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PubMed2000

Neuropsychology of childhood epilepsy: pre- and postsurgical assessment.

Childhood epilepsy is one of the most prevalent forms of chronic and disabling childhood disorders. Because it disrupts brain maturation, it has long been thought to produce non-specific consequences such as mental deficiency and behavioral problems. However, advances in medical knowledge have shown that childhood epilepsy should not be considered as a single disorder, and it is now becoming apparent that various clinical entities have different cognitive expressions that yet need to be specified. The purpose of this paper is to provide an up-to-date analysis of this multi-faceted pathology. The first section is devoted to the characterization of the neuropsychological profile that accompanies focal epilepsies, as defined by the site of the epileptic process. We report the first group study of children with frontal lobe epilepsy. The results indicate that frontal lobe epilepsy produces symptoms (deficits of planning, attention and motor dexterity) that are akin to those found in frontal-lesioned adults. Similarly, like in adults, temporal lobe epilepsy produces memory impairment in children as well as behavioral and academic disturbances. Occipito-parietal lobe epilepsy is rare in children and its effects still need to be specified. The second section deals with the neuropsychological techniques used in presurgical evaluation. Finally, the various neurosurgical procedures that are increasingly being used as part of the arsenal of epilepsy treatment are described along with the neuropsychological findings that are associated with these interventions. It can be concluded that the beneficial effects of epilepsy surgery (callosotomy, hemispherectomy, temporal and extra-temporal resections) by far outweigh the few cognitive deficits that are occasionally reported following these interventions.

Adult↗

PubMed2000

Visual and neurobehavioral impairment associated with polychlorinated biphenyls.

To determine whether residents exposed to PCBs and thermolysis products had impaired neurobehavioral functions, the performance of 98 exposed adults was compared with 58 unexposed regional referents (all volunteers). Visual field performance, color confusion index, balance as sway speed, blink reflex latency R-1, hearing, grip strength, simple and choice visual reaction times problem solving for Culture Fair and digit symbol, recall memory, peg placement, trail making A and B for attention and dexterity and long-term memory were tested. A profile of mood states (POMS) and questionnaires for chemical exposures, medical histories and the frequency of 35 symptoms were completed. Only statistically significant differences are described. Exposed subjects had slower simple and choice reaction times and faster sway speeds with eyes closed and open. Color discrimination and visual performance scores were lower and visual fields were often constricted. Scores on Culture Fair, digit symbol, vocabulary and verbal recall were lower. Placement of pegs in a slotted pegboard was slower and trail making A and B took longer. Even embedded memory test scores including vocabulary were lower. POMS scores were elevated. There were no competing chemical exposures, confounding factors or other explanations for the findings. Long residential exposure to PCBs was associated with visual defects and impaired neurophysiologic and neuropsychologic functions.

Adult↗

PubMed2000

[Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case].

Robotics has been commonly employed in numerous industrial fields for several decades. However, the application of this technology to surgery is a recent innovation. It provides new possibilities for facilitating specific surgical tasks, especially in the field of laparoscopy. We report a case of laparoscopic radical prostatectomy completed with the help of a remotely controlled da Vinci robot. This system offered a user friendly surgical platform and enhanced surgical dexterity. Operating time was 420 minutes and the hospital stay was 4 days. The bladder catheter was removed after 3 days. One week later, the patient was fully continent. Pathologic examination showed a pT3a tumor, with negative margins. Robotically assisted laparoscopic radical prostatectomy is feasible. Further developments in this field of technology may have new applications in laparoscopic telesurgery.

Equipment Design↗

PubMed1997

Why do older workers have problems with technology?

Why do older workers seem to have problems with technology? In this paper, I will review several possible reasons and illustrate them with evidence, often anecdotal, from our work as ergonomics practitioners. We find that older workers have more to "unlearn" from their accumulated experience. They may suffer from gradual or not so gradual ailing faculties of sight, hearing, dexterity, stamina, memory, and reaction time. They may exhibit a fear of making mistakes, and they may have strongly established preferences and pessimism about technological gimmicks. But the real problem is often that the designers have failed to anticipate the requirements of their users; they have failed to design for a range of abilities broader than their own; they have failed to test their designs with real people; and they have failed to learn from the experience of the market. Getting design right for older users is really only a continuation of getting design right for all.

Activities of Daily Living↗

PubMed2000

Lessons learned--15 years of the WHO-NCTB: a review.

Based on expert recommendations, the World Health Organization (WHO) recommended the Neurobehavioral Core Test Battery (NCTB) in 1983 to detect neurotoxicity in world-wide populations. The NCTB consists of 7 neurobehavioral tests (Digit Symbol, Digit Span, Benton visual memory test/recognition form, Santa Ana dexterity test, Simple Reaction Time, Pursuit Aiming II, and Profile of Mood States). Research with the NCTB provides the context for the results of a mini-symposium held in 1999 to discuss the lessons learned about using the NCTB in working populations. Speakers from Africa, Asia, Europe, and North America reviewed data from 94 studies using the NCTB, including 63 from China, 13 from Korea, 11 from Poland, three from South Africa, three from the USA, and one from Ecuador. Although a consensus was not sought in the symposium, the key lessons learned that emerged from the various presentations, were: * The NCTB is effective in testing adults with 12 or more years of formal education, but can not reliably test persons with less than 9 years of education. * People from cultures very different from those in Europe and North America (eg, aboriginal and African cultures) may not be tested effectively by the NCTB, although others such as at least some Asian populations, can be. To address this problem, the construct validity of the NCTB should be established in a wide range of countries. * The POMS measures of emotion proved to be very sensitive to neurotoxic exposures in several countries, but the POMS was the NCTB test most affected by cultural differences. The Digit Symbol or the Milan modification of that test was also highly sensitive to neurotoxic exposures. * Examiner drift following training to administer the NCTB is a significant problem in technically trained Examiners. Pursuit Aiming II is very difficult to score reliably.

Adult↗

PubMed2000

Testing gloves used for common nursing tasks.

Nursing tasks often require high levels of dexterity. Gloves should not hinder hand function. Gloves bought for use by nurses need to be tested in ergonomic trials based on nursing tasks.

Anthropometry↗

PubMed2001

[Two cases of digitalis toxicity with reversible and severe decrease of visual acuity].

BACKGROUND: We performed electrophysiologic tests on two patients with digitalis toxicity who first had photophobia and xanthopsia and revealed reversible reduced visual acuity and binocular central scotoma. CASES: The patients were a 72-year-old male and a 54-year-old male who had symptoms of digitalis toxicity. FINDINGS: The corrected visual acuity was severely decreased during digitalis toxicity, 0.02 oculus dexter (OD) and 0.1 oculus sinister (OS) in case 1 and 0.04 OD and 0.2 OS in case 2. But visual acuity recovered as the blood levels of digitalis decreased to the normal level and the corrected visual acuity was 0.7 OD and 0.8 OS in case 1 and 0.8 OD and 0.9 OS in case 2. We recorded 30 Hz-flicker electroretinogram (ERG), single flash ERG, photopic ERG, and scotopic ERG when digitalis blood levels were elevated and normal. Decreased amplitudes of 30 Hz-flicker ERG and photopic ERG suggested that photoreceptor function was disturbed at digitalis toxicity and cone dysfunction was more severely disturbed than rod dysfunction. CONCLUSION: 30 Hz-flicker ERG, as well as electrocardiogram and digitalis blood level, is a relatively convenient and useful measure of digitalis toxicity. It is necessary consiler toxicity when severe visual dysfunction is observed in patients with digitalis therapy.

Aged↗

PubMedDate not supplied

[Motor skill recovery in rats with various forelimb preference subjected to lesions in the caudate nucleus].

Rats were trained for retrieving a sunflower seed from a tube using a forelimb. In the process of training, all the animals were divided in two groups: with the right- and left-limb preference. The period of learning was divided in two emotional (after the period of anxiety the animal takes a sunflower seed from the flow of a chamber) and three motor stages (different degrees of dexterity and precision in reaching a seed in the tube and grasping it). After a rat learned the skilled movement, the caudate nucleus was lesioned contralaterally to the preferred limb. After surgery, the animals were tested for recovery of the motor skill. The stages of recovery were the same as during learning. "Right-" and "left-handed" rats were compared in the percentage of animals performing each stage, duration of each stage, the depth of the tube reached by the animal's forelimb, and time required for obtaining the best results. The "right-handed" rats dominated in the percentage of animals performing the emotional stages and later began to recover the skilled movement (the crucial motor stage) but faster acquired their individual maximal depth of reaching a seed in the tube than the "left-handed" animals. The recovery of the skilled movement in the "left-handed" animals was a more gradual process than that in the "right-handed" ones.

Animals↗

PubMed1975

Management and prevention of primary perilymph fistula in otosclerosis surgery.

Management of 10 cases of primary perilymph fistula is described. The modified technique of stapedectomy described in this article, seems to prevent primary perilymph fistula; time will tell if it will prevent secondary fistula. The hearing gain obtained with this technique is slightly inferior to the gain obtained with Gelfoam-wire prosthesis, but most significant is the fact that discrimination score is excellent in all cases. The author is convinced that the extra time and dexterity required to perform this procedure are well justified by the safety provided and the results obtained.

Adult↗

PubMedDate not supplied

The older worker.

About one person in eight remains employed past 65, the average age for retirement in the U.S. These persons tend to be highly reliable. They can adapt and learn new technology, but may require extra time to do so. Older workers have particular needs in the workplace due to physiological changes that accompany aging. They may require more lighting, and they may have decreased mobility, physical strength, and dexterity. These factors often have no impact on their ability to accomplish job duties. This chapter underscores the significant contributions that older workers often provide, and also addresses retirement planning.

Aged↗

PubMed2001

Unexplainable nondermatomal somatosensory deficits in patients with chronic nonmalignant pain in the context of litigation/compensation: a role for involvement of central factors?

OBJECTIVE: To address the prevalence and characteristics of nondermatomal somatosensory deficits (NDSD) in subjects with chronic pain in the context of compensation/litigation. METHODS: Data were collected via standardized history, examination, and patient- as well as physician-drawn body maps in a consecutive series of 194 subjects seen for the purpose of an independent medical examination. RESULTS: Forty-nine subjects (25.3%) with primarily widespread pain (often diagnosed as fibromyalgia) presented with hemisensory or quadrotomal deficits to pinprick and other cutaneous stimuli on the side of lateralized pain or worse pain. The NDSD limbs often had impairment of vibration sense (not infrequently associated with "forehead vibration split"), reduced strength, dexterity or movement, and extreme sensitivity to superficial skin palpation or profound insensitivity to deep pain. Spatial, temporal, qualitative, and evolutionary patterns of NDSD emerged associated with cognitive/affective symptoms. NDSD subjects were more often born outside Canada, more likely to be injured at work, present with abnormal pain behavior, and have negative investigations. CONCLUSION: NDSD are a prevalent problem associated with chronic pain. Future research should explore the prevalence of NDSD in other pain populations, the role of personality and related factors, and the underlying biological substrate of these deficits.

Adolescent↗

PubMed2000

[Vascularized peroneal reconstruction after bloc resection of tumors or congenital malformations of the upper limb in children].

Limb salvage surgery is the standard care for most malignant tumor affecting the extremities in the child, and a vascularized fibula transfer is probably the most popular microsurgical option to reconstruct long-bone defects. Between 1994 and 1999, nine children with intractable diseases of the upper limb were treated using free vascularized fibula grafts (one patient had resection in 1983 and initially prosthetic reconstruction, then fibula transplant in 1996). There were 6 boys and 3 girls. Mean age was 10 years (between 6 and 16). Eight patients had defects after sarcoma resection, one had an aggressive enchondroma. The reconstructed sites were the humerus (= 6), the radius (n = 3). The length of the bone defect ranged from 8 to 19 cm (mean: 14.4 cm). The fibula head with the cartilage and the growth plate was used in 3 children. One girl, 4.5 years old with congenital pseudoarthrosis of radius and cubitus had a resection and reconstruction with a U shaped fibula transplant. One patient died from lung and brain metastasis, two years after the reconstruction. There were no local recurrences. The complications were numerous but usually benign; fracture of the grafted fibula n = 7, necessity of additional bone grafts (n = 4) malunion (n = 1) needed reoperation, pseudoarthrosis (n = 2) with reoperation, ankle valgus (n = 1) required reoperation, necrosis of the fibula head (n = 1), radial inclination (n = 1). The ten patients had bone union. The mean period required to obtain radiographic bone union was 5 months. The functional results of the remaining patients were evaluated according to the scale of ENNEKING. The results ranged from 21 to 30 points. Our results were satisfactory with regard to pain, emotional acceptance, manual dexterity. The vascularized fibula graft is indicated in children with large bone defects, more than 8 cm in the humerus, radius and ulna.

Adolescent↗

PubMed2001

Carpal collapse in rheumatoid arthritis--prevalence and clinical significance: a preliminary study.

OBJECTIVE: To evaluate the prevalence and clinical significance of carpal collapse in Mexican women with rheumatoid arthritis (RA). METHODS: We evaluated the carpal height ratio (CHR) of 97 women with RA and 90 healthy women. Using plain radiographs of both hands, measurements were performed by 2 radiologists in a single blind fashion. We analyzed functional class, characteristics and duration of the disease, and presence of rheumatoid factor (RF). RESULTS: CHR values of the controls were 0.49+/-0.02 (values reported in American Caucasian women are 0.54+/-0.04). Thirty-five patients had carpal collapse (defined as CHR < or = 0.43) in the right hand, 30 in the left hand, and 23 bilaterally. Carpal collapse was associated with RF seropositivity and roentgenographic degree of progression (p < 0.01), as well as with cumulative dose of steroids. As 95% of the patients were right-handed, dexterity was not apparently affected. We observed no differences in Health Assessment Questionnaire, functional class, or disease duration between patients with and those without carpal collapse. CONCLUSION: The definition of carpal collapse may have ethnic related differences. Carpal collapse is common in Mexican women with RA and it is not an indicator of functional limitations.

Adult↗

PubMed2001

[Possibilities of subjective and objective evaluation of spasticity].

In this paper the most commonly used methods of assessment patients with spasticity has been presented. "Measuring" of spasticity is necessary for evaluation of new methods of treatment. This could be made directly or indirectly--in that case the sequela of spasticity is measured. In this elaboration as well subjective as objective methods of examination in spasticity has been described. The tone intensity scales, spasm frequency scores, global scales of motor impairment, ADL scales, upper extremity dexterity and strength testing, examination techniques and maneuvers to differentiate rectus femoris from iliopsoas and gastrocnemius from soleus tightness, clinical gait scores, EMG and goniometric pendulum test has been mentioned.

Humans↗

PubMed1999

Claude Bernard and pancreatic function revisited after 150 years.

In 1848, Claude Bernard described the lipolytic function of the pancreas. His experimental procedure was original and as he always affirmed, easily replicable. In this study we repeated the original Bernardian experiments for emulsification and saponification of fats, following the original descriptions from his laboratory manuscripts. The results were astonishingly similar to those obtained by Bernard, confirming the validity of his experiments and conclusions, as well as emphasising again his original concepts on the importance of experimental repeatability in scientific medicine. Considering the surgical difficulties we encountered, we must conclude that Claude Bernard required great manual dexterity to obtain these results without the benefit of modern technology and anaesthesia.

France↗

PubMedDate not supplied

[Cataract surgery: institutions, techniques and scientific models from Brisseau to Daviel].

The intellectual biography of Jacques Daviel (1693-1762) offers unexpected opportunities to recall fundamental steps in the history of scientific ideas, academic institutions and surgical techniques. Kepler had, in fact, ousted the crystalline lens from the full seat of the visual power to the refracting medium, but his work had no effect on the central core of the eye doctors' practice, namely, cataract surgery. Daviel's audacity, which was not to push down but to extract the lens with the cataract, brought the Keplerian revolution to a completion. In addition, physiologists and philsophers tried to befriend Daviel, and they made use of his exceptional manual dexterity to work out Molyneux's question, that is, the test of the man born blind who recovered his sight, which posed problems in the 18th century in the theory of knowledge.

Cataract Extraction↗

PubMed2001

[Study on the effects of walking on functional fitness in aged patients with the hand-arm vibration syndrome].

PURPOSE: This article reports the effectiveness of mild walking exercise for maintaining functional fitness in aged patients with the hand-arm vibration syndrome (HAVS). SUBJECTS AND METHODS: Fifty-two patients suffering from vibration syndrome, for which they received annual compulsory examination from December 1998 to March 1999 at the San-in Rosai Hospital, were examined. They all were male, with a mean age (standard deviation) of 69.1 (7.3) years, and were randomly allocated to an intervention group (N = 26) and a control group (N = 26). The goal of the intervention was to achieve and maintain at least 30 minutes of walking a day. Functional fitness was assessed by a sitting and standing test, a zigzag walking test, a hand working test with a pegboard for dexterity, and a self-care working test proposed by the Physical Fitness Research Institute, Meiji Life Foundation of Health and Welfare. RESULTS: There were no significant differences between the two groups regarding baseline characteristics. The proportions of subjects with regular exercise habits after the intervention were 84.6% (22/26) and 53.8% (14/26) in the intervention and control groups, respectively, the difference being significant. The total scores for functional fitness were improved in the intervention, while decline was noted in the control group. Sitting and standing and self-care working ability were also improved in the intervention group as against the deterioration with age in the control group. CONCLUSIONS: Our findings show to some extent that intervention using mild exercise, walking for 30 min, is effective for aged patients with HAVS to maintain and improve functional fitness.

Aged↗

PubMed2002

A clinical and microbiological evaluation of denture cleansers for geriatric patients in long-term care institutions.

BACKGROUND: Many elderly patients in long-term care hospitals cannot adequately brush their dentures because of disease, dementia and poor dexterity. Such inadequate cleaning may allow for the multiplication of Candida spp. and bacteria, which could serve as reservoirs for disseminating infections. OBJECTIVE: To assess the efficacy of 3 denture cleansers in reducing the number of microorganisms on dentures in a hospitalized geriatric population. METHODS: Three brands of cleanser (Denture Brite, Polident and Efferdent) were compared; water was used as the control. Microbiological samples were obtained before and after 3 one-week periods of cleanser use; these samples were taken by a microbiologist blinded to the assigned treatment. In the statistical analysis, the ranks of the differences between the before-treatment and after-treatment scores of each regimen were compared by means of the general linear model. In addition, the efficacy of each cleanser in reducing accumulation of plaque, stain and food was assessed. RESULTS: The rank of the differences in the number of colony-forming units (CFUs) of Candida spp. before and after one week of use of Denture Brite (p = 0.04) and Polident (p = 0.01), was significantly greater than that of the control group, but there was no difference between Efferdent use and control (p = 0.10). No significant differences in reduction of Streptococcus mutans were observed between Denture Brite (p = 0.13) or Polident (p = 0.12) and the control group, whereas dentures cleaned with Efferdent exhibited significantly greater reduction in Streptococcus mutans (p = 0.02) than dentures cleaned with water. Over all study periods, there were no significant differences among the cleansers in reduction of Candida spp. or Streptococcus mutans. Dentures cleaned with Denture Brite, Polident or Efferdent appeared to have similar reductions in the level of plaque, stain and food, and all had substantially greater reductions than dentures cleaned with water only. The significant difference in the rank of the reduction in Candida spp. CFUs (p = 0.005) was related to the variance between study periods (p = 0.01) and the variance between subjects (p = 0.008). CLINICAL SIGNIFICANCE: The use of denture cleansers significantly reduced the number of microorganisms on dentures in a hospitalized geriatric population.

Aged↗