Changes in stroke rehabilitation during the SARS-CoV-2 shutdown in Switzerland

Introduction: Many stroke survivors require continuous outpatient rehabilitation therapy to maintain or improve their neurological functioning, independence, and quality of life. In Switzerland and many other countries, the shutdown to contain SARS-CoV-2 infections led to mobility restrictions and a decrease in therapy delivery. This study investigated the impact of the COVID-19 shutdown on stroke survivors’ access to therapy, physical activity, functioning and mood. Methods: A prospective observational cohort study in stroke subjects. At 4 time-points (before, during, after the shutdown, and at 3-month follow-up), the amount of therapy, physical activities, motor function, anxiety, and depression were assessed. Results: Thirty-six community-dwelling stroke subjects (median 70 years of age, 10 months post-stroke) were enrolled. Therapy reductions related to the shutdown were reported in 72% of subjects. This decrease was associated with significantly extended sedentary time and minimal deterioration in physical activity during the shutdown. Both parameters improved between reopening and 3-month follow-up. Depressive symptoms increased slightly during the observation period. Patients more frequently reported on self-directed training during shutdown. Conclusion: The COVID-19 shutdown had measurable immediate, but no persistent, effects on post-stroke outcomes, except for depression. Importantly, a 2-month reduction in therapy may trigger improvements when therapy is fully re-initiated thereafter.

Neonatal Hemoglobin Levels in Preterm Infants Are Associated with Early Neurological Functioning

<b><i>Background:</i></b> Neonatal anemia may compromise oxygen transport to the brain. The effects of anemia and cerebral oxygenation on neurological functioning in the early neonatal period are largely unknown. <b><i>Objective:</i></b> This study aimed to determine the association between initial hemoglobin levels (Hb) and early neurological functioning in preterm infants by assessing their general movements (GMs). <b><i>Methods:</i></b> A retrospective analysis of prospectively collected data on preterm infants born before 32 weeks of gestation was conducted. We excluded infants with intraventricular hemorrhage &#x3e; grade II. On day 8, we assessed infants’ GMs, both generally as normal/abnormal and in detail using the general movement optimality score (GMOS). We measured cerebral tissue oxygen saturation (r_cSO₂) on day 1 using near-infrared spectroscopy. <b><i>Results:</i></b> We included 65 infants (median gestational age 29.9 weeks [IQR 28.2–31.0]; median birth weight 1,180 g [IQR 930–1,400]). Median Hb on day 1 was 10.3 mmol/L (range 4.2–13.7). Lower Hb on day 1 was associated with a higher risk of abnormal GMs (OR = 2.3, 95% CI: 1.3–4.1) and poorer GMOSs (<i>B</i> = 0.9, 95% CI: 0.2–1.7). Hemoglobin strongly correlated with r_cSO₂ (rho = 0.62, <i>p</i> &#x3c; 0.01). Infants with lower r_cSO₂ values tended to have a higher risk of abnormal GMs (<i>p</i> = 0.06). After adjusting for confounders, Hb on day 1 explained 44% of the variance of normal/abnormal GMs and r_cSO₂ explained 17%. Regarding the explained variance of the GMOS, this was 25% and 16%, respectively. <b><i>Conclusions:</i></b> In preterm infants, low Hb on day 1 is associated with impaired neurological functioning on day 8, which is partly explained by low cerebral oxygenation.

Combining Kangaroo Care and Live-Performed Music Therapy: Effects on Physiological Stability and Neurological Functioning in Extremely and Very Preterm Infants

Interventions such as kangaroo care (KC) and live-performed music therapy (LPMT), are increasingly used to facilitate stress reduction in neonates. This study aims to investigate the effect of combining the two on physiological responses and neurological functioning in very preterm infants. Infants received six sessions of LPMT. KC was added to one LPMT session. Physiological responses included heart rate, respiratory rate and oxygen saturation. We videotaped infants for 30 min before and after two sessions to assess general movements (GMs). We included 17 infants, gestational age median 26.0 weeks (IQR 25.6–30.6 weeks), of whom six were males. Combined interventions showed a decrease in heart rate from mean 164 bpm before to 157 bpm during therapy, p = 0.001. Oxygen saturation levels increased during combination therapy from median 91.4% to 94.5%, p = 0.044. We found no effects of LPMT or combined interventions on GMs. Infants with a postnatal age (PNA) < 7 days generally seem to display less optimal GMs after therapy compared with infants with a PNA >7 days. In conclusion, combining interventions is equally beneficial for physiological stability and neurological functioning as LPMT alone. Future studies should focus on the effects of this combination on parent-infant bonding.

Agitation Following Severe Traumatic Brain Injury Is a Clinical Sign of Recovery of Consciousness

Objective: Severe traumatic brain injury (sTBI) often results in disorders of consciousness. Patients emerging from coma frequently exhibit aberrant behaviors such as agitation. These non-purposeful combative behaviors can interfere with medical care. Interestingly, agitation is associated with arousal and is often among the first signs of neurological recovery. A better understanding of these behaviors may shed light on the mechanisms driving the return of consciousness in sTBI patients. This study aims to investigate the association between posttraumatic agitation and the recovery of consciousness.Methods: A retrospective chart review was conducted in 530 adult patients (29.1% female) admitted to Stony Brook University Hospital between January 2011 and December 2019 with a diagnosis of sTBI and Glasgow Coma Scale (GCS) ≤8. Agitation was defined as a Richmond Agitation Sedation Scale (RASS) &gt; +1, or any documentation of equivalently combative and violent behaviors in daily clinical notes. The ability to follow verbal commands was used to define the recovery of consciousness and was assessed daily.Results: Of 530 total sTBI patients, 308 (58.1%) survived. Agitation was present in 169 of all patients and 162 (52.6%) of surviving patients. A total of 273 patients followed commands, and 159 of them developed agitation. Forty patients developed agitation on hospital arrival whereas 119 developed agitation later during their hospital course. Presence of in-hospital agitation positively correlated with command-following (r = 0.315, p &lt; 0.001). The time to develop agitation and time to follow commands showed positive correlation (r = 0.485, p &lt; 0.001). These two events occurred within 3 days in 54 (44.6%) patients, within 7 days in 81 (67.8%) patients, and within 14 days in 96 (80.2%) patients. In 71 (59.7%) patients, agitation developed before command-following; in 36 (30.2%) patients, agitation developed after command-following; in 12 (10.1%) patients, agitation developed on the same day as command-following.Conclusion: Posttraumatic agitation in comatose patients following sTBI is temporally associated with the recovery of consciousness. This behavior indicates the potential for recovery of higher neurological functioning. Further studies are required to identify neural correlates of posttraumatic agitation and recovery of consciousness after sTBI.

Regulation of Protein Synthesis: an Approach to Treat Autistic Spectrum Disorder (ASD)

: Autistic Spectrum Disorder (ASD) is a disorder with different etiologies and poor elucidation, characterized by changes in social and cognitive skills. ASD has been characterized that affect large numbers of people in the world. In spite of its great importance, surprisingly just a modest progress has been achieved toward comprehending this pathology and designing new therapies. The molecular dysfunctions observed in people with autism are evidenced by the interference in the synthesis of synaptic proteins, which impairs their development and plasticity, leading to characteristics of individuals with ASD. The present work investigates in detail the mTOR pathway and the proteins related to its regulation and neurological functioning. The path of protein synthesis and translation is promising for the treatment of various disorders and its elucidation may, for example, result in drugs that facilitate the diagnosis and open the range of treatments, improving the quality of life of ASD patients.

Psychiatric Aspects of Epilepsy

A seizure is defined as transient change in neurological functioning which is characterised by hypersynchronous discharges of neurons in the brain regions whereas epilepsy is defined as a syndrome consisting of various recurrent seizures and it is associated with the psychological and neuropathological effects. Early recognition and management of psychiatric disorders in patients with epilepsy is extremely important, because it improves the quality of life and aids in better seizure control. Newer antiepileptics with less interaction with psychotropics and less behavioural manifestations should be used for management of epilepsy; and psychotropics having low potential for lowering seizure threshold are generally preferred. A holistic approach to assess psychiatric comorbidity and judicious use of medicine can help in comprehensive patient care planning and reduced health burden.

What are the Neurocognitive Features of Hoarding?

What do we know about brain patterns in hoarding? In this chapter, the word neurocognitive refers to two aspects of the brain—neurological functioning and how the brain processes information, both of which appear to be affected in people who hoard objects. Neurological functions...

A possible effect of montelukast on neurological aging examined by the use of register data

Background The leukotriene receptor antagonist montelukast has been shown to rejuvenate aged brains in rats; however, data on humans are still scarce. Objective To investigate if montelukast may alleviate degenerative neurological changes using a register data. Setting Norwegian registry data analyses. Method The present observational study was based on data from the Norwegian Prescription Database and the Tromsø Study. The former has information regarding the use of prescription medicine; the latter includes tests for brain function such as subjective memory and finger-tapping. Multivariate linear regression analyses were performed to see how the use of various medications correlated with the test results, correcting for likely confounders. Main outcome measure Results on seven different tests considered relevant for neurological health were used as outcome. Results Previous use of montelukast correlated with improved scores on cognitive or neurological functioning (F = 2.20, p = 0.03 in a multivariate test). A range of other medications were tested with the same algorithm, including drugs acting on the immune system, but none of them correlated with (overall) significantly improved test results. Conclusion The present data suggest that montelukast may alleviate degenerative neurological changes associated with human aging.