Measuring Oxygen Cost During Level Walking in Individuals with Acquired Brain Injury in the Clinical Setting

This study examined the test-retest reliability of oxygen cost (ml·kg^-1·min^-1) during level walking in individuals with acquired brain injury (ABI). Ten individuals with ABI (5 men, 5 women) (Traumatic brain injury, 1, central pontine myelinolysis, 1, stroke 8) and 21 healthy controls (11 men, 10 women). Measurements of gross and net (walking minus resting) oxygen consumption (ml·kg^-1·min^-1), and oxygen cost (ml·kg^-1·min^-1) during level walking at self-selected speeds. Measurements were taken on two occasions within one week. Oxygen cost was significantly lower (p < 0.05) in individuals with ABI on the second test versus the first test. Percentage variability in oxygen cost from test to re-test ranged from 14.7 to 17.3% in the control group and from 17.4 to 20.8% in the brain injury group. Clinical populations may demonstrate a significant decrease in oxygen cost between testing occasions. Individuals require at least one period of familiarisation if oxygen cost is used as an outcome measure during level walking in clinical groups. The amount of familiarisation has yet to be investigated in individuals with ABI.

Key Points

Individuals with brain injury during level walking

• May demonstrate a significant decrease in oxygen cost between testing occasions.
• May require at least one period of familiarisation if oxygen cost is used as an outcome measure
• The degree of familiarisation required in this clinical group needs further investigation

Key Words: Oxygen consumption brain injury, test re-test, level walking     

The discovery of novel vasopressin V1b receptor ligands for pharmacological, functional and structural investigations

Until recently, pharmacological studies dealing with vasopressin receptor isoforms were severely hampered by the lack of selective agonists or antagonists that recognize the pituitary V(1b) vasopressin receptor. By contrast, many selective vasopressin-related compounds are available for characterization of the vasopressor (V(1a)) or antidiuretic (V(2)) vasopressin receptor subtypes. Recently, SSR149415, a selective nonpeptide molecule, was discovered with nanomolar affinity for mammalian V(1b) receptors and good selectivity for the other vasopressin and oxytocin receptor isoforms. This molecule exhibits potent antagonist properties both in vitro and in vivo. We also designed synthetic peptides derived from [deaminocysteine(1),arginine(8)]vasopressin (dAVP), modified in position 4 by various amino acid residues. Some of these, d[cyclohexylalanine(4)]AVP or d[lysine(4)]AVP, have a high affinity and an excellent selectivity for the human V(1b) receptor subtype. However, they exhibit a mixed V(1b)/V(2) pharmacological profile for the rat vasopressin receptor isoforms. Whatever the species considered, these peptides behave as agonists both in bioassays performed in vitro and in vivo. The d[cyclohexylalanine(4)]AVP was tritiated and represents the first selective radiolabelled ligand available for studying the human V(1b) receptors. The discovery of these new selective V(1b) agonists and V(1b) antagonist allows an accurate pharmacological characterization of all the vasopressin receptor isoforms. As emphasized in this review, attention to the vasopressin and oxytocin receptor species differences is of critical importance in studies with all vasopressin and oxytocin ligands.     

Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients

The objective was to determine whether a cannabis-based medicinal extract (CBME) benefits a range of symptoms due to multiple sclerosis (MS). A parallel group, double-blind, randomized, placebo-controlled study was undertaken in three centres, recruiting 160 outpatients with MS experiencing significant problems from at least one of the following: spasticity, spasms, bladder problems, tremor or pain. The interventions were oromucosal sprays of matched placebo, or whole plant CBME containing equal amounts of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) at a dose of 2.5-120 mg of each daily, in divided doses. The primary outcome measure was a Visual Analogue Scale (VAS) score for each patient's most troublesome symptom. Additional measures included VAS scores of other symptoms, and measures of disability, cognition, mood, sleep and fatigue. Following CBME the primary symptom score reduced from mean (SE) 74.36 (11.1) to 48.89 (22.0) following CBME and from 74.31 (12.5) to 54.79 (26.3) following placebo [ns]. Spasticity VAS scores were significantly reduced by CBME (Sativex) in comparison with placebo (P =0.001). There were no significant adverse effects on cognition or mood and intoxication was generally mild.     

Satisfaction of members of interdisciplinary rehabilitation teams with goal planning meetings

OBJECTIVE: To study how satisfied members of interdisciplinary rehabilitation teams are with goal planning meetings. DESIGN: Survey. SETTING: A regional rehabilitation center for people with acute nonprogressive brain injuries in the United Kingdom. PARTICIPANTS: Forty-four rehabilitation professionals who participated in 31 goal-planning meetings held between January 1, 2001, and March 30, 2001. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Responses to a questionnaire about staff satisfaction with rehabilitation team meetings. RESULTS: Forty-four of 46 members of 21 different rehabilitation teams completed the questionnaires. They included 12 occupational therapists, 7 physiotherapists, 7 physicians, 6 nurses, 5 clinical psychologists, 5 speech pathologists, and 2 social workers. Median scores of different domains were as follows: participation, 13; behavior, 20; outcome, 14; and process, 16. Correlations between the participation and outcome domains (rho=.731, P=.01) and the process and outcome domains (rho=.384, P=.05) were significant. None of the domain scores correlated with features of the meetings. Scores given by chairpersons for participation (P=.001) and outcome (P=.047) were significantly higher than those given by other participants. CONCLUSIONS: Professionals were satisfied with the behavior of other participants and the process of goal-planning meetings. Satisfaction with outcome was related to satisfaction with the participation in and the process of the meetings. Chairpersons were more satisfied with the participation domain.