Asymmetry of arm-swing not related to handedness.

This study systematically investigated the symmetry of arm-swing kinematics in 16 normal subjects (8 right-handed, 8 left-handed) during treadmill locomotion, including forward walking (2-6 km/h), running (8 km/h), and backward walking (4 km/h). Kinematic data of both sides were compared. Significant differences between the left and right amplitudes of arm-swing (p<0.05) were detected in 47 of the 96 gait trials (16 subjects x 6 conditions). The mean magnitude of the side differences was 8.6 cm during forward walking (averaged across all subjects). The mean index of asymmetry of 12.5+/-24.0 (+/-S.D.) indicated a trend towards left arm-swing preference. In 10 of the 16 subjects, the individual direction of the arm-swing asymmetry could be reproduced across different velocities and locomotor modes. The asymmetry was not related to handedness, nor was it related to asymmetrical leg movements. The first comprehensive normative data of arm-swing asymmetry during treadmill walking are provided. A certain degree of asymmetry is physiological.

Impact and Effectiveness of Dual Aspiration Technique in Stent-Assisted Mechanical Thrombectomy: Recent Improvements in Acute Stroke Management.

BACKGROUND AND PURPOSE: To evaluate feasibility and impact of dual aspiration technique (DAT) within stent-assisted mechanical thrombectomy on procedural parameters and clinical outcome. MATERIALS AND METHODS: Within 16 months, 76 consecutive patients (mean age 70.7 year; range 33-89) underwent stent-assisted mechanical thrombectomy. Of 52 enrolled patients (68.4 %) with occlusion of the anterior circulation, 22 patients (42.3 %) underwent DAT; 30 patients (57.7 %) were treated in conventional monoaspiration technique (MAT). Epidemiological data, clinical and imaging characteristics (mRS, NIHSS, ASPECTS) as well as procedural details were analyzed (TICI, number of retrieval, procedure time). Clinical outcome was determined with mRS at discharge and after 90 days. RESULTS: In the context of DAT additional carotid artery stenting was required in 45.5 % (10/22) in underlying tandem lesion (vs. 0/30 MAT). No differences were found in NIHSS at admission (MAT: 20.5, range 15-29; DAT: 18.6; range 11-25), mRS at admission (MAT: 4.6 vs. DAT: 4.57) or ASPECT score (MAT: 8.3, ±1.5; DAT: 8.4, ±1.5; P > 0.05). TICI ≥ 2b/3 was conducted in 90 % (MAT) and 100 % (DAT), respectively. The procedure time was longer in the MAT group (65 min, ±25.9, range 18-126) compared to the DAT group (49.7 min, ±15, range 32-101; P = 0.016). The clinical outcome increased from admission to discharge and in follow-up after 90 days (mRS ≥ 2: MAT: 53.3 %, DAT: 54.5 %; P > 0.05). CONCLUSIONS: The dual aspiration technique with an additional intermediate guide catheter placed closed to the stent retriever leads to decreased procedure time in the anterior circulation. Even in cases with higher thrombus load and treated in DAT, clinical outcome improved.

Effects of bilateral subthalamic nucleus stimulation on parkinsonian gait.

Gait analysis was carried out to assess the effects of L-dopa and bilateral subthalamic nucleus stimulation on gait velocity, cadence, stride length, and gait kinematics in nine patients with PD. Substantial effects of bilateral subthalamic nucleus stimulation on gait, with an increase in gait velocity and stride length comparable to that of a suprathreshold L-dopa dose, were found. Interestingly, stride length was more improved by L-dopa and cadence more by subthalamic nucleus stimulation. In two patients with freezing during the "on" period, subthalamic nucleus stimulation failed to reduce this symptom effectively.

Assessment of sensorimotor functions after traumatic brain injury (TBI) in childhood - Methodological aspects.

Various basic qualitative and quantitative methods for the evaluation of sensorimotor functions after Traumatic Brain Injury (TBI) are introduced and discussed. Methodological aspects are illustrated by a single case follow-up study of a child after severe TBI (age 11; 7–12;1 yrs; 6, 8 and 12 month post TBI) in comparison to an age-matched healthy control group (N=16). The evaluation consisted of neurological investigation, Barthel-Index, Terver Numeric Score for Functional Assessment, Rappaport Disability Rating Scale (modified version), a coordination-test for children (KTK), a pilot-tested Motor Function Score, quantitative evaluation of spatiotemporal gait parameters on a walkway and on a treadmill, and the kinematic assessment of hand motor functions. Quantitative movement analyses revealed two general types of motor disorder: Slowing of movements and compensatory motor strategies. Averaged z-scores showed deficits, which were pronounced in fine motor skills (hand movements: 1.86, gait: 1.3). During follow-up, a strong improvement rate during the first (-0.48 z-scores) and nearly no improvement rate (-0.03 z-scores) during the second time interval was seen. Clinical scores and developmental tests were not able to document the whole restitutional course, whereas motor tests with special emphasis on functional aspects and the quantitative movement assessment seemed to be suitable methods. We conclude that a sufficient evaluation of sensorimotor functions after TBI in childhood needs an increase in procedural uniformity on onehand and the combination of various qualitative and quantitative methods on the other hand. To connect both claims, further research is necessary.

Kinematic analysis of prehension movements in children.

The kinematics of the reach-to-grasp movement were analyzed in ten healthy children (age 6-7 years) under different experimental conditions: distance and size of the target objects, and visual feedback during the reach were varied in a within-subjects design. To assess age-related differences, the same experiments were performed in ten healthy adults. The experimental set-up was scaled according to body proportions to obtain equivalent conditions for both age groups. The temporal coupling between the transport and grasp components of prehension was very similar in children and adults. Peak transport velocity increased by the same factor in both age groups when the object distance was doubled. However, the decelerating approach phase was shorter in the children, who opened their hands relatively wider than adults. Unlike the adults, children failed to scale their grip aperture according to object size when visual feedback during the movement was lacking. The grip aperture increased with object distance in adults, but not in the children. The intrasubject variability of kinematic parameters was distinctly higher in the children. The results suggest that grip formation is not yet mature at an age of 6-7 years, depending more on visual feedback than in adult prehension.

Gait analysis of sporadic and hereditary spastic paraplegia.

OBJECTIVES: Sporadic (SSP) and hereditary spastic paraplegias (HSP) are clinically and genetically heterogeneous disorders, which are characterised by a slowly progressive spastic paraparesis. Initial symptoms and the rate of progression are variable even among members of the same family. Spastic paraparesis is the major and most disabling clinical symptom and was assessed with gait analysis using a three-dimensional infrared movement analysis system. METHODS AND RESULTS: 22 patients with clinically and/or genetically confirmed SSP/HSP were compared with age-matched control subjects. Significantly lower values were found for gait velocity, stride length, step height and the range of motion of the knee-angle. The gait pattern is characterised by a severe spasticity of both legs with only mild paresis. The balance-related gait parameters show a broad-based gait without inwardly rotated feet. No correlation was found between disease duration and the severity of the gait disorder and the central motor conduction time to the leg muscles and the abnormal gait parameters. The gait pattern did not differ between the 7 SSP cases and the 15 HSP cases. CONCLUSIONS: We conclude that three-dimensional gait analysis can uncover specific features of such rare gait disorders, and may be used as an objective tool to quantify the impairment of gait parameters in patients with SSP/HSP and thus can be used to monitor disease progression and the effect of therapeutic interventions.

Gait analysis in idiopathic normal pressure hydrocephalus--which parameters respond to the CSF tap test?

OBJECTIVES: Normal pressure hydrocephalus (NPH) is an often underestimated cause of hypokinetic gait disorders in the elderly. Diagnosing NPH is a complex problem, since many symptoms overlap with other neurological diseases. The purpose of the present study was to characterize the gait pattern in NPH quantitatively. Additionally, we analyzed the improvement of gait parameters following tapping of cerebrospinal fluid (CSF). METHODS: Gait analysis was performed in 10 patients and 12 age-matched healthy controls during overground and treadmill locomotion. RESULTS: Compared to healthy controls, patients with NPH walked significantly slower, with shorter and more variable strides and a somewhat lower cadence. The feet were not lifted to a normal height and the dorsal extension of the forefoot prior to heel-strike was insufficient. Balance-related gait parameters such as step width and the foot rotation angles were significantly increased in NPH, while their variability was lower. Only some gait parameters improved after tapping 30 ml CSF. Gait velocity increased by about 23% due to an increased stride length, while the cadence remained unchanged. Balance-related gait parameters and the foot-to-floor clearance during swing were not affected by the treatment. CONCLUSIONS: In conclusion, we found a triad of decreased stride length, decreased foot-to-floor clearance and a broad-based gait to be the typical features of the gait abnormality in NPH. Only the stride length improved following a diagnostic spinal tap. These results may help to more reliably diagnose the condition of NPH in a routine clinical setting.

Defective production of interleukin-2 in patients with idiopathic Parkinson's disease.

The pathogenesis of Parkinson's disease (PD) is largely unknown. Recently, several studies have presented evidence of an immunological dysfunction in patients suffering from PD. We studied the immune responsiveness of patients with idiopathic PD (n = 20) by investigation of the ability of peripheral blood mononuclear cells to produce cytokines after mitogenic stimulation in a whole blood assay. A group of age-related healthy blood donors served as control (n = 19). Additionally, white blood count, leukocyte differentiation and lymphocyte subtyping were performed. PD patients had a significantly higher neutrophil count, but analysis of T-cell subsets showed no difference between the two groups. In peripheral blood, secretion of interleukin-2 (IL-2) after mitogenic stimulation was significantly diminished in the patients' group (p < 0.01), whereas values of IFN-alpha 2, IL-6, IFN-gamma and sIL-2R were comparable in both groups. IL-2 production correlated negatively with the mean annual dose of levodopa treatment and correlated significantly (p < 0.002) with amantadine uptake. Analysis of sex, age, duration of illness and other drug intake revealed no correlation with cytokine release. Our findings support the view that there is a selective abnormality in the immune repertoire of peripheral blood lymphocytes in patients suffering from PD, the reasons for which need to be explored.

Analysis of gait in cervical myelopathy.

Gait disorders are a frequent symptom of cervical spondylotic myelopathy (CSM). Twelve patients with CSM underwent gait analysis before and after decompressive surgery. They were assessed on a walkway and a treadmill and compared with a healthy matched control group. The following features were observed in the CSM group before surgery: significantly reduced gait velocity and step length (P<0. 05), prolonged double support, increased step width, and reduced ankle joint extension during treadmill walking. Knee and hip kinematics did not differ from controls. Two months after surgery, spatio-temporal parameters had moved towards normal values, velocity, step length and cadence had increased significantly, and there was reduction of step width during treadmill walking, indicating improved equilibrium. Gait analysis is an objective tool to document functional recovery after decompressive surgery in CSM.

Influence of secretagogues on volume and protein pattern in rabbit lacrimal fluid.

After certain tear proteins had been found to be markers of duct cell activity in the rabbit lacrimal gland, different secretagogues were tested to increase volume and protein secretion. Carbamyl-choline and the peptides eledoisin and vasoactive intestinal peptide (VIP) stimulated volume flux as well as secretion of the marker proteins indicating duct cell activation. Beta-adrenergic stimulation also increased secretion of a further tear protein. This might indicate that water is secreted by the duct cells. These are stimulated by the secretagogues mentioned above. Beta-adrenergic stimulation might in addition activate the acinar cell system.

Children's spatial behavior is differentially affected after traumatic brain injury.

Spatial behavior in 20 children with severe traumatic brain injury (TBI) and 20 healthy controls was investigated using the Kiel Locomotor Maze. Children had to remember defined locations in an experimental chamber with completely controlled intra- and extra-maze cues until learning criterion was reached. In a second experiment, spatial orientation strategies were assessed. Children with TBI were shown to be impaired in spatial learning and spatial memory. Spatial orientation was found to be deficient even in cases where spatial learning and memory proved to be unimpaired, especially in tasks that demanded the use of relational place strategies. Children who suffered a TBI at an early age proved to be more severely impaired in spatial learning and orientation than older children.

Topical anesthetic induced pain as a diagnostic tool for kerato conjunctivitis sicca (KCS).

Duration and intensity of pain induced by instillation of an acid local anesthetic eyedrop were compared in 321 normals and 77 KCS-patients. The medium duration of pain was increased in KCS-patients (16.23 s) compared to normals (7.64 s). Also the main intensity of pain was increased (KCS: 1.34, normals 0.63). Both differences were highly significant (< 0.001). The sensitivity of duration (limit 12 s) was 64% and the specificity 69%. Except BUT this very simple test is the only one that uses a well defined stress to the tear film to test its capacity for adaptation. Furthermore it is the first KCS-test, that includes the individual sensitivity, which is an important parameter for assessment of KCS-patients.

[Significance of subjective sensitivity in evaluation of keratoconjunctivitis sicca]. / Die Bedeutung der subjektiven Empfindlichkeit in der Beurteilung der Keratoconjunctivitis sicca (KCS).

In patients with keratoconjunctivitis sicca (KCS) frequently a mismatch between the symptoms and clinical signs of impaired tear film is found. Thus, we conducted a study to determine whether tests can be found that provide information on increased sensitivity in KCS patients. Thirty patients with and without KCS were investigated by the following methods: a specific anamnestic questionnaire, esthesiometry and provocation of ocular pain by instillation of a local anesthetic eye drop. Esthesiometry only showed a shift towards higher sensitivity, but the other tests indicated significantly increased ocular sensitivity in KCS patients. These very simple methods permit better understanding of the specific situation in the individual patient.

[Diagnosis of keratoconjunctivitis sicca in rheumatoid arthritis. The value of various tests]. / Zur Diagnose der Keratoconjunctivitis sicca bei rheumatoider Arthritis. Die Wertigkeit verschiedener Tests.

In this study we examined 85 patients in the range of 25 to 60 years with rheumatoid arthritis (RA) and a control group of 35 persons without any systemic diseases. The 85 patients with RA were split into two groups: first group was made up of 32 patients with keratoconjunctivitis sicca (KCS) and the second of 53 patients without KCS. The aim was to decide whether the simple ocular ferning test has more diagnostic value than the "classical" tests: break-up time (BUT), Schirmer-1-test and concentration of lysozyme in the tear fluid. Therefore, we compared the tests with reference to sensitivity, specificity and prognostic value in the three groups. The results of the ocular ferning test are markedly better than the results of the other tests: sensitivity is 82.2%, specificity 92.5% and prognostic value 86.6%. The corresponding values are: BUT: 51.6%-77.8%-63.1%; Schirmer-1-test: 34.4%-90.8%-73.5%, lysozyme concentration: 73.4%-51.0%-52.7%. The ocular ferning test is an easy, practical, cheap, and reliable completion to the conventional tests; it is also easy on the patients.

[Medical-social aspects of repatriation flights]. / Medizinisch-soziale Aspekte von Repatriierungsflügen.

The increase of journeys abroad has led to a continual rise of international flights repatriating ill or injured persons. These repatriations flights are carried out by rescue organisations such as the German Air Rescue Organisation. A survey of the patients transported has been made in respect with the patient collective. The following factors were taken into accounts: the severity of condition with regulation aids of the NACA (National Advisory Committee for Aeronautics), used by the American Army. Together with medical and social indications an additional parameter had be considered. A questionnaire is available to access the social indications. A neutral observer is recommended to protect the interest of the patient, insurance company and the rescue organisation.

[Gait disturbances in neurology]. / Gangstörungen in der Neurologie.

Gait disorders lead to loss of mobility and therefore of an individual's autonomy. The greatest risk factor for gait disorders is old age. Other important factors include drugs and their side effects, cognitive impairment, and alcohol abuse. In successful aging there is only a slight decline in gait velocity. The classification into lower- (peripheral), middle- (spinal, basal ganglia), and higher-level gait disorders (e.g. frontal or psychogenic) is still common but contradictory. Gait disorders in neurology are frequent. Detailed descriptions of gait patterns in hypokinetic gait disorders, dystonic, hemi-, and paraparetic gait, ataxia, vestibular, neuromuscular, and psychogenic gait are given. Besides reduction of risk factors, improving the physical state (physiotherapy, sports), descriptions of walking aids, and the prevention of falls are extraordinarily important for the therapy of gait disorders.

Influence of alcohol on gait in patients with essential tremor.

OBJECTIVE: To study the effect of ethanol on gait in patients with essential tremor (ET). METHODS: Using a three-dimensional opto-electronic gait analysis system, the authors analyzed gait at free-speed walking, at a given velocity, and during tandem gait. Patients with ET with advanced disease were examined before and after a small oral dose of ethanol. The results of the patients with ET were compared with those from age-matched healthy controls (HCs). The primary outcome criteria were the number of missteps and the ataxia score during tandem gait. RESULTS: Before alcohol, patients with ET had more missteps and an abnormal ataxia score compared with HCs. The ingestion of alcohol with a mean blood level of 0.45% led to a significant improvement of the ataxia score and the number of missteps. HCs showed a worsening of the ataxia score and an increase of the number of missteps after alcohol, which failed to reach significance. CONCLUSIONS: Orally administered ethanol improved gait ataxia in patients with essential tremor (ET). This may reflect a reversible effect of ethanol on receptors being involved in the pathology of ET. Ethanol may act via an influence of the inferior olive or directly on alcohol-sensitive gamma-aminobutyric acid receptors within the cerebellum.

[Confidence and fear of the doctor when meeting the suicidal patient (author's transl)]. / Sicherheit und Angst des Arztes in der Begegnung mit dem suizidalen Patienten

In the encounter with the suicidal patient, the doctor enters a field of emotional high tension. He seeks to protect himself against the fear which agressive and destructive tendencies arouse in him by measures which are, in many respects, questionable. The doctor can only find real confidence when faced with a suicidal patient if he perceives his own insecurity and fears. Consequently the treatment of the suicidal patient becomes a permanent balancing act. In describing here three important polarities an attempt is made to make this risk of the attitude of suspense and the therapeutic possibilities arising from it intelligible.