关键词： Cues   task performance   systematic review   neurological disorder  

摘要： Purpose: To examine in people with neurological disorders, which method/s of providing external cues to improve task performance are most effective. Methods: Medline, EMBASE, and PsycINFO were systematically searched. Two reviewers independently screened, extracted data, and assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Twenty six studies were included. Studies examined a wide-range of cues including visual, tactile, auditory, verbal, and multi-component cues. Cueing (any type) improved walking speed when comparing cues to no cues (mean difference (95% confidence interval): 0.08 m/s (0.06-0.10), I-2 = 68%, low quality of evidence). Remaining evidence was analysed narratively;evidence that cueing improves activity-related outcomes was inconsistent and rated as very low quality. It was not possible to determine which form of cueing may be more effective than others. Conclusion: Providing cues to encourage successful task performance is a core component of rehabilitation, however there is limited evidence on the type of cueing or which tasks benefit most from external cueing. Low-quality evidence suggests there may be a beneficial effect of cueing (any type) on walking speed. Sufficiently powered randomised controlled trials are needed to inform therapists of the most effective cueing strategies to improve activity performance in populations with a neurological disorder.

关键词： Sawtooth fetal heart rate pattern   Fetal heart rate monitoring   Neurological sequelae   Case report  

摘要： Background The sawtooth fetal heart rate pattern is rare, and has been reported as a possible indicator of neurological sequelae in newborns. However, we observed this fetal heart rate pattern in an infant with normal neurological function. Case presentation A 29-year-old primigravida Japanese woman presented to our hospital at 40 weeks and 1 day of gestation with marked vaginal bleeding. Since admission, fetal heart rate tracing consistently demonstrated a sawtooth-like pattern. There were 3-4 oscillations per minute, and their amplitude was 30-40 beats per minute. An emergency cesarean section was performed because of non-reassuring fetal status. Evidence of placental abruption was not observed. The newborn was a male weighing 2936 g, with an Apgar score of 1 and 3 at 1 minute and 5 minutes, respectively. The infant received brain cooling, but was discharged uneventfully. A follow-up examination at age 3 years demonstrated no developmental restriction. Conclusion Although the Apgar score of the newborn was low, the infant had no neurological sequelae. Thus, the sawtooth fetal heart rate pattern may not be linked to in utero irreversible fetal central nervous system injury.

关键词： Behavior   Biology and life sciences   Dementia   Depression   Epilepsy   Health care   Health care providers   Medical personnel   Medicine and health sciences   Mental health and psychiatry   Mood disorders   Neurology   Nurses   People and places   Population groupings   Professions   Psychology   Psychoses   Research Article   Social sciences  

摘要： Background Over 75% of people with mental neurological and substance use disorders (MNSD) live in low and middle-income countries with limited access to specialized care. The World Health Organization's Mental Health Gap Action Program (mhGAP) aims to address the human resource gap but it requires contextualization. Aims We conducted a qualitative study in rural coastal Kenya to explore the local terms, perceived causes and management modalities of priority MNSD listed in the mhGAP, to inform implementation in this setting. Methods We conducted 8 focus group discussions with primary health care providers and traditional health practitioners and used the framework method to conduct thematic analysis. We identified local terms, perceived causes and treatment options for MNSD. We also explored possibilities for collaboration between the traditional health practitioners and primary health care providers. Results We found local terms for depression, psychoses, epilepsy, disorders due to substance use and self-harm/suicide but none for dementia. Child and adolescent mental and behavioral problems were not regarded as MNSD but consequences of poor parenting. Self-harm/suicide was recognized in the context of other MNSD. Causes of MNSD were broadly either biological or supernatural. Treatment options were dependent on perceived cause of illness. Most traditional health practitioners were willing to collaborate with primary health care providers mainly through referring cases. Primary health care providers were unwilling to collaborate with traditional health practitioners because they perceived them to contribute to worsening of patients' prognoses. Conclusions Local terms and management modalities are available for some priority MNSD in this setting. Community level case detection and referral may be hindered by lack of collaboration between traditional health practitioners and primary health care providers. There is need for training on the recognition and management of a

关键词： Myasthenic crisis   Intensive care unit   Clinical characteristics   Management   Outcomes   Survival predictor  

摘要： Background: Myasthenic crisis (MC) often requires admission to an intensive care unit (ICU). Methods: We retrospectively investigated 113 consecutive patients with first MC admitted to the neurological ICU. Patients' demographic, clinical and other characteristics were examined, as well as therapeutic interventions, mortality and functional outcome. Results: MC patients at first onset admitted to neurological ICU had a mortality rate of 18.6%. PCO2 level before intubation and score on Myasthenia Gravis-Activities of Daily Living (MG-ADL) scale at MC onset correlated with duration of ventilation and length of ICU stay. Compared with patients with good functional outcome, patients with intermediate or poor functional outcome were older at first MC onset, had lower pH and PO2, and had higher PCO2 before intubation. Multivariate logistic analysis identified pre-intubation PCO2 level as an independent predictor of survival. Cox regression showed that age at first MC onset requiring ICU management was the factor which significantly influenced the mortality. Conclusions: Our results suggest that PCO2 before intubation and MG-ADL score at MC onset may be useful indicators of more severe disease likely to require extensive respiratory support and ICU management. Higher pre-intubation PCO2 indicates chronic respiratory acidosis that can increase risk of severe disability and death, especially in patients with older age at first MC onset.

关键词： Neurological early rehabilitation   Paroxysmal sympathetic hyperactivity (PSH)   Outcome   Case control study  

摘要： Background: Paroxysmal Sympathetic Hyperactivity (PSH) is a frequently observed condition among critically ill patients on intensive care units. According to different studies, PSH is associated with worse recovery and increased mortality in acute-care facilities. In this monocentric, retrospective case-control study, we investigated whether this association also applies to post-acute neurological early rehabilitation. Methods: The study included n=387 patients, admitted to an intensive care or intermediate care unit within 1 year (2016). Among these, 97 patients showed clinical signs of PSH. For each patient with PSH, a patient without PSH was identified, controlling for age, gender, functional and respiratory status upon admission. However, for 25 patients with PSH, there was no suitable control patient fulfilling all defined matching criteria. Primary outcome was type of discharge, dichotomized into favorable (follow-up rehabilitation) and unfavorable outcome (all others). Secondary outcome measures were functional and respiratory status, number of secondary diagnoses, duration of treatment interruptions and length of stay at discharge. Results: About 25% of neurological early rehabilitation patients showed clinical signs of PSH. A young age (OR=0.94;CI=0.91-0.97) and less severe PSH symptoms (OR=0.79;CI=0.69-0.90) were independent predictors of a favorable outcome. In addition, severity of PSH symptoms was associated with weaning duration, while the occurrence of PSH symptoms alone had no influence on most secondary outcome variables. The treatment on intermediate care units proved to be longer for patients with PSH symptoms, only. Conclusions: Patients with PSH represent a large group of neurological early rehabilitation patients. Overall, we did not find PSH-related differences in most of the examined outcome measures. However, severe PSH symptoms seem to be associated with poorer outcome and longer treatment on intermediate care units, in order to prevent pos

关键词： Neurological recovery   Obesity   Parvalbumin interneurons   Stroke-induced Neurogenesis   Stroke   Type 2 diabetes  

摘要： Type 2 diabetes (T2D) hampers stroke recovery though largely undetermined mechanisms. Few preclinical studies have investigated the effect of genetic/toxin-induced diabetes on long-term stroke recovery. However, the effects of obesity-induced T2D are mostly unknown. We aimed to investigate whether obesity-induced T2D worsens long-term stroke recovery through the impairment of brain's self-repair mechanisms - stroke-induced neurogenesis and parvalbumin (PV)+ interneurons-mediated neuroplasticity. To mimic obesity-induced T2D in the middle-age, C57bl/6j mice were fed 12 months with high-fat diet (HFD) and subjected to transient middle cerebral artery occlusion (tMCAO). We evaluated neurological recovery by upper-limb grip strength at 1 and 6 weeks after tMCAO. Gray and white matter damage, stroke-induced neurogenesis, and survival and potential atrophy of PV-interneurons were quantitated by immunohistochemistry (IHC) at 2 and 6 weeks after tMCAO. Obesity/T2D impaired neurological function without exacerbating brain damage. Moreover, obesity/T2D diminished stroke-induced neural stem cell (NSC) proliferation and neuroblast formation in striatum and hippocampus at 2 weeks after tMCAO and abolished stroke-induced neurogenesis in hippocampus at 6 weeks. Finally, stroke resulted in the atrophy of surviving PV-interneurons 2 weeks after stroke in both non-diabetic and obese/T2D mice. However, after 6 weeks, this effect selectively persisted in obese/T2D mice. We show in a preclinical setting of clinical relevance that obesity/T2D impairs neurological functions in the stroke recovery phase in correlation with reduced neurogenesis and persistent atrophy of PV-interneurons, suggesting impaired neuroplasticity. These findings shed light on the mechanisms behind impaired stroke recovery in T2D and could facilitate the development of new stroke rehabilitative strategies for obese/T2D patients.

关键词： Local shape complexity   Fractal dimensionality   Elliptical Fourier  

摘要： Background: Local shape complexity can be biologically meaningful as a marker of disease, trauma, or change in brain structure over time. Fractal dimensionality (FD) is currently the dominant measure of local shape complexity used in neuroimaging but its limitations are not well understood. New method: Elliptical Fourier harmonic power requirement (HPR) may provide complementary information to FD. We benchmarked the performance of FD and HPR on a series of simulated shapes, systematically manipulating aspects of local shape complexity, and a series of clinical contours (glioma tumour cores and stroke lesions from the BRATS and ATLAS datasets). HPR was calculated as the point of 99.9% harmonic power. FD was calculated at six resolutions (8 x 8, 16 x 16, 32 x 32, 64 x 64, 128 x 128, and 256 x 256), by using an approach which computationally indexes the complexity of the shape boundary (i.e. the number of cells defining the contour) relative to the total grid size. Results and comparison with existing methods: PR and FD were moderately positively correlated (r approximate to 0.2 to 0.8 depending on shape properties), and both were sensitive to the frequency and amplitude of local complexity. FD was most biased by rotation, while HPR was more biased by global shape features such as deep invaginations. FD indicated an aggregate measure of complexity across the whole contour, while HPR indicated the point of highest complexity. Conclusions: The HPR index provides conceptually distinct local complexity information from the current FD standard. Future research will benefit from using these complementary measures.

关键词： Biomechanics   Rehabilitation   Gait   Balance   Wearable sensing   Sparse sensing   Machine learning   Parkinson's disease  

摘要： BackgroundClinical balance assessments often rely on functional tasks as a proxy for balance (e.g., Timed Up and Go). In contrast, analyses of balance in research settings incorporate quantitative biomechanical measurements (e.g., whole-body angular momentum, H) using motion capture techniques. Fully instrumenting patients in the clinic is not feasible, and thus it is desirable to estimate biomechanical quantities related to balance from measurements taken from a subset of the body segments. Machine learning algorithms are well-suited for this type of low- to high-dimensional mapping. Thus, our goal was to develop and test an artificial neural network that to predict segment contributions to whole-body angular momentum from linear acceleration and angular velocity signals (i.e., those typically available to wearable inertial measurement units, IMUs) taken from a sparse set of body *** motion capture data were collected from five able-bodied individuals and five individuals with Parkinson's disease (PD) walking on a non-steady-state locomotor circuit comprising stairs, ramps and changes of direction. Motion data were used to calculate angular momentum (i.e., gold standard output data) and body-segment linear acceleration and angular velocity data from local reference frames at the wrists, ankles and neck (i.e., network input). A dynamic nonlinear autoregressive neural network was trained using the able-bodied data (pooled across subjects). The neural network was tested on data from individuals with PD with noise added to simulate real-world IMU *** coefficients of the predicted segment contributions to whole-body angular momentum with the gold standard data were 0.989 for able-bodied individuals and 0.987 for individuals with PD. Mean RMS errors were between 2 and 7% peak signal magnitude for all body segments during completion of the locomotor *** results suggest that estimating segment contributions to angu

关键词： Neurology   Physicians   Junior   Career choice   Workforce   Medical   Medical education  

摘要： BackgroundThe rapidly rising rates of brain diseases due to the growing ageing population and the explosion in treatment options for many neurological conditions increase the demand for neurologists. We report trends in doctors' career choices for neurology;investigate factors driving their choices;and compare doctors' original choices with their specialty *** multi-cohort, multi-purpose nation-wide study using both online and postal questionnaires collected data on career choice, influencing factors, and career destinations. UK-trained doctors completed questionnaires at one, three, five, and ten years after qualification. They were classified into three groups: graduates of 1974-1983, graduates of 1993-2002, and graduates of *** was more popular among graduates of 2005-2015 than earlier graduates;however, its attraction for graduates of 2005-2015 doctors reduced over time from graduation. A higher percentage of men than women doctors chose neurology as their first career choice. For instance, among graduates of 2005-2015, 2.2% of men and 1.1% of women preferred neurology as first choice in year 1. The most influential factor on career choice was enthusiasm for and commitment to the specialty in all cohorts and all years after graduation. Only 39% who chose neurology in year 1 progressed to become neurologists later. Conversely, only 28% of practicing neurologists in our study had decided to become neurologists in their first year after qualification. By year 3 this figure had risen to 65%, and by year 5 to 76%.ConclusionsCareer decision-making among UK medical graduates is complicated. Early choices for neurology were not highly predictive of career destinations. Some influential factors in this process were identified. Improving mentoring programmes to support medical graduates, provide career counselling, develop professionalism, and increase their interest in neurology were suggested.

关键词： internet   carers   mental health   technology   review  

摘要： Background: Nonprofessional carers who provide support to an individual with a psychiatric or neurological disorder will often themselves experience symptoms of stress, anxiety, or low mood, and they perceive that they receive little support. Internet-based interventions have previously been found to be effective in the prevention and treatment of a range of mental health difficulties in carers. Objective: This review seeks to establish the status of internet-based interventions for informal (nonprofessional) carers of people with psychiatric or neurological disorders by investigating (1) the number and quality of studies evaluating the efficacy or effectiveness of internet-based carer interventions and (2) the impact that such interventions have on carer mental health, as well as (3) how internet-based interventions compare with other intervention types (eg, face-to-face treatment). Methods: A systematic literature search was conducted in January 2019 using the EMBASE (1974-present), Ovid MEDLINE (1946-present), PsychARTICLES, PsychINFO (1806-present), and Global Health (1973-present) databases, via the Ovid Technologies database. Search terms included carer, caregiver, online, technology, internet-based, internet, interactive, intervention, and evaluation. Studies selected for inclusion in this review met the following predetermined criteria: (1) delivering an intervention aimed primarily at informal carers, (2) carers supporting individuals with psychiatric disorders, stroke, dementia, or brain injury, (3) the intervention delivered to the carers was primarily internet based, (4) the study reported a pre-and postquantitative measure of carer depression, anxiety, stress, burden, or quality of life, (5) appeared in a peer-reviewed journal, and (6) was accessible in English. Results: A total of 46 studies were identified for inclusion through the detailed search strategy. The search was conducted, and data were extracted independently by 2 researchers. The majority