Previous research has extensively explored visual encoding of smoothly curved, closed contours described by sinusoidal variation of pattern radius as a function of polar angle (RF patterns). Although the contours of many biologically significant objects are curved, we also confront shapes with a more jagged and angular appearance. To study these, we introduce here a novel class of visual stimuli that deform smoothly from a circle to an equilateral polygon with N sides (AF patterns). Threshold measurements reveal that both AF and RF patterns can be discriminated from circles at the same deformation amplitude, approximately 18.0arcsec, which is in the hyperacuity range. Thresholds were slightly higher for patterns with 3.0 cycles than for those with 5.0 cycles. Discrimination between AF and RF patterns was 75% correct at an amplitude that was approximately 3.0 times the threshold amplitude, which implies that AF and RF patterns activate different neural populations. Experiments with jittered patterns in which the contour was broken into several pieces and shifted inward or outward had much less effect on AF patterns than on RF patterns. Similarly, thresholds for single angles of AF patterns showed no significant difference from thresholds for the entire AF pattern. Taken together, these results imply that the visual system incorporates angles explicitly in the representation of closed object contours, but it suggests that angular contours are represented more locally than are curved contours.

The Muscular Dystrophy Child Health Index of Life with Disabilities (MDCHILD) is a new patient-reported outcome measure for Duchenne muscular dystrophy (DMD). The Priority Framework of Outcomes underpins the content for the MDCHILD. The MDCHILD incorporates the health-related priorities of males with DMD and their parents. The MDCHILD was deemed sensible by children, their parents, and health care professionals.

Background Physical inactivity is associated with increased health risks. Primary care providers (PCPs) are well positioned to support increased physical activity (PA) levels through screening and provision of PA prescriptions. However, PCP counseling on PA is not common. Objective This study aimed to assess the feasibility of implementing an electronic health (eHealth) tool to support PA counseling by PCPs and estimate intervention effectiveness on patients’ PA levels. Methods A pragmatic pilot study was conducted using a stepped wedge cluster randomized trial design. The study was conducted at a single primary care clinic, with 4 pre-existing PCP teams. Adult patients who had a periodic health review (PHR) scheduled during the study period were invited to participate. The eHealth tool involved an electronic survey sent to participants before their PHR via an email or a tablet; data were used to automatically produce tailored resources and a PA prescription in the electronic medical record of participants in the intervention arm. Participants assigned to the control arm received usual care from their PCP. Feasibility was assessed by the proportion of completed surveys and patient-reported acceptability and fidelity measures. The primary effectiveness outcome was patient-reported PA at 4 months post-PHR, measured as metabolic equivalent of task (MET) minutes per week. Secondary outcomes assessed determinants of PA, including self-efficacy and intention to change based on the Health Action Process Approach behavior change theory. Results A total of 1028 patients receiving care from 34 PCPs were invited to participate and 530 (51.55%) consented (intervention [n=296] and control [n=234]). Of the participants who completed a process evaluation, almost half (88/178, 49.4%) stated they received a PA prescription, with only 42 receiving the full intervention including tailored resources from their PCP. A cluster-level linear regression analysis yielded a non–statistically significant positive difference in MET-minutes reported per week at follow-up between intervention and control conditions (mean difference 1027; 95% CI −155 to 2209; P=.09). No statistically significant differences were observed for secondary outcomes. Conclusions Our results suggest that it is feasible to build an eHealth tool that screens and provides tailored resources for PA in a primary care setting but suboptimal intervention fidelity suggests greater work must be done to address PCP barriers to resource distribution. Participant responses to the primary effectiveness outcome (MET-minutes) were highly variable, reflecting a need for more robust measures of PA in future trials to address limitations in patient-reported data. Trial Registration ClinicalTrials.gov NCT03181295; https://clinicaltrials.gov/ct2/show/NCT03181295

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ObjectivesDysphagia in childhood has important health impacts for the child and their family as well as the healthcare system. This systematic review aims to determine the effectiveness of neuromuscular electrical stimulation (NMES) for treatment of oropharyngeal dysphagia in children.MethodsA search was performed on November 2020 in MEDLINE (from 1946), EMBASE (from 1947), PsycINFO (from 1806), CINAHL (from 1937), CENTRAL (from 1996) and Scopus (from 1970) databases. Studies of children (≤18 years) diagnosed with oropharyngeal dysphagia using NMES in the throat/neck region were included. Screening, data extraction, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the Cochrane Collaboration’s tool for randomised controlled trials (RCTs) and a modified Newcastle-Ottawa assessment for observational studies. A meta-analysis was not conducted due to clinical heterogeneity in studies.ResultsTen studies were included (5 RCTs, 4 case series, 1 cohort study; including 393 children, mean or median age below 7 years, including children with neurologic impairments). In all studies, swallowing function improved after NMES treatment. The standardised mean difference (SMD) for improvement of swallowing dysfunction in treatment compared with control groups in the RCTs ranged from 0.18 (95% CI −0.7 to 1.06) to 1.49 (95% CI 0.57 to 2.41). Eight of 10 studies reported on the child’s feeding ability, and, with one exception, there was improvement in feeding ability. Few studies reported on health status (N=2), impact on caregiver (N=1), adverse events and harms (N=2), and child’s quality of life (N=1). In most studies, outcome follow-up was less than 6 months. The studies demonstrated moderate to high risk of bias.ConclusionsNMES treatment may be beneficial in improving swallowing function for children with dysphagia, however, given the quality of the studies, inadequate outcome reporting, and short follow-up duration, uncertainty remains. Well-designed RCTs are needed to establish its effectiveness before its adoption in clinical practice.PROSPERO registration numberCRD42019147353.

Primary Subject area Complex Care Background Dysphagia is common in children with medical complexity and can result in undernutrition, respiratory complications and negatively impact child and caregiver quality of life; however, evidence on the effectiveness of treatments for dysphagia in children is limited. Neuromuscular electrical stimulation (NMES) is a novel proposed treatment for dysphagia where electrical current is applied to neck muscles using cutaneous electrodes during swallowing therapy. It is hypothesized that NMES improves dysphagia by strengthening swallowing muscles and/or enhancing sensory signals of the swallowing response. Objectives To systematically review the evidence on the effectiveness of NMES for treatment of oropharyngeal dysphagia in children. Design/Methods MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Scopus databases were searched from inception to November 2020. Studies of children (18 years and younger) diagnosed with oropharyngeal dysphagia using NMES in the throat/neck region were included. Screening, data extraction, and risk of bias assessment followed PRISMA guidelines. Risk of bias was assessed using the Cochrane Collaboration’s tool for RCTs and the Newcastle-Ottawa tool for observational studies. [Registration: PROSPERO CRD42019147353] Results Of the 844 records screened, 26 were identified for full text review, and 8 studies were included (4 RCTs and 4 cohort studies). These studies represented 338 children, with a mean (or median) age below 7 years, including children with and without neurological impairments. In all studies, swallowing function as measured by imaging studies improved after NMES treatment; in the trials, the standardized mean difference ranged from 0.32 (95% CI -0.56, 1.20) to 1.18 (95% CI 0.40, 1.97) compared to control groups who received usual care without NMES. Seven of eight studies reported on the child’s feeding ability, and, with one exception, there was improvement in feeding ability (Figure 1). Few studies reported on health status (N=1), child’s quality of life (N=1), and adverse events and harms (N=1). No studies reported on the social impact on the child, impact on the caregiver, and the caregiver’s quality of life. In most studies, outcome follow-up was limited to less than 6 months. Overall, the studies demonstrated moderate to high risk of bias. A pooled intervention effect and meta-analysis was not conducted due to clinical heterogeneity. Conclusion NMES treatment may be beneficial in improving swallowing function for children with dysphagia, however, given the quality of the studies, inadequate outcome reporting, and short follow-up duration, additional well-designed RCTs are needed to establish its effectiveness.

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