Force Platform-Based Intervention Program for Individuals Suffering with Neurodegenerative Diseases like Parkinson.

The term "neurodegenerative disease" refers to a set of illnesses that primarily affect brain's neurons. Substantia nigra (a midbrain dopaminergic nucleus) with lack of hormone called dopamine causes Parkinson's disease (PD), a neurological disorder. PD leads to tremor, stiffness, impaired posture and balance, and loss of automatic movements. Patient with Parkinson's often develops a parkinsonian gait that includes a tendency to lean forward, small quick steps as if hurrying forward, and reduced swinging of the arms. They also may have trouble initiating or continuing movement. Gait analysis is often used to diagnose neurodegenerative illnesses and determine their stage. In this study, we attempt to investigate postural balance, and of gait signals for Parkinson's patients, also, we incorporate interim rehabilitation technique. We included 25 PD patients who had 2.5 to 3 IV score of Hoehn and Yahr scale. A ten-minute walk test has been performed to observe primary and secondary results of dual task interference on gait velocities, and gait time motion vector for right and left legs was observed. Two experimental ground conditions include three conditions of trunk alignment, that is, erect on a regular basis (RE), trunk dorsiflexion 30° (TF1), and trunk dorsiflexion 50° (TF2) were analysed. We identified the walking speed of PD patients was decreased, and trunk dorsiflexion variables influence the gait pattern of Parkinson's disease patients, where higher 95% CI for TF1 condition was reported. The regular erect trunk showed swing time reduction (0.7%) in PD, so the higher unified PD rating scale (UPDRS) values have significant difference in swing phase time in Parkinson's patients. The average Hoehn and Yahr scale (H&Y scale) was 4.3 ± 2.5 reported in the study participants. In a 10-week follow-up evaluation, the stance duration was shown to be substantial, as was the slower speed gait in the baseline condition. Excessive flexion was discovered in our investigation at the lower limb joints, particularly the knee and ankle. Patients with Parkinson's disease had similar maximum dorsiflexion and minimum plantarflexion values in stance. The trunk fraction conditions were found significant in patients after rehabilitation training. The best response to rehabilitation treatment was seen when the trunk was rotated. When steps and posture distribution analysis performed, we found that the trunk flexure 1 (p < 0.05), and trunk flexure 2 (p < 0.01) were shown significant values. When GRF threshold characteristics are employed, mean accuracy improves by 52%. Regardless of gait posture, the step regular trunk flexure had significantly higher posture than the corresponding level steps, with a considerable rise in the 50 in trunk dorsiflexion 2 gait relative to the step "L." This study shows that there was some significant improvement observed in the gait parameters among patients with PD's which shows positive impact of the intervention. Furthermore, rehabilitation programmes can aid and improve poor gait features in patients with Parkinson's disease, especially those who are in the early stages of the condition. This gait and balance research provides a rationale for intervention treatments, and their use in clinical practise enhances evidence of therapeutic efficacy. However, prolonged follow-up is needed to determine whether the advantages will remain all across disease's course, and future studies may recommend a specific rehabilitation technique based on gait analysis results.

Evaluación del impacto del confinamiento sobre la salud y el estilo de vida de las personas usuarias de los centros neurorrehabilitadores de Lleida y Reus de la Fundació Esclerosi Múltiple / Evaluation of the impact of lockdown on the health and lifestyle of users of the Fundació Esclerosi Múltiple’s neurorehabilitation centres in Lleida and Reus

Introducción: El día 13 de marzo de 2020 se decretó el estado de alarma con motivo de la pandemia de la COVID-19, lo que supuso un confinamiento domiciliario total en España. Los centros neurorrehabilitadores de la Fundació Esclerosi Múltiple (FEM) atienden a personas diagnosticadas de enfermedades neuroprogresivas con déficits de salud importantes. Analizamos cómo el confinamiento puede afectar a su forma de vida. Objetivos: Evaluar y gestionar el impacto del confinamiento en la persona con esclerosis múltiple (EM) y otras enfermedades neurodegenerativas. Pacientes y métodos: Estudio observacional analítico. Se aplicó un cuestionario anónimo a todas las personas que estaban en tratamiento rehabilitador integral en dos de los centros de la FEM, que incluía características demográficas y clínicas de los sujetos, junto con la evaluación del impacto de la pandemia en la esfera física, social y psicológica. Resultados: Se han analizado un total de 202 encuestas. La edad media de los participantes ha sido de 49,09 años. Un 77,8% presenta EM, mientras que un 22,2% tiene otras patologías. Los síntomas físicos que han aparecido más frecuentemente han sido debilidad muscular, pérdida de equilibrio y fatiga. La población estudiada se ha mantenido activa durante el confinamiento. Más de la mitad no refiere aumento en los síntomas cognitivos, pero sí que aparece, a nivel emocional, un aumento de la sensación de preocupación. Conclusiones: Podemos afirmar que las acciones desplegadas desde la FEM, para reducir las consecuencias del confinamiento, han sido efectivas y han bajado al máximo la aparición de conductas desadaptativas. El estudio también nos ha abierto la puerta a añadir nuevas líneas de intervención.(AU)

Introduction: On 13 March 2020, a state of alarm was declared due to the COVID-19 pandemic, resulting in total lockdown in Spain. The neurorehabilitation centres of the Fundació Esclerosi Múltiple (FEM) provide care for people diagnosed with neuroprogressive diseases with significant health deficits. We look at how lockdown can affect their way of life. Aims: To assess and manage the impact of lockdown on persons with multiple sclerosis (MS) and other neurodegenerative diseases. Patients and methods. Analytical observational study. An anonymous questionnaire was administered to all the patients undergoing comprehensive rehabilitation treatment at two of the FEM centres; the survey included questions on the demographic and clinical characteristics of the subjects, and an assessment of the impact of the pandemic on the physical, social and psychological spheres. Results: A total of 202 surveys were analysed. The average age of the participants was 49.09 years and 77.8% had MS, while 22.2% had other conditions. The most frequently reported physical symptoms were muscle weakness, loss of balance and fatigue. The study population remained active during lockdown. More than half of them did not report any increase in cognitive symptoms, but they did mention an increased sense of worry on an emotional level. Conclusions: We can state that the actions deployed by the FEM to reduce the consequences of lockdown have been effective and have minimised the occurrence of maladaptive behaviours. The study has also opened the door for us to add new lines of intervention.(AU)

[Evaluation of the impact of lockdown on the health and lifestyle of users of the Fundacio Esclerosi Multiple's neurorehabilitation centres in Lleida and Reus]. / Evaluación del impacto del confinamiento sobre la salud y el estilo de vida de las personas usuarias de los centros neurorrehabilitadores de Lleida y Reus de la Fundació Esclerosi Múltiple.

INTRODUCTION: On 13 March 2020, a state of alarm was declared due to the COVID-19 pandemic, resulting in total lockdown in Spain. The neurorehabilitation centres of the Fundacio Esclerosi Multiple (FEM) provide care for people diagnosed with neuroprogressive diseases with significant health deficits. We look at how lockdown can affect their way of life. AIMS: To assess and manage the impact of lockdown on persons with multiple sclerosis (MS) and other neurodegenerative diseases. PATIENTS AND METHODS: Analytical observational study. An anonymous questionnaire was administered to all the patients undergoing comprehensive rehabilitation treatment at two of the FEM centres; the survey included questions on the demographic and clinical characteristics of the subjects, and an assessment of the impact of the pandemic on the physical, social and psychological spheres. RESULTS: A total of 202 surveys were analysed. The average age of the participants was 49.09 years and 77.8% had MS, while 22.2% had other conditions. The most frequently reported physical symptoms were muscle weakness, loss of balance and fatigue. The study population remained active during lockdown. More than half of them did not report any increase in cognitive symptoms, but they did mention an increased sense of worry on an emotional level. CONCLUSIONS: We can state that the actions deployed by the FEM to reduce the consequences of lockdown have been effective and have minimised the occurrence of maladaptive behaviours. The study has also opened the door for us to add new lines of intervention.

TITLE: Evaluación del impacto del confinamiento sobre la salud y el estilo de vida de las personas usuarias de los centros neurorrehabilitadores de Lleida y Reus de la Fundació Esclerosi Múltiple.Introducción. El día 13 de marzo de 2020 se decretó el estado de alarma con motivo de la pandemia de la COVID-19, lo que supuso un confinamiento domiciliario total en España. Los centros neurorrehabilitadores de la Fundació Esclerosi Múltiple (FEM) atienden a personas diagnosticadas de enfermedades neuroprogresivas con déficits de salud importantes. Analizamos cómo el confinamiento puede afectar a su forma de vida. Objetivos. Evaluar y gestionar el impacto del confinamiento en la persona con esclerosis múltiple (EM) y otras enfermedades neurodegenerativas. Pacientes y métodos. Estudio observacional analítico. Se aplicó un cuestionario anónimo a todas las personas que estaban en tratamiento rehabilitador integral en dos de los centros de la FEM, que incluía características demográficas y clínicas de los sujetos, junto con la evaluación del impacto de la pandemia en la esfera física, social y psicológica. Resultados. Se han analizado un total de 202 encuestas. La edad media de los participantes ha sido de 49,09 años. Un 77,8% presenta EM, mientras que un 22,2% tiene otras patologías. Los síntomas físicos que han aparecido más frecuentemente han sido debilidad muscular, pérdida de equilibrio y fatiga. La población estudiada se ha mantenido activa durante el confinamiento. Más de la mitad no refiere aumento en los síntomas cognitivos, pero sí que aparece, a nivel emocional, un aumento de la sensación de preocupación. Conclusiones. Podemos afirmar que las acciones desplegadas desde la FEM, para reducir las consecuencias del confinamiento, han sido efectivas y han bajado al máximo la aparición de conductas desadaptativas. El estudio también nos ha abierto la puerta a añadir nuevas líneas de intervención.

Getting into a "Flow" state: a systematic review of flow experience in neurological diseases.

BACKGROUND: Flow is a subjective psychological state that people report when they are fully involved in an activity to the point of forgetting time and their surrounding except the activity itself. Being in flow during physical/cognitive rehabilitation may have a considerable impact on functional outcome, especially when patients with neurological diseases engage in exercises using robotics, virtual/augmented reality, or serious games on tablets/computer. When developing new therapy games, measuring flow experience can indicate whether the game motivates one to train. The purpose of this study was to identify and systematically review current literature on flow experience assessed in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Additionally, we critically appraised, compared and summarized the measurement properties of self-reported flow questionnaires used in neurorehabilitation setting. DESIGN: A systematic review using PRISMA and COSMIN guidelines. METHODS: MEDLINE Ovid, EMBASE Ovid, CINAHL EBSCO, SCOPUS were searched. Inclusion criteria were (1) peer-reviewed studies that (2) focused on the investigation of flow experience in (3) patients with neurological diseases (i.e., stroke, traumatic brain injury, multiple sclerosis and/or Parkinson's disease). A qualitative data synthesis was performed to present the measurement properties of the used flow questionnaires. RESULTS: Ten studies out of 911 records met the inclusion criteria. Seven studies measured flow in the context of serious games in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Three studies assessed flow in other activities than gaming (song-writing intervention and activities of daily living). Six different flow questionnaires were used, all of which were originally validated in healthy people. None of the studies presented psychometric data in their respective research population. CONCLUSION: The present review indicates that flow experience is increasingly measured in the physical/cognitive rehabilitation setting in patients with neurological diseases. However, psychometric properties of used flow questionnaires are lacking. For exergame developers working in the field of physical/cognitive rehabilitation in patients with neurological diseases, a valid flow questionnaire can help to further optimize the content of the games so that optimal engagement can occur during the gameplay. Whether flow experiences can ultimately have positive effects on physical/cognitive parameters needs further study.

Telemedicine in the Coronavirus Disease 2019 Pandemic: A Pediatric Rehabilitation Perspective.

ABSTRACT: In the spring of 2020, coronavirus disease 2019 evolved into a worldwide pandemic, forcing traditional face-to-face healthcare to a standstill. Telemedicine was quickly adopted as a major tool for pediatric rehabilitation services. This article describes the national legislative response of the United States to the coronavirus disease 2019 pandemic and the opportunities and challenges of implementing telemedicine in pediatric rehabilitation outpatient settings, consultations, as well as physician and patient education. The feasibility of performing a remote pediatric musculoskeletal and neurological tele-evaluation is also discussed. Although challenges exist, telemedicine has demonstrated its potential and has proven to be a practical system. Future developments in technology and accessibility, in addition to support from government and third-party payers, have the potential to make telemedicine an effective and vital platform in a coordinated healthcare system.

Forced activity and environmental enrichment mildly improve manifestation of rapid cerebellar degeneration in mice.

Exercise therapy represents an important tool for the treatment of many neurological diseases, including cerebellar degenerations. In mouse models, exercise may decelerate the progression of gradual cerebellar degeneration via potent activation of neuroprotective pathways. However, whether exercise could also improve the condition in mice with already heavily damaged cerebella remains an open question. Here we aimed to explore this possibility, employing a mouse model with dramatic early-onset cerebellar degeneration, the Lurcher mice. The potential of forced physical activity and environmental enrichment (with the possibility of voluntary running) for improvement of behaviour and neuroplasticity was evaluated by a series of behavioural tests, measuring BDNF levels and using stereological histology techniques. Using advanced statistical analysis, we showed that while forced physical activity improved motor learning by ∼26 % in Lurcher mice and boosted BDNF levels in the diseased cerebellum by 57 %, an enriched environment partially alleviated some behavioural deficits related to behavioural disinhibition. Specifically, Lurcher mice exposed to the enriched environment evinced reduced open arm exploration in elevated plus maze test by 18 % and increased immobility almost 9-fold in the forced swim test. However, we must conclude that the overall beneficial effects were very mild and much less clear, compared to previously demonstrated effects in slowly-progressing cerebellar degenerations.

AI-Based Methods and Technologies to Develop Wearable Devices for Prosthetics and Predictions of Degenerative Diseases.

Neurodegenerative diseases, mainly amyotrophic lateral sclerosis, Parkinson, Alzheimer, and rarer diseases, have gained the attention of healthcare service providers due to their impact on the economy of countries where healthcare is a public service. These diseases increase with aging and affect the neuromotor cells and cognitive areas in the brain, causing serious disabilities in people affected by them.Early prediction of these syndromes is the first strategy to be implemented, then the developing of prostheses that rehabilitate motion and the primary cognitive functions. Prostheses could recover some important disabilities such as motion and aphasia, reduce the cost of assistance and increase the life quality of people affected by neurodegenerative diseases.Due to recent advances in the field of artificial intelligence (AI) (deep learning, brain-inspired computational paradigms, nonlinear predictions, neuro-fuzzy modeling), the early prediction of neurodegenerative diseases is possible using state-of-the-art computational technologies. The latest generation of artificial neural networks (ANNs) exploits capabilities such as online learning, fast training, high level knowledge representation, online evolution, learning by data and inferring rules.Wearable electronics is also developing rapidly and represents an important enabling technology to deploy physical and practical (noninvasive) devices using AI-based models for early prediction of neurodegenerative diseases and of intelligent prostheses.Here we describe how to apply advanced brain-inspired methods for inference and prediction, the evolving fuzzy neural network (EFuNN) paradigm and the spiking neural network (SNN) paradigm, and the system requirements to develop a wearable electronic prosthesis for functional rehabilitation.

Terapia Ocupacional em doenças neurológicas e os significados do serviço ambulatorial prestado na perspectiva do usuário / Terapia ocupacional en enfermedades neurológicas y el significado del servicio ambulatorio proporcionado desde la perspectiva del usuario / Occupational therapy in neurological diseases and the meanings of ambulatory service provided from the user's perspective

O presente estudo objetivou identificar como o paciente neurológico, em atendimento no setor de Terapia Ocupacional (T.O), percebe a influência desse serviço em sua saúde global. O estudo foi desenvolvido em um Centro Especializado em Reabilitação II (CER II), de uma cidade de médio porte do interior de São Paulo, que dispõe do serviço de Terapia Ocupacional em Neurologia Ambulatorial Adulto e Idoso. O instrumento utilizado para a coleta de dados foi um roteiro de perguntas semiestruturado, aplicado na forma de entrevista. Foram abordados tópicos para a caracterização dos participantes e para o registro de suas percepções. Os temas destacados abrangeram: como o usuário se sente com o tratamento; quais sentimentos se destacam nesse processo; mudanças percebidas no decorrer das intervenções; e grau de satisfação com o serviço. A análise de dados foi realizada de forma qualitativa por meio dos dados provindos das entrevistas. Houve a prevalência do sexo masculino (n=10), na faixa etária acima de 18 anos e menor de 60 (n=8), com maior incidência de Acidente Vascular Encefálico (n=6). Nas questões abertas foi possível identificar a prevalência de sentimentos positivos, a percepção do usuário sobre a contribuição positiva da T.O em relação ao ganho de independência, qualidade de vida e que todos os participantes recomendariam o serviço ofertado pela T.O. O estudo possibilitou um feedback sobre a intervenção prestada e demonstrou que o significado da intervenção contempla a complexidade da base holística do tratamento.

El objetivo de la presente investigación es evaluar como el paciente neuropata, en cuidados por la Terapia Ocupacional (T.O), percibe la importancia del servicio en su salud general. La investigación fue desarrollada en el Centro Especialista en Rehabilitación II (CER II), ubicado en una ciudad del departamento de São Paulo, el centro cuenta con un ambulatorio de terapia ocupacional neurológica para adultos y ancianos. Para recolectar los informes fue puesta en práctica una encuesta con un cuestionario semiestructurado, fueron abordados temas con el fin de caracterizar y registrar sus visiones con las siguientes cuestiones principales: ¿Cómo se siente el paciente con el tratamiento recebido?, ¿Cuáles son los sentimientos destacados en este proceso?, los cambios percibidos por el paciente hacia las citas y el grado de satisfacción con el servicio. El análisis de datos fue hecho cualitativamente con los datos recibidos de la encuesta. Hubo un predominio del sexo masculino (n = 10), en el grupo de edad mayor de 18 años y menor de 60 (n = 8), con mayor incidencia de accidente vascular encefálico (n = 6). En las preguntas abiertas fue posible identificar el predominio de sentimientos positivos, la percepción del paciente sobre la contribución positiva de la T.O en relación con la ganancia de independencia, calidad de vida y que todos los participantes recomendarían el servicio ofrecido por la T.O. La investigación proporcionó un feedback positivo sobre la intervención y demostró que el significado de la intervención, aborda la complejidad de la base holística del tratamiento.

The following study aimed to identify how the neurological patient, who is receiving care in the occupational herapy (O.T.) sector, realizes on this service's influence in their global health. The study was developed in a Specialized Center for Rehabilitation II (CER II), located in a medium-sized town in the interior of São Paulo, which has an Occupational Therapy in Adult and Elderly Outpatient Neurology Service. The instrument used for data collection was a semi-structured questionnaire, applied as an interview. Topics for characterizing the participants and recording their perceptions were addressed. The highlighted topics covered: how the user feels about the treatment; what feelings stand out in this process; changes perceived in the course of activities; and degree of satisfaction with the service. Data analysis was performed qualitatively based on the information from the interviews. There was a prevalence of males (n = 10) aged over 18 and under 60 (n = 8), with a higher incidence of stroke (n = 6). In the open questions it was possible to identify positive feelings prevalence, the user's perception of the positive contribution of O.T. regarding gaining independence and quality of life and that all participants would recommend the service offered by O.T. The study provided feedback on the intervention given and showed that the intervention meaning fulfills the complexity of holistic basis of treatment.

Training the brain: could it improve multiple sclerosis treatment?

Multiple sclerosis (MS) is a neurological disease characterized by neuroinflammation, demyelination and axonal degeneration along with loss of function in the central nervous system. For many years, research in MS has focused on the efficacy of pharmacological treatments. However, during the last years, many publications have been dedicated to the study of the efficacy of non-pharmacological strategies, such as physical exercise and cognitive training. Beneficial effects of the combination of both strategies on cognitive function have been described in both ageing adults and patients with neurodegenerative diseases, such as MS. The analysis of combining both physical and cognitive stimulation can be summarized by the environmental enrichment (EE) experiments, which are more suitable for animal models. EE refers to housing conditions consisting of exercise and cognitive and social stimulation. In this review, we will summarize the available studies that describe the influence of EE in both MS patients and MS animal models.

Muscle-Organ Crosstalk: The Emerging Roles of Myokines.

Physical activity decreases the risk of a network of diseases, and exercise may be prescribed as medicine for lifestyle-related disorders such as type 2 diabetes, dementia, cardiovascular diseases, and cancer. During the past couple of decades, it has been apparent that skeletal muscle works as an endocrine organ, which can produce and secrete hundreds of myokines that exert their effects in either autocrine, paracrine, or endocrine manners. Recent advances show that skeletal muscle produces myokines in response to exercise, which allow for crosstalk between the muscle and other organs, including brain, adipose tissue, bone, liver, gut, pancreas, vascular bed, and skin, as well as communication within the muscle itself. Although only few myokines have been allocated to a specific function in humans, it has been identified that the biological roles of myokines include effects on, for example, cognition, lipid and glucose metabolism, browning of white fat, bone formation, endothelial cell function, hypertrophy, skin structure, and tumor growth. This suggests that myokines may be useful biomarkers for monitoring exercise prescription for people with, for example, cancer, diabetes, or neurodegenerative diseases.

Investigating the Clinical Significance and Research Discrepancies of Balance Training in Degenerative Cerebellar Disease: A Systematic Review.

OBJECTIVE: The aims of this study were to understand the clinical significance of balance training in degenerative cerebellar disease and to analyze inconsistencies among published data. DESIGN: Five databases were searched from inception to October 8, 2019. Cochrane guidelines informed review methods, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The Australian National Health and Medical Research Council Evidence Hierarchy, PEDro scale, and Joanna Briggs Institute Critical Appraisal Tools were used to evaluate methodological quality. Outcome measures examined included ataxia severity, gait speed, and balance. RESULTS: Fourteen articles were identified that met inclusion criteria. The quality of evidence was moderate to high, with recent articles being of higher quality. Nine of 12 articles showed statistical improvements in ataxia severity (reduction ranging from 1.4 to 2.8 in the Scale for the Assessment and Rating of Ataxia points), three of eight showed statistical improvements in gait speed (average increase of 0.1 m/sec), and six of nine showed improvements in balance measures (average increase of 1.75 in Berg Balance Scale and 1.5 in Dynamic Gait Index). CONCLUSION: Most studies showed statistical and clinically significant ataxia severity improvements in subjects who performed balance training. The amount of balance challenge and frequency of training were important factors in determining the extent of training benefit. Gait speed may also improve if walking exercises are included in the balance training, but more studies need to be conducted. Balance measures statistically improved with training, but these improvements did not meet criteria for clinical significance. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe the cause(s) of discrepancies in the literature regarding the benefits of balance training in degenerative cerebellar disease; (2) Determine if benefits from balance training are clinically meaningful for individuals with cerebellar degeneration; and (3) Understand the best practices gleaned from the current literature regarding balance training for these diseases. LEVEL: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Increased Microglial Exosomal miR-124-3p Alleviates Neurodegeneration and Improves Cognitive Outcome after rmTBI.

Repetitive mild traumatic brain injury (rmTBI) is considered to be an important risk factor for long-term neurodegenerative disorders such as Alzheimer's disease, which is characterized by ß-amyloid abnormalities and impaired cognitive function. Microglial exosomes have been reported to be involved in the transportation, distribution, and clearance of ß-amyloid in Alzheimer's disease. However, their impacts on the development of neurodegeneration after rmTBI are not yet known. The role of miRNAs in microglial exosomes on regulating post-traumatic neurodegeneration was investigated in the present study. We demonstrated that miR-124-3p level in microglial exosomes from injured brain was significantly altered in the acute, sub-acute, and chronic phases after rmTBI. In in vitro experiments, microglial exosomes with upregulated miR-124-3p (EXO-124) alleviated neurodegeneration in repetitive scratch-injured neurons. The effects were exerted by miR-124-3p targeting Rela, an inhibitory transcription factor of ApoE that promotes the ß-amyloid proteolytic breakdown, thereby inhibiting ß-amyloid abnormalities. In mice with rmTBI, the intravenously injected microglial exosomes were taken up by neurons in injured brain. Besides, miR-124-3p in the exosomes was transferred into hippocampal neurons and alleviated neurodegeneration by targeting the Rela/ApoE signaling pathway. Consequently, EXO-124 treatments improved the cognitive outcome after rmTBI, suggesting a promising therapeutic strategy for future clinical translation.

The Working Life of People with Degenerative Cerebellar Ataxia.

The aim of the present study was to characterize and analyze the most important individual and organizational variables associated with job accommodation in subjects with degenerative cerebellar ataxia by administering a series of international and validated work activity-related scales. Twenty-four workers (W) and 58 non-workers (NW) were recruited: 34 with autosomal dominant ataxia and 48 with autosomal recessive ataxia (27 with Friedreich ataxia and 21 with sporadic adult-onset ataxia of unknown etiology). The severity of ataxia was rated using the Scale for the Assessment and Rating of Ataxia. Our results showed that the ataxic W were predominantly middle-aged (41-50 years), high school graduate, and married men with a permanent work contract, who had been working for more than 7 years. The W with ataxia exhibited a good level of residual working capacity, irrespective of gender, age range, and duration of the disease, and they were observed to have a low or average-to-low job stress-related risk. Supporting patients with ataxia to find an appropriate job is an important priority because about 78% of NW search for a job and W and NW have the same potential work abilities (no relevant differences were found in terms of disease characteristics, gender, and work resilience). In this view, introducing NW to work-life may have a potential rehabilitative aspect. Findings of this study highlight that equal job opportunities for subjects affected by cerebellar ataxia are recommended.

Physical Activity & People with Disabilities - A Qualitative Process and Outcome Pilot Evaluation of the Non-Profit Organization AccesSurf Hawai'i.

Physical Activity (PA) is essential for the prevention of non-communicable diseases (NCD). The risk of developing NCDs is three times as high among people with disabilities than people without disabilities. In 2016, an estimated 158,570 people in Hawai'i had disabilities. So far, only limited studies have considered increasing PA opportunities for people with disabilities. AccesSurf is a non-profit organization empowering people with disabilities to perform adaptive swimming and surfing. The purpose of this study was to conduct qualitative process and pilot outcome evaluation of AccesSurf. A focus group was conducted to explore the perspectives of six AccesSurf participants on AccesSurf's process, participants' outcomes, and suggestions. Participants were individuals with neurological health conditions, aged between 30 to 64 years. The analysis followed a deductive-inductive approach. Focus group participants reported on process variables, such as the positive environment and the provision of a range of PA opportunities (eg, adaptive swimming & surfing, stand up/outrigger/va'a paddling, kayaking, and surf skiing). They recognized AccesSurf's positive contribution to their physical, mental, and social health. Participants not only felt empowered through AccesSurf, but also increased their PA frequency and built athletic identities. A comfortable environment and provision of a variety of opportunities for participants were identified as advantageous AccesSurf outputs, fostering progressive short- and long-term outcomes that result in life-changing effects. This research shows that AccesSurf may play an important role towards increasing PA among participants.

Cognitive rehabilitation, self-management, psychotherapeutic and caregiver support interventions in progressive neurodegenerative conditions: A scoping review.

BACKGROUND: Despite its potentially significant impact, cognitive disability may be overlooked in a number of progressive neurodegenerative conditions, as other difficulties dominate the clinical picture. OBJECTIVE: We examined the extent, nature and range of the research evidence relating to cognitive rehabilitation, self-management, psychotherapeutic and caregiver support interventions in Parkinsonian disorders, multiple sclerosis (MS), frontotemporal dementias (FTD), motor neuron disease and Huntington's disease. METHODS: Scoping review based on searches of MEDLINE and CINAHL up to 15 March 2016. RESULTS: We included 140 eligible papers. Over half of the studies, and almost all the randomised controlled trials, related to MS, while a number of single case studies described interventions for people with FTD. CR interventions addressed functional ability, communication and interaction, behaviour or memory. The majority of psychotherapy interventions involved cognitive behavioural therapy for depression or anxiety. Self-management interventions were mainly available for people with MS. There were few reports of interventions specific to caregivers. Numerous methodological challenges were identified. CONCLUSIONS: The limited range of studies for all conditions except MS suggests a need firstly to synthesise systematically the available evidence across conditions and secondly to develop well-designed studies to provide evidence about the effectiveness of CR and other psychological interventions.

Transcranial Direct Current Stimulation in Neurodegenerative Disorders.

Cortical excitability modulation and neuroplasticity are considered essential mechanisms for improving clinical and cognitive abilities in neurodegenerative disorders (NDDs). In such context, transcranial direct current stimulation (tDCS) shows great promise for facilitating remodeling of neurosynaptic organization. The aim of this review was to provide an overview of how tDCS is currently used as a neurorehabilitation strategy in some NDDs. We describe results from studies in which tDCS was applied in mild cognitive impairment, Alzheimer's disease, and primary progressive aphasia. Currently, findings related to the ability of tDCS to restore cognitive dysfunctions and behavioral impairments in these NDDs do not seem to support the notion that tDCS shows clear therapeutic efficacy in patients with mild cognitive impairment, Alzheimer disease, and primary progressive aphasia. This is probably because tDCS research in this area is still in its early stages. Methodological concerns, such as differences in tDCS parameters (eg, intensity or duration), target sites, and study design (eg, the relationship between tDCS and the rehabilitation strategy), or the use of underpowered sample sizes may also contribute to these outcomes. Nevertheless, it is important to note that almost no studies have evaluated how the underlying neurophysiological state of patients should guide the application of tDCS. These results should not prevent the use of tDCS in these NDDs, but they should trigger a deeper evaluation of how tDCS should be used. Transcranial direct current stimulation cannot be considered a neurorehabilitation apparatus by itself but should be instead viewed as a method for weakly modulating existing brain excitability. Future studies should aim to improve our understanding of the neurophysiological mechanisms that underlie the clinical effects of tDCS with the final goal of designing and performing individualized stimulation protocols that can be tailored for each NDD patient and combined with other appropriate neurorehabilitation strategies.

Gait assessment system based on novel gait variability measures.

In this paper, a novel gait assessment system based on measures of gait variability reflected through the variability of shapes of gait cycles trajectories is proposed. The presented gait assessment system is based on SVM (support vector machine) classifier and on gait variability-based features calculated from the hip and knee joint angle trajectories recorded using wearable IMUs during walking trials. A system classifier was trained to distinguish healthy gait patterns from the pathological ones. The features were extracted by calculating the distances between the joint trajectories of the individual gait cycles using 4 different distance functions. As result, the system is able to provide a Gait Variability Index (GVI), which is a numeric value that can be used as an indicator of a degree to which a pathological gait pattern is close to a healthy gait pattern. The system and GVI were tested in three experiments, involving subjects suffering from gait disorders caused by different neurological diseases. The results demonstrated that the proposed gait assessment system would be suitable for supporting clinicians in the evaluation of gait performances during the gait rehabilitation procedures.

Integrated care of chronic degenerative non-communicable diseases and rehabilitation: the odd couple?

Chronic degenerative non-communicable diseases affecting different organs and systems are considered by the World Health Organization (WHO) as the emergent epidemic in the third millennium...

Ameliorative Effects of Endurance Exercise with Two Different Intensities on Nandrolone Decanoate-Induced Neurodegeneration in Rats: Involving Redox and Apoptotic Systems.

Despite the importance of this issue, less has been paid to the influence of exercise on the neural side effects of anabolic androgenic steroids and mechanisms. We investigated the effects of two levels of endurance exercise on neurodegeneration side effects of nandrolone. The study period was 8 weeks. Wistar rats were divided into nine groups including the control (CTL) group, mild exercise (mEx) group, and vehicle (Arach) group which received arachis oil intramuscularly, nandrolone (Nan) group which received nandrolone decanoate 5 mg/kg two times weekly, mEx+Arach group which treated with arachis oil along with mild exercise, mEx+Nan group which treated with nandrolone along with mild exercise, severe exercise (sEx) group, sEx+Arach, and sEx+Nan groups. Finally, brain samples were taken for histopathological, biochemical, and western blot analysis. Nandrolone significantly decreased the intact cells of the hippocampus, total antioxidant capacity (TAC) (P < 0.05 versus CTL and Arach groups), TAC to malondialdehyde ratio (TAC/MDA), and Bcl-2. Nandrolone increased the Bax/Bcl-2 ratio of the brain tissue (P < 0.01 versus CTL and Arach groups). Combination of mild exercise and nandrolone rescued the intact cells to some extent, and this effect was associated with the improvement of Bcl-2 level and Bax/Bcl-2 ratio of brain tissue. Combination of severe exercise and nandrolone rescued the intact cells and improved the TAC, TAC/MDA, and Bax/Bcl-2 ratios. The findings suggest that low- and high-intensity endurance exercise decreased the risk of neurodegeneration effect of nandrolone in the hippocampus of rats. This effect can be explained by the regulation of the redox system and cell homeostasis.