Cognitive remediation and professional insertion of people with schizophrenia: RemedRehab, a randomized controlled trial.

BACKGROUND: People suffering from schizophrenia cannot easily access employment in European countries. Different types of vocational programs coexist in France: supported employment, sheltered employment (ShE), and hybrid vocational programs. It is now acknowledged that the frequent cognitive impairments constitute a major obstacle to employment for people with schizophrenia. However, cognitive remediation (CR) is an evidence-based nonpharmacological treatment for these neurocognitive deficits. METHODS: RemedRehab was a multicentric randomized comparative open trial in parallel groups conducted in eight centers in France between 2013 and 2018. Participants were recruited into ShE firms before their insertion in employment (preparation phase). They were randomly assigned to cognitive training Cognitive Remediation for Schizophrenia (RECOS) or Treatment As Usual (TAU). The aim of the study was to compare with the benefits of the RECOS program on access to employment and work attendance for people with schizophrenia, measured by the ratio: number of hours worked on number of hours stipulated in the contract. RESULTS: Seventy-nine patients were included in the study between October 2018 and September 2019. Fifty-three patients completed the study. Hours worked / planned hours equal to 1 or greater than 1 were significantly higher in the RECOS group than in the TAU group. CONCLUSIONS: Participants benefited from a RECOS individualized CR program allows a better rate of work attendance in ShE, compared to the ones benefited from TAU. Traditional vocational rehabilitation enhanced with individualized CR in a population of patients with schizophrenia is efficient on work attendance during the first months of work integration.

On the mechanical characterization and modeling of polymer gel brain substitute under dynamic rotational loading.

The use of highly sensitive soft materials has become increasingly apparent in the last few years in numerous industrial fields, due to their viscous and damping nature. Unfortunately these materials remain difficult to characterize using conventional techniques, mainly because of the very low internal forces supported by these materials especially under high strain-rates of deformation. The aim of this work is to investigate the dynamic response of a polymer gel brain analog material under specific rotational-impact experiments. The selected polymer gel commercially known as Sylgard 527 has been studied using a specific procedure for its experimental characterization and numerical modeling. At first an indentation experiment was conducted at several loading rates to study the strain rate sensitivity of the Sylgard 527 gel. During the unloading several relaxation tests were performed after indentation, to assess the viscous behavior of the material. A specific numerical procedure based on moving least square approximation and response surface method was then performed to determine adequate robust material parameters of the Sylgard 527 gel. A sensitivity analysis was assessed to confirm the robustness of the obtained material parameters. For the validation of the obtained material model, a second experiment was conducted using a dynamic rotational loading apparatus. It consists of a metallic cylindrical cup filled with the polymer gel and subjected to an eccentric transient rotational impact. Complete kinematics of the cup and the large strains induced in the Sylgard 527 gel, have been recorded at several patterns by means of optical measurement. The whole apparatus was modeled by the Finite Element Method using explicit dynamic time integration available within Ls-dyna(®) software. Comparison between the physical and the numerical models of the Sylgard 527 gel behavior under rotational choc shows excellent agreements.

[Validation of a brief screening scale evaluating praxic abilities for use in memory clinics. Evaluation in 419 controls, 127 mild cognitive impairment and 320 demented patients]. / Validation d'une batterie brève d'évaluation des praxies gestuelles pour consultation Mémoire. Evaluation chez 419 témoins, 127 patients atteints de troubles cognitifs légers et 320 patients atteints d'une démence.

INTRODUCTION: The aim of this study was to build a brief clinical scale evaluating praxic abilities of the upper limbs for use in memory clinics and to produce norms. PATIENTS AND METHODS: The scale includes three subtests: symbolic gestures (five gestures), pantomimes (five gestures) and imitation of meaningless gestures (eight gestures). Data were collected in a sample of 419 normal subjects. Sensitivity and specificity were established from their comparison to data collected from 320 demented patients. A group of 127 patients with mild cognitive impairment was also studied. RESULTS: Cut-off scores were proposed based on the fifth percentile observed in three classes of age and three levels of education. The specificity was high. Sensitivity was higher for imitation of meaningless gestures than for pantomimes and the least for symbolic gestures. The group of patients with mild cognitive impairment was half-way between demented patients and normal subjects. CONCLUSION: The proposed scale meets its initial aims of brevity and high specificity. It can easily be used in memory clinics and identifies apraxia in dementia patients. It therefore usefully contributes to clinical diagnosis.