FES-rowing: a well-tolerated and highly beneficial exercise for a patient with Brown-Sequard syndrome.

CONTEXT: Brown-Séquard Syndrome (BSS) is a rare neurological condition associated with Spinal Cord Injury (SCI). Hemisection of the spinal cord causes paralysis of the homolateral side, and thermoalgesic dysfunction on the opposite side. Cardiopulmonary and metabolic alterations have been reported. For all these patients, regular physical activity is highly recommended and functional electrical stimulation (FES) may be a good option, especially for those with paraplegia. However, to our knowledge, the effects of FES have primarily been studied in those with complete SCI and data regarding application and effects in patients with incomplete lesions (with sensory feedback) is lacking. The present case report therefore evaluated the feasibility and effectiveness of a 3-month FES-rowing program in a patient with BSS. METHODS: Knee extensor muscle strength and thickness, walking and rowing capacities as well as quality of life were evaluated before and after 3 months of FES-rowing (two sessions per week) in a 54 year old patient with BSS. RESULTS: The individual had excellent tolerance and adherence to the training protocol. All measured parameters were greatly improved after 3 months: on average, + 30% rowing capacity, + 26% walking capacity, + 24.5% isometric strength, + 21.9% quadriceps muscle thickness, + 34.5% quality of life. CONCLUSION: FES-rowing appears to be well tolerated and highly beneficial for a patient with incomplete SCI and could therefore be considered as an appealing exercise option for these patients.

Determining the Interrater Reliability of the SOFMER Activity Score (version 2) for Individuals in Rehabilitation Centers.

OBJECTIVE: To assess the interrater reliability of the SOFMER Activity Score (SAS) (version 2 [v2], an 8-item [4 motor and 4 cognitive] and 5-level scale) and improve its scoring system before conducting further validation steps. DESIGN: Cross-sectional, prospective, observational, noninterventional, and multicentric study. SETTING: The study was conducted between November 2018 and September 2019 in 4 French rehabilitation centers (2 public university hospitals for adults and 2 private not-for-profit rehabilitation centers for children). PARTICIPANTS: The study included 101 participants (N=101; mean age, 44.5±25.4 years; 28.7% younger than 18 and 18.8% older than 65 years). The female/male sex ratio was 0.6. The causes for admission to the center were mainly neurologic (65%) or orthopedic (24%). INTERVENTIONS: None. MAIN OUTCOME MEASURES: Activity limitation was rated with the SAS the same day by 2 independent multidisciplinary teams. The interrater reliabilities of the score items were assessed using weighted kappa coefficients. RESULTS: All weighted kappa coefficients ranged between 0.83 and 0.92, indicating "good" to "excellent" interrater reliability. Interteam score disagreements occurred in 227 of 808 scores (28%). The reason for most disagreements was unnoticed human or material aid during the observation period. CONCLUSIONS: The results demonstrate the high interrater reliability of the SASv2 and allow carrying out further validation steps after minor changes to item scoring instructions and clearer definitions of some items that help improving scoring standardization. The SASv2 may then become a consistent measure of activity level for clinical research or burden of care investigations.

Analysis of microplastics in drinking water and other clean water samples with micro-Raman and micro-infrared spectroscopy: minimum requirements and best practice guidelines.

Microplastics are a widespread contaminant found not only in various natural habitats but also in drinking waters. With spectroscopic methods, the polymer type, number, size, and size distribution as well as the shape of microplastic particles in waters can be determined, which is of great relevance to toxicological studies. Methods used in studies so far show a huge diversity regarding experimental setups and often a lack of certain quality assurance aspects. To overcome these problems, this critical review and consensus paper of 12 European analytical laboratories and institutions, dealing with microplastic particle identification and quantification with spectroscopic methods, gives guidance toward harmonized microplastic particle analysis in clean waters. The aims of this paper are to (i) improve the reliability of microplastic analysis, (ii) facilitate and improve the planning of sample preparation and microplastic detection, and (iii) provide a better understanding regarding the evaluation of already existing studies. With these aims, we hope to make an important step toward harmonization of microplastic particle analysis in clean water samples and, thus, allow the comparability of results obtained in different studies by using similar or harmonized methods. Clean water samples, for the purpose of this paper, are considered to comprise all water samples with low matrix content, in particular drinking, tap, and bottled water, but also other water types such as clean freshwater.

Publication language and the estimate of treatment effects of physical therapy on balance and postural control after stroke in meta-analyses of randomised controlled trials.

BACKGROUND: Findings regarding the impact of language bias on treatment effect estimates (TEE) are conflicting, and very few studies have assessed these impacts in rehabilitation. The purpose was to compare TEE between studies published in non-English language (SPNEL) and those published in English language (SPEL) included in a previously published meta-analysis assessing the effects of physical therapy on balance and postural control after stroke. METHODS: Six databases were searched until January 2019. Two independent reviewers selected randomised trials, extracted data, and assessed risk of bias. We conducted subgroup meta-analyses according to the language of study publication, then compared TEE between SPEL and SPNEL subgroups by using a random-effects meta-regression model. RESULTS: From 13,123 records, 132 SPEL (n = 5219) and 13 SPNEL (n = 693) were included. SPNEL had a weight in the pooled estimate (8.2%) significantly lower than SPEL (91.8%; p<0.001). Compared to SPEL, SPNEL had both significantly worse methodological quality (p = 0.002) and quality of reporting for blinding of outcome assessment (p<0.001); and a significantly worse quality of reporting for incomplete outcome data (p<0.001). SPNEL had a significantly worse precision (i.e. inverse of variance) of TEE than SPEL (p = 0.005). Overall, the TEE was not significantly different between SPNEL and SPEL (standardised mean difference -0.16, 95% confidence interval [-0.53; 0.22], heterogeneity I2 = 78%). However, when PT was compared to sham treatment or usual care, SPNEL significantly over-estimated treatment effects (SMD -0.68, 95%CI [-1.03; -0.33], I2 = 39%) compared to SPEL. Restriction of the search to SPEL only did not change the direction of TEE for 8 out of 9 comparisons. CONCLUSIONS: SPNEL had a worse methodological quality than SPEL and were likely to over-estimate treatment effect. If inclusion of SPNEL in a systematic review is considered to be relevant, the impact of such studies on TEE should be explored by sensitivity analyses to ensure the findings validity.

Inconclusive efficacy of intervention on upper-limb function after tetraplegia: A systematic review and meta-analysis.

BACKGROUND: Rehabilitation aims to improve hand-arm function, upper-limb strength, and functional independence that has been impaired by tetraplegia. On the basis of evidence derived from stroke rehabilitation, interventions aiming to increase intensity (i.e., duration and/or number of movements practiced) or alter brain plasticity (including motor imagery, virtual reality, transcranial direct-current or magnetic stimulations; i.e., neuromodulation) are now used during tetraplegic rehabilitation. However, no meta-analysis has investigated the efficacy of these interventions. OBJECTIVE: This systematic review and meta-analysis investigated, separately, the efficacy of these interventions to alter hand-arm function, upper-limb strength, and functional independence of individuals with tetraplegia. METHODS: Two independent reviewers followed the PROSPERO protocol (CRD42018098506) for this systematic review. MEDLINE, PEDro CENTRAL, and SCOPUS databases were searched for reports of randomized controlled trials of individuals with tetraplegia that were published in English. We performed a meta-analysis of intensive versus less intensive interventions and neuromodulation versus sham interventions considering hand-arm function, strength, and functional independence. RESULTS: From 168 records identified, we included 29 studies (all but 1 were single-centre) in the systematic review (647 participants with C2 to T1 tetraplegia [American Spinal Injury Association impairment scale A to D]). Interventions lasted from 66 to 40,320min. Five studies were retained in the intensity meta-analyses and 5 in the neuromodulation meta-analyses. Overall, 3/5 and 1/5 studies had adequate methodology (Cochrane Risk of Bias score ≥6/10). For each outcome, the p-values for the overall effect were>0.05. Heterogeneity was low, but when analyzing intensity, it was moderate for functional independence and high for hand-arm function. Quality of evidence was very low to low. CONCLUSIONS: We can provide no recommendations for using intensive versus less intensive interventions or neuromodulation versus sham during tetraplegia rehabilitation. Further multicentre studies of high methodological quality are required to reduce uncertainty about the efficacy of these interventions.

Limited evidence of physical therapy on balance after stroke: A systematic review and meta-analysis.

BACKGROUND: Stroke results in balance disorders and these directly affect autonomy and quality of life. The purpose of this systematic review and meta-analysis was to determine the efficacy of physical therapy (PT) on balance and postural control after stroke. METHODS: We included all randomized controlled trials assessing the efficacy of PT on balance and postural control in adult patients after stroke without language restriction. Medline, Embase/Scopus, Cochrane Central Register of Controlled Trials, PEDro, Pascal, and Francis databases were searched until January 2019. Primary outcomes were balance (Berg Balance scale and Postural Assessment Scale for Stroke) and postural control with postural deviation or stability measurement in sitting or standing static evaluation. A pair of independent reviewers selected studies, extracted data, and assessed risk of bias. Meta-analyses with subgroups (categories of PT, time post-stroke, and lesion location) and meta-regression (duration of PT) were conducted. RESULTS: A total of 145 studies (n = 5912) were selected from the 13,123 records identified. For balance, evidence was found in favor of the efficacy of functional task-training alone (standardized mean difference 0.39, 95% confidence interval [0.09; 0.68], heterogeneity I2 = 63%) or associated with musculoskeletal intervention and/or cardiopulmonary intervention (0.37, [0.19; 0.55], I2 = 48%), electrostimulation (0.91, [0.49; 1.34], I2 = 52%) immediately after intervention, compared to sham treatment or usual care (ST/UC). For postural deviation eyes open, assistive devices were more effective than no treatment (-0.21, [-0.37; -0.05], I2 = 0%) immediately after intervention; for postural stability eyes open, functional task-training and sensory interventions were more effective than ST/UC (0.97, [0.35; 1.59], I2 = 65% and 0.80, [0.46; 1.13], I2 = 37% respectively) immediately after intervention. CONCLUSIONS: Functional task-training associated with musculoskeletal intervention and/or cardiopulmonary intervention and sensory interventions seem to be immediately effective in improving balance and postural stability, respectively. The heterogeneity of PT and the weak methodological quality of studies limited the interpretation and the confidence in findings.

Regression of left hyperschematia after prism adaptation: A single case study.

Prism adaptation (PA) is a promising treatment in the rehabilitation of post-stroke cognitive disorders such as unilateral spatial neglect or constructional deficits. Right brain damage can bring about another representational spatial disorder, termed «hyperschematia¼, and defined by a left-sided disproportionate expansion of drawings by copy and from memory, and by an overestimation of left lateral extent when a leftward movement is required. This case study aimed at evaluating the effect of PA induced by prismatic lenses creating a shift to the left on hyperschematia signs. A 63-year-old woman with left hyperschematia, consecutive to a right fronto-temporo-parietal hematoma, was exposed to a leftward optical deviation produced by prismatic lenses. An anatomical MRI studied topography of the brain lesion; the patient's lesion was then mapped onto tractography reconstructions of white matter pathways. Results showed that PA significantly reduced the left-sided expansion of drawing by copy and from memory, and the overestimation of left lateral extent, immediately after prism removal and 4 days later, indicating a persistent long lasting cognitive effect. MRI showed a right hemisphere disconnection of the posterior and long segments of the arcuate fasciculus, and of the inferior longitudinal and fronto-occipital fasciculi. Overall, these findings suggest that: i) PA is effective also in hyperschematia by re-orientating spatial attention towards the right side of space, with a relative rightward PA-induced unbalance, and re-setting the spatial representation to the left side of space, contralateral to the side of the lesion; ii) the left misrepresentation of lateral extent may be related to a disconnection between visual coordinates and attentional networks to the frontal lobe.

In Situ Bioprinting of Autologous Skin Cells Accelerates Wound Healing of Extensive Excisional Full-Thickness Wounds.

The early treatment and rapid closure of acute or chronic wounds is essential for normal healing and prevention of hypertrophic scarring. The use of split thickness autografts is often limited by the availability of a suitable area of healthy donor skin to harvest. Cellular and non-cellular biological skin-equivalents are commonly used as an alternative treatment option for these patients, however these treatments usually involve multiple surgical procedures and associated with high costs of production and repeated wound treatment. Here we describe a novel design and a proof-of-concept validation of a mobile skin bioprinting system that provides rapid on-site management of extensive wounds. Integrated imaging technology facilitated the precise delivery of either autologous or allogeneic dermal fibroblasts and epidermal keratinocytes directly into an injured area, replicating the layered skin structure. Excisional wounds bioprinted with layered autologous dermal fibroblasts and epidermal keratinocytes in a hydrogel carrier showed rapid wound closure, reduced contraction and accelerated re-epithelialization. These regenerated tissues had a dermal structure and composition similar to healthy skin, with extensive collagen deposition arranged in large, organized fibers, extensive mature vascular formation and proliferating keratinocytes.

Long-lasting reduction in postural asymmetry by prism adaptation after right brain lesion without neglect.

BACKGROUND: Right brain damage (RBD) involves postural asymmetry and spatial frame disorders. In acute RBD patients, postural asymmetry is immediately reduced after one single session of prism adaptation (PA), without assessment of effects on spatial frames. AIM: To assess long-term effects of PA on posture and spatial frames in chronic RBD patients, without neglect. METHOD: Six chronic RBD patients without neglect (mean delay 45 months) were included. Each patient sustained 10 PA sessions of 20 min during 2 weeks. Outcome measures were: (1) posturographic analysis (mediolateral position of centre of pressure (X cop), (2) subjective straight ahead (SSA) and perception of longitudinal body axis (LBA). Each parameter was assessed by three pretests and three post-tests (+2 h, day + 3 and day + 7). RESULTS: In pretests, patients showed a shift of the X cop and SSA. In post-tests, results displayed (1) a significant reduction in mediolateral postural asymmetry at D + 7; (2) a significant left deviation of SSA at D + 3 and enduring at D + 7; and (3) no significant modification of LBA. The mean curves of X cop and SSA between pre- and post-tests were similar. CONCLUSIONS: PA involves persistent reduction in postural asymmetry in RBD patients without neglect. These findings were obtained at a chronic stage. This new effect cannot be explained by reduction in spatial attentional shift. Improvement may be explained by a better calibration of extra personal space frames used for posture, without effect on personal space frame. Findings argue in favour of a bottom-up effect of PA on mechanisms underlying spatial cognition.