The effects of locomotor training in children with spinal cord injury: a systematic review

Purpose: Discuss the effectiveness of locomotor training (LT) in children following spinal cord injury (SCI). This intervention was assessed following an exhaustive search of the literature using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement as a guideline.

Method: Six databases were searched including PubMed, PEDro, CINAHL, Cochrane, PsycINFO, and Web of Knowledge in January 2016 and November 2016, without date restrictions. Inclusion criteria were: studies in English and peer-reviewed and journal articles with a primary intervention of LT in children following SCI.

Results: Twelve articles, reporting eleven studies, were included. A systematic review assessing locomotor training in children with SCI published in April 2016 was also included. Participants were ages 15 months to 18 years old. Forms of LT included body-weight supported treadmill or over ground training, functional electrical stimulation, robotics, and virtual reality. Protocols differed in set-up and delivery mode, with improvements seen in ambulation for all 41 participants following LT.

Conclusion: Children might benefit from LT to develop or restore ambulation following SCI. Age, completeness, and level of injury remain the most important prognostic factors to consider with this intervention. Additional benefits include improved bowel/ bladder management and control, bone density, cardiovascular endurance, and overall quality of life. Looking beyond the effects LT has just on ambulation is crucial because it can offer benefits to all children sustaining a SCI, even if restoration or development of walking is not the primary goal. Further rigorous research is required to determine the overall effectiveness of LT.     

A Prematriculation Intervention to Improve the Adjustment of Students to Medical School

Background and purpose: The transition from a baccalaureate program to a medical curriculum can be a difficult period for some students. Our study asked whether providing students with review materials and a means of assessing their degree of preparedness prior to matriculation influenced actual and perceived performance in 1st-year basic science courses. Methods: Didactic review materials in basic science subjects encountered in the 1st year were made available to prematriculants online. Access to materials for each subject was contingent upon completion of a pretest. Prematriculants were free to use the materials as they saw fit. Once students matriculated, performance in basic science subjects was compared between those who had accessed the materials and those who had not. Students who accessed the materials were also surveyed to determine if they perceived any benefit from their use. Results: More than half of matriculants chose to access the intervention materials. There was no significant difference in MCAT, prerequisite grade point average, or total grade point average between those students who chose to access the intervention materials and those who did not. Students who accessed the intervention materials reported gains in confidence in their ability to perform well in medical school. Those students who accessed the intervention materials had significantly higher examination scores in an early basic science course than those who did not. Conclusions: An online prematriculation intervention can provide useful background material to interested students. Access to this material increased performance in a 1st-year basic science course and was perceived as valuable by students.     

Light treatment for neuropsychiatric behaviors in Alzheimer's disease

Neuropsychiatric behaviors are common in people with Alzheimer's disease (AD) and make both professional and lay caregiving difficult. Light therapy has been somewhat successful in ameliorating disruptive behaviors. This randomized trial tested the effects of morning or afternoon bright light exposure compared with usual indoor light on the presence, frequency, severity, and occupational disruptiveness of neuropsychiatric behaviors in nursing home residents with AD. Light was administered for 1 hr daily (Monday-Friday) for 10 weeks. The Neuropsychiatric Inventory-Nursing Home was used to assess behavior at baseline and end of the intervention. Analyses revealed statistically significant differences between groups on agitation/aggression, depression/dysphoria, aberrant motor behavior, and appetite/eating disorders. The magnitude of change was small and may not represent clinically significant findings. Agitation/aggression and nighttime behaviors commonly occurred and were highly correlated with occupational disruptiveness. Interventions that decrease the presence and/or severity of neuropsychiatric behaviors have the potential to significantly decrease caregiver burden.     

Impact of Alzheimer disease patients' sleep disturbances on their caregivers

Sleep disturbance symptoms are common in persons living with Alzheimer disease (AD). However little is known about the impact of sleep disturbance symptoms in patients living with AD on caregiver burden and quality of life (QOL). The aims of this study were to determine the prevalence of symptoms of disturbed sleep in patients with AD, identify the care-recipient sleep disturbance symptoms that predict caregiver burden and QoL, and determine how care-recipient sleep disturbance symptoms compare to other caregiver and patient characteristics when predicting caregiver QoL. Caregiver burden was assessed using the Screen for Caregiver Burden. Sixty percent of the care-recipients had at least one sleep symptom. In 130 caregiver/patient dyads, nocturnal awakenings, nocturnal wandering, and snoring predicted caregiver burden. Multivariate modeling demonstrated that caregiver burden, caregiver physical and mental health, and caregiver depression were predictors of overall caregiver QoL. Treating disturbed sleep in care-recipients and caregiver mental health symptoms could have important public health impact by improving the lives of the caregiving dyad.     

The utility of a HindIII polymorphism of factor VIII examined by rapid DNA analysis

A previously described HindIII restriction fragment length polymorphism (RFLP) of factor VIII (FVIII) has its polymorphic site in the unsequenced nineteenth intron. We have located the polymorphic site, as well as an invariant site, by amplifying and sequencing IVS 19 using the polymerase chain reaction (PCR). The oligonucleotide primers were synthesized from known FVIII sequence on either side of the 19-20 splice junction. The amplified product was cloned into a plasmid and sequenced by the dideoxy chain termination method. The polymorphic HindIII site was 103 bp and the invariant site 184 bp from the 3' end of the nineteenth exon. The frequency of the polymorphism was determined in 457 subjects (643 chromosomes) of seven ethnic groups on whom frequency of the BclI RFLP of IVS 18 was also assessed. The HindIII site is highly polymorphic in all groups, approximately 0.25:0.75, the expected heterozygosity averaging 37.6%, and the observed number of heterozygotes did not differ significantly from expectation. The (+):(-) allelic ratio is similar in all groups, except African-Americans in whom it is reversed. Strong allelic association (linkage disequilibrium) is present between the HindIII polymorphism of IVS 19 and the BclI polymorphism of IVS 18.     

Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease

OBJECTIVES: To test whether the addition of melatonin to bright-light therapy enhances the efficacy in treating rest–activity (circadian) disruption in institutionalized patients with Alzheimer's disease (AD).
DESIGN: Randomized, controlled trial.
SETTING: Two nursing homes in San Francisco, California.
PARTICIPANTS: Fifty subjects (mean age 86) with AD.
INTERVENTION: Experimental subjects received 1 hour of morning light exposure (≥2,500 lux in gaze direction) Monday to Friday for 10 weeks and 5 mg melatonin (LM, n=16) or placebo (LP, n=17) in the evening. Control subjects (n=17) received usual indoor light (150–200 lux).
MEASUREMENTS: Nighttime sleep variables, day sleep time, day activity, day:night sleep ratio, and rest–activity parameters were determined using actigraphy.
RESULTS: Linear mixed models were employed to test the primary study hypotheses. No significant differences in nighttime sleep variables were found between groups. At the end of the intervention, the LM group showed significant improvement in daytime somnolence as indicated by a reduction in the duration of daytime sleep, an increase in daytime activity, and an improvement in day:night sleep ratio. The LM group also evidenced a significant increase in rest–activity rhythm amplitude and goodness of fit to the cosinor model.
CONCLUSION: Light treatment alone did not improve nighttime sleep, daytime wake, or rest–activity rhythm. Light treatment plus melatonin increased daytime wake time and activity levels and strengthened the rest–activity rhythm. Future studies should resolve the question of whether these improvements can be attributed to melatonin or whether the two zeitgebers interact to amplify efficacy.