Neurological Patients Research Articles

Evaluation of Musculoskeletal System in Caregivers of Rehabilitation Patients: A cross-sectional study

Musculoskeletal health is an important component of physical health. It was aimed to assess the musculoskeletal system involvement, fatigue, and quality of life among caregivers of various patient groups in this study. The study comprised 55 caregivers, consisting of 37 female and 18 male, with an average age of 41.24±12.25 years. The individuals’ musculoskeletal, neck, and low back pains, musculoskeletal discomfort, posture, spinal functionality, low back disability, neck disability, fatigue, and quality of life were assessed using the Numeric Rating Scale, Cornell Musculoskeletal Discomfort Questionnaire, New York Posture Rating Scale, Spine Functional Index, Oswestry Disability Index, Bournemouth Questionnaire, Fatigue Severity Scale, and Short Form-36 questionnaires, respectively. All parameters evaluated were similar among caregivers of orthopedic, pediatric, and neurological patients (p>0.05). Significant correlations were observed among the parameters of musculoskeletal pain, neck pain, low back pain, musculoskeletal discomfort, posture, spinal functionality, neck and low back disability and fatigue severity in individuals (from -0.267 to 0.754). Additionally, significant correlations were found between the subscales of SF-36 and these parameters, ranging from -0.273 to 0.754. The musculoskeletal system is affected in all caregivers, and caregivers across different patient groups exhibit similar effects.

Trends of Mortality among Neuro-Medicine Inpatient admitted at a Tertiary Care Neuro Specialized Referral Hospital in Bangladesh

Background: Understanding the patterns and determinants of inpatient mortality among neurological patients presenting with medical problem at a tertiary care Neuro-Specialized Hospital is crucial for optimizing care delivery and improving patient outcomes. Objective: This study was aimed to investigate the factors contributing to inpatient mortality in this population. Methodology: This was a retrospective study of all patients who died during and after admission into Neuro Critical Care department of National Institute of Neurosciences and Hospital, Dhaka, Bangladesh. This is the largest tertiary care center and the only national referral center hospital in Bangladesh. Data on demography and events from 2017 to 2022 leading to death were collected and were analyzed from emergency unit, HDU and ward. The records were evaluated with the trends of mortality. The aged up to 92years with different treatment purpose was considered as study population. Data including patient demographics, primary neurological diagnoses were collected and analyzed. The subjects were collected from neuro-medicine inpatient departments. Results: A total of 244 deaths were recorded among the 1312 patients admitted during the 6-years period giving a mortality rate of 18.59% cases. Among them 59.1% cases were male and 40.9% cases were female. The highest number of the patients belongs to the age group 18-65 years 80.9%. According to length of stay in hospital more than 30 days was 48.51%. Most of the patient got admitted to the hospital in emergency ward 22.6%. Yearly mortality trends were lowest in the year 2019(10.3%) and gradually increased in the year 2022 (32.7%). Conclusion: In conclusion the death rate of patients is significant among the admitted neurological diseases conditions. Journal of National Institute of Neurosciences Bangladesh, January 2024;10(1):3-7

Should antinuclear antibodies (ANA) be used to screen for connective tissue disease in neurological patients?

Patients with connective tissue diseases (CTD) can have a wide range of neurological manifestations. Neurological complaints may be the presenting symptom of CTD. Therefore, screening for CTD using anti-nuclear antibodies (ANA) is a common practice. However, due to the abundance of positive ANA in a healthy population, interpretation of the results may be complex. we retrospectively evaluated files of patients hospitalized for evaluation of neurological symptoms in Sheba Medical Center during the years 2007-2022. Data was collected regarding epidemiology, ANA status, and rheumatological diagnosis. 4723 patients' files were reviewed. Of them, 46.6% were positive for ANA. 6.9% of them were diagnosed with CTD. This population had significantly higher rates of positive ANA status (71.2% vs 28.8%, p<0.001), was significantly older (59.4 vs 53.4years, p<0.001) and had a significantly higher ANA titer (1:484.8, 1:268 p<0.001) compared to patients without CTD. Factors which were found predictive for CTD diagnosis included female gender, older age, ANA titer above 1:160, and the diagnosis of a non-vascular etiology for the neurological disease. Females, older patients, patients with high ANA titer and with diagnosis of a non-vascular cause to their neurological complains may be more likely to harbor a CTD and should probably be further evaluated.

Abstract TP102: Exploring the Role of Podcasts in Stroke Recovery and Prevention

The recovery process for stroke patients requires ongoing reinforcement of critical health information. Traditional education methods of written handouts often fail to adequately meet patient needs, particularly for those with limited literacy, or busy lifestyles. Podcasts are emerging as a powerful tool in patient education, offering a flexible, accessible, and engaging format that can be accessed anytime, anywhere. The hypothesis was that by prescribing podcasts, we could ensure patients have continuous access to vital information, allowing for repeated exposure and improved retention of key concepts. Studies have shown that podcasts can significantly enhance knowledge retention and listener engagement, even when listeners are engaged in other activities, as verified by EEG. This makes podcasts a practical solution for reinforcing key health messages and catering to diverse learning preferences, offering an alternative for patients who may struggle with written materials. Since neurological patients struggle to retain complex medical information provided during brief consultations, this can lead to gaps in understanding, and consequently suboptimal outcomes. Putting this hypothesis to the test, our method was to create a podcast with episode topics selected by a multidisciplinary stroke team, focusing on the frequently asked questions posed by stroke survivors and caregivers. Each podcast episode features interviews with expert guests or stroke survivors who discuss strategies and resources relevant to the topic. To enhance accessibility, links to printable information and specialist directories are provided in the show notes of each episode. The results demonstrate global demand for access to such specialized information, with regular listeners in 56 countries, all 50 of the United States and over 1600 downloads in outlying US territories. Each new episode consistently averages 300 audio downloads or video views in the first week they are released. In conclusion, neurology providers are encouraged to incorporate podcasts as a standard component of their stroke patient education strategy. Also, future research should focus on developing specialized neurological podcasts tailored to community needs, providing insight into how to aid them to better understand and manage their conditions, ultimately contributing to improved adherence to treatment plans and better quality of life.

Surgical versus non-surgical treatment of thoracolumbar burst fractures in neurologically intact patients: A Cost-utility analysis.

Many efforts have been made to determine what is the best treatment strategy for neurologically intact patients with TL burst fractures: surgery or nonoperative management. Studies comparing clinical outcomes have produced mixed and inconclusive results creating lack of consensus in the expert community. Therefore, it is necessary to explore other important components of healthcare such as economics to settle this controversial debate. The goal of the current study was to perform a cost-utility analysis comparing surgical treatment to nonoperative treatment for neurologically intact TL burst fractures (AOSpine classification types A3 and A4) from a societal perspective in a multicenter and international setting. We performed a cost-utility analysis from a societal perspective comparing the cost-utility of surgical treatment versus non-surgical treatment of thoracolumbar (TL) burst fractures in neurologically intact patients. Patient demographics and all clinical and outcome data were taken from an observational, prospective multicenter cohort study comparing surgical versus non-surgical treatment of TL burst fractures in neurological intact patients. The ICER was calculated comparing surgical versus non-surgical treatment for the full analysis population with a one-year time horizon, two-year time horizon as well as the working-life time horizon. Costs were taken from the clinical study, patient diaries with productivity loss documented, current scientific literature in addition to national and international healthcare costing guidelines and databases. The mean difference in cost between the two treatment groups were calculated, firstly by applying the central limit theorem, and secondly by using bootstrapping. To calculate the average cost per patient in each treatment group, the Kaplan-Meier Sample Average (KMSA) estimator was used in order to take account of the censored patients. To evaluate the derived models and to explore uncertainty, sensitivity analysis was used. Eleven sites from different regions (North America, Europe, Middle east, and Asia) completed the recruitment and follow-up for 213 patients. One hundred and thirty patients were treated surgically (61.0 %) and eighty-three patients (39.0 %) were treated non-surgically. At one-year, the ICER for surgical treatment was $191,648.00 USD per QALY. Compared to a willingness to pay threshold of $100,000, surgical treatment was not cost-effective within the one-year timeframe. At two-years, the non-surgical group had visited the surgeon or general practitioner more often (0.31 vs 0.25). The non-surgical group had visited physiotherapist and other allied health more often (3.68 vs 1.68). The utilization of NSAIDs and opioids remained higher in the non-surgical group (2.66 vs 2.39) (1.52 vs 0.75). The average workdays lost remained higher in the non-surgical group (143.12 vs 114.78). The caregiver days taken off work remained higher in the non-surgical group (29.86 vs 2.39). At 2 years, surgical treatment showed to be a dominant strategy with a $28,978.50 savings per QALY. At lifetime horizon, surgical treatment remained the cost-effective strategy at $25,530.18 savings per QALY. Our cost-utility analysis showed surgical management to be cost-effective at two years compared to non-operative management in neurologically intact TL burst fractures from a societal perspective. This finding was maintained through the working-lifetime horizon. Surgical treatment became cost-effective largely due to the greater productivity loss of patients and caregivers within the non-surgical group. This investigation highlights the viability for surgical management of TL burst fractures to provide societal benefit especially when productivity is valued.

Inpatient Implementation of Portable Ocular Fundus Photography Among Neurology Residents.

Background: Nonmydriatic ocular fundus photography has been studied with demonstrated benefit in the evaluation of emergency department neurological complaints, particularly in triaging headache and focal neurological deficits. Likewise, portable fundus camera usage may be practical for inpatients with neurological complaints, although feasibility has not been studied in a neurology teaching service. Purpose: The objective of this study is to determine if a portable, nonmydriatic fundus camera could be integrated into routine clinical care by neurology inpatient housestaff at a tertiary medical center. Research Design: Housestaff were asked to obtain fundus photographs for patients with specific indications for fundoscopy. Study Sample: During a 1-month pilot period, housestaff were successfully able to upload images from 21 patients, which were reviewed by a neuro-ophthalmology attending, with input from on-call ophthalmology if desired. Results: Surveys of housestaff before (n = 13) and after (n = 12) implementation demonstrated increased confidence in camera operation and in ocular structure identification, description, and interpretation. Thematic analysis on qualitative feedback suggested benefits in clinical (improving fundus visualization, aiding in triage, sharing images with offsite staff), health systems (reducing length of stay, reducing ophthalmology consultations, reduced unnecessary testing), and educational domains (facilitating group discussions of images, sharing photographs with patients). Conclusions: Overall, inpatient portable fundus photography was shown to be feasible and effective for rapid fundus visualization for neurological inpatients, enhancing the ability to share, document, and compare examinations among neurology housestaff. Further work is needed to confirm clinical and educational benefits of portable fundus photography usage by neurology residents, as suggested by this healthcare quality improvement pilot study.

Left neck and right biceps muscle vibrations have similar effects on perceived body orientation

Vibrating muscles to manipulate proprioceptive input creates the sensation of an apparent change in body position. This study investigates whether vibrating the right biceps muscle has similar effects as vibrating the left posterior neck muscles. Based on previous observations, we hypothesized that both types of muscle vibration would shift the perception of healthy subjects’ subjective straight-ahead (SSA) orientation in the horizontal plane to the left. Such a finding would be extremely interesting for future treatment of spatial neglect, a disorder following right-sided stroke brain lesions. Twenty healthy participants (11 females, 9 males, aged 20–52) were tested under five conditions: baseline (no vibration), vibration of left neck muscles, vibration of right biceps with the arm fixed to the wall, vibration of right biceps with the arm lying on a table, and vibration of right triceps with the arm fixed to the wall. Participants had to align a laser pointer (by verbal instructions) with their perceived SSA position in complete darkness. ANOVA revealed significant SSA shifts with neck and biceps vibrations but not with triceps vibration. The largest leftward SSA shift occurred with right biceps vibration while the arm was lying on the table (-6.1°), followed by left neck muscle vibration (-6.0°), and right biceps vibration with the arm fixed to the wall (-5.4°). Post-hoc power analyses showed high power (> 0.98) for the significant differences compared to the baseline condition. The finding that right biceps vibration affects SSA perception similarly to left neck muscle vibration offers potential for clinical applications in treating spatial neglect. Future research should explore the therapeutic efficacy of vibrating the right biceps in neurological patients with spatial neglect.

Group rehabilitation in Parkinson’s disease: A case study combining music and physiotherapy

ABSTRACT Introduction Neurological patients, such as those with Parkinson’s disease (PD) often have multiple treatment needs beyond motor rehabilitation. The integration of multiple therapy modalities allows a single therapist to address physical, social and emotional needs. Method This study presents a case example of an integrated approach in the form of a small group therapy intervention integrating music and physiotherapy methods. Five men (60–70 years) with PD participated in 20 sessions over five months, which included group discussion, listening to and making music, and music-supported physiotherapy interventions addressing flexibility, respiration, relaxation, rhythmic movements, and speech. Data were collected from pre- and post-therapy tests as well as a thematic analysis of the therapist’s clinical notes. Results The quantitative analysis found that each participant showed a pattern of improvement in physical and psychosocial measures, with the most notable group-level improvement being an increase of 44% in participants’ self-reported relaxation ability. Participants also improved their balance and coordination when walking. The qualitative analysis indicated that music plays an important role in developing social bonds within the group. Discussion This study provides an example of how a multi-professional approach to rehabilitation can efficiently address the complex needs of patients with PD and provides insights relevant to further rehabilitation research.

End-tidal carbon dioxide-guided extracorporeal cardiopulmonary resuscitation improves neurological prognosis in patients: a single-center retrospective cohort study.

Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an effective intervention for restoring adequate circulatory perfusion after cardiac arrest. Ensuring high-quality Cardiopulmonary Resuscitation (CPR) before initiating Extracorporeal Membrane Oxygenation (ECMO) is critical to mitigate tissue hypoxia and ischemia. This study aimed to evaluate the effect of End-Tidal Carbon Dioxide (ETCO2) Goal-Directed CPR (GDCPR) on neurological function before ECMO using a retrospective case-control analysis. The medical records of all patients who received ECPR treated at Zhongshan City People's Hospital were collected between January 2020 and March 2023. In this retrospective cohort study, the patients were divided into Conventional CPR (CCPR) and ETCO2-GDCPR groups based on whether ETCO2 was used as a guide for CPR. A total of 71 patients were included, of whom 46 comprised the CCPR group and 25 comprised the GDCPR group. Approximately 37% of patients who received ECPR had good cerebral function at discharge, with a higher rate in the GDCPR group (52%) compared with the CCPR group (28%) (p = 0.047). Multivariate analysis showed that the Highest Interleukin-6 (H-IL6) levels after ECMO (Odds Ratio [OR = 1.001], 95% Confidence Interval [95% CI 1.000-1.003], p = 0.005) was a risk factor for neurological function at discharge. The other risk factors for poor prognosis in patients who received ECPR included pre-ECMO CPR protocols (OR=10.74, 95% CI 1.90-60.48, p = 0.007) and IL6 levels after ECMO (OR = 1.002, 95% CI 1.001-1.003, p = 0.005). ECMO duration (OR = 0.83, 95% CI 0.74-0.94, p = 0.002) was identified as a protective factor. Patients with short ECMO duration have a poor prognosis. The area under the curve for ECMO duration was 0.86 (0.77-0.94, p < 0.01), while that for H-IL6 was 0.19 (0.09-0.29, p < 0.01). ETCO2-guided ECPR is associated with improved neurological prognosis and patient outcomes. Therefore, monitoring ETCO2 levels should be considered a crucial component of evaluating resuscitation efficacy during CPR.

Age- and sex-adjusted CT-based reference values for temporal muscle thickness, cross-sectional area and radiodensity

Muscle mass has been traditionally assessed by measuring paraspinal muscle areas at the level of the third lumbar vertebra on computed tomography (CT). Neurological or neurosurgical patients seldom undergo CT scans of the lumbar region. Instead, temporal muscle thickness (TMT), cross-sectional area (TMA) and radiodensity measured from head CT scans are readily available measures of muscle mass and quality in these patient cohorts. The purpose of this retrospective study was to establish CT-based reference values for TMT, TMA and radiodensity for each decade of age from 0 to 100 years normalized by age and sex, and to define cut-off values for subjects at risk for sarcopenia as defined by the European Working Group on Sarcopenia in Older People (EWGSOP). Subjects diagnosed with a concussion at the Oulu University Hospital between January 2014 and December 2022 (n = 9254) were identified to obtain a reference population. Subjects with significant pre-existing co-morbidities were excluded. TMT, TMA and radiodensity were measured, measurement reliability was quantified, and sex-adjusted reference values were calculated for each age decade. Quantile regression was used to model age-related changes in muscle morphomics. A total of 500 subjects [250 (50.0%) males] with a mean age of 49.2 ± 27.9 years were evaluated. Inter- and intra-observer reliability was almost perfect for TMT and TMA, and substantial-to-almost perfect for radiodensity. The mean TMT, TMA and radiodensity were 5.2 ± 1.9 mm, 284 ± 159 mm2 and 44.6 ± 17.7HU, respectively. The cut-off values for reduced TMT, TMA and radiodensity for males/females using the European Working Group on Sarcopenia in Older People compliant criteria were ≤ 4.09 mm/≤3.44 mm, ≤ 166 mm2/≤156 mm2, and ≤ 35.5HU/≤35.2HU, respectively. We described a standardized CT-based TMT and TMA measurement protocol practical for clinical use with almost perfect reliability. Using the protocol, we produced quantile regression models for the detection of reduced TMT, TMA and radiodensity at the lowest 5th, 10th, 20th, 30th, 40th and 50th percentiles as well as the EWGSOP compliant criteria cut-off values for reduced muscle mass to facilitate generalizable radiological sarcopenia research.

BDNF levels in serum and CSF are associated with clinicoradiological characteristics of aggressive disease in MS patients

BackgroundBDNF has increasingly gained attention as a key molecule controlling remyelination with a prominent role in neuroplasticity and neuroprotection. Still, it remains unclear how BDNF relates to clinicoradiological characteristics particularly at the early stage of the disease where precise prognosis for the further MS course is crucial.MethodsBDNF, NfL and GFAP concentrations in serum and CSF were assessed in 106 treatment naïve patients with MS (pwMS) as well as 73 patients with other inflammatory/non-inflammatory neurological or somatoform disorders using a single molecule array HD-1 analyser. PwMS were evaluated for highly active profiles by applying the aggressive disease course criteria proposed by ECTRIMS. Serum/CSF values were logarithmically transformed and compared across groups using one-way ANOVA, while correlations were calculated using Pearson’s correlations. ROC analysis and AUC comparisons for diagnostic performance of the three biomarkers were computed in an explorative analysis.ResultsSerum BDNF (sBDNF) concentrations were higher in treatment naïve pwMS with disease onset after the age of 40 years (p = 0.029), in pwMS with ≥2 gadolinium-enhancing lesions (p = 0.009) and with motor, cerebellar, cognitive or sphincter symptoms at onset (p = 0.036). BDNF correlated positively with NfL (r = 0.198, p = 0.014) and GFAP (r = 0.253, p = 0.002) in serum, but not in CSF. Neurological patients with an acute inflammatory relapse showed significantly higher sBDNF levels (p = 0.03) compared to somatoform controls, while patients without acute relapse did not differ from somatoform controls (p = 0.4). Better diagnostic performance was found for sBDNF than sNfL and sGFAP in differentiating between patients with vs. without 2 or more gadolinium-enhancing lesions (p < 0.05) and for sBDNF as compared to sNfL for separating patients with disease onset after vs. before age of 40 years.ConclusionIn pwMS, BDNF serum levels differ depending on disease-related characteristics, suggesting that not only inflammatory activity but also remyelination capacities may vary with disease severity. BDNF is increased when other biomarkers of neuroaxonal damage and neurodegeneration, such as NfL and GFAP, are elevated, possibly as a compensatory mechanism, and reflect possibly further pathophysiological aspects in MS beyond NfL and GFAP, probably including an apoptotic role for BDNF in neuroinflammation.

Early Neuro-Deterioration and Mortality Among Neurology Inpatients in a Zambian Referral Hospital: A Prospective Cohort Study.

Neurocritical illnesses occur disproportionately in countries with limited health care capacity. Identifying risk factors of reversible neurodeterioration may improve care in resource-limited settings. We investigated whether early neurodeterioration (END) predicted inpatient mortality at a resource-limited Zambian hospital. We conducted a prospective observational cohort study from January to August 2023 of neurology inpatients at Zambia's national referral hospital. All inpatients older than 18 years were eligible for inclusion and monitored from admission to discharge in a clinical registry. END was defined as a drop in the Glasgow Coma Scale (GCS) within 3 days of admission. We used linear regression to compare mortality between participants with and without END. We enrolled 500 participants. Two hundred ninety-five participants had GCS recorded more than once within 3 days of admission. END occurred in 53 participants (18%) and predicted increased mortality (72% vs 11%, odds ratio [OR] 18.98, 95% CI 7.74-46.51, p < 0.001), even after a single-point GCS drop (70%, OR 13.08, 95% CI 3.2-53.47, p < 0.001). Seizures were more frequent in participants with END (27% vs 12.5%, χ2 = 9.9, p = 0.002). The leading mortality drivers were aspiration pneumonia (34%) and sepsis (31%). END was common, associated with unfavorable outcomes, and frequently driven by preventable and/or treatable factors. Protocolized interventions for reversible complications may improve neurologic outcomes in resource-limited settings.

Neurological post-COVID syndrome is associated with substantial impairment of verbal short-term and working memory

A substantial proportion of patients suffer from Post-COVID Syndrome (PCS) with fatigue and impairment of memory and concentration being the most important symptoms. We here set out to perform in-depth neuropsychological assessment of PCS patients referred to the Neurologic PCS clinic compared to patients without sequelae after COVID-19 (non-PCS) and healthy controls (HC) to decipher the most prevalent cognitive deficits. We included n = 60 PCS patients with neurologic symptoms, n = 15 non-PCS patients and n = 15 healthy controls. Basic socioeconomic data and subjective complaints were recorded. This was followed by a detailed neuropsychological test battery, including assessments of general orientation, motor and cognitive fatigue, screening of depressive and anxiety symptoms, information processing speed, concentration, visuomotor processing speed, attention, verbal short-term and working memory, cognitive flexibility, semantic and phonematic word fluency, as well as verbal and visual memory functions. Neurologic PCS patients had more complaints with significantly higher fatigue scores as well as higher levels of depressive and anxiety symptoms compared to Non-PCS and HC. Deep neuropsychological assessment showed that neurologic PCS patients performed worse in a general screening of cognitive deficits compared to HC. Neurologic PCS patients showed impaired mental flexibility as an executive subfunction, verbal short-term memory, working memory and general reactivity (prolonged reaction time). Multiple regression showed fatigue affected processing speed; depression did not. Self-reported cognitive deficits of patients with neurologic PCS including fatigue, concentration, and memory deficits, are well mirrored in impaired performance of cognitive domains of concentration and working memory. The present results should be considered to optimize treatment algorithms for therapy and rehabilitation programs of PCS patients with neurologic symptoms.

The Potential Role of Speech Rate as an Etiologic Factor in Dysphonia.

Speech rate is deemed as one of the contributing factors in dysphonia. This study sought out if dysphonic patients speak faster than their normal counterparts. Also, the effects of dysphonia subtype (organic, functional, and neurologic), sex, and age on speech rate were investigated. An analytical cross-sectional study. Reading and connected speech samples of 188 participants (128 dysphonic patients and 60 normal controls) were transcribed and their speech rates while eliminating the voiceless parts and pauses by freeware Praat were calculated in syllable/word per minute. The results indicated that dysphonic patients significantly speak faster than normal controls in connected speech with moderate to large strength of effect size (P < 0.05) and this pattern was mostly not affected by sex. The speech rate did not differ significantly between subgroups of dysphonic patients (P > 0.05), except for speech rate in connected speech and average speech rate of reading and connected speech tasks between organic, functional, and neurological dysphonic patients with normal controls (P < 0.05). Also, there was no correlation between speech rate and age (P > 0.05). According to the preliminary outcomes, the increased rate of speech may be a contributing factor to dysphonia. Additional research is required to clarify the role of speech rate in clinical settings.

Impact of chin tuck exercise on neurological dysphagia patients

Impact of chin tuck exercise on neurological dysphagia patients

Key considerations in setting up a therapeutic plasma exchange service for neurology patients

Key considerations in setting up a therapeutic plasma exchange service for neurology patients

Neurocritical Care in 2024: Where are We Headed?

Providing specialized care to critically ill neurology patients has improved outcomes for patients with neurological emergencies; however, there are still some gaps in neurocritical care (NCC) that offer opportunities for improvement. Among these gaps, improving education of the multidisciplinary NCC team, targeting individualized treatments for neurologically critically ill patients, and reducing disparities for undeserved patients as well as disadvantaged areas are priorities to advance the field. This review focuses on the current challenges neurointensivists face, including difficulties in neuroprognostication, ethical challenges in end-of-life care, and neuropalliative care. Challenges also involve providing specific NCC education for the multidisciplinary NCC team, as well as advancing research to provide treatments for critically ill neurological patients. Finally, the authors describe future directions that can take NCC to the next level.

Stimulating neuroplasticity: Therapeutic applications of an extended digital musical instrument

ABSTRACT Introduction Music therapy has been widely applied to aid individuals both psychologically and physically, including as rehabilitation training for stroke patients. Recently, the use of novel technologies such as Digital Musical Instruments (DMIs) and Virtual Reality (VR) has become more common in this field. To broaden the application of music therapy with these technologies to neurological patients, it is important to understand their effects on the brain. Method The aim of this propositional study is to present a quantitative evaluation of brain network changes, using functional Magnetic Resonance Imaging (fMRI), occurring in individuals who used an XR-based Extended DMI (EDMI), namely, BehCreative. BehCreative is an immersive EDMI that provides sound and visual feedback based on the user’s body movements. Five healthy individuals underwent ten training sessions with BehCreative and resting-state fMRI scans (before the first and after the last session). Results Functional connectivity changes between those scans were examined. A strengthened connection between brain areas associated with movement and audiovisual feedback processing was identified, possibly associated with an increase in motivation and cognitive engagement during audio-visual tasks. In general, connectivity changes pointed to an increase in arousal in the tested subjects, which may have been linked to the activation of the reward system during the use of the EDMI. Discussion These results are in line with our initial hypothesis, which was that training with BehCreative stimulates the neuroplasticity of the reward system. This study builds upon our previous research, on the therapeutic potential of DMIs.

Social Determinants of Genetics Referral and Completion Rates Among Pediatric Neurology Patients

Social Determinants of Genetics Referral and Completion Rates Among Pediatric Neurology Patients

Systematic Localisation Based on History and Clinical Examination.

Localisation in neurology is an important step in determining the location of a neurological lesion based on history taking and clinical examination before confirmation with imaging. Lesions can vary from the cortical to the subcortical, brainstem, and spinal cord levels, in which every presentation and finding from the patient can provide a rough idea of where the pathology is located. A differential diagnosis can later be made according to the duration of the symptoms and the cumulative signs and symptoms presented. This is considered the most important step in managing neurological patients to ensure that no stone is left unturned in making an accurate diagnosis.