Journal articles on the topic 'Paediatric Learning Disorders Visual Motor'

Scores on the Test of Visual-motor Skills, Developmental Test of Visual-motor Integration, and Bender-Gestalt test were compared for a sample of 44 elementary school children referred for evaluation of learning disorders. While the tests shared common variance, the mean standard score on the Test of Visual-motor Skills was significantly lower than the means of the other two tests, suggesting caution in the clinical use of the new scale.

Many learning disabled students demonstrate psychological/behavioral and perceptual motor characteristics that affect physical education placement and programming. Among the characteristics exhibited by these students are hyperactivity, disorders of attention, impulsivity, poor self-concept, social imperception, delay in social play development, and deficiencies in body equilibrium, visual motor control, bilateral coordination, repetitive finger movements, and fine motor coordination. Activities found to benefit learning disabled students are jogging, relaxation, highly structured teacher-directed routines, and noncompetitive games, all of which must be carefully sequenced. Testing must be done to determine the type and extent of the learning disabled students’ problems, and activities must be selected on the basis of the results of such tests.

Learning to read, write and calculate are proving to be some of the most significant cognitive processes in early education. The objective of this systematic review is to explore the associations between the psychomotor component and the academic achievement in writing, reading, and mathematics. An organized and methodical research of electronic databases was completed in order to determine significant studies. Twenty eligible articles were strictly evaluated, with extracted and summarized keywords. The two components of the psychomotor activity that influence reading were primarily the orientation ability and the fine motor skill, which is the one responsible for the correct spelling of “mirror-writing”. Differences in motor function were observed after intervention programmes. The results of all researchers have shown that there is a link between dysgraphia, dyslexia and the orientation ability or visual perception. Meanwhile, the role of cognitive and motor skills that underpinned mathematical performance was highlighted, and children who had a high capacity for spatial and visual orientation benefited from a better understanding and perception of geometric figures. However, the importance of students'''' spatial reasoning in relation to mathematics was identified, but only in terms of geometry. Poor quality of spatial notions has been found to be one of the causes of delay in the acquisition of reading, writing and mathematical calculation. The role of fine motor skills in the writing process was also noted, being of real importance in times when the child manipulates the writing tool and puts a word or a sentence on the page.

Object Up to 16% of children in the US between the ages of 3 and 17 years have either attention deficit–spectrum disorder or a learning disability (LD). Sports-related concussions among youth athletes represent a significant public health concern, and neurocognitive testing is a method to evaluate the severity of cognitive impairment and recovery after a sports-related concussion. The goal of this study was to assess baseline neurocognitive differences between athletes with attention deficit hyperactivity disorder (ADHD) and/or LD versus those with neither disorder and to establish normative data for these special populations. Methods Between August 2007 and March 2012, 6636 young athletes underwent baseline neurocognitive testing performed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) battery. Of these participants, 90 had self-reported LD only, 262 had self-reported ADHD only, and 55 reported both. Those with ADHD and/or LD were matched with 407 participants with no history of ADHD or LD by age, sex, and number of prior concussions. The mean scores and SDs were calculated for each group to obtain normative values. A pairwise comparison between each diagnostic group was done to assess whether LD and/or ADHD diagnostic status predicted participants' baseline neurocognitive scores. Results Participants with ADHD had significantly lower verbal memory, visual memory, and visual motor processing speed scores, along with significantly higher reaction time, impulse control, and symptom scores compared with those without LD or ADHD. Participants with LD had similar results, with significantly lower verbal memory, visual memory, and visual motor processing speed scores, higher reaction time and symptom score, but did not differ in their impulse control score compared with those without LD or ADHD. Participants with both LD and ADHD had a significantly lower visual motor speed score and a significantly higher reaction time and symptom score than those without LD or ADHD, but did not differ with regard to the other composite scores. Conclusions Athletes with ADHD and/or LD have lower baseline ImPACT neurocognitive scores compared with athletes without ADHD and LD. Preliminary normative neurocognitive data for these special populations are provided.

Background: There is limited evidence examining the impact of learning disorders on testing and screening scores used in evaluation following concussion in adolescents. Purpose: To examine differences in clinical measures between adolescents with a history of dyslexia or ADD/ADHD and those without a history of learning disorder (LD) following concussion. Methods: Data were collected from participants enrolled in the North Texas Concussion Network Prospective Registry (ConTex). Participants ages 10-18 who had been diagnosed with a concussion sustained within 30 days of enrollment were included. Participants were separated into three groups based on self-reported prior diagnosis: dyslexia, ADD/ADHD, and no history of LD. Clinical measures from initial presentation were examined, including ImPACT®, King-Devick (KD), SCAT-5 symptom log, Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder (GAD-7) scale. Independent t-test analysis was performed to compare scores between groups. Results: A total of 993 participants were included; 68 with dyslexia, 141 with ADD/ADHD, and 784 with no history of LD. There was no difference in age, sex, time since injury, or history of concussion between the dyslexia group and no LD group. In the ADD/ADHD group, there were significantly more male participants (64.5% and 50.3% respectively, p=0.002). Participants with a history of dyslexia had a significant increase in KD time (63.7 sec vs 56.5 sec, p=0.019). Additionally, ImPACT® testing showed a decrease in visual motor speed (28.87 vs 32.99, p= 0.010). Total symptom score was higher in this group as well (36.22 vs 28.27, p=0.013). In those with a history of ADD/ADHD, multiple domains were found to be significantly different on ImPACT® testing including visual motor speed (30.05), reaction time (0.75), and cognitive efficiency (0.23) when compared to those with no LD (32.99, 0.71, and 0.27 respectively, p=0.004, 0.047, 0.027). KD time was also significantly higher in this group (62.1 sec vs 56.5 sec, p=0.008), as was the total symptom score (32.99 vs 28.27, p=0.043). PHQ-8 and GAD-7 were both significantly higher in the group with ADD/ADHD (5.79 and 5.06 respectively, p=0.001) than those with no LD (4.32 and 3.56, p=0.001). Conclusion: Differences were seen in participants with a history of dyslexia and ADD/ADHD on clinical concussion measures, including ImPACT® and KD testing, SCAT-5 symptom log, and screenings for depression and anxiety. A better understanding of the unique profiles seen in these patients will aid providers in their evaluation and assist as they counsel families regarding their child’s injury.

Abstract Objective To examine differences in clinical measures between adolescents with dyslexia, ADD/ADHD, and those without a learning disorder (LD) following concussion. Method Data from the North Texas Concussion Registry (ConTex) were extracted. Participants ages 10–18 with a diagnosed concussion within 30 days of enrollment were included and categorized based on self-reported prior diagnosis of dyslexia, ADD/ADHD, and no history of LD. ImPACT, King-Devick (KD), SCAT-5 symptom log, Patient Health Questionnaire (PHQ-8), and Generalized Anxiety Disorder (GAD-7) scale were compared between groups using a one-way ANOVA followed by a Tukey test for multiple comparisons. Results Of 993 eligible participants, 68 had dyslexia, 141 had ADD/ADHD, and 784 had no history of LD. There were significantly more male participants in the ADD/ADHD group compared to the no LD group (64.5% vs. 50.3%, p = 0.002). No other demographic differences were noted between groups. In the dyslexia group, SCAT-5 symptom score was higher (36.22 vs. 28.27, p = 0.037) and ImPACT visual motor control was lower compared to the no LD group (28.87 vs. 32.99, p = 0.027). In the ADD/ADHD group, ImPACT symptom score was higher (30.69 vs. 20.94, p < 0.001) and visual motor control was lower compared to the no LD group (30.05 vs. 32.99, p = 0.009). KD time (62.1 sec), PHQ-8 (5.79), and GAD-7 (5.06) were higher in the ADD/ADHD group compared to the no LD group (56.5 sec, 4.32, 3.56; p = 0.022, p = 0.003, p = 0.002). Conclusions Differences in clinical measures were seen in participants with a history of dyslexia and ADD/ADHD that may aid providers in their evaluation following adolescent concussion.

One hundred sixty-nine learning impaired (LI) and 71 non-learning impaired (NLI) children underwent a hybrid go/no-go choice reaction time visual-motor task to study the behavioral and physiological fundamentals of learning disorders. A left button was pressed for Left Arrow (LA) stimuli, a right for Right Arrow (RA) stimuli, none (no-go) for a non-directional arrow. Stimulus specific visual evoked potentials were formed and, with PZ as index electrode, were lag-correlated to frontal electrodes to form Event-Related Correlations (ERC). Exploratory t-statistic significance probability maps (t-SPM) were used to define regions of interest (ROI). Behaviorally, there was a right-hand advantage over the left in the NLI group, but less in the LI group. Electrophysiologically, RA and LA conditions increased correlation between visual areas (PZ) and contralateral frontal areas (F3 and F4). A unilateral ROI, at electrode FC1, also preceded both left- and right-handed responses. Neurobehaviorally, increased visual-motor correlation was associated with better performance, especially for the left hemisphere, at F3 and FC1. Surprisingly, visual-motor correlations were not associated with performance for the NLI group in the RA and no-go condition. Our data support previously reported difficulties of learning impaired children in low-level information processing. Furthermore, we hypothesize that LI, in contrast to NLI children, demonstrate difficulty in automatizing routine tasks.

In order to effectively habilitate adults with apraxia and children with developmental dyspraxia, teachers and clinicians must have a sound understanding of the neuromotor basis of movement as well as an understanding of the etiology of this motor disorder. This paper describes the neural basis of apractic disorders from both an anatomical and a neuropsychological framework. Motor control and learning theories are used as a foundation for intervention programming. The functional-based approach espoused in this manuscript emphasizes that educators and therapists provide the individual with apraxia with enhanced polymodal sensory input–tactile, vestibular-proprioceptive, verbal, and visual information–within a context-dependent environment. The literature reviewed in this paper should help practitioners and researchers better understand those problems seen in individuals who have apractic disorders and should assist them in developing more effective motor remediation programs.

Background and PurposeRobotic devices for walking rehabilitation allow new possibilities for providing performance-related information to patients during gait training. Based on motor learning principles, augmented feedback during robotic-assisted gait training might improve the rehabilitation process used to regain walking function. This report presents a method to provide visual feedback implemented in a driven gait orthosis (DGO). The purpose of the study was to compare the immediate effect on motor output in subjects during robotic-assisted gait training when they used computerized visual feedback and when they followed verbal instructions of a physical therapist.SubjectsTwelve people with neurological gait disorders due to incomplete spinal cord injury participated.MethodsSubjects were instructed to walk within the DGO in 2 different conditions. They were asked to increase their motor output by following the instructions of a therapist and by observing visual feedback. In addition, the subjects’ opinions about using visual feedback were investigated by a questionnaire.ResultsComputerized visual feedback and verbal instructions by the therapist were observed to result in a similar change in motor output in subjects when walking within the DGO. Subjects reported that they were more motivated and concentrated on their movements when using computerized visual feedback compared with when no form of feedback was provided.Discussion and ConclusionComputerized visual feedback is a valuable adjunct to robotic-assisted gait training. It represents a relevant tool to increase patients’ motor output, involvement, and motivation during gait training, similar to verbal instructions by a therapist.

Reading and writing are basic skills that guarantee child’s learning. Therefore, it is important that the child has mastered these skills to the best extent. Unfortunately, not all children can meet the requirements in the field of learning to read and write. Problems of varying intensity and range appear, they are caused by various disorders of the perceptual-motor functions. Children who may have problems with reading and writing in the future can already be seen in the kindergarten. Therefore, the aim of the study was to diagnose the risk of dyslexia and dysgraphia among children aged 5-6. The study included 300 children from kindergartens in Biała Podlaska, Poland. The results of the study showed that children at risk for dyslexia and dysgraphia are present in the study group. The most frequent manifestations of these disorders were in the field of fine motor skills, gross motor skills, language functions, visual functions and attention. They were caused by various factors related to the functioning of the nervous system that affect its development. Among the children diagnosed with these disorders, therapeutic measures have been taken to help reduce developmental delays and make it easier for them to learn in primary school.

AbstractAn objective in current research on children with fetal alcohol spectrum disorders (FASD) is to determine neurobehavioral profiles to identify affected individuals. Deficits observed when children with FASD are compared to typically developing controls may be confounded by lower IQ scores in the subjects with FASD. To determine if prenatal alcohol exposure is associated with neurobehavioral deficits after controlling for IQ differences, multivariate analyses were conducted to compare alcohol-exposed (ALC) subjects to a comparison group closely matched on IQ (IQC). The initial analysis included a broad neuropsychological battery with measures of language, executive function, visual–motor integration, motor ability, and academic achievement. Additional, in depth comparisons focused on visual sustained attention, verbal learning and memory and parent/guardian-reported behavior problems. Group differences (ALC < IQC) were found on verbal learning and parent-rated behavior problems. Group differences were marginally significant (measures within the broad neuropsychological comparison) or not significant (visual attention, retention of verbal material) on the remaining comparisons. Therefore, some deficits (e.g., verbal learning and behavior problems) in children with heavy prenatal alcohol exposure cannot be explained by the lower FSIQ observed in the population. These areas of relative weakness could be useful in distinguishing children with FASD from other children with lowered IQ. (JINS, 2011, 17, 463–473)

In the aging society, the number of people suffering from vascular disorders is rapidly increasing and has become a social problem. The death rate due to stroke, which is the second leading cause of global mortality, has increased by 40% in the last two decades. Stroke can also cause paralysis. Of late, brain-computer interfaces (BCIs) have been garnering attention in the rehabilitation field as assistive technology. A BCI for the motor rehabilitation of patients with paralysis promotes neural plasticity, when subjects perform motor imagery (MI). Feedback, such as visual and proprioceptive, influences brain rhythm modulation to contribute to MI learning and motor function restoration. Also, virtual reality (VR) can provide powerful graphical options to enhance feedback visualization. This work aimed to improve immersive VR-BCI based on hand MI, using visual-electrotactile stimulation feedback instead of visual feedback. The MI tasks include grasping, flexion/extension, and their random combination. Moreover, the subjects answered a system perception questionnaire after the experiments. The proposed system was evaluated with twenty able-bodied subjects. Visual-electrotactile feedback improved the mean classification accuracy for the grasping (93.00% ± 3.50%) and flexion/extension (95.00% ± 5.27%) MI tasks. Additionally, the subjects achieved an acceptable mean classification accuracy (maximum of 86.5% ± 5.80%) for the random MI task, which required more concentration. The proprioceptive feedback maintained lower mean power spectral density in all channels and higher attention levels than those of visual feedback during the test trials for the grasping and flexion/extension MI tasks. Also, this feedback generated greater relative power in the μ -band for the premotor cortex, which indicated better MI preparation. Thus, electrotactile stimulation along with visual feedback enhanced the immersive VR-BCI classification accuracy by 5.5% and 4.5% for the grasping and flexion/extension MI tasks, respectively, retained the subject’s attention, and eased MI better than visual feedback alone.

ObjectivesTo examine treatment, comorbidity status and diagnosis among the French sample of the Caregiver Perspective of Pediatric ADHD (CAPPA) survey.MethodsCarers in 10 EU countries, including France, completed an Internet survey regarding ADHD diagnosis, treatment and comorbidities. Descriptive statistics were calculated for categorical [n (%)] and continuous variables [mean, standard deviation (SD), median, range].ResultsEU carers representing 3688 children/adolescents (6–17 years) with ADHD completed the survey; 486 were from France (median age 10 years, 84% male). Most (77%) French children/adolescents were currently receiving pharmacological treatment(s): 74% stimulant, 15% non-stimulant and 22% antipsychotic. Across countries, stimulant use ranged from 60% (Italy) to 93% (Germany/Netherlands), non-stimulant use from 1% (Germany) to 18% (Sweden) and antipsychotic use from 8% (Germany) to 46% (Italy). Many French children/adolescents received behaviour therapy (BT) after ADHD diagnosis (59%). Among those receiving BT, 52% began prior to starting medication. BT was often discontinued within 6 months (44%) or 6–12 (30%) months. 52% of carers reported ≥ 1 comorbidity; they reported the highest rates of conduct (24%), sleep (11%), eating (6%) and motor-coordination (6%) disorders, and the second-highest rates of anxiety (22%), learning difficulties (15%), oppositional defiant disorder (5%), bipolar disorder (4%) and epilepsy (2%). Time to diagnosis from first doctor's visit averaged 7 months (SD 11, median 3). 81% received a specialist referral. French carers reported the highest perceived difficulty (‘great deal’/’a lot’ of difficulty) obtaining a diagnosis (43%) and a specialist referral (53%).ConclusionsThis sample of French children/adolescents with ADHD had higher non-stimulant and antipsychotic use than most other countries and higher reports of certain comorbid conditions. Carers perceived greater difficulty in obtaining a diagnosis and seeing a specialist, although time to diagnosis was lower compared with a number of other countries.

Background. Obstructive sleep apnea syndrome (OSAS) affects up to 4% of a pediatric population, with many comorbidities in the medium-long term. Functional alterations in the prefrontal cortex (PFC) may explain why OSAS impacts aspects such as executive functions, memory, motor control, attention, visual-spatial skills, learning, and mood regulation. Emotional intelligence (EI) is a complex neuropsychological function that could be impaired in many clinical conditions. Purpose. The aim of the study is to evaluate the difference in emotional intelligence skills among children with OSAS and healthy subjects (nOSAS). Methods. 129 children (72 males; mean age 7.64±1.98 years) affected by OSAS were compared to 264 non-OSAS (nOSAS) children (138 males; mean age 7.98±2.13) similar for gender, age, and socioeconomic status. In order to assess the emotional quotient, the Bar-On Emotional Quotient Inventory: Youth Version (EQ-i:YV) was used. Results. The comparison for means and standard deviation between OSAS children and nOSAS children for EQ-i:YV scores showed significant differences for Interpersonal, Adaptability, and Stress Management scales and EQ Total score. Conclusions. Our findings highlighted the role of intermittent hypoxia in the genesis of the effects of sleep-related respiratory disorders, which involves also aspects different from physical impairments.

Abstract Objective The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) is a commonly utilized sport concussion assessment. Previous literature examined differences in concussion rates, symptom scores, and invalid baselines between healthy athletes and athletes with neurodevelopmental disorders. There are no current studies that investigate cognitive profiles of athletes with autism. The present study explores possible differences in ImPACT performance for these athletes. Method Participants included 31,368 high school athletes (mean age = 15.0, SD = 1.2; mean education = 9.0; SD = 1.4; 43.9% female) selected from a larger database who completed baseline ImPACT testing from 2008–2016. Self-reported neurodevelopmental history consisted of these distinct groups: attention-deficit/hyperactivity disorder (ADHD; 3.6%), learning disorders (LD; 1.3%), Autism (0.3%), ADHD/LD (0.6%). ImPACT Composite Scores were analyzed using Mixed-model ANCOVA (age and gender covariates)-Verbal Memory (VerbM), Visual Memory (VisM), Visual Motor Speed (VisMot), Reaction Time (RT), and Impulse Control (IC). Composites were standardized and RT was reverse coded. For comparison purposes, individuals from all neurodevelopmental groups were utilized. Results There was a main effect for Composites and neurodevelopmental history (p &lt; .01). An interaction effect between Composites and neurodevelopmental history was found (p &lt; .01). The Autism group scored significantly lower than healthy athletes on VerbM, VisM, VisMot, and RT. No difference was found for IC. Pattern differences between neurodevelopmental groups will also be reported. Discussion Results reveal cognitive profile differences for athletes with Autism and other neurodevelopmental disorders. The ImPACT provides normative data for LD and ADHD athletes; however, our results indicate similar pattern differences for Autism and ADHD/LD. Future research should investigate whether separate norms may be beneficial for these groups.

Abstract In this paper, we develop an algorithm-based approach to the problem of stability of salient performance variables during motor actions. This problem is reformulated as stabilizing subspaces within high-dimensional spaces of elemental variables. Our main idea is that the central nervous system does not solve such problems precisely, but uses simple rules that achieve success with sufficiently high probability. Such rules can be applied even if the central nervous system has no knowledge of the mapping between small changes in elemental variables and changes in performance. We start with a rule ”Act on the most nimble” (the AMN-rule), when changes in the local feedback-based loops occur for the most unstable variable first. This rule is implemented in a task-specific coordinate system that facilitates local control. Further, we develop and supplement the AMN-rule to improve the success rate. Predictions of implementation of such algorithms are compared with the results of experiments performed on the human hand with both visual and mechanical perturbations. We conclude that physical, including neural, processes associated with everyday motor actions can be adequately represented with a set of simple algorithms leading to sloppy, but satisfactory, solutions. Finally, we discuss implications of this scheme for motor learning and motor disorders.

IntroductionChildren who suffer from traumatic brain injury (TBI) are at risk of permanent brain damage and developmental deficits. Reports on neurodevelopmental outcomes in paediatric TBI suffer from small sample size and varying outcome definitions in the neurocognitive domains tested. This protocol describes a systematic review and meta-analysis of paediatric TBI in the following key neurocognitive domains: executive function, perceptual–motor function, language, learning and memory, social cognition and complex attention.MethodsA comprehensive search comprising studies from Medline, Cochrane, Embase and PsycINFO published from 1988 to 2019 will be conducted. We will include studies on children ≤18 years old who suffer from mild, moderate and severe TBI as determined by the Glasgow Coma Scale that report neurocognitive outcomes in domains predetermined by the Diagnostic and Statistical Manual of Mental Disorders fifth edition criteria. Systematic reviews, meta-analyses, randomised controlled trials, case–control, cohort and cross-sectional studies will be included. References from systematic reviews and meta-analyses will be hand-searched for relevant articles. A meta-analysis will be performed and effect sizes will be calculated to summarise the magnitude of change in each neurocognitive domain compared at different timepoints and stratified by severity of TBI. Included studies will be pooled using pooled standardised mean differences with a random effects model to determine an overall effect. In the scenario that we are unable to pool the studies, we will perform a narrative analysis.Ethics and disseminationEthics approval is not required for this study.The authors of this study will publish and present the findings in a peer-reviewed journal as well as national and international conferences. The results of this study will provide understanding into the association between different severities of paediatric TBI and long-term neurocognitive outcomes.PROSPERO registration numberCRD42020152680.

AbstractIn order to understand how language abilities emerge in typically and atypically developing infants and toddlers, it is important to embrace complexity in development. In this paper, we describe evidence that early language development is an experience-dependent process, shaped by diverse, interconnected, interdependent developmental mechanisms, processes, and abilities (e.g. statistical learning, sampling, functional specialization, visual attention, social interaction, motor ability). We also present evidence from our studies on neurodevelopmental disorders (e.g. Down syndrome, fragile X syndrome, Williams syndrome) that variations in these factors significantly contribute to language delay. Finally, we discuss how embracing complexity, which involves integrating data from different domains and levels of description across developmental time, may lead to a better understanding of language development and, critically, lead to more effective interventions for cases when language develops atypically.

When learning and interacting with the world, people with Autism Spectrum Disorders (ASD) show compromised use of vision and enhanced reliance on body-based information. As this atypical profile is associated with motor and social difficulties, interventions could aim to reduce the potentially isolating reliance on the body and foster the use of visual information. To this end, head-mounted displays (HMDs) have unique features that enable the design of Immersive Virtual Realities (IVR) for manipulating and training sensorimotor processing. The present study assesses feasibility and offers some early insights from a new paradigm for exploring how children and adults with ASD interact with Reality and IVR when vision and proprioception are manipulated. Seven participants (five adults, two children) performed a self-turn task in two environments (Reality and IVR) for each of three sensory conditions (Only Proprioception, Only Vision, Vision + Proprioception) in a purpose-designed testing room and an HMD-simulated environment. The pilot indicates good feasibility of the paradigm. Preliminary data visualisation suggests the importance of considering inter-individual variability. The participants in this study who performed worse with Only Vision and better with Only Proprioception seemed to benefit from the use of IVR. Those who performed better with Only Vision and worse with Only Proprioception seemed to benefit from Reality. Therefore, we invite researchers and clinicians to consider that IVR may facilitate or impair individuals depending on their profiles.

We are expanding the use of the MIT-MANUS robotics to persons with impairments due exclusively to orthopedic disorders, with no neurological deficits. To understand the reliability of repeated measurements of the robotic tasks and the potential for registering changes due to learning is critical. Purposes of this study were to assess the learning effect of repeated exposure to robotic evaluations and to demonstrate the ability to detect a change in protocol in outcome measurements. Ten healthy, unimpaired subjects (mean age = 54.1 ± 6.4 years) performed six repeated evaluations consisting of unconstrained reaching movements to targets and circle drawing (with and without a visual template) on the MIT-MANUS. Reaching outcomes were aiming error, mean and peak speed, movement smoothness and duration. Outcomes for circle drawing were axis ratio metric and shoulder–elbow joint angles correlation metric (was based on a two-link model of the human arm and calculated hand path during the motions). Repeated-measures ANOVA (p≤ .05) determined if difference existed between the sessions. Intraclass correlations (R) were calculated. All variables were reliable, without learning across testing sessions. Intraclass correlation values were good to high (reaching,R≥ .80; circle drawing,R≥ .90). Robotic measurement ability to differentiate between similar but distinct tasks was demonstrated as measured by axis ratio metric (p< .001) and joint correlation metric (p= .001). Outcome measures of the MIT-MANUS proved to be reliable yet sensitive to change in healthy adults without motor learning over the course of repeated measurements.

This article suggests how brain mechanisms of learning, attention, and volition may give rise to hallucinations during schizophrenia and other mental disorders. The article suggests that normal learning and memory are stabilized through the use of learned top-down expectations. These expectations learn prototypes that are capable of focusing attention upon the combinations of features that comprise conscious perceptual experiences. When top-down expectations are active in a priming situation, they can modulate or sensitize their target cells to respond more effectively to matched bottom-up information. They cannot, however, fully activate these target cells. These matching properties are shown to be essential towards stabilizing the memory of learned representations. The modulatory property of top-down expectations is achieved through a balance between top-down excitation and inhibition. The learned prototype is the excitatory on-center in this top-down network. Phasic volitional signals can shift the balance between excitation and inhibition to favor net excitatory activation. Such a volitionally mediated shift enables top-down expectations, in the absence of supportive bottom-up inputs, to cause conscious experiences of imagery and inner speech and thereby to enable fantasy and planning activities to occur. If these volitional signals become tonically hyperactive during a mental disorder, the top-down expectations can give rise to conscious experiences in the absence of bottom-up inputs and volition. These events are compared with data about hallucinations. The article predicts where these top-down expectations and volitional signals may act in the laminar circuits of visual cortex and, by extension, in other sensory and cognitive neocortical areas, and how the level of abstractness of learned prototypes may covary with the abstractness of hallucinatory content. A similar breakdown of volition may lead to delusions of control in the motor system. (JINS, 2000, 6, 583–592.)

Abstract Objective Neonatal jaundice (hyperbilirubinemia) remains present in 60% of births in the United States1. Current literature links hyperbilirubinemia with neurodevelopmental problems, particularly with attention deficit hyperactivity disorder (ADHD), general learning difficulties, and non-progressive developmental delays. Moderate elevations in bilirubin are also suggested to increase the risk for cognitive, perceptual, motor, and auditory disorders. Imaging studies have shown selective patterns of injury to specific brain regions associated with deficits in executive function, including impulse control and working memory as well as different subtypes of attention problems grounded in reward circuitry system dysfunction in children with bilirubin encephalopathy. Method Neuropsychological functioning of a 12-year old Hispanic female with a history of high levels of perinatal bilirubin, and subsequent developmental and cognitive difficulties in speech, learning, attention and memory as well as problems with socialization and anxiety is presented with the purpose of adding to existing literature. Comprehensive neuropsychiatric interview and neuropsychological testing was completed. Results Results revealed several areas of neurocognitive weaknesses with deficits in areas of intellectual functioning, learning (reading and mathematics), expressive language, visual memory, attention, and auditory processing. Emotional and behavioral measures evidenced significant deficits in social-emotional functioning, particularly with interpersonal skills, sense of adequacy, and self-reliance, which resulted in increased anxiety contributing to cognitive and academic deficits. Conclusions Neuropsychological profile was consistent with cognitive, academic, behavioral and emotional manifestations theoretically associated with neuropathological findings in hyperbilirubinemia. Furthermore, similar to existing literature, cognitive deficits were observed in the absence of a clear cause of neonatal jaundice following a full-term, uncomplicated pregnancy.

Relevance. Adolescent’s health has largely determined by socio-hygienic parameters of life and studying process and teenagers studied at vocational agrarian lyceums are particular layer of society, characterized by a set of risk factors of various kinds, potentially dangerous to health, this fact makes the problem of maintaining the pupil’s health of this group particularly relevant. Objective. To study the health of adolescents – pupils of the professional agrarian lyceum and to identify the risk factors of the educational and industrial environment that can adversely affect their health. Materials and methods. Under direct supervision, there were 131pupils (128 male, 3 female gender), aged 15-18 years, who master various agricultural professions at Odnorobivskiy professional agrarian lyceum (Zolochiv district, Kharkiv region). Training conditions were investigated by the method of hygienic inspection in conformity with the current sanitary standards. Characteristics of pupil’s life activity were given according to the questionnaire "Mode of life". The state of pupil’s health was studied on the results of thorough medical examinations, indicators of acute and chronic morbidity, followed by distribution by groups of health. Results. The educational state of pathological defeats of pupils can be estimated as the result of prolonged, uncontrolled effects on the body of teenagers such negative factors as insufficient illumination areas, disorders of diet, lack of diversity and usefulness of the diet, widespread disturbance of regime-organizational learning and disorders in the structure of free time, hypodynamia, as well as the influence of the complex of negative factors of the educational-production regimen and professionally determined factors. Negative facts in the pupil’s life were: breach of requirements for catering (48%), disorders of the day regimen (46%), low motor activity (51%). Conclusions: A significant disadvantage was inadequate illumination of training and production premises, which is a significant negative factor that can adversely affects the pupil’s functional health cause premature fatigue and strain that together are as a risk factor of dysadaptation states and further disorders by visual analyzer. The observed pathological disorders of this contingent and increasing the percentage of certain classes of diseases can be negative factor, able to significantly reduce and complicate the adaptation process to the educational and professional regimen that requires the development of a comprehensive system of prophylactic measures to prevent the development of disease of pupils, during the education at professional agrarian lyceum.

Abstract Introduction Baseline symptom, balance, and neurocognitive scores have become an integral piece of the concussion management process. Factors such as sleep, learning disorders, fitness level, and sex have been linked to differences in performance on baseline assessments; however, it is unclear how tobacco use may affect these scores. The objective of this study was to compare baseline concussion assessment scores between service academy cadets who use and do not use tobacco. Methods Cadets completed a standard battery of concussion baseline assessments per standard of care and were classified into two groups: tobacco users (n = 1,232) and nonusers (n = 5,922). Dependent variables included scores on the Balance Error Scoring System, Standardized Assessment of Concussion, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Brief Symptom Inventory-18, and Brief Sensation Seeking Scale (BSSS). Separate Mann–Whitney U-tests were used to compare all baseline assessment scores between groups with an adjusted P-value &lt; 0.004. Results Cadets that used tobacco performed significantly worse on the impulse control (P &lt; 0.001) section of the ImPACT, reported greater ImPACT symptom severity scores (P &lt; 0.001), and were more likely to take risks as measured by the BSSS (P &lt; 0.001). No differences were detected for Balance Error Scoring System, Standardized Assessment of Concussion, Brief Symptom Inventory-18, and Sport Concussion Assessment Tool-3 symptom scores, verbal memory, visual memory, visual-motor speed, or reaction time on the ImPACT (P &gt; 0.004). Conclusions Tobacco users performed significantly worse than tobacco nonusers on the impulse control section of the ImPACT, reported greater symptom severity scores on the ImPACT, and were more likely to take risks as measured by the BSSS. Despite statistical significance, these results should be interpreted with caution, as the overall effect sizes were very small. Future research should examine the influence of tobacco use on recovery post-concussion.

AbstractHistoric background and development of our somatocognitive approachMensendieck physiotherapy of the Oslo School is a tradition of physiotherapy founded by the American physician Bess Mensendieck, a contemporary and fellow student of Sigmund Freud at the Paris School of Neurology. It builds on the principles of functional anatomy and the theories of motor learning. We have further developed the theory and practice from this physiotherapy tradition, challenged by the enormous load of patients with longstanding, incapacitating pain on western health care systems, by seeking to incorporate inspirational ideas from body oriented dynamic psychotherapy and cognitive psychotherapy. We developed somatocognitive therapy as a hybrid of physiotherapy and cognitive psychotherapy by focusing on the present cognitive content of the mind of the patient, contrary to a focus on analysis of the subconscious and interpretation of dreams, and acknowledging the important role of the body in pain-eliciting defense mechanisms against mental stress and negative emotions.The core of this somatocognitive therapy(1) To promote awareness of own body, (2) graded task assignment related to the motor patterns utilized in daily activities, (3) combined with an empathic attitude built on dialogue and mutual understanding, and emotional containment and support. The goal is for the patient to develop coping strategies and mastery of own life. In addition, (4) manual release of tensed muscles and applied relaxation techniques are important.Methods and results of an illustrative studyOne area in particular need of development and research is sexual pain disorders. We have applied this somatocognitive therapy in a randomized, controlled intervention study of women with chronic pelvic pain (CPP).Wesummarize methods and results of this study.Methods40 patients with CPP were included in a randomized, controlled intervention study. The patients were randomized into (1) a control group, receiving treatment as usual (Standard Gynecological Treatment, STGT) and (2) a group receiving STGT + Mensendieck Somatocognitive Therapy (MSCT). The patients were assessed by means of Visual Analogue Scale of Pain (VASP), Standardized Mensendieck Test (SMT) for analysis of motor patterns (posture, movement, gait, sitting posture and respiration), and General Health Questionnaire (GHQ-30) assessing psychological distress, at baseline (inclusion into study), after three months of out-patient therapy and at 1 year follow-up. Results: The women averaged 31 years, pain duration 6.1 years, average number of previous surgical procedures 1.8 per women. In the STGT group, no significant change was found, neither in pain scores, motor patterns or psychological distress during the observation period. In the group receiving STGT + MSCT, significant reduction in pain score and improvement in motor function were found at the end of therapy, and the significant improvement continued through the follow-up (64% reduction of pain scores, and 80% increase in the average score for respiration, as an example of motor pattern improvement). GHQ scores were significantly improved for anxiety and coping (p < 0.01).ConclusionsSomatocognitive therapy is anewapproach that appears to be very promising in the management of chronic gynecological pain. Short-term out-patient treatment significantly reduces pain scores and improves motor function.ImplicationsChronic pelvic pain in women is a major health care problem with no specific therapies and poor prognosis. A novel, somatocognitive approach has documented positive effects. It is now studied by other clinical researchers in order to reinforce its evidence base.

Abstract Introduction 17% of children with sickle cell disease (SCD) between the ages of 6 and 16 could have silent infarcts1. Depending on the area of the brain affected silent infarcts can cause problems with attention, coordination, visual-motor speed and executive function. Children with SCD in the UK do not receive routine MRI scans. Subtle defects in cognition can be assessed with neuropsychometric testing which involves multiple tests assessing many areas of cognition. However, testing is limited to those with known neurological deficits due to lack of funding and shortage of specialist staff. There is a need for a robust screening tool for assessment of cognition, which could identify children for further specialist testing. The Cogstate battery is computer-based program that assesses cognition and has been used in several clinical settings, both adult and paediatric2-3. The Cogstate battery is reported to be culturally neutral and is available in several languages. Additionally the Cogstate battery is free from practice effects and so could be used as an annual assessment tool in order to identify any declines as early as possible. The Cogstate battery has not yet been used to assess cognition in children with SCD. Research Objectives The aim of this study was to assess the feasibility of using the Cogstate Battery as a tool for the assessment of cognition in children with SCD. It was hypothesised that the Cogstate battery would be easy to use within this setting and would be acceptable to patients, parents and assessors. Methods Eight clinically well children, aged 10-17 with SCD were recruited through St Mary's Hospital paediatric haematology outpatient clinics. The Cogstate software was downloaded onto a Windows laptop computer and an anonymous profile was created for each child before testing. A battery of 6 tests (Table 1) was created aiming to assess a range of cognitive domains within a reasonable amount of time. Every child completed the battery of tests once, which included a short practice before each test. After testing each patient was asked to give an opinion of how they found the tests. Upon completion of the test the patients' results were uploaded to the Cogstate website which generated a test report and a case report form. A mark was given for each test and a score of over 90 represents normal cognition in the area tested, 81-90 represents mild impairment and below 81 represents impairment.Table 1.Tests used in the Cogstate battery and corresponding cognitive domains assessedTest NameCognitive Domain TestedContinuous paired associate learning (CPAL)Paired associate learningDetection (DET)Psychomotor functionGroton maze learning test (ME)Executive functionGroton maze learning test-delayed recall (ME)Delayed recallIdentification (IDN)AttentionOne card learning (OCL)LearningOne-back memory (ONBA)Working memory Results 8 patients completed the battery, taking on average 29 minutes (Table 2). The battery was easy to carry out and although some children reported it as boring, they all finished the tests without distress. The test report generated by the Cogstate website allowed results to be analysed quickly and with ease. An overall score from each test is clearly indicated. The Continuous Paired Associate Learning test was not displayed as part of the test report as there was insufficient normal data to draw conclusions from the results within the age group tested. Table 2. Summary Report of 8 patients tested PatientID DET(Psychomotor function) IDN(Attention) OCL(Learning) ONBS(Processing speed) ONBA(Working memory) ME(Executive function & delayed recall) 0001 87 75 82 78 83 99 0002 106 105 94 90 117 99 0003 96 101 95 95 117 98 0004 76 76 94 81 94 93 0005 86 84 98 81 89 89 0006 98 104 97 97 94 111 0007 94 90 91 83 101 86 0008 91 88 108 90 96 95 Conclusion The Cogstate battery is a feasible tool for paediatric SCD patients and can be undertaken in a clinic setting. This feasibility study will help design a prospective, comparative study of cognition in children with SCD using the Cogstate battery and conventional neuropsychometric assessment and once validated, would be a useful tool to assess cognition and institute timely educational and medical intervention. References: 1. Pegelow J Pediatr. 2002 Mar;140(3):348-54. 2. Hammers, Am J Alzheimers Dis. 2011 Jun;26(4):326-33 3. Harel PLoS One. 2014 Jul 11;9(7):e101750 Disclosures No relevant conflicts of interest to declare.

Aim. The article discusses the results of a psychological study of the development of mental functions in children with convulsive paroxysms in the anamnesis. In order to identify common patterns of mental dysontogenesis in children with cerebral organic pathology, the data obtained are compared with the results of other studies. Methods. As experimental research methods, methods of neuropsychological diagnosis of higher mental functions in children were used (Tsvetkova, 2002), the diagnostic complex Forecast and prevention of learning problems at school (Yasyukova, 2002). Statistical analysis was performed using the SPSS statistical analysis software. Results. The results of the study showed that the early onset of seizures in children is combined with impaired auditory perception, short-term speech memory, visual linear thinking and motor awkwardness. The prolonged presence of convulsive paroxysms in the history of a preschool child is associated with the pathology of the development of kinesthetic praxis, as well as speech functions and forms of thinking associated with speech. A significant number of seizures in the history of the disease has a more destructive and total effect on the brain of the child in comparison with the age of onset and the duration of the disease. The data obtained are similar to the results of psychological studies of children with other cerebral organic pathology. Consequently, pathological cerebral processes and conditions of various nature can lead to similar disorders in the development of mental functions, presumably those that are at the time the pathological factor begins in the sensitive period of development. This allows using the concept of levels of neurocognitive response in a situation of organic damage to the brain of a child. Conclusion. The picture of the mental development disorder of children with convulsive paroxysms in the anamnesis is mediated by the age of onset, the duration and massiveness of the disease. Children with various diseases of the central nervous system, presumably, have common patterns of mental dysontogenesis.

Purpose: Physicians report balance disorders and fatigue as the symptoms of Multiple Sclerosis (MS) disease. The present study compares the effect of transcranial Direct Current Stimulation (tDCS) and core stability training on the balance and disability of patients with MS. Methods: This is a pre-test, post-test experiment study. The statistical population included all patients with MS who reffered to Rofaydeh Rehabilitation Hospital in Tehran City, Iran, in the winter of 2019. A total of 30 male and female patients aged 27-70 years were selected through available and purposive sampling methods and then randomly divided into experimental and control groups (each group 15 persons). The initial measurements of the participants’ kinetic variables of postural control were carried out by the posturography device, and afterward, Kurtzke Expanded Disability Status Scale (EDSS) was employed to measure disability. The participants’ training included core stability training for 8 weeks (30-40 min, 3 sessions per week) with 20 min online cerebellar transcranial direct current stimulation, 2 sessions per week (The first and third sessions). Then, the research variables were measured again. Results: The results demonstrated the significant influence of cerebellar tDCS on the variables of postural control equilibrium in the second sensory condition (P<0.001), third sensory condition (P<0.001), fourth sensory condition (P<0.001), fifth sensory condition (P=0.034), and combine equilibrium (P<0.001). Besides, the cerebellar current stimulation enhanced the sensory performance of the experimental group in using the vestibular system input data (P<0.001) and vision (P<0.001), but it had no significant effect on the ability to use somatosensory input (P=0.203) and vision preference (P=0.343). This research also revealed that the cerebellar current stimulation decreased EDSS in MS patients (P=0.026). Conclusion: The cerebellar tDCS has a beneficial effect on balance, EDSS, and modified fatigue impact scale in MS patients. The study findings also indicate that the cerebellum, vestibular system, and visual system are related, and they have an impact on balance, and cerebellar stimulation can facilitate learning motor skills.

Abstract Background Schizophrenia (Sz) and other psychoses are complex mental disorders, characterised by sensory, cognitive and emotional symptoms, but mainly distinguished by positive and negative symptoms. Cognitive impairment is a core feature of schizophrenia, with research into cognitive deficits indicating that cognitive impairment precedes clinical disease onset and is still evident after positive symptoms are no longer present. The current mainstream treatment for Sz are first and second-generation antipsychotics, such as chlorpromazine and aripiprazole respectively. However, about a third of patients treated with antipsychotic drugs have no change in their symptoms despite adequate trials of several antipsychotic drugs. Treatment-resistant schizophrenia (TRS) refers to individuals with a F20-F29 diagnosis who have had at least two courses of antipsychotic treatment with little to no symptomatic relief. Emerging evidence into the factors associated with antipsychotic treatment response has investigated genetic, demographic and clinical factors and their relation to treatment response, with emerging evidence from cognitive data inferring a domain specific deficit in TRS populations for verbal, general cognition (IQ) and executive function tasks. Methods Publications were selected from a systematic search from four databases: PsycINFO, Ovid MEDLINE(R), Scopus and Web of Science. Following inclusion/exclusion criteria, cognitive test outcomes were extracted for each responder group (TRS/NTRS; treatment responders), as well as variables such as age of psychotic illness onset, average chlorpromazine equivalents and duration of illness. Neuropsychological tasks and subtests identified across publications were then grouped into one of seven exclusive cognitive domains (e.g. executive function) prior to analysis based on recommendations from existing literature. Following this, a random-effects model was adopted to test the differences between responder groups in each cognitive domain across publications. Results From the 17 publications identified, sample sizes ranged from 817 to 36, with the majority of publications using a sample size of ~65 TRS/NTRS cases, and a total sample size of N = 1,943 across studies. The random-effects model indicates that cases reaching treatment resistance criteria demonstrated marked neuropsychological performance generally across all domains (d = 0.372, 95CIs 0.29; 0.46], p&lt; .001), with this being most marked in tasks of verbal memory and learning (d = 0.49, 95CIs [0.28; 0.70], p&lt;. 001), verbal intelligence and processing (d = 0.38, 95CIs [0.17; 0.58], p&lt; .001), IQ/general cognitive functioning (d = 0.46, 95CIs [0.17; 0.75], p = 0.002), attention, Working memory and Visual-motor/processing speed (d = 0.38, 95CIs [0.24; 0.51], p&lt; 0.001) and executive function (d = 0.41, 95CIs [0.13; 0.68], p = 0.003), with these all demonstrating a close to medium effect size. There was no significant differences between responder groups in test performance for visual-spatial memory and learning (d = .16, 95CIs [-0.16; 0.48], p = 0.334) and visual-spatial intelligence and processing (d = .50, 95CIs [-0.05; 01.04], p = 0.074) tasks. Discussion In line with existing literature, treatment resistant schizophrenia appears to demonstrate domain specific marked performance on tasks relating to verbal memory, verbal intelligence, as well as tasks relating to executive function, attention and working memory in relation to responders. When considering the clinical importance of identification of treatment resistance in the early disease stages (i.e. at first episode) the use of domain specific cognitive testing could help improve prediction of future antipsychotic response/non-response.

Abstract Patients who survive an acute episode of TTP often describe persistent problems with concentration, memory and fatigue in spite of continued remission. To assess these symptoms, we performed neuropsychological tests assessing 11 cognitive domains. We hypothesized that domains assessing complex attention/concentration skills and high level memory functions would be affected because these are characteristically abnormal in disorders with diffuse microvascular subcortical lesions. The Oklahoma TTP-HUS Registry enrolled 247 consecutive patients with their first episode of clinically diagnosed TTP from 11-13-1995 (the date of our initial ADAMTS13 measurement) to 6-30-2006; ADAMTS13 activity was measured in 228 (92%) patients immediately before their first plasma exchange treatment; 42 (18%) patients had ADAMTS13 activity <10%; 31 were currently alive; 25 (81%) were included in this study (3 patients were excluded because of dementia, 1 was too young to be evaluated, 1 was incarcerated, 1 was lost to follow-up). 21 (84%) patients were women; 9 (36%) were black; median age was 44 years (range 20–64); median time since their last episode was 46 months (range 2–127). At the time of the evaluation physical examinations and the Mini-Mental State Exams were normal. Median hematocrit was 39% (range 31–51%, 1 women had iron deficiency). Median platelet count was 303 (range 81–518; 1 woman has had persistent mild thrombocytopenia). ADAMTS13 levels remained <10% in 4 patients and were 10–20% in 4 additional patients. Results from the neuropsychological tests were compared to normal population values matched for age and education level and converted to a score with a mean value of 0 and a standard deviation of 1. Neurocognitive test domain Patients mildly impaired* Mean score P (score) *Patients were categorized as mildly impaired if they scored ≥ 1 standard deviation below the mean (≤16th percentile). List learning 9 (36%) −0.85 0.001 Manual dexterity 10 (40%) −0.65 0.006 Complex attention, sequencing 7 (28%) −0.61 0.003 Rapid language generation 8 (32%) −0.46 0.013 The 25 patients as a group performed significantly worse than the population norms for 4 of the 11 domains. 18 (72%) patients were mildly impaired on 1 or more of these 4 domains; 10 of these patients had no severe neurologic abnormalities (seizure, stroke, coma, focal signs) during their acute episode. These are the 4 domains that are expected to be abnormal in patients with diffuse microvascular subcortical lesions. For the 7 other domains that are expected to be unaffected in these patients, our patients did not perform worse than the normal population: general cognitive functioning, visual perceptual skills, simple sustained attention, simple reaction time, executive function, semantic and visual memory. Conclusions: Patients who appear to have a complete recovery from their acute episode of TTP may have persistent neurocognitive abnormalities, causing deficits of attention, processing speed, and memory, slower motor function and fatigue. The pattern of neurocognitive abnormalities is similar to patients with other diffuse microvascular or thrombotic abnormalities, such as sickle cell anemia. Awareness of these potential problems is important to provide appropriate support.

Individuals face numerous challenges with many disorders, particularly when multiple disfunctions are diagnosed and especially for visually effected wheelchair users. This scenario, in reality creates in a degree of incapacity on the part of the wheelchair user in terms of performing simple activities. Based on their specific medical needs confined patients are treated in a modified method. Independent navigation is secured for individuals with vision and motor disabilities. There is a necessity for communication which justifies the use of virtual reality (VR) in this navigation situation. For the effective integration of locomotion besides, it must be under natural guidance. Electroencephalography (EEG), which uses random brain impulses, has made significant progress in the field of health. The custom of an automated audio announcement system modified to have the help of Virtual Reality (VR) and EEG for training of locomotion and individualised interaction of wheelchair users with visual disability is demonstrated in this study through an experiment. Enabling the patients who were otherwise deemed incapacitated to participate in social activities, as the aim was to have efficient connections. The natural control, feedback, stimuli, and protection these subsequent principles founded this project. Via properly conducted experiments, a multilayer computer rehabilitation system was created that integrated natural interaction assisted by EEG, which enabled the movements in the virtual environment and real wheelchair. For blind wheelchair operator patients this study involved of expounding the proper methodology. For educating the value of life and independence of blind wheelchair users, outcomes proven that VR with EEG signals has that potential. To protect their life straightaway and to report all these disputes, the military system should have high speed, more precise portable prototype device for nursing the soldier health, recognition of solider location and report about health sharing system to the concerned system. FPGA-based soldier’s health observing and position gratitude system is proposed in this paper. Reliant on heart rate which is centred on EEG signals the soldier health is observed in systematic bases. By emerging Verilog HDL programming language and executing on Artix-7 development FPGA board of part name XC7ACSG100t the whole work is approved in a Vivado Design Suite. Classification of different abnormalities, and cloud storage of EEG along with type of abnormalities, artifact elimination, abnormalities identification based on feature extraction, exist in the segment of suggested architecture. Irregularity circumstances are noticed through developed prototype system and alert the physically challenged (PHC) individual via audio announcement. An actual method for eradicating motion artefacts from EEG signals that have anomalies in the PHC person's brain has been established, and the established system is a portable device that can deliver differences in brain signal variation intensity. Primarily the EEG signals can be taken and the undesirable artifact can be detached, later structures can be mined by DWT these are the two stages through which artifact deletion can be completed. The anomalies in signal can be noticed and recognized by using machine learning algorithms known as Multirate SVM classifiers, when the features have been extracted using a combination of HMM and GMM. Intended for capable declaration about action taken by a blind person, these result signals are protected in storage devices and conveyed to the controller. Pretending daily motion schedules allows the pretentious EEG signals to be caught. Aimed at the validation of planned system, the database can be used and continued with numerous recorded signals of EEG. The projected strategy executes better in terms of re-storing theta, delta, alpha, and beta (TDAB) complexes of the original EEG with less alteration and a higher signal to noise ratio (SNR) value of the EEG signal which illustrates in the quantitative analysis. The projected method used Verilog HDL and MATLAB software for both formation and authorization of results in order to yield improved results. Since from the achieved results, it is initiated that 32% enhancement in SNR, 14% in MSE and 65% enhancement in recognition of anomalies, hence design is effectively certified and proved for standard EEG signals datasets on FPGA.

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Bipolar disorder not otherwise specified -overdiagnosed or underdiagnosed?</strong></p><p>E Allers</p><p><strong>2. The prognosis of major depression untreated and treated: Does the data reflect the true picture of the prognosis of this very common disorder?</strong></p><p>E Allers</p><p><strong>3. Can we prolong our patients' life expectancy? Providing a better quality of life for patients with severe mental illness</strong></p><p>O A Betencourt</p><p><strong>4. The scope of ECT practice in South Africa</strong></p><p>J Benson-Martin, P Milligan</p><p><strong>5. Biomarkers for schizophrenia: Can we evolve like cancer therapeutics?</strong></p><p>P Buckley<strong></strong></p><p><strong>6. Relapse in schizophrenis: Major challenges in prediction and prevention</strong></p><p>P Buckley</p><p><strong>7. Informed consent in biological treatments: The right to know the duty to inform</strong></p><p><strong></strong>I Chetty</p><p><strong>8. Effectiveness of a long-acting injectable antipsychotic plus an assertive monitoring programme in first-episode schizophrenia</strong></p><p><strong></strong>B Chiliza, L Asmal, O Esan, A Ojagbemi, O Gureje, R Emsley</p><p><strong>9. Name, shame, fame</strong></p><p>P Cilliers</p><p><strong>10. Can we manage the increasing incidence of violent raging children? We have to!</strong></p><p>H Clark</p><p><strong>11. Serotonin, depression and antidepressant action</strong></p><p>P Cowen</p><p><strong>12. Prevalence and correlates of comorbid psychiatris illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit</strong></p><p>L Dannatt, K J Cloete, M Kidd, L Weich</p><p><strong>13. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers</strong></p><p>A K Domingo, S Seedat, T M Esterhuizen, C Laurence, J Volmink, L Asmal</p><p><strong>14. Neuropeptide S -emerging evidence for a role in anxiety</strong></p><p>K Domschke</p><p><strong>15. Pathogenetics of anxiety</strong></p><p>K Domschke</p><p><strong>16. The effects of HIV on the fronto-striatal system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>17. Effects of acute antipsychotic treatment on brain morphology in schizophrenia</strong></p><p>R Emsley, L Asmal, B Chiliza, S du Plessis, J Carr, A Goosen, M Kidd, M Vink, R Kahn</p><p><strong>18. Development of a genetic database resource for monitoring of breast cancer patients at risk of physical and psychological complications</strong></p><p>K Grant, F J Cronje, K Botha, J P Apffelstaedt, M J Kotze</p><p><strong>19. Unipolar mania reconsidered: Evidence from a South African study</strong></p><p><strong></strong>C Grobler</p><p><strong>20. Antipsychotic-induced movement disorders: Occurence and management</strong></p><p>P Haddad</p><p><strong>21. The place of observational studies in assessing the effectiveness of long-acting injectable antipsychotics</strong></p><p>P Haddad</p><p><strong>22. Molecular mechanisms of d-cycloserine in fear extinction: Insights from RNS sequencing</strong></p><p>S Hemmings, S Malan-Muller, L Fairbairn, M Jalali, E J Oakeley, J Gamieldien, M Kidd, S Seedat</p><p><strong>23. Schizophrenia: The role of inflammation</strong></p><p>DC Henderson</p><p><strong>24. Addictions: Emergent trends and innovations</strong></p><p>V Hitzeroth</p><p><strong>25. The socio-cultural-religious context of biological psychiatric practice</strong></p><p>B Janse van Rensburg</p><p><strong>26. Biochemical markers for identifying risk factors for disability progression in multiple sclerosis</strong></p><p><strong></strong>S Janse van Rensburg, M J Kotze, F J Cronje, W Davis, K Moremi, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>27. Alcohol-induced psychotic disorder: Brain perfusion and psychopathology - before and after antipsychotic treatment</strong></p><p>G Jordaan, J M Warwick, D G Nel, R Hewlett, R Emsley</p><p><strong>28.'Pump and dump': Harm reduction strategies for breastfeeding while using substances</strong></p><p>L Kramer</p><p><strong>29. Adolescent neuropsychiatry - an emerging field in South African adolescent psychiatric services</strong></p><p>A Lachman</p><p><strong>30. Recovery versus remission, or what it means to be healthy for a psychiatric patient?</strong></p><p>B Latecki</p><p><strong>31. Holistic methods utilised to normalise behaviours in youth diagnosed with neuro-biochemical disorders</strong></p><p>P Macqueen</p><p><strong>32. Candidate genes and novel polymorphisms for anxiety disorder in a South African cohort</strong></p><p>N McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D Stein, V Russel, C Lochner</p><p><strong>33. Higher visual functioning</strong></p><p>A Moodley</p><p><strong>34. The effects of prenatal methylmercury exposure on trace element and antioxidant levels in rat offspring following 6-hydroxydopamine-induced neuronal insult</strong></p><p>Z M Moosa, W M U Daniels, M V Mabandla</p><p><strong>35. Paediatric neuropsychiatric movement disorders</strong></p><p>L Mubaiwa</p><p><strong>36. The South African national female offenders study</strong></p><p>M Nagdee, L Artz, C de Clercq, P de Wet, H Erlacher, S Kaliski, C Kotze, L Kowalski, J Naidoo, S Naidoo, J Pretorius, M Roffey, F Sokudela, U Subramaney</p><p><strong>37. Neurobiological consequences of child abuse</strong></p><p>C Nemeroff</p><p><strong>38. What do Stellenbosch Unviversity medical students think about psychiatry - and why should we care?</strong></p><p>G Nortje, S Suliman, K Seed, G Lydall, S Seedat</p><p><strong>39. Neurological soft skins in Nigerian Africans with first episode schizophrenia: Factor structure and clinical correlates</strong></p><p><strong></strong>A Ojagbemi, O Esan, O Gureje, R Emsley</p><p><strong>40. Should psychiatric patients know their MTHFR status?</strong></p><p>E Peter</p><p><strong>41. Clinical and functional outcome of treatment refractory first-episode schizophrenia</strong></p><p>L Phahladira, R Emsley, L Asmal, B Chiliza</p><p><strong>42. Bioethics by case discussion</strong></p><p>W Pienaar</p><p><strong>43. Reviewing our social contract pertaining to psychiatric research in children, research in developing countries and distributive justice in pharmacy</strong></p><p>W Pienaar</p><p><strong>44. The performance of the MMSE in a heterogenous elderly South African population</strong></p><p>S Ramlall, J Chipps, A I Bhigjee, B J Pillay</p><p><strong>45. Biological basis addiction (alocohol and drug addiction)</strong></p><p>S Rataemane</p><p><strong>46. Volumetric brain changes in prenatal methamphetamine-exposed children compared with healthy unexposed controls</strong></p><p><strong></strong>A Roos, K Donald, G Jones, D J Stein</p><p><strong>47. Single voxel proton magnetic resonance spectroscopy of the amygdala in social anxiety disorder in the context of early developmental trauma</strong></p><p>D Rosenstein, A Hess, S Seedat, E Meintjies</p><p><strong>48. Discussion of HDAC inhibitors, with specific reference to supliride and its use during breastfeeding</strong></p><p>J Roux</p><p><strong>49. Prevalence and clinical correlates of police contact prior to a first diagnosis of schizophrenia</strong></p><p>C Schumann, L Asmal, K Cloete, B Chiliza, R Emsley</p><p><strong>50. Are dreams meaningless?</strong></p><p>M Solms</p><p><strong>51. The conscious id</strong></p><p>M Solms<strong></strong></p><p><strong>52. Depression and resilience in HIV-infected women with early life stress: Does trauma play a mediating role?</strong></p><p>G Spies, S Seedat</p><p><strong>53. State of affairs analysis for forensic psychiatry in SA</strong></p><p>U Subramaney</p><p><strong>54. Escitalopram in the prevention of post-traumatic stress disorder: A pilot randomised controlled trial</strong></p><p>S Suliman, S Seedat, J Pingo, T Sutherland, J Zohar, D J Stein</p><p><strong>55. Epigenetic consequences of adverse early social experiences in primates</strong></p><p>S Suomi</p><p><strong>56. Risk, resilience, and gene x environment interactions in primates</strong></p><p>S Suomi</p><p><strong>57. Biological aspects of anorexia nervosa</strong></p><p>C Szabo</p><p><strong>58. Agents used and profiles of non-fatal suicidal behaviour in East London</strong></p><p>H Uys</p><p><strong>59. The contributions of G-protein coupled receptor signalling to opioid dependence</strong></p><p>J van Tonder</p><p><strong>60. Emerging trend and innovation in PTSD and OCD</strong></p><p>J Zohar</p><p><strong>61. Making the SASOP treatment guidelines operational</strong></p><p>E Allers</p><p><strong>Poster Presentations</strong></p><p><strong>62. Neuropsychological deficits in social anxiety disorder in the context of early developmental trauma</strong></p><p><strong></strong>S Bakelaar, D Rosenstein, S Seedat</p><p><strong>63.Social anxiety disorder in patients with or without early childhood trauma: Relationship to behavioral inhibition and activation and quality of life</strong></p><p><strong></strong>S Bakelaar, C Bruijnen, A Sambeth, S Seedat</p><p><strong>64. Exploring altered affective processing in obssessive compulsive disorder symptom subtypes</strong></p><p>E Breet, J Ipser, D Stein, C Lochner<strong><br /></strong></p><p><strong>65. To investigate the bias toward recognising the facial expression of disgust in obsessive compulsive disorder as well as the effect of escitalopram</strong></p><p>E Breet, J Ipser, D Stein, C Lochner</p><p><strong>66. A fatal-case of nevirapine-induced Stevens-Johnson's syndrome in HIV mania</strong></p><p>A Bronkhorst, Z Zingela, W M Qwesha, B P Magigaba<strong></strong></p><p><strong>67. Association of the COMT G472A (met/met) genotype with lower disability in people diagnosed with multiple sclerosis</strong></p><p>W Davis, S J van Rensburg, L Fisher, F J Cronje, D Geiger, M J Kotze</p><p><strong>68. Homocycsteine levels are associated with the fat mass and obesity associated gene FTO(intron 1 T&gt;A) polymorphism in MS patients</strong></p><p>W Davis, S J Van Rensburg, M J Kotze, L Fisher, M Jalali, F J Cronje, K Moremi, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>69. Analysis of the COMT 472 G&gt;A (rs4680) polymorphism in relation to environmental influences as contributing factors in patients with schizophrenia</strong></p><p>D de Klerk, S J van Rensburg, R A Emsley, D Geiger, M Rensburg, R T Erasmus, M J Kotze</p><p><strong>70. Dietary folate intake, homocysteine levels and MTHFR mutation detection in South African patients with depression: Test development for clinical application </strong></p><p>D Delport, N vand der Merwe, R Schoeman, M J Kotze</p><p><strong>71. The use ofexome sequencing for antipsychotic pharmacogenomic applications in South African schizophrenia patients</strong></p><p>B Drogmoller, D Niehaus, G Wright, B Chiliza, L Asmal, R Emsley, L Warnich</p><p><strong>72. The effects of HIV on the ventral-striatal reward system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>73. Xenomelia relates to asymmetrical insular activity: A case study of fMRI</strong></p><p>S du Plessis, M Vink, L Asmal</p><p><strong>74. Maternal mental helath: A prospective naturalistic study of the outcome of pregancy in women with major psychiatric disorders in an African country</strong></p><p>E du Toit, L Koen, D Niehaus, B Vythilingum, E Jordaan, J Leppanen</p><p><strong>75. Prefrontal cortical thinning and subcortical volume decrease in HIV-positive children with encephalopathy</strong></p><p>J P Fouche, B Spottiswoode, K Donald, D Stein, J Hoare</p><p><strong>76. H-magnetic resonance spectroscopy metabolites in schizophrenia</strong></p><p>F Howells, J Hsieh, H Temmingh, D J Stein</p><p><strong>77. Hypothesis for the development of persistent methamphetamine-induced psychosis</strong></p><p><strong></strong> J Hsieh, D J Stein, F M Howells</p><p><strong>78. Culture, religion, spirituality and psychiatric practice: The SASOP Spirituality and Psychiatry Special Interest Group Action Plan for 2012-2014</strong></p><p>B Janse van Rensburg</p><p><strong>79. Cocaine reduces the efficiency of dopamine uptake in a rodent model of attention-deficit/hyperactivity disorder: An <em>in vivo</em> electrochemical study</strong></p><p><strong></strong>L Kellaway, J S Womersley, D J Stein, G A Gerhardt, V A Russell</p><p><strong>80. Kleine-Levin syndrome: Case in an adolescent psychiatric unit</strong></p><p>A Lachman</p><p><strong>81. Increased inflammatory stress specific clinical, lifestyle and therapeutic variables in patients receiving treatment for stress, anxiety or depressive symptoms</strong></p><p>H Luckhoff, M Kotze, S Janse van Rensburg, D Geiger</p><p><strong>82. Catatonia: An eight-case series report</strong></p><p>M Mabenge, Z Zingela, S van Wyk</p><p><strong>83. Relationship between anxiety sensitivity and childhood trauma in a random sample of adolescents from secondary schools in Cape Town</strong></p><p>L Martin, M Viljoen, S Seedat</p><p><strong>84. 'Making ethics real'. An overview of an ethics course presented by Fraser Health Ethics Services, BC, Canada</strong></p><p>JJ McCallaghan</p><p><strong>85. Clozapine discontinuation rates in a public healthcare setting</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>86. Retrospective review of clozapine monitoring in a publica sector psychiatric hospital and associated clinics</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>87. Association of an iron-related TMPRSS6 genetic variant c.2007 C&gt;7 (rs855791) with functional iron deficiency and its effect on multiple sclerosis risk in the South African population</strong></p><p>K Moremi, S J van Rensburg, L R Fisher, W Davis, F J Cronje, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus, M Kidd, M J Kotze</p><p><strong>88. Identifying molecular mechanisms of apormophine-induced addictive behaviours</strong></p><p>Z Ndlazi, W Daniels, M Mabandla</p><p><strong>89. Effects of lifestyle factors and biochemistry on the major neck blood vessels in patients with mutiple sclerosis</strong></p><p>M Nelson, S J van Rensburg, M J Kotze, F Isaacs, S Hassan</p><p><strong>90. Nicotine protects against dopamine neurodegenration and improves motor deficits in a Parkinsonian rat model</strong></p><p>N Ngema, P Ngema, M Mabandla, W Daniels</p><p><strong>91. Cognition: Probing anatomical substrates</strong></p><p>H Nowbath</p><p><strong>92. Chronic exposure to light reverses the effects of maternal separation on the rat prefrontal cortex</strong></p><p>V Russel, J Dimatelis</p><p><strong>93. Evaluating a new drug to combat Alzheimer's disease</strong></p><p>S Sibiya, W M U Daniels, M V Mabandla</p><p><strong>94. Structural brain changes in HIV-infected women with and without childhood trauma</strong></p><p>G Spies, F Ahmed, C Fennema-Notestine, S Archibald, S Seedat</p><p><strong>95. Nicotine-stimulated release of hippocampal norepinephrine is reduced in an animal model of attention-deficit/ hyperactivity disorder: the spontaneously hypertensive rat</strong></p><p>T Sterley</p><p><strong>96. Brain-derive neurotrophic factor (BDNF) protein levels in anxiety disorders: Systematic review and meta-regression analysis</strong></p><p>S Suliman, S M J Hemmings, S Seedat</p><p><strong>97. A 12-month retrospective audit of the demographic and clinical profile of mental healthcare users admitted to a district level hospital in the Western Cape, South Africa</strong></p><p>E Thomas, K J Cloete, M Kidd, H Lategan</p><p><strong>98. Magnesium recurarization: A comparison between reversal of neuromuscular block with sugammadex v. neostigmine/ glycopyrrolate in an <em>in vivo</em> rat model</strong></p><p><strong></strong>M van den Berg, M F M James, L A Kellaway</p><p><strong>99. Identification of breast cancer patients at increased risk of 'chemobrain': Case study and review of the literature</strong></p><p>N van der Merwe, R Pienaar, S J van Rensburg, J Bezuidenhout, M J Kotze</p><p><strong>100. The protective role of HAART and NAZA in HIV Tat protein-induced hippocampal cell death</strong></p><p>S Zulu, W M U Daniels, M V Mabandla</p>

Introduction: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders which is characterized by poor attention and subsequently lower learning capacities comparing with normal children. The purpose of this study was to compare the effectiveness of neurofeedback and perceptual-motor exercises as two common non-pharmacological treatments on visual attention. Method: 40 combined medicated ADHD children (aged 5-12 years) were allocated randomly in two groups: neurofeedback training and perceptual-motor exercises. Visual attention and motor proficiency were assessed before and after the treatment by Continuous Performance Test (CPT) and Bruininks-Oseretsky Test (BOT), respectively. Results: according to repeated measures ANOVA, both groups showed significant improvement in three attention-related areas of CPT including reaction time, omission and commission errors (p<0.001), while the difference between two groups was not significant (p>0.05). However, in perceptual-motor exercises group, motor proficiency improved significantly (p<0.01). Conclusion: neurofeedback training intervention, as well as perceptual-motor exercises, are effective in improving ADHD symptoms and given the similar effect of both interventions and their lack of side-effects, perceptual-motor exercises appear to be the more appropriate option for reducing symptoms of ADHD, due to its additional effect on motor proficiency, rich content of purposeful activities and social interactions.

The Rey–Osterrieth Complex Figure (ROCF) test is a commonly used neuropsychological assessment tool. It is widely used to assess the visuo-constructional ability and visual memory of neuropsychiatric disorders, including copying and recall tests. By drawing the complex figure, the functional decline of a patient in multiple cognitive dimensions can be assessed, including attention and concentration, fine-motor coordination, visuospatial perception, non-verbal memory, planning and organization, and spatial orientation. This review first describes the different versions and scoring methods of ROCF. It then reviews the application of ROCF in the assessment of visuo-constructional ability in patients with dementia, other brain diseases, and psychiatric disorders. Finally, based on the scoring method of the digital system, future research hopes to develop a new digital ROCF scoring method combined with machine learning algorithms to standardize clinical practice and explore the characteristic neuropsychological structure information of different disorders.

AbstractCraniopharyngiomas (CP) are brain tumors that often occur in children and adolescent that results in many neurological and endocrinological disorders. The aim of this systematic review is to provide updated version of studies used to formalize standard tests used for cognitive impairment in pediatric patients with craniopharyngioma. A systematic review was conducted in PubMed, EBSCO, ProQuest, Science Direct, Wiley Online, and Springer to identify studies assessing cognitive impairment in pediatric patients with craniopharyngioma. Academic and learning dysfunctions were reported in seven studies among 41 of 178 patients (23%). Visual–spatial deficits were reported in six studies. Speech and verbal dysfunctions were reported in three studies. Memory deficits were reported in eight studies among 61 of 197 patients (31%). Motor dysfunctions were reported in five studies. Sleep related issues were reported in four studies among 33 of 70 patients (47.1%). Patients with treated pediatric CP demonstrate a high incidence of neurological deficits including cognitive dysfunctions. Academic and learning dysfunctions, visual–spatial deficits, speech and verbal dysfunctions, memory deficits, and sleep-related issues were the most commonly reported cognitive deficits in the present study.

AbstractEmerging research has demonstrated that anti-myelin oligodendrocyte associated disorders (MOG-AD) are associated with a less severe clinical course than demyelinating conditions associated with the presence of aquaporin-4 antibodies. While a heterogeneity of neuropsychological outcomes in pediatric demyelinating conditions have been described in the literature, no studies to date have investigated the neuropsychological sequelae of pediatric MOG-AD specifically. The objective of the present case series was to describe the clinical and neuropsychological phenotypes of seven pediatric patients (ages 3–15 years) with MOG-AD of different diagnoses (e.g., acute disseminated encephalomyelitis, optic neuritis, multiple sclerosis, and neuromyelitis spectrum disorders). Neuropsychological outcomes were evaluated by retrospective chart review. Results indicated largely intact neuropsychological profiles in five of the seven patients, with mild weaknesses in attention, executive functioning, processing speed, visual-motor/fine-motor skills, and mood concerns being observed. Two patients with a Kurtzke Extended Disability Status Scale of 0 still demonstrated findings on neuropsychological testing. Of the other two patients, one demonstrated higher levels of impairment in the context of a complex medical history and premorbid learning difficulties, while the other demonstrated declines in functioning likely associated with an earlier age of onset. Findings suggest that neuropsychological outcomes may be correspondingly less severe in this population compared with what has previously been described in the pediatric demyelinating disease literature. This differential impact may contribute to the heterogeneity of neuropsychological outcomes found in previous studies, and future research should separate participants with myelin oligodendrocyte antibodies given the difference in clinical course, treatment outcomes, and neuropsychological sequelae.

Introduction: Emergency school closures are often used as public health interventions during infectious disease outbreaks to minimize the spread of infection. However, Over 80% of children in the world have had their education impacted by coronavirus. For children with special needs who receive special education services, access to face-to-face education and other resources at school is of particular importance. These services focus not only on academic achievement, but also on social, emotional, psychological and physical health and well-being. The American Academy of Pediatrics advocates for students to attend school in person. Students with special needs are divided into seven educational groups: hearing impairment, visual impairment, physical-motor disorders, intellectual disabilities, behavioral-emotional disorders, autism spectrum disorder, specific learning disorder, and severe and multiple disabilities. Each of these groups should have a different way of teaching and learning than other groups and normal students. For proper planning and accommodation of children with special needs, we must prioritize safety. In order for these students to be able to use rehabilitation services, face-to-face education conditions must be provided for them in accordance with health protocols.

Abstract Background To describe the pattern of comorbidities in school-aged children with cerebral palsy (CP) and to identify which, if any, were associated with poor school attendance. A cross-sectional study, using the key informant methodology, between December 2017 and July 2018 was conducted in Cross River State, Nigeria. Assessments, confirmation of CP and identification of systemic comorbidities using standard tools and questionnaires were performed. Children confirmed to have CP between the ages 4 to 15 years were included. Results Three hundred and eighty-eight children were confirmed to have CP, 59% males. The mean age was 9.2 years ± SD 4.0; 28% were non-ambulatory (gross motor function classification system (GMFCS) level IV-V) and spastic CP was seen in 70%. Comorbidities included Speech impairment 85%, feeding difficulties 86%, and swallowing difficulties 77%, learning difficulties 88%, abnormal behaviour 62%, visual acuity impairment 54%, objective perceptual visual disorders 46%, communication difficulties 45%, epilepsy 35%, hearing impairment 12% and malnutrition 51%. Learning difficulties (OR 10.1, p < 0.001; CI: 3.6–28.1), visual acuity impairment (OR 2.8, p = 0.002; CI: 1.5–5.3), epilepsy (OR 2.3, p = 0.009; CI:1.2–4.3) manual ability classification scale 4–5 (OR 4.7,p = 0.049; CI:1.0–22.2) and CP severity (GMFCS V-VI) OR 6.9 p = 0.002, CI: 2.0–24.0.) were seen as increasing the likelihood of poor school attendance. Conclusion Comorbidities were common, and some were associated with limited school attendance. A multidisciplinary tailored approach to care, with application of available therapeutic interventions for comorbidities is suggested. This may be useful in reducing barriers to school attendance.

Abstract Objective The presence of neurodevelopmental disorders (ND) such as attention-deficit/hyperactivity disorder (ADHD) and learning disorders (LD) have demonstrated effects on Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) performance. No current research has directly examined whether autism spectrum disorder (ASD) has similar effects. The current study compared ImPACT cognitive and symptom profiles in athletes with self-reported ASD to other NDs and healthy controls using case-control matching. Method The current study compared ImPACT baselines of high school athletes with ASD to athletes with other NDs (ADHD, LD, and co-occurring ADHD/LD) and healthy controls on cognitive composites and symptom reporting. Participants included 435 athletes (87 controls, 87 with ASD, 87 with ADHD, 87 with LD, and 87 with ADHD/LD) selected from a larger naturalistic sample. Athletes were matched to the ASD group based on age, sex, and sport using randomized case-matched selection from the larger database. Results Results revealed that athletes with ASD performed more poorly than healthy controls on the Visual Motor Speed composite. No differences were found for Post-concussion Symptom Scale (PCSS) domain scores. Differences in cognitive and symptom profiles among the athletes with other NDs were also found. Conclusions Results elucidate patterns of baseline performance for athletes with ASD, demonstrating that there may not be significant differences between ASD and healthy controls on four of the five ImPACT composites, and no symptom reporting differences. Cognitive and symptom differences found for other NDs should be considered when interpreting baseline performance and for making return-to-play decisions in the absence of baseline assessment.

Introduction: Stroke is among the top 10 causes of death in children. Survivors face many potential years of disability but few studies have explored factors which contribute to poor outcome. Our aims were to describe factors associated with mortality, neurological disability and recurrence in a population of Australian children with arterial ischaemic stroke (AIS). Methods: Prospective consecutive single centre cohort study of children 1 month-18 years with AIS, from 2003-2013, who underwent standardised diagnostic work up. The NINDS common data element framework was used to select risk factors, laboratory and radiological variables of interest. The Paediatric Stroke Outcome Measure (PSOM) was used to classify neurological outcome at 12 months and the CASCADE system was used to classify aetiology. Recurrence was defined as clinical (completed stroke/TIA) or radiological event with new infarction. Chi 2 analyses were used to identify risk factors for poor outcome. Results: A total of 126 cases of childhood AIS were identified. 6% of children died, 27% had recurrent events (21 clinical, 5 radiological strokes, 9 TIAs). 63% of children had poor neurological outcome (total PSOM≥2) with motor disability (53%) being most common. Male gender, prothrombotic disorders and cortical infarct location were significantly associated with mortality (P<0.05). Hemiparesis, facial weakness, visual disturbance or altered consciousness at presentation, non-atherosclerotic arteriopathies and infection were significantly associated with poorer neurological outcome (p<0.05). Arteriopathies, multiple infarcts and haemorrhagic transformation were associated with recurrence (p<0.05). Conclusion: The economic and social costs of childhood AIS are likely substantial because long term neurological deficits are common. The finding that arteriopathies are a risk factor for recurrence is consistent with data from overseas. These findings will inform development of longitudinal multicentre Australian studies of childhood AIS.

Abstract Background One of the causal mechanisms underlying neurodevelopmental disorders (NDDs) is chromatin modification and the genes that regulate chromatin. AT-rich interactive domain 1B (ARID1B), a chromatin modifier, has been linked to autism spectrum disorder and to affect rare and inherited genetic variation in a broad set of NDDs. Methods A novel preclinical mouse model of Arid1b deficiency was created and validated to characterize and define neuroanatomical, behavioral and transcriptional phenotypes. Neuroanatomy was assessed ex vivo in adult animals and in vivo longitudinally from birth to adulthood. Behavioral testing was also performed throughout development and tested all aspects of motor, learning, sociability, repetitive behaviors, seizure susceptibility, and general milestones delays. Results We validated decreased Arid1b mRNA and protein in Arid1b+/− mice, with signatures of increased axonal and synaptic gene expression, decreased transcriptional regulator and RNA processing expression in adult Arid1b+/− cerebellum. During neonatal development, Arid1b+/− mice exhibited robust impairments in ultrasonic vocalizations (USVs) and metrics of developmental growth. In addition, a striking sex effect was observed neuroanatomically throughout development. Behaviorally, as adults, Arid1b+/− mice showed low motor skills in open field exploration and normal three-chambered approach. Arid1b+/− mice had learning and memory deficits in novel object recognition but not in visual discrimination and reversal touchscreen tasks. Social interactions in the male–female social dyad with USVs revealed social deficits on some but not all parameters. No repetitive behaviors were observed. Brains of adult Arid1b+/− mice had a smaller cerebellum and a larger hippocampus and corpus callosum. The corpus callosum increase seen here contrasts previous reports which highlight losses in corpus callosum volume in mice and humans. Limitations The behavior and neuroimaging analyses were done on separate cohorts of mice, which did not allow a direct correlation between the imaging and behavioral findings, and the transcriptomic analysis was exploratory, with no validation of altered expression beyond Arid1b. Conclusions This study represents a full validation and investigation of a novel model of Arid1b+/− haploinsufficiency throughout development and highlights the importance of examining both sexes throughout development in NDDs.

Background: Vision deficits are highly prevalent in children with neurodevelopmental disorders including those with motor delays, learning and reading difficulties, and maladaptive behaviors. These deficits can interfere with their participation and performance in everyday life activities and therefore, require a comprehensive approach to therapy. As such, optometrists and occupational therapists are an optimal team to provide interprofessional collaborative care, reported in research as best practice, in the treatment of these children. However, little is known about the long-called-for collaboration between these professions. The purpose of this study was to explore factors and implications associated with a collaborative practice between optometrists and occupational therapists in the co-management of vision deficits in the pediatric population. Methods: A qualitative, descriptive design was employed to explore perceptions of collaborative practice among teams of optometrists and occupational therapists in the remedial care of children with visual deficits. Following IRB approval, co-located optometrists and occupational therapists were recruited for this study. Semistructured interviews served as the primary data collection tool to investigate the factors and implications of collaborative practice. Results: Eleven professionals provided informed consent and took part in this study, including five occupational therapists and six optometrists. Following thematic analysis, four overarching themes emerged including 1) professional boundaries, 2) co-located, integrated practice, 3) professional growth, and 4) improved patient care. Participants indicated that although barriers exist, exercising humility, upholding patient-centered focus, maintaining mutual respect, communicating frequently, and co-location were factors that enable collaboration. Positive outcomes related to both the provider and the patient were further highlighted supporting the interprofessional collaboration between these professionals. Conclusions: The findings of this qualitative study add to the body of evidence underpinning interprofessional collaborative practice. Furthermore, this study supports the coordination of care, through optometry and occupational therapy collaboration, in the treatment of visual deficits in children with special needs.

Abstract The Y-group plays an important role in the generation of upward smooth pursuit eye movements and contributes to the adaptive properties of the vertical vestibulo-ocular reflex. Malfunction of this circuitry may cause eye movement disorders, such as downbeat nystagmus. To characterize the neuron populations in the Y-group, we performed immunostainings for cellular proteins related to firing characteristics and transmitters (calretinin, GABA-related proteins and ion channels) in brainstem sections of macaque monkeys that had received tracer injections into the oculomotor nucleus. Two histochemically different populations of premotor neurons were identified: The calretinin-positive population represents the excitatory projection to contralateral upgaze motoneurons, whereas the GABAergic population represents the inhibitory projection to ipsilateral downgaze motoneurons. Both populations receive a strong supply by GABAergic nerve endings most likely originating from floccular Purkinje cells. All premotor neurons express nonphosphorylated neurofilaments and are ensheathed by strong perineuronal nets. In addition, they contain the voltage-gated potassium channels Kv1.1 and Kv3.1b which suggests biophysical similarities to high-activity premotor neurons of vestibular and oculomotor systems. The premotor neurons of Y-group form a homogenous population with histochemical characteristics compatible with fast-firing projection neurons that can also undergo plasticity and contribute to motor learning as found for the adaptation of the vestibulo-ocular reflex in response to visual-vestibular mismatch stimulation. The histochemical characterization of premotor neurons in the Y-group allows the identification of the homologue cell groups in human, including their transmitter inputs and will serve as basis for correlated anatomical-neuropathological studies of clinical cases with downbeat nystagmus.