Loewenstein Hospital Rehabilitation Center

Evidence supporting the association between breastfeeding patterns and autism is inconsistent. This study examined sociodemographic and birth factors related to breastfeeding duration and subsequent autism spectrum disorder (autism) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, compared to a neurotypically developing cohort, based on electronic health records. Demographics, feeding preferences, and breastfeeding duration as reported by parents during routine baby wellness visits were analyzed for a cohort of 11,766 (1.9%) children with autism spectrum disorder diagnosis and a random subsample of 12,000 (2.03%) neurotypically developing children. Autism spectrum disorder diagnosis was based on a national autism registry and assigned after electronic health records were completed. Preterm, very low birth weight, multiple births, and complex medical comorbidities were excluded. Infants subsequently diagnosed with autism were breastfed for an average of 5.0 months, 1.5 months shorter than neurotypically developing. Fewer autism spectrum disorder infants were exclusively breastfed in the first year of life. Two-way analysis of variance indicated a significant effect of socioeconomic status and autism spectrum disorder on breastfeeding duration, and a significant interaction of socioeconomic status with autism spectrum disorder. Shorter breastfeeding duration among infants with subsequent autism spectrum disorder was confirmed, calling for closer monitoring for autism traits in infants with breastfeeding difficulties. These challenges were independent of birth parameters; however, they were influenced by socioeconomic factors.Lay AbstractThis study found that infants later diagnosed with autism were breastfed for a shorter duration than their typically developing peers, with differences influenced by socioeconomic status. These findings highlight the importance of monitoring breastfeeding challenges as a potential early indicator of autism, particularly in families of mid-range socioeconomic status.

BackgroundThe brain network supporting visual-scene memory includes ventral (what) and dorsal (where, how) visual processing streams, and hubs within the medial temporal cortex, plus frontal, temporal, and parietal regions comprising the core-recollection memory system. However, the exact relationship between these regions and the capacity to memorize different types of visual-scene elements remains debated. Functional neuroimaging studies point to dissociable as well as common network components supporting perception and memory of different aspects of visual information. In the current neuropsychological study, we assess impact of stroke lesion topography on recall of identity, location, and action of event participants, as assessed by the WMS-III Family Pictures subtest.MethodsNinety-three first-event stroke patients (54 and 39 right- and left-hemisphere damaged, respectively; RHD, LHD) in the sub-acute phase performed the Family Pictures task. Voxel-based lesion-symptom mapping (VLSM) analysis identified brain lesions implicated in memory deficits for the composite score and separately for each scene element: characters' identity, the action they performed, and location of occurrence.ResultsBehavioral analysis revealed significant impairment in identity, location, and action memory among right hemisphere damage (RHD) patients compared to matched healthy controls. Performance was significantly lower in delayed compared to immediate testing condition, and memory domains showed a hierarchy of scores: highest for identity, intermediate for location, and lowest for action. VLSM revealed a markedly different pattern of lesion effects in the two hemispheres. In the RH, network was dominated by large voxel clusters in middle and superior temporal and inferior parietal regions. In contradistinction, the LH network was dominated by large voxel clusters in temporo-occipital and medial temporal lobe (MTL) regions. VLSM conjunction analysis disclosed further distinctions between anatomical regions subserving memory of character identity, action, and location.DiscussionVisual scene memory is supported by a bi-hemispheric network dominated in the LH by temporo-occipital/MTL structures and in the RH by temporo-parietal components of the core recollection network. The LH network regions were mostly implicated in a non-specific manner, whereas in the RH network more regions were implicated in memory for specific scene elements.

Non-invasive Brain Stimulation may modulate motor function. One commonly investigated method is transcranial direct current stimulation (tDCS). In the last few years, a new stimulation technique has been developed and studied, namely transcranial random noise stimulation (tRNS). Both stimulation techniques have displayed a certain degree of inconsistency regarding their impact on motor performance. One explanation for this may be related to differences in the sex of the participants. Thirty healthy individuals (15 female) participated in a single-blind counterbalanced crossover trial. All participants received three stimulation conditions: high frequency-tRNS, tDCS, and sham stimulation. Stimulation was applied for 10 min at 1.0 mA, with a frequency range of 101–640 Hz for the tRNS. In all stimulation conditions, the anode (for tDCS) was placed over C4 and the cathode over the contralateral orbit. The participants performed a sequential reaching motor task on a digital tablet before, during, and immediately after the stimulation. Movement time, reaction time, and peak velocity did not differ between stimulation conditions. However, within-condition analyses showed improvements in movement time and peak velocity following tRNS only, while reaction time improved in all stimulation conditions. No significant effect of sex was observed. While no clear advantage for a specific stimulation condition was statistically confirmed, these within-condition effects suggest that tRNS may modestly enhance motor performance and warrant further investigation. Additionally, in this experimental setup, sex did not influence the effects of tRNS and tDCS on motor performance.

Abstract Oculomotor function is a sensitive marker of neurological impairment with smooth pursuit deficiencies investigated in various disorders. However, the oculomotor deficits following traumatic brain injury (TBI) have not been fully characterized. In this study, we employed a novel bedside eye-tracking paradigm to assess oculomotor dysfunction in 30 TBI patients and 30 age-matched controls. Our paradigm utilized short, repeated linear tracking segments with head-free recording, enabling the extraction of multiple oculomotor indices, including saccadic pursuit, tracking deviation under occlusion, initial tracking speed, initial saccade latency, pupil response, and vergence instability. TBI patients exhibited widespread deficits across these indices (AUC = 0.71–0.84), which correlated significantly with functional recovery, as measured by the Functional Independence Measure (R = 0.41–0.78, p < 0.001) but not with the initial Glasgow Coma Scale scores. These findings suggest that TBI disrupts multiple components of the oculomotor system, extending to predictive tracking, pupil-linked arousal, and binocular coordination. Additionally, preliminary testing in disorders of consciousness (DOC) patients revealed fragmented tracking, suggesting a potential application for assessing perceptual awareness. Our findings support the use of eye tracking as a promising tool for quantifying brain function in TBI, with potential applications in prognosis, rehabilitation monitoring, and broader neurological assessment.

Injuries are a major cause of morbidity and mortality among children with neurodevelopmental conditions. Identifying injuries associated with this vulnerable population could inform specific preventive actions. To compare the injury risk among children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), or coexisting ASD and ADHD with children with typical development (TD). This population-based cohort study involved 325 412 children born between 2005 and 2009, followed up until the end of 2021. Data analysis was conducted from February 2 to November 14, 2023. The study data were extracted from the Clalit Health Service (CHS) database, which contains comprehensive clinical and sociodemographic data on all members of the CHS admitted to the emergency departments (EDs) of all hospitals in Israel during the study period. Children who were members of CHS born between 2005 and 2009 were classified into 4 groups: ASD, ADHD, ASD and ADHD, and TD (control). Negative binomial regression models were used to assess incidence rate ratios (IRRs) of ED visits between the study groups and the control group. These models were adjusted for birth year, sector, and socioeconomic status. IRRs for specific injuries were also assessed. The statistical significance of IRRs was assessed using 95% CIs. A total of 325 412 children (163 183 boys [50%]) were included in the study. Children with ASD, ADHD, or both had significantly higher ED visit rates than children with TD (IRR, 1.48 [95% CI, 1.42-1.55], 1.45 [95% CI, 1.39-1.52], and 1.29 [95% CI, 1.28-1.30], respectively). Children with ADHD had also higher rates of ED visits due to physical injuries compared with controls (IRR, 1.18 [95% CI, 1.16-1.20]), whereas children with ASD with or without ADHD did not (IRR, 0.96 [95% CI, 0.89-1.05] and 0.91 [95% CI, 0.83-1.00], respectively). A focused analysis of the injury profiles revealed that children with ASD or comorbid ASD and ADHD had higher rates of ingestion and inhalation injuries (IRR, 1.57 [95% CI, 1.06-2.25] and 1.80 [95% CI, 1.28-2.48], respectively) and lower rates of orthopedic injuries (IRR, 0.78 [95% CI, 0.69-0.89] and 0.83 [95% CI, 0.74-0.93], respectively), and animal-inflicted injuries (IRR, 0.44 [95% CI, 0.22-0.79] and 0.92 [95% CI, 0.60-1.35], respectively) than controls. In this large cohort study, different types of injury were associated with children with ASD and ADHD. The causes underlying these associations should be further investigated to develop effective approaches for injury reduction among these children.

Background and ObjectiveChronic low back pain disability (CLBPD) is a syndrome that includes pain, disability, emotional impairments, and social problems. The study was conducted to examine the effect of an inpatient rehabilitation program on the performance of everyday life tasks (daily activities), and report on pain in CLBPD patients with primary activities of daily living (ADL) deficits.MethodsIn a retrospective cohort study, demographic and clinical data were retrieved from records of inpatients admitted consecutively to the program. Scores of the Spinal Pain Independence Measure (SPIM) and of changes in reported pain levels were used to assess improvement in the performance of daily activities and pain reduction. T-tests were used to assess the significance of score changes. Spearman’s correlations and analysis of variance were used to assess relationships of SPIM gain and affecting factors.ResultsNinety-nine patients were included. Daily task performance improved in 71 patients (71.7%). The SPIM score increased from 48.7 (SD 16.3) at admission to the rehabilitation program to 57.8 (SD 12.5) at discharge (P<0.001). The SPIM score at admission negatively affected SPIM gain (P<0.001). The SPIM gain was significant for admission SPIM scores of 50 or lower (P<0.05), but differences in SPIM scores were not as noticeable for patients with admission SPIM scores above 50. Relief in pain was reported in 59 patients (59.6%) and was not associated with function.ConclusionsThe multidisciplinary rehabilitation program, which improved function and provided limited pain relief in inpatients with CLBPD primary ADL deficits, can be effective for the most severe CLBPD cases.

Background Studies that have shown neurological improvement following cranioplasty (CP) after decompressive craniectomy (DC) in patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) did not include control groups. The aim of this study was to assess the justification of CP for these patients. Methods Data were collected from medical records of inpatients with UWS and MCS admitted between 2002 and 2018. Results Of the 144 participants (mean age 40 years, 76% males, 75% in UWS), 37% had CP following DC. The Loewenstein Communication Scale (LCS) gain was 12±17 and 16±17 for the control and study patients, respectively. The corresponding consciousness recovery rate (based on Coma Recovery Scale-Revised scores) was 51% and 53%, respectively. One-year survival rates were 0.80 and 0.93, and 5-year survival rates were 0.67 and 0.73, respectively. Mean outcome values were higher for the study group, but the differences between the groups did not reach statistical significance. Conclusions The study did not demonstrate that CP increases brain recovery or survival. Nevertheless, it showed that CP did not decrease them either, and it did not increase complications rate. The findings, therefore, support offering CP to patients with UWS and MCS as CP does not increase risks and can achieve additional goals for these patients.

Transcranial direct current stimulation (tDCS) exerts beneficial effects on motor recovery after stroke, presumably by enhancement of adaptive neural plasticity. However, patients with extensive damage may experience null or deleterious effects with the predominant application mode of anodal (excitatory) stimulation of the damaged hemisphere. In such cases, excitatory stimulation of the non-damaged hemisphere might be considered. Here we asked whether tDCS exerts a measurable effect on movement quality of the hemiparetic upper limb, following just a single treatment session. Such effect may inform on the hemisphere that should be excited. Using a single-blinded crossover experimental design, stroke patients and healthy control subjects were assessed before and after anodal, cathodal and sham tDCS, each provided during a single session of reaching training (repeated point-to-point hand movement on an electronic tablet). Group comparisons of endpoint kinematics at baseline—number of peaks in the speed profile (NoP; smoothness), hand-path deviations from the straight line (SLD; accuracy) and movement time (MT; speed)—disclosed greater NoP, larger SLD and longer MT in the stroke group. NoP and MT revealed an advantage for anodal compared to sham stimulation of the lesioned hemisphere. NoP and MT improvements under anodal stimulation of the non-lesioned hemisphere correlated positively with the severity of hemiparesis. Damage to specific cortical regions and white-matter tracts was associated with lower kinematic gains from tDCS. The study shows that simple descriptors of movement kinematics of the hemiparetic upper limb are sensitive enough to demonstrate gain from neuromodulation by tDCS, following just a single session of reaching training. Moreover, the results show that tDCS-related gain is affected by the severity of baseline motor impairment, and by lesion topography.