An integrated approach to neuroscience care: An innovative model to support the new integrated care system.

Integrated care systems join up health and care services, so that people have the support they need, in the right place, at the right time. The aims include improving outcomes in healthcare, tackling inequalities in access and enhancing productivity and value for money. This is needed for neuroscience care as the traditional delivery of neuroscience care is inefficient, outdated and expensive, and can involve complex referral pathways and long waiting times.

Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest.

Background: Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the USA. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established.

Influence of Cooling duration on Efficacy in Cardiac Arrest Patients (ICECAP): study protocol for a multicenter, randomized, adaptive allocation clinical trial to identify the optimal duration of induced hypothermia for neuroprotection in comatose, adult survivors of after out-of-hospital cardiac arrest.

Background: Cardiac arrest is a common and devastating emergency of both the heart and brain. More than 380,000 patients suffer out-of-hospital cardiac arrest annually in the United States. Induced cooling of comatose patients markedly improved neurological and functional outcomes in pivotal randomized clinical trials, but the optimal duration of therapeutic hypothermia has not yet been established.

Treatment of spasticity.

Spasticity is characterized by an enhanced size and reduced threshold for activation of stretch reflexes and is associated with "positive signs" such as clonus and spasms, as well as "negative features" such as paresis and a loss of automatic postural responses. Spasticity develops over time after a lesion and can be associated with reduced speed of movement, cocontraction, abnormal synergies, and pain. Spasticity is caused by a combination of damage to descending tracts, reductions in inhibitory activity within spinal cord circuits, and adaptive changes within motoneurons.

Prevalence and incidence of chronic conditions among adults with cerebral palsy: A systematic review and meta-analysis.

Aim: To assess the prevalence and incidence of chronic conditions among adults with cerebral palsy (CP) and compare them to the prevalence and incidence among adults without CP.

Method: We searched MEDLINE and Embase for studies reporting the prevalence or incidence of one or more chronic conditions among adults with CP. Two independent reviewers screened titles, abstracts, and full-text articles.

Intrathecal baclofen pumps: what the neurologist needs to know.

Increasing numbers of patients have an intrathecal baclofen pump implanted as part of spasticity management. Neurologists may be asked about the management of these devices when patients attend emergency departments for unrelated illnesses. Occasionally, the intrathecal baclofen system itself will directly lead to an acute presentation.

Functional electrical stimulation to aid walking in patients with adrenomyeloneuropathy: A case study and observational series.

Adrenomyeloneuropathy (AMN) is a rare inherited condition where affected individuals develop slowly progressive spastic paraparesis with a gradual decline in walking ability. There is no cure for AMN and treatment focuses on supportive measures and aids. One treatment option is functional electrical stimulation (FES), a treatment, approved by The National Institute for Health and Care Excellence (NICE), for managing foot drop in upper motor neuron disorders.

European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and/or botulinum toxin type A.

Objective: To develop an algorithm for the selection of adults with disabling spasticity for treatment with intrathecal baclofen (ITB) and/or botulinum toxin type A (BoNT A).

Methods: A European Advisory Board of 4 neurologists and 4 rehabilitation specialists performed a literature review on ITB and BoNT A treatment for disabling spasticity. An online survey was sent to 125 physicians and 13 non-physician spasticity experts.

Early Convalescent Plasma for High-Risk Outpatients with Covid-19.

Background: Early administration of convalescent plasma obtained from blood donors who have recovered from coronavirus disease 2019 (Covid-19) may prevent disease progression in acutely ill, high-risk patients with Covid-19.

Methods: In this randomized, multicenter, single-blind trial, we assigned patients who were being treated in an emergency department for Covid-19 symptoms to receive either one unit of convalescent plasma with a high titer of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or placebo. All the patients were either 50 years of age or older or had one or more risk factors for disease progression.

The effectiveness of peroneal nerve functional electrical simulation for the reduction of bradykinesia in Parkinson's disease: A feasibility study for a randomised control trial.

Objectives: To assess the feasibility of a multi-site randomised controlled trial to evaluate the effect of functional electrical stimulation on bradykinesia in people with Parkinson's disease.

Design: A two-arm assessor blinded randomised controlled trial with an 18 weeks intervention period and 4 weeks post-intervention follow-up.

Setting: Two UK hospitals; a therapy outpatient department in a district general hospital and a specialist neuroscience centre.

Reducing Intrathecal Baclofen Related Infections: Service Evaluation and Best Practice Guidelines.

Objectives: Intrathecal baclofen (ITB) pumps are an effective treatment for spasticity; however infection rates have been reported in 3-26% of patients in the literature. The multidisciplinary ITB service has been established at The National Hospital for Neurology and Neurosurgery, UCLH, Queen Square, London for over 20 years. Our study was designed to clarify the rate of infection in our ITB patient cohort and secondly, to formulate and implement best practice guidelines and to determine prospectively, whether they effectively reduced infection rates.

Innovative treatment of clinically diagnosed meniscal tears: a randomized sham-controlled trial of the Mulligan concept 'squeeze' technique.

The purpose of this study was to assess the effects of the Mulligan Concept (MC) 'squeeze' technique compared to a sham technique in participants with a clinically diagnosed meniscal tear. A multi-site randomized sham-controlled trial of participants ( = 23), aged 24.91 ± 12.

TREATING GROIN AND HIP FLEXOR PAIN USING PRIMAL REFLEX RELEASE TECHNIQUE™: A CASE SERIES.

Background And Purpose: The nervous system plays a significant role in groin/hip flexor pain which is a common complaint in the active population. Patient examinations that lack consideration of the nervous system's involvement may result in chronic pain and dysfunctional breathing patterns due to continuously excited (also known as "up-related") primal reflexes. Primal Reflex Release Technique™ (PRRT™) is a novel treatment paradigm that was designed to calm primal reflexes from their excitatory state.

Improvement in overactive bladder symptoms in patients using functional electrical stimulation of the common peroneal nerve for walking.

Objective: Functional electrical stimulation is used to improve walking speed and reduces falls in people with upper motor neurone foot-drop. Following anecdotal observations of changes in bladder symptoms, an observational study was performed to explore this association further.

Design: A total of 47 consecutive patients attending for setup with functional electrical stimulation during a six-month period were asked to complete a questionnaire assessing bladder symptoms (ICIQ-OAB (International Consultation on Incontinence Questionnaire Overactive Bladder)) at baseline and three  months during routine appointments.

Using the MyoKinesthetic System to Treat Bilateral Chronic Knee Pain: A Case Study.

Objective: The purpose of this case study was to report the effects of the MyoKinesthetic (MYK) system on pain, functional ability, and psychosocial well-being of a 20-year-old female collegiate softball athlete diagnosed with chronic bilateral knee pain associated with osteoarthritis.

Clinical Features: The patient presented with bilateral chronic knee pain lasting more than 2 years. A clinical examination and radiographic imaging revealed chondromalacia and the beginning stages of osteoarthritis of the knee.

AN ALTERNATIVE APPROACH TO THE TREATMENT OF MENISCAL PATHOLOGIES: A CASE SERIES ANALYSIS OF THE MULLIGAN CONCEPT "SQUEEZE" TECHNIQUE.

Background: Partial meniscectomy does not consistently produce the desired positive outcomes intended for meniscal tears lesions; therefore, a need exists for research into alternatives for treating symptoms of meniscal tears. The purpose of this case series was to examine the effect of the Mulligan Concept (MC) "Squeeze" technique in physically active participants who presented with clinical symptoms of meniscal tears.

Description Of Cases: The MC "Squeeze" technique was applied in five cases of clinically diagnosed meniscal tears in a physically active population.

Cerebral palsy.

Cerebral palsy has always been known as a disorder of movement and posture resulting from a non-progressive injury to the developing brain; however, more recent definitions allow clinicians to appreciate more than just the movement disorder. Accurate classification of cerebral palsy into distribution, motor type and functional level has advanced research. It also facilitates appropriate targeting of interventions to functional level and more accurate prognosis prediction.

Balance dysfunction in hereditary and spontaneous spastic paraparesis.

Objective: To determine how postural sway is affected in people with spastic paraparesis (pwSP) and the impact of different impairments.

Methods: In 20 pwSP and 18 matched healthy controls standing postural sway was measured with eyes open and closed. Vibration threshold, isometric ankle and hip muscle strength and ankle stiffness with the participant at rest or preactivating the muscle was measured.

The effects of functional electrical stimulation on walking in hereditary and spontaneous spastic paraparesis.

Objectives:  To investigate in people with spastic paraparesis (SP): 1) the factors contributing to foot drop and reduced toe clearance while walking; 2) short-term effects of bilateral functional electrical stimulation (FES) of the common peroneal nerve.

Materials And Methods:  Long term (>0.5 years) users of FES with SP were compared to matched controls (N = 11 per group).

Muscle paresis and passive stiffness: key determinants in limiting function in Hereditary and Sporadic Spastic Paraparesis.

Background: People with Hereditary and Sporadic Spastic Parapresis (SP) walk with a stiff legged gait characterised by a lack of knee flexion.

Objective: We investigated the relationship between lower limb strength and stiffness and knee flexion during swing phase while walking in 20 people with SP and 18 matched controls.

Methods: Maximal isometric strength was measured using a dynamometer.

Intrathecal baclofen in multiple sclerosis: too little, too late?

The majority of patients with multiple sclerosis (MS) have symptoms of spasticity that increasingly impair function as the disease progresses. With appropriate treatment, however, quality of life can be improved. Oral antispasticity medications are useful in managing mild spasticity but are frequently ineffective in controlling moderate to severe spasticity, because patients often cannot tolerate the adverse effects of increasing doses.

An electronic regulatory document management system for a clinical trial network.

A computerized regulatory document management system has been developed as a module in a comprehensive Clinical Trial Management System (CTMS) designed for an NIH-funded clinical trial network in order to more efficiently manage and track regulatory compliance. Within the network, several institutions and investigators are involved in multiple trials, and each trial has regulatory document requirements. Some of these documents are trial specific while others apply across multiple trials.