Inhibitory Control of Adjacent Finger Movements while Performing a Modified Version of the Halstead Finger Tapping Test: Effects of Age, Education and Sex.

OBJECTIVE: Selective motor inhibition is known to decline with age. The purpose of this study was to determine the frequency of failures at inhibitory control of adjacent finger movements while performing a repetitive finger tapping task in young, middle-aged and older adults. Potential education and sex effects were also evaluated. METHODS: Kinematic recordings of adjacent finger movements were obtained on 107 healthy adults (ages 20-80) while they performed a modified version of the Halstead Finger Tapping Test (HTFF). Study participants were instructed to inhibit all finger movements while tapping with the index finger. RESULTS: Inability to inhibit adjacent finger movements while performing the task was infrequent in young adults (2.9% of individuals between 20 and 39 years of age) but increased with age (23.3% between the ages of 40 and 59; 31.0% between ages 60 and 80). Females and males did not differ in their inability to inhibit adjacent finger movements, but individuals with a college education showed a lower frequency of failure to inhibit adjacent finger movements (10.3%) compared to those with a high school education (28.6%). These findings were statistically significant only for the dominant hand. CONCLUSION: Selective motor inhibition failures are most common in the dominant hand and occur primarily in older healthy adults while performing the modified version of the HFTT. Monitoring selective motor inhibition failures may have diagnostic significance.

Kinematic recordings while performing a modified version of the Halstead Finger Tapping Test: Age, sex, and education effects.

Introduction: This study attempts to demonstrate that kinematic recordings of finger movements help explain the well-known effects of age, education, and sex on the Halstead Finger Tapping Test (HFTT). Method: High-speed kinematic recordings were obtained on 107 healthy adults (ages 21 to 80 years) while they performed a modified version of the Halstead Finger Tapping Test (HFTT). The number of "valid" taps and "invalid" taps (i.e., lever movements that did not produce an increase in the mechanical number count), tapping speed variability, "learning" and "fatigue" effects was obtained. Results: Previous age, education, and sex effects were replicated. Males had faster start and stop times when finger tapping and these measures correlated with the number of valid taps per 10 s. Educational level correlated with start times, not stop times. Age correlated only with the number of valid taps. Variability of tapping movements correlated with the number of invalid taps, but not valid taps. Females had more invalid taps than males. Fatigue and learning effects were independent of the person's age, education, and sex. Conclusion: Kinematic recordings of finger tapping help explain the well-known age, education, and sex effects on finger tapping speeds. A modified method of administrating the HFTT is also introduced to assess fatigue and learning effects while performing this task.

Vitamin d is related to gait recovery after total hip arthroplasty: A prospective analysis.

OBJECTIVES: To investigate the association between baseline serum levels of 25-hydroxyvitamin D (25(OH)D) and gait pattern in patients undergoing total hip arthroplasty (THA). METHODS: Prospective study of patients with hip osteoarthritis undergoing primary THA between January 2012 and December 2013. Blood samples were collected on the day of hospital admission. Gait analyses were performed before surgery and 3 months postoperatively. Internal moments were captured. RESULTS: Major improvements were observed in gait data after THA. 25(OH)D levels correlated with change in peak extension (R=0.25, p=0.017) and peak power generation (R=0.25, p=0.04). Multiple linear regression analyses were performed. In model 1, 25(OH)D and change in gait speed explained the variability of peak extension (R2=0.1, p=0.004). In model 2, only 25(OH)D explained the variability of peak power generation (R2=0.05, p=0.044). CONCLUSIONS: 25(OH)D levels were correlated with change in peak extension and peak power generation. The effect of 25(OH)D on change in gait variables after THA is modest.

Incidence of infectious complications in hip and knee arthroplasties in rheumatoid arthritis and osteoarthritis patients.

INTRODUCTION: Rheumatoid arthritis (RA) is one of the major indications of total hip (THA) or knee (TKA) arthroplasty. International studies have suggested that RA is a risk factor for prosthesis infections. OBJECTIVES: To compare patients with RA and patients with osteoarthritis (OA) of other etiologies with regard to the incidence of prosthesis, incisional, and other systemic postoperative infections in THA and TKA. METHODS: Retrospective, comparative cohort of patients followed up after undergoing THA or TKA at the Hospital SARAH-Brasília, from 1996 to 2007. RESULTS: Seventy-five arthroplasties (28 TKA and 47 THA) were identified in RA patients. As controls, 131 surgeries (56 TKA and 75 THA) in OA patients were randomly selected and stratified by surgery and gender. No significant difference was observed between the RA and OA groups regarding the rates of prosthesis infections (TKA 7.1% vs. 0% and THA 2.1% vs. 0%, respectively, both with P > 0.1), incisional infections (TKA 14.3% vs. 3.3% and THA 4.3 vs. 1.3%, respectively, both with P > 0.1), and systemic infections (TKA 7.1% vs. 3.6%, P = 0.92 and THA 4.3% vs. 10.7%, P > 0.1, respectively). After multiple logistic regression, the results did not change. CONCLUSIONS: RA was not identified as a risk factor for perioperative infections in THA and TKA in this case series of the Hospital SARAH-Brasília, as compared with the group of patients with primary OA or OA secondary to non-inflammatory diseases. The low incidence of infections in both groups may explain our findings.

Incidence of regional pain syndrome after carpal tunnel release. Is there a correlation with the anesthetic technique?

BACKGROUND AND OBJECTIVES: Complex regional pain syndrome (CRPS) previously known as reflex sympathetic dystrophy refers to a set of signs and symptoms that include pain, increased sweating, and vasomotor instability. Pain is usually triggered by a noxious stimulus in a peripheral nerve, which is disproportionate to the triggering stimulus. Its development after surgery is not uncommon varying with the type of intervention. An incidence of 2.1 to 5% has been reported after carpal tunnel release (CTR). Sympathetic blockade may prevent the onset of CRPS. However, there is no study validating this technique to prevent CRPS after CTR. The objective of the present study was to define the incidence of CRPS after CTR and its relationship with four anesthetic techniques. METHODS: Patients were randomly distributed to undergo one of the following techniques: general anesthesia, regional intravenous anesthesia with lidocaine, regional intravenous anesthesia with lidocaine and clonidine, or axillary plexus block. Postoperatively, they were followed-up by a nurse who was unaware of the anesthetic technique used, and follow-up was done through electronic patient records for up to 6 months after the anesthesia. During this period signs and symptoms typical of CRPS were investigated and, if positive, treatment was instituted. A descriptive evaluation using the chi-square test was performed. RESULTS: Three-hundred and one patients were investigated. Twenty-five of them developed CRPS, an incidence of 8.3%. Predominance was not observed among the anesthetic techniques used. Other factors such as smoking, profession, and other concomitant diseases were also investigated, and none showed a relationship with the development of post-CTR CRPS. CONCLUSIONS: Complex regional pain syndrome has an incidence of 8.3% after CTR surgery without association with the anesthetic techniques investigated.

Effect of isolated anticonvulsant drug use and associated to midazolam as pre-anesthetic medication on the Bispectral Index (BIS) in patients with cerebral palsy.

BACKGROUND AND OBJECTIVES: Patients with cerebral palsy (CP) frequently receive drugs for the treatment of concomitant diseases, such as seizures. Midazolam is a benzodiazepine with hypnotic action most often used as pre-anesthetic medication and its drug interactions in patients with CP are unknown. The objective of the present study was to evaluate the effect of midazolam as pre-anesthetic drug on the BIS of patients with CP undergoing chronic treatment with anticonvulsant agents. METHOD: Three groups of patients were assessed: CP without anticonvulsant treatment, CP undergoing treatment with anticonvulsant and a group with no disease and no medication use (control group). On the day before the surgery, with the patients conscious and in dorsal decubitus, the BIS monitor was placed and the basal BIS values were recorded. On the following day, 40 minutes before the surgery, the patients received 0.6 mg*kg(-1) of midazolam orally. Before the start of the anesthetic procedure, the same procedure for BIS recording was carried out after midazolam administration. RESULTS: A total of 107 patients were studied - 39 patients from the Control Group (CG) and 68 with a diagnosis of CP. Among these, 17 used anticonvulsant drugs. Regarding the mean BIS value after the midazolam administration, there was no difference between patients from the CG and those in the CP group that did not take anticonvulsant drugs, whereas the ones who took anticonvulsants exhibited a difference (p = 0.003). The possibility of decrease in the BIS after midazolam use increases according to the number of anticonvulsant drugs used by the patient. CONCLUSIONS: The chronic use of anticonvulsants associated to oral midazolam as pre-anesthetic medication can lead to the decrease in the BIS values, which configures deep level of hypnosis.

Computerized procedure for analyzing hand kinematics with a peg-moving task (Sarah-Pegworks).

This article describes Sarah-Pegworks, a computerized procedure for analyzing hand kinematics based on the peg-moving task. The procedure, developed in Visual Basic 6 programming language, includes (1) processing raw data from an infrared motion-tracking system, (2) identifying movement components, and (3) analyzing and presenting hand kinematic information in numerical and graphic outputs. Fifty-five normal adults set the parameters relative to filtering and movement identification. A case was presented to illustrate the clinical value of this procedure.