Kamlesh Jha is an Associate Professor of Physiology at All India Institute of Medical Sciences, Patna, India. He has more than 10 years of teaching experience in the field of Physiology. His interest of field is Neurophysiology especially Autonomic Physiology and Electro-diagnostics. Till date, he has published more than 10 research articles in national and international journals, published three book chapters and presented his works in many national/international conferences. At Present, he is working upon the EEG signal processing in cognitive physiology.

Autonomic nervous system has very important role in the regulation of the overall homeostatic mechanism of our body. It could be tested in a non-invasive way with good reproducibility and accuracy. It is a promising tool of investigation for many sub clinical conditions and prognostication of many chronic disorders too. The tests are mainly based upon the heart rate and blood pressure recordings and the effect of sympathovagal influence upon its regulation. The test is done following certain pre-requisites to avoid any interference with the result due to any external reason. To start with, Heart Rate Variability (HRV) is tested using sophisticated computer based system followed by Deep Breathing Test (DBT), Valsalva Manoeuvre (VR), Isometric Hand grip Test (IHT) and Orthostatic Test (OT) in the same sequence. The DBT and VR is mainly a pulse rate based test and it usually quantifies the parasympathetic function whereas OT and IHT is mainly blood pressure based test and

used for quantifying sympathetic function. HRV is very specific test of ANS utilized for the assessment of cardio vagal function in objective manner. The principle components of HRV includes Standard Deviations of RR intervals (SDNN), Root Mean Square Deviations of RR intervals (RMSSD), total power, Low Frequency variations (LF), Very Low Frequency Variations (VLF) and High Frequency variations (HF) in the heart rate besides other parameters. HF represents mainly Parasympathetic functions whereas LF and VLF mainly represents sympathovagal balance and sympathetic functions respectively.

Tribhuwan Kumar is a Faculty of Physiology at All India Institute of Medical Sciences, Patna, India. He has an inherent interest in the field of Cardiovascular Physiology and its relation with autonomic functions. Besides, he has a keen interest in the field of Medical Education. Besides having more than 10 years of teaching experience as Faculty of Physiology, he has good research experience with many research publications in national and international journals. He is also member of Association of Physiologists and Pharmacologists of India and South Association of Physiologists.

Like all internal organs heart is innervated by autonomic nervous system (ANS). The constant fluctuation in blood pressure and heart rate is mainly due to interactions between the mutually opposing actions of sympathetic and parasympathetic subdivisions of the ANS. The vagal activity dominates at rest and is mainly responsible for heart rate variability (HRV).The HRV analysis can be used to find out early signs of development of pathological process, presence of functional disorder, assess stress coping ability, evaluate treatment effectiveness and prognosis to name a few. The response of parasympathetic system to stimulation is quick and transient whereas the response to sympathetic stimulation is slower but of higher amplitude. This fluctuation can be analyzed and quantified by time domain and frequency domain analysis methods that provide insight of cardiac autonomic regulation in health and disease. Out of the time domain parameters rMSSD (square root of the mean

squared differences of successive NN intervals) and pNN50 (proportion of differences in consecutive NN intervals that are longer than 50 ms) describes short term variations, SDANN describes slow changes in the HRV whereas SDNN (standard deviation of NN) describes both short term and long term variability. The frequency domain or power spectral density (PSD) analysis describes heart rate as function of frequency and reveals the cyclical pattern in the series of changing RR intervals. It provides means to quantify autonomic balance at any given time. Some frequency domain parameters are Total Power (TP), Very Low Frequency (VLF), Low Frequency (LF), High Frequency (HF) and LF/HF ratio. Higher LF/HF ratio reflects sympathetic dominance whereas lower value means parasympathetic dominance.

Ramji Singh is working as a Professor and Head of the Department of Physiology at All India Institute of Medical Sciences, Patna. With more than 30 years of teaching experience, he has enormous experience in the field of Clinical and Experimental Neurophysiology. He has more than 50 research publications in national and international indexed journals. Presently, he is supervising many research projects in the department including neurocognitive and behavioural physiology. He is also a member of the elite club of FAIMER fellows and has been a well-recognized figure in the field of Indian medical education technology.

Autonomic nervous system plays an important role in the homeostasis of internal organ system and their integrated functions in the human body. The derangement of this function at any level may affect multiple system functions

simultaneously. Disorders associated with autonomic functions are quite common, but only recently medical world has started quantifying the autonomic functions to make it a reasonably sensitive and specific diagnostic and prognostic tool. Testing and quantifying autonomic function is very complex because of the wider distribution and diverse functions it is associated

with. One relatively simple battery of tests that is used commonly is Ewing battery which includes Valsalva maneuver, Deep Breathing Response (DBR), Orthostatic Testing (OT) and Isometric Handgrip Test (IHT). Besides Heart Rate Variability (HRV) is another important test of autonomic function that has high reproducibility and specificity. Most of these tests could be performed even in a resource limited settings with fair accuracy. Out of these tests deep breathing test, Valsalva manoeuvre and HRV are heart rate based tests and quantifies the cardiovagal function by assessing the heart rate changes

during various manoeuvre whereas IHT is a BP based test meant for sympathetic system. Orthostatic test includes both HR and BP response to change in posture from supine to standing, hence quantifies both the vagal and sympathetic system functions. One another test which is also of significance is Quantitative Sudomotor Axon Reflex Test (QSART) which is based

upon the quantitative estimation of sweat produced due to local acetylcholine stimulation. The test is useful in diagnosing distal small fibre autonomic neuropathy. Although autonomic function assessment is complex, it has got enormous value in clinical field. Standardization of the techniques and training of medical personals in the field may prove it an important tool in the clinical diagnostics.

Yogesh Kumar is presently working as an Associate Professor of Physiology at All India Institute of Medical Sciences, Patna. He is a proficient Educationist with more than 10 years of teaching experience in the field of Physiology. He has good research experience with more than eight research papers to his name published in national and international journals. He is working mainly in the field of Neurophysiology with special interest in Electrophysiology of seizure disorders.

The autonomic nervous system play a very important role as it regulate many important func-tions such as heart rate, blood pressure (BP), res¬piration, temperature regulation, gastrointestinal, bladder, and sexual function. If auto¬nomic nervous system is not working properly than an individual is bound to suffer from many diseases. A physician mainly concentrate on symptoms of dysautonomia, but it is then necessary to deter¬mine if these symptoms are really due to involvement of auto¬nomic systems. Previously methods to evaluate autonomic function were either unavailable or too invasive. Nowadays we have tests which non-invasively evaluate the severity and distribution of au¬tonomic failure. They have sufficient sensitivity to detect even subclinical dysautonomia. Stan¬dard laboratory testing evaluates cardiovagal, sudomotor and adrenergic autonomic functions. Cardiovagal function can be evaluated by a number of meth¬ods. In the time domain, the commonly used and most reliable approach is to quantify heart rate response to deep breathing and to

the Valsalva manoeuvre. Cardiovagal function can also be quantified in the frequen¬cy domain. The highest frequency peak (>0.15 Hz) reflects oscillations of heart rate due to respiratory sinus arrhythmia and is considered to be a measure of cardiovagal function. Sudomotor function can be evaluated with the quanti¬tative sudomotor axon reflex test and the thermoregulatory sweat test. Adrenergic function is evaluated by the blood pressure and heart rate responses to the Valsalva manoeuvre and to head-up tilt. Tests are useful in defining the presence of autonomic failure, their natural history, and response to treatment. They can also define patterns of dysautonomia that are useful in helping the clinician diagnose certain autonomic conditions. Some clinical uses of autonomic function testing are: 1) Distal small fibre neuropathy: Common causes are diabetic and inherited neuropathy, but the most common cause is idiopath¬ic. QSART will show abnormalities at the feet and normal sweating more proximally in about three out of four patients tested; 2) Generalized autonomic failure: For a clinician symptoms of generalized failure include orthostatic light-headedness, syncope, erectile dysfunction, and symptoms

suggestive of neurogenic bladder and bowel. Examples of gener¬alized autonomic failure are the autonomic neuropathies and multiple system atrophy; 3) Selective autonomic failure: Autonomic tests can confirm that a specific autonomic function is affected and that other systems are intact;
4) Synucleinopathies: These are neuro-degenerative disorders characterized by

fibrillary aggregates of alpha-synuclein protein in oligodendroglia and in se¬lective population of neurons e.g., Parkinson’s disease and multiple system atrophy and; 5) Orthostatic intolerance: It refers to development of symptoms after assuming the standing posture that clears on sitting or lying down. Specific examples are orthostatic hypotension, postural tachycardia syndrome, and neurocardiogenic syncope. Clinical management of the dysautonomia depends on good clinical judgment. Autonomic testing increases sensitivity and specificity in the detection of autonomic failure. There are limitations of clinical autonomic testing. The non-in¬vasive approach is appropriate but imperfect. Autonomic testing is a growing and evolving field so it is important that we should keep on updating guidelines.

James D Weinstein completed his MD in 1964 from University of Pennsylvania and his internship from New England Center Hospital in Boston 1965. He worked

as a Neurosurgeon for more than 40 years in New Jersey and West Virginia. He has published more than 25 papers in reputed journals.

Although billions of dollars have been spent for research on Alzheimer’s disease (AD), little progress has been made in finding a therapy which stops the progressive dementia characteristic of the disease. Numerous drugs, having failed over years of research, suggest the need for a reevaluation of how the research is now being done. To that end, three changes in current AD research methodology are offered and these changes are absolutely necessary to provide the means to find an effective treatment for the disease. First, AD is a disease of four etiologies rather than from a single primary cause. These four should be treated simultaneously for an effective therapy. Second, AD drug testing is wasting much time effort and money by aiming for a statistical verification of the slowing of dementia. The end point should be the complete cessation of progressive dementia, and testing should begin with small cohorts. Third, combination therapies with drugs currently available, used off label, ought to be tried. One example of such a combination is reviewed.

Ivanova Natalia Evgenievna, doctor of medical Sciences, Professor, head of the scientific Department of the "Russian Polenov Neurosurgical Institute ", - branch of “National Medical Research Center after V. A. Almazov ", chief neurologist of the Institute, honored doctor of the Russian Federation, Deputy editor-in-chief Of the Russian neurosurgical journal. prof. A. L. Polenov, member of the Board of the Association of neurosurgeons of Russia. The main directions of scientific and practical activity are neurosurgical pathology of brain vessels, neurotrauma, neurorehabilitation and ultrasound diagnostics. Author of 450 scientific works, including 30 patents and three monographs, supervisor of 30 candidates and 4 doctors of Sciences in "nerve diseases" and "neurosurgery"

Introduction: The purpose of early rehabilitation (as a combination of neurological, rehabilitation and neurosurgical interferences in the form of interdisciplinary work) is promoting spontaneous recovery of patients and prevention of secondary complications.

Purpose: to assess the results of use early rehabilitation.

Methods: CT, MRT, EEG, ENM, rehabilitation scales.

Results: 1800 neurosurgical patients (neurotrauma, neurooncology, vascular neurosurgery, pediatric neurosurgery, vertebrologie, epilepsy, pain and spastic syndromes) received early rehabilitation. Etiology, pathogenesis, pathophysiological mechanisms, pathological conditions, the disease stage and duration of dysfunction before surgery have great importance for

the restoration of the disturbed functions. Neuroreanimation department: methods used in the acute period can produce paradoxical responses and lead to a breakdown of compensation: the need to find methods of stabilizing stem dysfunction as early as possible, stem dysfunction correction, body-oriented techniques, treatment of bulbar disorders, breathing exercises, passive gymnastics and position treatment with the gradual expansion of the motion mode, early verticalization prevention of bedsores, polymodal sensory stimulation. Neurosurgical and rehabilitational departments: kinesitherapy with a maximum extension motor mode treatment for dysphagia, prevention and treatment of spasticity, treatment of flaccid paresis, correction of dysfunction of the pelvic organs, cognitive rehabilitation, speech therapy techniques, neuropsychological methods, prevention and treatment of pressure

ulcers, simulation methods. Consequent cognitive impairment that worsen the prognosis of rehabilitation after neurosurgical pathology, a high degree of disability ( including those, due to the presence of intellectual and memory impairment), makes the problem of diagnosis and treatment of cognitive dysfunction socially significant.

Conclusions: Early rehabilitation improved the outcome and the long-term quality of life.

Panaree Busarakumtragul has completed her PhD from Mahidol University, Thailand and short course training from Innsbruck University, Innsbruck Medical

School, Austria. At present, she is the Associate Dean of Administrative and Academic Affair. She has published a number of international papers in reputed journals and has been serving as an Editorial Board Member of repute.

Brain Derived Neurotrophic Factor (BDNF) protein has many important function in neuronal survival, synaptic plasticity, and neurogenesis in rat hippocampus including learning and memory. The lower BDNF protein level results in a decrease in synaptic transmission leading to neuronal damage in hippocampus and neurodegenerative diseases. Aim of this study is to investigate the association between serum BDNF protein and dyslipidemia on memory performance in Thai Alzheimer Disease (AD) patients. After this research project has been certified by human ethic committee of Srinakharinwirot University, we recruited male and female volunteer subjects with aged 45 or more. Before all subjects began to participate in this research,

they had to perform Thai Mini Mental State Examination (TMMSE) which represented memory performance. Then 30 healthy subjects were enrolled as control group whereas 15 AD patients were participated as experimental group. 10 milliliters of venous blood samples were withdrawn from left antecubital vein and left at room temperature (25oC) until they become clotted. They were centrifuged to seperate supernatant for BDNF protein assay by Enzyme Linked Immunosorbent Assay (ELISA) (Milliplex assay kit, Merck Millipore, Germany). Additionally, supernatant was used to analyze lipid profiles including triglycerides, total cholesterol, low density lipoprotein and high density lipoprotein by colorimetric method. Serum BDNF protein in AD patients was lower and significantly different from that in control group at p<0.05. However, lipid profiles in AD had no significant difference from control group. Furthermore, TMMSE scores in AD was significantly lower than that in control group at p<0.001. However, memory performance in AD patients has changed significantly in the same manner of serum BDNF protein. It can be concluded that significant difference of lower level of serum BDNF protein in AD patients at p<0.05 may cause the lower scores of TMMSE leading to a decrease in memory performance in Thai AD patients.

Aurelian Anghelescu is a founding member (2007) and Prime Vice-President of the Romanian Society for Neurorehabilitation (RoSNeRa) - affiliated to WFNR; Romanian Spinal Cord Society (RoSCoS) - affiliated to ISCoS and ESCIF and; member of the International Spinal Cord Society (ISCoS, since 2000), World Federation for Neurorehabilitation (WFNR, since 2008). He is Coordinator of Romanian team in five international projects and participated in four national projects. He is co-author of two patent certificates (appointed by Romanian State Office for Inventions and Marks, OSIM), nine books, and over 70 published papers. He is actively implied in national educational prophylactic interventions, aimed to prevent severe central nervous lesions.

Age-related gait and balance disturbances represent one of the most common geronto neurological symptoms, with different etiology and clinical pathological features (antalgic gait, paretic, spastic, ataxic, sensory deficit, hypokinetic, dyskinetic, anxious, and psychogenic) and often lead to falls in seniors. The pathogenesis of gait disorders include sensory deficits (visual, vestibular, somatosensory), neurodegenerative processes (cortical, extrapyramidal, cerebellar), cognitive degradation, depression and anxiety (primary or concerning falls), orthostatic hypotension, cardiac arrhythmia or

insufficiency, adverse effects of medication, toxic factors (alcohol). Physiopathological basis of gait and balance dysfunctions is better understood with modern neuroanatomical mapping technique (diffusion-tensor tractography, DTI). The authors make a review of the literature regarding age and gender-related effect on microstructural topographic degeneration of the white matter (WM), respectively the disproportionate myelin alterations (density and topography) in different pathological neurologic entities: stroke, Parkinson's disease, leuconevraxitis, cerebral small vessel disease, Alzheimer.

For geronto neurological impaired people, falling represent an important cause of injury, disability, even death, and a major public health problem. Prevention is better than cure, and can considerably reduce the psychological and physical

morbidity, and the dependence on family care, social support and healthcare services. A targeted and adequate prophylaxis with multilevel interventions at endogenous and/or exogenous pathological items, addressing general public and community-dwelling elderly in prevention programs focused to raise awareness, represent the real cure for injurious falling.

Surendra Kumar Anand completed his MSc from School of Life Sciences (SLS), Jawaharlal Nehru University (JNU), Delhi, India in 2016. Currently, he is pursuing his PhD from Laboratory of Cellular and Molecular Neurobiology (Lab 215), SLS, JNU under the supervision of Dr. Amal Chandra Mondal, Associate Professor, SLS, JNU. He is interested in studying the fundamental cellular and molecular mechanisms that orchestrate the brain regeneration process in the zebrafish model, especially the role of neurotrophins. He has published a review article and a research article in reputed international journals. Besides he has four poster presentations, one oral presentation and volunteering experience in national and international conferences and symposia.

Brain-derived neurotrophic factor (BDNF), acting via its receptor TrkB, is known to promote neuronal maturation, differentiation, maintenance and survival during embryonic development through its cognate receptor TrkB. The BDNF/ TrkB system is highly conserved among vertebrates. Although the role of BDNF and TrkB during brain development is well established, their role in adult neurogenesis and brain regeneration awaits thorough investigation. In this study, we used the zebrafish stab wound injury model to determine whether the injury induced regeneration response in the telencephalon region is governed by BDNF/TrkB system or not. We induced stab wound injury in the mid-dorsal region of telencephalon of zebrafish

brain without and with ANA-12 (selective TrkB antagonist) injection and examined the proliferation activity in selected brain

regions using immunohistochemistry. We found that proliferation activity was significantly low in ANA-12 injected injured fish

as compared to vehicle control injured fish. Other major findings of the study include the temporal pattern of proliferation activity

after an injury and activation of adult neural stem cells (aNSCs) situated distantly apart from the injury site in the zebra fish brain.

Introduction: Stroke has high prevalence and severe consequences for public health. Annually there are 450000, strokes in Russia and post-stroke aphasia is seen in 35.9% of cases, so as dysarthria is seen in 13%. There is a need to develop a differentiated system of rehabilitation with justification of principles, areas and methods of correction and restorative influence.

Aim: To explore methods of logopedic influence with differentiated approach and personalized sensory stimulation based on the leading modality of perception of speech function disorders in acute and early recovery periods of stroke.

Patients & Methods: 138 patients were included. The experimental group: 108 acute stroke patients in early period of rehabilitation (up to three months). Also 30 patients received ambulatory basis treatment. All patients were right-handed with ischemic, hemorrhagic stroke in the left hemisphere verified by CT/MRI. We defined three groups by leading perception modality and observed patients

through recovery dynamics. We provided logopedic and neuropsychological examination of patients, selected the method of synergistic approach and used neuropsychological, neurolinguistic and statistical methods in ascertaining and training experiments.

Results: We implemented the differentiated approach depending on the aphasia form and patients’ sensory profile by gradual complication of training tasks and training methods, considering the psycho-physiological state. Thus, application of differentiated sensory stimulation methods considering perceptual leading modality was effective for all patients, regardless to aphasia form.

Conclusion: The combination of different sensory stimulation with dominant representational system demonstrates efficiency of developed model of logopedic impact in the acute and early stroke recovery period.

Sara Karimi is a working as a PhD student from Kashan University of medical sciences, Iran .She holds a Master Degree (MSc) in Animal physiology from Shahid Beheshti University, Iran. She is extending her valuable service as a Research Scholar in Dr. Haghparast lab for 2 years and has been a recipient of many award and grants. Her research experience includes various programs, contributions and participation in different countries for diverse fields of study. Her research interests as a Research Scholar reflect in her wide range of publications in various national and international journals.

Orexinergic neurons are discretely localized within the lateral hypothalamus. In addition, several lines of evidence specify that orexins may also participate in the regulation of a variety of affective and cognitive processes. Orexin-1 receptor (OX1r) is distributed extensively throughout the prefrontal cortex. Effort-based decision-making is mediated largely by the anterior cingulate cortex (ACC). Hence, in the present study, we conducted an experiment to clarify the role of OX1r in the ACC in effort-based decision making. 20 male Wistar rats were used in this study. The rats had been trained in an effort-based form of cost-benefit T-maze decision making task. The two goal arms were different in the amount of accessible reward. After the rats had learned unequal size of reward, they then underwent barrier training. Rats were given three training days with a 30 cm barrier. The animals could choose high reward arm (HRA) and pay cost to achieve large reward or obtain a low reward in the other arm (LRA) without any cost. Before surgery, all animals were selecting the HRA on almost every trial. During test days, the rats received local injections of either DMSO 20%/0.5 μl, as vehicle, or SB334867 (3, 30, 300 nM/0.5 μl), as selective OX1r antagonist, within the ACC. Our results demonstrate profound effects of ACC's OX1r on effort based decision making, SB334867 administration into the ACC, changed the animal's preference to a LRA. These results imply that OX1r has a crucial role for allowing the animal to try to acquire greater rewards.

Mathilde DeGraff completed her Undergraduate degree in Health Sciences and Doctorate of Physical Therapy at Boston University in 2013. In 2017, she became Neurologic Certified Specialist. She has over four years of experience working at Rusk Rehabilitation at NYU Langone Health located in New York City where she is now a permanent Senior Physical Therapist in the acute inpatient rehabilitation department. She has presented at multiple conferences across the USA to promote physical therapies impact in both acute care and inpatient rehabilitation, with a focus on neurological conditions including Parkinson's disease and she is an active member of the APTA

 

Holly Battsek completed her Undergraduate degree in Health Sciences and Doctorate of Physical Therapy at Boston University in 2013. In 2017, she became a Neurologic Certified Specialist. She has over four years of experience working at Rusk Rehabilitation at NYU Langone Health located in New York City, with her most recent rotation being inpatient rehabilitation for the medically complex patient. She has presented at multiple conferences across the USA and has an abstract published in a Journal of Rehabilitation Medicine. Her presentations and research focus on promoting the benefits of physical therapy in the acute, inpatient and outpatient settings for the neurologically impaired population.

Acute motor-sensory axonal neuropathy (AMSAN) is a rare subtype of Guillian Barre Syndrome (GBS) accounting for 3-5% of cases. Symptoms include impaired joint proprioception and ataxia. Treatment includes medication and physical therapy (PT), with limited research on PT protocols. This case demonstrates the effectiveness of weighted exercise and gait training in an ataxic patient with AMSAN in an inpatient rehabilitation unit. Patient is a 40yo female with AMSAN initially treated with plasmapheresis and IVIG prior to admission to rehabilitation. Physical therapy presented with bilateral extremity

ataxia, weakness and impaired proprioception and sensation in all extremities. Patient received daily 60-90 minute PT sessions for seven weeks. Patient initially required a 3-person assist for transfers and was unable to ambulate. Week one focused on frenkel exercises and beasy-board transfers. Weighted exercise started on week two with 3 lb ankle weights (AW) for proprioceptive feedback, starting with standing weight-shifting and seated multidirectional toe taps. This progressed to pregait exercises including standing marching and toe taps onto a step with body weight support (BWS). This advanced to gait

training over-ground with BWS and RW. At week 6 AW were removed for all training. By discharge patient was independent with bed mobility, supervision with RW for transfers, and ambulating 160 ft. There is evidence on using weights to improve proprioception and ataxia in populations such as multiple sclerosis, and further research is needed in the GBS/AMSAN population. This case describes a PT protocol that can effectively improve functional independence in AMSAN patient with ataxia.