Background: Neurocritical care requires rapid and accurate monitoring to prevent secondary brain injuries in patients with neurological diseases. Automatic pupillometry is a tool for assessing pupillary response (Neurological Pupil index). The role of nurses is central in monitoring and caring for the patient's neurological status to minimize secondary brain injuries and suffering.  Currently, it is unclear if ambient light can influence the Neurological Pupil index. Objective: The aim was to evaluate if the Neurological Pupil index is affected of ambient light during automatic pupillometry in unconscious or sedated intensive care patients. Method: A crossover design where pupillometry measurements were performed in bright and dark rooms at six time points on 20 intensive care patients. The results were analyzed using the Wilcoxon signed-rank test and presented with descriptive statistics. Results: Significant differences in the Neurological Pupil index were observed between dark and bright conditions. The majority of participants showed higher NPi in dark environments compared to light. There was individual variation in NPi measurements, with some participants showing larger differences than others. Conclusion: NPi is higher in dark environments compared to bright ones, and there are also individual differences. The results can guide clinical practice to improve the critical care nurse's assessment of neurological status in patients. Consistent lighting conditions during neurologic assessments of patients may potentially enhance the assessment of pupillary reactions and potentially enhanced nursing care for the patient.

京都大学 / 新制・課程博士 / 博士(工学) / 甲第24812号 / 工博第5155号 / 新制||工||1985(附属図書館) / 京都大学大学院工学研究科マイクロエンジニアリング専攻 / (主査)教授 横川 隆司, 教授 安達 泰治, 教授 永樂 元次 / 学位規則第4条第1項該当 / Doctor of Philosophy (Engineering) / Kyoto University / DGAM

No / In October 2015 I started an optional Student Supervised Physiotherapy clinic for neurologically impaired patients. The primary aim of the clinic is to provide an experiential learning environment for Levels 5 and 6 students. The secondary aim of the clinic is to provide an assessment, review and treatment to local service users experiencing neurological problems and who are seeking further/alternate physiotherapy within a learning environment. The clinic is the first dedicated student supervised neurological physiotherapy clinic in the UK that we are aware of.

No description available.

La prise en charge rapide et systématique des patients en traumatologie par des protocoles tels que l’Advanced Trauma Life SupportTM maximise la survie. À l’intérieur de ces protocoles, l’examen le plus souvent proposé pour l’évaluation neurologique est l’International Standards For Neurological Classification of Spinal Cord Injury (ISNCSCI). Cet outil d’évaluation des patients avec une lésion médullaire traumatique (LMT) est le plus reconnu mondialement, mais n’est pas adapté à la prise en charge initiale en traumatologie de par son exhaustivité. L’objectif principal de ce mémoire était de combler le besoin pour un outil d’évaluation neurologique adapté au patient avec une LMT en contexte aigu.La première partie de ce travail consista au développement et à la validation d’une version simplifiée de l’ISNCSCI qui a été nommée le Montreal Acute Classification of Spinal Cord Injury (MAC-SCI). Sa validation par rapport à l’ISNCSCI révéla une capacité à déterminer correctement le grade de sévérité ainsi que l’étage lésionnel de la LMT dans 100% des cas. La seconde partie de ce travail évalua la capacité du MAC-SCI à détecter les variations neurologiques périopératoires et montra qu’aucune détérioration neurologique n’était ratée. Finalement, la troisième partie de ce travail évalua l’implémentation clinique du MAC-SCI et montra des taux de complétion 2,4 fois supérieurs à ceux de l’ISNCSCI. Nous souhaitons que le MAC-SCI soit incorporé dans les protocoles de traumatologie à grande échelle dans le but d’uniformiser l’évaluation neurologique des patients en situation de traumatologie et ultimement d’améliorer les soins prodigués aux patients blessés médullaires. / Rapid and systematic management of trauma patients using protocols such as the Advanced Trauma Life SupportTM maximizes survival. Within these protocols, the tool the most often suggested for neurological assessment is the International Standards For Neurological Classification of Spinal Cord Injury (ISNCSCI). This assessment tool for patients with traumatic spinal cord injury (TSCI) is the most recognized worldwide, but is not suitable for initial trauma care due to its comprehensiveness. The main objective of this thesis was to fulfill the need for a neurological assessment tool adapted to the patient with TSCI in an acute context. The first part of this study consisted in the development and validation of a simplified version of the ISNCSCI which was named the Montreal Acute Classification of Spinal Cord Injury (MAC-SCI). Its validation against the ISNCSCI revealed an ability to correctly determine the grade of severity as well as the neurological level of injury of the TSCI in 100% of cases. The second part of this study assessed the ability of the MAC-SCI to detect perioperative neurological variations and showed that no neurological deterioration was missed. Finally, the third part of this study evaluated the clinical implementation of the MAC-SCI and showed completion rates 2.4 times higher than the ISNCSCI. We would like the MAC-SCI to be incorporated into large-scale trauma protocols in order to standardize the neurological assessment of trauma patients and ultimately improve the care provided to patients with spinal cord injuries.

Acquired brain injury (ABI) and long-term neurological conditions (such as multiple sclerosis, Parkinson’s disease), are major causes of disability in the UK, and can lead to significant physical, cognitive, neuro-behavioural, psychological and social difficulties for sufferers. Individuals affected by an ABI or neurological conditions commonly report difficulties around emotional adjustment, reduced attention, mental control, and self-efficacy and their health-related quality of life also often appears to be much reduced. Whilst conventional neuro-rehabilitation has tended to address physical and cognitive impairments and deficits rather than psychological sequelae, recently a growing trend for more holistic approaches appears to have emerged (e.g., Wilson et al., 2000, 2013). Amongst these approaches, mindfulness-based interventions (collectively known as MBIs) have sought to address this gap in terms of therapeutic intervention. There is a growing body of research evidence pointing to the utility of MBIs in the rehabilitation and support of these populations in improving perceived quality of life and increasing self-management of these conditions. However, the research still remains limited and debate persists in terms of the conceptual and theoretical framework of mindfulness. The present study sought to evaluate the effectiveness of an adapted, short-form MBI group programme for a mixed population of patients (n = 22) currently offered in a local neuro-rehabilitation service. A specific pre-post control group design was adopted in order to investigate whether the intervention produced improvements in mindfulness skills, and whether these would in turn lead to improvements in measures associated with self-efficacy and perceived quality of life. Results indicated participants completing the MBI group programme showed significantly higher mean scores across measures of mindfulness. The results also indicated that these improvements were predictive of improvements across self-efficacy and quality of life measures, with large effect sizes observed. The findings would appear to support the research hypothesis that a suitably modified MBI is beneficial for a mixed ABI population. Findings, study limitations, clinical relevance and implications, as well as methodological and theoretical considerations and directions for future research are discussed in light of the main research questions.

The research, on which this account is based, took place within the context of Blooming Acres, my home, and the learning community that I co-founded with my wife Sherri-Ann. In the first chapters, I tell the story of how I came to home-educate learners with complex special needs at my farm north of Toronto, Canada. I describe the neurological disorders that the children in my care are diagnosed with and map out the main literature that guides how I think about and practice education. The aim of this section is to paint a picture of the context in which the research takes place and describe my role in this community. The second section consists of my research with two of the children who lived and learned at Blooming Acres. This includes their stories as told by them, their parent(s), and the educators at Blooming Acres. As I juxtaposed the life experiences of these learners with each other, and wove together aspects of these stories, significant themes emerged relating to their academic and medical histories, as well as their social, extracurricular, and family life, and finally, their experience at Blooming Acres. I employed a life history methodology; one that honours the meaning and knowledge that exists in the storied lives of individuals. As I applied this methodology and engaged in the storied lives of these learners I learned more about what it is like to live and learn with neurological disorders. Four major themes emerged. The first, Pathology for Support / Support for Pathology, relates to learning issues, referral, assessment, diagnosis, medications and “school battles”. Second, Parent Stress includes behavioural issues, judgment, stressful calls from teachers and principals and school failure. Third, Oasis Teachers / Mentors is an expression of care, support, social competence, self-esteem and relationships. Finally, Strengths and Coping is a culmination of issues such as advocacy for support, strategies for success, identifying and coping with stress, understanding diagnosis and becoming well. These emergent themes are articulated within the context of neurology and school failure (risk) and the context of transformation and getting well (resilience). This work contributes to parenting, education, social work, disabilities, medical and risk / resiliency literature.

Toxocara canis is endoparasitic geohelminth of canids. In its life cycle it uses paratenic host (even humans) and can cause severe problems called cerebral toxocariasis when attacks central nervous system. The exact mechanism of pathogenicity in nervous system is unknown and experimental studies examines rather the acute phase of toxocariasis, therefore we characterized the course of cerebral toxocarosis in mice from acute to chronic phase in this master thesis. We found larvae of the parasite in the brains of mice. The larvae in the tissues occurred both, individually and in clusters. The presence of larvae was observed in regions that affect both movement and memory. We did not find any visible injury nor inflammation surrounding the larvae in the tissue. However, histological examination showed brain tissue pathologies in all mice, namely local necrosis, hemorrhages, thickened vessel walls, cell infiltrates in tissue and around vessels and abnormal angiogenesis. The mice showed neurological symptoms with increasing frequency from the 9th week post infection. Production of specific antibodies was also monitored. The level of antibodies in reinfected mice was higher compared to antibody levels of mice with a single infection. No correlation with the presence of neurological symptoms was shown. Key...

La discipline neurologique met en présence des soignants sains et des patients frappés de handicaps extrêmes auxquels le progrès médico-technique, fondé au XVIIe sur la mathématisation de la nature et le modèle du « corps-machine », n’a pas mis de terme. Comment se représenter l’aphasie, l’anosognosie, les altérations motrices et sensorielles chez autrui ? On se réfèrera aux travaux de Husserl et aux phénoménologues du corps pour approcher le mystère du vécu de la chair dans la maladie neurologique autrement que la sémiologie conventionnelle l’enseigne. Ce contact bouleversant avec les grands cérébrolésés n’est pas exempt d’intérêt, voire de jouissance : le spectacle du dépouillement humain par la perte du langage, du mouvement ou d’autres attributs, pourrait, dans un effet de miroir, et par une « association accouplante », permettre au témoin ici neurologue de se démonter lui-même et tendre vers l’élucidation de sa propre chair. Mais le système nerveux, par quoi la douleur ou le plaisir se manifestent à la conscience et au corps, qui afflige en même tant qu’il est affligé, est condamné à la forclusion du fait de son rôle nécessaire de médiateur physiologique. L’exclusivité d’une visée intentionnelle, dénoncée par Michel Henry, soutenue et entretenue par l’essor hégémonique de l’imagerie médicale, semble manquer ici la souffrance insoluble dans la donation extatique. Ce travail qui proposait, dans une démarche critique, de revisiter les soubassements du savoir neurologique, nous conduit vers une aporie : quelle est la phénoménologie du handicap neurologique s’il ne s’écrit ni ne se lit en termes positifs ? Devant l’insuffisance du logos à dire les altérations du monde et des vécus de la chair, s’invitent la réserve puis la métaphore artistique. C’est spécifiquement le travail du peintre Simon Hantaï qui ouvrira une voie entre phénomène mondain et incarnation. Il s’agira avec lui, dans un renoncement au savoir totalisant, d’apprendre à mettre en perspective les données des neurosciences et, ce que ni la science ni l’empathie pour autrui ne peuvent expliciter. Nous suggèrerons d’intégrer à la pratique médicale neurologique une démarche éthique autrement appelée « sagesse des limites » ; limites entre les savoirs, dont la figure toujours complexe, instable et miroitante, n’est pas sans évoquer une dimension baroque de la neurologie. / [Summary made by Reverso] The neurological discipline puts in the presence of nursing healthy and patients struck by extreme handicaps in which the medical technical progress, based(established) in the XVIIth on the mathématisation of the nature and the model of the "body-machine", did not put term. How to represent itself the aphasia, the anosognosie, the driving and sensory changes to others? We shall refer to the works of Husserl and to the phénoménologues of the body to approach the mystery of the real-life experience of the flesh in the neurological disease otherwise than the conventional semiology teaches him(it). This contact upsetting with the cérébrolésés big is not exempt from interest, even from enjoyment: the show(entertainment) of the human perusal by the loss of the language, the movement or the other attributes, could, in an effect of mirror, and by an accouplante " association ", allow the witness(baton) here neurologist to get confused itself and to aim towards the clarification of its own flesh. But the nervous system, by which the pain or the pleasure show themselves in the consciousness and in the body, which saddens even so much that it is saddened, is condemned to the debarment because of its necessary role of physiological mediator. The exclusivity of a deliberate aim, denounced(cancelled) by Michel Henry, supported and maintained by the hegemonic development of the medical imaging, seems to miss here the insoluble suffering in the ecstatic donation. This work which suggested, in a critical approach(initiative), revisiting the bases of the neurological knowledge, leads(drives) us towards an aporia: what is the phenomenology of the neurological handicap if he does not spell nor is read in positive terms? In front of the insufficiency of logos to say the changes of the world and the real-life experiences of the flesh, invite each other the reserve then the artistic metaphor. It is specifically the work of the painter Simon Hantaï that will open a way between worldly phenomenon and embodiment. It will be a question with him, in a renunciation of the adding up knowledge, of learning to put in perspective the data of the neurosciences and, what neither the science nor the empathy for others can clarify. We shall suggest to integrate(join) into the neurological medical practice an ethical otherwise called approach(initiative) " wisdom of the limits "; limits between the knowledges, the face(figure) of which always complex, unstable and gleaming, is not without evoking a baroque dimension(size) of the neurology.

Les neurones exprimant l'hormone de mélano-concentration (MCH) sont observés dans l'hypothalamus postérieur de tous les vertébrés, de la lamproie à l'Homme. Ces neurones sont impliqués dans diverses fonctions comme le cycle veille/sommeil ou la prise alimentaire. Ils forment une population non homogène et au moins deux sous-populations sont reconnues, chez le rat. La première sous-population est composée de neurones nés au 11ème jour de vie embryonnaire (E11) qui projettent massivement sur les régions les plus postérieures du système nerveux central. La seconde est générée à E12/E13 et les neurones la caractérisant projettent sur les régions les plus antérieures du cerveau et expriment le peptide CART (cocaine and amphetamine regulated transcript) et le récepteur NK3 (neurokinine). L'objectif de notre travail était de comprendre l'origine de ces deux sous-populations. Pour cela, nous avons utilisé des approches histologiques, moléculaires et in vitro. Les neurones à MCH sont parmi les premiers neurones à naître et à différencier leur phénotype chimique le long d'une région longitudinale définie par une prolifération intense, appelée " cell cords " par Keyser en 1972. Cette bande longitudinale est caractérisée par l'expression de gènes comme Sonic Hedgehog (Shh), Nkx2.1, Nkx2.2 et a été récemment renommée " diagonale intrahypothalamica " ou ID. La différenciation des neurones à MCH dépend de l'expression du facteur morphogène Shh et ces neurones expriment Nkx2.1 et Nkx2.2, facteurs de transcription régulés positivement par Shh. Les neurones de la première sous-population envoient des projections le long du premier tractus longitudinal à se mettre en place, le tractus postopticus (tpoc). Ceux issus de la deuxième sous-population se différencient concomitamment au développement des régions télencéphaliques et leurs projections changent de direction pour innerver les régions antérieures du cerveau sous la dépendance de protéines de guidage axonal, Nétrine1 et Slit2. Nétrine1 permet d'attirer les axones MCH exprimant le récepteur DCC précocement vers la moelle épinière et plus tardivement vers le télencéphale alors que Slit2 contraint les axones MCH exprimant Robo2 à sortir de l'hypothalamus. L'étude du modèle " MCH " permet de mettre en lumière un changement d'organisation précocement au cours du développement dans l'axe longitudinal du prosencéphale. La bande longitudinale d'expression des facteurs de transcription Shh, Nkx2.2 peut être perçue comme une extension rostrale de la colonne neurogénique médiane déjà décrite chez des espèces d'invertébrés possédant une symétrie bilatérale. Les neurones générés le long de cette colonne le sont très tôt au cours du développement. / Neurons expressing melanin-concentrating hormone (MCH) are observed in the vertebrate posterior hypothalamus, from lampreys to humans. These neurons are involved in various functions such as sleep/wake cycle or food intake. They form a non-homogeneous population and at least two sub-populations are indentified in the rat. The first sub-population is composed of neurons born on the 11th embryonic day (E11) that project heavily on posterior regions of the central nervous system. The second is characterized by neurons born at E12/E13, projecting in anterior regions of the brain and expressing the peptide CART (cocaine and amphetamine Regulated Transcript) and the NK 3 receptor (neurokinin). The aim of this study was to understand the origin of these two sub-populations. For this, we used histological, molecular and in vitro approaches. MCH neurons are among the first neurons to be born and to differentiate their chemical phenotype along a longitudinal region defined by intense proliferation and called " cell cord " by Keyser in 1972. This longitudinal band is characterized by the expression of genes such as Sonic Hedgehog (Shh), Nkx2.1, Nkx2.2 and was recently named " diagonal intrahypothalamica " or ID. Differenciation of MCH neurons depends on expression of the morphogenetic factor Shh and these neurons express Nkx2.1 and Nkx2.2, transcription factors upregulated by Shh. The neurons of the first sub-population send projections along the tractus postopticus (tpoc), which is the first longitudinal tract to develop. Neurons of the second sub-population differentiate concomitantly to the development of the basal forebrain and their projections innervate anterior brain regions. Our results obtained in vitro showed that Netrin1 attracts MCH axons and that this reponse is mediated by DCC. Slit2 repulses MCH axons and this reponse is mediated by the Robo2 receptor. Overall, our study of the development of the MCH system shed light on an organizational change in the longitudinal axis of the forebrain during early development : a primary longitudinal organization characterized by the longitudinal expression of Shh and Nkx2.2 and the path of the tractus postopticus in the diencephalon and mesencephalon. MCH neurons of the first sub-population develop during this stage. Then, as the basal telencephalon extends and expresses Netrin1, the medial forebrain bundle differentiates, inducing a change in the main axis of the forebrain ; meanwhile MCH neurons of the second sub-population appear. MCH sub-populations reflect distinct developmental stages of the forebrain.