Τετάρτη, 6 Απριλίου 2016

Development of a Spontaneously Active Dorsal Root Ganglia Assay using Multi-well Multielectrode Arrays

In vitro phenotypic assays of sensory neuron activity are important tools for identifying potential analgesic compounds. These assays are typically characterized by hyperexcitable and/or abnormally spontaneously active cells. While manual electrophysiology experiments provide high-resolution biophysical data to characterize both in vitro models and potential therapeutic modalities (e.g., action potential characteristics, the role of specific ion channels and receptors), these techniques are hampered by their low throughput. We have established a spontaneously active dorsal root ganglia (DRG) platform using mutil-well multielectrode arrays (MEAs) that greatly increases the ability to evaluate the effects of multiple compounds and conditions on DRG hyperexcitability within the context of a cellular network. We show that spontaneous DRG firing can be attenuated with selective Na+ and Ca2+ channel blockers, as well as enhanced with K+ channel blockers. In addition, spontaneous activity can be augmented with both the TRPV1 agonist capsaicin and the peptide bradykinin, and completely blocked with neurokinin receptor antagonists. Finally, we validated the utility of this assay by demonstrating that commonly used neuropathic pain therapeutics suppress DRG spontaneous activity. Overall, we have optimized primary rat DRG cells on a multi-well MEA platform in order to generate and characterize spontaneously active cultures that has the potential to be used as an in vitro phenotypic assay to evaluate potential therapeutics in rodent models of pain.

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Associative spike-timing dependent potentiation of the basal dendritic excitatory synapses in the hippocampus in vivo

Spike timing dependent plasticity in the hippocampus has rarely been studied in vivo. Using extracellular potential and current source density analysis in urethane-anesthetized adult rats, we studied synaptic plasticity at the basal-dendritic excitatory synapse in CA1 after excitation-spike (ES) pairing; E was a weak basal-dendritic excitation evoked by stratum oriens stimulation, and S was a population spike evoked by stratum radiatum apical-dendritic excitation. We hypothesize that positive ES pairing - generating synaptic excitation before a spike - results in long-term potentiation (LTP), while negative ES-pairing results in long-term depression (LTD). Pairing (50 pairs at 5 Hz) at ES intervals of -10 to 0 ms resulted in significant input-specific LTP of the basal-dendritic excitatory sink, lasting 60-120 min. Pairing at +10 to +20 ms ES intervals, or unpaired 5-Hz stimulation, did not induce significant basal-dendritic, or apical-dendritic LTP or LTD. No basal-dendritic LTD was found after stimulation of stratum oriens with 200 pairs of high-intensity pulses at 25 ms interval. Pairing-induced LTP was abolished by pre-treatment with an N-methyl-D-aspartate receptor antagonist 3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP), which also reduced spike bursting during 5-Hz pairing. Pairing at 0.5 Hz did not induce spike bursts or basal dendritic LTP. In conclusion, ES pairing at 5 Hz resulted in input-specific basal-dendritic LTP at ES intervals of -10 ms to 0 ms, but no LTD at ES intervals of -20 to 20 ms. Associative LTP likely occurred because of theta-rhythmic coincidence of subthreshold excitation with a backpropagated spike burst, which are conditions that can occur naturally in the hippocampus.

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Strategies for targeting primate neural circuits with viral vectors

Understanding how the brain works requires understanding how different types of neurons contribute to circuit function and behavior. Progress on this front has been accelerated by the new tools of optogenetics and chemogenetics, which provide an unprecedented level of control over distinct neuronal types in small animals. In primates, however, targeting specific types of neurons with these tools remains challenging. In this review, we discuss existing and emerging strategies for directing genetic manipulations to targeted neurons in the adult primate central nervous system. We review the literature on viral vectors for gene delivery to neurons, focusing on adeno-associated viral vectors and lentiviral vectors, their tropism for different cell types, and prospects for new variants with improved efficacy and selectivity. We discuss two projection targeting approaches for probing neural circuits: anterograde projection targeting and retrograde transport of viral vectors. We conclude with an analysis of cell type-specific promoters and other nucleotide sequences that can be used in viral vectors to target neuronal types at the transcriptional level.

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Implicit Learning and Generalization of Stretch Response Modulation in Humans

Adaptation of neural responses to repeated muscle stretching likely represents implicit learning to minimize muscle resistance to perturbations. To test this hypothesis, the forearm was placed on a horizontal manipulandum. Elbow flexors or extensors compensated an external load and were stretched by 20° or 70° rotations. Participants were instructed not to intervene by intentionally modifying the muscle resistance elicited by stretching. In addition to phasic stretch reflexes (SRs), muscle stretching was associated with inhibitory periods (IPs) in thjavascript:void(0)e ongoing muscle activity starting at minimal latencies of ~35 ms. The SR amplitude decreased dramatically across 5-12 trials and was not restored after a resting period of 3-5 min, despite the increase in stretch amplitude from 20 to 70°, but IPs remained present. When SRs were suppressed, stretching of originally non-stretched, antagonist muscles initiated after the rest period, showed immediate SR suppression while IPs remained present in the first and subsequent trials. Adaptation to muscle stretching thus includes features characteristic of implicit learning such as memory consolidation and generalization. Adaptation may be achieved by central shifts in the threshold positions at which muscles begin to be activated. Shifts are thought to be prepared in advance and triggered with stretch onset. Threshold position resetting provides a comprehensive explanation of the results in the broader context of the control of posture, movement, and motor learning in the healthy and damaged nervous system.

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The involvement of model-based but not model-free learning signals during observational reward learning in the absence of choice

A major open question is whether computational strategies thought to be used during experiential learning, specifically model-based and model-free reinforcement-learning, also support observational learning. Furthermore, the question of how observational learning occurs when observers must learn about the value of options from observing outcomes in the absence of choice, has not been addressed. In the present study we used a multi-armed bandit task that encouraged human participants to employ both experiential and observational learning while they underwent functional magnetic resonance imaging (fMRI). We found evidence for the presence of model-based learning signals during both observational and experiential learning in the intraparietal sulcus. However, unlike in experiential learning, model-free learning signals in the ventral striatum were not detectable during this form of observational learning. These results provide insight into the flexibilty of the model-based learning system, implicating this system in learning during observation as well as from direct experience, and further suggest that the model-free reinforcement-learning system may be less flexible with regard to its involvement in observational learning.

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Fast Adapting Mechanoreceptors are Important for Force Control in Precision Grip but not for Sensorimotor Memory

Sensory feedback from cutaneous mechanoreceptors in the fingertips is important in effective object manipulation, allowing appropriate scaling of grip and load forces during precision grip. However the role of mechanoreceptor subtypes in these tasks remains incompletely understood. To address this issue, psychophysical tasks which may specifically assess function of type I rapidly adapting (RAI) and slowly adapting (SAI) mechanoreceptors were used with object manipulation experiments to examine the regulation of grip force control in an experimental model of graded reduction in tactile sensitivity (healthy volunteers wearing two layers of latex gloves). With gloves, tactile sensitivity decreased significantly from 1.9 ± 0.4μm to 12.3 ± 2.2μm in the Bumps task assessing function of RAI afferents, but not in a grating orientation task assessing SAI afferents (1.6±0.1mm to 1.8±0.2mm). Six axis force/torque sensors measured peak grip (PGF) and load forces (PLF) generated by the fingertips during a grip-lift task. With gloves there was a significant increase of PGF (14±6%), PLF (17±5%) and grip and load force rates (26±8%; 20±8%). A variable weight series task was used to examine sensorimotor memory. There was a 20% increase in PGF when the lift of a light object was preceded by a heavy relative to a light object. This relationship was not significantly altered when lifting with gloves, suggesting that the addition of gloves did not change sensorimotor memory effects. We conclude that RAI fibres may be important for the online force scaling but not for the build-up of a sensorimotor memory.

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Novel method for functional brain imaging in awake minimally restrained rats

Functional magnetic resonance imaging (fMRI) in rodents holds great promise for advancing our knowledge about human brain function. However, the use of anesthetics to immobilize rodents during fMRI experiments has restricted the type of questions that can be addressed using this technique. Here we describe an innovative procedure to confine rodents in order to carry out fMRI without the need of anesthetics (including initial anesthesia). We show that with 8-10 days of acclimation rats can be conscious and remain still during fMRI experiments under minimal stress. In addition, we provide fMRI results of conscious rodents in a variety of commonly used fMRI experimental paradigms and we demonstrate the improved quality of these scans by comparing results when the same rodents were scanned under anesthesia. We show that our awake scanning procedure permits an improved evaluation of brain networks and brain response to external stimuli with minimal movement artifact. The present study demonstrates the feasibility and value of fMRI in awake rodents, which should provide more direct, forward and reverse, translational opportunities regarding brain functional correspondences between human and rodent research.

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High-resolution and cell-type-specific photostimulation mapping shows weak excitatory versus strong inhibitory inputs in the bed nucleus of the stria terminalis

The bed nucleus of the stria terminalis (BNST) is a key component of the extended amygdala, and has been implicated in anxiety and addiction. As individual neurons function within neural circuits, it is important to understand local microcircuits and larger network connections of identified neuronal types, and understand how maladaptive changes in the BNST neural networks are induced by stress and drug use. However, due to limitations of classic anatomical and physiological methods, local circuit organization of synaptic input to specific BNST neuron types is not well understood. In this study, we report on our application of high-resolution and cell-type specific photostimulation methodology developed in our laboratory to local circuit mapping in the BNST. Under calibrated experimental conditions, laser photostimulation via glutamate uncaging or channelrhodopsin-2 photoactivation evokes spiking of BNST neurons perisomatically, without activating spikes from axons of passage or distal dendrites. Whole cell recordings combined with spatially restricted photostimulation of presynaptic neurons at many different locations over a large region allow high resolution mapping of presynaptic input sources to single recorded neurons in the BNST. We constructed maps of synaptic inputs impinging onto corticotrophin releasing hormone-expressing (CRH+) BNST neurons in the dorsolateral BNST, and found that the CRH+ neurons receive predominant local inhibitory synaptic connections with very weak excitatory connections. Through cell-type specific optogenetic stimulation mapping, we generated maps of somatostatin-expressing-neuron specific inhibitory inputs to BNST neurons. Taken together, the photostimulation-based techniques offer us powerful tools for determining the functional organization of local circuits of specific BNST neuron types.

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Microstimulation of the Lumbar DRG Recruits Primary Afferent Neurons in Localized Regions of Lower Limb

Patterned microstimulation of the dorsal root ganglion (DRG) has been proposed as a method for delivering tactile and proprioceptive feedback to amputees. Previous studies demonstrated that large and medium diameter afferent neurons could be recruited separately, even several months after implantation. However, those studies did not examine the anatomical localization of sensory fibers recruited by microstimulation in the DRG. Achieving precise recruitment with respect to both modality and receptive field locations will likely be crucial to create a viable sensory neuroprosthesis. In this study, penetrating microelectrode arrays were implanted in the L5, L6 and L7 DRG of four isoflurane-anesthetized cats instrumented with nerve cuff electrodes around the proximal and distal branches of the sciatic and femoral nerves. A binary search was used to find the recruitment threshold for evoking a response in each nerve cuff. The selectivity of DRG stimulation was characterized by the ability to recruit individual distal branches to the exclusion of all others at threshold. 84.7% (N=201) of the stimulation electrodes recruited a single nerve branch, with nine of the 15 instrumented nerves recruited selectively. The median stimulation threshold was 0.68 nC/phase and the median dynamic range (increase in charge while stimulation remained selective) was 0.36 nC/phase. These results demonstrate the ability of DRG microstimulation to achieve selective recruitment of the major nerve branches of the hindlimb suggesting that this approach could be used to drive sensory input from localized regions of the limb. This sensory input might be useful for restoring tactile and proprioceptive feedback to a lower limb amputee.

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Physiological modulators of Kv3.1 channels adjust firing patterns of auditory brainstem neurons

Many rapidly firing neurons, including those in the Medial Nucleus of the Trapezoid Body (MNTB) in the auditory brainstem, express "high threshold" voltage-gated Kv3.1 potassium channels that activate only at positive potentials and are required for stimuli to generate rapid trains of actions potentials. We now describe the actions of two imidazolidinedione derivatives, AUT1 and AUT2, which modulate Kv3.1 channels. Using CHO cells stably expressing rat Kv3.1 channels, we found that lower concentrations of these compounds shift the voltage of activation of Kv3.1 currents towards negative potentials, increasing currents evoked by depolarization from typical neuronal resting potentials. Single channel recordings also showed that AUT1 shifted the open probability of Kv3.1 to more negative potentials. Higher concentrations of AUT2 also shifted inactivation to negative potentials. The effects of lower and higher concentrations could be mimicked in numerical simulations by increasing rates of activation and inactivation respectively, with no change in intrinsic voltage-dependence. In brain slice recordings of mouse MNTB neurons, both AUT1 and AUT2 modulated firing rate at high rates of stimulation, a result predicted by numerical simulations. Our results suggest that pharmaceutical modulation of Kv3.1 currents represents a novel avenue for manipulation of neuronal excitability, and has the potential for therapeutic benefit in the treatment of hearing disorders.

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Pain Reduction and Repeat Injections after Transforaminal Epidural Injection with Particulate versus Non-particulate Steroid for the Treatment of Chronic Painful Lumbosacral Radiculopathy

Corticosteroid choice for lumbar transforaminal epidural injection (TFESI) remains controversial. Whether to utilize particulate or non-particulate steroid preparations for these injections remains an unanswered question in the literature.

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Joint motion quality in chondromalacia progression assessed by vibroacoustic signal analysis

Due to the specific biomechanical environment of the patellofemoral joint, chondral disorders, including chondromalacia, are often observed in this articulation. Chondromalacia via pathological changes in cartilage may lead to qualitative impairment of knee joint motion.

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Pulmonary rehabilitation in lung cancer

Lung cancer remains a challenging disease with high morbidity and mortality despite targeted therapy. Symptom burden related to cancer impairs quality of life and functional status in lung cancer patients and survivors. Pulmonary rehabilitation has been recognized as an effective, non-invasive intervention for patients with chronic respiratory disease. It is well established that pulmonary rehabilitation benefits chronic obstruction pulmonary disease (COPD) patients through improved exercise capacity and symptoms.

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The morphology and clinical significance of the intraforaminal ligaments at the l5-s1 level


The extraforaminal ligaments between the L5-S1 lumbar spinal nerves and the tissues surrounding the intervertebral foramina have been well studied. However, little research has been undertaken to describe the local anatomy of the intraforaminal portion of the L5-S1 spine; detailed anatomic studies of the intraforaminal ligaments of the L5-S1 have not been performed.

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The Effect of Distractive Function on Volitional Preemptive Abdominal Contraction During a Loaded Forward Reach in Normal Subjects

Volitional preemptive abdominal contraction (VPAC) is used to protect the spine and preventing injury. No published studies to data have examined the effect of distraction on VPAC use during function.

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The Histone Variant H3.3 Is Enriched at Drosophila Amplicon Origins but Does not Mark Them for Activation

Eukaryotic DNA replication begins from multiple origins. The origin recognition complex (ORC) binds origin DNA and scaffolds assembly of a pre-Replicative Complex (pre-RC), which is subsequently activated to initiate DNA replication. In multicellular eukaryotes, origins do not share a strict DNA consensus sequence and their activity changes in concert with chromatin status during development, but mechanisms are ill-defined. Previous genome-wide analyses in Drosophila and other organisms have revealed a correlation between ORC binding sites and the histone variant H3.3. This correlation suggests that H3.3 may designate origin sites, but this idea has remained untested. To address this question, we examined the enrichment and function of H3.3 at the origins responsible for developmental gene amplification in the somatic follicle cells of the Drosophila ovary. We found that H3.3 is abundant at these amplicon origins. H3.3 levels remained high when replication initiation was blocked, indicating that H3.3 is abundant at the origins before activation of the pre-RC. H3.3 was also enriched at the origins during early oogenesis, raising the possibility that H3.3 bookmarks sites for later amplification. However, flies null mutant for both of the H3.3 genes in Drosophila did not have overt defects in developmental gene amplification or genomic replication, suggesting that H3.3 is not essential for the assembly or activation of the pre-RC at origins. Instead, our results imply that the correlation between H3.3 and ORC sites reflects other chromatin attributes that are important for origin function.

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Saccharomyces cerevisiae Tti2 Regulates PIKK Proteins and Stress Response

The TTT complex is composed of the three essential proteins Tel2, Tti1 and Tti2. The complex is required to maintain the steady state levels of the phosphatidylinositol 3-kinase-related kinase (PIKK) proteins including mTOR, ATM/Tel1, ATR/Mec1, and TRRAP/Tra1, all of which serve as regulators of critical cell signaling pathways. Due to their association with heat shock proteins, and with newly synthesized PIKK peptides, components of the TTT complex may act as co-chaperones. Here, we analyze the consequences of depleting the cellular level of Tti2 in Saccharomyces cerevisiae. We show that yeast expressing low levels of Tti2 are viable under optimal growth conditions, but the cells are sensitive to a number of stress conditions that involve PIKK pathways. In agreement with this, depleting Tti2 levels decreased expression of Tra1, Mec1, and Tor1, affected their localization and inhibited stress responses in which these molecules are involved. Tti2 expression was not increased during heat shock, implying that it does not play a general role in the heat shock response. However, steady state levels of Hsp42 increase when Tti2 is depleted and tti2L187P has a synthetic interaction with exon 1 of the human Huntingtin gene containing a 103 residue polyQ sequence, suggesting a general role in protein quality control. We also find that overexpressing Hsp90 or its co-chaperones is synthetic lethal when Tti2 is depleted, an effect possibly due to imbalanced stoichiometry of a complex required for PIKK assembly. These results indicate that Tti2 does not act as a general chaperone, but may have a specialized function in PIKK folding and/or complex assembly.

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Genomic Signatures of Experimental Adaptation to Antimicrobial Peptides in Staphylococcus aureus

The evolution of resistance against antimicrobial peptides has long been considered unlikely due to their mechanism of action, yet experimental selection with AMPs results in rapid evolution of resistance in several species of bacteria. Although numerous studies have utilized mutant screens to identify loci that determine AMP susceptibility, there is a dearth of data concerning the genomic changes which accompany experimental evolution of AMP resistance. Using genome re-sequencing we analysed the mutations which arise during experimental evolution of resistance to the cationic AMPs iseganan, melittin and pexiganan, as well as to a combination of melittin and pexiganan, or to the aminoglycoside antibiotic streptomycin. Analysis of 17 independently replicated Staphylococcus aureus selection lines, including unselected controls, showed that each AMP selected for mutations at distinct loci. We identify mutations in genes involved in the synthesis and maintenance of the cell envelope. This includes genes previously identified from mutant screens for AMP resistance, and genes involved in the response to AMPs and cell-wall-active antibiotics. Furthermore, transposon insertion mutants were used to verify that a number of the identified genes are directly involved in determining AMP susceptibility. Strains selected for AMP resistance under controlled experimental evolution displayed consistent AMP-specific mutations in genes which determine AMP susceptibility. This suggests that different routes to evolve resistance are favored within a controlled genetic background.

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Performance Variability as a Predictor of Response to Aphasia Treatment

Background. Performance variability in individuals with aphasia is typically regarded as a nuisance factor complicating assessment and treatment. Objective. We present the alternative hypothesis that intraindividual variability represents a fundamental characteristic of an individual's functioning and an important biomarker for therapeutic selection and prognosis. Methods. A total of 19 individuals with chronic aphasia participated in a 6-week trial of imitation-based speech therapy. We assessed improvement both on overall language functioning and repetition ability. Furthermore, we determined which pretreatment variables best predicted improvement on the repetition test. Results. Significant gains were made on the Western Aphasia Battery-Revised (WAB) Aphasia Quotient, Cortical Quotient, and 2 subtests as well as on a separate repetition test. Using stepwise regression, we found that pretreatment intraindividual variability was the only predictor of improvement in performance on the repetition test, with greater pretreatment variability predicting greater improvement. Furthermore, the degree of reduction in this variability over the course of treatment was positively correlated with the degree of improvement. Conclusions. Intraindividual variability may be indicative of potential for improvement on a given task, with more uniform performance suggesting functioning at or near peak potential.

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Standard EEG in diagnostic process of prolonged disorders of consciousness

After a comatose state, severely brain-injured patients might remain in a vegetative state (VS; Multi-Society Task Force on PVS, 1994), and eventually evolve in a minimally conscious state (MCS; Giacino et al., 2002). On the basis of the complexity of patients' behaviours, a sub categorization of MCS patients into "MCS minus" (MCS-) and "MCS plus" (MCS+) has been recently proposed (Bruno et al., 2011). The distinction among the above diagnostic groups can be very difficult, because of fluctuations of clinical conditions and presence of severe sensori-motor deficits (Majerus et al., 2005).

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Pharyngeal Electrical Stimulation in Dysphagia Poststroke: A Prospective, Randomized Single-Blinded Interventional Study

Background. Pharyngeal electrical stimulation (PES) appears to promote cortical plasticity and swallowing recovery poststroke. Objective. We aimed to assess clinical effectiveness with longer follow-up. Methods. Dysphagic patients (n = 36; median = 71 years; 61% male) recruited from 3 trial centers within 6 weeks of stroke, received active or sham PES in a single-blinded randomized design via an intraluminal pharyngeal catheter (10 minutes, for 3days). The primary outcome measure was the Dysphagia Severity Rating (DSR) scale (<4, no-mild; ≥4, moderate-severe). Secondary outcomes included unsafe swallows on the Penetration-Aspiration Scale (PAS ≥ 3), times to hospital discharge, and nasogastric tube (NGT) removal. Data were analyzed using logistic regression. Odds/hazard ratios (ORs/HRs) >1 for DSR <4, hospital discharge, and NGT removal and OR <1 for PAS ≥3, indicated favorable outcomes for active PES. Results. Two weeks post–active PES, 11/18 (61%) had DSR <4: OR (95% CI) = 2.5 (0.52, 14). Effects of active versus sham for secondary outcomes included the following: PAS ≥3 at 2 weeks, OR (95% CI) = 0.61 (0.27, 1.4); times to hospital discharge, 39 days versus 52 days, HR (95% CI) = 1.2 (0.55, 2.5); NGT removal 8 versus 14 days, HR (95% CI) = 2.0 (0.51, 7.9); and DSR <4 at 3 months, OR (95% CI) = 0.97 (0.13, 7.0). PES was well tolerated, without adverse effects or associations with serious complications (chest infections/death). Conclusions. Although the direction of observed differences were consistent with PES accelerating swallowing recovery over the first 2 weeks postintervention, suboptimal recruitment prevents definitive conclusions. Our study design experience and outcome data are essential to inform a definitive, multicenter randomized trial.

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Lower motor neurons – counting cogs in the ALS machine

Lower motor neuron (LMN) degeneration is at the core of amyotrophic lateral sclerosis (ALS), producing much of the disability through the disease course and ultimately death from denervation of the respiratory muscles. The LMN and the muscle it innervates are uniquely accessible parts of the nervous system such that they are readily amenable to functional and structural interrogation. For this reason, there have been extensive neurophysiological and pathological studies of the diseased LMN in ALS.

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Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial

Resistance exercise (RE) improves neuromuscular function and physical performance after stroke. Yet, the effects of RE emphasizing eccentric (ECC; lengthening) actions on muscle hypertrophy and cognitive funct...

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Flexible optical intubation via the Ambu Aura-i vs blind intubation via the single-use LMA Fastrach: a prospective randomized clinical trial

This study was designed to compare the Ambu Aura-i to the single-use LMA Fastrach regarding time to intubation, success rate, and airway morbidity in patients undergoing elective surgery requiring general anesthesia.

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Middle cerebral artery blood flow velocity during beach chair position for shoulder surgery under general anesthesia


The goal of the present study was to examine changes of middle cerebral artery (VMCA) blood flow velocity in patients scheduled for shoulder surgery in beach chair position.

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Peripheral nerve block in patients with Ehlers-Danlos syndrome, hypermobility type: a case series

Ehlers-Danlos syndrome (EDS) is an inherited disease characterized by defects in various collagens or their post translational modification, with an incidence estimated at 1 in 5000. Performance of peripheral nerve block in patients with EDS is controversial, due to easy bruising and hematoma formation after injections as well as reports of reduced block efficacy. The objective of this study was to review the charts of EDS patients who had received peripheral nerve block for any evidence of complications or reduced efficacy.

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Correlation between extraction force during tracheal intubation stylet removal and postoperative sore throat


To examine postoperative sore throat resulting from tracheal intubation stylet removal.

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Does the perioperative analgesic/anesthetic regimen influence the prevalence of long-term chronic pain after mastectomy?


To investigate if the anesthetic/analgesic regimen is associated with the risk of reporting long-term chronic postmastectomy pain (CPMP).

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Sacramento County health officer breaks down fentanyl overdoses

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Sacramento County health officer breaks down fentanyl overdoses

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Cooper Health Systems receives 11 Demers Mercedes Sprinter Type II Vans

Beloeil, Quebec – Demers Ambulances announces the delivery of 11 Mercedes Sprinter Type II Vans to Cooper Health Systems, NJ, USA. First Priority Emergency Vehicles in New Jersey, a Demers' dealer, sold the vehicles produced in the Plattsburgh, NY, USA, facility in partnership with Spenser ARL. This is the latest in Demers' ongoing expansion of sales. "We set new standards in an industry ...

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Sacramento County health officer breaks down fentanyl overdoses

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Sacramento County health officer breaks down fentanyl overdoses

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Function in Sitting Test


Bedside evaluation of sitting balance stated to evaluate sensory, motor, proactive, reactive and steady state balance factors.

  • 14 items
  • Ordinal Scale (0-4) for each test item:
    • 4: Independent, Completes the task independently and successfully
    • 3: Needs Cues, Completes the task independently and successfully; may need verbal / tactile cues or more time
    • 2: Upper extremity support, Unable to complete task without using upper extremities for support or assistance
    • 1: Needs assistance, Unable to complete task successfully without physical assistance
    • 0: Complete assistance, Requires complete physical assistance to perform task successfully, is unable to complete task successfully with physical assistance, or dependent
  • Testing Instructions:
    • One trial of each item is allowed
    • Verbal directions and demonstration are given as needed by the therapist
    • Standard Position: Individual seated at edge of hospital bed with half of upper leg supported (neutral abd/adduction / rotation), hips and knees at 90 degrees and feet flat in support
    • Hands are placed in lap unless needed for support
    • See Gorman et al, 2010 for measure
Area of Assessment: Balance Non-Vestibular
ICF Domain: Activity
Assessment Type: Performance Measure
Length of Test: 06 to 30 Minutes
Time to Administer:
Less than 15 minutes
Number of Items: 14
Equipment Required:
  • Standard hospital bed (without air mattress)
  • Stopwatch
Training Required:
Cost: Free
Actual Cost: Free
Diagnosis: Stroke, Traumatic Brain Injury
Populations Tested:
  • Acute Stroke
  • Population-based, inpatient sample of adults with sitting balance dysfunction, excluding persons with SCI, signigicant bracing/orthotics, and inability to perform testing safely
Standard Error of Measurement (SEM):

Acute Stroke:  (Gorman et al, 2010; n=31, age 61.5 (10.9) years, <=3 months post stroke, Modified Rankin Scale of moderate / moderately severe / severe)

  • SEM= 2.03

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko and Greenwald, 2014, n=125, age=60.0 (16.6) years)

  • SEM= 1.40

Balance Participants: (Gorman, Rivera, and McCarthy, 2014) (n=6; Mean Age= 68.7)
***Medical diagnoses of the balance participants included Parkinson's disease (n=1), multiple sclerosis (n=1), and cerebrovascular accident (n=5).

  • SEM= 3.58
Minimal Detectable Change (MDC):

Acute Stroke: (Calculated from Gorman et al, 2010)

  • MDC=5.63

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko & Greenwald, 2014)

  • MDC=5.5
Minimally Clinically Important Difference (MCID):

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko & Greenwald, 2014)

  • MCID> 6.5
Cut-Off Scores:
Not Established
Normative Data:
Not Established
Test-retest Reliability:

Balance Participants: (Gorman, Rivera, and McCarthy, 2014), n=6; mean age = 68.7
***Medical diagnoses of the balance participants included Parkinson's disease (n=1), multiple sclerosis (n=1), and cerebrovascular accident (n=5).

  • Excellent: ICC=0.97
Interrater/Intrarater Reliability:

Balance Participants: (Gorman, Rivera, and McCarthy, 2014), n=6; mean age = 68.7
***Medical diagnoses of the balance participants included Parkinson's disease (n=1), multiple sclerosis (n=1), and cerebrovascular accident (n=5).

  • Intra-rater Reliability: Excellent ICC=0.99
  • Inter-rater Reliability: Excellent ICC=0.991
Internal Consistency:

Acute Stroke: (Gorman et al, 2010)

  • Excellent internal consistency (Cronbach's alpha = 0.98)
Criterion Validity (Predictive/Concurrent):

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko & Greenwald, 2014)

Concurrent Validity: Good to Excellent concurrent validity with the Berg Balance Scale and Functional Independence Measure at both admission and discharge (Spearman ρ=.71–.85).

Construct Validity (Convergent/Discriminant):
Not Established
Content Validity:
Not Established
Face Validity:
Not Established
Floor/Ceiling Effects:
Not Established

Adults With Sitting Balance Dysfunction: (Gorman, Harro, Platko and Greenwald, 2014, n=125, age=60.0 (16.6) years)

Responsiveness: Strong as evidenced by the large effect size (.83), standardized response mean (1.04), and index of responsiveness (1.07).


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Gorman, SL, Radtka, S, et al. "Development and validation of the function in sitting test in adults with acute stroke." Journal of Neurologic Physical Therapy 34(3)(2010): 150-160. Find it on PubMed

Gorman, SL, et al. "Examining the Function in Sitting Test for Validity, Responsiveness, and Minimal Clinically Important Difference in Inpatient Rehabilitation." Archives of Physical Medicine and Rehabilitation 95.12 (2014): 2304-11.

Gorman SL, Rivera M, McCarthy L. "Reliability of the Function in Sitting Test (FIST)." Rehabilitation research and practice. 2014;2014:593280.

Instrument in PDF Format: Yes

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Does Interactive Hand Rehabilitation Experiences an Improvement of Upper Limb Function in Hemiplegic Children? A Double Blind Randomized Controlled Trial

Source: International Journal of Therapies and Rehabilitation Research
Ragab Kamal Elnaggar.
ABSTRACT Background: Several clinical studies evoked the interest of interactive robotic assisted exercise for rehabilitation of upper limbs in cerebral palsied children. This study aimed to evaluate the effectiveness of an interactive hand rehabilitation program using an end effector robotic system in treatment of hemiplegic children. Methods: In a double blind randomized controlled trial, 38 hemiplegic children were randomized to either traditional therapy group (TT group, n=24) who received a traditional rehabilitation program or interactive therapy group (IT group, n=24) who received an interactive robotic assisted exercise program. Intervention was conducted for one hour/session, three sessions/week for four consecutive months. Maximum hand grip strength, fine motor skill, and bimanual hand function were measured prior to and after the intervention using a hand held dynamometer, Peabody Developmental Motor Scale (PDMS), and Assisting Hand Assessment (AHA) respectively. Results: No difference between groups at the baseline (p˃0.05). Significant differences of all outcome measure were recorded within both groups (p˂0.05), and significant differences between both groups favoring the IT group were reported post intervention (p˂0.05). Conclusion: A four months of supervised interactive hand rehabilitation program using an end effector, anatomical limitation free robotic system possibly used to improve hand function in hemiplegic cerebral palsied children.

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