Return to work within a year after first stroke: blue and white collar workers comparison, predictors and causal mediation assessed during inpatient rehabilitation.

BACKGROUND: Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact. OBJECTIVES: 1) compare characteristics for individuals who before stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators. METHODS: Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan-Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed. RESULTS: A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension.Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator. CONCLUSION: Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified.

Long-term prediction of functional independence using adjusted and unadjusted single items of the functional independence measure (FIM) at discharge from rehabilitation.

CONTEXT: Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury. OBJECTIVES: (1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3-6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict "good" functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors. METHODS: This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and "good" functional independence (FIM motor score ≥ 65) reporting adjusted R2, odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation. RESULTS: The top three predictors, each from a different FIM domain, were Toilet (adjusted R2 = 0.53, Transfers domain), Toileting (adjusted R2 = 0.46, Self-care domain), and Bowel (adjusted R2 = 0.35, Sphincter control domain). These three items were also predictors of "good" functional independence (AUC: 0.84-0.87) and their predictive power increased (AUC: 0.88-0.93) when adjusted by age, paraplegia, time since injury, and length of stay. CONCLUSIONS: Discharge FIM items accurately predict long-term functional independence.

Transcutaneous Electrical Neuromodulation of the Cervical Spinal Cord Depends Both on the Stimulation Intensity and the Degree of Voluntary Activity for Training. A Pilot Study.

Electrical enabling motor control (eEmc) through transcutaneous spinal cord stimulation offers promise in improving hand function. However, it is still unknown which stimulus intensity or which muscle force level could be better for this improvement. Nine healthy individuals received the following interventions: (i) eEmc intensities at 80%, 90% and 110% of abductor pollicis brevis motor threshold combined with hand training consisting in 100% handgrip strength; (ii) hand training consisting in 100% and 50% of maximal handgrip strength combined with 90% eEmc intensity. The evaluations included box and blocks test (BBT), maximal voluntary contraction (MVC), F wave persistency, F/M ratio, spinal and cortical motor evoked potentials (MEP), recruitment curves of spinal MEP and cortical MEP and short-interval intracortical inhibition. The results showed that: (i) 90% eEmc intensity increased BBT, MVC, F wave persistency, F/M ratio and cortical MEP recruitment curve; 110% eEmc intensity increased BBT, F wave persistency and cortical MEP and recruitment curve of cortical MEP; (ii) 100% handgrip strength training significantly modulated MVC, F wave persistency, F/M wave and cortical MEP recruitment curve in comparison to 50% handgrip strength. In conclusion, eEmc intensity and muscle strength during training both influence the results for neuromodulation at the cervical level.

Cervical Electrical Neuromodulation Effectively Enhances Hand Motor Output in Healthy Subjects by Engaging a Use-Dependent Intervention.

Electrical enabling motor control (eEmc) through transcutaneous spinal cord stimulation is a non-invasive method that can modify the functional state of the sensory-motor system. We hypothesize that eEmc delivery, together with hand training, improves hand function in healthy subjects more than either intervention alone by inducing plastic changes at spinal and cortical levels. Ten voluntary participants were included in the following three interventions: (i) hand grip training, (ii) eEmc, and (iii) eEmc with hand training. Functional evaluation included the box and blocks test (BBT) and hand grip maximum voluntary contraction (MVC), spinal and cortical motor evoked potential (sMEP and cMEP), and resting motor thresholds (RMT), short interval intracortical inhibition (SICI), and F wave in the abductor pollicis brevis muscle. eEmc combined with hand training retained MVC and increased F wave amplitude and persistency, reduced cortical RMT and facilitated cMEP amplitude. In contrast, eEmc alone only increased F wave amplitude, whereas hand training alone reduced MVC and increased cortical RMT and SICI. In conclusion, eEmc combined with hand grip training enhanced hand motor output and induced plastic changes at spinal and cortical level in healthy subjects when compared to either intervention alone. These data suggest that electrical neuromodulation changes spinal and, perhaps, supraspinal networks to a more malleable state, while a concomitant use-dependent mechanism drives these networks to a higher functional state.

The Role of Audiovisual Speech in Fast-Mapping and Novel Word Retention in Monolingual and Bilingual 24-Month-Olds.

Three experiments examined the role of audiovisual speech on 24-month-old monolingual and bilinguals' performance in a fast-mapping task. In all three experiments, toddlers were exposed to familiar trials which tested their knowledge of known word-referent pairs, disambiguation trials in which novel word-referent pairs were indirectly learned, and retention trials which probed their recognition of the newly-learned word-referent pairs. In Experiment 1 (n = 48), lip movements were present during familiar and disambiguation trials, but not retention trials. In Experiment 2 (n = 48), lip movements were present during all three trial types. In Experiment 3 (bilinguals only, n = 24), a still face with no lip movements was present in all three trial types. While toddlers succeeded in the familiar and disambiguation trials of every experiment, success in the retention trials was only found in Experiment 2. This work suggests that the extra-linguistic support provided by lip movements improved the learning and recognition of the novel words.

Evoked and oscillatory EEG activity differentiates language discrimination in young monolingual and bilingual infants.

Language discrimination is one of the core differences between bilingual and monolingual language acquisition. Here, we investigate the earliest brain specialization induced by it. Following previous research, we hypothesize that bilingual native language discrimination is a complex process involving specific processing of the prosodic properties of the speech signal. We recorded the brain activity of monolingual and bilingual 4.5-month-old infants using EEG, while listening to their native/dominant language and two foreign languages. We defined two different windows of analysis to separate discrimination and identification effects. In the early window of analysis (150-280 ms) we measured the P200 component, and in the later window of analysis we measured Theta (400-1800 ms) and Gamma (300-2800 ms) oscillations. The results point in the direction of different language discrimination strategies for bilingual and monolingual infants. While only monolingual infants show early discrimination of their native language based on familiarity, bilinguals perform a later processing which is compatible with an increase in attention to the speech signal. This is the earliest evidence found for brain specialization induced by bilingualism.

In vitro activity of terpenes against Candida albicans and ultrastructural alterations.

OBJECTIVE: The purpose of this study was to investigate the in vitro activity of terpene blends combined with tissue conditioner against Candida albicans and the effect on its morphology and sub-micro structure. STUDY DESIGN: The minimal inhibitory concentration (MIC) of terpenes, obtained from a by-product of kraft pulping, was determined using broth microdilution against C. albicans strains, and the activity of terpenes combined with Coe-Comfort tissue conditioner was assessed. Cell morphologic alterations were evaluated using scanning electronic microscopy and transmission electronic microscopy. Data was analyzed using Student's t test P < .05. RESULTS: The MIC of terpene blends fluctuated between 0.097% and 0.39% (v/v). Coe-Comfort tissue conditioner mixed with terpenes exhibited a total inhibition of C. albicans (P < .05). Terpenes induced ultrastructural alterations, even at the MIC value, including an increase in size, shape modification, cell wall damage with perforations, pronounced disconnection between cell wall and cytoplasm, and cytoplasmic vacuoles. CONCLUSIONS: Terpenes had pronounced effects against C. albicans alone and in combination with Coe-Comfort tissue conditioner, which mainly resulted in cell wall damage.