Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice Guidelines.

The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury.

Development of a Best Evidence Statement for the Use of Pressure Therapy for Management of Hypertrophic Scarring.

Pressure therapy has been considered standard, first-line intervention for the treatment of hypertrophic scars since its introduction in the 1960s. Although widely used, this scar management technique has historically been based on a wide array of anecdotal evidence as opposed to strong scientific support. Evidence has become more prevalent in recent years, necessitating a synthesis to develop an evidence-based clinical guideline. The clinical question was asked, "Among individuals with or at risk to develop active hypertrophic scars, does treatment with pressure therapy improve aesthetic and functional outcomes?" An evidence-based practice project was completed with aims to synthesize relevant literature to determine recommendations for the use of pressure therapy in individuals at risk for hypertrophic scars. A systematic search of the literature was conducted for the dates January 1950 to February 2014 of the following databases: MEDLINE, CINAHL, Cochrane Database for Systematic Reviews, Burntherapist.com, Cochrane Libraries, Ebsco, Google Scholar, OT Seeker, Ovid, MedLine, PEDro.org, Pubmed.gov, Pubmed Clinical Queries, and hand search of relevant articles through use of reference lists. Search terms included scar, hypertroph*, pressure therapy, compression therapy, pressure garment, burn, scald, trauma as well as MeSH terms cicatrix and hypertrophic. Articles were reviewed in terms of ability to answer the clinical question as well as strength of conclusions. A total of 45 articles were found and critiqued, 28 of which were relevant to the clinical question. Evidence strength ranged from level 1 to level 5. Results from the studies were synthesized to create clinical recommendations to guide treatment. Based on best available evidence, it is recommended that pressure therapy is utilized to decrease scar height and erythema that it is used for grafts and wounds requiring 14 to 21 days to heal, for 23 hours/day for 12 months, fit to achieve 20 to 30 mm Hg of pressure, fit by a skilled technician, and replaced every 2-3 months. In addition, it is not recommended that pressure therapy is used to treat abnormal pigmentation, nor used to hasten scar maturation. This literature search revealed insufficient evidence addressing the impact of pressure therapy on scar pliability. Among individuals with or at risk to develop active hypertrophic scars, treatment with pressure therapy does improve outcomes, particularly for aesthetic concerns including scar thickness and erythema. Applicability of research to practice: The practical treatment recommendations presented may improve consistency and efficacy of pressure therapy utilization at the point of care.

Practice guidelines for the application of nonsilicone or silicone gels and gel sheets after burn injury.

The objective of this review was to systematically evaluate available clinical evidence for the application of nonsilicone or silicone gels and gel sheets on hypertrophic scars and keloids after a burn injury so that practice guidelines could be proposed. This review provides evidence based recommendations, specifically for the rehabilitation interventions required for the treatment of aberrant wound healing after burn injury with gels or gel sheets. These guidelines are designed to assist all healthcare providers who are responsible for initiating and supporting scar management interventions prescribed for burn survivors. Summary recommendations were made after the literature, retrieved by systematic review, was critically appraised and the level of evidence determined according to Oxford Centre for Evidence-based Medicine criteria.

Efficacy of the canine influenza virus H3N8 vaccine to decrease severity of clinical disease after cochallenge with canine influenza virus and Streptococcus equi subsp. zooepidemicus.

Since first emerging in the North American canine population in 2004, canine influenza virus (CIV) subtype H3N8 has shown horizontal transmission among dogs, with a high level of adaptation to this species. The severity of disease is variable, and coinfection by other respiratory pathogens is an important factor in the degree of morbidity and mortality. The first influenza vaccine for dogs, an inactivated vaccine containing CIV subtype H3N8, was conditionally approved by the U.S. Department of Agriculture (USDA) for licensure in May 2009 and fully licensed in June 2010. This study evaluates the efficacy of this vaccine to reduce the severity of illness in dogs cochallenged with virulent CIV and Streptococcus equi subsp. zooepidemicus.

Lesions of the mammillary body region alter hippocampal movement signals and theta frequency: implications for path integration models.

Cells throughout the hippocampal formation are involved in processing spatial information. These same cells also show an influence of locomotor activity, and these movement signals are thought to be critical for the path integration abilities of these cells. Nuclei in the mammillary region provide ascending influences to the hippocampal formation and have been implicated in influencing both hippocampal spatial and theta signals. Here, we report the effects of mammillary lesions on movement-related signals in several hippocampal subregions. We find first, as predicted by earlier work, these lesions cause an approximately 1 Hz reduction in the frequency of theta modulation of cell firing. According to recent theoretical work, this might, in turn, be expected to influence the size of hippocampal place fields. Our data do not confirm this prediction for any of the hippocampal regions examined. Second, we report lesion effects on the relationship between firing rate and running speed for the hippocampal cells. These lesions caused a reduction in both the slope and intercept of rate-by-speed functions for cells in the hippocampus and postsubiculum. Surprisingly, cells in subiculum showed an opposite effect, so that the excitatory influence of locomotion was enhanced. Path integration theories predict that the speed at which path integration occurs is related to the strength of this movement signal. In remarkable accordance with this prediction, we report that the timing of the place cell signals is slowed following mammillary lesions for hippocampal and postsubicular cells, but, in contrast, is speeded up for subicular cells. In fact, the timing for place signals across lesion condition and brain region is predicted by a single linear function which relates timing to the strength of the running speed signal. Thus, these data provide remarkable support for some aspects of current path integration theory, while posing a challenge for other aspects of these same theories.

Lesions of the mammillary body region severely disrupt the cortical head direction, but not place cell signal.

The rat limbic system contains a variety of location (place and grid) cells and directional (head direction; HD) cells, thought to be critical for navigation. The HD cells can be found throughout many portions of the hippocampal formation, as well as additional limbic cortical and subcortical regions. These HD-containing regions are generally strongly interconnected anatomically. Earlier work, along with theoretical considerations, suggest that despite the ubiquitous presence of HD cells, there may be a single region which is critical for the initial formation of this HD signal. Specifically, it has been suggested that the critical HD cell network resides in a reciprocal loop formed by the interconnected lateral mammillary nucleus and dorsal tegmental nucleus of Gudden. Unlike the HD cells, place cells have not been observed in subcortical structures. They are, however, found in various forms throughout much of the hippocampal formation. Theoretical accounts of the place cells suggest that they are partly dependent on a path integration process which is, in turn, dependent on the HD cells. According to the above reasoning, lesions of the mammillary bodies should completely eliminate both HD and place/grid cells in the hippocampal formation. Here, we tested for both HD and place cell activity in various hippocampal formation sub regions following lesions of the mammillary bodies. We found that these lesions caused nearly complete elimination of the HD cell signal, but left the place cell signal largely intact. Our interpretation of these findings is somewhat limited by the fact that we did not provide a thorough test of the path integration abilities of the post lesion place cells. These findings pose a challenge for current theoretical accounts of place and grid cells. They also help to explain the role played by the mammillary bodies in spatial learning and memory.

Stress-induced alterations in hippocampal plasticity, place cells, and spatial memory.

Acute, inescapable, and unpredictable stress can profoundly modify brain and cognition in humans and animals. The present study investigated the ensuing effects of 2-h variable "audiogenic" stress on three related levels of hippocampal functions in rats: long-term potentiation, place cell activity, and spatial memory. In agreement with prior findings, we observed that stress reduced the magnitude of Schaffer collateral/commissural-Cornu Ammonis field 1 long-term potentiation in vitro, and selectively impaired spatial memory on a hidden platform version of the Morris water maze task. We also observed that stress impaired the stability of firing rates (but not firing locations) of place cells recorded from dorsal Cornu Ammonis field 1 in rats foraging freely on a novel open-field platform located in a familiar surrounding room. These findings suggest that stress-induced modifications in synaptic plasticity may prevent the storage of stable "rate maps" by hippocampal place cells, which in turn may contribute to spatial memory impairments associated with stress.

The effect of positioning devices and pressure therapy on outcome after full-thickness burns of the neck.

The postoperative management of full-thickness burns of the neck can be a challenge for burn therapists despite the availability of many treatment modalities to minimize scar hypertrophy and contracture. Interventions include pressure appliances, massage, exercise, and positioning devices. The objective of this study was to identify factors associated with the development of neck contractures and optimal treatment strategies for their prevention. We performed a retrospective chart review of all patients admitted to our pediatric burn center between 1989 and 2003 with acute full-thickness neck burns. Rehabilitation protocols used for each patient were examined. The necessity of a reconstructive procedure was analyzed, as well as time from initial grafting to that procedure. We identified 49 eligible subjects. Patients ranged in age from 0.6 to 14.2 years at the time of injury. The number of factors present which inhibited both positioning and application of pressure to the neck was found to be significantly related to the need for neck reconstruction (P < .01). Patients who had tracheostomies had a mean time to neck reconstruction of 20.3 months compared with 43.4 months in patients without tracheostomies (P < .05). Also, although not statistically significant, greater than 80% of patients who were discharged with reduced range of motion of the neck required reconstruction compared with fewer than 65% of patients with normal neck range. Delayed pressure and positioning of the neck after skin grafting result in an earlier and more frequent need for neck reconstruction.

Leukocyte profile of cattle persistently infected with bovine viral diarrhea virus.

Animals acutely infected with bovine viral diarrhea virus (BVDV) exhibit transient immunosuppression as a result of the virus' predilection for cells that play critical roles in the host immune system. Acute BVDV infections have major effects on thymic and follicular T-lymphocytes, as well as follicular B-lymphocytes, often resulting in severe reduction in circulating numbers of lymphocytes and suppression of functional activities of these cells. Granulocytes and monocytes are equally susceptible to BVDV infections with reduction in numbers and suppression functions. However, there is limited information on the leukocyte profile of cattle persistently infected (PI) with BVDV. This study reports on phagocytic activities of granulocytes and monocytes as well as immunophenotyping by flow cytometric analysis of leukocytes isolated from healthy non-PI (NPI) and PI animals. No significant differences were found between the leukocyte profiles and the phagocytic activities of PI animals when compared to a group of healthy NPI animals.

Subicular place cells generate the same "map" for different environments: comparison with hippocampal cells.

Since the initial discovery of place cells in the hippocampus proper, similar spatial firing has been observed in additional regions throughout the hippocampal formation. One such region is the subiculum. Here, most cells show a significant, consistent variation in rate relative to location. Thus, subicular and hippocampal cells are similar, in providing a representation of momentary location in space. However, there are also some fundamental differences. First, many subicular cells have a directional signal superimposed on the place-related patterns. In contrast, hippocampal cells in the open field paradigm used here typically do not show a genuine directional component. The second critical difference has to do with how the cells code different environments. As is well known, hippocampal cells show different spatial patterns in environments which offer distinctly different stimulus properties. For example, a hippocampal cell which fires in the northwest portion of a striped cylinder will likely display a different field, or no field, when recorded in a gray square. In contrast, subicular cells are likely to show the same behavior across environments, such as choosing the northwest region of both enclosures. Further, if two environments differ in size, the subicular patterns will expand/shrink to fit. Thus, it appears that subicular cells form a rigid framework of interrelated firing fields which is fit into each new enclosure. In contrast, hippocampal cells create a new "map" specific to each environment. This suggests that the hippocampal and subicular regions work together to help provide the overall cognitive mapping abilities of the animal.

Neuronal implementation of hippocampal-mediated spatial behavior: a comparative evolutionary perspective.

The hippocampal formation (HF) of mammals and birds plays a strikingly similar role in the representation of space. This evolutionarily conserved property, however, belies the contrasting spatial ecology of animals such as rats and homing pigeons, differing spatial ecologies that should have promoted the evolution of group-specific adaptations to the HF representation of space. However, the spatial response properties of pigeon and rat HF neurons reveal surprising similarity in the contribution of position, direction, and trajectory toward explaining spatial variation in firing rate. By contrast, the asymmetrical distribution of neuronal response properties in the left and right HF of homing pigeons, but not rats, indicates a difference in network organization. The authors propose that hippocampal evolution may be characterized by inertia with respect to changes in the basic spatial elements that determine the response properties of neurons but considerable plasticity in how the neuronal response elements are organized into functional networks.

Movement-related correlates of single cell activity in the interpeduncular nucleus and habenula of the rat during a pellet-chasing task.

The habenula and interpeduncular nucleus (IPN) are part of a dorsal diencephalic conduction system which receives input from cholinergic, striatal, and hypothalamic areas, and sends output to several, disparate midbrain regions. These output regions include the dorsal tegmental nucleus, which is part of a navigation-related system that provides a signal for directional heading. The habenula and IPN also project to the dorsal and medial Raphe nuclei, thought to be involved in mood and behavioral state regulation. Here, cells in both the habenula and IPN were recorded in freely moving rats while they foraged for food pellets. There were four major findings. First, many of the cells tended to fire in sporadic bouts of relatively high versus low rates, and this may be related to intrinsic cell properties discovered during in vitro studies. Second, although these regions are connected to the direction signaling circuit, they do not, themselves demonstrate a directional signal. Third, about 10% of the cells in the lateral habenula showed a strong correlation between rate and angular head motion. This may constitute an important, requisite input to the above-mentioned head direction circuit. Finally, many of the cells in each region showed a temporally coarse correlation with running speed, so that bouts of high frequency firing coincided with episodes of higher behavioral activation. This last finding may be related to work which shows an influence of the habenula on locomotor activity, and in relation to the protective effects of exercise in relation to stress, as mediated by the Raphe nuclei.

Movement-related correlates of single-cell activity in the medial mammillary nucleus of the rat during a pellet-chasing task.

Although the functional role of the mammillary bodies has remained obscure, lesion studies suggest this structure may play a role in memory-in particular, memory for spatial information. Indeed, anatomically, the mammillary bodies are strongly interconnected with limbic system regions, such as the hipppocampal formation, which are also thought to play a role in spatial behavior. Each of these limbic regions so far investigated contains cells that signal either the momentary location and/or directional heading of an animal as it travels through space. In fact, the lateral mammillary nucleus itself contains head direction cells, and is thought to be critical for the initial calculation of this directional signal. Here, we provide an initial report on cell activity in the medial mammillary nucleus. Cells were recorded while rats performed a pellet-chasing task that has been used for much of the work on place and head direction cells. The main findings are 1) approximately 1/3 of the cells showed a temporally precise relationship to angular motion of the head, so that they differentially indicated clockwise versus counterclockwise angular motion, 2) approximately 60% of the cells showed a temporally coarse correlation with translational motion, 3) firing rate for almost all cells was strongly modulated at theta frequency, and 4) no cells showed evidence of either directional or place-related activity. These data suggest that the medial and lateral mammillary nuclei together provide the directional and trajectory information thought to be critical for generation of the spatial signals in the hippocampal region.