Hearing threshold estimation by Auditory Steady State Responses (ASSR) in children

Hearing threshold identification in very young children is always problematic and challenging. Electrophysiological testing such as auditory brainstem responses (ABR) is still considered the most reliable technique for defining the hearing threshold. However, over recent years there has been increasing evidence to support the role of auditory steady-state response (ASSR). Retrospective study. Forty-two children, age range 3-189 months, were evaluated for a total of 83 ears. All patients were affected by sensorineural hearing loss (thresholds ≥ 40 dB HL according to a click-ABR assessment). All patients underwent ABRs, ASSR and pure tone audiometry (PTA), with the latter performed according to the child’s mental and physical development. Subjects were divided into two groups: A and B. The latter performed all hearing investigations at the same time as they were older than subjects in group A, and it was then possible to achieve electrophysiological and PTA tests in close temporal sequence. There was no significant difference between the threshold levels identified at the frequencies tested (0.25, 0.5, 1, 2 and 4 kHz), by PTA, ABR and ASSR between the two groups (Mann Whitney U test, p < 0.05). Moreover, for group A, there was no significant difference between the ASSR and ABR thresholds when the children were very young and the PTA thresholds subsequently identified at a later stage. Our results show that ASSR can be considered an effective procedure and a reliable test, particularly when predicting hearing threshold in very young children at lower frequencies (including 0.5 kHz)

Práticas de bloqueios neuromusculares para o tratamento da espasticidade no Brasil

Botulinum toxin type A (TBA) is one of the most effective and safe treatments for spasticity. To evaluate some scales can be used, as the Modified Ashworth Scale (MAS). Therapeutic success in the application depends on the correct identification of the problem and biomechanical application of the affected muscle, which can be done by surface palpation techniques or auxiliary methods such as electromyography. Objective: To evaluate the methods of TBA applications for the treatment of spasticity performed in the practice of medical rehabilitation for children and adults. Methods: exploratory, cross-sectional study with a convenience sample size recruited in scientific events in Rio de Janeiro, São Paulo, Goiânia, Belo Horizonte, Curitiba and Ribeirão Preto (Brazil). Questionnaires regarding the treatment of spasticity containing multiple choice questions about groups of patients and treated muscles were applied. Responses were analyzed for frequency for each answer. No association test of variables or hypothesis were used. Results: 49 questionnaires were analyzed. 47% apply TBA for less than five years. The most used technique for locating points of application was muscular palpation (80%). To quantify the functional gains, 78% reported the use the MAS scale. 57% applies in adults and children. The most common children age group treated was 5-10 years (83%) and the most treated muscle group was the triceps surae (73.8%). Regarding the use of phenol, 16 used with a frequency of 1 to 5 patients per month. 45% of applicators used phenol associeted with TBA. Conclusion: The TBA is widely used in the treatment of spasticity, however there is no standardization in the form of application, method of analyzing the treatment success or the necessity of a combined agentA toxina botulínica do tipo A (TBA) é um dos tratamentos mais efetivos e seguros para espasticidade. Para a avaliação algumas escalas podem ser utilizadas como a Escala Modificada de Ashworth (MAS). O sucesso terapêutico na aplicação depende da correta identificação do problema biomecânico e aplicação no músculo acometido, o que pode ser feito por técnicas de palpação de superfície ou métodos auxiliares como eletromiografia. Objetivo: Avaliar os métodos de aplicações da TBA e outros tipos de bloqueios como fenol para tratamento da espasticidade realizados na prática de médicos de reabilitação infantil e de adultos. Métodos: Estudo exploratório, transversal, com amostra dimensionada pela conveniência em eventos científicos nas cidades Rio de Janeiro, São Paulo, Goiânia, Belo Horizonte, Curitiba e Ribeirão Preto com questionários a respeito do tratamento da espasticidade que continham questões de múltipla escolha sobre grupos de pacientes e músculos tratados. As respostas foram analisadas quanto à frequência para cada questão. Não foi foram realizados testes de associação de variáveis ou de hipótese. Resultados: Foram analisados 49 questionários. 47% aplicam TBA há menos de 5 anos. A técnica mais utilizada para localização de pontos de aplicação foi a palpação muscular (80%). Para quantificação dos ganhos funcionais 78% utilizam a escala MAS. 57% faz aplicação em adultos e crianças. A faixa etária de tratamento mais comum entre as crianças foi 5 a 10 anos (83%) com o grupo muscular mais aplicado o tríceps sural (73,8%). Em relação ao uso do fenol, 16 utilizam com uma frequência de 1 a 5 pacientes por mês. 45% dos aplicadores sempre utilizam fenol em conjunto com TBA. Conclusão: A TBA é largamente utilizada no tratamento de espasticidade, porém não existe uma padronização na forma de aplicação, método de avaliação ou sobre necessidade de outro agente combinad

Parental oral health literacy influences preschool children's utilization of dental services

Abstract: Parental behavior towards their children's oral health is strongly influenced by parent's Oral Health Literacy (OHL) level. This study evaluated the impact of parental OHL on preschool children's utilization of dental services. A cross-sectional study was conducted with parents of 419 children aged 3 to 5 years who answered a self-administered questionnaire about their perception of their children's oral health and whether their children had already been to a dental visit. Parental OHL level was assessed by the validated version of the Oral Health Literacy Adult Questionnaire (OHL-AQ) translated into Brazilian Portuguese. Univariate and multivariate Poisson regression analyses with robust variance were used for the data analysis (α = 0.05). Most children had already been to a dental visit (73%). Overall, 31.7% of the parents or guardians reported that their children had experienced dental pain or dental caries. Parental OHL level was classified by tercile as low, medium, and high. The final model showed independent associations between children who had already been to a dental visit and higher parental OHL level (PR = 1.16; 95%CI = 1.00-1.35) when compared to the lowest OHL level, higher parental educational level (PR = 1.39; 95%CI = 1.03–1.87) when compared to lower educational level, the report of children's pain and dental caries (PR = 1.22; 95%CI = 1.09–1.36) and married parents or parents in a common-law marriage (PR = 1.17; 95%CI = 1.03–1.93). The prevalence of children who had already been to a dental visit was higher among those parents with a higher OHL level when compared to those with a lower OHL level

MUNDUS project : MUltimodal neuroprosthesis for daily upper limb support

Background: MUNDUS is an assistive framework for recovering direct interaction capability of severely motor impaired people based on arm reaching and hand functions. It aims at achieving personalization, modularity and maximization of the user’s direct involvement in assistive systems. To this, MUNDUS exploits any residual control of the end-user and can be adapted to the level of severity or to the progression of the disease allowing the user to voluntarily interact with the environment. MUNDUS target pathologies are high-level spinal cord injury (SCI) and neurodegenerative and genetic neuromuscular diseases, such as amyotrophic lateral sclerosis, Friedreich ataxia, and multiple sclerosis (MS). The system can be alternatively driven by residual voluntary muscular activation, head/eye motion, and brain signals. MUNDUS modularly combines an antigravity lightweight and non-cumbersome exoskeleton, closed-loop controlled Neuromuscular Electrical Stimulation for arm and hand motion, and potentially a motorized hand orthosis, for grasping interactive objects. Methods: The definition of the requirements and of the interaction tasks were designed by a focus group with experts and a questionnaire with 36 potential end-users. Five end-users (3 SCI and 2 MS) tested the system in the configuration suitable to their specific level of impairment. They performed two exemplary tasks: reaching different points in the working volume and drinking. Three experts evaluated over a 3-level score (from 0, unsuccessful, to 2, completely functional) the execution of each assisted sub-action. Results: The functionality of all modules has been successfully demonstrated. User’s intention was detected with a 100% success. Averaging all subjects and tasks, the minimum evaluation score obtained was 1.13 ± 0.99 for the release of the handle during the drinking task, whilst all the other sub-actions achieved a mean value above 1.6. All users, but one, subjectively perceived the usefulness of the assistance and could easily control the system. Donning time ranged from 6 to 65 minutes, scaled on the configuration complexity. Conclusions: The MUNDUS platform provides functional assistance to daily life activities; the modules integration depends on the user’s need, the functionality of the system have been demonstrated for all the possible configurations, and preliminary assessment of usability and acceptance is promising

A Wearable Multi-Site System for NMES-Based Hand Function Restoration

Reaching and grasping impairments significantly affect the quality of life for people who have experienced a stroke or spinal cord injury. The long-term well-being of patients varies greatly according to the restorable residual capabilities. Electrical stimulation could be a promising solution to restore motor functions in these conditions, but its use is not clinically widespread. Here, we introduce the HandNMES, an electrode array (EA) for neuromuscular electrical stimulation (NMES) aimed at grasp training and assistance. The device was designed to deliver electrical stimulation to extrinsic and intrinsic hand muscles. Six independent EAs, positioned on the user forearm and hand, deliver NMES pulses originating from an external stimulator equipped with demultiplexers for interfacing with a large number of electrodes. The garment was designed to be adaptable to user needs and anthropometric characteristics; size, shape, and contact materials can be customized, and stimulation characteristics such as intensity of stimulation and virtual electrode location, and size can be adjusted. We performed extensive tests with nine healthy subjects showing the efficacy of the HandNMES in terms of stimulation performance and personalization. Because encouraging results were achieved, in the coming months, the HandNMES device will be tested in pilot clinical trials

Recovery of the macrozoobenthic community of the Comacchio lagoon system (northern Adriatic Sea)

From 1976 to 1992 the Comacchio lagoon system (a polyhaline lagoon on the northern Adriatic Sea coast) was exploited for intensive farming of eels and other fish. This activity, and its consequent increased release of organic matter, has led to hypereutrophication of the lagoon, resulting in a bloom of cyanobacteria and all almost total elimination of cukaryotes at both the planktonic and benthic level. After farming stopped, the ecological conditions tended to improve and the macrozoo-benthic community underwent a spectacular recovery The current communities do not differ substantially fi om those present before this ecological catastrophe, with the exception of a low level of internal differentiation not only among different lagoon sites but air, different substrates

Sudden hearing loss and the risk of subsequent cerebral ischemic stroke

We investigated the risk of ischemic stroke after an episode of sudden sensorineural hearing loss. Our findings suggest that SSNHL does not significantly increase the risk of ischemic stroke