White matter abnormalities in fetal alcohol spectrum disorders: Focus on axon growth and guidance.

Fetal Alcohol Spectrum Disorders (FASDs) describe a range of deficits, affecting physical, mental, cognitive, and behavioral function, arising from prenatal alcohol exposure. FASD causes widespread white matter abnormalities, with significant alterations of tracts in the cerebral cortex, cerebellum, and hippocampus. These brain regions present with white-matter volume reductions, particularly at the midline. Neural pathways herein are guided primarily by three guidance cue families: Semaphorin/Neuropilin, Netrin/DCC, and Slit/Robo. These guidance cue/receptor pairs attract and repulse axons and ensure that they reach the proper target to make functional connections. In several cases, these signals cooperate with each other and/or additional molecular partners. Effects of alcohol on guidance cue mechanisms and their associated effectors include inhibition of growth cone response to repellant cues as well as changes in gene expression. Relevant to the corpus callosum, specifically, developmental alcohol exposure alters GABAergic and glutamatergic cell populations and glial cells that serve as guidepost cells for callosal axons. In many cases, deficits seen in FASD mirror aberrancies in guidance cue/receptor signaling. We present evidence for the need for further study on how prenatal alcohol exposure affects the formation of neural connections which may underlie disrupted functional connectivity in FASD.

Physical Therapy Management of Adults with Mild Traumatic Brain Injury.

Rehabilitation for individuals after mild traumatic brain injury (mTBI) or concussion requires emphasis on both cognitive and physical rest, with a gradual return to activity including sports. As the client becomes more active, the rehabilitation professional should pay close attention to symptoms associated with mTBI, such as headache, dizziness, nausea, and difficulty concentrating. The systematic approach to return to play provided by the Berlin Consensus Statement on Concussion in Sport can apply to adults with mTBI. This protocol calls for gradually increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to an mTBI, the injured individual may incur injuries to the vestibular and balance system that are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves in a few sessions with a vestibular physical therapist. In conditions such as gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist and a home exercise program. In all of the above-stated conditions, it is essential to consider that a patient with protracted symptoms of mTBI or postconcussion syndrome will recover more slowly than others and should be monitored for symptoms throughout the intervention.

Integrating Spanish language training across a Doctor of Physical Therapy curriculum: a case report of one program's evolving model.

BACKGROUND AND PURPOSE: As the Hispanic population continues to expand in the United States, health professionals increasingly may encounter people who speak Spanish and have limited English proficiency. Responding to these changes, various health profession educators have incorporated Spanish language training into their curricula. Of 12 doctor of physical therapy (DPT) programs identified as including elective or required Spanish courses, the program at The University of Texas at El Paso is the only one integrating required Spanish language training across the curriculum. The purpose of this case report is to describe the development, implementation, and preliminary outcomes of the evolving educational model at The University of Texas at El Paso. CASE DESCRIPTION: The University of Texas at El Paso is situated immediately across the border from Mexico. Responding to the large population with limited English proficiency in the community, faculty began to integrate required Spanish language training during a transition from a master-level to a DPT curriculum. The Spanish language curriculum pillar includes a Spanish medical terminology course, language learning opportunities threaded throughout the clinical courses, clinical education courses, and service-learning. Forty-five DPT students have completed the curriculum. OUTCOMES: Assessment methods were limited for early cohorts. Clinically relevant Spanish verbal proficiency was assessed with a practical examination in the Spanish course, a clinical instructor-rated instrument, and student feedback. Preliminary data suggested that the model is improving Spanish language proficiency. DISCUSSION: The model still is evolving. Spanish language learning opportunities in the curriculum are being expanded. Also, problems with the clinical outcome measure have been recognized. Better definition of intended outcomes and validation of a revised tool are needed. This report should promote opportunities for collaboration with others who are interested in linguistic competence.

Management of athletes with postconcussion syndrome.

Rehabilitation for athletes with postconcussion syndrome requires emphasis on both cognitive and physical rest with a gradual return to activity and sports. As the athlete becomes more active, the rehabilitation and sport professional should pay close attention to symptoms of concussion, like headache, dizziness, nausea, and difficulty concentrating. The Zurich Consensus Statement on Concussion in Sport provides a systematic approach to increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to a concussion, the injured athlete may have incurred injuries to the vestibular and balance system, which are not directly related to concussion. These conditions are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves with a few sessions with a vestibular therapist and a home exercise program. In conditions like gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist. In all of these conditions, it is important to consider that the patient with postconcussion syndrome will likely recover more slowly than others and should be monitored for symptoms of postconcussion syndrome throughout intervention.

Erythropoietin mediates tissue protection through an erythropoietin and common beta-subunit heteroreceptor.

The cytokine erythropoietin (Epo) is tissue-protective in preclinical models of ischemic, traumatic, toxic, and inflammatory injuries. We have recently characterized Epo derivatives that do not bind to the Epo receptor (EpoR) yet are tissue-protective. For example, carbamylated Epo (CEpo) does not stimulate erythropoiesis, yet it prevents tissue injury in a wide variety of in vivo and in vitro models. These observations suggest that another receptor is responsible for the tissue-protective actions of Epo. Notably, prior investigation suggests that EpoR physically interacts with the common beta receptor (betacR), the signal-transducing subunit shared by the granulocyte-macrophage colony stimulating factor, and the IL-3 and IL-5 receptors. However, because betacR knockout mice exhibit normal erythrocyte maturation, betacR is not required for erythropoiesis. We hypothesized that betacR in combination with the EpoR expressed by nonhematopoietic cells constitutes a tissue-protective receptor. In support of this hypothesis, membrane proteins prepared from rat brain, heart, liver, or kidney were greatly enriched in EpoR after passage over either Epo or CEpo columns but covalently bound in a complex with betacR. Further, antibodies against EpoR coimmunoprecipitated betacR from membranes prepared from neuronal-like P-19 cells that respond to Epo-induced tissue protection. Immunocytochemical studies of spinal cord neurons and cardiomyocytes protected by Epo demonstrated cellular colocalization of Epo betacR and EpoR. Finally, as predicted by the hypothesis, neither Epo nor CEpo was active in cardiomyocyte or spinal cord injury models performed in the betacR knockout mouse. These data support the concept that EpoR and betacR comprise a tissue-protective heteroreceptor.