THE EFFECTS OF VARIOUS HEEL SLOPES ON LUMBOSACRAL BIOMECHANICAL ANGLES IN STUDENTS WITH HYPER LORDOSIS

Posture disorders in school-age children are highly frequent. Poor movement and lack of physical mobility are the main causes of physical weaknesses. Thus, corrective exercises with the aim of solving these problems are significant. The aim of this study was an evaluation of the effects of various heel slopes on lumbosacral biomechanical angles in students with hyperlordosis. In this quasi-experimental study, 15 female students who were di- agnosed with hyperlordosis, participated in this study. They were divided into 3 groups (n=5) and performed corrective exercises on +3.7°, 0°, and -3.7° slopes for 8 weeks, 3 times a week. The changes in the lumbar lordosis angle (LLA), sacral based angle (SBA), and lumbosacral angle (LSA) were determined. Data were analyzed by SPSS 18 software using non-parametric test followed by the Krus- cal-wallis test. P<0.05 was considered significant. The results indicated no significant difference regarding the changes in LLA, SBA, and LSA in students with hyperlordosis (p>0.05) de- spite the decrease in the means of the angles in all groups. The results showed that by increasing the heel slope, the lumbo - sacral slope decreases also the lumbosacral angle decreases by decreasing the heel slope, this may indicate an association between these angles.The findings can help parents choose more appropriate shoes for their children to both prevent the incidence of posture dis- orders during childhood and spinal disorders in adulthood.

NEUROPSYCHOLOGICAL EVALUATION OF NARRATIVE DISCOURSE PATTERNS IN INDIVIDUALS WITH EARLY STAGE VASCULAR DEMENTIA VS. PATIENTS WITH EARLY STAGE ALZHEIMER’S DISEASE

Individuals in the early stages of dementia may demonstrate language difficulties. The aim of the study was an evaluation of the differences in narrative discourse abilities across two types of dementia, i.e., Vascular Dementia (VaD) and Alzheimer’s Disease (AD) in comparison to the young and old elderly. The AD and VaD groups displayed a lower performance than the age-matched YE on tasks involving reasoning. The VaD partici- pants outperformed patients with AD in verbal memory and narrative discourse. Discourse macrostructure analyses showed that the VaD reproduced more propositions than did the AD participants, but that these were comparable to YE and OE. There were more conjunctions in narratives reproduced by the VaD participants as compared to other groups, although this tendency was only present in the story but not in fairy tale reproductions themselves. Individ- uals in the AD group had more difficulties than YE and OE individuals in figuring out the moral of fairy tales. Clinical and control groups reproduced the microstructure and superstructure of texts comparatively well. Discourse recall correlated with performance on verbal memory, attention/working memory, and reasoning. Differences in narrative discourse abilities were found. Alzheimer’s Disease (AD) patients scored lower in verbal memory than did Vascular Dementia (VaD) patients. Both groups however obtained lower results than the young and old elderly.

ERPS AS AN INDEX OF IMPAIRED WORKING MEMORY IN AN ISCHEMIC BRAIN STROKE APHASIC PATIENT AWAKENED FROM A LONG-TERM COMA FOLLOWING AN AMPHETAMINE OVERDOSE

Nowadays, amphetamines constitute the prescription drugs most commonly abused by adolescents and young adults (Berman, O’Neill, Fears et al. 2008). The prevalence of problematic (mainly illegal) use of amphetamines as a stimulant by college students, and here especially before serious examinations, has also been rising. This fact represents a serious public health concern. The patient, aged 19, was awakened from from a long-term coma that had lasted 21 days following an amphetamine overdose and manifested tetraparesis, cortical blindness and deficits in cognitive and emotional processes. After a year of rehabilitation the majority of symptoms had disappeared, but cortical blindness andworking memory deficits remained. In addition, frontal lobe syndrome symptoms appeared. After two years of therapy as a result of immense tiredness caused by all an night wedding reception she started to manifest Charles-Bonnet syndrome. She experienced strange visual sensations such as visual hallucinations and saw various non-existing shapes (coloured blots, patterns and fireworks of vivid colours). She also saw objects (often terrifying) as well as animals (mainly African) and people with deformed faces and long teeth, and persons in African dress with feathers and coral beads in their hair. Her real identity was not remembered by the patient for longer than 2 hours and even then she insisted on being referred to as Shakira. She was given a qEEG examination (in open and closed eyes conditions) and ERPs with the use of auditory stimuli at the period when the hallucinations (to a small degree) still occurred. Studies conducted into the functional neuroimaging of the brain work in milliseconds in the examined patient can explain her symptoms. A comparison of the subject’s ERPs with the grand average of ERPs in healthy controls shows that the N170 and N 250 components are impaired in the subject: the occipital-temporal area of the subject brain shows a strong positivity instead of negativities. This positivity might reflect an enhanced reactivity of neurons in the corresponding area induced by the removal of lateral inhibition from the neurons as a result of local damage. ------------------------------------------------------------------------------------------------------------------------------------

STUDY OF UNILATERAL SPATIAL NEGLECT IN PARKINSON'S PATIENTS

In Africa, few studies are interested in unilateral spatial neglect (NSU) in Parkinson's disease. However, this syndrome is a deficit to detect, respond to or orientate towards meaningful stimuli (Heil- man, KM 1973), observable after an injury affecting the non-dominant hemisphere for language. The significant handicap it entails justifies the need for early diagnosis and care. The NSU study is mo- tivated by its link with neurocognitive phenomena that are important on the theoretical level (attention, visuospatial and perceptual awareness). The objective is to study USN in Parkinson's pa tients, followed and hospitalized at the Neurology Department of Hassan II University Hospital in Fez. The visual-graphic test that has been used to detect this pathology is that of Bell's test. The test focuses on the detection of targets placed among several stimuli on a sheet of A4 paper. The material included 120 people: 60 Parkinsonian patients: 34 men (56,7%), and 26 women (43,3%) and 60 control subjects: 34 men (56,7%), and 26 women (43,3%). The groups were matched by age and sex. Different aspects of neglect have been observed throughout the Bell's test. It was found that total omission of bell figures was significantly influenced by age, being less frequent in the 35-49 age group in both groups, and higher in the elderly (50-80 years), as well the level of education. It have been reduced considerably with the increase in education. The hand used and the laterality had no effect; t = 3.76 degrees of freedom (df) = 108.27 and p = 0.000. Unilateral spatial neglect has a negative effect in subjects with Parkin- son's disease. It deserves to be systematically sought for a better clinical evaluation and therapeutic management of the patients.

AN EVALUATION OF TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) IN THE REDUCTION OF OCCUPATIONAL BURNOUT SYNDROME IN NURSES

The aim of the study was to answer the question as to whether transcranial direct current stimulation (tDCS) is more effective in reducing burnout syndrome in nurses than the commonly used individual psychotherapy. The study included 40 nurses from various health care facilities located in the Lesser Poland and Podkarpackie Voivodeship suffering from burnout syndrome. They were assigned to the experimental group while 20 to the control group. Two different therapy models were used: the experimental group (A) included 20 of the nurses treated with the use of transcranial direct current stimulation (tDCS), four times a week for 8 weeks, in sessions that lasted initially 10, then 15, 20, 25 and finally 30 minutes and the control group (B) included 20 of the nurses treated with individual psychotherapy employed for 8 weeks, once a week for 30 minutes. To evaluate the results we used: screening with a clinical interview, the Mini–Mental State Examination (MMSE), the Beck Depression Inventory and a Polish adaptation of the Italian questionnaire created by Massimo Sentinello (LBQ). Treatment was provided. The transcranial direct current stimulation (tDCS) used in Group A is more effective in reducing many symptoms than is the case with individual psychotherapy. Comparing the intragroup effects, it was found that the tDCS employed in Group A significantly reduced the intensity of depressive symptoms among the surveyed nurses [F (1.38) = 57.62; p <0.001; η2 = 0.603] while the individual psychotherapy used in Group B failed to produce a statistically significant effect [F (1.38) = 1.794; p = 0.188; η2 = 0.045]. These include a reduction of depression, a reduction in chronic psychophysical exhaustion, vegetative problem reduction, and the improvement of nurse-patient relations. Neurotherapy with the use of transcranial direct current stimulation (tDCS) is more effective in reducing burnout syndrome than the commonly used individual psychotherapy. It also helps to return these nurses to full professional activity. The studies presented above recommend the use of new neurotechnologies in therapy as a result of their usefulness and non-invasive character.

NEUROPSYCHOLOGICAL FACTORS OF SUBJECTIVE COGNITIVE COMPLAINTS OF THE OLDER ADULTS

Subjective cognitive complaints (SCCs) are defined as belief of the decline of a cognitive condition compared with an earlier period of functioning. Many studies have shown the relationship between SCCs with objective neuropsychological results as well its dependency on psychological characteristics. Considering the complex nature of SCCs, this study tested the relationship between SCCs reported in the attention domain with the results obtained in neuropsychological attention tasks, as well as with psychological cha racteristics and among complaints reported in various domains of functioning. Sixty participants over 60 years of age took part in the study. Subjects were tested for the intensity of SCCs in everyday func tioning, psychological characteristics (mood; anxiety, state and trait; and personality traits) and various aspects of attention domain (switching, divided, and focus). The SCC intensity reported in various areas of functioning was associated with each other as well as with psychological characteristics (personality traits, anxiety, and mood/depression). There were no significant relations between the SCC intensity reported in the attention domain and the outcomes obtained in neuropsychological attention tasks. Our results showed that the intensity of SCCs may be a result of subjects’ psychological characteristics and that the tendency to report complaints in various spheres of functioning simultaneously may be observed. It seems to be important to consider that SCCs are related to several psychological factors when it is included in a cognitive diagnosis and treated as a direct indicator of a cognitive condition.

FUNCTIONAL NEUROMARKERS IN PARKINSON’S DISEASE (PD)

New neurotechnologies which help to study not only the structure but also brain work, especially in milliseconds, allow for a more accurate diagnosis of a given disease entity. The aim of our study was to characterize the functional neuromarkers, including a new neuromarker, that is high rolandic beta, in Parkinson’s disease (PD). A 76-year-old male patient, a university professor, a widower, in an intimate relationship with a beloved partner, was tested in the Reintegration and Training Center of the Polish Society of Neuropsychology. Five years earlier (when he was 71 years old), following long-term stress, he had had a transient ischemic attack (TIA). In the following years he experienced two neurological episodes, and was diagnosed, on the basis of MRI findings and clinical symptoms, with vascular (multi-infarct) Parkinsonism. A sudden deterioration in his functioning, including hand tremors at rest, bradykinesia (motor slowdown), asymmetrical gait difficulties, postural instability, and falls typical for PD, as well as MRI finding (the appearance of ‘a swallow tail ’ on the left side, and the lack on the right of the substantia nigra within the midbrain) was the cause of further differential diagnosis. He was assessed using the HBI methodology (Kropotov 2016; Pąchalska, Kaczmarek, Kropotov 2014). EEG was recorded from 19 scalp sites, in resting state conditions, with eyes open and eyes closed, and during the cued GO/NOGO tasks with animal/plants as GO/NOGO stimuli. The electrodes were applied according to the International 10-20 system. The EEG was recorded referentially to linked ears, allowing for a computational re-referencing of the data (remontaging). Event related potentials (ERPs) were used to assess the functional changes manifested by the patient. To compare our patient with healthy controls we used the normative Human Brain Index (HBI), a database obtained through joint research by Swiss, Norwegian, Polish and Russian neuroscientists (Kropotov 2018). This database included behavioral parameters and ERP measures in 6 different neuropsychological tasks for 1000 healthy subjects. What is striking, no signs of cognitive dysfunction was found; however observed were an asymmetrical frontal lobe alpha (a neuromarker of depression) and excessive Rolandic beta (a neuromarker of Parkinson’s disease). We will discuss the results on the basis of recent subject literature findings, including the personal factors that might influenced the process of the diagnosis and treatment of this patient, ones which should be also taken into account in any differential diagnosis. The obtained results show the importance of using HBI methodology in clinical practice. Physicians involved in the diagnosis and treatment of those with progressive ambulatory impairment and an abnormal white matter (WM) signal on neuroimaging, should when formulating any differential diagnosis consider the use of this approach. ------------------------------------------------------------------------------------------------------------------------------------

COGNITIVE FUNCTIONING AND SAFETY DETERMINANTS IN THE WORK OF A TRAIN DRIVERS

The reports of committees investigating the causes of rail accidents indicate the significance of the so-called human factor (e.g. UTK, 2019). In addition to issues related to perso nality functioning, the organization and culture of work, this also includes variables related to the cognitive functioning of train drivers themselves. These are significant factors that determine the occurrence of accidents that result from ignoring or not spotting railway signals and signs. The purpose of this study was to verify the relationship between cognitive functioning and safety determinants, which was measured using an eye-tracking technique. The application of this technique was intended to check its usefulness in the field of railway traffic safety and to achieve an approximate simulation environment of the real working conditions of a train driver. In the present study, the Vienna Test System was used as a me - thod for the determination of cognitive functioning. Based on the variables described in the subject literature, the following tests were applied: Determination Test, Visual Memory Test, Visual Pursuit Test, Reaction Time, Cognitrone, Signal Detection and Vigilance. In addition to computer cognitive tests, an eye-tracking test method was designed based on a film recorded in real train-driving situation. Measures describing areas of interest (AOI) that are crucial for safety were analysed. Due to the pilot nature of the research, only 10 passenger train drivers participated in the study. The results of the study showed a link between the cognitive functioning of the train drivers and visual security determinants. Significant correlations were found with stress tolerance resulting from cognitive overload, visual memory, alertness and concentration ability under time pressure. The study confirmed the significant role of the train driver's cogni- tive functioning in the analysis and perception of safety-critical signals. The use of an eye-tracking method has delivered results that are in agreement with studies based on other methods. This pro- vides a sound basis for the continuation of research using eye- tracking in the assessment of rail transport safety. In the future, the research should be extended to include an analysis of the effect of demographic and situational variables (types of signalling devices and signage) and a broader model of the relationship between cog- nitive functioning and the driver's visual attention. This will provide data that is crucial for the prevention of railway incidents and the development of training plans for train drivers.

REHABILITATION AND MODULATION AIMED AT AMELIORATING AWARENESS IN ANOSOGNOSIA FOR HEMIPLEGIA

Anosognosia for hemiplegia is a multifaceted syndrome that has a detrimental impact on the patient. Various theories based on behavioural and neuroanatomical data have been proposed to explain the mechanisms underlying the symptoms. These approaches have resulted in the development of a number of different proce- dures aimed at reducing symptoms or enhancing residual aware- ness. The article reviews rehabilitation attempts and their effects on individual cases and groups of patients. A selection of material was made using indexed articles published between 1987 and 2019. The inclusion criteria were: i) the presence of a neuropsychological assessment and ii) the presence of one or more methods specifically used to reduce AHP symptoms, or to enhance residual forms of awareness. The review indicates that intervention procedures have moved from bottom-up to more cognitive and metacognitive approaches. In fact, initially anosognosia for hemiplegia was considered to be a co-oc- current symptom of other neuropsychological conditions (e.g. spa- tial neglect) and interventions were borrowed from the rehabilitation techniques that had had success in relieving these other disorders. When anosognosia was identified as an independent syndrome and residual forms of awareness were demonstrated, procedures attempting to modulate awareness started to focus on specific components of the disease, such as visual perspective, motor monitoring and the updating of beliefs. Although further research is needed in this field, the most recent approaches seem to give more stable, lasting results than earlier methods. A timeline for interventions relating to anosognosia is suggested, and ethical issues are also discussed.

NEUROMARKERS OF ANXIETY IN A PATIENT WHO HAD EXPERIENCED A TRANSIENT ISCHEMIC ATTACK (TIA) OF THE LEFT BRAIN HEMISPHERE AS A RESULT OF A CRITICAL STENOSIS OF THE INTERNAL CAROTID ARTERY (ICA) OPERATED ON BY ENDARTERECTOMY (CEA)

The search for neuromarkers is a very promising way to improve psychiatric and psychological care. They are now considered to be an innovative diagnostic tool in psychiatry and neuropsychology, but more broadly in all human health sciences. The aim of our study was to find the neuromarker of anxiety in a patient who had experienced a Transient IschemicAttack (TIA) of the left brain hemisphere as a result of a critical stenosis of the Internal Carotid Artery (ICA) operated on byendarterectomy (CEA). We will present the case of a 54-year-old man,an architect, who experienced a Transient Ischemic Attack (TIA) of the left brain hemispherecaused by a critical stenosis of theInternal Carotid Artery (ICA) and was treated successfully with surgical endarterectomy (CEA). One year after the surgery itself, the patient developed severe postoperative anxiety, headaches, difficulty in sleepingas well as the inability to continue working in his profession. Strong anxiety was notedon the adapted 100-millimeter Visual Analogue Anxiety Scale (VAAS). The patient was assessed using the Human Brain Index (HBI) methodology (Kropotov 2009; 2016; 2017; Pąchalska, Kaczmarek&Kropotov 2014) which consisted of recording 19-channel EEG in resting state conditions, during the cued GO/NOGO task and comparing the parameters of EEG spectra and Event-Related Potentials (ERPs) with the normative and patient databases of the Human Brain Index(HBI). No signs of cognitive dysfunction was found, however an excessive Rolandic beta was observed. In line with the working hypothesis as to the presence of an anxiety neuromarker, the patient’s studies confirmed an increased P1 time wave in the left hemisphere of the brain in ERP in response to visual stimuli, i.e. an anxiety neuromarker. Following the detection of this neuromarkera specific anodic Transcranial Direct Current Stimulations (tDCS) protocol was proposed (see: Kropotov 2016; Pąchalska, Kaczmarek & Kropotov 2020). Ten tDCS sessions were performed and the postoperativeanxiety was found to be resolved. The patient returned to work. The use of Human Brain Index (HBI) methodologyenabling the isolation of the Event Related Potentials (ERPs) patterns revealed the presence of a distinct anxietyneuromarker. Neurotherapy with the use of tDCS allowed the reduction of anxiety symptoms and the patient’s return to work. The above case study indicates the necessity to use new neurotechnologies in the diagnosis of mental diseases, with particular emphasis on postoperative anxiety.