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Regeneration of axons and synaptic connections by touch sensory neurons in the leech central nervous system.

In studies of axonal regeneration, it has been difficult to determine (a) whether growth along the normal pathway is important for restoration of connections with previous targets and (b) whether the new synapses resemble the old in strength and location. To address these problems at the level of individual nerve cells, we have studied touch (T) sensory neurons in the leech after their axons have been severed and we have confirmed that their axons regenerate electrical connections with some of their usual synaptic targets in the central nervous system. Injections of horseradish peroxidase and Lucifer Yellow dye into separate T cells in unoperated animals showed that T cell axons typically run close to one another within single ganglia or from ganglion to ganglion. Knowledge of one T cell's arborizations thus revealed the groundplan of others in the same ganglia and the sites of apparent contact with its synaptic targets. For regenerating axons, those sprouts that encountered the normal pathway (as marked by homologous axons) grew preferentially along it. Despite the striking coincidence of old and new pathways, regenerated branching patterns within the ganglionic neuropils were usually incomplete and sometimes had atypical branches. Synaptic connections with normal targets (other T cells as well as S and C cells) were abnormally weak physiologically. The numbers of apparent contacts seen with the light microscope were also lower than normal. In addition, the strength of the synaptic potentials, normalized to the number of contacts (calculated as microvolts per contact), was generally smaller in the regenerated connections than in the controls, and smallest at earliest times, during the first 6 weeks following injury. It thus appears to be characteristic of T cell regeneration that axon regrowth is aided by the recognition of specific pathways and that successful regeneration, as assayed anatomically and physiologically, occurs frequently but usually incompletely.

Animals↗

The good touch/bad touch dilemma.

Child sexual abuse prevention programs of all kinds have multiplied. This paper examines one critical concept that is taught in virtually every program: the distinction between good and bad touch. Evaluation research has demonstrated that this is a difficult concept for young children to learn and retain. This paper offers the hypothesis that the reason for this difficulty can be found in the attribution skills of young children.

Child↗

Some influences of touch and pressure cues on human spatial orientation.

During constant velocity rotation about his recumbent Z axis, a blindfolded subject feels as if he were on an orbital path in the same direction. This experienced motion results from the pattern of touch and pressure stimulation of the body surface. If the subject changes the pressure pattern on his body by bracing himself in the rotating apparatus in different ways, it is possible for him to influence profoundly and systematically his apparent orientation. For example, pressure on the top of his head while he is rotating can make the subject feel he is upside down on a cylindrical path. The changes in apparent ongoing posture elicited by different patterns of pressure cues are very similar for different subjects and are constant for the same subject over time. During experienced orbital motion, a subject will hear a continuously emitting sound source--one that is stationary in the external environment--as circling his head in the direction opposite that of his true rotation. If the rotating subject is permitted unrestricted sight of his surroundings, he neither experiences orbital motion nor mislocalizes sounds. These observations provide insight into the spatial orientation mechanisms that normally allow an organism to distinguish accurately between those changes in activity at its receptors contingent on its own movements, and those resulting from movement within the environment. They also provide a way of understanding some of the postural illusions experienced during exposure to unusual force environments, including free fall.

Adolescent↗

Therapeutic touch in health visiting practice.

Therapeutic touch has been shown to be effective in treating a wide range of physical and emotional health problems. Jean Sayre-Adams describes the practice of this complementary therapy, and its increasing use by health visitors and nurses.

Clinical Nursing Research↗

Therapeutic touch in primary care.

Therapeutic Touch (TT) is an intervention that may be used in a variety of settings to help patients in their healing processes. This article describes the basic assumptions and framework from which this technique has developed. It includes an explanation of how to perform the technique, resources for study, and more information about TT and related alternative modalities. The author provides descriptions of actual patient interventions from her practice using TT.

Complementary Therapies↗

Multi-site electromyographic analysis of non-contact therapeutic touch.

Therapeutic Touch (TT) has been an active change agent within the field of medicine since its introduction as a nursing intervention in 1975. A critical factor which has been missing from the research conducted in this area, however, is definitive scientific evidence or documentation that TT has an objective quantifiable impact upon the physiology of the subject. This study utilized a randomized ABAC methodological design to investigate the effect of TT without contact (NCTT) upon autonomic and CNS parameters. The subjects were blinded to the true nature of the experimental protocol as well as the fact that a healing study was being conducted in order to control for placebo and expectation effects. The impact of NCTT was assessed by multi-site surface EMG recordings located at the Frontalis, Cervical 4 paraspinals, Thoracic 6 paraspinals, and Lumbosacral 3 paraspinals. Autonomic indicators of physiological activity were also monitored and included hand and head temperature, heart rate, and end tidal CO2 levels. The results demonstrated that all of the autonomic indicators showed a general trend towards lower levels of arousal over time. The data also showed that three of the four muscle regions monitored--C4, T6, and L3 paraspinals--indicated a significant reduction in energy during and following the NCTT treatment sessions for a majority of the subjects. For example, the C4 EMG showed a significant NCTT treatment effect (F = 10.31; df = 1; p < .009 level), while the T6 EMG (F = 13.49; df = 1; p < .004) and L3 EMG (F = 4.74; df = 1; p < .05) also demonstrated significance. In addition to the habituation effects seen in the autonomic variables, the implications of neutralization of postural homeostasis and lowering of emotional arousal are discussed along with consideration of the Eastern concept of "nadis."

Adult↗

Four hugs a day using therapeutic touch.

Imagine a prescription which prescribed four hugs per day to a patient suffering from depression. Hanning described findings that four hugs per day was an antidote for depression, eight hugs per day would achieve mental stability and twelve hugs per day would achieve real psychological growth. If this is the case, touch has a greater significance than most of us would realise. The following assignment was written whilst I was undertaking ENB 176 using reflective practice to explain the benefits or problems in using certain techniques.

Adult↗

Effects of gentle human touch on preterm infants: pilot study results.

A pilot study was conducted to evaluate the effects of gentle human touch (GHT) provided for 15 minutes a day to preterm infants from day 7 to day 12 of life. The study suggested that GHT has no adverse effects on the oxygen saturation or heart rate levels of small preterm infants and that GHT has a soothing effect as evidenced by decreased levels of active sleep, motor activity, and behavioral distress. These results can provide NICU nurses with a basis for guiding parents in their early interactions with preterm infants in the NICU.

Female↗

[Concurrent characterization of spinal amino acid release and touch-evoked allodynia produced by spinal glycine or GABAA receptor antagonists].

BACKGROUND: Previous work has shown that spinal strychinine (STR; glycine antagonist) or bicuculline (BIC; GABAA antagonist) yields a touch-evoked allodynia (TEA) that was blocked by NMDA receptor antagonists and that spinal NMDA receptor activation evokes glutamate release. In the present study, we examined the effects of spinal STR and BIC on TEA and the spinal release of amino acids, and spinal NMDA receptor activation with intrathecal NMDA. METHODS: In halothane-anesthetized (1.0%) Sprague-Dawley rats, TEA was assessed after intrathecal injection of STR (3 micrograms) or BIC (10 micrograms). TEA was scored as 0: no appearance to 3: strong agitation and was evaluated at 10-min intervals after injection of the drugs. Simultaneously, spinal release was monitored by using a microdialysis probe implanted into the lumbar subarachnoid space four days prior to the experiment. Glutamate (Glu) and taurine (Tau) in dialysates were measured by HPLC-UV. To assess the contribution of presynaptic glutaminergic neuron, the effects of intrathecal NMDA (3 micrograms) combined with either STR or BIC on spinal release were also examined. RESULTS: Time course of average TEA scores after intrathecal STR or BIC was similar at 10, 20 and 30 min (STR: 1.6, 0.3, 0; and, BIC: 1.8, 0.9, 0.1). Intrathecal BIC alone evoked a transient spinal release of Glu and Tau with increases by 54% and 68% respectively in the 0-10min samples while STR exerted no effect. Intrathecal NMDA faciliated the effects of BIC and STR on TEA score and spinal release of Glu and Tau. CONCLUSION: It is suggested that the development of allodynia may result from either a loss of GABAA inhibition on the presynaptic terminals and/or by a loss of postsynaptic glycine inhibition, the former facilitating spinal glutamate release, and the latter not.

Amino Acids↗

Abnormal tactile experience early in life disrupts active touch.

The importance of early tactile experience in the development of discriminative somatomotor function was assessed by examining the proficiency and movement strategies of rats raised without normal sensory inputs provided by their mystacial vibrissae. Infant-trimmed animals had their whiskers clipped daily from birth to 45 d of age, after which they were allowed to regrow for 60-70 d before initiation of behavioral training, which lasted as long as several months. Adult-trimmed animals had their whiskers trimmed for comparable periods during adulthood. Rats were tested on one of two tactile discriminations, rough versus smooth or rough versus rough, that differed with respect to the overall size of their surface features. Whisker movements during task performance were examined in detail using video-based motion analysis software. Infant-trimmed animals performed rough versus smooth discriminations as well as adult-trimmed rats or normally reared animals. Except for one subject, infant-trimmed rats were severely impaired in their ability to distinguish rough versus rough surfaces. Deficits persisted in spite of months of training with the regrown vibrissae. The animals that failed to master this task displayed whisking patterns that notably lacked frequencies in the normal range of 6-12 Hz. Thus, abnormal tactile experience early in life substantially, and perhaps permanently, impairs sensorimotor integration underlying active touch.

Animals↗

[Teaching therapeutic touch: report of an experience].

The present study shows the experience of learning Therapeutic Touch (concepts and technique) lived by nurses and nursing students in Brazil. The students' perception was registered when they were learning the process. The chief promoter is the nurse Dolores Krieger who has taught this technique at New York University for nurses as part of their master or doctoral programs. The authors verified that most part of the students increased their sensibility to perceive symptoms detectable by T.T.

Health Knowledge, Attitudes, Practice↗

An innovative approach to pain management in critical care: therapeutic touch.

Nursing research suggests that pain in critically ill patients is inadequately controlled and has deleterious effects. The critical care nurse must depend on the patient's perception of pain and its expression in physiological and behavioural responses. Ventilatory support, fluctuating levels of consciousness, hemodynamic instability and severity of illness are often barriers to the expression and interpretation of pain. This article includes a review of the nursing literature pertaining to pain management in the critically ill patient. Existing practices are examined and alternative approaches explored. Therapeutic touch (TT), one innovative approach, is proposed as an adjunct to pharmacological intervention TT is a non-invasive, holistic practice that promotes comfort, relaxation, stress reduction and heating. Clinical studies suggest that TT prolongs the interval between analgesies. The authors highlight the 10-year clinical experience of a critical care nurse practising TT in a 30-bed critical care and trauma centre.

Critical Care↗

Effects of dialogue and therapeutic touch on preoperative and postoperative experiences of breast cancer surgery: an exploratory study.

PURPOSE/OBJECTIVES: To obtain preliminary data and determine the feasibility of a large-scale experimental study to test the efficacy of the Rogerian Science of Unitary Human Beings-based intervention of dialogue and therapeutic touch (TT) on pre- and postoperative anxiety and mood and postoperative pain from breast cancer surgery. DESIGN: Experimental. SETTING: Mid-Atlantic region; ambulatory. SAMPLE: 29 Caucasian and 2 African American English-speaking women with positive breast cancer biopsy (experimental, n = 14; control, n = 17), ranging in age from 31-84 years old (F = 55.6). METHODS: Treatments administered in subjects' homes within seven days prior to surgery and 24 hours after hospital discharge. Experimental treatment consisted of 10 minutes of TT and 20 minutes of dialogue. Control treatment consisted of 10 minutes of quiet time and 20 minutes of dialogue. Data (Spielberger State-Trait Anxiety Inventory. Affects Balance Scale, and Visual Analog Scale-Pain) were collected at the conclusion of each home visit. MAIN RESEARCH VARIABLES: Anxiety, mood, and pain. FINDINGS: The experimental group had lower preoperative state anxiety than the control groups (p = 0.008). No difference was found for preoperative mood. No differences were found for any postoperative measure. CONCLUSIONS: A large-scale study of dialogue and TT would require changes in design and recruitment strategies. IMPLICATIONS FOR NURSING PRACTICE: Nurses may provide more comprehensive care by incorporating dialogue and TT or quiet time into their pre- and postoperative care. Additional research, however, is recommended to determine the differential effects of dialogue, TT, and quiet time on women's experiences with breast cancer prior to incorporating these noninvasive modalities into clinical practice.

Adult↗

Computer-automated dementia screening using a touch-tone telephone.

BACKGROUND: This study investigated the sensitivity and specificity of a computer-automated telephone system to evaluate cognitive impairment in elderly callers to identify signs of early dementia. METHODS: The Clinical Dementia Rating Scale was used to assess 155 subjects aged 56 to 93 years (n = 74, 27, 42, and 12, with a Clinical Dementia Rating Scale score of 0, 0.5, 1, and 2, respectively). These subjects performed a battery of tests administered by an interactive voice response system using standard Touch-Tone telephones. Seventy-four collateral informants also completed an interactive voice response version of the Symptoms of Dementia Screener. RESULTS: Sixteen cognitively impaired subjects were unable to complete the telephone call. Performances on 6 of 8 tasks were significantly influenced by Clinical Dementia Rating Scale status. The mean (SD) call length was 12 minutes 27 seconds (2 minutes 32 seconds). A subsample (n = 116) was analyzed using machine-learning methods, producing a scoring algorithm that combined performances across 4 tasks. Results indicated a potential sensitivity of 82.0% and specificity of 85.5%. The scoring model generalized to a validation subsample (n = 39), producing 85.0% sensitivity and 78.9% specificity. The kappa agreement between predicted and actual group membership was 0.64 (P<.001). Of the 16 subjects unable to complete the call, 11 provided sufficient information to permit us to classify them as impaired. Standard scoring of the interactive voice response-administered Symptoms of Dementia Screener (completed by informants) produced a screening sensitivity of 63.5% and 100% specificity. A lower criterion found a 90.4% sensitivity, without lowering specificity. CONCLUSIONS: Computer-automated telephone screening for early dementia using either informant or direct assessment is feasible. Such systems could provide wide-scale, cost-effective screening, education, and referral services to patients and caregivers.

Aged↗

No-touch technique for intraocular malignant melanomas.

Large variations in intraocular pressure occur during enucleation, scleral depression, 32P testing, and vigorous rubbing of an eye. Data from animal studies show that during a critical phase of an intraocular malignant melanoma, ocular massage significantly decreased longevity due to increased metastastic disease. We report "no-touch" technique to prevent tumor spread from occurring secondary to ocular manipulation during enucleation. This technique avoids IOP elevations above 50 mm Hg before freezing completely around the tumor, thereby preventing flow of fluid and blood to or from the tumor prior to the manipulation necessary for enucleation. Theoretically, the patient with an ocular tumor should be warned against vigorous rubbing of his eyes and hard lid squeezes or diagnostic techniques that elevate IOP. The ophthalmologist should perform enucleation with gentieness and avoid pressure on the globe. Patients who are being followed up with a suspected ocular tumor should be warned not to rub or vigorously squeeze their eyelids.

Animals↗

No-touch technique for reducing aortic wall trauma during renal artery stenting.

Cholesterol embolism, a serious but infrequent complication of renal artery stenting, may be avoided by minimizing contact between the guide catheter and the atherosclerotic aorta. In this report, we illustrate the "no-touch" technique for stenting renal arteries. By placing a second 0.035-inch J-wire within the guide catheter during cannulation of the renal artery to prevent the tip of the guide from rubbing the aortic wall, we minimize the contact between the guide catheter and atherosclerotic plaques and reduce the potential for intimal disruption and cholesterol embolization.

Arteriosclerosis↗

The use of touch preparations (tissue imprints) in the rapid intraoperative diagnosis of metastatic lymph node disease in cancer staging procedures.

Three hundred lymph nodes submitted for the intraoperative diagnosis of metastatic disease were studied by use of touch preparations (TP), i.e., tissue imprints, using the modification previously described by the senior author, the conventional frozen section (FS), and permanent sections. There were 215 negative and 85 positive lymph nodes. Compared with permanent sections, TP gave an accuracy of 99% and the FS an accuracy of 98.7%. In view of this reliability and the significant saving of valuable intraoperative time provided by the TP technique, we recommend that TP be used instead of the FS in cancer staging procedures where many lymph nodes are submitted for immediate intraoperative examination for the determination of extent of surgery.

Diagnostic Errors↗

Quick diagnosis of malignant melanoma with the touch-fluorescence method during operation.

Nine cases of primary melanotic melanoma, three cases of metastatic amelanotic melanoma, and 26 cases of pigmented and unpigmented tumors other than melanoma were examined with the touch-fluorescence method using preparations from the cut surface of the lesions. Fluorescent melanoma cells were easily detected with a fluorescence microscope in all the cases of malignant melanoma whether the melanoma was melanotic or amelanotic. The fluorescent melanoma cells could be divided into three types by configuration: round, spindle-shaped, and pleomorphic. The main cell type of superficial spreading melanoma was round and that of nodular melanoma and acral lentiginous melanoma was chiefly pleomorphic. Fluorescent tumor cells were not seen in pigmented and unpigmented tumors other than melanoma, except in pigmented basal cell epithelioma; this fact made it possible to apply this method routinely for quick diagnosis of malignant melanoma during operation.

Adult↗