A web-based therapy program enhances occupational performance and visual perception in children with unilateral cerebral palsy [commentary]

The efficacy of high-intensity therapy programs in improving upper limb function in children with unilateral spastic cerebral palsy has previously been established. However, these programs can be labour-intensive and are not feasible for all families. The use of interactive computer play to augment face-to-face therapy is appealing as it may afford a low-cost means of intensive therapy delivery, typically in the home setting. This trial was well designed, conducted and reported. The observed differences between the intervention and control groups in motor and processing skills, occupational performance and visual perception validates the proposal that web-based training permits repetitive practice of the perceptual, cognitive and motor control components of a task. The absence of improvement in the Assisting Hand Assessment and the Melbourne Assessment of Unilateral Upper Limb function scores for the impaired limb could be due to the lack of specificity of the training: it was neither goal-directed nor task-specific. Alternatively, the program may not have been sufficiently intense to achieve experience-dependent neuroplastic changes. Participants completed an average of 32 hours (of the recommended 40 to 60 hours) over 20 weeks, with six participants completing ≤ 10 hours. These training hours were substantially less and were distributed over a longer period than typically advocated for other efficacious ‘high-dose’ therapy programs. The efficacy of home programs for children with cerebral palsy has been demonstrated and is a central component of service provision for this client population. Web-based programs afford another mode of service delivery for therapists that may, by their tech-based nature, be of greater appeal to children and adolescents than more traditional approaches to home program prescription. Web-based programs facilitate repetitive practice and can improve the quality of performance of activities of living, motor and processing skills. Clinicians should consider the intensity, duration and specificity of training when considering implementing such programs in practice. Provenance: Invited. Not peer-reviewed

Visfatin reduces gap junction mediated cell-to-cell communication in proximal tubule-derived epithelial cells

Background/Aims: In the current study we examined if the adipocytokine, visfatin, alters connexin-mediated intercellular communication in proximal tubule-derived epithelial cells. Methods: The effects of visfatin (10-200ng/mL) on cell viability and cytotoxicity in HK2-cells were assessed by MTT, crystal violet and lactate dehydrogenase assays. Western blot analysis was used to confirm expression of Cx26, Cx40 and Cx43. The effect of visfatin (10-200ng/mL) on TGF-β1 secretion was confirmed by ELISA, and the effects of both TGF-β1 (2-10ng/mL) and visfatin (10-200ng/mL) on connexin expression were assessed by western blot. Functional intercellular communication was determined using transfer of Lucifer Yellow and paired-whole cell patch clamp electrophysiology. Results: In low glucose (5mM), visfatin (10-200ng/mL) did not affect membrane integrity, cytotoxicity or cell viability at 48hrs, but did evoke a concentration-dependent reduction in Cx26 and Cx43 expression. The expression of Cx40 was unaffected. At 48hrs, visfatin (10-200ng/mL) increased the secretion of TGF-β1 and the visfatin-evoked changes in connexin expression were mimicked by exogenous application of the pro-fibrotic cytokine (2-10ng/ml). Visfatin reduced dye transfer between coupled cells and decreased functional conductance, with levels falling by 63% as compared to control. Although input resistance was increased following visfatin treatment by 166%, the change was not significant as compared to control. The effects of visfatin on Cx-expression and cell-coupling were blocked in the presence of a TGF-β1 specific neutralizing antibody. Conclusions: The adipocytokine visfatin selectively evoked a non-toxic reduction in connexin expression in HK2-cells. The loss in gap-junction associated proteins was mirrored by a loss in functional conductance between coupled cells. Visfatin increased TGF-β secretion and the pattern of change for connexins expression was mimicked by exogenous application of TGF-β1. The effect of visfatin on Cx-expression and dye transfer were negated in the presence of a TGF-β1 neutralising antibody. These data suggest that visfatin reduces connexin-mediated intercellular communication in proximal tubule-derived epithelial cells via a TGF-β dependent pathway. © 2013 S. Karger AG, Base

Implementing public involvement standards in cerebral palsy register research

BACKGROUND: In 2018, the National Institute for Health Research launched Draft Standards for Public Involvement in Research. The Northern Ireland Cerebral Palsy Register (NICPR) was competitively selected as a “test-bed” project to pilot the Draft Standards over a one-year period. AIM: This perspective paper aims to describe the NICPR's experience of piloting the Draft Standards for Public Involvement in Research, highlighting successes and challenges. METHOD: Three of the six Draft Standards were piloted from April 2018 to April 2019: Standard 2 “working together”, Standard 4 “communications” and Standard 5, “impact”. RESULTS: Implementation of Standard 2 resulted in formation of a dedicated Public Involvement Group. Standard 4 was implemented by revision of the NICPR's Privacy Notice and development of the NICPR website. Standard 5 was not implemented during the test-bed pilot period. DISCUSSION: Benefits of use of the Draft Standards in cerebral palsy register research included development of relationships, improving quality, accessibility and relevance of NICPR materials, increasing skills and confidence, networking opportunities, advocating for others and feeling empowered to shape cerebral palsy research. Challenges included administrative issues, absence of dedicated and sustained funding, limitations in the availability and applicability of public involvement training and the time required for meaningful public involvement. CONCLUSIONS: Standards for Public Involvement provide a useful framework for structuring and embedding meaningful public involvement. Sustained, authentic public involvement in cerebral palsy register research ensures that people affected by the condition are empowered to engage, inform, develop and lead research that meets their needs