Cognitive Effects of Lyme Disease in Children

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 185-189
Author(s):  
Wayne V. Adams ◽  
Carlos D. Rose ◽  
Stephen C. Eppes ◽  
Joel D. Klein
Keyword(s):  
Lyme Disease ◽  
Cognitive Skills ◽  
Pediatric Population ◽  
Disease Stage ◽  
Controlled Study ◽  
Fine Motor ◽  
Information Processing Speed ◽  
Duration Of Symptoms ◽  
Healthy Sibling ◽  
Motor Dexterity

Objective. To measure possible cognitive sequelae of Lyme disease (LD) within a pediatric population. Design. Prospective, blinded, controlled study of cognitive skills in children who had been treated for LD. Setting. A children's hospital in an area endemic for LD. Patients. Forty-one children with strictly defined LD were compared with 14 control children who had subacute rheumatological diseases, and with 23 healthy sibling controls. Outcome measures. Neuropsychologic measures were administered to each child to assess the following cognitive areas: IQ, information processing speed, fine-motor dexterity, novel-problem solving and executive functioning, short-term and intermediate memory, and the ability to acquire new learning. Predisease and postdisease academic achievement test scores were also gathered. Impressions from parents concerning the disease's subsequent impact were also obtained. Results. No differences between LD and control groups were found for any of the numerous neuropsychologic measures. Analyses also failed to show differences between LD patients grouped with respect to the presence or absence of known neurologic involvement, disease stage, duration of symptoms before therapy, or type of antibiotic treatment. No predisease versus postdisease difference in academic performance was found. No perceived long-term deterioration in cognitive, social, or personality areas was reported by parents. Conclusion. Children appropriately treated for LD have an excellent prognosis for unimpaired cognitive functioning.

scholarly journals Computerized Symbol Digit Modalities Test in a Swiss Pediatric Cohort – Part 2: Clinical Implementation

2021 ◽  
Vol 12 ◽  
Author(s):  
Marie-Noëlle Klein ◽  
Ursina Jufer-Riedi ◽  
Sarah Rieder ◽  
Céline Hochstrasser ◽  
Michelle Steiner ◽  
...  
Keyword(s):  
Test Performance ◽  
Repeated Measures ◽  
Analysis Of Covariance ◽  
Fine Motor ◽  
Clinical Implementation ◽  
Information Processing Speed ◽  
Repeated Measures Anova ◽  
Repeated Measures Analysis ◽  
Significant Difference ◽  
Motor Dexterity

BackgroundInformation processing speed (IPS) is a marker for cognitive function. It is associated with neural maturation and increases during development. Traditionally, IPS is measured using paper and pencil tasks requiring fine motor skills. Such skills are often impaired in patients with neurological conditions. Therefore, an alternative that does not need motor dexterity is desirable. One option is the computerized symbol digit modalities test (c-SDMT), which requires the patient to verbally associate numbers with symbols.MethodsEighty-six participants (8–16 years old; 45 male; 48 inpatients) were examined, 38 healthy and 48 hospitalized for a non-neurological disease. All participants performed the written SDMT, c-SDMT, and the Test of Non-verbal Intelligence Fourth Edition (TONI-4). Statistical analyses included a multivariate analysis of covariance (MANCOVA) for the effects of intelligence (IQ) and hospitalization on the performance of the SDMT and c-SDMT. A repeated measures analysis of variance (repeated measures ANOVA) was used to compare performance across c-SDMT trials between inpatients and outpatients.ResultsThe MANCOVA showed that hospitalization had a significant effect on IPS when measured with the SDMT (p = 0.04) but not with the c-SDMT (p = 0.68), while IQ (p = 0.92) had no effect on IPS. Age (p < 0.001) was the best predictor of performance of both tests. The repeated measures ANOVA revealed no significant difference in within-test performance (p = 0.06) between outpatient and inpatient participants in the c-SDMT.ConclusionPerformance of the c-SDMT is not confounded by hospitalization and gives within-test information. As a valid and reliable measure of IPS for children and adolescents, it is suitable for use in both inpatient and outpatient populations.

309 The Effect of 24 Hour Call on Fine Motor Dexterity, Cognition, and Mood

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 265-266
Author(s):  
Gary R Simonds ◽  
Cara Rogers ◽  
Chris Busch
Keyword(s):  
Work Hours ◽  
Fine Motor ◽  
Extensive Experience ◽  
Significant Decrement ◽  
Before And After ◽  
Overall Performance ◽  
Work Shifts ◽  
Motor Dexterity ◽  
Manual Performance ◽  
Limited Change

Abstract INTRODUCTION There continues much debate about optimal work hours for the neurosurgical resident in training. Multiple entities have asserted that cognitive and manual performance deteriorate with prolonged work shifts. We sought to study the effects of 24 hours of neurosurgical duty on manual dexterity, cognition, and mood. METHODS Subjects underwent multiple batteries of validated dexterity, cognitive, and mood evaluations before and after a 24 hour stint of neurosurgical duty. This included a night of neurosurgical call. All subjects were required to stay awake throughout their 24 hour stint. RESULTS >27 subjects underwent the full battery of testing before and after their 24 hours of neurosurgical activities. 13 were seasonedneurosurgical residents and P.A..’s- that is they had extensive experience with neurosurgical call. 14 were non-seasoned medical students who had no previous experience with 24 straight hours of medical activities. Overall performance of the group showed no significant decrement in performance in dexterity, cognition, or overall mood. When divided into a seasoned group and a non-seasoned group however, the non-seasoned group demonstrated statistically significant decrements in multiple functions in dexterity, cognitive, and mood testing. The seasoned group demonstrated no decrements in dexterity or cognition, and only limited change in isolated mood functions (no changes in overall mood). CONCLUSION We believe that this study raises interesting questions about neurosurgical training with respect to the alleged detrimental effects of prolonged work hours. The results suggest that fatigue-induced decrements in professional function can be ameliorated by experience. If this is the case, an argument can be made that we are turning the training paradigm upside down with the current ACGME restrictions. Since long and arduous hours are a fact of life in a neurosurgical career, learning how to recognize and manage fatigue during training will improve physician resilience and therefore patient care.

Sporadic unilateral vestibular schwannoma in the pediatric population

2009 ◽  
Vol 4 (2) ◽  
pp. 125-129 ◽  
Author(s):  
Brian P. Walcott ◽  
Ganesh Sivarajan ◽  
Bronislava Bashinskaya ◽  
Douglas E. Anderson ◽  
John P. Leonetti ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Tumor Size ◽  
Pediatric Population ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Duration Of Symptoms

Object Vestibular schwannomas (VSs) are rare in the pediatric population. Most often, these lesions manifest as a bilateral disease process in the setting of neurofibromatosis Type 2. Even in the absence of additional clinical diagnostic criteria, the presentation of a unilateral VS in a young patient may be a harbinger of future penetrance for this hereditary tumor syndrome. Methods The authors retrospectively reviewed the charts of a cohort of 7 patients who presented with apparently sporadic, unilateral VSs. These patients had previously undergone surgery via translabyrinthine, retrosigmoid, or combined approaches. Clinical outcomes were reviewed with emphasis on facial nerve function and follow-up for signs and symptoms of a heritable disorder. Results All patients underwent microsurgical resection in a multidisciplinary effort by the senior authors. The average tumor size was 4.57 cm, with an average duration of symptoms prior to definitive diagnosis of 31.2 months. The tumor size at the time of presentation followed a trend different from reports in adults, while the duration of symptoms did not. At a follow-up average of 6.3 years (range 1–12 years), 100% of patients demonstrated good facial function (House-Brackmann Grade I or II). No patient in this cohort demonstrated symptoms, objective signs, or genetic analysis indicating the presence of neurofibromatosis Type 2. Conclusions Diagnosis and management of sporadic, unilateral VSs in children is complicated by clinical presentations and surgical challenges unique from their adult counterparts. Careful consideration should be given to a heritable genetic basis for sporadic unilateral VS in the pediatric population. Results of genetic testing do not preclude the necessity for long-term follow-up and systemic investigation. In patients who present with large tumors, preliminary experience leads the authors to suggest that a combined retrosigmoid-translabyrinthine approach offers the greatest opportunity for preservation of facial nerve function.

A-170 Socioeconomic Status as a Predictor of Fine Motor and Graphomotor Outcomes in Patients with Pediatric Brain Tumor

2021 ◽  
Vol 36 (6) ◽  
pp. 1225-1225
Author(s):  
Viannae Carmona ◽  
Dianne Kong ◽  
Ashley M Whitaker
Keyword(s):  
Socioeconomic Status ◽  
Brain Tumor ◽  
Pediatric Brain Tumor ◽  
Fine Motor ◽  
Visual Motor Integration ◽  
Visual Motor ◽  
Motor Dexterity ◽  
Motor Outcomes ◽  
Pediatric Brain

Abstract Objective As the field of neuropsychology strives to provide equitable care among diverse and disadvantaged populations, disparities in treatment and long-term outcomes continue to disproportionately impact individuals of lower socioeconomic status (SES). Motor deficits are common following pediatric brain tumor (PBT) diagnoses. However, while the relationship between SES and cognitive outcomes in this population is well documented, the role of SES in predicting more basic motor outcomes is not yet understood. This retrospective cross-sectional study was designed to determine the impact of SES on fine motor and graphomotor outcomes in PBT patients to ensure appropriate interventions and accommodations for those at higher risk. Method 225 patients with PBT (52.9% male; $ \overset{-}{\textrm{x}} $ age = 12 yrs; SD = 5.3 yrs) underwent neuropsychological evaluation, including assessment of graphomotor speed/coordination, visual-motor integration, and fine motor dexterity. Estimated median household income was used as a proxy for SES ($ \overset{-}{\textrm{x}} $=$71,543; SD = $23,480). Linear regression analyses were used to explore the role of SES in predicting motor outcomes. Results Lower SES predicted poorer graphomotor speed, F(1,96) = 5.205, p = 0.013, graphomotor coordination, F(1,60) = 3.890, p = 0.027, visual-motor integration, F(1,88) = 8.116, p = 0.003, and fine motor dexterity, F(1,166) = 3.755, p = 0.027. All analyses were significant even after implementing false discovery rates. Conclusions Consistent with lower SES predicting poorer cognitive late effects, SES also plays a role in motor-related outcomes of PBT. Unfortunately, lower SES is also associated with barriers in accessing formal evaluations and services required to mitigate such deficits. Therefore, patients with lower SES should be considered higher risk and receive interventions and accommodations even in the absence of formal assessment to prevent delays in care.

scholarly journals Lyme Arthritis in Children on the Uptick in Western New York Area

2019 ◽  
Vol 12 ◽  
pp. 117954411989085
Author(s):  
Lauren N Lucente ◽  
Aseel Abu-Dayya ◽  
Teresa Hennon ◽  
Shamim Islam ◽  
Brian H Wrotniak ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
Lyme Disease ◽  
Clinical Features ◽  
Health Care Providers ◽  
Pediatric Population ◽  
Geographic Area ◽  
Rapid Onset ◽  
Lyme Arthritis ◽  
Care Providers

Objective: This study explores a suspected increasing incidence of Lyme arthritis in the Western New York pediatric population. In addition, we aim to describe a clinical picture of Lyme arthritis and the clinical features that distinguish it from other forms of arthritis. Methods: Patients diagnosed with Lyme arthritis between January 2014 and September 2018 were identified using International Classification of Diseases—10th Revision (ICD 10) codes for Lyme disease and Lyme arthritis. Patients were included in the study if they (1) exhibited arthritis, (2) tested positive for Lyme antibodies, and (3) exhibited a positive Western blot. Results: A total of 22 patients were included in the study. There was a general trend toward an increasing number of cases of Lyme arthritis over the 45-month observation period. We identified 1 case in each 2014 and 2015, 4 cases in 2016, 7 in 2017, and 9 in the first 9 months of 2018. In total, 17 patients had arthritis as their only symptom at the time of diagnosis and 10 patients had a rash or a history that prompted suspicion of Lyme disease. The knee was the most frequent joint (86.4% of patients), and patients typically had 2 or fewer joints affected (86.4% of patients). Conclusions: A significant increase ( P = .02) in Lyme arthritis cases was observed at Oishei Children’s Hospital of Buffalo. Lyme arthritis may clinically present similarly to other forms of arthritis, such as oligoarticular juvenile idiopathic arthritis, so health care providers should be aware of distinguishing clinical features, which include rapid onset of swelling and patient age. Because the geographic area of endemic Lyme disease is expanding, all health care providers need to be aware of Lyme arthritis as a possible diagnosis.

scholarly journals Effect of Various OR Noise on Fine Motor Skills, Cognition, and Mood

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Cara Marie Rogers ◽  
Hannah Palmerton ◽  
Brian Saway ◽  
Devin Tomlinson ◽  
Gary Simonds
Keyword(s):  
Operating Room ◽  
Verbal Learning ◽  
Mood States ◽  
Mood Disturbance ◽  
Fine Motor ◽  
Profile Of Mood States ◽  
Total Mood Disturbance ◽  
Motor Dexterity ◽  
The Impact ◽  
Surgeon Performance

Background. The amalgam of noises inherent to the modern-day operating room has the potential of diluting surgeon concentration, which could affect surgeon performance and mood and have implications on quality of care and surgeon resilience. Objective. Evaluate the impact of operating room environmental noises on surgeon performance including fine motor dexterity, cognition, and mood. Methods. 37 subjects were tested under three different environmental noise conditions including silence, a prerecorded soundtrack of a loud bustling operating room, and with background music of their choosing. We used the Motor Performance Series to test motor dexterity, neuropsychological tests to evaluate cognitive thinking, and Profile of Mood States to test mental well-being. Results. Our results showed that typical operating room noise had no impact on motor dexterity but music improved the speed and precision of movements and information processing skills. Neurocognitive testing showed a significant decrement from operating room noise on verbal learning and delayed memory, whereas music improved complex attention and mental flexibility. The Profile of Mood States found that music resulted in a significant decrease in feelings of anger, confusion, fatigue, and tension along with decreased total mood disturbance, which is a measure of psychological distress. Loud operating room noise had a negative impact on feelings of vigor but no increase in total mood disturbance. Conclusion. Our results suggest that loud and unnecessary environmental noises can be distracting to a surgeon, so every effort should be taken to minimize these. Music of the surgeons’ choosing does not negatively affect fine motor dexterity or cognition and has an overall positive impact on mood and can therefore be safely practiced if desired.

scholarly journals Hyperosmia in Lyme disease

2014 ◽  
Vol 72 (8) ◽  
pp. 596-597 ◽  
Author(s):  
Basant K. Puri ◽  
Jean A. Monro ◽  
Peter O. O. Julu ◽  
Michele C. Kingston ◽  
Mussadiq Shah
Keyword(s):  
Lyme Disease ◽  
Body Mass ◽  
Systematic Study ◽  
Controlled Study ◽  
Cranial Neuropathy ◽  
Neurological Involvement ◽  
Sensory Sensitivity ◽  
Sense Of Smell ◽  
Control Subjects

Neurological involvement in Lyme disease has been reported to include meningitis, cranial neuropathy and radiculoneuritis. While it is known that in some cases of asceptic meningitis patients may develop hyperosmia, the association between hyperosmia and Lyme disease has not previously been studied. Objective To carry out the first systematic study to ascertain whether hyperosmia is also a feature of Lyme disease. Method A questionnaire regarding abnormal sensory sensitivity in respect of the sense of smell was administered to 16 serologically positive Lyme disease patients and to 18 control subjects. Results The two groups were matched in respect of age, sex and body mass. None of the 34 subjects was suffering from migraine. Eight (50%) of the Lyme patients and none (0%) of the controls suffered from hyperosmia (p=0.0007). Conclusion This first systematic controlled study showed that Lyme disease is associated with hyperosmia.

QS54. Use of a Computerized Surgical Simulator to Evaluate Gross and Fine Motor Dexterity

2008 ◽  
Vol 144 (2) ◽  
pp. 291
Author(s):  
Aaron Goldberg ◽  
Stephanie R. Goldberg ◽  
James P. Neifeld
Keyword(s):  
Fine Motor ◽  
Surgical Simulator ◽  
Motor Dexterity

Computerized Pharmaceutical Algorithm Reduces Medication Administration Errors During Simulated Resuscitations

2010 ◽  
Vol 15 (4) ◽  
pp. 274-281
Author(s):  
Girish G. Deshpande ◽  
Adalberto Torres ◽  
David L. Buchanan ◽  
Susan C. Shane Gray ◽  
Suzanne C. Brown ◽  
...  
Keyword(s):  
Critical Care ◽  
Medication Errors ◽  
Point Of Care ◽  
Pediatric Population ◽  
Correct Recall ◽  
Medication Administration ◽  
High Rate ◽  
Controlled Study ◽  
Usual Practice ◽  
Clinical Scenarios

ABSTRACT OBJECTIVE Medication errors involving intravenous medications continue to be a significant problem, particularly in the pediatric population due to the high rate of point-of-care and weight-adjusted dosing. The pharmaceutical algorithm computerized calculator (pac2) assists in converting physician medication orders to correct volumes and rates of administration for intravenous medications. This study was designed to assess the efficacy of the pac2 in simulated clinical scenarios of point-of-care dosing. Methods The study design was a within-subject controlled study in which 33 nurses from pediatrics, pediatric critical care, or critical care (mean nursing experience of 10.9 years) carried out various point-of-care medication-dosing scenarios with and without the aid of the pac2. RESULTS Use of the pac2 resulted in a significantly higher percentage (mean [95% CI]) of medication volumes calculated and drawn accurately (91% [87–95%] versus 61% [52–70%], p<0.0001), a higher percentage of correct recall of essential medication information (97% [95–99%] versus 45% [36–53%], p<0.0001), and better recognition of unsafe doses (93% [87–99%] versus 19% [12–27%], p<0.0001) as compared to usual practice. The pac2 also significantly reduced average medication calculation times (1.5 minutes [1.3–1.7 minutes] versus 1.9 minutes [1.6–2.2 minutes], p=0.0028) as compared to usual practice. CONCLUSIONS The pac2 significantly improved the performance of drug calculations by pediatric and critical care nurses during simulated clinical scenarios designed to mimic point-of-care dosing. These results suggest that the pac2 addresses an area of safety vulnerability for point-of-care dosing practices and could be a useful addition to a hospital's overall program to minimize medication errors.

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