Aberrant Movement Research Articles

The Influence of Centralization and Directional Preference on Spinal Control in Patients With Nonspecific Low Back Pain

Prospective cohort, test-retest design. Directional preference (DP) with centralization (CEN) and DP without CEN are common pain-pattern responses assessed by Mechanical Diagnosis and Therapy (MDT). Although there is evidence that MDT can reduce pain and disability in the short term by treating the patient with direction-specific exercises concordant with the patient's DP, the mechanism responsible for this is unclear. To determine whether clinical signs of impaired spinal control improve immediately after eliciting a DP-with-CEN response or a DP-without-CEN response in patients with nonspecific low back pain. Participants underwent a standardized MDT assessment and were classified into the following pain-pattern subgroups: DP with CEN, DP without CEN, or no DP. Clinical signs of impaired spinal control were assessed pre-MDT assessment and post-MDT assessment by an independent examiner. Four spinal control tests were conducted: aberrant lumbar movements while bending forward, the active straight leg raise (ASLR) test, the Trendelenburg test, and the prone instability test. Differences in spinal control pre-MDT assessment and post-MDT assessment were calculated for the 3 pain-pattern subgroups and compared with chi-square tests. We hypothesized that a larger proportion of patients in the DP-with-CEN subgroup would exhibit improved spinal control than patients categorized as DP without CEN or no DP. Of 114 patients recruited, 51 patients (44.7%) were categorized as DP with CEN, 23 (20.2%) as DP without CEN, and 40 (35.1%) as no DP. Before MDT assessment, between 28.9% (Trendelenburg test) and 63.7% (ASLR test) of patients showed impaired spinal control. After MDT assessment, a larger proportion of patients in the DP-with-CEN subgroup (43%) showed improvement than those in the no-DP subgroup (7%) on aberrant lumbar movements (P = .02). Likewise, more patients in the DP-with-CEN subgroup (50%) improved on the ASLR test than those in the no-DP subgroup (8%, P<.01) or the DP-without-CEN subgroup (7%, P = .01). Changes in Trendelenburg test and prone instability test outcomes did not reach statistical significance. Immediately following MDT assessment, a larger proportion of patients with a DP-with-CEN pain pattern showed improvement in clinical signs of spinal control compared to patients with a DP-without-CEN or no-DP pain pattern. The current study was registered in the Dutch trial registry at http://www.trialregister.nl/trialreg/index.asp (NTR4246). Therapy, level 2b.

The Grace of Destruction: A Vital Ethology of Extreme Cinemas by Elena Del Río

Reviewed by: The Grace of Destruction: A Vital Ethology of Extreme Cinemas by Elena Del Río Kyler Chittick Elena Del Río. The Grace of Destruction: A Vital Ethology of Extreme Cinemas. New York/London: Bloomsbury, 2016. 312676pp. Much like her first book, Deleuze and the Cinemas of Performance: Powers of Affection (2008), Elena Del Río's The Grace of Destruction: A Vital Ethology of Extreme Cinemas privileges the body's expressive and affective capacities over representational paradigms and narrative form. Reasserting [End Page 186] a filmic and philosophical allegiance to the body, Del Río's latest work advances an original assessment of violence in contemporary cinema, with a particular focus on "negative affects" and the forces, extremities, and moral codes that precede and exceed acts of violence. Deploying an array of theoretical insights from multiple disciplines, Grace of Destruction engages a selection of films that demonstrate a certain extremity (3). For Del Río, "extreme cinemas" should not be confused with extremely violent films that display "sensationalist physicalit[ies]" (4) but films in which socio-moral systems and structures produce "negative affects" in subjects/individuals, often culminating in acts of violence. Del Río stresses the importance of separating "force" from "violence" but reiterates the latter's "immanence" to the former (8). Grace of Destruction does not, then, analyze cinematic violence as a series of decontextualized, individuated acts but as grounded on a "sustained practice of intensity that […] pervades the everyday body and its inherently aberrant movements and affects" (4). By engaging the "negative affects produced in such situations as moral/religious oppression, biopolitical violence, […] gender relations, the event of death, and in closing, planetary extinction" (3), Grace of Destruction is dedicated to uncovering the eminently political potentialities deployed in affective relations between bodies and other bodies and between bodies and the oppressive/repressive forces confining them. Following Nietzsche's genealogy of morals, the first chapter of Grace of Destruction provides an incisive examination of Michael Haneke's The White Ribbon (2009) and Lars von Trier's Dogville (2003). Del Río stresses that both films demonstrate a commitment to Nietzschean "slave morality," or "the morality of utility that turns the possibility of action and open aggression into the triumph of reaction and ressentiment" (32). The primary conveyance of this chapter is that White Ribbon and Dogville both demonstrate a battle between stronger and weaker forces in which opportunities for direct action/aggression (or active forces) are repressed or forestalled by a stronger pouvoir, thus breeding reactive forces. Impulses to convert reactive forces into active ones (puissance) emerge, albeit in a displaced fashion, whereby acts of aggression and revenge are misdirected and, thus, inadequately challenge (and in many ways, strengthen) the morally righteous figures that initially manifested such reactive forces. For example, in her analysis of The White Ribbon, Del Rio remarks that patriarchal figures, including the pastor, doctor, and baron, possess tremendous amounts of power and agency within the small German community in which the film is set (35). Particularly unable to stand up to their father are the pastor's children, who experience intense physical abuse, verbal [End Page 187] aggression, and shame for the smallest "infractions," including indulging in pubescent sexual desires (35). Denied of the ability to actively confront or respond to their father, or to harness their puissance, the children engage in a series of terrorizing, violent acts against the adults in their community (35–37). While these acts could be read as the children's "means [of] transform[ing] passive reactions into active ones," Del Río stresses that these "violent actions actually arise as a displaced response to the incapacitating powers of the father" (37). The children's anger and resentment toward their father, misdirected toward the community as a whole, ultimately feeds (and reveals the children's powerlessness to) the violent, repressive, and moral codes that initially bred their ressentiment (37–38). The most engaging chapter in Grace of Destruction, aptly titled "Bare Life," is also its most interdisciplinary. Invoking Deleuze, Foucault, and Agamben, this chapter explores the philosophies of "biopolitics" and "bare life" in the context of Haneke's Code Unknown (2000), and Carlos Reygadas's Battle...

Core Stabilization Exercise and Movement System Impairment Approaches for Patients with Movement Control Impairment: A Review Article

Treatment-based and movement system impairment-based classifications have been widely used to identify movement control impairment (MCI) in patients with non-specific low back pain. Clinical observation of aberrant movement patterns is an essential aspect of the examination to identify patients with MCI. The treatment of these patients is a therapeutic exercise that involves static and dynamic stability of core stabilizing muscles. Although exercise prescriptions for these patients are similar, intervention may vary based upon its concept. Interventions include the core stabilization exercise (CSE) approach based upon stabilizing system model, and movement system impairment (MSI) approach based upon kinesiopathologic model. CSE focuses on neuromuscular function to compensate for impairment of intervertebral disc and joints, whereas MSI emphasizes movement correction and enhances movement efficiency to prevent injury and impairment. Both approaches seem equally effective in reducing pain and disability for the MCI group. Therefore, clinicians can utilize either approach for rehabilitating patients with MCI. However, if differences in effectiveness are found when utilizing these different approaches we should explore if the MCI classification needs further definition. In addition, further study needs to investigate the underlying mechanisms in patients with MCI, and the ability of each approach to change those mechanisms.

Spontaneous and evoked pain-associated behaviors in a rat model of neuropathic pain respond differently to drugs with different mechanisms of action

Given that patients with neuropathic pain suffer a mixture of spontaneous and evoked pain symptoms, we assessed the effects of drugs with different mechanism of action on spontaneous and evoked pain-associated behaviors in a rat model of neuropathic pain induced by chronic constriction injury (CCI) of the sciatic nerve. Frequent aberrant limb movement on the operated side was measured to assess spontaneous pain-associated behavior, and mechanical allodynia and thermal hyperalgesia were evaluated to assess evoked pain-associated behaviors. These three types of behavior were assessed after administration of the following drugs: pregabalin (α2δ-subunit ligand), morphine (μ-opioid receptor agonist), perampanel (α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid [AMPA] receptor antagonist), clonidine, dexmedetomidine (α2-adrenoceptor agonists), and diclofenac (non-steroidal anti-inflammatory drug [NSAID]). Pregabalin at an oral dose of 10 or 30mg/kg significantly alleviated frequent aberrant limb movement and mechanical allodynia, but not thermal hyperalgesia. Morphine at a subcutaneous dose of 1 or 3mg/kg significantly improved all three types of behavior. Perampanel at an oral dose of 1mg/kg attenuated only frequent aberrant limb movement. Intraperitoneal administration of clonidine (0.01 or 0.03mg/kg) and dexmedetomidine (0.03mg/kg) significantly improved all three types of behavior, while diclofenac did not relieve any of the behaviors. Pregabalin, clonidine, and dexmedetomidine significantly decreased motor performance at doses close to analgesic doses in the rotarod test. The present study demonstrates that responses to spontaneous and evoked pain symptoms in neuropathic pain condition differ depending on a drug's mechanism of action. The selection and application of drugs according to the specific symptoms would be considered for the medication of patients with neuropathic pain.

Aberrant movement of β-tropomyosin associated with congenital myopathy causes defective response of myosin heads and actin during the ATPase cycle

We have investigated the effect of the E41K, R91G, and E139del β-tropomyosin (TM) mutations that cause congenital myopathy on the position of TM and orientation of actin monomers and myosin heads at different mimicked stages of the ATPase cycle in troponin-free ghost muscle fibers by polarized fluorimetry. A multi-step shifting of wild-type TM to the filament center accompanied by an increase in the amount of switched on actin monomers and the strongly bound myosin heads was observed during the ATPase cycle. The R91G mutation shifts TM further towards the inner and outer domains of actin at the strong- and weak-binding stages, respectively. The E139del mutation retains TM near the inner domains, while the E41K mutation captures it near the outer domains. The E41K and R91G mutations can induce the strong binding of myosin heads to actin, when TM is located near the outer domains. The E139del mutation inhibits the amount of strongly bound myosin heads throughout the ATPase cycle.

A literature review of clinical tests for lumbar instability in low back pain: validity and applicability in clinical practice.

BackgroundSeveral clinical tests have been proposed on low back pain (LBP), but their usefulness in detecting lumbar instability is not yet clear. The objective of this literature review was to investigate the clinical validity of the main clinical tests used for the diagnosis of lumbar instability in individuals with LBP and to verify their applicability in everyday clinical practice.MethodsWe searched studies of the accuracy and/or reliability of Prone Instability Test (PIT), Passive Lumbar Extension Test (PLE), Aberrant Movements Pattern (AMP), Posterior Shear Test (PST), Active Straight Leg Raise Test (ASLR) and Prone and Supine Bridge Tests (PB and SB) in Medline, Embase, Cinahl, PubMed, and Scopus databases. Only the studies in which each test was investigated by at least one study concerning both the accuracy and the reliability were considered eligible. The quality of the studies was evaluated by QUADAS and QAREL scales.ResultsSix papers considering 333 LBP patients were included. The PLE was the most accurate and informative clinical test, with high sensitivity (0.84, 95% CI: 0.69 - 0.91) and high specificity (0.90, 95% CI: 0.85 -0.97).The diagnostic accuracy of AMP depends on each singular test. The PIT and the PST demonstrated by fair to moderate sensitivity and specificity [PIT sensitivity = 0.71 (95% CI: 0.51 - 0.83), PIT specificity = 0.57 (95% CI: 039 - 0.78); PST sensitivity = 0.50 (95% CI: 0.41 - 0.76), PST specificity = 0.48 (95% CI: 0.22 - 0.58)].The PLE showed a good reliability (k = 0.76), but this result comes from a single study. The inter-rater reliability of the PIT ranged by slight (k = 0.10 and 0.04), to good (k = 0.87).The inter-rater reliability of the AMP ranged by slight (k = −0.07) to moderate (k = 0.64), whereas the inter-rater reliability of the PST was fair (k = 0.27).ConclusionsThe data from the studies provided information on the methods used and suggest that PLE is the most appropriate tests to detect lumbar instability in specific LBP. However, due to the lack of available papers on other lumbar conditions, these findings should be confirmed with studies on non-specific LBP patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12998-015-0058-7) contains supplementary material, which is available to authorized users.

Optochemical dissection of T-box gene-dependent medial floor plate development.

In addition to their cell-autonomous roles in mesoderm development, the zebrafish T-box transcription factors no tail a (ntla) and spadetail (spt/tbx16) are required for medial floor plate (MFP) formation. Posterior MFP cells are completely absent in zebrafish embryos lacking both Ntla and Spt function, and genetic mosaic analyses have shown that the two T-box genes promote MFP development in a non-cell-autonomous manner. On the basis of these observations, it has been proposed that Ntla/Spt-dependent mesoderm-derived signals are required for the induction of posterior but not anterior MFP cells. To investigate the mechanisms by which Ntla and Spt regulate MFP development, we have used photoactivatable caged morpholinos (cMOs) to silence these T-box genes with spatiotemporal control. We find that posterior MFP formation requires Ntla or Spt activity during early gastrulation, specifically in lateral margin-derived cells that converge toward the midline during epiboly and somitogenesis. Nodal signaling-dependent MFP specification is maintained in the absence of Ntla and Spt function; however, midline cells in ntla;spt morphants exhibit aberrant morphogenetic movements, resulting in their anterior mislocalization. Our findings indicate that Ntla and Spt do not differentially regulate MFP induction along the anterior-posterior axis; rather, the T-box genes act redundantly within margin-derived cells to promote the posterior extension of MFP progenitors.

A Dynamin-Actin Interaction Is Required for Vesicle Scission during Endocytosis in Yeast

SummaryActin is critical for endocytosis in yeast cells, and also in mammalian cells under tension. However, questions remain as to how force generated through actin polymerization is transmitted to the plasma membrane to drive invagination and scission. Here, we reveal that the yeast dynamin Vps1 binds and bundles filamentous actin. Mutational analysis of Vps1 in a helix of the stalk domain identifies a mutant RR457-458EE that binds actin more weakly. In vivo analysis of Vps1 function demonstrates that the mutation disrupts endocytosis but not other functions of Vps1 such as vacuolar trafficking or peroxisome fission. The mutant Vps1 is stably expressed in cells and co-localizes with the endocytic reporters Abp1 and the amphiphysin Rvs167. Detailed analysis of individual endocytic patch behavior indicates that the mutation causes aberrant movements in later stages of endocytosis, consistent with a scission defect. Ultrastructural analysis of yeast cells using electron microscopy reveals a significant increase in invagination depth, further supporting a role for the Vps1-actin interaction during scission. In vitro analysis of the mutant protein demonstrates that—like wild-type Vps1—it is able to form oligomeric rings, but, critically, it has lost its ability to bundle actin filaments into higher-order structures. A model is proposed in which actin filaments bind Vps1 during invagination, and this interaction is important to transduce the force of actin polymerization to the membrane to drive successful scission.

CSM 2015 Sports Physical Therapy Section Platform Presentations (Abstracts SPL1–SPL67)

CSM 2015 Sports Physical Therapy Section Platform Presentations (Abstracts SPL1–SPL67)

Acetylcholinesterase inhibitor modifications: a promising strategy to delay the progression of Alzheimer's disease.

Alzheimer's disease (AD), a fatal, progressive, neurodegenerative disorder, is the most common cause of old-age dementia, accounting for 50–75% of dementia patients. Early stages of AD are marked by vocabulary shrinkage, spatial disorientation, depression, apraxia, and deterioration of recent forms of declarative memory. In course of time, the patients require close supervision due to the loss of cognitive and functional abilities, and at the terminal stages of the disease, all forms of memory are severely impaired with the patients needing nursing home care (World Alzheimer Report, 2013).

Recalibration of oculomotor and cerebellar activity to reduce low back pain in a professional tennis player

Event Abstract Back to Event Recalibration of oculomotor and cerebellar activity to reduce low back pain in a professional tennis player Frederick R. Carrick1, 2*, Benjamin R. Behrendt1, 3 and Susan Esposito4 1 Carrick Institute for Graduate Studies, United States 2 Senior Research Fellow of Bedfordshire Centre for Mental Health Research in association with the University of Cambridge (BCMHR-CU), United Kingdom 3 NeuroWorks Healthcare LLC, United States 4 Life University, Department of Chiropractic Sciences, United States Background: On-going moderate low back pain (LBP) in a sixteen-year-old world class professional tennis player received neurological care at our clinic. Methods: MRI, CT, and X-RAY findings of his low back were inconclusive except for mild posterior disc bulging at L3/4, L4/5 and L5/S1. Neurological examination revealed abnormal cerebellar output and oculomotor breakdown. Notably, there was right hyperopia, which was reduced with vestibular-ocular head movements (VOR); left coractasia; left accommodation spasm; slower rightward saccades and hypermetric leftward saccades with irregular phase profile and normal re-fixation; initial gaze-shifting downward produced retrocolic activity during normal viewing and during tennis. Cerebellar findings included slower alternating hand movements on the left; sluggish myotatic stretch response (MSR) in his left brachioradialis and left achilles; a right patellar MSR which was pendular. He was treated with multi-axial rotation to affect the vestibular apparatus, brainstem and cortical connections, oculomotor therapy, laser therapy and manual manipulation of joint mechano-receptors. Results: After fourteen days in a multi-day treatment program aberrant eye movements improved: He was able to maintain gaze holding; pursuits at 0.01 Hz were within more normal range; optokinetic responses during saccades improved; his accommodation spasm was absent; spontaneous facial movement was abated; retrocolic neck reactions diminished; V:A ratios improved; low back pain was relieved. Conclusion: Intensive multi-day therapy which incorporates therapies (vestibular, occult-motor, mechanoreceptor stimulation) to improve the reflexogenic systems may help alleviate impairments in athletes. This tennis player’s symptoms were improved and he was able to return to play. The authors recommend further investigation into the utilization of a multi-modal vestibular, ocular and motoric programs to correct performance among athletes. Keywords: Tennis, Low Back Pain, vestibular therapy, Off Vertical Axis Rotation (OVAR), reflexogenic, oculomotor, Eye therapy Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Carrick FR, Behrendt BR and Esposito S (2015). Recalibration of oculomotor and cerebellar activity to reduce low back pain in a professional tennis player. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00045 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 30 Oct 2015; Published Online: 02 Nov 2015. * Correspondence: Prof. Frederick R Carrick, Carrick Institute for Graduate Studies, Cape Canaveral, FL, 32920, United States, drfrcarrick@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Frederick R Carrick Benjamin R Behrendt Susan Esposito Google Frederick R Carrick Benjamin R Behrendt Susan Esposito Google Scholar Frederick R Carrick Benjamin R Behrendt Susan Esposito PubMed Frederick R Carrick Benjamin R Behrendt Susan Esposito Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial.

Randomized controlled trial. Low back pain is a common disorder. Patients with low back pain frequently have aberrant and pain-provocative movement patterns that often are addressed with motor control exercises. To compare the effects of low-load motor control (LMC) exercise and those of a high-load lifting (HLL) exercise. Seventy participants with recurrent low back pain, who were diagnosed with nociceptive mechanical pain as their dominating pain pattern, were randomized to either LMC or HLL exercise treatments. Participants were offered 12 treatment sessions over an 8-week period. All participants were also provided with education regarding pain mechanisms. Participants were assessed prior to and following treatment. The primary outcome measures were activity (the Patient-Specific Functional Scale) and average pain intensity over the last 7 days (visual analog scale). The secondary outcome measure was a physical performance test battery that included 1 strength, 3 endurance, and 7 movement control tests for the lumbopelvic region. Both interventions resulted in significant within-group improvements in pain intensity, strength, and endurance. The LMC group showed significantly greater improvement on the Patient-Specific Functional Scale (4.2 points) compared with the HLL group (2.5 points) (P<.001). There were no significant between-group differences in pain intensity (P=.505), strength, and 1 of the 3 endurance tests. However, the LMC group showed an increase (from 2.9 to 5.9) on the movement control test subscale, whereas the HLL group showed no change (from 3.9 to 3.1) (P<.001). An LMC intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL intervention, but not in pain intensity, strength, or endurance. Registered at ClinicalTrials.gov (NCT01061632). Therapy, level 2b-.

MULTIMODAL NEUROREHABILITATION IN YOUNG BOY WITH COMPLEX REGIONAL PAIN SYNDROME

Event Abstract Back to Event MULTIMODAL NEUROREHABILITATION IN YOUNG BOY WITH COMPLEX REGIONAL PAIN SYNDROME Frederick R. Carrick1*, David J. Traster1* and Susan Esposito2* 1 Carrick Institute, United States 2 Life University, United States Background: We describe a 12 year-old male who presents with severe pain and an inability to tolerate light touch. A three year history of severe, progressing headaches, and head pain which has progressed down his back and shoulders was reported. The patient also presented with fatigue, light sensitivity and decreased appetite. Methods: A diagnosis of complex regional pain syndrome with associated dysautonomia was confirmed by neurologic examination. Aberrant vertical eye movements were observed and a right beating nystagmus was present during eccentric gaze fixation and confirmed on videonystagmography. This nystagmus matched the frequency of the patient’s midline stereotopies in his hands. Rib excursion measured 0.5 inches and a posterior suboccipital hemangioma was noted. The patient participated in an in house neurorehabilitation program that included off-vertical-axis-rotation vestibular rehabilitation and oculomotor rehabilitation strategies. Results: The combination of treatment protocols produced a profound change in the patient’s state of being. Pain and ability to tolerate touch significantly reduced over a short period of time and the patient was able to return to school and athletics. Conclusion: This case of complex regional pain syndrome showed significant improvements beyond traditional applications after administration a multimodal neurorehabilitation regimen as described. The authors suggest further investigation into the mechanisms of the vestibular rehabilitation and oculomotor rehabilitation in regards to complex regional pain syndrome. Keywords: Complex Regional Pain Syndromes, Reflex Sympathetic Dystrophy, Neurorehabilitation, dysautonomia, allodynia Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Case Reports for Poster Presentation Citation: Carrick FR, Traster DJ and Esposito S (2015). MULTIMODAL NEUROREHABILITATION IN YOUNG BOY WITH COMPLEX REGIONAL PAIN SYNDROME. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00099 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Sep 2015; Published Online: 02 Nov 2015. * Correspondence: Prof. Frederick R Carrick, Carrick Institute, Cape Canaveral, United States, drfrcarrick@post.harvard.edu Dr. David J Traster, Carrick Institute, Cape Canaveral, United States, dtraster3@gmail.com Dr. Susan Esposito, Life University, Marietta, United States, susan.esposito@life.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Frederick R Carrick David J Traster Susan Esposito Google Frederick R Carrick David J Traster Susan Esposito Google Scholar Frederick R Carrick David J Traster Susan Esposito PubMed Frederick R Carrick David J Traster Susan Esposito Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Anti-NMDA-receptor antibody encephalitis in infants.

PurposeAnti-N-methyl-d-aspartate (NMDA) receptor antibody encephalitis is an autoimmune disorder manifesting subacutely with prominent aberrant movements and psychiatric symptoms. The clinical course is one of progressive clinical deterioration that can be halted and often reversed by early diagnosis and treatment. Patterns of presentation and etiology of anti-NMDA-receptor antibody encephalitis are dependent on age and can be challenging to recognize in very young children.ReportsSequential clinical case observations of anti-NMDA-receptor antibody encephalitis presenting in very young children were examined over a year at a single tertiary pediatric institution. Cerebrospinal fluid confirmed anti-NMDA-receptor antibodies in two cases (a 21-month-old boy and a 29-month-old girl) that demonstrated either bizarre behavioral patterns or status epilepticus both associated with progressive deterioration. Once recognized, the clinical course was arrested and reversed by aggressive treatment with plasma exchange, immunoglobulin, and high dose IV steroids.ConclusionInfants with anti-NMDA-receptor antibody encephalitis can present with frank seizures or seizure mimics. Regardless, prompt recognition and aggressive treatment of anti-NMDA-receptor antibody encephalitis, while challenging, can quickly arrest deterioration and hasten recovery, thereby, limiting neurological morbidity.

Co-occurrence of Dystonic and Dyskinetic Tongue Movements with Oral Apraxia in Post-regression Dysphagia in Classical Rett Syndrome Years of Life 1 Through 5.

We do not know the natural history of dysphagia in classical Rett syndrome (RTT) by stage or age. This study investigated swallowing physiology in 23 females ages 1:7 to 5:8 (years, months) with classical Rett syndrome to determine common and distinguishing features of dysphagia in post-regression early Pseudostationary Stage III. In-depth analysis of videofluoroscopic swallowing studies (VFSS) found dysmotility of oral stage events across subjects implicating oral apraxia. Impaired motility was further compromised by recurrent dystonic and dyskinetic movements that co-occurred with oral apraxia during oral ingestion in 78% (n=18) of the subjects with RTT. Of this group, 44% displayed rocking and/or rolling lingual pattern, 56% had recurrent oral tongue retroflexions, and/or elevated posturing of the tongue tip, and, 72% displayed multi-wave oropharyngeal transfer pattern. The proportion of subjects whose swallowing motility was disrupted by aberrant involuntary tongue movements did not differ significantly between bolus types (liquid, puree, and solid) trialed. Liquid ingestion was significantly more efficient in subjects using bottles with nipples than their counterparts who used spouted or straw cups. Dystonic and dyskinetic tongue movements disrupted liquid ingestion in subjects using cups with spouts or straws significantly more than those using bottles. Analysis of food ingestion revealed that significantly more subjects were able to orally form, transport, and transfer a puree bolus into the pharynx than they were a solid bolus. A significantly larger number of subjects aspirated and penetrated liquid than they did puree or solid. No significant relationship was found between subjects with airway contamination and those with dystonic and dyskinetic tongue movements. Subjects' rocking and rolling lingual patterns were consistent with those evidenced in adults with Parkinson's disease. Subjects' tongue retroflexions were classified as provisionally unique to RTT. VFSS pre-planning, fluoroscopic procedures, and therapeutic strategies specific to this specialty population were derived.

Prevalence and individual risk factors associated with clinical lumbar instability in rice farmers with low back pain.

IntroductionClinical lumbar instability (CLI) is one of the subgroups of chronic non-specific low back pain. Thai rice farmers often have poor sustained postures during a rice planting process and start their farming at an early age. However, individual associated factors of CLI are not known and have rarely been diagnosed in low back pain. This study aimed to determine the prevalence and individual associated factors of CLI in Thai rice farmers.MethodsA cross-sectional survey was conducted among 323 Thai rice farmers in a rural area of Khon Kaen province, Thailand. Face-to-face interviews were conducted using the 13-item Delphi criteria questionnaire, after which an objective examination was performed using aberrant movement sign, painful catch sign, and prone instability test to obtain information. Individual factors such as sex, body mass index, waist-hip ratio, smoking, and number of years of farming experience, were recorded during the face-to-face interview.ResultsThe prevalence of CLI in Thai rice farmers calculated by the method described in this study was 13% (age 44±10 years). Number of years of farming experience was found to be significantly correlated with the prevalence of CLI (adjusted odds ratio =2.02, 95% confidence interval =1.03–3.98, P<0.05).ConclusionThis study provides prevalence of CLI in Thai rice farmers. Those with long-term farming experience of at least 30 years have a greater risk of CLI.

An exploratory examination of the association between altered lumbar motor control, joint mobility and low back pain in athletes.

Background:Low back pain (LBP) is a common cause of lost playing time and can be a challenging clinical condition in competitive athletes. LBP in athletes may be associated with joint and ligamentous hypermobility and impairments in activation and coordination of the trunk musculature, however there is limited research in this area.Objectives:To determine if there is an association between altered lumbar motor control, joint mobility and low back pain (LBP) in a sample of athletes.Materials and Methods:Fifteen athletes with LBP were matched by age, gender and body mass index (BMI) with controls without LBP. Athletes completed a questionnaire with questions pertaining to demographics, activity level, medical history, need to self-manipulate their spine, pain intensity and location. Flexibility and lumbar motor control were assessed using: active and passive straight leg raise, lumbar range of motion (ROM), hip internal rotation ROM (HIR), Beighton ligamentous laxity scale, prone instability test (PIT), observation of lumbar aberrant movements, double leg lowering and Trendelenburg tests. Descriptive statistics were compiled and the chi square test was used to analyze results.Results:Descriptive statistics showed that 40% of athletes with LBP exhibited aberrant movements (AM), compared to 6% without LBP. 66% of athletes with LBP reported frequently self-manipulating their spine compared to 40% without LBP. No significant differences in motor control tests were found between groups. Athletes with LBP tended to have less lumbar flexion (63 ± 11°) compared to those without LBP (66 ± 13°). Chi-Square tests revealed that the AM were more likely to be present in athletes with LBP than those without (X2 = 4.66, P = 0.03).Conclusions:The presence of aberrant movement patterns is a significant clinical finding and associated with LBP in athletes.

Stability of daily home-based measures of postural control over an 8-week period in highly functioning older adults.

The focus of this study was to monitor daily objective measures of standing postural control over an 8-week period, recorded in a person's home, in a population of healthy older adults. Establishing natural patterns of variation in the day-to-day signal, occurring in the relative absence of functional decline or disease, would enable us to determine thresholds for changes in postural control from baseline that could be considered clinically important. Eighteen community-dwelling older adults (3 M, 15 F, 72 ± 6 years) participated in a home-based trial where each day they were asked to complete a technology-enabled routine consisting of a short questionnaire, as well as a quiet standing balance trial. Centre of pressure (COP) excursions were calculated over the course of each daily balance trial to generate variables such as postural sway length and mean sway frequency. The data demonstrated large differences between subjects in centre of pressure measures (coefficients of variation ranging 37-107 %, depending on the variable). Each participant also exhibited variations in their day-to-day trials (e.g. coefficients of variation across 8 weeks ranging ~17-56 %, within person for mean COP distance). Inter- and intra-subject differences were not strongly related to functional tests, suggesting that these variations were not necessarily aberrant movement patterns, but are seemingly representative of natural movement variability. The idea of applying a group-focused approach at an individual level may result in misclassifying important changes for a particular individual. Early detection of deterioration can only be achieved through the creation of individual trajectories for each person, that are inherently self referential.

Visual processing and social cognition in schizophrenia: Relationships among eye movements, biological motion perception, and empathy

Schizophrenia patients have impairments at several levels of cognition including visual attention (eye movements), perception, and social cognition. However, it remains unclear how lower-level cognitive deficits influence higher-level cognition. To elucidate the hierarchical path linking deficient cognitions, we focused on biological motion perception, which is involved in both the early stage of visual perception (attention) and higher social cognition, and is impaired in schizophrenia. Seventeen schizophrenia patients and 18 healthy controls participated in the study. Using point-light walker stimuli, we examined eye movements during biological motion perception in schizophrenia. We assessed relationships among eye movements, biological motion perception and empathy. In the biological motion detection task, schizophrenia patients showed lower accuracy and fixated longer than healthy controls. As opposed to controls, patients exhibiting longer fixation durations and fewer numbers of fixations demonstrated higher accuracy. Additionally, in the patient group, the correlations between accuracy and affective empathy index and between eye movement index and affective empathy index were significant. The altered gaze patterns in patients indicate that top-down attention compensates for impaired bottom-up attention. Furthermore, aberrant eye movements might lead to deficits in biological motion perception and finally link to social cognitive impairments. The current findings merit further investigation for understanding the mechanism of social cognitive training and its development.

Pain, Disability, and Diagnostic Accuracy of Clinical Instability and Endurance Tests in Subjects With Lumbar Spondylolisthesis

ObjectiveThe aims of this study were (1) to investigate the relationship between the main clinical tests to detect spinal instability, the perceived pain and disability, and symptomatic spondylolisthesis (SPL) characteristics, (2) to investigate the relationship between endurance and instability tests, and (3) to measure the diagnostic accuracy of these tests in unstable SPL diagnosed against dynamic radiographs. MethodsFour instability tests were evaluated on 119 subjects: aberrant movements, active straight leg raising (ASLR), prone instability test, and passive lumbar extension test (PLE); and 2 endurance tests, prone bridge test and supine bridge test (SBT). The results were compared with the numeric rating scale for pain and the Oswestry Disability Index for disability. These tests were used as index tests and compared with dynamic radiographs as reference standard on 64 subjects. ResultsA significant relationship between disability and all the clinical tests but ASLR was observed. The relation between tests and pain was weaker, not significant for prone instability test and aberrant movement and critical for ASLR (P = .05). There was a low relationship between endurance tests and instability tests. Only PLE showed a significant association with dynamic radiographs (P = .017). ConclusionEndurance and instability tests appear to be weakly related to the amount of pain but significantly related to the disability in symptomatic SPL. Of the tests evaluated, PLE exhibited the best ability to predict positive dynamic radiographs.