Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 2nd International Conference on Neurological Disorders and Stroke The Oberoi Dubai, Dubai, UAE.

Day 2 :

Keynote Forum

Yusuf Albustanji

United Arab Emirate University, UAE

Keynote: Toward an Arabic Scales of Cognitive and Communicative Ability for Neuro-rehabilitation (ASCCAN)

Time : 09:30-10:15

Conference Series Stroke 2016 International Conference Keynote Speaker Yusuf Albustanji photo
Biography:

Yusuf Al-Bustanji is an assistant professor at United Arab Emirates University. He is a licensed and certified speech language pathologist specializing in Neurogenic Communication Disorders from The Ohio State University. He has over 20 years of experience in providing clinical evidence-based therapy services to individuals diagnosed with communication and swallowing disorders in acute care and rehabilitation centers at hospital settings.

Abstract:

Although scientists have systematically studied neurogenic-communicative disorders for well over a century, very little information is available for neurogenic –communicative disorders in Arabic. For example, although aphasia (an acquired expressive and / or receptive language disorder) was recently investigated in Arabic population, there are only four published studies that investigated this disorder in Arabic. These studies have examined Palestinian Arabic (Friedmann, 1998, 2002), Algerian Arabic (Mimouni & Jarema, 1997), Moroccan Arabic (Diouny, 2007), and Jordanian Arabic (Albustanji, 2008). To date, there have been no published studies examining Emirati Arabic (EA). This is also true for cognitive-linguistic deficits associated with Traumatic Brain Injury (TBI) and dementia.rnrnThese scale measurements are highly demanded to assist in differential diagnosis, guide treatment, discharge planning, and, more importantly, evaluate the efficacy of treatment for individuals as well as broad programs of service. Developing such evaluation measurements, therefore, have important indications for patients, clinicians, and health care policy. rnrnThe specific aims of this project is to explain how the clinicians can design an Arabic assessment tool that is:rn1- An Arabic-linguistically specific and culturally appropriatern2- Reliable test that meet basic psychometric standards rn3- Extends the comprehensiveness of current tests by tapping a broad range of cognitive-linguistic deficits.rn4- Measures both impairment and functional ability.rn5- Can be administered in approximately 30 minutes.rn

  • Special ALS session sponsored by Brunstlmedizin-Neuronanomed Zentrum
    Register Here

Session Introduction

Albert Ludolph

RKU -Universitäts-Rehabilitationskliniken, Germany

Title: The clinical picture and concept of ALS in 2016

Time : 10:45-11:15

Biography:

Albert C. Ludolph, MD, Professor of Neurology and Chairman of the Department of Neurology at the University Hospital and Medical Faculty of Ulm. He is also acting Director of the Academic Neuroscience Centre of the University of Ulm. 1979 –1984 resident at the Department of Neurology and Psychiatry, University of Münster FRG, 1984 – 1985 joined Deutsche Forschungsgemeinschaft: Institute of Neurotoxicology, Albert Einstein College of Medicine. 1985 - 1989 joined the Department of Neurology at the University of Münster. 1990 - 1992 has been visiting Assoc. Professor at the Center for Research on Occupational and Environmental Toxicology, Portland (Oregon). In 1996 became C4 Professor of Neurology and Chair Department of Neurology, University of Ulm. Since 2003 became the Chair of the Academic Neuroscience Center, University of Ulm. 2005 – 2009 became the Deputy Chair of the European ALS-MND-Group. Since 2009 –became Chair of the World Federation of Neurology, ALS Research and Advisory Board of Hoffmann La-Roche,and Knopp Pharma of Drug Development in ALS. In 2015 awarded Erb-Gedenkmünze of the German Society of Neurology (DGN). He is investigator in more than 40 clinical trials with total amount of Publications of 407. He has established and currently leads the ALS-Centre at the University Hospital of Ulm and directs a multidisciplinary team for ALS care, clinical and experimental research.

Abstract:

Jean-Martin Charcot was the first to describe ALS by his revolutionary clinicoanatomical method in the middle of the 19th century. In the late 20th century, on the basis of molecular markers Heiko Braak and colleagues introduced a staging method for neurodegenerative diseases which are now the basis for innovative approaches to their pathogenesis („Braak staging“). Recently, a staging system was also proposed for amyotrophic lateral sclerosis (ALS) which showed that ALS primarily affects the frontal cortex, including the motor cortex, and then sequentially spreads into subcortical structures. This staging concept can be translated into the cinical picture and offers new insights into the disease. First, it shows that ALS is not a disease restricted to motor neurons („motor neuron disease“), but rather affects mutiple systems of the central nervous system („multisystem degeneration“). Secondly, the distribution of pareses is characteristic of the „Wernicke-Mann“ type of central pareses. Thirdly, in a characteristic sequence of events, ocular movements are part of the picture with frontal executive deficits showing up early. They are followed by deficits of the olivocerebellar system. The involvement of frontal structures in ALS has been suspected since the late 19th century; now we know that this has an anatomical basis which is reflected by sequential involvement of frontal lobe function. These deficits are temporally and spatially distinct from the deficits seen in behavioral FTD, suggesting the presence of two entities rather than a spectrum ranging from ALS to FTD. More surprisingly for the clinician, Braaks results show that the hippocampus is involved in late stages. Finally, successfull attempts have been made to translate the post mortem findings into the in vivo situation by using MRI and DTI by measuring the fractional anisotropy of corticoefferent tracts. This new concept of the disease does not have major therapeutical impact yet. It explains why a modifier of glutamate release like riluzole has a moderate influence on the disease; however, it opens avenues for new strategies of therapeutic modification and even prevention of the sporadic disease. It should be mentioned that the genetic subforms of ALS may be more easily therapeutically influenced. Following the example of spinal muscular atrophy (SMA), currently attempts are made to influence transcription of disease genes, such as the superoxide dismutase (SOD).

Marco Pagani

Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy

Title: Metabolic and cognitive patterns in Amyotrophic Lateral Sclerosis

Time : 11:20-11:50

Biography:

Marco Pagani MD 1985; PhD in Brain Neurophysiology and Nuclear Medicine Methodology, 2000, at Karolinska Institute of Stockholm] is a Senior Researcher at the Institute of Cognitive Sciences and Technologies of the Italian National Research Council (ISTC-CNR) and is Senior Advisor of the European Neuroimaging Committee of EANM. His work focuses on the physiopathology of brain perfusion, metabolism, electrical activity and anatomy, applied to neurodegenerative, neurological and psychiatric disorders. One of the most relevant research lines he has pursued is the implementation of multivariate analysis and the relative identification of brain networking in normal and pathological conditions. He tutored PhD students investigating depression, post-traumatic stress disorder and autism and has published in Peer Reviewed Journals more than 100 full papers (mean IF > 4.36), eight of which focussed on ALS related investigations. He has presented more than 120 communications at international Conferences has given more than 40 Keynotes and Plenary Lectures at International Conferences, has taught at more than 30 CME, Workshops and Courses and has been awarded three International Prizes.

Abstract:

Functional and structural neuroimaging have highlighted in ALS the diffusion of anatomical and functional lesions beyond the classic motor areas. The value of 18F-FDG-PET as biomarker is currently gaining more importance and its possible role in supporting ALS diagnosis has been proposed. 1. Recent studies in large cohorts of ALS patients reported a very high discriminant value of 18F-FDGPET showing a clear pattern of hypometabolism in frontal and occipital cortex and hypermetabolism in midbrain being the latter the neurobiological correlate of diffuse subcortical gliosis. 2. Moreover spatially distinct networks identified ALS with an accuracy of 99%. 3. In a recent investigation we demonstrated a continuum of frontal lobe metabolic impairment reflecting the clinical and anatomic continuum ranging from pure ALS, through ALS with intermediate cognitive deficits, to ALS associated with frontal lobe dementia. 4. The finding that patients with intermediate cognitive impairment display a characteristic metabolic pattern suggests to investigate ALS by functional neuroimaging along with neuropsychological testing to disclose the early metabolic signature of a possible cognitive impairment.

Lina Machtoub

Innsbruck Universitätsklinik für Radiologie, Neuronanomed ALS Zentrum- BrünstlMedizin, Germany

Title: Nanomedicine in the diagnosis and therapy of ALS

Time : 11:55-12:25

Biography:

Lina Machtoub, MD, PhD University of Tokyo Japan, 2002, Director of Neuronanomed ALS Zentrum - BrünstlMedicine. In 2003, joined Max Planck Institute, Germany, after granting a research award from Alexander von Humboldt foundation. In 2006, became visiting scientist at Harvard Medical University, Boston working on several clinical research projects focusing on the development of clinical multimodal diagnostic approaches based on nanobiotechnology. In 2009, joined Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, where conducted research on developing highly sensitive, diagnostic, and targeted imaging probes with implications of in vivo imagingtargeted contrast contrast agents. Her recent work was focuced on the implication of nanotherapeutics approaches for diagnosis & treatment for neurodegenerative disorders with focus on motor neuron diseases.

Abstract:

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is the most common adult-onset motor neuron disease. It is a rapidly advancing neurodegenerative disorder, characterized by the deterioration of both upper and lower motor neurons, with a mean time of survival from onset of symptoms to death of 2–5 years. The pathophysiology of ALS remains poorly understood. The only FDA approved therapy for ALS is riluzole, a glutamatergic neurotransmission inhibitor, with modest benefits on survival. Many other agents have shown promising results in preclinical trials, but have yet to show benefit in human clinical trials. Given the limited therapeutic treatment options to date, the most important approach to improve the patient's quality of life remains symptom-based management. Recently the interest in nanoneuromedicine has grown rapidly due to the immediate need for improved biomarkers and therapies for degenerative nervous system disorders. The advent of nanomedicines can enhance the delivery of biologically active molecules for targeted therapy and imaging. In addition, nanomedical advances are leading to therapies that target CNS pathobiology and as such, can interrupt disordered protein aggregation, deliver functional neuroprotective proteins and alter the oxidant state of affected neural tissues. The work presents the latest contribution of nanomedicine with some underlying new developments in cell based delivery strategies, which could be a promising approach for the treatment of ALS.

Ayman Al Boudi

Rashid Hospital, UAE

Title: Long term care of ALS patients

Time : 12:30-13:00

Biography:

Ayman Alboudi MD, Tishreen university. Master in neurology, MRCP UK. Currently specialist neurologist at Rashid hospital in Dubai – UAE. Principle investigator in prospective studies on cognitive impairment in MS patients.

Abstract:

Objectives:  Highlight the different presentations of MND  Acknowledge the long survival rate in our cases Three cases has recently been diagnosed with MND and managed with the mean age of 51y. The duration of the disease is 5-19 y. each case has different presentation. 1 female and 2 males. The female presented with progressive weakness started in her 32y old, and it was mainly on the Rt side then progressed gradually to the 4 limbs and respiratory failure, with preservation of the mental and sphincters functions. The second case was a male presented with general tiredness and weakness progressed over 1y until he became on ventilator. Notably he showed no upper motor neuron signs clinically and on EMG there was clear denervation which is consistent with primary muscular atrophy Third case is a male presented in his 44y old with progressive spastic gait which within 2 y developed to Quadra paresis. The patient became on ventilator after 2y of onset and up to this moment he still has his full mental abilities. Conclusion: MND is not studied well in our region, and still the clinical course, pathology and pathogenesis still not well determined. It is possible that we have different genetic mutations and clinical progression than western and other regions, especially that we have increased percentage of consanguineous marriage. In addition, absence of the end of life policy in our country play a major role in keeping those patients

  • Stroke Rehabilitation and Recovery

Chair

Yusuf Al-bustanji

United Arab Emirate University, UAE

Co-Chair

Antonio Incisa della Rocchetta

Wellington Hospital, UK

Biography:

Benjamin Chitambira completed his BSc Physiotherapy Honours degree from the University of Zimbabwe in 1995. He also completed a Postgraduate Certificate in Healthcare Leadership from the Open University in the UK in 2014. With over 19 years’ experience as a neuro-physiotherapist, he has been carrying out research on optokinetic chart stimulation as a clinical specialist physiotherapist in the Richard Stevens Stroke Unit for over 8 tears. With 11 papers published in peer reviewed journals and 4 international conference presentations, he has been a peer reviewer and guest editor for reputable journals and now serves as an editorial board member of peer reviewed journals.

Abstract:

Background: Stroke causes disability and has a huge cost to the health economy. The aim is to compare and explore recovery of movements and function in hemiplegic dense acute strokes treated by the optokinetic chart stimulation (OKCS) based OKCSIB protocol versus those treated conventionally. Methods: The A4 size optokinetic chart consists of repeated bundles of rainbow colours. The chart is placed 20 centimetres in front of a patient’s face. It is moved from side to side at approximately one cycle per second for 3 minutes then up and down for 3 minutes and finally forwards and backwards for another 3 minutes. Once patients can stand with assistance of 2 therapists, sensory interaction for balance is added. Specific active-assisted upper limb anti-gravity extensor exercises are carried out for the affected upper limb. Results: The experimental participant fully recovered affected upper and lower limb movements, at 20/20 on STREAM, by the 3 months follow up. On the other hand, the control participant did not recover voluntary movements of the affected upper and lower limb at all; remaining at 0/20. Instead, by the 3 months follow up, the control participant had developed spasticity of the affected hand and affected lower limb. The control participant’s affected lower limb was already in a flexor pattern of hip flexion and external rotation with knee flexion. The control participant was discharged to a nursing home with use of sling hoists. Conclusion: OKCS led to recovery of movements. RCTs are required to verify the evidence for its use.

Ali Bani-Ahmed

University of Tabuk, Saudi Arabia

Title: Primary motor cortex and “true” motor recovery in chronic stroke

Time : 14:15:14:45

Biography:

Abstract:

One major prerequisite for successful restorative therapies after stroke is a finer knowledge of how motor training reshapes the brain after injury and whether this reshaping is adaptive or maladaptive. We specifically investigated longitudinal neural changes (functional MRI, fMRI) in the primary motor cortices (M1) occurring as a function of “true” motor recovery following a motor training. Task-related fMRI measures were collected in 11 chronic patients and 12 age- and gender-matched controls immediately before and after a four-week training period (1080 repetitions per participant). Training comprised variable practice of a reach-to-grasp task executed with the impaired hand in patients and the dominant hand in controls. During practice, groups received faded (17% average) knowledge of performance about arm joint movements. Magnitude of M1 activation and anterior trunk displacement, a measure of compensatory movement strategies employed by patients to accomplish a reaching task, were analyzed. Prior training, relative to controls, patients exhibited a trend towards greater activation in M1 contralateral to the tested hand and significantly greater activation in ipsilateral M1. They also showed increased trunk movement and stronger and significant M1 activation-trunk movement correlations. After training, patients exhibited “normalization” of bilateral M1 activation, a decrease in compensatory trunk recruitment, and a trend toward “normalization” of motor activation-trunk movement relationships. We conclude that M1 is likely to play a major role in “true” recovery, suggested here by decreased use of compensatory strategies. We also suggest that combined movement kinematics-fMRI approach could help to gain a better understanding of underlying mechanisms of intervention.

Antonio Incisa della Rocchetta

Wellington Hospital Acute Neurological Rehabilitation Unit, UK

Title: Prolonged disorders of consciousness- the assessment and therapy pathway

Time : 14:45-15:15

Biography:

Antonio Incisa della Rocchetta has completed his PhD in 1990 at McGill University, Montreal Canada. He is the Lead Neuropsychologist at the Unit for Prolonged Disorders of Consciousness Wellington Hospital, London. He has published in international peer-reviewed journals and has been in clinical practice for over 20 years.

Abstract:

The management of patients in a Prolonged Disorder of conciousness state is complex and most recent guidelines recommend that these patients are managed in a specialised unit by a specialist multi-disciplinary team. The Prolonged Disorders of Consciousness (PdoC) Unit at the Wellington Hospital was created according to these guidelines, to diagnose and treat patients with prolonged disorders of consciousness, aiming to optimise their care and management before discharge. The assessment and therapy pathway and its implementation will be presented including the internationally recommended assessment tools used. The processes for keeping the family involved and informed about diagnosis and prognosis, with advice about possible key decisions such as long-term care and the appropriateness of life-sustaining measures including antibiotics and resuscitation will also be highlighted. Functional imaging research has indicated that a sizeable proportion of patients (17-19 percent) diagnosed as lacking awareness with behavioural diagnostic tools are in fact aware. A programme of research and clinical assessment of level of consciousness is planned, utilising functional imaging techniques (fMRI and EEG) in order to identify these patients. The ethical implications of this will be discussed.

Biography:

Abstract:

BACKGROUND: Malignant middle cerebral artery (MCA) stroke is associated with high mortality rates and high levels of morbidity among survivors. Several randomized studies have now shown that decompressive craniectomy, when performed in selected patients, can be beneficial. Here we present our initial experiences implementing decompressive craniectomy procedures in patients with brain infarcts at our hospital in Saudi Arabia. MATERIAL AND METHODS: Between October 2008 and July 2011, four out of six patients with hemispheric brain infarcts complicated by malignant edema underwent decompressive craniectomy and duraplasty within 72 hours of symptom onset. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Clinical outcome was assessed at 12 months using the modified Rankin scale (mRS). RESULTS: Two patients over 65 years old who were in poor medical condition were not treated surgically; both died within 4 days. Three females and one male, ranging in age from 38 to 57 years, underwent craniectomy. Of these, two died 7 and 21 days after stroke onset. One patient recovered with minor functional disability (mRS = 2) while the other had a residual moderately severe functional disability (mRS = 4) at final follow-up. Unexpectedly, given the small number of patients, the presence of co-morbid illness, the timeline of clinical deterioration post admission, and the lowest pre-operative GCS statistically predicted survival. CONCLUSIONS: Decompressive craniectomy rates are increasing in clinical practice, and the procedure can be life-saving. To our knowledge, our four surgical cases are among the first reported in Saudi Arabia. We call for national awareness of the management of such cases and early intervention. We also call for pre-stroke health status/co-morbidity, and both the rate and extent of neurological decline post admission to be added as potential outcome predictors in future research.

Tamsin Reed

Wellington Hospital Acute Neurological Rehabilitation Unit, UK

Title: Using advanced technology to maximise patient outcomes in Stroke Rehabilitation

Time : 15:45-16:15

Biography:

Tamsin qualified as a Physiotherapist at Nottingham University in 2001. Following a few years working in the public sector and deciding to specialise in Neurological Rehabilitation, she started working at the Wellington Hospital in London, on the Neurological Rehabiulitation Unit. Tamsin completed a Masters in Neurological Rehabilitation and developped a keen interest in the use of Functional electrical stimulation and robotics in Neurological Rehabilitation. She has presented on this topic at the ISPRM in Berlin and in Qatar and had posters accepted at various other internatinoal conferences. Tamsin is chair of the WFNR special interest group on the “Use of Advanced Technologies in Neurological Rehabilitation

Abstract:

In recent years there has been a huge increase in the number of advanced technologies on the market aiming to maximise patient outcomes in Neurological Rehabilitation. Scientific Evidence as well as public demand are also increasing. This presentation will look at the existing evidence on the use of Technology in Stroke Rehabilitation and how this can be integrated into practise to maximise intensity and recovery. It will also use clinical examples and experience to illustrate how these devices can be integrated into the Rehabilitaion Pathway. Examples used will include various devices such as the Erigo, Lokomat, Armeo, Indego Exoskelton and various upper and lower limb FES devices.

Yusuf Albustanji

United Arab Emirate University, UAE

Title: Agrammatism in Arabic Broca’s aphasia

Time : 16:45-17:15

Biography:

Yusuf Al-Bustanji is an assistant professor at United Arab Emirates University. He is a licensed and certified speech language pathologist specializing in Neurogenic Communication Disorders from The Ohio State University. He has over 20 years of experience in providing clinical evidence-based therapy services to individuals diagnosed with communication and swallowing disorders in acute care and rehabilitation centers at hospital settings.

Abstract:

Agrammatism is a language disorder characterized by morpho-syntactic impairments affecting the production and comprehension of connected speech. One characteristic of this deficit is the omission and/or substitution of grammatical morphemes in stroke survivals with Broca’s aphasia. The studies of agrammatism show that not all morpho-syntactic elements are impaired to the same degree and that some of this variation may be due to language-specific differences. This study investigated the production of morpho-syntactic elements in 15 Arabic speaking individuals with agrammatism and 15 age-matched neurologically healthy individuals. Two experiments were conducted to examine the production of complementizer, tense, agreement and negation morphology in Arabic. The results indicated that the speakers of Arabic with agrammatism had marked dissociations in producing specific morpho-syntactic elements. The observed impairment patterns overlapped, in many respects, with those observed in other linguistic groups. The findings are discussed with respect to current theories of agrammatism, including both morpho-syntactic and computational accounts.

Biography:

Kate Walker (Bachelor of Science in Human Communication Science) is a Senior Speech and Language Therapist in Acute Neurorehabilitation at the Wellington Hospital in London. Kate has worked with patients with complex stroke needs for over eight years, with her interest and expertise in alternative and augmentative communication stemming from her background in Western Australia. She continues to practice clinically as a highly regarded and advanced communication specialist.

Abstract:

Communication is a fundamental part of any human relationship – to share ideas, knowledge, feelings, needs and smiles. For patients with stroke, damage to speech and language centres in the brain can be a common and debilitating consequence, often requiring long periods of therapy. The overall objective of speech and language therapy in this context is to optimise individuals' ability to communicate, thereby improving quality of life. The role of technology in assistive communication therapies has grown over the years with the advancing skills and devices now available. Individuals with severe language or speech problems often rely on communication devices to supplement existing speech or replace speech that is not functional. These special augmentative aids help a person to express themselves by allowing the patient to interact with and control their environment. Having adequate assistive technology often means the difference between isolation and participation, and from dependence and independence. This presentation will explore the dynamic relationship between technology and communication after stroke, using patient case study examples from speech and language therapy services at the Wellington Hospital in London.

Biography:

Abstract:

Introduction: Decompressive hemicraniectomy (DH) is an emergency procedure in patients with large middle cerebral artery (MCA) infarctions. It improves survival but may not improve the overall outcome. This creates frequent disagreements between the neurosurgical on one hand and the neurological and/or the critical care teams. In the current survey, we aimed to explore the perspective on DH of each of these specialties to establish common grounds for moving forward. Methods: An electronic survey was distributed via email and social media groups to members of these specialties in Saudi Arabia and the Gulf countries. Local practices as well as common triggers for referral for DH were explored. The perceived outcomes of these procedures as well as individual impression of what constitutes good clinical outcomes were entertained. Inquiries regarding the patients’ population who are unlikely to benefit from the procedure were sought. Results: 89 physicians participated: 41 (46.1%) neurologists, 34 (38.2%) neurosurgeons and 14 (15.7%) intensivists. The majority of participants have been in practice for over 10 years (47.1%). Nine participants (10.1%) were from the Gulf Council Countries (four neurologists, and five neurosurgeons). Participants are mostly practicing in intermediate volume centers (50 to 150 stroke admissions per year; in 46.6%) or high volume centers (over 150 stroke cases per year; in 38.6%). The number of cases of DH was up to five per year in 58.6%, six to ten in 21.8%, and more than ten cases per year in 19.5%. The most frequent number of cases referred for DH was reported by the neurosurgeons to be over ten per year (in 40.6%) but the majority of neurosurgeons performed five cases or under per year (in 43.8%). Half of the neurosurgeons preferred to be consulted immediately on candidates with large MCA strokes while the rest wanted to be consulted only when radiological (28.1%) or clinical (12.5%) changes occur. The most important referral trigger for DH was clinical changes (76.9% of intensivists, 61.1% of neurologists, and 51.9% of neurosurgeons). In large MCA stroke setting, 29.3% of neurologists saw no value for ICP monitoring vs. 6.3% of neurosurgeons. All the intensivists expressed that ICP monitoring is somewhat (50%) or very valuable (50%) in this setting. The modified Rankin Scale (mRS) cutoff for good clinical outcome was 3 for 73.6% of respondents. Only 7.4% of neurosurgeons and 6.3% of neurologists (but none of the intensivists) thought that mRS-score of 5 could still be considered a good clinical outcome. There was agreement that DH only improves survival (64.4%). A third of the neurologists considered it to improve functional outcome compared to 15.4% of intensivists and 14.8% of neurosurgeons. Among intensivists, 30.8% had the impression that DH is not different from the natural history of large MCA stroke compared to 11.1% of neurosurgeons and 6.1% of the neurologists. There was agreement (66.7%) that patients older than 60 years with involvement of more than one territory should be excluded from DH. Only 7.7% of neurosurgeons excluded patients with dominant hemispheric strokes. Conclusion: There is a consensus among participants on the timing, indication and exclusions factors for patients with large MCA stroke. Guidelines issued by a committee of the three involved specialties are strongly recommended by our findings.

  • Poster Presentations
Location: 18:15-19:00 @ Foyer

Session Introduction

Jency Thomas

La Trobe University, Australia

Title: Effect of Diabetes on hippocampal gene expression
Biography:

Jency Thomas is an early career researcher and a teaching academic at La Trobe University. In a short career span Jency has 6 papers in A* Journals with one invited book chapter. Jency Thomas, is an early career researcher, building on from her PhD work she is developing her interest on metabolic diseases and mental health outcomes. Jency has made significant contribution and added new knowledge in the field of diabetes and cognitive impairment. She has significant experience working with range of antioxidants including omega-3 fatty acid and polyphenols. As an early career researcher she is keen to understand the effect of metabolic syndrome such as obesity, hypertension, dyslipidemia and diseases like cardiovascular and diabetes on mental health outcomes. Jency’s paper “Dietary Supplementation with resveratrol and/or docosahexaenoic acid alter hippocampal gene-expression in adult C57Bl/6 mice”. Journal of Nutrition Biochemistry was awarded the best original research paper, by University of Newcastle 2013. Her achievement is also recognised by invitation to write book chapter on “diabetes and gene expression”. Currently she is involved in number of projects, including a project on Australian Longitudinal Study on Women’s Health Data (ALSWH), Dr Thomas currently has access to database of large cohort of Australian mid-aged and Old age Women (>20,000).Dr Thomas is investigating the mental health profile of mid aged and old aged diabetic Australian women; this project is undertaken as a “Master’s Thesis Project”, for whom Dr Thomas is one of the primary supervisor

Abstract:

Diabetes is a metabolic disorder that leads to other health complications over a period of time and is the cause for considerable morbidity and mortality world-wide. The complications of diabetes in the peripheral tissues are well characterized including coronary heart disease, retinal degeneration, renal disorders, and also micro and macro vascular complications. Over the last few decades much emphasis has been placed on the complications of diabetes that occur in the central nervous system (CNS). One such neuropathology due to diabetes in CNS is cognitive impairment. The hippocampus, the limbic structure, is involved in higher brain functions and appears to be particularly vulnerable to diabetes. presents a study on the comparison of gene expression profile in the hippocampus of a streptozotocin (STZ) induced diabetic mice and a vehicle treated control animals. Here it is demonstrated that diabetes causes significant alterations in the genes that plays a crucial role in synaptic function and plasticity and also for neurogenesis, both of which are required for normal cognitive functions. Six weeks after diabetes was established in these mice, a number of genes had altered expression including genes involved in epigenetic regulation, and this included histone deacetylase (Hdac) 4, 9 and 11. Interestingly Hdac 4 and 9 are abundantly present in the hippocampus and are required for hippocampal dependent learning, memory and synaptic plasticity. Glycogen synthase kinase beta (Gsk3β) which has been shown to have a crucial role in metabolic and neurodevelopmental functions and considered to be an important regulator of synaptic functions, also exhibited significant decrease in the STZ induced diabetic mice as opposed to the buffer treated control group. The marked decrease of these genes that are crucial for higher functions in the hippocampus underscores the impact of uncontrolled diabetes on the hippocampus. Furthermore genes that have been linked to neurological disorder and cognitive dysfunction such as apolipoprotien E (ApoE) showed increased expression in diabetic mice as opposed to the non- diabetic control group. These findings implicate the abnormal transcription of genes which could disrupt normal cognitive functions in the hippocampus and also underscores epigenetic mechanisms involved in disease conditions like diabetes.

Biography:

Shi-Uk Lee has completed his PhD from Seoul National University and postdoctoral studies from Stanford University School of Medicine. He is the director of Department of Physical Medicine and Rehabilitation, Seoul National University Boramae Medical Center. He is Professor in Departtment of Rehabilitation Medicine, Seoul National University College of Medicine.

Abstract:

Asymmetry in weight distribution is the main cause of frequent fall in hemiplegic patients. Weight distribution during upright standing in early rehabilitation is important for the determination of asymmetry. Currently used upright standing training methods for stroke patients are tilt table (T/T), standing frame (S/F), and parallel bar (P/B). Among these, S/F is a relatively new training method and its exact indication and usefulness is not understood. Additionally, to our knowledge, changes of weight distribution on these methods have not been reported. Objective : Our research questions were 1) How does the weight distribution change according to T/T, S/F and P/B in subacute stroke patients? 2) Especially what does the upright posture on S/F differ from others in terms of weight distribution? Methods : Six patients (2 males and 4 females, mean age 73.7 years) in subacute stage of stroke were included in the study. Weight distribution in upright posture was assessed with the computerized wireless balanciometer (CWB) during their ‘P-bar standing try’ level of recovery. The patients were divided into two groups according to the motor power of knee extensor on the hemiplegic side. In group A (n=3), the motor power was less than ‘3’ in manual motor grade. Others (n=3) were assigned into group B (motor power > 3). Group A were provided with knee stabilizer on their hemiplegic side during standing. CWB is composed of insoles with 3 sensors located on medial and lateral side of foot front and heel region. The percentage of weight that was carried at each sensors were recorded wirelessly. The patients were asked to stand ‘comfortably still’ for more than 30 seconds for 1 trial, and the trial repeated for 3 times to obtain median value. Results : The average percentage of total body weight on hemiplegic side were calculated for tilting table, standing frame and p-bar which were 33.9% (SD 11.4), 17.8% (SD 18.0) and 14.2% (SD 23.5) each. And the average percentage of total body weight on the hemiplegic side for P-bar in group A and B were 13.7% (SD 22.7) and 31.3%(SD 26.2) each. And the value was 29.5% (SD 12.1) and 38.3% (SD 11.1) in tilting table. Conclusion : In upright posture on S/F or P/B, asymmetry of weight distribution between hemiplegic and intact side aggravated in comparison to that on T/T. This phenomenon was more evident in patients with weaker knee extensors. Therefore S/F is an upright training tool similar to P/B in terms of weight distribution and should be applied with concomitant balance training to facilitate the use of hemiplegic lower extremity for the early treatment to obtain symmetry of weight distribution.

Biography:

Hsiao-Yu Chen has completed her PhD at 2004 from University of Ulster, UK. She is the Dean of College of Health and Professor of Department of Nursing. She has published more than 35 papers in reputed journals.

Abstract:

The purpose of this study was to evaluate the effectiveness of a self-management program in prevention complications, promoting self-efficacy and health status in people with spinal cord injury. Methods: The study adopted a quasi-experimental pre-test and post-test control group design. Data was collected from October 2014 to July 2015. Qualified participants were recruited from Spinal Injury Association in Taiwan. All participants were evaluated with instruments of personal information, self-efficacy and health status, indicators at baseline and at 3 months and 6 months. The experimental group (n = 30) received self-management program in addition to teaching by the researcher, whereas the control group (n = 27) received without a self-management program. Several descriptive analysis functions were employed to explain the distribution conditions of the data. Subsequently, chi-square test and Mann-Whitney U test were performed to compare the experimental and control group. To obtain inferential statistics, generalised estimating equation (GEE) was used to compare the pre-test and post-test scores obtained from the experimental and control groups. Results: The total 57 participants were participated in this study. The average age was 40.63 years old. The results indicated that, after received the SCI self-management program, the experimental group exhibited a considerably greater improvement in self-efficacy and health status. Although, we recorded no marked differences emerged between the experimental and control groups by using a GEE. The statistics showed that the prevention of complications, the experimental group had somewhat decrease(p = .094)than the control group. Conclusion: Our study results confirmed that the SCI self-management program is an effective instrument for preventing complications, promoting self-efficacy and health status in people with SCI, and is a practical health education tool. However, monitoring these people over the long term is necessary. We plan to use the proposed SCI self-management program with a larger number of people with SCI before them discharge from hospital and to continuously monitor their improvement.

Biography:

Magda Ahmed Eldomiaty has completed his PhD at the age of 37 years from Tanta University and postdoctoral studies from Tanta University College of Medicine Egypt. She is prof. Of Anatomy and embryology in Taibah University Saudi Arabia, Tanta University Egypt. She is international reviewer in many international journals. She has published more than 25 papers in reputed journals and has been serving as an editorial board member of Edorium Journal of Anatomy and Embryology.

Abstract:

The study demonstrated the expression of muscle-derived myokines in the dentate gyrus (DG), medial frontal cortex (mFC) and cerebellum during depression and after voluntary exercise. Depression was developed by forced swimming (15 minutes/day) for 2 weeks and evaluated by automatic monitoring of the locomotor activity. Voluntary exercise was performed through accessing voluntary rat wheel for 3 weeks. Brain sections were processed and immunostained with antibodies against BDNF, MIF, VEGF and IL6. Light microscopic study and measuring the integrated optic density (IOD) of the photographs using ImajeJ software were performed to evaluate the myokines’ expression. Microscopically; BDNF was expressed in the cytoplasm and nuclei of nearly all neurons of DG, mFC and in granular and Purkinje cells of the cerebellum. MIF expression was mainly cytoplasmic in neurons of subgranular zone of DG, neurones of mFC and in Pukinje cells of cerebellum. VEGF showed cytoplasmic expression in many neurons of DG, mFC and in purkinje cells. IL6 was also cytoplasmic but expressed more in the glial cells, endothelial cells and purkinje cells. After voluntary running protocol; the IOD of BDNF increased significantly in upper and lower limbs of DG (P= 0.005 and p<0.001 respectively), mFC (P=0.001) and cerebellum (P=0.001). IOP of MIF significantly increased in both limbs of DG (p<0.001), mFC (p=0.001) but not in the cerebellum (P=0.052). IOP of VEGF and IL6 showed significant increase of in both limbs of DG (p<0.001), mFC (p<0.001) and cerebellum (p=0.001). The study could re-define the muscle derived myokines that might help in managing depression.

Biography:

Abstract:

Objectives: Stroke has been emerged as a major health problem in Libya, importing an enormous burden on the health care system. The presented study aimed to determine the pattern of stroke admissions to medical unit of Iben Sina teaching hospital, Sirte, Libya and to investigate for etiologies, risk factors and sequel in stroke patients. Materials & Methods: Data from 150 patients, who were admitted to Ibensina teaching hospital, Sirte between April 2008 and July 2009, were reviewed retrospectively. Patients age, sex, body mass Index, underlying diseases, risk factors as well as etiologies of stroke were recorded. Results: Total of 2229 patients was admitted to Medical department, IbenSina teaching hospital during the study period, 130 of them were admitted as stroked patients. The mean age was 59.83+14.17 years with male to female ratio of 1.6:1. 46.2% of the stroked patients were cerebral thrombosis, for 22.3% of stroked patients the cause was cerebral hemorrhage and for 15.4% was transient ischemic attack. Hypertension was the common underlying disease in our patients (33%), followed by combination of Diabetes Mellitus and hypertension (19.2%), ischemic heart disease (16.1%) and Diabetes mellitus alone (15.3%). Hypertension was the common risk factor (52.3%), followed by Dyslipideamia (38.4%), Obesity (36.1%), Diabetes Millitus (34.6), smoking (30.7%) and atrial fibrillation (3.8%). Hemiparesis was the commonest sequelae (42.3%) followed by hemi plegia (26.95) and no sequelae in (17.7%). Mortality rate was (13.1%), cerebral hemorrhage was associated with high mortality (8.46%). Conclusions: Our study revealed that, Cerebral thrombo-embolism was the common cause of stroke in our patients admitted to IbenSina teaching hospital.

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