Deficits of hand coordination and laterality of carotid endarterectomy

2015 ◽  
Vol 122 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Eric J. Heyer ◽  
Kaitlin A. Mallon ◽  
Joanna L. Mergeche ◽  
Yaakov Stern ◽  
E. Sander Connolly
Keyword(s):  
Carotid Artery ◽  
Motor Coordination ◽  
Dominant Hand ◽  
Neurocognitive Performance ◽  
Rate Analysis ◽  
Before And After ◽  
Group Rate ◽  
Z Scores ◽  
Hand Coordination ◽  
Grooved Pegboard Test

OBJECT Neurocognitive performance is used to assess multiple cognitive domains, including motor coordination, before and after carotid endarterectomy (CEA). Although gross motor strength is impaired with ischemia of large cortical areas or of the internal capsule, the authors hypothesize that patients undergoing CEA demonstrate significant motor deficits of hand coordination contralateral to the operative side, which is more clearly manifest in the nondominant hand than in the dominant hand with ischemia of smaller cortical areas. METHODS The neurocognitive performance of 374 patients was evaluated with a battery of neuropsychometric tests. Both asymptomatic and symptomatic patients undergoing CEA were included. The authors evaluated the patients' dominant and nondominant hand performance on the Grooved Pegboard test, a test of hand coordination, to demonstrate their functional laterality. Neurocognitive dysfunction was evaluated as the difference in performance before and after CEA according to group-rate and event-rate analyses. The z scores were generated for all tests using a reference group of patients who were having simple spine surgery. Dominant and nondominant motor coordination functions were evaluated as raw scores and as calculated z scores. RESULTS According to event-rate analysis, significantly more patients undergoing CEA of the opposite carotid artery demonstrated nondominant than dominant hand deficits of coordination (41.2% vs 26.4%, respectively, p = 0.02). Similarly, according to group-rate analysis, in patients undergoing CEA of the opposite carotid artery, raw difference scores from the Grooved Pegboard test reflected greater nondominant than dominant hand deficits of coordination (21.0 ± 54.4 vs 9.7 ± 37.0, respectively, p = 0.02). CONCLUSIONS Patients undergoing CEA of the opposite carotid artery are more likely to demonstrate nondominant than dominant hand deficits of coordination because of greater dexterity in the dominant hand before surgery.

scholarly journals Midazolam Sedation Induces Upper Limb Coordination Deficits That Are Reversed by Flumazenil in Patients with Eloquent Area Gliomas

2019 ◽  
Vol 131 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Nan Lin ◽  
Ruquan Han ◽  
Xuan Hui ◽  
Kaiying Zhang ◽  
Adrian W. Gelb
Keyword(s):  
Upper Limb ◽  
Motor Coordination ◽  
Motor Dysfunction ◽  
Task Completion ◽  
Control Group ◽  
Dominant Hand ◽  
Nondominant Hand ◽  
Eloquent Area ◽  
Before And After ◽  
Contralateral Hand

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Midazolam has been found to exacerbate or unmask limb motor dysfunction in patients with brain tumors. This study aimed to determine whether the exacerbated upper limb motor-sensory deficits are mediated through benzodiazepine sites by demonstrating reversibility by flumazenil in patients with gliomas in eloquent areas. Methods This was an interventional, parallel assignment, nonrandomized trial. Study subjects were admitted in the operating room. Patients with supratentorial eloquent area gliomas and volunteers of similar age without neurologic disease were sedated with midazolam, but still responsive and cooperative. Motor and sensory functions for upper extremities were evaluated by the Nine-Hole Peg Test before and after midazolam, as well as after flumazenil reversal. Results Thirty-two cases were included: 15 in the glioma group and 17 in the control group. The total dose of midazolam and flumazenil were comparable between the groups. In the glioma group, the times to task completion after midazolam in the contralateral hand (P = 0.001) and ipsilateral hand (P = 0.002) were 26.5 (95% CI, 11.3 to 41.7) and 13.7 (95% CI, 5.0 to 22.4) seconds slower than baseline, respectively. After flumazenil reversal, the contralateral hand (P = 0.99) and ipsilateral hand (P = 0.187) performed 1.2 (95% CI, −3.3 to 5.8) and 1.5 (95% CI, −0.5 to 3.5) seconds slower than baseline, respectively. In the control group, the dominant (P < 0.001) and nondominant hand (P = 0.006) were 2.9 (95% CI, 1.4 to 4.3) and 1.7 (95% CI, 0.5 to 2.9) seconds slower than baseline, respectively. After flumazenil, the dominant hand (P = 0.99) and nondominant hand (P = 0.019) performed 0.2 (95% CI, −0.7 to 1.0) and 1.3 (95% CI, −0.2 to 2.4) seconds faster than baseline, respectively. Conclusions In patients with eloquent area gliomas, mild sedation with midazolam induced motor coordination deficits in upper limbs. This deficit was almost completely reversed by the benzodiazepine antagonist flumazenil, suggesting that this is a reversible abnormality linked to occupation of the receptor by midazolam.

scholarly journals Grooved pegboard test performance before and after cerebrospinal fluid tap test in patients with idiopathic normal pressure hydrocephalus

2021 ◽  
Author(s):  
Caiyan Liu ◽  
Liling Dong ◽  
Chenhui Mao ◽  
Jie Li ◽  
Xinying Huang ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Test Performance ◽  
Diffusion Tensor ◽  
Normal Pressure ◽  
Dominant Hand ◽  
Imaging Analysis ◽  
Tap Test ◽  
Before And After ◽  
Hand Performance ◽  
Grooved Pegboard Test

Abstract Introduction Motor impairment in patients with idiopathic normal pressure hydrocephalus (iNPH) can extend beyond gait and include deficits in upper extremity functions and psychomotor speed. Evaluation of upper extremity function will be helpful for iNPH patients who are unable to ambulate (e.g., wheelchair-bound patients) and may not be able to comply with the gait evaluation. Our study aimed to explore the use of the grooved pegboard test (GPT) to assess responsiveness to the cerebrospinal fluid (CSF) tap test (TT) in iNPH patients. Methods Sixty-five possible NPH patients were enrolled retrospectively and all underwent detailed neuropsychological and walking assessments, CSF TTs, and brain magnetic resonance imaging. The GPT results before and after the CSF TT were compared and correlated with the other clinical assessments. In diffusion tensor imaging analysis, the fractional anisotropy (FA) and mean diffusivity (MD) values of periventricular white matter were measured by the region of interest method and were correlated with pegboard test performance. Results Compared with 0-hour GPT-dominant and nondominant hand performance, GPT-dominant hand and nondominant hand performance on the 24-hour and 72-hour CSF TT were significantly improved (all P < 0.01). There were no statistically significant differences between 24-hour and 72-hour dominant hand GPT performance. The improvement ratios in the complex visual motor speed index (i.e., the GPT performance combined with the symbol-digit modalities test score) were significantly different between the CSF TT responder and nonresponder groups. The baseline GPT performance correlated with walking test, cognitive function, and functional scores. The diffusion tensor imaging analysis of eighteen patients showed that bilateral GPT performance was significantly correlated with FA values in right periventricular lesions (both P < 0.05). Conclusion GPT could measure the change of upper extremity motor function after TT and correlated the lower extremity motor function. It was worth further investigation to its application for iNPH patients unable to comply with the gait evaluation.

Reversal of Focal Misery Perfusion after Intracranial Angioplasty: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 48 (2) ◽  
pp. 436-440 ◽  
Author(s):  
Colin P. Derdeyn ◽  
DeWitte T. Cross ◽  
Christopher J. Moran ◽  
Ralph G. Dacey
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Intracranial Stenosis ◽  
Oxygen Extraction Fraction ◽  
Oxygen Extraction ◽  
Positron Emission ◽  
Misery Perfusion ◽  
Before And After ◽  
Hemodynamic Measurements

Abstract OBJECTIVE AND IMPORTANCE The presence of reduced blood flow and increased oxygen extraction fraction (OEF) (misery perfusion) in the hemisphere distal to an occluded carotid artery is a proven risk factor for subsequent stroke. Whether angioplasty of intracranial stenosis is sufficient to reverse this condition has not been documented. CLINICAL PRESENTATION A 67-year-old man exhibited progressive right hemispheric ischemic symptoms despite maximal antiplatelet and antithrombotic therapy. Angiography demonstrated focal 80% stenosis of the supraclinoid segment of the ipsilateral internal carotid artery. TECHNIQUE 15O positron emission tomographic measurements of cerebral blood flow and OEF were made before and after transfemoral percutaneous angioplasty. OEF values measured before angioplasty were elevated in the middle cerebral artery distal to the stenosis. Angioplasty reduced the degree of luminal stenosis to 40% (linear diameter). OEF values measured 36 hours after angioplasty were normal. CONCLUSION Angioplasty of intracranial stenosis can restore normal cerebral blood flow and oxygen extraction, despite mild residual stenosis after the procedure. Hemodynamic measurements may be useful for the identification of patients with the greatest potential to benefit from angioplasty.

Differences in Eye-Hand Motor Coordination of Video-Game Users and Non-Users

1983 ◽  
Vol 57 (1) ◽  
pp. 155-158 ◽  
Author(s):  
Jerry L. Griffith ◽  
Patricia Voloschin ◽  
Gerald D. Gibb ◽  
James R. Bailey
Keyword(s):  
Video Games ◽  
Video Game ◽  
Empirical Data ◽  
Motor Coordination ◽  
Pursuit Rotor ◽  
Hand Coordination

The recent proliferation of electronic video games has caused an outcry from those who question the merits of the games, while others maintain the games improve eye-hand coordination. At present, no empirical data are available to indicate whether there are differences in eye-hand coordination between video game users and non-users. Comparing 31 video game users and 31 non-users showed users have significantly better eye-hand motor coordination on a pursuit rotor. However, no relationship was found between an individual's eye-hand motor coordination and the amount of time spent weekly playing video games or the length of experience with video games.

scholarly journals Testing the visual-motor coordination and reaction speed in children aged between 10–14 years old

2021 ◽  
Vol 15 (2) ◽  
pp. 110-121
Author(s):  
Dan Alexandru SZABO ◽  
◽  
Andreea Roxana UJICĂ ◽  
Ovidiu URSU ◽  
◽  
...  
Keyword(s):  
Rural Areas ◽  
Motor Coordination ◽  
Theoretical Foundation ◽  
Dominant Hand ◽  
Test Results ◽  
Point Of Interest ◽  
Hand Eye Coordination ◽  
Group Information ◽  
Visual Motor ◽  
Reaction Speed

The present study aimed to debate a topic less addressed by most people, which involved research on a group of 20 students from rural areas, aged 10–14 years, which consists of performing two tests, namely the Ruler drop test and the Hand-eye coordination test, which aims at the reaction speed of the dominant and non-dominant hand and also the hand-eye coordination capacity of the subjects. The paper aimed to identify whether somatic factors and age influence the results of the group. In order to perform the two tests, it was necessary, for the beginning, information related to the study group, information on weight, age, height, dominant hand, respectively dominant eye. These represented the point of interest of the research, being reported individually to the test results, thus constituting the study basis of statistics. After obtaining the results, we concluded that a significant significance is encountered when comparing the dominant hand with the non-dominant one, obtaining a positive value for the dominant hand. At the same time, we interpreted after the research that females tend to have a much faster reaction speed, more significant than the males when it comes to using the non-dominant hand. The hypothesis was confirmed, with differences in somatic factors’ influence, but the others do not show significant values except those stated above. In addition to the practical part, the research involves an interesting theoretical foundation being reached aspects related to proprioception, coordination, speed, ways of using tests, and the opinion of other researchers who have conducted similar studies.

scholarly journals Grooved Pegboard Test Performance Before and After Cerebral-Spinal Fluid Tap Test in Patients with Normal Pressure Hydrocephalus

2020 ◽  
Author(s):  
Caiyan Liu ◽  
Liling Dong ◽  
Chenhui Mao ◽  
Jie Li ◽  
Xinying Huang ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Upper Extremity ◽  
Normal Pressure Hydrocephalus ◽  
Test Performance ◽  
Normal Pressure ◽  
Periventricular White Matter ◽  
Tap Test ◽  
Functional Scores ◽  
Before And After ◽  
Grooved Pegboard Test

Abstract Background Motor impairment in patients with normal pressure hydrocephalus (NPH) can extend beyond gait and include deficits in upper extremity functions and psychomotor speed. Evaluation of upper extremity function will be helpful for NPH patients who are unable to ambulate (e.g., wheelchair-bound patients) and may not be able to comply with the gait evaluation. Our study aimed to explore the use of the grooved pegboard test to assess responsiveness to the cerebrospinal fluid (CSF) tap test in patients with NPH. Methods Seventy-seven possible NPH patients were enrolled from 2013 to 2018. All patients underwent detailed neuropsychological and walking assessments, CSF tap tests, and brain magnetic resonance imaging. The grooved pegboard test results before and after the CSF tap test were compared and correlated with the other clinical assessments. In diffusion tensor imaging analysis, the fractional anisotropy (FA) and mean diffusivity (MD) values of periventricular white matter were measured by the region of interest method and were correlated with pegboard test performance.Results The grooved pegboard test scores significantly improved after the CSF tap test and correlated with patient walking ability, cognitive function, and functional scores (P < 0.01). The improvement ratios in the complex visual motor speed index (i.e., the grooved pegboard test performance combined with the Symbol-Digit Modalities Test performance) were significantly different between the CSF tap test responder and nonresponder groups. The grooved pegboard test times were significantly correlated with the FA values in right periventricular lesions (P=0.017).Conclusions The performance on the grooved pegboard test was related to lower extremity motor ability and cognitive function. It can be used as an alternative evaluation tool for patients who are unable to ambulate and may not be able to comply with the gait evaluation.

scholarly journals Problem-based learning in dentistry: Diagnostic capability of dentists in the detection of calcified carotid artery atheroma on digital panoramic radiographs

2020 ◽  
Vol 9 (11) ◽  
pp. e70991110451
Author(s):  
Beatriz Caio Felipe ◽  
Fernanda Chiguti Yamashita ◽  
Amanda Lury Yamashita ◽  
Ana Carolina Caio Passoni ◽  
Breno Gabriel da Silva ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Problem Based Learning ◽  
Kappa Coefficient ◽  
Operational Characteristic ◽  
Panoramic Radiographs ◽  
Kappa Test ◽  
Experienced Radiologist ◽  
Diagnostic Capability ◽  
Before And After ◽  
Systemic Health

Objective: The aim of this study was to evaluate the diagnostic capability of dentists in the identification of suggestive images of calcified carotid artery atheroma (CCAA) on panoramic radiographs (PRs) before and after using a problem-based learning method (PBL). Methodology: Five dentists (no specialists in oral and maxillofacial radiology) analyzed 102 digital PRs divided into: PRs with suggestive images of CCAA (n=51) and without suggestive images of CCAA (n=51). After the first analysis, the examiners attended an activity on soft tissue calcifications using the PBL method. Afterwards, they analyzed the 102 PRs again. The results of the analysis were calculated using the Cohen's Kappa Test and the Receptor Operational Characteristic Curves (ROC). Results and Discussion: Regarding examiners’ performance before and after the activity, the intra-examiner test showed reasonable Kappa coefficients (0-0.40). For inter-examiner agreement after the activity, the Kappa coefficient was almost perfect (> 0.80). When comparing examiners’ performance after the activity with a template performed by an experienced radiologist, the Kappa Coefficient was > 0.80 with significant agreement (p<0.05). Conclusion: The precision and the probability of correctly detecting suggestive images of CCAA on PRs increased when the examiners participated in the active pedagogical method. The continuing education of the dentist and how it can make a difference in the systemic health of patients should be considered.

scholarly journals Computed tomography indicators of cerebral microperfusion improve long term after carotid stenting in symptomatic patients

2019 ◽  
Author(s):  
Pawel J Winklewski ◽  
Mariusz Kaszubowski ◽  
Grzegorz Halena ◽  
Agnieszka Sabisz ◽  
Kamil Chwojnicki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Predictive Value ◽  
Carotid Artery Stenting ◽  
Ct Perfusion ◽  
Carotid Stenting ◽  
Cerebral Microcirculation ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Before And After

Objectives: We tested the hypothesis that computed tomography (CT) perfusion markers of cerebral microcirculation would improve 36 months after internal carotid artery stenting for symptomatic carotid stenosis while results obtained 6–8 weeks after the stenting procedure would yield a predictive value. Methods: We recruited consecutive eligible patients with >70% symptomatic carotid stenosis with a complete circle of Willis and normal vertebral arteries to the observational cohort study. We detected changes in the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and permeability surface area-product (PS) before and after carotid stenting. We have also compared the absolute differences in the ipsilateral and contralateral CT perfusion markers before and after stenting. The search for regression models of “36 months after stenting” results was based on a stepwise analysis with bidirectional elimination method. Results: A total of 34 patients completed the 36 months follow-up (15 females, mean age of 69.68±S.D. 7.61 years). At 36 months after stenting, the absolute values for CT perfusion markers had improved: CBF (ipsilateral: +7.76%, contralateral: +0.95%); CBV (ipsilateral: +5.13%, contralateral: +3.00%); MTT (ipsilateral: –12.90%; contralateral: –5.63%); TTP (ipsilateral: –2.10%, contralateral: –4.73%) and PS (ipsilateral: –35.21%, contralateral: –35.45%). MTT assessed 6–8 weeks after stenting predicted the MTT value 36 months after stenting (ipsilateral: R2=0.867, contralateral R2=0.688). Conclusions: We have demonstrated improvements in CT perfusion markers of cerebral microcirculation health that persist for at least 3 years after carotid artery stenting in symptomatic patients. MTT assessed 6–8 weeks after stenting yields a predictive value.

scholarly journals Enhanced Visual Feedback Using Immersive VR Affects Decision Making Regarding Hand Use With a Simulated Impaired Limb

2021 ◽  
Vol 15 ◽  
Author(s):  
Naoko Sakabe ◽  
Samirah Altukhaim ◽  
Yoshikatsu Hayashi ◽  
Takeshi Sakurada ◽  
Shiro Yano ◽  
...  
Keyword(s):  
Decision Making ◽  
Visual Feedback ◽  
Upper Limb ◽  
Positive Reinforcement ◽  
Motor Coordination ◽  
Negative Impact ◽  
Dominant Hand ◽  
Long Term Effects ◽  
Upper Limb Function ◽  
Feedback Enhancement

The long-term effects of impairment have a negative impact on the quality of life of stroke patients in terms of not using the affected limb even after some recovery (i.e., learned non-use). Immersive virtual reality (IVR) has been introduced as a new approach for the treatment of stroke rehabilitation. We propose an IVR-based therapeutic approach to incorporate positive reinforcement components in motor coordination as opposed to constraint-induced movement therapy (CIMT). This study aimed to investigate the effect of IVR-reinforced physical therapy that incorporates positive reinforcement components in motor coordination. To simulate affected upper limb function loss in patients, a wrist weight was attached to the dominant hand of participant. Participants were asked to choose their right or left hand to reach toward a randomly allocated target. The movement of the virtual image of the upper limb was reinforced by visual feedback to participants, that is, the participants perceived their motor coordination as if their upper limb was moving to a greater degree than what was occurring in everyday life. We found that the use of the simulated affected limb was increased after the visual feedback enhancement intervention, and importantly, the effect was maintained even after gradual withdrawal of the visual amplification. The results suggest that positive reinforcement within the IVR could induce an effect on decision making in hand usage.

scholarly journals Is staged bilateral thalamic radiosurgery an option for otherwise surgically ineligible patients with medically refractory bilateral tremor?

2018 ◽  
Vol 128 (2) ◽  
pp. 617-626 ◽  
Author(s):  
Ajay Niranjan ◽  
Sudesh S. Raju ◽  
Edward A. Monaco ◽  
John C. Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Median Time ◽  
Rating Scale ◽  
Maximum Dose ◽  
Karnofsky Performance Status ◽  
Dominant Hand ◽  
Complete Restoration ◽  
Increased Risk ◽  
Before And After ◽  
Median Maximum

OBJECTIVEUnilateral Gamma Knife thalamotomy (GKT) is a well-established treatment for patients with medically refractory tremor who are not eligible for invasive procedures due to increased risk of compications. The purpose of this study was to evaluate whether staged bilateral GKT provides benefit with acceptable risk to patients suffering from disabling medically refractory bilateral tremor.METHODSEleven patients underwent staged bilateral GKT during a 17-year period (1999–2016). Eight patients had essential tremor (ET), 2 had Parkinson's disease (PD)–related tremor, and 1 had multiple-sclerosis (MS)–related tremor. For the first GKT, a median maximum dose of 140 Gy was delivered to the posterior-inferior region of the nucleus ventralis intermedius (VIM) through a single isocenter with 4-mm collimators. Patients who benefitted from unilateral GKT were eligible for a contralateral GKT 1–2 years later (median 22 months). For the second GKT, a median maximum dose of 130 Gy was delivered to the opposite VIM nucleus to a single 4-mm isocenter. The Fahn-Tolosa-Marin (FTM) clinical tremor rating scale was used to score tremor, drawing, and drinking before and after each GKT. The FTM writing score was assessed only for the dominant hand before and after the first GKT. The Karnofsky Performance Status (KPS) was used to assess quality of life and activities of daily living before and after the first and second GKT.RESULTSThe median time to last follow-up after the first GKT was 35 months (range 11–70 months). All patients had improvement in at least 1 FTM score after the first GKT. Three patients (27.3%) had tremor arrest and complete restoration of function (noted via FTM tremor, writing, drawing, and drinking scores equaling zero). No patient had tremor recurrence or diminished tremor relief after the first GKT. One patient experienced new temporary neurological deficit (contralateral lower-extremity hemiparesis) from the first GKT. The median time to last follow-up after the second GKT was 12 months (range 2–70 months). Nine patients had improvement in at least 1 FTM score after the second GKT. Two patients had tremor arrest and complete restoration of function. No patient experienced tremor recurrence or diminished tremor relief after the second GKT. No patient experienced new neurological or radiological adverse effect from the second GKT. Statistically significant improvements were noted in the KPS score following the first and second GKT.CONCLUSIONSStaged bilateral GKT provided effective relief for medically refractory, disabling, bilateral tremor without increased risk of neurological complications. It is an appropriate strategy for carefully selected patients with medically refractory bilateral tremor who are not eligible for deep brain stimulation.

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