACT

AIM: Early warning scores are commonly used in hospital settings, but little is known about their use in care homes. This study aimed to evaluate the impacts of National Early Warning Scores alongside other measures in this setting.

DESIGN: Convergent parallel design.

METHODS: Quantitative data from 276 care home residents from four care homes were used to analyse the relationship between National Early Warning Scores score, resident outcome and functional daily living (Barthel ADL (Barthel Index for Activities of Daily Living)) and Rockwood (frailty). Interviews with care home staff (N = 13) and care practitioners (N = 4) were used to provide qualitative data.

RESULTS: A statistically significant link between National Early Warning Scores (p = .000) and Barthel ADL (p = .013) score and hospital admissions was found, while links with Rockwood were insignificant (p = .551). Care home staff reported many benefits of National Early Warning Scores, including improved communication, improved decision-making and role empowerment. Although useful, due to the complexity of the resident population’s existing health conditions, National Early Warning Scores alone could not act as a diagnostic tool.

PMID:34780677 | DOI:10.1002/nop2.1091

Biometrics. 2021 Nov 15. doi: 10.1111/biom.13588. Online ahead of print.

ABSTRACT

We thank the editors for organizing the discussions and the discussants for insightful comments. Our rejoinder provides results and comments to address the questions raised in the discussions. Specifically, we present results showing DICA largely demonstrates better or comparable stability as compared with standard ICA. We also validate the DICA in real fMRI application by showing DICA generally shows higher reliability in reproducibly recovering major brain functional networks as compared with the standard ICA. We provide details on the computational complexity of the method. The computational cost of DICA is very reasonable with the analysis of the fMRI and DTI data easily implementable on a PC or laptop. Finally, we include discussions on several directions for extending the DICA framework in the future.

PMID:34780668 | DOI:10.1111/biom.13588

Fam Med. 2021 Nov;53(10):886-889. doi: 10.22454/FamMed.2021.332061.

ABSTRACT

BACKGROUND AND OBJECTIVES: Most literature about flexible nasolaryngoscopy comes from specialty clinics, making it unclear if these indications can be effectively managed without referral. This study evaluated effectiveness of diagnosis and management of upper airway complaints, utilizing flexible nasal endoscopic procedures, in a family medicine center.

METHODS: We performed retrospective chart review for all patients who had nasal endoscopy, nasopharyngoscopy, and nasolaryngoscopy performed at the University of Florida Family Medicine Center over 3 years (n=89) with 5 additional years of follow up. We used descriptive statistics to evaluate indications, diagnoses, effectiveness of management by family medicine, and referral rate.

RESULTS: The most common primary indications were hoarseness (n=33, 37%), chronic cough (n=20, 22%), nasal obstruction (n=9, 10%), and unilateral ear dysfunction (n=6, 7%). The most common primary diagnoses found were allergic rhinitis/postnasal drip (n=41, 46%), laryngopharyngeal reflux (LPR)/gastroesophageal reflux disease (GERD; n=24, 27%), masses concerning for malignancy (n=4, 4.5%), true vocal cord (TVC) polyp (n=3, 3%), TVC nodules (n=3, 3%), and epistaxis (n=3, 3%). Of the four concerning masses, two were confirmed cancers (2%). In addition, there was one case (1%) of erythroleukoplakia with dysplasia of the TVC. Most patients had documented improvement with family medicine management (n=57, 64%) and another six (7%) had follow up without documentation of status and no need for referral. Thus, a total of 71% (n=64) did not require referral and 20% (n=18) needed specialist referral.

CONCLUSIONS: Flexible nasal endoscopic procedures are effective in the care of patients in a family medicine residency center and can be safely performed and taught to residents.

PMID:34780657 | DOI:10.22454/FamMed.2021.332061

Biometrics. 2021 Nov 15. doi: 10.1111/biom.13590. Online ahead of print.

ABSTRACT

We are grateful for the opportunity to provide a discussion on this paper. We will first focus on the general context. Next, we will emphasize the novel key ideas proposed by the authors before formulating some open questions.

PMID:34780667 | DOI:10.1111/biom.13590

Am J Occup Ther. 2021 Sep 1;75(5):7505205010. doi: 10.5014/ajot.2021.041749.

ABSTRACT

IMPORTANCE: Motor vehicle accidents are the leading cause of unintentional deaths of children ages 1 and older, particularly children with health care needs.

OBJECTIVE: To explore family caregivers’ experiences and current practices while transporting children diagnosed with autism spectrum disorder (ASD).

DESIGN: A concurrent nested mixed-methods approach was used to gain insight into caregiver experiences.

SETTING: Participants completed an online Qualtrics survey.

PARTICIPANTS: A convenience sample of 54 caregivers of children with ASD from 17 U.S. states.

RESULTS: Themes that emerged include sensory behaviors of children, education related to child passenger safety, and participation in the community. Statistically significant findings suggest a correlation between caregivers (n = 39) being less likely to participate in activities away from home if the child had attempted to elope (p = .013), displayed aggressive behaviors (p = .005), or demonstrated self-injurious behaviors (p = .001).

CONCLUSIONS AND RELEVANCE: The findings suggest a correlation between caregivers limiting the distance traveled during vehicular transportation and behavioral safety concerns. If caregivers must limit travel, they may refrain from accessing the community and engaging in leisure pursuits. What This Article Adds: The findings suggest that therapists who treat children with ASD should be familiar with child passenger safety restraints, particularly for elopement.

PMID:34780642 | DOI:10.5014/ajot.2021.041749

Am J Occup Ther. 2021 Sep 1;75(5):7505205020. doi: 10.5014/ajot.2021.041087.

ABSTRACT

IMPORTANCE: Occupational therapy use in the neurological critical care unit (NCCU) may relate to patient factors, but data about these relationships remain unpublished.

OBJECTIVE: To examine how patient factors predict NCCU occupational therapy use and intervention types.

DESIGN: Retrospective cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 2015.

SETTING: NCCU in a large, urban academic hospital.

PARTICIPANTS: Adults (age ≥18 yr; N = 1,134) admitted to the NCCU.

MEASURES: Using length of stay (LOS), number of comorbidities, Glasgow Coma Scale (GCS) score, gender, age, and racial-ethnic minority status as independent variables, separate regression models identified predictors for each dependent variable: receipt of NCCU occupational therapy, occupational therapy onset (days after admission), and receipt of self-care or home management (ADL-Home); functional activities or cognitive training (Func-Cog); and therapeutic exercise (Ther-Ex).

RESULTS: Four hundred twenty patients (37.0%) received occupational therapy in the NCCU. Receipt of occupational therapy was positively associated with LOS, number of comorbidities, GCS score, and age. Earlier occupational therapy onset was associated with higher GCS score and shorter LOS. Receipt of ADL-Home or Func-Cog interventions was significantly predicted by number of occupational therapy sessions, but patients with longer LOS were less likely to receive ADL-Home interventions. Receipt of Ther-Ex interventions became less likely as GCS score increased.

CONCLUSIONS AND RELEVANCE: Patients are more likely to receive occupational therapy services if they are older and have a longer NCCU LOS, more comorbidities, and a higher level of consciousness. What This Article Adds: A patient’s level of consciousness is clearly associated with occupational therapy utilization and hospital outcomes, but it should not be the only factor considered when prioritizing patients for NCCU occupational therapy services. Compared with patients who were more awake and alert, patients with a lower level of consciousness had a later onset of occupational therapy, which suggests an opportunity for NCCU occupational therapists to collaborate with physicians in the modification of sedation protocols to enable early rehabilitation.

PMID:34780634 | DOI:10.5014/ajot.2021.041087