Multifactorial motor behavior assessment for real-time evaluation of emerging therapeutics to treat neurologic impairments.

Integrating multiple assessment parameters of motor behavior is critical for understanding neural activity dynamics during motor control in both intact and dysfunctional nervous systems. Here, we described a novel approach (termed Multifactorial Behavioral Assessment (MfBA)) to integrate, in real-time, electrophysiological and biomechanical properties of rodent spinal sensorimotor network activity with behavioral aspects of motor task performance. Specifically, the MfBA simultaneously records limb kinematics, multi-directional forces and electrophysiological metrics, such as high-fidelity chronic intramuscular electromyography synchronized in time to spinal stimulation in order to characterize spinal cord functional motor evoked potentials (fMEPs). Additionally, we designed the MfBA to incorporate a body weight support system to allow bipedal and quadrupedal stepping on a treadmill and in an open field environment to assess function in rodent models of neurologic disorders that impact motor activity. This novel approach was validated using, a neurologically intact cohort, a cohort with unilateral Parkinsonian motor deficits due to midbrain lesioning, and a cohort with complete hind limb paralysis due to T8 spinal cord transection. In the SCI cohort, lumbosacral epidural electrical stimulation (EES) was applied, with and without administration of the serotonergic agonist Quipazine, to enable hind limb motor functions following paralysis. The results presented herein demonstrate the MfBA is capable of integrating multiple metrics of motor activity in order to characterize relationships between EES inputs that modulate mono- and polysynaptic outputs from spinal circuitry which in turn, can be used to elucidate underlying electrophysiologic mechanisms of motor behavior. These results also demonstrate that proposed MfBA is an effective tool to integrate biomechanical and electrophysiology metrics, synchronized to therapeutic inputs such as EES or pharmacology, during body weight supported treadmill or open field motor activities, to target a high range of variations in motor behavior as a result of neurological deficit at the different levels of CNS.

Neuroimaging results, short-term assessment of psychomotor development and the risk of autism spectrum disorder in extremely premature infants (≤28 GA) - a prospective cohort study (preliminary report).

OBJECTIVE: Infants ≤28 GA are at particular risk of psychomotor and neurological developmental disorder. They also remain at a higher risk of developing autism spectrum disorder (ASD), characterized by persistent deficits in communication/social interactions and restricted, repetitive behaviors, activities and interests. Monitoring their development by a team of specialists (a neurologist, psychologist, psychiatrist) allows us to make an early diagnosis and to implement appropriate therapy. Neuroimaging studies during the neonatal period may be helpful in clarifying diagnosis and prognosis. Objective: The aim of the study was to search for the interrelation between the results of neuroimaging and the neurological, psychological and psychiatric evaluation at the age of 2. PATIENTS AND METHODS: Material and methods: Neonates born at ≤28 weeks between 01.06.2013 and 31.12.2015 and hospitalized at NICU were enrolled. We present the results of the first 12 children who have attained 2 years of corrected age and have undergone both neuroimaging, and neurological, psychological and psychiatric assessments. Transfontanel ultrasound was performed according to general standards, MRI between 38 and 42 weeks of corrected age. Neurological examination based on the Denver scale, ASD screening with use of the STAT test and psychological DSR assessment were performed at 2 years of corrected age. RESULTS: Results: Median GA was 26 weeks and median weight 795 g. The ultrasound examination was normal in 9 cases (75%) and MRI in 4 (33%). Abnormalities in the cerebellum were the main additional information found in MRI as compared to US. Neurological examination was normal in 8 infants (67#37;), in 4 of whom neuroimaging was normal. In 4 (33%) infants the neurological examination was abnormal. Psychomotor development at an average level or above was found in seven (58#37;) children. In 4 of them neuroimaging was normal, whereas 3 had ventricular dilatation and haemorrhagic infarct. There were no abnormalities within the cerebellum in this group. In the remaining 5 children (42#37;) psychomotor development was rated as delayed. All of them had cerebellar haemorrhage. An increased risk of ASD was observed in 4 children who developed cerebellar hemorrhage. CONCLUSION: Conclusions: 1. The use of MRI at a term-equivalent age may contribute to the prognosis of neurodevelopmental outcomes in extremely premature infants, allowing risk stratification and thus enhancing early monitoring of a child's development and functional status 2. There is a clear tendency towards abnormal psychomotor development and positive screening for ASD to co-occur with abnormal MRI findings in the cerebellum.

Evaluating the motor slowing hypothesis of depression.

The purpose of this study was to evaluate the hypothesis that processing speed deficits are the primary cognitive deficits in those with depression, consistent with the motor slowing hypothesis. Participants (n=223) were research volunteers who served in the US military since September 11, 2001, and denied a history of significant brain injuries. Depression was measured using a structured interview, the Personality Assessment Inventory (PAI), and the Beck Depression Inventory-II (BDI-II). Outcomes included performance on 10 processing speed variables. Invalid performance/report accounted for significant variance for 8 of 10 processing speed measures. There was not a consistent pattern of slowed processing speed in those with current depressive diagnoses compared to those without. However, depression symptom burden per the PAI Depression scale was significant for 7 of 10 processing speed tests. Only non-dominant fine motor dexterity was significantly slower in those with high versus low burden using BDI-II quartiles. Thus, the motor slowing hypothesis was supported, but only for depression burden and not diagnostic status or high versus low categorical classification. These results underscore the importance of validity assessment and consideration of how one measures psychiatric constructs when evaluating relations among symptoms and cognition.

Video-based eye tracking for neuropsychiatric assessment.

This paper presents a video-based eye-tracking method, ideally deployed via a mobile device or laptop-based webcam, as a tool for measuring brain function. Eye movements and pupillary motility are tightly regulated by brain circuits, are subtly perturbed by many disease states, and are measurable using video-based methods. Quantitative measurement of eye movement by readily available webcams may enable early detection and diagnosis, as well as remote/serial monitoring, of neurological and neuropsychiatric disorders. We successfully extracted computational and semantic features for 14 testing sessions, comprising 42 individual video blocks and approximately 17,000 image frames generated across several days of testing. Here, we demonstrate the feasibility of collecting video-based eye-tracking data from a standard webcam in order to assess psychomotor function. Furthermore, we were able to demonstrate through systematic analysis of this data set that eye-tracking features (in particular, radial and tangential variance on a circular visual-tracking paradigm) predict performance on well-validated psychomotor tests.

Oculometric Assessment of Sensorimotor Impairment Associated with TBI.

PURPOSE: Diffuse tissue damage from impact or blast traumatic brain injury (TBI) degrades information processing throughout the brain, often resulting in impairments in sensorimotor function. We have developed an eye-movement assessment test, consisting of a simple, appropriately randomized, radial tracking task together with a broad set of oculometric measures that can be combined to yield a sensitive overall indicator of sensorimotor functional status. We show here that this multidimensional method can be used to detect and characterize sensorimotor deficits associated with TBI. METHODS: To compare dynamic visuomotor processing of TBI subjects (n = 34) with a separate control population (n = 41), we used the Comprehensive Oculometric Behavioral Response Assessment (COBRA) method (Liston & Stone, J Vision. 14:12, 2014) to quantify 10 performance metrics for each subject. Each TBI subject's set of oculometrics was then combined to compute a single TBI impairment vector whose magnitude we refer to as the impairment index. RESULTS: In our TBI population, several individual oculometrics were significantly degraded, including pursuit latency, initial pursuit acceleration, pursuit gain, catch-up saccade amplitude, proportion smooth tracking, and speed responsiveness. Furthermore, the TBI impairment index discriminated TBI subjects from controls with an 81% probability that increased with self-reported TBI severity; although the 9 subjects self-reporting "little-to-no" residual impairment were statistically indistinguishable from controls (58% probability), the remaining 25 subjects were easily detectable (91% probability). Given the demonstrated link between higher-order visual perception/cognition and eye movements, we interpret the observed TBI-related impairments as degradations in the speed, accuracy, and precision of information processing within cortical circuits supporting higher-order visual processing and sensorimotor control, not just low-level brainstem motor deficits. CONCLUSIONS: We conclude that multidimensional oculometric testing could be used as a sensitive screen for subtle neurological signs of subclinical neurological insults, to quantify functional impairment, to monitor deterioration or recovery, and to evaluate treatment efficacy.

Neurobehavioral assessment of children presenting diverse congenital cardiopathologies.

Brain maturation in 1-36 month old children suffering from congenital cardiopathologies was assessed after a study of psychomotor development. The Rogers' test (Rogers et al., Developmental programming for infants and young children. Volume 2. Early intervention developmental profile, Revised edition, ESL/ELT Michigan, Ann Arbor, 1981) was applied to 65 children, of whom 21 presented with simple cardiopathologies (CpS) and 22 with complex cardiopathologies (CpC). All children were matched by age, sex and socioeconomic status to 22 healthy children in a control group (C). Mean differences between the three groups were established by applying the Kruskal-Wallis test, and mean differences between the C and CpS/CpC groups were determined using the Mann-Whitney test. The proportion of cases evaluated as "low" in each group was calculated by applying the Rogers' test, and a test of proportion differences was applied between the C and CpS/CpC groups. CpS children performed similarly to the C, whereas CpC children scored significantly lower than C children on all variables. It is highly likely that the suboptimal psychomotor performance observed in CpC children was due to compromised hemodynamics and related to subclinical immaturity of cerebral development.

Reliability and validity of age band 1 of the Movement Assessment Battery for Children--second edition.

The purpose of this study was to examine specific aspects of the reliability and validity of age band 1 of the Movement Assessment Battery for Children--Second Edition (MABC-2) (Henderson, Sugden, & Barnett, 2007) in Greek preschool children. One hundred and eighty-three children participated in the study; the children ranged in age from 36 to 64 months old (M = 50 months, SD = 9 months). Test-retest reliability of the MABC-2 was evaluated using intraclass correlation coefficient (ICC). Cronbach's alpha for the items of each motor domain was estimated to determine internal consistency. Confirmatory factor analysis was used to examine the factorial validity of the MABC-2 test. Correlation coefficients among individual item scores and the total score were also calculated to further examine validity. The ICC for all test items was good, except for the drawing trail task, which was moderate. Cronbach's alpha coefficient values were .51, .70 and .66 for manual dexterity, aiming and catching, and balance, respectively. In the confirmatory factor analysis, goodness-of-fit indices suggested a satisfactory fit of the data to the model. The correlation coefficients between each test item and the total score were moderate. The results suggest that the MABC-2 can be a reliable and valid tool for the assessment of movement difficulties among 3-5-year-old children.

Assessment of cardiac autonomic nervous activity in frail elderly people with postural abnormalities and in control subjects.

Heart rate variability (HRV), which is considered to reflect the activity of the autonomic nervous system (ANS), has been shown to decline with age. The aim of the present study was to explore cardiac ANS in older patients showing frontal-subcortical dysfunction with "Psychomotor Disadaptation Syndrome" (PDS), through the 24-h HRV. We enrolled 14 patients with PDS (mean age: 84.5+/-6.9 years), they were compared to 13 frail control subjects (mean age: 80.6+/-6.7 years). Cardiac ANS activity was assessed by 24-h ECG recordings from three leads with a Holter digital monitor. The decrease in cardiac ANS activity observed in PDS subjects was greater than the alteration found in normally aging subjects. The abnormalities of ANS that aggravate the effects of aging can be seen as a type of physical deconditioning. Such patients could benefit from particular attention in physical training.

Socioeconomic status, anthropometric status, and psychomotor development of Kenyan children from resource-limited settings: a path-analytic study.

BACKGROUND: Sub-optimal physical growth has been suggested as a key pathway between the effect of environmental risk and developmental outcome. AIM: To determine if anthropometric status mediates the relation between socioeconomic status and psychomotor development of young children in resource-limited settings. STUDY DESIGN: A cross-sectional study design was used. SUBJECTS: A total of 204 (105 girls) children from two resource-limited communities in the Coast Province, Kenya. The mean age of these children was 29 months (SD = 3.43; range: 24-35 months). OUTCOME MEASURE: Psychomotor functioning was assessed using a locally developed and validated measure, the Kilifi Developmental Inventory. RESULTS: A significant association was found between anthropometric status (as measured by weight-for-age, height-for-age, mid-upper arm circumference, and head circumference) and psychomotor functioning and also between socioeconomic status and anthropometric status; no direct effects were found between socioeconomic status and developmental outcome. The models showed that weight, height and to a lesser extent mid-upper arm circumference mediate the relation between socioeconomic status and developmental outcome, while head circumference did not show the same effect. CONCLUSION: Among children under 3 years living in poverty, anthropometric status shows a clear association with psychomotor development while socioeconomic status may only have an indirect association.

Task-switching in schizophrenia: active switching costs and passive carry-over effects in an antisaccade paradigm.

It has been hypothesized that impaired task-switching underlies some of the behavioural deficits in schizophrenia. However, task-switching involves many cognitive operations. In this study our goal was to isolate the effects on latency and accuracy that can be attributed to specific task-switch processes, by studying the inter-trial effects in blocks of randomly mixed prosaccades and antisaccades. By varying the preparatory interval between an instructional cue and the target, we assessed the costs of both (1) an active reconfiguration process that was triggered by the cue, and (2) passive carry-over effects persisting from the prior trial. We tested 15 schizophrenic subjects and 14 matched controls. A very short preparatory interval increased error rates and saccadic latencies in both groups, but more so in schizophrenia, suggesting difficulty in rapidly activating saccadic goals. However, the contrast between repeated and switched trials showed that the costs of task switching in schizophrenia were not significantly different from the controls, at either short or long preparatory intervals, for both antisaccades and prosaccades. These results confirm prior observations that passive carry-over effects are normal in schizophrenia, and show that active reconfiguration is also normal in this disorder. Thus problems with executive control in schizophrenia may not affect specific task-switching operations.

[Backward disequilibrium in the elderly: review of symptoms and proposition of a tool for quantitative assessment]. / La rétropulsion du sujet âgé: mise au point sur un symptôme grave et proposition d'une échelle pour une évaluation quantifiée.

PURPOSE: Although there is currently no epidemiological data on backward disequilibrium, this disturbance of posture does not seem to be rare in frail elderly. ACTUALITIES AND STRONG POINTS: Backward disequilibrium is characterized by the following criteria: the location of buttocks on the anterior side of the seat while the trunk rested at the back of the armchair in the sitting position; an inadequate forward of the trunk and a backward projection of the trunk outside the base of support during sit-to-stand; and a posterior projection of the center of mass outside the base of support in the standing position. Several pathological situations either somatic (degenerative, ischemic and traumatic brain lesions), psycho-somatic (psychomotor disadaptation syndrome, extended bed confining, non-use) or psychological (depression) affections can entail backward disequilibrium. Falls, loss of autonomy and the risk of the vicious circle with its causes are the main consequences of backward disequilibrium. PROSPECTS AND PROJECTS: Although the geriatrician is familiarized with backward disequilibrium, there is no scale to quantify it. In this paper we review causes, consequences and management of backward disequilibrium, and in order to assess it, we propose a semi-quantitative scale, based on some activities of everyday living which are sitting position, sit-to-stand, back-to-sit and standing position. So, a backward disequilibrium score could be determined.

Quantitative assessment of neuromotor function in adolescents with high functioning autism and Asperger Syndrome.

BACKGROUND: Motor impairment in children with Asperger Syndrome (AS) or High functioning autism (HFA) has been reported previously. This study presents results of a quantitative assessment of neuromotor skills in 14-22 year old HFA/AS. METHODS: 16 HFA/AS and 16 IQ-matched controls were assessed by the Zurich Neuromotor Assessment (ZNA). RESULTS: The HFA/AS group showed strongest impairments of dynamic balance skills and diadochokinesis. Motor abilities were associated with degree of social withdrawal in the full sample and severity of current autistic symptoms in the HFA/AS group. CONCLUSION: Similar motor patterns as in younger children were found in the older adolescents. The association of autistic symptoms with motor performance points towards an essential role of motor impairment in autism spectrum disorders.

Pre- and post-right middle cerebral artery stroke in a young adult: a case study examining the sensitivity of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).

Right-hemisphere strokes are associated with a number of neurobehavioral deficits. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a relatively new, but widely used screening battery; however, there is little published research in patients who have sustained strokes. We present a rare case of stroke in a 22-year-old psychiatric patient, who received neuropsychological evaluations before and after sustaining a right middle cerebral artery (MCA) stroke. The RBANS demonstrated sensitivity to post-stroke changes despite pre-stroke cognitive impairments and a complex psychiatric overlay, with the Visuospatial/Constructional index being one of the most sensitive indicators of right hemisphere dysfunction. Line Orientation fell from normal to defective levels; these findings were associated with decline in related standard neuropsychological measures.

Getting the run around: accessing services for children with developmental co-ordination disorder.

BACKGROUND: Accessing services for children with developmental co-ordination disorder (DCD) is frequently difficult for parents who have to navigate both health and education systems to find a diagnosis and appropriate interventions. METHOD: A qualitative study design incorporating a phenomenological perspective was utilized to understand the nature of the experiences of these parents in attempting to access support for their children with DCD. Twelve parents, whose children attended the Kids Skills Clinic at the University of Western Ontario and were identified as having DCD, were interviewed by the second author. Interviews were transcribed verbatim and analysed using constant comparative method. Member checking, peer checking and code-recoding were carried out to enhance rigour in data analysis. RESULTS: A number of themes emerged focusing on the common problems experienced leading to occupational therapy referral. Parents' journeys to seek and access services for their children with DCD were characterized by a sense of maternal knowing, experience of frustration, trivialization of the problem, a sense of 'going it alone', and 'getting the run around'. CONCLUSIONS: Implications for health and educational professionals working with children, in terms of recognition of DCD and referral for services, are described.

Validation of a Developmental Neuropsychological Assessment (NEPSY) through comparison of neurological, scholastic concerns, and control groups.

Validity of the standard, 13 subtest A Developmental Neuropsychological Assessment (NEPSY) was investigated by comparing scores for 30 children with neurological conditions, 35 children with scholastic concerns, and 39 controls. Overall differences were found among the groups with and without controlling for IQ (Lambda = .60, Lambda = .001; Lambda = .70, P < .001). Four of five NEPSY domain scores differed among the three groups. Language and Sensorimotor domain score differences were found even when IQ was controlled, and group status accounted for substantial variance in these domain scores. Regarding specific tasks, Phonological Processing and Fingertip Tapping were among the subtests that varied the most between groups, especially when children with scholastic concerns were compared with controls. Findings offer preliminary support for the validity of several NEPSY indexes.

Clumsiness, dyspraxia and developmental co-ordination disorder: how do health and educational professionals in the UK define the terms?

At the turn of the century, the idea that there might be a discrete childhood syndrome, which had 'clumsiness' of movement as its defining symptom, began to emerge. Since then numerous labels have been applied to the syndrome. In spite of recent attempts to standardise the terminology used, variation continues to compromise inter-professional communication and interpretation of research. The aim of this study was to determine how the three terms 'Clumsy', 'Dyspraxia' and 'Developmental Co-ordination Disorder (DCD)' are viewed by health and educational professionals in the UK. Two hundred and thirty-four adults (57% from the health professions and 43% from education) provided a written definition of each term. Content analysis of the 702 definitions was used to determine: (1) the extent to which the terms were familiar/acceptable to the respondents; and (2) to capture differences in the meaning of the term being defined. The results indicated that the terms 'DCD' and 'Dyspraxia' were less familiar than the term 'clumsy' which was, however, least acceptable. Amongst those professionals who were familiar with all three terms, there was general agreement that all were used to describe some sort of overall movement difficulty. Beyond that point, divergence of understanding and inter-professional differences in emphasis emerged. The implications of these differences for clinical and educational practice, research and policy making are discussed.

[Clinical and fine motor therapy assessment in Wilson disease]. / Klinische und feinmotorische Therapiekontrolle bei Morbus Wilson.

At the time of diagnosis and after therapy, we examined 33 patients suffering from Wilson's disease. We applied a standardized diagnostic score system on the basis of clinical signs. Without observing any differences between pseudoparkinsonian and pseudosclerosis subtypes, patients with neurological symptoms significantly improved by 2.33 points. Patients with initially more severe symptoms showed the same improvement as less affected patients. Fine motor disturbances were evaluated using the V-scope system. Finger tapping and drawing a spiral were compared to values of a healthy control group (n = 52). Patients with neurological symptoms showed significantly decreased frequencies in both tests. The clinical score was related to frequencies in finger tapping but not in drawing a spiral. Therefore finger tapping can be used as an objective diagnostic tool to evaluate the severity of Wilson's disease, while spiral testing appears to be a sensitive screening tool.

Assessment of neglect reveals dissociable behavioral but not neuroanatomical subtypes.

In the current study, we investigated whether standard assessment techniques of visuospatial neglect are sensitive to detecting dissociable subtypes. We administered a battery of tasks commonly used to detect the presence of visuospatial neglect to 120 patients with unilateral right hemisphere infarcts and, in most cases, performed a systematic analysis of their lesions to quantify and localize brain damage. Using a factor analysis, we discovered seven relatively independent constructs, three of which were specifically related to the presence of left hemispatial neglect: Left Attentional Processing, Line Bisection, and Word Reading. Impairments in two of these factors, Left Attentional Processing and Line Bisection, occurred together in most cases but also occurred independently in 38 cases. There were no cases in whom Word Reading was present without concomitant deficits in one or the other two factors. These three factors could not be distinguished neuroanatomically; that is, lesions were equally likely in the temporal/parietal cortex, dorsolateral frontal cortex, or in deep frontal structures. These data confirm the notion that hemispatial neglect is a complex and multifaceted disorder composed of cognitively independent processes. These processes, however, cannot be dissociated neuroanatomically based on currently available assessment techniques.

The good side after stroke: ipsilateral sensory-motor function needs careful assessment.

Twenty subjects were examined 4-6 weeks after stroke to establish whether a sensory-motor ipsilateral deficit occurs early after stroke. Each underwent a timed test of repetitive side-to-side movement of both the upper and lower limbs ipsilateral to the cerebral infarct, and an assessment of motor disability using the Motor Assessment Scale. Results were compared with a group studied almost a year after their stroke, and with 41 age-matched healthy volunteers. There was a significantly worse performance (p < 0.005) on the right ipsilateral side, but not the left ipsilateral side, compared with normal volunteers, a finding similar to that of a group previously studied about a year after the stroke. There was no relationship between the severity of the motor deficit and performance of the side, possibly owing to reduction in cerebral activation as a result of a right hemispheric lesion. These observations have importance in rehabilitation and education as well as practical skills, including driving a car and maintaining balance.