Single-center, double-blind, randomized, placebo-controlled pilot study of Canoxidin® for prevention of catheter encrustation in patients with indwelling catheters.

INTRODUCTION AND OBJECTIVES: Long-term use of an indwelling catheter is associated with complications such as catheter encrustation and infection. Canoxidin® is a novel oral treatment that can potentially prevent catheter encrustation, as it contains a urine acidifier and a combination of two crystallization inhibitors. This study aimed to evaluate the effects of Canoxidin® on catheter encrustation in patients with indwelling Foley catheters. PATIENTS AND METHODS: This was a single-center, double-blind, randomized, placebo-controlled study. Neuro-urology patients aged ≥18 years with an indwelling catheter (urethral or suprapubic) were randomized to treatment consisting of either Canoxidin® or placebo for one month. Foley catheters (two per patient, one before treatment and one after treatment) were removed for analysis of the presence and degree of encrustation. RESULTS: A total of 40 patients were enrolled and randomized, 28 of whom had analyzable catheters (13 assigned to Canoxidin® and 15 assigned to placebo). The patients had a mean age of 51.8 years, and eight (28.6%) were female. Two patients (13.3%) in the placebo group and eight patients (61.5%) in the Canoxidin® group experienced an improvement (less encrustation). There was a significant association between Canoxidin® and improvement (odds ratio: 10.4, 95% confidence interval: 1.6 to 66.9, P = 0.016). No adverse effects attributable to the treatment were reported. CONCLUSIONS: The overall rate of catheter encrustation was high among those with indwelling Foley catheters. One-month treatment with Canoxidin® reduced the formation of these encrustations, with an excellent short-term safety profile.

Inpatient rehabilitation of working-age adults with ischemic stroke: comparing men and women clinical and functional characteristics at admission and predicting functionality. / Rehabilitación en régimen de ingreso en adultos en edad laboral tras un ictus isquémico: análisis clinicofuncional desde una perspectiva de género.

INTRODUCTION: The role of gender in functional independence for activities of daily living after ischemic stroke is still controversial. We aim to a) compare clinical characteristics of men and women at inpatient rehabilitation admission b) compare their functional independence at admission and discharge c) identify predictors of functional independence. MATERIALS AND METHODS: Retrospective observational cohort study. State-of-the-art variables were used for admission and discharge comparisons and to predict total FIM (Functional Independence Measure) at discharge, FIM gain, FIM efficiency and FIM effectiveness using multivariate linear regressions. RESULTS: 144 patients (33% women) admitted to inpatient rehabilitation in a Spanish specialized center, with less than 3 weeks since ischemic stroke onset were included. Men were older (p = 0.039), 19.6% of men had diabetes mellitus (6.4% of women) (p = 0.038), with 52.6% of men being non-smokers (72.3% of women) (p = 0.022). No significant differences were observed in FIM at admission, discharge, FIM gain, efficiency or effectiveness (total, motor either cognitive FIM). Regression analysis identified sex (ß = -0.13), stroke severity (ß = -0.25) and admission total FIM (ß = -0.69) as significant predictors of total FIM gain (R2 = 0.42). The same variables predicted discharge total FIM: sex (ß = -0.12), severity (ß = -0.23) and admission total FIM (ß = 0.59) (R2 = 0.51). FIM efficiency was predicted by admission total FIM (ß = -0.64), severity (ß = -0.24), age (ß = -0.17) and length of stay (ß = -0.45) (R2 = 39.9%). FIM effectiveness model explained only 13.5% of the variance. CONCLUSIONS: No functional differences between men and women in any independence measure were found. Sex was a significant predictor but leaving half of the variance unexplained.

TITLE: Rehabilitación en régimen de ingreso en adultos en edad laboral tras un ictus isquémico: análisis clinicofuncional desde una perspectiva de género.Introducción. El papel del género en la independencia funcional en las actividades de la vida diaria tras un ictus isquémico es aún controvertido. Proponemos: a) comparar características clínicas de hombres y mujeres en el momento del ingreso a rehabilitación hospitalaria; b) comparar su independencia funcional en el ingreso y en el alta, y c) identificar predictores de independencia funcional. Materiales y métodos. Estudio de cohortes retrospectivo observacional. Se incluyeron variables descritas en estudios previos en comparaciones ingreso-alta y en regresión lineal multivariante de la Functional Independence Measure (FIM) en el momento del alta, la ganancia, la eficiencia y la efectividad. Resultados. Se estudió a 144 pacientes (33%, mujeres) admitidos a rehabilitación en un centro español (= 3 semanas tras un ictus isquémico). Los hombres eran mayores (p = 0,003), un 19,6% diabéticos (un 6,4% de las mujeres; p = 0,03) y un 52,6% fumadores (un 72,3% de las mujeres; p = 0,02). No observamos diferencias significativas en la FIM en el momento del ingreso, del alta, la ganancia, la eficiencia ni la efectividad (FIM total, motora ni cognitiva). El análisis de regresión identificó el sexo (beta = ­0,13), la gravedad (beta = ­0,25) y la FIM total en el momento el ingreso (beta = ­0,69) como predictores de la ganancia de la FIM total (R2 = 0,42). Las mismas variables predicen la FIM total en el alta: género (beta = ­0,12), gravedad (beta = ­0,23) y FIM total en el ingreso (beta = 0,59) (R2 = 0,51). La FIM en el ingreso (beta = ­0,64), la gravedad (beta = ­0,24), la edad (beta = ­0,17) y el tiempo de estancia hospitalaria (beta = ­0,45) predicen la eficiencia de la FIM total (R2 = 39,9). El modelo de efectividad de la FIM explica únicamente el 13,5% de la varianza. Conclusiones. No encontramos diferencias funcionales entre hombres y mujeres. El sexo es un predictor significativo, pero no explica la mitad de la varianza.

[The impact of educational level on cognitive assessments in young patients admitted to rehabilitation after ischaemic stroke]. / El impacto del nivel educativo en las valoraciones cognitivas de los pacientes jóvenes ingresados en rehabilitación tras un ictus isquémico.

INTRODUCTION AND OBJECTIVE: We propose to assess the impact of educational level on cognitive tests at admission and discharge after a period of cognitive rehabilitation in young patients after ischaemic stroke. MATERIALS AND METHODS: We considered secondary and higher education (group A) and less than 6 years of formal education (group B). We compared A and B using χ2 and Kruskal-Wallis. We studied A and B as predictors of verbal and working memory at discharge. Verbal and working memories were assessed at admission and discharge using Rey Auditory Verbal Learning Test (RAVLT) and DIGITS of the Barcelona Test respectively. RESULTS: We analysed n=277 patients (55% belonging to A, mean age of 51 years) admitted to a specialised centre in Spain between 2009 and 2019. We found significant differences (P<.05) at admission, all in favour of A in the assessments of attention, inhibition, visuoperception, visuoconstruction, verbal fluency and comprehension. In DIGITS and RAVLT-learning we found differences at admission. In Digits and RAVLT-recognition we found differences at discharge, all in favour of A. We found no differences in age, severity, time at admission, or length of stay in hospital. Nor did we find differences in cognitive gains or treatment efficiency in memory tests. The groups A and B did not predict RAVLT (R2=.53) or DIGITS (R2=.48). CONCLUSIONS: A scores better in 63% of tests at admission and in 75% of tests at discharge, A and B are similar in gains and efficiency on memory tests.

[Intensities in the application of robotic technologies in upper extremity rehabilitation after a stroke: a systematic review of randomised controlled clinical trials]. / Intensidades en la aplicación de tecnologías robóticas en la rehabilitación de las extremidades superiores tras un ictus: revisión sistemática de ensayos clínicos controlados aleatorizados.

INTRODUCTION: In the vast majority of cases stroke entails long-term limitations in the use of the upper extremities that are affected. Robotic technologies provide beneficial results in motor rehabilitation, but the optimal levels of intensity are not known. AIMS: To review the scientific literature (over the last 10 years) on robotic therapies (intervention group) compared to conventional therapies (control group) in the chronic phase of stroke, and to study correlations between variables that characterise the interventions and intensity variables. SUBJECTS AND METHODS: A systematic review was conducted of randomised controlled clinical trials in PubMed, Web of Science, Cochrane Library and Google Scholar, with results assessed by the Fugl-Meyer Assessment-Upper Extremity Motor Score (mFMA-UE). The methodological quality was analysed using the Physiotherapy Evidence Database scale (PEDro). RESULTS: Thirteen studies from evidence level I (92%, excellent) were selected. Positive correlations between minutes per week and improvements in mFMA-UE are observed in the control group and in the intervention group, with a higher level of significance for the latter. Negative correlations are observed between the number of months since the lesion and improvements in the control and intervention groups. An exponential regression is included, which illustrates differences between the control group and the intervention group in favour of the latter. A negative correlation is observed between the total duration and the number of minutes per week. CONCLUSION: Significant correlations are observed between intensity (minutes per week) and mFMA-UE, with a higher level of significance in the intervention group.

TITLE: Intensidades en la aplicación de tecnologías robóticas en la rehabilitación de las extremidades superiores tras un ictus: revisión sistemática de ensayos clínicos controlados aleatorizados.Introducción. El ictus conlleva limitaciones a largo plazo en el uso de las extremidades superiores afectadas en la gran mayoría de los casos. Las tecnologías robóticas aportan resultados beneficiosos en rehabilitación motora, pero se desconocen los niveles óptimos de intensidad. Objetivos. Revisar la literatura científica (últimos diez años) sobre terapias robóticas (grupo de intervención) en comparación con las terapias convencionales (grupo control) en la fase crónica del ictus y estudiar correlaciones entre las variables que caracterizan a las intervenciones y las variables de intensidad. Sujetos y métodos. Se realizó una revisión sistemática de ensayos clínicos controlados aleatorizados en PubMed, Web of Science, Cochrane Library y Google Scholar, con resultados valorados mediante la Fugl-Meyer Assessment-Upper Extremity Motor Score (mFMA-UE). La calidad metodológica se analizó mediante la escala Physiotherapy Evidence Database (PEDro). Resultados. Se seleccionaron 13 estudios, de nivel de evidencia I (92% excelente). Se observan correlaciones positivas entre los minutos semanales y las mejoras en la mFMA-UE en el grupo control y el grupo de intervención, con mayor nivel de significación para este último. Se observan correlaciones negativas entre el número de meses desde la lesión y las mejoras en el grupo control y en el grupo de intervención. Se incluye una regresión exponencial, que ilustra diferencias entre el grupo control y el grupo de intervención en favor de éste. Se observa una correlación negativa entre la duración total y la cantidad de minutos semanales. Conclusión. Se observan correlaciones significativas entre la intensidad (minutos semanales) y la mFMA-UE, con un mayor nivel de significación en el grupo de intervención.

Hybrid EEG/EOG-based brain/neural hand exoskeleton restores fully independent daily living activities after quadriplegia.

Direct brain control of advanced robotic systems promises substantial improvements in health care, for example, to restore intuitive control of hand movements required for activities of daily living in quadriplegics, like holding a cup and drinking, eating with cutlery, or manipulating different objects. However, such integrated, brain- or neural-controlled robotic systems have yet to enter broader clinical use or daily life environments. We demonstrate full restoration of independent daily living activities, such as eating and drinking, in an everyday life scenario across six paraplegic individuals (five males, 30 ± 14 years) who used a noninvasive, hybrid brain/neural hand exoskeleton (B/NHE) to open and close their paralyzed hand. The results broadly suggest that brain/neural-assistive technology can restore autonomy and independence in quadriplegic individuals' everyday life.

Focal vibration in neurorehabilitation.

During the last decade, many studies have been carried out to understand the effects of focal vibratory stimuli at various levels of the central nervous system and to study pathophysiological mechanisms of neurological disorders as well as the therapeutic effects of focal vibration in neurorehabilitation. This review aimed to describe the effects of focal vibratory stimuli in neurorehabilitation including the neurological diseases or disorders like stroke, spinal cord injury, multiple sclerosis, Parkinson's' disease and dystonia. In conclusion, focal vibration stimulation is well tolerated, effective and easy to use, and it could be used to reduce spasticity, to promote motor activity and motor learning within a functional activity, even in gait training, independent from etiology of neurological pathology. Further studies are needed in the future well-designed trials with bigger sample size to determine the most effective frequency, amplitude and duration of vibration application in the neurorehabilitation.

Urethral sphincter EMG-controlled dorsal penile/clitoral nerve stimulation to treat neurogenic detrusor overactivity.

The goal of this study was to investigate whether real-time external urethral sphincter (EUS) EMG-controlled dorsal genital nerve (DGN) stimulation can suppress undesired detrusor bladder contractions in patients with both neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD). Detrusor pressure (Pdet) and EUS EMG were recorded in 12 neurogenic patients who underwent two filling cystometries. The first one was without stimulation and was intended to confirm the NDO and DSD and to set the EMG detection threshold. The second one was with real-time EMG-controlled stimulation of DGNs. Two detection methods were analyzed to detect bladder contractions. The first method was a Kurtosis-scaled root mean square (RMS) detector and was used on-line. The second was a simple RMS detector and was used off-line. Of 12 patients included, 10 patients showed both NDO and DSD. In nine of these ten patients relevant EMG concomitant to detrusor activity was detected and stimulation could suppress at least one detrusor contraction. The second filling compared to the first one showed an increase of 84% in bladder capacity (p = 0.002) and a decrease of 106% in Pdet (p = 0.002). Nine false-positive detections occurred during the ten fillings with electrical stimulation. The mean increases of both time and Pdet between stimulation and bladder contraction onsets for method 1 were 1.8 s and 4 cmH(2)O and for method 2 were 0.9 s and 2 cmH(2)O, respectively. This study shows that EUS EMG can be used in real time to detect the onset of a bladder contraction. In combination with DGN stimulation has been shown to be feasible to suppress undesired bladder contractions and in turn to increase bladder capacity in subjects with both NDO and DSD.

H reflex modulation by transcranial magnetic stimulation in spinal cord injury subjects after gait training with electromechanical systems.

STUDY DESIGN: Prospective longitudinal study. OBJECTIVES: The aim of this study was to examine the effects of transcranial magnetic stimulation (TMS) on the soleus H reflex in patients with spinal cord injury (SCI) before and after locomotion training. SETTING: Neurorehabilitation hospital in Barcelona, Spain. METHODS: H reflex was elicited in 29 incomplete patients with SCI at 20, 50 and 80 ms after single vertex TMS, and compared with 13 healthy subjects. Patients were subdivided in two groups according to time since injury (<3 months, 3-12 months), and all received training with electromechanical systems. The H reflex modulation pattern to TMS was reassessed and the results were analyzed as a function of change in the patient clinical score. RESULTS: Healthy subjects showed a significant H reflex facilitation at 20 ms (186.1%) and at 80 ms (190.6%) compared with the control H reflex. In patients, the H reflex facilitation at 20 ms was significantly reduced before training (142.5%, P=0.039) compared with healthy subjects. After training, patients with <3 months exhibited an increase in H reflex facilitation at 20 ms (170.7%, P=0.04), a greater gait velocity (P=0.014) and a positive correlation with the walking index for spinal cord injury (WISCI II) scale (P=0.050), compared with those with >3 months. CONCLUSIONS: TMS-induced H reflex modulation may help in the assessment of changes in the descending control of leg reflexes. Our results suggest that the changes on reflex modulation in patients with SCI occur within the first 3 months after injury.

The effect of a prepulse stimulus on the EMG rebound following the cutaneous silent period.

The cutaneous silent period (CSP) is a spinal inhibitory reflex mediated by Adelta fibres. The postinhibitory rebound of electromyographic (EMG) activity following the CSP has been mainly attributed to resynchronization of motoneurons, but the possibility of startle reflex activity contributing to the EMG burst has also been suggested. Several types of reflexes may be suppressed by a preceding weak stimulus--a phenomenon called prepulse inhibition (PPI). Our aim was to study whether PPI would diminish the EMG rebound, thereby providing further evidence for excitatory reflex activity contained within the postinhibitory EMG rebound following the CSP. Ten healthy subjects underwent CSP testing following noxious digit II stimulation in two conditions, with and without a prepulse applied to digit III. Rectified surface EMG recordings were obtained from right orbicularis oculi, sternocleidomastoid and thenar muscles of the dominant hand during thumb abduction with 25% of maximum force. The area of the EMG rebound and the EMG reflex responses in orbicularis oculi and sternocleidomastoid were significantly smaller in recordings where a prepulse stimulus was applied 100 ms before the stimulus as compared to control responses without prepulse. CSP onset and end latency, CSP duration, and the degree of EMG suppression were not influenced. Prepulses significantly reduced subjective discomfort as based on visual analog scale scores. Inhibition of the EMG rebound by prepulse stimulation supports the hypothesis that the excitatory EMG activity following the CSP contains not only resynchronization of motoneuronal firing, but also an excitatory reflex component. The most probable type of reflex seems to be a somatosensory startle reflex, a defence reaction which is generated in structures located in the caudal brainstem following an unexpected intense stimulus. Reduction of the discomfort associated with high-intensity electrical fingertip stimulation by a prepulse without affecting CSP parameters underlines the utility of PPI in the context of CSP testing.

Patient controlled versus automatic stimulation of pudendal nerve afferents to treat neurogenic detrusor overactivity.

PURPOSE: We investigated whether patients with neurogenic detrusor overactivity can sense the onset of bladder contraction and in turn suppress the contraction by electrical stimulation of the dorsal penile-clitoral nerve. MATERIALS AND METHODS: A total of 67 patients with different neurological disorders were recruited to undergo 3 filling cystometries. The first cystometry was done without stimulation. The second cystometry was performed with automatic controlled stimulation based on detrusor pressure. The third cystometry was done with patient controlled stimulation using a push button. RESULTS: Four females and 13 males underwent all 3 fillings. Compared to cystometry 1 average bladder capacity for cystometries 2 and 3 was 60% higher. Compared to peak pressure for cystometry 1 average peak pressure during suppressed contractions for cystometries 2 and 3 was 49% and 26% lower, respectively. The average delay of the onset of stimulation during cystometry 3 with respect to cystometry 2 was 5.7 seconds. CONCLUSIONS: The study shows that patient controlled genital nerve stimulation is as effective as automatic controlled stimulation to treat neurogenic detrusor overactivity. Thus, patient controlled stimulation is feasible in select patients, although patients must be trained in the technique.