Outcomes of the NuroSleeve and Occupational Therapy on Upper Limb Function of an Individual with Chronic Hemiparesis Following a Stroke: A Case Report

Background: Upper limb neuromuscular impairments can adversely impact function. This case report investigates the process and outcomes of occupational therapy (OT) for training in the use of the NuroSleeve, a novel research-grade exoskeletal powered orthosis, with a participant with chronic right hemiparesis following a stroke. Method: The participant engaged in 24 OT sessions using the NuroSleeve over 10 weeks. Therapeutic interventions included neuromuscular reeducation, device management, and engagement in occupation-based activities with training to use the NuroSleeve. The Canadian Occupational Performance Measure (COPM), ABILHAND, Patient Reported Outcomes Measurement Information System Upper Extremity Short Form 7a (PROMIS UE SF), Action Research Arm Test (ARAT), and Manual Muscle Testing (MMT) were administered before and after the 24 sessions. Results: With the NuroSleeve, there were clinically important increases in COPM performance and satisfaction for 6/8 and 7/8 goals, respectively; ABILHAND showed a clinically important increase of 4.959 logits; and there was an 11-point increase on the ARAT, indicating a clinically important difference. T-score on the PROMIS UE SF was 33.7 (SD = 2) compared to 23 (SD = 2.8) without the device. MMT remain unchanged. Conclusion: The data suggest that the NuroSleeve was the primary source of increased function and that incorporating OT with the NuroSleeve has benefits

Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: A cross sectional study

<p>Abstract</p> <p>Background</p> <p>The study of severe maternal morbidity survivors (near miss) may be an alternative or a complement to the study of maternal death events as a health care indicator. However, there is still controversy regarding the criteria for identification of near-miss maternal morbidity. This study aimed to characterize the near miss maternal morbidity according to different sets of criteria.</p> <p>Methods</p> <p>A descriptive study in a tertiary center including 2,929 women who delivered there between July 2003 and June 2004. Possible cases of near miss were daily screened by checking different sets of criteria proposed elsewhere. The main outcome measures were: rate of near miss and its primary determinant factors, criteria for its identification, total hospital stay, ICU stay, and number and kind of special procedures performed.</p> <p>Results</p> <p>There were two maternal deaths and 124 cases of near miss were identified, with 102 of them admitted to the ICU (80.9%). Among the 126 special procedures performed, the most frequent were central venous access, echocardiography and invasive mechanical ventilation. The mean hospital stay was 10.3 (± 13.24) days. Hospital stay and the number of special procedures performed were significantly higher when the organ dysfunction based criteria were applied.</p> <p>Conclusion</p> <p>The adoption of a two level screening strategy may lead to the development of a consistent severe maternal morbidity surveillance system but further research is needed before worldwide near miss criteria can be assumed.</p

Neuromotor prosthetic to treat stroke-related paresis: N-of-1 trial

Background: Functional recovery of arm movement typically plateaus following a stroke, leaving chronic motor deficits. Brain-computer interfaces (BCI) may be a potential treatment for post-stroke deficits Methods: In this n-of-1 trial (NCT03913286), a person with chronic subcortical stroke with upper-limb motor impairment used a powered elbow-wrist-hand orthosis that opened and closed the affected hand using cortical activity, recorded from a percutaneous BCI comprised of four microelectrode arrays implanted in the ipsilesional precentral gyrus, based on decoding of spiking patterns and high frequency field potentials generated by imagined hand movements. The system was evaluated in a home setting for 12 weeks Results: Robust single unit activity, modulating with attempted or imagined movement, was present throughout the precentral gyrus. The participant acquired voluntary control over a hand-orthosis, achieving 10 points on the Action Research Arm Test using the BCI, compared to 0 without any device, and 5 using myoelectric control. Strength, spasticity, the Fugl-Meyer scores improved. Conclusions: We demonstrate in a human being that ensembles of individual neurons in the cortex overlying a chronic supratentorial, subcortical stroke remain active and engaged in motor representation and planning and can be used to electrically bypass the stroke and promote limb function. The participant’s ability to rapidly acquire control over otherwise paralyzed hand opening, more than 18 months after a stroke, may justify development of a fully implanted movement restoration system to expand the utility of fully implantable BCI to a clinical population that numbers in the tens of millions worldwide

Como os trabalhadores de um Centro Obstétrico justificam a utilização de práticas prejudiciais ao parto normal

Este estudo busca entender as justificativas dos trabalhadores de um Centro Obstétrico do Sul do Brasil para a utilização de práticas do parto normal consideradas prejudiciais pela Organização Mundial da Saúde. A pesquisa é do tipo exploratória, desenvolvida em julho de 2009, por meio de entrevista com 23 trabalhadores. Na análise, houve a conformação de três núcleos temáticos: Ações e condutas na dependência do trabalhador de saúde; Práticas rotineiras como facilitadoras do trabalho e Restrição da participação da parturiente no processo decisório. Algumas justificativas para o emprego das práticas: perpetuação de modelos inadequados, facilitação para a assistência no momento do parto e autoritarismo que alguns trabalhadores exercem sobre a parturiente por acreditarem serem detentores do conhecimento

Toward a model-based predictive controller design in brain-computer interfaces

A first step in designing a robust and optimal model-based predictive controller (MPC) for brain-computer interface (BCI) applications is presented in this article. An MPC has the potential to achieve improved BCI performance compared to the performance achieved by current ad hoc, nonmodel-based filter applications. The parameters in designing the controller were extracted as model-based features from motor imagery task-related human scalp electroencephalography. Although the parameters can be generated from any model-linear or non-linear, we here adopted a simple autoregressive model that has well-established applications in BCI task discriminations. It was shown that the parameters generated for the controller design can as well be used for motor imagery task discriminations with performance (with 8-23% task discrimination errors) comparable to the discrimination performance of the commonly used features such as frequency specific band powers and the AR model parameters directly used. An optimal MPC has significant implications for high performance BCI applications.Grants K25NS061001 (MK) and K02MH01493 (SJS) from the National Institute of Neurological Disorders And Stroke (NINDS) and the National Institute of Mental Health (NIMH), the Portuguese Foundation for Science and Technology (FCT) Grant SFRH/BD/21529/2005 (NSD), the Pennsylvania Department of Community and Economic Development Keystone Innovation Zone Program Fund (SJS), and the Pennsylvania Department of Health using Tobacco Settlement Fund (SJS)

Closing the Mind's Eye: Incoming Luminance Signals Disrupt Visual Imagery

Mental imagery has been associated with many cognitive functions, both high and low-level. Despite recent scientific advances, the contextual and environmental conditions that most affect the mechanisms of visual imagery remain unclear. It has been previously shown that the greater the level of background luminance the weaker the effect of imagery on subsequent perception. However, in these experiments it was unclear whether the luminance was affecting imagery generation or storage of a memory trace. Here, we report that background luminance can attenuate both mental imagery generation and imagery storage during an unrelated cognitive task. However, imagery generation was more sensitive to the degree of luminance. In addition, we show that these findings were not due to differential dark adaptation. These results suggest that afferent visual signals can interfere with both the formation and priming-memory effects associated with visual imagery. It follows that background luminance may be a valuable tool for investigating imagery and its role in various cognitive and sensory processes

Associated use of infrared thermography and ozone therapy for diagnosis and treatment of an inflammatory process in an equine: case report.

This study aims to was a clinical case report relating the use of infrared thermography (IR) associated to the ozone therapy as complementary tools to diagnose and treat a non-infectious inflammatory process in the locomotor system of an athlete-horse of the Amazon. The heart rate (HR), respiratory rate (RR), and rectal temperature (RT) were measured both rest and after walking. Radiographic evaluation, complete hemogram and creatine phosphokinase dosage (CPK) were primarily conducted. The IR examination was additionally undertaken, and the thermograms were analyzed using Flir Tools. Ozone therapy was performed via intramuscular in the scapular area. All comparisons were done using ANOVA and Tukey test (5%). The animal presented HR, RR, and RT all within normal ranges. When the animal was made to walk it demonstrated pain, and HR (48 beats.min-1) and RR (60 breaths.min-1). The creatine phosphokinase dosage was 79 UL-1 and the IR showed that the thoracic region had a surface temperature of up to 39.1ºC, indicating of an inflammatory process. After the ozone therapy was a reduction in the white color pattern from 39.1ºC to 37.2ºC. The infrared thermography is an efficient technique that can be used for the diagnosis of inflammation, and ozone therapy is an innovative treatment