No description available.

No description available.

No description available.

No description available.

Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease which affects approximately 2.5 million people worldwide, including approximately 7,000 children. The etiology of MS is unclear, although researchers generally agree that both environmental and genetic factors are involved. It is also unclear why some patients may only have one demyelinating event (acquired demyelinating syndrome, or ADS) and others develop chronic demyelinating disease (MS). Recent evidence suggests an association between smoking and multiple sclerosis (MS) in adults. A question remains if there is a similar association between secondhand tobacco smoke exposure and MS in children. The purpose of this study is to explore the association between tobacco smoke exposure (TSE) and MS risk in a cohort of children with demyelinating disease. Methods: Data was obtained from the Canadian National Demyelinating Disease Study. This study included two disease groups, which are distinguished by a single (ADS) versus chronic demyelinating attacks (MS). Parents’ self-report of their child’s exposure to smoke in the home, as well as biomarker verification by serum cotinine, classified a child as exposed or not exposed. Logistic regression models were created to determine the association between TSE and the odds of MS compared to healthy controls, the odds of ADS compared to healthy controls, and the odds of MS compared to patients with ADS. In order to determine factors and exposures which distinguish MS from ADS, an assessment of interaction was performed to examine the relationship between TSE and MS risk genes, TSE and serum vitamin D levels, and TSE and prior Epstein Barr Virus exposure on the odds for developing MS compared to ADS patients.. Finally, serum cotinine levels were compared to neurologic functional scores in order to assess if a dose response mechanism exists creating impaired function for pediatric MS. Results: TSE was not significantly associated with increased odds for MS compared to healthy controls (OR= 1.84; 95%CI 0.86, 3.95) but was significantly associated with higher odds of monophasic ADS compared to healthy controls (OR=2.24; 95%CI 1.08, 4.63). TSE alone was not associated with increased odds for MS compared to ADS; however, the presence of both TSE and HLA alleles increased the odds for MS by 3.2 (95%CI 1.04, 9.79) when compared to ADS patients. An additive effect was also found between TSE and lower vitamin D, which together increased the odds for MS compared to patients with monophasic ADS (OR=2.89; 95%CI 1.21, 7.46). EBV was individually associated with MS compared to ADS (OR=4.12; 95%CI 1.62, 10.9) and odds for MS appeared to increase further with the addition of TSE (OR=5.13; 95%CI 1.79, 14.9), however sample size limited interpretation of the interaction analysis. TSE had minimal impact on neurological functional score measures, although long-term follow up with regard to exposure could not be properly assessed. Conclusion: Exposure to tobacco smoke through secondhand sources was not related to MS but TSE may increase the odds of monophasic demyelinating disease occurrence (ADS). The finding of additive effects between TSE and other disease modifying factors (HLA, vitamin D) may provide valuable insight into why some children have only one demyelinating attack (monophasic ADS) while others have multiple attacks and are diagnosed with MS. These effects should be further explored in a larger population of pediatric patients and compared to healthy children. Intervention methods should be tailored to help explain to parents the benefits of reducing their child’s exposures to environmental tobacco smoke. / Public Health

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No description available.

Voluntary or involuntary muscle activation can be captured by surface electromyography (EMG), which detects muscle action potentials via sensors on the surface of the skin. The technique has been prominent in the study of physiological underpinnings of movement for over 80 years and continues to be an essential tool in scientific research. Its research topic applications include motor disorders caused by stroke, spinal cord injury, cerebral palsy, multiple sclerosis, and many others. Benefits of integrating surface EMG into healthcare have been extensively argued and supported by scientific research, but adoption in clinical settings has been frustratingly slow. The overall goal of this thesis is to advance the clinical adoption of surface EMG by developing techniques that emphasize accessibility and the needs of the end-user (i.e., clinicians). In the first chapter, this dissertation leverages theoretical and empirical literature concerning influencers of adoption, and published clinician perspectives, to determine an effective translation strategy. Developing enhanced therapeutic surface EMG techniques and complementary assessments techniques were identified as key strategic goals. In Chapter 2, I develop a new classification-based surface EMG biofeedback system designed to emphasize tailorability, flexibility, and accessibility. The system performed well during a single session in healthy participants and one individual with multiple sclerosis. In Chapter 3, tailored interventions were implemented across multiple sessions in a group of multiple sclerosis patients with severe motor impairment. Implementation was found to be feasible, and the classification record emerged as an efficient and intuitive means to monitor and assess characteristics of a training session. In Chapter 4, I develop and test an easy-to-replicate surface EMG acquisition approach, and an analysis method using simple cursor placements. The analysis method was reliable between raters and sessions in healthy male and female participants. Overall, this thesis contributes to the translation of surface EMG methods into clinical practice. / Thesis / Doctor of Science (PhD) / Surface electromyography (EMG) is the recording of electrical potentials within the muscle that drive muscle contraction, and ultimately movement. There are many surface EMG techniques that provide insightful glimpses of the processes governing movement, and they have long been used to study movement impairments caused by traumatic injuries, neurodevelopmental disorders, and neurodegenerative diseases. Use of surface EMG to inform treatment decisions and optimize therapeutic interventions may significantly improve health outcomes. However, clinicians across the various healthcare fields have been slow to take advantage of surface EMG, and it remains underutilized despite significant efforts promote its use. The goal of this thesis is to develop accessible surface EMG techniques that can be applied in therapy and assessment scenarios. Ultimately, beyond the thesis, this work is intended to advance the clinical adoption of surface EMG so that its benefits may be accessed by a greater portion of practicing clinicians and their patients.

Multiple sclerosis is a commonly diagnosed neurological disease that currently has no cure. Due to the significant physical and emotional impact that this disease has on the course of life, depressive symptoms frequently occurs among its sufferers. Many interventions have been developed and studied in an effort to reduce the depressive symptoms without the use of traditional antidepressant medications. This integrated literature review examines empirical evidence regarding non-pharmacologic interventions for depression published between 2003 and 2008. Cognitive behavioral therapy, complementary therapy, and support interventions were examined. Although no single intervention was shown to completely alleviate depressive symptoms, most interventions had a favorable impact.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.