Subclinical Vestibular Deficits Illustrated in Patients With Exercise Intolerance After mTBI Using Force Plate Protocols

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S4.1-S4
Author(s):  
Mohammad Mortazavi ◽  
Tyler R. Marx ◽  
Leslie Streeter ◽  
Arvind Balaji ◽  
Brett Dusenberry ◽  
...  
Keyword(s):  
Exercise Tolerance ◽  
Force Plate ◽  
Vestibular Function ◽  
Exercise Intolerance ◽  
Therapeutic Exercise ◽  
Patients Âgés ◽  
Average Change ◽  
Symptom Exacerbation ◽  
Before And After ◽  
Shed Light

ObjectiveInvestigate the changes in sway velocity vestibular markers in mTBI patients with exercise intolerance (EI) during exertional testing as part of a 5-Step Exertional Rehab Protocol (ERP).BackgroundExertional testing can be used to determine one's therapeutic exercise threshold. A number of systems have been shown to be related to Exercise Intolerance (EI) including autonomic, cervical, and vestibular, and visual. Vestibular function can be measured before and after exercise and may shed light into its impact on EI.Design/MethodsRetrospective review of 342 trials of exertional testing in mTBI patients, ages 10–60, in 2020. Exertional testing was completed with pre/post force plate sway velocity calculated. Protocol A involved single leg stances, while protocol B involved 2 feet stances. A concussion specialist determined exercise tolerance (ET) by evaluating for the onset of signs/symptoms or cardiovagal dysautonomia.ResultsOf 342 exertional test trials, 34.8% exhibited EI due to symptom exacerbation and/or signs of autonomic dysfunction. Vestibular Force Plate sway velocities in both protocol A and B were significantly worsened in the EI group by an average change of 0.32 deg/sec, compared to those in the ET group who exhibited only an average change of 0.03 deg/sec sway velocity (p = 0.0004). The EI group using protocol A, showed an average change of 0.86 deg/sec compared to those in the ET group using protocol A, who exhibited only an average change of 0.03 deg/sec sway velocity (p = 0.0041). EI group using protocol B, showed an average change of 0.12 deg/sec sway velocity compared to those in the ET group using protocol B, who also exhibited an average change of 0.03 deg/sec (p = 0.0013).ConclusionsSubclinical vestibular markers such as sway velocity measures may be used to identify etiologies for EI in mTBI. Furthermore, these vestibular testing may be a subclinical measure that can aid exercise and sport clearance decisions.

Late Exercise Tolerance Testing Using a Dynamic High Intensity Interval Multidirectional Movement Protocol

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S8.1-S8
Author(s):  
Mohammad Mortazavi ◽  
Katelyn Paulsen ◽  
Tyler R. Marx ◽  
Monica Pita Other ◽  
Luke Muratalla Maes, Other ◽  
...  
Keyword(s):  
Exercise Testing ◽  
High Intensity ◽  
Exercise Tolerance ◽  
Late Phase ◽  
Force Plate ◽  
Retrospective Chart Review ◽  
Exercise Intolerance ◽  
Post Exercise ◽  
Average Change ◽  
High Intensity Interval

ObjectiveAnalyze the utility of a 5-step exertional rehab protocol (ERP) that included High Intensity Interval Multi-Directional Movement (HIIT-MD) or step 5. We assessed the incidence and etiologies of exercise intolerance (EI) during Step 5 in concussed patients who tolerated maximal linear exertion.BackgroundExertional testing can be used to determine appropriate levels of exercise tolerance (ET) in concussed patients. Traditionally linear modalities have been used to determine max ET prior to clearance. HIIT-MD protocols can be the next appropriate step to bridge clearance for more dynamic activities.Design/MethodsRetrospective chart review included 130 step 5 trials for EI; of those, 72 had pre/postexercise King Devick (KD) and force plate (FP) testing. Patients were 10–59 years old and clinic visits occurred 2019–2020. EI rate was recorded and failure reason was documented by our clinic's concussion specialist. The difference between pre/post exercise KD and FP was investigated.ResultsOf 130 step 5 trials, 21.54% failed due to EI. Reason for EI included the onset of symptoms (82.1%), followed by signs of dysautonomia (39.3%). Symptoms and dysautonomia combined were noted in 35.7% of those with EI. Symptoms appeared in combination with another marker 69.6% of the time. The average change in KD times pre/post exercise testing was +2.52 seconds longer in the EI group compared to −2.45 seconds shorter in the ET group (p = 0.62). The EI group demonstrated an average change of 0.36 deg/sec sway velocity increase after exercise compared to 0.13 deg/sec in the ET group (p = 0.93).ConclusionsThere is evidence for the utility of a HITT-MD protocol for dynamic exercise/sports clearance. Exercise testing progression and concussion clearance should include a dynamic HITT-MD protocol to ascertain no late phase dynamic EI. Dysautonomia and/or vestibulocular aggravation may be contributors to late phase EI. If EI exists, identifying and targeting underlying causes can aid optimal recovery.

scholarly journals Terrorism before and after 9/11 – a more dangerous world?

2017 ◽  
Vol 4 (4) ◽  
pp. 205316801773975 ◽  
Author(s):  
Meagan Smith ◽  
Sean M. Zeigler
Keyword(s):  
Civil Conflict ◽  
New Age ◽  
Domestic Terrorism ◽  
Terrorist Activity ◽  
The Past ◽  
Opposite Trend ◽  
Before And After ◽  
Shed Light

Was 9/11 the opening salvo in a new age of terrorism? Some argue that this act ushered in a more chaotic world. Others contend an increased focus on terrorism in the past 15 years is the result of conflating terrorist activity with insurgency. We shed light on these claims by analyzing data on domestic and transnational terrorist incidence from 1989 to 2014. The evidence suggests that the years since 9/11 have been different from those preceding them. Once the prevalence of conflicts is accounted for, the post-9/11 era is a significantly less terror prone period than the years before it. A country not suffering civil conflict was upwards of 60 percent more likely to experience terrorism prior to or during the year 2001 than since. However, the opposite trend holds for those countries with a higher proportion of Muslims. Prior to 2001, countries with higher Muslim populations experienced less domestic terrorism. Since 9/11, these countries have experienced significantly more terrorism – both domestic and international – than they had previously.

scholarly journals The Usefulness of Impedance Cardiography for Predicting Beneficial Effects of Cardiac Rehabilitation in Patients with Heart Failure

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Grzegorz Gielerak ◽  
Paweł Krzesiński ◽  
Ewa Piotrowicz ◽  
Ryszard Piotrowicz
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Exercise Tolerance ◽  
Impedance Cardiography ◽  
The Other ◽  
Pronounced Increase ◽  
Fluid Content ◽  
Beneficial Effects ◽  
Patients With Heart Failure ◽  
Before And After

Aim. Cardiac rehabilitation (CR) is an important part of heart failure (HF) treatment. The aim of this paper was to evaluate if thoracic fluid content (TFC) measured by impedance cardiography (ICG) is a useful parameter for predicting the outcome of CR.Methods. Fifty HF patients underwent clinical and noninvasive haemodynamic (TFC) assessments before and after 8-week CR.Results. As a result of CR, the patients’ exercise tolerance improved, especially in terms of peak VO2(18.7 versus 20.8 mL × kg−1× min−1;P=0.025). TFC was found to identify patients with significantly improved peak VO2after CR. “High TFC” patients (TFC > 27.0 kOhm−1), compared to those of “low TFC” (TFC < 27.0 kOhm−1), were found to have more pronounced increase in peak VO2(1.3 versus 3.1 mL × kg−1× min−1;P=0.011) and decrease in TFC (4.0 versus 0.7 kOhm−1;P<0.00001). On the other hand, the patients with improved peak VO2(n=32) differed from those with no peak VO2improvement in terms of higher baseline TFC values (28.4 versus 25.3 kOhm−1;P=0.039) and its significant decrease after CR (2.7 versus 0.2 kOhm−1;P=0.012).Conclusions. TFC can be a useful parameter for predicting beneficial effects of CR worth including in the process of patients’ qualification for CR.

Mental disorders that occur against the background of water-electrolyte disorders in patients with neoplasms of chiasmal-sellar region

2020 ◽  
pp. 38-56
Author(s):  
K. V. Koval ◽  
G. E. Chmutin ◽  
P. L. Kalinin ◽  
M. A. Kutin ◽  
V. V. Ivanov
Keyword(s):  
Mental Disorders ◽  
Postoperative Period ◽  
World Literature ◽  
Sellar Region ◽  
Electrolyte Disorders ◽  
Appropriate Treatment ◽  
Specific Category ◽  
Neurosurgical Patients ◽  
Before And After ◽  
Shed Light

The work is devoted to assessing the results of the analysis of world literature for a period of more than 50 years: it reflects the data on the nature of the occurrence of mental disorders developing in patients with tumors of the chiasmal-sellar region against the background of water-electrolyte disorders both before and after surgery. The presented data shed light on the occurrence of the variants of mental disorders in such a specific category of neurosurgical patients, which may allow the clinician to timely determine the appropriate treatment tactics and reduce the severity of complications in the postoperative period.

scholarly journals Impact of Grameen Bank micro credit on change in livelihood status of women beneficiaries

1970 ◽  
Vol 7 (2) ◽  
pp. 381-386 ◽  
Author(s):  
S Kuhinur ◽  
M Rokonuzzaman
Keyword(s):  
Family Income ◽  
Three Dimensions ◽  
Farm Size ◽  
Grameen Bank ◽  
Organizational Participation ◽  
Existing Problems ◽  
Average Change ◽  
Before And After ◽  
Status Of Women ◽  
Micro Credit

Grameen Bank (GB) is one of the largest NGO working with the socio-economic upliftment of the poor section, specially women of the society. The main focus on the present study is to determine change in livelihood status of women beneficiaries of GB in twenty selected centers of Jaforgonj north of Debidwar branch under Comilla district; and to identify the existing problems faced by GB participants. Data were collected from 100 randomly selected sample (15% of population), out of population size 663 of GB beneficiaries. Data indicated that change in livelihood status scores of the respondents varied from 4 to 24. The average change in livelihood status score was 13.94. The largest proportion (62 percent) of women belonged to medium, compared to 25 percent and 13 percent belong to low and high change in livelihood status categories respectively. Results of t-test on change of livelihood status in three dimensions namely ‘change of farm and house hold materials', ‘change of housing, health and sanitation' and ‘change of annual family income' in terms of ‘before' and ‘after' involvement were found highly significant. Out of 11 selected characteristics, education, annual income, credit availability, communication with GB employee and staff and attitude towards micro-credit program of GB were positively significant and only age and non-localite behaviour were negatively significant with dependent variable of change in livelihood status. Family size, farm size, organizational participation and attitude towards community did not show any significant relationship with change in livelihood status. Problems faced by beneficiaries in respect of ‘lack of sufficient amount of credit' was the most serious problems, credit disbursement delayed was the second problem and the third problem was ‘belief on dogmatism and fatalism' with problem index 199 among the six existing problems. Keywords: Grameen Bank; Micro credit; Livelihood status;  Women beneficiaries DOI: 10.3329/jbau.v7i2.4750 J. Bangladesh Agril. Univ. 7(2): 381-386, 2009

scholarly journals The Investment in Fixed Assets Before and After the Global Financial Crisis (Empirical Study for Industry and Investment Sector in Palestine Stock Exchange)

2021 ◽  
Vol 12 (4) ◽  
pp. 52
Author(s):  
Tamer Bahjat Sabri
Keyword(s):  
Financial Crisis ◽  
Global Financial Crisis ◽  
Stock Exchange ◽  
Return On Assets ◽  
Significant Difference ◽  
Fixed Assets ◽  
Before And After ◽  
The Global Financial Crisis ◽  
Investment In Fixed Assets ◽  
Shed Light

This paper seeks to shed light on investment in fixed assets before and after the financial crisis that took place in 2008 and compare the two periods together in the sectors of industry and investment in Palestine Stock Exchange. The period between 2005 – 2007 was chosen to represent to the pre-crisis time and the period between 2010 -2012 was chosen to represent the post-crisis time. The population of the study consists of fifteen organizations from both sectors. To test the hypothesis of the study, the independent samples T-test was employed.The average ratio of fixed assets to the total assets of industry and investment rose from 56.2% before the crisis to 58.5% after the crisis. As for the hypotheses of the study, the findings showed no difference except for the seventh hypothesis. There was a statically significant difference in the ratio of fixed assets to equity between the listed companies that a high return on assets and those that have a low return.

scholarly journals Field (In)dependence Flexibility Following a Virtual Immersion Is Associated With Cybersickness and Sense of Presence

2021 ◽  
Vol 2 ◽  
Author(s):  
A. Maneuvrier ◽  
L. M. Decker ◽  
P. Renaud ◽  
G. Ceyte ◽  
H. Ceyte
Keyword(s):  
Visual Cues ◽  
Subjective Experience ◽  
A Posteriori ◽  
Future Studies ◽  
Sense Of Presence ◽  
Before And After ◽  
High Level ◽  
Shed Light ◽  
Rod And Frame Test ◽  
Rod And Frame

Field dependence–independence (FDI) is a psychological construct determining an individual’s approach of the perception–cognition coupling. In virtual reality (VR) context, several studies suggest that an individual’s perceptive style is susceptible to shift toward a more FI mode through down-weighting of conflicting visual cues. The present study proposes to investigate the potential flexible nature of FDI following a virtual immersion and to assess if this flexibility might be associated with the subjective experience of VR. 86 participants explored a real-world–like virtual environment for approximately 10 min. FDI levels were measured before and after the VR exposure using the rod-and-frame test. Their subjective experience of VR was measured a posteriori (cybersickness and sense of presence) and used in order to build two experimental groups via a cluster analysis. The results showed that only participants with a poor subjective experience of VR (i.e., a low level of sense of presence associated with a high level of cybersickness) significantly shifted to a more FI mode, which is discussed as a sensory re-weighting mechanism. Pragmatical applications are discussed, and future studies are outlined, based on the conclusion that FDI might be more flexible than we thought, which could shed light on the psychophysiology of VR.

scholarly journals «Raccogliere, pubblicare, illustrare carte». Editori ed edizioni di documenti medievali in Lombardia tra Otto e Novecento

2017 ◽  
Author(s):  
Gianmarco De Angelis
Keyword(s):  
Medieval Studies ◽  
State Identity ◽  
Legal Documents ◽  
Before And After ◽  
Long Eighteenth Century ◽  
Local Traditions ◽  
Italian Unification ◽  
First Time ◽  
The Great War ◽  
Shed Light

A long Eighteenth Century, in continuity with the erudite tradition and the editorial method of Muratori, and a very brief Nineteenth Century, between the first decade after Italian Unification and the eve of the Great War, when a new and (at last) professional generation of scholars (Bonelli, Vittani, Torelli, Manaresi) brought a sweeping change in the field of palaeographic and diplomatic researches and of publications of medieval legal documents: these two are the coordinates (conceptual earlier than chronological) of the present monography, that for the first time deals in a historiographical perspective with a crucial season of Medieval studies in Lombardy, concentrating upon careers, projects and works of its protagonists. The focus is on the editors and editions of charters, but around them we find many other individuals and institutions of the regional and national cultural scene. The Leitmotiv is the delineation of a modern philogical method in the editions of Lombard sources, but the wider context is represented by more general (and stronger, and ideologically characterised) themes of Medieval Studies before and after the national Unification of Italy: the problems of Lombard legacy, the myth of communal age in the Risorgimento culture, the Visconti-Sforza state identity. Finally, this study about editors and editions of medieval charters in Lombardy allows to shed light on the organization of regional historical research, within an intense (and not always simple) dialogue between the hegemonic Milanese capital and the proud local traditions of the other towns and provinces.

scholarly journals Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

2021 ◽  
Vol 12 ◽  
Author(s):  
Keita Tsukada ◽  
Shin-ichi Usami
Keyword(s):  
Cochlear Implantation ◽  
Round Window ◽  
Surgical Techniques ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potential ◽  
Flexible Electrodes ◽  
Caloric Testing ◽  
Before And After ◽  
Window Approach ◽  
Caloric Response

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique.Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria).Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA.Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.

scholarly journals PENERAPAN PRAKTIK KEPERAWATAN BERBASIS BUKTI PURSED LIP BREATHING PADA PASIEN DENGAN PENYAKIT PARU OBSTRUKTIF KRONIK DI RUANG RSU PUSAT PERSAHABATAN JAKARTA

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Seven Sitorus
Keyword(s):  
Quality Of Care ◽  
Pulmonary Disease ◽  
Significant Influence ◽  
Exercise Tolerance ◽  
P Value ◽  
Evidence Based ◽  
Copd Exacerbation ◽  
Before And After ◽  
Evidence Based Nursing

Background: Chronic Obstruction Pulmonary Disease (COPD) is disease characterized by obstruction air flow in the breath not wholly reversible. One treatment can be done on improving exercise tolerance is exercise respiration as pursed lip breathing ( PLB ). Purse lip breathing is a techniques of breathing carried out to expelling air by creating power through  in move closer /pursed lips. Purpose: provide an illustration of the application of the practice of evidence based nursing of pursed lip breathing in patients COPD in RSUP Persahabatan Jakarta. Method:  the implementation of the practice of evidence based nursing pursed lip breathing is applied to 12 people sample ( 10 men and 2 women ) diagnosed with COPD exacerbation. Result: the majority of sex respondents is man as many as 10 ( 83,3 % ) persons and women as many as 2 ( 16,7 % ) a person .mean the age of respondents is 61,5 years ± 10.4 .mean the value of PEF ( Peak Expiratory Flow ), the value of the saturation oxygen , the value of respiratori rate before the intervention in a consecutive manner is 131.6 ±  44.6; 92.1 ± 2.44; 31.5 ±  2 . While value after the intervention is 175.0 ±  60.0; 97,1 ± 1.6; 22,6 ± 1.7 with P value = 0.001, α = 0.05. Conclusions: there are significant influence the application of pursed lip breathing between before and after the intervention in patients COPD. Advice: Intervention evidence based nursing can be applied to all patients COPD so reached the quality of care of nursing based on research

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