Translating Sleep Research: Does Sleep Promote Learning a Functional Motor Task?

Sleep has been demonstrated to produce off-line improvements in motor learning in young adults. Evidence of sleep-dependent off-line motor learning has been demonstrated across a wide variety of simple motor tasks that have limited implications in rehabilitation. It remains unclear whether a functional motor task that is clinically-relevant will benefit from sleep to produce off-line motor skill enhancement. Addressing this question was the purpose of this dissertation. A novel walking task was used to assess the role of sleep in learning a functional motor task in young adults. Twenty-four young individuals were randomly assigned to either the sleep or the no-sleep group. Results indicate that young participants who slept after practicing the novel walking task demonstrated a significant off-line improvement in performance on the functional task, while those participants who stayed awake failed to demonstrate off-line learning. Only a few recent studies have investigated sleep-dependent off-line motor learning in older adults, and the findings of these studies offer mixed conclusions. Only one study has examined the role of sleep in motor learning in middle-aged adults. These studies all used simple motor tasks. Therefore, we examined sleep-dependent off-line learning of the novel walking task in 20 middle-aged and 20 older adults. Only the middle-aged and older adults in the sleep condition demonstrated significant off-line improvement in performance on the novel walking task. However, when compared with the magnitude of off-line learning in young adults, the results indicate that the magnitude of off-line improvement was less for middle-aged and older adults groups. In summary, this body of work indicates that sleep enhances learning a functional motor task that is clinically-relevant in young, middle-aged, and older adults. Clinicians should consider sleep as an important factor when structuring rehabilitation interventions. Emphasis should be placed on addressing sleep disorders and ensuring adequate sleep for individuals who undergo rehabilitation

Time rather than sleep appears to enhance off-line learning and transfer of learning of an implicit continuous task

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author’s publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.There is increasing evidence that sleep promotes off-line enhancement of a variety of explicitly learned motor tasks in young adults. However, whether sleep promotes off-line consolidation of implicitly learned motor tasks is still under question. Furthermore, the role of sleep in promoting transfer of learning remains unknown. This study examined the role of sleep in learning and transfer of learning of an implicit continuous motor task. Twenty-three neurologically intact individuals (mean age 26.4 years) were randomly assigned to either a sleep group or a no-sleep group. The sleep group practiced a continuous tracking task in the evening and underwent retention and transfer testing the following morning, while the no-sleep group practiced the tracking task in the morning and underwent retention and transfer testing in the evening. The results show that in both the sleep and no-sleep groups, performance improved off-line without further practice for both the general skill and the sequence-specific skill. The results also indicate that sleep and time promote transfer of learning of both sequence-specific and general skill learning to a spatial and temporal variation of the motor task. These findings demonstrate that sleep does not play a critical role in promoting off-line learning and transfer of learning of an implicit continuous motor task

Sleep characteristics of individuals with chronic stroke: A pilot study

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Changes in sleep characteristics in individuals with chronic stroke are not well described, particularly compared with healthy individuals. Therefore, the aim of this pilot study was to explore the sleep characteristics in individuals with chronic stroke compared to age- and sex-matched controls. Sixteen individuals with chronic stroke and ten age- and sex-matched controls underwent two nights of polysomnographic recording. The sleep characteristics of interest included total sleep time, sleep efficiency, and percent time, as well as time in minutes spent in stages N1, N2, and N3 and stage R sleep. The individuals with chronic stroke spent less percent time in stage N3 compared with controls (P=0.048). No significant differences in the other sleep characteristics were found between the stroke and control groups. Individuals with chronic stroke present with altered stage N3 sleep compared with healthy controls. These alterations in stage N3 sleep might be a sign of neuronal dysfunction and may impact recovery following stroke. A larger scale study is needed to confirm these findings.American Heart Association Scientist Development Grant (09SDG2060618

Sleep parameters, functional status, and time post-stroke are associated with offline motor skill learning in people with chronic stroke

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author’s publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background: Mounting evidence demonstrates that individuals with stroke benefit from sleep to enhance learning of a motor task. While stage NREM2 sleep and REM sleep have been associated with offline motor skill learning in neurologically intact individuals, it remains unknown which sleep parameters or specific sleep stages are associated with offline motor skill learning in individuals with stroke. Methods: Twenty individuals with chronic stroke (>6 months following stroke) and 10 control participants slept for three consecutive nights in a sleep laboratory with polysomnography. Participants practiced a tracking task the morning before the third night and underwent a retention test the morning following the third night. Offline learning on the tracking task was assessed. Pearson’s correlations assessed for associations between the magnitude of offline learning and sleep variables, age, upper-extremity motor function, stroke severity, depression, and time since stroke occurrence. Results: Individuals with stroke performed with significantly less error on the tracking task following a night of sleep (p = 0.006) while the control participants did not (p = 0.816). Increased sleep efficiency (r = −0.285), less time spent in stage NREM3 sleep (r = 0.260), and more time spent in stage REM sleep (r = −0.266) were weakly-to-moderately associated with increased magnitude of offline motor learning. Furthermore, higher upper-extremity motor function (r = −0.400), lower stroke severity (r = 0.360), and less time since stroke occurrence (r = 0.311) were moderately associated with increased magnitude of offline motor learning. Conclusion: This study is the first study to provide insight into which sleep stages and individual characteristics may be associated with offline learning in people with stroke. Further research is needed to delineate which factors or combination of factors promote offline motor learning in people with neurologic injury to best promote motor recovery in these individuals

Quality-of-life among women with breast cancer: application of the international classification of functioning, disability and health model

BackgroundThis study aimed to identify the factors that influence Breast Cancer (BC) women’s quality of life (QoL) based on the International Classification of Functioning, Disability and Health (ICF) framework.MethodA cross-sectional study was conducted among 188 women with BC. The dependent variable, QoL, was measured using the Quality of Life Index (QLI-c). The independent variables were measured using the following Arabic-validated questionnaires: Pittsburgh Sleep Quality Index (PSQI), Female Sexual Function Index (FSFI), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ).ResultsThere was a significant positive correlation between monthly income (r = 0.17, p = 0.016) and QoL, and significant negative correlation between the stage of disease (r = −0.221, p = 0.002) and duration of first diagnosis (r = −0.280, p = 0.004) with QoL. Poor sleep quality, sexual dysfunction, fatigue, depression, and anxiety had significant negative correlations with QoL (p < 0.01). Multiple regression analysis revealed that among the various factors that might affect QoL, sexual dysfunction, poor sleep quality, depression, and anxiety were significant predictors of QoL (p ≤ 0.05).ConclusionThe ICF provided an excellent framework to explore the factors influencing QoL among women with BC. This study has given evidence for the relationship of demographic, clinical, and body functional factors with QoL among women with BC. Interestingly, sexual dysfunction, poor sleep quality, depression, and anxiety factors are predictors of QoL. Awareness of these factors that predict QoL will guide healthcare professionals to improve the health and QoL of BC women

The relationship between sleep quality and gait in people with multiple sclerosis : a pilot study

Background: Gait deficits are common among people with multiple sclerosis (PwMS). Therefore, investigating factors that may influence walking in PwMS is important. Previous studies in older adults and other neurological populations demonstrated the relationship between sleep quality and gait performance. Despite the fact that the prevalence of poor sleep quality is very high among PwMS, little is known about the effect of sleep quality on gait among PwMS. Objective: This study aimed to explore the relationship between sleep quality and gait performance in PwMS. Methods: Forty-one PwMS participated in the study between February 2019 and December 2019. Participants were asked to walk at a self-selected speed over 10m with an inertial measurement unit (IMU) attached over the back. Walking speed, step length (left and right), and step time were calculated. Sleep was estimated objectively using a wrist-worn triaxle-accelerometer; the derived parameters were sleep efficiency (SE) and the number of awakening after sleep onset (NASO). Results: SE significantly correlated with step length (p=0.02 ). Furthermore, the NASO significantly correlated with gait speed (p=0.03 ), and step-time (p=0.02 ). These correlations remained significant even after adjusting for age and disease duration. Conclusion: We observed that when corrected for disease duration and age there were relationships between NASO and SE to gait parameters; these observations warrant further investigations

Translation, cultural adaptation and validation of the Arabic version of the king’s Parkinson’s disease pain scale

Purpose: Pain in Parkinson’s disease (PD) is a highly prevalent non-motor symptom occurring in this population. The King’s PD Pain Scale (KPPS) was developed to assess pain in people with PD. This study aimed to provide a cross-cultural adaptation and translation of the KPPS into the Arabic language (A-KPPS), and to investigate the construct and convergent validity, internal consistency, and reliability of the translated scale. Materials and Methods: The English KPPS was translated into Arabic and back-translated into English by an independent translation team. The Arabic version was tested in 103 native Arabic speaking PD patients. We assessed construct validity, convergent validity, and test-retest reliability of the A-KPPS using factor analysis method, comparison with other valid and reliable measures, and using intra-class correlations, respectively. Results: The A-KPPS had three main factors “somatic pain”, “visceral and burning pain” and “orofacial pain”, rather than the original four factors scale. The A-KPPS correlated with measures of disease motor severity, depression, anxiety, quality of life and pain (p < 0.05). Furthermore, the A-KPPS total score had high test-retest reliability (ICC = 0.9). Conclusions: The A-KPPS demonstrated moderate to good validity and reliability. The A-KPPS can facilitate the assessment and treatment of pain in Arabic-speaking people with PD worldwide.Jordan University of Science and Technology - grant No. [HK-20170012/HK-20170158

Hybrid brain-computer interface and functional electrical stimulation for sensorimotor training in participants with tetraplegia: a proof-of-concept study

Background and Purpose: Impaired hand function decreases quality of life in persons with tetraplegia. We tested functional electrical stimulation (FES) controlled by a hybrid brain-computer interface (BCI) for improving hand function in participants with tetraplegia. Methods: Two participants with subacute tetraplegia (participant 1: C5 Brown-Sequard syndrome, participant 2: complete C5 lesion) took part in this proof-of-concept study. The goal was to determine whether the BCI system could drive the FES device by accurately classifying participants' intent (open or close the hand). Participants 1 and 2 received 10 sessions and 4 sessions of BCI-FES, respectively. A novel time-switch BCI strategy based on motor imagery was used to activate the FES. In one session, we tested a hybrid BCI-FES based on 2 spontaneously generated brain rhythms: a sensory-motor rhythm during motor imagery to activate a stimulator and occipital alpha rhythms to deactivate the stimulator. Participants received BCI-FES therapy 2 to 3 times a week in addition to conventional therapy. Imagery ability and muscle strength were measured before and after treatment. Results: Visual feedback was associated with a 4-fold increase of brain response during motor imagery in both participants. For participant 1, classification accuracy (open/closed) for motor imagery-based BCI was 83.5% (left hand) and 83.8% (right hand); participant 2 had a classification accuracy of 83.8% for the right hand. Participant 1 had moderate improvement in muscle strength, while there was no change for participant 2. Discussion and Conclusion: We demonstrated feasibility of BCI-FES, using 2 naturally generated brain rhythms. Studies on a larger number of participants are needed to separate the effects of BCI training from effects of conventional therapy

Evaluation of the effectiveness of sleep hygiene education and FITBIT devices on quality of sleep and psychological worry: a pilot quasi-experimental study among first-year college students

BackgroundCollege students report disturbed sleep patterns that can negatively impact their wellbeing and academic performance.ObjectivesThis study examined the effect of a 4-week sleep hygiene program that included sleep education and actigraph sleep trackers (FITBITs) on improving sleep quality and reducing psychological worry without control group.Design, settings, and participantsA pilot quasi-experimental design, participants were randomly selected medical and health sciences from a university students in the United-Arab-Emirates.MethodsStudents were asked to wear FITBITs and log their daily sleep data and completed the Pittsburgh Sleep Quality Index (PSQI) and Penn State Worry Questionnaire (PSWQ). Extensive sleep hygiene education was delivered via lectures, a WhatsApp group, and the Blackboard platform. In total, 50 students completed pre-and post-assessments and returned FITBIT data.ResultsThere was a significant difference in the prevalence of good sleep postintervention compared with pre-intervention (46% vs. 28%; p = 0.0126). The mean PSQI score was significantly lower post-intervention compared with pre-intervention (6.17 ± 3.16 vs. 7.12.87; p = 0.04, Cohen’s d 0.33). After the intervention, subjective sleep quality, sleep latency, and daytime dysfunction were significantly improved compared with pre-intervention (p &lt; 0.05). In addition, FITBIT data showed total sleep time and the number of restless episodes per night were significantly improved postintervention compared with pre-intervention (p = 0.013). The mean PSWQ score significantly decreased from pre-intervention to p = 0.049, Cohen’ d = 0.25. The correlation between PSQI and PSWQ scores was significant post-intervention (β = 0.40, p = 0.02).ConclusionOur results may inform university educational policy and curricular reform to incorporate sleep hygiene awareness programs to empower students and improve their sleep habits

Knowledge and attitudes of physiotherapists toward sleep: A survey study.

Sleep has been considered as a critical brain state that affects various body functions relevant to physiotherapy (PTs) practice such as motor learning and relearning, pain management, and cognitive function. Despite the importance of sleep for successful rehabilitation outcomes, sleep is often overlooked by PTs. The purpose of this study was to assess the attitude and perception of PTs on the need to assess sleep and provide education about sleep for their patients, as well as the perceived need for PTs to be educated on sleep topics. A survey questionnaire to assess physical therapist's perceptions and attitudes about sleep was utilized in this study. 90 PTs fill out the survey. All respondents agreed that poor sleep is important to people's health, 93% agreed that PTs should assess patients' sleep habits and sleep quality and 88% agreed that addressing sleep issues may impact PTs outcomes. The majority did not receive education about sleep during PT education (75%) or following graduation (86%). Most respondents (95%) think PTs should receive education about sleep. our findings indicated that PTs recognize that sleep impacts their outcomes and patients' sleep should be assessed, as well as the need to receive education about sleep. Therefore, PT education programs may consider incorporating education about sleep, and the development of continuing education courses is also needed