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1.
Zhonghua Er Ke Za Zhi ; 57(11): 837-843, 2019 Nov 02.
Artigo em Chinês | MEDLINE | ID: mdl-31665837

RESUMO

Objective: To summarize the clinical features of leukoencephalopathy with vanishing white matter disease (VWM) in children. Methods: A retrospective cohort study was performed on 54 genetically diagnosed VWM patients in Peking University First Hospital from January 2007 to March 2019. Paper registration form and electronic medical record system were used to collect the data,and the children were divided into five groups according to the age of disease onset:<1 year, 1-<2 years, 2-<4 years, 4-<8 years and 8-<18 years respectively. The progression of motor function, episodic aggravation, epileptic seizures, survival time, brain magnetic resonance imaging (MRI) and genotype features were analyzed and compared. Non-parametric test, χ(2) test or Fisher's exact test were used for comparison among groups; Kaplan-Meier survival curve was adopted to delineate the survival status of the children. Results: Fifty-four VWM patients were included in the study, including 34 males and 20 females.The age of disease onset was 2 years and 8 months (ranged from 6 months to 9 years and 7 months). Onset age was less than 1 year in 5 cases; onset age was 1-<2 years in 12 cases; onset age was 2-<4 years in 25 cases; onset age was 4-<8 years, in 10 cases; onset age was 8-<18 years in 2 cases; 94% (51/54) of patients had complaint of motor regression at the first visit; 87% (47/54) of patients suffered from episodic aggravation. Episodic seizures occurred in 43% (23/54) patients. In survivors with disease durations of 1-3 years, in 38% (9/24) patients the disease was classified as grades Ⅳ-Ⅴ by gross motor function classification system (GMFCS). For the onset age 1-<2 years group, 1 patient was classified as GMFCS Ⅳ among 3 survivors with disease durations of 1-3 years. As for the 2-<4 years group, 6 patients were classified as GMFCS Ⅳ-Ⅴ among 15 patients with disease durations of 1-3 years, whereas 1 patient was classified as GMFCS Ⅳ-Ⅴ among 4 patients with disease durations of 1-3 years in the 4-<8 years group. Lesions, liquefaction and diffusion restriction in brain MRI were compared among different groups, and it was revealed that the earlier the age of disease onset was, the more likely the subcortical white matter (frontal lobe P<0.01,temporal and parieto-occipital lobe both P=0.002), internal capsule (anterior limb P<0.01, posterior limb P=0.00) and brain stem (midbrain P=0.001, pons P<0.01) were to be involved. In addition, internal capsule (anterior limb P=0.002, posterior limb P=0.005) and brain stem (midbrain P=0.001, pons P=0.003) showed more diffuse restricted diffusion. Moreover, the subcortical white matter (frontal and parieto-occipital lobe both P<0.01, temporal lobe P=0.005) showed earlier rarefaction. The 1-year and 2-year survival rates of the overall patients were 81% and 75% respectively, while the 15-year survival rate was 45%. EIF2B5 gene variation was the most common, which accounts for 43% (23/54), followed by EIF2B3 (22%, 12/54). Conclusions: The majority of VWM patients complained of motor regression at the first visit, episodic aggravation and epileptic seizures are common in the course. Earlier age at onset is associated with more rapid clinical progression, shorter survival time as well as more extensive lesions, liquefaction and diffusion restriction in brain MRI. The most common variant gene is EIF2B5, followed by EIF2B3.


Assuntos
Encéfalo/diagnóstico por imagem , Leucoencefalopatias/patologia , Adolescente , Tronco Encefálico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Transtornos dos Movimentos/fisiopatologia , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 98(38): e17249, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567992

RESUMO

RATIONALE: Diabetic striatopathy (DS) is an uncommon movement disorder among diabetic patients characterized by clinical hemichorea-hemiballism with neuroimage change of the striatum. Here, we report a case of DS with relapsed hemichorea-hemiballism attacks even during euglycemic period, and the MRI changes by volumetric analysis. PATIENT CONCERNS: A 69-year-old diabetic female suffered from a relapsed episode of hemichorea-hemiballism during her euglycemic period after the treatment of hyperglycemia. DIAGNOSES: To investigate the serial MRI changes in a case with diabetic striatopathy who had clinical hemichorea-hemiballism syndrome. INTERVENTIONS: Semi-quantitative volumetric analyses from T1 images of these brain MRIs were obtained during the disease course. OUTCOMES: Besides, the negative finding of the first brain MRI during her first hospital admission, three afterward MRI examinations disclosed a waxing-and-waning mode of volume change from high-signal T1 images in left striatum. The clinical symptoms paralleled with the neuroimage changes in striatum. The MR signal volume changes were valuable for the clinical course of the hemichorea-hemiballism caused by diabetic striatopathy LESSONS:: Serial MR images for the diabetic striatopathy presented as a key pathognomonic relationship with the clinical hemichorea-hemiballism syndrome, assessed by our simplied volumetric analysis. Clinical involuntary movements may relapse and persist even with euglycemic condition as our case.


Assuntos
Corpo Estriado/diagnóstico por imagem , Complicações do Diabetes/diagnóstico por imagem , Transtornos dos Movimentos/etiologia , Idoso , Corpo Estriado/fisiopatologia , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética , Transtornos dos Movimentos/diagnóstico por imagem , Transtornos dos Movimentos/fisiopatologia , Neuroimagem , Síndrome
3.
Ideggyogy Sz ; 72(7-8): 285-288, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31517463

RESUMO

Morvan syndrome is a rare disease characterized by peripheral nerve hyperexcitability, encephalopathy, dys-autonomia and significant insomnia. The patient, who was included in the present study, was followed-up at our clinics for confusion, myokymia, hyperhidrosis, epileptic seizures, tachycardia, agitation, hypokalemia, and hyponatremia. The cranial MRI of the patient demonstrated hyperintensities at the T2 and FLAIR sections of the medial temporal lobe and insular lobes. Electromyography and neurotransmission examination results were concordant with peripheral nerve hyperreactivity. Contactin-associated protein-like 2 antibodies and leucine-rich glioma inactivated protein 1 antibodies were detected as positive. The patient was diagnosed with Morvan syndrome; intravenous immunoglobulin and corticosteroid treatment was started. Almost full remission was achieved. This very rare syndrome implies challenges in diagnosis and treatment; however, remission can be achieved during the follow-up. In addition, caution is needed in the long-term follow-up of these patients regarding the development of malignancies.


Assuntos
Encefalopatias , Encéfalo/diagnóstico por imagem , Transtornos dos Movimentos/fisiopatologia , Doenças Musculares/fisiopatologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Corticosteroides/uso terapêutico , Autoanticorpos/sangue , Eletromiografia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Encefalite Límbica , Transtornos dos Movimentos/tratamento farmacológico , Doenças Musculares/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Convulsões/etiologia , Resultado do Tratamento
4.
Hum Mov Sci ; 67: 102513, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31493621

RESUMO

BACKGROUND: Anxiety disorders are the most common mental disorders. Changes in psychomotor behavior can be observed in gross motor skills, with gait disturbances thought to reflect defective brain functions in psychiatric conditions. While balance deficits are well documented in anxiety, only little is known about gait characteristics of people with anxiety. OBJECTIVE: This study wishes to examine the existence of differences in gait, balance, mobility and muscle strength between people with anxiety and healthy individuals, and to investigate the relationship between level of anxiety and motor characteristics. METHODS: An observational study was conducted in a psychiatric out-patient unit at a large Israeli general hospital. The sample consisted of 93 participants, ages 18-65: 48 of them (27 female, 21 male) categorized as having anxiety, and 45 (25 female, 20 male) without anxiety. Participants were divided into two groups of various ages and both genders, and completed two questionnaires and four physical tests: objective anxiety assessment (Hamilton Anxiety Rating Scale); spatiotemporal gait parameters (10-meter walking test); balance function (Unipedal Stance Test); muscle strength evaluation, and mobility (Time Up and Go Test). No attempt was made to correlate between the anxiety and control groups based on age and/or gender. RESULTS: Participants with anxiety (both genders) were characterized by slower walking speed, shorter step length, and fewer steps per minute (p < 0.001), as well as balance deficiency and mobility dysfunction (p < 0.001), compared to the control group. Muscle strength in women with anxiety was found to be significantly lower than in healthy women. CONCLUSIONS: To the best of our knowledge, this study is the first of its kind to examine spatiotemporal gait components in patients with anxiety. Based on the findings, there is room to consider implementing gait analysis into the physical examination of patients with anxiety, as well as muscle strength, balance, and mobility function. Correct assessment and proper treatment of these aspects might contribute to the well-being of patients with anxiety.


Assuntos
Transtornos de Ansiedade/fisiopatologia , Marcha/fisiologia , Força Muscular/fisiologia , Equilíbrio Postural/fisiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/fisiopatologia , Amplitude de Movimento Articular , Inquéritos e Questionários , Estudos de Tempo e Movimento , Caminhada/fisiologia , Adulto Jovem
5.
IEEE Int Conf Rehabil Robot ; 2019: 459-464, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31374672

RESUMO

Clinical assessment of abnormal neuromechanics is typically performed by manipulation of the affected limbs; a process with low inter- and intra-rater reliability. This paper aims at formalizing a framework that closes the loop between a clinician's expertise and computational algorithms, to enhance the clinician's diagnostic capabilities during physical manipulation. The framework's premise is that the dynamics that can be measured by manipulation of a limb are distinct between movement disorders. An a priori database contains measurements encoded in a space called the information map. Based on this map, a computational algorithm identifies which probing motions are more likely to yield distinguishing information about a patient's movement disorder. The clinician executes this movement and the resulting dynamics, combined with clinician input, is used by the algorithm to estimate which of the movement disorders in the database are most probable. This is recursively repeated until a diagnosis can be confidently made. The main contributions of this paper are the formalization of the framework and the addition of the information map to select informative movements. The establishment of the framework provides a foundation for a standardized assessment of movement disorders and future work will aim at testing the framework's efficacy.


Assuntos
Algoritmos , Bases de Dados Factuais , Diagnóstico por Computador , Transtornos dos Movimentos , Extremidade Superior/fisiopatologia , Humanos , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/fisiopatologia , Reprodutibilidade dos Testes
6.
Artigo em Inglês | MEDLINE | ID: mdl-31413900

RESUMO

Background: Functional movement disorders (FMDs) have been rarely described in the elderly population. Methods: This is a retrospective chart review of elderly patients with FMDs (onset >60 years) attending the movement disorders clinic at a tertiary care teaching institute in India. Results: Out of 117 patients diagnosed with FMD at our center, 18 patients had an onset after the age of 60 years. The male-to-female ratio was 10:8 and the duration of symptoms ranged from 1 day to 5 years. Social (10/18) and physical factors (5/18) with an evident temporal relationship with the onset of FMD were identified in 15 out of 18 patients. Six of them had a past history of depression, anxiety, or other psychiatric illnesses. The tremor was the most frequent phenomenology seen in 11 (61.1%) patients, followed by dystonia in seven (38.8%), choreoballism and tics in two each, and hemifacial spasm and functional gait in one each. Seven patients had more than one phenotype. Discussion: Tremor was the most frequent movement disorder seen in our patients with FMD. Surprisingly, tics (n = 2) and choreoballistic (n = 2) movements were also found in our patients with FMD, which has not been reported previously in an elderly population. Both physical and social factors were identified preceding the development of FMDs in majority of our patients.


Assuntos
Envelhecimento/fisiologia , Transtornos dos Movimentos/fisiopatologia , Tiques/fisiopatologia , Tremor/fisiopatologia , Idoso , Depressão/fisiopatologia , Distonia/fisiopatologia , Distúrbios Distônicos/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico , Tiques/diagnóstico
7.
PLoS One ; 14(7): e0206024, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31335914

RESUMO

Motion analysis systems are widely employed to identify movement deficiencies-e.g. patterns that potentially increase the risk of injury or inhibit performance. However, findings across studies are often conflicting in respect to what a movement deficiency is or the magnitude of association to a specific injury. This study tests the information content within movement data using a data driven framework that was taught to classify movement data into the classes: NORM, ACLOP and ACLNO OP, without the input of expert knowledge. The NORM class was presented by 62 subjects (124 NORM limbs), while 156 subjects with ACL reconstruction represented the ACLOP and ACLNO OP class (156 limbs each class). Movement data from jumping, hopping and change of direction exercises were examined, using a variety of machine learning techniques. A stratified shuffle split cross-validation was used to obtain a measure of expected accuracy for each step within the analysis. Classification accuracies (from best performing classifiers) ranged from 52 to 81%, using up to 5 features. The exercise with the highest classification accuracy was the double leg drop jump (DLDJ; 81%), the highest classification accuracy when considering only the NORM class was observed in the single leg hop (81%), while the DLDJ demonstrated the highest classification accuracy when considering only for the ACLOP and ACLNO OP class (84%). These classification accuracies demonstrate that biomechanical data contains valuable information and that it is possible to differentiate normal from rehabilitating movement patterns. Further, findings highlight that a few features contain most of the information, that it is important to seek to understand what a classification model has learned, that symmetry measures are important, that exercises capture different qualities and that not all subjects within a normative cohort utilise 'true' normative movement patterns (only 27 to 71%).


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Exercício , Transtornos dos Movimentos/fisiopatologia , Movimento , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Masculino
8.
Handb Clin Neurol ; 160: 345-355, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277859

RESUMO

Electrophysiologic mapping remains an integral component of deep brain stimulation (DBS) surgical procedures, particularly in movement disorder cases where functional maps are used to guide DBS lead placement in patients with Parkinson's disease, dystonia, or tremor. Overall, the goal of the surgical procedure is to implant the distal end of a chronic, multicontact depth electrode into a specific brain region for the purpose of delivering therapeutic electrical stimulation. Regions that are currently targeted for patients with movement disorders include the subthalamic nucleus, the ventral intermediate nucleus of the thalamus, and the globus pallidus. Multiple imaging modalities are used initially to derive a stereotactic plan and guide the initial microelectrode trajectory. Changes in neuronal firing rate and pattern, both spontaneous and in response to somatosensory stimulation, are used to establish the location of the tip of the microelectrode(s), while acute stimulation can be used to estimate the proximity of neighboring brain regions. In this chapter, we will provide an overview of the microelectrode recording process as it is commonly applied to refine image-based targeting of lead placement for DBS surgery.


Assuntos
Mapeamento Encefálico/métodos , Estimulação Encefálica Profunda/métodos , Transtornos dos Movimentos/fisiopatologia , Transtornos dos Movimentos/terapia , Mapeamento Encefálico/instrumentação , Estimulação Encefálica Profunda/instrumentação , Globo Pálido/fisiologia , Humanos , Microeletrodos , Transtornos dos Movimentos/diagnóstico , Núcleo Subtalâmico/fisiologia
9.
J Neurosurg Sci ; 63(4): 441-449, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31210040

RESUMO

Substantia nigra (SN) hyperechogenicity has been proved to be a characteristic finding for idiopathic Parkinson's disease (PD), occurring in more than 90% of the patients. This echofeature is owed to increased amounts of iron in the SN region and reflects a functional impairment of the nigrostriatal dopaminergic system. In a prospective blinded study in which a group of patients with early mild signs and symptoms of unclear Parkinsonism were followed until a definite clinical diagnosis of PD, the hyperechogenicity of the SN was demonstrated to be highly predictive of a final diagnosis of PD. For the diagnosis of PD in individuals with early motor symptoms, both the sensitivity and positive predictive value of SN hyperechogenicity were higher than 90% and both the specificity and negative predictive value were higher than 80%. For early differential diagnosis between PD and atypical Parkinsonian syndromes, the sensitivity and positive predictive value of SN hyperechogenicity were higher than 90%, and both the specificity and negative predictive value were higher than 80%. The diagnostic specificity is increased if combining the TCS findings of SN, lenticular nucleus and third ventricle. In asymptomatic adult subjects, SN hyperechogenicity, at least unilaterally, indicates a subclinical functional insufficiency of the nigrostriatal dopaminergic system. Recent papers revealed that SN hyperechogenicity might suggest preclinical PD. Reduced echogenicity of midbrain raphe indicates increased risk of depression in PD patients. Caudate nucleus hyperechogenicity has been associated with drug-induced psychosis, and frontal horn dilatation >20 mm with dementia. Transcranial brain sonography can be a valuable tool for managing patients with Parkinsonian signs and symptoms.


Assuntos
Encéfalo/fisiopatologia , Transtornos dos Movimentos/fisiopatologia , Doença de Parkinson/fisiopatologia , Diagnóstico Diferencial , Humanos , Transtornos dos Movimentos/diagnóstico , Doença de Parkinson/diagnóstico , Sensibilidade e Especificidade , Ultrassonografia/métodos
10.
J Neurol ; 266(8): 1927-1936, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31073716

RESUMO

OBJECTIVES: Developing disease modifying therapies for Parkinson's disease (PD) calls for outcome measurement strategies focused on characterizing early stage disease progression. We explored the psychometric evidence for using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part II (patient motor experience of daily living) and part III (clinician motor examination) in this context. METHODS: MDS-UPDRS-II and -III data were collected at screening, month 12, and month 24 from 384 early stage PD patients (diagnosis ≤ 2 years; Hoehn and Yahr stage 1/2) in the Parkinson's Progression Markers Initiative (PPMI) study. Psychometric analysis, based on Rasch measurement theory (RMT), was performed on both the original MDS UPDRS-II and -III scales and exploratory content-driven scale structures. RESULTS: RMT analyses showed neither scale was well targeted to early PD. A marked floor effect appeared for most items and a clear item gap was consistently observed in very mild severity of motor signs and levels of motor impact. The original MDS-UPDRS-II and -III scales also displayed disordered thresholds (9/13 and 20/33 items, respectively), indicating response scales not functioning as expected, and misfit (5/13 and 12/33 items, respectively), flagging areas for potential improvement. CONCLUSIONS: The MDS-UPDRS-II and -III have psychometric limitations which limits the precision of measurement of motor symptoms and impact in early PD. This can lead to insensitivity in detecting differences and clinical change. Importantly, the diagnostic psychometric evidence provided by the RMT analysis provides a clear starting point for how to improve the quantification of clinically relevant concepts to characterize the course of early PD.


Assuntos
Progressão da Doença , Internacionalidade , Testes de Estado Mental e Demência/normas , Doença de Parkinson/diagnóstico , Sociedades Médicas/normas , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/diagnóstico , Transtornos dos Movimentos/fisiopatologia , Doença de Parkinson/fisiopatologia
11.
Otolaryngol Clin North Am ; 52(4): 759-767, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076164

RESUMO

The primary movement disorders affecting the voice are laryngeal dystonia (including spasmodic dysphonia), essential voice tremor, and Parkinson disease. Diagnosis of these conditions is clinical and based on a detailed history, voice evaluation, and physical and laryngoscopic examination. Laryngeal dystonia and essential voice tremor are hyperfunctional disorders and are treated most commonly with botulinum toxin injections. Parkinson disease is a hypofunctional disorder that may affect the voice and most commonly is treated with Lee Silverman Voice Treatment.


Assuntos
Disfonia/diagnóstico , Disfonia/etiologia , Músculos Laríngeos/fisiopatologia , Transtornos dos Movimentos/fisiopatologia , Toxinas Botulínicas/administração & dosagem , Disfonia/terapia , Eletromiografia , Humanos , Injeções Intralesionais , Laringoscopia , Qualidade da Voz , Treinamento da Voz
12.
Muscle Nerve ; 60(3): 242-249, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31026080

RESUMO

INTRODUCTION: Balance impairment contributes to gait dysfunction, falls, and reduced quality of life in adults with Charcot-Marie-Tooth disease (CMT) but has been minimally examined in pediatric CMT. METHODS: The CMT Pediatric Scale (CMTPedS) was administered to 520 children with CMT. Associations between balance function (Bruininks-Oseretsky Test of Motor Proficiency [BOT-2]) and sensorimotor and gait impairments were investigated. RESULTS: Daily trips/falls were reported by 42.3% of participants. Balance (BOT-2) varied by CMT subtype, was impaired in 42% of 4-year-olds, and declined with age (P < 0.001). Vibration (P < 0.001), pinprick (P < 0.004), ankle dorsiflexion strength (P < 0.001), and foot alignment (P < 0.004) were associated with BOT-2 balance (adjusted R2 = 0.28). The visual dependence of balance increased with age. DISCUSSION: Balance impairment occurs from a young age in children with CMT. Balance intervention studies are required in pediatric CMT and should consider the degree of sensorimotor impairment, foot malalignment, and visual dependence. Muscle Nerve, 2019.


Assuntos
Doença de Charcot-Marie-Tooth/fisiopatologia , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos dos Movimentos/fisiopatologia , Força Muscular/fisiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Marcha/fisiologia , Humanos , Masculino , Modalidades de Fisioterapia , Qualidade de Vida , Adulto Jovem
13.
Pract Neurol ; 19(4): 295-301, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30872358

RESUMO

The neurological examination should always begin before the patient enters the doctor's office. Movement disorders in particular lend themselves to a spot diagnosis. In today's busy buzzing world, it seems wasteful not to make use of the various diagnostic clues that can be picked up readily while the patient is still in the waiting room. We present several illustrative examples, drawn from the literature and from our own experience. These are divided according to the different waiting room 'stages': the patient sitting in the waiting room, the response on being summoned to enter the consulting room-including rising from the chair, exchanging initial pleasantries and the way of walking. We also discuss the importance of paying attention to the patient's behaviour, clothing, posture, breathing patterns, facial expression and major gait abnormalities.


Assuntos
Transtornos dos Movimentos/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Exame Neurológico/métodos , Visita a Consultório Médico , Encaminhamento e Consulta , Humanos , Transtornos dos Movimentos/fisiopatologia , Doenças do Sistema Nervoso/fisiopatologia , Exame Neurológico/normas , Encaminhamento e Consulta/normas
14.
Neurorehabil Neural Repair ; 33(4): 319-328, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30880592

RESUMO

BACKGROUND: Persistent deficits in arm function are common after stroke. An improved understanding of the factors that contribute to the performance of skilled arm movements is needed. One such factor may be self-efficacy (SE). OBJECTIVE: To determine the level of SE for skilled, goal-directed reach actions in individuals with mild motor impairment after stroke and whether SE for reach performance correlated with actual reach performance. METHODS: A total of 20 individuals with chronic stroke (months poststroke: mean 58.1 ± 38.8) and mild motor impairment (upper-extremity Fugl-Meyer [FM] motor score: mean 53.2, range 39 to 66) and 6 age-matched controls reached to targets presented in 2 directions (ipsilateral, contralateral). Prior to each block (24 reach trials), individuals rated their confidence on reaching to targets accurately and quickly on a scale that ranged from 0 ( not very confident) to 10 ( very confident). RESULTS: Overall reach performance was slower and less accurate in the more-affected arm compared with both the less-affected arm and controls. SE for both reach speed and reach accuracy was lower for the more-affected arm compared with the less-affected arm. For reaches with the more-affected arm, SE for reach speed and age significantly predicted movement time to ipsilateral targets ( R2 = 0.352), whereas SE for reach accuracy and FM motor score significantly predicted end point error to contralateral targets ( R2 = 0.291). CONCLUSIONS: SE relates to measures of reach control and may serve as a target for interventions to improve proximal arm control after stroke.


Assuntos
Transtornos dos Movimentos/fisiopatologia , Transtornos dos Movimentos/psicologia , Autoeficácia , Acidente Vascular Cerebral/complicações , Extremidade Superior , Fenômenos Biomecânicos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos dos Movimentos/etiologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior/fisiopatologia
15.
NeuroRehabilitation ; 44(1): 43-66, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30814368

RESUMO

BACKGROUND: During gait training in persons with central nervous system (CNS) movement disorders, virtual reality (VR) can offer added value by providing task-specific gait training in more interactive and motivating environments. OBJECTIVE: To summarize current evidence for the effectiveness of VR-enhanced gait training in persons with CNS movement disorders. METHODS: PubMed, Web of Science and CENTRAL were systematically searched for studies using VR during walking to improve gait outcomes (spatiotemporal, functional, kinematic and kinetic). Meta-analyses were performed to estimate pooled effects. RESULTS: Eighteen studies with in total 337 patients were included (12 studies with people post-stroke, 4 with multiple sclerosis, 1 with Parkinson's disease, 1 with traumatic brain injury). Spatiotemporal and functional parameters significantly improved in each population after the VR training. Compared to gait training without VR, differences in favor of VR were found for spatiotemporal and functional parameters only in people post-stroke. CONCLUSION: VR-enhanced gait training is an effective method to improve spatiotemporal and functional parameters in persons with CNS movement disorders. Current evidence supports that, in comparison to training without VR, for people post-stroke VR-enhanced gait training is more effective to improve gait function. Future research regarding other outcome measures and other CNS movement disorders is necessary.


Assuntos
Terapia por Exercício/métodos , Marcha/fisiologia , Transtornos dos Movimentos/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Terapia de Exposição à Realidade Virtual/métodos , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Masculino , Transtornos dos Movimentos/fisiopatologia , Estudos Prospectivos
16.
J Clin Neurosci ; 63: 1-7, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30827880

RESUMO

Of all the truncothalamic nuclei, the centromedian-parafascicular nuclei complex (CM-Pf) is the largest and is considered the prototypic thalamic projection system. Located among the caudal intralaminar thalamic nuclei, the CM-Pf been described by Jones as "the forgotten components of the great loop of connections joining the cerebral cortex via the basal ganglia". The CM, located lateral relative to the Pf, is a major source of direct input to the striatum and also has connections to other, distinct region of the basal ganglia as well as the brainstem and cortex. Functionally, the CM participates in sensorimotor coordination, cognition (e.g. attention, arousal), and pain processing. The role of CM as 'gate control' function by propagating only salient stimuli during attention-demanding tasks has been proposed. Given its rich connectivity and diverse physiologic role, recent studies have explored the CM as potential target for neuromodulation therapy for Tourette syndrome, Parkinson's disease, generalized epilepsy, intractable neuropathic pain, and in restoring consciousness. This comprehensive review summarizes the structural and functional anatomy of the CM and its physiologic role with a focus on clinical implications.


Assuntos
Núcleos Intralaminares do Tálamo/fisiologia , Transtornos dos Movimentos/fisiopatologia , Gânglios da Base/fisiologia , Córtex Cerebral/anatomia & histologia , Córtex Cerebral/fisiologia , Córtex Cerebral/fisiopatologia , Humanos , Núcleos Intralaminares do Tálamo/anatomia & histologia , Núcleos Intralaminares do Tálamo/fisiopatologia , Doença de Parkinson/fisiopatologia
17.
J Bone Joint Surg Am ; 101(5): e17, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845041

RESUMO

BACKGROUND: Elbow injuries disrupt the surrounding periarticular soft tissues, which include the muscles, tendons, capsule, ligaments, and cartilage. Damage to these tissues as a result of elbow trauma causes clinically significant contracture in 50% of patients. However, it is unclear which of these tissues is primarily responsible for the decreased range of motion. We hypothesized that all tissues would substantially contribute to elbow contracture after immobilization, but only the capsule, ligaments, and cartilage would contribute after free mobilization, with the capsule as the primary contributor at all time points. METHODS: Utilizing a rat model of posttraumatic elbow contracture, a unilateral soft-tissue injury was surgically induced to replicate the damage that commonly occurs during elbow joint dislocation. After surgery, the injured limb was immobilized for 42 days. Animals were evaluated after either 42 days of immobilization (42 IM) or 42 days of immobilization with an additional 21 or 42 days of free mobilization (42/21 or 42/42 IM-FM). For each group of animals, elbow mechanical testing in flexion-extension was completed post-mortem with (1) all soft tissues intact, (2) muscles/tendons removed, and (3) muscle/tendons and anterior capsule removed. Total extension was assessed to determine the relative contributions of muscles/tendons, capsule, and the remaining intact tissues (i.e., ligaments and cartilage). RESULTS: After immobilization, the muscles/tendons and anterior capsule contributed 10% and 90% to elbow contracture, respectively. After each free mobilization period, the muscles/tendons did not significantly contribute to contracture. The capsule and ligaments/cartilage were responsible for 47% and 52% of the motion lost at 42/21 IM-FM, respectively, and 26% and 74% at 42/42 IM-FM, respectively. CONCLUSIONS: Overall, data demonstrated a time-dependent response of periarticular tissue contribution to elbow contracture, with the capsule, ligaments, and cartilage as the primary long-term contributors. CLINICAL RELEVANCE: The capsule, ligaments, and cartilage were primarily responsible for persistent motion loss and should be considered during development of tissue-targeted treatment strategies to inhibit elbow contracture following injury.


Assuntos
Contratura/fisiopatologia , Membro Anterior/lesões , Articulações/lesões , Transtornos dos Movimentos/fisiopatologia , Lesões dos Tecidos Moles/fisiopatologia , Animais , Fenômenos Biomecânicos/fisiologia , Contratura/etiologia , Modelos Animais de Doenças , Masculino , Distribuição Aleatória , Amplitude de Movimento Articular/fisiologia , Ratos Long-Evans , Lesões dos Tecidos Moles/complicações
18.
Exp Brain Res ; 237(4): 1077-1092, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30758515

RESUMO

Transfer, in which capability acquired in one situation influences performance in another is considered, along with retention, as demonstrative of effectual learning. In this regard, interlimb transfer of functional capacity has commanded particular attention as a means of gauging the generalisation of acquired capability. Both theoretical treatments and prior empirical studies suggest that the successful accomplishment of a physical training regime is required to bring about generalised changes that extend to the untrained limb. In the present study, we pose the following question: Does interlimb transfer occur if and only if the training movements are executed? We report findings from JG-an individual recruited to a larger scale trial, who presented with (unilateral) deficits of motor control. We examined whether changes in the performance of the untrained right limb arose following practice undertaken by the impaired left limb, wherein the majority of JG's attempts to execute the training task were unsuccessful. Comparison was made with a group of "control" participants drawn from the main trial, who did not practice the task. For JG, substantial gains in the performance of the untrained limb (registered 3 days, 10 days and 1 year following training) indicated that effective learning had occurred. Learning was, however, expressed principally when the unimpaired (i.e. untrained) limb was utilised to perform the task. When the impaired limb was used, marked deficiencies in movement execution remained prominent throughout.


Assuntos
/fisiologia , Atividade Motora/fisiologia , Transtornos dos Movimentos/fisiopatologia , Desempenho Psicomotor/fisiologia , /fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Adulto Jovem
19.
Curr Neurol Neurosci Rep ; 19(3): 12, 2019 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-30747347

RESUMO

PURPOSE OF REVIEW: Functional movement disorders are common and disabling causes of abnormal movement control. Here, we review the current state of the evidence on the use of neuroimaging in Functional movement disorders, particularly its role in helping to unravel the pathophysiology of this enigmatic condition. RECENT FINDINGS: In recent years, there has been a shift in thinking about functional movement disorder, away from a focus on high-level psychological precipitants as in Freudian conversion theories, or even an implicit belief they are 'put-on' for secondary gain. New research has emphasised novel neurobiological models incorporating emotional processing, self-representation and agency. Neuroimaging has provided new insights into functional movement disorders, supporting emerging neurobiological theories implicating dysfunctional emotional processing, self-image and sense of agency. Recent studies have also found subtle structural brain changes in patients with functional disorders, arguing against a strict functional/structural dichotomy.


Assuntos
Encéfalo/diagnóstico por imagem , Transtornos dos Movimentos/diagnóstico por imagem , Neuroimagem/métodos , Encéfalo/fisiopatologia , Discinesias/diagnóstico por imagem , Discinesias/fisiopatologia , Humanos , Transtornos dos Movimentos/fisiopatologia
20.
Int J Geriatr Psychiatry ; 34(5): 738-744, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30729576

RESUMO

OBJECTIVE: Compromised functional abilities in older adults with dementia with Lewy bodies (DLB) represent a significant burden to families and frequently lead to institutionalization. Contributing factors to this compromise are poorly understood. METHODS: Using data collected at a first study visit, multiple regression modeling was used to examine the associations between Braak staged Alzheimer disease (AD) pathology, Apolipoprotein E (ApoE) status, Parkinsonian gait, cognition, and functional status from a cohort of 102 cases with an autopsy-confirmed diagnosis of dementia stemming from combined Lewy body and AD pathology. RESULTS: On average, 60% of functional activities were compromised per case. Worse functional status was associated with older age at first study visit, compromised cognitive status, and Parkinsonian gait after controlling for gender, mental status, and other covariates. Worse cognitive status predicted worse functional status in both the low and high Braak groups. CONCLUSIONS: Older persons with DLB presenting with moderately compromised cognition and Parkinsonian gait should be expected to have impaired functional abilities. Providing these patients with supportive environments may help them to remain independent for longer periods of time.


Assuntos
Doença de Alzheimer/fisiopatologia , Cognição/fisiologia , Marcha/fisiologia , Doença por Corpos de Lewy/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/metabolismo , Doença de Alzheimer/patologia , Apolipoproteínas E/metabolismo , Autopsia , Encéfalo/patologia , Estudos de Coortes , Feminino , Humanos , Corpos de Lewy , Masculino , Transtornos dos Movimentos/fisiopatologia , Análise de Regressão
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