scholarly journals 038 Tremor: a clinical and neurophysiological study

2019 ◽  
Vol 90 (e7) ◽  
pp. A13.2-A13
Author(s):  
Alessandro Fois ◽  
Neil Mahant ◽  
Steve Vucic ◽  
Victor SC Fung
Keyword(s):  
Essential Tremor ◽  
Upper Limb ◽  
Temporal Discrimination ◽  
Clinical Trial Design ◽  
Clinical Problem ◽  
Future Research ◽  
Cross Sectional ◽  
Clinical Criteria ◽  
Dystonic Tremor ◽  
Neurophysiological Studies

IntroductionTremor is a common clinical problem seen in a number of diseases. Robust classification and diagnosis of tremor remains controversial due to overlap in clinical features and lack of established biomarkers. This hampers effective research including therapeutic trials. We present our research protocol for a cross-sectional study which aims to find more robust methods of tremor classification and diagnosis.MethodsAdults with upper limb tremor of varying aetiologies, diagnosed using current clinical criteria (including essential tremor, Parkinsonian tremor, and dystonic tremor), and age-matched controls are eligible for recruitment. Participants undergo a clinical and neurophysiological assessment, including accelerometry, surface electromyography, long-latency stretch reflexes, temporal discrimination, and tonic vibration reflexes. Data will be analysed using a cluster analysis to identify robust tremor syndromes and biomarkers associated with them. We aim to recruit 100 participants prior to analysis.ResultsAt time of writing, 13 participants with upper limb tremor have been studied (6 with essential tremor, 5 with dystonic tremor, and 2 with indeterminate tremor; mean age 66 years, range 18–85). Participants tolerated the clinical and neurophysiological studies well with 100% completion rate after recruitment. With current rates of recruitment we anticipate completion of recruitment and commencement of data analysis in October 2019.ConclusionsOur protocol aims to identify robust tremor phenotypes and biomarkers for them. This will allow patients with tremor to be classified into more biologically homogeneous diagnostic categories, aiding future research into the mechanism of tremor and more rational clinical trial design.

scholarly journals Current therapy for the upper limb after stroke: a cross-sectional survey of UK therapists

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030262 ◽  
Author(s):  
Rachel Stockley ◽  
Rosemary Peel ◽  
Kathryn Jarvis ◽  
Louise Connell
Keyword(s):  
Upper Limb ◽  
Online Survey ◽  
Current Therapy ◽  
Future Research ◽  
Evidence Based ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Constraint Induced Movement Therapy ◽  
Therapy Interventions ◽  
The Uk

ObjectivesTo survey the reported content, frequency and duration of upper limb treatment provided by occupational and physiotherapists for people after stroke in the UK.DesignA cross-sectional online survey was used. Description and analysis of the data were based on items from the Template for Intervention Description and Replication (Who, Where, What and How much).SettingThe online survey was distributed via professional and social networks to UK-based therapists.ParticipantsRespondents were occupational or physiotherapists currently working clinically in the UK with people after stroke. Over the 6 week data collection period, 156 respondents opened the survey, and 154 completed it. Respondents comprised 85 physiotherapists and 69 occupational therapists.ResultsRespondents reported treating the upper limb a median of three times a week (range: 1 to 7) for a mean of 29 min (SD: 18). Most (n=110) stated this was supplemented by rehabilitation assistants, family and/or carers providing additional therapy a median of three times a week (range 1 to 7). Functional training was the most commonly reported treatment for people with mild and moderate upper limb deficits (>40%). There was much less consistency in treatments reported for people with severe upper limb deficits with less than 20% (n=28) reporting the same treatments.ConclusionsThis study provides a contemporaneous description of reported therapy in the UK for people with upper limb deficits after stroke and a detailed template to inform standard therapy interventions in future research. Several evidence-based therapies were reported to be used by respondents (eg, constraint induced movement therapy), but others were not (eg, mental imagery). The findings also highlight that the current reported provision of upper limb therapy is markedly less than what is likely to be effective. This underlines an urgent need to configure and fund services to empower therapists to deliver greater amounts of evidence-based treatment for people with upper limb deficits after stroke.

scholarly journals Does My Neck Make Me Clumsy? A Systematic Review of Clinical and Neurophysiological Studies in Humans

2021 ◽  
Vol 2 ◽  
Author(s):  
Samantha C. Harman ◽  
Zhen Zheng ◽  
Julie C. Kendall ◽  
Dein Vindigni ◽  
Barbara I. Polus
Keyword(s):  
Neck Pain ◽  
Upper Limb ◽  
Case Series ◽  
Objective Measures ◽  
Cross Sectional ◽  
Kinesthetic Sense ◽  
Neurophysiological Studies ◽  
Healthy Cohort ◽  
Sensorimotor Performance

Introduction: Clumsiness has been described as a symptom associated with neck pain and injury. However, the actuality of this symptom in clinical practice is unclear. The aim of this investigation was to collect definitions and frequency of reports of clumsiness in clinical studies of neck pain/injury, identify objective measures of clumsiness and investigate the association between the neck and objective measures of clumsiness.Methods: Six electronic databases were systematically searched, records identified and assessed including a risk of bias. Heterogeneity in designs of studies prevented pooling of data, so qualitative analysis was undertaken.Results: Eighteen studies were retrieved and assessed; the overall quality of evidence was moderate to high. Eight were prospective cross-sectional studies comparing upper limb sensorimotor task performance and ten were case series involving a healthy cohort only. Clumsiness was defined as a deficit in coordination or impairment of upper limb kinesthesia. All but one of 18 studies found a deterioration in performing upper limb kinesthetic tasks including a healthy cohort where participants were exposed to a natural neck intervention that required the neck to function toward extreme limits.Conclusion: Alterations in neck sensory input occurring as a result of requiring the neck to operate near the end of its functional range in healthy people and in patients with neck pain/injury are associated with reductions in acuity of upper limb kinesthetic sense and deterioration in sensorimotor performance. Understanding the association between the neck and decreased accuracy of upper limb kinesthetic tasks provide pathways for treatment and rehabilitation strategies in managing clumsiness.

scholarly journals Optimizing Communication of Emergency Response Adaptive Randomization Clinical Trials to Potential Participants

2016 ◽  
Author(s):  
Bredan McEvoy ◽  
David Haidar ◽  
Jason Tehranisa ◽  
William J. Meurer
Keyword(s):  
Clinical Trial ◽  
Interactive Video ◽  
Clinical Trial Design ◽  
Altered Mental Status ◽  
Future Research ◽  
Correct Identification ◽  
Cross Sectional ◽  
Absolute Increase ◽  
Adaptive Randomization ◽  
Allocation Method

AbstractIntroductionAcute clinical stroke trials are challenging to communicate to patients and families considering participation. Response adaptive randomization (RAR) is a technique that alters the proportion of trial subjects receiving active treatment, based on the outcomes of previous subjects. We aimed to determine how well interactive videos would improve understanding of a simulated acute stroke trial scenario that incorporated a design with RAR.MethodsWe performed a cross-sectional study of emergency department patients who were without stroke, altered mental status, or critical illness. Subjects viewed a hypothetical stroke and clinical trial scenario. They were randomized into one of four groups with either an RAR or fixed randomization clinical trial design and with either a standard consent video, or an interactive video.Results:We enrolled 720 participants. In the RAR group with interactive video, 128 out of 149 (85.9%) of the subjects were able to correctly identify the allocation method, compared to the 172 out of 285 (61.6%) in the RAR group with the uninterrupted video for an absolute increase of 25.6% (95% Cl 17-33%). The RAR group with interactive video had a higher odds of correct identification of allocation method (O.R. 2.767, 95% Cl [1.011 – 7.570] while controlling for age, sex, ethnicity, education, self-reported understanding of protocol, stroke awareness and agreement to participate in trial.Conclusions:The interactive video increased participant understanding of an RAR design in a simulated stroke scenario. Future research should focus on whether acute trial recruitment can be enhanced using similar techniques.

scholarly journals Dynamic hyperinflation induced by the 6-minute pegboard and ring test in hospitalized patients with exacerbated COPD

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241639
Author(s):  
Cassia Fabiane de Barros ◽  
Rosimeire Marcos Felisberto ◽  
Kelly Cristina Albanezi Nucci ◽  
Andre Luis Pereira de Albuquerque ◽  
Elaine Paulin ◽  
...  
Keyword(s):  
Upper Limb ◽  
Hospital Setting ◽  
Tertiary Hospital ◽  
Hospitalized Patients ◽  
Ring Test ◽  
Chronic Obstructive ◽  
Dynamic Hyperinflation ◽  
Upper Limbs ◽  
Cross Sectional ◽  
Clinical Criteria

Background The six-minute pegboard and ring test (6-PBRT) has been used to evaluate functional capacity of the upper limbs in stable chronic obstructive pulmonary disease (COPD) patients. To the best of our knowledge, no studies have evaluated dynamic hyperinflation (DH) during exercise with upper limbs in the hospital setting. The aim of this study was to evaluate physiological responses and DH induced by 6-PBRT in hospitalized patients with acute exacerbation of COPD (AECOPD). Methods A cross-sectional study was conducted in a tertiary hospital enrolling patients who were hospitalized due to AECOPD. All included participants underwent an evaluation of lung function and 6-PBRT when they reached minimum clinical criteria. Ventilatory and hemodynamics parameters were monitored during 6-PBRT and until 6 minutes of rest after the test. Symptoms of dyspnea and upper limb fatigue were also measured. Results Eighteen patients (71.3±5.1 years) with a mean FEV1 of 43.2±18.3% were included in the study (11 females). Prevalence of DH after 6-PBRT was 50% (considering the drop of 150 ml or 10% of inspiratory capacity, immediately after the end of the test). There was a significant increase in respiratory rate, minute volume, dyspnea, and upper limb fatigue after the end of 6-PBRT (p<0.05). Dyspnea recovered more precociously than the perception of fatigue, being reestablished within four minutes of rest. An increase in heart rate, systolic and diastolic blood pressures was also induced by 6-PBRT (p<0.05), requiring 6 minutes of recovery to return to baseline. No adverse events were observed during 6-PBRT. We concluded that 6-PBRT induces physiological changes during its execution, at safe levels, requiring a maximum of 6 minutes for recovery. Finally, the test proved to be safe and applicable for patients hospitalized due to AECOPD.

A Silenced Population

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Kim Gryglewicz ◽  
Melanie Bozzay ◽  
Brittany Arthur-Jordon ◽  
Gabriela D. Romero ◽  
Melissa Witmeier ◽  
...  
Keyword(s):  
At Risk ◽  
Depressive Symptomatology ◽  
The United States ◽  
Future Research ◽  
At Risk Youth ◽  
Peer Relationship ◽  
Student Records ◽  
Cross Sectional ◽  
Increased Risk ◽  
Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

Cross-Lagged Relationships Between Self-Esteem, Self-Construal, and Happiness in a Three-Wave Longitudinal Study

2019 ◽  
Vol 40 (3) ◽  
pp. 177-185
Author(s):  
Daniela Moza ◽  
Laurențiu Maricuțoiu ◽  
Alin Gavreliuc
Keyword(s):  
Structural Equation ◽  
Time Lag ◽  
Self Esteem ◽  
Equation Modeling ◽  
Future Research ◽  
Cross Sectional ◽  
Self Construal ◽  
Self Worth ◽  
Practical Implications ◽  
Independent Person

Abstract. Previous research established that an independent construal of the self is associated with higher self-esteem, which, in turn, is associated with increased happiness. Regarding the directionality of these relationships, theoretical arguments have suggested that self-construal precedes self-esteem and that self-esteem precedes happiness. However, most research in this area is cross-sectional, thus limiting any conclusions about directionality. The present study tested these relationships in 101 Romanian undergraduates using a 3-wave cross-lagged design with a 6-month time lag between every two waves. Structural equation modeling analyses revealed that self-esteem is an antecedent of both happiness and dimensions of independent self-construal (i.e., consistency vs. variability and self-expression vs. harmony). In other words, one’s positive evaluation of self-worth precedes one’s self-perception as being a happy and independent person. The findings are discussed with respect to the theoretical and practical implications, along with limitations and suggestions for future research.

scholarly journals Complementary Medicine and Self-Care Strategies in Women with (Recurrent) Urinary Tract and Vaginal Infections: A Cross-Sectional Study on Use and Perceived Effectiveness in The Netherlands

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 250
Author(s):  
Louise Witteman ◽  
Herman A. van Wietmarschen ◽  
Esther T. van der Werf
Keyword(s):  
Urinary Tract ◽  
The Netherlands ◽  
Complementary Medicine ◽  
Self Care ◽  
Future Research ◽  
Perceived Effectiveness ◽  
Vaginal Infections ◽  
Cross Sectional ◽  
Treatment Implementation ◽  
Specific Symptoms

Due to the excessive use of antibiotic and antimycotic treatments, the risk of resistant microbes and fungi is rapidly emerging. Previous studies have demonstrated that many women with (recurrent) urinary tract infection (UTI) and/or vaginal infections (VIs) welcome alternative management approaches to reduce the use of antibiotics and antifungals and avoid short- and long-term adverse effects. This study aims to determine which complementary medicine (CM) and self-care strategies are being used by women suffering from (recurrent) UTI and VI in The Netherlands and how they perceive their effectiveness in order to define directions for future research on safety, cost-effectiveness, and implementation of best practices. A cross-sectional online survey was performed among women, ≥18 years old, with a history of UTIs; 162 respondents were included in the data analysis, with most participants aged between 50 and 64 years (36.4%). The women reported having consulted a CM practitioner for UTI-specific symptoms (23.5%) and VI-specific symptoms (13.6%). Consultations of homeopaths, acupuncturists, and herbal physicians are most often reported. Overall, 81.7% of the women suffering from UTI used complementary or self-care strategies besides regular treatment, and 68.7% reported using CM/self-care strategies to treat vaginal symptoms. UTI- related use of cranberries (51.9%), vitamin C (43.8%), and D-mannose (32.7%) were most reported. Perceived effectiveness was mostly reported for homeopathic remedies and D-mannose. The results showed a substantial burden of UTI and VI on daily and sexual activities. Besides the frequency of use, the indication of perceived effectiveness seems to be an important parameter for further and rigorously designed research to encourage nonantibiotic/antifungal treatment implementation into daily clinical practice.

scholarly journals Social Engagement and Episodic Memory in Non-Hispanic Black and White Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 343-343
Author(s):  
Abbey Hamlin ◽  
A Zarina Kraal ◽  
Laura Zahodne
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Episodic Memory ◽  
Cognitive Aging ◽  
Social Engagement ◽  
Future Research ◽  
Social Activities ◽  
Linear Regression Models ◽  
Significant Positive Association ◽  
Cross Sectional

Abstract Social engagement may confer cognitive benefits in older adulthood, but studies have typically been restricted to largely non-Hispanic White (NHW) samples. Levels of social engagement vary across race such that NHW report larger social networks, more frequent participation in social activities, and greater social support than non-Hispanic Blacks (NHB). Associations between social engagement and cognition may also vary by race, but research is sparse. The current cross-sectional study examined associations between different aspects of social engagement and episodic memory performance, as well as interactions between social engagement and race among NHB and NHW participants in the Michigan Cognitive Aging Project (N = 247; 48.4% NHB; age = 64.19 ± 2.92). Social engagement (network size, activities, support) was self-reported. Episodic memory was a z-score composite of immediate, delayed, and recognition trials of a list-learning task. Separate hierarchical linear regression models quantified interactions between race and each of the three social engagement variables on episodic memory, controlling for sociodemographics, depressive symptoms, and health conditions. Results showed a main effect of more frequent social activity on better episodic memory, as well as an interaction between race and social support indicating a significant positive association in NHB but not NHW. These preliminary findings suggest that participating in social activities may be equally beneficial for episodic memory across NHB and NHW older adults and that social support may be particularly beneficial for NHB. Future research is needed to determine the potential applications of these results in reducing cognitive inequalities through the development of culturally-relevant interventions.

The Association of School Nurse Workload With Student Health and Academic Outcomes: A Cross-Sectional Study

2021 ◽  
pp. 105984052110129
Author(s):  
Krista Schroeder ◽  
Ally Young ◽  
Gail Adman ◽  
Ann Marie Ashmeade ◽  
Estherlyn Bonas ◽  
...  
Keyword(s):  
Academic Outcomes ◽  
Student Outcomes ◽  
School Nurse ◽  
School Nurses ◽  
Future Research ◽  
Student Health ◽  
Office Visits ◽  
School Students ◽  
Cross Sectional ◽  
Nurse Workload

This study assessed associations between school nurse workload and student health and academic outcomes. We hypothesized that lower school nurse workload would be associated with better student outcomes, with associations being greater for members of groups who experience health disparities. Our methods entailed secondary analysis of data for New York City school students in kindergarten through 12th grade during 2015–2016 ( N = 1,080,923), using multilevel multivariate regression as the analytic approach. Results demonstrated lower school nurse workload was associated with better outcomes for student participation in asthma education but not chronic absenteeism, early dismissals, health office visits, immunization compliance, academic achievement, or overweight/obesity. Our findings suggest school nurses may influence proximal outcomes, such as participation in disease-related education, more easily than downstream outcomes, such as absenteeism or obesity. While contrary to our hypotheses, results align with the fact that school nurses deliver community-based, population health–focused care that is inherently complex, multilevel, and directly impacted by social determinants of health. Future research should explore school nurses’ perspectives on what factors influence their workload and how they can best impact student outcomes.

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