Book

Functional Neurology, Rehabilitation and Ergonomics, Volume 4 Issue 1

ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Background: Persistent vegetative states (PVS) and locked-in syndrome (LIS) are well differentiated disorders of consciousness that can be reached after a localized brain injury in the brainstem. The relations of the lesion topography with the impairment in the whole-brain architecture and functional disconnections are poorly understood. Methods: Two patients (PVS and LIS) and 20 age-matched healthy volunteers were evaluated using diffusion tensor imaging (DTI). Anatomical network was modeled as a graph whose nodes are represented by 71 brain regions. Inter-region connections were quantified through Anatomical Connection Strength (ACS) and Density (ACD). Complex networks properties such as local and global efficiency and vulnerability were studied. Mass univariate testing was performed at every connection using network based statistic approach. Results: LIS patients’ network showed significant differences from controls in the brainstem-thalamus-frontal cortex circuitry, while PVS patients showed a widespread disruption of anatomical connectivity in both hemispheres. Both patients showed a reorganization of network attributes, with decreased global and local efficiency, significantly more pronounced in PVS. Conclusions: Our results suggest that DTI-based network connectivity combined with graph theory is useful to study the long-range effect of confined injuries and the relationship to the degree of consciousness impairment, underlying PVS and LIS.
Article
Full-text available
Little of the 150 years of research in Cognitive Neurosciences, Human Factors, and the mathematics of Production Management have found their way into educational policy and certainly not into the classroom or in the production of educational materials in any meaningful or practical fashion. While more mundane concepts of timing, sequencing, spatial organization, and Gestalt principles of perception are well known and applied, as well as the maintenance of simplistic notions of developmental brain organization and hemisphericity for language rather than the neurophysiology of embodied language, these concepts still inform pre-K-3 curriculum and clinical neurological practice in both the diagnostic and therapeutic modalities. The paper overviews the science of human physiologic efficiencies to develop a fundamental understanding that the concept of localization of function in the brain is a just reflection of plasticity and required for optimized function, but understanding brain function by that alone would obscure the understanding of the education and rehabilitation process from early childhood through the older years. Diagnostic and therapeutic systems need to address pathways in the brain and their changes as a result of intervention rather than examine more static notions of localized function.
Article
Full-text available
We model the brainstem as two layers of purely excitatory and inhibitory cells, with a time delay in transmission of information between the layers. The response to a localized afferent impulse is a strong function of this inhibitory delay; at first showing increased amplification as the delay increases, but at larger delays showing increased convection away from the impulse location. These features are consistent with the function of the brainstem in regulating attentional levels, and have possible implications for the understanding of higher brain mechanisms
Article
Full-text available
Exposure to musical training in childhood has been studied extensively as models of neuroplasticity. The long-term training and continued practice of complex bi-manual motor sequences are highly associated with changes in brain structure and cortical motor maps compared with individuals without such training. We know that the anterior corpus callosum, with fibers connecting frontal motor regions and pre-frontal areas coordinating bimanual activity is larger in musicians who started training prior to age seven than in either controls. Additionally, auditory experiences during early postnatal development shape the functional neurology of auditory cortical representation resulting in increased functional areas of the auditory cortex. The developing brain is far more plastic than the adult brain explaining the results that we see in recovery of function after brain damage in childhood, neuronal connections are being continuously remodeled by experience, enrichment, and by performance on specific and complex movements during motor and cognitive learning. New skill acquisition, present to a much greater degree in childhood is highly associated with structural changes in the intracortical and subcortical networks in motor skill training. The relationship between music, visual, and spatial training on brain organization and plasticity are discussed with applications for solutions to the rehabilitation of the brain impaired.
Article
Full-text available
An application is discussed that uniquely integrates auditory and visual stimulation with force modulation. It was developed to answer unmet needs of Occupational Therapists, Art Therapists and Music Therapists, who treat developmental disorders, as well as therapists specializing in neurological aftercare and hand rehabilitation. Squeezing the special pressure sensitive grip sensors causes the application to generate sounds, voices and music, along with captivating imagery, based on the level of force applied and according to the therapy objective. The described system’s development was guided by the assumption that the human brain intuitively associates sound pitch with tension. The system uses the association of pitch with muscle tension to simplify the creation of music by transforming grip-induced muscle tension to musical phrases which provides a new therapy option based on sensory integration. The grip force sensors’ sensitivity and responsiveness can be adjusted to the patient’s motor skills, thus making the transformation more “natural.”. Even patients suffering severe disabilities find the grip squeezing force and the produced sounds highly correlated in a direct and natural manner. The musicality and continuity of the musical creation highly depends on the patient’s skills, Farah Jubran and Gerry Leisman 214 pace and the system’s speed of response. The system’s “on-the-fly tuning” helps matching the system tempo with the patient’s pace, accelerating or decelerating speed, to determine the desired level of challenge and gratification during the treatment. The system helps in reducing passivity and increasing motivation and awareness through the sense of control granted to the patient playing the tool, as well as in reducing involuntary movement. In addition, the system allows the creation of personalized treatment programs that make use of meaningful images or photos from the patient and his/her world and surroundings.
Article
Full-text available
Background: The neuroimaging findings of acute central transtentorial herniation are well documented; however survival in this condition is unusual. Case report: A 20-year-old woman developed central transtentorial herniation secondary to acute hydrocephalus after the obstruction of a ventriculo-peritoneal shunt inserted for the treatment of chronic hydrocephalus. The surgical ventricular drainage was delayed, and after being in coma for several days, the patient was finally diagnosed as being in a persistent vegetative state (PVS). The neuroimaging studies revealed a severe bilateral infarction of thalamus, subthalamus, mesocephalus and left superior cerebellum, a distribution suggestive of ischemia affecting perforating arteries arising from the top of the basilar artery and proximal segment of the posterior cerebral artery, as well as from the superior cerebellar artery. Conclusion: Survivors of central transtentorial herniation can sustain severe damage to the thalamus and mesencephalon, despite a relative preservation of the neocortex, leading to a PVS syndrome.
Chapter
Full-text available
Infectious diseases emerging throughout history have included some of the most feared plagues of the past. New infections continue to emerge today, while many of the old plagues are with us still. These are global problems (William Foege, former CDC director now at the Carter Center, terms them global infectious disease threats). As demonstrated by influenza epidemics, under suitable circumstances, a new infection first appearing anywhere in the world could traverse entire continents within days or weeks.
Article
Full-text available
INTRODUCCIÓN: El diagrama de las razones de Reiber o reibergrama cobra cada día mayores usos para la caracterización de la síntesis intratecal de proteínas. El reibergrama fue definido para las clases mayores de inmunoglobulinas pero luego ha sido utilizado para evaluar otras proteínas basado en la teoría de la difusión molecular/velocidad de flujo del líquido cefalorraquídeo (LCR). MÉTODO: El C3c, producto de la degradación del factor del complemento C3 y con una masa molecular de 145 KDa, se acerca a las características moleculares de la IgG para las leyes de la difusión de Fick. Se asume las constantes de la IgG en la fórmula de Reiber para evaluar la síntesis intratecal de C3c así como su correspondiente reibergrama. Se estudiaron 27 pacientes y 27 controles a los que se les dosificó albúmina y C3c en suero y LCR por inmunodifusión radial. RESULTADOS: Con el reibergrama propuesto para el C3c se evaluaron estos pacientes. Se comprueba la validez de este reibergrama para distintas condiciones de barrera con o sin síntesis intratecal de C3c. CONCLUSION: El reibergrama y su fórmula correspondiente propuesto para la C3c puede ser usado para la evaluación de la síntesis intratecal de C3c.
Article
Full-text available
IgG SUBCLASSES INTRATHECAL SYNTHESIS PATTERNS IN EOSINOPHILIC MENINGOENCEPHALITIS DUE TO ANGIOSTRONGYLUS CANTONENSIS Summary. Introduction. There is a growing interest to know the characteristics of meningoencephalitis due to Angiostrongylus cantonensis because of it is an emergent disease. Objective. To describe the intrathecal synthesis pattern of IgG subclasses in pediatric patients suffering from eosinophilic meningoencephalitis due to Angiostrongylus cantonensis. Patients and methods. Ten pediatric patients with the disease were studied. During the firs diagnostic lumbar puncture an eosinophilic pleocitosis was found. Simultaneously a serum sample was taken. Eight days later, a second lumbar and venous puncture was performed. To every serum and cerebrospinal fluid sample IgA, IgM, IgG, albumin and the four subclasses of IgG were quantified by immunodiffusion and a differential cell count. Results. During the first diagnostic lumbar puncture, all the cases had blood-cerebrospinal fluid barrier dysfunction with absence of immunoglobulins intrathecal synthesis with a mean of 450 × 10 6 cells/L and 48% of eosino-phils average. In the second lumbar punction there was a 40% patients with dysfunction of the blood-cerebrospinal fluid barrier and with a synthesis pattern IgA+IgM+IgG in the 50% o patients and with IgA+IgG in four patients. The synthesis pattern of IgG subclasses was IgG 1 +IgG 2 in six patients, IgG 1 +IgG 2 +IgG 3 in one patient, IgG 1 +IgG 2 +IgG 4 in one more patient and two patients without intrathecal synthesis. Conclusion. The intrathecal synthesis pattern of IgG subclasses can contribute to eosino-philic meningoencephalitis diagnosis due to Angiostrongylus cantonensis. [REV NEUROL 2003; 36: 506-9] INTRODUCCIÓN Las meningoencefalitis por Angiostrongylus cantonensis (Chen, 1935) resultan de interés creciente en muchas partes del mundo por sus características de infección emergente. En América se describió por primera vez en Cuba en 1981 [1], luego en Nueva Orleans y Puerto Rico en 1986 [2], en República Dominicana en 1992 [3] y, aunque no se han encontrado eviden-cias, se ha comunicado en Jamaica desde 1996 [4] y en Haití desde 1997 [5]. Recientemente, se produjo una epidemia de meningitis causada por Angiostrongylus cantonensis en viajeros que regresaban del Caribe [6]. Este nemátodo parasita habitualmente el pulmón de la rata como hospedador definitivo y al hombre como hospedador casual , cuando éste se pone en contacto con las larvas presentes en algunos de los hospedadores intermediarios de su ciclo de vida, que son diversas especies de moluscos terrestres. Desde el punto de vista neuroinmunológico, se ha estudiado el patrón de síntesis intratecal de las inmunoglobulinas mayores ORIGINAL eran hombres, 17 (34%) presentaban una EMT derecha; 30 (60%), EMT izquierda, y dos (4,3%), bilateral. 16 pacientes (34,8%) referían aura autonómica; 14 (27,5%), aura psíquica; cuatro (7,8%), disfasia; 13 (25,5%) no presentaban aura, mientras que en dos (3,9%) el aura era mixta: autonómica-psíquica. El aura presentaba asociación con la lateralidad de la lesión (p= 0,023) y con tener antecedentes de haber sufrido lesión cerebral durante la primera infancia (p= 0,011). Refe-rente al control de las crisis, 15 pacientes (29,2%) estaban libres de crisis en los últimos 6 meses, y 36 (70,6%) presentaban crisis. Los factores que se asociaron al pronóstico de control médico fueron la edad de presentación de la primera crisis (p= 0,024) y la duración de la epilepsia (p= 0,018). Conclusiones. Hasta un 29% de los pacientes afectos de EMT puede controlarse médicamente; son factores de buen pronóstico un inicio tardío de la epilepsia, así como una corta duración de la enfermedad. [REV NEUROL 2003; 36: 501-6] Palabras clave. Esclerosis mesial temporal. Factores pronósticos. Farmacorresistencia. Tratamiento farmacológico. mens, 17 (34%) apresentavam EMT direita; 30 (60%) EMT esquer-da, e dois (4,3%), bilateral. 16 doentes (34,8%) referiam aura auto-nómica; 14 (27,5%), aura psíquica; quatro (7,8%), disfasia e 13 (25,5%) não apresentavam aura, enquanto que em dois (3,9%) a aura era mista: autonómica-psíquica. A aura apresentava associa-ção com a lateralidade da lesão (p=0,023), e com o antecedente de ter sofrido lesão cerebral na primeira infância (p=0,011). Relativa-mente ao controlo das crises: 15 doentes (29,2%) estavam livres de crises nos últimos 6 meses e 36 (70,6%) apresentavam crises. Os factores que se associaram ao prognóstico de controlo médico fo-ram a idade de apresentação da primeira crise (p=0,024) e a dura-ção da epilepsia (p=0,018). Conclusões. Até 29% dos doentes com EMT pode controlar-se medicamente; são factores de bom prognós-tico o início tardio da epilepsia, assim como a curta duração da doença. [REV NEUROL 2003; 36: 501-6] Palavras chave. Esclerose mesial temporal. Factores prognósticos. Fármaco-resistência. Tratamento farmacológico.
Conference Paper
Full-text available
Recent spectacular advances in neurosciences have stimulated the hope that the application of our understanding that it is no longer about cerebral asymmetries and simplistic left-right differences but more complex applications of networks, and communication system principles that have led to newly developed concepts and findings that have not, as yet, found there way into the classroom. We are at the cusp of developing breakthrough concepts in the understanding of how children learn in the formal setting of the classroom in the context of brain function and how that function can be modified. We believe that the techniques and knowledge of neuroscience as well as Human Factors and Industrial Engineering notions of efficiency and production management can provide a service to education at all stages throughout life. Although the human brain - the most crucial part of the anatomy - is the most complex mechanism known to man, it is now being analyzed in ways that are clearly significant for education. Recent research on the human brain has provided data relevant to understanding the processes of human learning and therefore to improving methods of teaching. Most currently prevailing patterns of education are heavily biased to wards left cerebral functioning and are antithetical to right cerebral functioning. Reading, writing and arithmetic are all logical linear processes, and for most of us are fed into the brain through our right hand. Most educational policies have tended to aggravate and prolong this one-sidedness. There is a kind of damping down of fantasy, imagination, clever guessing, and visualization in the interests of rote-learning, reading, writing, and arithmetic. Great emphasis is placed upon being able to say what one has on one's mind clearly and precisely the first time. The atmosphere emphasizes intra-verbal skills, ”Using words to talk about words that refer to still other words" What emerges as the central proposition of this paper is that (A) the examination and study of regional cerebral differences in brain function as a way of explaining and evaluating the learning process within the educational system is a non-starter. (B) The evaluation of students by standardized aptitude and achievement tests is not sufficient although probably still necessary and (C) the educational systems would be better to examine student performance and teach towards “cognitive efficiency” rather than simply mastery v. non-mastery with methods that employ both psychophysics that examine person-environment interaction and mathematical means of examining optimization and the strategy used to get there as well as how far or close a student is functioning from a mathematically derived optimization regression line or, in fact, how quickly the learner is progressing in that direction. Educators, although perhaps not palatable to conceive of early childhood education as such, are producing a product and production management techniques should be useful for evaluating not just the product but the process or “manufacture” of that product as well.
Article
Full-text available
We studied autistics by quantitative EEG spectral and coherence analysis during three experimental conditions: basal, watching a cartoon with audio (V–A), and with muted audio band (VwA). Significant reductions were found for the absolute power spectral density (PSD) in the central region for delta and theta, and in the posterior region for sigma and beta bands, lateralized to the right hemisphere. When comparing VwA versus the V–A in the midline regions, we found significant decrements of absolute PSD for delta, theta and alpha, and increments for the beta and gamma bands. In autistics, VwA versus V–A tended to show lower coherence values in the right hemisphere. An impairment of visual and auditory sensory integration in autistics might explain our results.
Article
Full-text available
Abstract The EEG has not been comprehensively used to study the brain function in Autistic Spectrum Disorder (ASD) patients. Therefore, the researchers recently developed a specifically designed software (EEGConn) to explore brain function based on advanced algorithms to explore EEG activity. They studied a group of 14 righthanded autistic patients with age 70.3±29.32 and 14 healthy subjects with IQs over 85. All recordings were performed with the subjects lying in a recumbent position, in eye opened condition; EEG ...
Article
Full-text available
Aims: Clinical guidelines recommend stroke patients are routinely screened for cognitive impairment. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was evaluated for screening for post-stroke cognitive impairment. Methods: The RBANS and a neuropsychological test battery were administered to 60 participants recruited from acute stroke wards. Results: Using a cut-off of < 70 points, the RBANS Total Index demonstrated 50% sensitivity and 100% specificity for detecting any cognitive impairment. ROC curve analysis identified an optimum total index cut-off score of < 84 points (sensitivity 84%; specificity 90%). The RBANS Indices did not have acceptable sensitivity and specificity using a cut-off of < 70 points. ROC curve analysis identified higher optimum cut-offs (sensitivity 79-89%; specificity 48-96%). Conclusion: The RBANS was an acceptable measure for detecting post-stroke cognitive impairment but does not include assessment of executive ability.
Article
Full-text available
Neural circuits linking activity in anatomically segregated populations of neurons in subcortical structures regulate complex behaviors such as walking, talking, language comprehension, and other cognitive functions associated with frontal lobes. The basal ganglia are also crucial elements in the circuits that confer human reasoning and adaptive function and are key elements in the control of reward-based learning, sequencing, discrete elements that constitute complete motor acts, and cognitive function. Imaging studies of intact humans and electrophysiologic studies of the brains and behavior of other species confirm these findings. We know that the relation between the basal ganglia and the cerebral cortical region allows for connections organized into discrete circuits. Rather than serving as a means for widespread cortical areas to gain access to the motor system, these loops reciprocally interconnect a large and diverse set of cerebral cortical areas with the basal ganglia. Neuronal activity within the basal ganglia associated with motor areas of the cerebral cortex is highly correlated with parameters of movement. Neuronal activity within the basal ganglia and cerebellar loops associated with the prefrontal cortex is related to the aspects of cognitive function. Thus, individual loops appear to be involved in distinct behavioral functions. Damage to the basal ganglia of circuits with motor areas of the cortex leads to motor symptoms, whereas damage to the subcortical components of circuits with non-motor areas of the cortex causes higher-order deficits. In this report, we review some of the anatomic, physiologic, and behavioral findings that have contributed to a reappraisal of function concerning the basal ganglia and cerebellar loops with the cerebral cortex and apply it in clinical applications to ADHD with biomechanics and a discussion of retention of primitive reflexes being highly associated with the condition.
Article
Full-text available
Left-handers are often excluded from study cohorts in neuroscience and neurogenetics in order to reduce variance in the data. However, recent investigations have shown that the inclusion or targeted recruitment of left-handers can be informative in studies on a range of topics, such as cerebral lateralization and the genetic underpinning of asymmetrical brain development. Left-handed individuals represent a substantial portion of the human population and therefore left-handedness falls within the normal range of human diversity; thus, it is important to account for this variation in our understanding of brain functioning. We call for neuroscientists and neurogeneticists to recognize the potential of studying this often-discarded group of research subjects.
Article
Full-text available
Objective: To study the Zolpidem arousing effect in persistent vegetative state (PVS) patients combining clinical evaluation, autonomic assessment by heart rate variability (HRV), and EEG records. Methods: We studied a group of 8 PVS patients and other 8 healthy control subjects, matched by age and gender. The patients and controls received drug or placebo in two experimental sessions, separated by 10-14 days. The first 30 minutes of the session were considered the basal record, and then Zolpidem was administered. All participants were evaluated clinically, by EEG, and by HRV during the basal record, and for 90 minutes after drug intake. Results: We found in all patients, time-related arousing signs after Zolpidem intake: behavioral (yawns and hiccups), activation of EEG cortical activity, and a vagolytic chronotropic effect without a significant increment of the vasomotor sympathetic tone. Conclusions: We demonstrated time-related arousing signs after Zolpidem intake. We discussed possible mechanisms to explain these patho-physiological findings regarding EEG cortical activation and an autonomic vagolytic drug effect. As this autonomic imbalance might induce cardiocirculatory complications, which we didn't find in any of our patients, we suggest developing future trials under control of physiological indices by bedside monitoring. However, considering that this arousing Zolpidem effect might be certainly related to brain function improvement, it should be particularly considered for the development of new neuro-rehabilitation programs in PVS cases. According to the literature review, we claim that this is the first report about the vagolitic effect of Zolpidem in PVS cases.
Article
Full-text available
Introduction: Zolpidem is a non-benzodiazepine drug used for the therapy of insomnia, which has selectivity for stimulating the effect of GABA-A receptors. Recently, a paradoxical arousing effect of zolpidem in patients with severe brain damage has been repeatedly reported. Methods: A placebo-controlled magnetic resonance study was conducted to evaluate its effect on BOLD and metabolites spectral signals in a patient with severe brain injuries and an age-matched healthy volunteer. A multi-modal analysis was used to assess aspects in the pharmacologically-induced changes in the resting-state brain metabolism. Results: A significantly increased BOLD signal was transiently localized in the left frontal cortices, bilateral anterior cingulated areas, left thalamus and right head of the caudate nucleus. The healthy subject showed a deactivation of the frontal, parietal and temporal cortices. BOLD signal changes were found to significantly correlate with concentrations of extravascular metabolites in the left frontal cortex. It is discussed that, when zolpidem attaches to modified GABA receptors of neurodormant brain cells, brain activation is induced. This might explain the significant correlations of BOLD signal changes and proton-MRS metabolites in this patient after zolpidem. Conclusion: It was concluded that proton-MRS and BOLD signal assessment could be used to study zolpidem-induced metabolic modulation in a resting state.
Article
Full-text available
Angiostrongylus cantonensis is a zoonotic pathogen that occasionally causes human angiostrongyliasis; its main clinical manifestation is eosinophilic meningitis. This report defines the concept of intrathecal activation of complement as evidence of intrathecal synthesis of major immunoglobulins during this disease. Details are presented of the activation of complement system components in cerebrospinal fluid, and their application to our understanding of this tropical disease, which is emerging in the Western hemisphere. Intrathecal synthesis of at least one of the major immunoglobulins and a wide spectrum of patterns may be observed. Although intrathecal synthesis of C3c is always present, C4 intrathecal synthesis does not occur in every patient. The diversity of intrathecal synthesis and activation of the different complement pathways enables their division into three variant groups (A, B, and C). Variant group A includes the classical and/or lectin pathway and involves two or more major immunoglobulins with C3 and C4 intrathecal synthesis. Variant group B involves C4 in cerebrospinal fluid that comes from blood in the intrathecal activation of the classical pathway. Variant group C includes the alternative pathway.
Chapter
Full-text available
Sustaining a spinal cord injury (SCI) is a physically and psychologically traumatic experience. Individuals who incur an SCI face immediate, profound, and often permanent life changes. Following acute stabilization and treatment of their most serious physical concerns, many individuals with SCI are transferred to an inpatient rehabilitation environment, to undertake the difficult process of learning, practicing and integrating the myriad new skills required for daily living with an SCI. Due to both the nature by which the majority of SCI's occur and to a variety of possible sources of premorbid cognitive impairment, persons with SCI often confront the additional challenge of undertaking rehabilitation having pre-injury or accident-related cognitive impairment. Pioneering research of these issues suggested that 25% to 57% of persons with acute SCI might have a concomitant traumatic brain injury (TBI; Roth et al., 1989; Scheuman and Morris, 1982), and some cognitive impairment may be present in 67% of individuals in SCI rehabilitation (Wilmot, Cope, Hall, and Acker, 1985). Most studies indicate that cognitive impairment affects between 40% and 50% of persons with SCI (Davidoff, Roth and Richards, 1992). Morris, Roth and Davidoff (1986) suggest that individuals with a dual diagnosis of primary SCI and concomitant cognitive impairment are at substantial risk for both complicated rehabilitation programs and unfavorable outcomes. According to Davidoff and colleagues (1992), the sequelae of even mild cognitive impairment include "difficulties with
Article
Full-text available
Abstract New information about the basal ganglia and cerebellar connections with the cerebral cortex has prompted a reevaluation of the role of the basal ganglia in cognition. We know that the relation between the basal ganglia and the cerebral cortical region allows for connections organized into discrete circuits. Rather than serving as a means for widespread cortical areas to gain access to the motor system, these loops reciprocally interconnect a large and diverse set of cerebral cortical areas with the basal ganglia. The properties of neurons within the basal ganglia or cerebellar components of these circuits resemble the properties of neurons within the cortical areas subserved by these loops. For example, neuronal activity within the basal ganglia and cerebellar loops with motor areas of the cerebral cortex is highly correlated with parameters of movement, whereas neuronal activity within the basal ganglia and cerebellar loops with areas of the prefrontal cortex is more related to the aspects of cognitive function. Thus, individual loops appear to be involved in distinct behavioral functions. Studies of the basal ganglia and cerebellar pathology support this conclusion. Damage to the basal ganglia or cerebellar components of circuits with motor areas of the cortex leads to motor symptoms, whereas damage to the subcortical components of circuits with nonmotor areas of the cortex causes higher-order deficits. In this report, we review some of the new anatomic, physiologic, and behavioral findings that have contributed to a reappraisal of function concerning the basal ganglia and cerebellar loops with the cerebral cortex and apply it in clinical applications to obsessive-compulsive disorder, Tourette's syndrome, and attention-deficit/hyperactivity disorder as examples of how compromise at different points in the system may yield similar but different clinical results.
Article
Full-text available
The term persistent vegetative state (PVS) refers to the only circumstance in which an apparent dissociation of both components of consciousness is found, characterized by preservation of wakefulness with an apparent loss of awareness. Several authors have recently demonstrated by functional neuroimaging studies that a small subset of unresponsive "vegetative" patients may show unambiguous signs of consciousness and command following that is inaccessible to clinical examination at the bedside. The term "estado vegetativo" used in Spanish to describe the PVS syndrome by physicians came from the English-Spanish translation. The Spanish term "vegetativo" is related to unconscious vital functions, and "vegetal" is relative to plants. According to our experience, when a physician informs to patients' relatives that his/her family member's diagnosis is a "estado vegetativo", they understand the he/she is no more a human being, that there is no hope of recovery. The European Task Force on Disorders of Consciousness has recently proposed a new term, unresponsive wakefulness syndrome (UWS), to assist society in avoiding the depreciatory term vegetative state. Our group has embraced the use of the new term UWS and might suggest that we change our concept and use of the term MCS to minimally responsive wakefulness state (MRWS), or minimally aware wakefulness state (MAWS). Medical terms must be current and avoid any pejorative description of patients, which will promote our abilities to serve humankind and challenge neuroscientists to offer society new and realistic hopes for neurorehabilitation.
Article
Full-text available
Objective: To assess the autonomic nervous system (ANS) in coma by heart rate variability (HRV). Methods: Sixteen comatose patients and 22 normal subjects with comparable ages and genders were studied. Patients were classified in two subgroups according to the Glasgow Coma Scale (GCS). Time, frequency, and informational HRV domain indices were calculated. Results: A notable reduction of HRV was found in patients. Regarding the time domain indices, the triangular index, and the Delta_RRs, were significantly reduced in the subgroup with GCS=3. Absolute power for the whole frequency spectrum decreased whenever GCS scores were lower. A significant decrement was found for absolute power of the VLF and LF bands in the subgroup of GCS=3, and although it was lower for the HF band in these patients, those changes were not statistically significantly different. The LF/HF ratio and the Shannon´s entropy indices were significantly reduced in the subgroup with GCS=3. Our results are discussed regarding the progressive dysfunction the ANS networks when coma deepens. Conclusions: The HRV procedure is a powerful tool to assess the ANS in comatose patients. Significance: HRV is a minimally invasive, low-cost methodology, suitable for assessing the ANS in coma.
Article
Full-text available
Little of 150 years of research in Cognitive Neurosciences, Human Factors, and the mathematics of Production Management have found their way into educational policy and certainly not into the classroom or in the production of educational materials in any meaningful or practical fashion. Whilst more mundane concepts of timing, sequencing, spatial organisation, and Gestalt principles of perception are well known and applied, the nature of Receiver Operating Characteristics (ROC) and the responsibility of the sender in that regard, as well as the maintenance of simplistic notions of developmental brain organization and hemisphericity for language rather than the neurophysiology of embodied language as an example, still inform pre-K-3 curriculum. The paper intends to overview the science of human physiologic efficiencies in engineering terms in an attempt to develop novel approaches and thinking to classroom-based practice and subsequently leadership and policy informed by current neuroscientific realities and by production management and optimization principles now applied to schools, and their consumers.
Article
Full-text available
Identifying the presence of cognitive impairment in patients admitted for inpatient rehabilitation is important as it may impact on their ability to participate in a rehabilitation program. The Folstein Mini Mental State Examination (MMSE) has been used by clinicians as a cognitive screening tool for its convenience, even though it is not sensitive, and often fails to detect cognitive impairment. Recently, the Montreal Cognitive Assessment (MoCA) has been developed as a brief cognitive screening tool to detect mild-moderate cognitive impairment. We performed a longitudinal study to compare the utility of the MMSE and MoCA in an inpatient rehabilitation setting. A total of 50 consecutive patients were studied with an average age of 71.7 years of age. The mean test score for MMSE was 26.5 and 22.2 for the MoCA. The Pearson's correlation coefficient between the scores was 0.695 (p < 0.003). The mean performance time for the MMSE was 7.4 minutes and 14.8 minutes for the MoCA. MMSE did not perform well as a screening instrument for mild cognitive impairment as there were 43 patients who scored 24 or more on MMSE, and 25 patients (58%) scored 25 or less on MoCA, indicating the presence of cognitive impairment. Even though the MoCA takes longer to administer, the additional important information provided indicates that the MoCA should be used rather than the MMSE as a cogni-tive screening tool.
Article
Full-text available
The SSEP is a relatively simple, non-invasive, and inexpensive bedside technique for assessing the integrity of transmission within the central nervous system, and is commonly used to assess both brainstem and cortical function. While, clinical examination and EEG may be hampered by barbiturate therapy in patients with severe intracranial hypertension or by other forms of drug intoxication, hypothermia, and other metabolic disturbances, SSEP components are robust in these conditions. Numerous authors recommend that SSEPs should be recorded within 24 h of a brain insult. During cardiopulmonary resuscitation it is usual to monitor cardiac and other physiological parameters, but rarely brain function. We suggest that the monitoring of SSEPs and other measures of brain function should begin as early as possible during CPR. This would surely provide the most powerful prognostic assessment after cardiac arrest, taking into consideration that the brain is the target organ in any cardio-respiratory resuscitation.
Conference Paper
The human brain is a complex organ designed to effect cognitive functions, such as attention, perception, memory, learning, and action. All of the nervous system is active during prenatal development and the aim of the presentation is to present data to allow us to better understand fetal cognitive functions. Fetal cognitive motor activity, including auditory discrimination, orienting, the wake–sleep cycle, FHRs, and defensive reactions, appear to be under the reflexive control of the brainstem, which also appears capable of learning-related activity. However, the fetus begins to processes sensory stimuli at a cortical level, including pain, from approximately 25 weeks of gestation. At gestational week 34, the fetus not only perceives complex external acoustics but can also discriminate between different sounds. Fetal action planning and anticipation of movement and action, a sense of agency, is established by 22 weeks and investigations using four-dimensional ultrasound demonstrate that complexity of fetal motor action and behavior increases as pregnancy progresses. The capacity of the fetus to learn and memorize are significant. At term, subcortical structures of the brain are well developed. There is high activity in primary cortical areas and low activity in association areas. Clinically relevant data on cognitive functions of the fetus could be important for the management of fetal pain and treatment of preterm infants as well as for improved neurodevelopmental outcome of fetuses from high-risk pregnancies. Finally, the brain's developmental journey, including development of cognitive functions, continues with the same intensity in the postnatal period.
Article
This is an biography of Erik Erikson, American postwar psychoanalyst and developmental psychologist. Historian Lawrence J. Friedman illuminates the relationship between Erikson's personal life and his ideas. Erik Erikson acutely reshaped views of human development with his concept of identity and his eight-stage model of the human life-cycle.
Article
The electroencephalography (EEG) affords the clinician an objective measure of cerebral dysfunction and suggests whether cortical, subcortical, or arousal mechanisms are involved in cerebral dysfunction. Some EEG patterns can be particularly suggestive of specific causes for encephalopathy or coma. In conjunction with other tests, EEG can also provide important information on the prognosis in encephalopathy and coma. One area of interest is the use of EEG for the evaluation of toxic/metabolic encephalopathies. EEG may be sensitive to a range of these disorders and may even reflect some specific toxic/metabolic dysfunctions. As a general rule, there is a progressive slowing of the dominant EEG frequencies and decreasing reactivity to external stimuli as the metabolic disturbance increases. With increasing hypoglycemia, there is a progressive slowing of the dominant EEG frequency, diffusely, bilaterally. In profound coma from hyperinsulinism, the EEG may show profuse spike activity and focal seizures.
Article
Ten cases of postanoxic coma have been studied. A clinical neurological examination with study of brainstem reflexes and the EEG recording were made on the first day (J1), the third day (J3) and the tenth day (J10) after the start of the coma. A recording of the visual evoked potentials, the brainstem evoked potentials and the somatosensory potentials combined was made at the same time. A clinical examination is carried out one month after the coma when the patient survives. According to the initial clinical examination, we distinguished 3 groups of subjects. The results show that in group III the visual evoked potentials such as EEG have a slightly significant prognostic value; frequently the near outcome lead to death whereas EEG activity persists and the visual evoked potentials disappear later. On the other hand, the association of brainstem evoked potentials and somatosensory potentials clearly has a higher prognostic value in this group. The disappearance of the shortest brainstem responses and the cortical somatosensory responses is clearly an unfavourable prognosis. This disappearance associated with the end EEG activity is the absolute proof of brain death. On the other hand, the persistence of these responses is of a better prognosis at least on the survival level, but their degradation during evolution is unfavourable.
Article
Although still considered experimental by some, computerized posturography is becoming more and more the standard assessment of balance and neuromuscular control mechanisms while standing. However, there is no consensus as to the data acquisition parameters to be used. Depending on which posturography school one belongs to, acquisition frequencies vary from a few Hz all the way to 1 kHz, and little attention is usually given to the post-sampling filter cut-off frequency (implemented either in the hardware or in the software used to acquire the data), often without realizing the consequences such choices will have on the results. But the sampling and the filter cut-off frequencies are particularly important when dealing with spectral analysis or when secondary measurements such as the center of pressure coordinates, sway path length, velocity or acceleration are calculated from the measured forces and moments. In this paper, frequency content of vertical ground reaction force and center of pressure path coordinates excursion were determined for 946 subjects of both genders, with various age, height, body type, health status and nationality. The results of this spectral analysis made it possible to draw some general conclusions as to what should be a proper acquisition frequency for posturographic data.
Article
Clinical assessment of the unresponsive patient is limited to examination of brainstem reflexes and simple motor responses to stimulation. It is thus difficult, especially if brainstem functions are intact, to give early, accurate prognostic information on comatose patients. Neurochemical tests and imaging have not been validated and have significant limitations. Electrophysiologic investigations provide a window into cerebral function and are tested, clinically useful, safe, available, and inexpensive. Persistent abnormalities of brainstem auditory evoked potentials and short-latency somatosensory evoked potentials reliably indicate the likelihood permanent vegetative state or death. Conversely, the presence of "cognitive" event-related brain potentials (e.g., P300 and mismatch negativity) reflects the functional integrity of higher-level information processing and, therefore, the likelihood of capacity for cognition. A combined clinical and electrophysiologic approach provides optimal prediction of outcome and level of disability.
Article
Objectives: To determine the prognostic value of an EEG grading scale and clinical outcome of treated seizures detected with continuous EEG (cEEG) during therapeutic hypothermia (TH) and rewarming post cardiac arrest (CA). Methods: Our cohort study retrospectively reviewed the electronic medical records and cEEGs of all patients undergoing TH after CA under protocol over 2 years. cEEG was initiated during TH and continued until restoration of normothermia (NT). EEGs were graded 1-3 (3 = most severe) using a departmentally developed EEG severity grading scale by 2 authors blinded to clinical outcome. Outcome was measured using the Cerebral Performance Category scale; grades 1-2 were considered a "good" outcome, 3-5 "poor." Results: Fifty-four patients were included; 51 remained on cEEG through NT. Nineteen died. EEG severity grading during both TH and NT statistically correlated with outcome (grade 1 = good, grade 3 = poor). Other EEG features correlating with poor outcome included seizures, nonreactive background, and epileptiform discharges. Changes in EEG grade during monitoring did not statistically correlate with outcome. Five patients had seizures; all occurred in patients with grade 3 EEG backgrounds and all had a poor outcome. Conclusion: Grades 1 and 3 on our EEG severity grading scale during TH and NT correlated with outcome. Treating seizures did not improve outcome in our cohort.
Article
In a sample of 976 consecutive cases derived from the recent world-wide Field Trial of Autism and other Pervasive Developmental Disorders, we tested the accuracy of the 15 ICD-10 criteria for the diagnosis of Autism, by comparing neural network models (NN) to more conventional multivariate competitors, namely, linear and quadratic discriminant function analyses and logistic regression. NNs were less accurate than competitors, both in terms of cross-validation results as well as in levels of shrinkage from training to test conditions. The clinical research implications of these results are discussed.