Two-dimensional coherence for measurement of asymmetry in postural steadiness.

Two-dimensional magnitude squared coherence (2D-MSC) is developed to compare the two-valued time series which represent the center of pressure (COP) under each foot. A sinusoidal multiple taper spectral estimator is used to reduce bias and improve spectral resolution. The measure is applied to evaluate symmetry in the dual-plate postural steadiness time series obtained from healthy young and elderly volunteers, and patients with Huntington's Disease (HD), a group in which asymmetries in postural steadiness are anticipated. The results demonstrate that the 2D-MSC is a robust measure of inter-limb coordination that may be of value in studies of aging and neurologic disease.

Analysis of gait abnormalities in Huntington disease.

OBJECTIVE: To evaluate patterns of successful gait strategy in Huntington disease (HD) at various stages of illness to improve fall avoidance and maintenance of independence. DESIGN: Repeated measurements of gait kinematic parameters and joint performance during gait cycles of six HD patients compared to 30 age-matched controls. SETTING: A standard gait laboratory. SUBJECTS: Six HD patients, rank-ordered for disease severity from minimal chorea to generalized dystonia, selected because they were ambulatory despite 3 to 17 years' disease duration. One patient was from a nursing home (walked with assistance) and five were living independently, either alone or with a working spouse who was the caregiver. MAIN OUTCOME MEASURES: Standardized gait evaluations (retroreflective markers on standard bony landmarks) from five video angles, fed into digitizer to computer-generate joint angles and standard gait kinematic parameters. RESULTS: Wide variability in gait kinematic parameters and joint interaction plots (phase plane and angle-angle plots) was observed between individuals and successive trials of the same limb, tending to increase with disease severity. Joint interaction plots show that random, highly variable distractions from planned trajectories are more apparent distally. CONCLUSIONS: Chorea in HD does not appreciably affect the center of gravity during ambulation, and the consistency of gait profiles at heel strike shows that the ultimate target is achieved in each step despite random and frequent variability during the gait cycle.

Approximate minimum bias multichannel spectral estimation for heart rate variability.

Spectral decomposition of variations in heart rate permits noninvasive measurement of autonomic nervous activity in humans and animals. Autonomic metrics based on spectral analysis are useful in monitoring clinical conditions such as diabetic neuropathy and reinnervation in heart transplant patients. A persistent problem in deriving such autonomic measures is the prerequisite of an accurate and unbiased power spectrum of heart rate variability (HRV). Numerous parametric and nonparametric power spectrum estimators have been introduced, each with its own advantages and drawbacks. Estimator bias has received little attention, despite the fact that at least one common HRV spectrum estimator, the autoregressive method, is known to exhibit bias even in idealized circumstances. We introduce an approximately minimum bias, nonparametric, multichannel spectrum estimation procedure for HRV and contemporaneous signals. The procedure, which is designed specifically for irregular sampling, does not require data segmentation and provides statistically consistent, low variance multichannel spectrum estimates. Estimator performance on simulated and clinical data is presented and compared with results from autoregressive models and Welch periodograms with and without compensation for irregular sampling. Results indicate that the proposed method exhibits advantages over conventional HRV spectrum estimators. Relative computational complexity of the proposed method is also considered.

Measures of postural steadiness: differences between healthy young and elderly adults.

Measures of postural steadiness are used to characterize the dynamics of the postural control system associated with maintaining balance during quiet standing. The objective of this study was to evaluate the relative sensitivity of center-of-pressure (COP)-based measures to changes in postural steadiness related to age. A variety of time and frequency domain measures of postural steadiness were compared between a group of twenty healthy young adults (21-35 years) and a group of twenty healthy elderly adults (66-70 years) under both eyes-open and eyes-closed conditions. The measures that identified differences between the eyes-open and eyes-closed conditions in the young adult group were different than those that identified differences between the eye conditions in the elderly adult group. Mean velocity of the COP was the only measure that identified age-related changes in both eye conditions, and differences between eye conditions in both groups. The results of this study will be useful to researchers and clinicians using COP-based measures to evaluate postural steadiness.

Evaluation of nonlinear dynamics in postural steadiness time series.

Fractal and correlation dimensions have been computed for time series obtained from tests of balance (postural steadiness). Although these measures appear to be reliable and differentiate subject groups, it has become clear that random (noise) time series may have finite dimensions and appear to demonstrate dynamics characteristic of nonlinear systems. Consequently, it is necessary to apply a test to distinguish a time series with putative nonlinear dynamics from random noise. A simple predictor was utilized to compare center of pressure (COP) time series with surrogate data constructed to have similar time and frequency domain characteristics. It was found that the original time series was more predictable than the surrogate data, suggesting that the COP data is derived from a nonlinear system.

Effect of an abdominal binder during wheelchair exercise.

The purpose of this study was to determine whether use of an abdominal binder would affect oxygen uptake, trunk range of motion, and duration of the stroke phase during wheelchair propulsion. The subjects were six paraplegic wheelchair athletes with T1-T6 injuries and no abdominal muscle function. Each subject performed two trials, one while wearing the binder and one without the binder. Each trial consisted of submaximal and maximal exercise tests conducted on wheelchair rollers. Oxygen uptake was determined by open circuit spirometry while heart rate was determined by telemetry. Max VO2 values averaged 2.51 l.min-1 while average maximum heart rate values were 190 b.min-1. A 3-D video-based motion analysis system was used to obtain kinematic parameters of wheelchair propulsion. In general, 30% of the cycle time was comprised of the stroke phase, while 70% was comprised of the recovery phase across speeds. There were no statistically significant effects of the abdominal binder on any of the cardiovascular or kinematic variables at submaximal or maximal levels of exercise. Under the conditions of this laboratory investigation, it appears that an abdominal binder does not alter physiological or selected biomechanical measures in highly trained athletes.

Contrast enhancement in spinal nerve roots: an experimental study.

PURPOSE: To examine histopathologically the endothelium of contrast-enhancing spinal nerve roots. METHODS: In five adult baboons, chronic compression of the left S-1 spinal nerve root sufficient to produce a change in the evoked potential was produced by means of a suture tied around the nerve. The animals were studied with MR at 8 and 16 days after nerve compression and then killed for histopathologic and electron microscopic studies. Histopathologic changes in the nerve roots demonstrating contrast enhancement were described. RESULTS: In all compressed spinal nerves, contrast enhancement was observed. Histopathologically, wallerian degeneration of the root and inflammation and disruption of the endothelium of capillaries in the spinal nerve were evident. CONCLUSIONS: Degenerative changes in the nerve root and the capillary endothelium of a lumbar spinal nerve are associated with contrast enhancement.

Vascular effects of spinal cord stimulation in the monkey.

Because of clinical reports suggesting beneficial effects of electrical stimulation in peripheral vascular disease, studies have been conducted in the monkey. Regional blood flow was measured prior to, during and following the application of electrical currents to the spinal cord. The flow measurements were made using radioactive microspheres. In addition, tissue temperatures and venous and arterial concentrations of epinephrine and norepinephrine were measured. The results show that electrical stimulation increases blood flow to the skin and muscle. It is hypothesized that the effect is due to sympathetic inactivation secondary to the application of electrical currents.

Fibrillation induced at powerline current levels.

Electrical fibrillation of the human heart results in many unfortunate deaths. Because little information is available on short duration high current fibrillation, current levels below 1 and 50 A were used to induce ventricular fibrillation in hogs. Application times ranged between 16 ms and 3 s. Fibrillation was only produced when currents were applied during the T-wave period of the cardiac cycle. However, only 50 percent of the current application during the T-wave caused fibrillation. The total body resistance of the hogs was also measured at the high voltages and currents. The average resistance for 90 current applications was 284 omega. Trends in the data show that the total resistance decreases for increasing voltage, for increasing electrode size, and for current applications following the first current application.

Cord/spine motion in experimental spinal cord injury.

We examined cord motion and cord-spine coupling associated with the axial tension and dorsal impact models of spinal cord injury. In 20 cats, distraction forces up to 15 kg were applied. Five microliters of radiopaque agent was injected into the central cord at C4-C7 (14 cats) and T6-L1 (6 cats) at 2-mm intervals. In 20 cats, 300 g/cm impacts were delivered after injection of contrast at 2-mm intervals from the impact point. Trials were conducted under fluoroscopy. At 5-kg distraction, vertebral motion averaged 2.12 mm and cord motion averaged 1.03 mm (coupling ratio = .49). At 10-kg coupling increased to .75. Between 10 and 15-kg distraction, the amount of increase in cord length slowed, as did the ratio (.59). Differences in length between load groups were significant at most levels, and motion corresponded with histologic injury reported previously. In the thoracolumbar region, minimal spine motion and no cord motion occurred. Spine motion was not seen with dorsal impact although cord motion at 2 mm from impact averaged 1.3 mm/300 g/cm, which decreased away from the impact point. The spinal cord has limited elasticity, which may be related to injury. Because spine and cord motion occur in clinical injury, experimental models need to incorporate this element.

Experimental spinal cord injury produced by axial tension.

Fifty cats underwent spine distraction with forces applied until the evoked potential (EP) amplitude was reduced 50 or 95%. Neurologic status and EPs were monitored for up to 6 weeks. Fifty percent reduction occurred at (x) = 4.2-kg distraction/kg body weight (BW); 95% at 7.4 kg distraction/kg BW: differences were significant (p less than .05). The 50% group showed quadriparesis at 24 hours (Tarlov 1), improving by 4 weeks (x = 3). Ninety-five percent-group animals were quadriplegic initially, progressing to Tarlov 2.2. Residual EP changes occurred, particularly in the 95% group. Early histologic changes included central necrosis and neuronal chromatolysis. Later, axon disruption was observed, with cystic degeneration and gliosis at 4-6 weeks. Tissue damage correlated with ultimate neurologic status. Correlations between latency changes and early neurologic status, and between amplitude and histology were observed. The axial tension model may be of value in the study of spinal cord injury mechanisms.

Stiffness and strain energy criteria to evaluate the threshold of injury to an intervertebral joint.

This study is focused to evaluate the threshold of injury to an intervertebral joint based on its mechanical response. The load-deflection behavior of the intervertebral joint indicated non-linear and sigmoidal characteristics with continuously changing stiffness (a measure of the ability to withstand external force). The load corresponding to the point of zero stiffness was identified, according to the classical theories of mechanics, as the maximum load carrying capacity. Further, the initiation of trauma was defined to occur at the point on the load-deflection curve at which the stiffness begins to decrease for the first time. The load, stiffness and energy absorbing capabilities of normal and degenerated intervertebral joints at the initiation of trauma was determined. Axial compressive load experiments were conducted on nine intervertebral joints of fresh human male cadavers and the resulting load-deflection responses were transformed into stiffness-deflection responses using the derivative principle. Energy characteristics were also derived. Load, stiffness and energy at the initiation of trauma were found to be 9.0 kN, 2850 N mm-1, and 10.2 J for normal and 4.4 kN, 1642 N mm-1, and 5.8 J for degenerated segments, respectively. The load and energy values at failure were 11.0 kN, and 18.0 J for normal and 5.3 kN and 5.7 J for degenerated intervertebral joints, respectively.

Comparison of the compression strength of human vertebral bodies with the mass and density of apatite: a study by 31P NMR spectroscopy.

The force needed to fracture individual human thoracic and lumbar vertebral bodies is compared with the mass and density of apatite. 31P NMR spectrometry was used to quantify the apatite, because it permits the mineral content of bone to be determined noninvasively with minimal nonspecific interference from the organic matrix or from variations in composition of the marrow. Experiments were performed with bones of similar structure and function from a single individual with no history of trabecular fractures, to compensate for the effects of the other variables that affect bone strength. The coefficient of correlation between compression strength and the volume density (i.e., g/cm3) of apatite was 0.95. The correlation of strength with the mass (i.e., grams) of apatite in a vertebral body also was reasonably good, r = 0.82, but correlations with areal density (i.e., g/cm2) and linear density (i.e., g/cm) were much poorer.

Microtrauma in the lumbar spine: a cause of low back pain.

Excessive mechanical stress on the intervertebral disc may be one of the causes of low back pain. Most studies testing this thesis, however, have been based on quantification of the mechanical response of functional units at failure. Typically, radiography is used to demonstrate trauma to the vertebral body at the failure load. The description of failure and radiographic demonstration of damage are meaningful in specifying the tolerance limits of the structure. It is important, however, to understand the sequence underlying the initiation of injury, which may occur at subfailure physiological loads. In this study, we identified the initiation of injury to the lumbar spine by subjecting functional units to axial compressive loads using the mechanical response as a basis. Because conventional radiography failed to detect trauma at this level, advanced sectioning techniques were used. The initiation of injury (microtrauma) is defined as the point on the load-deflection curve where the structure exhibits a decreasing level of resistance for the first time before reaching its ultimate load-carrying capacity. The load deflection curve on this basis was classified into the ambient or preload phase, physiological loading phase, traumatic phase, and post-traumatic phase. Structures loaded to the end of the physiological loading phase did not exhibit any yielding or microtrauma. Injury in the form of microfractures of the endplate not detected on radiography, however, was observed under cryomicrotomy for structures loaded into the traumatic loading phase.

Tensile strength of spinal ligaments.

Spinal ligaments from 41 fresh human male cadavers were tested. The ligaments were tested in situ by sectioning all elements except the one under study. The force deflection curves demonstrated a sigmoidal shape, and the point at which an increase in deflection was obtained with decreasing force was taken as failure. The force and deformation at failure are shown for each ligament as a function of spinal level.

Effects of spinal cord stimulation on spasticity and spasms secondary to myelopathy.

16 subjects with severe spasms secondary to traumatic and nontraumatic myelopathy underwent epidural spinal cord stimulation. 4 patients had a complete motor and sensory spinal cord lesion. 6 of the subjects with an incomplete spinal cord lesion were ambulatory. All patients had previously undergone extensive trials with medications and physical therapy. All 14 subjects in whom a satisfactory placement of the electrode could be obtained had a reduction in the severity of the spasms. In 6 patients, the spasms were almost abolished. Extremity, trunkal and abdominal spasms were affected. Clonus in the upper extremities was consistently reduced. Marked improvement in bladder and bowel function was observed in each of 2 subjects. In over 1-year follow-up, 5 subjects show persistence of the results, with less stimulation required to maintain the therapeutic effects. No neurological deterioration occurred following the procedure or after long-term spinal stimulation. 1 patient showed after several months of continuous stimulation increased voluntary motor control present only when spinal cord stimulation was activated. Complications included 1 system infection, 1 electrode migration, 1 wire breakage and skin breakdown at a connector site, development of high impedance in 1 electrode and 1 skin breakdown over the lead.

Effect of hypertension on small-vessel healing after microvascular anastomosis.

Artery-to-artery microvascular anastomosis (MVA) has become an established therapeutic alternative for patients with giant intracranial aneurysms and other forms of cerebrovascular disease. Many patients afflicted with cerebrovascular disease also suffer from hypertension. To evaluate the effect of hypertension on healing of small arteries following MVA, 36 spontaneously hypertensive rats were subjected to end-to-side MVA of their common carotid arteries. At specific times after surgery the rats were sacrificed; the anastomotic site was removed and examined with light microscopy and scanning electron microscopy. All MVA's were patent, and there was no evidence of thrombus formation or stenosis at the operative site in any group. Also, there was no difference between the spontaneously hypertensive rats and the control normotensive rat group in the rate of endothelial coverage of the MVA. The presence of hypertension appears to have no effect on healing of small arteries in the rat.