scholarly journals Reducing the Soleus Stretch Reflex With Conditioning: Exploring Game- and Impedance-Based Biofeedback

2021 ◽  
Vol 2 ◽  
Author(s):  
Ronald C. van 't Veld ◽  
Eline Flux ◽  
Alfred C. Schouten ◽  
Marjolein M. van der Krogt ◽  
Herman van der Kooij ◽  
...  
Keyword(s):  
Learning Curve ◽  
Clinical Application ◽  
Stretch Reflex ◽  
Conditioning Session ◽  
Functional Independence ◽  
Reflex Response ◽  
Conditioning Paradigm ◽  
Negative Side Effects ◽  
Slow Learning

People with spasticity, i.e., stretch hyperreflexia, have a limited functional independence and mobility. While a broad range of spasticity treatments is available, many treatments are invasive, non-specific, or temporary and might have negative side effects. Operant conditioning of the stretch reflex is a promising non-invasive paradigm with potential long-term sustained effects. Within this conditioning paradigm, seated participants have to reduce the mechanically elicited reflex response using biofeedback of reflex magnitude quantified using electromyography (EMG). Before clinical application of the conditioning paradigm, improvements are needed regarding the time-intensiveness and slow learning curve. Previous studies have shown that gamification of biofeedback can improve participant motivation and long-term engagement. Moreover, quantification of reflex magnitude for biofeedback using reflexive joint impedance may obtain similar effectiveness within fewer sessions. Nine healthy volunteers participated in the study, split in three groups. First, as a reference the “Conventional” group received EMG- and bar-based biofeedback similar to previous research. Second, we explored feasibility of game-based biofeedback with the “Gaming” group receiving EMG- and game-based biofeedback. Third, we explored feasibility of game- and impedance-based biofeedback with the “Impedance” group receiving impedance and game-based biofeedback. Participants completed five baseline sessions (without reflex biofeedback) and six conditioning sessions (with reflex biofeedback). Participants were instructed to reduce reflex magnitude without modulating background activity. The Conventional and Gaming groups showed feasibility of the protocol in 2 and 3 out of 3 participants, respectively. These participants achieved a significant Soleus short-latency (M1) within-session reduction in at least –15% in the 4th–6th conditioning session. None of the Impedance group participants showed any within-session decrease in Soleus reflex magnitude. The feasibility in the EMG- and game-based biofeedback calls for further research on gamification of the conditioning paradigm to obtain improved participant motivation and engagement, while achieving long-term conditioning effects. Before clinical application, the time-intensiveness and slow learning curve of the conditioning paradigm remain an open challenge.

scholarly journals Acquisition of a simple motor skill: task-dependent adaptation and long-term changes in the human soleus stretch reflex

2019 ◽  
Vol 122 (1) ◽  
pp. 435-446 ◽  
Author(s):  
N. Mrachacz-Kersting ◽  
U. G. Kersting ◽  
P. de Brito Silva ◽  
Y. Makihara ◽  
L. Arendt-Nielsen ◽  
...  
Keyword(s):  
Operant Conditioning ◽  
Stretch Reflex ◽  
Conditioning Session ◽  
H Reflex ◽  
Reflex Change ◽  
Reflex Pathways ◽  
Term Change ◽  
Neurologically Normal ◽  
Spinal Stretch Reflex

Changing the H reflex through operant conditioning leads to CNS multisite plasticity and can affect previously learned skills. To further understand the mechanisms of this plasticity, we operantly conditioned the initial component (M1) of the soleus stretch reflex. Unlike the H reflex, the stretch reflex is affected by fusimotor control, comprises several bursts of activity resulting from temporally dispersed afferent inputs, and may activate spinal motoneurons via several different spinal and supraspinal pathways. Neurologically normal participants completed 6 baseline sessions and 24 operant conditioning sessions in which they were encouraged to increase (M1up) or decrease (M1down) M1 size. Five of eight M1up participants significantly increased M1; the final M1 size of those five participants was 143 ± 15% (mean ± SE) of the baseline value. All eight M1down participants significantly decreased M1; their final M1 size was 62 ± 6% of baseline. Similar to the previous H-reflex conditioning studies, conditioned reflex change consisted of within-session task-dependent adaptation and across-session long-term change. Task-dependent adaptation was evident in conditioning session 1 with M1up and by session 4 with M1down. Long-term change was evident by session 10 with M1up and by session 16 with M1down. Task-dependent adaptation was greater with M1up than with the previous H-reflex upconditioning. This may reflect adaptive changes in muscle spindle sensitivity, which affects the stretch reflex but not the H reflex. Because the stretch reflex is related to motor function more directly than the H reflex, M1 conditioning may provide a valuable tool for exploring the functional impact of reflex conditioning and its potential therapeutic applications. NEW & NOTEWORTHY Since the activity of stretch reflex pathways contributes to locomotion, changing it through training may improve locomotor rehabilitation in people with CNS disorders. Here we show for the first time that people can change the size of the soleus spinal stretch reflex through operant conditioning. Conditioned stretch reflex change is the sum of task-dependent adaptation and long-term change, consistent with H-reflex conditioning yet different from it in the composition and amount of the two components.

scholarly journals Long term outcome of functional independence and quality of life after traumatic SCI in Germany

Spinal Cord ◽  
2021 ◽  
Author(s):  
Florian Möller ◽  
Rüdiger Rupp ◽  
Norbert Weidner ◽  
Christoph Gutenbrunner ◽  
Yorck B. Kalke ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Functional Independence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cord Injury ◽  
Over Time

Abstract Study design Multicenter observational study. Objective To describe the long-term outcome of functional independence and quality of life (QoL) for individuals with traumatic and ischemic SCI beyond the first year after injury. Setting A multicenter study in Germany. Methods Participants of the European multicenter study about spinal cord injury (EMSCI) of three German SCI centers were included and followed over time by the German spinal cord injury cohort study (GerSCI). Individuals’ most recent spinal cord independence measure (SCIM) scores assessed by a clinician were followed up by a self-report (SCIM-SR) and correlated to selected items of the WHO short survey of quality of life (WHO-QoL-BREF). Results Data for 359 individuals were obtained. The average time passed the last clinical SCIM examination was 81.47 (SD 51.70) months. In total, 187 of the 359 received questionnaires contained a completely evaluable SCIM-SR. SCIM scores remained stable with the exception of reported management of bladder and bowel resulting in a slight decrease of SCIM-SR of −2.45 points (SD 16.81). SCIM-SR scores showed a significant correlation with the selected items of the WHO-QoL-BREF (p < 0.01) with moderate to strong influence. Conclusion SCIM score stability over time suggests a successful transfer of acquired independence skills obtained during primary rehabilitation into the community setting paralleled by positively related QoL measurements but bladder and bowel management may need special attention.

scholarly journals Acceptance and Intake of COVID-19 Vaccines among Older Germans

2021 ◽  
Vol 10 (7) ◽  
pp. 1388
Author(s):  
Marta Malesza ◽  
Erich Wittmann
Keyword(s):  
Side Effects ◽  
Long Term Effects ◽  
Negative Side ◽  
Factors Influencing ◽  
Vaccination Acceptance ◽  
Negative Side Effects

The main aim of this study was to investigate the various factors influencing COVID-19 vaccination acceptance and actual intake among older Germans aged over 75 years old (n = 1037). We found that the intention to get vaccinated or intake of the COVID-19 vaccine were positively related to the perceptions of becoming infected, perceptions of the severity of the potential long-term effects, the vaccine’s efficacy, and the benefits of vaccination. Meanwhile, the intention to get the vaccine or vaccine intake were decreased by perceptions of the negative side-effects and the general impediments to vaccination.

The Safety of the Esmarch Tourniquet

Foot & Ankle ◽  
1993 ◽  
Vol 14 (5) ◽  
pp. 278-283 ◽  
Author(s):  
William C. Biehl ◽  
James M. Morgan ◽  
F. William Wagner ◽  
Rodney A. Gabriel
Keyword(s):  
Learning Curve ◽  
Clinical Application ◽  
Medial Malleolus ◽  
Foot And Ankle ◽  
Surgical Case ◽  
Significant Difference ◽  
Mean Pressure ◽  
Continued Use

The use of an Esmarch bandage as a tourniquet in surgery has been criticized. Many authors claim that the pressures under the Esmarch are inconsistent and may be extremely high. We have seen few, if any, problems from the use of an Esmarch in surgery of the foot and ankle. The purpose of this study was to evaluate the pressures generated under the Esmarch tourniquet in a situation that mimics its clinical application, and to determine whether pressures of appropriate magnitude and consistency are obtained in order to recommend its continued use in surgery. Ten volunteers performed numerous applications of the Esmarch. The number of wraps and the width of the Esmarch bandage used were varied. The Esmarch was applied as it would be for a surgical case. Pressures directly beneath the Esmarch were recorded 8 cm proximal to the distal tip of the medial malleolus. Considering all volunteers and all pressures generated, a 3-in Esmarch applied with three wraps gave a mean pressure (±SD) of 225 ± 46 mm Hg. A 3-in Esmarch applied with four wraps gave a mean pressure of 291 ± 53 mm Hg. A 4-in Esmarch applied with three wraps gave a mean pressure of 233 ± 35 mm Hg, and a 4-in Esmarch with four wraps gave a mean pressure of 284 ± 42 mm Hg. The maximum pressures generated by any individual were as follows: 3-in three wraps, 321 mm Hg; 3-in four wraps, 413 mm Hg; 4-in three wraps, 328 mm Hg; and 4-in four wraps, 380 mm Hg. There was no significant difference in the magnitude or consistency of pressures generated between the experienced and inexperienced wrappers. There did not appear to be a learning curve for the application of the Esmarch bandage. We conclude that an Esmarch bandage, used as a tourniquet, can generate safe and reliable pressures. Either a 3-in or 4-in Esmarch bandage applied above the ankle with three circumferential overlapping wraps consistently results in pressures that are in a safe range.

Clinical application of compressed spectral array in long-term EEG monitoring of comatose patients

1978 ◽  
Vol 45 (2) ◽  
pp. 211-225 ◽  
Author(s):  
A Bricolo ◽  
S Turazzi ◽  
F Faccioli ◽  
F Odorizzi ◽  
G Sciarretta ◽  
...  
Keyword(s):  
Clinical Application ◽  
Eeg Monitoring

scholarly journals Antioxidative and antimicrobial potentials of Parmelia saxatilis and Pseudoevernia furfuracea

2016 ◽  
pp. 9-18
Author(s):  
Jasmina Cilerdzic ◽  
Mirjana Stajic ◽  
Jelena Vukojevic
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Side Effects ◽  
Klebsiella Pneumoniae ◽  
Bacterial Species ◽  
Phenol Content ◽  
Negative Side Effects ◽  
Highly Correlated ◽  
Ethanol Extracts

Even though numerous lichen species possess significant medical potentials they are still unexplored, and particularly species and strains originating from Serbia. Therefore, the aim of this study was to evaluate the antioxidative and antimicrobial potential of ethanol extracts of Parmelia saxatilis and Pseudoevernia furfuracea collected in Serbia. The tested extracts were good scavengers of DPPH radicals, with capacities ranging from 14.76% to 79.76% in P. saxatilis and from 21.39% to 90.04% in P. furfuracea. In P. saxatilis level of DPPH? neutralisation was highly correlated with phenol content (r2 = 0.9981) and in P. furfuracea with amount of total flavonoides (r2 = 0.9641). The extract of P. furfuracea inhibited the growth of all tested microorganisms with exception of Aspergillus flavus, while P. saxatilis extract affected only growth of bacterial species. Among tested microorganisms, Staphylococcus aureus and Klebsiella pneumoniae were the most sensitive, while Enterococcus faecalis, Pseudomonas aeruginosa as well as micromycetes were the least sensitive to tested extracts. Because of these potentials and the fact that their long term usage does not have any negative side effects on organism and development of microbial resistance, the extracts could be included in conventional therapy.

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