Thumb and finger movement is reduced after stroke: An observational study.

Hand motor impairment is common after stroke but there are few comprehensive data on amount of hand movement. This study aimed to compare the amount of thumb and finger movement over an extended period of time in people with stroke and able-bodied people. Fifteen stroke subjects and 15 able-bodied control subjects participated. Stroke subjects had impaired hand function. Movement of the thumb and index finger was recorded using stretch sensors worn on the affected hand (stroke subjects) or the left or right hand (control subjects) for ∼4 hours during the day. A digit movement was defined as a monotonic increase or decrease in consecutive sensor values. Instantaneous digit position was expressed as a percentage of maximal digit flexion. Mixed linear models were used to compare the following outcomes between groups: (1) average amplitude of digit movement, (2) digit cadence and average digit velocity, (3) percentage of digit idle time and longest idle time. Amplitude of digit movement was not different between groups. Cadence at the thumb (between-group mean difference, 95% CI, p value: -0.6 movements/sec, -1.0 to -0.2 movements/sec, p = 0.003) and finger (-0.5 movements/sec, -0.7 to -0.3 movements/sec, p<0.001) was lower in stroke than control subjects. Digit velocity was not different between groups. Thumb idle time was not different between groups, but finger idle time was greater in stroke than control subjects (percentage of idle time: 6%, 1 to 11%, p = 0.02; longest idle time: 375 sec, 29 to 721 sec, p = 0.04). Rehabilitation after stroke should encourage the performance of functional tasks that involve movements at faster cadences, and encourage more frequent movement of the digits with shorter periods of inactivity.

To trust, or not to trust? Individual differences in physiological reactivity predict trust under acute stress.

The stress response represents an evolutionarily ancient array of biological responses to challenge or threat that facilitate survival by promoting adaptive behaviors. 'Adaptive' in the evolutionary sense, however, does not easily translate to explain stress' effect on human decisions. Much research demonstrates that acute stress alters decision-making, but outcomes are obscured by a range of methodological factors. Further, less is known about how stress affects decision-making in social contexts in which people so often act. This is of great importance in today's increasingly complex social environment, replete with potential stressors, where cooperation and trust are critical. Here the aim was to explore acute stress' effect on prosocial decision-making, while also controlling for methodological factors that may contribute to varied research outcomes. Ninety-six participants were exposed between-subjects to acute stressors with or without a significant social evaluative component, or a control procedure, after which they performed a variant of the Trust Game (a social decision-making task requiring cooperation and trust with a 'partner'). Task performance occurred at different times with respect to exposure to examine the roles of temporally distinct biological stress pathways. Overall acute stress was associated with reduced trust, but a more complex pattern emerged when accounting for individual differences in physiological stress responses via multivariate analysis. In keeping with the complexity of stress itself, acute stress may enhance or reduce propensity to trust based on an individual's unique pattern of physiological reactivity.

Cystitis Cystica as a Large Solitary Bladder Cyst.

Background: In this case we describe the rare and not previously documented presentation of cystitis cystica as a large solitary cystic lesion within the bladder wall. Case Presentation: We present a case of a 46-year-old Russian male with a history of lower urinary tract symptoms and suprapubic pain. CT urogram showed a 5.8 cm filling defect/cystic mass related to the base of the bladder and prostate with 8 mm thick wall. The patient underwent cystoscopy and contrast study of bladder lesion with urethral dilatation and transurethral deroofing of bladder wall cyst under general anesthesia. A histologic diagnosis of cystitis cystica was made. Conclusion: This case described the rare presentation of a large solitary bladder cyst arising from the anterior bladder wall, identified histologically as cystitis cystica. Cystitis cystica presenting as a large cystic lesion of the bladder wall is rare; however, a diagnosis of cystitis cystica should be considered in unexplained cystic defects of the bladder wall.

Brief Report: Assessment of Intervention Effects on In Vivo Peer Interactions in Adolescents with Autism Spectrum Disorder (ASD).

This study aimed to evaluate the effectiveness of a randomized controlled trial of a social skills intervention, the Program for the Education and Enrichment of Relational Skills (PEERS: Laugeson et al. in J Autism Dev Disord 39(4): 596-606, 2009), by coding digitally recorded social interactions between adolescent participants with ASD and a typically developing adolescent confederate. Adolescent participants engaged in a 10-min peer interaction at pre- and post-treatment. Interactions were coded using the Contextual Assessment of Social Skills (Ratto et al. in J Autism Dev Disord 41(9): 1277-1286, 2010). Participants who completed PEERS demonstrated significantly improved vocal expressiveness, as well as a trend toward improved overall quality of rapport, whereas participants in the waitlist group exhibited worse performance on these domains. The degree of this change was related to knowledge gained in PEERS.

Clinical physiotherapists had both positive and negative perceptions about delivering two different interventions in a clinical trial: a mixed methods study.

QUESTION: What are clinical physiotherapists' perceptions about delivering two interventions during a randomised trial: the MOBILISE trial? DESIGN: Mixed methods study using semi-structured interviews involving closed- and open-ended questions. PARTICIPANTS: Thirteen physiotherapists involved in delivering the intervention for the trial. RESULTS: All thirteen physiotherapists (100%) had a preference for their patients to get one of the interventions, mostly dependent on the individual patient. Most were frustrated if their patients were not allocated to their preferred intervention but 62% were satisfied with the intervention they delivered and 100% would be happy to be involved in future research. Two significant themes emerged from the open-ended data: that there were both positive and negative aspects of being involved in the trial. The positive aspects included the trial's value as a way of participating in research and as a way of providing evidence for practice. The negative aspects were that the design of the trial was not always reflective of usual clinical practice and the trial's impact on departments, therapists and patients. CONCLUSION: Clinical physiotherapists had both positive and negative perceptions about delivering two different interventions in a clinical trial. However, they were all interested in participating in future research, suggesting that the positive aspects outweighed the negative.

Treadmill walking with body weight support in subacute non-ambulatory stroke improves walking capacity more than overground walking: a randomised trial.

QUESTIONS: Is treadmill walking with body weight support during inpatient rehabilitation detrimental to walking quality compared with assisted overground walking? Does it result in better walking capacity, perception of walking or community participation? DESIGN: Analysis of secondary outcomes of a randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: 126 patients unable to walk within 4 weeks of a stroke who were undergoing inpatient rehabilitation. INTERVENTION: The experimental group undertook up to 30 minutes of treadmill walking with body weight support via an overhead harness per day while the control group undertook up to 30 minutes of overground walking. OUTCOME MEASURES: The secondary outcomes were walking quality and capacity, walking perception, community participation and falls. RESULTS: Six months after entering the study, there was no difference between the groups of independent walkers in terms of speed (MD 0.10 m/s, 95% CI -0.06 to 0.26) or stride (MD 6 cm, 95% CI -7 to 19). The independent walkers in the experimental group walked 57 m further (95% CI 1 to 113) in the 6 min walk than those in the control group. The experimental group (walkers and non-walkers) rated their walking 1 point out of 10 (95% CI 0.1 to 1.9) higher than the control group. There was no difference between the groups in community participation or number of falls. CONCLUSION: Treadmill training with body weight support results in better walking capacity and perception of walking compared to overground walking without deleterious effects on walking quality.