A Descriptive Study on the Clinical Correlates of Conversion Disorder

Aim: Conversion disorder is defined by the presence of deficits affecting the voluntary motor or sensory functions lacking any known neurological cause. The aim of the study is to describe the sociodemographic profile and clinical characteristics including the frequency distribution of various types of presentations of patients with conversion disorders in a tertiary care psychiatric facility and to assess the presence of depression and anxiety and its level of severity in those patients. Methods: After obtaining informed consent, 50 consecutive patients who had met with the ICD-10 diagnosis criteria for conversion disorder and those who meet the inclusion/exclusion criteria, were enrolled for the study. They were interviewed using a semi-structured Performa and were administered Hospital Anxiety and Depression scale (HADS) and the results were analysed using SPSS software and interpreted. Results: Majority of the study patients were young adolescents (48%), females (76%), rural residents (60%), mostly unmarried (46%). Dissociative motor disorders (30%) were the most common presentation followed by mixed dissociative disorder (26%) and Dissociative convulsions (22%). HAD scale revealed that, both depression and anxiety scores were significantly high in major number of patients. Conclusion: The most common presenting symptom was that of dissociative motor type followed by dissociative convulsions with considerably high rates of depression (48%) and anxiety (54%). This made us to conclude that conversion as a phenomenon emerges to uphold its significance as a non-verbal communication process of the subconscious Mind. Keywords: Conversion, Dissociation, Hysteria, Dissociative Motor Disorder, Dissociative Convulsions, Laterality, Depression, Anxiety.

Effectiveness of Occupational Therapy Using a Sensory Integration Approach: A Multiple-Baseline Design Study

Importance: Occupational therapy using an Ayres Sensory Integration® (ASI) approach is a common intervention that has not been extensively studied in children with idiopathic sensory processing and integration challenges (e.g., without a diagnosis of autism). Objective: To test the effectiveness of ASI using measures related to motor coordination and functional performance in children with a sensory-based motor disorder (SBMD). Design: Nonconcurrent, multiple baseline, single subject. Setting: Outpatient clinic that was part of a children’s hospital in an urban setting. Participants: Three boys (ages 5–8 yr) with an SBMD. Intervention: Each participant received ASI 3 times per week for 10 wk. Outcomes and Measures: Three motor probes were measured weekly. Pre- and posttest assessments included goal attainment scaling (GAS) and the Bruininks–Oseretsky Test of Motor Proficiency–Second Edition (BOT–2). Results: All 3 participants showed improvements in motor probes during the intervention period on the basis of a 2 SD band method of analysis. Statistically significant improvements were noted across GAS goals, and positive changes were found on the BOT–2, with large effect sizes. Conclusions and Relevance: Findings suggest improved motor performance and high goal achievement using ASI for children with idiopathic sensory processing and integration challenges. What This Article Adds: This study adds to a body of literature suggesting that ASI is effective in increasing functional performance in children with sensory processing and integration challenges. Future studies using multiple baseline designs are feasible in the clinic setting and can help build the evidence base for ASI.

THE EFFECT OF NUTRITIONAL STATUS ON GROSS MOTOR SKILL IN PRE SCHOOL CHILDREN

Background and Purpose : Nutritional status is one aspect that influences children’s development. Children whose nutritional needs are not being met are at risk of experiencing developmental disorders, where one aspect of development that is affected is their gross motor skills. Indonesia has a number of malnutrition up to 17.7% with a motor disorder rate of 13-18%. This study aims to analyze the relationship between nutritional status and gross motor skill status of children aged 60-72 months in Islam Al karomah Surabaya Kindergarten. Methods : This study use obervational analytic method with cross sectional design study design. The sample in this study were children who attend Islamic Al Karomah kindergarten in Surabaya. The number of samples was 40 respondents in the Islam Al Karomah Surabaya Kindergarten. The sampling technique of this study was total sampling with nutritional status as independent variable and gross motor skill status as dependent variable. The instuments of this study are Z-Scores (Body Mass Index for age) and Developmental Pre Screening Questionnaire for collecting data and was analyzed by Fisher’s Exact test (a=0.05). Results : Almost all of the children with normal gross motor skills (78.1%) have a normal nutritional status with the results of Fisher’s Exact analysis shown p value = 0.007 (p<0.05). Conclusion : there is a relationship between the nutritional status and gross motor skill status of children aged 60-72 months in Islam Al karomah Surabaya Kindergarten.

Analysis of Graphomotor Tests with Machine Learning Algorithms for an Early and Universal Pre-Diagnosis of Dysgraphia

Five to ten percent of school-aged children display dysgraphia, a neuro-motor disorder that causes difficulties in handwriting, which becomes a handicap in the daily life of these children. Yet, the diagnosis of dysgraphia remains tedious, subjective and dependent to the language besides stepping in late in the schooling. We propose a pre-diagnosis tool for dysgraphia using drawings called graphomotor tests. These tests are recorded using graphical tablets. We evaluate several machine-learning models and compare them to build this tool. A database comprising 305 children from the region of Grenoble, including 43 children with dysgraphia, has been established and diagnosed by specialists using the BHK test, which is the gold standard for the diagnosis of dysgraphia in France. We performed tests of classification by extracting, correcting and selecting features from the raw data collected with the tablets and achieved a maximum accuracy of 73% with cross-validation for three models. These promising results highlight the relevance of graphomotor tests to diagnose dysgraphia earlier and more broadly.

Altered Cortical-Striatal Network in Patients With Hemifacial Spasm

Objective: Hemifacial spasm (HFS) is a kind of motor disorder, and the striatum plays a significant role in motor function. The purpose of this study was to explore the alterations of the cortical-striatal network in HFS using resting-state functional magnetic resonance imaging (fMRI).Methods: The fMRI data of 30 adult patients with primary unilateral HFS (15 left-side and 15 right-side) and 30 healthy controls were collected. Six subregions of the striatum in each hemisphere were selected for functional connectivity (FC) analysis. One-sample t-test was used to analyze the intragroup FC of the HFS group and the control group. Two-sample t-test was used to compare the difference of FC between the two groups. The correlation between the abnormal FC and severity of HFS was evaluated by using the Spearman correlation analysis.Results: Compared with the controls, the striatal subregions had altered FC with motor and orbitofrontal cortex in patients with HFS. The altered FC between striatal subregions and motor cortex was correlated with the spasm severity in patients with HFS.Conclusion: The FC of the cortical-striatal network was altered in primary HFS, and these alterations were correlated with the severity of HFS. This study indicated that the cortical-striatal network may play different roles in the underlying pathological mechanism of HFS.

Tele-Rehabilitation for Postural Control by Means of Virtual Reality Rehabilitation System in an Adolescent With Motor Disorder: A Case Study

The coming of an unforeseen and hostile event such as the COVID-19 pandemic has brought about various changes in everyone's daily life. During the lockdown period, a huge number of restrictions were imposed, hence interrupting a wide range of activities previously proven to be necessary for some people. Due to the circumstances, rehabilitation treatments for children with neurodevelopmental disorders have been suspended, resulting in consequent distress for the children themselves and their parents. To overcome this problem, a tele-rehabilitation approach has proven to be an excellent solution to give continuity to children's rehabilitation. The tele-rehabilitation approach allows access to rehabilitation services directly from home. During lockdown due to the COVID-19 pandemic, the Virtual Reality Rehabilitation System (VRRS) HomeKit, developed by Khymeia, was employed as a rehabilitation system for the treatment of posture and balance of an adolescent with disabilities for the first time ever. Specifically, a 17-year-old female patient was enrolled and evaluated by the clinical staff before and after the home-training sessions. The system was delivered to the patient's home so that she could perform the tasks in a familiar environment, while under the supervision of the clinical staff. Through a specific platform, using different modules of the system, therapists could remotely check that the proposed exercises were properly performed and provide feedback and/or increase the difficulty according to the patient's needs and progress. Therefore, the treatment performed was carried out at home in a personalized, intensive, and playful way; characteristics do not present in a traditional treatment. Our results are promising and demonstrate both the efficacy of rehabilitation exercises carried out at home and the feasibility of home-based rehabilitation, when using the VRRS HomeKit even with adolescents. The VRRS HomeKit presents some limitations, such as the need to have the line connection and free space at home, the presence of technical issues, and the education of parents and patients to understand the instructions. Despite the limitations, this study provides the basis for continuing the experience of tele-rehabilitation on patients with a motor disorder also by customizing the exercises to their characteristics.

The proSAAS chaperone provides neuroprotection and attenuates transsynaptic α–synuclein spread in rodent models of Parkinson’s disease

ABSTRACTParkinson’s disease is a devastating motor disorder involving the aberrant aggregation of the synaptic protein synuclein (aSyn) and degeneration of the nigrostriatal dopaminergic tract. We previously showed that proSAAS, a small secreted chaperone protein widely expressed in neurons within the brain, is able to block aSyn-induced dopaminergic cytotoxicity in primary nigral neuron cultures. We show here that coinjection of proSAAS-encoding lentivirus profoundly reduced the motor asymmetry caused by unilateral nigral AAV-mediated human aSyn overexpression. This positive functional outcome was accompanied by significant amelioration of the human aSyn-induced loss of both nigral tyrosine hydroxylase-positive cells and striatal tyrosine hydroxylase-positive terminals, demonstrating clear proSAAS-mediated protection of the nigro-striatal tract. ProSAAS overexpression also reduced the content of human aSyn protein in both the nigra and striatum and reduced the loss of tyrosine hydroxylase protein in both regions. Since proSAAS is a secreted protein, we tested the possibility that proSAAS is able to block the transsynaptic spread of aSyn from the periphery to the central nervous system, increasingly recognized as a potentially significant pathological mechanism. The number of human aSyn-positive neurites in the pons and caudal midbrain of mice following administration of human aSyn-encoding AAV into the vagus nerve was considerably reduced in mice coinjected with proSAAS-encoding AAV, supporting proSAAS-mediated blockade of transsynaptic aSyn transmission. We suggest that proSAAS may represent a promising target for therapeutic development in Parkinson’s disease.SignificanceThis paper describes two independent avenues of research that both provide support for the in vivo neuroprotective function of this small chaperone protein. In the first approach, we show that proSAAS overexpression provides remarkably effective protection against dopaminergic neurotoxicity in a rat model of Parkinson’s disease. This conclusion is supported both by three independent assays of motor function as well as by quantitative analysis of surviving dopaminergic neurons in brain areas involved in the control of motor function. In the second line of research, we show that in mice, the spread of human synuclein across synapses can be blunted by proSAAS overexpression.