Virtual reality games for movement rehabilitation in neurological conditions: how do we meet the needs and expectations of the users?

Purpose: To review quantitative and qualitative studies that have examined the users' response to virtual reality game-based interventions in people with movement disorders associated with chronic neurological conditions. We aimed to determine key themes that influenced users' enjoyment and engagement in the games and develop suggestions as to how future systems could best address their needs and expectations. Key message and implications: There were a limited number of studies that evaluated user opinions. From those found, seven common themes emerged: technology limitations, user control and therapist assistance, the novel physical and cognitive challenge, feedback, social interaction, game purpose and expectations, and the virtual environments. Our key recommendations derived from the review were to avoid technology failure, maintain overt therapeutic principles within the games, encompass progression to promote continuing physical and cognitive challenge, and to provide feedback that is easily and readily associated with success. Conclusions: While there have been few studies that have evaluated the users' perspective of virtual rehabilitation games, our findings indicate that canvassing these experiences provides valuable information on the needs of the intended users. Incorporating our recommendations may enhance the efficacy of future systems to optimize the rehabilitation benefits of virtual reality games. [Box: see text].     

Novel LMNA mutations in patients with Emery‐Dreifuss muscular dystrophy and functional characterization of four LMNA mutations

Mutations in LMNA cause a variety of diseases affecting striated muscle including autosomal Emery‐Dreifuss muscular dystrophy (EDMD), LMNA‐associated congenital muscular dystrophy (L‐CMD), and limb‐girdle muscular dystrophy type 1B (LGMD1B). Here, we describe novel and recurrent LMNA mutations identified in 50 patients from the United States and Canada, which is the first report of the distribution of LMNA mutations from a large cohort outside Europe. This augments the number of LMNA mutations known to cause EDMD by 16.5%, equating to an increase of 5.9% in the total known LMNA mutations. Eight patients presented with either p.R249W/Q or p.E358K mutations and an early onset EDMD phenotype: two mutations recently associated with L‐CMD. Importantly, 15 mutations are novel and include eight missense mutations (p.R189P, p.F206L, p.S268P, p.S295P, p.E361K, p.G449D, p.L454P, and p.W467R), three splice site mutations (c.IVS4 + 1G>A, c.IVS6 ? 2A>G, and c.IVS8 + 1G>A), one duplication/in frame insertion (p.R190dup), one deletion (p.Q355del), and two silent mutations (p.R119R and p.K270K). Analysis of 4 of our lamin A mutations showed that some caused nuclear deformations and lamin B redistribution in a mutation specific manner. Together, this study significantly augments the number of EDMD patients on the database and describes 15 novel mutations that underlie EDMD, which will contribute to establishing genotype–phenotype correlations. Hum Mutat 31:–16, 2011. © 2011 Wiley‐Liss, Inc.     

"No me ponían mucha importancia": care-seeking experiences of undocumented Mexican immigrant women with chronic illness

This interpretive phenomenological study explored the health care-seeking experiences of undocumented Mexican immigrant women. Interviews and observations were conducted with 26 uninsured Mexican immigrant women with a chronic illness residing in California. Participant narratives revealed that their health care seeking experiences were often characterized by a lack of recognition of their human plight and devaluation of their personhood. Both structural and social barriers to care exist for immigrant women. Modifying current policies to allow undocumented immigrants more options to access care could help reduce stigma, reduce suffering, and encourage clinicians to recognize their humanity and their legitimate medical needs.     

Generation and characterization of a live attenuated enterotoxigenic Escherichia coli combination vaccine expressing six colonization factors and heat-labile toxin subunit B

Live attenuated oral enterotoxigenic Escherichia coli (ETEC) vaccines have been demonstrated to be safe and immunogenic in human volunteers and to provide a viable approach to provide protection against this important pathogen. This report describes the construction of new ETEC vaccine candidate strains from recent clinical isolates and their characterization. All known genes for ETEC toxins were removed, and attenuating deletion mutations were made in the aroC, ompC, and ompF chromosomal genes. An isolate expressing coli surface antigen 2 (CS2), CS3, heat-labile toxin (LT), heat-stable toxin (ST), and enteroaggregative Escherichia coli heat-stable toxin 1 (EAST1) was attenuated to generate ACAM2007. The subsequent insertion of the operon encoding CS1 created ACAM2017, and this was further modified by the addition of an expression cassette containing the eltB gene, encoding a pentamer of B subunits of LT (LTB), to generate ACAM2027. Another isolate expressing CS5, CS6, LT, ST, and EAST1 was attenuated to generate ACAM2006, from which a lysogenic prophage was deleted to create ACAM2012 and an LTB gene was introduced to form ACAM2022. Finally, a previously described vaccine strain, ACAM2010, had the eltB gene incorporated to generate ACAM2025. All recombinant genes were incorporated into the chromosomal sites of the attenuating mutations to ensure maximal genetic stability. The expression of the recombinant antigens and the changes in plasmids accompanying the deletion of toxin genes are described. Strains ACAM2025, ACAM2022, and ACAM2027 have been combined to create the ETEC vaccine formulation ACE527, which has recently successfully completed a randomized, double-blind, placebo-controlled phase I trial and is currently undergoing a randomized, double-blind placebo-controlled phase II challenge trial, both in healthy adult volunteers.