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1.
Artigo em Inglês | MEDLINE | ID: mdl-36674140

RESUMO

INTRODUCTION: Multiple sclerosis (MS) is a neurodegenerative disease that, despite mainly affecting women, is more severe in men and causes motor, cognitive and emotional alterations. The objective of this study was to determine the possible relationship between motor, cognitive and emotional alterations. MATERIALS AND METHODS: This is a descriptive, observational and cross-sectional study, with 67 patients with MS (20 men and 47 women), who were given the following questionnaires: Expanded Disability Status Scale (EDSS), Two-Minute Walk Test (2MWT), Berg Balance Scale, Beck's Depression Inventory (BDI-II), State-Trait Anxiety Inventory (STAI) and Prefrontal Symptoms Inventory (PSI) to analyze their cognitive level, body mass index (BMI) and percentage of muscle mass. In addition, regression analysis was conducted to study the relationship among variables. RESULTS: No significant differences were found between men and women in any of the variables. Regarding the relationship between parameters, the regression analysis was statistically significant, showing an effect of age on the walking and balance performance (ß â‰… -0.4, p < 0.05); in addition, there was a relationship between 2MWT and STAI A/S, indicating that both older age and a high anxiety state could impact walking performance. On the other hand, prefrontal symptoms showed moderate relationships with both anxiety and depression (ß â‰… 0.6, p < 0.05); thus, high levels of anxiety and depression could increase prefrontal alterations. CONCLUSIONS: There is a relationship between motor and emotional variables. Specifically, state anxiety is related to walking resistance. No relationship was found between depression and cognitive alteration and balance or walking ability. Only age has an effect in these relationships.


Assuntos
Transtornos Motores , Esclerose Múltipla , Doenças Neurodegenerativas , Masculino , Humanos , Feminino , Esclerose Múltipla/complicações , Esclerose Múltipla/psicologia , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Cognição
2.
In Vivo ; 37(1): 304-309, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36593045

RESUMO

BACKGROUND/AIM: The dorsal striatum is a brain area integrating information for movement output. The local field potentials (LFPs) reflect the neuronal activity that can be used for monitoring brain activities and controlling movement. MATERIALS AND METHODS: Rhythmic low gamma power activity (30.1-45 Hz) in the dorsal striatum was monitored according to voluntary motor movement in rotarod and bar tests in 0.5 mg/kg haloperidol-induced mice. RESULTS: Haloperidol can effectively induce movement impairment indicated by decreased low gamma LFP with the lessened rotarod test's latency fall, and the enhanced bar test's descending latency. L-DOPA was used for the induction of a dopamine-dependent signal. The results showed that 25 mg/kg of L-DOPA could reverse the effect of haloperidol by enhancing low gamma oscillation concomitantly with the improvement in behavioral movement as fast as 60 min after administration, suggesting that dopamine signaling increases low gamma frequency of LFP in correlation with the improved mice movement. This work supports quantitative LFP assessment as a monitoring tool to track drug action on the nervous system. CONCLUSION: In animal models of motor impairment, oral dopaminergic treatment can be effective in restoring motor dysfunction by stimulating low gamma power activity in the dorsal striatum.


Assuntos
Dopamina , Transtornos Motores , Camundongos , Animais , Levodopa , Haloperidol/efeitos adversos , Transtornos Motores/induzido quimicamente , Transtornos Motores/tratamento farmacológico , Encéfalo
3.
Am J Speech Lang Pathol ; 32(1): 37-54, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36599109

RESUMO

PURPOSE: Successful adoption and use of aided augmentative and alternative communication (AAC) must address how to promote fluid, efficient, and organized execution of the motor behavior needed to access the AAC system. A substantial number of people who use AAC have significant motor impairments and require "alternative" access options, such as eye gaze or switch use. Such individuals may be particularly vulnerable to interference from a poorly designed system. However, the inherent demands of alternative access methods have received little direct study. The goal of this tutorial is to offer a clinically and theoretically guided framework for considerations concerning AAC access, with the hope of spurring further discussion and empirical research. METHOD: A framework that draws upon dynamic systems theory was used to illustrate the interactions between the various elements of importance to AAC access. Information and research from the fields of motor learning, developmental dynamic systems theory, AAC, and assistive technology was integrated into this tutorial to examine their applications for alternative AAC access methods. RESULTS: The framework illustrated that AAC access involves a complex coordination between individual skills, the demands of the communication environment, the activity being undertaken, and the supports and demands inherent in the AAC system itself. CONCLUSIONS: Awareness of the many demands that alternative forms of access place on the person who uses them can guide clinicians during assessment and intervention decision making regarding access options for individuals with significant motor impairments. Specific directions for future research are considered.


Assuntos
Auxiliares de Comunicação para Pessoas com Deficiência , Transtornos da Comunicação , Transtornos Motores , Humanos , Comunicação , Motivação , Transtornos da Comunicação/diagnóstico , Transtornos da Comunicação/terapia
4.
BMJ Open ; 13(1): e061648, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36599639

RESUMO

OBJECTIVES: To determine if a newer design of total knee replacement (TKR) (Journey II BCS) produces superior patient-reported outcomes scores and biomechanical outcomes than the older, more established design (Genesis II). SETTING: Patients were recruited from an NHS University Hospital between July 2018 and October 2019 with surgery at two sites. Biomechanical and functional capacity measurements were at a University Movement and Exercise Laboratory. PARTICIPANTS: 80 participants undergoing single-stage TKR. INTERVENTIONS: Patients were randomised to receive either the Journey II BCS (JII-BCS) or Genesis II TKR. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was the Oxford Knee Score (OKS), at 6 months. Secondary outcomes were: OKS Activity and Participation Questionnaire, EQ-5D-5L and UCLA Activity scores, Timed Up and Go Test, 6 min walk test, lower limb kinematics and lower limb muscle activity during walking and balance. RESULTS: This study found no difference in the OKS between groups. The OKS scores for the JII-BCS and Genesis II groups were mean (SD) 42.97 (5.21) and 43.13 (5.20) respectively, adjusted effect size 0.35 (-2.01,2.71) p=0.771In secondary outcome measures, the Genesis II group demonstrated a significantly greater walking range-of-movement (50.62 (7.33) vs 46.07 (7.71) degrees, adjusted effect size, 3.14 (0.61,5.68) p=0.02) and higher peak knee flexion angular velocity during walking (mean (SD) 307.69 (38.96) vs 330.38 (41.40) degrees/second, adjusted effect size was 21.75 (4.54,38.96), p=0.01) and better postural control (smaller resultant centre of path length) during quiet standing than the JII-BCS group (mean (SD) 158.14 (65.40) vs 235.48 (176.94) mm, adjusted effect size, 59.91 (-105.98, -13.85) p=0.01.). CONCLUSIONS: In this study population, the findings do not support the hypothesis that the Journey II BCS produces a better outcome than the Genesis II for the primary outcome of the OKS at 6 months after surgery. TRIAL REGISTRATION NUMBER: ISRCTN32315753.


Assuntos
Artroplastia do Joelho , Transtornos Motores , Osteoartrite do Joelho , Humanos , Equilíbrio Postural , Osteoartrite do Joelho/cirurgia , Estudos de Tempo e Movimento , Resultado do Tratamento
5.
Res Dev Disabil ; 133: 104394, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36543036

RESUMO

BACKGROUND: Although research has demonstrated associations between motor coordination difficulties and psychological problems in school-age children, including emotional and behavioral problems, longitudinal changes in these problems in children with motor coordination difficulties are not fully understood. AIMS: The current study aimed to identify patterns in the trajectory of emotional and behavioral problems in school-age children with motor coordination difficulties, and to elucidate the effect of co-existing neurodevelopmental traits on the occurrence and course of these problems. METHODS AND PROCEDURES: Using the Developmental Coordination Disorder Questionnaire, 773 children were defined as cases with motor coordination difficulties and followed for 4 years, from 6 to 10 years of age. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire completed by children's parents or guardians. OUTCOMES AND RESULTS: We identified four trajectory patterns of emotional and behavioral problems. Children with higher autism spectrum disorder and attention deficit hyperactivity disorder traits were more likely to be assigned to poor prognostic trajectory patterns. CONCLUSIONS AND IMPLICATIONS: Our findings emphasize the importance of assessing emotional and behavioral problems and co-existing neurodevelopmental traits in children with motor coordination difficulties in early elementary school.


Assuntos
Transtornos do Comportamento Infantil , Transtornos Motores , Criança , Humanos , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Transtornos do Comportamento Infantil/epidemiologia , Transtornos Motores/epidemiologia
6.
Brain Behav Immun ; 107: 345-360, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36328163

RESUMO

Almost 2/3rds of stroke survivors exhibit vascular cognitive impairment and a third of stroke patients will develop dementia 1-3 years after stroke. These dire consequences underscore the need for effective stroke therapies. In addition to its damaging effects on the brain, stroke rapidly dysregulates the intestinal epithelium, resulting in elevated blood levels of inflammatory cytokines and toxic gut metabolites due to a 'leaky' gut. We tested whether repairing the gut via intestinal epithelial stem cell (IESC) transplants would also improve stroke recovery. Organoids containing IESCs derived from young rats transplanted into older rats after stroke were incorporated into the gut, restored stroke-induced gut dysmorphology and decreased gut permeability, and reduced circulating levels of endotoxin LPS and the inflammatory cytokine IL-17A. Remarkably, IESC transplants also improved stroke-induced acute (4d) sensory-motor disability and chronic (30d) cognitive-affective function. Moreover, IESCs from older animals displayed senescent features and were not therapeutic for stroke. These data underscore the gut as a critical therapeutic target for stroke and demonstrate the effectiveness of gut stem cell therapy.


Assuntos
Pessoas com Deficiência , Transtornos Motores , Acidente Vascular Cerebral , Animais , Ratos , Humanos , Acidente Vascular Cerebral/terapia , Transplante de Células-Tronco
7.
Georgian Med News ; (331): 36-41, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36539128

RESUMO

The second common disease that is neurodegenerative is connected with PD in elderly patients which is the distribution of gender. The proliferation has been reported in the last decade in homocysteine (Hcy) along with other diseases, epilepsy, Alzheimer, and idiopathic Parkinson's. Objectives - identifying the elevated level of Hcy which is a common factor for developmental disease and making the increase in motor disability of Hcy. With Parkinson's disease, a total of 70 patients were included in the case-control research which indicates that the newly diagnosed patients are not receiving any treatment at the department of neurology. These patients were compared with 70 healthy individuals attending the hospital for routine checkups matched for age and sex who were considered the control group. measurements of serum Hcy levels were done in both the case and control groups by the ELIZA method. This study shows that The mean Hcy level among the Parkinson's bunch was (16.884 ± 15.582) which is essentially higher than that of the control bunch (9.493 ± 3.752) at p=0.000 and albeit The Hcy level is higher in the currently analyzed patients (14.895±9.073) contrasted and recently analyzed patients (17.640±17.453) this distinction is genuinely non-critical Hcy level has a moderate direct relationship with the importance of brain highlights of the illness (r=0.682) in a genuinely huge way (p=0.000) While the connection with the term is exceptionally powerless (r=0.198) and measurably non-critical. Parkinson's patients have raised degrees of Hcy contrasted with ordinary individuals and there is an immediate relationship between the Hcy level and the importance of brain highlights of the sickness despite the fact that the Hcy level expanded with the span of the illness this shows a non-critical connection with sickness importance.


Assuntos
Pessoas com Deficiência , Transtornos Motores , Doença de Parkinson , Humanos , Idoso , Doença de Parkinson/diagnóstico , Encéfalo , Hospitais , Homocisteína
8.
Orphanet J Rare Dis ; 17(1): 448, 2022 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-36564803

RESUMO

BACKGROUND: Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases caused by defective enzyme activity involved in the catalysis of glycosaminoglycans. Published data on adult patients with MPS remains scarce. Therefore, the present qualitative survey study was aimed at understanding knowledge of the disease, unmet needs, expectations, care, and overall medical management of adult/adolescent patients with MPS I, II and VI and their caregivers in France. RESULTS: A total of 25 patients (MPS I, np = 11; MPS II, np = 9; MPS VI, np = 5) were included and about 36 in-depth interviews (caregivers alone, nc = 8; patients-caregiver pair, nc+p = 22; patients alone, np = 6) were conducted. Except one (aged 17 years), all patients were adults (median age: 29 years [17-50]) and diagnosed at median age of 4 years [0.4-30], with mainly mothers as caregivers (nc = 16/19). Patients were classified into three groups: Group A, Patients not able to answer the survey question because of a severe cognitive impairment (np = 8); Group B, Patients able to answer the survey question with low or no cognitive impairment and high motor disability (np = 10); and Group C, Patients able to answer the survey question with low or no cognitive impairment and low motor disability (np = 7). All groups were assessed for impact of disease on their daily lives based on a scale of 0-10. Caregivers in Group A were found to be most negatively affected by the disease, except for professional activity, which was most significantly impacted in Group B (4.7 vs. 5.4). The use of orthopaedic/medical equipments, was more prevalent in Groups A and B, versus Group C. Pain management was one of the global unmet need expressed by all groups. Group A caregivers expected better support from childcare facilities, disability clinics, and smooth transition from paediatric care to adult medicine. Similarly, Group B caregivers expected better specialised schools, whereas Group C caregivers expected better psychological support and greater flexibility in weekly infusion schedules for their patients. CONCLUSIONS: The survey concluded that more attention must be paid to the psychosocial status of patients and caregivers. The preference for reference centre for follow-up and treatment, hospitalizations and surgeries were evident. The most significant needs expressed by the patients and caregivers include better understanding of the disease, pain management, monitoring of complications, flexibility in enzyme replacement therapy, home infusions especially for attenuated patients, and improved transitional support from paediatric to adult medicine.


Assuntos
Pessoas com Deficiência , Transtornos Motores , Mucopolissacaridoses , Mucopolissacaridose I , Adulto , Feminino , Adolescente , Humanos , Criança , Pré-Escolar , Cuidadores/psicologia , Motivação , Mucopolissacaridoses/diagnóstico , França
9.
J Neuroinflammation ; 19(1): 293, 2022 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-36482436

RESUMO

BACKGROUND: HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP) is an incapacitating neuroinflammatory disorder for which no disease-modifying therapy is available, but corticosteroids provide some clinical benefit. Although HAM/TSP pathogenesis is not fully elucidated, older age, female sex and higher proviral load are established risk factors. We investigated systemic cytokines and a novel chronic inflammatory marker, GlycA, as possible biomarkers of immunopathogenesis and therapeutic response in HAM/TSP, and examined their interaction with established risk factors. PATIENTS AND METHODS: We recruited 110 People living with HTLV-1 (PLHTLV-1, 67 asymptomatic individuals and 43 HAM/TSP patients) with a total of 946 person-years of clinical follow-up. Plasma cytokine levels (IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-γ, TNF) and GlycA were quantified by Cytometric Bead Array and 1NMR, respectively. Cytokine signaling and prednisolone response were validated in an independent cohort by nCounter digital transcriptomics. We used multivariable regression, machine learning algorithms and Bayesian network learning for biomarker identification. RESULTS: We found that systemic IL-6 was positively correlated with both age (r = 0.50, p < 0.001) and GlycA (r = 0.45, p = 0.00049) in asymptomatics, revealing an 'inflammaging" signature which was absent in HAM/TSP. GlycA levels were higher in women (p = 0.0069), but cytokine levels did not differ between the sexes. IFN-γ (p = 0.007) and IL-17A (p = 0.0001) levels were increased in untreated HAM/TSP Multivariable logistic regression identified IL-17A and proviral load as independent determinants of clinical status, resulting in modest accuracy of predicting HAM/TSP status (64.1%), while a machine learning-derived decision tree classified HAM/TSP patients with 90.7% accuracy. Pre-treatment GlycA and TNF levels significantly predicted clinical worsening (measured by Osame Motor Disability Scale), independent of proviral load. In addition, a poor prednisolone response was significantly correlated with higher post-treatment IFN-γ levels. Likewise, a transcriptomic IFN signaling score, significantly correlated with previously proposed HAM/TSP biomarkers (CASP5/CXCL10/FCGR1A/STAT1), was efficiently blunted by in vitro prednisolone treatment of PBMC from PLHTLV-1 and incident HAM/TSP. CONCLUSIONS: An age-related increase in systemic IL-6/GlycA levels reveals inflammaging in PLHTLV-1, in the absence of neurological disease. IFN-γ and IL-17A are biomarkers of untreated HAM/TSP, while pre-treatment GlycA and TNF predict therapeutic response to prednisolone pulse therapy, paving the way for a precision medicine approach in HAM/TSP.


Assuntos
Infecções por HTLV-I , Transtornos Motores , Doenças Neuroinflamatórias , Feminino , Humanos , Teorema de Bayes , Citocinas , Vírus Linfotrópico T Tipo 1 Humano , Interleucina-17 , Interleucina-6 , Leucócitos Mononucleares , Transtornos Motores/virologia , Doenças Neuroinflamatórias/virologia , Infecções por HTLV-I/complicações
10.
Arq Neuropsiquiatr ; 80(11): 1126-1133, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36577411

RESUMO

BACKGROUND: Depression is an important nonmotor symptom of Parkinson's disease (PD) and has been associated with the motor symptoms in these individuals. OBJECTIVES: To determine whether there are relationships between depressive symptoms and abnormalities in axial postural alignment and axial motor deficits, especially postural instability, and trunk rigidity in PD. METHODS: In this cross-sectional study, 65 individuals were evaluated using the Beck Depression Inventory-II (BDI-II) for the analysis of depressive symptoms and underwent a postural assessment of head, trunk, and hip sagittal alignment through computerized photogrammetry. The MDS-UPDRS was used to assess clinical aspects of PD, the Trunk Mobility Scale was used to assess axial rigidity, and the MiniBESTest to assess balance. To determine the relationship between depressive symptoms and postural alignment, multiple linear regression analysis was performed. RESULTS: The participants with depressive symptoms had more severe motor deficits as well as greater trunk rigidity and worse postural instability (p < 0.05). When the postural angles were compared between men and women using Student's t-test, it was found that men had greater flexion angles of the head (p = 0.003) and trunk (p = 0.017). Using multiple linear regression analysis corrected for the age and sex of the participants, we verified that the anterior trunk inclination was significantly larger in the PD population with depressive symptoms (R2 = 0.453, ß = 0.116, and p = 0.045). CONCLUSION: PD individuals with depressive symptoms have more severe flexed trunk posture, mainly in older men. Additionally, more severe depressive symptoms are associated with worsening postural instability, trunk rigidity and motor deficits in this population.


ANTECEDENTES: A depressão é um sintoma não motor importante da doença de Parkinson (DP) e tem sido associada aos sintomas motores nesses indivíduos. OBJETIVOS: Determinar se existem relações entre sintomas depressivos e anormalidades no alinhamento postural axial e déficits motores axiais, especialmente instabilidade postural e rigidez de tronco na DP. MéTODOS: Neste estudo transversal, 65 indivíduos foram avaliados pelo BDI-II para análise de sintomas depressivos e submetidos à avaliação postural do alinhamento sagital de cabeça, tronco e quadril por meio de fotogrametria computadorizada. A MDS-UPDRS avaliou os aspectos clínicos, TMS avaliou rigidez axial e o MiniBESTest equilíbrio. Para determinar a relação entre sintomas depressivos e alinhamento postural, realizou-se uma análise de regressão linear múltipla. RESULTADOS: Os participantes com sintomas depressivos apresentaram déficits motores mais graves, bem como maior rigidez de tronco e pior instabilidade postural (p < 0,05). Quando comparados os ângulos posturais entre homens e mulheres pelo teste t de Student, verificou-se que os homens apresentaram maiores graus de flexão da cabeça (p = 0,003) e do tronco (p = 0,017). Por meio da análise de regressão linear múltipla corrigida para a idade e sexo dos participantes, verificamos que a inclinação anterior do tronco foi significativamente maior nos indivíduos com DP com sintomas depressivos do que sem sintomas depressivos (R2 = 0,453, ß = 0,116 e p = 0,045) CONCLUSãO: Indivíduos com DP com sintomas depressivos apresentam postura de tronco flexionado mais severa, principalmente em homens mais idosos. Além disso, os sintomas depressivos mais graves pioram significativamente a instabilidade postural, a rigidez do tronco e os déficits motores nessa população.


Assuntos
Transtornos Motores , Doença de Parkinson , Masculino , Humanos , Feminino , Idoso , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Estudos Transversais , Depressão/etiologia , Transtornos Motores/complicações , Tronco , Equilíbrio Postural
11.
Clin Nutr ESPEN ; 52: 254-256, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36513462

RESUMO

This opinion paper presents a brief review on the potential use of Creatine (Cr) to improve the inflammatory profile in individuals with Cerebral Palsy (CP). CP is a condition that causes muscle atrophy followed by reduced strength and altered muscle tone. The prevalence of chronic diseases is higher in people with CP due to this, which are often associated with peripheral inflammation, but there are no studies that have evaluated central inflammation in this condition. Nevertheless, the anti-inflammatory action of Cr has already been observed in different types of studies. Thus, the use of experimental models of CP to evaluate the expression of the inflammatory markers, especially in the brain, as well as approaches to reduce the impairments already observed becomes essential. Results obtained in these preclinical studies may contribute to the quality of therapeutic strategies offered to children suffering from CP, the most common cause of chronic motor disability in childhood.


Assuntos
Paralisia Cerebral , Pessoas com Deficiência , Transtornos Motores , Criança , Humanos , Paralisia Cerebral/complicações , Creatina/uso terapêutico , Transtornos Motores/complicações , Inflamação/tratamento farmacológico , Inflamação/complicações , Suplementos Nutricionais
12.
Front Immunol ; 13: 1056944, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36569880

RESUMO

Objective: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease preferentially affects the optic nerve and the spinal cord. The first attack usually occurs in the third or fourth decade, though patients with disease onset in the fifties or later are not uncommon. This study aimed to investigate the clinical characteristics and prognosis in patients with different age of onset and to explore the correlations between age of onset and clinical characteristics and prognostic outcomes. Method: We retrospectively reviewed the medical records of 298 NMOSD patients diagnosed according to the 2015 updated version of diagnostic criteria. Patients were divided into early-onset NMOSD (EO-NMOSD) (<50 years at disease onset) and late-onset NMOSD (LO-NMOSD) (≥50 years at disease onset) based on the age of disease onset. LO-NMOSD patients were divided into two subgroups: relative-late-onset NMOSD (RLO-NMOSD) (50~70 years at disease onset) and very-late-onset NMOSD (≥70 years at disease onset). Clinical characteristics, laboratory findings, neuroimaging features, and prognostic outcomes were investigated. Results: Compared to EO-NMOSD patients, patients with LO-NMOSD showed more frequent transverse myelitis (TM) (58.20% vs. 36.00%, p = 0.007) while less frequent optic neuritis (ON) (23.10% vs. 34.80%, p = 0.031) and brainstem/cerebral attacks (7.50% vs. 18.30%, p = 0.006) as the first attack. Patients with LO-NMOSD showed less frequent relapses, higher Expanded Disability Status Scale (EDSS) score at the last follow-up, fewer NMOSD-typical brain lesions, and longer segments of spinal cord lesions. Patients with older onset age showed a higher proportion of increased protein levels in cerebrospinal fluid during the acute phase of attacks. Age at disease onset positively correlated with length of spinal cord lesions at first attack and at last follow-up, negatively correlated with ARR-1 (ARR excluding the first attack, calculated from disease onset to final follow-up), irrespective of AQP4-IgG serostatus. Patients with older age at disease onset progressed to severe motor disability sooner, and age of onset positively correlated with EDSS score at the last follow-up, irrespective of AQP4-IgG serostatus. Conclusion: Age of disease onset affects clinical characteristics and prognosis outcomes of patients with NMOSD.


Assuntos
Pessoas com Deficiência , Transtornos Motores , Neuromielite Óptica , Humanos , Neuromielite Óptica/diagnóstico , Neuromielite Óptica/epidemiologia , Idade de Início , Prognóstico , Aquaporina 4 , Estudos Retrospectivos , Recidiva Local de Neoplasia , Imunoglobulina G
13.
J Neurol Sci ; 443: 120472, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36403298

RESUMO

Eye movements are fundamental diagnostic and progression markers of various neurological diseases, including those affecting the cerebellum. Despite the high prevalence of abnormal eye movements in patients with cerebellar disorders, the traditional rating scales do not focus on abnormal eye movements. We formed a consortium of neurologists focusing on cerebellar disorders. The consortium aimed to design and validate a novel Scale for Ocular motor Disorders in Ataxia (SODA). The primary purpose of the scale is to determine the extent of ocular motor deficits due to various phenomenologies. A higher score on the scale would suggest a broader range of eye movement deficits. The scale was designed such that it is easy to implement by non-specialized neurological care providers. The scale was not designed to measure each ocular motor dysfunction's severity objectively. Our validation studies revealed that the scale reliably measured the extent of saccade abnormalities and nystagmus. We found a lack of correlation between the total SODA score and the total International Cooperative Ataxia Rating Scale (ICARS), Scale for Assessment and Rating of Ataxia (SARA), or Brief Ataxia Rating Scale (BARS). One explanation is that conventionally reported scales are not dedicated to eye movement disorders; and when present, the measure of ocular motor function is only one subsection of the ataxia rating scales. It is also possible that the severity of ataxias does not correlate with eye movement abnormalities. Nevertheless, the SODA met the consortium's primary goal: to prepare a simple outcome measure that can identify ocular motor dysfunction in patients with cerebellar ataxia.


Assuntos
Ataxia Cerebelar , Transtornos Motores , Nistagmo Patológico , Transtornos da Motilidade Ocular , Humanos , Ataxia Cerebelar/complicações , Ataxia Cerebelar/diagnóstico , Ataxia/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/etiologia
14.
Sci Rep ; 12(1): 16669, 2022 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-36198900

RESUMO

Embodied cognition theories posit direct interactions between sensorimotor and mental processing. Various clinical observations have been interpreted in this controversial framework, amongst others, low verb generation in word production tasks performed by persons with Parkinson's disease (PD). If this were the consequence of reduced motor simulation of prevalent action semantics in this word class, reduced PD pathophysiology should result in increased verb production and a general shift of lexical contents towards particular movement-related meanings. 17 persons with PD and bilateral deep brain stimulation (DBS) of the subhtalamic nucleus (STN) and 17 healthy control persons engaged in a semantically unconstrained, phonemic verbal fluency task, the former in both DBS-off and DBS-on states. The analysis referred to the number of words produced, verb use, and the occurrence of different dimensions of movement-related semantics in the lexical output. Persons with PD produced fewer words than controls. In the DBS-off, but not in the DBS-on condition, the proportion of verbs within this reduced output was lower than in controls. Lowered verb production went in parallel with a semantic shift: in persons with PD in the DBS-off, but not the DBS-on condition, the relatedness of produced words to own body-movement was lower than in controls. In persons with PD, DBS induced-changes of the motor condition appear to go along with formal and semantic shifts in word production. The results are compatible with the idea of some impact of motor system states on lexical processing.


Assuntos
Estimulação Encefálica Profunda , Transtornos Motores , Doença de Parkinson , Núcleo Subtalâmico , Estimulação Encefálica Profunda/métodos , Humanos , Semântica , Núcleo Subtalâmico/fisiologia
15.
Pediatr Neurol ; 137: 54-61, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36270133

RESUMO

BACKGROUND: Limited data exist regarding seizure burden, electroencephalogram (EEG) background, and associated outcomes in neonates with acute intracranial infections. METHODS: This secondary analysis was from a prospective, multicenter study of neonates enrolled in the Neonatal Seizure Registry with seizures due to intracranial infection. Sites used continuous EEG monitoring per American Clinical Neurophysiology Society guidelines. High seizure burden was defined a priori as seven or more EEG-confirmed seizures. EEG background was categorized using standardized terminology. Primary outcome was neurodevelopment at 24-months corrected age using Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS). Secondary outcomes were postneonatal epilepsy and motor disability. RESULTS: Twenty-seven of 303 neonates (8.9%) had seizures due to intracranial infection, including 16 (59.3%) bacterial, 5 (18.5%) viral, and 6 (22.2%) unknown. Twenty-three neonates (85%) had at least one subclinical seizure. Among 23 children with 24-month follow-up, the WIDEA-FS score was, on average, 23 points lower in children with high compared with low seizure burden (95% confidence interval, [-48.4, 2.1]; P = 0.07). After adjusting for gestational age, infection etiology, and presence of an additional potential acute seizure etiology, the effect size remained unchanged (ß = -23.8, P = 0.09). EEG background was not significantly associated with WIDEA-FS score. All children with postneonatal epilepsy (n = 4) and motor disability (n = 5) had high seizure burden, although associations were not significant. CONCLUSION: High seizure burden may be associated with worse neurodevelopment in neonates with intracranial infection and seizures. EEG monitoring can provide useful management and prognostic information in this population.


Assuntos
Pessoas com Deficiência , Epilepsia , Transtornos Motores , Recém-Nascido , Criança , Humanos , Estudos Prospectivos , Transtornos Motores/complicações , Convulsões , Eletroencefalografia , Epilepsia/complicações
16.
Stroke ; 53(12): 3717-3727, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36252104

RESUMO

BACKGROUND: Network meta-analysis is a method that can estimate relative efficacy between treatments that may not have been compared directly within the literature. The purpose of this study is to present a network meta-analysis of non-conventional interventions to improve upper extremity motor impairment after stroke. METHODS: A literature search was conducted in 5 databases from their inception until April 1, 2021. Terms were used to narrow down articles related to stroke, the upper extremity, and interventional therapies. Randomized controlled trials written in English were eligible if; 50% poststroke patients; ≥18 years old; applied an intervention for the upper extremity, and/or used the Fugl-Meyer upper extremity scale as an outcome measure; the intervention had ≥3 randomized controlled trials with comparisons against a conventional care group; conventional care groups were dose matched for therapy time. A Bayesian network meta-analysis approach was taken to estimate mean difference (MD) and 95% CI. RESULTS: One hundred seventy-six randomized controlled trials containing 6781 participants examining 20 non-conventional interventions were identified for inclusion within the final model. Eight of the identified interventions proved significantly better than conventional care, with modified constraint induced movement therapy (MD, 6.7 [95% CI, 4.3-8.9]), high frequency repetitive transcranial magnetic stimulation (MD, 5.4 [95% CI, 1.9-8.9]), mental imagery (MD, 5.4 [95% CI, 1.8-8.9]), bilateral arm training (MD, 5.2 [95% CI, 2.2-8.1]), and intermittent theta-burst stimulation (MD, 5.1 [95% CI, 0.62-9.5]) occupying the top 5 spots according to the surface under the cumulative ranking curve. CONCLUSIONS: Overall, it would seem that modified constraint induced movement therapy has the greatest probability of being the most effective intervention, with high-frequency repetitive transcranial magnetic stimulation, mental imagery, and bilateral arm training all having similar probabilities of occupying the next spot in the rankings. We think this analysis can provide a guide for where future resources and clinical trials should be directed, and where a clinician may begin when considering alternative therapeutic interventions.


Assuntos
Transtornos Motores , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Adolescente , Reabilitação do Acidente Vascular Cerebral/métodos , Metanálise em Rede , Teorema de Bayes , Extremidade Superior , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Recuperação de Função Fisiológica
17.
Int Rev Neurobiol ; 165: 229-249, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36208902

RESUMO

Under the traditional models of care for People with Parkinson's Disease (PD, PwP), many of their needs remain unmet and a substantial burden of motor and non-motor symptoms they experience may not be tackled sufficiently. An introduction of palliative care (PC) interventions early in the course of PD offers profound benefits: it may improve quality of life of patients, their families and caregivers through the prevention and relief of medical symptoms, while, at the same time, emphasizing their emotional needs and spiritual wellbeing, establishing goals of care, and engaging in the advance care planning (ACP). The ongoing Coronavirus Disease 2019 (Covid-19) pandemic poses an unprecedented set of challenges for PwP and has in many ways (both directly and indirectly) magnified their suffering, thus rapidly raising the demand for PC interventions. Covid-19, as well as the repercussions of prolonged mobility restrictions and limited health-care access might exacerbate the severity of PD motor symptoms and interact negatively with a range of non-motor symptoms, with a detrimental effect on quality of life. Greater motor disability, higher amount of levodopa-induced motor fluctuations with an increased daily off-time, fatigue, anxiety, depression, sleep disturbances, pain and worsening of cognitive complaints might dominate the clinical presentation in PwP during the Covid-19 pandemic, alongside raising psychological and spiritual concerns and anticipatory grief. Here, we aim to provide a foundation for pragmatic and clinically orientated PC approach to improve quality of life and relieve suffering of PwP in the context of the current, ongoing Covid-19 pandemic.


Assuntos
COVID-19 , Pessoas com Deficiência , Transtornos Motores , Doença de Parkinson , Etnicidade , Humanos , Levodopa , Cuidados Paliativos , Pandemias , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Doença de Parkinson/terapia , Qualidade de Vida/psicologia
18.
Nat Commun ; 13(1): 5660, 2022 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-36198701

RESUMO

Cerebral Palsy (CP) is the most common pediatric motor disability with multiple symptoms and etiologies. CP is exhibited through sensorimotor delays, impaired posture resulting in limited activities and participation. Our recently concluded, single arm, unblinded, pilot study (NCT04882592) explored whether an intervention combining non-invasive spinal neuromodulation during an activity-based neurorehabilitation therapy (ABNT) can improve voluntary sensory-motor function captured via the Gross Motor Function Measure (GMFM-88) scores (primary outcome). Sixteen children diagnosed with CP with Gross Motor Function Classification Scale levels I-V were recruited and received the same intervention (2x/week for 8 weeks) to correct the dysfunctional connectivity between supraspinal and spinal networks using the normally developed proprioception. We demonstrate that the intervention was associated with clinically and statistically significant improvement in GMFM-88 scores in all children, thus meeting the prespecified primary endpoint. However, the improvement with ABNT alone needs further exploration. No serious adverse events were observed (safety endpoint).


Assuntos
Paralisia Cerebral , Pessoas com Deficiência , Transtornos Motores , Reabilitação Neurológica , Paralisia Cerebral/reabilitação , Criança , Humanos , Destreza Motora , Projetos Piloto
19.
Arq. ciências saúde UNIPAR ; 26(3): 631-642, set-dez. 2022.
Artigo em Português | LILACS | ID: biblio-1399312

RESUMO

Transtorno do espectro autista (TEA) é um transtorno do neurodesenvolvimento que se manifesta na infância, apresentando alterações na morfologia, fisiologia, conectividade cerebral e ocasionando em distúrbios motores. Objetivo: avaliar o déficit de equilíbrio em crianças com transtorno do espectro autista em uma cidade localizada no interior do Rio Grande do Sul. Método: a amostra foi composta por 11 crianças com idade entre 3 e 14 anos, frequentadores de uma instituição de atendimento a autistas. Os participantes foram submetidos às seguintes avaliações: Bateria Psicomotora (BPM), Timed-up and Go Test e Tinetti. Resultados: observou-se predomínio do sexo masculino, redução estatisticamente significativa dos escores da escala de equilíbrio, (24,27 ±4,1; p=0,03) e escore total (13,45 ±2,5; p=0,022), sem diferença no escore da escala de marcha (10,82 ± 2,4 ; p=0,059), através da Escala de Equilíbrio e Mobilidade de Tinetti, e, na avaliação da BPM, 54,54% apresentaram perfil psicomotor normal. Nas correlações, encontrou-se relação direta entre o fator praxia global da BPM e escore total de Tinetti (r= 0,522; p=0,05). Houve ainda relação entre os fatores psicomotores com o equilíbrio na BPM, sendo moderada para tonicidade (r= 0,582; p=0,03) e fortes entre noção do corpo (r=0,811; p=0,001), estruturação espaço temporal (r= 0,894; p=0,000), praxias global (r= 0,963; p=0,000) e fina (r=0,894; p=0,000). Em relação a análise dos fatores da BPM, a maioria dos pacientes apresentava dificuldade na praxia global, sendo 45,5% da amostra dispráxica. Foi possível ainda estabelecer correlação moderada entre a Praxia Global da BPM e o TUG (r=0,548, p=0,04) e, embora não significativa,com a Tinetti (r=0,522, p=0,05),. Foi observada também uma correlação moderada entre a Tonicidade e a TUG (R=0,601,p=0,025).Conclusão: crianças com TEA apresentam alteração no equilíbrio, representando um baixo risco de quedas, e comprometimento da praxia global, assim como uma correlação entre déficit de equilíbrio e alterações na tonicidade, noção do corpo, estruturação espaço temporal e praxias global e fina desses indivíduos.


Autistic Spectrum Disorder (ASD) is a neurodevelopmental disorder that manifests in childhood, with alterations in morphology, physiology, brain connectivity and causing motor disorders. Objective: to assess the balance deficit in children with ASD in a city located in the interior of Rio Grande do Sul. Method: the sample consisted of 11 children aged between 3 and 14 years old, regulars at an autism care institution. Participants were submitted to the following evaluations: Psychomotor Battery, Timed-Up and Go Test, and Tinetti. Results: there was a predominance of males, a statistically significant reduction in the balance scale scores (24,27 ±4,1; p=0.03) and total score (13,45 ±2,5; p=0.022), with no difference in the gait scale score (10,82 ± 2,4; p=0.059), using the Tinetti Balance and Mobility Scale, and, in the assessment of the BPM, 54.54% had a normal psychomotor profile. In the correlations, a direct relationship was found between the global BPM praxis factor and the total Tinetti score (r= 0.522). There was also a relationship between psychomotor factors and BPM balance, being moderate for tonicity (r= 0.582), and strong between body notion (r=0.811), temporal space structuring (r= 0.894), global praxis (r= 0.963), and fine praxis (r=0.894). Regarding the analysis of BPM factors, most patients had difficulty in global praxis, with 45.5% of the dyspraxic sample. It was also possible to establish a moderate correlation between the Global Praxia of the BPM and the TUG (r=0.548, p=0.04) and, although not significant, with Tinetti (r=0.522, p=0.05). There was also a moderatecorrelation between tonicity and TUG (r=0.601, p=0.025). Conclusion: children with ASD present balance alterations, representing a low risk of falls, and impairment of global praxis, as well as correlation between balance deficits and alterations with tonicity, body notion, temporal space structure, and global and fine praxis of these individuals.


El trastorno del espectro autista (TEA) es un trastorno del neurodesarrollo que se manifiesta en la infancia, presentando cambios en la morfología, la fisiología, la conectividad cerebral y provocando trastornos motores. Objetivo: evaluar el déficit de equilibrio en niños con trastorno del espectro autista en una ciudad del interior de Rio Grande do Sul. Método: la muestra consistió en 11 niños de entre 3 y 14 años, que asistían a una institución para pacientes autistas. Los participantes fueron sometidos a las siguientes evaluaciones: Batería psicomotriz (BPM), Test de tiempo y marcha y Tinetti. Resultados: se observó un predominio de varones, reducción estadísticamente significativa de las puntuaciones de la escala de equilibrio, (24,27 ±4,1; p=0,03) y de la puntuación total (13,45±2,5; p=0,022), sin diferencia en la puntuación de la escala de marcha (10,82 ± 2,4 ; p=0,059), a través de la Escala de Equilibrio y Movilidad de Tinetti, y, en la evaluación del BPM, el 54,54% presentó perfil psicomotor normal. En las correlaciones, se encontró una relación directa entre el factor de praxis global del BPM y la puntuación total de Tinetti (r= 0,522; p=0,05). También hubo una relación entre los factores psicomotores y el equilibrio en el BPM, siendo moderada para la tonicidad (r= 0,582; p=0,03) y fuerte entre la noción corporal (r=0,811; p=0,001), la estructuración espacio-temporal (r= 0,894; p=0,000), las prácticas globales (r= 0,963; p=0,000) y las finas (r=0,894; p=0,000). En cuanto al análisis de los factores de la BPM, la mayoría de los pacientes tenían dificultades en la praxis global, siendo el 45,5% de la muestra disprática. También se pudo establecer una correlación moderada entre la Praxis Global del BPM y el TUG (r=0,548, p=0,04) y, aunque no significativa, con el Tinetti (r=0,522, p=0,05),. También se observó una correlación moderada entre la tonicidad y el TUG (R=0,601,p=0,025).Conclusión: los niños con TEA presentan alteración del equilibrio, representando un bajo riesgo de caídas, y alteración de la praxis global, así como una correlación entre el déficit de equilibrio y las alteraciones de la tonicidad, la noción corporal, la estructuración espacio-temporal y la praxis global y fina de estos individuos.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Criança Excepcional/estatística & dados numéricos , Equilíbrio Postural , Transtorno do Espectro Autista , Acidentes por Quedas/estatística & dados numéricos , Estudos de Avaliação como Assunto , Transtornos Motores
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