Preliminary Assessment of HABIT for Children with Unilateral Cerebral Palsy Using Fidelity Measures

Purpose/ Hypothesis: The purpose of this study was to behaviorally code participants’ behaviors of a Hand Arm Bimanual Intensive Training (HABIT) camp. It was hypothesized the HABIT program would implement high levels of motor and social behaviors using behavioral coding as a measurement of fidelity. Number of Subjects: Five children (Mean age=8.8 years, SD=1.6 years), three females, diagnosed with unilateral cerebral palsy (CP), right-side impairment. Participants were classified as Manual Ability Classification System (MACS) levels I-III. Materials and Methods: The HABIT camp took place over a two-week period, ten days of intervention, four hours daily for a total of 40 hours. Oversight of daily intervention was directed by two therapists assisted by seven volunteers trained on HABIT key principles. A fidelity measurement was implemented to establish if participant behaviors were congruent with the intervention principles of HABIT through behavioral coding. Video footage was collected at random intervals throughout the intervention to measure the following behaviors’ duration: right/left contact, right/left object manipulation, tasks [i.e., therapist-provided activities that either do (complex tasks) or do not (simple tasks) cognitively challenge the subject], social engagement with peers, and focused attention (i.e., when subject focuses on an object while object exploration occurs). This preliminary report contains three random videos per participant, averaging approximately 30 minutes per video (total of 6.75 hours). Datavyu software was used to code behaviors [interrater reliability =85.4% 8.6]. The variables were summed as durations and normalized as percentages. Results: On average, the percentage of the duration of contacts was relatively equal between left (M= 63.8, SD=11.7) and right (M=46.1, SD=12.5) hands. The percent of the duration of object manipulation varied between the left (M=20.0, SD=10.9) and right (M=5.7, SD=5.8) hands. Children were engaged in simple tasks (e.g., playing with play dough) (M=34.9, SD=12.4) more often than complex tasks (e.g., target game) (M=20.7, SD=12.8), but varied by participant. Children were socially engaged with their peers (M=51.0, SD=12.9), alongside focused on an object while exploring it (M=34.8, SD=13.3). Conclusions: Both hands performed a similar duration of contact. Manipulations differed greatly between hands, favoring the unaffected left hand. It may be due to MACS classification systems and the use of their affected hand primarily for support. Simple tasks were performed more often than complex tasks, and social engagement with peers occurred most of the time. Clinical Relevance: This preliminary report of the 2022 HABIT camp suggests the intervention accomplishes its established high-intensity and engagement principles of intervention but may be limited to meeting challenging task goals. This study adds to existing research testing HABIT’s methodological approach to physical therapy intervention and to fidelity use in clinical settings relating to HABIT programming.https://digitalcommons.unmc.edu/surp2023/1008/thumbnail.jp

Intraneuronal Aβ immunoreactivity is not a predictor of brain amyloidosis-β or neurofibrillary degeneration

Amyloid β (Aβ) immunoreactivity in neurons was examined in brains of 32 control subjects, 31 people with Down syndrome, and 36 patients with sporadic Alzheimer’s disease to determine if intraneuronal Aβ immunoreactivity is an early manifestation of Alzheimer-type pathology leading to fibrillar plaque formation and/or neurofibrillary degeneration. The appearance of Aβ immunoreactivity in neurons in infants and stable neuron-type specific Aβ immunoreactivity in a majority of brain structures during late childhood, adulthood, and normal aging does not support this hypothesis. The absence or detection of only traces of reaction with antibodies against 4–13 aa and 8–17 aa of Aβ in neurons indicated that intraneuronal Aβ was mainly a product of α- and γ-secretases (Aβ(17–40/42)). The presence of N-terminally truncated Aβ(17–40) and Aβ(17–42) in the control brains was confirmed by Western blotting and the identity of Aβ(17–40) was confirmed by mass spectrometry. The prevalence of products of α- and γ -secretases in neurons and β- and γ-secretases in plaques argues against major contribution of Aβ-immunopositive material detected in neuronal soma to amyloid deposit in plaques. The strongest intraneuronal Aβ(17–42) immunoreactivity was observed in structures with low susceptibility to fibrillar Aβ deposition, neurofibrillary degeneration, and neuronal loss compared to areas more vulnerable to Alzheimer-type pathology. These observations indicate that the intraneuronal Aβ immunoreactivity detected in this study is not a predictor of brain amyloidosis or neurofibrillary degeneration. The constant level of Aβ immunoreactivity in structures free from neuronal pathology during essentially the entire life span suggests that intraneuronal amino-terminally truncated Aβ represents a product of normal neuronal metabolism

Two knockdown models of the autism genes SYNGAP1 and SHANK3 in zebrafish produce similar behavioral phenotypes associated with embryonic disruptions of brain morphogenesis

Despite significant progress in the genetics of autism spectrum disorder (ASD), how genetic mutations translate to the behavioral changes characteristic of ASD remains largely unknown. ASD affects 1–2% of children and adults, and is characterized by deficits in verbal and non-verbal communication, and social interactions, as well as the presence of repetitive behaviors and/or stereotyped interests. ASD is clinically and etiologically heterogeneous, with a strong genetic component. Here, we present functional data from syngap1 and shank3 zebrafish loss-of-function models of ASD. SYNGAP1, a synaptic Ras GTPase activating protein, and SHANK3, a synaptic scaffolding protein, were chosen because of mounting evidence that haploinsufficiency in these genes is highly penetrant for ASD and intellectual disability (ID). Orthologs of both SYNGAP1 and SHANK3 are duplicated in the zebrafish genome and we find that all four transcripts (syngap1a, syngap1b, shank3a and shank3b) are expressed at the earliest stages of nervous system development with pronounced expression in the larval brain. Consistent with early expression of these genes, knockdown of syngap1b or shank3a cause common embryonic phenotypes including delayed mid- and hindbrain development, disruptions in motor behaviors that manifest as unproductive swim attempts, and spontaneous, seizure-like behaviors. Our findings indicate that both syngap1b and shank3a play novel roles in morphogenesis resulting in common brain and behavioral phenotypes

Heme drives hemolysis-induced susceptibility to infection via disruption of phagocyte functions

International audienceHemolysis drives susceptibility to bacterial infections and predicts poor outcome from sepsis. These detrimental effects are commonly considered to be a consequence of heme-iron serving as a nutrient for bacteria. We employed a Gram-negative sepsis model and found that elevated heme levels impaired the control of bacterial proliferation independently of heme-iron acquisition by pathogens. Heme strongly inhibited phagocytosis and the migration of human and mouse phagocytes by disrupting actin cytoskeletal dynamics via activation of the GTP-binding Rho family protein Cdc42 by the guanine nucleotide exchange factor DOCK8. A chemical screening approach revealed that quinine effectively prevented heme effects on the cytoskeleton, restored phagocytosis and improved survival in sepsis. These mechanistic insights provide potential therapeutic targets for patients with sepsis or hemolytic disorders

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications