Potential benefits of spinal cord stimulation treatment on quality of life for paralyzed patients with spinal cord injury.

Spinal cord injury (SCI) is a severe central nervous system injury that can cause sensory or motor dysfunction. Although mortality rates for people with spinal cord injuries have dropped dramatically with advances in medicine, chronic long-term sequelae after SCI persist. The most bothersome problems reported by patients include pain, spasticity, urinary dysfunction, and loss of motor function. Thus, quality of life (QoL) is an essential issue in chronic SCI. Spinal cord stimulation (SCS) applies an adjustable, nondamaging electrical pulse that can reduce uncomfortable comorbidities and improve mobility, thus enhancing the QoL of patients with SCI. This review summarizes pivotal breakthroughs from SCS for individual clinical impairment from SCI. We conclude that careful evaluation of SCS can help improve neuropathic pain, spasms, motor symptoms, and voiding dysfunction in patients with SCI, thus improving QoL.

Developing and validating the Taiwan version of the meaningful activity participation assessment (T-MAPA) with Rasch analysis.

BACKGROUND: Meaningful activity participation has shown good predictability for healthy ageing in older adults, and their participation can be assessed using the Meaningful Activity Participation Assessment (MAPA). However, the MAPA has never been validated in any Taiwanese population. Moreover, different cultures may interpret meaningful activity participation differently. This study thus aimed to cross-culturally adapt the MAPA into a Taiwan version (i.e., the T-MAPA) and to investigate the psychometric properties of the T-MAPA in older adults in Taiwan. METHODS: This study consisted of 3 phases. First, the original MAPA was cross-culturally adapted in 6 stages, including forward, synthesis of, and back translations, cognitive debriefing, expert review, and pilot testing on 18 older adults. Second, a Rasch-Andrich rating scale model was applied to evaluate the psychometric properties (including category function, unidimensionality, item functioning and targeting, and reliability) of the adapted version in a sample of 146 older adults. Lastly, the convergent validity and test-retest reliability were examined on 120 and 49 older adults, respectively. RESULTS: After cross-cultural adaptation, the first version of the T-MAPA contained 29 items. Optimal category function was obtained by reducing the response categories of the frequency subscale to 4 and retaining a 5-point rating for the meaningfulness subscale. After the removal of 1 misfit item, a 28-item T-MAPA was generated. This version demonstrated unidimensionality, measurement invariance among different subgroups (regarding sex and education), acceptable item targeting (< 1 logit) and negligible floor and ceiling effects (1.37%; 0.68%), high reliability (person reliability coefficient = 0.86; small standard error < 0.5 with large test information > 4), confirmed convergent validity (absolute r = .49-0.54 with psychological well-being, depressive symptoms, and mental and physical health), and excellent test-retest reliability (intraclass correlation coefficient = 0.94). CONCLUSION: The cross-culturally adapted 28-item T-MAPA is suitable for application to the older population in Taiwan to measure meaningful activity participation. Future examinations of the T-MAPA in other populations with specific clinical features are warranted to extend its utility in practice.

Median Nerve Stimulation Facilitates the Identification of Somatotopy of the Subthalamic Nucleus in Parkinson's Disease Patients under Inhalational Anesthesia.

Deep brain stimulation (DBS) improves Parkinson's disease (PD) symptoms by suppressing neuropathological oscillations. These oscillations are also modulated by inhalational anesthetics used during DBS surgery in some patients, influencing electrode placement accuracy. We sought to evaluate a method that could avoid these effects. We recorded subthalamic nucleus (STN) neuronal firings in 11 PD patients undergoing DBS under inhalational anesthesia. Microelectrode recording (MER) during DBS was collected under median nerve stimulation (MNS) delivered at 5, 20, and 90 Hz frequencies and without MNS. We analyzed the spike firing rate and neuronal activity with power spectral density (PSD), and assessed correlations between the neuronal oscillation parameters and clinical motor outcomes. No patient experienced adverse effects during or after DBS surgery. PSD analysis revealed that peripheral 20 Hz MNS produced significant differences in the dorsal and ventral subthalamic nucleus (STN) between the beta band oscillation (16.9 ± 7.0% versus 13.5 ± 4.8%, respectively) and gamma band oscillation (56.0 ± 13.7% versus 66.3 ± 9.4%, respectively) (p < 0.05). Moreover, 20-Hz MNS entrained neural oscillation over the dorsal STN, which correlated positively with motor disabilities. MNS allowed localization of the sensorimotor STN and identified neural characteristics under inhalational anesthesia. This paradigm may help identify an alternative method to facilitate STN identification and DBS surgery under inhalational anesthesia.

Sevoflurane and Parkinson's Disease: Subthalamic Nucleus Neuronal Activity and Clinical Outcome of Deep Brain Stimulation.

BACKGROUND: General anesthetics-induced changes of electrical oscillations in the basal ganglia may render the identification of the stimulation targets difficult. The authors hypothesized that while sevoflurane anesthesia entrains coherent lower frequency oscillations, it does not affect the identification of the subthalamic nucleus and clinical outcome. METHODS: A cohort of 19 patients with Parkinson's disease with comparable disability underwent placement of electrodes under either sevoflurane general anesthesia (n = 10) or local anesthesia (n = 9). Microelectrode recordings during targeting were compared for neuronal spiking characteristics and oscillatory dynamics. Clinical outcomes were compared at 5-yr follow-up. RESULTS: Under sevoflurane anesthesia, subbeta frequency oscillations predominated (general vs. local anesthesia, mean ± SD; delta: 13 ± 7.3% vs. 7.8 ± 4.8%; theta: 8.4 ± 4.1% vs. 3.9 ± 1.6%; alpha: 8.1 ± 4.1% vs. 4.8 ± 1.5%; all P < 0.001). In addition, distinct dorsolateral beta and ventromedial gamma oscillations were detected in the subthalamic nucleus solely in awake surgery (mean ± SD; dorsal vs. ventral beta band power: 20.5 ± 6.6% vs. 15.4 ± 4.3%; P < 0.001). Firing properties of subthalamic neurons did not show significant difference between groups. Clinical outcomes with regard to improvement in motor and psychiatric symptoms and adverse effects were comparable for both groups. Tract numbers of microelectrode recording, active contact coordinates, and stimulation parameters were also equivalent. CONCLUSIONS: Sevoflurane general anesthesia decreased beta-frequency oscillations by inducing coherent lower frequency oscillations, comparable to the pattern seen in the scalp electroencephalogram. Nevertheless, sevoflurane-induced changes in electrical activity patterns did not reduce electrode placement accuracy and clinical effect. These observations suggest that microelectrode-guided deep brain stimulation under sevoflurane anesthesia is a feasible clinical option.

Self-evaluation by community older adults on the applicability of the healthy beat acupunch exercise program.

Objectives To evaluate the applicability of the Healthy Beat Acupunch (HBA) exercise program for older adults at community care centers and to explore their perceived impacts and suggestions for program protocol after six months of HBA exercises. Design & setting This prospective and descriptive study recruited 113 older adults from four community care centers. Intervention The HBA exercises were conducted 3 times a week, 40 min per session, for six months. Main outcome measures The program evaluation focused on four criteria: simplicity, safety, suitability, and helpfulness of the three phases of the HBA program using a 10-point ladder scale. The semi-structured interviews were focused on the participants' exercise experiences, perceived impacts on their health, and suggestions for the HBA program protocol. Results The average scores of the four criteria in each phase of the program ranged between 9.59 and 9.98 points. Participants reported an increase in their limb flexibility (n = 31) and that they were more relaxed (n = 26) and more energetic (n = 26) after engaging in the HBA exercises. Most of the participants suggested that the HBA program should be offered three times a week, 40 min per session, with 30 people in a group, and led by instructors who were professional, hardworking, easygoing, and enthusiastic, regardless of gender and age. Conclusions The HBA program was rated at a high level of simplicity, safety, suitability, and helpfulness by community older adults, which indicated that the program was considered as appropriate and applicable for the older population.

Resistance Band Exercises Reduce Depression and Behavioral Problems of Wheelchair-Bound Older Adults with Dementia: A Cluster-Randomized Controlled Trial.

OBJECTIVES: To test the effects of a 15-month wheelchair-bound resistance band exercise program on depression and behavioral problems of wheelchair-bound older adults with dementia. DESIGN: Single-blind, cluster-randomized controlled trial with repeated measures. SETTING: Eight nursing homes in southern Taiwan. PARTICIPANTS: Wheelchair-bound nursing home older adults with dementia who participated voluntarily (N = 150) were cluster-randomized to two groups (experimental or control group); 127 completed the study (experimental: four nursing homes, n = 65; control: four nursing homes, n = 62). INTERVENTION: The resistance band exercises were conducted three times per week in 40-minute sessions in the following two sequences: volunteer-led sessions for the first 6 months (Stage I) followed by DVD-guided sessions for the next 9 months (Stage II). MEASUREMENTS: Depression, as measured using the Cornell Scale for Depression in Dementia, and behavioral problems, as measured using the Clifton Assessment Procedures for the Elderly-Behavior Rating Scale, of participants were observed at six time points at 3-month intervals: pretest, two posttests at Stage I, and three posttests at Stage II. RESULTS: By the sixth month of the study, experimental group participants were significantly less depressed and had fewer behavioral problems than control group participants (all P < .05). These small but statistically significant differences persisted throughout the 9 months of the DVD-guided sessions (all P < .05). CONCLUSION: Volunteer-led sessions followed by DVD-guided sessions of resistance band exercise is effective and practical in institutional settings.

Influences of Aerobic Dance on Cognitive Performance in Adults with Schizophrenia.

Cognitive impairment is one of the core features of schizophrenia. This study examined the influences of an aerobic dance programme on the cognitive functions of people with schizophrenia. A quasi-experimental matched-control design was applied. The experimental group (n = 17) participated in a 60-minute aerobic dance group class three times a week for 3 months. The control group (n = 19) participated in colouring and handwriting activities. Cognitive functions were measured before and after the interventions for both groups. The intervention group experienced significant improvements in processing speed, memory and executive function, whereas no significant changes were noted in any measures in the control group. While there were no significant between-group differences, the data showed approximately medium effect sizes that favoured the intervention group in regard to processing speed (Cohen's d = 0.51), memory (d = 0.35-0.41) and the spontaneity and fluency aspects of executive function (d = 0.51). While the small sample size and lack of randomization were the primary methodological shortcomings, this study provides preliminary results supporting aerobic dance as an adjunct activity-based intervention to improve cognitive functions in people with schizophrenia. More rigorous studies are needed to validate the findings. Copyright © 2016 John Wiley & Sons, Ltd.

Accuracy of Wristband Activity Monitors during Ambulation and Activities.

PURPOSE: The main purpose of this study was to examine the accuracy of wristband activity monitors on measuring step counts at prescribed speeds on a treadmill and under short bouts of common daily activities. METHODS: Thirty healthy young adults wore three wristband activity monitors on both wrists while walking or jogging on a treadmill at different speeds (54, 80, 107, and 134 m·min) and performing six different common daily activities for 5 min each. The monitors included the Fitbit Flex, the Garmin Vivofit, and the Jawbone UP. The common daily activity conditions included two sitting activities (playing a tablet computer game and folding laundry), two walking activities (pushing a stroller, carrying a bag), and two stair climbing activities (down and up). Absolute percentage error (APE) scores were computed to examine the accuracy between actual observed steps and monitor-detected steps. RESULTS: Under the treadmill condition, the APE ranged between 1.5% and 9.6%. Accuracy was improved at faster speeds (134 m·min) for all the monitors (APE < 2.5%). In the common daily activity conditions, substantial step counts were registered when folding laundry. All monitors significantly underestimated actual steps (all APE >33%) when pushing a stroller. Higher APE was observed when worn on the dominant wrist under the common daily activity conditions. CONCLUSIONS: The wristband activity monitors examined were more accurate for measuring step counts between 80 and 134 m·min as compared with a slower speed. Accuracy under each common daily activity condition ranged widely between monitors and activity, with less error when worn on the nondominant wrist. These results will help to inform researchers on the use and accuracy of wristband activity monitors for future studies.

Health Promotion Outcomes of a Newly Developed Elastic Band Exercise Program for Older Adults in the Community: A Pilot Test.

BACKGROUND: Studies indicate that the incidence of disease, the mortality rate, and medical costs are significantly higher in people aged 65 years and over who do not engage in physical activities than in their peers who do engage in these activities. Therefore, promoting appropriate physical activity among older adults in the community is essential to delaying the health implications of aging. PURPOSE: This pilot test was developed to assess the effectiveness of a newly developed Senior Elastic Band (SEB) exercise program on the health of older adults in community care stations. METHODS: A quasiexperimental design was used. A convenience sample of 20 participants from a community care station was recruited. The SEB intervention included three phases (warm-up, aerobic motion, and static stretching) and was conducted three times per week, 40 minutes per session for 1 month. Twelve health indicators in three categories (functional fitness, self-perceived health status, and sleep quality) were examined before and immediately after 1 month of SEB exercises. RESULTS: Participants showed improved performance at the end of the 1-month study for the following indicators: lung capacity, cardiopulmonary fitness, upper and lower body flexibilities, upper limb muscle power, lower limb muscle endurance, and self-perceived physical health status (all ps < .05). No significant differences were identified for the other indicators. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The SEB exercise program shows preliminary and promising effects on improving the health of older adults in a community care station. Healthcare professionals who work with older adults living in the community may consider the SEB exercise program as a health promotion modality to recommend and implement with this population. However, we recommend further testing the long-term effects of this program on a larger population.

Sliding and lower limb mechanics during sit-stand-sit transitions with a standing wheelchair.

PURPOSE: This study aimed to investigate the shear displacement between the body and backrest/seat, range of motion (ROM), and force acting on the lower limb joints during sit-stand-sit transitions by operating an electric-powered standing wheelchair. METHODS AND MATERIALS: The amounts of sliding along the backrest and the seat plane, ROM of lower limb joints, and force acting on the knee/foot were measured in twenty-four people with paraplegia. RESULTS: Without an antishear mechanism, the shear displacement was approximately 9 cm between the user's body and the backrest/seat surfaces. During standing up, the user's back slid down and the thigh was displaced rearward, but they moved in opposite directions when wheelchair sat back down. A minimum of 60 degrees of ROM at the hip and knee was needed during sit-stand-sit transitions. The maximal resultant forces acting on the knee restraints could reach 23.5% of body weight. CONCLUSION: Sliding between the body and backrest/seat occurred while transitioning from sitting to standing and vice versa. A certain amount of ROM at lower limb joints and force acting on the knee was necessitated during sit-stand-sit transitions. Careful consideration needs to be given to who the user of the electric powered standing wheelchair is.

Glucagon-like peptide-1 receptor agonist activation ameliorates venous thrombosis-induced arteriovenous fistula failure in chronic kidney disease.

High shear stress that develops in the arteriovenous fistula of chronic kidney diseases (CKD) may increase H2O2 and thromboxane A2 (TXA2) release, thereby exacerbating endothelial dysfunction, thrombosis, and neointimal hyperplasia. We investigated whether glucagon-like peptide-1 receptor agonist/exendin-4, a potentially cardiovascular protective agent, could improve TXA2-induced arteriovenous fistula injury in CKD. TXA2 administration to H2O2-exposed human umbilical vein endothelial cells increased apoptosis, senescence, and detachment; these phenotypes were associated with the downregulation of phosphorylated endothelial nitric oxide synthase/heme oxygenase-1 (eNOS/HO-1) signalling. Exendin-4 reduced H2O2/TXA2-induced endothelial injury via inhibition of apoptosis-related mechanisms and restoration of phosphorylated eNOS/HO-1 signalling. Male Wistar rats subjected to right common carotid artery-external jugular vein anastomosis were treated with exendin-4 via cervical implant osmotic pumps for 16-42 days. High shear stress induced by the arteriovenous fistula significantly increased venous haemodynamics, blood and tissue H2O2 and TXB2 levels, macrophage/monocyte infiltration, fibrosis, proliferation, and adhesion molecule-1 expression. Apoptosis was also increased due to NADPH oxidase gp91 activation and mitochondrial Bax translocation in the proximal end of the jugular vein of CKD rats. Exendin-4-treatment of rats with CKD led to the restoration of normal endothelial morphology and correction of arteriovenous fistula function. Exendin-4 treatment or thromboxane synthase gene deletion in CKD mice markedly reduced ADP-stimulated platelet adhesion to venous endothelium, and prevented venous occlusion in FeCl3-injured vessels by upregulation of HO-1. Together, these data reveal that the use of glucagon-like peptide-1 receptor agonists is an effective strategy for treatment of CKD-induced arteriovenous fistula failure.