小児神経学および医学ジャーナル

We present a rare case of craniospinal atypical teratoid/rhabdoid tumor (ATRT) with leptomeningeal carcinomatosis in young adult. A previously healthy 25 year old man presented to the hospital after a one week history of intermittent confusion, intractable headache and a single new onset seizure. Two lumbar punctures were completed and both revealed elevated RBC, elevated protein and predominantly lymphocytic pleocytosis. Both lumbar punctures were unrevealing with normal cytology and flow cytometry. Contrasted magnetic resonance imaging (MRI) of the brain revealed extensive intracranial leptomeningeal and cranial nerve enhancement. Contrasted MRI of the spinal cord revealed extensive leptomeningeal and dural enhancement with multifocal areas of nodular mass-like enhancement along the entire spinal cord. Spinal biopsies were performed and a pathological diagnosis of ATRT was made. Aggressive radiotherapy and chemotherapy treatment were started. Unfortunately, the patient expired within 12 months of the initial diagnosis.

The following article presents a clinical study of the psychic mechanisms in the case of a six yea old adopted boy. For this child, the loss of his helpful objects (his country, culture and friends) resulted in his psyche being caught up in a melancholic temptation, where the current experience of loss brought to light his previous losses and a fragile narcissism. The case raises clinical and psychopathological questions about the quality of his relationship to the internal object, the nature of his identifications and the formation of his superego, caught up in the melancholic position.

Purpose: (1) To develop a smart jacket with sensors embedded in the sleeve that monitors the upper limb movement through a User Centered Design (UCD) process and (2) to assess by means of a Usability Test whether this tool can be used in upper limb rehabilitation of people with neurological diseases such as spinal cord injuries or strokes.

Methods: 32 participants (aged 25-65), 16 patients with neurological diseases and 16 experts were included in the UCD process for two years of development divided in three parts: (i) focus group, (ii) pilot test and (iii) evaluation of the product, which contains the usability test (UT). During UT the participants performed 10 actions wearing the jacket and assessed it by filling out usability questionnaire with 11 questions that answer eight usability items (satisfaction, effectiveness, easiness of use, safety, comfort, usability, aesthetics and feedback).

Results: User’s scores about satisfaction, effectiveness, easiness of use and safety were above 4.5, comfort and usability above 4.0. Expert’s scores about satisfaction, usability, effectiveness were below 4.0. Safety, comfort and easiness of use remained above 4. In both groups, aesthetics were the worst rated with a score less than 4.0. Feedback could not be assessed because it was not operational.

Conclusion: Based on inputs, the device showed to be tool for the upper limb rehabilitation because it monitors the patients’ movements, it provides a feedback and it collects data for the therapist. However, several aspects such as feedback and aesthetics need to be addressed to improve its usability.