Partial Balint's syndrome and left homonymous hemianopsia presenting after resection of a right occipito-parietal glioblastoma.

A 66-year-old left-handed male was admitted to our acute inpatient rehabilitation (AIR) unit following a resection of the right occipito-parietal glioblastoma. He presented with symptoms of horizontal oculomotor apraxia, contralateral optic ataxia and left homonymous hemianopsia. We diagnosed this patient with partial Bálint's syndrome (BS)- oculomotor apraxia, optic ataxia but not simultanagnosia. BS is typically caused by bilateral posterior parietal lesions, but we here describe a unique case due toresection of a right intracranial tumor. A short AIR stay allowed our patient to learn how to compensate for visuomotor and visuospatial deficits, and improved his quality of life significantly.

COVID-19 Molecular Pathophysiology: Acetylation of Repurposing Drugs.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces immune-mediated type 1 interferon (IFN-1) production, the pathophysiology of which involves sterile alpha motif and histidine-aspartate domain-containing protein 1 (SAMHD1) tetramerization and the cytosolic DNA sensor cyclic-GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) signaling pathway. As a result, type I interferonopathies are exacerbated. Aspirin inhibits cGAS-mediated signaling through cGAS acetylation. Acetylation contributes to cGAS activity control and activates IFN-1 production and nuclear factor-κB (NF-κB) signaling via STING. Aspirin and dapsone inhibit the activation of both IFN-1 and NF-κB by targeting cGAS. We define these as anticatalytic mechanisms. It is necessary to alleviate the pathologic course and take the lag time of the odds of achieving viral clearance by day 7 to coordinate innate or adaptive immune cell reactions.

Devising a Method to Study if Wernicke's Aphasia Patients are Aware That They Do Not Comprehend Language or Speak It Understandably.

Wernicke's Aphasia (WA) is characterized by an individual speaking fluent gibberish without the ability to understand anything that is said to them or anything they attempt to read. It is caused by damage to the left posterior temporoparietal cortex, also known as Wernicke's area. An additional intriguing symptom of WA patients is their apparent obliviousness to their own lack of understanding despite their intact reasoning or other cognitive abilities. Their only deficit seems to be in the basic rules of language that define word meaning, also known as phonology. Growing out of a project in an undergraduate class, we devised a phonology-free approach to communicating with WA patients that attempts to answer the questions of whether WA patients know that they do not understand what is said to them, that others do not understand what they have said, and if these patients are distressed by this lack of communication. We here describe the process and the resulting method.

Pure apraxia of speech due to infarct in premotor cortex.

Apraxia of speech (AOS) is now recognized as an articulation disorder distinct from dysarthria and aphasia. Various lesions have been associated with AOS in studies that are limited in precise localization due to variability in size and type of pathology. We present a case of pure AOS in setting of an acute stroke to localize more precisely than ever before the brain area responsible for AOS, dorsal premotor cortex (dPMC). The dPMC is in unique position to plan and coordinate speech production by virtue of its connection with nearby motor cortex harboring corticobulbar tract, supplementary motor area, inferior frontal operculum, and temporo-parietal area via the dorsal stream of dual-stream model of speech processing. The role of dPMC is further supported as part of dorsal stream in the dual-stream model of speech processing as well as controller in the hierarchical state feedback control model.

Isolated, relative aproverbia without focal lesion.

We have seen a patient with a profound, isolated, and quite selective deficit in proverb interpretation-aproverbia. The patient presented to us after an anoxic brain injury with aproverbia. Interestingly, the aproverbia appeared to be premorbid to the presenting event. Furthermore, the patient had no brain lesion that has been associated or even proposed as a cause of deficit in proverb or metaphor interpretation. The patient did have acute bilateral hippocampi lesions and associated severe anterograde amnesia, but he retained good retrograde memory with which he is able to give good, logical but concrete explanations for proverbs. This case highlights the need, importance, and interest in further neuropsychologic, imaging and functional studies of proverb and interpretation in patients and normal subjects populations.

Neutralizing antibodies derived from the B cells of 1918 influenza pandemic survivors.

Investigation of the human antibody response to influenza virus infection has been largely limited to serology, with relatively little analysis at the molecular level. The 1918 H1N1 influenza virus pandemic was the most severe of the modern era. Recent work has recovered the gene sequences of this unusual strain, so that the 1918 pandemic virus could be reconstituted to display its unique virulence phenotypes. However, little is known about adaptive immunity to this virus. We took advantage of the 1918 virus sequencing and the resultant production of recombinant 1918 haemagglutinin (HA) protein antigen to characterize at the clonal level neutralizing antibodies induced by natural exposure of survivors to the 1918 pandemic virus. Here we show that of the 32 individuals tested that were born in or before 1915, each showed seroreactivity with the 1918 virus, nearly 90 years after the pandemic. Seven of the eight donor samples tested had circulating B cells that secreted antibodies that bound the 1918 HA. We isolated B cells from subjects and generated five monoclonal antibodies that showed potent neutralizing activity against 1918 virus from three separate donors. These antibodies also cross-reacted with the genetically similar HA of a 1930 swine H1N1 influenza strain, but did not cross-react with HAs of more contemporary human influenza viruses. The antibody genes had an unusually high degree of somatic mutation. The antibodies bound to the 1918 HA protein with high affinity, had exceptional virus-neutralizing potency and protected mice from lethal infection. Isolation of viruses that escaped inhibition suggested that the antibodies recognize classical antigenic sites on the HA surface. Thus, these studies demonstrate that survivors of the 1918 influenza pandemic possess highly functional, virus-neutralizing antibodies to this uniquely virulent virus, and that humans can sustain circulating B memory cells to viruses for many decades after exposure-well into the tenth decade of life.

Depth spreading through empty space induced by sparse disparity cues.

A key goal of visual processing is to develop an understanding of the three-dimensional layout of the objects in our immediate vicinity from the variety of incomplete and noisy depth cues available to the eyes. Binocular disparity is one of the dominant depth cues, but it is often sparse, being definable only at the edges of uniform surface regions, and visually resolvable only where the edges have a horizontal disparity component. To understand the full 3D structure of visual objects, our visual system has to perform substantial surface interpolation across unstructured visual space. This interpolation process was studied in an eight-spoke depth spreading configuration corresponding to that used in the neon color spreading effect, which generates a strong percept of a sharp contour extending through empty space from the disparity edges within the spokes. Four hypotheses were developed for the form of the depth surface induced by disparity in the spokes defining an incomplete disk in depth: low-level local (isotropic) depth propagation, mid-level linear (anisotropic) depth-contour interpolation or extrapolation, and high-level (anisotropic) figural depth propagation of a disk figure in depth. Data for both perceived depth and position of the perceived contour clearly rejected the first three hypotheses and were consistent with the high-level figural hypothesis in both uniform disparity and slanted disk configurations. We conclude that depth spreading through empty visual space is an accurately quantifiable perceptual process that propagates depth contours anisotropically along their length and is governed by high-level figural properties of 3D object structure.

Museum Meanderings XII: E-Museum Jacob Lawrence Paintings and Rehabilitation Medicine.

ABSTRACT: In the April 1930 issue of the journal, Founding Editor-in-Chief William Rush Dunton, Jr, MD, initiated a new series: Museum Meanderings. Eleven installments of the series ran intermittently until December 1931. Here, a 12th installment, an e-museum "tour" of paintings by the great American artist Jacob Lawrence (1917-2000) relevant to rehabilitation medicine, is offered. In particular, his Occupational Therapy No. 1 (1949) is a most thought-provoking and inspiring masterpiece. The painting depicts five women performing various sewing activities with space in the painting brilliantly divided. The painting has been discussed by art critics, but it has not been appreciated that all the women appear actually to be the same person! Thus, the painting shows the stages or cycle of rehabilitation. Echoing Rush Dunton's thoughts in 1930, we invite further contributions to the series.

From the Birth of Occupational Therapy and Physical Medicine and Rehabilitation to Randomized Controlled Trials: The American Journal of Physical Medicine & Rehabilitation: A Centennial Review.

ABSTRACT: The American Journal of Physical Medicine & Rehabilitation has entered its second century of publication. In this centennial review, we chronicle the evolution of the journal from its origin in 1922 as the Archives of Occupational Therapy to the present. In particular, we focus on the contributions to the journal and the field of physical medicine and rehabilitation by Founding Editor-in-Chief William Rush Dunton, Jr, MD, and the rise of publication of randomized controlled studies in the journal, thus fulfilling Dr Dunton's original vision and dream for the field and the journal.

The use of visual feedback, in particular mirror visual feedback, in restoring brain function.

This article reviews the potential use of visual feedback, focusing on mirror visual feedback, introduced over 15 years ago, for the treatment of many chronic neurological disorders that have long been regarded as intractable such as phantom pain, hemiparesis from stroke and complex regional pain syndrome. Apart from its clinical importance, mirror visual feedback paves the way for a paradigm shift in the way we approach neurological disorders. Instead of resulting entirely from irreversible damage to specialized brain modules, some of them may arise from short-term functional shifts that are potentially reversible. If so, relatively simple therapies can be devised--of which mirror visual feedback is an example--to restore function.

Correcting Sherrington's Gait Dysfunction With an Off the Shelf Knee Orthotic.

This professional opinion describes the use of an off the shelf knee orthotic to correct the gait and functional mobility of a patient with hemisensory loss including proprioception following a stroke and provides supporting video. Interestingly, this case corrects a human analogue of a functional deficit found experimentally in monkeys in the 19th century by Mott and Sherrington.

Rehabilitation After Complete Hemisensory Loss: Report of Two Cases.

The role and function that proprioception plays in movement and motor learning have been debated since the 19th century but can be difficult to isolate and study. Lesions at various points along the proprioceptive pathway result in afferent paresis that can be significantly disabling. Compensatory mechanisms can help with successful rehabilitation and provide an opportunity to study the role of these mechanisms in sensory feedback. Here, we present two cases of adult patients with complete hemisensory loss after a stroke: one patient with a cortical stroke and the other one with a thalamic stroke. First, we see that that motor learning can occur without proprioception, with the help of visual feedback. Second, proprioception plays an important role in movement: in the upper limb, it can facilitate individual finger movements, and in the lower limb, it maintains sufficient knee flexion to prevent the knee from going into recurvatum (backward bending) during ambulation.

A developmental theory of synaesthesia, with long historical roots: a comment on Hochel & Milan.

The recent surge of scientific investigation into synaesthesia, ably reviewed by Hochel and Milan (2008), is representative of an increasing recognition that our various sensory modalities are intimately interconnected rather than separate. The origin of these interconnections is the subject of an intriguing theory by Maurer and Maurer (1988). They suggest that all of us begin life as synaesthetes, with subsequent neural development reducing the connections among the senses. We present some historical roots of the idea that human life begins with the senses intertwined. The influential 18th-century philosopher Jean-Jacques Rousseau described an early theory of child development in his book Emile (1762), hypothesizing that if "a child had at its birth the stature and strength of a man ... all his sensations would be united in one place, they would exist only in the common 'sensorium'." A half-century later, a young Mary Shelley (1818) brought this idea into popular culture with the Frankenstein creature's recollection of his early experience: "A strange multiplicity of sensations seized me, and I saw, felt, heard, and smelt, at the same time; and it was, indeed, a long time before I learned to distinguish between the operations of my various senses." William James in The Principles of Psychology (1890) expressed a similar idea. In this context, the assumption of many 20th-century scientists that the senses were largely separate appears to be an historical aberration.