Sensory functions of institutionalized Romanian infants: A pilot study

The Test of Sensory Functions in Infants (TSFI) is one tool that occupational therapists use to identify sensory processing disorders among infants. However, data on the reliability of TSFI scores with infants with developmental delays are lacking. Test-retest reliabilities for TSFI total test and subtest scores were determined with a sample of 26 infants with developmental delays. All infants were between 10 months and 18 months of age. The test-retest interval ranged from 5 days to 10 days. Magnitudes of difference between test and retest scores and percentages of agreement among the TSFI classification categories (i.e., normal, at-risk, deficient) also were determined to examine relationships between test scores. Reliability for the total test score was borderline, with an intraclass correlation coefficient of .78. Reliability coefficients for the five subtests ranged from .54 to .74. Percentage of agreement for the total test classification categories between test and retest was adequate (81%). Percentages of agreement for subtest classification categories were low, ranging from 58% to 68%. TSFI scores should be interpreted cautiously and used only in conjunction with findings from additional developmental assessments and clinical observations for infants with developmental delays.

Cortical vision impairment (CVI) and Cerebral Palsy (CP) lead to decrement in sensory and motor functions of infants. The current study examined the effectiveness of sensory integration interventions on sensory, motor, and oculomotor skills in infants with cortical vision impairment. Thirty-four infants with and CP aged 12–18 months were enrolled to the study. The infants were randomly divided into two groups as the control and intervention groups. The intervention group took sensory integration intervention 2 days a week for 8 weeks in addition to conventional physiotherapy 2 days a week for 8 weeks. The control group only received the conventional physiotherapy program 2 days a week for 8 weeks. The duration of the treatment sessions were 45 min for both interventions. Before and after the intervention, sensory processing functions were evaluated with the Test of Sensory Functions in Infants (TSFI), and motor functions were evaluated with the Alberta Infant Motor Scale (AIMS). There was a statistically significant difference between the pre- and post-test mean TSFI total and AIMS scores in the intervention group and control group (p < 0.001). The intervention group mean TSFI scores were more statistically significant than the those of the control group. Mean post-intervention AIMS scores did not differ between groups. Sensory integration intervention delivered with the conventional physiotherapy program was more effective than the conventional physiotherapy program in increasing sensory processing skills in one measure in infants with CVI and CP.

The aim of this study was to investigate the effects of a sensory integration-based occupational therapy intervention programme on the sensory functions and neuromotor performance of a 14-month-old baby with Down syndrome (DS). The study evaluated the baby's sensory functions using the Test of Sensory Functions in Infants (TSFI) and neuromotor performance using the Neuro Sensory Motor Development Assessment (NSMDA) after recording demographic information. The infant participated in a 12-week occupational therapy intervention program, receiving 45-minute sessions once a week, and the family was provided with a home program. Evaluations were conducted before and after the intervention. The results showed positive improvements in the infant's sensory functions and neuromotor performance. The baby's NMDA functional level score decreased from 17 to 11, while the TSFI total score increased from 29 to 42. The study found that sensory integration-based occupational therapy intervention could be effective in improving sensory functions and neuromotor performance in a baby with DS. These results suggest that clinical management of sensory and neuromotor function may be of benefit to a significant number of babies with DS.

Relationship between sleep characteristics, motor development, and sensory processing in late preterm infants.

Although exclusive breastfeeding (EBF) is recommended for the first 6 months of life, breastfeeding rates in most developed countries are low. Sensory over-responsivity (SOR) has been found to interfere with infant and childcare, development, and routines, but has not yet been examined as a breastfeeding barrier. The aim of this study was to explore the association between infant sensory responsiveness and EBF and whether it can predict EBF cessation prior to 6 months of age. In this cohort prospective study participants were 164 mothers and their infants recruited 2 days after birth in a maternity ward between June 2019 and August 2020. At this time, participating mothers completed a demographic and delivery information questionnaire. At 6 weeks after birth, the mothers completed the Infant Sensory Profile 2 (ISP2), reporting their infants' sensory responsiveness in daily activities. At 6 months, infants' sensory responsiveness was assessed using the Test of Sensory Functions in Infants (TSFI) and the Bayley Scales of Infant and Toddler Development-3rd Edition (Bayley-III) was administered. Additionally, mothers provided information about their breastfeeding status and were divided into two groups accordingly: EBF and non-EBF (NEBF). The incidence of atypical sensory responsiveness (mostly of the SOR type) at 6 weeks was twice as high among NEBF infants than EBF infants (36.2% vs. 17%, χ2=7.41, P=0.006). Significant group differences were found in the ISP2 touch section (F=10.22, P=0.002). In addition, NEBF infants displayed more SOR behaviors than EBF infants in the TSFI deep touch (F=2.916, P=0.001) and tactile integration subtests (F=3.095, P<0.001), and had lower scores in the adaptive motor functions subtest (F=2.443, P=0.013). Logistic regression modeling revealed that ISP2 at 6 weeks (typical vs. atypical) and TSFI total score at 6 months predicted 28% of NEBF at 6 months (χ2=23.072, P=0.010). Infant atypical sensory responsiveness, predominantly of the SOR type, was found to predict NEBF at 6 months after birth. This study contributes to the understanding of EBF barriers, highlighting the importance of early identification of SOR in infants. Findings may suggest developing early sensory interventions and providing individualized breastfeeding support tailored to the infant's unique sensory profile.

Premature infants are at risk of sensory processing difficulties and developmental delays due to an immature central nervous system and possible episodes of medical instability, discomfort, pain and stress during the first weeks or months after birth. To investigate the effect of Ayres Sensory Integration (ASI) on the development of premature infants in the first 12 months of life. A pre-/post-test experimental design was used to randomly divide 24 premature infants from a low socioeconomic setting in Bloemfontein, South Africa, into experimental and control groups after being matched by corrected age and gender. Developmental status was determined with the Bayley III Scales of Infant and Toddler Development, the Test of Sensory Functions in Infants and the Infant/Toddler Sensory Profile. The experimental group received 10 weeks of ASI intervention. ASI intervention had a positive effect on the sensory processing and development of premature infants, especially in terms of cognitive, language and motor development. ASI intervention at an early age enhances the developmental progress of premature infants.

Sensorimotor development in cocaine-exposed infants

Individuals with stroke in an acute stroke unit spend the majority of their day inactive and alone. There is strong evidence that greater physical activity, and emerging evidence that greater social and cognitive activity after stroke promotes functional recovery. One approach found to increase activity levels in all these activity domains following stroke is an enriched environment, which is an intervention designed to stimulate physical, social and cognitive activity. The enriched environment is well investigated in animal models post stroke and refers to housing conditions that are designed to stimulate motor and sensory functions, as well as social and cognitive activity. Evidence has shown that rodents recovering within an enriched environment starting 24-hours post stroke showed greater functional recovery than recovery in standard housing conditions. The first clinical translation of an enriched environment was undertaken in the subacute inpatient rehabilitation setting, which showed that individuals with stroke (n=14) undergoing enriched rehabilitation were 1.2 times more engaged in ‘any activity’ as compared to no enrichment. However, the enriched environment has not yet been explored in an acute stroke unit. Thus, the primary aim of this thesis was to investigate whether an enriched environment embedded in an acute stroke unit could increase activity levels in physical, social, cognitive and combined activity domains across individuals with acute stroke.Study 1 examined the effect of embedding an enriched environment in an acute stroke unit on activity levels using a controlled before-after observational design. Activity levels were observed in a control group receiving usual care, and subsequently in a group who recovered in an enriched acute stroke unit. The enriched environment focused on three key areas: 1) creating a stimulating environment including communal areas for eating, socialising and group activities, and provision of resources throughout the ward and at the patient bedside; 2) involvement of patients and families to increase activity outside therapy hours, and 3) using change management strategies to support staff to implement the enriched environment within existing staffing levels. Behavioural mapping was used to determine the primary outcome measure ‘any’, physical, social and cognitive activity. Participants were observed every 10-minutes from 7.30am till 7.30pm on weekday and weekends. We found that the enriched group (n=30) spent a significantly greater proportion of their day engaged in ‘any activity’ (p=0.005), physical (p<0.001), social (p=0.007) and cognitive activity (p=0.002) as compared to the control group (n=30). Furthermore, the enriched group spent a lower proportion in a supine position, in their room and being alone. The secondary aims were to explore the impact of an enriched environment on functional outcomes, adverse events and length of stay. No differences between groups were found for functional outcomes at discharge from the acute stroke unit and at 3-months post stroke. The enriched group experienced fewer adverse events (p=0.001) and a shorter length of stay (p=0.02).In study 2, the aim was to determine if increased activity levels were sustained 3-months after completion of the before-after pilot study. After completion of study 1, the environmental enrichment was continued in the acute stroke unit, but change management strategies to support staff were withdrawn. Thirty stroke patients were recruited to the sustainability group. Increased patient activity levels were sustained 6-months post implementation of the enriched environment.In study 3 the impact of the enriched environment on timing and nature of activity levels, and the amount of staff assistance provided to patients to undertake activities was examined. We specified time periods to determine the effect of enrichment strategies on activity levels. Activity was significantly increased during periods of scheduled communal activity, weekday hours outside scheduled activity and weekends, but no effect was observed on weekdays after 5pm. Specific activities, which increased significantly, included upper limb, communal socialising, listening and iPad activities. No difference in amount of staff assistance was observed during activities.In study 4, nursing and allied health professionals (n=10) were interviewed to evaluate their perceptions and experiences while working in an enriched environment. Thematic analysis showed that staff perceived the enriched environment to make a positive contribution to recovery after stroke and that interdisciplinary teamwork was more visible. Staff surveys supported this view. In addition, staff experienced that change management strategies were critical to not relapse into old work routine. Brief patients and carers surveys showed that consumers appeared to be positive towards the enriched environment in the acute stroke unit.Taken together, these studies demonstrated that embedding an enriched environment into an acute stroke unit was feasible, significantly increased activity levels in individuals with stroke and activity levels were sustained 6-months post implementation. Furthermore, staff perceived that the enriched environment made a positive contribution to patient recovery after stroke. The promising results of an enriched environment in an acute stroke unit warrant larger studies to determine our ultimate goal: can an enriched environment result in greater functional recovery after stroke.

Objective: The limited availability of donor sites for nerve grafts and the morbidity associated with their harvesting serve as motivating factors to actively conduct research to find alternatives to the status quo. Experimental and clinical studies have shown that a vein segment used to bridge a peripheral nerve defect leads to a functional nerve repair. Both FK-506 and b-FGF have been reported to enhance peripheral nerve regeneration. This study compared the effects of FK-506 with that of b-FGF on peripheral nerve regeneration in a rat autogenous vein graft conduit model. Methods: The main trunk of the right sciatic nerve was transected and bridged by an autogenous vein in 30 rats. Small osmotic pumps were placed just proximal to the anastomoses. Groups of 10 rats were assigned to receive saline solution, b-FGF (2,000 units), or FK-506 (0.5 mg/kg/day) via the osmotic pumps for 2 weeks. Sciatic nerve regeneration was evaluated by sensory function, walking track analysis, electrophysiologic studies, and light microscopic evaluation. Results: On post-operative day 90, there was a statistically significant difference (p <.005) in nerve regeneration between the rats who received saline compared with those who received FK-506 or b-FGF. This was determined using sensory function tests, sciatic function index, and electrophysiologic studies. The number of nerve axons, as determined by histological analysis, revealed there were significantly more nerve fibers which were regenerated in both experimental groups (FK-506 and b-FGF) when compared with rats who received saline. There was no statistically significant difference in the number of nerve axons that regenerated in rats injected with FK-506 vs. rats injected with b-FGF. Conclusion: FK-506 and b-FGF promote similar nerve regeneration in rats compared with control.

Olfactory ensheathing cells show promise in preclinical animal models as a cell transplantation therapy for repair of the injured spinal cord. This is a report of a clinical trial of autologous transplantation of olfactory ensheathing cells into the spinal cord in six patients with complete, thoracic paraplegia. We previously reported on the methods of surgery and transplantation and the safety aspects of the trial 1 year after transplantation. Here we address the overall design of the trial and the safety of the procedure, assessed during a period of 3 years following the transplantation surgery. All patients were assessed at entry into the trial and regularly during the period of the trial. Clinical assessments included medical, psychosocial, radiological and neurological, as well as specialized tests of neurological and functional deficits (standard American Spinal Injury Association and Functional Independence Measure assessments). Quantitative test included neurophysiological tests of sensory and motor function below the level of injury. The trial was a Phase I/IIa design whose main aim was to test the feasibility and safety of transplantation of autologous olfactory ensheathing cells into the injured spinal cord in human paraplegia. The design included a control group who did not receive surgery, otherwise closely matched to the transplant recipient group. This group acted as a control for the assessors, who were blind to the treatment status of the patients. The control group also provided the opportunity for preliminary assessment of the efficacy of the transplantation. There were no adverse findings 3 years after autologous transplantation of olfactory ensheathing cells into spinal cords injured at least 2 years prior to transplantation. The magnetic resonance images (MRIs) at 3 years showed no change from preoperative MRIs or intervening MRIs at 1 and 2 years, with no evidence of any tumour of introduced cells and no development of post-traumatic syringomyelia or other adverse radiological findings. There were no significant functional changes in any patients and no neuropathic pain. In one transplant recipient, there was an improvement over 3 segments in light touch and pin prick sensitivity bilaterally, anteriorly and posteriorly. We conclude that transplantation of autologous olfactory ensheathing cells into the injured spinal cord is feasible and is safe up to 3 years of post-implantation, however, this conclusion should be considered preliminary because of the small number of trial patients.

ObjectiveSensory integration progresses along a normal developmental sequence. However, few studies have explored how age difference affects the way sensory integration functions in Taiwanese children as they develop. Therefore, this study aims to pinpoint the role of age in sensory integration.MethodA purposive sampling plan was employed. The study population comprised 1,000 Chinese children aged 36 to 131 months (mean = 74.48 months, standard deviation = 25.69 months). Subjects were scored on seven subsets of the Test of Sensory Integration Function (TSIF). An analysis of variance (ANOVA) was used to identify differences between four age groups (ages 3–4, 5–6, 7–8, and 9–10 years), in the categories of the TSIF.ResultsANOVA revealed that age is a significant factor in each of the seven tasks of sensory integration associated with various stages of development. The effect of age was significant in all four groups for the subscale of Bilateral Integration Sequences. The function of sensory integration for the children aged 5–8 years did not produce statistically significant results for the subscale of Postural Movement, Sensory Discrimination, Sensory Seeking, or Attention and Activity. For the subscale of Sensory Modulation and Emotional Behavior, the effect of age was significant in only group 1 (children aged 3–4 years) and group 2 (children aged 5–6 years).ConclusionThere was significant difference between group 1 and group 2 for seven categories. Significant differences were contributed by the differences from group 1 (3–4 years) and group 4 (9–10 years) in five subscales (Postural Movement, Bilateral Integration Sequences, Sensory Discrimination, Sensory Seeking, and Attention and Activity). There were three developmental trends in the seven categories of the TSIF.

Tracheomalacia is characterized by weakness of the tracheal wall resulting in dynamic airway collapse during respiration; severe cases often require surgical intervention. Off-label external splinting with degradable implants has been reported in humans; however, there remains a need to develop splints with tunable mechanical properties and degradation profiles for the pediatric population. The objective of this pilot study is to assess the safety and efficacy of silk fibroin-based splints in a clinically relevant preclinical model of tracheomalacia. Silk splints were evaluated in a surgically induced model of severe tracheomalacia in N = 3 New Zealand white rabbits for 17, 24, and 31 days. An image-based assay was developed to quantify the dynamic change in airway area during spontaneous respiration, and histopathology was used to study the surrounding tissue response. The average change in area in the native trachea was 23% during spontaneous respiration; surgically induced tracheomalacia resulted in a significant increase to 86% (P < 0.001). The average change in airway area after splint placement was reduced at all terminal time points (17, 24, and 31 days postimplantation), indicating a clinical improvement, and was not statistically different than the native trachea. Histopathology showed a localized inflammatory reaction characterized by neutrophils, eosinophils, and mononuclear cells, with early signs suggestive of fibrosis at the splint and tissue interface. This pilot study indicates that silk fibroin splints are well tolerated and efficacious in a rabbit model of severe tracheomalacia, with marked reduction in airway collapse following implantation and good tolerability over the studied time course. NA Laryngoscope, 129:2189-2194, 2019.

Previous research has indicated that when rats are raised in enriched versus impoverisshed environments significant structural and chemical changes occur in the brain. Enriched environments usually include group housing in a large cage with many inanimate objects that are changed daily. The purpose of this study was to examine by electron microscopy, cellular morphology in rat brains after exposure to enriched versus impoverished environments.Neonatal Long-Evans hooded rats were raised in either enriched or impoverished environments from day 10 to day 70. After 60 days of enrichment, the animals were given several behavioral tests, were euthanized, the brains were surgically removed, and the septum, hippocampus, and cortex were dissected free. For scanning electron microscopy (SEM), the tissue was fixed in 2.5% glutaraldehyde in Sorensen’s phosphate buffer for 24 hr, rinsed and then post-fixed in 2% osmium tetroxide for 1 hr, dehydrated through a graded ethanol series, critical point dried, mounted on specimen holders, sputter coated and examined. Other specimens were embedded in Epon 812, sectioned for transmission electron microscopy (TEM) stained with uranyl acetate followed by lead citrate and examined. SEM demonstrated that brain tissue from rats exposed to enriched environments had more and larger neuronal vessels extending through the tissue than brain tissue from impoverished animals (Fig. 1 &amp; 2).

Throughout Europe, grasslands are managed primarily for agricultural production but also provide a range of ecosystem services, the magnitude of which is influenced by their area, management and the abiotic properties of the ecosystem. The grassland area in Europe has been affected by significant changes in recent decades, including abandonment and conversion to arable land. This study presents an assessment of changes in the permanent grassland area with reference to Slovakia and provides an assessment of the bioenergy potential of permanent grassland surplus to agricultural needs. In 2015, of the total permanent grassland area (868,000 ha) 42% had ceased to be used as feed for milk or meat production and had been abandoned. Results from field experiments show that low‐level improvement of permanent grasslands, e.g., by oversowing commonly sown agricultural grassland species and low‐dose fertilization (up to 30 kg N ha−1 year−1) could provide herbage biomass of 1.7 million tonnes of herbage dry matter per year. This would be sufficient to generate an energy output of approximately 31.3–31.9 PJ/year (4.5% of the current gross inland energy consumption of Slovakia). Low‐intensity use of the currently surplus permanent grassland is also considered to have potential beneficial outcomes in terms of delivery of ecosystem services. Results are also discussed in the context of countries beyond the case‐study area.

Blood flow restriction applied during low-load resistance training (LL-BFR) induces a similar increase in the cross-sectional area of muscle fibers (fCSA) compared to traditional high-load resistance training (HL-RT). However, it is unclear whether LL-BFR leads to differential changes in myofibrillar spacing in muscle fibers and/or extracellular area compared to HL-RT. Therefore, this study aimed to investigate whether the hypertrophy of type I and II fibers induced by LL-BFR or HL-RT is accompanied by differential changes in myofibrillar and non-myofibrillar areas. In addition, we examined if extracellular spacing was differentially affected between these two training protocols. Twenty recreationally active participants were assigned to LL-BFR or HL-RT groups and underwent a 6-week training program. Muscle biopsies were taken before and after the training period. The fCSA of type I and II fibers, the area occupied by myofibrillar and non-myofibrillar components, and extracellular spacing were analyzed using immunohistochemistry techniques. Despite the significant increase in type II and mean (type I + II) fCSA (p < 0.05), there were no significant changes in the proportionality of the myofibrillar and non-myofibrillar areas [∼86% and ∼14%, respectively (p > 0.05)], indicating that initial adaptations to LL-BFR are primarily characterized by conventional hypertrophy rather than disproportionate non-myofibrillar expansion. Additionally, extracellular spacing was not significantly altered between protocols. In summary, our study reveals that LL-BFR, like HL-RT, induces skeletal muscle hypertrophy with proportional changes in the areas occupied by myofibrillar, non-myofibrillar, and extracellular components.