Articles: function.
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Cochrane Db Syst Rev · Jun 2017
ReviewCognitive rehabilitation for adults with traumatic brain injury to improve occupational outcomes.
Cognitive impairment in people with traumatic brain injury (TBI) could affect multiple facets of their daily functioning. Cognitive rehabilitation brings about clinically significant improvement in certain cognitive skills. However, it is uncertain if these improved cognitive skills lead to betterments in other key aspects of daily living. We evaluated whether cognitive rehabilitation for people with TBI improves return to work, independence in daily activities, community integration and quality of life. ⋯ There is insufficient good-quality evidence to support the role of cognitive rehabilitation when compared to no intervention or conventional rehabilitation in improving return to work, independence in ADL, community integration or quality of life in adults with TBI. There is moderate-quality evidence that cognitive rehabilitation provided as a home programme is similar to hospital-based cognitive rehabilitation in improving return to work status among active duty military personnel with moderate-to-severe TBI. Moderate-quality evidence suggests that one cognitive rehabilitation strategy (cognitive didactic) is no better than another (functional experiential) in achieving return to work in veterans or military personnel with TBI.
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Neuroscientific research has made a concerted effort to determine cortical localization using various functional imaging techniques. This approach has undoubtedly yielded important novel anatomical knowledge, albeit at times contradictory, regarding the structural organization of the vestibular cortex. Unfortunately however, this knowledge has not translated to our understanding regarding how neural mechanisms control vestibular function. ⋯ Contrastingly, in the second half of this review, I present previous findings that show how disrupting interhemispheric interactions can modulate the brainstem-mediated vestibular-ocular reflex (VOR). I conclude by speculating why interhemispheric competition induces correlated biases at the cortical and brainstem level respectively. Specifically, I propose that brainstem-mediated vestibulo-spatial and vestibulo-temporal transformations, in addition to coding for head displacement, underpin a generalized cortical magnitude estimation system which the CNS uses to construct dynamic spatio-temporal maps of the physical world, in-turn ensuring spatial orientation.
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Randomized Controlled Trial Multicenter Study Comparative Study
Study protocol for the Balanced Solution versus Saline in Intensive Care Study (BaSICS): a factorial randomised trial.
The effectiveness and safety of balanced crystalloid fluids compared with saline (0.9% sodium chloride) as a fluid of choice in critically ill patients remain unclear. The effects of different fluid infusion rates on outcomes are also unknown. ⋯ The BaSICS trial will provide robust evidence on whether a balanced crystalloid, compared with saline, improves important patient outcomes in critically ill patients. BaSICS will also provide relevant information on whether bolus infusion rate affects outcomes in this population.
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The high prevalence of obesity is associated with an enormous medical, social, and economic burden. The metabolic dysfunction, dyslipidaemia, and inflammation caused by obesity contribute to the development of a wide variety of disorders and effects on the nervous system. In the CNS, mild cognitive impairment can be attributed to obesity-induced alterations in hippocampal structure and function in some patients. ⋯ In the peripheral nervous system, obesity-driven alterations in the autonomic nervous system prompt imbalances in sympathetic-parasympathetic activity, while alterations in the sensory-somatic nervous system underlie peripheral polyneuropathy, a common complication of diabetes. Pharmacotherapy and bariatric surgery are promising interventions for people with obesity that can improve neurological function. However, lifestyle interventions via dietary changes and exercise are the preferred approach to combat obesity and reduce its associated health risks.