Focal Movement Research Articles

Anticipatory postural adjustments modify the movement-related potentials of upper extremity voluntary movement

To elucidate the effect on movement-related potentials (MRPs) of anticipatory postural adjustments (APAs) accompanied by voluntary focal movement, we examined the MRPs of shoulder flexion movement under standing and sitting postural conditions in 12 normal subjects. MRPs were evaluated based on three components: readiness potential (RP), motor potential (MP), and movement-monitoring potential. APAs were observed in the activities of postural muscles including the biceps femoris and erector spinae muscles only under standing conditions. The amplitudes of the three MRP components were larger under standing conditions than under sitting conditions for all recorded electrode positions, and the RP and MP amplitudes at the vertex position, which lies over the supplementary motor area (SMA), showed a prominent increase under standing conditions with the highest statistical significance. These results suggest that a recruited neural process of the cortical area including the SMA may be necessary to generate voluntary movement accompanied by APA.

Coordination between postural and movement controls: effect of changes in body mass distribution on postural and focal component characteristics

Whole-body reaching movements are accomplished through a combination of anticipatory postural adjustments (APAs) and focal movements. Two different modes of central organization is usually proposed for this coordination: first, a single-process control, where the APAs and the focal movements would share a common command; second, where the APAs and the focal movements would be independently controlled through parallel commands (dual-process control). Here, we investigated which one of these modes of control could better explain the coordination between the trunk and the upper limb for standing subjects reaching for a target located beyond arm's length. This was done evaluating the effect of changing the APAs settings on the arm movement. The APAs modification was achieved by shifting the subject's centre of mass prior to the focal movement onset; this was done by adding an asymmetric load on either side of the head (a control condition with the load fixed centrally at the top of the head was also performed). As it changed the body mass distribution, the muscular torques and the orientation of the head inertia tensor, it is assumed that the addition of the asymmetric load led to a change in the APAs. Analyses indeed showed that both the initial head and trunk displacement towards the supporting side (during the unloading of the moving leg) were smaller when the load was fixed on the side of the supporting leg than when it was fixed on the side of the moving leg. However, changing the initial conditions, and therefore the APAs settings, had no significant effect on the path and kinematics of the focal hand movement. Therefore, subjects cancelled out the effect of the trunk motion on the hand-in-space motion through compensatory arm movements. These results support the dual-process control hypothesis for the postural and the focal components.

Emergency treatment of movement disorders

Movement disorder emergencies occur in both hypokinetic and hyperkinetic patients. Prompt recognition of these emergencies is crucial, and diagnosis is based on history and phenomenology. Supportive and temporizing measures must be implemented immediately before disease-specific therapy is begun. For neuroleptic malignant syndrome and related conditions, we recommend a three-tier approach depending on severity, starting with benzodiazepines, dopamine agonists or levodopa, and dantrolene or electroconvulsive therapy. Methylprednisolone pulse therapy also is beneficial for neuroleptic malignant syndrome due to abrupt medication withdrawal in patients with Parkinson's disease. In treatment of other acute antidopaminergic-induced emergencies, anticholinergics usually suffice. To manage airway obstruction related to movement disorders, we rely on laryngoscopic evaluation to determine whether noninvasive or invasive interventions are needed. Hyperkinetic emergencies are treated individually based on the type of abnormal movements. If an antidopaminergic is needed, we prefer a dopamine depletor to a dopamine receptor blocker because of the risk of tardive syndromes with the latter. When focal hyperkinetic movements dominate the picture, botulinum toxin injection is a useful adjunct to medications.

Fatigue-induced adaptive changes of anticipatory postural adjustments

To examine the fatigue-induced adaptive changes (e.g., timing) of anticipatory postural adjustments (APAs), APAs of 30 research participants were recorded before (baseline) and after (post-test) conditions of either rest (control group, n=15) or fatigue (fatigue group, n=15). Muscle fatigue was generated using a dead-lift exercise performed to exhaustion. Self-initiated postural perturbations were induced using a rapid unilateral arm-raising maneuver (focal movement), and APAs were obtained using electromyography (EMG) recorded bilaterally in the lumbar and thoracic paraspinal muscles as well as the hamstring muscles. Postural stability during the focal movement was assessed using a force plate. Results showed that fatigue had no effect on postural stability during the focal movement, and yet caused earlier APA onsets in three of the six muscles evaluated. In spite of early APA activation, the APA EMG integrals of two of the three postural control muscles which exhibited fatigue-induced early APA onsets (T9 and L4 contralateral paraspinals) did not differ between baseline and post-test measures. The findings suggest that early APA onset may enhance postural stability by permitting a longer duration APA which can counteract fatigue-induced decreases in the force-producing capability of muscles that contribute to postural stability.

A Woman With Spontaneous Focal Muscle Movements

Abstract The present case is about a patient who had rolling muscle contractions, which were electrically silent. She was diagnosed as having Rippling Muscle Disease, in her case; this disorder was likely autoimmune associated. RMD can be hereditary, acquired due to de novo mutations, or have autoimmune etiology. Most of the time RMD is associated with myasthenia gravis. Depending of the form of RMD, patients respond to dantrolene and/or immunossupresants.

Segmental myoclonus as the presenting symptom of an acute disseminated encephalomyelitis: A case report

Segmental myoclonus is described as the involuntary contractions of contiguous muscles innerved by the brain stem or by spinal cord. The underlying causes of segmental myoclonus in children are demyelinating diseases and intrinsic tumors. Here, we report a case who was presented with segmental myoclonus on his left arm and later diagnosed as atypical monosymptomatic presentation of acute disseminated encephalomyelitis (ADEM). The case represents the first in the literature in which ADEM is considered as the possible cause of segmental myoclonus. Our findings demonstrate that: (i) in focal movement disorders such as segmental myoclonus, a careful neuroradiological examination of the neuroanatomical region for the possible presence of organic lesions might be rewarding, (ii) ADEM might be one of the potentially reversible causes of myoclonus.

Human whole-body reaching in normal gravity and microgravity reveals a strong temporal coordination between postural and focal task components

Previous experiments by our group in normal gravity (1 G) have revealed spatial relationships between postural and focal components of whole-body reaching and pointing movements. We suggested that these relationships could be explained partly through the use of gravity to displace the CoM and attain the object or target position. In this study we compared human whole-body reaching in 1 G and microgravity (0 G) in order to more fully investigate how gravity contributes to strategies adopted for task execution and to determine possible invariant temporal relationships between multiple segments. Whole-body reaching movements made from the standing position in two experimental conditions of execution speed (naturally paced and as fast as possible) were recorded during periods of 1 G and 0 G in parabolic flight. Overall, at each speed of reaching, movement times were significantly slower when performed in 0 G than in 1 G for two of the three subjects, but all subjects were able to produce significantly faster movements in 0 G than in 1 G. Despite similar general trends across subjects observed in 1 G, angular displacements of reaching movements performed in 0 G differed greatly between subjects. There were changes at all joints, but above all at the shoulder and the ankle. However, despite a high intersubject and intratrial variability in 0 G, in both gravity conditions all subjects demonstrated times to peak curvilinear velocity for the finger (end effector) and the whole-body centre of mass (CoM) that coincided, regardless of the speed of execution. Moreover, cross-correlations between multiple segment curvilinear velocities and those of the CoM revealed tight, highly correlated temporal relationships between segments proximal to the CoM (which was expected). However, for more distal segments, the correlations were weaker, and the movements lagged behind movements of the CoM. The major and most interesting finding of this study was that although the finger was the most distal within the segment chain, with respect to the CoM, it was highly correlated with the CoM (0.99--0.98, all conditions) and with no time lag. Despite the large intersubject and inter-environmental variability recorded in this study, temporal relationships between postural task components (CoM displacements) and those of the focal movement (end-effector trajectory) were consistently conserved.

Walking delays anticipatory postural adjustments but not reaction times in a choice reaction task

During standing, anticipatory postural adjustments (APAs) and focal movements are delayed while performing a choice reaction task, compared with a simple reaction task. We hypothesized that APAs and focal movements of a choice reaction task would be similarly delayed during walking. Furthermore, reaction times are delayed during walking compared with standing. We further hypothesized that APAs and focal movements would be delayed during walking, compared with standing, for both simple and choice reaction tasks. Subjects either walked or stood on a treadmill while holding on to stable handles. They were asked to push or pull on the handles in response to a visual cue. Muscle activity was recorded from muscles of the leg (APA) and arm (RT). Our results were in agreement with previous work showing APA onset was delayed in the choice reaction task compared with the simple reaction task. In addition, the interval between the onset of APA and focal movement activity increased with choice reaction tasks. The task of walking did not delay the onset of focal movement for either the simple or choice reaction tasks. Walking did delay the onset of the APA, but only during choice reaction tasks. The results suggest the added demand of walking does not significantly modify the control of focal arm movements. However, additional attentional demands while walking may compromise anticipatory postural control.

Novel movement disorder of the lower lip: Is it epilepsia partialis continua? Clues from a secondary case

A 28-year-old woman developed an acute-onset novel movement disorder of the lower lip mimicking focal dystonia. Investigations showed it to be a presentation of epilepsia partialis continua occurring in association with agenesis of the corpus callosum. It responded favorably to anti-epileptic drug therapy. Recently, Kleopa and Kyriakides reported on 4 patients who developed sudden-onset movement disorder characterized by a tonic sustained, lateral and outward protrusion of half of the lower lip. They failed to find any causative factors, despite extensive investigation. Treatment with anticholinergics, clonazepam, and botulinum toxin injection failed to improve the movement disorder. I present an additional case of similar focal movement disorder occurring in the presence of agenesis of the corpus callosum. A scalp electroencephalogram revealed focal epileptic activity, and the movement disorder responded favorably to treatment with antiepileptic drugs.

Accurate technique for complete geometric calibration of cone‐beam computed tomography systems

Cone-beam computed tomography systems have been developed to provide in situ imaging for the purpose of guiding radiation therapy. Clinical systems have been constructed using this approach, a clinical linear accelerator (Elekta Synergy RP) and an iso-centric C-arm. Geometric calibration involves the estimation of a set of parameters that describes the geometry of such systems, and is essential for accurate image reconstruction. We have developed a general analytic algorithm and corresponding calibration phantom for estimating these geometric parameters in cone-beam computed tomography (CT) systems. The performance of the calibration algorithm is evaluated and its application is discussed. The algorithm makes use of a calibration phantom to estimate the geometric parameters of the system. The phantom consists of 24 steel ball bearings (BBs) in a known geometry. Twelve BBs are spaced evenly at 30 deg in two plane-parallel circles separated by a given distance along the tube axis. The detector (e.g., a flat panel detector) is assumed to have no spatial distortion. The method estimates geometric parameters including the position of the x-ray source, position, and rotation of the detector, and gantry angle, and can describe complex source-detector trajectories. The accuracy and sensitivity of the calibration algorithm was analyzed. The calibration algorithm estimates geometric parameters in a high level of accuracy such that the quality of CT reconstruction is not degraded by the error of estimation. Sensitivity analysis shows uncertainty of 0.01 degrees (around beam direction) to 0.3 degrees (normal to the beam direction) in rotation, and 0.2 mm (orthogonal to the beam direction) to 4.9 mm (beam direction) in position for the medical linear accelerator geometry. Experimental measurements using a laboratory bench Cone-beam CT system of known geometry demonstrate the sensitivity of the method in detecting small changes in the imaging geometry with an uncertainty of 0.1 mm in transverse and vertical (perpendicular to the beam direction) and 1.0 mm in the longitudinal (beam axis) directions. The calibration algorithm was compared to a previously reported method, which uses one ball bearing at the isocenter of the system, to investigate the impact of more precise calibration on the image quality of cone-beam CT reconstruction. A thin steel wire located inside the calibration phantom was imaged on the conebeam CT lab bench with and without perturbations in source and detector position during the scan. The described calibration method improved the quality of the image and the geometric accuracy of the object reconstructed, improving the full width at half maximum of the wire by 27.5% and increasing contrast of the wire by 52.8%. The proposed method is not limited to the geometric calibration of cone-beam CT systems but can be used for many other systems, which consist of one or more point sources and area detectors such as calibration of megavoltage (MV) treatment system (focal spot movement during the beam delivery, MV source trajectory versus gantry angle, the axis of collimator rotation, and couch motion), cross calibration between Kilovolt imaging and MV treatment system, and cross calibration between multiple imaging systems. Using the complete information of the system geometry, it was demonstrated that high image quality in CT reconstructions is possible even in systems with large geometric nonidealities.

Blefaroespasmo y blefarocolisis. Caras diferentes de una misma moneda

The eyelid movements are mediated mainly by the orbicularis oculi (OO) and the levator palpebrae superioris (LPS) muscles. Dissociated upper lid functions exhibit different counterbalanced action of these muscles, and in blinking they show a strictly reciprocal innervation. The disturbance of this close LPS-OO relationship likely leads to many of the central lid movement disorders.Two major lid postural disorders, the blepharospasm (BSP) and the blepharocolysis (BCO), share two different clinical aspects: the involuntary eyelids' closure along with the inability to open the eyes. BSP consists of an involuntary overactivity of the OO, with LPS co-contraction activity, and is expressed as frequent and prolonged blinks, clonic bursts, prolonged tonic contraction or a blend of all of them. BCO (commonly named 'so-called lid opening apraxia') is an involuntary overinhibition of the LPS muscles with no evidence of ongoing OO activity; it exists a co-inhibition of these muscles. BSP and BCO occur in many instances of idiopathic dystonias and basal ganglia diseases and, less frequently, in rostral brainstem lesions. Both may coincide in the same patient.BSP and BCO should be considered different expressions of the dystonic focal eyelid movement disorders, related to the increase of the two counteracting components of the normal eyelid motor and blinking patterns: the excessive OO activation in the BSP; the excessive LPS inhibition in the BCO.

Psychogenic Tics: Diagnostic Value of the Placebo Test

Motor tics are characterized by abrupt onset of brief, unsustained focal movements that are usually preceded by a premonitory sensation and are suppressible. Psychogenic tics (pseudotics) are rarely described. It may not be easy to distinguish organic from functional tics because they can coexist. Using a case illustration, the value of a "staged" placebo test in aiding the diagnosis of psychogenic tics is described. In addition, a concise summary of the clinical phenomenology of tics and the diagnosis and management of psychogenic movement disorders is provided.

Uterine contractions evaluated on cine MR imaging in patients with uterine leiomyomas

Purpose: Submucosal leiomyoma is one of the most recognized causes of infertility and habitual abortion. The purpose of this study is to evaluate uterine peristalsis, a cycle-related inherent contractility of uterus probably responsible for sperm transport and conservation of pregnancy, in patients with uterine leiomyomas using cine magnetic resonance (MR) imaging. Materials and methods: Study population consisted of 26 female patients (age range: 19–51 years, mean: 41 years), in which 16 patients had submucosal leiomyomas and 10 patients had intramural or subserosal leiomyomas. We prospectively performed MR imaging of the midsagittal plane of uterus using 1.5 T magnet (Symphony, Siemens Medical Systems) with a body array coil, and obtained 60 half-Fourier acquisition single shot turbo spin echo (HASTE) images (Echo time=80 ms, FOV=300 mm, slice thickness 5 mm, matrix 256×256) within 2 min, and displayed them on cine mode at 12× faster than real speed. Evaluated were peristaltic movements at the endometral–myometrial junction and focal myometrial movements, adjacent to leiomyomas, regarding presence, direction, frequency, and conduction. Results: The peristaltic movements were identified in 12/16 patients with submucosal lesions and 10/10 with other leiomyomas. The frequency and direction were cycle-related. Loss of peristalsis was noted adjacent to submucosal myomas in 4/12 patients, but was not in others. Focal myometrial movements were noted in 9/16 patients with submucosal myomas, but not in others. Conclusions: Uterine peristaltic movements were partly interrupted by submucosal leiomoymas, but not by myometrial or subserosal leiomyomas. Loss of peristalsis and focal myometrial movements was noted only adjacent to submucosal leiomyomas. These findings are considered to represent dysfunctional contractility, and may be related with pregnancy loss.

The role of anticipatory postural adjustments in a rocking on heels movement

We studied the anticipatory postural adjustments (APAs) associated with a voluntary rocking on heels movement performed in a self-paced manner. Ground reaction forces and the EMG activity of the leg muscles were recorded. Such a movement shifted the centre of gravity (CG) backwards, due to APAs on the lower limbs. It is generally assumed that APAs only generate corrections in the opposite direction to the perturbation due to the focal movement. However, our study shows that APAs, by creating the initial backward oriented impulse, displace the CG backwards and generate the dynamic conditions required to move.

Expression of the focal adhesion protein paxillin in normal and breast cancer tissues.

Cell–matrix interactions regulate various cellular processes including survival, cell growth and differentiation (Boudreau and Bissel, 1998; Giancotti, 2000). Integrins are the major surface receptors that mediate such interactions (Hynes, 1992). They are composed of a and b chain heterocomplexes. Engagement of integrin receptors and their clustering leads to the formation of ‘focal adhesions’ where integrins link to intracellular cytoskeletal complexes and bundles of actin filaments. However, these complexes not only serve to connect the cytoskeleton to the matrix but also serve as a framework for the association of signalling proteins that regulate signal transduction pathways leading to integrin-induced changes in cell behaviour (Burridge et al., 1988). Focal adhesions contain multiple proteins such as vinculin, talin and tensin. Other proteins localized in focal adhesions include kinases, phospholipases and proteases. The actin cytoskeleton needs to be dynamic for cell shape changes in cell contacts and cell motility. The deregulation of cytoskeletal function contributes to malignant transformation. In normal cells, the cytoskeleton is very stable and there is little movement of cells. In cells that have become cancerous, the cytoskeleton is disrupted in such a way as to increase cell motility. Paxillin is a focal adhesion-associated adaptor protein that plays a key role in cell spreading and motility (Schaller, 2001). This protein was originally identified as a substrate for the non-receptor tyrosine kinase oncogene pp60v-src in Rous sarcoma virus-transformed fibroblasts (Glenney and Zokas, 1989). Paxillin is ubiquitously expressed, albeit in variable amounts, with low levels in platelets and neuronal cells. It is highly conserved among various species. Although the role of paxillin as a regulatory protein in focal adhesion dynamics and cell movement, has been well studied in cultured cells, its specific role in signalling in the complex organization of individual tissues has not yet been established. The

Proprioception and locomotor disorders.

Advances in our understanding of movement control allow us to define more precisely the requirements for the rehabilitation of patients with movement disorders. Most purposeful, complex movements are programmed in the central nervous system (CNS) and adapted by proprioceptive feedback. The selection of and interaction between different sources of afferent input is task dependent. Simple stretch reflexes are thought to be involved primarily in the control of focal movement. For more complex motor behaviours such as locomotion, afferent input related to load and hip-joint position probably has an important role in the proprioceptive contribution to the activation pattern of the leg muscles. There is increasing evidence that movement disorders such as spasticity and Parkinson's disease involve the defective use of afferent input in combination with secondary compensatory processes. This has implications for therapy, which should be directed to take advantage of the plasticity of the CNS.

Role of peripheral afference during acquisition of a complex coordination task.

It has long been supposed that the interference observed in certain patterns of coordination is mediated, at least in part, by peripheral afference from the moving limbs. We manipulated the level of afferent input, arising from movement of the opposite limb, during the acquisition of a complex coordination task. Participants learned to generate flexion and extension movements of the right wrist, of 75 degrees amplitude, that were a quarter cycle out of phase with a 1-Hz sinusoidal visual reference signal. On separate trials, the left wrist either was at rest, or was moved passively by a torque motor through 50 degrees, 75 degrees or 100 degrees, in synchrony with the reference signal. Five acquisition sessions were conducted on successive days. A retention session was conducted 1 week later. Performance was initially superior when the opposite limb was moved passively than when it was static. The amplitude and frequency of active movement were lower in the static condition than in the driven conditions and the variation in the relative phase relation across trials was greater than in the driven conditions. In addition, the variability of amplitude, frequency and the relative phase relation during each trial was greater when the opposite limb was static than when driven. Similar effects were expressed in electromyograms. The most marked and consistent differences in the accuracy and consistency of performance (defined in terms of relative phase) were between the static condition and the condition in which the left wrist was moved through 50 degrees. These outcomes were exhibited most prominently during initial exposure to the task. Increases in task performance during the acquisition period, as assessed by a number of kinematic variables, were generally well described by power functions. In addition, the recruitment of extensor carpi radialis (ECR), and the degree of co-contraction of flexor carpi radialis and ECR, decreased during acquisition. Our results indicate that, in an appropriate task context, afferent feedback from the opposite limb, even when out of phase with the focal movement, may have a positive influence upon the stability of coordination.

Is It Status?

Nonconvulsive status epilepticus (NCSE) is difficult to diagnose in the obtunded/comatose patient. Such patients often have other serious medical conditions, and the diagnosis is frequently delayed. We review criteria for diagnosis, treatment, and prognosis of NCSE in this setting. Terms that have been used to describe SE in obtunded/comatose patients without tonic-clonic convulsions include subtle generalized SE, electrographic SE, SE in comatose patients, generalized electrographic SE, non-tonic-clonic SE, subclinical SE, and NCSE. Sometimes the same term has been used when describing different disorders, and different terms are often applied for the same entity. The incidence of NCSE in obtunded/comatose patients is uncertain. Clinically they may display subtle, intermittent focal or multifocal rhythmic movements suggestive of seizures; there may not be movements. NCSE can occur in a variety of disorders, including hypoxia, metabolic disturbances, and after convulsive seizures. A number of EEG patterns have been described in NCSE, and many of these are controversial, particularly as to whether they are ictal. These include periodic lateralized epileptiform discharges (PLEDS), bilateral independent PLEDS (BIPLEDS), periodic epileptiform discharges (PEDS), which can be either focal or generalized, and generalized triphasic waves (TWs). The diagnostic criteria for NCSE also are controversial, and there are no agreed-on criteria to diagnose NCSE in obtunded/comatose patients, nor is there consensus on how it should it be treated. Furthermore, outcome is poor, and several studies suggest that treatment may not be helpful.

Anticipatory postural adjustments under simple and choice reaction time conditions

Two different schemes of the central organization of anticipatory postural adjustments (APAs) have been proposed: one of them assumes that postural and focal components of an action are results of a single control process (single-process hypothesis) while the other one suggests that these two components result from two relatively independent control processes (dual-process hypothesis). To distinguish between the two hypotheses, we investigated changes in the relative timing of the postural and focal components under self-paced, simple reaction time (SRT) and choice reaction conditions (CRT). Standing subjects performed one of four small arm movements resulting in a standard postural perturbation (dropping a load). APAs were quantified as changes in the background muscle activity as well as shifts of the center of pressure. APAs occurred at a larger delay prior to the focal movement under the self-paced condition than under the SRT condition. Under the CRT condition, actual RTs were longer than under SRT, but APAs were more similar to those under self-paced conditions. A negative correlation between the reaction time and APA onset was found. The findings demonstrate that the focal and APA components of an action can be decoupled, thus supporting the dual-process hypothesis. Changes in APAs with action suggest a possibility of modifications of a function that transforms two parallel control signals into a single command to the focal and postural muscles, based on postural requirements and behavioral constraints.

Consistency of voice produced by patients with adductor spasmodic dysphonia: a preliminary investigation.

Adductor spasmodic dysphonia (ADSD) is an idiopathic focal laryngeal movement disorder causing involuntary and uncontrollable spasms in the vocal fold musculature, primarily during voice onset. Although phonatory instability has been reported through clinical observation and empirical study, no examination of phonatory performance consistency in ADSD has been done. Phonatory instability refers to phonatory unsteadiness and has been previously defined by the presence of acoustic aberrations during speech. Performance consistency pertains to variations in these phonatory aberrations across repeated trials or over time. This study focused on the phonatory performance consistency of those with ADSD by using three acoustic measures of phonatory instability. Twenty patients with ADSD were recorded during three trials of reading a standard passage. Eight of the 20 patients were recorded twice during two separate recording sessions held approximately 6 months apart. The number of phonatory breaks, frequency shifts, and aperiodic segments were the dependent measures. Data were subjected to inferential statistical analysis to test for significant differences among the measures in two conditions: across three trials produced within one recording session and across multiple trials produced during two distinct recording sessions. No significant differences were found for any of the measures either as a function of trials recorded on the same day or across the two recording sessions. The data suggest a need for describing phonatory instability and performance consistency as separate entities with regard to neurological voice disorders.