Day 1 :
Keynote Forum
Sanjeev Gupta
Banarsidas Chandiwala Institute of Physiotherapy, India
Keynote: Role of tele-physiotherapy in managing contemporary challenges to neurorehab- An Indian perspective
Time : 10:30
Biography:
Abstract:
This presentation starts with an introduction to Indian context and neurorehab. The presentation unveils the scope and potential of tele-physiotherapy in the different domains of physiotherapy and neurorehab. From a possible provision to address a forbidden remote client tele-physiotherapy now has emerged as a tall solution for growing challenges of urban especially metropolitan lives. The presentation shall look into the scope of tele-physiotherapy and explore its inevitable acceptance and possibilities in urban culture. Tele-physiotherapy surely fixes many issues with its ubiquitous and ambient nature. With growing popularity of wearable and virtual gears artificial intelligence can be the key to our many issues and challenges. Another very important collateral benefit of tele-physiotherapy is spontaneous, simultaneous and effortless recording of data and information pertaining to therapist–patient interaction during therapy. This would offer great help in medico-legal situations, big data analysis, drawing trends etc. This can be a strong tool for insurance companies to gauge client participation and adherence to regime that affects their policy cost and claims as a direct implication. Advantages of internet of things (IoT), GPS and social media can be tapped for group participation, real time motivation and inspirational updates. The presentation discusses scope of Telemedicine, IoT, Big Data Analysis (BDA), ICT and Ambient Intelligence (AI) etc. Further portion unfolds opportunities to collaborate with mobile apps developers, gaming giants and notifications agencies etc. to incorporate physiotherapy features such that they become more yielding. Finally it puts light on challenges to application of tele-physiotherapy in Indian context. The presentation shall include clinical opinion based on a ground study highlighting present preparedness of all stakeholders, with reasons vested therein.
Keynote Forum
Sri Krishnan
Ryerson University, Canada
Keynote: Digital technologies and machine learning for ubiquitous monitoring of neurological and neuromuscular disorders
Time : 11:30
Biography:
Sridhar Krishnan has joined Ryerson University, Toronto, Canada in 1999, and currently he is a Professor of Electrical and Computer Engineering, and Co-director of the Institute for Biomedical Engineering, Science and Technology (iBEST). From 2007-2017, he was a Canada Research Chair in Biomedical Signal Analysis. He has published 310 papers in refereed journals and conferences and six of his papers have won best paper awards. He is a Fellow of the Canadian Academy of Engineering.
Abstract:
Many neurological and neuromuscular disease management and screening could benefit from long-term processing and analysis of physiological signals such as EEG, EMG, EOG, PSG, speech, and gait rhythm. The advancements in wearable digital health technologies and the availability of massive storage and computational processing power has made it possible for implementation of advanced mathematical and signal processing techniques for pre-processing tasks such as removal of noise and reduction of interferences/artifacts, extraction of robust features/signatures from physiological signals, and implementing machine learning systems for informed clinical decision making. For example, signal analysis research (SAR) group at Ryerson University has analyzed gait rhythm for automatic classification of Parkinson’s, Huntington’s and ALS. We have also processed and analyzed the non-stationary nature of polysomnographic sleep signals in identifying RBD disorders and PLMS. The group is also involved in processing and analyzing sensor information related to EOG and voices in identifying signal features related to diseases such as Parkinson’s and sleep related disorders. The challenges associated in these areas are that the signals acquired are non-stationary, produced by non-linear systems, and have variabilities associated with them they could be analyzed to provide rich information in temporal, spectral or spatial domains by using advancements of signal processing and machine learning. The cost effective and patient comfort associated with human factors make them valuable for home-based, telehealth and mobile health based long-term data acquisition and monitoring application. The exponential growth in digital technologies related to sensors and communications (For example, Internet of Things-IoT), and the availability of data and machine learning/AI techniques are all poised to make the field of clinical decision making and patient management even more affordable and ubiquitous. In any of these digital healthcare designs, security and privacy protocols have to be incorporated as part of the design process pipeline.
- Neuromuscular Disease | Neurosurgery | Neuroimmunology | Epilepsy | Parkinson’s Diseases | Neuro Oncology
Location: Taunus
Chair
Anita Gopesh
University of Allahabad, India
Co-Chair
Sanjeev Gupta
Banarsidas Chandiwala Institute of Physiotherapy, New Delhi, India
Session Introduction
Sankar Bandyopadhyay
Penn State College Of Medicine, USA
Title: Growing challenges with phenotype-based practice, muscle biopsy in neuromuscular diseases? A few novel presentations
Biography:
Sankar Bandyopadhyay is an Associate Professor of Neurology in College of Medicine, Penn State University. He practices at Penn State Neuroscience Institute. He got his M.B.B.S degree from Calcutta National Medical College. He got a fellowship in Clinical Neurophysiology from Medical College of Georgia in 2001. His are of researches are bone health in neuromuscular diseases, vitamin-D deficiency, clinical neuromuscular disorders and others.
Abstract:
Introduction
Phenotype-based disease-classification and fixed histology, are not infallible.
Objective
Appreciation of novel phenotypes and histological findings.
Methods
Case studies. Histology.
Results
Case 1: 45 year-old woman with 10 year of proximal lower extremity, 2 year of bilateral finger flexion weakness with supportive objective evidence. CK 734. EMG and muscle biopsies: myopathic.
Presumptive Diagnosis: Early onset Inclusion Body Myositis.
Final diagnosis: Acid maltase deficiency (Adult onset Pompe disease), after Dried blood test and GAA sequencing, with novel IBM phenotype (MUSCLE & NERVE by same author)
Case 2: 53 year man with 2 years of progressive bilateral arms, forearms and thigh weakness. Objective weakness was corresponding. Prominent contractures of bilateral hamstrings and biceps. EMG and muscle biopsy: myopathic. Ck 162.
Phenotypic diagnosis: atypical late onset Emery-Dreifuss or Bethlem Muscular dystrophy.
Final diagnosis: 2B LGMD or Miyoshi myopathy.
Novel features: contractures, normal CK, hamstring type).
Case 3: 78 year man with 18 months of proximal lower extremity and distal upper extremity weakness. CK 379. EMG myopathic. Muscle biopsy: myopathic, rimmed vacuoles PLUS C5b-9 (seen in membrane attack complex disease e.g. dermatomyositis).
Final diagnosis: Sporadic IBM with Dermatomyositis histology profile.
Novel feature: C5b-9 positive staining in IBM (MUSCLE & NERVE by author). No response to immunosuppressives.
Case 4: 77 year old with 2 years of proximal LE and Grip weakness. CK 415. EMG and muscle biopsy: myopathic with rimmed vacuoles. TDP-43 positive (Sporadic IBM). Strongly positive C5b-9.
Final diagnosis: Sporadic IBM with Dermatomyositis histology profile.
Novel features: C5b-9 in IBM. TDP43 and C5b-9 co-existence.
Conclusion
Phenotype and histology based evidences are proving inadequate in neuromuscular diagnosis with growing evidences. Genotype is still a developing concept with caveats of unknown significance of variants.
Anita Gopesh
University of Allahabad, India
Title: Paraneuronal gill NE cells in fishes: Probable bio-indicators
Biography:
Anita Gopesh has 35 years of experience in research and teaching at a prestigious University of Allahabad, India. She has expertise in Neuroendocrine System and Noval Paraneuronal Cells in fish. She has the distinction of introducing the third and peripheral NE cell system of fish. She is the Head of Department of Zoology, University of Allahabad.The finding of ps neurosecretory system associated with carotid labyrinth in fishes is significant as it can be paralleled with the glomus cells and carotid body of mammals, including man.
Abstract:
Various kinds of paraneuronal cells have been identified in vertebrate body, outside central nervous system which is known to control various essential functions of the body through neurotransmitters produced by these cells. It is now well established that these cell systems act in an autocrine and/or paracrine mode of action and belong to the diffuse neuroendocrine cell systems as defined by Toni. Pseudobranchial neuro-secretory system in one such system which is very similar to the NECS reported on the gill filaments of certain fishes. The association of pseudobranchial neurosecretory system with the carotid labyrinth-a chemosensory structure derived from pseudobranch, reflects towards a chemosensory role of the systems in the biology of these fishes. Immunohistochemical investigations on carotid labyrinth and pseudobranchial neurosecretory cells have revealed the presence of several bioactive substances (NPY, TH, VIP, NO, Serotonin etc.) in these cells, suggesting multiple functional roles of these cells. The gills of the fish are known to be multi-functional. This novel gill NE system is described in detail and the cells belonging to this system are compared with the NECs observed in the gill filament of fish and glomus cells found in the carotid body of mammals. The functional significance of pseudobranchial neurosecretory cells in the vertebrate phylogeny of oxygen chemosensory complex is also discussed.
Jo Ferrie
University of Glasgow, Scotland
Title: Running out of time: The experience of living with a neurological condition
Biography:
Jo Ferrie is a Sociologist based at the University of Glasgow. She has worked in the Disability Studies field for 15 years, examining the socially constructed barriers that turn impairment into disability, with the aim of removing these barriers. In 2013, she has published the largest global qualitative study of the experience of living with motor neuron disease with Philly Robertson-Reick and Nick Watson. She joined the Euan MacDonald Centre as a PI in 2012 and worked on a number of projects with them, MND Scotland and the Anne Rowling Clinic to further understand the impact of neurological conditions on people and their families. She is also the Director of Glasgow Q-Step (a £3 million centre to create a step change in how social science graduates use and understand quantitative data) and is seconded to the University of Edinburgh as Deputy Director–Training of the Scottish Graduate School of Social Sciences.
Abstract:
Statement of the Problem: Adults diagnosed with motor neuron disease (MND) and similar neurological conditions face a time-limited future with few treatment options and no cure. Their experience of receiving a diagnosis is distressing, even when given well. Distress is exacerbated by waiting times, notions of illegitimacy, progressive and frightening symptoms.
Method: This paper draws on a number of studies, using phenomenological qualitative interviews of over 50 families (around 10% of families who live with MND in Scotland) since 2011. The research draws on the social model of disability, to determine barriers to being and doing are constructed for participants and what can be done to remove them. It will reflect particularly on experiences of diagnosis and use Bury’s notion of biographical disruption to examine the impact of this on identity. Further this paper will draw on a recent evaluation of the Speak Unique project (voice-banking and restoration to produce personalized voices) and the value of participating in medical research.
Findings: The families who participated unanimously reported difficult experiences of diagnosis. Many struggled to have symptoms taken seriously, to access neurological services, most waited over a year to be diagnosed, many felt consultants avoided a diagnosis and some felt abandoned following diagnosis. In contrast, participants who were taken seriously, with a shorter wait to diagnosis (<6 months) and met with a neurological nurse around the time of diagnosis, were less disrupted. Being aware of and involved in research opportunities gave participants a sense of doing that enabled a recovery of identity.
Conclusion & Significance: Professionals working with and for, adults with neurological conditions, particularly MND, are fully aware of the brutality of these conditions. This paper contributes to wider understandings of how families cope outside of medicalized spaces and what support they need, above what is currently available.
Biography:
K P Singh is a Professor in the Department of Zoology, University of Allahabad, India. He started his research on “Developmental neurotoxicity of CNS acting drugs on different aspects of teratology in general and neuroteratology in particular like neuroanatomy, pharmacology, neurochemistry and neurobehavior in rodent (Rat/Mice) model”. At present, his laboratory is involved to investigate the effect of novel psychotropic (antiepileptic, antipsychotic, antidepressant) drug exposure during pregnancy and lactation on fetal/neonatal birth defects, neuropathological alterations in different regions of fetal brain viz, cerebral cortex, caudate putamen, hippocampus and cerebellum etc., neurodevelopmental delay in offspring as well as long-lasting impact on neurobehavioral impairment in young-adult offspring.
Abstract:
Clinical and non-clinical literature revealed that in utero exposure to classical psychotropic drugs may lead to abnormal brain development and related functional disorders in children, but reports on new generation psychotropic drugs are limited and inconclusive. Therefore, present study has been taken to reveal the impact of therapeutic psychotropic agents on fetal brain development and genesis of psychiatric disorders in young offspring. In this study, pregnant C-F rats were used and equivalent therapeutic doses of some atypical psychotropic drugs of different classes like antipsychotics (RIS, QUE, ARI and ASN), antiepileptics (PGB, ESL and GBP) and antidepressants (VEN) were administered during sensitive phase of fetal brain development. At GD 21, about half of the dams of drugs exposed and non-exposed dams were sacrificed and their fetal brains were assessed for architectural pattern of neurocortical layers, neuronal migrations and neuronal apoptosis (Bax, Bcl-2, Annexin-5 kit assay, EM & RT-PCR), and their lasting impact on neurodevelopment and genesis of psychiatric disorders in young offspring. This laboratory revealed that therapeutically relevant doses of atypical psychotropic drugs may induce default neural migration, altered neuroarchitectural pattern; enhanced apoptotic neurodegeneration in different neuronal layers of neocortex and hippocampus of fetal brain and overt expression of anxiety, depression and cognition (learning and memory) like psychiatric disorders in young offspring. The neurobiology and genesis of these psychiatric disorders is associated with confounding factors (intrinsic and extrinsic). This study concludes that prenatal exposure to atypical psychotropic agents may induce abnormal fetal brain development and neurobehavioral sequelae in young offspring, therefore precautions should be taken by the health care providers before prescribing these agents to pregnant population.
Mervat Wahba
University of Tennessee, USA
Title: Riche-Cannieu anastomosis associated with carpal tunnel syndrome: A case report
Biography:
Mervat Nasry Wahba is a Neurologist in Memphis, Tennessee and is affiliated with multiple hospitals in the area, including Baptist Memorial Hospital-Memphis and Methodist Hospitals of Memphis. She has completed her Medical degree at Cairo University School of Medicine and has been in practice for more than 20 years. She is one of the 62 doctors at Baptist Memorial Hospital-Memphis and one of 52 doctors at Methodist Hospitals of Memphis who specialize in Neurology.
Abstract:
Anomalous anastomoses between the Median (MN) and Ulnar (UN) nerves in the upper extremity are well documented. The commonest anomalous innervation is Martin Gruber Anastomosis (MGA), described as the connection from MN to UN in the forearm. Another anomalous connection is from the UN to the MN in the hand and is known as the Riche-Cannieu anastomosis (RCA). This anomaly was described in 1897 by Riche and Cannieu with the findings of a cross over in the palm, between the deep branch of the UN and the recurrent branch of the MN. The RCA is described in cadaveric dissections with a frequency that ranges from 3.12 to 77%. In RCA, three patterns may be observed which include both sensory and all intrinsic hand muscles innervated exclusively by the ulnar nerve (referred to as the all ulnar hand) or only complete hand motor innervation by the UN or lastly, some median innervated muscles supplied by the UN. We present an interesting case of carpal tunnel syndrome in which there was delay in the median sensory latencies bilaterally on recording from digit II, delayed mixed nerve action potentials bilaterally. On testing the median motor nerves, the left median compound motor action potential (CMAP) was non-recordable on stimulating the left median nerve despite preserved left thenar strength and muscle bulk. On recording from the left abductor pollicis brevis (APB) while stimulating the left ulnar nerve, the CMAP was normal. Carpal tunnel syndrome was present bilaterally. The recognition of concomitant anomalies as Riche-Cannieu anastomosis affords a better characterization of the degree of carpal tunnel syndrome and avoids confusing electrophysiological interpretations.