Post-Stroke Depression: Prevalence, Associated Factors, and Relationship to Disability in a Tertiary Care Center in Sri Lanka

Background and Objectives The prevalence of stroke in urban Sri Lanka is estimated at 10.4 per 1000 and is expected to rise. Post-stroke depression (PSD) is an independent predictor of poor long-term outcomes. It leads to suboptimal rehabilitation, decreased quality of life, and increased mortality and is under-recognized. The main objectives of this study were to estimate the prevalence of depression in stroke, assess factors associated with PSD, and assess the relationship of PSD to disability. Materials and Methods A descriptive cross-sectional study was conducted at the Neurology and Medical Ward, National Hospital of Sri Lanka. Non-probability, consecutive sampling was used to collect data from patients with ischemic stroke admitted from January 2019 to January 2020. Patients with significant pre-existing depression, cognitive impairment, and language deficits were excluded. A structured, pre-tested interviewer-administered questionnaire was used to assess the prevalence and associated factors of PSD. Beck's Depression Inventory (BDI) was administered 3 months following the stroke to screen for depression. Modified Rankin Score (MRS) was used to assess disability on admission, discharge, and at 3 months. Results Eighty-one stroke patients were screened. The mean age was 66.6 years (±standard deviation [SD]: 12.5). Male:female ratio was 1.2:1. Depression at 3 months of follow-up was observed in 35.8% (95% confidence interval [CI]: 25.4–47.2%) of participants. Following bivariate analysis, large vessel stroke (p < 0.001), cortical stroke (p < 0.001), frontal lobe lesions (p < 0.001), history of past stroke (p = 0.014), and sexual dysfunction (p = 0.026) were associated with increased risk of PSD. The odds of a person with severe disability developing PSD was 7.9 times more than a person with a less severe disability at discharge from hospital and at 3 months of follow-up (odds ratio [OR] =7.9; 95% CI: 2.7–23.3, p = 0.000). Conclusions PSD occurs in one-third of strokes, keeping with previous studies. The risk of having PSD is higher among patients with severe disabilities. The difference in risk factors identified compared with previous studies can be attributable to differences in methodology. Identifying risk factors for post-stroke depression is essential to mitigate the poor outcome.

A semi-standardized music therapy intervention for girls with Rett syndrome: A descriptive essay

Rett syndrome (RTT) is a severe neurodevelopmental disorder resulting in a wide range of functional impairments and therefore greatly impacts the lives of both patients and their families. While genetic and medical aspects have been studied for several decades, rehabilitation intervention research is still in its infancy. In this study, the investigating researchers have presented a rehabilitative framework by using music therapy for girls with RTT. This model is founded upon the use of music therapy in light of Stern’s proposal of subjective experience and affect attunement; it also refers to Rosenbaum’s family-centered rehabilitation medicine perspective. This study both describes the theory behind this intervention and presents a newly developed outcome measure. This novel tool may have future clinical and research applications. Music therapy for patients with RTT has not been well researched yet, and as a result, is not universally recommended. However this study’s findings suggest that music therapy is an important component of multidisciplinary therapy. Further collaborative research should be encouraged in order to study and implement the use of music therapy in the treatment of severe disabilities. Projects such as the Enablin+program with the support from the European Commission constitute fundamental tools in promoting integrative medical research and international networks.

Examining the Transition Networks of Secondary Special Educators: An Explanatory Sequential Mixed Methods Study

Successful outcomes for youth with disabilities require collaboration within and beyond the school system. Collaboration ideally includes a range of professionals across school systems, service systems, and communities coming together as part of a “transition network” to support the transition process. Using a quantitative survey of 509 secondary special educators and 25 semi-structured interviews, this explanatory sequential mixed methods study (a) examined the characteristics of transition networks (i.e., the social networks of secondary special educators), (b) identified variables associated with larger networks, and (c) explored educators’ interpretations of these associations. Quantitative analyses indicated that larger networks were associated with working at the high school level, supporting students with moderate/severe disabilities, increased years of experience, and greater knowledge about establishing collaborative partnerships. Interview analyses provided context for the quantitative results. These findings provide a deeper portrait of prevailing transition collaborations and have implications for educators charged with delivering high-quality transition programming.

Efficacy of Paraeducators Facilitating Peer Support Arrangements for Elementary Students With Multiple Disabilities

Previous findings demonstrate peer support arrangements improve academic and social outcomes for secondary students with severe disabilities, but further research is needed to determine (a) the degree to which this practice would benefit younger students, (b) the impact on student independence, and (c) how teachers can best support paraeducator implementation. In this multiple-probe-across-participants design study, a teacher trained five paraeducators to facilitate peer support arrangements with four elementary students with multiple disabilities who were eligible for alternate assessment. We identified functional relations between teacher training and paraeducator implementation and between peer support arrangements and peer interactions. Interactions increased to levels similar to those of peers without disabilities. Students decreased their reliance on paraeducators for classroom routines when peers provided support. These findings show that the effectiveness of peer support arrangements extends to elementary students with multiple disabilities and replicate initial evidence for a promising model of teacher-implemented training for paraeducators.

Nationwide trends in prevalence of underweight, overweight, and obesity among people with disabilities in South Korea from 2008 to 2017

Objectives This study investigated the 10-year trends of weight and prevalence of underweight, overweight and obesity according to disability grade and types compared with those without disabilities. Methods This serial cross-sectional analysis was conducted using national disability registration data with national general health checkup data from 2008 to 2017. Age-standardized prevalence of underweight and obesity were analyzed for each year, according to the presence, type, and severity of disabilities. Odds of underweight, overweight, obesity, and severe obesity were examined by multinomial logistic regression after adjusting for socio-demographic and clinical variables using data in 2017. Results Over 10 million subjects in each year were included in the analysis. In 2017, 14,246,785 people with age between 19 and 110 years were included and 53.1% was men. For 10 years, age-standardized prevalence of obesity and severe obesity showed significant increases regardless of sex and presence of disability. However, age-standardized underweight prevalence in people without disability tended to decrease whereas it was an increase in 2012 and the prevalence has remained steady since in people with disability. People with disabilities had higher odds of underweight compared to those without disability (OR 1.41, 95% CI 1.38–1.44 in male and OR 1.31, 95% CI 1.28–1.34 in female), especially in those with severe disabilities (OR 2.00, 95% CI 1.94–2.06 in male and OR 1.83, 95% CI 1.77–1.89 in female). Women with disabilities are more likely to be obese than those without disabilities regardless of disability severity (OR 1.40, 95% CI 1.38–1.41). Participants with mental disorder showed the highest prevalence of obesity, followed by epilepsy and developmental disability. Conclusions Having a disability was associated with higher odds/probability of both obesity and underweight. The intersection of female, severe disability, and mental/developmental disabilities was associated with probability of severe obesity. Simultaneous efforts are needed to develop health policy to reduce both the prevalence of obesity and underweight.

Implementation of wheelchair controller using mouth and tongue gesture

In this paper, a simple human-machine interface allowing people with severe disabilities to control a motorized wheelchair using mouth and tongue gesture is presented. The development of the proposed system consists of three principal phases: the first phase is mouth detection which performed by using haar cascade to detect the face area and template matching to detect mouth and tongue gestures from the lower face region. The second phase is command extraction; it is carried by determining the mouth and tongue gesture commands according to the detected gesture, the time taken to execute the gestures, and the previous command which is stored in each frame. Finally, the gesture commands are sent to the wheelchair as instruction using the Bluetooth serial port. The hardware used for this project were; laptop with universal serial bus (USB) webcam as a vision-based control unit, Bluetooth module to receive instructions comes from the vision control unit, standard joystick used in case of emergency, joystick emulator which delivers to the control board signals similar to the signals that are usually generated by the standard joystick, and ultrasonic sensors to provide safe navigation. The experimental results showed the success of the proposed control system based on mouth and tongue gestures.

Phase-Changing Glauber Salt Solution for Medical Applications in the 28–32 °C Interval

(1) Background: The field of medicine requires simple cooling materials. However, there is little knowledge documented about phase change materials (PCM) covering the range of 28 to 40 degrees Celsius, as needed for medical use. Induced mild hypothermia, started within 6 h after birth, is an emerging therapy for reducing death and severe disabilities in asphyxiated infants. Currently, this hypothermia is accomplished with equipment that needs a power source and a liquid supply. Neonatal cooling is more frequent in low-resource settings, where ~1 million deaths are caused by birth-asphyxia. (2) Methods: A simple and safe cooling method suitable for medical application is needed for the 28 to 37.5 °C window. (3) Results: Using empirical experiments in which the ingredients in Glauber salt were changed, we studied the effects of temperature on material in the indicated temperature range. The examination, in a controlled manner, of different mixtures of NaCl, Na2SO4 and water resulted in a better understanding of how the different mixtures act and how to compose salt solutions that can satisfy clinical cooling specifications. (4) Conclusions: Our Glauber salt solution is a clinically suited PCM in the temperature interval needed for the cooling of infants suffering from asphyxia.

Monitoring Program Keluarga Harapan Berbasis Mobile GIS Menggunakan K-Means Clustering

Poverty is a condition that is below the line of minimum requirement standard values, both for food and non-food. The Government of Indonesia has various programs to overcome poverty-based assistance social, including the family hope program. This family hope program is the provision of conditional cash assistance to very poor households in which there are pregnant women, toddlers, elementary, junior high, high school, elderly, and severe disabilities. The amount of assistance obtained based on the level of family poverty with poverty level parameters is seen from the many categories of very poor households concerned along with the obligation of participants to carry out important commitments in the field of Health and Education. The purpose of this research is the development of a mobile-based poor family monitoring application using the k-means clustering method. Validity test results using sample data 21, it can be concluded that the system can group poor families into 7 clusters with a thoroughness rate of 90.4%. Based on these results, K-Means Clustering can be said to have a high accuracy value for clustering poor families.

Affordances for Motor Development in the Home Environment for Young Children with and without CHARGE Syndrome

Affordances in the home environment are critical to early motor development. Currently, the home environment has not been examined in children with deafblindness or severe disabilities. The present study examined differences in, and relationships between, the home environment and motor development in children with and without CHARGE syndrome. CHARGE syndrome is a low-incidence, complex disorder with sensory and motor impairments. Participants included 28 parents of children with CHARGE syndrome and 32 parents of children without disabilities. Children with CHARGE syndrome achieved motor milestones significantly later and had fewer outside space affordances than children without disabilities. Older children had a greater variety of stimulation and fine motor toys, and those that achieved independent walking later had more outside space and fine and gross motor toys. Early experiences may be more important for children with CHARGE syndrome than children without disabilities. Moreover, parents can play a vital role in their children’s motor development to help them reach their motor milestones.

Senolytic Therapy for Cerebral Ischemia-Reperfusion Injury

Ischemic stroke is one of the leading causes of death, and even timely treatment can result in severe disabilities. Reperfusion of the ischemic stroke region and restoration of the blood supply often lead to a series of cellular and biochemical consequences, including generation of reactive oxygen species (ROS), expression of inflammatory cytokines, inflammation, and cerebral cell damage, which is collectively called cerebral ischemia-reperfusion (IR) injury. Since ROS and inflammatory cytokines are involved in cerebral IR injury, injury could involve cellular senescence. Thus, we investigated whether senolytic therapy that eliminates senescent cells could be an effective treatment for cerebral IR injury. To determine whether IR induces neural cell senescence in vitro, astrocytes were subjected to oxygen-glucose deprivation/reoxygenation (OGD/R). OGD/R induced astrocyte senescence and senescent cells in OGD/R-injured astrocytes were effectively eliminated in vitro by ABT263, a senolytic agent. IR in rats with intraluminal middle cerebral artery occlusion induced cellular senescence in the ischemic region. The senescent cells in IR-injured rats were effectively eliminated by intravenous injections of ABT263. Importantly, ABT263 treatment significantly reduced the infarct volume and improved neurological function in behavioral tests. This study demonstrated, for the first time, that senolytic therapy has therapeutic potential for cerebral IR injury.