Apraxia in neurorehabilitation: Classification, assessment and treatment

Apraxia is a higher-order motor disorder impairing the ability to correctly perform skilled, purposive movements as the result of neurological disorders most commonly stroke, dementia and movement disorders. It is increasingly recognised that apraxia negatively influences activities of daily living (ADL). Early diagnosis and treatment should be part of the neurorehabilitation programme. The aim of the present article is to describe the most important subtypes of apraxia such as ideational and ideomotor apraxia as well as their impact on ADL and outcome. Furthermore, the relationship to associated disorders such as aphasia is discussed. Finally, strategies concerning assessment, management and treatment of the disorder are presented.

Osseointegration of hollow cylinder based spinal implants in normal and osteoporotic vertebrae: a sheep study

INTRODUCTION: Osteoporosis is not only responsible for an increased number of metaphyseal and spinal fractures but it also complicates their treatment. To prevent the initial loosening, we developed a new implant with an enlarged implant/bone interface based on the concept of perforated, hollow cylinders. We evaluated whether osseointegration of a hollow cylinder based implant takes place in normal or osteoporotic bone of sheep under functional loading conditions during anterior stabilization of the lumbar spine. MATERIALS AND METHODS: Osseointegration of the cylinders and status of the fused segments (ventral corpectomy, replacement with iliac strut, and fixation with testing implant) were investigated in six osteoporotic (age 6.9 +/- 0.8 years, mean body weight 61.1 +/- 5.2 kg) and seven control sheep (age 6.1 +/- 0.2 years, mean body weight 64.9 +/- 5.7 kg). Osteoporosis was introduced using a combination protocol of ovariectomy, high-dose prednisone, calcium and phosphor reduced diet and movement restriction. Osseointegration was quantified using fluorescence and conventional histology; fusion status was determined using biomechanical testing of the stabilized segment in a six-degree-of-freedom loading device as well as with radiological and histological staging. RESULTS: Intact bone trabeculae were found in 70% of all perforations without differences between the two groups (P = 0.26). Inside the cylinders, bone volume/total volume was significantly higher than in the control vertebra (50 +/- 16 vs. 28 +/- 13%) of the same animal (P<0.01), but significantly less (P<0.01) than in the near surrounding (60 +/- 21%). After biomechanical testing as described in Sect. "Materials and methods", seven spines (three healthy and four osteoporotic) were classified as completely fused and six (four healthy and two osteoporotic) as not fused after a 4-month observation time. All endplates were bridged with intact trabeculae in the histological slices. CONCLUSIONS: The high number of perforations, filled with intact trabeculae, indicates an adequate fixation; bridging trabeculae between adjacent endplates and tricortical iliac struts in all vertebrae indicates that the anchorage is adequate to promote fusion in this animal model, even in the osteoporotic sheep.

The functional relationship between yawning and vigilance

BACKGROUND: Although yawning is a ubiquitous and phylogenetically old phenomenon, its origin and purpose remain unclear. The study aimed at testing the widely held hypothesis that yawning is triggered by drowsiness and brings about a reversal or suspension of the process of falling asleep. METHODS: Subjects complaining of excessive sleepiness were spontaneously yawning while trying to stay awake in a quiet and darkened room. Changes in their electroencephalogram (EEG) and heart rate variability (HRV) associated with yawning were compared to changes associated with isolated voluntary body movements. Special care was taken to remove eye blink- and movement-artefacts from the recorded signals. RESULTS: Yawns were preceded and followed by a significantly greater delta activity in EEG than movements (p< or =0.008). After yawning, alpha rhythms were attenuated, decelerated, and shifted towards central brain regions (p< or =0.01), whereas after movements, they were attenuated and accelerated (p<0.02). A significant transient increase of HRV occurred after the onset of yawning and movements, which was followed by a significant slow decrease peaking 17s after onset (p<0.0001). No difference in HRV changes was found between yawns and movements. CONCLUSIONS: Yawning occurred during periods with increased drowsiness and sleep pressure, but was not followed by a measurable increase of the arousal level of the brain. It was neither triggered nor followed by a specific autonomic activation. Our results therefore confirm that yawns occur due to sleepiness, but do not provide evidence for an arousing effect of yawning.

Impact of coil position and electrophysiological monitoring on determination of motor thresholds to transcranial magnetic stimulation

OBJECTIVE: We compared motor and movement thresholds to transcranial magnetic stimulation (TMS) in healthy subjects and investigated the effect of different coil positions on thresholds and MEP (motor-evoked potential) amplitudes. METHODS: The abductor pollicis brevis (APB) 'hot spot' and a standard scalp position were stimulated. APB resting motor threshold (APB MEP-MT) defined by the '5/10' electrophysiological method was compared with movement threshold (MOV-MT), defined by visualization of movements. Additionally, APB MEP-MTs were evaluated with the '3/6 method,' and MEPs were recorded at a stimulation intensity of 120% APB MEP-MT at each position. RESULTS: APB MEP-MTs were significantly lower by stimulation of the 'hot spot' than of the standard position, and significantly lower than MOV-MTs (n=15). There were no significant differences between the '3/6' and the '5/10' methods, or between APB MEP amplitudes by stimulating each position at 120% APB MEP-MT. CONCLUSIONS: Coil position and electrophysiological monitoring influenced motor threshold determinations. Performing 6 instead of 10 trials did not produce different threshold measurements. Adjustment of intensity according to APB MEP-MT at the stimulated position did not influence APB MEP amplitudes. SIGNIFICANCE: Standardization of stimulation positions, nomenclature and criteria for threshold measurements should be considered in design and comparison of TMS protocols.

Evaluation of control and surveillance strategies for classical swine fever using a simulation model

Classical swine fever (CSF) outbreaks can cause enormous losses in naïve pig populations. How to best minimize the economic damage and number of culled animals caused by CSF is therefore an important research area. The baseline CSF control strategy in the European Union and Switzerland consists of culling all animals in infected herds, movement restrictions for animals, material and people within a given distance to the infected herd and epidemiological tracing of transmission contacts. Additional disease control measures such as pre-emptive culling or vaccination have been recommended based on the results from several simulation models; however, these models were parameterized for areas with high animal densities. The objective of this study was to explore whether pre-emptive culling and emergency vaccination should also be recommended in low- to moderate-density areas such as Switzerland. Additionally, we studied the influence of initial outbreak conditions on outbreak severity to improve the efficiency of disease prevention and surveillance. A spatial, stochastic, individual-animal-based simulation model using all registered Swiss pig premises in 2009 (n=9770) was implemented to quantify these relationships. The model simulates within-herd and between-herd transmission (direct and indirect contacts and local area spread). By varying the four parameters (a) control measures, (b) index herd type (breeding, fattening, weaning or mixed herd), (c) detection delay for secondary cases during an outbreak and (d) contact tracing probability, 112 distinct scenarios were simulated. To assess the impact of scenarios on outbreak severity, daily transmission rates were compared between scenarios. Compared with the baseline strategy (stamping out and movement restrictions) vaccination and pre-emptive culling neither reduced outbreak size nor duration. Outbreaks starting in a herd with weaning piglets or fattening pigs caused higher losses regarding to the number of culled premises and were longer lasting than those starting in the two other index herd types. Similarly, larger transmission rates were estimated for these index herd type outbreaks. A longer detection delay resulted in more culled premises and longer duration and better transmission tracing increased the number of short outbreaks. Based on the simulation results, baseline control strategies seem sufficient to control CSF in low-medium animal-dense areas. Early detection of outbreaks is crucial and risk-based surveillance should be focused on weaning piglet and fattening pig premises.

Bovine Tuberculosis Risk Factors for British Herds Before and After the 2001 Foot-and-Mouth Epidemic: What have we Learned from the TB99 and CCS2005 Studies?

Over the last couple of decades, the UK experienced a substantial increase in the incidence and geographical spread of bovine tuberculosis (TB), in particular since the epidemic of foot-and-mouth disease (FMD) in 2001. The initiation of the Randomized Badger Culling Trial (RBCT) in 1998 in south-west England provided an opportunity for an in-depth collection of questionnaire data (covering farming practices, herd management and husbandry, trading and wildlife activity) from herds having experienced a TB breakdown between 1998 and early 2006 and randomly selected control herds, both within and outside the RBCT (the so-called TB99 and CCS2005 case-control studies). The data collated were split into four separate and comparable substudies related to either the pre-FMD or post-FMD period, which are brought together and discussed here for the first time. The findings suggest that the risk factors associated with TB breakdowns may have changed. Higher Mycobacterium bovis prevalence in badgers following the FMD epidemic may have contributed to the identification of the presence of badgers on a farm as a prominent TB risk factor only post-FMD. The strong emergence of contact/trading TB risk factors post-FMD suggests that the purchasing and movement of cattle, which took place to restock FMD-affected areas after 2001, may have exacerbated the TB problem. Post-FMD analyses also highlighted the potential impact of environmental factors on TB risk. Although no unique and universal solution exists to reduce the transmission of TB to and among British cattle, there is an evidence to suggest that applying the broad principles of biosecurity on farms reduces the risk of infection. However, with trading remaining as an important route of local and long-distance TB transmission, improvements in the detection of infected animals during pre- and post-movement testing should further reduce the geographical spread of the disease.

Paleozoic-aged brine and authigenic helium preserved in an Ordovician shale aquiclude

Consideration of the geosphere for isolation of nuclear waste has generated substantial interest in the origin, age, and movement of fl uids and gases in low-permeability rock formations. Here, we present profi les of isotopes, solutes, and helium in porewaters recovered from 860 m of Cambrian to Devonian strata on the eastern fl ank of the Michigan Basin. Of particular interest is a 240-m-thick, halite-mineralized, Ordovician shale and carbonate aquiclude, which hosts Br–-enriched, post-dolomitic brine (5.8 molal Cl) originating as evaporated Silurian seawater. Authigenic helium that has been accumulating in the aquiclude for more than 260 m.y. is found to be isolated from underlying allochthonous, 3He-enriched helium that originated from the rifted base of the Michigan Basin and the Canadian Shield. The Paleozoic age and immobility of the pore fl uids in this Ordovician aquiclude considerably strengthen the safety case for deep geological repositories, but also provide new insights into the origin of deep crustal brines and opportunities for research on other components of a preserved Paleozoic porewater system.

Religion and the Senses in Early Modern Europe

Sensation is the subject of a burgeoning field in the humanities. This volume examines its role in the religious changes and transformations of early modern Europe. Sensation was not only central to the doctrinal disputes of the Reformation, but also critical in shaping new or reformed devotional practices. From this vantage point the book explores the intersections between the world of religion and the spheres of art, music, and literature; food and smell; sacred things and spaces; ritual and community; science and medicine. Deployed in varying, often contested ways, the senses were essential pathways to the sacred. They permitted knowledge of the divine and the universe, triggered affective responses, shaped holy environments, and served to heal, guide, or discipline body and soul.

Introduction XXIX European Seminar in Ethnomusicology: Cultural Mapping and Musical Diversity

«Cultural mapping» has become a central keyword in the UNESCO strategy to protect world cultural and natural heritage. It can be described as a tool to increase the awareness of cultural diversity. As Crawhall (2009) pointed out, cultural mapping was initially considered to represent the «landscapes in two or three dimensions from the perspectives of indigenous and local peoples». It thus transforms the intangible cultural heritage to visible items by establishing profiles of cultures and communities, including music traditions. Cultural mapping is used as a resource for a variety of purposes as broad as peace building, adaptation to climate change, sustainability management, heritage debate and management, but can also become highly useful in the analysis of conflict points. Music plays a significant role in each of these aspects. This year’s symposium invites to highlight, yet also to critically reassess this topic from the following ethnomusicological perspectives: - The method of cultural mapping in ethnomusicology What approaches and research techniques have been used so far to establish musical maps in this context? What kinds of maps have been developed (and, for example, how far do these relate to indigenous mental maps that have only been transmitted orally)? How far do these modern approaches deviate from the earlier cultural mapping approaches of the cultural area approaches that were still evident with Alan P. Merriam and in Alan Lomax` Cantometrics? In how far are the methods of cultural mapping and of ethnomusicological fieldwork different and how can they benefit from each other? - Intangible cultural heritage and musical diversity As the 2003 UNESCO Convention for the Safeguarding of the Intangible Cultural Heritage pointed out in Article 12, each state signing the declaration «shall draw up, in a manner geared to its own situation, one or more inventories of the intangible cultural heritage, present in its territory and monitor these.» This symposium calls for a critical re-assessment of the hitherto established UNESCO intangible cultural heritage lists. The idea is to highlight the sensitive nature and the effects of the various heritage representations. «Heritage» is understood here as a selection from a selection – a small subset of history that relates to a given group of people in a particular place, at a specific time (Dann and Seaton 2001:26). This can include presentations of case studies, yet also a critical re-analysis of the selection process, e.g. who was included – or even excluded (and why)? Who were the decision makers? How can the role of ethnomusicology be described here? Where are the (existent and possible) conflict points (politically, socially, legally, etc.)? What kinds of solution strategies are available to us? How is the issue of diversity – that has been so strongly emphasized in the UNESCO declarations – reflected in the approaches? How might diversity be represented in future approaches? How does the selection process affect musical canonization (and exclusion)? What is the role of archives in this process? - Cultural landscape and music As defined by the World Heritage Committee, cultural landscapes can be understood as a distinct geographical area representing the «combined work of nature and man» (http://whc.unesco.org/en/culturallandscape/). This sub-topic calls for a more detailed – and general – exploration of the exact relation between nature/landscape (and definition of such) and music/sound. How exactly is landscape interrelated with music – and identified (and vice versa)? How is this interrelation being applied and exploited in a (inter-)national context?

Music Piracy on Peer-to-Peer Networks

Content providers from the music industry argue that peer-to-peer (P2P) networks such as KaZaA, Morpheus, iMesh, or Audiogalaxy are an enormous threat to their business. They furthermore blame these networks for their recent decline in sales figures. For this reason, an empirical investigation was conducted during a period of 6 weeks on one of the most popular files-sharing systems, in order to determine the quantity and quality of pirated music songs shared. We present empirical evidence as to what extent and in which quality music songs are being shared. A number of hypotheses are outlined and were tested. We studied, among other things, the number of users online and the number of flies accessible on such networks, the free riding problem, and the duration per search request. We further tested to see if there are any differences in the accessibility of songs based on the nationality of the artist, the language of the song, and the corresponding chart position. Finally, we outline the main hurdles users may face when downloading illegal music and the probability of obtaining high quality music tracks on such peer-to-peer networks.

Driving and emergency braking may be impaired after tibiotalar joint arthrodesis: conclusions after a case series.

PURPOSE To assess whether reaction time (RT) and movement time (MT), as the two components of the total brake response time (TBRT) and brake force (BF) are different in patients with a foot joint arthrodesis in comparison to controls. METHODS The study was a comparative case series in a driving simulator under realistic driving conditions. Mobile patients without a walker, ≥6 months after surgery who were driving a car and had no neurological co-morbidity, knee or hip joint prosthesis were included in the study. The selection criteria resulted in 12 patients with right tibiotalar joint arthrodesis (TTJA) and 12 patients with another right foot joint arthrodesis (OFJA), who were compared to 17 individuals without any ankle-joint pathology. For TBRT, an empirical safe driving threshold of 700 ms was used. The outcome measures were RT, MT, TBRT, BF and McGuire score. RESULTS MT (p = 0.034) and TBRT (p = 0.026) were longer in TTJA patients in comparison with the controls. Also, more patients with TTJA than patients with OFJA and controls exceeded the safe driving threshold (p = 0.028). The outcomes in OFJA patients and in controls were comparable. The McGuire score was similar between the TTJA and OFJA patients (p = 0.26). CONCLUSIONS Significantly slower MT and TBRT, and significantly more patients exceeding the safe driving threshold, were observed after a tibiotalar-joint arthrodesis in comparison to the controls. Patients with OFJAs were not significantly different from the controls. Driving and emergency braking may be impaired after tibiotalar-joint arthrodesis.