Return to work within a year after first stroke: blue and white collar workers comparison, predictors and causal mediation assessed during inpatient rehabilitation.

BACKGROUND: Most research focuses around impairments in body function and structure, with relatively only a small number exploring their social impact. OBJECTIVES: 1) compare characteristics for individuals who before stroke were blue collar vs. white collar workers 2) identify clinical, functional, and job-related factors associated with return to work within 1 year after discharge 3) identify specific ADL individual items (assessed at rehabilitation discharge) as return to work predictors and 4) identify return to work causal mediators. METHODS: Retrospective observational cohort study, analyzing adult patients with stroke admitted to rehabilitation between 2007 and 2021, including baseline Barthel Index (BI) and return to work assessments between 2008 and 2022. Kaplan-Meier survival curves and Cox proportional hazards were applied. Causal mediation analyses using 1000-bootstrapped simulations were performed. RESULTS: A total of 802 individuals were included (14.6% returned to work), 53.6% blue-collar and 46.4% white-collar. Blue-collar workers showed significantly higher proportion of ischemic stroke, diabetes, dyslipidemia, and hypertension.Individuals not returning to work presented a higher proportion of blue collar, dominant side affected, aphasia, lower BI scores, and larger length of stay (LOS). Multivariable Cox proportional hazards identified age at injury, aphasia, hypertension, and total discharge BI score (C-Index = 0.74). Univariable Cox models identified three independent BI items at all levels of independence: bathing (C-Index = 0.58), grooming (C-Index = 0.56) and feeding (C-Index = 0.59). BI efficiency (gain/LOS) was a causal mediator. CONCLUSION: Blue collar workers showed higher proportion of risk factors and comorbidities. Novel factors, predictors, and a return to work mediator were identified.

Long-term prediction of functional independence using adjusted and unadjusted single items of the functional independence measure (FIM) at discharge from rehabilitation.

CONTEXT: Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury. OBJECTIVES: (1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3-6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict "good" functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors. METHODS: This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and "good" functional independence (FIM motor score ≥ 65) reporting adjusted R2, odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation. RESULTS: The top three predictors, each from a different FIM domain, were Toilet (adjusted R2 = 0.53, Transfers domain), Toileting (adjusted R2 = 0.46, Self-care domain), and Bowel (adjusted R2 = 0.35, Sphincter control domain). These three items were also predictors of "good" functional independence (AUC: 0.84-0.87) and their predictive power increased (AUC: 0.88-0.93) when adjusted by age, paraplegia, time since injury, and length of stay. CONCLUSIONS: Discharge FIM items accurately predict long-term functional independence.

Transcutaneous Electrical Neuromodulation of the Cervical Spinal Cord Depends Both on the Stimulation Intensity and the Degree of Voluntary Activity for Training. A Pilot Study.

Electrical enabling motor control (eEmc) through transcutaneous spinal cord stimulation offers promise in improving hand function. However, it is still unknown which stimulus intensity or which muscle force level could be better for this improvement. Nine healthy individuals received the following interventions: (i) eEmc intensities at 80%, 90% and 110% of abductor pollicis brevis motor threshold combined with hand training consisting in 100% handgrip strength; (ii) hand training consisting in 100% and 50% of maximal handgrip strength combined with 90% eEmc intensity. The evaluations included box and blocks test (BBT), maximal voluntary contraction (MVC), F wave persistency, F/M ratio, spinal and cortical motor evoked potentials (MEP), recruitment curves of spinal MEP and cortical MEP and short-interval intracortical inhibition. The results showed that: (i) 90% eEmc intensity increased BBT, MVC, F wave persistency, F/M ratio and cortical MEP recruitment curve; 110% eEmc intensity increased BBT, F wave persistency and cortical MEP and recruitment curve of cortical MEP; (ii) 100% handgrip strength training significantly modulated MVC, F wave persistency, F/M wave and cortical MEP recruitment curve in comparison to 50% handgrip strength. In conclusion, eEmc intensity and muscle strength during training both influence the results for neuromodulation at the cervical level.

The Role of Audiovisual Speech in Fast-Mapping and Novel Word Retention in Monolingual and Bilingual 24-Month-Olds.

Three experiments examined the role of audiovisual speech on 24-month-old monolingual and bilinguals' performance in a fast-mapping task. In all three experiments, toddlers were exposed to familiar trials which tested their knowledge of known word-referent pairs, disambiguation trials in which novel word-referent pairs were indirectly learned, and retention trials which probed their recognition of the newly-learned word-referent pairs. In Experiment 1 (n = 48), lip movements were present during familiar and disambiguation trials, but not retention trials. In Experiment 2 (n = 48), lip movements were present during all three trial types. In Experiment 3 (bilinguals only, n = 24), a still face with no lip movements was present in all three trial types. While toddlers succeeded in the familiar and disambiguation trials of every experiment, success in the retention trials was only found in Experiment 2. This work suggests that the extra-linguistic support provided by lip movements improved the learning and recognition of the novel words.

Cervical Electrical Neuromodulation Effectively Enhances Hand Motor Output in Healthy Subjects by Engaging a Use-Dependent Intervention.

Electrical enabling motor control (eEmc) through transcutaneous spinal cord stimulation is a non-invasive method that can modify the functional state of the sensory-motor system. We hypothesize that eEmc delivery, together with hand training, improves hand function in healthy subjects more than either intervention alone by inducing plastic changes at spinal and cortical levels. Ten voluntary participants were included in the following three interventions: (i) hand grip training, (ii) eEmc, and (iii) eEmc with hand training. Functional evaluation included the box and blocks test (BBT) and hand grip maximum voluntary contraction (MVC), spinal and cortical motor evoked potential (sMEP and cMEP), and resting motor thresholds (RMT), short interval intracortical inhibition (SICI), and F wave in the abductor pollicis brevis muscle. eEmc combined with hand training retained MVC and increased F wave amplitude and persistency, reduced cortical RMT and facilitated cMEP amplitude. In contrast, eEmc alone only increased F wave amplitude, whereas hand training alone reduced MVC and increased cortical RMT and SICI. In conclusion, eEmc combined with hand grip training enhanced hand motor output and induced plastic changes at spinal and cortical level in healthy subjects when compared to either intervention alone. These data suggest that electrical neuromodulation changes spinal and, perhaps, supraspinal networks to a more malleable state, while a concomitant use-dependent mechanism drives these networks to a higher functional state.

Recuperación de la función de la extremidad superior en esclerosis múltiple mediante neuromodulación eléctrica espinal asistida con exoesqueleto robótico / Recovery of the function of the upper limb in multiple sclerosis through electrical spinal neuromodulation assisted with robotic exoskeleton

OBJETIVOS: evaluar la efectividad de la combinación de la neuromodulación eléctrica espinal transcutánea asistida con exoesqueleto robótico en la recuperación de la función de la extremidad superior en personas con esclerosis múltiple. MÉTODOS: ensayo clínico aleatorizado con grupo control (doble ciego). Para la recogida de datos se emplean diversas escalas como: Nine Hole Peg Test, Functional Independence Measure o Modified Ashworth Scale entre otras. El estudio durará 18 semanas en las que se realizarán cuatro evaluaciones: inicial, continua, postratamiento y de seguimiento tras dos meses sin tratamiento. La muestra estará formada por personas diagnosticadas de esclerosis múltiple. DISCUSIÓN: se espera que la combinación de estas técnicas o abordajes mejore la funcionalidad de la extremidad superior en estas personas y consecuentemente su calidad de vida e independencia en su cotidianeidad

OBJECTIVE: Evaluate the effectiveness of combination in robotic exoskeleton-assisted transcutaneous spinal electrical neuromodulation on upper limb recovery function in people with multiple sclerosis. METHODS: Randomized clinical trial with control group (double blind). Data was collected with various scales such as: Nine Hole Peg Test, Functional Independence Measure or Modified Ashworth Scale. The study will last 18 weeks in wich 4 evaluations will be made: initial, continuous, post-treatment and follow-up after 2 months without treatment. The sample will be created on patients diagnosed multiple sclerosis. DISCUSSION: The combination of these techniques or approaches is expected to improve the functionality of upper limb on these patients and consequently their quality of life and independence in their daily life

Estimulación no invasiva cerebral y medular para la recuperación motora y funcional tras una lesión medular / Non-invasive brain and spinal cord stimulation for motor and functional recovery after a spinal cord injury

INTRODUCCIÓN: La lesión medular es un evento traumático o no traumático que causa una alteración de la función sensorial, motora o autonómica y, en última instancia, afecta a las características físicas, psicológicas y el bienestar social de la persona que lo sufre. El abordaje integral de la lesión medular requiere muchos recursos de salud y puede representar una considerable carga financiera para los pacientes, sus familias y la comunidad. OBJETIVO: Revisar la bibliografía publicada sobre el uso de la estimulación cerebral no invasiva, incluida la estimulación magnética transcraneal repetitiva (EMTr), la estimulación de corriente continua directa transcraneal (tDCS), así como la estimulación medular no invasiva transcutánea (tcSCS), como estrategias terapéuticas para mejorar la funcionalidad de los pacientes con lesión medular. Los estudios se agruparon bien como de estimulación no invasiva cerebral, bien como de estimulación medular no invasiva. DESARROLLO: Se identificaron 32 estudios: 21 de estimulación cerebral (14 en EMTr y 7 en tDCS) y 11 de estimulación medular (tcSCS). Todos los estudios se realizaron en pacientes adultos que sufrieron una lesión medular. A pesar de la variabilidad significativa en los protocolos de tratamiento, las características de los pacientes y la evaluación clínica, los cambios observados se describieron en casi todos los estudios sin producir efectos secundarios con mejoría motora o funcional. CONCLUSIÓN: La estimulación cerebral no invasiva, así como la estimulación medular, son técnicas prometedoras para la rehabilitación de pacientes con lesión medular debido a su novedad, su efectividad y mínimos efectos secundarios

INTRODUCTION: Spinal cord injury is a traumatic or non-traumatic event that causes an alteration of sensory, motor or autonomic functioning and ultimately affects the physical, psychological and social well-being of the person who suffers it. A comprehensive approach to spinal cord injury requires many health resources and can place a considerable financial burden on patients, their families and the community. AIM: To review the literature published to date on the use of non-invasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcutaneous non-invasive spinal cord stimulation (tcSCS), as therapeutic strategies to improve the functionality of patients with spinal cord injury. The studies were grouped as addressing either non-invasive brain stimulation or non-invasive spinal cord stimulation. DEVELOPMENT: Altogether 32 studies were identified: 21 involving brain stimulation (14 in rTMS and 7 in tDCS) and 11 with spinal cord stimulation (tcSCS). All the studies were conducted in adult patients who had undergone a spinal cord injury. Despite significant variability in treatment protocols, patient characteristics and clinical assessment, the changes observed were reported in almost all the studies without producing any side effects and with motor or functional improvement. CONCLUSION: Non-invasive brain stimulation, as well as spinal cord stimulation, are promising techniques for the rehabilitation of patients with spinal cord injury due to their novelty, effectiveness and minimal side effects

Evoked and oscillatory EEG activity differentiates language discrimination in young monolingual and bilingual infants.

Language discrimination is one of the core differences between bilingual and monolingual language acquisition. Here, we investigate the earliest brain specialization induced by it. Following previous research, we hypothesize that bilingual native language discrimination is a complex process involving specific processing of the prosodic properties of the speech signal. We recorded the brain activity of monolingual and bilingual 4.5-month-old infants using EEG, while listening to their native/dominant language and two foreign languages. We defined two different windows of analysis to separate discrimination and identification effects. In the early window of analysis (150-280 ms) we measured the P200 component, and in the later window of analysis we measured Theta (400-1800 ms) and Gamma (300-2800 ms) oscillations. The results point in the direction of different language discrimination strategies for bilingual and monolingual infants. While only monolingual infants show early discrimination of their native language based on familiarity, bilinguals perform a later processing which is compatible with an increase in attention to the speech signal. This is the earliest evidence found for brain specialization induced by bilingualism.

In vitro activity of terpenes against Candida albicans and ultrastructural alterations.

OBJECTIVE: The purpose of this study was to investigate the in vitro activity of terpene blends combined with tissue conditioner against Candida albicans and the effect on its morphology and sub-micro structure. STUDY DESIGN: The minimal inhibitory concentration (MIC) of terpenes, obtained from a by-product of kraft pulping, was determined using broth microdilution against C. albicans strains, and the activity of terpenes combined with Coe-Comfort tissue conditioner was assessed. Cell morphologic alterations were evaluated using scanning electronic microscopy and transmission electronic microscopy. Data was analyzed using Student's t test P < .05. RESULTS: The MIC of terpene blends fluctuated between 0.097% and 0.39% (v/v). Coe-Comfort tissue conditioner mixed with terpenes exhibited a total inhibition of C. albicans (P < .05). Terpenes induced ultrastructural alterations, even at the MIC value, including an increase in size, shape modification, cell wall damage with perforations, pronounced disconnection between cell wall and cytoplasm, and cytoplasmic vacuoles. CONCLUSIONS: Terpenes had pronounced effects against C. albicans alone and in combination with Coe-Comfort tissue conditioner, which mainly resulted in cell wall damage.

Integración de la metodología cuantitativa y cualitativa en la Investigación en Enfermería. A propósito de un proyecto en curso / Integration of quantitative and qualitative methodology in nursing research. By way of an ongoing project

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