Browsing by Subject "RECOVERY"

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  • Sajanti, Antti; Lyne, Sean B.; Girard, Romuald; Frantzen, Janek; Rantamaki, Tomi; Heino, Iiro; Cao, Ying; Diniz, Cassiano; Umemori, Juzoh; Li, Yan; Takala, Riikka; Posti, Jussi P.; Roine, Susanna; Koskimäki, Fredrika; Rahi, Melissa; Rinne, Jaakko; Castren, Eero; Koskimäki, Janne (2020)
    P75 neurotrophic receptor (p75NTR) is an important receptor for the role of neurotrophins in modulating brain plasticity and apoptosis. The current understanding of the role of p75NTR in cellular adaptation following pathological insults remains blurred, which makes p75NTR's related signaling networks an interesting and challenging initial point of investigation. We identified p75NTR and related genes through extensive data mining of a PubMed literature search including published works related to p75NTR from the past 20 years. Bioinformatic network and pathway analyses of identified genes (n=235) were performed using ReactomeFIViz in Cytoscape based on the highly reliable Reactome functional interaction network algorithm. This approach merges interactions extracted from human curated pathways with predicted interactions from machine learning. Genome-wide pathway analysis showed total of 16 enriched hierarchical clusters. A total of 278 enriched single pathways were also identified (p
  • Brown, Hugh C. A.; Berninger, Frank A.; Larjavaara, Markku; Appiah, Mark (2020)
    High deforestation rates, especially in the tropics, currently result in the annual emission of large amounts of carbon, contributing to global climate change. There is therefore an urgent need to take actions to mitigate climate change both by slowing down deforestation and by initiating new sinks. Tropical forest plantations are generally thought to sequester carbon rapidly during the initial years but there is limited knowledge on their long-term potential. In this study, we assessed the carbon sequestration in old (42-47 years) timber plantations of Aucoumea klaineana, Cedrela odorata, Tarrietia utilis, and Terminalia ivorensis, and secondary forests of similar ages, by comparing their basal areas and above-ground carbon stocks (AGC) to that of nearby primary forests. Additionally, we estimated and compared timber volume and stumpage value in the three forest types. Systematic random sampling of ninety-three 20 m x 20 m plots in eleven forest sites (2 secondary forests, 2 primary forests, and 7 timber plantations) was undertaken to determine the effect of forest type on AGC, basal area, timber volume, and stumpage value. After 42 years of growth, mean AGC of the timber plantations (159.7 +/- 14.3 Mg ha(-1)) was similar to that of primary forests (173.0 +/- 25.1 Mg ha(-1)) and both were significantly higher than the mean AGC of the secondary forests (103.6 +/- 12.3 Mg ha(-1)). Mean basal area and timber volume of the timber plantations and secondary forests were similar to that of the primary forests, though in each case the timber plantations had significantly higher values compared to the secondary forests. Mean timber value of the plantations ($8577 ha(-1)) was significantly higher than both secondary ($1870 ha(-1)) and primary forests ($3112 ha(-1)). Contrary to our expectations, naturally regenerated trees (woody recruits) within the timber plantations had similar AGC levels, basal area, timber volume, and value compared to the secondary forests. Long-rotation tropical forest plantations under low-intensity management could achieve higher AGC levels and thus have higher climate change mitigation potential and timber values compared to naturally regenerated secondary forests, and are able to reach values similar to primary forests. Monoculture timber plantations could facilitate the successful colonization of their understoreys by native woody recruits that contribute considerably to stand AGC and timber values. Long-rotation forest plantations in the tropics therefore have a critical role to play in forest rehabilitation and climate change mitigation while having the potential to provide modest financial returns to landowners through selective harvesting of timber and/or payments for carbon sequestration.
  • Korpela, Katri; Salonen, Anne; Saxen, Harri; Nikkonen, Anne; Peltola, Ville; Jaakkola, Tytti; de Vos, Willem; Kolho, Kaija-Leena (2020)
    BACKGROUND The effects of antibiotics on infant gut microbiota are unclear. We hypothesized that the use of common antibiotics results in long-term aberration in gut microbiota. METHODS Antibiotic-naive infants were prospectively recruited when hospitalized because of a respiratory syncytial virus infection. Composition of fecal microbiota was compared between those receiving antibiotics during follow-up (prescribed at clinicians' discretion because of complications such as otitis media) and those with no antibiotic exposure. Fecal sampling started on day 1, then continued at 2-day intervals during the hospital stay, and at 1, 3 and 6 months at home. RESULTS One hundred and sixty-three fecal samples from 40 patients (median age 2.3 months at baseline; 22 exposed to antibiotics) were available for microbiota analyses. A single course of amoxicillin or macrolide resulted in aberration of infant microbiota characterized by variation in the abundance of bifidobacteria, enterobacteria and clostridia, lasting for several months. Recovery from the antibiotics was associated with an increase in clostridia. Occasionally, antibiotic use resulted in microbiota profiles associated with inflammatory conditions. CONCLUSIONS Antibiotic use in infants modifies especially bifidobacterial levels. Further studies are warranted whether administration of bifidobacteria will provide health benefits by normalizing the microbiota in infants receiving antibiotics.
  • Harma, Mikko; Karhula, Kati; Ropponen, Annina; Puttonen, Sampsa; Koskinen, Aki; Ojajarvi, Anneli; Hakola, Tarja; Pentti, Jaana; Oksanen, Tuula; Vahtera, Jussi; Kivimaki, Mika (2018)
    Objectives The aim of this study was to examine whether changes in work shifts and shift intensity are related to changes in difficulties to fall asleep, fatigue, and sleep length. Methods Questionnaire responses of hospital employees (N=7727, 93% women) in 2008, 2012, 2014 and 2015 were linked to daily-based records of working hours during three months preceding each survey. We used conditional logistic regression and longitudinal fixed-effects analyses to investigate odds ratios (OR) and 95% confidence intervals (CI) for each 25% within-individual change in the proportion of working hour characteristics in relation to changes in fatigue, difficulties to fall asleep, and 24-hour sleep length. Results Change in night but not in morning or evening shifts was associated with parallel changes in odds for longer sleep length (OR 1.45, 95% CI 1.28-1.64) and fatigue during free days (OR 1.38, 95% CI 1.16-1.64). Similarly, short shift intervals and having >2 but not >4 consecutive night shifts were associated with increased odds of fatigue during work and difficulties to fall asleep (OR 1.42, 95% CI 1.19-1.72 and OR 1.10, 95% CI 1.05-1.19, respectively). Among workers aged >= 50 years, the associations were the strongest between night shifts and longer sleep (OR 2.24,95% CI 1.52-3.81) and between higher proportion of short shift intervals and fatigue during free days (OR 1.68, 95% CI 1.10-2.54). Conclusions Among shift workers with fatigue or sleep problems, decreasing the proportion of night shifts and quick returns and giving preference to quickly forward-rotating shift systems may reduce fatigue.
  • Karhula, Kati; Harma, Mikko; Sallinen, Mikael; Lindholm, Harri; Hirvonen, Ari; Elovainio, Marko; Kivimaki, Mika; Vahtera, Jussi; Puttonen, Sampsa (2016)
    Although the prevalence of work-related stress has increased, knowledge on the contributions of that stress to long-term adverse health effects is still lacking. Stress biomarkers can reveal early signs of negative health effects, but no previous studies have measured both acute stress reactions and long-term exposure to job strain using both salivary cortisol and -amylase (AA). The present study examines the association between job strain and these biomarkers among shift-working female health care professionals in the laboratory and the field. The 95 participants were recruited from hospital wards categorized in either the top (high job strain [HJS] group, n = 42) or the bottom quartile of job strain (low job strain [LJS] group, n = 53), as rated by survey responses. Participants' self-perceived job strain was at least as high or low as the ward's average estimation. Saliva samples were collected during the Trier Social Stress Test (TSST), preselected morning and night shifts, and a day off. There was a larger increase in the cortisol concentration of participants in the HJS than in the LJS group (2.27- vs. 1.48-fold, respectively, nonsignificant) during the TSST. Participants in the HJS group also had higher salivary AA levels 30 min after awakening on the morning-shift day than those in the LJS group (p = .02), whereas the salivary cortisol awakening response on the day off was higher in the LJS group (p = .05, education as a covariate). The remaining stress-biomarker results did not differ significantly between groups. These data suggest that HJS in shift-working health care professionals is weakly associated with changes in stress biomarkers.
  • Majander, Anna; Bowman, Richard; Poulton, Joanna; Antcliff, Richard J.; Reddy, M. Ashwin; Michaelides, Michel; Webster, Andrew R.; Chinnery, Patrick F.; Votruba, Marcela; Moore, Anthony T.; Yu-Wai-Man, Patrick (2017)
    Background The onset of Leber hereditary optic neuropathy (LHON) is relatively rare in childhood. This study describes the clinical and molecular genetic features observed in this specific LHON subgroup. Methods Our retrospective study consisted of a UK paediatric LHON cohort of 27 patients and 69 additional cases identified from a systematic review of the literature. Patients were included if visual loss occurred at the age of 12 years or younger with a confirmed pathogenic mitochondrial DNA mutation: m. 3460G>A, m. 11778G>A or m. 14484T>C. Results In the UK paediatric LHON cohort, three patterns of visual loss and progression were observed: (1) classical acute (17/27, 63%); (2) slowly progressive (4/27, 15%); and (3) insidious or subclinical (6/27, 22%). Diagnostic delays of 3-15 years occurred in children with an insidious mode of onset. Spontaneous visual recovery was more common in patients carrying the m. 3460G>A and m. 14484T>C mutations compared with the m. 11778G>A mutation. Based a meta-analysis of 67 patients with available visual acuity data, 26 (39%) patients achieved a final best-corrected visual acuity (BCVA) >= 0.5 Snellen decimal in at least one eye, whereas 13 (19%) patients had a final BCVA Conclusions Although childhood-onset LHON carries a relatively better visual prognosis, approximately 1 in 5 patients will remain within the visual acuity criteria for legal blindness in the UK. The clinical presentation can be insidious and LHON should be considered in the differential diagnosis when faced with a child with unexplained subnormal vision and optic disc pallor.
  • Lesnikova, Angelina; Casarotto, Plinio; Fred, Senem Merve; Voipio, Mikko; Winkel, Frederike; Stenizeig, Anna; Antila, Hanna; Umemori, Juzoh; Biojone, Caroline; Castrén, Eero (2021)
    Perineuronal nets (PNNs) are an extracellular matrix structure rich in chondroitin sulfate proteoglycans (CSPGs), which preferentially encase parvalbumin-containing (PV+) interneurons. PNNs restrict cortical network plasticity but the molecular mechanisms involved are unclear. We found that reactivation of ocular dominance plasticity in the adult visual cortex induced by chondroitinase ABC (chABC)-mediated PNN removal requires intact signaling by the neurotrophin receptor TRKB in PV+ neurons. Additionally, we demonstrate that chABC increases TRKB phosphorylation (pTRKB), while PNN component aggrecan attenuates brain-derived neurotrophic factor (BDNF)-induced pTRKB in cortical neurons in culture. We further found that protein tyrosine phosphatase sigma (PTP sigma, PTPRS), receptor for CSPGs, interacts with TRKB and restricts TRKB phosphorylation. PTP sigma deletion increases phosphorylation of TRKB in vitro and in vivo in male and female mice, and juvenile-like plasticity is retained in the visual cortex of adult PTP sigma-deficient mice (PTP sigma(+/-)). The antidepressant drug fluoxetine, which is known to promote TRKB phosphorylation and reopen critical period-like plasticity in the adult brain, disrupts the interaction between TRKB and PTP sigma by binding to the transmembrane domain of TRKB. We propose that both chABC and fluoxetine reopen critical period-like plasticity in the adult visual cortex by promoting TRKB signaling in PV+ neurons through inhibition of TRKB dephosphorylation by the PTP sigma-CSPG complex.
  • Heikkinen, Paula H.; Pulvermüller, Friedemann; Mäkelä, Jyrki P.; Ilmoniemi, Risto J.; Lioumis, Pantelis; Kujala, Teija; Manninen, Riitta-Leena; Ahvenainen, Antti; Klippi, Anu (2019)
    Neuromodulation technologies, such as transcranial magnetic stimulation (TMS), are promising tools for neurorehabilitation, aphasia therapy included, but not yet in common clinical use. Combined with behavioral techniques, in particular treatment-efficient Intensive Language-Action Therapy (ILAT, previously CIAT or CILT), TMS could substantially amplify the beneficial effect of such behavioral therapy alone (Thiel et al., 2013; Martin et al., 2014; Mendoza et al., 2016; Kapoor, 2017). In this randomized study of 17 subjects with post-stroke aphasia in the chronic stage, we studied the combined effect of ILAT and 1-Hz placebo-controlled navigated repetitive TMS (rTMS) to the right-hemispheric inferior frontal cortex-that is, to the anterior part of the non-dominant hemisphere's homolog Broca's area (pars triangularis). Patients were randomized to groups A and B. Patients in group A received a 2-week period of rTMS during naming training where they named pictures displayed on the screen once every 10 s, followed by 2 weeks of rTMS and naming combined with ILAT. Patients in group B received the same behavioral therapy but TMS was replaced by sham stimulation. The primary outcome measures for changes in language performance were the Western Aphasia Battery's aphasia quotient AQ; the secondary outcome measures were the Boston naming test (BNT) and the Action naming test (Action BNT, ANT). All subjects completed the study. At baseline, no statistically significant group differences were discovered for age, post-stroke time or diagnosis. ILAT was associated with significant improvement across groups, as documented by both primary and secondary outcome measures. No significant effect of rTMS could be documented. Our results agree with previous results proving ILAT's ability to improve language in patients with chronic aphasia. In contrast with earlier claims, however, a beneficial effect of rTMS in chronic post-stroke aphasia rehabilitation was not detected in this study.
  • Boström, Anna; Hielm-Bjorkman, Anna; Chang, Yu-Mei; Weller, Renate; Davies, Emma (2014)
  • Danquah, Jones Abrefa; Appiah, Mark; Ari, Pappinen (2011)
  • Villnäs, Anna; Norkko, Joanna; Lukkari, Kaarina; Hewitt, Judi; Norkko, Alf (2012)
    Disturbance-mediated species loss has prompted research considering how ecosystem functions are changed when biota is impaired. However, there is still limited empirical evidence from natural environments evaluating the direct and indirect (i.e. via biota) effects of disturbance on ecosystem functioning. Oxygen deficiency is a widespread threat to coastal and estuarine communities. While the negative impacts of hypoxia on benthic communities are well known, few studies have assessed in situ how benthic communities subjected to different degrees of hypoxic stress alter their contribution to ecosystem functioning. We studied changes in sediment ecosystem function (i.e. oxygen and nutrient fluxes across the sediment water-interface) by artificially inducing hypoxia of different durations (0, 3, 7 and 48 days) in a subtidal sandy habitat. Benthic chamber incubations were used for measuring responses in sediment oxygen and nutrient fluxes. Changes in benthic species richness, structure and traits were quantified, while stress-induced behavioral changes were documented by observing bivalve reburial rates. The initial change in faunal behavior was followed by non-linear degradation in benthic parameters (abundance, biomass, bioturbation potential), gradually impairing the structural and functional composition of the benthic community. In terms of ecosystem function, the increasing duration of hypoxia altered sediment oxygen consumption and enhanced sediment effluxes of NH4 + and dissolved Si. Although effluxes of PO4 were not altered significantly, changes were observed in sediment PO4 sorption capability. The duration of hypoxia (i.e. number of days of stress) explained a minor part of the changes in ecosystem function. Instead, the benthic community and disturbancedriven changes within the benthos explained a larger proportion of the variability in sediment oxygen- and nutrient fluxes. Our results emphasize that the level of stress to the benthic habitat matters, and that the link between biodiversity and ecosystem function is likely to be affected by a range of factors in complex, natural environments.
  • Poganitsch-Korhonen, M.; Masliukaite, I.; Nurmio, M.; Lahteenmaki, P.; van Wely, M.; van Pelt, A. M. M.; Jahnukainen, K.; Stukenborg, J-B (2017)
  • Lassas, Matti; Saksala, Teemu (2019)
    Let (N, g) be a Riemannian manifold with the distance function d(x, y) and an open subset M subset of N. For x is an element of M we denote by D-x the distance difference function D-x:F x F -> R, given by D-x(z(1), z(2)) = d(x, z(1)) - d(x, z(2)), z(1), z(2) is an element of F = N \ M. We consider the inverse problem of determining the topological and the differentiable structure of the manifold M and the metric g vertical bar M on it when we are given the distance difference data, that is, the set F, the metric g vertical bar F, and the collection D(M) = {D-x; x is an element of M}. Moreover, we consider the embedded image D(M) of the manifold M, in the vector space C(F x F), as a representation of manifold M. The inverse problem of determining (M, g) from D(M) arises e.g. in the study of the wave equation on R x N when we observe in F the waves produced by spontaneous point sources at unknown points (t, x) is an element of R x M. Then D-x (z(1), z(2)) is the difference of the times when one observes at points z(1) and z(2) the wave produced by a point source at x that goes off at an unknown time. The problem has applications in hybrid inverse problems and in geophysical imaging.
  • Boström, Anna Fredrika; Hyytiäinen, Heli Katariina; Koho, Petteri; Cizinauskas, Sigitas; Hielm-Björkman, Anna Katrina (2018)
    Background: The Finnish neurological function testing battery for dogs (FINFUN) was developed to meet the increasing demand for objective outcome measures in veterinary physiotherapy. The testing battery should provide consistent, reproducible results and have established face and content validity. Internal consistency and intra-and inter-rater reliability of the FINFUN were also investigated. Results: The FINFUN comprised 11 tasks: lying, standing up from lying, sitting, standing up from sitting, standing, proprioceptive positioning, starting to walk, walking, trotting, walking turns and walking stairs. A score from 0 to 4, (0: unable to perform task, 4: performing task with normal motor function) was given for each task, the maximum score being 44. Twenty-six dogs were filmed when performing the FINFUN. Seven observers scored the performances from the video recordings. The FINFUN was considered to have appropriate face and content validity based on a pilot study, clinical experience and critical reflection of the development process. Its internal consistency was excellent, with no Cronbach's alpha values below 0.922. The intra-rater reliability for total score of experienced observers was almost perfect: 0.999 (observer 1) and 0.994 (observer 2). The inter-rater reliability for both experienced and novice observers' total scores was also almost perfect (0.919-0.993). Analysis of each individual task showed substantial intra-rater and inter-rater agreement for the tasks "lying" and "sitting". Conclusions: The FINFUN is an objective, valid and reliable tool with standardized scoring criteria for evaluation of motor function in dogs recovering from spinal cord injury.
  • Korpela, Jussi; Lassas, Matti; Oksanen, Lauri (2019)
    An inverse boundary value problem for the 1+1 dimensional wave equation (partial derivative(2)(t) - c(x)(2)partial derivative(2)(x))u(x,t) = 0, x is an element of R+ is considered. We give a discrete regularization strategy to recover wave speed c(x) when we are given the boundary value of the wave, u(0,t), that is produced by a single pulse-like source. The regularization strategy gives an approximative wave speed (c) over tilde, satisfying a Holder type estimate parallel to (c) over tilde - c parallel to
  • Jokelainen, Jarno; Belozerskikh, Anna; Mustonen, Harri; Udd, Marianne; Kylänpää, Leena; Lindström, Outi; Mazanikov, Maxim; Pöyhiä, R. (2020)
    Background Endoscopic retrograde cholangiopancreatography (ERCP) requires moderate to deep sedation, usually with propofol. Adverse effects of propofol sedation are relatively common, such as respiratory and cardiovascular depression. This study was conducted to determine if doxapram, a respiratory stimulant, could be used to reduce the incidence of respiratory depression. Methods This is a single-center, prospective randomized double-blind study performed in the endoscopy unit of Helsinki University Central Hospital. 56 patients were randomized in a 1:1 ratio to either receive doxapram as an initial 1 mg/kg bolus and an infusion of 1 mg/kg/h (group DOX) or placebo (group P) during propofol sedation for ERCP. Main outcome measures were apneic episodes and hypoxemia (SpO(2) <90%). Mann-Whitney test for continuous variables and Fisher's exact test for discrete variables were used and mixed effects modeling to take into account repeated measurements on the same subject and comparing both changes within a group as a function of time and between the groups. Results There were no statistically significant differences in apneic episodes (p = 0.18) or hypoxemia (p = 0.53) between the groups. There was a statistically significant rise in etCO(2) levels in both groups, but the rise was smaller in group P. There was a statistically significant rise in Bispectral Index (p = 0.002) but not modified Observer's Assessment of Agitation/Sedation (p = 0.21) in group P. There were no statistically significant differences in any other measured parameters. Conclusions Doxapram was not effective in reducing respiratory depression caused by deep propofol sedation during ERCP. Further studies are warranted using different sedation protocols and dosing regimens.
  • Salo, Karita S.-T.; Mutanen, Tuomas P.; Vaalto, Selja M. I.; Ilmoniemi, Risto J. (2020)
    The combination of transcranial magnetic stimulation (TMS) and electroencephalography (EEG) is commonly applied for studying the effective connectivity of neuronal circuits. The stimulation excites neurons, and the resulting TMS-evoked potentials (TEPs) are recorded with EEG. A serious obstacle in this method is the generation of large muscle artifacts from scalp muscles, especially when frontolateral and temporoparietal, such as speech, areas are stimulated. Here, TMS–EEG data were processed with the signal-space projection and source-informed reconstruction (SSP–SIR) artifact-removal methods to suppress these artifacts. SSP–SIR suppressed muscle artifacts according to the difference in frequency contents of neuronal signals and muscle activity. The effectiveness of SSP–SIR in rejecting muscle artifacts and the degree of excessive attenuation of brain EEG signals were investigated by comparing the processed versions of the recorded TMS–EEG data with simulated data. The calculated individual lead-field matrix describing how the brain signals spread on the cortex were used as simulated data. We conclude that SSP–SIR was effective in suppressing artifacts also when frontolateral and temporoparietal cortical sites were stimulated, but it may have suppressed also the brain signals near the stimulation site. Effective connectivity originating from the speech-related areas may be studied even when speech areas are stimulated at least on the contralateral hemisphere where the signals were not suppressed that much.
  • Bielinis, Ernest; Simkin, Jenni; Puttonen, Pasi; Tyrvainen, Liisa (2020)
    A common problem among students is the problem of delaying important work activities, which is conceptualized as procrastination. Since procrastination can cause considerable costs for society, we would like to find a method to effectively alleviate the symptoms of this conditioning. It has been proven in an earlier study that staying in the forest environment increases vitality and reduces anxiety, and the negative state of these features can be associated with the intensification of procrastination symptoms. Therefore, it is likely that watching a forest video may decrease the probability or intensity of procrastination. To measure the impact of the forest environment on the level of procrastination of the subjects, a randomized experiment was carried out, in which the subjects watched in random order (on different days) one of two 15-min videos: one showing a walk in the forest area and one showing a walk in an urban environment (control). We measured the level of so-called 'fluid procrastination' including three aspects: 'lack of energy to do the work', 'inability to get to work' and 'pessimistic attitude to do the work' with a set of questions the respondents completed before and after the experiment. The results showed that one aspect of fluid procrastination ('pessimistic attitude to do the work') can be effectively lowered by watching a video showing the forest environment. In contrast, watching a video of an urban environment increased the procrastination levels for two other aspects of procrastination ('lack of energy to do the work', 'inability to get to work'). We also measured three other parameters before and after the experiment: mood state, restoration and vitality. Watching the video from forest area raised mood and restoration and watching the video from urban area, decreased mood, vitality and restoration. The study suggests that watching a video showing forest landscapes could be used as an effective remedy for problems related to procrastination among students.
  • Cooke, Marie; Ritmala-Castren, Marita; Dwan, Toni; Mitchell, Marion (2020)
    Background Pharmacological interventions for sleep (analgesic, sedative and hypnotic agents) can both disrupt and induce sleep and have many negative side effects within the intensive care population. The use of complementary and alternative medicine therapies to assist with sleep has been studied but given the variety of modalities and methodological limitations no reliable conclusions have been drawn. Objective To synthesise research findings regarding the effectiveness of using complementary and alternative medicine interventions within the domains of mind and body practices (relaxation techniques, acupuncture) and natural biologically based products (herbs, vitamins, minerals, probiotics) on sleep quality and quantity in adult intensive care patients. Review method used Systematic review Data sources Five databases were searched in August 2018 and updated in February 2019 and 2020. Review methods: Searches were limited to peer reviewed randomised controlled trials, published in English involving adult populations in intensive care units. Interventions were related to the complementary and alternative medicine domains of mind and body practices and natural products. Included studies were assessed using Cochrane's risk of bias tool. Results Seventeen studies were included. The interventions used varied: 4 investigated melatonin; 4 music +/- another therapy; 3 acupressure; 2 aromatherapy and 1 each for relaxation and imagery, reflexology, bright light exposure and inspiratory muscle training. Measurement of sleep quantity and quality was also varied: 5 studies used objective measures such as Polysomnography and Bispectral index with the remaining using subjective patient or clinician assessment (for example, Richards-Campbell Sleep Questionnaire, Pittsburgh Sleep Quality Index, observation). Given the different interventions, outcomes and measures used in the studies a meta-analysis was not possible. Generally, the results support the use of complementary and alternative medicine for assisting with sleep with 11 out of 17 trials reporting significant results for the interventions examined. Conclusions Complementary and alternative medicine interventions, in particular, melatonin and music, have shown promise for improving sleep in adults with critically conditions; however, further research that addresses the limitations of small sample sizes and improved techniques for measuring sleep is needed.
  • Rodionov, Andrei; Savolainen, Sarianna; Kirveskari, Erika; Mäkelä, Jyrki P.; Shulga, Anastasia (2020)
    Recovery of lower-limb function after spinal cord injury (SCI) is dependent on the extent of remaining neural transmission in the corticospinal pathway. The aim of this proof-of-concept pilot study was to explore the effects of long-term paired associative stimulation (PAS) on leg muscle strength and walking in people with SCI. Five individuals with traumatic incomplete chronic tetraplegia (>34 months post-injury, motor incomplete, 3 females, mean age 60 years) with no contraindications to transcranial magnetic stimulation (TMS) received PAS to one or both legs for 2 months (28 sessions in total, 5 times a week for the first 2 weeks and 3 times a week thereafter). The participants were evaluated with the Manual Muscle Test (MMT), AIS motor and sensory examination, Modified Asworth Scale (MAS), and the Spinal Cord Independence Measure (SCIM) prior to the intervention, after 1 and 2 months of PAS, and after a 1-month follow-up. The study was registered at (NCT03459885). During the intervention, MMT scores and AIS motor scores increased significantly (p = 0.014 and p = 0.033, respectively). Improvements were stable in follow-up. AIS sensory scores, MAS, and SCIM were not modified significantly. MMT score prior to intervention was a good predictor of changes in walking speed (Radj2 = 0.962). The results of this proof-of-concept pilot study justify a larger trial on the effect of long-term PAS on leg muscle strength and walking in people with chronic incomplete SCI.