Marisa Megna

Persons With Moderate Alzheimer's Disease Improve Activities and Mood via Instruction Technology

Background: Three studies assessed the (a) effectiveness of verbal instructions presented via technology in helping persons with moderate Alzheimers disease perform daily activities and (b) impact of activity engagement on mood. Methods: The 3 studies targeted coffee preparation with 2 women, use of make-up with 2 women, and use of make-up and tea preparation with 3 women. Intervention effects on activity performance were assessed through nonconcurrent multiple baseline designs across participants or multiple baseline designs across activities. The impact of activity on mood was assessed by recording indices of happiness during activity trials and parallel nonactivity periods. Results: Verbal instructions presented via technology were effective in helping all participants perform the target activities. The participants also showed mood improvement (ie, increases in indices of happiness) during the activity. Conclusion: These results suggest that the approach reported may be a useful strategy for helping persons with Alzheimers disease.

High and low frequency transcutaneous electrical nerve stimulation inhibits nociceptive responses induced by CO2 laser stimulation in humans.

The aim of the study was to evaluate the effects of transcutaneous electric nerve stimulation (TENS) on CO(2) laser evoked potentials (LEPs) in 16 normal subjects. The volar side of the forearm was stimulated by 10 Hz TENS in eight subjects and by 100 Hz TENS in the remainder; the skin of the forearm was stimulated by CO(2) laser and the LEPs were recorded in basal conditions and soon after and 15 min after TENS. Both low and high frequency TENS significantly reduced the subjective rating of heat stimuli and the LEPs amplitude, although high frequency TENS appeared more efficacious. TENS seemed to exert a mild inhibition of the perception and processing of pain induced by laser Adelta fibres activation; the implications of these effects in the clinical employment of TENS remain to be clarified.

Technology-assisted messaging opportunities for two persons emerged from a minimally conscious state and showing extensive motor disabilities

Objective: To extend the assessment of a special messaging technology with two adults emerged from a minimally conscious state and showing extensive motor disabilities as well as limited or no oral/verbal skills. Method: The study involved a non-concurrent multiple baseline design across participants. Both participants started with baseline in which the technology was not available, and continued with intervention in which the technology was used. The technology involved a net-book computer provided with specific software, a global system for mobile communication (GSM) modem, microswitches, and pre-recorded lists of persons and messages. Results: Both participants learned to send out and receive (listen to) messages independently during the intervention. They sent out a mean of three or three and a half messages and received a mean of one and a half messages per 20-minute session. Conclusions: Special messaging technology may help post-coma persons with multiple disabilities engage in basic communication with distant partners.

Combined antimuscarinics for treatment of neurogenic overactive bladder.

Antimuscarinic drugs are the first line pharmacotherapy for overactive bladder, but they are not always effective to achieve complete continence. Nevertheless in some patients urodynamic investigations reveal insufficient effects with continuing incontinence events even with dose optimization. The aims of this study is to evaluate the effect of association of Oxybutynin chloride, Trospium chloride and Solifenacin succinate administered orally for a minimum of 12 weeks in subjects with suprasacral spinal cord injury with urge-incontinence, urodynamic–proven neurogenic detrusor overactivity dysfunction and detrusor-external sphincter dyssynergia to improve level of continence, reduce the risks of urologic complications and enhance QOL. This study was a randomized, double blind, controlled, balanced-parallel-groups investigation of orally administed Oxybutynin in addition to Trospium chloride in the first group and Oxybutynin in addition to Solifenacin in the other group. A total of 12 patients with neurogenic detrusor overactivity and clean intermittent catheterization were allocated into two treatment groups: 5 mg tablet of Oxibutinin and 20 mg tablet of Trospium Chloride were administed respectively 3 times a day and 4 times a day in the first group (Group A). 5 mg tablet of Oxibutinin and 10 mg tablet of Solifenacin were administed respective 3 times a day and once daily in the second group (Group B). In both group of patients we found a significant decrease in incontinence episodes, with an improvement of bladder compliance, bladder capacity and volume voided. Side effects were higher in patients of group B, but in general well tolerated. In conclusion a combined antimuscarinic treatment might be a right option for patients affected by neurogenic bladder refractory to previous antimuscarinic monotherapy, and might slow down or delay other more invasive treatments.

The Use and Alpha-Lipoic Acid (ALA), Gamma Linolenic Acid (GLA) and Rehabilitation in the Treatment of Back Pain: Effect on Health-Related Quality of Life

The aim of this trial was to evaluate the effects of α-lipoic acid (ALA) and γ-linolenic acid (GLA) and the beneficial effect of physical exercise on positive sensory symptoms and neuropathic pain in patients with compressive radiculopathy syndrome from disc-nerve root conflict. Often these painful syndromes after the acute event, tend to recurrence becoming subacute or chronic syndromes that become for the period of interest disabiling is an event very important in these cases proper prevention, based on a maintenance drug therapy and the strengthening exercises of paravertebral muscles, flexibility exercises on the spine and when needed on the reduction of body weight. In this Observational Cohort, two-arm trial, 203 patients were enrolled and divided into two groups, the first, “ALA and GLA group”, (n = 101) received oral dose of 600 mg of α-lipoic acid (ALA) and 360 mg of γ-linolenic acid (GLA) and a rehabilitation program for six weeks, the second (n = 102) treated with only rehabilitation program. Patients were recruited at the centre of Physical Medicine and Rehabilitation, have undergone a physiatric examination at the primary outcome (t0) and secondary outcomes were recorded at monitoring visits scheduled at two weeks = t1, four weeks = t2, six weeks = t3, and at the same has been administered the following scale: VAS scale, SF-36, Oswestry Low Back Pain Disability Questionnaire, Aberdeen Back Pain Scale (ABPS), Revised Leeds Disability Questionnaire (LDQ), Roland and Morris Disability Questionnaire. Significant improvements has been noted in the “ALA and GLA group” for paresthesia, stabbing and burning pain, as showed by VAS (Visual Analogue Scale), Oswestry Low Back Pain Disability Questionnaire, Aberdeen Low Back Pain Scale; also, improvements of “quality of life” has been noted, in the same group, as showed by SF-36, LDQ (Revised Leeds Disability Questionnaire), Roland and Morris disability questionnaire. These all outcome measure showed decreases statistically significant. Oral treatment with α-lipoic acid (ALA) and γ-linolenic acid (GLA) for six weeks in synergy with rehabilitation therapy improved neuropathic symptoms and deficits in patients with radicular neuropathy.

BOTULINUM TOXIN TYPE A IN THE TREATMENT OF SIALORRHEA IN PARKINSON'S DISEASE

protein (CRP) and erythrocyte sedimentation rate (ESR) were 261 mg/L and 137 mm/h, respectively. Blood and urine cultures were negative. X-rays of the feet showed osteoarthritic changes. Chest x-ray showed no pulmonary pathology. Over the following 48 hours, the pain and swelling progressed to involve the metatarsophalyngeal joints, wrists, and elbows bilaterally; swinging fevers and rigors persisted. On-call staff started her on ceftriaxone for suspected sepsis. The patient subsequently developed a blanching nonpruritic maculopapular rash involving the arms, legs, and trunk. A vasculitic, myeloma, and arthrogenic virus screen and computed tomography (CT) imaging of the abdomen and pelvis were normal. Complement levels, C3 (0.75 g/L) and C4 (0.08 g/L) were low, and lymphopenia persisted. Given the cluster of symmetrical, inflammatory arthritis; rash; lymphopenia; low complement levels; extremely high ESR (4100 mm/h), and her history of miscarriages, we queried acute systemic vasculitis and arranged a rheumatology consultation. An aspirate of the first metatarsophalyngeal joint revealed monosodium urate crystals and neutrophils consistent with gout. A skin biopsy showed small vessel lymphocytic vasculitis with eosinophilic tissue invasion typical of an allergic reaction. The cephalosporin was discontinued, and colchicine was commenced. Serum urate level was 0.41 mmol/L. Within 2 days, all symptoms and signs had resolved, and she could mobilize independently. Eight weeks later, her ESR had fallen to 46 mm/h and CRP to 4 mg/L. Gouty arthritis in elderly people presents differently from that in the non-geriatric population and differs between men and women. Although younger adults typically have monoarticular symptoms, up to half of geriatric patients develop polyarticular disease, although this presentation seems more prevalent in men. Consequently, gout can often be misdiagnosed as rheumatoid arthritis, lupus erythematosus or osteoarthritis. Because estrogen appears to have a uricosuric effect, older women are more prone to attacks than younger women, partly because of higher urate levels; 50% to 60% of people aged 60 and older and almost all of those aged 80 and older with gout are female. Gout is also commonly associated with osteoarthritis. The use of diuretic agents, especially thiazides, is seen in up to 60% of geriatric patients with gout but more frequently in women and mostly in the presence of impaired renal function. Gout is commonly seen in obese patients with metabolic syndrome, in whom high levels of endogenous insulin act on renal tubules to cause urate retention. There is also an association between gout and cardiovascular morbidity, perhaps mediated by obesity, insulin resistance, and hypertension. This elderly obese female patient also had these comorbidities, as well as osteoarthritis, and was on diuretic therapy. There were several atypical features in this case. The involvement of multiple joints sequentially was unusual but has been reported elsewhere. The high fever suggested underlying sepsis but can be seen in more than 40% of cases of polyarticular gout. Administration of an antibiotic clouded the diagnosis by inducing an allergic rash. Extreme elevation of ESR is rarely encountered in acute gout, and levels greater than 130 mm/h have not been reported. Baseline ESR is higher in elderly people, but only a few serious disorders typically result in levels greater than 100 mm/h at any age. The classic presentation of gouty arthritis is acute monoarticular involvement in a middle-aged man. The recognition of atypical manifestations, as demonstrated in this elderly patient, is important. Although this patient had some of the common presenting features and risk factors for gout in this age group, she also had many atypical findings, which made the diagnosis difficult, a dilemma previously noted. One should consider gout in the geriatric patient with acute polyarthritis even if there is swinging pyrexia and features of possible sepsis. Acute gout should also be added to the list of possible causes of extreme elevation of ESR.

Post-coma persons emerged from a minimally conscious state and showing multiple disabilities learn to manage a radio-listening activity

This study assessed microswitch-based technology to enable three post-coma adults, who had emerged from a minimally conscious state but presented motor and communication disabilities, to operate a radio device. The material involved a modified radio device, a microprocessor-based electronic control unit, a personal microswitch, and an amplified MP3 player. The study was carried out according to a non-concurrent multiple baseline design across participants. During the intervention, all three participants learned to operate the radio device, changing stations and tuning on some of them longer amounts of time than on others (i.e., suggesting preferences among the topics covered by those stations). They also ended a number of sessions before the maximum length of time allowed for them had elapsed. The practical (rehabilitation) implications of the findings were discussed.

Role of Biphosphonates and Lymphatic Drainage Type Leduc in the Complex Regional Pain Syndrome (Shoulder–Hand Syndrome)

BACKGROUND Complex regional pain syndrome (CRPS) is a clinical entity that has been termed in numerous ways in the last years. Clinically, CRPS describes an array of painful conditions that are characterized by a continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. The pain is regional and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings. DESIGN Case report. SETTING University Medical Center. Patients. In this report, we described the case of a 68-year-old hemiplegic female affected by cerebrovascular accident that presented a clinical case of CRPS shoulder-hand syndrome (CRPS-SHS) at the right hand after a hemorrhagic stroke. INTERVENTIONS This report evaluated the effects of biphosphonates and lymphatic drainage type Leduc in CRPS-SHS. OUTCOME MEASURES The pain level of the patients was measured with the visual analog scale. A scoring system for the clinical severity of CRPS-SHS, laboratory tests, and X-ray films were also performed. RESULTS We reported in this patient a great improvement of pain and edema of the right hand, with a significant reduction of bone demineralization. CONCLUSIONS This combined treatment may be a viable alternative for this syndrome; however, further investigation is needed to determine its reproducibility in large case series.

Post-coma persons with multiple disabilities use assistive technology for their leisure engagement and communication

BACKGROUND Interventions for post-coma persons, who have emerged from a minimally conscious state but present with extensive neuro-motor impairment and lack of or minimal verbal skills, need to promote occupation and communication through the use of assistive technology. OBJECTIVE These two studies were aimed at assessing two technology-aided programs to promote leisure engagement and communication for three post-coma participants with multiple disabilities. METHODS Study I assessed a program to allow a woman and a man with extensive neuro-motor impairment and lack of speech to switch on music and videos, make requests to caregivers, and send messages to (communicate with) relevant partners and receive messages from those partners. Study II assessed a program to allow a post-coma woman with extensive motor impairment and reduced verbal behavior to activate music, videos and requests, send and receive messages, and make telephone calls. RESULTS Data showed that both programs were successful. The participants of Study I managed leisure engagement, requests, as well as text messaging. The participant of Study II showed consistent leisure engagement, text messaging, and telephone calls. CONCLUSIONS Assistive technology can be profitably used to provide post-coma persons with multiple disabilities relevant leisure and communication opportunities.

Possible role of alpha-lipoic acid in the treatment of peripheral nerve injuries

Recent findings on the antioxidant effects of pretreatment with α-lipoic acid (α-LA) on the crush injury of rat sciatic nerve confirm the possible usefulness of α-LA administration in humans with peripheral nerve injuries. We discussed this issue in relation with our recent results in which the combined employment of α-LA and γ-linolenic acid with a rehabilitation program for six weeks reduced sensory symptoms and neuropathic pain in patients with compressive radiculopathy syndrome from disc-nerve root conflict in comparison with patients submitted to rehabilitation program alone for six weeks.