Pandemic-associated mental health changes in youth with neuroinflammatory disorders.

BACKGROUND: Children with neuroinflammatory disorders have high rates of anxiety and depression, alongside low rates of physical activity. Given general concerns for mental and physical health in children during the COVID-19 pandemic lockdown, here we sought to understand how sleep, anxiety, depression, and physical activity changed with the lockdown in children with neuroinflammatory disorders. We hypothesized that outcomes would worsen during the lockdown, and that they would differ by underlying disorder category and age. METHODS: Patients attending a specialized neuroinflammatory clinic (n = 314) completed questionnaires (n = 821 responses; Jan 2017-Aug 2020) assessing sleep, anxiety, depression, and physical activity. Respondents had either: childhood-onset chronic or recurrent neuroinflammatory disorders (CRNI), a history of Autoimmune Encephalitis (AE) or Monophasic Acquired Demyelinating Syndromes (monoADS). We performed linear mixed models to examine the association between our outcome measures (sleep, anxiety, depression, and physical activity) and categories of disorder type, sex, age, physical activity, relapses, and time (pre- vs. post- COVID-19 lockdown). Participant ID acted as a random effect, to account for repeated measures. RESULTS: Sleep significantly increased in the first 6 months of the COVID-19 lockdown (F(1, 544)=56.85, P<0.001,). Across the whole group, anxiety and depression did not change with the pandemic, but we found differing trends by age category. Anxiety decreased in teenagers (≥13y) (Z = 3.96, P<0.001), but not for pre-teens. Depression remained higher in teenagers than preteens across both timepoints (F(1, 597)=6.30, p = 0.012). Physical activity levels did not change with the pandemic in comparison to pre-pandemic (F(1, 629)=1.92, P = 0.166). Anxiety was higher in inactive individuals regardless of timing (F(2, 547)=3.74, p = 0.024). CONCLUSION: For youth with neuroinflammatory disorders, the COVID-19 pandemic lockdown resulted in increased hours of nighttime sleep but did not result in significant overall changes in self-reported anxiety or depression. Pre-lockdown, teenagers had higher depression and anxiety scores than preteens. Post-lockdown, anxiety and depression scores decreased in teenagers compared to pre-teens. Physical activity was low both pre- and post-lockdown, and rates of anxiety were higher for inactive participants at both timepoints. Differences based on age suggest that younger children (<13 years) were more negatively affected by the pandemic than older children (≥ 13 years).

Proceedings from the 8th Annual University of Calgary Leaders in Medicine Research Symposium.

On November 14, 2016, the Leaders in Medicine (LIM) program at the Cumming School of Medicine, University of Calgary hosted its 8th Annual Research Symposium. Professor Stephen Sawcer, Professor of Neurological Genetics at the University of Cambridge and an Honorary Consultant Neurologist at Addenbrooke's Hospital, was the keynote speaker and presented a lecture entitled, "Multiple sclerosis genetics - prospects and pitfalls". This was not only a cutting edge address on genetics but also a thoughtful overview on Dr. Sawcer's career and career choices. We were extremely grateful for the opportunity to have Dr. Sawcer participate in our annual symposium.

Effort matching between arms depends on relative limb geometry and personal control.

Proprioception encompasses our sense of position and movement of our limbs, as well as the effort with which we engage in voluntary actions. Historically, sense of effort has been linked to centrally generated signals that elicit voluntary movements. We were interested in determining the effect of differences in limb geometry and personal control on sense of effort. In experiment 1, subjects exerted either extension or flexion torques to resist a torque applied by a robot exoskeleton to their reference elbow. They attempted to match this torque by exerting an equal effort torque (in a congruent direction with the reference arm) with their opposite (matching) arm in different limb positions (±15°). Subjects produced greater matching torque when their matching arm exerted effort toward the mirrored position of the reference (e.g., reference/matching arms at 90°/105° elbow flexion) vs. away (e.g., 90°/75° flexion). In experiment 2, a larger angular difference between arms (30°) resulted in a larger discrepancy in matched torques. Furthermore, in both experiments 1 and 2, subjects tended to overestimate the reference arm torque. This motivated a third experiment to determine whether providing more personal control might influence perceived effort and reduce the overestimation of the reference torques that we observed ( experiments 3a and 3b). Overestimation of the matched torques decreased significantly when subjects self-selected the reference torque that they were matching. Collectively, our data suggest that perceived effort between arms can be influenced by signals relating to the relative geometry of the limbs and the personal control of motor output during action. NEW & NOTEWORTHY This work highlights how limb geometry influences our sense of effort during voluntary motor actions. It also suggests that loss of personal control during motor actions leads to an increase in perceived effort.

Using Robotics to Quantify Impairments in Sensorimotor Ability, Visuospatial Attention, Working Memory, and Executive Function After Traumatic Brain Injury.

OBJECTIVE: To investigate the use of a robotic assessment tool to quantify sensorimotor, visuospatial attention, and executive function impairments in individuals with traumatic brain injury (TBI). SETTING: Foothills Hospital (Calgary, Canada). PARTICIPANTS: Twenty-three subjects with first-time TBI in the subacute to chronic phase participated in this study. Normative data were collected from 275 to 494 neurologically intact control subjects for each robotic task. DESIGN: A prospective observational case series. Subjects with TBI completed brief clinical cognitive and motor assessments followed by robotic assessments of upper limb reaching, position sense, bimanual motor ability, attention, and visuospatial skills. Scores of subjects with TBI were compared with normative data. MAIN MEASURES: Robotic task performance was computed for each subject on each task, as well as performance on specific task parameters. Clinical assessments included the Montreal Cognitive Assessment, Fugl-Meyer upper extremity assessment, and Purdue Peg Board. RESULTS: Subjects with TBI demonstrated a variety of deficits on robotic tasks. The proportion of TBI subjects who were significantly different from controls ranged from 36% (dominant arm reaching) to 60% (bimanual object hitting task). CONCLUSION: Robotic measures allowed us to quantify a range of impairments specific to each subject, and offer an objective tool with which to examine these abilities after TBI.