CMC is more than a measure of corticospinal tract integrity in acute stroke patients

In healthy subjects, motor cortex activity and electromyographic (EMG) signals from contracting contralateral muscle show coherence in the beta (15-30 Hz) range. Corticomuscular coherence (CMC) is considered a sign of functional coupling between muscle and brain. Based on prior studies, CMC is altered in stroke, but functional significance of this finding has remained unclear. Here, we examined CMC in acute stroke patients and correlated the results with clinical outcome measures and corticospinal tract (CST) integrity estimated with diffusion tensor imaging (DTI). During isometric contraction of the extensor carpi radialis muscle, EMG and magneto encephalographic oscillatory signals were recorded from 29 patients with paresis of the upper extremity due to ischemic stroke and 22 control subjects. CMC amplitudes and peak frequencies at 13-30 Hz were compared between the two groups. In the patients, the peak frequency in both the affected and the unaffected hemisphere was significantly (p < 0.01) lower and the strength of CMC was significantly (p < 0.05) weaker in the affected hemisphere compared to the control subjects. The strength of CMC in the patients correlated with the level of tactile sensitivity and clinical test results of hand function. In contrast, no correlation between measures of CST integrity and CMC was found. The results confirm the earlier findings that CMC is altered in acute stroke and demonstrate that CMC is bidirectional and not solely a measure of integrity of the efferent corticospinal tract.Peer reviewe

Exploring functional brain networks using independent component analysis:functional brain networks connectivity

Abstract Functional communication between brain regions is likely to play a key role in complex cognitive processes that require continuous integration of information across different regions of the brain. This makes the studying of functional connectivity in the human brain of high importance. It also provides new insights into the hierarchical organization of the human brain regions. Resting-state networks (RSNs) can be reliably and reproducibly detected using independent component analysis (ICA) at both individual subject and group levels. A growing number of ICA studies have reported altered functional connectivity in clinical populations. In the current work, it was hypothesized that ICA model order selection influences characteristics of RSNs as well as their functional connectivity. In addition, it was suggested that high ICA model order could be a useful tool to provide more detailed functional connectivity results. RSNs’ characteristics, i.e. spatial features, volume and repeatability of RSNs, were evaluated, and also differences in functional connectivity were investigated across different ICA model orders. ICA model order estimation had a significant impact on the spatial characteristics of the RSNs as well as their parcellation into sub-networks. Notably, at low model orders neuroanatomically and functionally different units tend to aggregate into large singular RSN components, while at higher model orders these units become separate RSN components. Disease-related differences in functional connectivity also seem to alter as a function of ICA model order. The volume of between-group differences reached maximum at high model orders. These findings demonstrate that fine-grained RSNs can provide detailed, disease-specific functional connectivity alterations. Finally, in order to overcome the multiple comparisons problem encountered at high ICA model orders, a new framework for group-ICA analysis was introduced. The framework involved concatenation of IC maps prior to permutation tests, which enables statistical inferences from all selected RSNs. In SAD patients, this new correction enabled the detection of significantly increased functional connectivity in eleven RSNs.Tiivistelmä Toiminnallisten aivoalueiden välinen viestintä on todennäköisesti avainasemassa kognitiivisissa prosesseissa, jotka edellyttävät jatkuvaa tiedon integraatiota aivojen eri alueiden välillä. Tämä tekee ihmisaivojen toiminnallisen kytkennällisyyden tutkimuksesta erittäin tärkeätä. Kytkennälllisyyden tutkiminen antaa myös uutta tietoa ihmisaivojen osa-alueiden välisestä hierarkiasta. Aivojen hermoverkot voidaan luotettavasti ja toistettavasti havaita lepotilan toiminnasta yksilö- ja ryhmätasolla käyttämällä itsenäisten komponenttien analyysia (engl. Independent component analysis, ICA). Yhä useammat ICA-tutkimukset ovat raportoineet poikkeuksellisia toiminnallisen konnektiviteetin muutoksia kliinisissä populaatioissa. Tässä tutkimuksessa hypotetisoitiin, että ICA:lla laskettaujen komponenttien lukumäärä (l. asteluku) vaikuttaa tuloksena saatujen hermoverkkojen ominaisuuksiin kuten tilavuuteen ja kytkennällisyyteen. Lisäksi oletettiin, että korkea ICA-asteluku voisi olla herkempit tuottamaan yksityiskohtaisia toiminnallisen jaottelun tuloksia. Aivojen lepotilan hermoverkkojen ominaisuudet, kuten anatominen jakautuminen, volyymi ja lepohermoverkkojen havainnoinnin toistettavuus evaluoitin. Myös toiminnallisen kytkennällisyyden erot tutkitaan eri ICA-asteluvuilla. Havaittiin että asteluvulla on huomattava vaikutus aivojen lepotilan hermoverkkojen tilaominaisuuksiin sekä niiden jakautumiseen alaverkoiksi. Pienillä asteluvuilla hermoverkojen neuroanatomisesti erilliset yksiköt pyrkivät keräytymään laajoiksi yksittäisiksi komponenteiksi, kun taas korkeammilla asteluvuilla ne havaitaan erillisinä. Sairauksien aiheuttamat muutokset toiminnallisessa kytkennällisyydessä näyttävät muuttuvan myös ICA asteluvun mukaan saavuttaen maksiminsa korkeilla asteluvuilla. Korkeilla asteluvuilla voidaan havaita yksityiskohtaisia, sairaudelle ominaisia toiminnallisen konnektiviteetin muutoksia. Korkeisiin ICA asteluvun liittyvän tilastollisen monivertailuongelman ratkaisemiseksi kehitimme uuden menetelmän, jossa permutaatiotestejä edeltävien itsenäisten IC-karttoja yhdistämällä voidaan tehdä luotettava tilastollinen arvio yhtä aikaa lukuisista hermoverkoista. Kaamosmasennuspotilailla esimerkiksi kehittämämme korjaus paljastaa merkittävästi lisääntynyttä toiminnallista kytkennällisyyttä yhdessätoista hermoverkossa

Which resources are matter to healthcare performance? A case study on Bahrain

The study aims at measuring the Bahrain public hospitals\u27 healthcare services quality. For this purpose, the study adopts quantitative and survey techniques through designing survey questionnaire based on the five quality dimensions of SERVQUAL model which are: Tangibles, Reliability, Responsiveness, Assurance and Empathy. A questionnaire distributed electronically among citizens and residents, by using the social media network. A total of 169 responses were collected. The responses were estimated and analyzed via correlations and multiple regression techniques. The main findings show that, there is a significant influence of health care service quality on overall patient, in addition to, there are no difference in patient perceptions of health service quality dimensions attributed to any of the demographic variables. The study recommends that, hospital administration should continue their commitment to provide medical services to patients in a timely manner. Employees must obtain incentives and training courses, which might significantly impact on their job satisfaction and retention, and it could help to develop their communication skills, improve the patient experience of care, improve the health of populations, reduce the per capita cost of healthcare, and reduce clinician and staff burnout

Immersive Virtual Reality in Improving Communication Skills in Children with Autism

Individuals in the Autism Spectrum often encounter situations where they have to respond to questions and situations that they do not know how to respond to, such as, questions asked by strangers including ones related to daily-life activities. A variety of research has been done to improve social and communication impairments in children with autism using technology. Immersive virtual reality is a relatively recent technology with a potential to bring an effective solution and used as a therapeutic tool to develop different skills. This paper presents a virtual reality solution to reduce the gap experienced by autistic children due to their inability to establish a communication. An interactive scenario-based system that uses role-play and turn-taking technique was implemented to evaluate and verify the effectiveness of immersive environment on the social performance of an autistic child. Preliminary testing of the system demonstrated the feasibility of VR-based system as a took for improving the communication skill in Autism Spectrum Disorder (ASD) children. The results of the comparative usability study show the effectiveness of immersive VR in motivating and satisfying the autistic