Peripheral Field Research Articles

Avatar-Based Patient Monitoring With Peripheral Vision: A Multicenter Comparative Eye-Tracking Study.

BackgroundContinuous patient monitoring has been described by the World Health Organization as extremely important and is widely used in anesthesia, intensive care medicine, and emergency medicine. However, current state-of-the-art number- and waveform-based monitoring does not ideally support human users in acquiring quick, confident interpretations with low cognitive effort, and there are additional problematic aspects such as alarm fatigue. We developed a visualization technology (Visual Patient), specifically designed to help caregivers gain situation awareness quickly, which presents vital sign information in the form of an animated avatar of the monitored patient. We suspected that because of the way it displays the information as large, colorful, moving graphic objects, caregivers might be able to perform patient monitoring using their peripheral vision, which may facilitate quicker detection of anomalies, independently of acoustic alarms.ObjectiveIn this study, we tested the hypothesis that avatar-based monitoring, when observed with peripheral vision only, increases the number of perceptible changes in patient status as well as caregivers’ perceived diagnostic confidence compared with a high-fidelity simulation of conventional monitoring, when observed with peripheral vision only.MethodsWe conducted a multicenter comparative study with a within-participant design in which anesthesiologists with their peripheral field of vision looked at 2 patient-monitoring scenarios and tried to identify changes in patient status. To ensure the best possible experimental conditions, we used an eye tracker, which recorded the eye movements of the participants and confirmed that they only looked at the monitoring scenarios with their peripheral vision.ResultsOverall, 30 participants evaluated 18 different patient status changes with each technology (avatar and conventional patient monitoring). With conventional patient monitoring, participants could only detect those 3 changes in patient status that are associated with a change in the auditory pulse tone display, that is, tachycardia (faster beeping), bradycardia (slower beeping), and desaturation (lower pitch of beeping). With the avatar, the median number of detected vital sign changes quadrupled from 3 to 12 (P<.001) in scenario 1, and more than doubled from 3 to 8 (P<.001) in scenario 2. Median perceived diagnostic confidence was confident for both scenarios with the avatar and unconfident in scenario 1 (P<.001), and very unconfident in scenario 2 (P=.024) with conventional monitoring.ConclusionsThis study introduces the concept of peripheral vision monitoring. The test performed showed clearly that an avatar-based display is superior to a standard numeric display for peripheral vision. Avatar-based monitoring could potentially make much more of the patient monitoring information available to caregivers for longer time periods per case. Our results indicate that the optimal information transmission would consist of a combination of auditory and avatar-based monitoring.

Burst or Conventional Peripheral Nerve Field Stimulation for Treatment of Neuropathic Facial Pain

Trigeminal Neuropathic Pain (TNP) is a chronic facial pain syndrome caused by a lesion or disease affecting one or more branches of the trigeminal nerve. It may, for example, result from accidental injury to a branch of the trigeminal nerve by trauma or during surgery; it may also be idiopathic. TNP is typically constant, in contrast to most cases of the commoner trigeminal neuralgia. In some cases, pain may be refractory to pharmacological treatment. Peripheral nerve field stimulation is recognized as an effective minimally invasive surgical treatment option for this debilitating condition. To date, stimulation has used conventional tonic waveforms, which generate paraesthesia in the stimulated area. This is the first report of the use of paraesthesia-free burst pattern stimulation for TNP. Seven patients were treated at the John Radcliffe Hospital for TNP from 2016 to 2018. Mean duration of preoperative symptoms was five years. All patients had exhausted pharmacological measures to limited effect. The initial three patients had tonic stimulation with the subsequent four having burst stimulation. Outcome was assessed using the numeric pain rating scale preoperatively and postoperatively at three and six months and one year. Side-effects and complications were also assessed as well as reduction in analgesic medication use. All patients achieved pain reduction of at least 50% at 6 months (range 50-100%, mean 81%, p = 0.0082). Those in the burst stimulation group were paraesthesia free. One patient developed a postoperative infection for which the system had to be removed and is awaiting reimplantation. There were no other complications in either group. Burst stimulation conferred similar pain control to tonic stimulation in our small cohort, and there were similar reductions in pain medication use. An additional benefit of burst stimulation is freedom from paraesthesia. Larger scale studies are needed to further evaluate burst stimulation and compare its efficacy with that of tonic stimulation.

A Retrospective Analysis of 25 Cases With Peripheral Nerve Field Stimulation for Chronic Low Back Pain and the Predictive Value of Transcutaneous Electrical Nerve Stimulation for Patient Selection

Transcutaneous electrical nerve stimulation (TENS) and peripheral nerve field stimulation (PNFS) may be proposed to patients with chronic lumbar pain refractory to conventional treatment. Aim of this study was to assess the importance of preoperatively treatment with TENS as a predictive value for later successful PNFS and impact of PNFS in follow-up of 12 months. Between 2012 and 2016, a retrospective analysis of 25 patients with chronic lumbar pain and implantation of a PNFS-system was performed. Pain intensity (NRS), health-related quality of life (EQ-5D-5L), Oswestry disability index (ODI), actual mood state scale (ASTS), and treatment satisfaction (CSQ-8) were assessed pre/postoperatively, after 6 and 12 months. TENS use before surgery was assessed. The cohort consisted of 25 patients with a median age of 56 years (IQR25-75 51-63). In a subgroup analysis, 18 patients used TENS before surgery, 7 did not use TENS and were excluded. No pain relief was observed in 14 patients. Ten of these patients showed later positive effect in PNFS trial stimulation. In four patients, pain relief with TENS was seen. One patient later on had no benefit after PNFS trial, three had sufficient pain relief. In the whole cohort, five patients had no benefit after PNFS trial, in 20 patients a neurostimulator was implanted. NRS, EQ-5D-5L, and ODI measures showed significant improvement in the whole follow-up after PNFS implantation. ASTS scale showed an increase of values for positive mood and a reduction in values for sorrow, fatigue, and anger. In 55%, a sustained reduction in demand for analgesics was seen after 6 months, 50% after 12 months, respectively. In this retrospective analysis, TENS has no predictive value in the selection of patients with low back pain for the PFNS treatment. PNFS is effective and safe to relieve significantly symptoms of chronic low back pain.

Driving difficulties as reported by older drivers with mild cognitive impairment and without neurological impairment

Objective: Considerable evidence indicates that medical conditions prevalent among older individuals lead to impairments in visual, cognitive, or psychomotor functions needed to drive safely. The purpose of this study was to explore the factors determining driving difficulties as seen from the viewpoint of 30 older drivers with mild cognitive impairment (MCI) and 30 age-matched controls without cognitive impairment.Methods: Perceptions of driving difficulties from both groups were examined using data from an extensive questionnaire. Samples of drivers diagnosed with MCI and age-matched controls were asked to report the frequency with which they experienced driving difficulties due to functional deficits and knowledge of new traffic rules and traffic signs.Results: The analysis revealed that 2 factors underlie MCI perceptions of driving difficulties, representing (1) difficulties associated with late detection combined with slowed response to relevant targets in the peripheral field of view and (2) difficulties associated with divided attention between tasks requiring switching from automatic to conscious processing particularly of long duration. The analysis for healthy controls revealed 3 factors representing (1) difficulties in estimating speed and distance of approaching vehicles in complex (attention-dividing) high-information-load conditions; (2) difficulties in moving head, neck, and feet; and (3) difficulties in switching from automatic responses to needing to use cognitive processing in new or unexpected situations.Conclusions: Though both group analyses show difficulties with switching from automatic to decision making, the difficulties are different. For the control group, the difficulty in switching involves switching in new or unexpected situations associated with high-information-load conditions, whereas this switching difficulty for the MCI group is associated with divided attention between easier tasks requiring switching. These findings underline the ability of older drivers (with MCI and without cognitive impairment) to indicate probable impairments in various driving skills. The patterns of difficulties perceived by the MCI group and the age-matched healthy control group are indicative of demanding driving situations that may merit special attention for road designers and road safety engineers. They may also be considered in the design of older drivers’ fitness to drive evaluations, training programs, and/or vehicle technologies that provide for older driver assistance.

Peripheral nerve field stimulation for peristomal pain

Chronic pain attributed to the abdominal wall is seen in 10-30% of patients who present to specialist pain clinics [24]. The most common cause is abdominal cutaneous nerve entrapment syndrome (ACNES). Trauma, including surgical incisions and tissue scarring, are well accepted causes of cutaneous nerve entrapment causing neuropathic pain [24]. The occurrence of peristomal neuropathic pain associated with an ileal-conduit formation is rare. A case of chronic cutaneous peristomal pain of the abdominal wall, refractory to conventional pharmacological therapies is described. The technique of peripheral nerve field stimulation (PNFS) for the successful management of peristomal neuropathic abdominal wall pain is reported.

Do Balance Demands Induce Shifts in Visual Proprioception in Crawling Infants?

The onset of hands-and-knees crawling during the latter half of the first year of life heralds pervasive changes in a range of psychological functions. Chief among these changes is a clear shift in visual proprioception, evident in the way infants use patterns of optic flow in the peripheral field of view to regulate their postural sway. This shift is thought to result from consistent exposure in the newly crawling infant to different patterns of optic flow in the central field of view and the periphery and the need to concurrently process information about self-movement, particularly postural sway, and the environmental layout during crawling. Researchers have hypothesized that the demands on the infant’s visual system to concurrently process information about self-movement and the environment press the infant to differentiate and functionalize peripheral optic flow for the control of balance during locomotion so that the central field of view is freed to engage in steering and monitoring the surface and potentially other tasks. In the current experiment, we tested whether belly crawling, a mode of locomotion that places negligible demands on the control of balance, leads to the same changes in the functional utilization of peripheral optic flow for the control of postural sway as hands-and-knees crawling. We hypothesized that hands-and-knees crawlers (n = 15) would show significantly higher postural responsiveness to movements of the side walls and ceiling of a moving room than same-aged pre-crawlers (n = 19) and belly crawlers (n = 15) with an equivalent amount of crawling experience. Planned comparisons confirmed the hypothesis. Visual-postural coupling in the hands-and-knees crawlers was significantly higher than in the belly crawlers and pre-crawlers. These findings suggest that the balance demands associated with hands-and-knees crawling may be an important contributor to the changes in visual proprioception that have been demonstrated in several experiments to follow hands-and-knees crawling experience. However, we also consider that belly crawling may have less potent effects on visual proprioception because it is an effortful and attention-demanding mode of locomotion, thus leaving less attentional capacity available to notice changing relations between the self and the environment.

Dependence of perceived display brightness on peripheral vision luminance and field of view: A comparison study

AbstractConsiderable research effort has been devoted to enhancing perceived display brightness by improving the display luminance level. However, studies have shown that the human visual system (HVS) is influenced not only by physical luminance but also by other factors, such as adaptation to the surrounding luminance. Therefore, enhancing the maximum display luminance alone cannot be an optimal solution. In this study, we investigated the effects of the peripheral vision luminance (PVL) level and field of view (FOV) on the display brightness perceived by the observer, by using Stevens' brightness function, irrespective of the effect of adaptation to surround luminance. The analysis of the experimental results revealed that the perceived display brightness is inversely related to the level of peripheral vision luminance on the display. It was also found that, whereas increase in FOV results in an increase in the absolute brightness value, it reduces the effect of PVL on the perceived display brightness. The findings of this study will serve as useful basic data for optimizing display specifications with respect to image signals.

A case of cancer-associated retinopathy with chorioretinitis and optic neuritis associated with occult small cell lung cancer

BackgroundCancer-associated retinopathy (CAR) is associated with various malignancies, including small cell lung cancer (SCLC). It is difficult to recognize, but prompt diagnosis is crucial for the patient, as retinopathy may be a herald sign that precedes systemic manifestations by months, thus allowing early treatment of the underlying malignancy.Case presentationWe present a rare case of CAR with chorioretinitis and optic neuritis in a patient with occult SCLC. The patient presented with rapidly progressive peripheral field loss and photopsias with “prism-like” visual disturbances. Her symptoms stabilized with intravenous methylprednisolone, and her cancer was treated with carboplatin, etoposide and radiotherapy.ConclusionsThis is the first reported case of SCLC-associated CAR to present with chorioretinitis. CAR can be a herald feature of SCLC, and early recognition of the disease should prompt a systemic evaluation for an occult malignancy, which may be critical for patient survival. Further understanding of CAR pathogenesis may offer potential avenues for treatment.

Editors' note: Mystery Case: Bilateral temporal crescent sparing after cardiac arrest

In their Mystery Case, Lindegger et al. presented the unique visual fields of a middle-aged man who complained of tunnel vision 6 months following a cardiac arrest. One challenge to the case was the appearance of the Goldmann perimetry findings, which are nearly the opposite of what would be seen in a lesion affecting the optic chiasm. Instead of having bitemporal loss of vision, the patient had sparing of the most peripheral temporal visual fields with additional sparing of the binocular central fields. Among the 394 survey responses to the case, only 22% of readers correctly localized the lesion to the bilateral calcarine cortex (38% localized the lesion incorrectly to the chiasm). Dr. Rosenberg, a neuro-ophthalmologist, appropriately considers these Goldmann visual field findings controversial, and even contrary to our current understanding of visual pathways. Sparing of the far peripheral nasal fields and crossing of the vertical meridian peripherally would be untenable for bilateral occipital lobe lesions and probably explains why the survey participants had great difficulty localizing the lesion. Lindegger et al. respond that the manual perimetry was performed by an experienced technician, but that some of these atypical visual field findings may have resulted from the fixation losses and cognitive impairment that follows cardiac arrest. In the article “Deep brain stimulation improves restless legs syndrome in patients with Parkinson disease,” Dr. Klepitskaya et al. reported sustained improvement in symptoms of restless legs syndrome (RLS) over 2 years in 22 patients with Parkinson disease (PD) who underwent subthalamic nucleus (STN) deep brain stimulation (DBS), despite a decrease in dopaminergic treatment. Drs. Marques et al. point out that the article misinterpreted the results of their previous study, which showed an emergence of RLS in patients with PD with a higher dose of dopamine agonists and a lower decrease in dopaminergic treatment after STN DBS.

The Impact of Visual Field Loss on Driving Skills: A Systematic Narrative Review.

Purpose:To review the evidence on the impact of visual field loss on skills required for driving.Methods:A literature search was undertaken using a systematic approach. Papers within scope were identified by two independent reviewers, and papers were grouped into similar themes for discussion.Key findings:Evidence suggests that both binocular and monocular visual field defects have a negative impact on driving skills. Both central and peripheral cause difficulties, but the degree of impact is dependent on the defect severity and compensation ability. Many factors that affect compensation to visual field loss and the effects of visual field loss on driving skills are discussed, including cognitive status, age and duration of visual field loss. In summary, in central visual field loss compensation, strategies include reduction of overall driving speed; whereas, in peripheral field loss, increased scanning is reported to aid adaptation.Conclusions:For driving, there is evidence that complete and/or binocular visual field loss poses more of a difficulty than partial and/or monocular loss, and central defects cause more problems than peripheral defects. A lack of evidence exists concerning the impact of superior versus inferior defects. The level of peripheral vision loss that is incompatible with safe driving remains unknown, as compensation abilities vary widely between individuals. This review highlights a lack of evidence in relation to the impact of visual field loss on driving skills. Further research is required to strengthen the evidence to allow clinicians to better support people with visual field loss with driving advice.

Etiology and Age Modifies Subjective Visual Function After Cerebral Hemispherectomy.

Cerebral hemispherectomy is typically used to treat patients with pharmacoresistant epilepsy. Visual-related outcomes are relatively unstudied in this population, aside from the knowledge that patients develop a complete homonymous hemianopia contralateral to the side of the hemispherectomy. The purpose of this study was to determine and characterize parent-reported functional visual, oculomotor, and postural changes in a large population of patients following cerebral hemispherectomy. An online survey was sent to parents of children who had undergone hemispherectomy for seizure control. Families were recruited by the Brain Recovery Project: Childhood Epilepsy Surgery Foundation. Parent-reported subjective visual function was assessed by the presence of peripheral field defects, ocular misalignment and anomalous head posture. A total of 196 (12.5%) participants responded. Postoperative follow-up was 92±78 months (range: 1-382). Ninety-three percent of parents reported the child had difficulties with peripheral vision. Torticollis was present postoperatively in 122 (62%) patients. Strabismus was noted in 93 (49%). Fifty-five (59%) of the strabismus patients demonstrated exotropia with the majority of exotropia patients demonstrating the exo-deviated eye in the direction contralateral to the hemispherectomy (74.5%). Both torticollis and strabismus were most frequently seen immediately after surgery. Sixty-six patients (34%) underwent strabismus treatment. Patients with younger age of seizure onset, younger age of surgery, and certain epilepsy etiologies (hemimegencephaly, Sturge-Weber syndrome) were more likely to develop strabismus and torticollis. Torticollis and strabismus are common after hemispherectomy and appear to be influenced by etiology and age at surgery. Preoperative discussion with parents and patients regarding those compensatory mechanisms is recommended, and postoperative ophthalmologic assessments are also encouraged.

A Smart Context-Aware Hazard Attention System to Help People with Peripheral Vision Loss.

Peripheral vision loss results in the inability to detect objects in the peripheral visual field which affects the ability to evaluate and avoid potential hazards. A different number of assistive navigation systems have been developed to help people with vision impairments using wearable and portable devices. Most of these systems are designed to search for obstacles and provide safe navigation paths for visually impaired people without any prioritisation of the degree of danger for each hazard. This paper presents a new context-aware hybrid (indoor/outdoor) hazard classification assistive technology to help people with peripheral vision loss in their navigation using computer-enabled smart glasses equipped with a wide-angle camera. Our proposed system augments users’ existing healthy vision with suitable, meaningful and smart notifications to attract the user’s attention to possible obstructions or hazards in their peripheral field of view. A deep learning object detector is implemented to recognise static and moving objects in real time. After detecting the objects, a Kalman Filter multi-object tracker is used to track these objects over time to determine the motion model. For each tracked object, its motion model represents its way of moving around the user. Motion features are extracted while the object is still in the user’s field of vision. These features are then used to quantify the danger using five predefined hazard classes using a neural network-based classifier. The classification performance is tested on both publicly available and private datasets and the system shows promising results with up to 90% True Positive Rate (TPR) associated with as low as 7% False Positive Rate (FPR), 13% False Negative Rate (FNR) and an average testing Mean Square Error (MSE) of 8.8%. The provided hazard type is then translated into a smart notification to increase the user’s cognitive perception using the healthy vision within the visual field. A participant study was conducted with a group of patients with different visual field defects to explore their feedback about the proposed system and the notification generation stage. The real-world outdoor evaluation of human subjects is planned to be performed in our near future work.

Quantitative Analysis of Calcium Oxide in the In Vivo Human Organs

Back Ground and PurposeWhen Ca2+ reacts with O2−, CaO is synthesized. If we can detect in vivo CaO in the human body, we will be able to investigate one of the pathogenesis of calcium metabolism. CT values can be assigned to the objects. The objects are assigned to different optical properties along with X‐ray CT values. Volume rendering 3D images are generated from discrete samples of the volume data obtained by X‐ray CT. To make volume rendering 3D images of a specific object are created from its optimal thresholding, opacity, and brightness. When exposed to water, CaO converts to Ca(OH)□. Volume rendering technique is carried out on the CaO to Ca(OH)□ transformation and quantitative the amount of CaO/Ca(OH)□ under the defined threshold with 100% opacity, 100% brightness, and black and red color assignment. This simplified volume rendering algorithm has found ubiquitous applications in materials science and biology of CaO. We will present a clinical usage of several common diseases.Materials and MethodsTwo clinical body CT data of osteoporosis (one was medically treated, the other was non‐treated), COPD, arteriosclerosis and back pain were used. We used the thresholding trapezoid curved algorithm which was combined with the segmentation methodology. After transferring the image data to the CT workstation, the 3D CaO image based on interactive direct volume rendering was made.ResultsThe case 1 was suffered from COPD (emphysematous type), arteriosclerosis, medically treated osteoporosis, and back pain. The 3D CaO image represented that the red lesions were seen in the ribs, the bilateral pleura or/and peripheral lung fields, the bilateral erector spinae muscle, the bilateral pedicle, the right crus, and the descending aorta posterior wall. But, there was no red lesion in the thoracic vertebra. In case 2 of postmenopausal untreated osteoporosis without any disease, there were red lesions at the cortex and the fracture lesion of the vertebra and the rib cortex. Others organs showed no CaO deposited lesions.ConclusionThis simplified technique is adapted for only in vivo CaO detection in the human body, and will attribute an in vivo calcium function and metabolism in the human organs. This is because CaO was the highest CT value in the human body. In COPD, CaO activated at the peripheral lung fields. The arteriosclerotic wall deposited CaO. In the untreated postmenopausal osteoporosis, CaO activated at the cortex and the vertebral fracture. But, the treated case did not show CaO deposited at the cortex. These CaO accumulated regions will indicate that it is considered that a chemical reaction between Ca2+ and O2− or/and O− occurred. These images will implicate CaO metabolisms in the human organs. These facts show that CaO is an important role for several diseases. We think that this simplified technique of 3D CaO imaging makes a new step of etiological researches. The 3D reconstructed anatomical fusion image in Case 1. The red lesions are seen at the ribs, the bilateral pleura or/and peripheral lung fields, the bilateral erector spinae muscle, the bilateral pedicle, the right crus, and the descending aorta posterior wall. .imageThe 3D reconstructed anatomical fusion image in Case 1. The red lesions are seen at the ribs, the bilateral pleura or/and peripheral lung fields, the bilateral erector spinae muscle, the bilateral pedicle, the right crus, and the descending aorta posterior wall. . Case 2: The untreated postmenopausal osteoporosis. CaO activates at the cortex and the vertebral fracture.imageCase 2: The untreated postmenopausal osteoporosis. CaO activates at the cortex and the vertebral fracture.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Pay attention to the outcome and the end point of anti-vascular endothelial growth factor therapy for retinopathy of prematurity

In the expert consensus published by the Pediatrics in 2013, it was first proposed that anti- VEGF drugs can be considered for retinopathy of prematurity (ROP) with stage 3, zone Ⅰ with plus disease. However, there are many problems worth the attention of ophthalmologists, including the advantages and disadvantages of anti-VEGF therapy compared with traditional laser therapy, systemic and ocular complications after anti-VEGF therapy, and what indicators are the end points of anti-VEGF therapy. Combined with this consensus and numerous research findings, we recommend that the first treatment for anti-VEGF or laser therapy should be considered from disease control effects. For the threshold and pre-threshold lesions, the effect of anti- VEGF therapy for zone Ⅱ lesions is better than that for zone Ⅰ lesions and the single-time effective rate is high. So, it is suggested that anti-VEGF therapy should be preferred for the first treatment. The choice of repeat treatment should be considered from the final retinal structure and functional prognosis. Laser therapy is advisable for the abnormal vascular regression slower and abnormalities in the posterior pole. It can reduce the number of reexaminations and prolong the interval between re-examinations. However, the premature use of laser has an inevitable effect on peripheral vision field. Excluding the above problems, supplemental therapy can still choose anti-VEGF therapy again. Most of the children with twice anti-VEGF therapy are sufficient to control the disease. Anti-VEGF therapy should be terminated when there are signs such as plus regression, threshold or pre-threshold lesions controlled without recurrence, peripheral vascularization, etc. Key words: Retinopathy of prematurity /drug therapy; Angiogenesis inhibitors/therapeutic applications; Antibodies, monoclonal/therapeutic applications; Reviews

Proceedings #49: Management of Trigeminal Autonomic Cephalgia with Cranial Peripheral Nerve and Peripheral Field Stimulation

Proceedings #49: Management of Trigeminal Autonomic Cephalgia with Cranial Peripheral Nerve and Peripheral Field Stimulation

Color Perception and Attentional Load in Dynamic, Time-Constrained Environments.

The capacity to perceive color in the peripheral field has attracted research interest for more than a decade. There is evidence that sensitivity to red-green color variations is lower than for yellow-blue in peripheral vision. Whether, and to what extent, color vision affects the visual focus of attention, which is normally much smaller than the visual field, has not yet been examined. We used a sport-specific decision-making task to assess whether the color of the jersey worn by players appearing in the periphery influences decision making by affecting the attentional and perceptual capabilities. Pairs of players wearing chromatic (blue, yellow, red, and green) and achromatic (black, white) colored jerseys were briefly presented across a range of visual angles on a 6 m concave immersive screen. Participants were required to decide to whom to pass and recall relevant information. Findings indicate that color perception changes vary with increasing visual angle, but that the focus of attention is too small to be influenced by jersey color sensitivity. Decision-making performance decreases with increasing visual angle, but is not influenced by color. The implications for decision-making processes in sport and other professional domains are discussed.

Thermal Microcautery, a Form of Peripheral Nerve Field Stimulation for Treatment of Painful Knee Osteoarthritis: Non-Randomized Controlled Trial

Background: Thermal Microcautery (TMC) is a form of peripheral nerve field stimulation and is a technique used in Traditional Indian Medicine (Agnikarma) to manage chronic pain. The aim was to asses TMC in painful knee osteoarthritis (PKO). Methods: A non-randomized controlled trial was employed. All PKO patients on a waiting list for knee replacement were offered PNFS-TMC. Patients in the intervention group received 4 sessions (2 weeks apart) of PNFS-TMC by a pin-point tip of a metal rod. The rod was heated over a flame for 5 minutes before being used to induce a single 1 mm second-degree burn over points of tenderness. The control group was selected from the same waiting list. The primary outcome was assessed by Visual Analogue Scale (VAS) scores. The secondary outcomes were changes in levels of physical day to day activity, sleep and analgesics. Results: 16 PNFS-TMC intervention group patients and 15 control group patients were subject to analysis. Baseline VAS score was higher in PNFS-TMC group [9 ± 1.23 (95% CI 8.38 - 9.61) versus 5.93 ± 2.11 (95% CI 4.81 - 7.06) in the control, P < 0.0001]. VAS scores after 8 weeks (i.e. 4 sessions) were lower in the PNFS-TMC group [4.64 ± 2.08 (95% CI 3.57 - 5.72) versus 6.73 ± 2.01 (95% CI 5.61 - 7.85) respectively with P = 0.0058]. In the PNFS-TMC group, VAS score decreased from 9 ± 1.23 (95% CI 8.38 - 9.61) at baseline to 4.64 ± 2.08 (95% CI 3.57 - 5.72) after 4 sessions (P < 0.0001). In control group, VAS score showed a non-significant increase in VAS score from 5.93 ± 2.11 (95% CI 4.81 - 7.06) to 6.73 ± 2.01 (95% CI 5.61 - 7.85) (P = 0.2844). Results indicate reduction of pain VAS scores in the PNFS-TMC group (P < 0.0001). Eleven patients (68.7%) experienced increased capacity to perform daily physical activities P < 0.0001 and 5 (31.2%) showed no change in activity P < 0.0418. 5 (33.3%) of the patients in the control group became worse and 10 (66.7%) experienced no change. Conclusions: PNFS-TMC could offer a simple, safe, cheap and effective method of pain management in chronic PKO patients.

Tennis Player Training Support System based on Sport Vision

Sports vision based tennis player training support system is proposed. In sports, gaze, dynamic visual acuity, eye movement and viewing place are important. In sports vision, Static eyesight, Dynamic visual acuity, Contrast sensitivity, Eye movement, Deep vision, Instant vision, Cooperative action of eye, hand and foot, and Peripheral field are have to be treated. In particular for the tennis, all of the items are very important. Furthermore, trajectory of gaze location and tennis racket stroke gives some instructions for skill-up of tennis play. Therefore, sports vision based tennis player training system is proposed. Through experiment, it is found that the proposed system does work well for improvement of tennis players’ skills.

Management of Persistent Idiopathic Facial Pain

Event Abstract Back to Event Management of Persistent Idiopathic Facial Pain Daniela Adamo1* 1 University of Naples Federico II, Department of Neuroscience, Reproductive Sciences and Dentistry, Italy Persistent idiopathic facial pain (PIFP) is a therapeutic challenge in daily clinical practice because the number of treatment strategies is limited (Benoliel and Gaul, 2017). Psychiatric comorbidity screening is recommended and should be considered in the management plan. Therapeutic trials of PIFP have been reported as efficient but, until now, these have been based on the results of case series and recommendations by experts. Antidepressants and cognitive behaviour therapy provide the best chance of pain relief and an improved quality of life. First line drugs, such as amitriptyline, duloxetine and venlafaxine, and antiepileptics, such as gabapentin or pregabalin, have been considered. These drugs may be prescribed individually or in combination. However, such treatments often have a limited efficacy, with poorly tolerated side effects (Weiss et al., 2017). Other strategies, such as botulinum toxin injections or cannabinoids, are considered as a new treatment route in cases unresponsive to first line drugs. Invasive treatments, such as pulsed radio frequency ablation (PFR) of the sphenopalatine ganglion, peripheral nerve field stimulators (PNFS) and repetitive transcranial magnetic stimulation (rTMS) have also been considered in cases with intractable facial pain (William et al., 2016).

Effect of helmet use on visual and auditory reaction time and peripheral field of vision

Background: In many Asian countries, motorcycles are an important means of transportation. The effectivity of helmets in reducing head injuries is studied, but the effect of helmets on the auditory and visual reaction time and peripheral field of vision of riders is of great concern. Moreover, the Indian markets are providing a large range of substandard helmets. Hence, the present study was designed to assess the effect of standard and substandard helmets on vision and hearing. Aims and Objectives: The aim of the study was to assess the following parameters - auditory reaction time, visual reaction time and peripheral field of vision without helmet, with standard helmet, and with substandard helmet and compare the same statistically. Materials and Methods: This comparative study was done in 57 subjects of the age group 18–25 years. The auditory and visual reaction time and peripheral field of vision were noted. A well informed written consent was taken from all the subjects. The statistical analysis was done by analysis of variance test and Paired “t”- test. Results: The helmet (standard and substandard) does not cause any significant change in visual reaction time and auditory reaction time for low-frequency sound as compared to without helmet. The auditory reaction time for high-frequency sound was significantly reduced in the substandard helmet. The field of vision is significantly decreased by the helmets in all four directions. Conclusion: A quiet, lighter, full-face helmet with minimum restriction of the field of vision should be redesigned. The use of substandard helmets should be discouraged.