Visual-spatial training in patients with sub-acute stroke without neglect: a randomized, single-blind controlled trial

Many people who have suffered a stroke will experience sensorimotor impairments that disrupt their performance of motor skills, including balance and gait. Furthermore, stroke-induced brain damage can Result in visual disorders that may significantly impact performance of normal daily activities. The primary aim of this study was to investigate the effects, on balance, of visual-spatial training as an add-on intervention to conventional neurorehabilitation in patients with subacute stroke without neglect; secondarily, it aimed to assess the effects of this training on activities of daily living. Thirty inpatients (17 M, age: 57.3±12.9 years) with a diagnosis of subacute stroke (< 180 days) were enrolled in this study and randomized into two groups: the visual-spatial training group and a control group. All patients were evaluated, using the Tinetti Balance and Gait Scale (TBG), the Berg Balance Scale, computerized posturography, and the Barthel Index (BI), both before (T0) and after (T1) four weeks of training sessions. In addition to conventional neurorehabilitation, each group performed a total of twelve 20-minute rehabilitation sessions (3 times/week for 4 weeks). Significant TIME x GROUP interactions were recorded in the experimental group with respect to the control group for the TBG score [F (1,18) =15.59; p = 0.0004] and BI score [F (1,28) =6.35; p = 0.01]. Both groups recorded non-significant improvements on the instrumental postural assessment. These data suggest that visualspatial training as an add-on intervention to conventional neurorehabilitation could be an effective complementary strategy to improve balance and activities of daily living.

Metabolic control and complications in Italian people with diabetes treated with continuous subcutaneous insulin infusion

BACKGROUND AND AIM

The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII).

METHODS AND RESULTS

Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy. Information on standard clinical variables, demographic data and acute and chronic diabetic complications was derived from local clinical management systems. The sample consisted of 6623 people with diabetes, which was obtained from 93 centres. Of them, 98.8% had type 1 diabetes mellitus, 57.2% were female, 64% used a conventional insulin pump and 36% used a sensor-augmented insulin pump. The median glycated haemoglobin (HbA_1c) level was 60 mmol/mol (7.6%). The HbA_1c target (i.e. <58 mmol/mol for age <18 years and <53 mmol/mol for age >18 years) was achieved in 43.4% of paediatric and 23% of adult participants. Factors such as advanced pump functions, higher rate of sensor use, pregnancy in the year before the study and longer duration of diabetes were associated with lower HbA_1c levels. The most common chronic complications occurring in diabetes were retinopathy, microalbuminuria and hypertension. In the year before the study, 5% of participants reported ≥1 episode of severe hypoglycaemic (SH) episodes (SH) and 2.6% reported ≥1 episode of ketoacidosis.

CONCLUSIONS

Advanced personal skills and use of sensor-based pump are associated with better metabolic control outcomes in Italian people with diabetes who were treated with CSII. The reduction in SH episodes confirms the positive effect of CSII on hypoglycaemia.

CLINICAL TRIAL REGISTRATION NUMBER

NCT 02620917 (ClinicalTrials.gov).

Visual evoked potential importance in the complex mechanism of amblyopia

To compare the visual evoked potential (VEP) responses of amblyopic eyes with VEP responses of sound eyes in amblyopic children. A study of 65 amblyopic children with pattern-reversal VEPs elicited by checkerboard stimuli with large, medium and small checks. The children were classified into three groups: Group A, 22 children with anisometropic amblyopia; Group B, 16 children with exotropic strabismic amblyopia; and Group C, 27 children with esotropic strabismic amblyopia. Visual acuity (VA) was significantly worse in the amblyopic eye as compared to the sound eye. However, no statistically significant difference was found between the amblyopic and sound eye of amblyopic children in the three groups for VEP P1 amplitude and latencies for any check sizes. VEP is a very important tool in understanding the complex amblyopic mechanism. Although the sound eye has superior VA, the absence of differences in VEP P1 amplitudes and latencies demonstrate the functional abnormality of the eye considered ‘good’. More studies are necessary to explain why the sound eye in amblyopic children cannot be considered completely normal. Special attention should therefore be paid to amblyopic treatment, as patching can have a negative effect on the sound eye.

Effects of ketanserin on the discrimination of electrical stimulation of the dorsal raphé nucleus in rats

The electrical stimulation of the dorsal raphé nucleus was used as a training cue in a discrimination paradigm. Sprague-Dawley rats were trained to discriminate between electrical stimulation (ES; 200 microA) of the dorsal raphé nucleus (DRN) and non-stimulation. This was accomplished by associating ES with intraperitoneal (i.p.) injection of lithium chloride (LiCl), following the session with electrical stimulation. This made the drinking of saccharin during ES aversive by conditioned taste aversion. Following training, rats decreased saccharin consumption in ES sessions. This discrimination was learned within three pairings of the ES with LiCl. Lowering the ES current to 50-100 microA resulted in levels of saccharin consumption similar to non-stimulation levels, whereas 150 microA showed a response intermediate between the stimulation response at 200 microA and non-stimulation. The discrimination of ES of the DRN (200 microA) was not affected by prior administration of the 5-HT2 antagonist ketanserin (1 or 2 mg/kg, i.p.), suggesting that activation of 5-HT2 receptors is not the primary discriminative cue generated by ES. However, the 5-HT2A/2C agonist DOI (0.25-0.5 mg/kg, i.p.), substituted for ES of the DRN, i.e. animals reduced saccharin consumption following DOI administration. This substitution of DOI for ES was antagonized by the administration of ketanserin (1 mg/kg, i.p.). These results suggest that ES of the DRN has properties that are similar to the activation of 5-HT2A/2C receptors by DOI. However, other stimuli such as activation of other 5-HT receptors are also involved, given that the discriminative cues of ES are not blocked by the 5-HT2A/2C antagonist ketanserin.