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Objective: Teleotoscopy requires the assistance of telehealth facilitators; but their training requirements remain to be determined. We evaluated the use of an otoscopy simulator to train facilitators to remote otoscopies sent via the Internet using a teleaudiology platform. Design: Neurotologists experts were asked to identify images using the otoscopy simulator and to perform an identification task of significant anatomical landmarks. The experts were asked to repeat those tasks remotely, with the help of facilitators who either received basic training, or no training prior to the experiment. Study sample: Three experts, three trained facilitators and three untrained facilitators participated in this study. Results: The use of an otoscopy simulator in addition to remote otoscopy yielded a good inter- and intrarater agreement (κ between 0.81-1, and 0.80-0.87, respectively). The accuracy of diagnosis was high on-site (11.7% error) and remotely (0% error). The time required for landmark identification task was not increased when performed remotely with a trained facilitator versus on-site otoscopy (9.3 versus 9.2 s/landmark). Conversely, the lack of training of facilitators increased significantly this time (15.6 s/landmark, p < 0.001). Conclusion: An otoscopic simulator coupled to teleaudiology software can be used to efficiently train both experts and facilitators to perform remote otoscopy. [ABSTRACT FROM AUTHOR]

Prospective memory (PM) has been shown to be impaired in children with acquired brain injuries (ABI) and is a major concern for parents. Few studies have addressed this issue and most used tasks that are not ecologically valid. The aims of this study were (1) to explore if children who have sustained an ABI suffer PM impairment, measured both by the Children's Cooking task (CCT) PM score and using the 2 PM subtests of the Rivermead Behavioral Memory Test (RBMT), and (2) to explore if the CCT PM score is sensitive to developmental changes in PM in typically developing children and in children with ABI. Fifty-four children with ABI and 33 typically developing controls participated in the study. Children with ABI had significantly lower PM scores and poorer performance in the CCT than their typically developing peers. PM scores increased significantly with age, indicating developmental progress of PM performance. [ABSTRACT FROM AUTHOR]

Objectives: To assess predictors and indicators of disability and quality-of-life 4 years after severe traumatic brain injury (TBI), using structural equation modelling (SEM). Methods: The PariS-TBI study is a longitudinal multi-centre inception cohort study of 504 patients with severe TBI. Among 245 survivors, 147 patients were evaluated upon 4-year follow-up, and 85 completed the full assessment. Two outcome measures were analysed separately using SEM: the Glasgow Outcome Scale-extended (GOS-E), to measure disability, and the QOLIBRI, to assess quality-of-life. Four groups of variables were entered in the model: demographics; injury severity; mood and cognitive impairments; somatic impairments. Results: The GOS-E was directly significantly related to mood and cognition, injury severity, and somatic impairments. Age and education had an indirect effect, mediated by mood/cognition or somatic deficiencies. In contrast, the only direct predictor of QOLIBRI was mood and cognition. Age and somatic impairments had an indirect influence on the QOLIBRI. Conclusion: Although this study should be considered as explorative, it suggests that disability and quality-of-life were directly influenced by different factors. While disability appeared to result from an interaction of a wide range of factors, quality-of-life was solely directly related to psycho-cognitive factors. [ABSTRACT FROM PUBLISHER]

This randomized controlled trial study aims to investigate the efficacy of an early psychological intervention called EMDR-RE compared to Critical Incident Stress Debriefing on 60 victims of workplace violence, which were divided into three groups: ‘EMDR-RE’ (n = 19), ‘CISD’ (n = 23), and ‘delayed EMDR-RE’ (n = 18). EMDR-RE and CISD took place 48 hours after the event, whilst third intervention was delayed by an additional 48 hours. Results showed that after 3 months PCLS and SUDS scores were significantly lower with EMDR-RE and delayed EMDR-RE compared to CISD. After 48 hours and 3 months, none of the EMDR-RE-treated victims showed PTSD symptoms. [ABSTRACT FROM AUTHOR]

The impact of congenital visual deprivation on speech production in adults was examined in an ultrasound study of compensation strategies for lip-tube perturbation. Acoustic and articulatory analyses of the rounded vowel /u/ produced by 12 congenitally blind adult French speakers and 11 sighted adult French speakers were conducted under two conditions: normal and perturbed (with a 25-mm diameter tube inserted between the lips). Vowels were produced with auditory feedback and without auditory feedback (masked noise) to evaluate the extent to which both groups relied on this type of feedback to control speech movements. The acoustic analyses revealed that all participants mainly altered F2 and F0 and, to a lesser extent, F1 in the perturbed condition – only when auditory feedback was available. There were group differences in the articulatory strategies recruited to compensate; while all speakers moved their tongues more backward in the perturbed condition, blind speakers modified tongue-shape parameters to a greater extent than sighted speakers. [ABSTRACT FROM PUBLISHER]

Objective:To validate a French version of the speech, spatial, and qualities of hearing scale (SSQ), a subjective evaluation of patients’ hearing disability, and to assess SSQ reproducibility across different language versions.Design:The SSQ was translated in accordance with the principles of the ‘Universalist approach’ of cross-cultural adaptation of patient-reported outcome instruments. Scores from a normal-hearing and a hearing-impaired population were compiled and compared, whenever possible, with data from the literature, collected using other language versions.Study sample:One hundred normal-hearing subjects and 230 hearing-impaired subjects.Results:Good reproducibility of scores and inter-subject variability were obtained between several language versions, even if scores found using the French version were slightly lower than those obtained using Dutch or English versions. A comparison of factor analysis outcomes between the English and French versions confirmed good conceptual equivalence across languages and robustness of the SSQ for use in international settings. The three main subscales (speech, spatial, and qualities) confirmed their usefulness in assessing different aspects of hearing disability.Conclusion:This study validated a French-language version of the SSQ, and assessed the reproducibility of the SSQ across subject groups, administration modes, and different countries/languages, confirming its potential as an international standard for hearing disability evaluation. [ABSTRACT FROM PUBLISHER]

Primary objective: To determine the features of stroke-related HO in a large sample of patients and to assess if HO risk is increased by haemorrhagic stroke. Research design: A case control study (risk factor of a rare event using retrospective analysis). Methods and procedures: Sixty-one patients with stroke-81 troublesome HOs-were included, each was matched with four controls, i.e. 244 patients with no HO after stroke. Matching criteria were age (±3.5 years) and sex. Data recorded were time from stroke to surgery, ischaemic or haemorrhagic stroke and presence of HO risk factors. Main outcomes and results: Mean age at time of stroke = 46.02 ± 11.4 years (15.9-76.3) for the case sub-group. Time from stroke to surgery = 23.4 ± 27.8 months (3.6-150.0). There was a significant relationship between haemorrhagic stroke and HO development (OR = 3.01; 95% CI = 1.14-7.98; p < 0.05), but not for ischaemic stroke. This became non-significant when all matching and risk factors were included in the model (adjusted OR = 1.98; 95% CI = 0.60-6.54; p = 0.26). Conclusion: Haemorrhagic stroke appears to increase the risk of HO development. Further studies are required to determine if this risk factor is independent from other comorbid factors. [ABSTRACT FROM AUTHOR]

Objective: To assess brain injury services utilization and their determinants using Andersen's model. Methods: Prospective follow-up of the PariS-TBI inception cohort. Out of 504 adults with severe traumatic brain injury (TBI), 245 survived and 147 received a 4-year outcome assessment (mean age 33 years, 80% men). Provision rates of medical, rehabilitation, social and re-entry services and their relations to patients' characteristics were assessed. Results: Following acute care discharge, 78% of patients received physiotherapy, 61% speech/cognitive therapy, 50% occupational therapy, 41% psychological assistance, 63% specialized medical follow-up, 21% community re-entry assistance. Health-related need factors, in terms of TBI severity, were the main predictors of services. Provision of each therapy was significantly associated with corresponding speech, motor and psychological impairments. However, care provision did not depend on cognitive impairments and cognitive therapy was related to predisposing and geographical factors. Community re-entry assistance was provided to younger and more independent patients. Conclusions: These quantitative findings illustrate strengths and weaknesses of late brain injury care provision in urban France and highlight the need to improve treatment of cognitive impairments. [ABSTRACT FROM AUTHOR]

Purpose State: A pilot-study with a comparison approach between aging and traumatic brain injury (TBI) is proposed to investigate everyday object memory patterns using a virtual HOMES test. Methods: Sixteen young controls, 15 older adults and 15 TBI patients underwent the HOMES test and traditional tests. Results: Older adults and TBI patients exhibited similar HOMES performances: poor recall, a greater recognition benefit, high false recognitions, but intact clustering and proactive interference effects. The age-related differences for HOMES measures were mainly mediated by executive functioning, while the HOMES performances in the TBI group were correlated with memory measures. Conclusion: The differential cognitive mediating effects for a similar everyday-like memory pattern are discussed by highlighting the need for more cautious interpretations of cognitive mechanisms behind similar behavioral patterns in different populations especially in clinical and rehabilitation settings. [ABSTRACT FROM AUTHOR]

Objective: To look for a relationship between physical fatigue and physical parameters in patients at least 3 months post stroke. Methods: We conducted a prospective cross-sectional study of 32 poststroke patients (average duration of stroke 40 months) who were recruited among in- and outpatients followed by the Department of Physical and Rehabilitation Medicine of a university hospital. Fatigue was defi ned as a Fatigue Severity Scale (FSS) score of 4 or more. The parameters studied were age, sex, time since stroke, Demeurisse Motor Index, Barthel Index score, new Functional Ambulation Category, Berg Balance Scale, 10-meter walk test, 6-minute walk test, Dijon Physical Activity Score, Montgomery and Asberg Depression Rating Scale, Epworth Sleepiness Scale, presence of pain, and length and area of the center of pressure displacement obtained posturographically. Results: Two-thirds of patients (65.6%) were fatigued. The mean FSS score was 4.3 ± 1.8. Fatigue was not associated with the physical parameters studied; notably, there was no correlation with motor impairment, autonomy and walking capacity, or balance and physical activity. However, after multivariate analysis, we found an association between physical fatigue and time since the occurrence of stroke (P = .05). Conclusions: Our study revealed a relationship between pain and physical fatigue, as reported by 2 other studies. Poststroke fatigue management should include appropriate pain management. Further studies are necessary to determine the causes of physical fatigue after stroke. [ABSTRACT FROM AUTHOR]

Primary objective: To describe the long-term disorders of consciousness in patients with dysautonomia and hypertonia treated with intrathecal baclofen therapy (IBT). Methods and procedures: Forty-three patients with severe traumatic brain injuries who were previously implanted with an intrathecal baclofen pump were included to be evaluated in the long-term with the Coma Recovery Scale-Revised. The Barthel Index, the Glasgow Outcome Scale, the Ashworth scale, the scores of hypertonic attacks, of sweating episodes and of voluntary motor responses were used to describe functional abilities and residual impairments. A retrospective analysis highlighted patients' characteristics at admission, before surgery and their complications. Main outcomes and results: After a mean follow-up of 10 years, nine of 43 (20.9%) patients had died, 13/43 (30.2%) patients were severely disabled or in an unresponsive wakefulness syndrome and 21/43 (48.8%) patients had good recovery of consciousness. The latter patients tended to receive IBT later, suggesting a later development of uncontrolled symptoms of dysautonomia and hypertonia. They needed lower doses of baclofen, suggesting that they had less severe symptoms. Their dysautonomia, limb hypertonia and voluntary motor responses improved significantly compared to patients with poor outcome. Conclusions: Recovery of good long-term consciousness is possible. A low level of consciousness recovery and the early development of severe and persistent symptoms of dysautonomia associated with hypertonia could be linked to poor long-term outcome. [ABSTRACT FROM AUTHOR]

Primary objective: The aim of the study was the validation of the Deasy-Spinetta Questionnaire (DSQ) in 6-11 year olds with attention to the verification of three factors (learning difficulties, socialization and emotionality) and its application in children treated for cerebellar tumour. Methods and procedures: Twenty-nine children aged between 6-11 years were compared with 609 classmates. Teachers completed the DSQ. Patients were evaluated according to Wechsler Scales, the Purdue Pegboard and the International Cooperative Ataxia Rating scale. Main outcomes and results: In classmates, the DSQ factorial analysis showed three factors: learning, socialization difficulties and disturbing behaviour. Teachers reported more learning difficulties in patients than in classmates. Learning difficulties in patients were greater for mathematics and reasoning than for reading. Patients were described as less active, without evidence of autistic-like behaviour or irritability. The teachers' report of learning difficulties was significantly correlated with IQ scores, but not with neurological deficits. Conclusions: The proposed DSQ scores are interesting for the assessment of learning and behavioural difficulties in children treated for cerebellar tumours, as they provide complementary ecological information to that given by clinical and neuropsychological testing. [ABSTRACT FROM AUTHOR]

Background: We sought to determine the epidemiological patterns of Staphylococcus bacteraemia, with a focus on the proportion of coagulase-negative Staphylococcus (CoNS) as compared to Staphylococcus aureus bacteraemia, and the prognosis. Methods: All patients with significant Staphylococcus bacteraemia at the university hospital in Reims in 2008 were included in the study. Data were retrieved retrospectively from the patient records using a standardized case investigation form. Quantitative variables were compared using the Mann-Whitney U-test and qualitative variables were compared using Fisher's exact test or Pearson's Chi-square test, as appropriate. Bivariate logistic regression was performed on both S. aureus and CoNS bacteraemia. All variables with a p-value of < 0.15 were entered into a multiple logistic regression model. Results: CoNS represented 31.6% of all strains isolated. The methicillin resistance rate was higher in CoNS (66.1%) than in S. aureus (19.1%) ( p < 0.0001). CoNS were more frequently associated with intravascular catheters and neoplastic disease, whereas S. aureus was associated with chronic renal failure ( p < 0.0001) and diabetes mellitus ( p == 0.004). Mortality was 30.7% for S. aureus and 19.6% for CoNS bacteraemia ( p == 0.12). Methicillin resistance was not associated with mortality ( p == 0.99). Factors independently associated with mortality in CoNS and S. aureus bacteraemia were age and acute renal failure. The presence of severe sepsis/septic shock was only associated with mortality in S. aureus bacteraemia. Conclusions: CoNS represent one third of Staphylococcus bacteraemia. The mortality difference between CoNS and S. aureus bacteraemia was not statistically significant. Acute renal failure is associated with mortality in both S. aureus and CoNS bacteraemia. [ABSTRACT FROM AUTHOR]

Many tools assess the reactions of humans encountering familiar or unfamiliar partners or environments. Companion animals belong to our everyday environment and influence our lives. Whereas many standardized tools test companion animals' reactions to humans, few evaluate humans' reactions to companion animals. We present here a test with a guinea pig that can be applied to a wide range of people in the home environment. This standardized test and simple coding system enabled us to characterize individual behavioral profiles of children and compare them in relation to different factors (e.g., gender, age, pet ownership). We observed 59 children (32 girls, 27 boys), aged between 6 and 12 years old. Our results show that most children first looked at the guinea pig (72%), smiled when they saw it (49%), and then went directly towards it without looking at their parent (79%). Many children touched the animal without hesitation (86%). Moreover, this test reveals more than the mere interest of children in guinea pigs. Indeed, a cluster analysis differentiated four behavioral profiles that reflected aspects of the children's experience, gender, and lifestyles. When encountering the unfamiliar guinea pig, children could be "confident" (go straight to the animal and touch it; 64%), "anxious" (look at parent; 12%), "indirect" (hesitate and touch; 14%), or "careful" (emit vocal and/or verbal behaviors; 10%). The potential future application of this research is to compare behavioral profiles quantitatively over the long term, taking into account the development and experiences of people with typical development and those with atypical development (e.g., autistic disorders). [ABSTRACT FROM AUTHOR]