Caloric vestibular stimulation (CVS) can temporarily reduce visuospatial neglect and related symptoms. The present study examined the effect of CVS on representational neglect during free exploration ...of the map of France. We asked patients to name cities they could mentally “see” on the map of France, without giving them any directional instructions related to the left or right sides of the map. In right brain damaged patients with left visuospatial neglect, the mental representation of the map was asymmetrical (favoring the right side). After stimulation, neglect patients named more towns on the left side of the map, leading to a significant reduction in map representation asymmetry. Our findings are consistent with previous studies on visuospatial neglect and are in favor of a central effect of vestibular stimulation on mechanisms involved in space representation.
Hypospadias surgery is performed by a plastic surgeon or urologist, depending on the geographical area of referral. A systematic review and meta-analysis that included 6603 patients found an ...incidence of fissure of 7.5%, stenosis or stricture 4.4%, and dehiscence 2.1%.7 Most boys grow up not knowing there was ever a problem, although most are followed up into their second decade to check for these complications. Fistula after single-stage primary hypospadias repair - A systematic review of the literature.
Given a mesh of wireless nodes for WiFi customers covering a city district, we describe a genetic algorithm-based approach to the problem of selecting a small fixed number of nodes as gateways to the ...internet, and linking the remaining nodes to the gateways either directly or by 'hopping', to create an efficient mesh network structure. The algorithm uses a modification of k-means clustering to allocate nodes to gateways.
Cognitive rehabilitation research has progressed slowly, in part due to incomplete reporting of intervention content and delivery and the difficulties this produces for discerning program ...effectiveness. This knowledge gap can be reduced by providing detailed intervention descriptions. We document the content/ingredients and therapeutic targets of a cognitive rehabilitation program for adults with mild-to-moderate cognitive impairment.
The documentation process used a method of participatory/collaborative research. Discussions with the clinical team identified session content/ingredients and therapeutic targets, which were then described using Body Functions, and Activities & Participation domains from the International Classification of Function, Disability and Health (ICF). Domains most frequently targeted by each clinician were identified as Primary Targets.
Each clinician produced a detailed description of session content, implementation, and ICF-coded therapeutic targets. This revealed that the whole program targets 29 ICF domains, seven of which were identified as Primary Targets: Higher-level Cognitive; Attention; Memory; Emotional; Global Psychosocial, Temperament and Personality, and Conversation.
Documentation of treatment targets enabled identification of appropriate outcome measures which are now being used to investigate program efficacy. This step-by-step explanation of the documentation process could serve as a guide for other teams wanting to document their rehabilitation interventions and/or establish similar programs.
IMPLICATIONS FOR REHABILITATION
Incomplete reporting of intervention content and delivery contributes to difficulties in discerning the effectiveness of complex rehabilitation programs.
Current recommendations for rehabilitation intervention reporting suggest that these difficulties can be partially overcome by providing detailed descriptions of intervention content/ingredients and treatment targets.
Human and physical resources differ widely from one clinical setting to another and the existence of clear program descriptions can guide clinicians who wish to create similar programs.
Detailed descriptions of rehabilitation interventions are necessary to accurately measure patient outcomes and generate testable hypotheses about proposed mechanisms of action.
Program descriptions are needed for the development of treatment theories and the advancement of evidence-based practice in rehabilitation.
Caloric vestibular stimulation (CVS) can temporarily reduce visuospatial neglect and related symptoms. The present study examined the effect of CVS on representational neglect during free exploration ...of the map of France. We asked patients to name cities they could mentally "see" on the map of France, without giving them any directional instructions related to the left or right sides of the map. In right brain damaged patients with left visuospatial neglect, the mental representation of the map was asymmetrical (favoring the right side). After stimulation, neglect patients named more towns on the left side of the map, leading to a significant reduction in map representation asymmetry. Our findings are consistent with previous studies on visuospatial neglect and are in favor of a central effect of vestibular stimulation on mechanisms involved in space representation.
Spatial neglect is one of the main predictors of poor functional recovery after stroke. Many therapeutic interventions have been developed to alleviate this condition, but to date the evidence of ...their effectiveness is still scarce.
The purpose of this study was to test whether combining prism adaptation (PA) and methylphenidate (MP) could enhance the recovery of neglect patients at a functional level.
RITAPRISM is a multicentre, randomized, double-blind, placebo-controlled study comparing PA plus placebo (control) versus PA plus MP. 24 patients were prospectively enrolled (10 in the placebo group and 14 in the MP group).
The main result is a long-term functional improvement (on the functional independence measure (FIM) and on Bergego's scale) induced by MP combined with PA. No serious adverse event occurred.
The long-term benefit on activities of daily living (ADL) obtained in this randomized controlled trial set this intervention apart from previous attempts and supports with a high level of evidence the value of combining PA and MP in order to improve the autonomy of neglect patients. Further studies will be needed to clarify the mechanism of this improvement. Although not specifically assessed at this stage, a part of the improvement in ADL might be related to the collateral effect of MP on mood, executive functions or fatigue, and/or the combined effect of PA and MP on motor intentional bias of neglect patients.
This study provides Class I evidence that adding MP to PA improves the functional outcome of neglect patients.
EUCTR2008-000325-20-FR.
Spatial neglect is one of the main predictors of poor functional recovery after stroke. Many therapeutic interventions have been developed to alleviate this condition, but to date the evidence of ...their effectiveness is still scarce.Objective: The purpose of this study was to test whether combining prism adaptation (PA) and methylphenidate (MP) could enhance the recovery of neglect patients at a functional level.Methods: RITAPRISM is a multicentre, randomized, double-blind, placebo-controlled study comparing PA plus placebo (control) versus PA plus MP. 24 patients were prospectively enrolled (10 in the placebo group and 14 in the MP group).Results: The main result is a long-term functional improvement (on the functional independence measure (FIM) and on Bergego's scale) induced by MP combined with PA. No serious adverse event occurred.Conclusions: The long-term benefit on activities of daily living (ADL) obtained in this randomized controlled trial set this intervention apart from previous attempts and supports with a high level of evidence the value of combining PA and MP in order to improve the autonomy of neglect patients. Further studies will be needed to clarify the mechanism of this improvement. Although not specifically assessed at this stage, a part of the improvement in ADL might be related to the collateral effect of MP on mood, executive functions or fatigue, and/or the combined effect of PA and MP on motor intentional bias of neglect patients.Classification of evidence: This study provides Class I evidence that adding MP to PA improves the functional outcome of neglect patients.Who trial registration id: EUCTR2008-000325-20-FR.
Objective Describe cognitive impairments and their impact on activities of daily living after a minor stroke in the context of a “pilote” consultation done in hospices civils de Lyon between vascular ...neurology and physical and rehabilitation services. Material/Patients and methods Thirty patients (21-67 years old) who have cognitive difficulties 6 months after minor stroke were included in the study. All patients received an assessment of complaints and cognitive performances (Montreal cognitive assessment scale, verbal span, 16 items free and cued recall, doors test, rey figure, symbol digit modalities test, verbal fluences, trail making test and the virtual action planning-supermarket test). Impact on activities of daily living was evaluated by cognitive difficulties scale of MacNair and Kahn (MacNair), the reintegration to normal living index (RNLI) and the sickness impact profile-65 (SIP-65). Correlations between cognitive performances and impact on activities of daily living were done (Spearman test). Results Eighty percent of patients complained of emotional modifications and 70% have reduced or stopped their work activity. Seventy percent of complaints concerned memory impairment, 54% concerned executive functioning impairment and 77% concerned processing speed impairment. Patients with right and bilateral stroke had a higher number of pathological indices at cognitive performances assessment than patients with left stroke (38 vs 27) and bigger impact on activities of daily living (MacNair: 68 vs 68; QRVN: 69 vs 82; SIP-65: 0.42 vs 0.25, respectively). Finally, there was negative correlation ( r = −0.69 et P = 0.008) between number of pathological indices and RNLI score. Discussion - Conclusion Patients who were initially diagnosed with minor stoke have persistent cognitive impairments at 6 months which have an impact on work and quality of life (mRS = 2). These impairments are dominant after right and bilateral stroke. They justify development of pluriprofessionnal consultations after a stroke (sixth action of stroke plan 2010-2014) and cognitive remediation protocols.
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