Interventions Facilitating Recovery of Consciousness Following Traumatic Brain Injury: A Systematic Review

People who experience disorders of consciousness (DoC) following a severe traumatic brain injury (TBI) have complex rehabilitation needs addressed by occupational therapy. To examine the effectiveness of interventions to improve arousal and awareness of people with DoC following a TBI. For this systematic review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched six databases in collaboration with a research librarian. Twenty-seven studies were included and grouped thematically. Multimodal sensory stimulation, familiar voices telling structured stories, and transcranial direct current stimulation had a moderate level of evidence. Multimodal sensory stimulation had the strongest evidence in support of its use in clinical practice. Occupational therapy practitioners should administer multimodal stimuli frequently as studies reported administering these interventions at least twice daily. Occupational therapy practitioners should incorporate personally relevant, meaningful, salient stimuli into interventions when treating patients with DoC.

Mobility Interventions for Patients With Disorders of Consciousness Following a Traumatic Brain Injury (June 2013-October 2020)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of mobility interventions to improve arousal and awareness in people with disorders of consciousness following a traumatic brain injury.

Noninvasive Nerve Stimulation for Patients With Disorders of Consciousness Following a Traumatic Brain Injury (June 2013-October 2020)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of noninvasive nerve stimulation to improve arousal and awareness in people with disorders of consciousness following a traumatic brain injury.

Animal-Assisted Therapy for Patients With Disorders of Consciousness Following a Traumatic Brain Injury (June 2013-October 2020)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of animal-assisted therapy to improve arousal and awareness for people with disorders of consciousness following a traumatic brain injury.

Sensory Stimulation for Patients With Disorders of Consciousness Following a Traumatic Brain Injury (June 2013-October 2020)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of sensory stimulation interventions to improve arousal and awareness in people with disorders of consciousness following a TBI.

A Framework for Addressing Clients' Functional Cognitive Deficits After COVID-19

Occupational therapy's focus on functional cognition offers a distinct approach to the assessment of and intervention for occupational performance deficits that may follow coronavirus disease 2019 (COVID-19). Although the majority of people survive COVID-19, many people experience persistent functional cognitive sequelae severe enough to interfere with occupational performance. After COVID-19, people may be categorized as either (1) those who experience severe or critical illness requiring hospitalization or (2) those with mild to moderate presentations of the virus without hospitalization. A third group of those who do not have ongoing signs of active infection but who experience new, lasting, or deteriorating symptoms has begun to emerge and may represent a distinct COVID-19 long-haul syndrome. By following the Occupational Therapy Practice Framework and using established processes for occupational therapy assessment and treatment of functional cognition, occupational therapy practitioners can tailor assessments and interventions to meet clients' needs.

Using Eye Tracking to Identify Left Unilateral Spatial Neglect (USN) in Persons With an Acute Right Hemisphere Stroke

Date Presented 03/28/20

USN is a common occurrence in right hemisphere stroke survivors. However, no gold standard measure of USN exists. We investigated whether eye tracking is a sensitive measure of left USN in eight people with acute right hemisphere stroke. Eye tracking was found to be more sensitive than paper-and-pencil–based tests and comparable to functional assessments of USN. We suggest that eye tracking may be a quick and effective way to screen for left USN.

Primary Author and Speaker: Kelsey Watters

Contributing Authors: Gabrielle Escalante, Leora Cherney, Sameer Ashaie

Rehabilitation Interventions to Facilitate Recovery of Consciousness Following a Traumatic Brain Injury: A Systematic Review

Date Presented 03/28/20

We report rehabilitation interventions delivered to facilitate recovery of consciousness for patients with a traumatic brain injury. Interventions reported may prompt OT practitioners to seek advanced training in preparatory stimulation methods. The results of this review identify gaps in the literature, specifically the content of OT treatment.

Primary Author and Speaker: Jennifer Weaver

Additional Authors and Speakers: Kristen Maisano, Alison Cogan, Trudy Mallinson

Contributing Authors: Sophie Leeds, Ann Guernon, Kelsey Watters, Jennifer Nebel, Theresa Bender Pape

Assessment of the Spastic Upper Limb with Computational Motion Analysis

This article presents the current status of integrating 3-dimensional motion analysis and electromyography to assess upper extremity function clinically. The authors used their approach to establish a normative database for 5 Shriners Hospital Upper Extremity Evaluation tasks, which provides ranges of motion at the point of task achievement. Also, the inter-joint correlations are provided to understand the movement coordination required for each task. Distal upper extremity motion is strongly related to proximal function, supporting the idea that treatment of the proximal upper extremity deficits may be best preceded by treatment of the more distal upper extremity segments.

Detection of 16 gamma-ray pulsars through blind frequency searches using the Fermi LAT

Pulsars are rapidly rotating, highly magnetized neutron stars emitting radiation across the electromagnetic spectrum. Although there are more than 1800 known radio pulsars, until recently only seven were observed to pulse in gamma rays, and these were all discovered at other wavelengths. The Fermi Large Area Telescope (LAT) makes it possible to pinpoint neutron stars through their gamma-ray pulsations. We report the detection of 16 gamma-ray pulsars in blind frequency searches using the LAT. Most of these pulsars are coincident with previously unidentified gamma-ray sources, and many are associated with supernova remnants. Direct detection of gamma-ray pulsars enables studies of emission mechanisms, population statistics, and the energetics of pulsar wind nebulae and supernova remnants.

The Fermi Gamma-Ray Space Telescope discovers the pulsar in the young galactic supernova remnant CTA 1

Energetic young pulsars and expanding blast waves [supernova remnants (SNRs)] are the most visible remains after massive stars, ending their lives, explode in core-collapse supernovae. The Fermi Gamma-Ray Space Telescope has unveiled a radio quiet pulsar located near the center of the compact synchrotron nebula inside the supernova remnant CTA 1. The pulsar, discovered through its gamma-ray pulsations, has a period of 316.86 milliseconds and a period derivative of 3.614 x 10(-13) seconds per second. Its characteristic age of 10(4) years is comparable to that estimated for the SNR. We speculate that most unidentified Galactic gamma-ray sources associated with star-forming regions and SNRs are such young pulsars.

Penetrating air gun wound in the neck

BACKGROUND

Injuries from air weapons can be serious and potentially fatal. It has been estimated that up to four million such weapons exist in UK households.

CASE REPORT

We present the case of an 8-year-old boy who sustained a penetrating neck wound from an air gun. Use of the flexible laryngoscope in the resuscitation room allowed localization of the gun pellet in the airway.

CONCLUSIONS

This approach, combined with careful clinical assessment led to immediate removal by direct laryngoscopy, thus avoiding the morbidity of unnecessary surgical exploration.

Cost and morbidity of MRSA in head and neck cancer patients: what are the consequences?

Methicillin resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial pathogen worldwide. The objectives of this study were to assess the morbidity and cost associated with the treatment of head and neck cancer patients who become colonized or infected with MRSA following major surgical procedures. We present a retrospective review of patients who underwent major surgery for head and neck cancer over a one year period and who then became MRSA positive in the post-operative period. MRSA affected 25/55 (45 per cent) patients who underwent major head and neck procedures during the period studied. The mean time of diagnosis was 13 days post-surgery. Morbidity included cellulitis, osteomyelitis and MRSA pneumonia. Thirteen of the patients who became MRSA positive (52 per cent of the MRSA group) required further surgery including plate removal, new flap formation and wound debridement as a result of the infection. Average in-hospital stay was almost three times more prolonged for patients who became MRSA positive compared to those who did not have MRSA. The costs of the first hospital stay were over three times more in the MRSA-positive group of patients. Antibiotic costs were increased by pound 2470 per patient because of MRSA. The extra stay in hospital, together with extra days in intensive care, extra medical and nursing care and additional costly antibiotic treatment, led to major cost implications and loss of health service resources in the unit. MRSA infection is a serious cause of morbidity in any surgical group of patients and this study focuses on the consequences for treatment of head and neck cancer patients in particular.

Management of a large bronchial haemangioma in an infant

Haemangiomas are the most common soft tissue tumor of infancy. Despite the benign and trivial nature of most cutaneous haemangiomas, airway haemangiomas are rare but potentially life threatening. We report the case of a 9-week-old infant with a left main stem bronchial haemangioma. This was successfully treated with the oral corticosteroids. We discuss the current available treatments for haemangiomas and highlight that treatment should be specific to each individual case.

Translevator anal anomalies with cutaneous fistulae passing deep to the scrotum

METHODS

The authors present a series of 9 patients collected from 4 centers with translevator anal anomalies, each of which has a fistula tracking forward deep to the scrotum and opening at the peno-scrotal junction. Whereas some would appear to be covered ani in type, others are deeper and would appear to fit in with an intermediate type of classification emphasizing the idea of a "spectrum" of malformation.

RESULTS

The anatomic arrangement, associated anomalies (eg, 2 had hypospadias), and surgical management is described briefly in each case. Careful examination may be necessary to identify the fistula.

CONCLUSIONS

It is recommended that the surgery be individualized depending on the findings. On a theoretical embryologic basis there is abnormality in the formation of the outer genital folds, and there also may be abnormality in some cases of the inner genital folds.

Reduction of glycemic and lipid levels in db/db diabetic mice by psyllium plant fiber

The soluble plant fiber psyllium significantly reduced fasting glucose and total cholesterol levels in the C57BL/KsJ db/db diabetic mouse relative to placebo-fed mice. Insulin levels were significantly higher in psyllium-fed than placebo-fed animals, indicating this fiber may delay the progression of diabetes in the animal model. High-density lipoprotein cholesterol levels rose moderately in both psyllium- and placebo-fed animals during the study, whereas triglyceride levels remained unchanged in both groups. Psyllium's effect on glycemic, lipid, and hormone parameters was not explained by weight loss or reduced food intake; these were similar in psyllium- and placebo-fed animals during the study. Our results show that psyllium fiber can beneficially moderate glycemic and lipid parameters in the db/db diabetes model.

Congenital leukonychia striata

Leukonychia striata of a unique appearance and distribution is described in a 51-year-old woman. Histopathologic examination of a specimen from the nail plate revealed a transverse band of parakeratosis on the ventral surface. Disturbance in keratinization on the nail plate is presumed to be secondary to abnormalities in the nail matrix. We review briefly the classification and pathogenesis of leukonychia, an interesting aberration in nail plate keratinization.

Clinical trial of cefuroxime axetil in children

Cefuroxime axetil tablets were given to 12 children (aged 19 months to 13.5 years) for a total of 14 episodes of lower respiratory tract infection. Doses ranged from 15 to 32 mg/kg/day. Six infections were regarded as cured and seven improved. In four cases, Haemophilus influenzae was present at the end of treatment. Serum levels of cefuroxime showed great variability. Absorption and penetration of the drug into the lower respiratory mucosa may not be sufficient to kill organisms which are sensitive in vitro. Cefuroxime axetil tablets were acceptable to most children.

Pigmentation induced by quinidine therapy

Abnormalities of pigmentation are a well-known side effect of antimalarial therapy. Quinidine, an antiarrhythmic agent, is structurally related to the common antimalarials but, to our knowledge, has not been associated with pigmentary abnormalities. We report a case of localized blue-gray pigmentation, clinically and histologically identical to antimalarial-induced pigmentation, in a patient receiving quinidine therapy.

Manipulation of platelet aggregation by prostaglandins and their fatty acid precursors: pharmacological basis for a therapeutic approach

Addition of the one-, two- or three- series endoperoxide to human platelet-rich plasma tend to suppress aggregation, through the action of their respective non-enzymatic breakdown products PGE1, PGD2, or PGD3 all of which elevate cyclic AMP levels. On the other hand, these stable primary products do not arise in appreciable amounts from intrinsic endoperoxides generated from either endogenous or exogenous free fatty acids. 5,8,11,14,17-Eicosapentaenoic acid (EPA) suppresses arachidonic acid (5,8,11,14-eicosatetraenoic acid) conversion by cyclooxygenase (as well as lipoxygenase) to aggregatory metabolites in platelets. Exogenously added EPA was capable of inhibiting PRP aggregation induced either by exogenous or endogenous (released by ADP or collagen) arachidonate. The hypothetical combination of an EPA-rich diet and a thromboxane synthetase inhibitor might abolish production of the pro-aggregatory species, thromboxane A2, and enhance formation of the anti-aggregatory metabolite, prostacyclin. Whereas EPA is not detectably metabolized by platelets, dihomo-gamma-linolenic acid (8,11,14-eicosatrienoic acid) is primarily converted by cyclooxygenase and thromboxane synthetase into the inactive metabolite, 12-hydroxyheptadecadienoic (HHD) acid. Pretreatment of human platelet suspensions with the thromboxane synthetase inhibitor imidazole unmasks the aggregatory property of PGH1 and DLL which was partially compromised by the PGE1 formed. The combination of the thromboxane synthetase inhibitor and an adenylate cyclase inhibitor unmasks a complete irreversible aggregation by DLL or PGH1. The basis of a dietary strategy that replaces AA with DLL must rely on the production by the platelet of an inactive metabolite (HHD) rather than thromboxane A2.

Vitamin C metabolism and atopic allergy

The procedure for carrying out the Leucocyte Ascorbic Acid Uptake Direct Antigen Challenge Test (LAADACT) is described. Leucocytes from normal individuals, when incubated in a buffered medium containing ascorbic acid, increase their ascorbic acid concentration by about 80%. When leucocytes from atopic individuals are incubated in a medium containing the antigen to which they are sensitive, as shown by positive skin tests, the leucocyte uptake of ascorbic acid is significantly reduced. Addition of antigen, to which atopic or normal individuals are not sensitive, to the incubation mixture does not reduce leucocyte ascorbic acid uptake. Measurement of ascorbic acid uptake into leucocytes is a relatively simple, routine, laboratory procedure. The LAADACT, therefore, provides a quick and accurate blood test for diagnosing sensitivity to specific antigens, and measuring relative antigenic sensitivities. The underlying mechanism of the LAADACT is discussed.