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Cohen H.,Royal National Orthopaedic Hospital | Cohen H.,University of Bath | McCabe C.,Royal National Orthopaedic Hospital | McCabe C.,University of the West of England | And 7 more authors.
European Journal of Pain (United Kingdom)

Background: Unusual symptoms such as digit misidentification and neglect-like phenomena have been reported in complex regional pain syndrome (CRPS), which we hypothesized could be explained by parietal lobe dysfunction. Methods: Twenty-two patients with chronic CRPS attending an in-patient rehabilitation programme underwent standard neurological examination followed by clinical assessment of parietal lobe function and detailed sensory testing. Results: Fifteen (68%) patients had evidence of parietal lobe dysfunction. Six (27%) subjects failed six or more test categories and demonstrated new clinical signs consistent with their parietal testing impairments, which were impacting significantly on activities of daily living. A higher incidence was noted in subjects with > 1 limb involvement, CRPS affecting the dominant side and in left-handed subjects. Eighteen patients (82%) had mechanical allodynia covering 3-57.5% of the body surface area. Allochiria (unilateral tactile stimulation perceived only in the analogous location on the opposite limb), sensory extinction (concurrent bilateral tactile stimulation perceived only in one limb), referred sensations (unilateral tactile stimulation perceived concurrently in another discrete body area) and dysynchiria (unilateral non-noxious tactile stimulation perceived bilaterally as noxious) were present in some patients. Greater extent of body surface allodynia was correlated with worse parietal function (Spearman's rho = -0.674, p = 0.001). Conclusion: In patients with chronic CRPS, detailed clinical examination may reveal parietal dysfunction, with severity relating to the extent of allodynia. © 2012 European Federation of International Association. Source

Yang M.,University of Ulster | Zheng H.,University of Ulster | Wang H.,University of Ulster | McClean S.,University of Ulster | And 2 more authors.
Health and Technology

This paper aims to study the feasibility of using a smart mobile phone with an embedded accelerometer in gait pattern monitoring. The second motivation is to examine the impact of the accelerometer sampling frequency on gait analysis. A mobile phone and a standalone accelerometer sensor were simultaneously attached to subject's lower back to record walking patterns. The degree of agreement between gait features derived from two devices was assessed in terms of average error rate, normalised limits of agreement and intra-class correlation. Various agreement levels were observed for three temporal features, three root mean square features, five regularity features and two symmetry features. The downsampling data were used to examine the impact of sample intervals on the gait features. Eleven out of 13 features have normalised mean difference less than 0.1 when sample intervals were less than 50ms. To carry out a further evaluation, the features derived from the downsampling gait data were used to classify subjects with chronic pain and health subjects, and a classification accuracy of 90% was achieved. The results showed that it is feasible and reliable to assess and monitor gait patterns based on spatio-temporal gait features derived from smart mobile phones with an embedded accelerometer. © 2012 IUPESM and Springer-Verlag. Source

Timon C.M.,University College Dublin | Astell A.J.,University of Sheffield | Astell A.J.,Ontario Shores Center for Mental Health science | Hwang F.,University of Reading | And 6 more authors.
British Journal of Nutrition

Dietary assessment in older adults can be challenging. The Novel Assessment of Nutrition and Ageing (NANA) method is a touch-screen computer-based food record that enables older adults to record their dietary intakes. The objective of the present study was to assess the relative validity of the NANA method for dietary assessment in older adults. For this purpose, three studies were conducted in which a total of ninety-four older adults (aged 65-89 years) used the NANA method of dietary assessment. On a separate occasion, participants completed a 4 d estimated food diary. Blood and 24 h urine samples were also collected from seventy-six of the volunteers for the analysis of biomarkers of nutrient intake. The results from all the three studies were combined, and nutrient intake data collected using the NANA method were compared against the 4 d estimated food diary and biomarkers of nutrient intake. Bland-Altman analysis showed a reasonable agreement between the dietary assessment methods for energy and macronutrient intake; however, there were small, but significant, differences for energy and protein intake, reflecting the tendency for the NANA method to record marginally lower energy intakes. Significant positive correlations were observed between urinary urea and dietary protein intake using both the NANA and the 4 d estimated food diary methods, and between plasma ascorbic acid and dietary vitamin C intake using the NANA method. The results demonstrate the feasibility of computer-based dietary assessment in older adults, and suggest that the NANA method is comparable to the 4 d estimated food diary, and could be used as an alternative to the food diary for the short-term assessment of an individual's dietary intake. © The Authors 2015. Source

Cook T.M.,Royal United Hospital | Payne S.,Royal United Hospital | Skryabina E.,Bath Institute of Medical Engineering | Hurford D.,Royal United Hospital | And 2 more authors.

The National Patient Safety Agency has issued a Patient Safety Alert with the aim of eliminating Luer connectors from equipment for lumbar puncture and subarachnoid injections by 1 April 2011, and from all neuraxial and regional anaesthesia equipment in 2013. B-link (UK) Ltd and InterVene Ltd have produced non-Luer connectors for neuraxial devices: the Neurax® and Spinalok® respectively. Using an adult spinal simulator, 59 experienced clinicians performed neuraxial procedures using these devices and reported on specific performance characteristics and overall usability. Cross-connectivity between non-Luer and Luer connectors was also examined. The median (IQR [range]) overall assessment scores (0-10 scale) of usability for the standard, Neurax and Spinalok systems were 8 (8-9 [7-10]), 6 (5-7 [0-8]) and 7 (6-8 [1-9]) for spinal procedures and 8 (8-9 [6-10]), 7 (5-8 [1-9]) and 4 (3-6 [0-9]) for epidural procedures, respectively. Both study systems scored significantly lower than standard equipment for overall performance of spinal and epidural procedures, although the performance of non-Luer devices was mostly rated 'adequate' or better. Both non-Luer connectors could cross-connect with one or more Luer connectors. Following feedback to the manufacturers, both systems have been modified and cross-connectivity apparently has been eliminated. Our results indicate that clinicians may not find non-Luer devices immediately 'user-friendly'. More importantly, some cross-connectivity with Luer devices was possible. Our findings illustrate that introducing equipment that is fully compliant with the National Patient Safety Agency alert poses a significant challenge to manufacturers and clinicians. We conclude that before introducing any non-Luer device into widespread use, independent, formal evaluation should be carried out. © 2010 The Association of Anaesthetists of Great Britain and Ireland. Source

Hall J.,Bath Center for Pain Services | Hall J.,University of Bath | Harrison S.,Maudsley Hospital | Cohen H.,Bath Center for Pain Services | And 6 more authors.
European Journal of Pain

Background: Visual disturbance, visuo-spatial difficulties, and exacerbations of pain associated with these, have been reported by some patients with Complex Regional Pain Syndrome (CRPS). Aims: We investigated the hypothesis that some visual stimuli (i.e. those which produce ambiguous perceptions) can induce pain and other somatic sensations in people with CRPS. Methods: Thirty patients with CRPS, 33 with rheumatology conditions and 45 healthy controls viewed two images: a bistable spatial image and a control image. For each image participants recorded the frequency of percept change in 1 min and reported any changes in somatosensation. Results: 73% of patients with CRPS reported increases in pain and/or sensory disturbances including changes in perception of the affected limb, temperature and weight changes and feelings of disorientation after viewing the bistable image. Additionally, 13% of the CRPS group responded with striking worsening of their symptoms which necessitated task cessation. Subjects in the control groups did not report pain increases or somatic sensations. Conclusions: It is possible to worsen the pain suffered in CRPS, and to produce other somatic sensations, by means of a visual stimulus alone. This is a newly described finding. As a clinical and research tool, the experimental method provides a means to generate and exacerbate somaesthetic disturbances, including pain, without moving the affected limb and causing nociceptive interference. This may be particularly useful for brain imaging studies. © 2010 Published by Elsevier Ltd. on behalf of European Federation of International Association for the Study of Pain Chapters. Source

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