[MEDICAL CLOWNS: THE TRIPLE VALUE - CLOWN-PARENT-PREMATURE NEONATE].

INTRODUCTION: The infant's brain develops rapidly during the prenatal and early postnatal period. Temporary new neural circuits appear, such as the sub-cortical plate (SCP). SCP links the thalamus and cortex in a time window of sensory circuits' intensive development, creating the basis for the infant's bonding interactions. SCP activity in premature neonates is vulnerable and hypoxic injury may have a long lasting influence on brain development. Preterm birth is an emotional trauma for the parents and may lead to depression, anxiety and stress. This has an impact on the family, effecting parents' function and adaption to their new role, and the development of deep emotional bonds with their infant. Parent-infant negative interaction in NICU or later may lead to non-functional parenthood, hence, early intervention in NICU is important and may improve parental function and bonding with the infant. Humor has positive effects on human physical and mental health. There has been a fast increase in the number of medical clowns in clinical departments, and research shows that the medical clown is effective in enhancing medical efficiency. However, as yet, there is no scientific evidence regarding medical clowns in the NICU. In the NICU, medical clowns create an imaginary triangle by connecting to the parents and their premature neonate, based on a sensory-emotional common denominator and a common language for clinical purposes. The medical clown's clinical model is based on five components related to the parents and the infant. These components serve as a human bridge linking the infant entourage/surrounding. Research based on objective indexes is necessary to evaluate the efficiency of medical clowns for parent-infant bonding and the significance of medical clowns for infant development.

Using a Sniff Controller to Self-Trigger Abdominal Functional Electrical Stimulation for Assisted Coughing Following Cervical Spinal Cord Lesions.

Individuals with cervical spinal cord lesions (SCLs) typically depend on caregivers to manually assist in coughing by pressing against their abdominal wall. Coughing can also be assisted by functional electric stimulation (FES) applied to abdominal muscles via surface electrodes. Efficacy of FES, however, depends on precise temporal synchronization. The sniff controller is a trigger that enables paralyzed individuals to precisely control external devices through alterations in nasal airflow. We hypothesized that FES self-triggering by sniff controller may allow for effective cough timing. After optimizing parameters in 16 able-bodied subjects, we measured peak expiratory flow (PEF) in 14 subjects with SCL who coughed with or without assistance. Assistance was either manual assistance of a caregiver, caregiver activated FES, button self-activated FES (for SCL participants who could press a button), or sniff-controlled self-activated FES. We found that all assisted methods provided equally effective improvements, increasing PEF on average by 25 ± 27% (F[4,52] = 7.99, p = 0.00004 ). There was no difference in efficacy between methods of assistance ( F[3,39] = 0.41, p = 0.75 ). Notably, sniff-controlled FES was the only method of those tested that can be activated by all paralyzed patients alone. This provides for added independence that is a critical factor in quality of life following SCL.