Comparison of Habitual Physical Activity and Sedentary Behavior in Adolescents and Young Adults With and Without Cerebral Palsy.

PURPOSE: The comparison of habitual physical activity and sedentary time in teenagers and young adults with cerebral palsy (CP) with typically developed (TD) peers can serve to quantify activity shortcomings. METHODS: Patterns of sedentary, upright, standing, and walking components of habitual physical activity were compared in age-matched (16.8 y) groups of 54 youths with bilateral spastic CP (38 who walk with limitations and 16 who require mobility devices) and 41 TD youths in the Middle East. Activity and sedentary behavior were measured over 96 hours by activPAL3 physical activity monitors. RESULTS: Participants with CP spent more time sedentary (8%) and sitting (37%) and less time standing (20%) and walking (40%) than TD (all Ps < .01). These trends were enhanced in the participants with CP requiring mobility devices. Shorter sedentary events (those <60-min duration) were similar for TD and CP groups, but CP had significantly more long sedentary events (>2 h) and significantly fewer upright events (taking <30, 30-60, and >60 min) and less total upright time than TD. CONCLUSION: Ambulant participants with CP, as well as TD youth must be encouraged to take more breaks from being sedentary and include more frequent and longer upright events.

Effects of Exercise Interventions on Habitual Physical Activity and Sedentary Behavior in Adolescents With Cerebral Palsy.

PURPOSE: Exercise interventions have been shown to increase motor capacities in adolescents with cerebral palsy; however, how they affect habitual physical activity (HPA) and sedentary behavior is unclear. The main objective was to correlate changes in HPA with changes in mobility capacity following exercise interventions. METHODS: A total of 54 participants (aged 12-20 y) with bilateral spastic cerebral palsy at Gross Motor Function Classification System (GMFCS) levels II and III received 4 months of group progressive resistance training or treadmill training. Mobility measurements and HPA (averaged over 96 h) were made before and after interventions. RESULTS: Averaged baseline mobility and HPA measures and improvements in each after both interventions were positively correlated in all participants. Percentage of sedentary/awake time decreased 2%, with significant increases in HPA measures of step count (16%), walk time (14%), and upright time (9%). Mobility measures and HPA changes were quite similar between Gross Motor Function Classification System levels, but improvement in HPA after group progressive resistance training was greater than after treadmill training (12% vs 4%) and correlated with mobility improvement. CONCLUSIONS: Mobility capacity improved after these interventions and was clearly associated with improved HPA. The group progressive resistance training intervention seems preferable to improve HPA, perhaps related to greater social interaction and motivation provided by group training.

Interleukin-1 Beta and Tumor Necrosis Factor Alpha Upregulation and Nuclear Factor Kappa B Activation in Skeletal Muscle from a Mouse Model of Chronic/Progressive Parkinson Disease.

BACKGROUND Skeletal muscle atrophy has been reported in patients with Parkinson disease (PD). The purpose of this study was to examine the potential implication of interleukin 1 beta (IL-1ß), tumor necrosis factor alpha (TNFα), and nuclear factor kappa B (NF kappa B) in skeletal muscle atrophy following PD induction. MATERIAL AND METHODS Chronic Parkinsonism was induced in 10 albino mice by MPTP/probenecid treatment, while 10 other albino mice remained without treatment and were subsequently used as controls. Gastrocnemius muscles were examined for the expression of IL-1ß and TNF-α, as well as the nuclear localization of NF kappa B, indicative of its activation, using immunohistochemistry in the 2 different groups. RESULTS IL-1ß and TNF-α expression and NF kappa B nuclear localization were significantly higher in the PD skeletal muscle compared with those in the controls (P value <0.01). CONCLUSIONS The present data are indicative of an association of PD with IL-1ß and TNF-α upregulation and NF kappa B activation in gastrocnemius muscles, potentially promoting the atrophy frequently observed in PD.

Association between sleep quality and inflammatory complement components in collegiate males.

BACKGROUND: An accumulating amount of evidence has linked humoral mediators of inflammation with sleep measures. Nevertheless, important details of this association, in particular the role of the complement components in the context of chronic sleep attributes, have remained largely uncharacterized. MATERIALS AND METHODS: Fifty university students (age, 23.3 ± 3.8 years; BMI, 23.7 ± 2.9 kg/m(2)) completed the study. Four dichotomized sleep measures assessed by the Pittsburgh Sleep Quality Index (PSQI) were used in association analysis using binary logistic regression with complement component 3, 4, and complement factor I (CFI). The sleep measures were defined as sleep quality (good sleep/poor sleep; PSQI ≤5/PSQI >5), bedtime (early/late; before 00:00 h/after 0:00 h), sleep duration (short/normal ≤6 h/>6 h), and sleep onset latency (normal/disturbed; 0-1 score/2-3 score on the PSQI component of sleep latency). RESULTS: The complement component 4 was associated with sleep quality (unadjusted, OR = 1.025, p < 0.05; adjusted for age, OR = 1.025, p < 0.05; adjusted for BMI, OR = 1.027, p < 0.05) and sleep duration (unadjusted, OR = 1.041, p < 0.01; adjusted for age, OR = 1.041, p < 0.01; adjusted for BMI, OR = 1.046, p < 0.01). CFI was associated with bedtime (unadjusted, OR = 0.737, p < 0.01; adjusted for age, OR = 0.717, p < 0.01; adjusted for BMI, OR = 0.677, p < 0.01) and with sleep duration (unadjusted, OR = 0.796, p < 0.05; adjusted for age, OR = 0.796, p < 0.05). CONCLUSION: The findings indicate the importance of the role of complement components in the dynamics of sleep. Therefore, sleep should be assessed in conditions where complement components are affected.

Duration and patterns of habitual physical activity in adolescents and young adults with cerebral palsy.

AIM: Adolescents and young adults with cerebral palsy (CP) show reduced motor function and gait efficiency, and lower levels of habitual physical activity (HPA), than adolescents with typical development and children with CP. This study examined activity duration and patterns in this population in the Middle East through long-term monitoring of a large sample using accelerometers. METHOD: Adolescents and young adults with bilateral CP at Gross Motor Function Classification System (GMFCS) levels II, III, and IV, were monitored in their habitual environment for four consecutive days with ActivPAL3 monitors. Time spent in sedentary, standing, and walking activities, and frequency of walking steps and transitions, were analysed for each GMFCS level. RESULTS: Measurements were made on 222 participants (132 males, 90 females; mean age 16 y 9 mo SD 2y, range 13 y 4 mo-22 y). The Mann-Whitney U test demonstrated significant differences (p<0.05) between GMFCS levels, showing reduced walking and standing activity and increased sedentary duration at higher GMFCS levels (p<0.001), except for increased standing time between GMFCS levels II and III (p=0.07). Participants in educational facilities exhibited less sedentary behaviour than those who were homebound (p<0.05). INTERPRETATION: These descriptions of duration and frequency of active and sedentary behaviours may serve as a basis for recommendations to minimize inactivity in this population. Adolescents and young adults with CP in the Middle East demonstrate similar patterns of HPA to their peers in other regions.

Individualized treadmill and strength training for chronic stroke rehabilitation: effects of imbalance.

BACKGROUND AND PURPOSE: Stroke survivors often have significant walking limitations and are at high risk for falling. Treadmill training, as a rehabilitation approach in stroke survivors, and its relationship to balance ability has not been widely studied. The main goal of this study was to investigate the effectiveness of an individualized treadmill-strength training protocol on functional outcomes in chronic stroke survivors. METHODS: Thirty adult participants with chronic stroke were recruited from 1 European and 4 Middle Eastern countries. Each completed 36 sessions of treadmill-strength training. The rehabilitation protocol was individualized according to each patient's cardiovascular fitness. Ten-meter walk test (10MWT), Berg Balance Scale (BBS), and 6-minute walk test (6MWT) were measured before (T0) and after training (T1) and 6 months later (T2). Paired t tests were used to test differences with training (T1 - T0) and retention after training (T2 - T1). RESULTS: Increases in all 3 measures from T0 to T1 were significant. There were no changes in 10MWT and BBS from T1 to T2, but 6MWT tended to increase. Separate analyses for subjects with BBS scores <41 at T0 demonstrated comparatively greater improvements from T0 to T1 than in those with BBS scores ≯40. Those with low scores also significantly increased from T1 to T2 in both walk tests. DISCUSSION: These findings suggest that a protocol combining treadmill with strength training has beneficial long-term effects on functional walking measures after chronic stroke, especially in patients who initially have low balance ability.

Evidence- based physiotherapy practice in Jordan: Evaluation and identification of implementation factors.

BACKGROUND: Evidence-based physiotherapy practice (EBPTP) is becoming increasingly important to improve patient outcomes and clinical decision-making in the physiotherapy profession. OBJECTIVE: To evaluate the EBPTP in Jordan and identify the barriers to its implementation in clinical practice. METHOD: The study used a cross-sectional survey of licensed physiotherapists working in Jordan using EBPTP self-reported questionnaire. Frequencies, percentages, and one sample Wilcoxon rank test were used to evaluate the EBPTP level. The EBPTP implementation was evaluated by demographic variations of participants, Spearman's correlation, and stepwise multiple linear regression analyses at 95% confidence interval. RESULTS: A total of 210 participants completed the survey. All EBPTP questionnaire elements showed significant positive levels (p = .00) except facility support reflecting non-significant negative level (p = .08). The EBPTP implementation was at a significantly lower level of uptake (p = .00). Clinical decision-making was based mainly on personal experience. The EBPTP implementation was significantly correlated with elements of the EBPTP questionnaire and differed by personal/organizational characteristics. There were four significant predictors of EBPTP implementation: understanding of EBPTP terminologies, facility support, formal training in EBPTP, and being a clinical instructor. CONCLUSION: The findings confirm a clear gap in EBPTP implementation among physiotherapists in Jordan. The EBPTP implementation factors were mainly based on education sectors and work facilities. Engagement of stakeholders and education sectors in EBPTP implementation is required to strengthen the standing of the physiotherapy profession in Jordan.

The associations between physical activity, health-related quality of life, regimen adherence, and glycemic control in adolescents with type 1 diabetes: A cross-sectional study.

BACKGROUND: Adolescents with Type 1 Diabetes (T1D) display a greater than two-fold higher risk of developing diabetes-related complications compared with their healthy peers and the risk increases markedly as glycated hemoglobin (HbA1c) increases. The majority of the known factors associated with improved glycemic control in adolescents with T1D are geared toward Western populations. Therefore, this study examined the associations between Physical Activity (PA), Health-Related Quality of Life (HRQoL), and regimen adherence on glycemic control in a Middle Eastern population of adolescents with T1D METHODS: The study utilized a cross-sectional design of Jordanian adolescents (aged 12-18) with T1D (n = 74). Self-reported measures used were the Pediatric Quality of Life-Diabetes Module, the International Physical Activity Questionnaire, and the Summary of Diabetes Self-Care Activities. HbA1c values were obtained from the medical records. Correlation analyses were conducted using Pearson's and Spearman's correlation tests. Multiple regression analyses were conducted to determine if HRQoL, PA, and regimen adherence predict glycemic control. RESULTS: Only 14.8 % of the participants demonstrated good glycemic control (HbA1c ≤ 7.5 %). Participants with poor control had a statistically significant lower mean PA of MET-minutes/week (3531.9 ± 1356.75 vs. 1619.81 ± 1481.95, p < .001) compared to those with good control. The total sample was found to demonstrate low HRQoL (47.70 ± 10.32). Participants were within the acceptable range of PA (1885.38 ± 1601.13) MET-minutes/week. HbA1c significantly inversely correlated with PA (r = -0.328, p = .010) and regimen adherence (r = -0.299, p = .018). The regression analysis revealed that PA significantly predicted glycemic control (ß = -0.367, p < .01) as adherence (ß = -0.409, p < .01) and disease duration did (ß = 0.444, p < .01). CONCLUSION: Better glycemic control was significantly associated with higher PA and regimen adherence levels. The correlation between PA and glycemic control depends highly on the level of regimen adherence or arguably, adherence acts as a buffer in the correlation between PA and glycemic control. There was no significant association between glycemic control and HRQoL.

Endurance exercise training suppresses myostatin upregulation and nuclear factor-kappa B activation in a mouse model of Parkinson's disease.

Background and Aim: Muscle atrophy is common in Parkinson's disease (PD). Although myostatin has been implicated in muscle atrophy, its expression in PD skeletal muscle has not been investigated. Therefore, this study aimed to elucidate the influence of PD induction and exercise training on myostatin expression in the gastrocnemius skeletal muscle. Materials and Methods: Thirty albino mice were randomly selected and separated into three groups of 10 mice each: Sedentary control, sedentary PD (SPD), and exercised PD (EPD). 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine and probenecid were used to induce chronic parkinsonism in the PD groups. Immunohistochemistry was used to investigate the expression of myostatin and nuclear factor kappa B (NF-kB) in gastrocnemius muscles of all three groups. Results: Myostatin expression and NF-kB nuclear localization, indicative of its activation, were significantly (p<0.01) higher in gastrocnemius skeletal muscle in the SPD group than in the control and EPD groups. Concomitantly, the average cross-sectional area of gastrocnemius muscle fibers in the SPD albino mice was significantly smaller (p<0.01) than in the control and EPD groups, indicating muscle atrophy. Conclusion: The present data are the first to indicate a correlation between PD induction and myostatin overexpression and NF-kB activation in the gastrocnemius muscle, potentially promoting the muscle atrophy commonly seen in PD. Additionally, the current data are the first to indicate the beneficial effects of exercise training on PD-associated myostatin overexpression, NF-κB activation, and muscle atrophy. Thus, our data are the first to suggest that myostatin and NF-κB might be regarded as potential therapeutic targets in an attempt to ameliorate skeletal muscle abnormalities commonly observed in PD.

Effectiveness of non-pharmacological rehabilitation interventions in pain management in patients with multiple sclerosis: Systematic review and meta-analysis.

BACKGROUND: Multiple sclerosis (MS) is a progressive inflammatory and autoimmune neurological disease caused by inflammation and demyelination of the central nervous system. Pain is a typical symptom of central nervous system demyelination, affecting 63% of adults with MS. Recently, the role of non-pharmacological pain management in patients is growing because the non-pharmacological interventions are considered safe, affordable, easy, and accessible. However, to date, no systematic reviews or meta-analyses have comprehensively examined the therapeutic effects of the variety of non-pharmacological therapeutic interventions in the management of pain in patients with MS. OBJECTIVE: The study aimed to conduct a systematic review with meta-analysis to assess the effectiveness of the non-pharmacological rehabilitation interventions in pain management in patients with MS. METHODS: A comprehensive search using PubMed, Cochrane, and Science Direct databases was performed and included all randomized controlled trials, randomized cross-over trials, and quasi-experimental trials assessing the effect of non-pharmacological interventions for managing pain in patients with MS. This study was conducted according to PRISMA guidelines of a systematic review and pair-wise meta-analysis. Meta-analyses were performed by calculating the standardized mean difference at a 95% confidence interval using Review Manager software. RESULTS: Twenty-nine papers were included in the systematic review, and only 22 of them were included in the meta-analysis. The pooled analysis showed a significant effect of neuromodulation and transcranial direct current stimulation on pain intensity reduction in patients with MS (SMD -0.51, 95% CI -0.51 to -0.09, P = 0.02), (SMD -0.67, 95% CI -1.18 to -0.16 P = 0.01), respectively. The analysis showed significant improvement in pain intensity in patient with MS after mind-body therapies (SMD -0.45, 95% CI -0.82 to -0.7, P = 0.02), mindfulness (SMD -0.55, 95% CI -0.96 to -0.14, P = 0.009), hypnosis (SMD -0.88, 95% CI -1.30 to -0.46, P = 0.0001), trigger point therapies (SMD -0.83, 95% CI -1.65 to -0.01, P = 0.05) and cognitive behavioral therapy (SMD -0.64, 95% CI -1.18 to -0.11, P = 0.02). However, there is no significant effect of relaxation therapy on pain reduction in patients with MS (SMD -0.82, 95% CI -1.94 to 0.31, P = 0.15). CONCLUSIONS: The results indicated that the majority of the non-pharmacological rehabilitation interventions showed potential therapeutic effects in reducing pain intensity in patients with MS.

The Perception of Physical Therapy Students towards Their Profession in Jordan.

Background: The physical therapy profession has grown rapidly in less than a century, increasing its importance, techniques, settings, and the responsibilities provided to its practitioners. Objectives: The aim of the study was to explore how undergraduate physiotherapy students view physiotherapy as their future career and their perception of the educational physiotherapy programs in Jordan. Methods: A cross-sectional study was conducted. A questionnaire designed to collect data on students' perceptions of their profession was delivered to 222 undergraduate physiotherapy students at Jordan University of Science and Technology in Irbid, Jordan. The response rate was 157 (70.72%). Descriptive statistics and the chi-square test were used to analyse the data. Results: Among 157 physiotherapy students, results were collected. Although students were satisfied with being physiotherapy students (p < 0.001), most of the study participants knew about physical therapy from their families, and they were not satisfied with the job opportunities in Jordan. Conclusions: Physiotherapy education in Jordan is rising rapidly. The public, patients, parents, and clinical preceptors in physiotherapy settings must recognize this educational and professional practice. It is noted that some levels of occupational awareness are intermediate. However, it would be beneficial to organize activities such as seminars and interviews in order to increase the level of professional awareness.

Endurance exercise training suppresses Parkinson disease-induced overexpression of apoptotic mediators in the heart.

BACKGROUNDWe have shown elevated levels of p53 and active caspase-3 in the heart with Parkinson disease (PD). The main aim of this study is to examine the effect of treadmill training on the cardiac expression of p53 and active caspase-3 in the mouse with induced Parkinsonism. METHODS: Thirty randomly selected normal albino mice were equally divided into the following 3 groups: sedentary control (SC), sedentary Parkinson diseased (SPD), and exercised Parkinson diseased (EPD). 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and probenecid (MPTP/p) were used to induce chronic Parkinson disease in the SPD and EPD animals. The expression of p53 and active caspase-3 was investigated, using immunohistochemistry, in the heart in each animal group. RESULTS: Both p53 and active caspase-3 expression was significantly (p value < 0.05) reduced in the PD heart following endurance exercise training. CONCLUSION: Our present data suggest that chronic exercise training reduced PD-induced upregulation of p53 and active caspase-3 in the heart. Thus, our study suggests that inhibiting p53 and/or active caspase-3 may be considered as a therapeutic approach to ameliorate PD cardiomyopathy.

Melatonin serum level, sleep functions, and depression level after bilateral anodal transcranial direct current stimulation in patients with Parkinson's disease: a feasibility study.

OBJECTIVE: Parkinson's disease (PD) is associated with non-motor complications such as sleep disturbance and depression. Transcranial direct current stimulation (tDCS) showed therapeutic effects on the motor dysfunctions. However, the potential effects of tDCS therapy on melatonin hormone, sleep dysfunctions, and depression in patients with PD still unclear. This feasibility study aimed to identify any potential changes in melatonin serum level, sleep functions and depression after the bilateral anodal tDCS in patients with PD. MATERIAL AND METHODS: Tensessions of bilateral anodal tDCS stimulation applied over left and right prefrontal and motor areas were given to twenty-five patients with PD. Melatonin serum level, Pittsburgh sleep quality index, and geriatric depression scale examined before and after tDCS stimulation. RESULTS: After bilateral anodal tDCS, there was a significant reduction in melatonin serum level, improvement in depression, improvements in overall sleep quality, and sleep latency. Correlations test showed significant associations between melatonin serum level reduction and changes in subjective sleep quality, and sleep duration, as well as between improvements in depression and overall sleep quality, sleep latency, and sleep disturbance. CONCLUSION: Bilateral anodal tDCS therapy was a feasible and safe tool that showed potential therapeutic effects on melatonin serum level, sleep quality, and depression level in patients with PD. Although the further large scale and randomized-control trial studies are crucially needed, there is still a need for such a feasibility study to be established before such trials can be implemented as is recommended in the new medical research council guidelines.

Mental and physical health-related quality of life and their associated factors among students of a comprehensive allied health institution.

BACKGROUND: Healthcare students are subjected to critical levels of mental and physical stress that might hinder their quality of life. OBJECTIVES: This study comprehensively investigated physical and mental Health-related Quality of Life (HR-QoL) and their associated factors among Allied Health (AH) students of nine academic majors. METHODS: Participants completed anonymous questionnaire included demographics and life style, HR-QoL measured by the 12-item Short-Form Health Survey (SF-12), Depression Anxiety Stress Scale (DASS21), and Nordic Musculoskeletal Questionnaire. SF-12 Physical (PCS) and Mental (MCS) Components Summary scores were compared between gender and between academic majors. Multiple linear regressions were conducted to examine factor associated with PCS and MCS scores. RESULTS: A total of 838 students (77.4% females) participated in the study. The overall PCS was 45.64±7.93 and statistically different between majors (P < 0.001). The Overall MCS score was 39.45±10.86 and statistically greater in males (P < 0.001). PCS scores were significantly associated with anxiety score, GPA, diet self-evaluation, and upper back and hip musculoskeletal pain. MCS scores were significantly associated with weekly clinical training hours, stress score, depression score, gender, university year, GPA, sleep self-evaluation, diet self-evaluation, and neck musculoskeletal pain. CONCLUSIONS: Low levels of mental and physical HR-QoL were observed among AH students and were associated with academic-related, health-related, and lifestyle-related factors. Longitudinal studies are needed to assess effective approaches to improve HR-QoL among AH students.

Electrocardiographic changes with the onset of diabetes and the impact of aerobic exercise training in the Zucker Diabetic Fatty (ZDF) rat.

BACKGROUND: Early markers of diabetic autonomic neuropathy (DAN) in an electrocardiogram (ECG) include elevated R wave amplitudes, widening of QTc intervals and decreased heart rate variability (HRV). The severity of DAN has a direct relationship with mortality risk. Aerobic exercise training is a common recommendation for the delay and possible reversal of cardiac dysfunction. Limited research exists on ECG measures for the evaluation of aerobic exercise training in Zucker Diabetic Fatty (ZDF) rat, a model of type 2 diabetes. The objective of this study was to assess whether aerobic exercise training may attenuate diabetes induced ECG changes. METHODS: Male ZDF (obese fa/fa) and control Zucker (lean fa/+) rats were assigned to 4 groups: sedentary control (SC), sedentary diabetic (SD), exercised control (EC) and exercised diabetic (ED). The exercised groups began 7 weeks of treadmill training after the development of diabetes in the ED group. Baseline (prior to the training) and termination measurements included body weight, heart weight, blood glucose and glycated hemoglobin levels and ECG parameters. One way repeated measures ANOVA (group) analyzed within and between subject differences and interactions. Pearson coefficients and descriptive statistics described variable relationships and animal characteristics. RESULTS: Diabetes caused crucial changes in R wave amplitudes (p < 0.001), heart rate variability (p < 0.01), QT intervals (p < 0.001) and QTc intervals (p < 0.001). R wave amplitude augmentation in SD rats from baseline to termination was ameliorated by exercise, resulting in R wave amplitude changes in ED animals similar to control rats. Aerobic exercise training neither attenuated QT or QTc interval prolongation nor restored decreases in HRV in diabetic rats. CONCLUSION: This study revealed alterations in R wave amplitudes, HRV, QT and QTc intervals in ZDF rats. Of these changes, aerobic exercise training was able to correct R wave amplitude changes. In addition, exercise has beneficial effect in this diabetic rat model in regards to ECG correlates of left ventricular mass.

Melatonin and dopamine serum level associations with motor, cognitive, and sleep dysfunctions in patients with Parkinson's disease: A cross-sectional research study.

BACKGROUND: Parkinson's disease (PD) is a multisystem-progressive neurodegenerative disease characterized by dopaminergic neurons, however, the role of the non-dopaminergic system (such as melatonin hormone) in the pathogenesis of PD is now emerging. OBJECTIVE: To identify any potential correlation between the dopamine and melatonin serum levels, and motor, cognitive, and sleep dysfunctions in patients with PD. METHOD: Cross-sectional piloting study conducted with a sample of 34 patients with PD (aged 50-72 yrs old). Correlation tests performed to identify any potential correlations between the biomarkers' serum levels and motor, cognitive, and sleep dysfunctional levels in "on-medication" status. RESULTS: Spearman's test showed significant correlations between the melatonin serum level and sleep dysfunctions including overall sleep quality (P = 0.010) and subjective sleep quality sub-score (P = 0.001). On the other hand, spearman's test showed significant correlations between the dopamine serum level and motor dysfunctions including Berg Balance Scale (P = 0.026), 10-Meter Walk Test (P = 0.016), and Fear of Falling Index (P = 0.007), as well as comparisons between the dopamine serum level and cognitive dysfunction (P = 0.048). CONCLUSIONS: Melatonin serum level would serve as a potential biomarker in understanding the PD pathogenesis, and the melatonin serum level should be considered in future studies related to PD besides the dopamine serum level.

Leeds sleep evaluation questionnaire in Jordanian university students. A psychometric investigation using comparative confirmatory factor analysis.

OBJECTIVES: To analyze the fit of different competing factor models (a one-factor model, 3 2-factor models, and 2 4-factor models) of the Leeds sleep evaluation questionnaire (LSEQ) in the data from a Jordanian student population. METHODS: A cross-sectional study was conducted on university students, with 2 sleep-related tools - the LSEQ and the sleep hygiene index (SHI). The students (n=166) at Jordan University of Science and Technology, Irbid, Jordan participated in this study from January-April, 2019. A total of 12 LSEQ models (6 models with all 10-items, and 6 models with one item deleted) were evaluated by using confirmatory factor analysis. The summary statistics of correlation coefficients, descriptive measures of item analysis, the model fit, and Cronbach's alpha were determined. RESULTS: The findings show that a 4-factor correlated solution was a plausible model for the LSEQ with 9-items, compared to a one-factor, 2-factor, and other 4-factor variant models. The deletion of one item from the original LSEQ improved the data fit significantly in the studied population. Moreover, correlation analysis between the LSEQ and SHI confirmed the divergent validity of the LSEQ. CONCLUSION: The results support the validity of a 4-factor structure of the LSEQ with 9-items with adequate internal consistency and divergent validity.

Conservative management of acute epidural hematoma in a pediatric age group.

OBJECTIVE: Craniotomy and evacuation is the standard treatment of acute epidural hematoma (EDH). Here, the authors report their experience in nonoperative management of acute EDH in children with mild head injury. METHODS: The authors retrospectively reviewed charts of patients with conservatively treated EDH at the Department of Neurosurgery, King Abdulla University Hospital, Irbid, Jordan, between August 2003 and October 2007. All patients had a Glasgow Coma Scale score of 14 or 15, and an initial computerized tomography (CT) scan demonstrating an EDH with or without skull fractures. Follow-up included neurological examination and brain CT. RESULTS: Six children (3 boys, 3 girls) with acute EDH were successfully managed at our department without surgical intervention. The Glasgow Outcome Scale score of all patients was 5, with no posttraumatic sequelae. Follow-up brain CT showed complete resolution of the EDH within 2-3 months. CONCLUSIONS: Our results demonstrated that pediatric EDH can be managed nonoperatively. The pronounced increase in the number of CT examinations for patients with head injuries has resulted in a greater proportion of EDH detected in conscious patients. We recommend such treatment be performed in specialized pediatric neurosurgical centers under close neurological observation.

Effectiveness of constraint-induced movement therapy (CIMT) as home-based therapy on Barthel Index in patients with chronic stroke.

OBJECTIVE: The goal of this study is to investigate the effectiveness of constraint-induced movement therapy (CIMT) on the Barthel Index (BI) scores in persons with stroke to assess dependency in survivers of stroke and to investigate the long-term effects of CIMT on dependency needs as measured by the BI, based on the hypothesis that CIMT as home-based therapy would be of significant benefit in stroke rehabilitation. METHODS: Twenty-seven participants, 16 men with a mean age of 58 (+/- 10.8) and 4 women with a mean age of 60 (+/- 6.3), participated in the study as an experimental group, and 17 participants, 12 men with a mean age of 58 (+/- 9.7) and 5 women with a mean age of 55 (+/-11.8), participated as a control group. The experimental/treatment group received traditional therapy with the CIMT where the intact contralateral upper limb was placed in a removable cast for 6 hours a day during waking hours for 4 weeks. The control group received traditional therapy only. Both groups were assessed using the BI on admission and on discharge from rehabilitation. In addition, 18 participants (14 male and 4 female), 64% of the experimental group, were reevaluated using the BI for the long-term benefits of CIMT on dependency. RESULTS: Using unpaired t test (SPSS version 15), statistically significant improvement was noted in the BI for the experimental group compared to the control group. After 6 months follow-up, BI was 96.3 +/- 2.7, indicating that the obtained gains were maintained at 6 months post discharge, compared to their BI score at 4 weeks (68.2 +/- 3.8) post CIMT (p value < .005). CONCLUSION: Following stroke, patients who received CIMT every day for 4 weeks in conjunction with traditional rehabilitation therapy showed significant changes in the BI upon discharge and this positive outcome was preserved after 6 months follow-up. This improvement indicates an overall significant improvement in ADL status for patients who received CIMT and has implications for future use in stroke rehabilitation as home-based therapy for stroke rehabilitation.