A scoping review on examination approaches for identifying tactile deficits at the upper extremity in individuals with stroke.

PURPOSE: Accurate perception of tactile stimuli is essential for performing and learning activities of daily living. Through this scoping review, we sought to summarize existing examination approaches for identifying tactile deficits at the upper extremity in individuals with stroke. The goal was to identify current limitations and future research needs for designing more comprehensive examination tools. METHODS: A scoping review was conducted in accordance with the Joanna Briggs Institute methodological framework and the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines. A database search for tactile examination approaches at the upper extremity of individuals with stroke was conducted using Medline (Ovid), The Cochrane Library (Wiley), CINAHL Plus with Full Text (Ebsco), Scopus (Elsevier), PsycInfo (Ebsco), and Proquest Dissertations and Theses Global. Original research and review articles that involved adults (18 years or older) with stroke, and performed tactile examinations at the upper extremity were eligible for inclusion. Data items extracted from the selected articles included: if the examination was behavioral in nature and involved neuroimaging, the extent to which the arm participated during the examination, the number of possible outcomes of the examination, the type(s) of tactile stimulation equipment used, the location(s) along the arm examined, the peripheral nerves targeted for examination, and if any comparison was made with the non-paretic arm or with the arms of individuals who are neurotypical. RESULTS: Twenty-two articles met the inclusion criteria and were accepted in this review. Most examination approaches were behavioral in nature and involved self-reporting of whether a tactile stimulus was felt while the arm remained passive (i.e., no volitional muscle activity). Typically, the number of possible outcomes with these behavioral approaches were limited (2-3), whereas the neuroimaging approaches had many more possible outcomes ( > 15 ). Tactile examinations were conducted mostly at the distal locations along the arm (finger or hand) without targeting any specific peripheral nerve. Although a majority of articles compared paretic and non-paretic arms, most did not compare outcomes to a control group of individuals who are neurotypical. DISCUSSION: Our findings noted that most upper extremity tactile examinations are behavioral approaches, which are subjective in nature, lack adequate resolution, and are insufficient to identify the underlying neural mechanisms of tactile deficits. Also, most examinations are administered at distal locations of the upper extremity when the examinee's arm is relaxed (passive). Further research is needed to develop better tactile examination tools that combine behavioral responses and neurophysiological outcomes, and allow volitional tactile exploration. Approaches that include testing of multiple body locations/nerves along the upper extremity, provide higher resolution of outcomes, and consider normative comparisons with individuals who are neurotypical may provide a more comprehensive understanding of the tactile deficits occurring following a stroke.

Influence of Single Bouts of Aerobic Exercise on Dual-Tasking Performance in Healthy Adults.

Dual-tasking performance (DTP) is critical for most real-life activities. Interventions to improve DTP would be clinically valuable. This study investigated effects of single-bouts of two different aerobic exercises on the performance of Extended cognitive Timed-Up and Go (ETUGcog), a dual-task test involving concurrent performance of a physical (ETUG) and cognitive (counting backwards serial 7 s) task. Twenty-two adults performed single bouts of high-intensity interval training (HIIT) and moderate-intensity exercise (MIE), separately. ETUGcog was performed before, immediately following, and 24 hours after each exercise. Number and rates of correct serial 7 s were significantly higher 24 hours after HIIT, with no difference in times to complete ETUGcog. No such effects were found for MIE. Single bouts of HIIT could provide delayed improvements in DTP.

Influence of a clinical experiential activity on student confidence in conducting effective fall-risk assessment on older adults.

The ability to confidently perform fall-risk assessment on older adults is critical for Doctor of Physical Therapy (DPT) students prior to entering workforce. The complex nature of falls makes it challenging to teach it realistically in traditional classroom settings. This could lead to lack of confidence in performing effective assessments in real clinical situations. For this purpose, an evidence-based experiential fall-risk assessment activity was implemented in the curriculum. The purpose was to investigate if this activity improved students' confidence in performing fall-risk assessment. Twenty-eight students completed this activity on thirty-three older adults from a senior living community. A 13-item questionnaire was used to investigate confidence before and after the activity. Significant improvements in students' confidence were noted for administering client interview (p = .001, r = -0.43), 30-Second Chair Stand Test (p = .046, r = -0.34) and 10-Meter Walk Test (p = .011, r = -0.27). Additionally, students demonstrated excellent inter-rater reliability (ICC > 0.9) with the faculty experts for administering 5-Times Sit-to-Stand, 10-Meter Walk, Berg Balance Scale, 4-Stage Balance, Timed Up and Go and 30-Second Chair Stand tests, and good inter-rater reliability (ICC = 0.78) for Single-Limb Stance Time test. This activity had a positive impact on DPT students' confidence in conducting effective fall-risk assessment.

Overexpression of serum response factor restores ocular dominance plasticity in a model of fetal alcohol spectrum disorders.

Neuronal plasticity deficits underlie many of the neurobehavioral problems seen in fetal alcohol spectrum disorders (FASD). Recently, we showed that third trimester alcohol exposure leads to a persistent disruption in ocular dominance (OD) plasticity. For instance, a few days of monocular deprivation results in a robust reduction of cortical regions responsive to the deprived eye in normal animals, but not in ferrets exposed early to alcohol. This plasticity deficit can be reversed if alcohol-exposed animals are treated with a phosphodiesterase type 1 (PDE1) inhibitor during the period of monocular deprivation. PDE1 inhibition can increase cAMP and cGMP levels, activating transcription factors such as the cAMP response element binding protein (CREB) and the serum response factor (SRF). SRF is important for many plasticity processes such as LTP, LTD, spine motility, and axonal pathfinding. Here we attempt to rescue OD plasticity in alcohol-treated ferrets using a Sindbis viral vector to express a constitutively active form of SRF during the period of monocular deprivation. Using optical imaging of intrinsic signals and single-unit recordings, we observed that overexpression of a constitutively active form of SRF, but neither its dominant-negative nor GFP, restored OD plasticity in alcohol-treated animals. Surprisingly, this restoration was observed throughout the extent of the primary visual cortex and most cells infected by the virus were positive for GFAP rather than NeuN. This finding suggests that overexpression of SRF in astrocytes may reduce the deficits in neuronal plasticity seen in models of FASD.

Phosphodiesterase type 4 inhibition does not restore ocular dominance plasticity in a ferret model of fetal alcohol spectrum disorders.

BACKGROUND: There is growing evidence that deficits in neuronal plasticity account for some of the neurological problems observed in fetal alcohol spectrum disorders (FASD). Recently, we showed that early alcohol exposure results in a permanent impairment in visual cortex ocular dominance (OD) plasticity in a ferret model of FASD. This disruption can be reversed, however, by treating animals with a Phosphodiesterase (PDE) type 1 inhibitor long after the period of alcohol exposure. AIM: Because the mammalian brain presents different types of PDE isoforms we tested here whether inhibition of PDE type 4 also ameliorates the effects of alcohol on OD plasticity. MATERIAL AND METHODS: Ferrets received 3.5 g/Kg alcohol i.p. (25% in saline) or saline as control every other day between postnatal day (P) 10 to P30, which is roughly equivalent to the third trimester equivalent of human gestation. Following a prolonged alcohol-free period (10 to 15 days), ferrets had the lid of the right eye sutured closed for 4 days and were examined for ocular dominance changes at the end of the period of deprivation. RESULTS: Using in vivo electrophysiology we show that inhibition of PDE4 by rolipram does not restore OD plasticity in alcohol-treated ferrets. CONCLUSION: This result suggests that contrary to PDE1, PDE4 inhibition does not play a role in the restoration of OD plasticity in the ferret model of FASD.