Abnormal Motor Patterns Research Articles

Validation of body surface colonic mapping (BSCM) against high resolution colonic manometry for evaluation of colonic motility

Abnormal cyclic motor pattern (CMP) activity is implicated in colonic dysfunction, but the only tool to evaluate CMP activity, high-resolution colonic manometry (HRCM), remains expensive and not widely accessible. This study aimed to validate body surface colonic mapping (BSCM) through direct correlation with HRCM. Synchronous meal-test recordings were performed in asymptomatic participants with intact colons. A signal processing method for BSCM was developed to detect CMPs. Quantitative temporal analysis was performed comparing the meal responses and motility indices (MI). Spatial heat maps were also compared. Post-study questionnaires evaluated participants’ preference and comfort/distress experienced from either test. 11 participants were recruited and 7 had successful synchronous recordings (5 females/2 males; median age: 50 years [range 38–63]). The best-correlating MI temporal analyses achieved a high degree of agreement (median Pearson correlation coefficient (Rp) value: 0.69; range 0.47–0.77). HRCM and BSCM meal response start and end times (Rp = 0.998 and 0.83; both p < 0.05) and durations (Rp = 0.85; p = 0.03) were similar. Heat maps demonstrated good spatial agreement. BSCM is the first non-invasive method to be validated by demonstrating a direct spatio-temporal correlation to manometry in evaluating colonic motility.

Esophageal motility disorder - has Chicago classification v4.0 simplified our management?

Addressing dysphagia is vital due to its prevalence and impact on healthcare expenditure. While high resolution manometry (HRM) effectively evaluates esophageal dysphagia, its role in oropharyngeal dysphagia and upper esophageal sphincter (UES) dysfunction remains debated. The fourth iteration of the Chicago classification (CC) offers an algorithmic approach for diagnosing abnormal motor patterns via HRM. This review assesses the CC's impact on dysphagia management. The Chicago classification version 4.0 emphasizes auxiliary and provocative techniques when the algorithm falls short of a conclusive diagnosis. It introduces stricter criteria for previously ambiguous conditions like ineffective motility and esophagogastric junction outflow obstruction. This version also introduces the concept of conclusive and inconclusive classifications based on symptoms, provocation maneuvers, and supportive testing minimizing ambiguity. The Chicago classification v4.0 remains a useful tool for the diagnosis of well characterized esophageal motility disorders. However, major limitations include reliance on HRM and a focus on distal esophagus contractile characteristics without considering proximal esophagus or upper esophageal sphincter, both of which can sometimes be the only evident abnormality in patients with dysphagia. Despite efforts to reduce ambiguity, diagnostic challenges persist. These limitations can be addressed in future updates.

MEASUREMENT OF WALKING IMPAIRMENT RECOVERY AFTER STROKE

Introduction: One of the most important goals in rehabilitating patients affected by stroke is re-establishing independent movement by activating as many motor patterns as possible and changing existing preexisting abnormal motor patterns Objective: To determine recovery level with the accent on motor functions recovery in a patient affected by an ischemic stroke for the first time. The study included patients with anterior circulation syndrome, posterior circulation syndrome, and lacunar syndrome in the acute and post-acute phases of physical therapy and rehabilitation.Material and methods: We conducted a prospective study, which included a total of 90 patients with the first onset of ischemic stroke. The first group consisted of 30 patients with the anterior circulation syndrome of; the second group of 30 patients with the posterior circulation syndrome and the third group of 30 patients with the lacunar syndrome. At the beginning of their early rehabilitation treatment at the Clinic of Physical Medicine and Rehabilitation, the Bamford Scale was used in the initial assessment of the clinical classification of stroke. After the rehabilitation treatment and six months after the stroke, an assessment of motor functions and improvement in overall functionality was performed using a six-minute walk test.Results: The six-minute walk test in all the studied groups showed significant improvement six months after the stroke compared to testing done immediately after their rehabilitation treatment (p = 0.01 anterior circulation, p = 0.05 posterior circulation, p = 0.01 lacunar syndrome). The six-minute walk test was statistically significantly better in patients with lacunar syndrome compared to patients with posterior circulation syndrome after the rehabilitation treatment (p = 0.005) and six months after stroke; p = 0.02.Conclusion: The importance of rehabilitation in the acute and post-acute phases of patients with first ischemic stroke is evident. The six-minute walk test in all studied groups showed statistically significant improvement after six months post-stroke period compared to post-rehabilitation testing. The results were statistically significantly better in patients with lacunar syndrome compared to patients with posterior circulation syndrome after the physical treatment and the time period of six months after the stroke.

Dysregulation of multiple signaling pathways: A possible cause of cerebral palsy.

Cerebral palsy (CP) is a lifelong disability characterized by the impairment of brain functions that result in improper posture and abnormal motor patterns. Understanding this brain abnormality and the role of genetic, epigenetic, and non-genetic factors such as signaling pathway dysregulation and cytokine dysregulation in the pathogenesis of CP is a complex process. Hypoxic-ischemic injury and prematurity are two well-known contributors of CP. Like in the case of other neurodevelopmental disorders such as intellectual disability and autism, the genomic constituents in CP are highly complex. The neuroinflammation that is triggered by maternal cytokine response plays a critical role in the pathogenesis of fetal inflammation response, which is one of the contributing factors of CP, and it continues even after the birth of children suffering from CP. Canonical Wnt signaling pathway is important for the development of mammalian fetal brain and it regulates distinct processes including neurogenesis. The glycogen synthase kinase-3 (GSK-3) antagonistic activity in the Wnt signaling pathway plays a crucial role in neurogenesis and neural development. In this review, we investigated several genetic and non-genetic pathways that are involved in the pathogenesis of CP and their regulation, impairment, and implications for causing CP during embryonic growth and developmental period. Investigating the role of these pathways help to develop novel therapeutic interventions and biomarkers for early diagnosis and treatment. This review also helps us to comprehend the mechanical approach of various signaling pathways, as well as their consequences and relevance in the understanding of CP.

Analysis of Intestinal Movements with Spatiotemporal Maps: Beyond Anatomy and Physiology.

Over 150years ago, methods for quantitative analysis of gastrointestinal motor patterns first appeared. Graphic representations of physiological variables were recorded with the kymograph after the mid-1800s. Changes in force or length of intestinal muscles could be quantified, however most recordings were limited to a single point along the digestive tract.In parallel, photography and cinematography with X-Rays visualised changes in intestinal shape, but were hard to quantify. More recently, the ability to record physiological events at many sites along the gut in combination with computer processing allowed construction of spatiotemporal maps. These included diameter maps (DMaps), constructed from video recordings of intestinal movements and pressure maps (PMaps), constructed using data from high-resolution manometry catheters. Combining different kinds of spatiotemporal maps revealed additional details about gut wall status, including compliance, which relates forces to changes in length. Plotting compliance values along the intestine enabled combined DPMaps to be constructed, which can distinguish active contractions and relaxations from passive changes. From combinations of spatiotemporal maps, it is possible to deduce the role of enteric circuits and pacemaker cells in the generation of complex motor patterns. Development and application of spatiotemporal methods to normal and abnormal motor patterns in animals and humans is ongoing, with further technical improvements arising from their combination with impedance manometry, magnetic resonance imaging, electrophysiology, and ultrasonography.

High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals

ObjectiveHigh-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems. DesignManometry studies from asymptomatic adults were solicited from motility centers worldwide, and were manually analyzed using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI) in standardized fashion. Normative thresholds were assessed using fifth and/or 95th percentile values. Chicago Classification v3.0 criteria were applied to determine motor patterns across HRM systems, study positions (upright vs supine), ages, and genders. ResultsOf 469 unique HRM studies (median age 28.0, range 18–79 years). 74.6% had a normal HRM pattern; none had achalasia. Ineffective esophageal motility (IEM) was the most frequent motor pattern identified (15.1% overall), followed by EGJ outflow obstruction (5.3%). Proportions with IEM were lower using stringent criteria (10.0%), especially in supine studies (7.1%–8.5%). Other motor patterns were rare (0.2%–4.1% overall) and did not vary by age or gender. DL thresholds were close to current norms across HRM systems, while IRP thresholds varied by HRM system and study position. Both fifth and 95th percentile DCI values were lower than current thresholds, both in upright and supine positions. ConclusionsMotor abnormalities are infrequent in healthy individuals and consist mainly of IEM, proportions of which are lower when using stringent criteria in the supine position. Thresholds for HRM metrics vary by HRM system and study position.

Therapeutic options at the Neonatal Pathology Ward

According to the World Health Organization, premature baby is a newborn baby that was born between 22nd and 37th week of pregnancy. The premature babies, due to immaturity of all systems, require special care from the whole medical personnel and holistic approach. The role of a physiotherapist at the Neonatal Pathology Ward is a very important aspect and care of a little patient should be adjusted individually. The most important assumptions of the methods in the care of premature babies at the intensive care unit include normalization of muscle tension, change of abnormal posture and motor patterns, as well as normal sensory experiences. Techniques and supports adjusted to physical and personality capabilities of a child are applied during therapy [1,2]. The Neonatal Pathology Ward is also a place for a clinical speech therapist who has a very important task in the care of a premature baby. A speech therapist who deals with therapy of a premature baby, checks anatomical conditions of the oral cavity, that is, tongue mobility, length of a frenulum, structure of the palate, and then develops a model of support individual for every patient [3]. Interdisciplinary work of the members of a medical team is necessary to provide modern and professional care for the patients.

Electrocolonography: Non-Invasive Detection of Colonic Cyclic Motor Activity From Multielectrode Body Surface Recordings.

This work validates a novel non-invasive method to identify periods of cyclic motor activity in the colon using multichannel skin-surface electrical recordings on the lower abdominal region, termed electrocolonography (EColG). EColG recordings were made from 21 human subjects during a 3 hr meal-response study. A signal processing pipeline based on Continuous Wavelet Transform time-frequency analysis was used to quantify the spectral power in the colonic frequency band ( ≈ 2-6 cycles per minute; cpm) during the fasted and fed states. EColG identified a substantial 7.4 ± 3.5× maximum transient increase in motor activity in the fed state versus the fasted state, as well as a 38.3 ± 16.7% sustained spectral power increase in the colonic frequency band. The dominant frequency was 3.61 ± 0.49cpm, with activity localized primarily in the infraumbilical region near the (recto-)sigmoid colon segments. The colonic meal-responses identified with EColG were closely concordant with rectosigmoid motor activity previously characterized by intracolonic high-resolution manometry. This study is the first to demonstrate that body surface electrical recordings can properly identify rhythmic colonic activity stimulated by food intake. The new EColG technique is inexpensive, portable, and presents the opportunity for reliably measuring colonic motility by noninvasive means. We anticipate that EColG could be applied to monitor the progression of post-operative ileus, and more precisely diagnose abnormal colonic motor patterns in patients suffering from common functional disorders, such as irritable bowel syndrome.

Descendant Epistemology

<h3>Objective:</h3> This study investigated the efficacy of sara rosenfeld johnson’s(SRJ) oral motor exercises for drooling in children with cerebral palsy (CP). <h3>Background:</h3> SRJ is a sensorimotival therapy. It provides sensory stimulation to the cheek, lip, gum, tongue and the tissues and muscles related to sucking, swallowing and breathing, which can promote the coordination of sucking, swallowing and breathing functions, and promote the development and functional maturation of the brain. <h3>Design/Methods:</h3> Forty children were identified drooling with CP, nineteen children were recruited in control group and twenty-one children were recruited in SRJ trentment group at random. All children had neuro-rehabilitation therapy. Children in SRJ trentment group had sara rosenfeld johnson’s oral motor exercises, and the treatment frequency was twice one day and 40 minutes once for six month. Oral motor evaluation had been done before and after treatment. <h3>Results:</h3> Salivation symptoms in SRJ treatment group improved significantly, the effective rate was 82.3%, but 17.3% in control group. The two groups had statistically significant differences(P&lt;0.01). <h3>Conclusions:</h3> Sara rosenfeld johnson’s oral motor exercises, improve the abnormal oral motor patterns in children with CP, is an effective and safe treatment option for salivation symptom in children with CP. <b>Disclosure:</b> XinYu Dong has nothing to disclose. Fang Wen has nothing to disclose.

High-resolution impedance manometry parameters in the evaluation of esophageal function of non-obstructive dysphagia patients.

High-resolution impedance manometry (HRIM) allows evaluation of esophageal bolus retention, flow, and pressurization. We explored novel HRIM measures and assessed their temporal relationship to dysphagia symptoms for boluses of different volume and consistency in non-obstructive dysphagia (NOD) patients. Thirty-three NOD patients (n=19 minor or no disorder of peristalsis ("Normal") and n=14 esophagogastric junction outflow obstruction ("EGJOO")) were evaluated with HRIM. Patients were administered 5 and 10mL liquid, semisolid, and 2 and 4cm solid boluses and indicated bolus perception during individual swallows using a 5-point Likert scale. HRIM was analyzed to assess Chicago Classification and pressure flow metrics, esophageal impedance integral (EII) ratio, and bolus flow time (BFT). Overall, bolus perception increased with increasing bolus consistency (P<0.001), but did not differ significantly between EGJOO and Normal patients. EGJOO patients had higher IRP4, higher levels of bolus residual (ie, EII ratio and IR), and restricted esophageal emptying. The results for linking semisolid bolus perception to semisolid-derived measures revealed more biomechanically plausible and consistent patterns when compared to those derived for liquid boluses. In Normal patients, perception of boluses of heavier viscosity was related to higher bolus flow resistance during transport, whilst in EGJOO, perception was related to restriction of esophageal emptying. These novel pressure-impedance measures may aid in the evaluation of NOD patients by revealing abnormal motor patterns, which may explain symptom generation. Future studies are needed to evaluate which of these measures are worthy of calculation and to establish protocol settings that allow for their meaningful interpretation.

Baby walkers and the phenomenon of toe-walking

Background. There is limited data in the literature regarding the clinical impact of baby walkers (BWs).&#x0D; Aim. In this study, we examined the hypothesis that the formation of abnormal motor pattern in the form of preferred moving without support on the heel, while using a BW.&#x0D; Objectives. We aimed to determine certain epidemiological impact of the use of infant walkers in order to identify the toe-walking pattern to determine the accuracy of its connection with the walker for estimating the volume and characteristics of the phenomenon.&#x0D; Methods. Three retrospective cohort studies were conducted. All the children included in the sample (n = 749) and 363 infants used BWs. Method selected anamnestic survey of parents on a specially designed, anonymous questionnaires and statistical analysis of data.&#x0D; Results. The study population had been using BWs for several years. The reasons for the use of infant walkers were identified. The relative risk of walking without heel support in the BWs user groups RR2 = 3.555 (2.535–4.990, 95% CI) and RR3 = 2.766 (1.178–6.494, 95% CI) was calculated for the second and third studies, respectively. There was an increase in the correlation between toe walking and the use of BWs with longer duration of use. The risk of toe walking in the BW user group (PAR = 19.647%) was calculated. The study revealed no static deformation associated with the use of BWs.&#x0D; Conclusion. The use of BWs was identified as a factor contributing to the formation of the toe-walking pattern and as a possible causal factor of idiopathic toe walking.

Clinical profile and the outcome of children admitted to a tertiary care hospital with non-traumatic coma

Objective: To study the clinical profile, the outcome and to determine clinical signs predictive of the outcome in pediatric patients admitted with non-traumatic coma. Methods: This prospective study was conducted over a period of two years on 150 children between age group 2 months and 14 years admitted with non-traumatic coma to the PICU of a tertiary care state government run hospital of eastern India. Clinical parameters at admission and at 48 hours were analysed. Relevant laboratory investigations and radiological studies were documented. Outcomes were analysed at the time of discharge or death. Results: CNS infection was the leading cause of coma in 57.3 % of the cases, out of which acute bacterial meningitis in 38.4% cases, encephalitis in 33.7% cases, cerebral malaria in 18.6% cases and tuberculous meningitis in 9.3% cases. The toxic-metabolic conditions (21.3%) were overall second followed by status epilepticus (7.4%), intracranial haemorrhage (4%), and others (10%). Among the 99 (66%) children survived, 59(39.3%) were normal, 17(11.3%) had mild, 17(11.3%) had moderate and 6(4%) had severe disability. Survival was highest in ischemic stroke patients (100%) followed by patients with CNS infection (71%). Poor pulse volume, abnormal blood pressure, respiratory pattern, poor GCS and abnormal brain stem reflexes at admission or at 48 hours showed significant correlation with mortality. The abnormal heart rate, abnormal motor pattern, the presence of papilledema and convulsion if present at 48 hrs were poor predictors of survival. Conclusion: CNS infection was the commonest aetiology and clinical signs at 48 hrs of admission were important predictors of mortality.

Physiological augmentation of esophageal distension pressure and peristalsis during conditions of increased esophageal emptying resistance.

Abdominal compression has been implemented as a provocative maneuver in high-resolution impedance manometry (HRIM) to "challenge" normal esophageal physiology with the aim of revealing abnormal motor patterns which may explain symptoms. In this study, we measured the effects of abdominal compression on esophageal functioning utilizing novel pressure-impedance parameters and attempted to identify differences between healthy controls and globus patients. Twenty-two healthy volunteers (aged 23-32years, 41% female) and 22 globus patients (aged 23-72years, 68% female) were evaluated with HRIM using a 3.2-mm water perfused manometric and impedance catheter. All participants received 10×5mL liquid swallows; healthy controls also received 10×5mL liquid swallows with abdominal compression created using an inflatable cuff. All swallows were analyzed to assess esophageal pressure topography (EPT) and pressure-flow metrics, indicative of distension pressure, flow timing and bolus clearance were derived. The effect of abdominal compression was shown as a greater contractile vigor of the distal esophagus by EPT and higher distension pressure based on pressure-flow metrics. Age and body mass index also increased contractile vigor and distension pressure. Globus patients were similar to controls. Intrabolus pressure and contractile vigor are indicative of the physiological modulation of bolus transport mechanisms. Provocative testing by abdominal compression induces changes in these esophageal bolus dynamics.

Passive and Active Control Strategies of a Leg Rehabilitation Exoskeleton Powered by Pneumatic Artificial Muscles

Nerve injury can cause lower limb paralysis and gait disorder. Currently lower limb rehabilitation exoskeleton robots used in the hospitals need more power to correct abnormal motor patterns of stroke patients’ legs. These gait rehabilitation robots are powered by cumbersome and bulky electric motors, which provides a poor user experience. A newly developed gait rehabilitation exoskeleton robot actuated by low-cost and lightweight pneumatic artificial muscles (PAMs) is presented in this research. A model-free proxy-based sliding mode control (PSMC) strategy and a model-based chattering mitigation robust variable control (CRVC) strategy were developed and first applied in rehabilitation trainings, respectively. As the dynamic response of PAM due to the compressed air is low, an innovative intention identification control strategy was taken in active trainings by the use of the subject’s intention indirectly through the estimation of the interaction force between the subject’s leg and the exoskeleton. The proposed intention identification strategy was verified by treadmill-based gait training experiments.

The learning curve for interpretation of oesophageal high‐resolution manometry: a prospective interventional cohort study

High-resolution manometry has become the preferred choice of oesophagologists for oesophageal motor assessment, but the learning curve among trainees remains unclear. To determine the learning curve of high-resolution manometry interpretation. A prospective interventional cohort study was performed on 18 gastroenterology trainees, naïve to high-resolution manometry (median age 32 ± 4.0 years, 44.4% female). An intake questionnaire and a 1-h standardised didactic session were performed at baseline. Multiple 1-h interpretation sessions were then conducted periodically over 15 months where 10 studies were discussed; 5 additional test studies were provided for interpretation, and results were compared to gold standard interpretation by the senior author. Hypothetical management decisions based on trainee interpretation were separately queried. Accuracy was compared across test interpretations and sessions to determine the learning curve, with a goal of 90% accuracy. Baseline accuracy was low for abnormal body motor patterns (53.3%), but higher for achalasia/outflow obstruction (65.9%). Recognition of achalasia reached 90% accuracy after six sessions (P = 0.01), while overall accurate management decisions reached this threshold by the 4th session (P < 0.001). Based on our data, the threshold of 90% accuracy for recognition of any abnormal from normal pattern was reached after 30 studies (3rd session) but fluctuated. Diagnosis of oesophageal body motor patterns remained suboptimal; accuracy of advisability of fundoplication improved, but did not reach 90%. High-resolution manometry has a steep learning curve among trainees. Achalasia recognition is achieved early, but diagnosis of other abnormal motor patterns and management decisions require further supervised training.

850c RNAi Therapeutics Ameliorate Liver Disease Associated with Alpha-1-Antitrypsin Deficiency

The segmentation motor pattern of the intestine, the most dominant pattern in response to eating, designed to optimally absorb nutrients, was described in the late 19th century. How the intestine switches from propulsion to segmentation was revealed recently by us in Nature Communications (in press). Fatty acids induce a low frequency transient rhythmic pacemaker in a network of interstitial cells of Cajal (ICC) associated with the deepmuscular neural plexus (ICC-DMP; 1-4 cycles/min), second to the dominant omnipresent slow wave pacemaker that is generated by ICC associated with the myenteric plexus (ICC-MP; 30-40 cycles/min) in both mouse and rat colon. The introduction of the second pacemaker is associated with slow wave activity changing into a waxing and waning electrical pattern. Not unlike the interaction of waves caused by two stones dropped in water, the pacemaker activities interact with each other, changing a propulsive motor pattern into a non-propagating rhythmic pattern of short-lasting contractions. Our aim of the present study was to understand the mechanism of initiation and control of this trigger for segmentation, and the switch that can change segmentation into propulsion and vice versa. Using intracellular electrical recordings (n=21), we found that the ICC-DMP pacemaker is under tonic inhibitory control by enteric nitrergic nerves and can be evoked by substance P acting on NK1 receptors of ICCDMP at 3.6 ± 0.6 cycles/min. Furthermore, the switch can be activated by medium chain fatty acids through the blood stream at 2.8 ± 0.5 cycles/min, and by short chain fatty acids via the lumen. To further understand the nature of the interaction between the two pacemakers we have developed a model based on the electrophysiological characteristics of the electrical pacemaker activities and based on phase-amplitude coupling of the electrical activities. The motor patterns of the musculature develop because both pacemaker activities propagate into the musculature from opposite sides. The segmentation activity develops when the propagation velocities of the two pacemakers are significantly different from each other. When the propagation velocities are similar, the two pacemakers strengthen each other to create strong low frequency propulsive activity. Hence, the ICC-DMP play a critical role in initiation and the regulation of the nature of the motor pattern of the intestine. It is likely therefore that abnormalities in the ICC-DMP pacemaker activity or its neural or nutrient control may give rise to either the propulsive or segmentation motor pattern becoming too dominant resulting in diarrhea or constipation. The ICC-DMP pacemaker will therefore become a target for rectifying abnormal motor patterns.

850b The intestine switches between propulsion and segmentation through a nutrient-or neurally-induced transient pacemaker

The segmentation motor pattern of the intestine, the most dominant pattern in response to eating, designed to optimally absorb nutrients, was described in the late 19th century. How the intestine switches from propulsion to segmentation was revealed recently by us in Nature Communications (in press). Fatty acids induce a low frequency transient rhythmic pacemaker in a network of interstitial cells of Cajal (ICC) associated with the deepmuscular neural plexus (ICC-DMP; 1-4 cycles/min), second to the dominant omnipresent slow wave pacemaker that is generated by ICC associated with the myenteric plexus (ICC-MP; 30-40 cycles/min) in both mouse and rat colon. The introduction of the second pacemaker is associated with slow wave activity changing into a waxing and waning electrical pattern. Not unlike the interaction of waves caused by two stones dropped in water, the pacemaker activities interact with each other, changing a propulsive motor pattern into a non-propagating rhythmic pattern of short-lasting contractions. Our aim of the present study was to understand the mechanism of initiation and control of this trigger for segmentation, and the switch that can change segmentation into propulsion and vice versa. Using intracellular electrical recordings (n=21), we found that the ICC-DMP pacemaker is under tonic inhibitory control by enteric nitrergic nerves and can be evoked by substance P acting on NK1 receptors of ICCDMP at 3.6 ± 0.6 cycles/min. Furthermore, the switch can be activated by medium chain fatty acids through the blood stream at 2.8 ± 0.5 cycles/min, and by short chain fatty acids via the lumen. To further understand the nature of the interaction between the two pacemakers we have developed a model based on the electrophysiological characteristics of the electrical pacemaker activities and based on phase-amplitude coupling of the electrical activities. The motor patterns of the musculature develop because both pacemaker activities propagate into the musculature from opposite sides. The segmentation activity develops when the propagation velocities of the two pacemakers are significantly different from each other. When the propagation velocities are similar, the two pacemakers strengthen each other to create strong low frequency propulsive activity. Hence, the ICC-DMP play a critical role in initiation and the regulation of the nature of the motor pattern of the intestine. It is likely therefore that abnormalities in the ICC-DMP pacemaker activity or its neural or nutrient control may give rise to either the propulsive or segmentation motor pattern becoming too dominant resulting in diarrhea or constipation. The ICC-DMP pacemaker will therefore become a target for rectifying abnormal motor patterns.

Comparison of postural control between healthy subjects and individuals with nonspecific low back pain during exposure to visual stimulus

Background Low back pain (LBP) is a common clinical problem. Many researchers have demonstrated that LBP disorders have difference in sensory strategies for postural control. Optokinetic stimulation (OKS) of optic flow has been widely applied to study its effect on vision, but has not been applied to LBP. Here we used OKS on different surfaces to investigate the characteristics of chronic nonspecific LBP (CNLBP) posture control, so as to provide new theoretical and experimental data for further recognizing CNLBP and enriching its treatment. Methods Fifteen individuals with CNLBP (age range 25–40 years) and 15 age and gender-matched control subjects were recruited. Each subject, while standing on a stable or soft surface, was exposed to random-dot patterns projected on a large screen, with the dots displaying expansion (+) and contraction (-) and velocities including 80°, 40°, and 20° per second. The visual stimulus used a “stimuli-interval” pattern. The peak velocity, different phases’ standard deviation (SD) of the anterior-posterior centre of pressure (COP) displacements and the total length of the medial-lateral COP sway (LML) for stable surface and soft surface were recorded by force platform. Results The main effect of surface on all parameters was significant, while the main effect of group and OKS showed no significance with the exception of peak velocity (F(3,95)=3.6, P=0.01) and A2 (F(5,140)=9.34, P &lt;0.01) for which the effect of OKS was significant. The interactions of group by OKS of A2 (F(5,140)=3.65, P &lt;0.01) and group by surface by OKS (F(5,140)=2.83, P=0.02), and surface by OKS of A1 and A3 (P &lt;0.05) were significant. It was reported that significantly more SD in amplitude in the T2 phase was seen in persons with CNLBP when confronting the + 40 stimuli on the soft surface (P &lt;0.05) compared to healthy individuals. Conclusions There was no significance between persons with CNLBP and healthy people when using the stable surface. Subjects with LBP showed decreased efficiency of postural adjustment when exposed to more complicated tasks and environments, especially OKS in the expansion direction, and displayed a visual-dependent phenomenon. This result suggested that the treatment of abnormal motor patterns in people with LBP should take the properties of task and environment into account.

Mediolateral foot placement ability during ambulation in individuals with chronic post-stroke hemiplegia

Mediolateral (ML) foot placement is an effective way to redirect the lateral trajectory of the body center of mass (BCoM) during ambulation, but has only been partly characterized in the chronic post-stroke population despite their increased risk for falling [1]. During able-bodied gait, the locomotor system coordinates lower limb swing phase kinematics such that an appropriate ML foot placement occurs upon foot contact. Muscle weakness and abnormal motor patterns may impair foot placement ability post-stroke. The purpose of this study was to characterize ML foot placement ability during post-stroke ambulation by quantifying ML foot placement accuracy and precision, for the both sound and affected feet. Age matched able-bodied individuals were recruited for comparison. All participants were instructed to target step widths ranging from 0 to 45% leg length, as marked on the laboratory floor. Results of this study confirmed that ML foot placement accuracy and precision were significantly lower for the post-stroke group as compared to the control group (p=0.0). However, ML foot placement accuracy and precision were not significantly different between the affected and sound limbs in the post-stroke group. The lowest accuracy for post-stroke subjects was observed at both extreme step width targets (0 and 45%). Future work should explore potential mechanisms underlying these findings such as abnormal motor coordination, lower limb muscle strength, and abnormal swing phase movement patterns.

Patient-reported outcomes and gut dysmotility in functional gastrointestinal disorders

Unlike chronic idiopathic intestinal pseudo-obstruction (CIIP), severe digestive syndromes that are not characterized by episodes resembling mechanical obstruction remain poorly characterized. The present study compared clinical features, small bowel motility, and quality of life (QoL) in patients with CIIP or severe functional gastrointestinal disorders (SFGID), compared to irritable bowel syndrome (IBS). We enrolled 215 consecutive patients: 70 CIIP, 110 malnourished SFGID [body mass index (BMI) 17.8±1.8kg m(-2) ] and 35 non-malnourished SFGID (BMI 22.8±3.6kgm(-2) ). Abnormal motor patterns that fulfilled diagnostic criteria for small bowel dysmotility were virtually absent in IBS patients, but were recorded in69 CIIP patients (98.6%), 82 malnourished SFGID patients (74.5%;), and 23 SFGID patients without malnutrition (65.7%) (P<0.0001). CIIP patients presented more frequently abnormal activity fronts, lack of response to feeding, and hypomotility than malnourished and non-malnourished SFGID patients (61.4%vs 42.7% and 31.4%, P<0.05 only vs non-malnourished SFGID; 8.6%vs 0.9% and 2.9%; 21.4%vs 0.9% and 0%, P<0.05). Quality of life mean scores were all significantly lower in CIIP patients and malnourished SFGID patients than in IBS. Bodily pain, general health, and vitality scores were lower in CIIP also compared to non-malnourished SFGID. Chronic idiopathic intestinal pseudo-obstruction and SFGIDs are frequently associated with small bowel dysmotility and marked derangements of QoL which are significantly more severe than in IBS and result particularly in being severe in patients with recurrent sub occlusive episodes or inability to maintain a normal body weight.