Long-term Disability Research Articles

Child care for young children with disabilities.

More than half (56%) of Canadian children aged 0 to 5 years are in non-parental child care, but data on child care attendance among children with disabilities is limited. This study examines child care participation among young children with disabilities in Canada, with a focus on different disability types. Analyses were conducted on 1,189 children aged 0 to 5 years identified with disabilities from Statistics Canada's 2023 Survey on Early Learning and Child Care Arrangements - Children with Long-term Conditions and Disabilities. Rates of child care participation, difficulties finding child care, difficulties within child care, and whether parents reported that their child had ever been denied a child care space because of their condition were examined. Logistic regression models tested for differences in the main child care arrangement and difficulty finding child care based on the child's disability while controlling for sociodemographic variables. Among children aged 0 to 5 years with disabilities, 45% attended a daycare centre, preschool, centre de la petite enfance, or before or after school care as their main child care arrangement; 17% attended another type of child care, such as a family child care home or care by a relative; and 38% did not regularly attend non-parental child care. The parents of nearly half of children with disabilities reported difficulty finding a child care arrangement, particularly for children with emotional conditions. Close to 1 in 10 parents of children with disabilities who were using child care reported that their child had been denied a child care space because of their condition. These findings highlight the need for information to support inclusive policies, practices, and resources for children with disabilities within the Canada-wide early learning and child care system.

Alteplase vs. Tenecteplase: An In-depth Analysis of Their Relative Effectiveness in Treating Acute Ischemic Stroke

Dear Editor, Stroke stands as the second-leading cause of death worldwide [1, 2]. Each year, over 12 million individuals are impacted by stroke, resulting in approximately 6.5 million fatalities [1]. Stroke globally ranks as the third-leading factor causing a combination of death and disability [2]. Every year, around seven hundred thousand individuals in the United States undergo an Acute Ischemic Stroke (AIS), making up 85% of all stroke cases [2]. New treatments like intravenous thrombolysis and mechanical thrombectomy have cut mortality by 10% compared to older methods, enhancing long-term disability prevention rates following Acute Ischemic Stroke [2]. Alteplase is the sole FDA-approved thrombolytic drug in AIS within the first 4.5 hours. Despite its potential for disability-free recovery, its usage is constrained by a brief time window and adverse effects, notably a 6% risk of symptomatic bleeding. In addition, its fibrinolytic efficacy is limited, achieving vascular reopening in less than half of the patients, and can cause cytotoxicity to the already hypoxic brain with resultant cerebral edema [2]. Tenecteplase (TNK), a modified variant of alteplase, has improved features including greater fibrin selectivity and longer half-life and is given as a single bolus instead of an infusion, thanks to genetic recombinant technology [3]. Numerous studies have supported TNK's efficacy over alteplase in treating AIS. In 2016, Bruce C.V. Campbell and colleagues demonstrated that, according to the analysis of modified Rankin scale scores, tenecteplase exhibited a more favorable overall functional outcome compared to alteplase [4]. A dosage of 0.25 mg/kg of tenecteplase emerges as a promising alternative to replace alteplase as the preferred treatment for patients with AIS occurring within 4.5 hours due to TNK's superior early neurological recovery rates and comparable safety outcomes [3]. Despite gathering evidence from experimental trials indicating TNK's advantages over alteplase for AIS, the use of TNK at a dosage of 0.4 mg/kg appears to pose safety concerns when compared to alteplase [3]. Bruce C.V. Campbell and his fellow researchers revealed in their study that in spite of the beneficial effects of TNK relative to alteplase, there was no significant variation in the speed of recovery to independent function. Notably, they found no discernible distinction in the occurrence of intracranial hemorrhage [4]. ---Continue

Post-Meningitic Syndrome: Pathophysiology and Consequences of Streptococcal Infections on the Central Nervous System.

Streptococcus species represent a significant global cause of meningitis, leading to brain damage through bacterial virulence factors and the host inflammatory response. Upon entering the central nervous system (CNS), excessive inflammation leads to various neurological and psychological complications. This review explores the pathophysiological mechanisms and associated outcomes of streptococcal meningitis, particularly its short- and long-term neurological sequelae. Neurological symptoms, such as cognitive impairment, motor deficits, and sensory loss, are shown to vary in severity, with children being particularly susceptible to lasting complications. Among survivors, hearing loss, cognitive decline, and cranial nerve palsies emerge as the most frequently reported complications. The findings highlight the need for timely intervention, including neurorehabilitation strategies that focus on optimizing recovery and mitigating long-term disabilities. Future recommendations emphasize improving early diagnosis, expanding vaccine access, and personalizing rehabilitation protocols to enhance patient outcomes. As a novel contribution, this review proposes the term "post-meningitic syndrome" to showcase the broad spectrum of CNS complications that persist following streptococcal meningitis, providing a framework for a future clinical and research focus.

Life satisfaction, perceived social support of mothers of children with cerebral palsy, and motor function of their children

Cerebral palsy (CP) is a leading cause of long-term disability in children worldwide where severe cases may require complete dependence on caregivers for mobility, self-care, and social participation. The demand for caregiving may negatively impact the level of life satisfaction of the caregivers, especially the mothers. This study was thus carried out to evaluate the level of life satisfaction of mothers of children with CP, its association with perceived social support, and the motor function of their children.MethodThe study involved 58 mothers of children with CP and their children. The level of life satisfaction, perceived social support, and socioeconomic status of the mothers were assessed using the satisfaction with life scale, the multidimensional scale of perceived social support, and the modified Kuppuswamy Socioeconomic Scale, respectively. The motor function of the children with CP was assessed using the Gross Motor Function Classification System (GMFCS).ResultAbout 38% of the mothers of children with cerebral palsy were fully satisfied with their lives. There was no significant association among the level of life satisfaction, perceived social support of mothers of children with CP, and the motor function of their children.ConclusionSix out of ten mothers of children with cerebral palsy are somewhat dissatisfied with life. It was recommended that measures to relieve factors leading to dissatisfaction with life should be put in place by national health policymakers.

Rehabilitation Interventions for Adults With Complex Regional Pain Syndrome: A Scoping Review Protocol.

This scoping review will explore the literature related to rehabilitation interventions for the treatment of adults living with complex regional pain syndrome (CRPS), describe the domains and outcome measures used to assess their effectiveness, and examine the neurophysiological bases of these interventions. The unremitting symptoms of CRPS, a chronic pain condition, are associated with long-term disability, poor psychological health, decreased emotional and social well-being, and reduced quality of life. Effective treatment for persistent symptoms is notoriously difficult. Therapeutic approaches such as graded motor imagery or pain exposure therapy are recommended for CRPS but show mixed results, insufficient effectiveness, variability in outcome measures, and unclear neurophysiological bases. This review will consider studies that include any form of non-invasive rehabilitation intervention delivered by a healthcare professional in any setting for adults with a CRPSdiagnosis. Quantitative, qualitative and observational studies, text and opinion papers will be considered. The Joanna Briggs Institute (JBI)methodology will be used to conduct this scoping review. MEDLINE, Embase, Scopus, APA PsycINFO, CINAHL, Cochrane, OpenGrey Google and ProQuest Dissertations and Theses Global (ProQuest) will be searched for studies in English published between 2007 and 2024. Two independent reviewers will screen the titles, abstracts, and full texts of the selected studies. Data collection will be performed using a tool developed by the researchers based on the standardised JBI tool. Data will be presented in a comprehensive narrative summary. https://doi.org/10.17605/OSF.IO/P967T.

AI Applications in Adult Stroke Recovery and Rehabilitation: A Scoping Review Using AI

Stroke is a leading cause of long-term disability worldwide. With the advancements in sensor technologies and data availability, artificial intelligence (AI) holds the promise of improving the amount, quality and efficiency of care and enhancing the precision of stroke rehabilitation. We aimed to identify and characterize the existing research on AI applications in stroke recovery and rehabilitation of adults, including categories of application and progression of technologies over time. Data were collected from peer-reviewed articles across various electronic databases up to January 2024. Insights were extracted using AI-enhanced multi-method, data-driven techniques, including clustering of themes and topics. This scoping review summarizes outcomes from 704 studies. Four common themes (impairment, assisted intervention, prediction and imaging, and neuroscience) were identified, in which time-linked patterns emerged. The impairment theme revealed a focus on motor function, gait and mobility, while the assisted intervention theme included applications of robotic and brain–computer interface (BCI) techniques. AI applications progressed over time, starting from conceptualization and then expanding to a broader range of techniques in supervised learning, artificial neural networks (ANN), natural language processing (NLP) and more. Applications focused on upper limb rehabilitation were reviewed in more detail, with machine learning (ML), deep learning techniques and sensors such as inertial measurement units (IMU) used for upper limb and functional movement analysis. AI applications have potential to facilitate tailored therapeutic delivery, thereby contributing to the optimization of rehabilitation outcomes and promoting sustained recovery from rehabilitation to real-world settings.

Improved Door-to-Needle Time After Implementation of Tenecteplase as the Preferred Thrombolytic for Acute Ischemic Stroke at a Large Community Teaching Hospital Emergency Department

Background: Acute ischemic stroke is a leading cause of death and long-term disability. To improve patient outcomes, timely restoration of blood flow to the ischemic brain tissue is vital. One reperfusion strategy includes the administration of thrombolytics. Historically, alteplase has been the thrombolytic of choice for acute ischemic stroke; however, given recent safety and efficacy data, tenecteplase has gained popularity due to its optimal pharmacokinetic profile. Objectives: This study compares outcomes between adult patients with acute ischemic stroke who received tenecteplase as the preferred thrombolytic versus alteplase. Methods: This was a single center, retrospective cohort study that included adult patients who received intravenous thrombolytic therapy, either tenecteplase 0.25 mg/kg or alteplase 0.9 mg/kg, for acute ischemic stroke from May 2021 to December 2023. The primary outcome was door-to-needle time. Secondary safety outcomes included the incidence of symptomatic intracerebral hemorrhage (ICH), any ICH on 24-hour follow-up imaging, major extracranial bleeding, and angioedema. Secondary efficacy outcomes included discharge with a favorable neurological outcome, discharge disposition, ICU length of stay, and overall length of stay. Secondary stroke metric times evaluated include door-to-computed tomography (CT) time, CT-to-needle time, neurologist notification-to-needle time, and thrombolytic decision-to-needle time. Results: Fifty patients were included in the alteplase group and 50 patients were included in the tenecteplase group. The primary outcome, door-to-needle time, was significantly shorter in the tenecteplase group (36 vs 30 minutes, P = .006). There were no statistically significant differences found in the secondary safety and efficacy outcomes. Patients who received tenecteplase experienced significantly faster CT-to-needle times (17 vs 11 minutes, P = .006), neurologist notification-to-needle times (32 vs 25 minutes, P = .001), and thrombolytic decision-to-needle times (9 vs 5 minutes, P < .001). Conclusions: In this retrospective, observational study, there was a statistically significant decrease in door-to-needle time with tenecteplase compared to alteplase. No significant differences in secondary safety and efficacy outcomes were observed.

One-year follow-up of neurobehavioral therapy in functional seizures or epilepsy with traumatic brain injury: A nonrandomized controlled trial.

Patients with traumatic brain injury (TBI) often present with seizures (functional and/or epileptic), but treatments for patients with TBI and seizures are limited. We examined treatment phase and 1-year post-enrollment outcomes following neurobehavioral therapy (NBT) for patients with TBI + functional seizures (FS) and TBI + epilepsy. In this multicenter, prospective, three-group, nonrandomized, controlled trial, with 1-year post-enrollment follow-up, three cohorts of adults were recruited: TBI + video-electroencephalography (EEG)-confirmed FS (n = 89), TBI + EEG-confirmed epilepsy (n = 29), and chart/history-confirmed TBI without seizures (n = 75). Exclusion criteria were recent psychotic or self-injurious behavior, current suicidal ideation, pending litigation or long-term disability, active substance use disorder, and inability to participate in study procedures. TBI + FS and TBI + epilepsy groups completed NBT for seizures, an evidence-based, 12-session, multimodal psychotherapy, whereas TBI without seizures participants received standard medical care. The primary outcome was change in seizure frequency; secondary outcomes were changes in mental health, TBI-related symptoms, disability, and quality of life. Reductions in average monthly seizures occurred during treatment in TBI + FS participants (p = .002) and were significant from baseline (mean = 16.75; 95% confidence interval [CI] = 11.44-24.53) to 12 months post-enrollment (mean = 7.28, 95% CI = 4.37-12.13, p = .002, d = .38). Monthly seizures decreased during treatment in TBI + epilepsy participants (p = .002); reductions were not statistically significant from baseline (mean = 2.38, 95% CI = 1.12-5.04) to 12-month postenrollment (mean = .98, 95% CI = .40-2.42, p = .07, d = .22). Regarding treatment-phase changes in secondary outcome measures, TBI + FS participants improved significantly on 10 of 19 variables (52.6%), TBI + epilepsy participants improved on five of 19 (26.3%), and TBI-onlycomparisons improved on only one of 19 (5.3%). NBT benefited patients with TBI + FS and TBI + epilepsy. Improvements were demonstrated at 1 year post-enrollment in those with TBI + FS. NBT may be a clinically useful treatment for patients with seizures.

Acute Sarcopenia: Mechanisms and Management.

Acute sarcopenia refers to the swift decline in muscle function and mass following acute events such as illness, surgery, trauma, or burns that presents significant challenges in hospitalized older adults. narrative review to describe the mechanisms and management of acute sarcopenia. The prevalence of acute sarcopenia ranges from 28% to 69%, likely underdiagnosed due to the absence of muscle mass and function assessments in most clinical settings. Systemic inflammation, immune-endocrine dysregulation, and anabolic resistance are identified as key pathophysiological factors. Interventions include early mobilization, resistance exercise, neuromuscular electrical stimulation, and nutritional strategies such as protein supplementation, leucine, β-hydroxy-β-methyl-butyrate, omega-3 fatty acids, and creatine monohydrate. Pharmaceuticals show variable efficacy. Future research should prioritize serial monitoring of muscle parameters, identification of predictive biomarkers, and the involvement of multidisciplinary teams from hospital admission to address sarcopenia. Early and targeted interventions are crucial to improve outcomes and prevent long-term disability associated with acute sarcopenia.

Relapse-Associated and Relapse-Independent Contribution to Overall Expanded Disability Status Scale Progression in Multiple Sclerosis Patients Diagnosed in Different Eras.

The introduction of disease-modifying therapies for multiple sclerosis (MS) has led to a deceleration of disease course over the years. Although decreased relapse rate constitutes a factor, the role of relapse-associated worsening (RAW) and progression independent of relapse activity (PIRA) in MS course deceleration is still unclear. We retrospectively examined long-term Expanded Disability Status Scale (EDSS) progression in patients referred to the MS Center of Montichiari (Italy) and diagnosed with relapsing-remitting MS from 1980 to 2022. To isolate PIRA, we deducted all EDSS changes associated with relapses from overall EDSS change. We compared the relative contribution of PIRA and RAW to EDSS progression in patients diagnosed in different periods using mixed-effects models. A total of 1,405 patients were included in the study, of whom 231 were diagnosed in 1980-1996 (pre-treatment era), 577 in 1997-2008 (injectable disease-modifying therapy era), and 597 after 2008 (oral drugs, monoclonal antibodies, and anti-CD20 era). Across ages, both PIRA and RAW were reduced in patients diagnosed in more recent periods as compared with earlier periods. The average contribution of PIRA to overall EDSS progression was already predominant in patients diagnosed in 1980-1996 (78%) and in 1997-2008 (76%), but it was significantly increased (p = 0.0009) in patients diagnosed in later years (87%). The deceleration of MS course observed throughout the years is determined not only by fewer RAW events, but also by a reduction in PIRA. However, the shift toward a mostly relapse-independent progression highlights the importance of evaluating new therapies based on their effect on PIRA. ANN NEUROL 2024.

Association of triglyceride glucose index with clinical outcomes in ischemic stroke: a retrospective study.

Stroke is a major cause of illness, death, and long-term disability and a major health concern worldwide. Experts consider insulin resistance (IR), a defining feature of the metabolic syndrome and a significant risk factor for stroke. Insulin resistance, or IR, is common among stroke patients. The triglyceride-glucose (TYG) index's relevance to both lipotoxicity and glucotoxicity has led to its proposal as an alternative indicator of IR. Examining the connection between elevated TYG INDEX scores and worse clinical outcomes in ischemic stroke patients is the main goal. Finding out how often bad outcomes (recurrence and all-cause death) are in ischemic stroke patients is the secondary goal. This was a retrospective observational study that involved patients admitted to the 850-bed Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, a tertiary care teaching hospital located in the Krishna district of Andhra Pradesh (India). The study was conducted over a period of six months. All the 95 patients who satisfied the eligibility criteria were included. The patients' TYG INDEX values were first determined and patients with ischemic stroke who had elevated TYG INDEX values were then compared for clinical outcomes including recurrence and all-cause death with ischemic patients with normal TYG INDEX. In this study, the total cholesterol of the patients (mean ± SD) was 165.01 ± 51.5mg/dL; Triglycerides was 157.031 ± 98.9mg/dL; HDL-c was 37.253 ± 5.52mg/dl; LDL-c was 107 ± 48.3mg/Dl; and FBS was 153.74 ± 71.52mg/dL. The chi-square test showed that only FBS, Triglyceride, and Total cholesterol were significantly associated with TYG INDEX whereas other variables like age, LDL, and HDL were not. There was no significant association between the TYG INDEX and clinical outcomes of ischemic stroke. In both groups of patients, risk and no risk TYG INDEX values, the mRS score showed variable and unpredictable relationship with the TYG INDEX. Contrary to the few studies that discovered one, our research leads us to the conclusion that there may not be a relevant association between the TYG INDEX and clinical results in patients with ischemic stroke.

Behavioral Risk Profiles of Stroke Survivors Among US Adults: Geographic Differences Between Stroke Belt and Non-Stroke Belt States.

Stroke, a leading cause of illness, death, and long-term disability in the US, presents with significant disparities across the country, most notably in southeastern states comprising the "Stroke Belt." This study intended to identify differences between Stroke Belt states (SBS) and non-Stroke Belt states (NSBS) in terms of prevalence of stroke, sociodemographic and behavioral risk factors, and health-related quality of life (HRQOL). We analyzed data from the 2019 Behavioral Risk Factor Surveillance System to compare demographic characteristics, risk factors, physical activity adherence, functional independence, and HRQOL among stroke survivors in SBS and NSBS. Of 18,745 stroke survivors, 4,272 were from SBS and 14,473 were from NSBS. Stroke was more prevalent in SBS (odds ratio [OR] = 1.39; 95% CI, 1.35-1.44; P < .001), with significant differences by age, sex, and race and ethnicity, except for Hispanic ethnicity. Selected stroke risk factors were more common in every category in SBS. Stroke survivors in SBS were less likely to meet physical activity guidelines for aerobic (OR = 0.77; 95% CI, 0.69-0.86; P < .001) and aerobic and strengthening combined (OR = 0.77; 95% CI, 0.70-0.86; P < .001) activities. Stroke survivors in SBS were more likely to not meet either physical activity guideline (OR = 1.31; 95% CI, 1.22-1.41; P < .001). Living in SBS significantly increased the odds of stroke occurrence. Stroke survivors from SBS reported lower HRQOL and insufficient physical activity as well as lower functional independence. Specific strategies are needed for residents of SBS, with a focus on policies and primary and secondary prevention practices across healthcare professions.

A pilot cross-sectional investigation of symptom clusters and associations with patient-reported outcomes in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post COVID-19 Condition.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is associated with long-term disability and poor quality of life (QoL). Cardinal ME/CFS symptoms (including post-exertional malaise, cognitive dysfunction and sleep disturbances) have been observed in Post COVID-19 Condition (PCC). To gain further insight into the potential role of ME/CFS as a post-COVID-19 sequela, this study investigates associations between symptoms and patient-reported outcomes, as well as symptom clusters. Participants included Australian residents aged between 18 and 65 years formally diagnosed with ME/CFS fulfilling the Canadian or International Consensus Criteria or PCC meeting the World Health Organization case definition. Validated, self-administered questionnaires collected participants' sociodemographic and illness characteristics, symptoms, QoL and functional capacity. Associations between symptoms and patient-reported outcomes were investigated with multivariate linear regression models. Hierarchical cluster analysis was performed to identify symptom clusters. Most people with ME/CFS (pwME/CFS) and people with PCC (pwPCC) were female (n = 48/60, 80.0% and n = 19/30, 63.3%, respectively; p = 0.12). PwME/CFS were significantly younger (x̄=41.75, s = 12.91 years) than pwPCC (x̄=48.13, s =10.05 years; p =0.017). Autonomic symptoms (notably dyspnoea) were associated with poorer scores in most patient-reported outcome domains for both cohorts. None of the four symptom clusters identified were unique to ME/CFS or PCC. Clusters were largely delineated by the presence of gastrointestinal and neurosensory symptoms, illness duration, ME/CFS criteria met and total symptoms. Illness duration may explain differences in symptom burden between pwME/CFS and pwPCC. PCC diagnostic criteria must be refined to distinguish pwPCC at risk of long-term ME/CFS-like illness and subsequently deliver necessary care and support.

Fluid biomarkers of chronic traumatic brain injury.

Traumatic brain injury (TBI) is a leading cause of long-term disability across the world. Evidence for the usefulness of imaging and fluid biomarkers to predict outcomes and screen for the need to monitor complications in the acute stage is steadily increasing. Still, many people experience symptoms such as fatigue and cognitive and motor dysfunction in the chronic phase of TBI, where objective assessments for brain injury are lacking. Consensus criteria for traumatic encephalopathy syndrome, a clinical syndrome possibly associated with the neurodegenerative disease chronic traumatic encephalopathy, which iscommonly associated with sports concussion, have been defined only recently. However, these criteria do not fit all individuals living with chronic consequences of TBI. The pathophysiology of chronic TBI shares many similarities with other neurodegenerative and neuroinflammatory conditions, such as Alzheimer disease. As with Alzheimer disease, advancements in fluid biomarkers represent one of the most promising paths for unravelling the chain of pathophysiological events to enable discrimination between these conditions and, with time, provide prediction modelling and therapeutic end points. This Review summarizes fluid biomarker findings in the chronic phase of TBI (≥6 months after injury) that demonstrate the involvement of inflammation, glial biology and neurodegeneration in the long-term complications of TBI. We explore how the biomarkers associate with outcome and imaging findings and aim to establish mechanistic differences in biomarker patterns between types of chronic TBI and other neurodegenerative conditions. Finally, current limitations and areas of priority for future fluid biomarker research are highlighted.

Complex Regional Pain Syndrome: a cross-sectional study of physical symptoms, disability, and psychological health in long term.

Knowledge about long-time residual symptoms, disabilities, and psychological health in complex regional pain syndrome (CRPS) is limited. The aim was to evaluate outcome, focusing on physical symptoms, disability, and psychological health, in individuals with CRPS through a cross-sectional survey study. Individuals with a confirmed diagnosis of CRPS were identified through medical charts and sent validated survey forms (Disabilities of the Arm, Shoulder and Hand-Quick version, Specific Hand Surgery Questionnaire-8 questions, EuroQol 5 Dimensions 3 levels, Life Satisfaction Questionnaire-11, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and Sense of Coherence-29) and complementary questions. Responders (response rate: 99/238, 42%; CRPS type 1: 72%; CRPS type 2: 28%; time since diagnosis median: 59 [34-94] months) reported remaining symptoms and disability (Disabilities of the Arm, Shoulder and Hand-Quick version score: 45 [20-70]) and more improvement in type 1 than in type 2. Only 9% of individuals with CRPS reported no residual pain or discomfort. Approximately 60% had problems in daily activities, 49% had sleeping problems, and 90% experienced moderate-extreme pain with 23% still on sick leave. The Hospital Anxiety and Depression Scale survey revealed significantly higher scores than a Swedish reference population. Individuals with a low Sense of Coherence and high pain catastrophizing had worse disability and were less satisfied with their lives and physical and psychological health. A lower level of education and more anxiety were associated with worsened disability over time. Individuals with CRPS suffer in the long term from pain, sleeping problems, and limitations in daily activities with occurrence of anxiety and depression, resulting in dissatisfaction with many aspects of their lives. A low Sense of Coherence and high pain catastrophizing are associated with a worse outcome. Biopsychosocial aspects should be addressed in clinical practice.

Minor strokes: Addressing the challenges of recanalization therapies and secondary prevention

Minor strokes, which account for about 50 % of all ischemic strokes are not necessarily benign and carry a substantial risk of long-term disability. Due to persisting uncertainties regarding optimal recanalization strategies mild strokes may represent a therapeutical challenge for clinicians. The aim of this review is to provide an overview of the current state of knowledge and questions remaining to be answered.

Removing environmental barriers to independent living: A feasibility randomised controlled trial targeting people ageing with long-term physical disabilities

Introduction: People ageing with long-term physical disabilities face unique challenges to maintaining independence. We developed a novel, evidence-based intervention – Removing Environmental Barriers to Independent Living – to support participation and reduce falls. Methods: To examine Removing environmental barriers to independent living’s feasibility and estimate its magnitude of efficacy, we conducted a single-blinded randomised controlled trial. Fifty participants who were aged 45–65 years with a physical disability for at least 5 years were randomised to intervention ( n = 24) or control ( n = 26). Activity performance, environmental barriers to performance, community participation, environmental fall hazards and fall prevention behaviours were assessed at baseline and at 6-month follow-up. Dose, adherence, fidelity and cost were examined. Linear mixed-effects models for repeated measures were used to assess the effects of time, group and group by time interaction on the continuous outcomes. Results: Removing environmental barriers to independent living had high fidelity and adherence and a low implementation cost. There were trends for greater improvements in activity limitations and activity performance among intervention versus control participants. Conclusion: Removing environmental barriers to independent living is a feasible intervention with high fidelity and adherence. Findings trended towards greater improvements in activity performance for intervention participants. Results could inform future planning for a larger pragmatic trial.

Salvage of a comminuted proximal tibial polymicrobial infected non-union with antibiotic loaded bio-composite and intramedullary nailing: a case report

Background. Management of open proximal metaphyseal fractures poses a significant challenge and is fraught with complications. These injuries are severe, often accompanied by extensive soft tissue and vascular damage, leading to high risks of infection and long-term disability. Case presentation. A 72-year-old male was severely injured in a road traffic accident. Plain X-rays and CT angiogram identified a comminuted proximal tibial fracture with transection of the popliteal artery and vein. Initial emergency treatment included fasciotomies, external fixation, and vascular primary repair. On the 12th day of admission, the patient underwent open reduction and internal fixation (ORIF) with dual plate fixation using a two incision technique. A plastic surgeon performed skin grafting, harvested from the patient’s thigh, to allow closure of his fasciotomy wounds immediately following ORIF. Four weeks post-operatively, the patient developed a wound breakdown over the lateral fasciotomy site, exposing the metal plates with a small defect developing on the medial fasciotomy wound in tandem. The patient’s course was further complicated by persistent polymicrobial infections. Over 6 months of antibiotic regimes, operative intervention was ultimately required. All of the infected metal implants were removed, the non-union sites were aggressively debrided. The tibial canal was reamed to prepare for a tibial nailing. An antibiotic loaded bio-composite was then inserted through the non-union sites into the canal followed by an intramedullary nail. A blocking screw was used to address the procurvatum deformity in the sagittal plane. The patient currently shows signs of recovery, mobilizing over short distances, weight-bearing with assistive aids and with healing wounds and early signs of callus formation on recent CT scans and plain X-rays. Conclusions. The management of complex tibial fractures with vascular involvement demands an aggressive multidisciplinary approach and continuous adaptability in treatment plans to address the evolving challenges of such severe injuries. This case exemplifies the utility of injectable antibiotic-loaded bio-composites in a limb-salvage setting and their ability to provide high doses of local antibiotics to an infection site which, in conjunction with appropriate stable fixation and systemic antibiotics, can aid in eradicating and treating fracture-related infections.

Knockout of neutrophil cytosolic factor 1 ameliorates neuroinflammation and motor deficit after traumatic brain injury

Traumatic brain injury (TBI) is a predominant cause of long-term disability in adults, yet the molecular mechanisms underpinning the neuropathological processes associated with it remain inadequately understood. Neutrophil cytosolic factor 1 (NCF1, also known as p47phox) is one of the cytosolic components of NADPH oxidase NOX2. In this study, we observed a reduction in the volume of TBI-induced brain lesions in NCF1-knockout mice compared to controls. Correspondingly, the neuronal loss induced by TBI was mitigated in the NCF1-knockout mice. Behavioral analysis also demonstrated that the motor coordination deficit following TBI was mitigated by the depletion of NCF1. Mechanistically, our findings revealed that NCF1 deficiency attenuated TBI-induced inflammatory responses by inhibiting the release of proinflammatory factors and reducing neutrophil infiltration into the brain parenchyma. Additionally, our results indicated that NCF1 deficiency significantly decreased the levels of reactive oxygen species in neutrophils. Taken together, our findings indicate that NCF1 plays a crucial role in the regulation of brain injury and secondary inflammation post-TBI.

A rare case of peripheral facial paralysis associated with meningococcal meningitis - case report

Introduction. Meningococcal meningitis is a severe form of bacterial meningitis caused by the bacterium Neisseria meningitidis (N. meningitidis). It is a medical emergency and requires prompt treatment to prevent severe complications or death. Peripheral facial paralysis is one of the rare complications that can occur in this condition. Aim. This paper aimed to draw attention to the possibility of an unexpected complication in a child with meningococcal meningitis, which requires prompt clinical and paraclinical management. Materials and methods. We present the case of a 2-year and 8-month-old female patient who, in the context of meningococcal meningitis, develops peripheral facial paralysis, a very rare complication, especially in the pediatric population. Results. The patient initially presented with clinical and paraclinical signs of a respiratory viral infection. However, in a febrile context, she has two generalized tonic-clonic paroxysmal episodes, characterized by gaze fixation, each lasting 2-3 minutes, followed by spontaneous recovery. Laboratory tests revealed neutrophilia, anemia, and elevated inflammatory markers, while the cranio-cerebral CT scan showed no structural changes. Blood cultures were also collected, and treatment was initiated with third-generation cephalosporin antibiotics, along with supportive and symptomatic therapy. The following day, the patient exhibited signs of right-sided peripheral facial paralysis, and intravenous corticosteroid therapy was added to the treatment. Approximately 24 hours after admission, the blood culture tested positive for gram-negative cocci, suggesting meningococcal meningitis. A cerebral MRI was performed, revealing changes indicative of acute meningoencephalitis. The clinical and paraclinical course was slowly favorable, with a slight persistence of facial asymmetry and intermittent ataxic syndrome. Conclusions. Meningococcal meningitis remains a relevant pathology in the pediatric population, able of causing severe complications that can result in long-term disability for the patient. Prompt treatment is crucial when this condition is suspected.