Effects of Transfer Training on Musculoskeletal Pain in the Caregiver of a Stroke Patient: a Case Report

The purpose of this case report was to evaluate the effectiveness of training of transfer techniques to a caregiver of a person who had suffered a stroke in decreasing musculoskeletal pain, depression and anxiety. This study adopted a single subject research design to evaluate the effectiveness of transfer-techniques training on musculoskeletal pain, depression, and anxiety in a 25-year-old female caregiver of a person with a stroke. The study was completed in four phases, including a baseline evaluation (1st and 3rd week), training (3rd, 5th and 7th week), post-training (9th week), and follow-up evaluation (11th week). During the 1st week, demographic and descriptive information (such as age, time since diagnosis, cognition and independence of daily living) were collected from the stroke patient. Also, pain severity, anxiety and depression levels of the caregiver were evaluated. In weeks 3, 5 and 7, transfer training was undertaken. The patient was involved in the training with the caregiver under the supervision of an occupational therapist in their own home. The effectiveness of the training with regard to musculoskeletal pain and depression and anxiety levels of the caregiver was evaluated in the 5th, 9th and 11th weeks. The data were analyzed using a visual analysis of trends and levels. The results showed a decrease in pain severity, anxiety and depression during training and post-training. The changes continued during the follow-up stage. This study suggests promising results for the effectiveness of the transfer-techniques training and justifies further clinical trials. A larger trial is required to confirm the effectiveness of transfer training in improving pain management in caregivers of stroke survivors

Prevalence, causes, and complications of acute kidney transplant rejection: survey in a single center

Backgrounds: Kidney transplantation has become a preferred surgical approach for several renal disorders. To acquire required information in basis of acute transplant rejection and its complications, it is important to determine rejection prevalence and its potential causes.Methods: In present retrospective study, during a 37-year survey, 2250 patients received conventional kidney transplantation. The patients who had suffered graft loss, death, and nephrectomy of transplanted kidney during the first month after transplantation enrolled the study and all required data recorded in designed questionnaire. Results: Of 2557 patients underwent kidney transplantation, 86 (3.36%) patients were suffered acute graft loss during the first month after transplantation, that 43 (50%) were males and 43 (50%) were females. Mean age of the patients with acute graft loss was 40.09±14.09. The most common underlying cause for acute graft loss in our study were as follows: acute rejection of transplanted kidney (34.9%), renal vein thrombosis (17.5%), heart infarction (13.9%), idiopathic (6.9%). Of 86 patients, thirty-three patients underwent nephrectomy subsequent to rejection, however, fifty-three patients well responded to medical treatment. In our study the amount of acute nephrectomy during the first month after transplantation was 38.4% (33 patients) which constituted 1.2% of the total graft losses.Conclusion: Renal vein thrombosis is the most common underlying reason for graft loss in kidney transplantation patients, and 1st week of the transplantation is the most probable postoperative time for graft rejection

Effect of Child Friendly Constraint Induced Movement Therapy on Unimanual and Bimanual Function in Hemiplegia

Objectives: Hemiplegia is a non-progressive damage in premature growing brain which causes movement disorders in one side of the body. The objective of present research is to study the method of modified constraints induced movement therapy (CIMT) which can be appropriate on unimanual and bimanual functions of children with Hemiplegia. Methods: This single-blinded, randomized, control trial study performed on twenty-eight participants who were selected based on specific inclusion criteria and divided into two groups of CIMT and conventional therapy. Intervention at CIMT was done six hours every day, for 10 days, whereas another group received conventional occupational therapy. Results: To analyze the data, independent-sample t-test and paired-sample t-test were used. Results showed that significant differences in variables of unimanual function, Jebson Taylor test and dexterity of involved hand in CIMT group, but, these variables did not show any difference in conventional group. Also bimanual functions in CIMT demonstrated significant difference in variables of bimanual function, bilateral coordination, and caregivers’ perception (how much) and (how well), whereas this variables did not show any difference in pre-test and post-test of conventional therapy. Discussion: Child friendly CIMT has fairly good effects on unimanual function and some variables of bimanual function of children with hemiplegia

Comparison of arm-hand bimanual intensive therapy and current therapy for unimanual and bimanual functions in children with cerebral palsy

Introduction: Studies have showed that although Constraint Induced Movement Therapy can lead into improvement of hand function in children with Cerebral Palsy, it has several important limitations. Charles and Gordon introduced Hand-Arm Bimanual Intensive Therapy (HABIT) in an attempt to compensate for such deficits. This study aimed at evaluating the efficacy of HABIT on unimanual and bimanual functions in children with Cerebral Palsy. Materials and Methods: The participants of this single-blinded randomized control study were twenty-eight children with CP who were divided into two groups of HABIT and controls according to a set of inclusionary and exclusionary criteria. Subjects in HABIT group received the intervention 6 hours per day over 10 successive days and the members of the other group were provided with occupational therapy services. Assessment tools administered in this study were Bruininks-Oseretsky Test of Motor Proficiency, Caregiver Functional Use Survey (CFUS), and Jebsen-Taylor Test in Hand Function. Independent and paired t tests were respectively used for comparing the two groups and to compare each group with regard to pre-test and post-test conditions. Results: Study results showed significant differences between two groups concerning dexterity, bilateral coordination, bimanual coordination, bimanual function, unimanual function and Caregiver Functional Use Survey (how well & how frequently) (P < 0.05). Also comparison of pre-test and post-test results for each of the two studied groups indicated improvement in most of domains evaluated. Conclusion: The protocol of Arm-Hand Bimanual Intensive Therapy may result in improvement of either bimanual or unimanual hand functions in children with cerebral palsy. Keywords: Arm-Hand bimanual intensive therapy, Hand function, Hemiplegia, Occupational therap

Effects of Transfer Training on Musculoskeletal pain in the Caregiver of a Stroke Patient: A Case Report

The purpose of this case report was to evaluate the effectiveness of training of transfer techniques to a caregiver of a person who had suffered a stroke in decreasing musculoskeletal pain, depression and anxiety. This study adopted a single subject research design to evaluate the effectiveness of transfer-techniques training on musculoskeletal pain, depression, and anxiety in a 25-year-old female caregiver of a person with a stroke. The study was completed in four phases, including a baseline evaluation (1st and 3rd week), training (3rd, 5th and 7th week), post-training (9th week), and follow-up evaluation (11th week). During the 1st week, demographic and descriptive information&nbsp; (such as age, time since diagnosis, cognition and independence of daily living) were collected from the stroke patient. Also, pain severity, anxiety and depression levels of the caregiver were evaluated. In weeks 3, 5 and 7, transfer training was undertaken. The patient was involved in the training with the caregiver under the supervision of an occupational therapist in their own home. The effectiveness of the training with regard to musculoskeletal pain and depression and anxiety levels of the caregiver was evaluated in the 5th, 9th and 11th weeks. The data were analyzed using a visual analysis of trends and levels. The results showed a decrease in pain severity, anxiety and depression during training and post-training. The changes continued during the follow-up stage. This study suggests promising results for the effectiveness of the transfer-techniques training and justifies further clinical trials. A larger trial is required to confirm the effectiveness of transfer training in improving pain management in caregivers of stroke survivors

Loss of Pten and Activation of Kras Synergistically Induce Formation of Intraductal Papillary Mucinous Neoplasia From Pancreatic Ductal Cells in Mice

BACKGROUND & AIMS: Intraductal papillary mucinous neoplasias (IPMNs) are precancerous cystic lesions that can develop into pancreatic ductal adenocarcinomas (PDACs). These large macroscopic lesions are frequently detected during medical imaging, but it is unclear how they form or progress to PDAC. We aimed to identify cells that form IPMNs and mutations that promote IPMN development and progression. METHODS: We generated mice with disruption of Pten specifically in ductal cells (Sox9CreER(T2);Pten(flox/flox);R26R(YFP) or Pten(ΔDuct/ΔDuct) mice) and used Pten(ΔDuct/+) and Pten(+/+) mice as controls. We also generated Kras(G12D);Pten(ΔDuct/ΔDuct) and Kras(G12D);Pten(ΔDuct/+) mice. Pancreata were collected when mice were 28 weeks to 14.5 months old and analyzed by histology, immunohistochemistry, and electron microscopy. We performed multiplexed droplet digital polymerase chain reaction to detect spontaneous Kras mutations in Pten(ΔDuct/ΔDuct) mice and study the effects of Ras pathway activation on initiation and progression of IPMNs. We obtained 2 pancreatic sections from a patient with an invasive pancreatobiliary IPMN and analyzed the regions with and without the invasive IPMN (control tissue) by immunohistochemistry. RESULTS: Mice with ductal cell-specific disruption of Pten but not control mice developed sporadic, macroscopic, intraductal papillary lesions with histologic and molecular features of human IPMNs. Pten(ΔDuct/ΔDuct) mice developed IPMNs of several subtypes. In Pten(ΔDuct/ΔDuct) mice, 31.5% of IPMNs became invasive; invasion was associated with spontaneous mutations in Kras. Kras(G12D);Pten(ΔDuct/ΔDuct) mice all developed invasive IPMNs within 1 month. In Kras(G12D);Pten(ΔDuct/+) mice, 70% developed IPMN, predominately of the pancreatobiliary subtype, and 63.3% developed PDAC. In all models, IPMNs and PDAC expressed the duct-specific lineage tracing marker yellow fluorescent protein. In immunohistochemical analyses, we found that the invasive human pancreatobiliary IPMN tissue had lower levels of PTEN and increased levels of phosphorylated (activated) ERK compared with healthy pancreatic tissue. CONCLUSIONS: In analyses of mice with ductal cell-specific disruption of Pten, with or without activated Kras, we found evidence for a ductal cell origin of IPMNs. We also showed that PTEN loss and activated Kras have synergistic effects in promoting development of IPMN and progression to PDAC