111 research outputs found
A new index to assess turning quality and postural stability in patients with Parkinson's disease
Parkinson's disease is a neuro-degenerative disorder characterized by the progressive death of dopamine neurons. This leads to delayed and uncoordinated movements, and impacts on the patientsâ motor performance with reduced movement intensity, increased axial rigidity and impaired cadence regulation. Turning provides privileged insights in postural instability and fall prediction, as it is regularly performed during daily activities, requires multi-limb coordination. The objective of this work was to define a Quality of Movement (QoM) index, inferred from inertial data related to turns, and strictly correlated with the patient's motor conditions, postural stability, and stage of the disease. Such a concise representation finds its main application in the remote monitoring of patients during daily activities at home. We have recorded and analyzed 180° turns in 72 patients, using inertial sensors embedded in the smartphone. We have set up an algorithm for binary classification of patients: mild vs. moderate/severe conditions, according to the Hoehn and Yahr scale of disease progression and disability degree. Our QoM index is defined as the a posteriori probability output by this binary classifier. It exhibits high correlation (r = 0.73) with the clinical score of postural stability, as well as with the average of four clinical scores related to movement impairment (r = 0.75). These results, together with the widespread smartphone use, provide a step in the direction of a practical, objective and reliable tool for PD patients remote monitoring in domestic environment
Geographic Disparity of Female Athlete Triad Awareness and Access to Resources in the NCAA
The Female Athlete Triad is a pervasive, multifactorial morbidity among college athletes. The geographic disparity of female athlete triad awareness and access to resources in NCAA is unknown. PURPOSE: To determine geographic disparities in awareness of Triad components and resource access in the National Collegiate Athletic Association (NCAA). METHOD: Division I-III NCAA compliance officers were sent an email containing a request to disseminate a web-based survey to cross country coaches in their respective conferences. The web-linked instrument included: a study synopsis; an informed consent statement, and; the IRB-approved survey tool. Respondents were grouped geographically based upon conference headquarters location, regions included; Northeast, Midwest, South, and West. Statistical analysis, using JMP software, included frequency distributions and chi-square tests for categorical association. RESULTS: Coaches (n = 143; age = 40.7 ± 11.9 years; coaching experience = 14.1 ± 10.3 years) from 45 conferences participated. Location impacted coachesâ awareness of the term âfemale athlete triadâ (p = 0.0183), which was highest in the West (90%), and; lowest in the South (74%). Geography did not influence Triad component recognition (p = 0.3907) (i.e. low energy availability, amenorrhea, low bone mineral density), however; only 54% of coaches correctly identified all Triad components. Coaches who had Triad awareness were more likely to possess understanding that menstrual irregularities are not a normal result of exercise (p = \u3c0.001). No relationship was identified between location and access to body composition technology (p = 0.2031), or; a registered dietician (p = 0.4869). However, only 30% and 53% of coaches had access to these biometric and dietetic resources, respectively. Western cross-country athletes (p = 0.0276) had the highest access to sport psychologists (50%); lowest access was in the Midwest (20%). CONCLUSION: Triad awareness and geographic resource disparities exist: Western coaches have a higher level of Triad awareness and superior access to psychological counseling, whereas; the South and Midwest had the lowest, respectively. Greater uniform access to resources amongst NCAA schools, regardless of geographic region, may positively impact Triad prevalence and outcomes
Does intraoperative microrecording really increase the risk of hemorrhagic complications in deep brain stimulation?
Subthalamic deep brain stimulation: clinical and neuropsychological outcomes in mild cognitive impaired parkinsonian patients.
Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: from the advanced phase towards the late stage of the disease?
Parkinson's disease progression at 30 years: a study of subthalamic deep brain-stimulated patients.
Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: from the advanced phase towards the late stage of the disease?
Deep Brain Stimulation of the Subthalamic Nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD), but only few studies investigated its long-term efficacy. Furthermore, little is known about the role of PD-subtype on STN-DBS long-term outcome
Sporadic Fatal Insomnia in Europe:Phenotypic features and diagnostic challenges
[Objective] Comprehensively describe the phenotypic spectrum of sporadic fatal insomnia (sFI) to facilitate diagnosis and management of this rare and peculiar prion disorder.[Methods] A survey among major prion disease reference centers in Europe identified 13 patients diagnosed with sFI in the past 20 years. We undertook a detailed analysis of clinical and histopathological features and the results of diagnostic investigations.[Results] Mean age at onset was 43 years, and mean disease duration 30 months. Early clinical findings included psychiatric, sleep, and oculomotor disturbances, followed by cognitive decline and postural instability. In all tested patients, videoâpolysomnography demonstrated a severe reduction of total sleep time and/or a disorganized sleep. Cerebrospinal fluid (CSF) levels of proteins 14â3â3 and tâtau were unrevealing, the concentration of neurofilament light protein (NfL) was more consistently increased, and the realâtime quakingâinduced conversion assay (RTâQuIC) revealed a positive prion seeding activity in 60% of cases. Electroencephalography and magnetic resonance imaging showed nonspecific findings, whereas fluorodeoxyglucose positron emission tomography (FDGâPET) demonstrated a profound bilateral thalamic hypometabolism in 71% of cases. Molecular analyses revealed PrPSc type 2 and methionine homozygosity at PRNP codon 129 in all cases.[Interpretation] sFI is a disease of young or middleâaged adults, which is difficult to reconcile with the hypothesis of a spontaneous etiology related to stochastic, ageârelated PrP misfolding. The combination of psychiatric and/or sleepârelated symptoms with oculomotor abnormalities represents an early peculiar clinical feature of sFI to be valued in the differential diagnosis. Videoâpolysomnography, FDGâPET, and especially CSF prion RTâQuIC and NfL constitute the most promising supportive diagnostic tests in vivo.Peer reviewe
Clinical performance of a multiparametric MRI-based post concussive syndrome index
IntroductionDiffusion Tensor Imaging (DTI) has revealed measurable changes in the brains of patients with persistent post-concussive syndrome (PCS). Because of inconsistent results in univariate DTI metrics among patients with mild traumatic brain injury (mTBI), there is currently no single objective and reliable MRI index for clinical decision-making in patients with PCS.PurposeThis study aimed to evaluate the performance of a newly developed PCS Index (PCSI) derived from machine learning of multiparametric magnetic resonance imaging (MRI) data to classify and differentiate subjects with mTBI and PCS history from those without a history of mTBI.Materials and methodsData were retrospectively extracted from 139 patients aged between 18 and 60âyears with PCS who underwent MRI examinations at 2âweeks to 1-year post-mTBI, as well as from 336 subjects without a history of head trauma. The performance of the PCS Index was assessed by comparing 69 patients with a clinical diagnosis of PCS with 264 control subjects. The PCSI values for patients with PCS were compared based on the mechanism of injury, time interval from injury to MRI examination, sex, history of prior concussion, loss of consciousness, and reported symptoms.ResultsInjured patients had a mean PCSI value of 0.57, compared to the control group, which had a mean PCSI value of 0.12 (pâ=â8.42e-23) with accuracy of 88%, sensitivity of 64%, and specificity of 95%, respectively. No statistically significant differences were found in the PCSI values when comparing the mechanism of injury, sex, or loss of consciousness.ConclusionThe PCSI for individuals aged between 18 and 60âyears was able to accurately identify patients with post-concussive injuries from 2âweeks to 1-year post-mTBI and differentiate them from the controls. The results of this study suggest that multiparametric MRI-based PCSI has great potential as an objective clinical tool to support the diagnosis, treatment, and follow-up care of patients with post-concussive syndrome. Further research is required to investigate the replicability of this method using other types of clinical MRI scanners
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