Inhibition of Return (IOR): Is it Consciousness of an Object without Attention or Attention without an Object and Consciousness?

The crux of the dispute on the mutual relations between attention and consciousness, and to which I have referred in this paper, lies in the question of what can be attended in spatial attention that obviously resonates with the phenomenological issue of intentionality (e.g., the noesis-noema structure). The discussion has been initiated by Christopher Mole. He began by calling for a commonsense psychology, according to which one is conscious of everything that one pays attention to, but one does not pay attention to all the things that one is conscious of. In other words, attention is supposed to be a condition which is sufficient but not necessary for consciousness, i.e., consciousness is a necessary concomitant of attention, but attention is not a necessary concomitant of consciousness. Mole seeks to validate his stance with data from psychology labs. His view is, however, partly confronted, for instance, by Robert Kentridge, Lee de-Wit and Charles Heywood, who used their experimental research on a neurological condition called blindsight as evidence of a dissociation between attention and consciousness, i.e., that visual attention is not a sufficient precondition for visual awareness. In this meta-theoretical state of affairs, I would like to focus on the cognitive phenomenon most often referred to as Inhibition of Return (IOR) and suggest that, following its micro dynamics from the perspective of micro-phenomenology, it can be used to actually showcase all of the options on both sides of the argument. One of my leading goals would be also to follow Mole’s attempt to link attention with agency but where we differ is that I wish to heuristically articulate the matter in terms of Merleau-Ponty’s phenomenological notion of embodied pre-reflective intentionality.

Rethinking individual autonomy in medical decision-making for young adults reliant on caregiver support: A case report and analysis

There is a gap in the clinical bioethics literature concerning the approach to assessment of medical decision-making capacity of adolescents or young adults who demonstrate diminished maturity due to longstanding reliance on caregiver support, despite having reached the age of majority. This paper attempts to address this question via the examination of a particular case involving assessment of the decision-making capacity of a young adult pregnant patient who also had a physically disabling neurological condition. Drawing on concepts from adolescent bioethics and feminist critiques of bioethical theory, we argue that limited life experience, secondary to a disabling neurological condition, can result in a lack of adult-like capacity even in a patient who is legally an adult. In such cases, it may be that autonomy, to the extent that it is to be relevant and meaningful, must be viewed through a relational lens. Furthermore, clinicians may avoid unjustifiably paternalistic practices by working with the patient help her gain a better appreciation of the consequences of her decision, thereby calling forward her capacity rather than resorting to being directive in counseling. We conclude that lessons from this case can be used to approach ethically complex instances of medical decision-making in adult patients with normal cognition but diminished experiential maturity.

Clipping versus coiling for aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis of prospective studies

Neurosurgical clipping and endovascular coiling are both standard therapies to prevent rebleeding after aneurysmal subarachnoid hemorrhage (aSAH). However, controversy still exists about which is the optimal treatment. This meta-analysis aims to assess the effectiveness and safety of two treatments with high-quality evidence. Web of Science, Cochrane Library, EMBASE, Pubmed, Sinomed, China National Knowledge Infrastructure, and Wanfang Data databases were systematically searched on August 5, 2021. Randomized controlled trials (RCTs) and prospective cohort studies that evaluated the effectiveness and safety of clipping versus coiling in aSAH patients at discharge or within 1-year follow-up period were eligible. No restriction was set on the publication date. Meta-analyses were conducted to calculate the pooled estimates and 95% confidence intervals (CI) of relative risk (RR). Eight RCTs and 20 prospective cohort studies were identified. Compared to coiling, clipping was associated with a lower rebleeding rate at discharge (RR: 0.52, 95% CI: 0.29––0.94) and a higher aneurysmal occlusion rate (RR: 1.33, 95% CI: 1.19–1.48) at 1-year follow-up. In contrast, coiling reduced the vasospasm rate at discharge (RR: 1.45, 95% CI: 1.23–1.71) and 1-year poor outcome rate (RR: 1.27, 95% CI: 1.16–1.39). Subgroup analyses presented that among patients with a poor neurological condition at admission, no statistically significant outcome difference existed between the two treatments. The overall prognosis was better among patients who received coiling, but this advantage was not significant among patients with a poor neurological condition at admission. Therefore, the selection of treatment modality for aSAH patients should be considered comprehensively.

Innovation and invention: the role of virtual occupational therapy in the management of motor neurone disease

Background: Motor neurone disease (MND) is a progressive neurological condition with no known cure. Supportive management and symptom control by a multidisciplinary team forms the mainstay of treatment. Caring for patients with MND throughout the COVID-19 required service providers to think of ways to adapt the service in order to meet the acute and constantly changing needs of their service users within pandemic guidelines. Aims: This paper explores innovative changes within the occupational therapy service provision during the pandemic and how it supports the multidisciplinary team (MDT) working. It also evaluates the merits and disadvantages of using virtual technology in specific areas of occupational therapy intervention. Methods: A set of prioritisation criteria was developed to understand the rationale for virtual versus face-to-face input. A reflective process has been used to identify and evaluate innovative service provision in occupational therapy in the management of motor neurone disease. Findings: Virtual consultations were an effective way of providing certain aspects of occupational therapy input. Virtual consultations were found to be less effective during moving and handling assessments, complex environmental adaptations assessment and when managing complex cognitive presentations. During the pandemic there was a rise in referrals for cognitive behavioural management, a specialist area of expertise for occupational therapy in this clinical area. A holistic approach was paramount in meeting the evolving needs of patients across functional domains. Occupational therapy complemented the caring and supportive role of nurses and other members of the MDT in the management of MND. Conclusions: Occupational therapy input can support an MDT by providing valuable assessment of functional decline, specialist equipment, supporting cognitive-behavioural performance, restoring life roles and minimising the challenges imposed by the environment. Using virtual technology discernibly can be an invaluable approach to occupational therapy practice within an MDT setting for managing a progressive neurological condition, such as MND, during a pandemic.

Factors associated with being an older rather than younger unpaid carer of adults with a chronic health condition: Results from a population-based cross-sectional survey in South Australia

Objective To examine sociodemographic characteristics and caring experiences associated with being an older rather than younger carer of an adult with a chronic health condition. Methods The population-based cross-sectional South Australian Health Omnibus survey was administered in 2016. Multiple logistic regression was used to identify sociodemographic characteristics and caring experiences associated with being an older (≥65 years) versus younger (<65 years) carer of one or more adult(s) with a chronic health condition. Results Of 988 survey respondents who self-identified as carers, 198(20%) were 65 years or over. Characteristics associated with being an older carer included having a partner, having poor physical health, being born outside Australia, have no formal qualification, living in a household of 1–2 people, have an annual household income ≤$60,000, and owning one's home. Carer experiences associated with older carer status included providing ≥40 h of care per week, perceived control over caring, and caring for someone with a neurological condition, whereas caring for someone with a mental illness, reporting poor mental health of their own, and providing personal care were inversely associated. Discussion Interventions directed at older carers should consider the increased likelihood that they may be investing large amounts of time in caring for someone with a neurological condition, and be culturally and linguistically diverse.

Oropharyngeal Dysphagia and Impaired Motility of the Upper Gastrointestinal Tract—Is There a Clinical Link in Neurocritical Care?

Patients in the neurological ICU are at risk of suffering from disorders of the upper gastrointestinal tract. Oropharyngeal dysphagia (OD) can be caused by the underlying neurological disease and/or ICU treatment itself. The latter was also identified as a risk factor for gastrointestinal dysmotility. However, its association with OD and the impact of the neurological condition is unclear. Here, we investigated a possible link between OD and gastric residual volume (GRV) in patients in the neurological ICU. In this retrospective single-center study, patients with an episode of mechanical ventilation (MV) admitted to the neurological ICU due to an acute neurological disease or acute deterioration of a chronic neurological condition from 2011–2017 were included. The patients were submitted to an endoscopic swallowing evaluation within 72 h of the completion of MV. Their GRV was assessed daily. Patients with ≥1 d of GRV ≥500 mL were compared to all the other patients. Regression analysis was performed to identify the predictors of GRV ≥500 mL/d. With respect to GRV, the groups were compared depending on their FEES scores (0–3). A total of 976 patients were included in this study. A total of 35% demonstrated a GRV of ≥500 mL/d at least once. The significant predictors of relevant GRV were age, male gender, infratentorial or hemorrhagic stroke, prolonged MV and poor swallowing function. The patients with the poorest swallowing function presented a GRV of ≥500 mL/d significantly more often than the patients who scored the best. Conclusions: Our findings indicate an association between dysphagia severity and delayed gastric emptying in critically ill neurologic patients. This may partly be due to lesions in the swallowing and gastric network.

Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition

Introduction: The growing years are paramount for bone growth and mineral accrual. Children with long-term neurological condition (LTNC) have multiple risk factors for poor bone health and fragility fractures. In Singapore, this has not been studied systematically therefore we aim to evaluate the risk factors associated with fragilty fractures in children with LTNC. Methods: In this study, the search for fragility fractures was done by a retrospective review of patients with LTNC who are under follow-up in the Paediatric Neurology clinic and of patients who presented with fracture to the Paediatric Orthopaedic clinic. Information on patient’s demographics, medical history, intervention, biochemical bone markers and fracture history were collected. Results: In a tertiary clinic population of 136 patients with LTNC, 65% were dependent on mobility (GMFCS V), 60% were underweight and 60% were fed via gastrostomy or nasogastric tube, or on oral pureed diet. Furthermore, 60% were on anticonvulsants. The fracture rate was 3% in this population and was associated with low-impact activities such as transfer and dressing. Only 7.4% had a vitamin D level measured and 33% had calcium measured. Conclusion: The local prevalence of fragility fractures in children with LTNC who are under follow-up at the Neurology clinic was found to be 3%. Risk factors identified were limited ambulation and compromised nutritional status associated with feeding difficulty. Recommendations to optimize bone health in children with LTNC were made. These include promoting weight-bearing activities, looking out for underweight, avoiding vitamin D deficiency and ensuring adequate calcium intake.

Expression Analysis of SOCS Genes in Migraine

Migraine is a complex neurological condition affecting a large proportion of persons. Dysregulation of several immune-related transcripts has been noted in migraineurs suggesting an immune-based background for this condition. We measured expression levels suppressor of cytokine signaling (SOCS) genes in the venous blood of migraineurs compared with controls. SOCS1 was down-regulated in patients without aura compared with controls [Ratio of mean expression (RME) = 0.08, P value &lt; 0.001]. This pattern was also detected among female subgroups (RME = 0.06, P value = 0.010), but not among male subgroups (RME = 0.22, P value = 0.114). Expression of SOCS1 was significantly higher in patients with aura compared with those without aura (RME = 5.89, P value = 0.037). Meanwhile, expression of SOCS2 was lower in migraineurs with aura compared with controls (RME = 0.03, P value &lt; 0.001). In addition, this gene was under-expressed in patients without aura compared with controls and in both sex-based subgroups of this group of patients (RME = 0.01, P value &lt; 0.001 for all comparisons). However, its expression was higher in male patients with aura compared with those without aura (P value &lt; 0.001). For SOCS3, we detected a lower level of expression in patients without aura compared with controls (RME = 0.07, P value &lt; 0.001). However, the expression of SOCS3 was higher in patients with aura compared with those without aura (RME = 7.46, P value = 0.001). SOCS5 was down-regulated in patients without aura compared with controls (RME = 0.10, P value &lt; 0.001). Expression of this gene was also lower in patients with aura compared with controls (RME = 0.03, P value &lt; 0.001), and in male patients of this group compared with controls (RME = 0.03, P value = 0.004). On the other hand, expression of SOCS5 was higher in male patients with aura compared with sex-matched patients without aura (RME = 6.67, P value = 0.001). SOCS2 levels could appropriately differentiate migraineurs from healthy subjects. The current study suggests the role of SOCS genes in the pathoetiology of migraine.

Quantitative Radiologic analysis and Clinical Outcomes of Urgent EC-IC Bypass for Hemodynamic Compromised Patients with Acute Ischemic Stroke

Objective The treatment of choice for acute ischemic stroke with large vessel occlusion is intra-arterial thrombectomy. The extracranial-to-intracranial (EC-IC) bypass was relatively devaluated; however, recent studies have shown that this surgery can be helpful when performed for a highly selective patient group. Methods We analyzed 41 patients who underwent urgent EC-IC bypass at the Seoul National University Bundang Hospital after being selected using strict operation criteria and retrospectively reviewed the effectiveness and safety of the surgery. In particular, quantitative data from perfusion computed tomography images were reconstructed to analyze the changes in pre- and postoperative perfusion status in terms of objective numerical values. We also clinically assessed the patients’ neurological outcome and complication rates. Results Immediate postoperatively, the volume of time-to-max (Tmax) > 6 second decreased significantly; it continued to improve significantly until 6 months postoperatively (preoperative, 89 ml; immediate postoperative, 21.5 ml; postoperative 6 months, 10.5 ml). Ischemic core-penumbra mismatch volumes were also significantly improved until 6 months postoperatively (preoperative, 77 ml; immediate postoperative, 21 ml; postoperative 6 months, 5.5 ml). Other perfusion parameters, such as Tmax > 10 s, Tmax > 8 s, and Tmax > 4 s also showed statistically significant improvement. In addition, the patient's neurological condition significantly improved. The surgical complication rate in this study was similar to those in previous studies. The predictors of good postoperative neurological condition were the patient's preoperative condition and perfusion status of the patient immediately postoperatively. Conclusion Emergent EC-IC bypass can be useful for patients with acute ischemic stroke with large vessel occlusion ineligible for IAT if surgery is performed well after applying the strict surgical indications.

Dyke-Davidoff-Masson Syndrome with crossed cerebellar atrophy

Dyke-Davidoff-Masson Syndrome (DDMS) is a rare neurological condition characterised clinically by recurrent seizures, facial asymmetry, hemiplegia and mental retardation likely due to foetal or early childhood cerebral insult. We describe the MRI findings of DDMS in a 10-year-old male child. MRI brain revealed right cerebral atrophy, ipsilateral thickening of calvarium, right lateral ventricular dilatation, hyper-pneumatisation of frontal sinus, and contralateral cerebellar atrophy which are consistent with DDMS.