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The clinical use of noninvasive cortical stimulation procedures is hampered by the limited duration of the analgesic effects and the need to perform stimulation in hospital settings. Here, we tested the feasibility and pilot efficacy of an internet-based system for at-home, long-duration, medically controlled transcranial motor cortex stimulation (H-tDCS), via a double-blinded, sham-controlled trial in patients with neuropathic pain refractory to standard-of-care drug therapy. Each patient was first trained at hospital, received a stimulation kit, allotted a password-protected Web space, and completed daily tDCS sessions during 5 weeks, via a Bluetooth connection between stimulator and a minilaptop. Each session was validated and internet-controlled by hospital personnel. Daily pain ratings were obtained during 11 consecutive weeks, and afterwards via iterative visits/phone contacts. Twenty full procedures were completed in 12 consecutive patients (500 daily tDCS sessions, including 20% sham). No serious adverse effects were recorded. Superficial burning at electrode position occurred in 2 patients, and nausea/headache in two others, all of whom wished to pursue stimulation. Six out of the 12 patients achieved satisfactory relief on a scale combining pain scores, drug intake, and quality of life. Daily pain reports correlated with such combined assessment, and differentiated responders from nonresponders without overlap. Clinical improvement in responders could last up to 6 months. Five patients asked to repeat the whole procedure when pain resumed again, with comparable results. At-home, long-duration tDCS proved safe and technically feasible, and provided long-lasting relief in 50% of a small sample of patients with drug-resistant neuropathic pain.

BackgroundInequalities in early childhood development (ECD) tend to persist into adulthood and amplify across the life course. To date, little research on inequalities in early childhood care and development in low/middle-income countries has been available to guide governments, donors and civil society in identifying which young children and families should be targeted by policies and programmes to improve nurturing care that could prevent them from being left behind.MethodsUsing data from 135 Demographic and Health Surveys and Multiple Indicator Cluster Surveys between 2010 and 2018, we assessed levels and trends of inequalities in exposure to risks of stunting or extreme poverty (under age 5; levels in 85 and trends in 40 countries), early attendance of early care and education programmes (36–59 months; 65 and 17 countries), home stimulation (36–59 months; 62 and 14 countries) and child development according to the Early Childhood Development Index (36–59 months; 60 and 13 countries). Inequalities within countries were measured as the absolute gap in three domains—child gender, household wealth and residential area—and compared across regions and country income groups.Results63% of children were not exposed to stunting or extreme poverty; 39% of 3–4-year olds attended early care and education; and 69% received a level of reported home stimulation defined as adequate. Sub-Saharan Africa had the lowest proportion of children not exposed to stunting or extreme poverty (45%), attending early care and education (24%) and receiving adequate home stimulation (47%). Substantial gaps in all indicators were found across country income groups, residential areas and household wealth categories. There were no significant reductions in gaps over time for a subset of countries with available data in two survey rounds.ConclusionsAvailable data indicate large inequalities in early experiences and outcomes. Efforts of reducing these inequalities must focus on the poorest families and those living in rural areas in the poorest countries. Improving and applying population-level measurements on ECD in more countries over time are important for ensuring equal opportunities for young children globally.

Background The Vakinankaratra region of Madagascar has a high burden of child undernutrition which, in addition to poor psychosocial stimulation, is a strong risk factor of poor child development. However, there are limited studies evaluating the relations between developmental deficits, child nutrition outcomes, and home stimulation in the region. The purpose of this study was to assess the development of children aged 11–13 months in relation to their nutritional status and to examine parental home stimulation attitudes and practices in the Vakinankaratra region. Methods Cognitive ( n  = 36), language ( n  = 36), motor ( n  = 36), and socioemotional ( n  = 76) development were assessed using the Bayley Scales of Infant and Toddler Development III. Household stimulation environment was evaluated using the family care indicators survey. Stunting (length-for-age z -score < − 2) and underweight (weight-for-age z -score < − 2) were determined using the 2006 WHO growth standards. Perceptions of and barriers to greater home stimulation for children were collected using focus group discussions among parents and in-depth interviews with community nutrition agents. Results Almost all mothers reported that parent–child interaction with talk and play was very important. Alarmingly high stunting rates (> 69%) were observed in this subsample. Limited time and tiredness were the major barriers to home stimulation mentioned by parents and confirmed by key informants. Children had a very limited variety of play materials, and most of the mothers used household objects (75%) and materials from outside the house (71%) as children’s toys. Composite cognitive [mean (SD): 60 (10.3)], motor [61.9 (13.4)], language [62 (13.2)], and socioemotional [85.1 (17.9]) scores were low. Fine motor, cognitive, and receptive and expressive language scores were correlated [0.4 <  r  < 0.7, p  < 0.05]. Conclusions The very high stunting rates and very low performance on cognitive, motor, language, and socioemotional development assessments of children in the Vakinankaratra region require urgent attention.

RESUMEN: Numerosos estudios han establecido el impacto negativo de la pobreza sobre el desarrollo cognitivo, examinando parcialmente algunos factores mediadores del mismo. El objetivo del presente artículo consiste en realizar un análisis teórico centrado en la estimulación en el hogar y la nutrición como factores mediadores, retomando los resultados de diferentes trabajos desarrollados desde el año 2000. Estos indican que la estimulación en el hogar sería un factor mediador clave del impacto de la pobreza sobre el desarrollo cognitivo, mientras que los efectos del estado nutricional dependerían del grado de severidad del déficit, no siendo determinantes en los casos de desnutrición leve o moderada. Se concluye sobre la importancia teórico-práctica de profundizar en el estudio simultáneo de los factores mediadores implicados. ABSTRACT: Numerous studies have established the negative impact of poverty on cognitive development, by partially examining some mediator factors thereof. The objective of this article is to perform a theoretical analysis focused on home stimulation and nutrition as mediating factors. To do this we took the results of different studies which address this issue, developed since 2000. The results indicate that home stimulation would be a key mediator factor of the impact of poverty on cognitive development, while the effects of nutritional status would depend on the severity of the deficit, not being decisive in cases of mild or moderate undernutrition. We conclude about the theoretical and practical importance of deepen in the simultaneous study of the involved mediators factors.

The shape and position of the electrodes is a key factor for the efficacy of transcranial electrical stimulations (tES). We have recently introduced the Regional Personalized Electrode (RePE), a tES electrode fitting the personal cortical folding, that has been able to differentiate the stimulation of close by regions, in particular the primary sensory (S1) and motor (M1) cortices, and to personalize tES onto such an extended cortical district. However, neuronavigation on individual brain was compulsory for the correct montage. Here, we aimed at developing and testing a neuronavigation-free procedure for easy and quick positioning RePE, enabling multisession RePE-tES at home. We used off-line individual MRI to shape RePE via an computerized procedure, while an developed Adjustable Helmet Frame (AHF) was used to properly position it in multisession treatments, even at home. We used neuronavigation to test the RePE shape and position obtained by the new computerized procedure and the re-positioning obtained via the AHF. Using Finite Element Method (FEM) model, we also estimated the intra-cerebral current distribution induced by transcranial direct current stimulation (tDCS) comparing RePE vs. non-RePE with fixed reference. Additionally, we tested, using FEM, various shapes, and positions of the reference electrode taking into account possible small displacements of RePE, to test feasibility of RePE-tES sessions at home. The new RePE neuronavigation-free positioning relies on brain MRI space distances, and produced a mean displacement of 3.5 ± 0.8 mm, and the re-positioning of 4.8 ± 1.1 mm. Higher electric field in S1 than in M1 was best obtained with the occipital reference electrode, a montage that proved to feature low sensitivity to typical RePE millimetric displacements. Additionally, a new tES accessory was developed to enable repositioning the electrodes over the scalp also at home, with a precision which is acceptable according to the modeling-estimated intracerebral currents. Altogether, we provide here a procedure to simplify and make easily applicable RePE-tDCS, which enables efficacious personalized treatments.

Purpose The purpose of this study is to compare the effectiveness and cost of home electrical stimulation and standardized biofeedback training in females with fecal incontinence Methods Thirty-six females suffering from fecal incontinence were randomized into two groups, matched for mean age (67.45 ± 7.2 years), mean body mass index (kg/m 2 ) (26.2 ± 3.9), mean disease duration (4.1 ± 0.8 years), mean number of births (2.7 ± 1.3), and reports of obstetric trauma (25 %). Questionnaires were used to evaluate their demographics, medical, and childbearing history. Subjects were randomized to home electrical stimulation or standardized biofeedback training for a period of 6 weeks. Subjective outcome measures included the frequency of fecal, urine, and gas incontinence by visual analog scale, Vaizey incontinence score, and subjects’ levels of fecal incontinence related anxiety. Objective outcome measures included pelvic floor muscle strength assessed by surface electromyography. We also compared the cost of each treatment modality. Results Only females who received home electrical stimulation (HES) reported a significant improvement in Vaizey incontinence score ( p  = 0.001), anxiety ( p  = 0.046), and in frequency of leaked solid stool ( p  = 0.013). A significant improvement in pelvic floor muscle strength was achieved by both groups. HES was much cheaper compared to the cost of standardized biofeedback training (SBT) (US$100 vs. US$220, respectively). Our study comprised a small female population, and the study endpoints did not include objective measures of anorectal function test, such as anorectal manometry, before and after treatment. Conclusions Home electrical stimulation may offer an alternative to standardized biofeedback training as it is effective and generally well-tolerated therapy for females with fecal incontinence.

Spinal cord injury (SCI) produces muscle wasting that is especially severe after complete and permanent damage of lower motor neurons, as can occur in complete conus and cauda equina syndrome. Even in this worst-case scenario, mass and function of permanently denervated quadriceps muscle can be rescued by surface functional electrical stimulation using a purpose designed home-based rehabilitation strategy. Early diagnostics is a key factor in the long-term success of this management. Function of quadriceps muscle was quantitated by force measurements. Muscle gross cross-sections were evaluated by quantitative color computed tomography (CT) and muscle and skin biopsies by quantitative histology, electron microscopy, and immunohistochemistry. Two years of treatment that started earlier than 5 years from SCI produced: (a) an increase in cross-sectional area of stimulated muscles; (b) an increase in muscle fiber mean diameter; (c) improvements in ultrastructural organization; and (d) increased force output during electrical stimulation. Improvements are extended to hamstring muscles and skin. Indeed, the cushioning effect provided by recovered tissues is a major clinical benefit. It is our hope that new trials start soon, providing patients the benefits they need.

Background: Primary progressive aphasia (PPA) is a neurodegenerative disease characterised by progressive impairment of speech and language abilities. Intensive speech and language teletherapy combined with remotely supervised, self-administered transcranial direct current stimulation (tDCS) may be suited to remove barriers to accessing potentially effective treatments, but there is only limited evidence on the feasibility of this combined approach. Methods: This pilot case series investigated the feasibility, tolerability and preliminary efficacy of a novel telerehabilitation programme combined with home-based, self-administered tDCS for people with primary progressive aphasia (pwPPA). The intervention programme was co-developed with pwPPA and their caregivers, to reflect their priorities regarding treatment content and outcomes (i.e., naming, functional communication). Results: Two pwPPA successfully completed the telerehabilitation intervention with daily naming training and communicative-pragmatic therapy paired with tDCS, over 10 consecutive workdays. Caregivers assisted in the setup of equipment required for teletherapy and home-based tDCS. Participants successfully completed the programme with a 95% completion rate. Home-based tDCS was well tolerated. Both participants showed improvements in naming and communication, suggesting preliminary efficacy of the intervention. Conclusions: Overall, this study demonstrates the feasibility and potential benefit of a novel, easily accessible and patient-relevant telerehabilitation intervention for pwPPA, which requires confirmation in a future larger-scale exploratory trial.

Background Pain is a common debilitating symptom in cancer patients and its management remains a challenge. Among the non-pharmacological analgesic treatment options, low intensity transcranial electrical stimulation (tES) represents a new unique analgesic modality. However, the evidence of tES effectiveness for cancer pain is limited, while the mechanisms of pain relief due to tES are still poorly understood. We propose to test the efficacy of repetitive transcranial direct current stimulation (tDCS) and alternating current stimulation (tACS) in cancer pain patients, and attempt to understand their mechanisms using electroencephalography (EEG) and quantitative sensory testing (QST) measures. Methods This article describes the protocol of a multicenter, sham-controlled, parallel-arm, triple-blinded randomized clinical trial assessing home-based tDCS and tACS in the treatment of cancer patients with persistent pain. 450 patients between 18 and 75 years old will be enrolled in this study. Treatment consists of 15 consecutive daily sessions of either anodal tDCS at 2 mA targeting the primary motor cortex or 10 Hz tACS targeting the dorsolateral prefrontal cortex. Following randomization (2:2:1 ratio), 180 patients will receive active tDCS, 180 patients active tACS, and 90 patients sham stimulation. The primary outcome is self-reported pain intensity on a numerical rating scale (NRS) assessed daily (15 days pre-treatment, 15 days during treatment and 15 days post-treatment). The secondary endpoints are medication intake, other cancer-associated symptoms and quality of life. We will also analyze psychophysical and neurophysiological correlates of ascending and descending pain processing using QST and EEG paradigms. Besides the NRS, which will be reported daily, assessments will be conducted at baseline (T0) and at three time points post-intervention (T1, T2, and T3). Discussion Positive findings of the study will indicate the therapeutic benefit of tES in patients with cancer-related pain. Group differences in mechanistic measures would yield potential biomarkers for tDCS- and tACS-induced analgesia, which could be used for personalizing and optimizing the intervention. In addition, changes in EEG or QST could provide insights into the mechanisms underlying the tES effects. Trial registration The study was registered at the German Clinical Trials Register under the identification number DRKS00031070.