Efficacy of transcranial alternating current stimulation over bilateral mastoids (tACSbm) on enhancing recovery of subacute post-stroke patients

Background and aims: Transcranial alternating current stimulation (tACS) offers another method of non-invasive brain stimulation in post-stroke rehabilitation. Because it is not known if tACS over bilateral mastoids (tACS_bm) can promote the functional recovery in subacute post-stroke patients, we wish to learn the effect of tACS_bm on improving neurological function and intracranial hemodynamics of subacute post-stroke patients.

Methods: Sixty subacute post-stroke patients (mean age: 65.4 ± 9.8 years), 15 to 60 days after the onset, were randomly assigned to receiving 15 sessions of usual rehabilitation program without (n = 30) or with tACS_bm (20 Hz and < 400 μA for 30-min; n = 30). The outcome measures included the NIH Stroke Scale (NIHSS) and measures of intracranial hemodynamics before and after treatment.

Results: At the fifteenth session, when compared with the baseline, the mean NIHSS scores of the patients in the tACS_bm group had significantly a larger decrease [18.3 ± 2.6 vs. 10.8 ± 2.7; p < 0.001] than that of the control group [19.1 ± 2.7 vs. 13.0 ± 2.4] [F(1,54) = 4.29, p = 0.043]. After both the first and fifteenth sessions, compared with the control group, the mean blood flow velocity (MFVs) of the tACS_bm group had significantly larger increase in the MCA, ACA, and PCA (p < 0.001), the Gosling pulsatility index (PI) of the tACS_bm group had also significantly larger decline in the MCA, ACA, and PCA than that of the control group (p < 0.001). The best predictor of the changes in the NIHSS scores was the decline in the pulsatility index in the vascular territory of both lesional and non-lesional MCA measured by the end of the last treatment session.

Conclusions: tACS_bm appeared to be effective for enhancing patients’ functional recovery and cerebral hemodynamics in the subacute phase. The extent of recovery seems to be associated with the decline of the resistance in vascular bed of the main cerebral arteries. The mechanisms behind this effect should be explored further through research.     

Cross-sectional study of quadriceps properties and postural stability in patients with chronic stroke and limited vs. non-limited community ambulation

Background: Changes in the paretic-side metabolism post-stroke and quadriceps muscle mechanical properties favour muscle wasting, affecting postural instability and walking impairment. Further clarification is needed in subjects post-stroke who show limited or non-limited community ambulation.

Objectives: To analyze between-limb differences in quadriceps muscle thickness, strength and thigh cutaneous temperature, as well as investigate postural stability in subjects with chronic stroke and limited vs. non-limited community ambulation and compared against healthy controls.

Methods: In this controlled cross-sectional study, 26 participants with chronic hemiparesis post-stroke (divided in a slow gait group (SG<0.8 m/s) (n = 13) and a fast gait group with full community ambulation speed (FG≥0.8 m/s)) and 18 healthy people were recruited. Thigh surface temperature, rectus femoris (RF) and vastus intermedius (VI) muscles thickness, quadriceps’ isometric maximal voluntary contraction and postural stability were measured.

Results: The SG presented significantly lower RF (P = .019) and VI (P = .006) muscle thickness, less peak force (P < .001) and lower temperature (P = .002) in the paretic vs the non-paretic limb. The FG showed significantly lower VI thickness (P = .036) and peak force (P < .001) in the paretic vs the non-paretic limb. Regarding balance, all indices were worse in the SG versus the FG and CG.

Conclusions: Subjects of the FG, despite showing full community ambulation speed, had less quadriceps strength and VI muscle thickness but not RF muscle wasting in the paretic limb. The paretic VI muscle wasting may be an important factor to reach normal walking. The SG showed between-limb differences in all the studied variables and the worst postural stability.     

Dementia Rating Scale-2 normative data for middle-and older-aged Castilian speaking Spaniards

Abstract

Objectives: The Dementia Rating Scale-2 (DRS-2) is frequently used as a dementia screening tool in clinical and research settings in Spain. The present study describes DRS-2 Total and subscale scores in community-dwelling Spaniards, aged 50–71, and provides normative data for its use in Castilian Spanish-speaking individuals. Methods: The sample consisted of 798 individuals who participated in an observational study on essential hypertension. Mean age was 62.8 years (SD = 5.4), mean education was 8.6 years (SD = 3.4) with 47.9% females. Almost all of them were receiving blood pressure-lowering drugs (93%) and most of them had fairly well-managed blood pressure control (M systolic/diastolic blood pressure = 142.3/77.0 ± 16.0/9.2 mm Hg). We applied a previously described method of data normalization from the Mayo’s Older Americans Normative Studies to obtain the Castilian Spanish DRS-2 norms. Results: Worse performance on Total and subscale scores was associated with older age (p < .05) and fewer years of education (p < .001). Women obtained lower raw Total scores than men (131.68 ± 7.2 vs. 133.10 ± 6.90, p < .005), but had fewer years of education (7.96 ± 3.33 vs. 9.17 ± 3.45, p < .001). This gender difference disappeared after correcting for age and years of education. Total and subscale scores are presented adjusted by age, and normative data are shown for Total scores adjusted by age and years of education. Conclusions: These norms are useful for studying cognitive status and cognitive decline in research and clinical settings in Castilian Spanish-speaking populations.     

Efficacy of elaborated semantic features analysis in Aphasia: a quasi-randomised controlled trial

ABSTRACT

Background: Word finding difficulty is one of the most common features of aphasia. Semantic Features Analysis (SFA) directly aims to improve word finding in people with aphasia. Evidence from systematic reviews suggests that SFA leads to positive outcomes, yet the evidence comprises single case studies and case series. There is a need to evaluate the efficacy of SFA in controlled group studies/trials.

Aims: To evaluate the efficacy of Elaborated Semantic Feature Analysis (ESFA) for word finding in people with aphasia. We investigated: (a) the efficacy of ESFA versus a delayed therapy/control, (b) the efficacy of two therapy approaches – individual versus a combination of individual and group therapy.

Methods and procedures: We ran a multi-centre, quasi-randomised controlled trial, nested in a larger study (Thales-Aphasia). Participants were recruited from community settings. They had to be people with aphasia due to stroke at least four months post-onset. Participants were randomized to individual vs combination vs delayed therapy/control groups. Both therapy groups had 3 h of ESFA per week for 12 weeks. Delayed therapy/control group had no intervention for 12 weeks and were then randomized to either individual or combination therapy. The primary outcome was confrontation naming. Secondary outcomes were the Boston Naming Test, Discourse, the Functional Assessment of Communication Skills for adults (ASHA–FACS), the Stroke and Aphasia Quality of Life scale (SAQOL-39g), the General Health Questionnaire-12 item, and the EQ-5D.

Outcomes and Results: Of the 72 participants of the Thales-Aphasia project, 58 met eligibility criteria for speech-language therapy and 39 were allocated to ESFA. The critical p-value was adjusted for multiple comparisons (.005). For the therapy versus control comparison, there was a significant main effect of time on the primary outcome (p < .001, η²_p = .42) and a significant interaction effect (p = .003, η²_p = .21). An interaction effect for the SAQOL-39g (p = .015, η²_p = .11) and its psychosocial domain (p = .013, η²_p = .12) did not remain significant after Bonferroni adjustment. For the individual versus combination ESFA comparison, there were significant main effects of time on the primary outcome (p < .001, η²_p = .49), the BNT (p < .001, η²_p = .29) and the ASHA-FACS (p = .001, η²_p = .18). Interaction and group effects were not significant.

Conclusion: Though underpowered, this study provides evidence on the efficacy of ESFA to improve word finding in aphasia, with gains similar in the two therapy approaches.     

Sociodemographic Characteristics,Risk Factors,and Prevalence of Comorbidity among Children and Adolescents with Intellectual Disability: A Cross-sectional Study

ABSTRACT

Introduction: Intellectual disability (ID) is characterized by limitations in cognitive and adaptive functioning. The aim of this study is to examine sociodemographic characteristics, perinatal and childhood risk factors, and prevalence of psychiatric and biomedical comorbidities in children with ID.

Methods: 260 patients with ID were included in the study (mean age: 8.42 ± 3.59, 61% male, 75% mild ID). The Ankara Developmental Screening Inventory, the Wechsler Intelligence Scale for Children–Revised, and the Porteus Maze Test were used to assess the intelligence of the participants. An additional questionnaire was used to investigate their sociodemographic characteristics and birth, developmental, and medical histories.

Results: Adverse perinatal/neonatal events (p < .001), biomedical comorbidities (p < .001) and seizure/convulsion history (p < .001) were strongly associated with the moderate-severe ID. The children with mild ID had more emotional-social deprivation (p = .022). Low socioeconomic situation, parental education, and teenage parenthood were risk factors for stimulus deficiency. While internalizing disorders were more common in those with mild ID and among girls, externalizing disorders were more common in those with moderate-severe ID and among boys.

Conclusion: Interventions to perinatal/neonatal events may reduce the rate of moderate-severe ID. Evaluation of psychiatric and medical comorbidities and elimination of emotional-social deprivation should be fundamental components of the services offered to children with ID.     

Effects of action observation therapy on hand dexterity and EEG-based cortical activation patterns in patients with post-stroke hemiparesis

Background: Previous reports have suggested that action observation training (AOT) is beneficial in enhancing the early learning of new motor tasks; however, EEG-based investigation has received little attention for AOT.

Objective: The purpose of this study was to illustrate the effects of AOT on hand dexterity and cortical activation in patients with post-stroke hemiparesis.Method: Twenty patients with post-stroke hemiparesis were randomly divided into either the experimental group (EG) or control group (CG), with 10 patients in each group. Prior to the execution of motor tasks (carrying wooden blocks from one box to another), subjects in the EG and CG observed a video clip displaying the execution of the same motor task and pictures showing landscapes, respectively. Outcome measures included the box and block test (BBT) to evaluate hand dexterity and EEG-based brain mapping to detect changes in cortical activation.

Results: The BBT scores (EG: 20.50 ± 6.62 at pre-test and 24.40 ± 5.42 at post-test; CG: 20.20 ± 6.12 at pre-test and 20.60 ± 7.17 at post-test) revealed significant main effects for the time and group and significant time-by-group interactions (p < 0.05). For the subjects in the EG, topographical representations obtained with the EEG-based brain mapping system were different in each session of the AOT and remarkable changes occurred from the 2nd session of AOT. Furthermore, the middle frontal gyrus was less active at post-test than at pre-test.

Conclusions: These findings support that AOT may be beneficial in altering cortical activation patterns and hand dexterity.     

Effects of constraint-induced movement therapy for lower limbs on measurements of functional mobility and postural balance in subjects with stroke: a randomized controlled trial*

Background: Constraint-induced movement therapy (CIMT) is suggested to reduce functional asymmetry between the upper limbs after stroke. However, there are few studies about CIMT for lower limbs.

Objective: To examine the effects of CIMT for lower limbs on functional mobility and postural balance in subjects with stroke.

Methods: A 40-day follow-up, single-blind randomized controlled trial was performed with 38 subacute stroke patients (mean of 4.5 months post-stroke). Participants were randomized into: treadmill training with load to restraint the non-paretic ankle (experimental group) or treadmill training without load (control group). Both groups performing daily training for two consecutive weeks (nine sessions) and performed home-based exercises during this period. As outcome measures, postural balance (Berg Balance Scale – BBS) and functional mobility (Timed Up and Go test – TUG and kinematic parameters of turning – Qualisys System of movement analysis) were obtained at baseline, mid-training, post-training and follow-up.

Results: Repeated-measures ANOVA showed improvements after training in postural balance (BBS: F = 39.39, P < .001) and functional mobility, showed by TUG (F = 18.33, P < .001) and by kinematic turning parameters (turn speed: F = 35.13, P < .001; stride length: F = 29.71, P < .001; stride time: F = 13.42, P < .001). All these improvements were observed in both groups and maintained in follow-up.

Conclusions: These results suggest that two weeks of treadmill gait training associated to home-based exercises can be effective to improve postural balance and functional mobility in subacute stroke patients. However, the load addition was not a differential factor in intervention.     

Effect of low-intensity pure tone auditory stimulation on patients with rapid eye movement sleep behavior disorder

Objective: This study aimed to investigate the influence of low-intensity pure tone auditory stimulation on patients with rapid eye movement (REM), sleep behavior disorder (RBD), and attempt to identify a new method of RBD intervention.

Methods: Patients diagnosed with idiopathic RBD (iRBD) or symptomatic RBD (sRBD) were given auditory stimulation of low-intensity pure tones during their REM sleep. Sleep parameters including sleep process, sleep architecture as well as eye movements (EMs) frequency, and amplitude were recorded by polysomnography monitoring at pre-, intra-, and post-stimulation.

Results: Thirteen iRBD and 18 sRBD patients completed this study. Auditory stimulation significantly reduced the EMs frequency and amplitude in iRBD and sRBD patients (p < 0.05). In the iRBD group, the intra-stimulated FSL increased significantly than the pre-stimulated FSL (p < 0.05). After stimulation, patients had similar sleep latency (FSL), rapid eye movement sleep latency (RSL) and periodic limb movements in sleep (PLMS) compared with control. In the sRBD group, the intra-stimulated total sleep time, sleep efficiency was significantly increased, whereas the RSL and PLMS were significantly reduced compared with the pre-stimulated ones (all p < 0.05). The sRBD patients had similar time in bed, FSL and RBD episodes compared with control (all p < 0.05) in spite of significant difference before stimulation (all p < 0.05). However, the sleep architecture was not influenced by the stimulation despite the decrease in N3% in iRBD group (p < 0.05).

Conclusion: Low-intensity pure tone auditory stimulation may be a potentially effective intervention for RBD, especially for sRBD.     

Restrictive eating is associated with emotion regulation difficulties in a non-clinical sample

ABSTRACT

The relationship between emotion regulation difficulties and restrictive eating has not been established in non-clinical samples. In this study, undergraduates (n = 98) provided information regarding general and specific emotion regulation difficulties on the Difficulties in Emotion Regulation Scale (DERS) and whether they had engaged in recent restrictive eating. Generalized linear models were used to determine if individuals endorsing versus denying recent restrictive eating differed on emotion regulation problems. Results indicated that individuals endorsing restrictive eating had elevated DERS Total (p < .001), Goals (p = .001), Impulse (p < .001), and Strategies (p < .001) scores. Results remained primarily unchanged after controlling for the related construct of dietary restraint. Findings indicate that endorsement of restrictive eating among non-clinical individuals is uniquely associated with emotion regulation deficits, especially those reflecting emotional under-control. Interventions targeting emotion regulation may enhance prevention and treatment of restrictive eating across severity.     

The feasibility and effectiveness of using prism adaptation to treat motor and spatial dysfunction in stroke survivors with multiple incidents of stroke

Background Strokes resulting in cognitive and motor problems can be debilitating and prolong recovery. Risk of a second stroke occurs for 40% of all first-time stroke survivors within five years. Prism adaptation treatment (PAT) may simultaneously improve functions of both spatial and motor systems. This has not been studied with a cohort comprised of multiple strokes nor measured change using specific motor outcomes.

Objectives To determine the feasibility and effectiveness of using PAT to improve spatial and motor functions in stroke survivors with multiple strokes.

Method A prospective intervention with retrospective comparison. Thirteen participants from an inpatient rehabilitation facility (IRF) comprised the treatment group; 13 others who only received standard care comprised the comparison group. Treatment group tested on: 4 motor and 3 spatial outcome measures before and after the 10 PAT sessions. The comparison group tested on: 1 motor and 3 spatial measures before and after standard care.

Results Thirteen participants successfully completed the PAT. Both groups improved on measures of spatial neglect over time (p < .001), but the treatment group showed greater improvement on two subtests of spatial function (Behavior inattention test) (p = .001 &; p = .002). Similarly, both groups improved in motor function (Functional independence measure) (p < .001), although the treatment group’s improvement was not statistically significant against the comparison group (p = .853).

Conclusion PAT is a feasible treatment for stroke survivors with multiple strokes. PAT did improve spatial neglect function more than standard care, only at one level of analysis of standard paper and pencil measures. Further research is necessary.     

Cognitive function and insulin resistance in elderly patients with type 2 diabetes

Purpose: To explore the relationship between cognitive impairment and insulin resistance (IR) in elderly patients with type-2 diabetes mellitus.

Materials and methods: Two hundred and twelve elderly patients with type-2 diabetes were enrolled in this study and assigned into either the cognitive impairment group (n = 100) or the normal cognitive group (n = 112). Gender, age, education, body mass index (BMI), total cholesterol, triglyceride, low-density lipoprotein cholesterol, creatinine (Cr), fasting plasma glucose, fasting insulin (FINS) and homeostasis model of assessment for IR index (HOMA-IR) were compared between the two groups. Multifactorial logistic regression analysis was performed.

Results: In cognitive impairment group, education level (33.00 vs 53.57%, p < 0.01) was lower, the level of BMI [(28.7 ± 4.5) kg/m² vs (23.9 ± 3.7) kg/m², p < 0.01], FINS [(21.8 ± 5.3) mU/L vs (12.9 ± 3.9) mU/L, p < 0.01], HOMA-IR [(6.9 ± 1.7) vs (3.9 ± 0.9), p < 0.01] were higher than the control group. In the logistic regression, education level (B = –0.996, p = 0.03), FINS (B = 1.120, p < 0.01) and HOMA-IR (B = 1.301, p < 0.01) were independent factors.

Conclusions: Our study demonstrates that the education level, FINS and HOMA-IR were independent factors of cognitive impairment in elderly patients with type-2 diabetes. IR is an important risk factor and higher education level in a protective factor for the cognitive impairment in elderly patients with type-2 diabetes.     

Evaluation of ghrelin,nesfatin-1 and irisin levels of serum and brain after acute or chronic pentylenetetrazole administrations in rats using sodium valproate

ABSTRACT

Objectives: In this study, we aim to reveal the alterations (due to seizure) in the serum and brain levels of nesfatin-1, ghrelin and irisin after acute or chronic pentylenetetrazole administrations in rats using sodium valproate.

Methods: 35 Wistar albino rats were randomly divided into five groups: Control, Acute Pentylenetetrazole group (APTZ), Acute Pentylenetetrazole+ Valproate group (AVPA), PTZ kindling group (PTZk) and PTZ kindling+ Valproate group (KVPA). Serum and brain levels of ghrelin, nesfatin-1 and FNDC5/irisin were determined with ELISA.

Results: Serum levels of ghrelin were significantly decreased in APTZ and PTZk groups compared to the control (p < 0.01). There was a statistically significant decrease in brain levels of ghrelin in all groups compared to the control group (p < 0.01). There was a statistically significant increase in serum nesfatin-1 levels in the APTZ and PTZk groups compared to the control (p < 0.05). Serum levels of nesfatin-1 were similar to the control group in both the acute and the chronic treatment groups. There was a statistically significant increase in brain nesfatin-1 levels of the KVPA group compared to the control (p < 0.05). Serum and brain levels of FNDC5/irisin were found significantly increased in APTZ, AVPA and PTZk groups compared to the control (p < 0.01).

Conclusions: Statistically significant alterations were detected in the serum and brain levels of these three peptides in both the PTZ-induced chronic epilepsy model and acute seizure model. The results of this study may suggest that the increase in FNDC5/irisin and nesfatin-1 levels, and the decrease in ghrelin levels may contribute to seizure pathophysiology. However, further studies are needed in order to confirm our hypothesis.     

Evaluation of corneal parameters in patients with Parkinson’s disease

The aim of this study was to evaluate blink rate (BR), tear tests and corneal parameters by Scheimpflug imaging and also to clarify the associations between the severity of disease and corneal parameters in patients with Parkinson’s disease (PD). Forty patients with PD and 40 healthy subjects were included in this study. All participants underwent a detailed neurological and ophthalmological evaluation. The severity of disease was measured according to Hoehn–Yahr (H–Y) scale. BR was determined for participants. Corneal parameters were measured using Pentacam. Additionally, Schirmer test, tear break-up time (TBUT), corneal fluorescein staining, and Ocular Surface Disease Index (OSDI) scores were assessed. Corneal parameters were significantly different between the patients with PD and healthy controls. The mean central corneal thickness (538.95 ± 30.9 μm versus 557.60 ± 26.6 μm, p = 0.005) was significantly reduced in patients with PD compared to healthy controls. The BR and the values of TBUT and Schirmer test scores were significantly lower in patients with PD than in controls. Also, corneal fluorescein staining and OSDI scores were higher in patients with PD than in controls. The BR was significantly negative correlated with the severity of the disease. Factors related to the corneal thickness were BR, TBUT and Schirmer test (p < 0.05 for all). Corneal thickness may decrease in patients with PD which may be affected by reduced BR and tear dysfunction.     

Intra- and inter-rater reliability of the 10-meter ambulation test in hemiparesis is better barefoot at maximal speed

Objectives Reliability of clinical tests to evaluate ambulation in chronic hemiparesis may vary according to the testing condition. The 10-meter ambulation test (AT10) assesses walking speed and step length over 10 m, starting and ending in seated position. In the present study, we compared the intra- and inter-reliability of AT10 in chronic hemiparesis in four different conditions: with shoes and barefoot, at free and maximal safe speed.

Methods Ten patients with hemiparesis, >1 year post-stroke (age 45 ± 12, time since stroke 16 ± 9 months, mean ± SD) participated in the reliability study (registration, ID-RCB-2017-A00090-53). All patients performed the AT10 twice, one week apart, in each of the four conditions. The number of steps and time to complete the task were manually recorded by four independent raters. The main outcome measurements were the intraclass correlation coefficients (ICC), coefficients of variation (CV), and mean raw differences (DIFF) of the three parameters of AT10 (speed, step length, and cadence) in each of the four conditions. Effects of wearing shoes and speed condition were explored using ANOVA.

Results Across all conditions, mean intra- and inter-rater ICCs were, respectively, 98.5 ± 0.1 and 99.9 ± 0.1% for speed, 98.3 ± 0.1 and 99.7 ± 0.2% for step length, and 96.5 ± 0.1 and 98.9 ± 0.6% for cadence. Mean intra- and inter-rater CV for speed were 0.051 ± 0.016 and 0.022 ± 0.002, respectively. Intra-rater reliability of speed assessments was higher at maximal than at free speed (ICC, CV, DIFF, p < 0.05). At free speed, intra-rater ICCs were higher barefoot than with shoes (p < 0.05).

Discussion Performing the 10-meter ambulation test barefoot at maximal speed optimizes its reliability.     

Effects of constraint-induced movement therapy on brain glucose metabolism in a rat model of cerebral ischemia: a micro PET/CT study

Purpose: Constraint-induced movement therapy (CIMT) can improve motor functions in stroke patients and ischemic rats. This study examined the effect of CIMT in ischemic rats using positron emission tomography (PET).

Methods: We used middle cerebral artery occlusion (MCAO) procedure to induce cerebral ischemia in rats. Male rats were divided into a negative control group (Normal, n = 4), a sham-operated group (Sham, n = 6), an ischemic group (Control, n = 6) and an ischemic CIMT-treated group (CIMT, n = 6). CIMT started at postoperative day 8 (d8) and lasted for 2 weeks. We utilized 2-[¹⁸F]-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) micro PET/CT imaging to evaluate glucose metabolism in different brain regions at baseline, before, and after treatment, respectively.

Results: CIMT improved behavioral performance in the ischemic CIMT group. At the end of treatment, the CIMT group showed lower standardized uptake values (SUVs) in the ipsilateral cingulate, motor and somatosensory cortex, respectively; as well as the anterodorsal hippocampus compared to the Control group (1.80% ± 0.10% vs. 1.92% ± 0.08%, 1.32% ± 0.14% vs. 1.48% ± 0.09%, 1.18% ± 0.14% vs. 1.42% ± 0.15%, 1.68% ± 0.09% vs. 1.79% ± 0.06%, P < 0.05). We also observed higher SUVs in the acbcore shell and cortex insular of the contralateral hemisphere compared to the Control group (2.07% group in the acbcore shell and cortex insular of contralateral P < 0.05).

Conclusion: CIMT improved behavioral outcomes in cerebral ischemic rats and this effect can be attributed to increased glucose utilization in the contralateral hemisphere.     

Eyes are mirror of the brain: comparison of multiple sclerosis patients and healthy controls using OCT

Abstract

Objective: To evaluate the thickness of choroid and retinal nerve fiber layer (RNFL) in multiple sclerosis (MS) patients with and without optic neuritis using enhanced depth imaging optical coherence tomography (EDI-OCT).

Methods: In this cross-sectional study, both eyes of 52?MS patients [n?=?104 eyes; 62 eyes of MS patients without optic neuritis (MS-NON) and 42 eyes of MS patients with optic neuritis (MS-ON)] and only one eye of 36 healthy control subjects (n?=?36 eyes) were evaluated. Complete ophthalmologic examination and EDI-OCT scanning were completed for all participants. Choroidal thickness measurements were executed at three different points.

Results: Choroidal thickness measurements were similar between MS patients and healthy control subjects. However, the mean subfoveal choroidal thickness was increased significantly in MS-ON group (399.13?±?82.91?μm) compared to MS-NON group (342.71?±?82.46?μm; p?=?0.004). Mean RNFL thickness was significantly reduced in MS patients (90.42?±?13.31?μm) compared to healthy controls (101.18?±?10.75?μm; p?<?0.001). Moreover, temporal RNFL thickness was significantly thinner in MS-ON group (54?±?14.50?μm) than MS-NON group (62.15?±?15.88?μm; p?=?0.01). In MS patients, temporal RNFL thickness was correlated with both Expanded Disability Status Score (r?=?0.383; p?<?0.001) and longer disease duration (r=–0.202; p?=?0.04).

Conclusion: The results of the present study suggest that RNFL thickness can be used as an important parameter while following up with MS patients. However, more studies using EDI-OCT are required with larger MS patient groups and automated method.     

Assessing Posttraumatic Stress Disorder in Adults with Mild Intellectual Disabilities or Borderline Intellectual Functioning

ABSTRACT

Introduction: Persons with mild intellectual disability or borderline intellectual functioning (MID-BIF, IQ 50–85) are at high risk for the development of posttraumatic stress disorder (PTSD). A diagnostic instrument to establish a valid and reliable DSM-5 PTSD diagnosis in adults with MID-BIF was lacking. Aim of the current study was to determine the reliability and validity of the Adapted ADIS-C PTSD-adults for the assessment of PTSD according to DSM-IV-TR and DSM-5 in adults with MID-BIF

Method: 106 adults (18– 72 years old) with MID-BIF were interviewed using the Adapted ADIS-C PTSD-adults

Results: Agreement between raters appeared to be good (mean Cohen’s kappa for traumatic event scores 0.84, fulfillment of PTSD A-criterion 0.50, and PTSD symptom scores 0.90). Content validity was supported by a significant positive association with scores on the IES-IDs, a DSM-IV PTSD screening instrument (DSM-IV: r = .58; DSM-5: r = .43; ps <.001). Convergent validity appeared to be good considering positive correlations between rates of PTSD symptoms and scores on the ADESS, measuring symptoms of anxiety and stress, depression, and social avoidance (DSM-IV: r = .47; DSM-5: r = .49; ps <.001)

Conclusion: The Adapted ADIS-C PTSD-adults is suitable for assessing DSM-5 PTSD in adults with MID-BIF, an important step to gain access to trauma-focused interventions that have shown to be applicable and potentially effective for this high-risk target group.     

Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds

Objective: This study examined the influence of Hispanic ethnicity and language/cultural background on performance on the NIH Toolbox Cognition Battery (NIHTB-CB). Method: Participants included healthy, primarily English-speaking Hispanic (n = 93; Hispanic-English), primarily Spanish-speaking Hispanic (n = 93; Hispanic-Spanish), and English speaking Non-Hispanic white (n = 93; NH white) adults matched on age, sex, and education levels. All participants were in the NIH Toolbox national norming project and completed the Fluid and Crystallized components of the NIHTB-CB. T-scores (demographically-unadjusted) were developed based on the current sample and were used in analyses. Results: Spanish-speaking Hispanics performed worse than English-speaking Hispanics and NH whites on demographically unadjusted NIHTB-CB Fluid Composite scores (ps < .01). Results on individual measures comprising the Fluid Composite showed significant group differences on tests of executive inhibitory control (p = .001), processing speed (p = .003), and working memory (p < .001), but not on tests of cognitive flexibility or episodic memory. Test performances were associated with language/cultural backgrounds in the Hispanic-Spanish group: better vocabularies and reading were predicted by being born outside the U.S., having Spanish as a first language, attending school outside the U.S., and speaking more Spanish at home. However, many of these same background factors were associated with worse Fluid Composites within the Hispanic-Spanish group. Conclusions: On tests of Fluid cognition, the Hispanic-Spanish group performed the poorest of all groups. Socio-demographic and linguistic factors were associated with those differences. These findings highlight the importance of considering language/cultural backgrounds when interpreting neuropsychological test performances. Importantly, after applying previously published NIHTB-CB norms with demographic corrections, these language/ethnic group differences are eliminated.     

Pilot randomized controlled trial to assess a physical therapy program on upper extremity function to counteract inactivity in chronic stroke

Background: In chronic stroke, feasible physical therapy (PT) programs are needed to promote function throughout life.

Objective: This randomized controlled pilot trial investigated the feasibility and effect of a PT program composed of strengthening exercises with elastic bands and bimanual functional training, with clearly defined doses based on the rate of perceived exertion (Borg scale), to counteract inactivity in chronic stroke.

Methods: Fifteen subjects > 6 month post-stroke were randomized to three-month of UE function training (UE group), or to lower extremity function training (LE group). At baseline (T0), post-intervention (T1) and three-month follow-up (T2) assessment included the Fugl-Meyer Assessment scale (FMA), Wolf Motor Function test (WMFT), grip strength, and muscle tone. Feasibility was also evaluated.

Results: The mixed-model ANOVAs revealed a significant interaction between the time and group factors for FMA (p < .001) and WMFT (p = .009). The UE group improved upper extremity function and motor recovery significantly more than the LE group. There was no significant interaction between treatment group and change in grip strength over time (p = .217). No between-group differences (p > .05) were found in muscle tone. In the UE group, the attendance rate was ≥85% for 71.4% of subjects and 85.7% showed high satisfaction. No adverse events were recorded. After treatment, adherence to the program was higher in the UE group.

Conclusions: The suggested PT program may be useful to improve the paretic UE function and motor recovery in chronic stroke. Moreover, it may be helpful to facilitate lifelong active involvement of stroke subjects in exercise.     

Effects of group versus individual therapy for patients with memory disorder after an acquired brain injury: A randomized,controlled study

Introduction: This randomized, controlled, single-blind study compared the efficacy of group versus individual memory rehabilitation therapy for patients with acquired brain injury (ABI). Subjects (N = 65) were assigned to individual (IT), group (GT), or no (NT) therapy during the three-week rehabilitation program. A neuropsychological assessment was conducted before treatment, immediately after completing treatment, and 4 months after completing treatment. Three levels of functioning were assessed: participation, disability, and impairment. The primary outcome measure was the Rivermead Behavioural Memory Test (RBMT). The results of the cognitive measures in the three groups at subsequent assessments were compared, and the effect sizes were calculated to investigate the magnitude of improvement.

Results: There were no significant changes in self-reported patient memory problems for the participation-level measures. However, relatives of participants in the GT group reported a decreased frequency of memory failures (p = .026). According to the ability-level measure (RBMT), both therapeutic groups had similar significant improvements (p < .001), and the effect sizes were large in both groups. Although the NT group also improved (p = .015), the effect size was small. The differences between the three groups were not significant according to analysis of variance (ANOVA). However, after therapy was completed, only the GT group continued to improve (p = .013). For the impairment-level measures, the IT group showed significant improvement post treatment in three out of four measures (p < .05). This group had medium effect sizes, while the other groups showed a small or marginal effect.

Conclusions: Cognitive rehabilitation – either in a group or individually – led to equally enhanced memory functioning in ABI patients, but the effects were not significantly different from those for patients in the NT group. GT and IT had specific effects on different levels of functioning.