COVID-19 lockdowns' effects on the quality of life, perceived health and well-being of healthy elderly individuals: A longitudinal comparison of pre-lockdown and lockdown states of well-being.

PURPOSE: . The concept of lockdown in relation to COVID-19 is thought to have an indirect impact on the quality of life and well-being of the elderly due to its consequences on the physical, psychological, and cognitive health of individuals. However, previous published studies on this subject are limited in terms of methodological approach used, including the absence of pre-confinement status and the type of experimental design, which is often cross-sectional. The present study proposes a longitudinal design with pre-confinement measures. It assesses changes in quality of life, perceived health, and well-being by comparing the period before lockdown (T1 = December 2019), three months after the start of the first lockdown (T2 = June 2020), and during the second lockdown (T3 = January 2021) due to COVID-19. MATERIALS AND METHODS: . This study is conducted with a group of 72 healthy elderly persons. They completed an electronic (online) survey assessing personal factors, activities, and participation as well as responding to the EuroQol-5D and Warwick-Edinburgh Mental Well-being Scale. RESULTS: . A decrease in quality of life, perceived health and well-being was observed between T1 and T2 and between T1 and T3, but no difference was reported between the two lockdown periods. The variables associated with these changes included energy level, level of happiness, physical activity, change in medical condition, memory difficulties, level of perceived isolation and age. CONCLUSION: . This study will help to target variables that may have a deleterious effect on older adults for consideration in future confinement settings and for preventive purposes.

Isotonic Saline Nebulization and Lung Function in Children With Mild Respiratory Ailments.

Nebulization with saline solution, although commonly used to alleviate respiratory symptoms, particularly in children, is often questioned concerning its effectiveness. In this study, we investigated the effects of isotonic saline nebulization on lung function in 40 children (mean age of 14±1 years) suffering from different types of airway disorders. Measurements were carried out directly before and up to 15 min after nebulization, for six days in a row, always on the same day time in the morning. The children were divided into two study groups according to the baseline ratio of forced expired volume in one second/forced vital capacity (FEV1/FVC), below and above 80 %. We found significant improvements after saline nebulization in FEV1, mid-expiratory flow at 50 % and 75 % of FVC (MEF50 and MEF75), and peak expiratory flow (PEF) in the group with the baseline FEV1/FVC less than 80 %. In contradistinction, children with an index greater than 80 % displayed no appreciable changes in the lung function variables when compared with the baseline level before saline nebulization. We conclude that isotonic saline nebulization might mitigate the functional signs of threatening pulmonary obstruction and as such may be clinically useful in pediatric patients with mild respiratory problems.

Impaired emotional biases in visual attention after bilateral amygdala lesion.

It is debated whether the amygdala is critical for the emotional modulation of attention. While some studies show reduced attentional benefits for emotional stimuli in amygdala-damaged patients, others report preserved emotional effects. Various factors may account for these discrepant findings, including the temporal onset of the lesion, the completeness and severity of tissue damage, or the extent of neural plasticity and compensatory mechanisms, among others. Here, we investigated a rare patient with focal acute destruction of bilateral amygdala and adjacent hippocampal structures after late-onset herpetic encephalitis in adulthood. We compared her performance in two classic visual attention paradigms with that of healthy controls. First, we tested for any emotional advantage during an attentional blink task. Whereas controls showed better report of fearful and happy than neutral faces on trials with short lags between targets, the patient showed no emotional advantage, but also globally reduced report rates for all faces. Second, to ensure that memory disturbance due to hippocampal damage would not interfere with report performance, we also used a visual search task with either emotionally or visually salient face targets. Although the patient still exhibited efficient guided search for visually salient, non-emotional faces, her search slopes for emotional versus neutral faces showed no comparable benefit. In both tasks, however, changes in the patient predominated for happy more than fear stimuli, despite her normal explicit recognition of happy expressions. Our results provide new support for a causal role of the amygdala in emotional facilitation of visual attention, especially under conditions of increasing task-demands, and not limited to negative information. In addition, our data suggest that such deficits may not be amenable to plasticity and compensation, perhaps due to sudden and late-onset damage occurring in adulthood.

Visuospatial bias in line bisection in Williams syndrome.

BACKGROUND: Recently, a study using the subjective straight-ahead task showed that individuals with Williams syndrome (WS) present a bias in the representation of body perception. The aim of the present study is to examine the horizontal midline body representation in WS participants using the bisection line task, which is an important benchmark for an egocentric frame of reference. METHOD: Fifteen WS participants (mean age = 21.7 ± 9.5 years) were compared with two typical development control groups: one composed of 15 participants matched on chronological age and one composed of 15 children matched on mental age. The task consisted of dividing each line in a series of 18 lines into two equal halves by drawing a vertical mark with a pencil in the centre of the line. RESULTS: Individuals with WS presented a significant leftward bias in comparison to mental age and chronological age groups. CONCLUSIONS: The leftward deviation in WS could be linked to the body representation bias and difficulties in the development of the egocentric reference system. An early detection of such deviation should help in the development of targeted interventions for WS individuals to improve visual-spatial skills and learning.

Acute gastric outlet obstruction secondary to exclusive paraoesophageal small bowel herniation: a case report.

INTRODUCTION: Herniation of abdominal viscera into the thorax may occur as a consequence of abnormal defects in the diaphragm. In adults, the most common condition relates to herniations through a weakened crural orifice via which the oesophagus normally traverses. These hiatus hernias are classified as types I-IV depending on the extent of visceral involvement. CASE REPORT: We present here a case of type IV hiatus hernia with massive mediastinal herniation of the small bowel, yet remarkable in that the stomach itself remained completely intra-abdominal. Gastric outlet obstruction occurred as a consequence of extrinsic proximal small bowel compression. DISCUSSION: To our knowledge this is the first reported case of paraoesophageal hernia exclusively involving small bowel, without involving any part of the stomach, and yet causing gastric outlet obstruction.

Where is the 'subjective straight ahead' in Williams syndrome?

BACKGROUND: Individuals with Williams Syndrome (WS) are known to have particular difficulties when performing visuo-spatial tasks, which could be related to their difficulties in using a specific reference system to determine spatial relations. The aim of the present study was to assess the internal representation of the body's sagittal plane, which is an important benchmark for an egocentric frame of reference. METHOD: The results of 18 WS individuals (mean age = 20.5 ± 9.2 years) on the subjective straight ahead (SSA) task were compared with those of two healthy control groups composed of 36 participants matched on chronological age matched on chronological age (CA) and 30 young children matched on non-verbal intellectual ability (YC). RESULTS: Individuals with WS showed a significant left deviation on the SSA body's sagittal plane representation compared with the chronological age control group and a marginal left deviation compared with the young children control group. A comparison with the objective SA (0°) showed a significant leftward deviation in the WS group but not in the two control groups. CONCLUSIONS: Individuals with WS showed a significant leftward deviation in the SSA task. This bias of the body's longitudinal axe representation could have a negative impact on the use of an egocentric reference system, which could be the cause for their difficulties in defining spatial relations (e.g. location and orientation) necessary for performing spatial tasks.

Functional neuro-anatomy of egocentric versus allocentric space representation.

INTRODUCTION: The functional neuroanatomy of the egocentric and allocentric representations of space remains poorly studied with neuroimaging. Here we aim to determine brain structures subserving two different kinds of spatial representations centred on the main axis of either the body or the external scene. METHOD: Sixteen healthy participants evaluated the alignment of a bar relative to the middle of their body (Ego) or relative to another stimulus (Allo) during functional MRI. In a control task (Ctrl), they had to judge the colour of the bar. RESULTS: Correct response rates and response times were similar in the three tasks. fMRI data revealed a predominant role of the right hemisphere in the egocentric task (Ego vs. Allo): selective activity was found in the occipital, superior parietal, and inferior frontal cortices, as well as in the precuneus and supplementary motor area. On the left side, the insula, thalamus, and cerebellum were also activated. Conversely, the allocentric task (Allo vs. Ctrl) showed selective activity centred on the left temporal gyrus. DISCUSSION: This study demonstrates a right hemisphere dominance for representations centred on the longitudinal body axis, but more left-sided activity for scene/object-centred representations of space. These new data shed light on the unique role of several regions involved in spatial perception and help better understand spatial deficits in patients with right hemispheric lesions.

Integration of visual and haptic informations in the perception of the vertical in young and old healthy adults and right brain-damaged patients.

OBJECTIVE: Multimodal perception raises the issue of sensory integration. The aim of this study is to assess whether the visuo-haptic subjective vertical could be predicted from the visual and haptic unimodal performances, according to a Bayesian model, which optimizes the reliability of the multimodal estimate. The limits of the model were assessed by evaluating the impact of aging, cerebral damage and spatial deficits. METHOD: Young and older healthy participants, as well as patients with a right hemisphere lesion, suffering from spatial neglect or not, had to align a rod with the gravitational vertical in the visual, haptic and visuo-haptic modalities. RESULTS: Visuo-haptic subjective vertical was correctly predicted by the model in healthy participants, as well as in patients in spite of different performances. An anticlockwise deviation of the subjective vertical was observed in the neglect group whatever the experimental conditions. By contrast, no deviation was observed in both non-neglect and healthy groups, for the visual and the visuo-haptic modalities. Nevertheless, the haptic subjective vertical was deviated, anticlockwise in the non-neglect patients and older healthy adults, and clockwise in the young healthy adults. Moreover, the variance was the smallest in the bimodal condition. CONCLUSION: The integration of visual and haptic signals appeared to obey a Bayesian model optimizing the reliability of the multimodal estimate. This holds true despite of aging, brain damage or visuospatial disorders. Regarding the perception of the vertical, multisensory integration does not seem thus to depend only on right posterior cortical areas.

Body representations and brain damage.

We review changes in body representation in patients with brain hemisphere damage and discuss their relationship with impaired limb movements in peripersonal space, navigation between objects/obstacles and control of the body's general posture and balance. The egocentric representation of the body's median sagittal axis (considered as the main zone around which movements are anchored) has been studied in most detail. This reference is distorted in patients with spatial neglect and involves a combination of ipsilesional translation and contralesional tilt. There are clear links with the patients' difficulties in egocentric tasks, activities of daily living and postural control. In both healthy subjects and patients, this reference axis can be modulated by somaesthetic, vestibular and visual stimulations; these phenomena have been used in rehabilitation programmes to reduce disease-induced deviations. A few studies have analyzed other lateral body reference (at the shoulders, in particular). These references were found to be more severely affected than the body midline (notably on the contralesional side). The severity of the distortion was related to the presence of lesions that mainly affected the parietal, somatosensory and multimodal association cortex (notably around the intraparietal sulcus) and, to a lesser extent, the middle temporal and frontal dorsolateral premotor cortex. These convergent results suggested that patients (notably those with neglect) have a complex distortion of the body schema and the perceptive representations of the body, that does not simply correspond to poor awareness of the contralateral hemicorpus.

Effects of pro-cholinergic treatment in patients suffering from spatial neglect.

Spatial neglect is a neurological condition characterized by a breakdown of spatial cognition contralateral to hemispheric damage. Deficits in spatial attention toward the contralesional side are considered to be central to this syndrome. Brain lesions typically involve right fronto-parietal cortices mediating attentional functions and subcortical connections in underlying white matter. Convergent findings from neuroimaging and behavioral studies in both animals and humans suggest that the cholinergic system might also be critically implicated in selective attention by modulating cortical function via widespread projections from the basal forebrain. Here we asked whether deficits in spatial attention associated with neglect could partly result from a cholinergic deafferentation of cortical areas subserving attentional functions, and whether such disturbances could be alleviated by pro-cholinergic therapy. We examined the effect of a single-dose transdermal nicotine treatment on spatial neglect in 10 stroke patients in a double-blind placebo-controlled protocol, using a standardized battery of neglect tests. Nicotine-induced systematic improvement on cancellation tasks and facilitated orienting to single visual targets, but had no significant effect on other tests. These results support a global effect of nicotine on attention and arousal, but no effect on other spatial mechanisms impaired in neglect.

Hemianopia and neglect influence on straight-ahead perception.

In spatial neglect, the pathological ipsilesional deviation of the subjective straight ahead (SSA) received both 'translational' and 'rotational' interpretations. Furthermore, hemianopia per se could also influence straight-ahead (SA) perception. Here, we aimed at disentangling the relative effects of neglect and hemianopia on the SSA by using a method analyzing translation and rotation in parallel. We included patients with a right hemisphere stroke. Ten had neglect and hemianopia, 6 neglect only, 3 hemianopia only, and 12 neither one nor the other. 15 were controls. Participants had to adjust a bar, movable in translation and rotation, SA of the navel, in darkness. Patients with spatial neglect showed systematic rightward translation, greater when hemianoptic. The rotation component appeared more variable and was influenced by the presence of a visual field defect, as most of the patients with hemianopia showed an anticlockwise rotation and most of the patients without hemianopia a clockwise rotation. Non-neglect patients and control subjects demonstrated a fair performance level. In conclusion, both neglect and hemianopia resulted in a translation error of the SSA to the ipsilesional side. In neglect patients, additional hemianopia resulted in a counterclockwise rotation. Furthermore, rotation and translation errors appeared dissociated, suggesting a different coding of these dimensions by the right posterior hemisphere.

Reducing rightward bias of subjective straight ahead in neglect patients by changes in body orientation.

BACKGROUND: The subjective straight ahead (SSA), a measure of the representation of body orientation, has been shown to be shifted to the lesion side in neglect patients, and to be influenced by stimulation of sensory systems involved in postural control. METHOD: This study investigates the influence of changing body orientation in the sagittal plane on the SSA in 21 patients with a right hemispheric lesion, of whom 12 had neglect, in comparison with six healthy control subjects. In order to quantify both horizontal components of SSA error (ie, yaw rotation and lateral shift), the study used a method requiring the alignment of a luminous rod with SSA. RESULTS: Neglect patients showed a significant rightward shift in the sitting position, which was greatly reduced in the supine position. No shift occurred in patients without neglect or in controls. Yaw rotation did not reach significance in any group. CONCLUSION: The data showed that the body centred frame of reference, mostly translated in neglect, is strongly improved in the supine position. Changing body orientation seems to be a convenient tool to correct the representation of body midline.

Where is the "straight ahead" in spatial neglect?

We investigated the subjective straight-ahead (SSA) projection of body-midline parts (head and trunk) in patients with neglect and patients with nonneglect, using a method disentangling lateral shift and lateral tilt components of the bias. Patients with neglect showed a similar counterclockwise SSA tilt for each body part and an ipsilesional lateral shift, more severe for the trunk than for the head. Thus, neglect results in a tilt of the body midline representation.

Perception of the vertical in patients with right hemispheric lesion: effect of galvanic vestibular stimulation.

Patients with right-brain injury present, more frequently in the acute phase, with a deviation of the subjective vertical (SV) contralateral to the lesion. The aim of this study was to investigate the influence of galvanic vestibular stimulation (GVS) on this disorder. Twelve patients presenting with a right hemispheric lesion, seven with neglect (N+) and five without (N-) were compared to eight control subjects. They had to orient vertically a luminous rod in darkness, in three galvanic stimulation (1.5 mA) conditions: cathode left, cathode right and no stimulation (baseline). Without stimulation, the patients' SV, and especially that of N+, showed an anticlockwise deviation. In comparison with baseline values, GVS induced a deviation toward the side opposite to the cathode in the three groups. In the patients, the deviation was of larger amplitude and appeared greater for left than for right cathodic stimulation. In conclusion, we showed an influence of vestibular stimulation on the SV of right brain-injured patients, especially when spatial neglect was present. As left cathodic stimulation can reduce the SV deviation associated with spatial neglect, such a tool could be introduced in rehabilitation.