Citizen seismology helps decipher the 2021 Haiti earthquake.

On 14 August 2021, the moment magnitude (Mw) 7.2 Nippes earthquake in Haiti occurred within the same fault zone as its devastating 2010 Mw 7.0 predecessor, but struck the country when field access was limited by insecurity and conventional seismometers from the national network were inoperative. A network of citizen seismometers installed in 2019 provided near-field data critical to rapidly understand the mechanism of the mainshock and monitor its aftershock sequence. Their real-time data defined two aftershock clusters that coincide with two areas of coseismic slip derived from inversions of conventional seismological and geodetic data. Machine learning applied to data from the citizen seismometer closest to the mainshock allows us to forecast aftershocks as accurately as with the network-derived catalog. This shows the utility of citizen science contributing to our understanding of a major earthquake.

Cognitive and behavioural post-traumatic impairments: what is the specificity of a brain injury ? A study within the ESPARR cohort.

OBJECTIVE: The variety and extent of impairments occurring after traumatic brain injury vary according to the nature and severity of the lesions. In order to better understand their interactions and long-term outcome, we have studied and compared the cognitive and neurobehavioral profile one year post onset of patients with and without traumatic brain injury in a cohort of motor vehicle accident victims. METHOD: The study population is composed of 207 seriously injured persons from the ESPARR cohort. This cohort, which has been followed up in time, consists in 1168 motor vehicle accident victims (aged 16 years or more) with injuries with all degrees of severity. Inclusion criteria were: living in Rhone county, victim of a traffic accident having involved at least one wheel-conducted vehicle and having occurred in Rhone county, alive at the time of arrival in hospital and having presented in one of the different ER facilities of the county. The cohort's representativeness regarding social and geographic criteria and the specificities of the accidents were ensured by the specific targeting of recruitment. Deficits and impairments were assessed one year after the accident using the Neurobehavioral Rating Scale - Revised and the Trail-Making Test. Within our seriously injured group, based on the Glasgow Score, the presence of neurological deficits, aggravation of neurological condition in the first 72hours and/or abnormal cerebral imaging, we identified three categories: (i) moderate/severe traumatic brain injury (n=48), (ii) mild traumatic brain injury (n=89), and (iii) severely injured but without traumatic brain injury (n=70). RESULTS: The most frequently observed symptoms were anxiety, irritability, memory and attention impairments, depressive mood and emotional lability. While depressive mood and irritability were observed with similar frequency in all three groups, memory and attention impairments, anxiety and reduced initiative were more specific to traumatic brain injury whereas executive disorders were associated with moderate/severe traumatic brain injury. DISCUSSION-CONCLUSION: The presence and the initial severity of a traumatic brain injury condition the nature and frequency of residual effects after one year. Some impairments such as irritability, which is generally associated with traumatic brain injury, do not appear to be specific to this population, nor does depressive mood. Substantial interactions between cognitive, affective and neurobehavioral disorders have been highlighted.

Prognostic factors of long-term outcome in cases of severe traumatic brain injury.

INTRODUCTION: The purpose of this monocentric study was to assess the long-term outcome of a group of severe traumatic brain-injured patients and explore the prognostic values of some clinical and paraclinical parameters available at the initial stage. METHODOLOGY: The patients included were victims of severe traumatic brain injuries in 2007 or 2008. A standardized assessment was performed for each patient including clinical, radiological, and electrophysiological data collected at the initial stage, The outcomes were assessed at least 2 years after injury. Depending on the patients' availability and ability to communicate, the assessments included measures of dependency for activities of daily living (ADL), cognitive functions, behaviour, mood, and quality of life. RESULTS: Eighteen patients were included, of whom ten were autonomous for ADL at the time of assessment. Memory complaints, attentional deficits, anxiety, and irritability were the main long-term impairments observed. A correlation analysis showed significant correlations between the dependency level (as rated by the Functional Independence Measure) and each of length of coma, length of the post-traumatic amnesia, and the N100 auditory evoked potentials. DISCUSSION: These results confirm the uniqueness of each patient regarding the long-term consequences of a traumatic brain injury and the multi-determined nature of each prognosis.

Does the rectus femoris nerve block improve knee recurvatum in adult stroke patients? A kinematic and electromyographic study.

Knee recurvatum (KR) during gait is common in hemiplegic patients. Quadriceps spasticity has been postulated as a cause of KR in this population. The aim of this study was to assess the role of rectus femoris spasticity in KR by using selective motor nerve blocks of the rectus femoris nerve in hemiparetic stroke patients. The data from six adult, post-stroke hemiplegic patients who underwent a rectus femoris nerve block for a stiff-knee gait were retrospectively analyzed. An extensive clinical and functional evaluation was performed and gait was assessed by motion analysis (kinematic, kinetic and electromyographic parameters) before and during the block realized using 2% lidocaine injected under a neurostimulation and ultrasonographic targeting procedure. The main outcome measures were the peak knee extension in stance and peak knee extensor moment obtained during gait analysis. No serious adverse effect of the nerve block was observed. The block allowed a reduction of rectus femoris overactivity in all patients. Peak knee extension and extensor moment in stance did not improve in any patient, but peak knee flexion during the swing phase was significantly higher after block (mean: 31.2° post, 26.4 pre, p < 0.05). Our results provide arguments against the hypothesis that the spasticity of the rectus femoris contributes to KR.

Clinical signs and radiographic evidence of esophageal perforation after tetraplegia.

A diagnosis of esophageal perforation at some time after cervical spine surgery is difficult to establish since there exists no clinical picture specific to tetraplegic patients. We carried out a detailed retrospective study of revelatory clinical manifestations and conventional radiographic data in a series of 16 patients hospitalized at Hôpital Henry-Gabrielle (Lyon, France) for rehabilitation purposes between 1983 and 2010 and who presented this complication. The most frequent clinical picture associates cervical pain, fever and dysphagia. Simple front and side X-rays of the cervical spine led in 77% of the cases to a diagnosis of esophageal perforation. The most prevalent radiographic signs of the latter consist in osteosynthesis hardware or instrumentation failure, prevertebral free air next to the cervical esophagus and enlarged prevertebral space. Visualized esophageal X-rays, also known as series, highlight parenchymal opacity next to the posterior wall of the esophagus. A diagnosis of esophageal perforation needs to be carried out in order to facilitate suitable treatment and avoid the compromising of vital functions.

Oral anticoagulant treatment - evaluating the knowledge of patients admitted in physical medicine and rehabilitation units.

INTRODUCTION: While numerous therapeutic education programs exist in physical medicine and rehabilitation (PM&R), they rarely concern pharmacological treatments. Nevertheless, drugs prescribed during a hospital stay can have a significant risk of adverse events. Vitamin K antagonists (VKA) are among them. OBJECTIVE OF THE STUDY: To assess patients' knowledge on their oral anticoagulant treatment before their hospital discharge. METHODS: Fifty patients were enrolled in this prospective, monocenter study. Their level of knowledge was assessed by a semi-structured interview between the pharmacist and the patients and/or their caregivers. RESULTS: Seventy percent of patients were able to give the name of the drug they were taking, 82% could explain its effect and finally, 24% of patient knew their INR target values. Twenty-two percent of patients were able to describe the symptoms in case of overdose and what to do in that case. Forty percent of patients were aware of food interactions and 60% of self-medication risks. The patient's knowledge and behavior acquired during their hospital stay are not enough to guarantee a safe treatment management upon discharge. Based on this study, therapeutic patient education sessions were implemented. CONCLUSION: These results suggest that specific drug therapy management sessions should be developed as part of PM&R's therapeutic education programs for patients.

Long-term outcomes of chronic minimally conscious and vegetative states.

OBJECTIVE: The present retrospective cohort study compares the long-term functional outcome, improvement or deterioration, of patients considered in a vegetative state (VS) or a minimally conscious state (MCS) 1 year after coma onset, then yearly for up to 5 years. METHODS: We reviewed the clinical courses of 12 patients in VS and 39 in MCS. The outcomes were assessed at 2, 3, 4, and 5 years after injury using the 5 categories of the Glasgow Outcome Scale plus an additional category for patients in MCS. A logistic regression analysis investigated the relationships between each outcome and 10 predictor variables. Four of these variables were auditory evoked potentials recorded at the early stage of coma. RESULTS: None of the patients in VS improved during the follow-up period: 1 was lost to follow-up, 9 died, and 2 remained in VS. Among patients in MCS, 3 were lost to follow-up, 14 died, 9 remained in MCS, and 13 emerged from MCS with severe disabilities. VS, age >39 years, and bilateral absence of cortical components of middle-latency auditory evoked potentials were significantly associated with deterioration. CONCLUSIONS: In contrast to patients in VS, a third of patients in MCS improved more than 1 year after coma onset. This emphasizes the need to define reliable boundaries between VS and MCS using repeated clinical evaluations and all imaging and neurophysiologic tools available today.

Effect of prism adaptation on left dichotic listening deficit in neglect patients: glasses to hear better?

Unilateral neglect is a disabling syndrome frequently observed following right hemisphere brain damage. Symptoms range from visuo-motor impairments through to deficient visuo-spatial imagery, but impairment can also affect the auditory modality. A short period of adaptation to a rightward prismatic shift of the visual field is known to improve a wide range of hemispatial neglect symptoms, including visuo-manual tasks, mental imagery, postural imbalance, visuo-verbal measures and number bisection. The aim of the present study was to assess whether the beneficial effects of prism adaptation may generalize to auditory manifestations of neglect. Auditory extinction, whose clinical manifestations are independent of the sensory modalities engaged in visuo-manual adaptation, was examined in neglect patients before and after prism adaptation. Two separate groups of neglect patients (all of whom exhibited left auditory extinction) underwent prism adaptation: one group (n = 6) received a classical prism treatment ('Prism' group), the other group (n = 6) was submitted to the same procedure, but wore neutral glasses creating no optical shift (placebo 'Control' group). Auditory extinction was assessed by means of a dichotic listening task performed three times: prior to prism exposure (pre-test), upon prism removal (0 h post-test) and 2 h later (2 h post-test). The total number of correct responses, the lateralization index (detection asymmetry between the two ears) and the number of left-right fusion errors were analysed. Our results demonstrate that prism adaptation can improve left auditory extinction, thus revealing transfer of benefit to a sensory modality that is orthogonal to the visual, proprioceptive and motor modalities directly implicated in the visuo-motor adaptive process. The observed benefit was specific to the detection asymmetry between the two ears and did not affect the total number of responses. This indicates a specific effect of prism adaptation on lateralized processes rather than on general arousal. Our results suggest that the effects of prism adaptation can extend to unexposed sensory systems. The bottom-up approach of visuo-motor adaptation appears to interact with higher order brain functions related to multisensory integration and can have beneficial effects on sensory processing in different modalities. These findings should stimulate the development of therapeutic approaches aimed at bypassing the affected sensory processing modality by adapting other sensory modalities.

Parietal damage dissociates saccade planning from presaccadic perceptual facilitation.

A well-known theory in the field of attention today is the premotor theory of attention which suggests that the mechanisms involved in eye movements are the same as those for spatial attention shifts. We tested a parietal damaged patient with unilateral optic ataxia and 4 controls on a dual saccade/attentional task and show a dissociation between saccadic eye movements and presaccadic perceptual enhancement at the saccade goal. Remarkably, though the patient was able to make the appropriate saccades to the left, impaired visual field (undistinguishable from saccades to his right, intact visual field), he was unable to discriminate the letter at the saccade goal (whereas his performance was like controls for letter discrimination in his right visual field). This suggests that saccade planning and presaccadic perceptual facilitation are separable--planning a saccade to a location does not necessitate that the processing of this location is enhanced. Based on these results, we suggest that the parietal cortex is necessary for the coupling between saccade planning and presaccadic perceptual facilitation.

[Deep brain stimulation and Parkinson's disease]. / Stimulation cérébrale profonde et maladie de Parkinson.

Ten years after the therapeutic revolution that emerged from the discovery of l-dopa, some pioneer teams led the rebirth of a new nonablative stereotaxical surgical treatment, which came from the interest of high frequency stimulation. Three targets were retained as the main location of a reversible functional inhibition: Vim, GPI and STN. The unilateral or bilateral stimulation, adjustable and possibly reversible, led to an exceptional medicosurgical collaboration, within expert dedicated places, based on the control of the Parkinson's disease's (PD) triad. The stimulation was initially applied to the most advanced forms of PD, after the medical control period of the motor performance, when the pejorative effects of the evolution settled and/or when side effects of the treatment appeared. Subsequently, the research of selection criterions and the strict control of the stereotaxical procedure during the per- and postoperatory period, with the collaboration of the patient and his family, progressively brought different teams to an earlier indication of this new treatment option, up to now reserved for fully medicosurgical concerted cases. Apparition of cognitive and postural decline as well as the known resistance stage to l-dopa tend to become a real contra-indication. Despite the initial relative weakness of controlled studies with limited number of patients, the multiplication of follow-up studies among high quality multicentric cohorts enabled the validation of practices respecting the differences related to the initial background of each different team. In Europe first, the prevalence of the subthalamic target is now to be generally admitted. A new objective is now imposing itself: trying to maintain the patient's quality of life, beyond the only motor benefit. The social adaptation of a young patient is now also taken into account. If this exemplary clinical research approach, efficient for a few highly selected patients, has not transformed the long-term prognostic of the PD, it will continue to improve the comprehension of this degenerative pathology and its extension. It still remains hopeful for the future in the actual constant technological progress, and that probably beyond the only PD.

Optic ataxia is not only 'optic': impaired spatial integration of proprioceptive information.

Optic ataxia is considered to be a specific visuo-manual guidance deficit, which combines pointing errors due to the use of the contralesional hand ("hand effect") and to the presentation of the visual target in the contralesional field ("field effect"). The nature of the hand effect has not been identified. The field effect is acknowledged as an impaired spatial integration of visual target location. However, spatial integration of proprioceptive information from the arm has never been experimentally tested in these patients. Here, we specifically investigated the capacity of two patients with unilateral optic ataxia in tasks requiring different levels of proprioceptive integration from primary information processing to proprioceptivo-motor integration. In a first experiment -proprioceptive pointing with the ipsilesional hand toward the index finger of the contralesional hand- revealed a large mislocalisation of the ataxic hand accounting for the hand effect. In a second experiment -proprioceptive pointing with the ataxic arm toward the finger of the ipsilesional hand- revealed reaching errors for non-visual targets, i.e. optic ataxia is not specific to 'optic' targets. Altogether, the present results call for a redefinition of this neurological condition in the framework of parietal functions.

Looking while imagining: the influence of visual input on representational neglect.

BACKGROUND: Subjects with hemispatial neglect often exhibit representational neglect: a failure to report details from the left side of mentally visualized images. This failure could reflect impaired ability to generate the left side of the mental image, or it could reflect failure to explore the left side of a normally generated mental image. When subjects with hemispatial neglect look at pictures or drawings, their attention tends to be drawn to objects on the right side, thereby aggravating their failure to explore the left side. If representational neglect represents a failure to explore the left side of a normally generated mental visual image, then it should be improved by blindfolding, which removes the attention-catching right-sided stimuli. However, if representational neglect represents a failure to generate the left side of the mental visual image, then blindfolding should have little impact on reporting of details of the image. METHODS: To determine which of these explanations is correct, we asked eight normal participants and eight brain-damaged patients with left representational neglect to imagine the map of France and to name as many towns as possible in 2 minutes. In different sessions, participants performed the task with eyes open or while blindfolded. RESULTS: Normal participants mentioned more towns while blindfolded than with vision, thus suggesting a distracting effect of visual details on mental imagery. Patients with neglect, however, showed no appreciable effect of blindfolding on reporting of details from either side of mental images. CONCLUSION: Representational neglect may represent a failure to generate the left side of mental images.

[Handicap and quality of life evaluation in amyotrophic lateral sclerosis]. / Evaluation du handicap et de la qualité de vie.

The impact of amyotrophic lateral sclerosis and consequent disability on everyday life can be assessed with generic or specific and/or functional quality of life scales. Generic scales SF36, SIP (Sickness Impact Profiles) and SIP/ALS 19, SEIQoL have been validated for the assessment of quality of life in SLA. A specific scale has also been worked out and validated in this disease, the ALSAQ-40 scale. The ALSFRS (ALS Functional Rating Scale) is a tool validated to evaluate the patient's functional capacities. However, the patient's quality of life felt does not depend only on the disease course but also the patient's previous psychological profile, the environmental, social conditions and spiritual aspirations. The absence of a cognitive deficit makes the patient particularly lucid about the progressive degradation of health status. Evaluation must be carried out with individually for each patient, taking into account the social and familial environments, to appreciate real living conditions, and the impact of this degenerative disease.

[Physical therapy in amyotrophic lateral sclerosis]. / Quelles sont les modalités de thérapie physique symptomatique dans la Sclérose Latérale Amyotrophique (techniques de désencombrement bronchique exclues)?

Amyotrophic lateral sclerosis is a neurodegenerative disease, without any curative treatment. Clinical expression is variable and related to loss of motor neurons in the cortex, brain stem and spinal cord. There is little scientific evidence demonstrating the usefulness of physical therapy in this disease. Only stretching exercises, proprioceptive neuromuscular facilitation techniques and functional mobility training seem to have a real benefit in terms of spasticity, quality-of-life and pain. The main objective of physical therapy appears to be the preservation of optimal quality-of-life throughout the course of this incurable degenerative disease.

[What are management practices for speech therapy in amyotrophic lateral sclerosis?]. / Quelles sont les modalités de la prise en charge orthophonique dans la Sclérose Latérale Amyotrophique?

Amyotrophic lateral sclerosis involves deterioration of speech and swallowing. The objectives of rehabilitation are to maintain a comprehensible speech, using exercises on airflow-phonic coordination and breath, lingual and labial movements. Rehabilitation exercises also focus on the different times of swallowing to improve management of the food bolus in the mouth, to learn facilitating techniques and to adopt postures favoring passage of the food bolus. No studies have addressed the question of the effectiveness of rehabilitation in amyotrophic lateral sclerosis, in term of quality of life, maintenance of comprehensible speech or reduction of respiratory risks. Rehabilitation programs are established on an individual basis according to the clinical presentation and course.

Left size distortion (hyperschematia) after right brain damage.

OBJECTIVE: To quantitate a size distortion involving the side of space contralateral to the lesion (contralesional) in two right-brain-damaged patients. METHODS: We studied two right-brain-damaged patients with lesions sparing the occipital lobe and a mild left neglect on target cancellation or line bisection. The lesions involved the temporoparietal region (Patient 1) and the basal ganglia and the insula (Patients 1 and 2). Patients were given drawing tasks and tasks requiring perceptual and visuomotor judgments of horizontal extent. RESULTS: In drawing objects such as a daisy both from memory and by copying, patients exhibited a disproportionate enlargement of the left-hand side of objects and added more left-sided petals to the drawn daisy. This pathologic behavior persisted when the patients were blindfolded and was likely to reflect a perceptual, rather than premotor, size distortion. In a task requiring the perceptual matching of two rectangles, patients underestimated the left-sided stimulus. In a visuomotor task requiring the reproduction of the horizontal extent of a segment, patients exhibited a hyperextension, when a leftward movement was required. CONCLUSIONS: We showed a disordered representation of extrapersonal space, possibly involving a contralesional relaxation of the spatial medium. The deficit does not arise at the level of retinotopic coordinate frames and is independent of unilateral spatial neglect.

Functional anatomy of the therapeutic effects of prism adaptation on left neglect.

OBJECTIVE: To investigate the anatomic substrates underlying the beneficial effect of prism adaptation in five patients with persistent left neglect following right stroke. METHODS: In a functional imaging PET study, we used a covariation analysis to examine linear changes of regional cerebral blood flow over sessions as a function of left neglect improvement. RESULTS: The network of significant brain regions associated with improvement of left neglect performance produced by prism adaptation involved the right cerebellum, the left thalamus, the left temporo-occipital cortex, the left medial temporal cortex, and the right posterior parietal cortex. CONCLUSION: Our results suggest that the realignment of visuomotor coordinates is processed by the cerebellum and that low level sensorimotor adaptation actively modulates cerebral areas, albeit now relying on intact cerebellocerebral connections. Hence, our data support the hypothesis that the beneficial effect of prism adaptation on the clinical presentation of left neglect derives from modulation of cortical regions implicated in spatial cognition.

Prism adaptation improves spatial dysgraphia following right brain damage.

Visuo-manual adaptation to prisms produces a long-lasting improvement of visuo-spatial neglect. Improvement is also observed in tasks that do not involve visuo-manual component and that can all be consider to rely on a rightward (ipsilesional) orienting bias. Here, we report positive effects of prism adaptation on spatial dysgraphia, in a neglect patient following right brain damage. A long-lasting improvement concerned the right-page preference reflecting the ipsilesional bias but also the sloping lines and the broken lines reflecting visuo-constructive disorders in handwriting. Moreover, a transient improvement was also evidenced for the graphic errors. These results reinforce the idea that the process of prism adaptation may activate brain functions related to multisensory integration and higher spatial representations and show a generalization at a functional level. Prism adaptation therefore appears as useful tool in the theoretical attempt to identify the underlying 'core' mechanisms of the neglect syndrome.

Ipsidirectional impairment of prism adaptation after unilateral lesion of anterior cerebellum.

In a patient with damage of the left cerebellar cortex (SCA territory), the authors tested four combinations of exposure to optical shift (leftward prisms, right hand; rightward prisms, right hand; leftward prisms, left (ataxic) hand; rightward prisms, left (ataxic) hand). He adapted to rightward but not leftward prisms, independent of which hand was used during exposure. This suggests a role of anterior cerebellar cortex in the computation or compensation of ipsidirectional visual error.

[Assessment of disability and quality of life in patients with cognitive disorders]. / Evaluation des incapacités et de la qualité de vie des patients présentant des troubles cognitifs.

OBJECTIVE: To identify disability, handicap and quality of life questionnaires available for patients with cognitive impairment. MATERIALS AND METHODS: We systematically reviewed the literature in Medline using the keywords assessment, evaluation, deficiency, disability, disadvantage, handicap, quality of life, scale, index, questionnaire, ICIDH-1, and ICIDH-2, combined with the cognitive deficits dysexecutive syndrome, memory deficits, attention deficits, neglect, apraxia, aphasia, agnosia and mood disorders. We focused on validated scales and distinguished scales dedicated to assess disability, handicap and quality of life. RESULTS: At the level of disability, global and specific scales are available. Specific scales exist for dysexecutive syndrome, memory deficits, attention deficits, unilateral neglect, aphasia and mood disorders. French adaptations of foreign language tests and original tests developed in French have been validated in these areas. No specific tool is available for isolated apraxia or agnosia. Generic scales and pathology-specific scales (for stroke, traumatic brain injury, and multiple sclerosis) are available for quality of life. For aphasia, specific tools are available for incapacity handicap and quality of life. CONCLUSION: Previous results show the impact of the ICIDH-1 framework on functional outcome assessment of cognitive impairments. This approach is often limited by the lack of theoretical background and by the difficulty to assess the involvement of environment and anosognosia.