2008 Progress Report on Brain Research

Highlights new research on various disorders, nervous system injuries, neuroethics, neuroimmunology, pain, sense and body function, stem cells and neurogenesis, and thought and memory. Includes essays on arts and cognition and on deep brain stimulation

Neuromodulation in the treatment of upper limb spasticity

In this thesis I investigated neurophysiological changes following transcutaneous electrical nerve stimulation (TENS) at 100 Hz, and TENS and transcutaneous spinal cord stimulation (tSCS) applied with high-frequency (10 kHz) trains (HF-TENS and HF-tSCS, respectively). I also assessed literature studying neuromodulation for spasticity in SCI and developed a mobile application (app) which aimed to improve spasticity self-management through education of triggers. Paired-pulses of cervical tSCS caused post-activation depression in posterior-root reflexes (PRRs) in wrist flexors and extensors at interstimulus intervals of < 2 s; showing a similar pattern of modulation observed in previous studies with H-reflex activity (8 healthy, able-bodied participants). Another study compared TENS, HF-TENS and HF-tSCS to sham stimulation. Changes in PRRs and motor-evoked potentials (MEPs) in the wrist flexor and extensor were assessed. HF-tSCS was most efficient at modulating corticospinal excitability immediately after intervention, causing a decrease in flexor MEPs lasting 30 minutes (p = 0.015), as well as a trend towards an increase in extensor MEPs. Late spinal inhibition of wrist flexors occurred following 60 minutes of HF-tSCS (p = 0.018). An app was designed to support users in identifying factors which trigger their spasticity by logging and rating events (Penn spasm frequency scale). The design of the app was assessed using questionnaires sent to clinicians and people with spasticity. Results showed that all responders felt that the design of the app could have potential in benefitting symptoms of spasticity. Bringing together neurophysiological and clinical measures of spasticity, a systematic review and meta-analysis of 27 studies assessed the effects of neuromodulation on spasticity in SCI. This revealed a lack of randomised control trials (RCTs). In 3 RCTs and 17 studies without a control group, there was a reduction in spasticity immediately following electrical stimulation according to clinical measures. Four studies included the H-reflex as an outcome measure, with 3/4 reporting no change, or varied results between participants

Jefferson Digital Commons quarterly report: April-June 2019

This quarterly report includes: Articles CREATE Day Presentations Dissertations From the Archives Grand Rounds and Lectures House Staff Quality Improvement and Patient Safety Posters JCIPE Student Hotspotting Posters Journals and Newsletters MPH Capstone Presentations Posters Sigma Xi Research Day What People are Saying About the Jefferson Digital Common

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Self-management Interventions for Psychological Outcomes Following Spinal Cord Injury

This item is only available electronically.A spinal cord injury (SCI) is a significant and lifelong neurological injury with devastating physical and psychological consequences. With no established cure, effective selfmanagement of symptoms is essential for maintaining long-term health and wellbeing. Selfmanagement interventions have demonstrated effectiveness for physical symptoms and sequelae. However, less is known about this approach for mental health outcomes. Methodological issues, including variation in the specific skills taught in self-management and a reliance on quasi-experimental and uncontrolled study designs, also limit conclusions regarding efficacy. Greater understanding of the psychological benefits of self-management in SCI may be achieved by consolidating the available high-quality evidence in this field.Thesis (M.Psych(Clinical)) -- University of Adelaide, School of Psychology, 202

Digital health rehabilitation can improve access to care in spinal cord injury in the UK: A proposed solution

© 2020, University Library System, University of Pittsburgh. All rights reserved. Lack of specialist beds, inadequate finance and shortage of skilled staff make it difficult for Spinal Cord Injury Centres (SCICs) in the United Kingdom (UK) to admit all newly injured individuals. Length of stay of those admitted can be too brief. At discharge, follow-up care is sparse and inadequate. We therefore propose that specialist spinal units redefine their roles and act as catalysts to build capacity by enhancing expertise in the wider community. SCICs can devolve certain tasks locally to less specialised units with their support, training, and guidance. This Commentary further proposes that use of Digital Health Technologies, (i.e., to deploy telemedicine, telehealth, and telerehabilitation), can enhance rehabilitation opportunities. The authors set-forth their vision for a comprehensive web portal that will serve as a primary resource for evidence-based practice, information on guidelines, care pathways, and protocols of SCI management. At any stage during the acute management of SCI and following discharge, rehabilitation specialists could conduct remote consultation with persons with SCI and acute care specialists via the web portal, allowing timely access to specialist input and better clinical outcomes. The proposed portal would also provide information, advice and support to persons with SCI and their family members. The strategic use of digital health technologies has been shown to result in cost and time savings and increase positive outcomes

Determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation:Perspectives of rehabilitation professionals and wheelchair users

Objective This study aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. The findings should contribute to the field of health promotion programs for wheelchair users. Methods Five focus groups were held with wheelchair users (n = 25), and two with rehabilitation professionals (n = 11). A thematic approach was used for data analysis in which the determinants were categorized using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model. Results Reported personal factors influencing dietary behaviour in wheelchair users were knowledge, boredom, fatigue, stage of life, habits, appetite, self-control, multiple lifestyle problems, intrinsic motivation, goal setting, monitoring, risk perception, positive experiences, suffering, action planning, health condition, function impairments, attitude and self-efficacy. Reported environmental factors influencing dietary behaviour in wheelchair users were unadjusted kitchens, monitoring difficulties, eating out, costs, unfavourable food supply, nutrition education/counselling, access to simple healthy recipes, eating together, cooking for others, and awareness and support of family and friends. Conclusions Important modifiable determinants of dietary behaviour in wheelchair users that might be influenced in lifestyle interventions are knowledge, fatigue, habits, self-control, intrinsic motivation, risk perception, attitude and self-efficacy. It is recommended to involve relatives, since they appear to significantly influence dietary behaviour

Evaluation of Participation and Environments for Individuals with Disabilities: An Evidence-Based Practice Project Bailey

This Evidence-Based Practice (EBP) project considered the following question: What measures are available to evaluate participation and environmental supports and barriers for individuals with disabilities and what are their psychometric properties