Frontostriatal deficit in Motor Neuron Disease/Amyotrophic Lateral Sclerosis (MND/ALS)

So far, cognitive derangements in MND/ALS have not been widely studied. Nevertheless, it seems that in subgroups of patients cognitive functions are impaired in different degree, so that often at least two sub-types of the syndrome are reported: Motor Neuron Disease/Amyotrophic Lateral Sclerosis/Dementia Syndrome (MND/ALS/DS) and Motor Neuron Disease/Amyotrophic Lateral Sclerosis/ Aphasia Syndrome (MND/ALS/AS. A third subtype showing both symptoms of cognitive impairment may be identified in subgroups of patients and denominated Motor Neuron Disease/Amyotrophic Lateral Sclerosis/Dementia-Aphasia Syndrome (MND/ALS/DAS). Frontostriatal system is reported as a network heavily damaged in MND/ALS/DS, MND/ALS/AS, MND/ALS/DAS. The system is plausibly responsible of motor skills and verbs production, hence to become aware of a possible frontostriatal deficit in subgroup of MND/ALS patients might consent us to link at the brain level (motor) action and verbs and possibly ideomotor praxia and verbs. We have used Goal-Oriented Perception Task (GOPT) and Action Fluency Task (AFT) in order to detect with some accuracy impairments related to gestaltic analysis directed toward a goal, and verb retrieval deficits possibly underlying executive system dysfunction that destabilizes the ability to mentally coordinate the information associated with a verb. These tests should consent to detect possible frontostriatal derangements. We have tested 10 MND/ALS patients and 10 healthy subjects matched fore age, sex and laterality. AFT showed that 3 out of 6 patients are heavily impaired in this test (6.3 (mean) verbs generated vs 13.3 of the control group). GOPT detected a remarkable impairment in all patients: p=0.0021 (grammatical side), p=0.0002 (perceptual side). Reported frontostriatal deficit in MND/ALS seems confirmed by this study, and probably it is more easily detected by GOPT than by AFT

Role of acupuncture in the management of severe acquired brain injuries (sABIs)

Acupuncture therapy has been used to treat several disorders in Asian countries and its use is increasing in Western countries as well. Current literature assessed the safety and efficacy of acupuncture in the acute management and rehabilitation of patients with neurologic disorders. In this paper, the role of acupuncture in the treatment of acute severe acquired brain injuries is described, acting on neuroinflammation, intracranial oedema, oxidative stress, and neuronal regeneration. Moreover, beneficial effects of acupuncture on subacute phase and chronic outcomes have been reported in controlling the imbalance of IGF-1 hormone and in decreasing spasticity, pain, and the incidence of neurovegetative crisis. Moreover, acupuncture may have a positive action on the arousal recovery. Further work is needed to understand the effects of specific acupoints on the brain. Allegedly concurrent neurophysiological measurements (e.g., EEG) may help in studying acupuncture-related changes in central nervous system activity and determining its potential as an add-on rehabilitative treatment for patients with consciousness disorders

Objective and automatic classification of Parkinson disease with Leap Motion controller

Background: The main objective of this paper is to develop and test the ability of the Leap Motion controller (LMC) to assess the motor dysfunction in patients with Parkinson disease (PwPD) based on the MDS-UPDRSIII exercises. Four exercises (thumb forefinger tapping, hand opening/closing, pronation/supination, postural tremor) were used to evaluate the characteristics described in MDS-UPDRSIII. Clinical ratings according to the MDS/UPDRS-section III items were used as target. For that purpose, 16 participants with PD and 12 healthy people were recruited in Ospedale Cisanello, Pisa, Italy. The participants performed standardized hand movements with camera-based marker. Time and frequency domain features related to velocity, angle, amplitude, and frequency were derived from the LMC data. Results: Different machine learning techniques were used to classify the PD and healthy subjects by comparing the subjective scale given by neurologists against the predicted diagnosis from the machine learning classifiers. Feature selection methods were used to choose the most significant features. Logistic regression (LR), naive Bayes (NB), and support vector machine (SVM) were trained with tenfold cross validation with selected features. The maximum obtained classification accuracy with LR was 70.37%; the average area under the ROC curve (AUC) was 0.831. The obtained classification accuracy with NB was 81.4%, with AUC of 0.811. The obtained classification accuracy with SVM was 74.07%, with AUC of 0.675. Conclusions: Results revealed that the system did not return clinically meaningful data for measuring postural tremor in PwPD. In addition, it showed limited potential to measure the forearm pronation/supination. In contrast, for finger tapping and hand opening/closing, the derived parameters showed statistical and clinical significance. Future studies should continue to validate the LMC as updated versions of the software are developed. The obtained results support the fact that most of the set of selected features contributed significantly to classify the PwPD and healthy subjects

Les perles d’émail: aspects ultrastructuraux et hypothèses de morphogenèse

Five enamel pearls were examined by Scanning Electron Microscope. Some external pearls presented a bare enamel surface, others were covered by a thin layer of cementum.The enamel pearls showed irregular dystrofic enamel surface or a thin layer without structure, rows of irregular Tome’s processes pits, enamel caps and focal holes. Some enamel pearls revealed little areas of enamel surface resorption like-resorbing lacunae with, in some cases, areas of tissue repair.La perle d’émail est une masse circulaire de matériel calcifié qui apparait le plus souvent dans la bifurcation des molaires et est attachée à la surface externe de la dent. Elle peut aussi être interne mais nous en savons très peu à ce sujet à cause du manque de publications. Cinq perles externes ont été observées au microscope électronique à balayage.Tandis que certaines perles externes présentent une surface à nu, d’autres sont recouvertes d’une fine couche de cément qui les protège. La surface de la perle d’émail présente des zones irrégulières d’hypominéralisation ou une fine couche sans structure, des rangées de petits trous irréguliers des processus de Tome et des trous focaux et des cratères

A Force-Feedback Exoskeleton for Upper-Limb Rehabilitation in Virtual Reality

This paper presents the design and the clinical validation of an upper-limb force-feedback exoskeleton, the L-EXOS, for robotic-assisted rehabilitation in virtual reality (VR). The L-EXOS is a five degrees of freedom exoskeleton with a wearable structure and anthropomorphic workspace that can cover the full range of motion of human arm. A specific VR application focused on the reaching task was developed and evaluated on a group of eight post-stroke patients, to assess the efficacy of the system for the rehabilitation of upper limb. The evaluation showed a significant reduction of the performance error in the reaching task (paired t-test, p < 0.02

Percutaneous Venous Angioplasty in Patients With Multiple Sclerosis And Chronic Cerebrospinal Venous Insufficiency: A Randomized Wait List Control Study

Objectives: Venous percutaneous transluminal angioplasty (vPTA) in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI) have shown contradictory results. Aim of the study is to evaluate the efficacy of the procedure in a randomized wait list control study. Materials: 66 adults with neurologist-confirmed diagnosis of MS and sonographic diagnosis of CCSVI were allocated in to vPTA-yes group (n=31) or vPTA-not group (n=35, control group). Venous PTA was performed immediately 15 days after randomization in PTA-yes group and 6 months later in the control group. Methods: Evoked potentials (EPs), clinical-functional measures (CFM) and upper limb kinematic measures (ULKM) were measured at baseline (T0) and six months after in both groups, just before the venous angioplasty in vPTA-not group (T1). Results: Comparing vPTA-yes and vPTA-not group, the CFM derived composite functional outcome showed 11(37%) versus 7(20%) improved, 1(3%) versus 3(8%) stable, 0 versus 7(20%) worsened and 19(61%) versus 18(51%) mixed patients (\u3c72=8.71, df=3, p=0.03). Unadjusted and adjusted (for baseline confounding variables) OR at 95% confident interval (95%CI) were respectively 1.93(1.3-2.8) P-value 0.0007 and 1.85(1.2-1.7) P-value 0.002. EPs and ULKM derived composite functional outcome showed no significant difference between the two groups. Conclusions: Venous angioplasty can positively impact a few CFM especially for the quality of life, but achieving disability improvement is unlikel

A new generation of orthodontic retainer using 3D printing technology: report of two cases

Aim In this article the fabrication and use of new type 3D printed splint of retainer after orthodontic treatments is reported. Case report Two cases, one of an adoescent female patient and the other of an adult female, are presented, describing step-by-step the clinical and laboratory procedures. The controls after 6 months are also reported. Conclusion Further randomized clinical trials are required in order to evaluate durability and efficacy and periodontal parameters in patients treated with this new type of retainer

Italian standardization of the Apples Cancellation Test

Hemispatial neglect due to right parieto-temporo-frontal lesions has a negative impact on the success of rehabilitation, resulting in poor functional gain. Recent research has shown that different types of neglect can impact in a different way on rehabilitation outcomes. The availability of a sensitive test, useful for distinguishing egocentric and allocentric forms of neglect, may be clinically important as all current clinical instruments fail to distinguish between these forms of disturbance, yet they differentially predict outcome. The Apples Test is a new instrument useful to evaluate both egocentric and allocentric forms of neglect. In order to establish Italian norms for this diagnostic instrument the test was administered to a sample of 412 healthy people of both genders (201 M and 211 F), aged from 20 to 80 years enrolled from 14 different rehabilitation centers in Italy. Based on the data, we established pathological performance cut-offs for the accuracy score (total omission errors), the asymmetry score for egocentric neglect (omission error difference), the asymmetry score for allocentric neglect (commission error difference) and execution time. The usefulness of the Apples Test for diagnostic purposes is illustrated by presenting three patients with different forms of neglect (egocentric, allocentric and mixed neglect)

Robotic assisted rehabilitation in Virtual Reality with the L-EXOS

This study presents the evaluation results of a clinical trial of robotic-assisted rehabilitation in Virtual Reality performed with the PERCRO L-Exos (Light-Exoskeleton) system, which is a 5-DoF force-feedback exoskeleton for the right arm. The device has demonstrated itself suitable for robotic arm rehabilitation therapy when integrated with a Virtual Reality (VR) system. Three different schemes of therapy in VR were tested in the clinical evaluation trial, which was conducted on a group of nine chronic stroke patients at the Santa Chiara Hospital in Pisa-Italy. The results of this clinical trial, both in terms of patients performance improvements in the proposed exercises and in terms of improvements in the standard clinical scales which were used to monitor patients receovery are reported and discussed. The evaluation both pre and post-therapy was carried out with both clinical and quantitative kinesiologic measurements. Statistically significant improvements were found in terms of Fugl-Meyer scores, Ashworth scale, increments of active and passive ranges of motion of the impaired limb, and quantitative indexes, such as task time and error