Changes in EEG alpha-band power during prehension indicates neural motor drive inhibition

Changes in alpha band activity (8-12 Hz) indicate the downregulation of brain regions during cognitive tasks, reflecting real-time cognitive load. Despite this, its feasibility to be used in a more dynamic environment with ongoing motor corrections has not been studied. This research used electroencephalography (EEG) to explore how different brain regions are engaged during a simple grasp and lift task where unexpected changes to the object's weight or surface friction are introduced. The results suggest that alpha activity changes related to motor error correction occur only in motor-related areas (i.e. central areas) but not in error processing areas (i.e., frontoparietal network) during unexpected weight changes. This suggests that oscillations over motor areas reflect the reduction of motor drive related to motor error correction, thus, being a potential cortical electrophysiological biomarker for the process and not solely as a proxy for cognitive demands. This observation is particularly relevant in scenarios where these signals are used to evaluate high cognitive demands co-occurring with high levels of motor errors and corrections, such as prosthesis use. The establishment of electrophysiological biomarkers of mental resource allocation during movement and cognition can help identify indicators of mental workload and motor drive, which may be useful for improving brain-machine interfaces.NEW & NOTEWORTHY We demonstrated that alpha suppression, an EEG phenomenon with high temporal resolution, occurs over the primary sensorimotor area during error correction during lift movements. Interpretations of alpha activity are often attributed to high cognitive demands, thus recognizing that it is also influenced by motor processes is important in situations where cognitive demands are paired with movement errors. This could further have application as a biomarker for error correction in human-machine interfaces, such as neuroprostheses.

Identifying the Optimal Parameters to Express the Capacity-Activity Interrelationship of Community-Dwelling Older Adults Using Wearable Sensors

Mobility is the primary indicator of quality of life among older adults. Physical capacity (PC) and physical activity (PA) are two determinants of mobility; however, PC and PA are complex constructs represented by numerous parameters. This research sought to identify the optimal parameters that may be used to represent PC and PA of older adults, while exploring the interrelationship of these two constructs. Participants were 76 community-dwelling older adults (M age = 74.05 ± 5.15 yrs.). The McRoberts MoveTest was used to objectively measure PC in the laboratory with the following tests: the Short Physical Performance Battery, the Sway test, Sit to Stands, and the Timed Up and Go. PA was then measured at home for one week using the McRoberts USB Dynaport. Correlation analyses resulted in 55% and 65% reductions of PC and PA parameters, respectively. Clustering identified five representative PC parameters and five representative PA parameters. Canonical correlation analysis identified a non-significant correlation between the two sets of parameters. A novel approach was used to define PC and PA by systematically reducing these constructs into representative parameters that provide clinically relevant information, suggesting that they are an accurate representation of one's PC and PA. A non-significant correlation between PC and PA suggests that there is no relationship between the two in this sample of community-dwelling older adults. The research provided insight into two important determinants of older adult mobility, and how they influence each other.

Salbutamol for analgesia in renal colic: study protocol for a prospective, randomised, placebo-controlled phase II trial (SARC)

BACKGROUND

Renal colic is the pain experienced by a patient when a renal calculus (kidney stone) causes partial or complete obstruction of part of the renal outflow tract. The standard analgesic regimes for renal colic are often ineffective; in some studies, less than half of patients achieve complete pain relief, and a large proportion of patients require rescue analgesia within 4 h. Current analgesic regimes are also associated with significant side effects including nausea, vomiting, drowsiness and respiratory depression. It has been hypothesised that beta adrenoreceptor agonists, such as salbutamol, may reduce the pain of renal colic. They have been shown to impact a number of factors that target the physiological causes of pain in renal colic (ureteric spasm and increased peristalsis, increased pressure at the renal pelvis and prostaglandin release with inflammation). There is biological plausibility and a body of evidence sufficient to suggest that this novel treatment for the pain of renal colic should be taken to a phase II clinical trial. The aim of this trial is to test whether salbutamol is an efficacious analgesic adjunct when added to the standard analgesic regime for patients presenting to the ED with subsequently confirmed renal colic.

METHODS

A phase II, randomised, placebo-controlled trial will be performed in an acute NHS Trust in the East Midlands. Patients presenting to the emergency department with pain requiring IV analgesia and working diagnosis of renal colic will be randomised to receive standard analgesia ± a single intravenous injection of Salbutamol. Secondary study objectives will explore the feasibility of conducting a larger, phase III trial.

DISCUSSION

The trial will provide important information about the efficacy of salbutamol as an analgesic adjunct in renal colic. It will also guide the development of a definitive phase III trial to test the cost and clinical effectiveness of salbutamol as an analgesic adjunct in renal colic. Salbutamol benefits from widespread use across the health service for multiple indications, extensive staff familiarity and a good side effect profile; therefore, its potential use for pain relief may have significant benefits for patient care.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN14552440 . Registered on 22 July 2019.

Robust Simultaneous and Proportional Myoelectric Control Scheme for Individuals with Transradial Amputations

Commercial myoelectric prostheses need to be accurate and clinically viable to be successful. This study proposed a simultaneous and proportional control scheme with frequency division technique (SPEC-FDT) to address limitations in current myoelectric prosthesis control, specifically to address non-stationaries such as contraction level variations and unintended activations. Twenty able-bodied participants (14 males and 6 females, age 23.4 ± 3.0) and four individuals with transradial amputations performed wrist movements (flexion/extension, rotations and combined movements) in two degrees-of freedom virtual tasks. The SPEC-FDT had a completion rate (CR)>90% for both control and clinical participants which was significantly higher than the conventional technique (CR=68%). Our results showed that SPEC-FDT is highly accurate for both able-bodied and clinical participants and provides a robust myoelectric control scheme allowing for increased prosthetic hand functions.

Epilepsy, anti-seizure medication, intellectual disability and challenging behaviour - Everyone's business, no one's priority

PURPOSE

People with Intellectual Disability (ID) and epilepsy are more likely to experience psychiatric conditions, challenging behaviour (CB), treatment resistance and adverse effects of anti-seizure medications (ASM) than those without. This population receives care from various professionals, depending on local care pathways. This study evaluates the training status, confidence, reported assessment and management practices of different professional groups involved in caring for people with ID, epilepsy and CB.

METHODS

A cross sectional survey using a questionnaire developed by expert consensus which measured self-reported training status, confidence, and approaches to assessment and management of CB in people with ID and epilepsy was distributed to practitioners involved in epilepsy and/or ID.

RESULTS

Of the 83 respondents, the majority had either a psychiatry/ID (n = 39), or Neurology/epileptology background (n = 31). Psychiatry/ID and Neurology/epileptology had similar confidence in assessing CB in ID-epilepsy cases, but Psychiatry/ID exhibited higher self-rated confidence in the management of these cases. While assessing and managing CB, Psychiatry/ID appeared more likely to consider mental health aspects, while Neurology/epileptology typically focused on ASM.

CONCLUSION

Psychiatry/ID and Neurology/epileptology professionals had varying training levels in epilepsy, ID and CB, had differing confidence levels in managing this patient population, and considered different factors when approaching assessment and management. As such, training opportunities in ID should be offered to neurology professionals, and vice versa. Based on the findings, a best practice checklist is presented, which aims to provide clinicians with a structured framework to consider causal explanations for CB in this population.

Effect of age and sex on strength and spatial electromyography during knee extension

Background

Multichannel surface electromyography (EMG) is a method to examine properties of motor unit (MU) activity using multiple electrodes arranged on a two-dimensional grid. This technique can be used to examine alterations in EMG activity distribution due to contraction intensity as well as due to physiological differences such as age or sex. Therefore, the purpose of this study was to compare strength and high-density surface EMG (HDsEMG) features during isometric and isokinetic knee extensions between older and younger men and women.

Methods

Twenty younger (ages 19–25 years) and twenty older (ages 64–78) men and women performed submaximal and maximal isometric (at a joint angle of 90°) and isokinetic knee extensions, while HDsEMG was recorded from the vastus lateralis. Spatial distribution was estimated using the root mean square (RMS), and 2-dimensional (2D) maps were developed to examine spatial features. Coefficient of variation (CV) and modified entropy were used to examine alterations in muscle heterogeneity and pattern. Peak torque and HDsEMG parameters were compared across age and gender.

Results

Younger males and females produced significantly higher mean torque than the older group (p < 0.001) for all contractions. Both age- and sex-related significant differences (p < 0.05) were found for EMG spatial features suggesting neuromuscular differences. Modified entropy was significantly higher and CV was lower for young females compared to young males (p < 0.05) across both isometric and isokinetic contractions.

Conclusions

We found that isometric and isokinetic knee extension strength, spatial distribution, and intensity differ as a function of age and sex during knee extensions. While there were no differences detected in entropy between age groups, there were sex-related differences in the younger age category. The lack of age-related differences in entropy was surprising given the known effects of aging on muscle fiber composition. However, it is often reported that muscle coactivation increases with age and this work was limited to the study of one muscle of the knee extensors (vastus lateralis) which should be addressed in future work. The findings suggest while both age and sex affect muscle activation, sex had a greater effect on heterogeneity. The results obtained will help to develop improved rehabilitation programs for aging men and women.

Characteristics and outcomes of patients with intellectual disability admitted to a specialist inpatient rehabilitation service

Rehabilitation services for people with mental illnesses have been extensively researched. However, services with similar aims and specifications for patients with intellectual disabilities (IDs) have had little focus. This study describes the characteristics and outcomes of 21 patients admitted to a specialist ID rehabilitation service over an 8-year time frame. Rather that solely accepting 'step-down' referrals, some patients were referred from community settings. During the study, 20 patients were discharged, 80% to lower levels of service restriction, while 14.3% to higher levels. The study suggested that rehabilitation services have an important role within the wider service model for people with ID. Within the service studied, patients were referred from both higher and lower levels of restriction, suggesting the rehabilitation service 'bridged the gap' between inpatient and community settings, supporting the aim of caring for patients in the least restrictive setting for their needs.

People with Intellectual and Developmental Disorders in the United Kingdom Criminal Justice System

This review aims to describe the way in which people with intellectual and/or developmental disabilities (IDD) are treated within the criminal justice system (CJS) in the United Kingdom (UK). The relevant empirical literature and national reports are reviewed, and the current care model for offenders with IDD described. The care of people with IDD within the CJS is relatively advanced in UK; however, offenders with IDD experience difficulties at all stages. This includes engagement with police and the courts, accessing adapted therapies, and after discharge from inpatient care or release from custody. This review highlights a number of strengths of the existing model of care, as well as ongoing challenges. Care of people with IDD within the CJS is highly political, and many aspects of the current model operate according to government policy, based upon charitable or independent review evidence, rather than empirical research. Further research on people with IDD in the CJS is urgently needed, to fully understand the factors related to treatment outcomes.

Problem behaviours and psychotropic medication use in intellectual disability: a multinational cross-sectional survey

BACKGROUND

Problem behaviours (PBs) are a common cause for clinician contact in people with disorders of intellectual development and may be a common cause for the prescription of psychotropic medication. We aimed to use a large, multinational sample to define the prevalence of PBs, the associations with psychotropic medication use, and to assess for any potential 'diagnostic overshadowing' by the label of PBs in a population of people with disorders of intellectual development.

METHOD

A multinational, multi-setting, cross-sectional service evaluation and baseline audit was completed. Data were collected from UK hospitals, UK community settings, Sri Lanka and Hong Kong. A semi-structured questionnaire was completed by treating clinicians, capturing demographic details, prevalence rates of intellectual disability and psychotropic medication use, alongside psychiatric co-morbidity.

RESULTS

A sample size of 358 was obtained, with 65% of included participants treated in an inpatient setting. Psychotropic use was prevalent (90%) in our sample, particularly antipsychotics (74%). The prevalence of PB was high (83%). There was no statistically significant association between psychotropic prescription and recorded psychiatric co-morbidity, suggesting prevalent 'off-label' use for PBs, or poor recording of psychiatric co-morbidity. There was some evidence of possible diagnostic overshadowing due to the PB classification. A higher dose of psychotropic medication was associated with aggression toward others (P = 0.03).

CONCLUSIONS

We found evidence of prevalent potential 'off-label' use for psychotropic medication, which may be due to PBs. We also found evidence of potential diagnostic-overshadowing, where symptoms of psychiatric co-morbidity may have been attributed to PBs. Our findings provide renewed importance, across borders and health systems, for clinicians to consider a holistic approach to treating PBs, and attempting to best understand the precipitants and predisposing factors before psychotropic prescribing.

Head banging as a form of self-harm among inpatients within forensic mental health and intellectual disability services

Introduction

“Head banging” is a common form of self-harm, linked to numerous negative outcomes including significant brain damage. However, little research has investigated the prevalence and correlates of head banging behaviour in clinical populations.

Method

Head banging episodes were identified from the incident records (n = 5417) of two inpatient forensic services (one intellectual disability and one mental health), using relevant search terms. Rates were compared between individual patients, by gender, diagnosis and level of security. Incident accounts were analysed qualitatively using thematic analysis.

Results

Two hundred and twenty nine incidents of head banging were recorded, occurring approximately every three days in each service. The prevalence of the behaviour between individual patients varied widely, ranging from one to 38 incidents within one year. Women and patients with intellectual disability appeared more likely to engage in head banging. Qualitative incident reports indicated that head banging was associated with mental distress, anger, and psychotic experiences.

Discussion

Head banging occurs frequently in forensic services, and has documented associations with traumatic brain injury in affected individuals, thus negatively impacting progress through the care pathway and treatment outcomes. Further research should investigate short and long term management strategies and treatment approaches, in order to minimise harm.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

A Systematic Review and Synthesis of Outcome Domains for use Within Forensic Services for People with Intellectual Disabilities

Aims

In response to the Winterbourne scandal, and the large number of people with intellectual disabilities (IDs) and offending behavior being treated in psychiatric hospitals, this study identified the domains that should be used to measure treatment outcomes of this group.

Methods

A systematic search of relevant databases was undertaken to identify domains. Sixty studies met the eligibility criteria, and findings were synthesized using content analysis. The findings were refined within a consultation and consensus exercises with carers, service users, and experts.

Results

The final framework encompassed three a priori super-ordinate domains (a) effectiveness, (b) patient safety, and (c) patient and carer experience. Within each of these, further sub-domains emerged from our systematic review and consultation exercises. These included severity of clinical symptoms, offending behaviors, reactive and restrictive interventions, quality of life and patient satisfaction.

Conclusions

To index recovery, services need to measure outcome using this framework.

The prevalence of obesity among forensic intellectual disability inpatients

Background

Inpatient mental health settings have been described as “obesogenic” environments, due to factors including psychotropic medication, high calorie food, restricted physical activity and sedentary lifestyles. No research has investigated obesity among forensic intellectual disability inpatients, despite this populations’ increased risk. Therefore, this paper aims to evaluate the prevalence and correlates of overweight and obesity on, and during admission.

Method

The weight and body mass index data of 46 inpatients (15 women and 31 men) within a specialist intellectual disability forensic service was examined for the study.

Results

Only six patients (13%) were a normal weight at admission, whereas 40 (87%) were overweight or obese. During their admission, 28 (61%) gained weight (average 11.8 kg), and one (2%) maintained. However, 17 patients (37%) lost weight (average 6.2 kg), though 16 remained in overweight/obese categories. There was no correlation between length of stay and weight/BMI.

Conclusions

The majority of patients were overweight or obese on admission, and approximately 60% gained weight during their admission. Women appeared at greater risk of obesity. There was no relationship between length of stay and weight. This is potentially due to the high prevalence of obesity on admission and the impact of previous admissions on weight. The results highlight the need for effective weight management interventions with this population.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Using three-dimensional gait data for foot/ankle orthopaedic surgery

We present the case of a forty year old male who sustained a torn carotid during strenuous physical activity. This was followed by a right hemispheric stroke due to a clot associated with the carotid. Upon recovery, the patient’s gait was characterized as hemiparetic with a stiff-knee pattern, a fixed flexion deformity of the toe flexors, and a hindfoot varus. Based on clinical exams and radiographs, the surgical treatment plan was established and consisted of correction of the forefoot deformities, possible hamstrings lengthening, and tendon transfer of the posterior tibial tendon to the dorsolateral foot. To aid in surgical planning, a three-dimensional gait analysis was conducted using a state-of-the-art motion capture system. Data from this analysis provided insight into the pathomechanics of the patient’s gait pattern. A forefoot driven hindfoot varus was evident from the presurgical data and the tendon transfer procedure was deemed unnecessary. A computer was used in the OR to provide surgeons with animations of the patient’s gait and graphical results as needed. A second gait analysis was conducted 6 weeks post surgery, shortly after cast removal. Post-surgical gait data showed improved foot segment orientation and position. Motion capture data provides clinicians with detailed information on the multisegment kinematics of foot motion during gait, before and during surgery. Further, treatment effectiveness can be evaluated by repeating gait analyses after recovery.

The Identification of Clinically Relevant Gait Variables in Children With Hypotonia

not available

Evaluation of the Minitek system for identification of nonfermentative and nonenteric fermentative Gram-negative bacteria

The Minitek identification system (MT) was compared with a conventional testing battery for the characterization of 735 isolates which included 57 species and groups of nonfermentative (NF) and nonenteric fermentative (NEF) gram-negative bacteria. The MT correctly identified 585 of 616 NF (94,96%) and 115 of 119 NEF (96.65%) bacteria and 700 of 735 strains (95.24%) overall. A total of 31 NF and NEF (4.22%) bacteria were misidentified, and no identification was determined for four strains (0.69%). All strains of Acinetobacter anitratus, Pseudomonas maltophilia, P. fluroescens, and P. putida and all but one strain of P. aeruginosa were correctly identified. The most frequently misidentified taxa were CDC group Va-1, P. pickettii (Va-2), P. mendocina, and Moraxella urethralis (M-4). Supplemental tests were needed for the complete identification of 214 strains (29.11%). An average of 1.54 supplemental tests were used with each of these strains. A total of 134 strains (18.23%) had their identification delayed by 1 day due to supplemental testing. We recommend the use of the 42 degree C growth test with the MT. When used in accord with the manufacturer's instructions and with the MT code book the MT was found to be a valuable system for the identification of a wide variety of common and infrequently encountered NF and NEF bacteria.