Effect of rhythmic auditory cueing on gait in cerebral palsy: A systematic review and meta-analysis

Auditory entrainment can influence gait performance in movement disorders. The entrainment can incite neurophysiological and musculoskeletal changes to enhance motor execution. However, a consensus as to its effects based on gait in people with cerebral palsy is still warranted. A systematic review and meta-analysis were carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal and kinematic parameters of gait in people with cerebral palsy. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and American Academy for Cerebral Palsy and Developmental Medicine guidelines, from inception until July 2017, on online databases: Web of Science, PEDro, EBSCO, Medline, Cochrane, Embase and ProQuest. Kinematic and spatiotemporal gait parameters were evaluated in a meta-analysis across studies. Of 547 records, nine studies involving 227 participants (108 children/119 adults) met our inclusion criteria. The qualitative review suggested beneficial effects of rhythmic auditory cueing on gait performance among all included studies. The meta-analysis revealed beneficial effects of rhythmic auditory cueing on gait dynamic index (Hedge’s g=0.9), gait velocity (1.1), cadence (0.3), and stride length (0.5). This review for the first time suggests a converging evidence toward application of rhythmic auditory cueing to enhance gait performance and stability in people with cerebral palsy. This article details underlying neurophysiological mechanisms and use of cueing as an efficient home-based intervention. It bridges gaps in the literature, and suggests translational approaches on how rhythmic auditory cueing can be incorporated in rehabilitation approaches to enhance gait performance in people with cerebral palsy

“Low road” to rehabilitation: A perspective on subliminal sensory neuroprosthetics

Fear can propagate parallelly through both cortical and subcortical pathways. It can instigate memory consolidation habitually and might allow internal simulation of movements independent of the cortical structures. This perspective suggests delivery of subliminal, aversive and kinematic audiovisual stimuli via neuroprosthetics in patients with neocortical dysfunctions. We suggest possible scenarios by which these stimuli might bypass damaged neocortical structures and possibly assisting in motor relearning. Anticipated neurophysiological mechanisms and methodological scenarios have been discussed in this perspective. This approach introduces novel perspectives into neuropsychology as to how subcortical pathways might be used to induce motor relearning. © 2018 Ghai et al

Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis

The use of dual-task training paradigm to enhance postural stability in patients with balance impairments is an emerging area of interest. The differential effects of dual tasks and dual-task training on postural stability still remain unclear. A systematic review and meta-analysis were conducted to analyze the effects of dual task and training application on static and dynamic postural stability among various population groups. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, from inception until June 2016, on the online databases Scopus, PEDro, MEDLINE, EMBASE, and SportDiscus. Experimental studies analyzing the effects of dual task and dual-task training on postural stability were extracted, critically appraised using PEDro scale, and then summarized according to modified PEDro level of evidence. Of 1,284 records, 42 studies involving 1,480 participants met the review's inclusion criteria. Of the studies evaluating the effects of dual-task training on postural stability, 87.5% of the studies reported significant enhancements, whereas 30% of the studies evaluating acute effects of dual tasks on posture reported significant enhancements, 50% reported significant decrements, and 20% reported no effects. Meta-analysis of the pooled studies revealed moderate but significant enhancements of dual-task training in elderly participants (95% CI: 1.16-2.10) and in patients suffering from chronic stroke (-0.22 to 0.86). The adverse effects of complexity of dual tasks on postural stability were also revealed among patients with multiple sclerosis (-0.74 to 0.05). The review also discusses the significance of verbalization in a dual-task setting for increasing cognitive-motor interference. Clinical implications are discussed with respect to practical applications in rehabilitation settings

Exploring bacterial outer membrane barrier to combat bad bugs

One of the main fundamental mechanisms of antibiotic resistance in Gram-negative bacteria comprises an effective change in the membrane permeability to antibiotics. The Gram-negative bacterial complex cell envelope comprises an outer membrane that delimits the periplasm from the exterior environment. The outer membrane contains numerous protein channels, termed as porins or nanopores, which are mainly involved in the influx of hydrophilic compounds, including antibiotics. Bacterial adaptation to reduce influx through these outer membrane proteins (Omps) is one of the crucial mechanisms behind antibiotic resistance. Thus to interpret the molecular basis of the outer membrane permeability is the current challenge. This review attempts to develop a state of knowledge pertinent to Omps and their effective role in antibiotic influx. Further, it aims to study the bacterial response to antibiotic membrane permeability and hopefully provoke a discussion toward understanding and further exploration of prospects to improve our knowledge on physicochemical parameters that direct the translocation of antibiotics through the bacterial membrane protein channels

Virtual Reality Enhances Gait in Cerebral Palsy: A Training Dose-Response Meta-Analysis

Virtual-reality-based training can influence gait recovery in children with cerebral palsy. A consensus concerning its influence on spatiotemporal gait parameters and effective training dosage is still warranted. This study analyzes the influence of virtual-reality training (relevant training dosage) on gait recovery in children with cerebral palsy. A search was performed by two reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on nine databases: PEDro, EBSCO, PubMed, Cochrane, Web of Science, EMBASE, ICI, Scopus, and PROQUEST. Of 989 records, 16 studies involving a total of 274 children with cerebral palsy met our inclusion criteria. Eighty-eight percent of the studies reported significant enhancements in gait performance after training with virtual reality. Meta-analyses revealed positive effects of virtual-reality training on gait velocity (Hedge's g = 0.68), stride length (0.30), cadence (0.66), and gross motor function measure (0.44). Subgroup analysis reported a training duration of 20–30 min per session, ≤4 times per week across ≥8 weeks to allow maximum enhancements in gait velocity. This study provides preliminary evidence for the beneficial influence of virtual-reality training in gait rehabilitation for children with cerebral palsy

Role of Sonification and Rhythmic Auditory Cueing for Enhancing Gait Associated Deficits Induced by Neurotoxic Cancer Therapies: A Perspective on Auditory Neuroprosthetics

Patients undergoing chemotherapy, radiotherapy, and immunotherapy experience neurotoxic changes in the central and peripheral nervous system. These neurotoxic changes adversely affect functioning in the sensory, motor, and cognitive domains. Thereby, considerably affecting autonomic activities like gait and posture. Recent evidence from a range of systematic reviews and meta-analyses have suggested the beneficial influence of music-based external auditory stimulations i.e., rhythmic auditory cueing and real-time auditory feedback (sonification) on gait and postural stability in population groups will balance disorders. This perspective explores the conjunct implications of auditory stimulations during cancer treatment to simultaneously reduce gait and posture related deficits. Underlying neurophysiological mechanisms by which auditory stimulations might influence motor performance have been discussed. Prompt recognition of this sensorimotor training strategy in future studies can have a widespread impact on patient care in all areas of oncology

A systematic integrative review of the literature on midwives and student midwives engaged in problematic substance use

ObjectiveThe objective of this systematic integrative review was to review the literature in relation to problematic substance use (PSU) in midwifery populations. Associated aims were to aggregate existing knowledge about midwives and student midwives’ personal engagement in PSU, to generate a holistic conceptualisation and synthesis of the existing literature regarding midwives and student midwives personally engaged in PSU and to present new understandings and perspectives to inform the development of future research questions. This review is the first of its kind.DesignSystematic searches were conducted in CINAHL, Academic Search Complete, MEDLINE, PSYCInfo, Scopus and the Cochrane Library. Findings were grouped into themes and subthemes relating to both midwives and student midwives and then analysed critically in relation to the wider literature. A quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). The PRISMA statement was used to guide reporting.SettingIncluded studies were conducted in Scotland, Ireland, Australia and New Zealand.ParticipantsStudies included a total of 6,182 participants.FindingsA total of 3 studies were included. All included study types comprised quantitative survey designs, yet one also included a mixed methods design with the use of semi structured interviews. Two overarching themes emerged relating to both midwives and student midwives engaged in problematic substance use. For midwives, three subthemes are described: harmful daily alcohol consumption, working hours and harmful daily alcohol consumption and features associated with harmful daily alcohol consumption. For student midwives, two subthemes are presented: escape avoidance and alcohol, tobacco and cannabis use.Key conclusionsThere is limited evidence available in relation to problematic substance use in midwifery populations in comparison to that available for other healthcare populations. Further research is required, and could usefully focus upon midwives and student midwives as distinct professions to be separated out from the wider healthcare workforce.Implications for practiceProblematic substance use among the healthcare workforce is associated with an increase in medical errors and inadequate care. Those affected can be reluctant to seek help, experience psychological distress and even contemplate suicide. Whilst evidence remains lacking for midwifery populations, they form a part of the general healthcare workforce and are exposed to similar workplace stressors. As such, it is likely that they too would be affected in similar ways

Effects of (music-based) rhythmic auditory cueing training on gait and posture post-stroke: A systematic review & dose-response meta-analysis

Abstract Gait dysfunctions are common post-stroke. Rhythmic auditory cueing has been widely used in gait rehabilitation for movement disorders. However, a consensus regarding its influence on gait and postural recovery post-stroke is still warranted. A systematic review and meta-analysis was performed to analyze the effects of auditory cueing on gait and postural stability post-stroke. Nine academic databases were searched according to PRISMA guidelines. The eligibility criteria for the studies were a) studies were randomized controlled trials or controlled clinical trials published in English, German, Hindi, Punjabi or Korean languages b) studies evaluated the effects of auditory cueing on spatiotemporal gait and/or postural stability parameters post-stroke c) studies scored ≥4 points on the PEDro scale. Out of 1,471 records, 38 studies involving 968 patients were included in this present review. The review and meta-analyses revealed beneficial effects of training with auditory cueing on gait and postural stability. A training dosage of 20–45 minutes session, for 3–5 times a week enhanced gait performance, dynamic postural stability i.e. velocity (Hedge’s g: 0.73), stride length (0.58), cadence (0.75) and timed-up and go test (−0.76). This review strongly recommends the incorporation of rhythmic auditory cueing based training in gait and postural rehabilitation, post-stroke

Effects of Rhythmic Auditory Cueing in Gait Rehabilitation for Multiple Sclerosis: A Mini Systematic Review and Meta-Analysis

Rhythmic auditory cueing has been shown to enhance gait performance in several movement disorders. The “entrainment effect” generated by the stimulations can enhance auditory motor coupling and instigate plasticity. However, a consensus as to its influence over gait training among patients with multiple sclerosis is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing in studies gait performance in patients with multiple sclerosis. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until Dec 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 602 records, five studies (PEDro score: 5.7 ± 1.3) involving 188 participants (144 females/40 males) met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e., velocity (Hedge's g: 0.67), stride length (0.70), and cadence (1.0), and reduction in timed 25 feet walking test (−0.17). Underlying neurophysiological mechanisms, and clinical implications are discussed. This present review bridges the gaps in literature by suggesting application of rhythmic auditory cueing in conventional rehabilitation approaches to enhance gait performance in the multiple sclerosis community

A Barrier to Entry: Examining the Bacterial Outer Membrane and Antibiotic Resistance

Gram-negative bacteria can resist antibiotics by changing the permeability via their outer membrane. These bacteria have a complex cell envelope that incorporates an outer membrane separating the periplasm from the external environment. This outer membrane contains many protein channels, also known as porins or nanopores, which mainly allow the influx of hydrophilic compounds, including antibiotics. One probable way bacteria may possibly develop antibiotic resistance is by reworking to reduce the inflow through these outer membrane porins or nanopores. The challenge now is to recognize and potentially comprehend the molecular basis of permeability via the bacterial outer membrane. To address this challenge, this assessment builds upon the author’s previous work to develop a comprehensive understanding of membrane porins and their crucial role in the influx of antibiotics and solutes. Furthermore, the work aspires to investigate the bacterial response to antibiotic membrane permeability and nurture discussion toward further exploration of the physicochemical parameters governing the translocation/transport of antibiotics through bacterial membrane porins. By augmenting our understanding of these mechanisms, we may devise novel approaches to mitigate antibiotic resistance in Gram-negative bacteria