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Annals of Medicine and Surgery (2012) Jan 2024Snakebites, a major health concern in developing countries, affect rural farming communities. Venom, primarily neurotoxin, injected during a snake bite disrupts the... (Review)
Review
OBJECTIVE
Snakebites, a major health concern in developing countries, affect rural farming communities. Venom, primarily neurotoxin, injected during a snake bite disrupts the nervous system, causing symptoms like muscle weakness, paralysis, altered sensation, and coordination issues. This review focuses on evaluating neurological and neuro-ophthalmological manifestations associated with snakebites.
METHODS
A database search was conducted in EMBASE and PubMed for studies published from 2000 to 2023. The investigation centered on examining neurological and neuro-ophthalmological symptoms and signs, treatment approaches, treatment outcomes, and long-term complications of snake bites.
RESULTS
Neurological and neuro-ophthalmological symptoms were common in both neurotoxic and hemotoxic snake bites, especially in neurotoxic cases. Ptosis was a prevalent manifestation across various snake bites, along with respiratory paralysis, limb weakness, dysphasia, and visual disturbances in some instances. However, most patients improved without residual neurological symptoms after treatment.
CONCLUSIONS
Understanding patterns of neurological manifestations contributes valuable insights for the comprehensive management of snakebite.
PubMed: 38222724
DOI: 10.1097/MS9.0000000000001523 -
Acta Neurologica Scandinavica Jul 2018Time sensitivity for pharmacological and mechanical arterial recanalization in acute ischemic stroke influences the choice of the reference hospital. The accurate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
Time sensitivity for pharmacological and mechanical arterial recanalization in acute ischemic stroke influences the choice of the reference hospital. The accurate selection and identification of patients with high probability of a large vessel occlusion (LVO) in the prehospital setting improve the rationalization of the transport in the more suitable centers. Aim of this analysis was to determine the diagnostic accuracy of prehospital stroke scales detecting LVO.
MATERIAL AND METHODS
Studies were searched into MEDLINE, EMBASE, and CINHAL databases between January 1990 and September 2017. Principal measurements of the meta-analysis were the overall accuracy level, sensitivity, and specificity of prehospital stroke scales.
RESULTS
Nineteen scoring systems were included in the analysis coming from 13 studies. A total of 9824 patients were considered. Although a higher heterogeneity was observed in the analysis, three scores showed better results in predicting a LVO (the stroke Vision, Aphasia, Neglect assessment, the National Institute of Health Stroke scale and the Los Angeles Motor Scale). We observed significant differences of overall accuracy only for scores including hemineglect as cortical neurological sign (P < .05).
CONCLUSIONS
This meta-analysis suggests that some prehospital scoring systems including cortical signs showed better accuracy to predict stroke due to LVO. However, the assessment of these signs could be difficult to investigate by paramedics and personnel of Emergency Medical Services, and for this reason, further prospective evaluations are needed.
Topics: Aged; Cerebrovascular Disorders; Emergency Medical Services; Female; Hospital Units; Humans; Male; Severity of Illness Index; Stroke
PubMed: 29430622
DOI: 10.1111/ane.12908 -
Journal of Neurotrauma Feb 2023Traumatic brain injury (TBI) leads to cognitive linguistic deficits that significantly impact on quality of life and well-being. Digital health offers timely access to... (Review)
Review
Traumatic brain injury (TBI) leads to cognitive linguistic deficits that significantly impact on quality of life and well-being. Digital health offers timely access to specialized services; however, there are few synthesized reviews in this field. This review evaluates and synthesizes reports of digital health interventions in TBI rehabilitation and caregiver education. Systematic searches of nine databases (PsycINFO, MEDLINE, CINAHL, Embase, Cochrane Library, Scopus, Web of Science Core Collection, speechBITE, and PsycBITE) were conducted from database inception to February 2022. Studies were included of interventions where the primary treatment focus (> 50%) was on improving communication, social, psychological or cognitive skills of people with TBI and/or communication partners. Data on participants, characteristics of the interventions, outcome measures and findings were collected. Risk of bias was accounted for through methodological quality assessments (PEDro-P and PEDro+, Risk of Bias in N-of-1 Trials) and intervention description. Qualitative data was analyzed using thematic synthesis. Forty-four articles met eligibility criteria: 20 randomized controlled trials, three single-case experimental designs, six non-randomized controlled trials, nine case series studies, and two case studies. Studies comprised 3666 people with TBI and 213 carers. Methodological quality was varied and intervention description was poor. Most interventions were delivered via a single digital modality (e.g., telephone), with few using a combination of modalities. Five interventions used co-design with key stakeholders. Digital health interventions for people with TBI and their caregivers are feasible and all studies reported positive outcomes; however, few included blind assessors. Improved methodological rigor, clearly described intervention characteristics and consistent outcome measurement is recommended. Further research is needed regarding multi-modal digital health interventions.
Topics: Humans; Caregivers; Quality of Life; Brain Injuries, Traumatic; Cognition Disorders; Cognition
PubMed: 35819294
DOI: 10.1089/neu.2021.0473 -
Frontiers in Neurology 2022Currently, little is known about Chinese-speaking primary progressive aphasia (PPA) patients compared to patients who speak Indo-European languages. We examined the...
INTRODUCTION
Currently, little is known about Chinese-speaking primary progressive aphasia (PPA) patients compared to patients who speak Indo-European languages. We examined the demographics and clinical manifestations, particularly reading and writing characteristics, of Chinese patients with PPA over the last two decades to establish a comprehensive profile and improve diagnosis and care.
METHODS
We reviewed the demographic features, clinical manifestations, and radiological features of Chinese-speaking PPA patients from 56 articles published since 1994. We then summarized the specific reading and writing errors of Chinese-speaking patients.
RESULTS
The average age of onset for Chinese-speaking patients was in their early 60's, and there were slightly more male patients than female patients. The core symptoms and images of Chinese-speaking patients were similar to those of patients who speak Indo-European languages. Reading and writing error patterns differed due to Chinese's distinct tone and orthography. The types of reading errors reported in Chinese-speaking patients with PPA included tonal errors, regularization errors, visually related errors, semantic errors, phonological errors, unrelated errors, and non-response. Among these errors, regularization errors were the most common in semantic variant PPA, and tonal errors were specific to Chinese. Writing errors mainly consisted of non-character errors (stroke, radical/component, visual, pictograph, dyskinetic errors, and spatial errors), phonologically plausible errors, orthographically similar errors, semantic errors, compound word errors, sequence errors, unrelated errors, and non-response.
CONCLUSION
This paper provides the latest comprehensive demographic information and unique presentations on the reading and writing of Chinese-speaking patients with PPA. More detailed studies are needed to address the frequency of errors in reading and writing and their anatomical substrates.
PubMed: 36561305
DOI: 10.3389/fneur.2022.1025660 -
International Journal of Language &... Jan 2021People with aphasia (PWA) frequently present impairments in reading comprehension. Such impairments can be particularly debilitating due to the limitations and... (Review)
Review
BACKGROUND
People with aphasia (PWA) frequently present impairments in reading comprehension. Such impairments can be particularly debilitating due to the limitations and constraints they impose on everyday life. Recent technological advancements in the field of information and communication technologies offer many compensative tools for PWA. However, most technological tools are designed for patients with speech production impairments. Instruments addressing reading impairments associated with aphasia remain scarce and underrepresented in the scientific literature.
AIMS
To conduct a state-of-the-art review of the technologies currently available to PWA and acquired reading impairments. In particular, this review covers (1) research on technologies explicitly developed to compensate for reading difficulties associated with aphasia; and (2) research into which accessibility features included in mainstream high-tech systems are helpful for PWA when trying to access written material.
METHODS & PROCEDURES
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) international standard, the authors conducted a systematic review from 2009 to 2019. The databases inspected were Scopus, Web of Science, PubMed, the Cochrane collection, IEEE Xplore, ScienceDirect and SpringerLink. Other research papers were included after checking the references of the selected papers.
MAIN CONTRIBUTION
The review reveals that research on compensative devices for reading impairments largely neglects tools for individuals with aphasia and acquired reading difficulties. Most of the studies in this field are qualitative investigations of how patients with literacy difficulties tackle everyday tasks with the help of mainstream technology (e.g., smartphone applications). Therefore, this paper highlights the scarce high-tech alternatives that support text comprehension in PWA and acquired reading impairments, and suggests further work on the development of customized software for smartphones and personal computers.
CONCLUSIONS
High-tech reading tools may help PWA to regain reading autonomy. PWA and acquired reading impairments employ a wide array of devices to overcome reading difficulties, which underlines the importance of reading in everyday life. However, the supports currently available are not yet flexible and accurate enough to answer their day-to-day needs. Thus, further work is necessary to enhance the compensative devices available to them. For instance, existing new technologies in the area of natural language processing (such as automatic text simplification) could potentially be used in compensative devices. What this paper adds What is already known on the subject Most research on high-tech compensative reading tools is focused on investigating how patients with aphasia and acquired reading impairments cope with their reading difficulties in everyday life by resorting to different types of technology. Yet, we still lack specific research on compensative reading technology for PWA. What this paper adds to existing knowledge This review shows that PWA with acquired reading impairments are offered limited options for accessing written content easily and autonomously-and those few resources that are available are not specifically designed for PWA. What are the potential or actual clinical implications of this work? Both aphasia and acquired reading impairments can vary in terms of both their severity and the associated typology of cognitive impairments. Therefore, it might be interesting to investigate flexible and highly adaptable reading support designed for them-and innovations in the field of information and communication technology might prove particularly fruitful.
Topics: Aphasia; Comprehension; Dyslexia; Humans; Reading; Writing
PubMed: 32918536
DOI: 10.1111/1460-6984.12569 -
Disability and Rehabilitation Nov 2022Community aphasia groups (CAGs) can provide a range of benefits to people with aphasia and support long-term psychosocial wellbeing. However, the dominant...
PURPOSE
Community aphasia groups (CAGs) can provide a range of benefits to people with aphasia and support long-term psychosocial wellbeing. However, the dominant speech-pathologist-led service delivery model is inherently limited in scope. Peer-led groups hold potential as a sustainable and empowering extension of this traditional model. The implementation of peer-led models likely requires targeted training and support, however little is known about the characteristics and impacts of CAG facilitation. This study reviews the literature on CAGs and their facilitation.
MATERIALS AND METHODS
We conducted a scoping review on this topic.
RESULTS
One hundred and seventy-seven texts were included, reporting on a heterogeneous range of activities. Most texts reported on speech-pathologist-led groups, however, a range of alternative models were also represented. While no studies directly compared the impacts of different facilitation models, some comparative benefits could be drawn from the literature. Facilitation was perceived as complex and challenging, and significant gaps were identified in the training of facilitators. Ten qualitative studies investigated characteristics and impacts of facilitator behaviours, providing a useful foundation for future development of training and evaluation tools.
CONCLUSIONS
Further investigation into alternative facilitation models and facilitator training needs will likely support the proliferation of high-quality CAGs.Implications for RehabilitationCommunity aphasia groups (CAGs) play an important role in supporting identity and wellbeing for individuals with chronic aphasia.The traditional speech-pathology led model of group service delivery is limited in scope; the addition of peer- and volunteer-led CAGs may facilitate access to groups and meet a range of different needs for individuals with aphasia.CAG facilitation is a complex and challenging task, likely requiring specialised training, however, this has not been widely available to facilitators.The development of specialised facilitator training will likely support the proliferation of sustainable and high-quality CAGs.
Topics: Humans; Aphasia; Qualitative Research; Speech-Language Pathology; Peer Group
PubMed: 34632891
DOI: 10.1080/09638288.2021.1971307 -
Cortex; a Journal Devoted To the Study... Aug 2020To investigate the literature for frequencies, profiles and neural correlates of limb and face apraxias in frontotemporal dementia (FTD). (Review)
Review
PURPOSE
To investigate the literature for frequencies, profiles and neural correlates of limb and face apraxias in frontotemporal dementia (FTD).
METHOD
The search conducted in Ovid Medline, PsycINFO and Scopus yielded 487 non-duplicate records, and 43 were included in the final analysis.
RESULTS
Apraxias are evident in diverse forms in all clinical variants of FTD within the first four years of the disease. Face apraxia and productive limb apraxia co-occur in the behavioural and nonfluent variants. The logopenic variant resembles Alzheimer's disease in terms of pronounced parietal limb apraxia and absence of face apraxia. The semantic variant exhibits conceptual praxis deficits together with relatively preserved imitation skills. Concerning the genetic variants of FTD, productive limb apraxia is common among carriers of the progranulin gene mutation, and subtle gestural alterations have been documented among carriers of the chromosome 9 open reading frame 72 gene mutation before the expected disease onset. The data on neural correlations suggest that the breakdown of praxis results from bilateral cortical and subcortical damage in FTD and that Alzheimer-type pathology of the cerebrospinal fluid increases the severity of limb apraxia in all of the variants. Face apraxia correlates with degeneration of the medial and superior frontal cortices.
CONCLUSIONS
Each of the clinical variants of FTD exhibits a characteristic profile of apraxias that may support early differentiation between the variants and from Alzheimer's disease. However, the screening procedures developed for stroke populations seem insufficient, and a multifaceted assessment tool is needed. Although valid and practical tests already exist for dementia populations, a concise selection of test items that covers all of the critical domains is called for.
Topics: Alzheimer Disease; Apraxias; Frontotemporal Dementia; Heterozygote; Humans; Neuropsychological Tests; Pick Disease of the Brain
PubMed: 32418629
DOI: 10.1016/j.cortex.2020.03.023 -
Disability and Rehabilitation Dec 2017To provide a systematic overview of the various tools available to screen for post-stroke visual impairment. (Review)
Review
PURPOSE
To provide a systematic overview of the various tools available to screen for post-stroke visual impairment.
METHODS
A review of the literature was conducted including randomised controlled trials, controlled trials, cohort studies, observational studies, systematic reviews and retrospective medical note reviews. All languages were included and translation was obtained. Participants included adults ≥18 years old diagnosed with a visual impairment as a direct cause of a stroke. We searched a broad range of scholarly online resources and hand-searched articles registers of published, unpublished and on-going trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Study selection was performed by two authors independently. The quality of the evidence and risk of bias were assessed using the STROBE, GRACE and PRISMA statements.
RESULTS
A total of 25 articles (n = 2924) were included in this review. Articles appraised reported on tools screening solely for visual impairments or for general post-stroke disabilities inclusive of vision. The majority of identified tools screen for visual perception including visual neglect (VN), with few screening for visual acuity (VA), visual field (VF) loss or ocular motility (OM) defects. Six articles reported on nine screening tools which combined visual screening assessment alongside screening for general stroke disabilities. Of these, three included screening for VA; three screened for VF loss; three screened for OM defects and all screened for VN. Two tools screened for all visual impairments. A further 19 articles were found which reported on individual vision screening tests in stroke populations; two for VF loss; 11 for VN and six for other visual perceptual defects. Most tools cannot accurately account for those with aphasia or communicative deficits, which are common problems following a stroke.
CONCLUSION
There is currently no standardised visual screening tool which can accurately assess all potential post-stroke visual impairments. The current tools screen for only a number of potential stroke-related impairments, which means many visual defects may be missed. The sensitivity of those which screen for all impairments is significantly lowered when patients are unable to report their visual symptoms. Future research is required to develop a tool capable of assessing stroke patients which encompasses all potential visual deficits and can also be easily performed by both the patients and administered by health care professionals in order to ensure all stroke survivors with visual impairment are accurately identified and managed. Implications for Rehabilitation Over 65% of stroke survivors will suffer from a visual impairment, whereas 45% of stroke units do not assess vision. Visual impairment significantly reduces the quality of life, such as being unable to return to work, driving and depression. This review outlines the available screening methods to accurately identify stroke survivors with visual impairments. Identifying visual impairment after stroke can aid general rehabilitation and thus, improve the quality of life for these patients.
Topics: Adult; Disability Evaluation; Humans; Mass Screening; Quality of Life; Retrospective Studies; Stroke; Stroke Rehabilitation; Vision Disorders
PubMed: 27669628
DOI: 10.1080/09638288.2016.1231846 -
International Psychogeriatrics Sep 2023Depression, anxiety, and apathy are the most commonly reported neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD). Understanding their prevalence in rarer... (Review)
Review
OBJECTIVES
Depression, anxiety, and apathy are the most commonly reported neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD). Understanding their prevalence in rarer dementias such as frontotemporal dementia (FTD), primary progressive aphasia (PPA), posterior cortical atrophy (PCA), young-onset AD (YOAD), and inherited dementias has implications for both clinical practice and research. In this study, we aimed to examine the current state of knowledge of the prevalence of these three NPS in less prevalent dementias.
DESIGN
We conducted a systematic review based on searches of EMBASE, PsycINFO, and PubMed up to September 2019.
RESULTS
47 articles meeting inclusion criteria were identified. Depression, anxiety, and apathy were commonly reported across the phenotypes studied but their prevalence showed large variation between studies. Apathy showed the highest reported frequency in FTD (50-100% across studies), behavioral variant frontotemporal dementia (bvFTD) (73-100%), and YOAD (44-100%). Anxiety was frequently reported in FTD (0-100%) and bvFTD (19-63%). Depression showed the highest prevalence in FTD (7-69%) and YOAD (11-55%). Among the three variants of PPA, sv-PPA is the one most investigated (seven articles). Three or fewer articles were identified examining NPS in the remaining PPA variants, PCA, familial AD, and familial FTD. Inconsistency in the tools used to measure symptoms and small sample sizes were common methodological limitations.
CONCLUSIONS
Future studies should consider the inclusion of larger sample sizes (e.g. through multicenter collaborations) and the use of harmonized protocols that include the combination of caregiver and patient-derived measures and symptom-specific questionnaires. More research is needed on the phenotype-specific barriers and facilitators for people living with dementia to successfully engage in self-reports of NPS.
Topics: Humans; Alzheimer Disease; Frontotemporal Dementia; Apathy; Prevalence; Depression; Anxiety; Multicenter Studies as Topic
PubMed: 32684177
DOI: 10.1017/S1041610220001118 -
International Journal of Language &... Sep 2017Cognitive-linguistic treatments and interventions targeting communication have been developed within the context of primary progressive aphasia (PPA), however knowledge... (Review)
Review
BACKGROUND
Cognitive-linguistic treatments and interventions targeting communication have been developed within the context of primary progressive aphasia (PPA), however knowledge about the scope of generalization and maintenance of therapy gains considering PPA subtypes remains scarce and awaits systematic investigation.
AIMS
To analyse the effects of semantic therapy on generalization and maintenance of treatment outcomes in individuals with PPA, considering its different subtypes.
METHODS & PROCEDURES
Central, PubMed, Medline, Web of Knowledge and Scopus were used to retrieve articles of interest. A total of 25 non-randomized studies published between 2000 and 2016 met the eligibility criteria and therefore were included in this study.
MAIN CONTRIBUTION
This systematic review provides evidence-based information for clinical practice in PPA. Generalization and maintenance effects post-treatment for each PPA variant are analysed and discussed. Several factors are described as important to maximize the scope for generalization and maintenance of treatment gains.
CONCLUSIONS & IMPLICATIONS
Generalization is particularly hard to achieve in the semantic variant, as in the face of degraded semantic knowledge learning is rigid and context dependent. In contrast, non-fluent and logopenic variants offer better scope for generalization. Maintenance patterns do not seem to be influenced by PPA subtype, but rather by other factors such as continued practice, treatment length and frequency of sessions. In the future, clinicians should consider the PPA subtype when planning the treatment protocol.
Topics: Aged; Aged, 80 and over; Aphasia, Primary Progressive; Cognition; Female; Generalization, Psychological; Humans; Language Tests; Language Therapy; Male; Middle Aged; Semantics; Treatment Outcome
PubMed: 28120406
DOI: 10.1111/1460-6984.12310