scholarly journals Assisted Movement With Enhanced Sensation (AMES): Coupling Motor and Sensory to Remediate Motor Deficits in Chronic Stroke Patients

2008 ◽  
Vol 23 (1) ◽  
pp. 67-77 ◽  
Author(s):  
Paul Cordo ◽  
Helmi Lutsep ◽  
Linda Cordo ◽  
W. Geoffrey Wright ◽  
Timothy Cacciatore ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Motor Deficits ◽  
Motor Impairments ◽  
Joint Rotation ◽  
Motor Disability ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Severe Motor ◽  
The Subject ◽  
Flexion And Extension

Background. Conventional methods of rehabilitation in patients with chronic, severe motor impairments after stroke usually do not lessen paresis. Objective. A novel therapeutic approach (assisted movement with enhanced sensation [AMES]) was employed in a medical device phase I clinical trial to reduce paresis and spasticity and, thereby, to improve motor function. Methods. Twenty subjects more than 1 year poststroke with severe motor disability of the upper or lower extremity were studied. A robotic device cycled the ankle or the wrist and fingers at 5°/s through ±17.5° in flexion and extension while the subject assisted this motion. Feedback of the subject's active torque was displayed on a monitor. Simultaneously, 2 vibrators applied a 60 pps stimulus to the tendons of the lengthening muscles, alternating from flexors to extensors as the joint rotation reversed from extension to flexion, respectively. Subjects treated themselves at home for 30 min/day for 6 months. Every other day prior to treatment, the therapy device performed automated tests of strength and joint positioning. Functional testing was performed prior to enrollment, immediately after completing the protocol, and 6 months later. Functional tests included gait and weight distribution (lower extremity subjects only) and the Stroke Impact Scale. Results. Most subjects improved on most tests, and gains were sustained for 6 months in most subjects. No safety problems arose. Conclusion. The AMES strategy appears safe and possibly effective in patients with severe chronic impairments. The mechanism underlying these gains is likely to be multifactorial.

scholarly journals Lower Extremity Motor Impairments in Ambulatory Chronic Hemiparetic Stroke: Evidence for Lower Extremity Weakness and Abnormal Muscle and Joint Torque Coupling Patterns

2017 ◽  
Vol 31 (9) ◽  
pp. 814-826 ◽  
Author(s):  
Natalia Sánchez ◽  
Ana Maria Acosta ◽  
Roberto Lopez-Rosado ◽  
Arno H. A. Stienen ◽  
Julius P. A. Dewald
Keyword(s):  
Lower Extremity ◽  
Degrees Of Freedom ◽  
Joint Torque ◽  
Motor Impairments ◽  
Lower Extremity Weakness ◽  
Joint Torques ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
Hip Extension ◽  
Flexion And Extension

Although global movement abnormalities in the lower extremity poststroke have been studied, the expression of specific motor impairments such as weakness and abnormal muscle and joint torque coupling patterns have received less attention. We characterized changes in strength, muscle coactivation and associated joint torque couples in the paretic and nonparetic extremity of 15 participants with chronic poststroke hemiparesis (age 59.6 ± 15.2 years) compared with 8 age-matched controls. Participants performed isometric maximum torques in hip abduction, adduction, flexion and extension, knee flexion and extension, ankle dorsi- and plantarflexion and submaximal torques in hip extension and ankle plantarflexion. Surface electromyograms (EMGs) of 10 lower extremity muscles were measured. Relative weakness (paretic extremity compared with the nonparetic extremity) was measured in poststroke participants. Differences in EMGs and joint torques associated with maximum voluntary torques were tested using linear mixed effects models. Results indicate significant poststroke torque weakness in all degrees of freedom except hip extension and adduction, adductor coactivation during extensor tasks, in addition to synergistic muscle coactivation patterns. This was more pronounced in the paretic extremity compared with the nonparetic extremity and with controls. Results also indicated significant interjoint torque couples during maximum and submaximal hip extension in both extremities of poststroke participants and in controls only during maximal hip extension. Additionally, significant interjoint torque couples were identified only in the paretic extremity during ankle plantarflexion. A better understanding of these motor impairments is expected to lead to more effective interventions for poststroke gait and posture.

scholarly journals Tendon and Motor Phenotypes in the Crtap-/- Mouse Model of Recessive Osteogenesis Imperfecta

2020 ◽  
Author(s):  
Matthew W. Grol ◽  
Nele A. Haelterman ◽  
Joohyun Lim ◽  
Elda M. Munivez ◽  
Marilyn Archer ◽  
...  
Keyword(s):  
Mouse Model ◽  
Osteogenesis Imperfecta ◽  
Bone Fragility ◽  
Joint Hypermobility ◽  
Motor Deficits ◽  
Motor Impairments ◽  
Matrix Gene ◽  
Severe Motor ◽  
Cross Links ◽  
Immature Cells

ABSTRACTOsteogenesis imperfecta (OI) is characterized by short stature, skeletal deformities, low bone mass with bone fragility, and motor deficits. A subset of OI patients also present with joint hypermobility; however, the role of tendon/ligament dysfunction in OI pathogenesis is largely unknown. Using the Crtap-/- mouse model of severe, recessive OI, we found that mutant Achilles tendons and patellar ligaments were thinner with increased collagen cross-links and reduced collagen fibril size at 1- and 4-months compared to wildtype. Patellar ligaments from Crtap-/- mice also had fewer progenitors with a concomitant increase in immature cells. RNA-seq analysis of Achilles tendons and patellar ligaments from 1-month Crtap-/- mice revealed dysregulation in matrix gene expression concomitant with predicted alterations in TGF-β, inflammatory, and metabolic signaling. Finally, a series of behavioral tests revealed severe motor impairments and reduced grip strength in 4-month Crtap-/- mice – a phenotype that correlates with the tendon/ligament pathology.

Does Co-occurred Cerebral Palsy Change the Prognosis of West Syndrome?

2019 ◽  
Vol 51 (01) ◽  
pp. 030-036
Author(s):  
Eszter Nagy ◽  
Nelli Farkas ◽  
Katalin Hollódy
Keyword(s):  
Cerebral Palsy ◽  
West Syndrome ◽  
Motor Deficits ◽  
Brain Malformation ◽  
Motor Disability ◽  
Brain Malformations ◽  
Causative Factors ◽  
Severe Motor ◽  
Magnetic Resonance Imaging Mri ◽  
Cerebrovascular Insult

Abstract Aim We aimed to examine the occurrence of cerebral palsy (CP) in children with West syndrome (WS), to estimate the possible causative factors by analyzing the neuroimaging examinations of patients, to evaluate their cognitive/motor function and epileptic status and to compare the prognosis of children with double pathology of WS and CP and of those without CP. Methods The clinical and magnetic resonance imaging (MRI) data of 62 patients with West syndrome were evaluated. A total of 39 of 62 patients (63%) suffered from CP (CP group). The non-CP group included 23 patients. Results Abnormal MRI was found in 55/62 (89%) patients. Main anomalies were: brain malformation (21), hypoxic-ischemic encephalopathy (13), cerebrovascular insult (8), infection (7), and other anomalies (6). In the CP group, the most common MRI abnormalities included pre/perinatal hypoxia/ischemia, brain malformation, cerebrovascular insult, and infection. In the non-CP group, brain malformations were the most frequent. Significantly more negative MRIs were found in the non-CP group. More than 60% of the patients were severely cognitively impaired, almost 90% of them had CP. Not only the occurrence of intellectual disability was lower in the non-CP group, but its severity was milder as well. A total of 78% of the children with CP had a very severe motor disability. Fifty-four percent in the CP and 67% in the non-CP group had therapy-resistant epilepsy. Conclusion WS has an especially unfavorable prognosis: cerebral anomaly was confirmed in 89% of our patients. CP was present in almost two-thirds of the children with WS, most of them had severe cognitive and motor deficits.

scholarly journals Tendon and motor phenotypes in the Crtap-/- mouse model of recessive Osteogenesis Imperfecta

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Matthew William Grol ◽  
Nele A Haelterman ◽  
Joohyun Lim ◽  
Elda M Munivez ◽  
Marilyn Archer ◽  
...  
Keyword(s):  
Mouse Model ◽  
Osteogenesis Imperfecta ◽  
Skeletal Maturity ◽  
Marker Gene ◽  
Joint Hypermobility ◽  
Motor Deficits ◽  
Matrix Remodeling ◽  
Motor Impairments ◽  
Severe Motor ◽  
Cross Links

Osteogenesis imperfecta (OI) is characterized by short stature, skeletal deformities, low bone mass, and motor deficits. A subset of OI patients also present with joint hypermobility; however, the role of tendon dysfunction in OI pathogenesis is largely unknown. Using the Crtap-/- mouse model of severe, recessive OI, we found that mutant Achilles and patellar tendons were thinner and weaker with increased collagen cross-links and reduced collagen fibril size at 1- and 4-months compared to wildtype. Patellar tendons from Crtap-/- mice also had altered numbers of CD146+CD200+ and CD146-CD200+ progenitor-like cells at skeletal maturity. RNA-seq analysis of Achilles and patellar tendons from 1-month Crtap-/- mice revealed dysregulation in matrix and tendon marker gene expression concomitant with predicted alterations in TGF-b, inflammatory, and metabolic signaling. At 4-months, Crtap-/- mice showed increased aSMA, MMP2, and phospho-NFkB in the patellar tendon consistent with excess matrix remodeling and tissue inflammation. Finally, a series of behavioral tests showed severe motor impairments and reduced grip strength in 4-month Crtap-/- mice – a phenotype that correlates with the tendon pathology.

scholarly journals Brainwave Analysis for Robot Movement Depending on Age and Sex Differences

2018 ◽  
Vol 7 (4.30) ◽  
pp. 276
Author(s):  
Norasyimah Sahat ◽  
Afishah Alias ◽  
Fouziah Md Yassin
Keyword(s):  
Sex Difference ◽  
Motor Impairments ◽  
Severe Motor ◽  
The Subject ◽  
The Individual ◽  
Left Movement ◽  
Communication Pathway ◽  
Attention Level ◽  
The Brain ◽  
Age And Sex

A Brain-Computer Interface (BCI) is a direct communication pathway between a human and external device. This system is very useful especially for disabled people as their brainwave still can emit electrical activity and can move the machine even with severe motor impairments. This research aims to investigate the brain waves produced by humans in terms of attention level for robot movement based on sex and age category of children (6-12 years), teenagers (18-25 years old) and adult (30 years and over). An Electroencephalography (EEG) device called Neurosky Mindwave Mobile has been used to obtain brainwave signals produced by humans. There were five aspects of robot movement namely forward (F), right (R), left (L), backward (B) and stop (S). From the analysis, the subject is less focus when doing the backward movement compared to another aspect of movements. Based on sex difference, the male has a higher attention level than female in every aspect of movement except for the left movement. The age group that has the highest attention level is teenager and the lowest is adult. It can be concluded that the attention level produced by human varies depending on age and sex difference of the individual itself.

Quick Reference: Chapter 3: The Musculoskeletal System and Chapter 4: The Nervous System

2000 ◽  
Vol 5 (3) ◽  
pp. 4-4
Keyword(s):  
Nervous System ◽  
Lower Extremity ◽  
Musculoskeletal System ◽  
Multistep Method ◽  
Manual Muscle Testing ◽  
Motor Deficits ◽  
Lower Extremity Weakness ◽  
Residual Symptoms ◽  
Muscle Testing ◽  
Almost All

Abstract Lesions of the peripheral nervous system (PNS), whether due to injury or illness, commonly result in residual symptoms and signs and, hence, permanent impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fourth Edition, divides PNS deficits into sensory and motor and includes pain in the former. This article, which regards rating sensory and motor deficits of the lower extremities, is continued from the March/April 2000 issue of The Guides Newsletter. Procedures for rating extremity neural deficits are described in Chapter 3, The Musculoskeletal System, section 3.1k for the upper extremity and sections 3.2k and 3.2l for the lower limb. Sensory deficits and dysesthesia are both disorders of sensation, but the former can be interpreted to mean diminished or absent sensation (hypesthesia or anesthesia) Dysesthesia implies abnormal sensation in the absence of a stimulus or unpleasant sensation elicited by normal touch. Sections 3.2k and 3.2d indicate that almost all partial motor loss in the lower extremity can be rated using Table 39. In addition, Section 4.4b and Table 21 indicate the multistep method used for spinal and some additional nerves and be used alternatively to rate lower extremity weakness in general. Partial motor loss in the lower extremity is rated by manual muscle testing, which is described in the AMA Guides in Section 3.2d.

Association of the Non-Motor Burden with Patterns of Striatal Dopamine Loss in de novo Parkinson’s Disease

2020 ◽  
Vol 10 (4) ◽  
pp. 1541-1549
Author(s):  
Seok Jong Chung ◽  
Sangwon Lee ◽  
Han Soo Yoo ◽  
Yang Hyun Lee ◽  
Hye Sun Lee ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
De Novo ◽  
Early Stage ◽  
Striatal Dopamine ◽  
Motor Deficits ◽  
Dopamine Depletion ◽  
Severe Motor ◽  
Severe Group ◽  
Striatal Dopamine Depletion

Background: Striatal dopamine deficits play a key role in the pathogenesis of Parkinson’s disease (PD), and several non-motor symptoms (NMSs) have a dopaminergic component. Objective: To investigate the association between early NMS burden and the patterns of striatal dopamine depletion in patients with de novo PD. Methods: We consecutively recruited 255 patients with drug-naïve early-stage PD who underwent 18F-FP-CIT PET scans. The NMS burden of each patient was assessed using the NMS Questionnaire (NMSQuest), and patients were divided into the mild NMS burden (PDNMS-mild) (NMSQuest score <6; n = 91) and severe NMS burden groups (PDNMS-severe) (NMSQuest score >9; n = 90). We compared the striatal dopamine transporter (DAT) activity between the groups. Results: Patients in the PDNMS-severe group had more severe parkinsonian motor signs than those in the PDNMS-mild group, despite comparable DAT activity in the posterior putamen. DAT activity was more severely depleted in the PDNMS-severe group in the caudate and anterior putamen compared to that in the PDMNS-mild group. The inter-sub-regional ratio of the associative/limbic striatum to the sensorimotor striatum was lower in the PDNMS-severe group, although this value itself lacked fair accuracy for distinguishing between the patients with different NMS burdens. Conclusion: This study demonstrated that PD patients with severe NMS burden exhibited severe motor deficits and relatively diffuse dopamine depletion throughout the striatum. These findings suggest that the level of NMS burden could be associated with distinct patterns of striatal dopamine depletion, which could possibly indicate the overall pathological burden in PD.

scholarly journals Recovery of Visuospatial Neglect Subtypes and Relationship to Functional Outcome Six Months After Stroke

2021 ◽  
pp. 154596832110329
Author(s):  
Margaret J. Moore ◽  
Kathleen Vancleef ◽  
M. Jane Riddoch ◽  
Celine R. Gillebert ◽  
Nele Demeyere
Keyword(s):  
Functional Outcomes ◽  
Stroke Severity ◽  
Visuospatial Neglect ◽  
Recovery Pattern ◽  
Stroke Impact Scale ◽  
Impact Scale ◽  
Significant Difference ◽  
Initial Severity

Background/Objective. This study aims to investigate how complex visuospatial neglect behavioural phenotypes predict long-term outcomes, both in terms of neglect recovery and broader functional outcomes after 6 months post-stroke. Methods. This study presents a secondary cohort study of acute and 6-month follow-up data from 400 stroke survivors who completed the Oxford Cognitive Screen’s Cancellation Task. At follow-up, patients also completed the Stroke Impact Scale questionnaire. These data were analysed to identify whether any specific combination of neglect symptoms is more likely to result in long-lasting neglect or higher levels of functional impairment, therefore warranting more targeted rehabilitation. Results. Overall, 98/142 (69%) neglect cases recovered by follow-up, and there was no significant difference in the persistence of egocentric/allocentric (X2 [1] = .66 and P = .418) or left/right neglect (X2 [2] = .781 and P = .677). Egocentric neglect was found to follow a proportional recovery pattern with all patients demonstrating a similar level of improvement over time. Conversely, allocentric neglect followed a non-proportional recovery pattern with chronic neglect patients exhibiting a slower rate of improvement than those who recovered. A multiple regression analysis revealed that the initial severity of acute allocentric, but not egocentric, neglect impairment acted as a significant predictor of poor long-term functional outcomes (F [9,300] = 4.742, P < .001 and adjusted R2 = .098). Conclusions. Our findings call for systematic neuropsychological assessment of both egocentric and allocentric neglect following stroke, as the occurrence and severity of these conditions may help predict recovery outcomes over and above stroke severity alone.

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