Breaking the operator variability in Kibler's scapular dyskinesis assessment.

INTRODUCTION: Alterations of scapular kinematics are generically reported as scapular dyskinesis (SD), and are a nonspecific response to various shoulder pathologies. The most widely used classification is Kibler's (K), which is, however, characterized by poor sensitivity. To overcome this limit, using a 3D motion analysis system, we identified a specific pattern for each type of SD according to Kibler. MATERIALS AND METHODS: We analyzed 34 patients with a total of 68 shoulders who came to our observation for shoulder pain. All patients underwent clinical examination, video-recording and motion analysis with SHoW Motion 3D kinematic tracking system (SM). Three independent observers classified SD into K types I, II and III. Only patients with concordant classification among the 3 operators were studied to identify a characteristic graphic pattern by type of SD. RESULTS: Typical patterns emerged from the examination with SM. K. type 1 consists of decreased or reversed posterior tilt and increased protraction in flexion-extension (FE) in early degrees of motion. K. type 2 consists of increased protraction and marked reversal of lateral rotation in abduction-adduction (Ab-Ad) in early degrees of movement. K. type 3 has been subdivided into two subgroups: K. type 3-A, composed of patients with massive rotator cuff lesions, shows an increase in all scapular movements in both FE and Ab-Ad. K. type 3-B, composed of patients with scapular stiffness and/or impingement, presents a slight increase in posterior tilt and lateral rotation in the final grades of FE and Ab-Ad. CONCLUSIONS: The SM system allows reproducible dynamic analyses with low intra- and intra- operator variability. In our study, we demonstrated its applicability in the classification of SD. It also provides an objective and quantitative assessment of motor pattern alteration that is essential in the follow-up of patients to evaluate the effectiveness of rehabilitation and/or surgical treatment. LEVEL OF EVIDENCE 3: According to "The Oxford 2011 Levels of Evidence".

A computer tablet software can quantify the deviation of scapula medial border from the thoracic wall during clinical assessment of scapula dyskinesis.

PURPOSE: Aim of this study is to establish an objective and easily applicable method that will allow clinicians to quantitatively assess scapular dyskinesis during clinical examination using a computer tablet software. Hypothesis is that dyskinetic scapulae present greater motion-deviation from the thoracic wall-compared to the non-dyskinetic ones and that the software will be able to record those differences. METHODS: Twenty-five patients and 19 healthy individuals were clinically evaluated for the presence of dyskinesis or not. According to the clinical diagnosis, the observations were divided into three groups; A. Dyskinetic scapulae with symptoms (n = 25), B. Contralateral non-dyskinetic scapulae without symptoms (n = 25), C. Healthy control scapulae (n = 38). Then, all individuals were tested using a tablet with the PIVOT™ image-based analysis software (PIVOT, Impellia, Pittsburgh, PA, USA). The motion produced by the scapula medial border and inferior angle deviation from the thoracic wall was recorded. RESULTS: The deviation of the medial border and inferior angle of the scapula from the thoracic wall was 24.6 ± 7.3 mm in Group A, 14.7 ± 4.9 mm in Group B, and 12.4 ± 5.2 mm in Group C. The motion recorded in the dyskinetic scapulae group was significantly greater than both the contralateral non-dyskinetic scapulae group (p < 0.01) and the healthy control scapulae group (p < 0.01). CONCLUSION: The PIVOT™ software was efficient to detect significant differences in the motion between dyskinetic and non-dyskinetic scapulae. This system can support the clinical diagnosis of dyskinesis with a numeric value, which not only contributes to scapula dyskinesis grading but also to the evaluation of the progress and efficacy of the applied treatment, thus providing a feedback to the clinician and the patient. LEVEL OF EVIDENCE: IV, laboratory study.

Neurological outcomes of congenital Zika syndrome in toddlers and preschoolers: a case series.

BACKGROUND: Congenital Zika syndrome causes a spectrum of neurological symptoms with varying effects on function that require different therapeutic strategies. To date, this spectrum of effects and its clinical implications have not been completely described. We describe the neurological examination findings in toddlers and preschoolers, including predominant symptom complexes and comorbidities. METHODS: This study is a case-series neurological evaluation of 75 children with congenital Zika syndrome in Campina Grande, Brazil. The study is part of a cohort of children with congenital Zika syndrome that started in 2015 and is still ongoing. Children with Zika virus infection detected during pregnancy (mothers exhibited rash and were followed and diagnosed by fetal ultrasound abnormalities or RT-PCR) or through microcephaly screening after birth, using Intergrowth 21 guidelines, were selected by laboratory and radiological criteria. Children were examined during a 10-day period in September, 2018, and underwent neurological interview, examination, and assessment of functional outcomes and comorbidities. Children were divided in groups of predominant corticospinal or neuromuscular clinical signs and the associations between these groups and clinical comorbidities were assessed. FINDINGS: All of the children recruited to the study from Nov 29, 2015 to Nov 30, 2017 had imaging correlates of congenital Zika syndrome. Children were assigned to groups depending on the signs exhibited, either corticospinal or neuromuscular, with or without dyskinetic signs. 75 children completed the evaluation, 38 (51%) girls and 37 (49%) boys. Median age was 33 months (range 26-40 months; IQR 29-34). Microcephaly was present at birth in 56 (75%) children, and 19 (25%) children were born with normal head circumference, 15 of whom later developed microcephaly. Neurological examination grouped four children as having isolated dyskinetic signs, 48 children were assigned to the corticospinal group and 23 into the neuromuscular group. Dyskinetic findings were present in 30 (40%) children, either alone (four [5%]) or combined with corticospinal (19 [40%] of 48) or neuromuscular (seven [30%] of 23) findings. Comorbidities were highly prevalent, and the neuromuscular group had worse functional outcomes, evaluated by gross motor function (p=0·026), manual abilities (p=0·0013), and communication function (p<0·0005) classification scales, than the corticospinal group, whereas pneumonia (p<0·0005) and urinary tract infections (p<0·0005) were more frequent in the corticospinal group. Cortical hyperexcitability was supported by several clinical correlates, such as early onset epilepsy, persistence of primitive reflexes, and dystonia. INTERPRETATION: We describe distinct neurological profiles in the congenital Zika syndrome spectrum, with functional outcomes tending to correlate with these groups. The clinical division of children based on the disease signs proposed here is supported by the literature on central and peripheral nervous system pathology in congenital Zika syndrome. The high prevalence of dyskinetic symptoms merits special attention. FUNDING: Brazilian National Council for Scientific and Technological Development and by the Coordination for the Improvement of Higher Education Personnel.

ENT involvement and orobuccal movements' disorders in Pandas patients: assessment and rehabilitations tools.

OBJECTIVE: PANDAS are known as the spectrum of autoimmune pathologies related to a previous or current infection by group A beta-hemolytic streptococcus (SBEGA), dealing with several neuropsychiatric manifestations that mainly affect pediatric age. The main features consist of behavioral disease or movement disease characterized by acute-onset, presenting especially through infant period or adolescence. Specific manifestations, occurring during the progression of the disease, are the presence of otorhinolaryngologic symptoms (ENT) and orofacial movement disorders associated with temporomandibular joint pain. PATIENTS AND METHODS: We enrolled 130 children (5-15 years) with a clinical diagnosis of PANDAS between 2012 and 2018. Participants were assessed using ENT specific parameters, PSG to examine respiratory disorders and conventional audiological evaluation. Descriptive and comparative statistical analyses were performed with a control group of 51 healthy patients. RESULTS: The prevalence of ENT symptoms associated was significantly detected in 88 patients of 130 in Group A (relative frequency (%) 67.6; p=0.041) and in 51 patients of 130 in the control Group B (relative frequency (%) 39.2; p=0.063). In relation to prevalence of SDB, 54 subjects have presented nocturnal respiratory obstructive symptoms from mild to severe (relative frequency (%) 61.3; p=0.033) vs. 20 patients of Group B (relative frequency (%) 39.2; p=0.055). The obstructive severity average type was correlated to the consensual adenotonsillar development (size 3-4), (relative frequency (%) 45.4; p=0.047). The audiological deficits found were mostly of transmissive type with OME correlated and linked to the presence of occasional episodes of AOM. The four PANDAS patients who presented orobuccal dystonia (relative frequency (%) 4.54; p=0.091) achieved an improvement of the algic symptoms through the exercises of self-rehabilitation. CONCLUSIONS: Findings from our study show that respiratory diseases, characterizing a group of patients with pandas, are the direct consequences of the malformed or hypertrophic condition and suggesting in these conditions surgical therapy as an approaching tool.

Development of the clinical assessment scale in autoimmune encephalitis.

OBJECTIVE: There is no scale for rating the severity of autoimmune encephalitis (AE). In this study, we aimed to develop a novel scale for rating severity in patients with diverse AE syndromes and to verify the reliability and validity of the developed scale. METHODS: The key items were generated by a panel of experts and selected according to content validity ratios. The developed scale was initially applied to 50 patients with AE (development cohort) to evaluate its acceptability, reproducibility, internal consistency, and construct validity. Then, the scale was applied to another independent cohort (validation cohort, n = 38). RESULTS: A new scale consisting of 9 items (seizure, memory dysfunction, psychiatric symptoms, consciousness, language problems, dyskinesia/dystonia, gait instability and ataxia, brainstem dysfunction, and weakness) was developed. Each item was assigned a value of up to 3 points. The total score could therefore range from 0 to 27. We named the scale the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The new scale showed excellent interobserver (intraclass correlation coefficient [ICC] = 0.97) and intraobserver (ICC = 0.96) reliability for total scores, was highly correlated with modified Rankin scale (r = 0.86, p < 0.001), and had acceptable internal consistency (Cronbach α = 0.88). Additionally, in the validation cohort, the scale showed high interobserver reliability (ICC = 0.99) and internal consistency (Cronbach α = 0.92). INTERPRETATION: CASE is a novel clinical scale for AE with a high level of clinimetric properties. It would be suitable for application in clinical practice and might help overcome the limitations of current outcome scales for AE. ANN NEUROL 2019;85:352-358.

Instrument-based assessment of motor function yields no evidence of dyskinesia in adult first-degree biological relatives of individuals with schizophrenia and schizoaffective disorder.

There is accruing evidence of spontaneous dyskinesia in individuals with schizophrenia that is independent of medication exposure. Dyskinetic motor behavior is also present in individuals who are at high risk of schizophrenia and appears to have prognostic value for the development of psychosis. Nonetheless, it remains unclear whether dyskinesia is present in first-degree relatives of individuals with schizophrenia and thus associated with genetic liability for schizophrenia (i.e., an endophenotype), or whether the motor abnormality is a biomarker specific to the disease state spectrum. There is also limited information about links between dyskinesia and clinically relevant phenomena such as symptoms and cognition. Because dyskinesia marking genetic liability is likely to be subtle, we used sensitive instrument-based measurement of handwriting fluency to quantify dyskinesia in medicated individuals with schizophrenia or schizoaffective disorder, unaffected first-degree biological relatives of individuals with schizophrenia and schizoaffective disorder, and control participants. Results indicated that medicated individuals with schizophrenia or schizoaffective disorder exhibited more dyskinesia than both relatives and controls, with no difference between relatives and controls. Dyskinesia in individuals with schizophrenia or schizoaffective disorder was unrelated to current antipsychotic medication dosage, but associated with worse working memory function and greater positive formal thought disorder. These results provide evidence that dyskinesia is not associated with unexpressed genetic liability for schizophrenia.

A Transitional Probability Model for Parkinson's Disease Motor States With Applications to Missing Data.

BACKGROUND: Parkinson's disease (PD) is a progressive neurodegenerative disorder with significant disability. Subjects with advanced PD often suffer from motor complications that may interfere significantly with their daily activities. Levodopa (LD) in combination with a dopa decarboxylase inhibitor such as carbidopa (CD) is considered the gold standard in the treatment of PD. However, long-term treatment with LD often leads to the development of motor complications. Motor complications include motor fluctuations and dyskinesia. Motor fluctuations are states where the subject cycles between periods of "on" state where subjects are in improved mobility and "off" state where subjects are in impaired mobility. Dyskinesia are the involuntary and irregular twisting and/or turning movements. METHODS: A Markov transitional probability model is proposed to estimate the likelihood of staying in one state versus transitioning from one state to another. RESULTS: An application of the model to an example from a clinical trial investigating the effect of an extended-release carbidopa-levodopa (CD-LD) product versus an immediate-release CD-LD product is illustrated. CONCLUSION: A Markov transitional probability model can be used to model the likelihood of staying in one state versus transitional from one state to another. The model can also be used as a basis for multiple imputation of missing data.

Scapula Dyskinesis: A Review of Current Concepts and Evaluation of Assessment Tools.

Scapula dyskinesis is prevalent in athletes conducting forceful overhead movements. This review summarizes our current understanding of the condition and evaluates the different options for assessing dyskinesis. Current methods for assessing scapula dyskinesis involve clinical observations, three-dimensional kinematics and three-dimensional wing computer tomography. Clinical observation is the most pragmatic method for assessing dyskinesis yielding inter-rater agreement of 79% and sensitivity of 76%. Similar sensitivities have been recorded using three-dimensional kinematics. Three-dimensional wing computer tomography has yielded a near-perfect interclass correlation coefficient of 0.972 when used to assess dyskinesis. Three-dimensional wing computer tomography, given its expense, low availability, and levels of irradiation, should be reserved for high-performance athletes where detailed assessments need to be made to aid rehabilitation. Observational assessments should remain the main modality used for general assessment.

Continuous Assessment of Levodopa Response in Parkinson's Disease Using Wearable Motion Sensors.

OBJECTIVE: Fluctuations in response to levodopa in Parkinson's disease (PD) are difficult to treat as tools to monitor temporal patterns of symptoms are hampered by several challenges. The objective was to use wearable sensors to quantify the dose response of tremor, bradykinesia, and dyskinesia in individuals with PD. METHODS: Thirteen individuals with PD and fluctuating motor benefit were instrumented with wrist and ankle motion sensors and recorded by video. Kinematic data were recorded as subjects completed a series of activities in a simulated home environment through transition from off to on medication. Subjects were evaluated using the unified Parkinson disease rating scale motor exam (UPDRS-III) at the start and end of data collection. Algorithms were applied to the kinematic data to score tremor, bradykinesia, and dyskinesia. A blinded clinician rated severity observed on video. Accuracy of algorithms was evaluated by comparing scores with clinician ratings using a receiver operating characteristic (ROC) analysis. RESULTS: Algorithm scores for tremor, bradykinesia, and dyskinesia agreed with clinician ratings of video recordings (ROC area > 0.8). Summary metrics extracted from time intervals before and after taking medication provided quantitative measures of therapeutic response (p < 0.01). Radar charts provided intuitive visualization, with graphical features correlated with UPDRS-III scores (R = 0.81). CONCLUSION: A system with wrist and ankle motion sensors can provide accurate measures of tremor, bradykinesia, and dyskinesia as patients complete routine activities. SIGNIFICANCE: This technology could provide insight on motor fluctuations in the context of daily life to guide clinical management and aid in development of new therapies.

Correlation of Quantitative Motor State Assessment Using a Kinetograph and Patient Diaries in Advanced PD: Data from an Observational Study.

INTRODUCTION: Effective management and development of new treatment strategies for response fluctuations in advanced Parkinson's disease (PD) largely depends on clinical rating instruments such as the PD home diary. The Parkinson's kinetigraph (PKG) measures movement accelerations and analyzes the spectral power of the low frequencies of the accelerometer data. New algorithms convert each hour of continuous PKG data into one of the three motor categories used in the PD home diary, namely motor Off state and On state with and without dyskinesia. OBJECTIVE: To compare quantitative motor state assessment in fluctuating PD patients using the PKG with motor state ratings from PD home diaries. METHODS: Observational cohort study on 24 in-patients with documented motor fluctuations who completed diaries by rating motor Off, On without dyskinesia, On with dyskinesia, and asleep for every hour for 5 consecutive days. Simultaneously collected PKG data (recorded between 6 am and 10 pm) were analyzed and calibrated to the patient's individual thresholds for Off and dyskinetic state by novel algorithms classifying the continuous accelerometer data into these motor states for every hour between 6 am and 10 pm. RESULTS: From a total of 2,040 hours, 1,752 hours (87.4%) were available for analyses from calibrated PKG data (7.5% sleeping time and 5.1% unclassified motor state time were excluded from analyses). Distributions of total motor state hours per day measured by PKG showed moderate-to-strong correlation to those assessed by diaries for the different motor states (Pearson's correlations coefficients: 0.404-0.658), but inter-rating method agreements on the single-hour-level were only low-to-moderate (Cohen's κ: 0.215-0.324). CONCLUSION: The PKG has been shown to capture motor fluctuations in patients with advanced PD. The limited correlation of hour-to-hour diary and PKG recordings should be addressed in further studies.

The Constant score and the assessment of scapula dyskinesis: Proposal and assessment of an integrated outcome measure.

The Constant-Murley score (CMS) is a popular measure of shoulder function. However, its ability to monitor the evolution of patients during rehabilitation after rotator-cuff repair is controversial. Moreover, CMS does not account for possible alterations in the scapulo-humeral coordination (SHC, scapula dyskinesis), which are apparent in variety of shoulder pathologies. To address these issues, a new formulation of CMS was firstly proposed, which rates the "affected-to-controlateral side difference in SHC" of a patient with respect to reference values of asymptomatic controls (Scapula-Weighted CMS). Then, 32 patients (53±9year-old) were evaluated with CMS and SW-CMS at 45, 70, 90-day and >6-month after rotator-cuff repair, to test three hypotheses: (1) CMS and SW-CMS are largely responsive to change; (2) accounting (SW-CMS) or not (CMS) for scapula dyskinesis leads to statistically different scores and SW-CMS cannot be predicted from CMS without clinically relevant differences; (3) 90% of patients recover a side-to-side SHC similar to asymptomatic controls at 90days. Results supported hypotheses 1 and 2. On the contrary (hypothesis 3), only 10% of patients recovered for SHC alterations at 90days, and 50% at follow-up. These findings support the use of SW-CMS and the importance of treating scapula dyskinesis after rotator-cuff repair.

Assessment of striatal & postural deformities in patients with Parkinson's disease.

BACKGROUND & OBJECTIVES: Though striatal and postural deformities are known to occur commonly in atypical Parkinsonism patients, these may also be seen in patients with Parkinson's disease (PD). These are frequently misdiagnosed as joint or orthopaedic pathology leading to unnecessary investigations. This study was conducted to observe the various striatal and postural deformities among patients with PD in India. METHODS: This study was conducted at a tertiary care teaching institute in north# India. Seventy consecutive patients with PD diagnosed as per the modified UK Brain Bank criteria were included. Various striatal (hand & foot) and postural (antecollis, camptocormia, scoliosis & Pisa syndrome) deformities and their relation with the duration of disease, severity [measured by the Unified Parkinson's Disease Rating Scale (UPDRS)] and levodopa intake were analyzed. RESULTS: Of the 70 patients with PD, 34 (48.57%) had either striatal or postural deformities. Striatal foot was the most common deformity observed (25.71%). Camptocormia was the second most common deformity (20%). Striatal and postural deformities were seen in more advanced PD as suggested by significantly higher UPDRS and Hoehn and Yahr scale (P<0.001). Striatal deformities were more ipsilateral to PD symptom onset side (agreement 94.44%). Pisa and scoliosis concavity were more on contralateral side to PD symptoms onset side (66.67%). INTERPRETATION & CONCLUSIONS: Our results showed that striatal and postural deformities were common and present in about half of the patients with PD. These deformities we more common in patients with advanced stage of PD.

Automatic assessment of medication states of patients with Parkinson's disease using wearable sensors.

Motor fluctuations are a major focus of clinical managements in patients with mid-stage and advance Parkinson's disease (PD). In this paper, we develop a new patient-specific algorithm that can classify those fluctuations during a variety of activities. We extract a set of temporal and spectral features from the ambulatory signals and then introduce a semi-supervised classification algorithm based on K-means and self-organizing tree map clustering methods. Two different types of cluster labeling are introduced: hard and fuzzy labeling. The developed algorithm is evaluated on a dataset from triaxial gyroscope sensors for 12 PD patients. The average result of using K-means and fuzzy labeling on the trunk and the more affected leg sensors' readings was 75.96%, 70.57%, and 86.93% for accuracy, sensitivity, and specificity, respectively. The accuracy for individual patients varied from 99.95% to 42.53%, which was correlated with dyskinesia severity and the improvement of the PD symptoms with medication.

Dynamical learning and tracking of tremor and dyskinesia from wearable sensors.

We have developed and evaluated several dynamical machine-learning algorithms that were designed to track the presence and severity of tremor and dyskinesia with 1-s resolution by analyzing signals collected from Parkinson's disease (PD) patients wearing small numbers of hybrid sensors with both 3-D accelerometeric and surface-electromyographic modalities. We tested the algorithms on a 44-h signal database built from hybrid sensors worn by eight PD patients and four healthy subjects who carried out unscripted and unconstrained activities of daily living in an apartment-like environment. Comparison of the performance of our machine-learning algorithms against independent clinical annotations of disorder presence and severity demonstrates that, despite their differing approaches to dynamic pattern classification, dynamic neural networks, dynamic support vector machines, and hidden Markov models were equally effective in keeping error rates of the dynamic tracking well below 10%. A common set of experimentally derived signal features were used to train the algorithm without the need for subject-specific learning. We also found that error rates below 10% are achievable even when our algorithms are tested on data from a sensor location that is different from those used in algorithm training.

Differentiation of pseudodyskinesis of inferior left ventricular wall from inferior myocardial infarction by assessment of regional myocardial strain using two-dimensional speckle tracking echocardiography.

PURPOSE: To differentiate pseudodyskinesis (PD) of the inferior left ventricular (LV) wall from inferior myocardial infarction (IMI) noninvasively, we performed focal site evaluation using two-dimensional speckle tracking transthoracic echocardiography (TTE). MATERIALS AND METHODS: Speckle tracking TTE was carried out in 57 patients, with 19 subjects in each of three groups (Group A, suspected PD; Group B, LV IMI; and Group C, controls). Inferior wall PD was defined as follows: compression of the inferior LV wall by the diaphragm in the LV short axis view with a normal electrocardiogram and no evidence of previous ischemic events. RESULTS: Respective values in Groups A-C for LV ejection fraction (EF) were 63.6 ± 4.2%, 52.3 ± 7.6%, and 61.5 ± 3.8%, for inferior wall speckle tracking focal site evaluation peak radial strain of 30.0 ± 14.3%, 7.5 ± 7.1%, and 42.1 ± 22.9%, for peak circumferential strain of 23.1 ± 6.0%, 16.8 ± 8.4%, and 22.7 ± 7.1%, and for longitudinal strain in the mid-inferior wall of 18.4 ± 3.4%, 11.4 ± 4.0% and 15.8 ± 5.9%. LVEF values were significantly lower in Group B than Groups A and C (P<0.001), as were those of radial, circumferential, and longitudinal strains (P<0.05). In receiver-operating characteristic analysis the optimal cut-off values with corresponding sensitivities and specificities for differentiation of PD from IMI were >19% with 84.2% and 94.7% for radial, >15% with 89.4% and 52.6% for circumferential, and >15% with 73.6% and 100% for longitudinal strain, respectively. CONCLUSIONS: Determination of regional strain from speckle tracking TTE, especially radial and longitudinal strains, can provide focal and quantitative noninvasive evaluation for distinguishing PD of the inferior wall from IMI.

On automated assessment of Levodopa-induced dyskinesia in Parkinson's disease.

A method for the analysis of accelerometer and gyroscope signals in order to automatically assess the Levodopa-induced dyskinesia (LID) in patients with Parkinson's disease is presented in this paper. Several accelerometers and gyroscopes are placed on certain positions on the subject's body and the obtained signals are analyzed in order to extract several features that depict the energy distribution over the frequency spectrum and the non-linear properties of the signal. These features are fed into an artificial neural network which is used for LID detection and severity classification. The method has been evaluated using a group of 29 subjects. Results are presented related to the body locations that the accelerometers and the gyroscopes are placed. The obtained results indicate high classification ability (84.3% average classification accuracy).

Evaluation of abnormal synergy patterns poststroke: relationship of the Fugl-Meyer Assessment to hemiparetic locomotion.

BACKGROUND: Assessment of poststroke motor impairment has historically focused on the ability to move within and outside of abnormal synergistic motor patterns and is typically quantified by the Fugl-Meyer Assessment (FMA). However, it is unclear if the voluntary, isolated movement tasks of the FMA are appropriate for evaluating walking task-specific motor control requirements because walking is cyclical and involves considerable sensorimotor integration. OBJECTIVE: The purpose of this study is to test whether the motor impairment measured by the FMA is indicative of motor dysfunction during walking in poststroke adults. METHODS: Thirty-four individuals with chronic poststroke hemiparesis and 17 healthy controls walked for 60 seconds on an instrumented treadmill while recording electromyographic activity (EMG) from 8 lower extremity muscles. EMG recordings were also obtained during the FMA for those with hemiparesis to examine muscle activation patterns. Each participant was examined with a battery of walking-specific clinical and biomechanical assessment tools and stratified based on the FMA synergy (FMS) score. To further quantify muscle activation patterns during walking, a nonnegative matrix factorization (NNMF) determined the number of independent modules required to describe 90% of the total variance in the EMG patterns. RESULTS: Stratification poorly differentiated motor activation across FMA tasks as well as EMG patterns during walking. While FMS correlated with 2 of 6 walking assessments, the number of EMG modules significantly correlated with all 6 walking performance measures. CONCLUSIONS: Voluntary, discrete activities as performed in the FMA may be inadequate to capture the complex motor behavior in walking. Conversely, walking-specific evaluations such as NNMF appear more appropriate.

[Dyskinesia in Parkinson's disease--major clinical features, aetiology, therapy]. / Dyskinesien bei Morbus Parkinson--Klinik, Atiologie, Therapie.

Parkinson's disease (PD), a slowly, progressive degenerative disorder of the central nervous system, which affects about ten million people world-wide, is currently treated symptomatically. Current treatment aim i. e. to balance the decreased dopamine turnover in striatal neurons. Chronic exposure to dopaminergic agents, however, supports onset of motor complications and dyskinesia in the long term. Dyskinesia appear mainly as chorea, athetosis, dystonia, stereotypia, ballism or a combination. Sometimes excessive abnormal facial, body and limb movements depend on the overall dosage of dopaminergic substitution. This is why the main therapy is based on reducing the total dosage of dopaminergic substances. Either alternative or additional well-tried substances like apomorphine, amantadine or clozapine are used. New possibilities in treatment emerge from substances like sarizotan, istradefylline, fipampezol or talampanel. Even so disability and reduced quality of life in PD patients and their caregivers may exist. This survey describes the major clinical features, aetiology and demographics of treatment-associated dyskinesia in PD.

Predictive value of assessment of general movements for neurological development of high-risk preterm infants: comparative study.

AIM: To assess the predictive value of normal, abnormal, or absent general movements in high-risk preterm infants for the later neurological development. METHODS: The study involved 120 high-risk preterm infants (gestational age, < or =37 weeks) having at least three or more antenatal, perinatal, or neonatal risk factors for impaired neurological development, and 112 age-matched controls. The method of general movements of fidgety character assessment was compared with classical neurological examinations performed longitudinally until the corrected age of two years. The age-adequate neurological examinations based on the criteria by Amiel-Tison and Grenier and Illingworth were used. Specialists in clinical psychology also monitored the child's development. The results of specialists' examinations were taken into account. RESULTS: Out of 83 high-risk preterm infants with normal fidgety movements, 81 (97%) had a normal neurological outcome. Abnormal or absent fidgety movements were followed by abnormal neurological outcome in 30 (81%) out of 37 infants. Cerebral palsy was diagnosed in 13 children, mental retardation in one, whereas 16 children had both cerebral palsy and mental retardation. The validity of the general movement assessment was 92%, sensitivity 94%, specificity 92%, positive predictive value 81%, and negative predictive value 98%. These values were better than those of the classical neurologic examination (60%, 97%, 43%, 44%, and 97%, respectively). CONCLUSION: The method of general movement assessment had significantly better validity, sensitivity, specificity, positive, and negative predictive value than classical neurological examination of high-risk preterm infants.

Assessment of motor behavior using a video system and a clinical rating scale in parkinsonian monkeys lesioned by MPTP.

The best current model of Parkinson's disease is the primate treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Quantification of animal movement is important for the study of severity of parkinsonian syndrome induced by MPTP and response to drug treatments. Both require clinical rating scales that measure motor behavior with well-defined objective items. However, evaluations using these scales depend on the observer scoring the different items, according to his/her experience. The video image analyzer system, which produces an activity curve in correlation with the visual study of animal motor behavior, offers an automatic evaluation method that is observer-independent and reproducible. Using such an system we defined items correlated with those used in clinical rating scales that are sensitive to animal motor changes, decrease in movements with MPTP intoxication and alleviation afforded by levodopa: global locomotor activity and specific activities (climbing, social interactions, eating and drinking behaviors).