General movement assessment is correlated with neonatal behavior neurological assessment/cerebral magnetic resonance imaging in preterm infants.

ABSTRACT: To explore the relationship between general movements (GMs) and neonatal behavior neurological assessment (NBNA)/cerebral magnetic resonance imaging (MRI) in preterm infants.Forty preterm infants were examined with GMs assessment before gestational age of 40 weeks; NBNA was performed at the age of 40 weeks; cerebral MRI was performed at the age of 42 weeks.Our experiment showed that preterm infants with poor GMs scores are more likely to have low NBNA scores (P = .001); preterm infants with abnormal cerebral MRI are more likely to have low NBNA scores (P = .002); preterm infants with poor GMs scores are more likely to have abnormal cerebral MRI (P = .012).GM assessment is correlated with NBNA and MRI results in preterm infants for neurological development.

Validation of Neuropad in the Assessment of Peripheral Diabetic Neuropathy in Patients with Diabetes Mellitus Versus the Michigan Neuropathy Screening Instrument, 10g Monofilament Application and Biothesiometer Measurement.

OBJECTIVE: Sudomotor dysfunction is a feature of Diabetic Peripheral Neuropathy (DPN). The indicator plaster Neuropad can provide an easy and accurate way to diagnose DPN. The aim of the present study was to evaluate Neuropad's specificity, sensitivity and accuracy in detecting DPN in patients with Diabetes Mellitus (DM). METHODS: A total of 174 patients with DM (79 with type 1 DM, 88 women), mean age 49.8 ± 16.1 years and mean DM duration 17.3 ± 7.7 years were included in the present study. The following methods were used to diagnose DPN: the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE, respectively), application of 10 g monofilament (MONO) and measurement of vibration perception threshold with biothesiometer (BIO). Neuropad was applied to both feet in all patients and according to the presence or absence of color change of the sticker, patients were divided in two groups: group A (n = 82, complete change in color from blue to pink, depicting normal perspiration) and group B (n = 92, incomplete or no change, depicting abnormal perspiration). RESULTS: MNSIQ and MNSIE were positive for DPN in 111 and 119 patients, respectively. BIO was abnormal in 109 and MONO in 59 patients. Sensitivity of Neuropad testing was 95% vs. MONO, 73% vs. BIO, 73% vs. MNSIE and 75% vs. ΜNSIQ. Specificity was 69, 81, 90 and 92%, respectively and accuracy of the test was 78, 76, 78 and 83%, respectively. CONCLUSION: Neuropad has a high sensitivity and specificity in detecting DPN vs. MNSIQ, MNSIE and BIO. Neuropad has a high sensitivity but moderate specificity vs. MONO. The accuracy of the test was high in all measurements.

Low-Cost Robotic Assessment of Visuo-Motor Deficits in Alzheimer's Disease.

A low-cost robotic interface was used to assess the visuo-motor performance of patients with Alzheimer's disease (AD). Twenty AD patients and twenty age-matched controls participated in this work. The battery of tests included simple reaction times, position tracking, and stabilization tasks performed with both hands. The regularity, velocity, visual and haptic feedback were manipulated to vary movement complexity. Reaction times and movement tracking error were analyzed. Results show a marked group effect on a subset of conditions, in particular when the patients could not rely on the visual feedback of hand movement. The visuo-motor performance correlated with the measures of global cognitive functioning and with different memory-related abilities. Our results support the hypothesis that the ability to recall and use visuo-spatial associations might underlie the impairment in complex motor behavior that has been reported in AD patients. Importantly, the patients had preserved learning effects across sessions, which might relate to visuo-motor deficits being less evident in every-day life and clinical assessments. This robotic assessment, lasting less than 1 h, provides detailed information about the integrity of visuo-motor abilities. The data can aid the understanding of the complex pattern of deficits that characterizes this pervasive disease.

Comparison of Neurosensory Assessment Methods in Plastic Surgery.

Sensory assessment of the skin is essential to document the function of the sensory fibers of the tested nerves. The Semmes-Weinstein monofilaments, disk-criminator, electrodiagnostic testing, and Pressure-Specified Sensory Device (PSSD) have been currently used to assess sensory function of peripheral nerves. None of these methods is optimal because of different drawbacks; however, an increasing number of articles, which recognize the reliability of PSSD, have been published during the last decade. In this review, following a short overview on basic physiology and assessment methods of the skin sensory receptors, we compared the sensory assessment methods and summarized the applications of the PSSD in the field of different clinical areas, mainly peripheral neuropathies, breast, and flap surgery.

Automated assessment of intranasal trigeminal function.

BACKGROUND: The intranasal trigeminal system is a key player in the perception of intranasal airflow. Why it has not been studied very well may be due to the lack of techniques that allow for fast, reliable and inexpensive routine investigation of the system. The basis of the current study is the notion that--within limits--the intranasal trigeminal system detects the overall mass of a stimulus and not just its concentration. Thus, changing the duration of the stimulus at a given concentration has a similar effect as changing its concentration. METHODOLOGY: Ninety-nine normosmic subjects participated [48 women and 51 men; mean (range) age = 45 years (20-88 years)]. In addition, 50 patients with olfactory loss were investigated once (28 women, 22 men; mean age 58 years, SD = 14 years; age range 24-88 years; causes of olfactory loss: viral infections n = 22, head trauma n = 8, chronic sinunasal disease n = 3, idiopathic n = 17). CO2-stimuli with various durations (multiples of 50 ms) were presented through a standard bilateral nasal cannula at an interval of 10 s; stimulus duration was increased by 50 ms from one stimulus presentation to the next, until the subject pushed a button indicating a painful sensation. This was the basis for automated assessment of CO2-pain responsiveness. RESULTS: This current study had four main findings: (1) Using the new, automated device CO2 pain responsiveness can be measured reliably, (2) CO2 pain responsiveness correlates with olfactory function, (3) as with olfaction, women are more sensitive to CO2 , and CO2-pain responsiveness also correlates with aging, (4) CO2-pain responsiveness is lower in patients with olfactory loss compared to normosmic, healthy controls, even when controlling for age. CONCLUSION: We have demonstrated that the current approach is a reliable and valid measure of intranasal trigeminal function.

Quantitative Assessment of Parkinsonian Tremor Based on an Inertial Measurement Unit.

Quantitative assessment of parkinsonian tremor based on inertial sensors can provide reliable feedback on the effect of medication. In this regard, the features of parkinsonian tremor and its unique properties such as motor fluctuations and dyskinesia are taken into account. Least-square-estimation models are used to assess the severities of rest, postural, and action tremors. In addition, a time-frequency signal analysis algorithm for tremor state detection was also included in the tremor assessment method. This inertial sensor-based method was verified through comparison with an electromagnetic motion tracking system. Seven Parkinson's disease (PD) patients were tested using this tremor assessment system. The measured tremor amplitudes correlated well with the judgments of a neurologist (r = 0.98). The systematic analysis of sensor-based tremor quantification and the corresponding experiments could be of great help in monitoring the severity of parkinsonian tremor.

ViibraTip for Testing Vibration Perception to Detect Diabetic Peripheral Neuropathy: A NICE Medical Technology Guidance.

VibraTip™ was selected by the Medical Technologies Advisory Committee (MTAC) to undergo evaluation through the National Institute for Health and Care Excellence (NICE). VibraTip™ provides a vibratory stimulus for the purpose of detecting diabetic peripheral neuropathy (DPN) in patients with type 1 or 2 diabetes mellitus, and is intended to replace the current practice of using the 128 Hz tuning fork or 10 g monofilament (comparators). The sponsor (McCallan Medical) provided clinical and economic submissions which were evaluated by an External Assessment Centre (EAC). Of six diagnostic studies identified, the EAC considered that only one was directly relevant to the assessment. This study indicated VibraTip™ had a sensitivity of 0.79 (95 % CI 0.69-0.90) and specificity of 0.82 (95 % CI 0.74-0.90) for DPN using a neurothesiometer at 25 V as a reference standard. This was non-inferior to the comparators, but the sample size (n = 141) was too small to draw unequivocal conclusions and it is unclear how generalisable results were to clinical practice. The sponsor presented a de facto cost-minimisation model that in the base case showed minimal cost savings and, in sensitivity analysis which assumed diagnostic superiority of VibraTip™, showed large savings. The EAC appraised this model and concluded it was flawed as it was not evidence based and costs were likely to be unrealistic. The MTAC considered that the technology showed promise but decided the case for adoption was not proven, and therefore made a research recommendation as is reflected in NICE Medical Technology Guidance 22.

Medical devices; neurological devices; classification of the brain injury adjunctive interpretive electroencephalograph assessment aid. Final order.

The Food and Drug Administration (FDA) is classifying the brain injury adjunctive interpretive electroencephalograph assessment aid into class II (special controls). The special controls that will apply to the device are identified in this order and will be part of the codified language for the brain injury adjunctive interpretive electroencephalograph assessment aid's classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

Quantitative assessment of upper limb motion in neurorehabilitation utilizing inertial sensors.

Two inertial sensor systems were developed for 3-D tracking of upper limb movement. One utilizes four sensors and a kinematic model to track the positions of all four upper limb segments/joints and the other uses one sensor and a dead reckoning algorithm to track a single upper limb segment/joint. Initial evaluation indicates that the system using the kinematic model is able to track orientation to 1 degree and position to within 0.1 cm over a distance of 10 cm. The dead reckoning system combined with the "zero velocity update" correction can reduce errors introduced through double integration of errors in the estimate in offsets of the acceleration from several meters to 0.8% of the total movement distance. Preliminary evaluation of the systems has been carried out on ten healthy volunteers and the kinematic system has also been evaluated on one patient undergoing neurorehabilitation over a period of ten weeks. The initial evaluation of the two systems also shows that they can monitor dynamic information of joint rotation and position and assess rehabilitation process in an objective way, providing additional clinical insight into the rehabilitation process.

A new integrated instrumental approach to autonomic nervous system assessment.

BACKGROUND AND OBJECTIVES: The autonomic nervous system (ANS) regulates involuntary body functions and is commonly evaluated by measuring reflex responses of systolic and diastolic blood pressure (BP) and heart rate (HR) to physiological and pharmacological stimuli. However, BP and HR values may not sufficient be to explain specific ANS events and other parameters like the electrocardiogram (ECG), BP waves, the respiratory rate and the electroencephalogram (EEG) are mandatory. Although ANS behaviour and its response to stimuli are well-known, their clinical evaluation is often based on individual medical training and experience. As a result, ANS laboratories have been customized, making it impossible to standardize procedures and share results with colleagues. The aim of our study was to build a powerful versatile instrument easy-to-use in clinical practice to standardize procedures and allow a cross-analysis of all the parameters of interest for ANS evaluation. METHODS: The new ANScovery System developed by neurologists and technicians is a two-step device: (1) integrating physiological information from different already existing commercial modules, making it possible to cross-analyse, store and share data; (2) standardizing procedures by an innovative tutor monitor able to guide the patient throughout ANS testing. RESULTS AND CONCLUSIONS: The daily use of the new ANScovery System in clinical practice has proved it is a versatile easy to use instrument. Standardization of the manoeuvres and step-by-step guidance throughout the procedure avoid repetitions and allow intra and inter-patient data comparison.

Assessment of bladder sensation in mice with a novel device.

OBJECTIVE: To develop and test the efficacy of an implantable bladder electrode device that can be used with the Neurometer electrodiagnostic stimulator to assess fiber-specific afferent bladder sensation in the mouse. METHODS: We constructed a ball-tipped platinum electrode and surgically implanted it into the mouse bladder. The Neurometer was connected to the electrode to apply selective nerve fiber stimuli (250 Hz for Aδ fibers and 5 Hz for C fibers) of increasing intensities to the bladder mucosa in the mouse to determine bladder sensory threshold (BST) values. Using 58 female C57BL/6J mice, we measured the temporal and interobserver consistency of BST measurements, the effects of intravesical administration of lidocaine and resiniferatoxin on the BST, and the effects of our device on voiding behavior and bladder mucosal integrity. RESULTS: BST values at 250 and 5 Hz did not vary significantly when measured 2, 4, and 6 days after device implantation, or when obtained by 2 blinded independent observers. Intravesical lidocaine yielded a transient increase in BST values at both 250 Hz and 5 Hz, whereas resiniferatoxin yielded a significant increase only at the 5 Hz stimulus frequency after 24 hours. Moderately increased micturition frequency and decreased volume per void were observed 4 and 6 days after device implantation. Histology revealed mild inflammatory changes in the area of the bladder adjacent to the implanted BST device. CONCLUSION: Assessment of neuroselective bladder sensation in mice is feasible with our device, which provides reproducible BST values for autonomic bladder afferent nerve fibers.

A low-cost body inertial-sensing network for practical gait discrimination of hemiplegia patients.

Gait analysis is widely used in detecting human walking disorders. Current gait analysis methods like video- or optical-based systems are expensive and cause invasion of human privacy. This article presents a self-developed low-cost body inertial-sensing network, which contains a base station, three wearable inertial measurement nodes, and the affiliated wireless communication protocol, for practical gait discrimination between hemiplegia patients and asymptomatic subjects. Every sensing node contains one three-axis accelerometer, one three-axis magnetometer, and one three-axis gyroscope. Seven hemiplegia patients (all were abnormal on the right side) and 7 asymptomatic subjects were examined. The three measurement nodes were attached on the thigh, the shank, and the dorsum of the foot, respectively (all on the right side of the body). A new method, which does not need to obtain accurate positions of the sensors, was used to calculate angles of knee flexion/extension and foot in the gait cycle. The angle amplitudes of initial contact, toe off, and knee flexion/extension were extracted. The results showed that there were significant differences between the two groups in the three angle amplitudes examined (-0.52±0.98° versus 6.94±2.63°, 28.33±11.66° versus 47.34±7.90°, and 26.85±8.6° versus 50.91±6.60°, respectively). It was concluded that the body inertial-sensing network platform provided a practical approach for wearable biomotion acquisition and was effective for discriminating gait symptoms between hemiplegia and asymptomatic subjects.

A novel animal model of closed-head concussive-induced mild traumatic brain injury: development, implementation, and characterization.

Closed-head concussive injury is one of the most common causes of traumatic brain injury (TBI). While single concussions result in short-term neurologic dysfunction, multiple concussions can result in cumulative damage and increased risk for neurodegenerative disease. Despite the prevalence of concussion, knowledge about what occurs in the brain following this injury is limited, in part due to the limited number of appropriate animal research models. To study clinically relevant concussion we recently developed a simple, non-invasive rodent model of closed-head projectile concussive impact (PCI) TBI. For this purpose, anesthetized rats were placed on a platform positioned above a torque-sealed microcentrifuge tube packed with fixed amounts of dry ice. Upon heating, rapid sublimation of the dry ice produced a build-up of compressed CO(2) that triggered an eruptive force causing the cap to launch as an intact projectile, resulting in a targeted PCI head injury. A stainless steel helmet was implemented to protect the head from bruising, yet allowing the brain to sustain a mild PCI event. Depending on the injury location and the application of the helmet, PCI-induced injuries ranged from severe (i.e., head injury with subdural hematomas, intracranial hemorrhage, and brain tissue damage), to mild (no head injury, intracranial hemorrhage, or gross morphological pathology). Although no gross pathology was evident in mild PCI-induced injury, the following protein changes and behavioral abnormalities were detected between 1 and 24 h after PCI injury: (1) upregulation of glial fibrillary acidic protein (GFAP) in hippocampal regions; (2) upregulation of ubiquitin carboxyl-terminal hydrolase L1 (UCHL-1) in cortical tissue; and (3) significant sensorimotor abnormalities. Overall, these results indicated that this PCI model was capable of replicating salient pathologies of a clinical concussion, and could generate reproducible and quantifiable outcome measures.

[Virtual reality for clinical assessment of elderly people: early screening for dementia]. / La réalité virtuelle au service de l'évaluation clinique de la personne âgée: le dépistage précoce de la démence.

Today, there are 24.3 million people suffering from dementia worldwide, that is a new case every 7 seconds (Ferri et al., 2005) and more than 80 million cases expected in 2040. Aging-related morbidity is a real social problem making screening a major challenge. Currently, screening and diagnostic tools for dementia remain independent from each other, screening tools being non-specific and diagnostic tools non-naturalistic. With the technological possibilities offered by virtual reality, it is becoming easier to investigate cognition and behavior in elderly people. Virtual reality allows a better understanding and assessment, and perhaps could stimulate cognitive functioning of elderly people. Combining measurements of cognitive impairment and disability might help close the gap between structural and naturalistic validity.

Minimally obtrusive wearable device for continuous interactive cognitive and neurological assessment.

This study demonstrates the feasibility of a minimally obtrusive wearable system that can assess cognitive performance continuously throughout normal life activities by excitation of the peripheral nervous system and detection of the central nervous system response. The new concept was tested with one possible implementation as a device the size of a wristwatch which interrogates the subject by means of haptic excitation (vibration) and records the responses (subtle hand movements detected by accelerometers). The system was programmed to perform simple reaction time trials and was tested with ten volunteers during 8 h of their normal daytime activities. Results indicate that the volunteers responded properly to most of the interrogations (>95%) and that the impact of the device on everyday activities was not significant. The ability to assess cognitive capabilities of individuals continuously during everyday activities could have far-reaching implications for diagnostics and treatment of many different neurological conditions.

Quantitative assessment of diabetic peripheral neuropathy with use of the clanging tuning fork test.

OBJECTIVE: To describe the clanging tuning fork (CTF) test, a novel method for using the C 128-Hz tuning fork to test for diabetic peripheral neuropathy (DPN), to evaluate the accuracy and reproducibility of this technique, and to compare it with the 5.07 (10 g) Semmes-Weinstein monofilament test. METHODS: To determine the mean and standard deviation for the CTF test, repeated measurements were taken on one toe of 12 patients with diabetes during one visit. After these tests, 30 randomly selected patients were tested on both feet, with right and left scores compared for reproducibility of the results. The scores of the CTF test were compared with the monofilament scores in 45 patients with diabetes. Presence of foot ulcers in 81 patients was correlated with both test scores. RESULTS: The mean duration of vibration sensation was 10.2 seconds, with a standard deviation of +/-1.3 seconds. The Pearson correlation coefficient comparing the right and the left foot scores for the same patient was 0.947 (P<0.05). Among patients with 8 seconds or less of vibration perception, results of monofilament testing were abnormal only in those whose vibration perception was less than or equal to 4 seconds. Of 32 patients with vibration perception of 4 seconds or less, 50% had normal monofilament test scores, including 29% of 17 patients with absent vibratory sensation. CONCLUSION: The CTF test is reproducible and accurate. It provides a quantitative assessment of DPN and can document severe neuropathy, even in the presence of a normal result with the 10-g monofilament test. The risk of foot ulcers, which is associated with diminished vibratory sensation, can therefore be detected earlier and more accurately with the CTF test. The CTF test should replace the 10-g monofilament test as the recommended technique for detection of DPN.

Validation of a novel screening device (NeuroQuick) for quantitative assessment of small nerve fiber dysfunction as an early feature of diabetic polyneuropathy.

OBJECTIVE: To validate a handheld screening device (NeuroQuick) for an early detection of diabetic distal symmetric polyneuropathy (DSP) by quantitative testing of cold sensation based on the wind chill factor (NeuroQuick threshold [NQT]). RESEARCH DESIGN AND METHODS: NQT was measured on the dorsum of the foot in 160 healthy subjects as well as 60 and 128 diabetic patients without and with DSP, respectively. DSP was diagnosed by a neurological examination, motor and sensory nerve conduction velocity, vibration perception threshold, and warm and cold thermal perception threshold (TPT) (TPT Medoc). In addition, a C-64 Hz tuning fork and TipTherm device were used as screening instruments. RESULTS: In the diabetic cohort, NQT correlated significantly with all nerve function tests, with the highest correlation coefficients being found on the foot versus Medoc warm TPT (r = 0.618, P < 0.001) and cold TPT (r = 0.529, P < 0.001). Among patients with DSP, NQT was abnormal, whereas Medoc warm TPT was normal in 34%, whereas only 5% showed the opposite constellation (P < 0.05). Likewise, the corresponding percentages for Medoc cold TPT were 32 and 11%, for TipTherm 47 and 2%, and for the tuning fork 29 and 10% (all P < 0.05), whereas no significant differences were noted when comparing NQT with peroneal motor nerve conduction velocity, sural sensory nerve conduction velocity, and malleolar vibration perception threshold. The coefficients of variation for repeated NQT measurements in 41 control and 41 diabetic subjects were 20.4 and 8.5%, respectively. CONCLUSIONS: The NeuroQuick is a valid and reliable screening tool for quantitative assessment of small nerve fiber dysfunction. This device appears to be more sensitive in detecting early diabetic polyneuropathy than both elaborate thermal testing and screening tests such as the tuning fork.