Multiple Impairments Research Articles

Successful salvage therapy with cetuximab-based modalities in the non-sensitive EGFR-mutant lung cancer patients with leptomeningeal metastasis who have heavily pretreated histories.

e14011 Background: Leptomeningeal metastasis (LM) is the deadliest complication of lung cancer. No standard therapy for the LM harbor non-sensitive epidermal growth factor receptor (EGFR)-mutant|(neither E19 del, E21 p.L858R nor E18 p. G719X mutation ). Previous studies showed cetuximab held the potential for treating the EGFR mutants who had failed 2 or more lines of standard cytotoxic chemotherapy and reversible EGFR TKIs. Methods: We screen the lung cancer patients with LM treated with Cetuximab-based regimen from July 1st, 2020 to Dec 31th 2020. The medical records were retrospectively reviewed and analyzed. Results: Three lung cancer patients with LM were included. All of them were heavily pretreated with various TKIs, chemotherapy, or/and with antiangiogenesis and PD-1 antibodies. When they were referred to our department, all these patients were in severe medical conditions. Case 1 has severe multiple cranial nerve impairment with cauda equina syndrome and massive malignant pleural effusion. Case 2 has intensively violent headaches with vomit and lumbosacral pain due to more than 500mm H2O of intracranial hypertension. Case 3 has acute pancreatitis due to oppressive obstruction of pancreatic duct by multiple metastatic tumors. The molecule test of tumor tissue or liquid from malignant pleural fluid have revealed E20 p.C797S in cis with p.T790M accompanied E19 del of EGFR gene in case 1, E21 p. R831H with E19 p.L747P of EGFR gene in case 2, and E20 p.S768_D770dup of EGFR gene in case 3, respectively. Their therapies were changed to cetuximab combined with TKI of afatinib or osimertinib, and local treatment including local radiation, intraventricular pemetrexed administration, or with intrathoracic drain. The disease control rate (DCR) was 100% of one partial remission (PR) and two stable disease (SD). The intracranial response was also observed in all the 3 patients showing CSF cytology turning negative or enhanced meningeal disappearance in MRI image with obviously relieved headache or/and improved cranial nerve palsy. The performance status of two patients was largely improved from Karnofsky Performance Status (KPS) scoring 20 to 90 and 50, respectively, and that of the other patient was stable with KPS scoring 50. The side effect is manageable skin rashes (grade II-III). Until this abstract was written, all the 3 patients were still alive. Conclusions: Cetuximab-based systemic therapy combined with local treatment demonstrated preliminary clinical activity in the rare EGFR-mutant lung cancer with LM who have already undergone heavily previous therapy, warranting further investigation.

Return to school after acquired brain injury in the UK – the educators' perspectives

Childhood acquired brain injury (ABI) is associated with poorer life outcomes. Increasing numbers of children and young people are surviving severe brain injury and returning to mainstream schools with multiple impairments. It is widely acknowledged that for these children, their school becomes by default their rehabilitation centre. International studies of this transition and a recent UK government report criticize educators' inconsistent implementation of support strategies, lack of educator training and poor communication between clinicians, educators, child and family. The educators' perspectives of the return‐to‐school are, however, not well represented in the literature. This study therefore explored the experiences of educators in the UK (N = 10) who had recently facilitated a return‐to‐school of a child with ABI aged 8–12 (N = 5) using semi‐structured interviews analysed by data‐driven thematic analysis. The findings highlight common experiences: a continuum of intensive problem‐solving with heavy reliance on the Special Educational Needs Coordinator; educators valuing collaboration with clinical specialists in context over general ‘training’; uncertainty over the validity of implementing support strategies from prior teaching experience; uncertainty about how to support the child's emotional needs; and frustration with UK statutory processes for Special Educational Needs and Disabilities. Recommendations are made for changes to practice and future research.

Effects of prolonged-release fampridine on multiple sclerosis-related gait impairments. A crossover, double-blinded, placebo-controlled study

BackgroundPeople with multiple sclerosis have reduced walking speed and impaired gait pattern. Prolonged release-fampridine is a potassium channel blocker that improves nerve conduction in patients with multiple sclerosis, leading to walking benefits. Whether fampridine alters gait pattern is unknown. MethodsIn this crossover, randomized controlled trial, patients with multiple sclerosis were tested for responder status during a 4-week run-in period. Patients were considered responders if they improved their 25-ft walk test by 10% and improved their perceived walking capacity. Responders were randomized to prolonged release-fampridine (10 mg b.i.d.) or placebo for a 6-week period. After a 2-week wash-out period, they were allocated to the other treatment for 6 weeks. Participants were assessed before and after both conditions. Three-dimensional gait analysis assessed kinematic, kinetic, mechanic and energetic variables while walking on a treadmill at comfortable speed. Six-minute walk test and 25-ft walk test were used to assess walking speed on middle and short-distances, respectively. Patient-reported outcome measures were also used. Repeated measures ANCOVAs were applied to assess the treatment effects. FindingsOut of 39 included patients, 24 responders (12 women; Expanded Disability Status Scale:4.25[4–5]; age:46 ± 10 years; maximal speed:0.93 ± 0.38 m·s−1) were identified. Among them, prolonged release-fampridine reduced the external mechanical work (−0.039 J·kg−1·m−1;p = 0.02), and improved knee flexion during swing phase (+5.3°; p = 0.02). No differences were found in other walking tests and patient-reported outcomes, at group-level. InterpretationProlonged release-fampridine increases knee flexion during swing phase and lowers mechanical external work. Whether these changes are related to clinically meaningful improvements in walking capacity and other functional variables should be further investigated.

Expanded Exploration of the Auditory Naming Test in Patients with Dementia.

Auditory naming tests are superior to visual confrontation naming tests in revealing word-finding difficulties in many neuropathological conditions. To delineate characteristics of auditory naming most likely to reveal anomia in patients with dementia, and possibly improve diagnostic utility, we evaluated a large sample of patients referred with memory impairment complaints. Patients with dementia (N = 733) or other cognitive impairments and normal individuals (N = 69) were evaluated for frequency of impairment on variables of the Auditory Naming Test (ANT) of Hamberger & Seidel versus the Boston Naming Test (BNT). Naming impairment occurred more frequently using the ANT total score (φ= 0.41) or ANT tip-of-the tongue score (TOT; φ= 0.19) but not ANT mean response time compared to the BNT in patients with dementia (p < 0.001). Significantly more patients were impaired on ANT variables than on the BNT in Alzheimer's disease (AD), vascular dementia (VaD), mixed AD/VaD, and multiple domain mild cognitive impairment (mMCI) but not in other dementias or amnestic MCI (aMCI). This differential performance of patients on auditory versus visual naming tasks was most pronounced in older, well-educated, male patients with the least cognitive impairment. Impaired verbal comprehension was not contributory. Inclusion of an ANT index score increased sensitivity in the dementia sample (92%). Poor specificity (41%) may be secondary to the inherent limitation of using the BNT as a control variable. The ANT index score adds diagnostic utility to the assessment of naming difficulties in patients with suspected dementia.

Trekking Poles to Aid Multiple Sclerosis Walking Impairment: An Exploratory Comparison of the Effects of Assistive Devices on Psychosocial Impact and Walking.

Walking dysfunction is reported by two-thirds of persons with multiple sclerosis (MS). Assistive devices are frequently recommended to improve walking; however, it is uncommon to consider their psychosocial impact, although many users abandon their assistive devices. The psychosocial impact, walking, balance, and fatigue associated with three assistive devices were compared to guide clinical decision making. Twenty-five persons with MS (median Expanded Disability Status Scale score, 4.0; range, 2.5-6.0) who reported walking difficulty were trained in the use of three assistive devices-a single-point cane (SPC), a four-point cane (FPC), and a trekking pole (TP)-at 1- to 2-week intervals, then used the assistive device for their usual activities. Outcome measures included the Psychosocial Impact of Assistive Devices Scale (PIADS), the 6-Minute Walk Test (6MWT), walking speed, cadence, stride length, stride time, the 12-item Multiple Sclerosis Walking Scale (MSWS-12), the Activities-specific Balance Confidence (ABC) scale, the 5-item Modified Fatigue Impact Scale (MFIS-5), and a visual analogue scale of fatigue (VAS-F). The SPC and TP were more positive in the PIADS adaptability, competence, and self-esteem subscales. The SPC and TP resulted in higher 6MWT, walking speed, cadence, stride length, stride time, and MSWS-12 scores compared with the FPC. No differences were found in ABC scale, MFIS-5, or VAS-F scores. Participants reported more positive psychosocial impact, and walked faster and with higher quality, with the SPC and TP than with the FPC. Clinicians should consider suggesting an SPC or TP to patients who may benefit from assistive device use and for whom psychosocial impact is an important consideration.

The impact of Parvovirus B19 on hereditary haemolytic anaemias.

The impact of Parvovirus B19 on hereditary haemolytic anaemias.

Managing older patients with heart failure calls for a holistic approach.

AimsThis study aims to assess the presence of geriatric domain impairments in an older heart failure (HF) outpatient population and to relate these domain impairments with 1 year mortality risk in comparison with a geriatric outpatient population without HF.Methods and resultsData were used from two different prospective cohort studies: 241 outpatients with HF (mean age 78 ± 9 years, 48% female) and 686 geriatric outpatients (mean age 80 ± 7 years, 55% female). We similarly assessed the following geriatric domains in both cohorts: physical function, nutritional status, polypharmacy, cognitive function, and activities in daily living. Cox proportional hazards analyses were used to relate individual domains to 1 year mortality risk in both populations and to compare 1 year mortality risk between both populations. Of the patients with HF, 34% had impairments in ≥3 domains, compared with 38% in geriatric patients. One‐year mortality rates were 13% and 8%, respectively, in the HF and geriatric populations; age‐adjusted and sex‐adjusted hazard ratio (95% confidence interval) for patients with HF compared with geriatric patients was 1.7 (1.3–2.6). The individual geriatric domains were similarly associated with 1 year mortality risk in both populations. Compared with zero to two impaired domains, age‐adjusted and sex‐adjusted mortality risk (hazard ratio, 95% confidence interval) for three, four, or five impaired domains ranged from 1.6 (0.6–4.2) to 6.5 (2.1–20.1) in the HF population and from 1.4 (0.7–2.9) to 7.9 (2.9–21.3) in the geriatric population.ConclusionsIn parallel with geriatric patients, patients with HF often have multiple geriatric domain impairments that adversely affect their prognosis. This similarity together with the findings that patients with HF have a higher 1 year mortality risk than a general geriatric population supports the integration of a multi‐domain geriatric assessment in outpatient HF care.

Emotional Behavioural and Autonomic Dysregulation (EBAD) in Rett Syndrome – EDA and HRV monitoring using wearable sensor technology

BackgroundRett syndrome (RTT) is a severe genetic neurodevelopmental disorder. Emotional, Behavioural and Autonomic Dysregulation (EBAD), is frequent in RTT and is associated with multiple impairments. There are major challenges in the clinical assessment of emotions, behaviours, and autonomic function in RTT patients that limit the management of symptoms. MethodsWeb-based technology (HealthTracker™) to measure the phenotype, and non-invasive, wearable sensor technology to evaluate autonomic function through Electrodermal Activity (EDA) and Heart Rate Variability (HRV) in 10 RTT patients was used, and treatment response of EBAD symptoms was monitored after different pharmacological treatments. Resultsand discussion: 4 patients received buspirone, 2 sertraline, 1 gabapentin and 3 were not started on medications. Buspirone normalized the EDA in 3 patients with associated improvement in EBAD, whilst another patient only improved marginally. Both patients treated with sertraline (including one with normal EDA) significantly improved symptomatically. The patients on unchanged regimens showed no change in symptoms and autonomic function. Within 24 h of our assessment, one patient required intensive inpatient care due to septicaemia – this patient had been on gabapentin and showed a sharp and sustained EDA increase without obvious worsening of emotional and behavioural symptoms. Unlike the EDA, the analyses of HRV metrics did not reveal patterns that were associated with clinical outcomes. Our findings suggest a reasonable association of EDA normalization and symptomatic improvement in RTT subjects with EBAD treated with buspirone and point out its potential application as a measure of dysautonomia in RTT. Very high and sustained EDA levels may be a biomarker for concurrent serious physical illness in RTT.

Smith-Magenis syndrome: Report of morphological and new functional cardiac findings with review of the literature.

Smith-Magenis syndrome (SMS) is a genetic disorder characterized by multiple congenital anomalies, sleep disturbance, behavioral impairment, and intellectual disability. Its genetic cause has been defined as an alteration in the Retinoic Acid-Induced 1 gene. Cardiac anomalies have been reported since the first description of this condition in patients with 17p11.2 deletion. Variable cardiac defects, including ventricular septal defects, atrial septal defects, tricuspid stenosis, mitral stenosis, tricuspid and mitral regurgitation, aortic stenosis, pulmonary stenosis, mitral valve prolapse, tetralogy of Fallot, and total anomalous pulmonary venous connection, have been anecdotally reported and systematic case series are still lacking. Herein, we define the spectrum of the cardiac phenotype and describe for the first time the cardiac function in a large cohort of pediatric patients with SMS. Revision of the literature and correlations between genotype and cardiac phenotype was performed.

Chronic Low Dose Neutron Exposure Results in Altered Neurotransmission Properties of the Hippocampus-Prefrontal Cortex Axis in Both Mice and Rats.

The proposed deep space exploration to the moon and later to Mars will result in astronauts receiving significant chronic exposures to space radiation (SR). SR exposure results in multiple neurocognitive impairments. Recently, our cross-species (mouse/rat) studies reported impaired associative memory formation in both species following a chronic 6-month low dose exposure to a mixed field of neutrons (1 mGy/day for a total dose pf 18 cGy). In the present study, we report neutron exposure induced synaptic plasticity in the medial prefrontal cortex, accompanied by microglial activation and significant synaptic loss in the hippocampus. In a parallel study, neutron exposure was also found to alter fluorescence assisted single synaptosome LTP (FASS-LTP) in the hippocampus of rats, that may be related to a reduced ability to insert AMPAR into the post-synaptic membrane, which may arise from increased phosphorylation of the serine 845 residue of the GluA1 subunit. Thus, we demonstrate for the first time, that low dose chronic neutron irradiation impacts homeostatic synaptic plasticity in the hippocampal-cortical circuit in two rodent species, and that the ability to successfully encode associative recognition memory is a dynamic, multicircuit process, possibly involving compensatory changes in AMPAR density on the synaptic surface.

Tract-specific MRI measures explain learning and recall differences in multiple sclerosis.

Cognitive difficulties are common and a key concern for people with multiple sclerosis. Advancing knowledge of the role of white matter pathology in multiple sclerosis-related cognitive impairment is essential as both occur early in the disease with implications for early intervention. Consequently, this cross-sectional study asked whether quantifying the relationships between lesions and specific white matter structures could better explain co-existing cognitive differences than whole brain imaging measures. Forty participants with relapse-onset multiple sclerosis underwent cognitive testing and MRI at 3 Tesla. They were classified as cognitively impaired (n = 24) or unimpaired (n = 16) and differed across verbal fluency, learning and recall tasks corrected for intelligence and education (corrected P-values = 0.007–0.04). The relationships between lesions and white matter were characterized across six measures: conventional voxel-based T2 lesion load, whole brain tractogram load (lesioned volume/whole tractogram volume), whole bundle volume, bundle load (lesioned volume/whole bundle volume), Tractometry (diffusion-tensor and high angular resolution diffusion measures sampled from all bundle streamlines) and lesionometry (diffusion measures sampled from streamlines traversing lesions only). The tract-specific measures were extracted from corpus callosum segments (genu and isthmus), striato-prefrontal and -parietal pathways, and the superior longitudinal fasciculi (sections I, II and III). White matter measure-task associations demonstrating at least moderate evidence against the null hypothesis (Bayes Factor threshold < 0.2) were examined using independent t-tests and covariate analyses (significance level P < 0.05). Tract-specific measures were significant predictors (all P-values < 0.05) of task-specific clinical scores and diminished the significant effect of group as a categorical predictor in Story Recall (isthmus bundle load), Figure Recall (right striato-parietal lesionometry) and Design Learning (left superior longitudinal fasciculus III volume). Lesion load explained the difference in List Learning, whereas Letter Fluency was not associated with any of the imaging measures. Overall, tract-specific measures outperformed the global lesion and tractogram load measures. Variation in regional lesion burden translated to group differences in tract-specific measures, which in turn, attenuated differences in individual cognitive tasks. The structural differences converged in temporo-parietal regions with particular influence on tasks requiring visuospatial-constructional processing. We highlight that measures quantifying the relationships between tract-specific structure and multiple sclerosis lesions uncovered associations with cognition masked by overall tract volumes and global lesion and tractogram loads. These tract-specific white matter quantifications show promise for elucidating the relationships between neuropathology and cognition in multiple sclerosis.

Transmitter and receiver impairment monitoring using adaptive multi-layer linear and widely linear filter coefficients controlled by stochastic gradient descent.

We propose a monitoring method for individual impairments in a transmitter (Tx) and receiver (Rx) by using filter coefficients of multi-layer strictly linear (SL) and widely linear (WL) filters to compensate for relevant impairments where the filter coefficients are adaptively controlled by stochastic gradient descent with back propagation from the last layer outputs. Considering the order of impairments occurring in a Tx or Rx of coherent optical transmission systems and their non-commutativity, we derive a model relating in-phase (I) and quadrature (Q) skew, IQ gain imbalance, and IQ phase deviation in a Tx or Rx to the WL filter responses in our multi-layer filter architecture. We evaluated the proposed method through simulations using polarization-division multiplexed (PDM)-quadrature phase shift keying and a transmission experiment of 32-Gbaud PDM 64-quadrature amplitude modulation over a 100-km single-mode fiber span. The results indicate that both Tx and Rx impairments could be individually monitored by using the filter coefficients of adaptively controlled multi-layer SL and WL filters precisely and simultaneously, decoupled by chromatic dispersion and frequency offset, even when multiple impairments existed.

Prevalence of Concurrent Functional Vision and Hearing Impairment and Association With Dementia in Community-Dwelling Medicare Beneficiaries

Impairments in vision or hearing are common and have been independently linked to higher risk of dementia in older adults. There is a limited understanding of the prevalence of concurrent functional vision and hearing impairment (dual sensory impairment) and its contribution to dementia risk. To examine the age-specific prevalence of functional dual sensory impairment among older adults, and to investigate the cross-sectional and 7-year longitudinal associations between functional dual sensory impairment and dementia. This cohort study of 7562 older adults used data from the US National Health and Aging Trends Study (NHATS), a nationally representative cohort study of community-dwelling, Medicare beneficiaries aged 65 years and older in the US. Participants in the study with complete data on hearing, vision, and dementia were included in analysis. Data were collected between 2011 and 2018, and between March 2018 and May 2020. Self-reported functional sensory impairments (ie, no sensory impairment, functional vision impairment only, functional hearing impairment only, and functional dual sensory impairment). Age-specific prevalence of functional sensory impairments was calculated. Generalized linear regression with a complementary log-log link and a discrete time proportional hazards model with a complementary log-log link were used to assess the cross-sectional and 7-year longitudinal hazard of dementia. Of 7562 participants, 3073 (40.7%) were ages 80 years or older and 4411 (58.3%) were women. Overall, 5.4% (95% CI, 4.7%-6.1%) of participants reported functional vision impairment only, 18.9% (95% CI, 18.9%-17.8%) reported functional hearing impairment only, and 3.1% (95% CI, 2.7%-3.5%) reported functional dual sensory impairment (prevalence estimates are weighted). Participants reporting sensory impairments were older (no impairment: age ≥90 years, 2.12% [95% CI, 1.79%-2.46%] vs functional dual sensory impairment: age ≥90 years, 20.06% [95% CI, 16.02%-24.10%]), had lower education (no impairment: <high school, 19.05% [95% CI, 17.27%-20.83%] vs functional dual sensory impairment: <high school, 46.15% [95% CI, 38.38%-53.92%]), and greater disease burden (eg, heart disease: no impairment, 15.30% [95% CI, 14.04%-16.55%] vs functional dual sensory impairment, 25.49% [95% CI, 19.96%-31.02%]). Compared with no impairment, functional vision impairment (adjusted hazard ratio [aHR], 1.89; 95% CI, 1.57-2.28), functional hearing impairment (aHR, 1.14; 95% CI, 1.00-1.31), and functional dual sensory impairment (aHR, 2.00; 95% CI, 1.57-2.53) were associated with a higher cross-sectional hazard of dementia. Over 7 years, functional vision impairment (aHR, 1.40; 95% CI, 1.12-1.74), functional hearing impairment (aHR, 1.09; 95% CI, 0.95-1.24), and functional dual sensory impairment (aHR, 1.50; 95% CI, 1.12-2.02) were associated with a higher hazard of incident dementia compared with no impairment. In this cohort study of US Medicare beneficiaries, dual sensory impairment was prevalent in older adults and associated with increased risk of dementia. These findings suggest that sensory rehabilitative interventions for multiple impairments may be an additional resource in efforts to reduce dementia risk.

Relation of Atrial Fibrillation to Cognitive Decline (from the REasons for Geographic and Racial Differences in Stroke [REGARDS] Study)

The association of atrial fibrillation (AF) with cognitive function remains unclear, especially among racially/geographically diverse populations. This analysis included 25,980 black and white adults, aged 48+, from the national REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, free from cognitive impairment and stroke at baseline. Baseline AF was identified by self-reported medical history or electrocardiogram (ECG). Cognitive testing was conducted yearly with the Six Item Screener (SIS) to define impairment and at 2-year intervals to assess decline on: animal naming and letter fluency, Montreal Cognitive Assessment (MoCA), Word List Learning (WLL) and Delayed Recall tasks (WLD). Multivariable regression models estimated the relationships between AF and baseline impairment and time to cognitive impairment. Models were adjusted sequentially for age, sex, race, geographic region, and education, then cardiovascular risk factors and finally incident stroke. AF was present in 2,168 (8.3%) participants at baseline. AF was associated with poorer baseline performance on measures of: semantic fluency (p<0.01); global cognitive performance (MoCA, p<0.01); and WLD (p<0.01). During a mean follow-up of 8.06 years, steeper declines in list learning were observed among participants with AF (p<0.03) which remained significant after adjusting for cardiovascular risk factors (p<0.04) and incident stroke (p<0.03). Effect modification by race, sex and incident stroke on AF and cognitive decline were also detected. In conclusion, AF was associated with poorer baseline cognitive performance across multiple domains and incident cognitive impairment in this bi-racial cohort. Additional adjustment for cardiovascular risk factors attenuated these relations with the exception of learning.

Comorbidities and functional impairments in children with attention deficit hyperactivity disorder in China: a hospital-based retrospective cross-sectional study

ObjectivesThe aim of this study was to assess comorbidity patterns and functional impairment in children with and without attention deficit hyperactivity disorder (ADHD).DesignHospital-based retrospective cross-sectional study; data collection occurred between...

Syntactic Gender Agreement Processing on Direct-Object Clitics by Spanish-Speaking Children with Developmental Language Disorder: Evidence from ERP.

Children with developmental language disorder (DLD) have a psycholinguistic profile evincing multiple syntactic processing impairments. Spanish-speaking children with DLD struggle with gender agreement on clitics; however, the existing evidence comes from offline, elicitation tasks. In the current study, we sought to determine whether converging evidence of this deficit can be found. In particular, we use the real-time processing technique of event-related brain potentials (ERP) with direct-object clitic pronouns in Spanish-speaking children with DLD. Our participants include 15 six-year-old Mexican Spanish-speaking children with DLD and 19 typically developing, age-matched (TD) children. Auditory sentences that matched or did not match the gender features of antecedents represented in pictures were employed as stimuli in a visual–auditory gender agreement task. Gender-agreement violations were associated with an enhanced anterior negativity between 250 and 500 ms post-target onset in the TD children group. In contrast, children with DLD showed no such effect. This absence of the left anterior negativity (LAN) effect suggests weaker lexical representation of morphosyntactic gender features and/or non-adult-like morphosyntactic gender feature checking for the DLD children. We discuss the relevance of these findings for theoretical accounts of DLD. Our findings may contribute to a better understanding of syntactic agreement processing and language disorders.

Simple Smartphone-Based Assessment of Gait Characteristics in Parkinson Disease: Validation Study.

BackgroundParkinson disease (PD) is a common movement disorder. Patients with PD have multiple gait impairments that result in an increased risk of falls and diminished quality of life. Therefore, gait measurement is important for the management of PD.ObjectiveWe previously developed a smartphone-based dual-task gait assessment that was validated in healthy adults. The aim of this study was to test the validity of this gait assessment in people with PD, and to examine the association between app-derived gait metrics and the clinical and functional characteristics of PD.MethodsFifty-two participants with clinically diagnosed PD completed assessments of walking, Movement Disorder Society Unified Parkinson Disease Rating Scale III (UPDRS III), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scale tests. Participants followed multimedia instructions provided by the app to complete two 20-meter trials each of walking normally (single task) and walking while performing a serial subtraction dual task (dual task). Gait data were simultaneously collected with the app and gold-standard wearable motion sensors. Stride times and stride time variability were derived from the acceleration and angular velocity signal acquired from the internal motion sensor of the phone and from the wearable sensor system.ResultsHigh correlations were observed between the stride time and stride time variability derived from the app and from the gold-standard system (r=0.98-0.99, P<.001), revealing excellent validity of the app-based gait assessment in PD. Compared with those from the single-task condition, the stride time (F1,103=14.1, P<.001) and stride time variability (F1,103=6.8, P=.008) in the dual-task condition were significantly greater. Participants who walked with greater stride time variability exhibited a greater UPDRS III total score (single task: β=.39, P<.001; dual task: β=.37, P=.01), HAM-A (single-task: β=.49, P=.007; dual-task: β=.48, P=.009), and HAM-D (single task: β=.44, P=.01; dual task: β=.49, P=.009). Moreover, those with greater dual-task stride time variability (β=.48, P=.001) or dual-task cost of stride time variability (β=.44, P=.004) exhibited lower MoCA scores.ConclusionsA smartphone-based gait assessment can be used to provide meaningful metrics of single- and dual-task gait that are associated with disease severity and functional outcomes in individuals with PD.

Algorithm-Driven Substance Use Disorder Treatment for Inner-City Clients With Serious Mental Illness and Multiple Impairments.

Mental health clients with serious mental illness in urban settings experience multiple chronic stresses related to poverty, unemployment, discrimination, homelessness, incarceration, hospitalization, posttraumatic stress disorder, pain syndromes, traumatic brain injury, and other problems. Substance use disorder exacerbates these difficulties. This study examined the efficacy of algorithm-driven substance use disorder treatments for 305 inner-city mental health clients with multiple challenges. Researchers assessed substance use quarterly using a combination of standardized self-reports and case manager ratings. Of the 305 multiply impaired clients who began treatment, 200 (66%) completed 2 years of treatment. One fourth (n = 53) of the completers were responders who developed abstinence and improved community function; one half (n = 97) were partial responders, who reduced substance use but did not become abstinent; and one fourth (n = 50) were nonresponders. Evidence-based interventions for substance use disorder can be effective for multiply impaired, inner-city clients, but numerous complications may hinder recovery.

A STUDY ON THE PREVALENCE OF CARDIAC AUTONOMIC NEUROPATHY IN DIABETIC PATIENTS – A HOSPITAL BASED STUDY.

Background: Diabetic Autonomic Neuropathy (DAN) is a serious and common complication of diabetes. Despite its relationship to an increased risk of cardiovascular mortality and its association with the multiple symptoms and impairments, the signicance of diabetic autonomic neuropathy has not been fully appreciated. DAN can manifests in a spectrum of things, ranging from resting tachycardia and xed heart rate (HR) to development of “silent” myocardial infarction.The prevalence of CAN is variable based on published studies and ranges from 2% to 91% in type I diabetes mellitus (T1DM) and 25% to 75% in type 2 diabetes (T2DM). This signicant variability can likely be attributed to the lack of a uniform 2 diagnostic criteria as well as underdiagnosis in the typical hospital setting. Aim And Objectives :To study the prevalence of cardiac autonomic neuropathy in hospital admitted diabetic patients. Materials And Methods : 60 diabetic patients were taken for the study of which 48 were males and 12 were females.The study was carried out in tertiary care teaching hospital in North east India after clearance from institutional ethics committee. Subjects were divided according to duration of diabetes as Group I : 0 – 5 years(24 patients), Group II : 6 – 9 years(24patients), Group II I: 10 years or more(12 patients). Then special interest was taken to nd out cardiac autonomic neuropathy and all the 5 tests were carried out in each of the patients to detect cardiac autonomic neuropathy and were divided into 3 groups. Group I ( normal autonomic function test), group II ( early DAN), group III ( denitive DAN ). Results : In the present study it has been observed that out of 24 (40%) cases of diabetes mellitus in the 0 – 5 year duration group, 4 cases (16.7%) are having autonomic neuropathy, out of 24 cases in the duration group 6 – 9 years, 10 cases (41.7%) are having autonomic neuropathy and in the duration group ≥ 10 years, 8 cases out of 12 (66.7%) showing neuropathy. In the present study prevalence of diabetic autonomic neuropathy out of 60 number of patients taken it was seen as: 38 cases (63.3%) with normal autonomic function tests placed in group I, 12 cases (20%) with only cardiac parasympathetic damage or early DAN were placed in group II and 10 cases (16.7%) with both cardiac parasympathetic and sympathetic damage or denitive DAN were placed in group III. So out of 60 diabetic patients, 22 patients (36.7%) showed abnormal cardiovascular reex in the present study. Conclusion: It has been observed from the present study that duration of diabetes mellitus is directly proportional to development of cardiac autonomic neuropathy.

Current Concepts in Arm Care Exercise Programs and Injury Risk Reduction in Adolescent Baseball Players: A Clinical Review.

Awareness of important injury risk factors associated with excessive pitching volume has been highlighted in the literature, but injury rates remain high. Shoulder pain in baseball players is associated with various changes in musculoskeletal movements, which presents as measurable impairments throughout the kinetic chain. Baseball coaches and rehabilitation professionals have utilized exercise programs targeting strength and flexibility of the throwing arm to prevent injuries. The purpose of this review is to summarize the current evidence regarding the effectiveness of arm care exercise programs in reducing upper extremity injury rates in adolescent baseball players. A search of electronic databases, including CINAHL with full text, MEDLINE, and SPORTDiscus was conducted to retrieve available articles in English from the years 2010 through 2020. The search terms injury prevention, exercise, and adolescent baseball were used. Clinical review. Level 4. Improving shoulder internal rotation range of motion by stretching the posterior shoulder muscles daily was associated with a 36% risk reduction of shoulder and elbow injuries. Group-based arm care exercise programs that target multiple musculoskeletal impairments demonstrated an approximately 50% reduced risk of elbow injury. For adolescent baseball players, arm care injury prevention programs focusing on important musculoskeletal impairments are effective at reducing injury incidence rates. Multimodal injury prevention programs that improve multiple musculoskeletal impairments are more comprehensive and may result in better injury reduction than programs focusing on a singular impairment.