2018 President\u27s Messages

Monthly messages from Dr. Susan J. Hunter (January-April) and Joan Ferrini-Mundy (July-December), University of Maine presidents to the University of Maine community

The Spanish version of the coma recovery scale-revised: Events on a correct timeline

Ferri, J.; Noe, E.; Llorens Rodríguez, R. (2015). The Spanish version of the coma recovery scale-revised: Events on a correct timeline. Brain Injury. 29(7-8):1002-1003. doi:10.3109/02699052.2015.1022884S10021003297-8Seel, R. T., Sherer, M., Whyte, J., Katz, D. I., Giacino, J. T., Rosenbaum, A. M., … Zasler, N. (2010). Assessment Scales for Disorders of Consciousness: Evidence-Based Recommendations for Clinical Practice and Research. Archives of Physical Medicine and Rehabilitation, 91(12), 1795-1813. doi:10.1016/j.apmr.2010.07.218Schnakers, C., Vanhaudenhuyse, A., Giacino, J., Ventura, M., Boly, M., Majerus, S., … Laureys, S. (2009). Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment. BMC Neurology, 9(1). doi:10.1186/1471-2377-9-35Tamashiro, M., Rivas, M. E., Ron, M., Salierno, F., Dalera, M., & Olmos, L. (2014). A Spanish validation of the Coma Recovery Scale-Revised (CRS-R). Brain Injury, 28(13-14), 1744-1747. doi:10.3109/02699052.2014.947621Noé, E., Olaya, J., Navarro, M. D., Noguera, P., Colomer, C., García-Panach, J., … Ferri, J. (2012). Behavioral Recovery in Disorders of Consciousness: A Prospective Study With the Spanish Version of the Coma Recovery Scale–Revised. Archives of Physical Medicine and Rehabilitation, 93(3), 428-433.e12. doi:10.1016/j.apmr.2011.08.04

Neuropsicología de los Estados Alterados de la Conciencia: Criterios Clínicos, Pronósticos y Diagnósticos

El daño cerebral adquirido constituye en la actualidad un importante problema sociosanitario. Entre 30-40% de pacientes con graves lesiones cerebrales tendrán una alta discapacidad con niveles alterados de la conciencia. Estos pueden originarse por lesiones corticales difusas y/o por lesiones localizadas en el troncoencéfalo, lugar donde se halla el sistema activador reticular ascendente. Otras estructuras encefálicas relacionadas son el córtex de asociación o el tálamo medial entre otras. Es necesario unificar criterios, protocolizar las valoraciones, así como validar herramientas de diagnósticos ya que son prácticamente inexistentes en este campo. Es importante poder describir la nomenclatura, la características clínicas, presentando una revisión histórica de las los diferentes términos que la literatura médica ha utilizado para la descripción de los pacientes con estados alterados de conciencia. Una importante aportación para un adecuado estudió es realizar la validación de escalas internacionales a la población española. La primera escala escogida es la “Coma Recovery Scale-Revised” (CRS-R), fue descrita inicialmente por Giacino et al. en 1991 y revisada por Giacino y Kalmar en 2004. Fue desarrollada para diferenciar a los pacientes en estado vegetativo de los pacientes que se encuentran en mínima conciencia y para identificar a aquellos pacientes que salen del grupo de pacientes con bajo nivel de conciencia. La otra escala validada es la “Mississipi Aphasia Screening Test (MASTsp), descrita por Nakase-Thompson en 2004. Está escala se utiliza como batería de cribado de las alteraciones del lenguaje en pacientes que han sufrido un ictus. Para nuestro grupo de pacientes con bajo nivel de conciencia, nos sirve en aquellos pacientes que mejoran su nivel de conciencia y empiezan a establecer comunicación. Para completar el estudio, se realizó diagnósticos del metabolismo de glucosa en estructuras cerebrales, centrando nuestro foco de estudio sobre las estructuras profundas, como son el tálamo, los ganglios basales o el tronco del encéfalo, utilizando la tomografía por emisión de positrones (PET).Disorders of consciousness are a major public health challenge. While the prevalence of these disorders is increasing, the percentage of diagnostic errors and failures in prognosis is still too high, all of which is generating a new social and healthcare problem. Most of these difficulties are due to the lack of consensus or the absence of information on how, when and why these patients should be assessed. This thesis includes, through various national and international articles published by the author, clinical and neuroimage data focused on a sample of patients with disorders of consciousness, including both patients in Vegetative State, and in a Minimal Consciousness State. The aim of this thesis is to help all the professionals who are dedicated to the care of these patients, to improve their diagnosis, increase their ability to make a better prognosis and to enhance their understanding of the causes that provoke these disorders through the study of cerebral metabolism assessed with positron emission tomography (FDG-PET). This thesis includes the clinical validation in Spanish population of two international assessment scales that have proved to be most useful in this population, as the "Coma Recovery Scale-Revised" (CRS-R), and the "Mississipi Aphasia Screening Test (MASTsp)." The aim is to provide the clinician with simple and powerful tools, in terms of statistical analysis, to allow the diagnosis of the different clinical situations that converge in these disorders. In parallel to the validation studies, the analysis of the brain structures involved in maintaining "arousal" and "awareness", performed in this thesis, has demonstrated, both with qualitative and quantitative methods (voxel-based analysis), a special vulnerability of the thalamus, and specifically of the cortico-thalamus-cortical connections of these patients, opening the door to future therapeutic interventions. In conclusion this paper provides the clinician with the tools and the information required to make a correct approach to the diagnosis of theses disorders. Also, our data form PET studies can contribute to a better knowledge of the neurobiological basis that generate these states in an effort to improve diagnosis and prognosis

Familial ALS-superoxide dismutases associate with mitochondria and shift their redox potentials

Recent studies suggest that the toxicity of familial amyotrophic lateral sclerosis mutant Cu, Zn superoxide dismutase (SOD1) arises from its selective recruitment to mitochondria. Here we demonstrate that each of 12 different familial ALS-mutant SOD1s with widely differing biophysical properties are associated with mitochondria of motoneuronal cells to a much greater extent than wild-type SOD1, and that this effect may depend on the oxidation of Cys residues. We demonstrate further that mutant SOD1 proteins associated with the mitochondria tend to form cross-linked oligomers and that their presence causes a shift in the redox state of these organelles and results in impairment of respiratory complexes. The observation that such a diverse set of mutant SOD1 proteins behave so similarly in mitochondria of motoneuronal cells and so differently from wild-type SOD1 suggests that this behavior may explain the toxicity of ALS-mutant SOD1 proteins, which causes motor neurons to die

Inmigración internacional y movilidad entre sectores: Una exploración de escenarios alternativos para España

Este trabajo explora los efectos económicos de la inmigración internacional en España a través de la construcción de un modelo de equilibrio general computable. Uno de los aspectos en los que se centra el trabajo es la influencia que tiene el grado de movilidad intersectorial de los trabajadores extranjeros, planteando dos escenarios alternativos: uno de perfecta movilidad y otro en el cual únicamente pueden trabajar en tres sectores concretos. Otra cuestión que se toma en cuenta a la hora de plantear las simulaciones es el grado de discriminación salarial de los inmigrantes frente a los trabajadores nativos. Los resultados sugieren que la selección de sectores estratégicos para recibir a los inmigrantes es un factor que mejoraría los efectos económicos de la inmigración. El régimen salarial es también un parámetro importante para explicar el impacto en el corto y en el largo [email protected]

Competition Enhances the Effectiveness and Motivation of Attention Rehabilitation After Stroke. A Randomized Controlled Trial

[EN] Attention deficits are among the most common cognitive impairments observed after experiencing stroke. However, a very limited number of studies have investigated the effectiveness of interventions that specifically focus on the rehabilitation of attention deficits among subjects with impaired attention. Although several interventions have included the use of computerized programs to provide dynamic stimuli, real-time performance feedback, and motivating tasks, existing studies have not exploited the potential benefits of multi-user interactions. Group-based and competitive interventions have been reported to be more enjoyable and motivating, depending on individual traits, and may potentially be more demanding, which may increase their effectiveness. This study investigated the effectiveness and motivating abilities of an intervention specifically designed to address attention deficits. This intervention combined paper-and-pencil tasks and interactive, computerized, multi-touch exercises, which were administered, either non-competitively or competitively, to a group of 43 individuals with chronic stroke. The mediating effects of competitiveness were evaluated for both intervention effectiveness and motivation. Participants were randomly sorted into two groups and underwent 20 one-hour group-based sessions, during which they either worked individually or competed with peers, according to their group allocation. Participants were assessed before and after the intervention, using the Conners' Continuous Performance Test, the d2 Test of Attention, the Color Trail Test, the Digit Span Test, and the Spatial Span Test. The competitiveness and subjective experiences of the participants after the intervention were investigated with the Revised Competitiveness Index and the Intrinsic Motivation Inventory, respectively. The results showed that participants who competed demonstrated significantly greater improvements in all cognitive abilities, except for divided attention, and reported greater enjoyment than their non-competitive peers. Both groups reported comparable levels of perceived competence, pressure, and usefulness. Interestingly, the competitiveness of the participants did not alter either the effectiveness or the subjective experience of the intervention. These findings suggest that competition might enhance the effectiveness and enjoyment of rehabilitation interventions designed to address attention deficits in individuals post-stroke, regardless of their level of competitiveness and without having a negative effect on their perceived pressure and competence.This study was funded by Ministerio de Economia y Competitividad of Spain (Project IDI-20110844), by Conselleria de Educacion, Cultura y Deporte of Generalitat Valenciana of Spain (Project SEJI/2019/017) and the European Union through the Operational Program of the European Regional Development Fund (ERDF) of the Valencian Community 2014-2020 (IDIFEDER/2018/029).Navarro, MD.; Llorens Rodríguez, R.; Borrego, A.; Alcañiz Raya, ML.; Noé, E.; Ferri, J. (2020). Competition Enhances the Effectiveness and Motivation of Attention Rehabilitation After Stroke. A Randomized Controlled Trial. 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The Lancet Neurology, 14(9), 893-902. doi:10.1016/s1474-4422(15)00147-7Baur, K., Schättin, A., de Bruin, E. D., Riener, R., Duarte, J. E., & Wolf, P. (2018). Trends in robot-assisted and virtual reality-assisted neuromuscular therapy: a systematic review of health-related multiplayer games. Journal of NeuroEngineering and Rehabilitation, 15(1). doi:10.1186/s12984-018-0449-9Bo, W., Lei, M., Tao, S., Jie, L. T., Qian, L., Lin, F. Q., & Ping, W. X. (2018). Effects of combined intervention of physical exercise and cognitive training on cognitive function in stroke survivors with vascular cognitive impairment: a randomized controlled trial. Clinical Rehabilitation, 33(1), 54-63. doi:10.1177/0269215518791007Chen, H.-C., Koh, C.-L., Hsieh, C.-L., & Hsueh, I.-P. (2009). Test–re-test reliability of two sustained attention tests in persons with chronic stroke. Brain Injury, 23(9), 715-722. doi:10.1080/02699050903013602Cicerone, K. D. (2005). Evidence-Based Practice and the Limits of Rational Rehabilitation. Archives of Physical Medicine and Rehabilitation, 86(6), 1073-1074. doi:10.1016/j.apmr.2005.01.003Cicerone, K. D., Langenbahn, D. M., Braden, C., Malec, J. F., Kalmar, K., Fraas, M., … Ashman, T. (2011). Evidence-Based Cognitive Rehabilitation: Updated Review of the Literature From 2003 Through 2008. Archives of Physical Medicine and Rehabilitation, 92(4), 519-530. doi:10.1016/j.apmr.2010.11.015Colomer, C., Llorens, R., Noé, E., & Alcañiz, M. (2016). Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke. Journal of NeuroEngineering and Rehabilitation, 13(1). doi:10.1186/s12984-016-0153-6Cooke, A., Kavussanu, M., McIntyre, D., & Ring, C. (2013). The Effects of Individual and Team Competitions on Performance, Emotions, and Effort. Journal of Sport and Exercise Psychology, 35(2), 132-143. doi:10.1123/jsep.35.2.132Cumming, T. B., Brodtmann, A., Darby, D., & Bernhardt, J. (2012). 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Imaging Social Motivation: Distinct Brain Mechanisms Drive Effort Production during Collaboration versus Competition. Journal of Neuroscience, 33(40), 15894-15902. doi:10.1523/jneurosci.0143-13.2013Llorens, R., Noé, E., Ferri, J., & Alcañiz, M. (2015). Videogame-based group therapy to improve self-awareness and social skills after traumatic brain injury. Journal of NeuroEngineering and Rehabilitation, 12(1). doi:10.1186/s12984-015-0029-1Loetscher, T., Potter, K.-J., Wong, D., & das Nair, R. (2019). Cognitive rehabilitation for attention deficits following stroke. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd002842.pub3Maclean, N., Pound, P., Wolfe, C., & Rudd, A. (2002). The Concept of Patient Motivation. Stroke, 33(2), 444-448. doi:10.1161/hs0202.102367Mandehgary Najafabadi, M., Azad, A., Mehdizadeh, H., Behzadipour, S., Fakhar, M., Taghavi Azar Sharabiani, P., … Khalaf, K. (2019). Improvement of Upper Limb Motor Control and Function After Competitive and Noncompetitive Volleyball Exercises in Chronic Stroke Survivors: A Randomized Clinical Trial. Archives of Physical Medicine and Rehabilitation, 100(3), 401-411. doi:10.1016/j.apmr.2018.10.012McAuley, E., Duncan, T., & Tammen, V. V. (1989). Psychometric Properties of the Intrinsic Motivation Inventory in a Competitive Sport Setting: A Confirmatory Factor Analysis. Research Quarterly for Exercise and Sport, 60(1), 48-58. doi:10.1080/02701367.1989.10607413Mikami, K., Jorge, R. E., Moser, D. J., Jang, M., & Robinson, R. G. (2013). Incident Apathy During the First Year After Stroke and Its Effect on Physical and Cognitive Recovery. The American Journal of Geriatric Psychiatry, 21(9), 848-854. doi:10.1016/j.jagp.2013.03.012Novak, D., Nagle, A., Keller, U., & Riener, R. (2014). Increasing motivation in robot-aided arm rehabilitation with competitive and cooperative gameplay. Journal of NeuroEngineering and Rehabilitation, 11(1), 64. doi:10.1186/1743-0003-11-64Peng, W., & Hsieh, G. (2012). The influence of competition, cooperation, and player relationship in a motor performance centered computer game. Computers in Human Behavior, 28(6), 2100-2106. doi:10.1016/j.chb.2012.06.014Petersen, S. E., & Posner, M. I. (2012). The Attention System of the Human Brain: 20 Years After. Annual Review of Neuroscience, 35(1), 73-89. doi:10.1146/annurev-neuro-062111-150525Rasquin, S. M. C., Lodder, J., Ponds, R. W. H. M., Winkens, I., Jolles, J., & Verhey, F. R. J. (2004). Cognitive Functioning after Stroke: A One-Year Follow-Up Study. Dementia and Geriatric Cognitive Disorders, 18(2), 138-144. doi:10.1159/000079193Raz, A., & Buhle, J. (2006). Typologies of attentional networks. Nature Reviews Neuroscience, 7(5), 367-379. doi:10.1038/nrn1903Rebok, G. W., Carlson, M. C., & Langbaum, J. B. S. (2007). 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Feasibility, safety and efficacy of transauricular vagus nerve stimulation in a cohort of patients with disorders of consciousness

This work was supported by grant from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement no. 778234- DoCMA project and by Conselleria de Educacion, Investigacion, Cultura y Deporte of Generalitat Valenciana (SEJI/2019/017) and Vicerrectorado de Investigacion, Innovacion y Transferencia of Universitat Politecnica de Valencia (PAID-06-18).Noé, E.; Ferri, J.; Colomer, C.; Moliner, B.; O'valle, M.; Ugart, P.; Rodríguez, C.... (2020). Feasibility, safety and efficacy of transauricular vagus nerve stimulation in a cohort of patients with disorders of consciousness. Brain Stimulation. 13(2):427-429. https://doi.org/10.1016/j.brs.2019.12.005S427429132Thibaut, A., Schiff, N., Giacino, J., Laureys, S., & Gosseries, O. (2019). Therapeutic interventions in patients with prolonged disorders of consciousness. The Lancet Neurology, 18(6), 600-614. doi:10.1016/s1474-4422(19)30031-6Engineer, N. D., Kimberley, T. J., Prudente, C. N., Dawson, J., Tarver, W. B., & Hays, S. A. (2019). Targeted Vagus Nerve Stimulation for Rehabilitation After Stroke. Frontiers in Neuroscience, 13. doi:10.3389/fnins.2019.00280Corazzol, M., Lio, G., Lefevre, A., Deiana, G., Tell, L., André-Obadia, N., … Sirigu, A. (2017). Restoring consciousness with vagus nerve stimulation. Current Biology, 27(18), R994-R996. doi:10.1016/j.cub.2017.07.060Yu, Y., Yang, Y., Wang, L., Fang, J., Chen, Y., He, J., & Rong, P. (2017). Transcutaneous auricular vagus nerve stimulation in disorders of consciousness monitored by fMRI: The first case report. Brain Stimulation, 10(2), 328-330. doi:10.1016/j.brs.2016.12.004Thibaut, A., Di Perri, C., Chatelle, C., Bruno, M.-A., Bahri, M. A., Wannez, S., … Laureys, S. (2015). Clinical Response to tDCS Depends on Residual Brain Metabolism and Grey Matter Integrity in Patients With Minimally Conscious State. Brain Stimulation, 8(6), 1116-1123. doi:10.1016/j.brs.2015.07.024Keute, M., Ruhnau, P., Heinze, H.-J., & Zaehle, T. (2018). Behavioral and electrophysiological evidence for GABAergic modulation through transcutaneous vagus nerve stimulation. Clinical Neurophysiology, 129(9), 1789-1795. doi:10.1016/j.clinph.2018.05.026Kleim, J. A., & Jones, T. A. (2008). Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage. Journal of Speech, Language, and Hearing Research, 51(1). doi:10.1044/1092-4388(2008/018)Thibaut, A., Wannez, S., Donneau, A.-F., Chatelle, C., Gosseries, O., Bruno, M.-A., & Laureys, S. (2017). Controlled clinical trial of repeated prefrontal tDCS in patients with chronic minimally conscious state. Brain Injury, 31(4), 466-474. doi:10.1080/02699052.2016.1274776Van Erp, W. S., Aben, A. M. L., Lavrijsen, J. C. M., Vos, P. E., Laureys, S., & Koopmans, R. T. C. M. (2019). Unexpected emergence from the vegetative state: delayed discovery rather than late recovery of consciousness. Journal of Neurology, 266(12), 3144-3149. doi:10.1007/s00415-019-09542-3Thibaut, A., Chennu, S., Chatelle, C., Martens, G., Annen, J., Cassol, H., & Laureys, S. (2018). Theta network centrality correlates with tDCS response in disorders of consciousness. Brain Stimulation, 11(6), 1407-1409. doi:10.1016/j.brs.2018.09.00

When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence

[EN] Accurate estimation of the functional independence of patients with unresponsive wakefulness syndrome (UWS) is essential to adjust family and clinical expectations and plan long-term necessary resources. Although different studies have described the clinical course of these patients, they have methodological limitations that could restrict generalization of the results. This study investigates the neurobehavioral progress of 100 patients with UWS consecutively admitted to a neurorehabilitation center using systematic weekly assessments based on standardized measures, and the functional independence staging of those patients who emerged from a minimally conscious state (MCS) during the first year post-emergence. Our results showed that one year after emergence, most patients were severely dependent, although some of them showed extreme or moderate severity. Clinically meaningful functional improvement was less likely to occur in cognitively-demanding activities, such as activities of daily living and executive function. Consequently, the use of specific and staging functional independence measures, with domain-specific evaluations, are recommended to detect the functional changes that might be expected in these patients. The information provided by these instruments, together with that obtained from repeated assessments of the preserved consciousness with standardized instruments, could help clinicians to adjust expectations and plan necessary resources for this population.This research was funded by the program RISE-Marie-Slodowska-Curie of the European Commission (Grant agreement 778234), by Conselleria de Educacion, Investigacion, Cultura y Deporte of Generalitat Valenciana (SEJI/2019/017), and by Vicerrectorado de Investigacion, Innovacion y transferencia of Universitat Politecnica de Valencia (PAID-06-18).Olaya, J.; Noé, E.; Navarro, MD.; O'valle, M.; Colomer, C.; Moliner, B.; Ippoliti, C.... (2020). When, How, and to What Extent Are Individuals with Unresponsive Wakefulness Syndrome Able to Progress? Functional Independence. Brain Sciences. 10(12):1-14. https://doi.org/10.3390/brainsci10120990S1141012Jennett, B., & Plum, F. (1972). PERSISTENT VEGETATIVE STATE AFTER BRAIN DAMAGE. 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