The procedures are performed using the Zimmer Trabecular Metal Total Ankle prosthesis (Zimmer, Warsaw, IN).

All methods described have been approved by our institutional review board and the local ethics committee and they have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
1. Preoperative Radiographic Evaluation
<ol>
	<li>Perform weight bearing radiographs of the ankle and the foot with antero-posterior, lateral, and rearfoot alignment views (Saltzman&#39;s view30).</li>
	<li>Perform a conventional computed tomography (CT) of the ankle and request any other diagnostic exams (such as magnetic resonance), if necessary, to better clarify the diagnosis.</li>
	<li>Measure the following parameters on the preoperative weight-bearing radiographs.
	<ol>
		<li>Measure the anterior distal tibial angle (ADTA, normal value 83.0 &#177; 3.6 &#176;) on the lateral ankle view: measure the angle between the anatomic axis of the tibia and the line connecting the distal points on the anterior and posterior edge of the tibial articular surface (Figure 1)30,31.</li>
		<li>Measure the lateral distal tibial angle (LDTA, normal value 89.0 &#177; 3.0 &#176;) on the anteroposterior ankle view: measure the angle subtended between the anatomic axis of the tibia and the line connecting the distal points on the medial and lateral edge of the tibial articular surface (Figure 2)32,33,34.</li>
		<li>Measure the tibio-talar ratio (TT ratio, normal value 34.8 &#177; 3.8%): measure this parameter on the lateral ankle view; it is the ratio between the posterior longitudinal talar length (the length between the posterior talar edge and the intercept of the anatomical tibial axis) and the full longitudinal talar length (Figure 1)33,35,36.</li>
		<li>Measure the tibio-talar surface angle (normal value 89.0 &#177; 2.6 &#176;) on the anteroposterior ankle view: measure the angle between the anatomic axis of the tibia and the line connecting the proximal point on the medial and lateral talar articular surface (Figure 2)37.</li>
	</ol>
	</li>
	<li>Use the CT to assess the available bone stock and to evaluate the severity of the avascular necrosis of the talus, if present.</li>
</ol>
2. Surgical Technique17
NOTE: This procedure is performed under general or regional anesthesia (spinal anesthesia).
<ol>
	<li>Place the patient in the supine position with a rigid board under the leg to sustain the alignment stand. Position a thick pad under the ipsilateral hip. Do not use a tourniquet.</li>
	<li>Make a longitudinal incision with a scalpel over the lateral malleolus that curves under its tip toward the sinus tarsi (Figure 3). Dissect the fibula and the anterior side of the tibia subperiosteally with the scalpel and the periosteal elevator to obtain a complete view of the osteophytes and the joint.</li>
	<li>Release the posterior capsule of the tibia and the fibula using a periosteal elevator.</li>
	<li>Make an oblique lateral malleolus osteotomy with a sagittal saw blade: begin from the posterior edge of the fibula, 6-7 cm proximal to the joint line; end on the anterior side of the fibula, 2 cm proximal to the joint line. Rotate the fibular malleolus distally and use a 1.6 mm K-wire to fix it to the calcaneus.</li>
	<li>Remove the anterior osteophytes with the sagittal saw blade and a rongeur until the ankle can be easily placed in a neutral position. 
	NOTE: The medial gutter release can be performed later during the tibial preparation.</li>
	<li>Measure the medial/lateral talar width with the manufacturer&#39;s sizer, choosing the largest size possible while avoiding overhang.</li>
	<li>Place the leg in the alignment stand that is assembled at the beginning of the procedure.</li>
	<li>Internally rotate the foot and use the trans-calcaneal pin to fix it to the foot plate. Use the 4.0 mm pin to fix the talus to the footplate: put the pin as distal as possible in the talar neck, thus facilitating further correction of talar tilt.</li>
	<li>Check the tibial alignment with fluoroscopy using a bar that is parallel to the mechanical tibial axis. Use fluoroscopy with the following parameters: 55 kilovolts, 3 milliampere-seconds.</li>
	<li>Insert two 5.0 mm pins on the medial border of the tibia while an assistant pushes the tibia anteriorly if an anterior sagittal talar shifting is present. To increase the rigidity of the construct, an adjunctive carbon fiber bar can be placed in a vertical position.</li>
	<li>Verify the level of the desired joint line with the pointer located through the &#39;&#39;Position&#39;&#39; hole of the cutting guide of the selected size. Check the amount of bone resection with the pointer placed in the &#39;&#39;Talus&#39;&#39; and &#39;&#39;Tibia #1&#39;&#39; hole.</li>
	<li>Use the 4.0 mm drill through the pre-cutting guide to pre-drill the talus and the tibia surfaces. Assemble the bone burr to the pneumatic handpieces and put the contralateral talar trial of the selected size between the bone burr and the cutting guide to assess the medial depth of the bone cut. Then, use the bone burr to make the definitive bone cuts through the &#39;&#39;Talus&#39;&#39; and the &#39;&#39;Tibia #1&#39;&#39; holes of the guide. Use the &#39;&#39;Tibia #2&#39;&#39; hole to reach the whole tibial cut on the medial side and to release osteophytes of the medial gutter</li>
	<li>Position the rail drill guides. Utilize antero-posterior fluoroscopy to verify they are properly placed to avoid lateral overhang. Drill the rails and position the provisional implant, then choose the insert size.</li>
	<li>Insert the definitive implants using the talar and tibial inserter.</li>
	<li>Use fluoroscopy to check the positioning, and use two or three 3.5 mm lag screws to fix the fibula; alternatively, use a plate-fixation of the lateral malleolus, if the deformity requires a malleolar lengthening or shortening that does not leave sufficient contact for screw fixation.</li>
	<li>Check the stability of the syndesmosis with a bone hookapplied to the lateral malleolus. Gently pull the fibula laterally to assess any residual tibiofibular instability. If a lateral movement of the lateral malleolus is present, stabilize it with a syndesmosis screw fixation across four cortices. Test the ankle range of motion.</li>
	<li>Repair the anterior talofibular ligament with resorbable suture before routine wound-closure.</li>
</ol>
3. Postoperative Care
<ol>
	<li>Place the leg into a cast and forbid weight-bearing for four weeks. Then allow weight-bearing with a walker-boot for two weeks.</li>
	<li>Allow calf strengthening, proprioceptive training and stretching of the triceps surae six weeks after the surgery.</li>
</ol>
4. Clinical and Radiographic Follow-Up
<ol>
	<li>Radiologically and clinically evaluate patients at one, two, six, and twelve months after the procedure and, afterward, every twelve months. The follow-up protocol consists of function and pain assessment with SF-12, VAS pain score, and AOFAS ankle and hindfoot scores collected at each time-point.</li>
	<li>Perform radiographic examination: request weight-bearing radiographs of the ankle and of the foot with antero-posterior, lateral and Saltzman&#39;s view at each end-point.</li>
	<li>Measure the following parameters on the postoperative radiographs at each end-point.
	<ol>
		<li>Measure the alpha angle (&#945;-angle) on the antero-posterior ankle view: measure the angle formed laterally by the anatomical axis of the tibia and the articular surface of the tibial component (Figure 4)38.</li>
		<li>Measure the beta angle (&#946;-angle) on the lateral ankle view: measure the angle subtended anteriorly by the anatomical axis of the tibia and the articular surface of the tibial component (Figure 5)18,38.</li>
		<li>Measure the gamma angle (&#947;-angle) on the lateral ankle view: measure the angle between a line through the anterior and the posterior edge of the talar component and a line along the center of the talar neck (Figure 5)39.</li>
		<li>Measure the Tibio-talar ratio.</li>
		<li>Measure the Tibio-talar surface angle.</li>
	</ol>
	</li>
</ol>

Dr. Usuelli receives grants and personal fees from Zimmer. Dr. D'Ambrosi, Dr. Maccario, Dr. Manzi and Dr. Indino have nothing to disclose.

We reported the methods and protocol we use performing TAR with lateral transfibular approach. The absolute contraindications for TAR are talar avascular necrosis involving more than 50% of the bone-stock, acute or active infection with or without osteomyelitis, diabetic syndrome with polyneuropathy, high anesthesiologic risks, neuromuscular disorders, peripheral vascular disease, and neuroarthropathy (Charcot arthropathy of the midfoot or hindfoot)19,42. The rel...

The most frequent etiology of ankle osteoarthritis is the post-traumatic origin. In fact, it is often secondary to traumatic injuries that typically affect young patients1,2. Ankle osteoarthritis influences patients&#39; quality of life to the same degree as hip osteoarthritis and even more than knee osteoarthritis3. Ankle fusion has been considered the gold-standard for the treatment of ankle osteoarthritis, but some studies show that it confers augmented stress and increased risk of osteoarthritis of the adjacent joints4,5,6,7; furthermore, there still exist a number of complications associated with ankle fusion, such as equinus or talipes deformity and painful non-union8,9. With the evolution of surgical techniques and implant designs, total ankle replacement (TAR) has become an excellent alternative to ankle fusion for a surgeon with a proper learning-curve10,11,12.
TAR allows the preservation of ankle range of motion and protects from adjacent joint degeneration13. The anterior approach permits an optimal visualization of the coronal alignment; at the same time, this approach is inclined to wound-healing complications14,15. Recently, a novel TAR implant was designed to be performed via the lateral transfibular approach that results in an ideal visualization of the center of rotation and curved resections that allow for sparing bone cuts16; moreover, this approach permits the implantation of components perpendicular to the bone trabeculae, thus limiting the shear forces at the level of the bone-implant interface16. This prosthesis consists of a fixed-bearing implant; an alignment coordinate system guides the bone resections and facilitates addressing both coronal and sagittal deformities17. The early results of ankle arthroplasty using this TAR implant have been published 12,16,17,18. The aim of the present paper is to present our preoperative, operative, and postoperative protocols for the treatment of the osteoarthritis of the ankle with TAR via the lateral approach.
Patient selection starts with a careful clinical examination and history. A medical history of inflammatory or vascular disease, neuropathy or neurologic disease and complicated diabetes may modify the indication. Poor soft tissue envelope of the ankle should be carefully evaluated because it may compromise the wound healing: skin and subcutaneous soft-tissue may already have been compromised from injury or previous surgery. The use of drugs that may influence healing must be considered. Muscle and tendon function, ankle and hindfoot alignment, and ankle range of motion should be evaluated: a detailed examination can indicate whether accessory procedures are needed at the time of surgery19.
We suggest always discussing the expectations of the patient concerning the outcomes of the procedure and the need for compliance with post-operative care. TAR is indicated for patients with an ankle joint disease due to post-traumatic, rheumatoid, or primary arthritis not responsive to conservative options that include physical therapy, activity modification, and non-steroidal anti-inflammatory drugs19. Also, lateral ankle instability may represent a cause of joint degeneration defined as ligamentous posttraumatic ankle osteoarthritis20. In addition, secondary osteoarthritis can be associated with systemic diseases: avascular necrosis of the talus, gout, hemophilia, post-infectious arthritis, and hereditary hemochromatosis21,22,23,24.
During the preoperative consultation, we routinely record the following clinical and functional scores: American Orthopaedic Foot &#38; Ankle Society (AOFAS) ankle and hindfoot score25,26,27, 12-Item Short Form Health Survey27,28, and Visual Analogue scale (VAS) pain score29.

<table border="0" cellpadding="0" cellspacing="0" width="880">
	<tbody>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Zimmer Total Ankle</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">82-0175-162-00</td>
			<td style="width:327px;">Total Ankle Replacement</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Calcaneus pin</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-040-00</td>
			<td>Trans-calcaneal pin</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">4.0 mm Pin</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-040-04</td>
			<td>Talar pin</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">5.0 mm Pin</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-040-05</td>
			<td>Tibial pins</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">1.6 mm k-wire</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-040-01</td>
			<td>1.6 mm Kirschner wire</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Moonray BlueLIne Dual</td>
			<td style="width:204px;">SIMAD</td>
			<td style="width:179px;"></td>
			<td>Mobile C-arm</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Pre-Cut Guide Drill</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-059-00</td>
			<td>Precutting bone drill</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Bur</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-076-00</td>
			<td>Bone resection burr</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Micro 100 Drill</td>
			<td style="width:204px;">Conmed Corporation</td>
			<td style="width:179px;">5053-009</td>
			<td>Pneumatic handpieces</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">3.5 mm ULS screws</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;"></td>
			<td>Fibular fixation screws</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Matlab version 2008</td>
			<td style="width:204px;">The MathWorks Inc.</td>
			<td style="width:179px;"></td>
			<td>Statistical software</td>
		</tr>
	</tbody>
</table>

treatment of ankle osteoarthritis with total ankle replacement through a lateral transfibular approach

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior approach. Recently, the lateral transfibular approach to the ankle has gained popularity since a new TAR implant was designed to be performed via this approach that results in an ideal visualization of the center of rotation of the ankle and curved resections that allow for sparing bone cuts. The aim of the present paper is to present our preoperative, operative, and postoperative protocols for the treatment of the osteoarthritis of the ankle with TAR via lateral approach. We present our preoperative clinical and radiographic protocol. In addition, we describe our surgical technique with some technical tips. Finally, we report our follow-up schedule that includes the collection of clinical, functional, and radiographic data. The results of this procedure are encouraging: TAR through a lateral transfibular approach provides reliable pain relief and improvements in functional outcomes in patients with ankle osteoarthritis.

We collected the results of a consecutive series of 114 patients (114 ankles) who underwent TAR via lateral transfibular approach between May 2013 and July 2016. All operative procedures were carried out by the senior author.
Data were analyzed with a statistical software (see Table of Materials). The ANOVA and kappa tests were performed40,41. For k-scor...

Watch this Scientific Journal Video about Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach at JoVE.com

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

We present our preoperative, operative, and postoperative protocols for the treatment of osteoarthritis of the ankle with total ankle replacement via lateral transfibular approach.

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior ...

treatment-ankle-osteoarthritis-with-total-ankle-replacement-through

Research

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11.7K Views.  Galeazzi Orthopedic Institute for Research and Care. We present our preoperative, operative, and postoperative protocols for the treatment of osteoarthritis of the ankle with total ankle replacement via lateral transfibular approach.

Video: Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

Measuring Sensitivity to Viewpoint Change with and without Stereoscopic Cues

The speed and accuracy of object recognition is compromised by a change in viewpoint; demonstrating that human observers are sensitive to this transformation. Here we discuss a novel method for simulating the appearance of an object that has undergone a rotation-in-depth, and include an exposition of the differences between perspective and orthographic projections. Next we describe a method by which human sensitivity to rotation-in-depth can be measured. Finally we discuss an apparatus for creating a vivid percept of a 3-dimensional rotation-in-depth; the Wheatstone Eight Mirror Stereoscope. By doing so, we reveal a means by which to evaluate the role of stereoscopic cues in the discrimination of viewpoint rotated shapes and objects.

We discuss a novel method forviewpoint-rotation of visual stimuli, and demonstrate using a mirror stereoscopethe three-dimensional percept of rotation-in-depth. The technique can be used to investigate the role of stereoscopic cues in encoding viewpoint-rotated figures.

The speed and accuracy of object recognition is compromised by a change in viewpoint; demonstrating that human observers are sensitive to this ...

Assessment of Age-related Changes in Cognitive Functions Using EmoCogMeter, a Novel Tablet-computer Based Approach

The main goal of this study was to assess the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on cognitive functions across the lifespan in a sample of 378 healthy subjects (age range 18-89 years). Consistent with previous findings we found an age-related cognitive decline across a wide range of neuropsychological domains (memory, attention, executive functions), thereby proving the usability of our tablet-based application. Regardless of prior computer experience, subjects of all age groups were able to perform the tasks without instruction or feedback from an experimenter. Increased motivation and compliance proved to be beneficial for task performance, thereby potentially increasing the validity of the results. Our promising findings underline the great clinical and practical potential of a tablet-based application for detection and monitoring of cognitive dysfunction.

We tested the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on cognition. Results show an age-related cognitive decline, thereby proving the usability of our application. Findings underline the great clinical and practical potential of a tablet-based application for detection and monitoring of cognitive dysfunction.

The main goal of this study was to assess the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on ...

Experimental Assessment of Mouse Sociability Using an Automated Image Processing Approach

Mouse is the preferred model organism for testing drugs designed to increase sociability. We present a method to quantify mouse sociability in which the test mouse is placed in a standardized apparatus and relevant behaviors are assessed in three different sessions (called session I, II, and III).
The apparatus has three compartments (see Figure 1), the left and right compartments contain an inverted cup which can house a mouse (called &#34;stimulus mouse&#34;).
In session I, the test mouse is placed in the cage and its mobility is characterized by the number of transitions made between compartments. In session II, a stimulus mouse is placed under one of the inverted cups and the sociability of the test mouse is quantified by the amounts of time it spends near the cup containing the enclosed stimulus mouse vs. the empty inverted cup. In session III, the inverted cups are removed and both mice interact freely. The sociability of the test mouse in session III is quantified by the number of social approaches it makes toward the stimulus mouse and by the number of times it avoids a social approach by the stimulus mouse.
The automated evaluation of the movie detects the nose of the test mouse, which allows the determination of all described sociability measures in session I and II (in session III, approaches are identified automatically but classified manually). To find the nose, the image of an empty cage is digitally subtracted from each frame of the movie and the resulting image is binarized to identify the mouse pixels. The mouse tail is automatically removed and the two most distant points of the remaining mouse are determined; these are close to nose and base of tail. By analyzing the motion of the mouse and using continuity arguments, the nose is identified.
<img alt="Figure 1" src="/files/ftp_upload/52508/52508fig1.jpg" /> 
Figure 1. Assessment of Sociability During 3 sessions. Session I (top): Acclimation of test mouse to the cage. Session II (middle): Test mouse moving freely in the cage while the stimulus mouse is enclosed in an inverted cup. Session III (bottom): Both test mouse and stimulus mouse are allowed to move freely and interact with each other.

This protocol describes a method to quantify mouse sociability. Mice are videotaped as they move and interact in a special cage. Movie processing allows for the automated quantification of sociability with excellent accuracy and reliability.

Mouse is the preferred model organism for testing drugs designed to increase sociability. We present a method to quantify mouse sociability in which the ...

A Treatment Package without Escape Extinction to Address Food Selectivity

Feeding difficulties and feeding disorders are a commonly occurring problem for young children, particularly children with developmental delays including autism. Behavior analytic interventions for the treatment of feeding difficulties oftentimes include escape extinction as a primary component of treatment. The use of escape extinction, while effective, may be problematic as it is also associated with the emergence of challenging behavior (e.g., extinction burst). Such challenging behavior may be an acceptable side effect in treatment cases where feeding problems are severe and chronic (e.g., failure to thrive). However, in more acute cases (e.g., selective eating), the negative side effect may be unwarranted and undesired. More recent research on the behavioral treatment of food selectivity has begun to evaluate treatments for feeding difficulties that do not include escape extinction (e.g., demand fading, behavioral momentum), with some success. However, research to date reveals individual differences in responsiveness to such treatments and no clear preferable treatment has emerged. This manuscript describes a multi-component treatment package that includes shaping, sequential presentation and simultaneous presentation, for the treatment of food selectivity in four young children with developmental delays. This treatment package extends the literature on the behavioral treatment for food selectivity and offers a multi-component treatment protocol that may be clinically applicable across a range of treatment scenarios and settings.

Feeding difficulties are a common problem for children with developmental disorders, including autism, and behavioral interventions often include escape extinction. Recent research has begun to evaluate treatments that do not include escape extinction. This manuscript describes a multicomponent treatment package that does not use escape extinction to treat feeding difficulties.

Feeding difficulties and feeding disorders are a commonly occurring problem for young children, particularly children with developmental delays including ...

Experimental Research Examining How People Can Cope with Uncertainty Through Soft Haptic Sensations

Human beings are constantly surrounded by uncertainty and change. The question arises how people cope with such uncertainty. To date, most research has focused on the cognitive strategies people adopt to deal with uncertainty. However, especially when uncertainty is due to unpredictable societal events (e.g., economical crises, political revolutions, terrorism threats) of which one is unable to judge the impact on one&#8217;s future live, cognitive strategies (like seeking additional information) is likely to fail to combat uncertainty. Instead, the current paper discusses a method demonstrating that people might deal with uncertainty experientially through soft haptic sensations. More specifically, because touching something soft creates a feeling of comfort and security, people prefer objects with softer as compared to harder properties when feeling uncertain. Seeking for softness is a highly efficient and effective tool to deal with uncertainty as our hands are available at all times. This protocol describes a set of methods demonstrating 1) how environmental (un)certainty can be situationally activated with an experiential priming procedure, 2) that the quality of the softness experience (what type of softness and how it is experienced) matters and 3) how uncertainty can be reduced using different methods.

To date research has focused on cognitive strategies people adopt to cope with uncertainty. This research examines instead an experiential way of dealing with uncertainty and introduces a set of experimental methods showing how the experience of haptic softness can serve as a tool to deal with uncertainty.

Human beings are constantly surrounded by uncertainty and change. The question arises how people cope with such uncertainty. To date, most research has ...

Pavlovian Conditioned Approach Training in Rats

Cues that are contingently paired with unconditioned, rewarding stimuli can acquire rewarding properties themselves through a process known as the attribution of incentive salience, or the transformation of neutral stimuli into attractive, &#34;wanted&#39; stimuli capable of motivating behavior. Pavlovian conditioned approach (PCA) develops after the response-independent presentation of a conditioned stimulus (CS; e.g., a lever) that predicts the delivery of an unconditioned stimulus (US; e.g., a food pellet) and can be used to measure incentive salience. During training, three patterns of conditioned responses (CRs) can develop: sign-tracking behavior (CS-directed CR), goal-tracking behavior (US-directed CR), and an intermediate response (both CRs). Sign-trackers attribute incentive salience to reward-related cues and are more vulnerable to cue-induced reinstatement of drug-seeking as well as other addiction-related behaviors, making PCA a potentially valuable procedure for studying addiction vulnerability. Here, we describe materials and methods used to elicit PCA behavior from rats as well as analyze and interpret PCA behavior in individual experiments.

Here, we present a protocol to elicit Pavlovian conditioned approach behavior in rats. This procedure can be used to measure individual differences in the tendency to approach and attribute incentive salience to reward-related cues and investigate addiction vulnerability.

Cues that are contingently paired with unconditioned, rewarding stimuli can acquire rewarding properties themselves through a process known as the ...

Eye-Tracking Control to Assess Cognitive Functions in Patients with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to progressive loss of motor and speech abilities. In addition, cognitive functions are impaired in a subset of patients. To evaluate these potential deficits in severely physically impaired ALS patients, eye-tracking is a promising means to conduct cognitive tests. The present article focuses on how eye movements, an indirect means of communication for physically disabled patients, can be utilized to allow for detailed neuropsychological assessment. The requirements, in terms of oculomotor parameters that have to be met for sufficient eye-tracking in ALS patients are presented. The properties of stimuli, including type of neuropsychological tests and style of presentation, best suited to successfully assess cognitive functioning, are also described. Furthermore, recommendations regarding procedural requirements are provided. Overall, this methodology provides a reliable, easy to administer and fast approach for assessing cognitive deficits in patients who are unable to speak or write such as patients with severe ALS. The only confounding factor might be deficits in voluntary eye movement control in a subset of ALS patients.

Cognitive deficits are common in about one third of patients with amyotrophic lateral sclerosis, a neurological condition leading to progressive impairments in speech and movement abilities. To conduct cognitive tests in patients unable to speak or write a reliable and easy to administer eye-tracking paradigm was developed.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to ...

Behavioral Disturbances: An Innovative Approach to Monitor the Modulatory Effects of a Nutraceutical Diet

In dogs, diets are often used to modulate behavioral disturbances related to chronic anxiety and stress caused by intense and restless activity. However, the traditional ways to monitor behavioral changes in dogs are complicated and not efficient. In the current clinical evaluation, a new, simple monitoring system was used to assess the effectiveness of a specific diet in positively modulating the intense and restless activity of 24 dogs of different ages and breeds. This protocol describes how to easily and rapidly evaluate improvement in a set of symptoms related to generalized anxiety by using a specific sensor, a mobile phone app, a wireless router, and a computer. The results showed that dogs treated with specific diets showed significant improvement in the times spent active and at rest after 10 days (p &lt; 0.01 and p &lt; 0.05, respectively). These dogs also showed an overall significant improvement in clinical and behavioral symptoms. A specific sensor, along with its related hardware, was demonstrated to successfully monitor behavioral changes relating to movement in dogs.

We report a simple approach to evaluate the effectiveness of a specific diet in positively modulating the daily activity and clinical and behavioral symptoms of dogs with evident behavioral disturbances.

In dogs, diets are often used to modulate behavioral disturbances related to chronic anxiety and stress caused by intense and restless activity. However, ...

Enactive Phenomenological Approach to the Trier Social Stress Test: A Mixed Methods Point of View

The single Trier Social Stress Test (TSST) and the TSST for groups (TSST-G) are the most used protocols to experimentally induce psychosocial stress. These tests are based on uncontrollability and social-evaluative threat, inducing psychological and physiological consequences (e.g., anxiety, emotional states, salivary cortisol increases). Many quantitative experimental studies have investigated these stress inducers and these consequences. But, as far as we know, this study is the first to provide a qualitative analysis to access the participants' voices so as to understand the dynamics of their experience throughout the TSST and the TSST-G. This paper outlines a mixed methods approach to the TSST. This approach can help to maximize the information that can be gained from the TSST, which researchers often use without looking more closely at what is qualitatively happening psychologically for participants during the stressor itself. In this way, this protocol is an example of mixed methods, showing the added value of using the enactive phenomenological approach to analyze experimental protocols more deeply. This kind of mixed methods is helpful to access the experience, to understand the actor's point of view, and to analyze in-depth the dynamics of cognitive processes like intentions, perceptions, enacted knowledge, and emotion. The discussion section shows the different uses of a mixed methods protocol, exploiting the enactive phenomenological approach to analyze a protocol or to give a cross vision of the same research subject. This section deals with different existing applications, pointing out some critical steps in this mixed methods approach.

Here, we present an original mixed method combining a quantitative and a qualitative approach to examine accurately participants&#39; experiences during the Trier Social Stress Test and the Trier Social Stress Test for groups.

The single Trier Social Stress Test (TSST) and the TSST for groups (TSST-G) are the most used protocols to experimentally induce psychosocial stress. ...

Use of a Wireless Video-EEG System to Monitor Epileptiform Discharges Following Lateral Fluid-Percussion Induced Traumatic Brain Injury

The lateral fluid percussion injury (FPI) model is well established and has been used to study TBI and post-traumatic epilepsy (PTE). However, considerable variability has been reported for the specific parameters used in different studies that have employed this model, making it difficult to harmonize and interpret the results between laboratories. For example, variability has been reported regarding the size and location of the craniectomy, how the Luer lock hub is placed relative to the craniectomy, the atmospheric pressure applied to the dura and the duration of the pressure pulse. Each of these parameters can impact injury severity, which directly correlates with the incidence of PTE. This has been manifested as a wide range of mortality rates, righting reflex times and incidence of convulsive seizures reported. Here we provide a detailed protocol for the method we have used to help facilitate harmonization between studies. We used FPI in combination with a wireless EEG telemetry system to continuously monitor for electrographic changes and detect seizure activity.&#160; FPI is induced by creating a 5 mm craniectomy over the left hemisphere, between the Bregma and Lambda and adjacent to the lateral ridge. A Luer lock hub is secured onto the skull over the craniectomy. This hub is connected to the FPI device, and a 20-millisecond pressure pulse is delivered directly to the intact dura through pressure tubing connected to the hub via a twist lock connector. Following recovery, rats are re-anesthetized to remove the hub. Five 0.5 mm, stainless steel EEG electrode screws are placed in contact with the dura through the skull and serve as four recording electrodes and one reference electrode. The electrode wires are collected into a pedestal connector which is secured into place with bone cement. Continuous video/EEG recordings are collected for up to 4 weeks post TBI.

Here we present a protocol to induce severe TBI with the lateral fluid percussion injury (FPI) model in adult, male Wistar rats. We also demonstrate the use of a wireless telemetry system to collect continuous video-EEG recordings and monitor for epileptiform discharges consistent with post-traumatic epileptogenesis.&#160;