Robot-aided neurorehabilitation of the upper extremities

Task-oriented repetitive movements can improve muscle strength and movement co-ordination in patients with impairments due to neurological lesions. The application of robotics and automation technology can serve to assist, enhance, evaluate and document the rehabilitation of movements. The paper provides an overview of existing devices that can support movement therapy of the upper extremities in subjects with neurological pathologies. The devices are critically compared with respect to technical function, clinical applicability, and, if they exist, clinical outcome

Street crossing behavior in younger and older pedestrians: an eye- and head-tracking study

Background Crossing a street can be a very difficult task for older pedestrians. With increased age and potential cognitive decline, older people take the decision to cross a street primarily based on vehicles’ distance, and not on their speed. Furthermore, older pedestrians tend to overestimate their own walking speed, and could not adapt it according to the traffic conditions. Pedestrians’ behavior is often tested using virtual reality. Virtual reality presents the advantage of being safe, cost-effective, and allows using standardized test conditions. Methods This paper describes an observational study with older and younger adults. Street crossing behavior was investigated in 18 healthy, younger and 18 older subjects by using a virtual reality setting. The aim of the study was to measure behavioral data (such as eye and head movements) and to assess how the two age groups differ in terms of number of safe street crossings, virtual crashes, and missed street crossing opportunities. Street crossing behavior, eye and head movements, in older and younger subjects, were compared with non-parametric tests. Results The results showed that younger pedestrians behaved in a more secure manner while crossing a street, as compared to older people. The eye and head movements analysis revealed that older people looked more at the ground and less at the other side of the street to cross. Conclusions The less secure behavior in street crossing found in older pedestrians could be explained by their reduced cognitive and visual abilities, which, in turn, resulted in difficulties in the decision-making process, especially under time pressure. Decisions to cross a street are based on the distance of the oncoming cars, rather than their speed, for both groups. Older pedestrians look more at their feet, probably because of their need of more time to plan precise stepping movement and, in turn, pay less attention to the traffic. This might help to set up guidelines for improving senior pedestrians’ safety, in terms of speed limits, road design, and mixed physical-cognitive trainings

Effects of age and eccentricity on visual target detection

The aim of this study was to examine the effects of aging and target eccentricity on a visual search task comprising 30 images of everyday life projected into a hemisphere, realizing a ±90° visual field. The task performed binocularly allowed participants to freely move their eyes to scan images for an appearing target or distractor stimulus (presented at 10°; 30°, and 50° eccentricity). The distractor stimulus required no response, while the target stimulus required acknowledgment by pressing the response button. One hundred and seventeen healthy subjects (mean age = 49.63 years, SD = 17.40 years, age range 20–78 years) were studied. The results show that target detection performance decreases with age as well as with increasing eccentricity, especially for older subjects. Reaction time also increases with age and eccentricity, but in contrast to target detection, there is no interaction between age and eccentricity. Eye movement analysis showed that younger subjects exhibited a passive search strategy while older subjects exhibited an active search strategy probably as a compensation for their reduced peripheral detection performance

Effects of Alzheimer’s Disease on Visual Target Detection: A “Peripheral Bias”

Visual exploration is an omnipresent activity in everyday life, and might represent an important determinant of visual attention deficits in patients with Alzheimer’s Disease (AD). The present study aimed at investigating visual search performance in AD patients, in particular target detection in the far periphery, in daily living scenes. Eighteen AD patients and 20 healthy controls participated in the study. They were asked to freely explore a hemispherical screen, covering ±90°, and to respond to targets presented at 10°, 30°, and 50° eccentricity, while their eye movements were recorded. Compared to healthy controls, AD patients recognized less targets appearing in the center. No difference was found in target detection in the periphery. This pattern was confirmed by the fixation distribution analysis. These results show a neglect for the central part of the visual field for AD patients and provide new insights by mean of a search task involving a larger field of view

Depicting Development Issues: Thematic Trends of Documentary Films of Mindanao-Based Filmmakers

Mindanao is the Philippine's second largest island in the south. Identifying Mindanao-based documentaries that have development themes remain unknown or unacknowledged. Using Phenomenology as theoretical framework and method, as a result, the researcher found out that similar to other documentary films in other parts of the country and the world, the themes showed by Mindanao-based documentaries reflect on agriculture, health, women and children, environment and population. However unlike its other foreign and local counterparts, a number of Mindanao-based documentaries anchor the mentioned development themes under the context of peace and conflict situation, human rights, indigenous peoples and their ancestral domains

Discovery potential of top-partners in a realistic composite Higgs model with early LHC data

Composite Higgs models provide a natural, non-supersymmetric solution to the hierarchy problem. In these models, one or more sets of heavy top-partners are typically introduced. Some of these new quarks can be relatively light, with a mass of a few hundred GeV, and could be observed with the early LHC collision data expected to be collected during 2010. We analyse in detail the collider signatures that these new quarks can produce. We show that final states with two (same-sign) or three leptons are the most promising discovery channels. They can yield a 5 sigma excess over the Standard Model expectation already with the 2010 LHC collision data. Exotic quarks of charge 5/3 are a distinctive feature of this model. We present a new method to reconstruct their masses from their leptonic decay without relying on jets in the final state.Comment: 28 pages 11 Figures 7 Tables, minor changes, added references, matches published versio

Consensus-Based Core Set of Outcome Measures for Clinical Motor Rehabilitation After Stroke—A Delphi Study

Introduction: Outcome measures are key to tailor rehabilitation goals to the stroke patient's individual needs and to monitor poststroke recovery. The large number of available outcome measures leads to high variability in clinical use. Currently, an internationally agreed core set of motor outcome measures for clinical application is lacking. Therefore, the goal was to develop such a set to serve as a quality standard in clinical motor rehabilitation poststroke. / Methods: Outcome measures for the upper and lower extremities, and activities of daily living (ADL)/stroke-specific outcomes were identified and presented to stroke rehabilitation experts in an electronic Delphi study. In round 1, clinical feasibility and relevance of the outcome measures were rated on a 7-point Likert scale. In round 2, those rated at least as “relevant” and “feasible” were ranked within the body functions, activities, and participation domains of the International Classification of Functioning, Disability, and Health (ICF). Furthermore, measurement time points poststroke were indicated. In round 3, answers were reviewed in reference to overall results to reach final consensus. / Results: In total, 119 outcome measures were presented to 33 experts from 18 countries. The recommended core set includes the Fugl–Meyer Motor Assessment and Action Research Arm Test for the upper extremity section; the Fugl–Meyer Motor Assessment, 10-m Walk Test, Timed-Up-and-Go, and Berg Balance Scale for the lower extremity section; and the National Institutes of Health Stroke Scale, and Barthel Index or Functional Independence Measure for the ADL/stroke-specific section. The Stroke Impact Scale was recommended spanning all ICF domains. Recommended measurement time points are days 2 ± 1 and 7; weeks 2, 4, and 12; 6 months poststroke and every following 6th month. / Discussion and Conclusion: Agreement was found upon a set of nine outcome measures for application in clinical motor rehabilitation poststroke, with seven measurement time points following the stages of poststroke recovery. This core set was specifically developed for clinical practice and distinguishes itself from initiatives for stroke rehabilitation research. The next challenge is to implement this clinical core set across the full stroke care continuum with the aim to improve the transparency, comparability, and quality of stroke rehabilitation at a regional, national, and international level

Manipulations to reduce simulator-related transient adverse health effects during simulated driving

User comfort during simulated driving is of key importance, since reduced comfort can confound the experiment and increase dropout rates. A common comfort-affecting factor is simulator-related transient adverse health effect (SHE). In this study, we propose and evaluate methods to adapt a virtual driving scene to reduce SHEs. In contrast to the manufacturer-provided high-sensory conflict scene (high-SCS), we developed a low-sensory conflict scene (low-SCS). Twenty young, healthy participants drove in both the high-SCS and the low-SCS scene for 10min on two different days (same time of day, randomized order). Before and after driving, participants rated SHEs by completing the Simulator Sickness Questionnaire (SSQ). During driving, several physiological parameters were recorded. After driving in the high-SCS, the SSQ score increased in average by 129.4 (122.9%, p=0.002) compared to an increase of 5.0 (3.4%, p=0.878) after driving in the low-SCS. In the low-SCS, skin conductance decreased by 13.8% (p<0.01) and saccade amplitudes increased by 16.1% (p<0.01). Results show that the investigated methods reduce SHEs in a younger population, and the low-SCS is well accepted by the users. We expect that these measures will improve user comfort

Ablation of the canonical testosterone production pathway via knockout of the steroidogenic enzyme HSD17B3, reveals a novel mechanism of testicular testosterone production

Male development, fertility, and lifelong health are all androgen-dependent. Approximately 95% of circulating testosterone is synthesized by the testis and the final step in this canonical pathway is controlled by the activity of the hydroxysteroid-dehydrogenase-17-beta-3 (HSD17B3). To determine the role of HSD17B3 in testosterone production and androgenization during male development and function we have characterized a mouse model lacking HSD17B3. The data reveal that developmental masculinization and fertility are normal in mutant males. Ablation of HSD17B3 inhibits hyperstimulation of testosterone production by hCG, although basal testosterone levels are maintained despite the absence of HSD17B3. Reintroduction of HSD17B3 via gene-delivery to Sertoli cells in adulthood partially rescues the adult phenotype, showing that, as in development, different cell-types in the testis are able to work together to produce testosterone. Together, these data show that HS17B3 acts as a rate-limiting-step for the maximum level of testosterone production by the testis but does not control basal testosterone production. Measurement of other enzymes able to convert androstenedione to testosterone identifies HSD17B12 as a candidate enzyme capable of driving basal testosterone production in the testis. Together, these findings expand our understanding of testosterone production in males

Bivalirudin started during emergency transport for primary PCI.

BACKGROUND: Bivalirudin, as compared with heparin and glycoprotein IIb/IIIa inhibitors, has been shown to reduce rates of bleeding and death in patients undergoing primary percutaneous coronary intervention (PCI). Whether these benefits persist in contemporary practice characterized by prehospital initiation of treatment, optional use of glycoprotein IIb/IIIa inhibitors and novel P2Y12 inhibitors, and radial-artery PCI access use is unknown. METHODS: We randomly assigned 2218 patients with ST-segment elevation myocardial infarction (STEMI) who were being transported for primary PCI to receive either bivalirudin or unfractionated or low-molecular-weight heparin with optional glycoprotein IIb/IIIa inhibitors (control group). The primary outcome at 30 days was a composite of death or major bleeding not associated with coronary-artery bypass grafting (CABG), and the principal secondary outcome was a composite of death, reinfarction, or non-CABG major bleeding. RESULTS: Bivalirudin, as compared with the control intervention, reduced the risk of the primary outcome (5.1% vs. 8.5%; relative risk, 0.60; 95% confidence interval [CI], 0.43 to 0.82; P=0.001) and the principal secondary outcome (6.6% vs. 9.2%; relative risk, 0.72; 95% CI, 0.54 to 0.96; P=0.02). Bivalirudin also reduced the risk of major bleeding (2.6% vs. 6.0%; relative risk, 0.43; 95% CI, 0.28 to 0.66; P<0.001). The risk of acute stent thrombosis was higher with bivalirudin (1.1% vs. 0.2%; relative risk, 6.11; 95% CI, 1.37 to 27.24; P=0.007). There was no significant difference in rates of death (2.9% vs. 3.1%) or reinfarction (1.7% vs. 0.9%). Results were consistent across subgroups of patients. CONCLUSIONS: Bivalirudin, started during transport for primary PCI, improved 30-day clinical outcomes with a reduction in major bleeding but with an increase in acute stent thrombosis. (Funded by the Medicines Company; EUROMAX ClinicalTrials.gov number, NCT01087723.)