Standardization and Validation of the Flash Visual Evoked Potential-P2 Conversion Scores in the Diagnosis of Amnestic Mild Cognitive Impairment and Alzheimer's Dementia

Amnestic mild cognitive impairment (aMCI), which is characterized by normal daily activity, but a significant decline in episodic memory, is now widely accepted as a risk factor for the development of Alzheimer's dementia (AD). Research suggests that many of the same neuropathological changes associated with AD also occur in patients diagnosed with aMCI. A recent review of the literature revealed that the latency of the flash visual-evoked potential-P2 (FVEP-P2) may possess pathognomonic information that may assist in the early detection of aMCI. While standards exist for the recording of FVEP-P2, individual clinics often use recording parameters that may differ, resulting in latencies that may not generalize beyond the clinic that produced them. The present article illustrates the process by which the FVEP-P2 latency can be standardized across clinics using FVEP-P2 Conversion Scores. We then demonstrate the diagnostic accuracy of the newly developed scores. Method: In the present investigation, we used the previously unpublished data containing the FVEP-P2 latencies of 45 AD and 60 controls. Result: We were able to demonstrate the process by which individual clinics may first standardize FVEP-P2 latencies and then examine patient performance using FVEP-P2 Conversion Scores, providing clinicians with a richer context from which to examine the patient performance. Conclusion: Consistent with the findings of previous research, the findings of the present investigation support the use of the FVEP-P2 Conversion Scores in the diagnosis of AD. Future directions, including the modification of recording parameters associated with the FVEP-P2, are also discussed.

Re-AbilityLab

This study aims to show the methodology of implementation of the Skills Laboratories (Re-AbilityLab) at the Institute of Physical Medicine and Rehabilitation of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo. These Skill Labs offer activities to maximize patient performance by promoting specific functional outcomes, which are described in the International Classification of Functionality. The activities are dynamic and carried out by a multidisciplinary team in the areas of health, education, and management. Innovation and strategic aspects of the knowledge economy are structured in the management of this project to enhance the achievement of purposes and results. The implementation process includes solutions adopted, definition of responsibilities, difficulties faced, benefits, functionality of the methods applied, and lessons learned. Mapping the process from the current scenario to the desired contributes to the transition from a care model (linear, refractory, obsolete) to an exponential model of care (intangibles, incremental innovation).

VestAid: A Tablet-Based Technology for Objective Exercise Monitoring in Vestibular Rehabilitation

(1) Background: Current vestibular rehabilitation therapy is an exercise-based approach aimed at promoting gaze stability, habituating symptoms, and improving balance and walking in patients with mild traumatic brain injury (mTBI). A major component of these exercises is the adaptation of the vestibulo-ocular reflex (VOR) and habituation training. Due to acute injury, the gain of the VOR is usually reduced, resulting in eye movement velocity that is less than head movement velocity. There is a higher chance for the success of the therapy program if the patient (a) understands the exercise procedure, (b) performs the exercises according to the prescribed regimen, (c) reports pre- and post-exercise symptoms and perceived difficulty, and (d) gets feedback on performance. (2) Methods: The development and laboratory evaluation of VestAid, an innovative, low-cost, tablet-based system that helps patients perform vestibulo-ocular reflex (VORx1) exercises correctly at home without therapist guidance, is presented. VestAid uses the tablet camera to automatically assess patient performance and compliance with exercise parameters. The system provides physical therapists (PTs) with near real-time, objective (head speed and gaze fixation compliance), and subjective (perceived difficulty and pre- and post- exercise symptoms) metrics through a web-based provider portal. The accuracy of the head-angle and eye-gaze compliance metrics was evaluated. The accuracy of estimated head angles calculated via VestAid’s low-complexity algorithms was compared to the state-of-the-art deep-learning method on a public dataset. The accuracy of VestAid’s metric evaluation during the VORx1 exercises was assessed in comparison to the output of an inertial measurement unit (IMU)-based system. (3) Results: There are low mean interpeak time errors (consistently below 0.1 s) across all speeds of the VORx1 exercise, as well as consistently matching numbers of identified peaks. The spatial comparison (after adjusting for the lag measured with the cross-correlation) between the VestAid and IMU-based systems also shows good matching, as shown by the low mean absolute head angle error, in which for all speeds, the mean is less than 10 degrees. (4) Conclusions: The accuracy of the system is sufficient to provide therapists with a good assessment of patient performance. While the VestAid system’s head pose evaluation model may not be perfectly accurate as a result of the occluded facial features when the head moves further towards an extreme in pitch and yaw, the head speed measurements and associated compliance measures are sufficiently accurate for monitoring patients’ VORx1 exercise compliance and general performance.

Evolution of writing impairment in spanish patients with alzheimer's disease

Background: Although some studies suggest that writing difficulties may be one of the early symptoms of Alzheimer's disease (AD), they have been scarcely studied compared to oral language. Particularly noteworthy is the paucity of longitudinal studies that enable the observation of writing impairment as cognitive decline progresses. Objective: The aim of this study was to examine the characteristics of writing in patients with AD and to monitor the deterioration of their performance over a follow-up period. Methods: Sixty-four participants (half with AD and half healthy elderly) were compared in a word and pseudo-word dictation task. Patients were evaluated every 6 months over a 2.5 year follow-up period. Results: The evolution of patient performance and error profile shows a typical pattern of deterioration, with early damage to the lexical pathway, which later extends to the phonological pathway and eventually affects peripheral processes. Conclusion: These results confirm the presence of writing difficulties from the early stages of AD, supporting the value of this task for early diagnosis. Furthermore, it allows us to explain the contradictory data obtained in previous investigations.

The Role of Fatigue in the Aging Swallow: A Review

Fatigue is a term commonly used to describe patient performance and/or subjective experience in the evaluation and management of swallowing disorders (known as dysphagia). There is an association between fatigue and aging, as well as fatigue and many dysphagia-causing diseases/disorders. Therefore, speech-language pathologists (SLPs) are justifiably aware of and concerned about the potential impact of fatigue on swallowing performance and mealtime behavior. However, there is minimal agreement on and understanding of what constitutes swallowing-related fatigue, how it is identified and measured, who is at risk, and its impact on swallowing function, overall health, and quality of life. The purpose of this review is to discuss the role of fatigue in swallowing and eating behavior in the context of aging, and how fatigue may be measured and managed clinically. We review the concept of fatigue and its clinical implications for swallowing function and mealtime behavior through the dichotomous framework of self-perceived fatigue versus measurable fatigability. Quantitative fatigability and patient-reported fatigue are discussed. We conclude with implications for future research.

A Study on the Standard Setting, Validity and Reliability of the Standardized Patient Performance Rating Scale – Student Version

BackgroundA standardized patient is a healthy person, trained to role-play a patient who gives feedback on the performance of the student. During the clinical skills training of students, the performance of a standardized patient is essential for the effectiveness of clinical education. MethodsIn this study, we have developed and determined the psychometric properties and standard-setting of the 9-item "Standardized Patient Performance Rating Scale – Student Version," which is designed for assessing the individual performance of standardized patients. For the scale development process, 702 medical students and seven educators participated in the study. Exploratory and confirmatory factor analyses were performed. Cronbach's alpha internal consistency coefficient and split-half reliability coefficient were calculated. For the standard-setting study, the extended Angoff method was used. ResultsAs a result of the exploratory factor analysis, the scale had a single-factor structure as confirmed by confirmatory factor analysis. Cronbach's alpha internal consistency coefficient was calculated as 0.91. The score of a standardized patient at the borderline was 24.11 out of 45.Conclusions"Standardized Patient Performance Rating Scale – Student Version" is a valid and reliable scale for assessing standardized patients' performances, and can be used for the standardized patient selection and evaluation process in the health sciences.