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Barcelona, Spain

Garcia-Rudolph A.,Institute Guttmann | Gibert K.,Polytechnic University of Catalonia
Expert Systems with Applications | Year: 2014

Cognitive rehabilitation (CR) treatment consists of hierarchically organized tasks that require repetitive use of impaired cognitive functions in a progressively more demanding sequence. Active monitoring of the progress of the subjects is therefore required, and the difficulty of the tasks must be progressively increased, always pushing the subjects to reach a goal just beyond what they can attain. There is an important lack of well-established criteria by which to identify the right tasks to propose to the patient. In this paper, the NeuroRehabilitation Range (NRR) is introduced as a means of identifying formal operational models. These are to provide the therapist with dynamic decision support information for assigning the most appropriate CR plan to each patient. Data mining techniques are used to build data-driven models for NRR. The Sectorized and Annotated Plane (SAP) is proposed as a visual tool by which to identify NRR, and two data-driven methods to build the SAP are introduced and compared. Application to a specific representative cognitive task is presented. The results obtained suggest that the current clinical hypothesis about NRR might be reconsidered. Prior knowledge in the area is taken into account to introduce the number of task executions and task performance into NRR models and a new model is proposed which outperforms the current clinical hypothesis. The NRR is introduced as a key concept to provide an operational model identifying when a patient is experiencing activities in his or her Zone of Proximal Development and, consequently, experiencing maximum improvement. For the first time, data collected through a CR platform has been used to find a model for the NRR. © 2014 Elsevier Ltd. All rights reserved. Source


Valls-Sole J.,University of Barcelona | Castellote J.M.,Complutense University of Madrid | Kofler M.,University of Barcelona | Casanova-Molla J.,University of Barcelona | And 2 more authors.
Journal of Pain | Year: 2012

Evoked potentials (EPs) to radiant or contact heat pain stimuli reflect the synchronization of brain activity to noxious inputs. However, we do not know how they relate to conscious awareness (AW) of a sensation. In healthy volunteers, we determined the time of AW for thermal noxious and non-noxious sensory inputs and examined its correlation to parametric measures of vertex EPs. Subjects had to report the position of the hand of a Libet's clock at the moment they perceived either a laser or a thermode stimulus. AW was determined after subtracting the position of the clock hand at the moment of stimulus delivery from the one reported by the subject, in ms. Subjects estimated AW in all single trials, including those in which no EPs could be identified. Mean AW was estimated earlier than the corresponding EP latency for both types and intensities of stimuli. There was a weak but significant negative correlation of AW to EPs amplitude, which was higher than the correlation of AW to EPs latency. Our results indicate that the timing of AW is influenced by the subjective relevance of sensory inputs. This feature could be used for the analysis of cognitive aspects of pain processing. Perspective: This article presents a way to measure the subjective awareness of the sensation induced by a noxious heat stimulus, either radiant or contact, in healthy human subjects. This method could be used for the analysis of cognitive aspects of pain processing. © 2012 by the American Pain Society. Published by Elsevier Inc. All rights reserved. Source


Baraniak A.,Polish National Medicines Institute | Izdebski R.,Polish National Medicines Institute | Fiett J.,Polish National Medicines Institute | Sadowy E.,Polish National Medicines Institute | And 17 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2013

The international project MOSAR was conducted in five rehabilitation centers; patients were screened for rectal carriage of extended-spectrum β-lactamase (ESBL)-producing members of the Enterobacteriaceae. Among 229 Klebsiella pneumoniae isolates, four clonal groups (CG) or complexes (CC) prevailed: CG17 in France, CG101 in Italy, CG15 in Spain, and CC147 in Israel. ESBLs, mainly CTX-Ms, were produced by 226 isolates; three isolates expressed AmpC-like cephalosporinases. High genetic diversity of K. pneumoniae populations was observed, with specific characteristics at each center. Copyright © 2013, American Society for Microbiology. All Rights Reserved. Source


Kumru H.,Institute Guttmann | Murillo N.,Institute Guttmann | Vidal Samso J.,Institute Guttmann | Valls-Sole J.,Unitat dEmg | And 8 more authors.
Neurorehabilitation and Neural Repair | Year: 2010

Objective. Spasticity with increased tone and spasms is frequent in patients after spinal cord injury (SCI). Damage to descending corticospinal pathways that normally exert spinal segmental control is thought to play an important causal role in spasticity. The authors examined whether the modulation of excitability of the primary motor cortex with high-frequency repetitive transcranial magnetic stimulation (rTMS) could modify lower limb spasticity in patients with incomplete SCI. Methods. Patients were assessed by the Modified Ashworth Scale, Visual Analogue Scale, and the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) and neurophysiologically with measures of corticospinal and segmental excitability by the Hmax/Mmax, T reflex, and withdrawal reflex. Fifteen patients received 5 days of daily sessions of active (n = 14) or sham (n = 7) rTMS to the leg motor area (20 trains of 40 pulses at 20 Hz and an intensity of 90% of resting motor threshold for the biceps brachii muscle). Result. A significant clinical improvement in lower limb spasticity was observed in patients following active rTMS but not after sham stimulation.This improvement lasted for at least 1 week following the intervention. Neurophysiological studies did not change. Conclusions. High-frequency rTMS over the leg motor area can improve aspects of spasticity in patients with incomplete SCI. © 2010 The Author(s). Source


Izdebski R.,Polish National Medicines Institute | Baraniak A.,Polish National Medicines Institute | Fiett J.,Polish National Medicines Institute | Adler A.,Tel Aviv Sourasky Medical Center | And 16 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2013

The prospective project MOSAR was conducted in five rehabilitation units: the Berck Maritime Hôpital (Berck, France), Fondazione Santa Lucia (Rome, Italy), Guttmann Institute (GI; Barcelona, Spain), and Loewenstein Hospital and Tel-Aviv Souraski Medical Center (TA) (Tel-Aviv, Israel). Patients were screened for carriage of Enterobacteriaceae resistant to expanded-spectrum cephalosporins (ESCs) from admission until discharge. The aim of this study was to characterize the clonal structure, extended-spectrum β-lactamases (ESBLs), and acquired AmpC-like cephalosporinases in the Escherichia coli populations collected. A total of 376 isolates were randomly selected. The overall number of sequence types (STs) was 76, including 7 STs that grouped at least 10 isolates from at least three centers each, namely, STs 10, 38, 69, 131, 405, 410, and 648. These clones comprised 65.2% of all isolates, and ST131 alone comprised 41.2%. Of 54 STs observed only in one center, some STs played a locally significant role, like ST156 and ST393 in GI or ST372 and ST398 in TA. Among 16 new STs, five arose from evolution within the ST10 and ST131 clonal complexes. ESBLs and AmpCs accounted for 94.7% and 5.6% of the ESC-hydrolyzing β-lactamases, respectively, being dominated by the CTX-M-like enzymes (79.9%), followed by the SHV (13.5%) and CMY-2 (5.3%) types. CTX-M-15 was the most prevalent β-lactamase overall (40.6%); other ubiquitous enzymes were CTX-M-14 and CMY-2. Almost none of the common clones correlated strictly with one β-lactamase; although 58.7% of ST131 isolates produced CTX-M-15, the clone also expressed nine other enzymes. A number of clone variants with specific pulsed-field gel electrophoresis and ESBL types were spread in some locales, potentially representing newly emerging E. coli epidemic strains. Copyright © 2013, American Society for Microbiology. All Rights Reserved. Source

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