Movement Disturbances Research Articles

Wernicke Encephalopathy in a Nonalcoholic

Wernicke encephalopathy (WE) is characterized by altered levels of consciousness and disturbances in eye movements and gait changes. The condition is caused by thiamine deficiency. The imaging findings are classic; however, it mimicking as a third ventricular tumor with obstructive hydrocephalus is rare. We report an elderly nonalcoholic patient who presented with altered mental status and gait disturbances. Computed tomography scan revealed a mass lesion in the area of third ventricle with obstructive hydrocephalus, but magnetic resonance imaging (MRI) of the brain revealed classic findings of WE. She was treated for that and a shunt procedure was avoided. WE is an uncommon neurological disorder with classic MRI findings. MRI also helps us to avoid confusing this condition with a third ventricular tumor and consequently avoids a shunt procedure. However, when diagnosed and treated in time the recovery is dramatic.

Spinal cord infarction in diabetic pregnancy: A case report

Spinal cord infarction (SCI) is uncommon as compared to cerebral stroke. Moreover, SCI during pregnancy is rare. Here, we report a case of SCI in diabetic pregnancy, properly diagnosed, promptly treated, and a good prognosis achieved. A 38-year-old, pregnant woman, para 1, with type 1 diabetes mellitus on insulin since 14 years of age, was admitted to our hospital for paresthesia and numbness in the lower left side of the body, with movement disturbances. On the basis of the temporal profile of the onset and the multiple resonance imaging scans, SCI was diagnosed. Steroid pulse therapy and low-dose aspirin administration was initiated. Her symptoms were improved and discharged. A repeat cesarean section was performed at 37 weeks of gestation and her postoperative course was uneventful. Her daily activities were not hindered severely, though she experienced defecation discomfort.

An Optimal Estimation of Aerodynamic Parameters for GPS Guided Missile

The disturbance factors in the missile flight are obvious,so the analytical equations of missile longitudinal disturbance of movement is derived . The missile body longitudinal aerodynamic parameters are fitting out with wind tunnel experimental data. The equation of system state takes the aerodynamic coefficient errors interference source and GPS error sources as the state variables, and the system measurement equation adopts GPS pseudo-range measurements. In passive segment, the aerodynamic coefficients disturbing errors sources of th missile longitudinal plane is estimated optimally with extended Kalman filter. The results show that the method accelerate the convergence speed of the disturbance source errors, and improve the estimation accuracy of the perturbation errors.

Spatial and temporal genetic structure of Symbiodinium populations within a common reef‐building coral on the Great Barrier Reef

The dinoflagellate photosymbiont Symbiodinium plays a fundamental role in defining the physiological tolerances of coral holobionts, but little is known about the dynamics of these endosymbiotic populations on coral reefs. Sparse data indicate that Symbiodinium populations show limited spatial connectivity; however, no studies have investigated temporal dynamics for in hospite Symbiodinium populations following significant mortality and recruitment events in coral populations. We investigated the combined influences of spatial isolation and disturbance on the population dynamics of the generalist Symbiodinium type C2 (ITS1 rDNA) hosted by the scleractinian coral Acropora millepora in the central Great Barrier Reef. Using eight microsatellite markers, we genotyped Symbiodinium in a total of 401 coral colonies, which were sampled from seven sites across a 12-year period including during flood plume-induced coral bleaching. Genetic differentiation of Symbiodinium was greatest within sites, explaining 70-86% of the total genetic variation. An additional 9-27% of variation was explained by significant differentiation of populations among sites separated by 0.4-13km, which is consistent with low levels of dispersal via water movement and historical disturbance regimes. Sampling year accounted for 6-7% of total genetic variation and was related to significant coral mortality following severe bleaching in 1998 and a cyclone in 2006. Only 3% of the total genetic variation was related to coral bleaching status, reflecting generally small (8%) reductions in allelic diversity within bleached corals. This reduction probably reflected a loss of genotypes in hospite during bleaching, although no site-wide changes in genetic diversity were observed. Combined, our results indicate the importance of disturbance regimes acting together with limited oceanographic transport to determine the genetic composition of Symbiodinium types within reefs.

Single-Photon Emission Computed Tomography Findings in a Patient With Fahr Disease Associated With a Schizophrenia-Like Psychosis

Article Abstract Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. Fahr disease is a rare sporadic or familial idiopathic basal ganglia calcification associated with neurologic disorders, such as movement disturbances and dementia. More rarely, schizophrenia-like psychosis characterized by paranoia, hallucinations, and delusions has also been reported to be associated with Fahr disease. This second type of case associated with Fahr disease may help clinicians better understand the mechanisms underlying neuropsychiatric symptoms that are critical for future rational drug discovery in schizophrenia.

Impaired exploratory eye movements in children with Asperger’s syndrome

Objective: Previous eye-tracking studies using an eye mark recorder have reported that disturbances in exploratory eye movements in adult schizophrenic patients are associated with social functioning. The current study sought to determine whether exploratory eye-movement disturbances are present in children with Asperger’s syndrome (AS) compared with typically developing (TD) children. Materials/Participants: The participants were 23 children with AS and 23 age-matched TD children. We measured exploratory eye movements using an EMR-8B eye mark recorder and an exploratory eye movement-measuring device. Method: Eye movements were recorded while participants freely observed a geometric figure (free viewing task), and while they complied with the instructions of an experimenter (repeat-comparison task). We assessed eye fixation points (EFPs) and total eye scanning length (TESL) in all tasks, and measured the responsive search score (RSS) in the repeat-comparison task. Results: In the free viewing task, children with AS exhibited significantly shorter TESL compared with TD children. In the repeat-comparison task, children with AS exhibited significantly lower RSS. Autism Spectrum Screening Questionnaire scores were negatively correlated with both EFP and TESL, but not RSS. Conclusion: The current results revealed that children with AS exhibited dysfunction in exploratory eye movements. Thus, assessing exploratory eye movements in a repeat-comparison task may be useful for detecting social impairment among children with AS.

Polysomnographic findings in dementia with Lewy bodies.

The clinical features of dementia with Lewy bodies (DLB) during wakefulness are well known. Other than rapid eye movement (REM) sleep behavior disorder, only limited data exists on other sleep disturbances and disorders in DLB. We sought to characterize the polysomnographic (PSG) findings in a series of DLB patients with sleep-related complaints. Retrospective study of patients with DLB who underwent clinical PSG at Mayo Clinic, Rochester or Mayo Clinic, Jacksonville over an almost 11-year span for evaluation of dream enactment behavior, excessive nocturnal movements, sleep apnea, hypersomnolence, or insomnia. The following variables were analyzed: respiratory disturbance index (RDI) in disordered breathing events/hour, periodic limb movement arousal index, arousals for no apparent reason (AFNAR), total arousal index, presence of REM sleep without atonia, and percent sleep efficiency. Data on 78 patients (71 male, 7 female) were analyzed. The mean age was 71±8 years. Seventy-five (96%) patients had histories of recurrent dream enactment during sleep with 83% showing confirmation of REM sleep without atonia±dream enactment during PSG. Mean RDI=11.9±5.8, periodic limb movement arousal index =5.9±8.5, arousals for no apparent reason index=10.7±12.0, and total arousal index=26.6±17.4. Sleep efficiency was <80% in 72% of the sample, <70% in 49%, and <60% in 24%. In patients who did not show evidence of significant disordered breathing (23 with RDI<5), 62% of arousals were AFNARs. In those patients who had significant disordered breathing (55 with RDI≥5), 36% of arousals were AFNARs. Six patients underwent evaluations with PSG plus multiple sleep latency test. Two patients had mean initial sleep latencies of <5 minutes, and both had RDI<5. No patient had any sleep onset REM periods. Nineteen patients have undergone neuropathologic examination, and 18 have had limbic-predominant or neocortical-predominant Lewy body pathology. One had progressive supranuclear palsy, but no REM sleep was recorded in prior PSG. In patients with DLB and sleep-related complaints, several sleep disturbances in addition to REM sleep behavior disorder are frequently present. In this sample, about 3/4 had a significant number of arousals not accounted for by a movement or breathing disturbance, and the primary sleep disorders do not seem to entirely account for the poor sleep efficiency in DLB, especially in those without a significant breathing disorder. Further studies are warranted to better understand the relationship between disturbed sleep, arousal, and DLB; such characterization may provide insights into potential avenues of treatment of symptoms that could impact quality of life.

Развитие двигательных нарушений у самцов мышей линии DBA/2J под влиянием повторного опыта агрессии

Changes in the behavior of DBA/2J mice after gaining repeated experience of aggression have been investigated. It was shown that the long-term experience of aggression led to development of hyperactivity estimated as increased motor activity in different tests: open field, elevated plus maze and during testing of reaction to a novelty. Symptoms of attention deficit estimated in the "partition" test as a reduction of the communicativeness and the lack of reaction to unfamiliar partner were noticed. Appearance of a large number of hyperkinesis manifested most often in the form of sudden involuntary head movements (jerks) was observed in the behavior of aggressive males during agonistic interactions. Most of the changes in the behavior of DBA/2J mice differed significantly from previously detected in the behavior of aggressive mice of C57BL/6J and CBA/Lac strains, suggesting a significant contribution of heredity that determines the features of behavioral disorders that occur under the influence of long-term experience of aggression. Similarity of symptomatics of movement disturbances in mice and in humans with some neurological diseases is discussed.

The infratentorial supracerebellar approach in surgery of lesions of the pineal region

Background:Surgery of pineal region lesions is considered a challenging task, due to the particular relationship of lesions in this location with neural and vascular structures. Few series with a significant experience of dealing with these patients have been reported.Methods:We review our experience using infratentorial supracerebellar approach in the surgery of pineal region, regarding the extension of the removal, postoperative morbidity, and discussing details of the surgical technique. In all cases, a supracerebellar infratentorial approach was used in the semi sitting position.Results:A total of 32 patients were operated in the past 20 years (3 germinomas, 3 teratoma, 3 pineocitoma, 2 pineal tumor of intermediate differentiation, 6 pineoblastomas, 6 low grade astrocytoma, 2 glioblastoma, 2 metastasis, 1 ependymoma, 1 epidermoid tumor, 1 cavernoma, and 2 arachnoid cyst). Total removal was achieved in 15 cases and subtotal extensive removal in 7 patients. In the remaining cases, only partial removal was possible, due to the involved pathological types. There was no surgical mortality and no cases of cerebellar venous infarction. Morbidity consisted of transient ocular movement disturbance in 14 patients, transient ataxia in 3 patients, and 1 case of local cerebrospinal fluid (CSF) fistula with meningitis that required surgical treatment.Conclusion:Supracerebellar infratentorial is a safe approach to lesions in the pineal region, and total or extensive subtotal removal is possible in most cases, with acceptable morbidity.

Meta review of systematic and meta analytic reviews on movement differences, effect of movement based interventions, and the underlying neural mechanisms in autism spectrum disorder.

Purposes: To identify and appraise evidence from published systematic and meta analytic reviews on (1) movement differences of individuals with autism spectrum disorders (ASD); (2) the effects of movement based interventions for ASD; (3) hypothesized underlying neural mechanisms for the movement characteristics.Methods: A meta review of published systematic and meta analytic reviews on movement differences, structural, and functional brain anomalies in ASD and the effects of movement based interventions for individuals with ASD between 1806 and October 2012. The methodological quality of the identified systematic and meta analytic reviews was independently assessed by two assessors with the assessment of multiple systematic reviews (AMSTAR).Results: The search yielded a total of 12 reviews that met the inclusion/exclusion criteria. The methodological quality of the reviews varied, but the review conclusions were similar. Although individuals with ASD generally perform less well than age-matched controls in developmental movement tasks, there are few exceptions whose movement abilities are intact. Most movement based interventions report their efficacies. However, all existing studies employ the research design that is inherently incapable of providing strong evidence, and they often fail to report the extent of psychosocial interactions within the movement interventions. The hypothesized neural mechanisms are still under development and speculative in nature.Conclusions: It is premature to designate movement disturbance as a core symptom of ASD. The effects of movement based interventions on the present ASD core symptoms need to be further validated by stronger evidence and verified theoretical mechanisms linking ASD with movement disorders.

Neuronal Responses in the Globus Pallidus during Subthalamic Nucleus Electrical Stimulation in Normal and Parkinson's Disease Model Rats

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been widely used as a treatment for the movement disturbances caused by Parkinson's disease (PD). Despite successful application of DBS, its mechanism of therapeutic effect is not clearly understood. Because PD results from the degeneration of dopamine neurons that affect the basal ganglia (BG) network, investigation of neuronal responses of BG neurons during STN DBS can provide informative insights for the understanding of the mechanism of therapeutic effect. However, it is difficult to observe neuronal activity during DBS because of large stimulation artifacts. Here, we report the observation of neuronal activities of the globus pallidus (GP) in normal and PD model rats during electrical stimulation of the STN. A custom artifact removal technique was devised to enable monitoring of neural activity during stimulation. We investigated how GP neurons responded to STN stimulation at various stimulation frequencies (10, 50, 90 and 130 Hz). It was observed that activities of GP neurons were modulated by stimulation frequency of the STN and significantly inhibited by high frequency stimulation above 50 Hz. These findings suggest that GP neuronal activity is effectively modulated by STN stimulation and strongly dependent on the frequency of stimulation.

Cervical myelopathy resulting from combined ossification of the ligamentum flavum and posterior longitudinal ligament: report of two cases and literature review

In the cervical spine, the combination of ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. There have been only four cases reported in the English literature. We describe two more cases that exhibited cervical myelopathy resulting from the combination of cervical OLF and OPLL and required surgery. A literature review with a comparative analysis between previous reports and present cases was also performed. Case report and literature review. Two patients with combined OLF and OPLL. Preoperative computed tomography, magnetic resonance imaging, and pathological findings from operative specimens were used to confirm the diagnoses. A 76-year-old man (Case 1) presented with disturbance of gait and fine finger movement. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C3-C4 level. Computed tomography showed OPLL at the C2-C6 levels (segmental type) and OLF at the left C3-C4 level. The patient underwent posterior decompression and OLF resection. A 75-year-old man (Case 2) presented with sensory disturbance and muscle weakness in his bilateral upper extremities and disturbance in fine finger movements. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C2-C3 and C3 levels. Computed tomography showed OPLL at the C3-C7 levels (mixed type) and OLF at the left C2-C3 and C3 levels. The patient also underwent posterior decompression and OLF resection. In both cases, histological examination of the surgical specimens showed osseous tissue and enchondral ossification within the ligamentum flavum, and the diagnosis in each case was OLF. After surgery, both patients' symptoms immediately improved, and no recurrence was observed at 2 years after surgery. We experienced two cases of cervical myelopathy resulting from the combination of OLF and OPLL in the cervical spine. The symptoms of myelopathy were treated successfully by laminectomy and laminoplasty with OLF resection in both cases. The literature review including the present two cases revealed that cervical OLF tended to occur adjacent or close to the margin of cervical OPLL, suggesting that the increased mechanical stress at the junction of OPLL may be a causative factor.

Quaternion-Based Kalman Filter With Vector Selection for Accurate Orientation Tracking

Human body orientation estimation from microinertial/magnetic sensor units is highly important for synthetic environments, robotics, and other human-computer interaction applications. In practice, the main challenge is how to deal with linear acceleration interference and magnetic disturbance which always cause significant attitude-estimation errors. In this paper, we present a novel quaternion-based Kalman filter with vector selection scheme for accurate human body orientation estimation using an inertial/magnetic sensor unit. In the proposed algorithm, the gyroscope measurement is used as an input to construct the linear process equation, and the accelerometer and magnetometer measurements are manipulated to establish the linear pseudomeasurement equation. A linear Kalman filter is then deployed to estimate the body orientation. In the Kalman filter framework, a vector selection scheme is designed to protect the algorithm against undesirable conditions such as temporary intensive movement and magnetic disturbance and enable it to acquire more accurate orientation estimation. The experimental results have shown that the proposed algorithm can provide accurate attitude estimations with regard to the ground truth.

I09 Optical motion sensing device (kinect) to assess motor function in HD—a pilot study

<h3>Background</h3> Motor impairment is an essential milestone in the clinical course of HD and motor age of onset is an important end point in genetic modifier studies. Objective assessment of motor function is therefore an important clinical endpoint. To date motor assessment relies on a clinical rating, ideally through an experienced rater following a standardised clinical scoring system, for example, the UHDRS. However, even under optimal circumstances, this approach is limited by inter- and intrarater variability and subjective error. More automated tools for motor assessment are available but expensive, technically involved and time consuming. <h3>Aims</h3> We sought to determine whether consumer electronic gaming devices (Kinect) can be used to analyse movement disturbances in symptomatic HD patients. <h3>Methods</h3> We used a Kinect developers kit and a custom-made user-interface to record and analyse movements of HD patients and controls in a clinical setting. <h3>Results</h3> Preliminary measurements/data of our pilot study suggest that Kinect device can be useful to objectively analyse chorea in HD patients and possibly other neurologic disorders. <h3>Conclusion</h3> A Kinect device is potentially useful for recording and analysing neurologic movement disorders, including HD.

Contextualized perceptions of movement as a source of expanded insight: People with multiple sclerosis' experience with physiotherapy

The hospitals' outpatient clinics for people with multiple sclerosis (PwMS) are important in the health care. Research regarding physiotherapy in such clinics is limited. The purpose was to investigate how PwMS perceive movement during single sessions of physiotherapy in a hospital's outpatient clinic, and what do these experiences mean for the patient's insight into their movement disturbances? Qualitative research interviews were performed with a purposive sample of 12 PwMS and supplemented with seven videotaped sessions. Content analysis was performed. The results indicate that contextualized perceptions of movement appear to be an essential source for PwMS to gain expanded insight with regard to their individual movement disturbances regardless of their ambulatory status. The contextualization implies that perceptions of movement are integrated with the physiotherapist's explanations regarding optimizing gait and balance or other activities of daily life. Perceptions of improvement in body part movement and/or functional activities are vital to enhancing their understanding of their individual movement disorders, and they may provide expanded insight regarding future possibilities and limitations involving everyday tasks. The implementation of movements, which transforms the perceived improvement into self-assisted exercises, appeared to be meaningful. Contextualized perceptions of improvements in movement may strengthen the person's sense of ownership and sense of agency and thus promote autonomy and self-encouragement. The findings underpin the importance of contextualized perceptions of movement based on exploration of potential for change, as an integrated part of information and communication in the health care for PwMS. Further investigations are necessary to deepen our knowledge.

Motor activation in patients with Pantothenate-Kinase Associated Neurodegeneration: A functional magnetic resonance imaging study

BackgroundIn a variety of dystonias, functional magnetic resonance imaging has shown deviations of cortical and basal ganglia activations within the motor network, which might cause the movement disturbances. Because these investigations have never been performed in secondary dystonia due to Pantothenate-Kinase Associated Neurodegeneration, we report our results in a small group of such patients from the Dominican Republic. MethodsFunctional magnetic resonance imaging was carried out in 7 patients with a genetically confirmed mutation of the PANK2 gene and a non-affected control group (matched pairs) using an event-related motor activation paradigm (hand movements). ResultsCompared to the control group (p ≤ 0.01), patients showed a larger amount of activated voxels starting in the contralateral cerebellum and contralateral premotor cortex 2 s before the actual hand movement. Whereas these “hyperactivations” gradually diminished over time, activations in the contralateral primary motor cortex and the supplementary motor area peaked during the next second and those of the contralateral putamen at the time of the actual hand movement. In a multiple regression analysis, all these areas correlated positively with the degree of dystonia of the contralateral arm as judged by the Burke–Fahn–Marsden-scale (p ≤ 0.001). ConclusionAs in other forms of dystonia, the increased activations of the motor system found in our patients could be related to the origin of the dystonic movements. Because in this condition the primary lesion affects the pallidum, a defect of the feed-back control mechanism between basal ganglia and cortex might be the responsible factor.

A Case of Primary Intramedullary Malignant Melanoma

A 78-year-old woman was admitted to our department with paraparesis and disturbance of bowel movements in January 2010. The first symptom, numbness of the right leg, appeared 16 months before admission and became progressively worse. Neurological examination revealed a motor power grade of 1/5 on the right leg and 2/5 on the left leg and urinary incontinence. Magnetic resonance imaging revealed an intramedullary mass at the T11 level and syringomyelia above and below the mass. The images were hyperintense in T1. She underwent a laminectomy through a posterior approach. A few pitchblack flecks were observed on the surface of the pia. Extramedullary extension was not observed. A midline cordotomy was performed and a syringomyelic cavity was released. A vacularized blue-black mass was found within the spinal cord. An intramedullary tumor was dissected from the surrounding yellow tissue. The tumor was totally removed, except for partial involvement to the T11 right posterior root. Pathologic examination of the surgical specimen revealed malignant melanoma. The patient did not have any other focus of malignant melanoma. With these data, the diagnosis of primary intramedullary malignant melanoma was established. Postoperatively, the motor paresis on the left leg improved, whereas the motor paresis on the right leg and the urinary sphincter disturbance persisted. Radiation therapy was performed using cobalt-60 at a dose of 35 Gy to the lower thoracic cord. At the time this article was written, about 3 years after the onset of symptoms, the patient is alive and there has been no recurrence of the tumor on follow-up magnetic resonance imaging.

P-696 - Psychiatric symptoms on huntington's disease

Huntington's disease (HD) is a genetic disorder characterized by movement disturbances, psychiatric symptoms, and cognitive impairment resulting in a subcortical dementia. It is an autosomal dominant neurodegenerative disease with almost complete penetrance. An increased number of CAG repeats in the 5’ region of the IT15 gene on chromosome 4 is believed to be the responsible mutation. CAG expansion beyond 35 repeats is associated with the expression of HD. A description of the psychiatric symptoms of Huntington's disease through a possible case. A 28 year-old, female, was admitted for injury and grandeur delusions, suspicion an mania that had started in the last two weeks. Grandmother and great grandmother diagnosed with Huntington's disease. Transcranial magnetic resonance seemed to show a descent on the peak of the N-Acetylaspartate neuronal marker. Genetic test shower 27 repeats of the CAG, that is, intermediate risk. Olanzapine was started up to 20 mg per day and carbamazepine was started up to 600 mg per day. She had a progressive clinical improvement and in one month was discharged. The diagnosis of HD is based upon presence of the typical clinical features and a family history of the disease. With the availability of genetic molecular testing, all suspected HD cases can be easily confirmed. In our case report, because of the medium-risk, genetic advice will be necessary, due to the probability of transmiting the illness onto the descendants, as well as a follow-up to predict its reappearing.

Multilocular disseminated Tarlov cysts: Importance of imaging and management options

With technological advancements and wider availability of multimodality imaging, incidental lesions are frequently identified in patients undergoing various imaging studies. We report here a case of multiloculated disseminated perineural or Tarlov cysts (TCs). The primary aim of this case study was to (1) provide a comprehensive review of the clinical, imaging, and histopathological features of TCs (2) to draw attention to the fact that multiple lumbosacral and dorsal TCs can produce nerve injuries and serious movement disturbances, and (3) to document the usefulness of the magnetic resonance imaging and bone scan in non-invasive diagnosis and guiding management in such cases. These cysts are clearly identified by magnetic resonance imaging (MRI) and computerized tomography imaging of the lumbosacral spine. However, there are no reports on the scintigraphic findings of multilocular disseminated TC in literature. TCs are typically benign, asymptomatic lesions that can simply be monitored. To date, no consensus exists about the best surgical strategy to use when indicated.

An exploration of sensory and movement differences from the perspective of individuals with autism.

Parents, teachers, and people who themselves experience sensory and movement differences have consistently reported disturbances of sensation and movement associated with autism. Our review of the literature has revealed both historical and recent references to and research about sensory and movement difference characteristics and symptoms for individuals with autism. What is notably infrequent in this literature, however, is research that highlights the perspective of the individual with autism. If we wish to truly understand the experience of sensory and movement differences for individuals with autism, we must explore their experiences and perspectives. This study presents a qualitative analysis of more than 40 h in-depth inquiry into the lives of five individuals with the autism label. Data were sorted into six categories: perception, action, posture, emotion, communication, and cognition. The insights into sensory and movement differences and autism offered by these individuals was illuminating. We found that the data strongly supported the presence of disruption of organization and regulation of sensory and movement differences in the lived experience of these participants with autism. The present data suggests that in autism this disruption of organization and regulation is amplified in terms of quantity, quality, intensity, and may affect everyday life. These data contribute to a more expansive view of autism that incorporates the possibility that autism is a disorder that affects motor planning, behavior, communication, the sensory motor system, and the dynamic interaction of all of these.