Homolateral Limb Research Articles

Unilateral Posterior Spinal Cord Ischemia Due to a Floating Aortic Thrombus: A Case Report

Introduction. Spinal cord ischemia (SCI) accounts for less than 1% of all strokes, and mostly affects the anterior cord. The ascending aorta (AA) is the rarest site of localization for aortic thrombi (5%). We report a singular case of posterior SCI due to a floating thrombus in the AA. Case presentation. A 75-year-old male with acute left hemiparesis and left tactile and proprioceptive sensory loss below the C5 dermatome (NIHSS 3) is presented. Spinal cord MRI showed a C4–C6 ischemic lesion, involving the left lateral posterior hemi-cord. CT angiography showed a 6 mm floating thrombus in the AA. According to cardiovascular surgeons, dual antiplatelet therapy and high-dose statin were started. After seven days, the patient was discharged with mild left distal hemiparesis and an unchanged sensory deficit. Conclusions. Posterior SCI is rarer than anterior ischemia and potentially unilateral. Its clinical presentation is mainly sensory with possible, but not systematic, weakness of the homolateral limbs. SCI is often caused by aortic pathologies in the elderly, but the incidence rate of non-aneurysmal aortic mural thrombus is about 0.45% and the AA represents a very rare location. In similar cases, conservative medical treatment is preferred despite the high-risk rates of embolic recurrences.

What Is Hemidystonia?

Hemidystonia is defined as dystonia restricted to one side of the body. It is traditionally believed to result from a lesion in the contralateral hemisphere. To describe a series of hemidystonia patients without lesions on brain imaging. We searched for individuals with potential hemidystonia who were included in the Dystonia Coalition or Movement Disorder Society Genetic mutation database (MDSgene), and conducted a systematic review. We found 10 individuals classified as hemidystonia or with homolateral limb dystonia among 3696 cases enrolled by the Dystonia Coalition, 9 cases in MDSgene, and one idiopathic case in the literature. None had evidence of a brain lesion. Body distributions used to define hemidystonia varied considerably and were not always restricted to one side of the body. Hemidystonia may be idiopathic or genetic, without any obvious brain lesion. The varied use of the term suggests the need for more specific clinical criteria to define "half the body."

Impact of hip abductor and adductor strength on dynamic balance and ankle biomechanics in young elite female basketball players

This study aimed to evaluate, in an isolated and relative manner, hip abductor (ABD) and adductor (AD) strength and to study the extent to which these factors are related to balance and ankle dorsiflexion mobility in young elite female basketball players. Sixty trainee-level elite female basketball players (13–18 years old), who voluntarily agreed to participate in the study, were divided into three subgroups based on competition age divisions (U14, U16, U18). Isometric hip ABD and AD strength in each leg was evaluated using the ForceFrame Strength Testing System, also calculating the strength ratio and imbalance between legs. Y Balance Test (YBT) and ankle dorsiflexion mobility were also assessed. ANOVA was used for between-group differences analysis. Likewise, the impact of hip strength on balance and ankle mobility was analyzed using Pearson's correlation coefficient. A linear regression model for dependent variables was created with all variables that exhibited significant correlations. A between-group comparison analysis for the three competition age subgroups (U14, U16, U18) revealed non-significant differences (p > 0.005) for the hip strength variables except for hip ABD strength. The correlation study showed low-moderate effect sizes for hip ABD (in both the contralateral and homolateral limb) and AD strength (only the homolateral limb) with YBT and ankle dorsiflexion. However, when performing a regression model, only right hip ABD significantly predicted right limb YBT scores (β = 0.592, p = 0.048). The present study indicated that, although both hip ABD and AD strength correlate with balance and ankle mobility with low-moderate effect sizes, only hip ABD strength was found to significantly predict YBT scores. Therefore, the potential role of hip ABD strength in particular, but also hip AD strength, for monitoring and enhancing balance and ankle mobility outcomes, should be taken into consideration when designing and implementing preventive strategies for lower-limb injuries.

Fisioterapia após cirurgia de câncer de mama melhora a amplitude de movimento e a dor ao longo do tempo

ABSTRACT Treatment of breast cancer can impair range of motion (ROM) and cause homolateral upper limb pain (UL). This study aimed to compare the ROM, intensity and characterization of UL homolateral pain between the 1st, 10th and 20th sessions of physiotherapy, besides correlating these variables. A clinical trial self-controlled study involving 49 women after mastectomy or quadrantectomy with pain complaint on UL was conducted. ROM was evaluated by goniometry and contralateral UL was adopted as control. The intensity of pain was evaluated by the visual analogue scale (VAS) and characterized by the McGill questionnaire, obtaining the number of words chosen (NWC) and the pain evaluation index (PRI). The ROM of the homolateral UL increased significantly over the 20 sessions. Comparing the homolateral UL with the control, only the abduction did not improve significantly after the 20th session. Pain intensity, PRI and NWC reduced significantly between 1st and 10th and between 1st and 20th sessions. The sensory and evaluative categories also decreased significantly. We observed a significant correlation between VAS, PRI and NWC in the 10th and 20th sessions. Physiotherapy increased ROM, reduced pain in the homolateral UL, and fewer words were chosen to characterize the pain. Significant improvements were observed at the beginning of treatment, but with additional gains over time. Exercises for bilateral flexion, abduction, and external rotation should be emphasized.

Proprioceptive Neuromuscular Facilitation in Shoulder Rehabilitation of Women Submitted to Surgical Treatment for Breast Cancer

Background: Survivors of breast cancer show loss of function of the homolateral limb after treatment, which involves reduction of the functional range of the shoulder, as well as impairment of the involved musculature. The aim of this study was to evaluate the electromyographic activity and the strength of the muscles in the shoulder complex of women who have been subjected to mastectomies, after an intervention using Proprioceptive Neuromuscular Facilitation (PNF) exercises. Methods: This study included 18 women submitted to modified radical mastectomy, with a mean age of 52.55±8.42 years. The training exercises with Proprioceptive Neuromuscular Facilitation occurred two times per week for eight weeks, the standards used were the diagonal pattern, with flexion-abductionexternal rotation and extension-adduction-internal rotation. For the evaluation of the electromyographic activity, electrodes were positioned in the muscles of the upper trapezius and deltoid (anterior, middle and posterior muscle fibers). Results: The electromyographic analysis demonstrated a 32% elevation in the Standard Envelope (SE) of the middle fiber of the deltoid muscle (DM), 15% in the SE of the upper trapezius (UT), an increase in muscle strength of 15% in the DM and 15% in the UT, also raising the strength of these muscles by 36%. Conclusion: The results of the proposed intervention allow us to conclude that, for the sample evaluated, there was an increase in the recruitment of motor units and of muscle strength of the shoulder affected by the surgery to treat breast cancer.

Intra- and Inter-Rater Reliability of Bioimpedance in the Evaluation of Lymphedema Secondary to Treatment of Breast Cancer.

The objective of the study was to evaluate the intra- and inter-rater reliability of bioimpedance in determining upper limb volume in women with lymphedema resulting from breast cancer treatment, as well as its correlation with the upper limb volume calculated by circumferential measurement. A blind cross-sectional study was performed in which 27 women (62.59 ± 10.50 years) were evaluated with upper limb lymphedema secondary to breast cancer treatment. Two examiners performed assessments in the same volunteers independently and twice, with an interval of 1 week between assessments. The collections were performed by the direct tetrapolar multifrequency segmental bioimpedance and by the circumference of the upper limb homolateral to the breast cancer. The results of the circumference showed that the homolateral limb had lymphedema. The intra- and inter-rater analysis showed excellent reliability with intraclass correlation coefficient (ICC) values ranging from 0.954 to 0.999 for the amount of liquid and excellent reliability with ICC values ranging from 0.852 to 0.999 for the electrical impedance of the upper limb with lymphedema. The correlation was strong and negative (p < 0.05) between intracellular, extracellular, and total water when associated with electrical impedance and moderate and positive (p < 0.05) when associated with upper limb volume for all frequencies. The correlations between upper limb volume and water quantities were moderate and positive (p < 0.05). The results indicate that bioimpedance is a reliable method for the evaluation of lymphedema, and the volume of the homolateral upper limb is associated with the amount of water in women with lymphedema secondary to the treatment of breast cancer.

Exclusive percutaneous peripheral veno-arterial ECMO with distal reperfusion of homolateral limb

ECMO is widely used through the world, but is still surrounded by important complications, most of them at the site of the surgical approach.

Modulation of phase durations, phase variations, and temporal coordination of the four limbs during quadrupedal split-belt locomotion in intact adult cats.

Stepping along curvilinear paths produces speed differences between the inner and outer limb(s). This can be reproduced experimentally by independently controlling left and right speeds with split-belt locomotion. Here we provide additional details on the pattern of the four limbs during quadrupedal split-belt locomotion in intact cats. Six cats performed tied-belt locomotion (same speed bilaterally) and split-belt locomotion where one side (constant side) stepped at constant treadmill speed while the other side (varying side) stepped at several speeds. Cycle, stance, and swing durations changed in parallel in homolateral limbs with shorter and longer stance and swing durations on the fast side, respectively, compared with the slow side. Phase variations were quantified in all four limbs by measuring the slopes of the regressions between stance and cycle durations (rSTA) and between swing and cycle durations (rSW). For a given limb, rSTA and rSW were not significantly different from one another on the constant side whereas on the varying side rSTA increased relative to tied-belt locomotion while rSW became more negative. Phase variations were similar for homolateral limbs. Increasing left-right speed differences produced a large increase in homolateral double support on the slow side, while triple-support periods decreased. Increasing left-right speed differences altered homologous coupling, homolateral coupling on the fast side, and coupling between the fast hindlimb and slow forelimb. Results indicate that homolateral limbs share similar control strategies, only certain features of the interlimb pattern adjust, and spinal locomotor networks of the left and right sides are organized symmetrically.

Mirror movements and involuntary homolateral limb synkinesis in a patient with probable Creutzfeldt–Jakob disease

We report a 63-year-old man, who was diagnosed with probable Creutzfeldt–Jakob disease, manifested by rapid progressive cognitive decline, gait disturbance, right focal hand dystonia, myoclonus, mirror movements, and involuntary homolateral limb synkinesis during alternating limb movements. Although the exact pathophysiology for contralateral and homolateral limb synkinesis is not known, dysfunction of the secondary motor areas and dorsal premotor cortex by spongiform degeneration of gray matter may cause these abnormalities.

Treadmill Locomotion in the Intact and Spinal Mouse

Because the genetic characteristics of several inbred strains of mice are well identified, their use is becoming increasingly popular in spinal cord injury research. In this context, it appears particularly important to document adequately motor patterns, such as locomotion in normal mice, to establish some baseline values of locomotor characteristics. It also seems crucial to determine the extent to which mice can express a locomotor pattern after a complete spinal transection to establish a baseline on which one can evaluate the effects of treatments after spinal injury. Therefore, we have used conventional techniques to document the kinematics of treadmill locomotion in intact mice (n = 11) and in mice with a complete section of the spinal cord at T8 (n = 12). The results show that the kinematics and EMG of adult normal mice can be adequately monitored with such conventional equipment and that mice can re-express hindlimb locomotion within 14 d after spinalization, without any pharmacological treatments. The angular excursions of the hip, knee, and ankle are similar to those of the intact mice, although the joints are sometimes more flexed. After spinal cord transection, out-of-phase alternation between the homologous limbs recovered, whereas the timing between homolateral limbs was completely lost. This remarkable ability of mice to express hindlimb locomotion after a complete spinalization should be taken into account in the evaluation of various procedures aimed at promoting the functional recovery of locomotion after spinal lesions.

The NMDA antagonist, MK-801, alters l-DOPA-induced air-stepping in neonatal rats

Administration of l-DOPA (sc) to neonatal rats suspended in harnesses induces coordinated stepping of all four limbs (diagonal progression; l-DOPA-induced air-stepping) by 5 days of age. Because NMDA also induces locomotion in several species, NMDA receptor activation may be required for l-DOPA to elicit coordinated air-stepping. The purpose of the present experiment was to determine if the NMDA receptor antagonist, MK-801, would block l-DOPA-induced air-stepping in developing rats. Neonatal rats administered MK-801 alone rarely air-stepped with the forelimbs or hindlimbs in a coordinated fashion, whereas those treated with l-DOPA alone primarily stepped with all four limbs using a diagonal progression pattern during the session. In contrast, the number of limbs that stepped during the session was gradually altered in 5- to 20-day-old rats treated with MK-801+ l-DOPA. Gaits of those rats progressed from diagonal progression to extension of the forelimbs beneath the chin with hindlimb alternation, to forelimb extension without hindlimb activity. Twenty-day-olds treated with MK-801+ l-DOPA subsequently became completely inactive when the forelimbs dropped from their elevated position beneath the chin. In addition to the sequence just described, 15-day-old rats treated with the lowest concentration of MK-801+ l-DOPA occasionally stepped with one pair of homolateral limbs or stepped with the hindlimbs in near synchrony while the forelimbs either stepped in alternation, were extended beneath the chin or groomed the face. Because limb participation during l-DOPA-induced air-stepping was altered in neonatal rats pretreated with MK-801, NMDA receptor activation may be important for locomotor coordination (gait).

Isofrequency and Multifrequency: Coordination Patterns as a Function of the Planes of Motion

A series of studies examine the maintenance of the relative phase of simultaneous cyclic limb movements by the manipulation of the planes of motion during isofrequency and multifrequency conditions. To evaluate predictions from a dynamic pattern approach in which differences in the limbs’ uncoupled frequencies give way to competitive interactions when the limbs are moved simultaneously, Experiment 1 determined the preferred frequencies of single-limb movements during sagittal and transverse planes of motions. The results revealed that the plane in which the motion was produced significantly affected the cycle frequencies. In investigating isofrequency coordination, Experiment 2 showed that homologous limbs were more accurate in attaining the relative phasing when moving in one as compared to two separate planes, whereas no such effect was observed for non-homologous limbs. Furthermore, the planes of motion significantly influenced the variability of relative phasing such that two-plane motions were less stable than one-plane motions. Experiment 3 examined the effect of the planes of motion upon multifrequency coordination and demonstrated that the homologous and homolateral limbs were less successful in producing the relative phasing when the motions were produced in one as compared to two planes, whereas this effect was not observed for the heterolateral limbs. These findings indicate that frequency detuning resulting from the planes manipulation affects the quality of phase-locking during isofrequency and multifrequency conditions, even though it may be assumed that additional neural constraints are involved in the interlimb coordination process.

Bilateral convergence nystagmus in unilateral dorsal midbrain stroke due to occlusion of the superior cerebellar artery

The authors report a 33-year-old man with left dorsal pontomesencephalic and cerebellar infarction due to an angiographically verified left superior cerebellar artery (SCA)-occlusion. Clinical presentation included dysarthria, homolateral limb ataxia, gait ataxia and contralateral spinothalamic sensory loss. Additionally, skew deviation, bilateral convergence nystagmus and pseudo-sixth nerve palsy of the left eye were observed. Vertical gaze and pupillary light reactions were preserved.This observation expands the spectrum of eye movement abnormalities due to midbrain involvement in isolated SCA-stroke and confirms a mesencephalic tectal territory of irrigation supplied by this artery. Additionally, it might give further evidence for the hypothesis of premotor control of convergence at a higher than mesencephalic level.

Unrestrained walking in cats with partial spinal lesions

In four cats with partial spinal lesions, performed at a low thoracic level, involving ventral quadrants and, to a different extent, the dorsolateral funiculi, several parameters of locomotion were analyzed during unrestrained walking at moderate speed (0.3–1.0 m/s). Special attention was paid to the analysis of support patterns and the durations of support phases in step cycles. The operated subjects displayed a much greater variability of support patterns than intact cats as well as changes in the relative duration of some support phases. The most striking difference was an increase in the relative duration of support on two homolateral limbs accompanied by a reduction of support on diagonal limbs. These changes were mainly due to an impairment of fore-hindlimb coordination as shown by an increase in the phase shifts between the movements of diagonal limbs. Other parameters of locomotion were essentially unaltered, except for cats in which the lesion destroyed bilaterally major portions of the dorsolateral funiculi.

Correlation between limb-joint angles of homolateral limbs of cats in unrestrained locomotion

Correlation between limb-joint angles of homolateral limbs of cats in unrestrained locomotion

Interlimb coordination during stepping in the cat: an electromyographic analysis

1. Simultaneous electromyographic (EMG) records were obtained from a single-joint extensor muscle of each of the four limbs of intact cats during repeated overground stepping trials. 2. In each limb, the temporal spacing of step cycles was determined by measurements of the intervals between consecutive terminations of EMG activity, since this occurs in a consistent relationship to the removal of the limb from the ground. By measuring the latencies between step cycles so determined, the temporal spacing of step cycles between limbs was determined. Each latency was expressed as a function of step duration or as a phase interval. 3. Analysis of the cooordination of step cycles of both homologous limb pairs (the forelimbs and hindlimbs), both homolateral limb pairs (the fore- and hindlimb on the right and left sides), and both sets of diagonal limbs suggest that the step cycles of the four limbs are coordinated according to a few frequently occurring patterns. However, the representation of a large number of phase intervals between these preferred patterns indicates a substantial amount of variability in interlimb coupling. 4. Analysis of the interaction of different interlimb-coupling patterns indicates that during alternate coordination of hindlimbs, coupling of the other limbs is fairly predictable. The step cycles of the forelimbs and hindlimbs are spaced according to a trotting form of coupling. During in-phase coordination of hindlimbs, the patterns of coordination of the other limbs are more diffuse. Forelimbs step cycles are coupled via a number of different modes, as are those of the forelimbs and hindlimbs. 5. It is concluded that the step cycles of different limbs are coordinated, but the association of observed patterns of coordination with any known neural pathways or the interaction of neural pathways should be approached with caution. The variability about the frequently occurring patterns is interpreted as an expression of the faculatative capabilities of the neural mechanisms controlling locomotion. Thus, these data favor a model of interlimb control during stepping, which recognizes preferred patterns of coordination and the variability about these patterns.

Locomotion in the cat: Basic programmes of movement

Observations in cats of flexion and extension movements of the 4 limbs have led to the conclusion that the different forms of alternative locomotion (e.g. walking, trotting, swimming) and in-phase locomotion (galloping, jumping) result from the interaction of 'programmes' for the coordination of (1) the homologous limbs (pair of hindlimbs or pair of forelimbs) and (2) the homolateral limbs (hind- and forelimb of the same side of the body). The movements of the homologous pairs of limbs are coupled out of phase in alternate locomotion and approximately in phase in the phase form of locomotion. The movements of the homolateral pairs of limbs occur approximately out of phase in the trotting type of coupling and approximately in phase in the pacing type of coupling. Transitions between the different forms of coupling occur abruptly over 1 or 2 steps. Therefore, for each type of coupling (homologous or homolateral) there are two distinct forms or 'programmes' of movement. The hypothesis is advanced that (a) all the characteristic patterns of locomotion in the cat result from different combinations of these 'programmes' of homologous and homolateral limb coupling; (b) the 'programmes' are mutually self reinforcing in the gaits in which the coordination of the movements of the 4 limbs is bilaterally symmetrical; (c) the 'programmes' act in competition in certain gaits which are not bilaterally symmetrical giving rise at times to a changing gait pattern, and (d) the temporary dominance of one 'programme' or another can determine the gait of the particular step.

OBSERVATIONS ON MONKEYS WITH BILATERAL LESIONS OF THE GLOBUS PALLIDUS

Wilson 1 made unilateral lesions in the lentiform nucleus of monkeys, which were then kept under observation for about three weeks. Small lesions caused no symptoms. Even when the destruction was extensive tremor or other involuntary movement was not observed. Some of these monkeys, however, showed a preference for using the homolateral limb in grasping food, but there was no real paresis. The symptoms, such as they were, pointed to an impairment of corticospinal fibers, which might be attributed to pressure on, or edema in, the internal capsule associated with the closely adjacent lesion. Wilson's statement it is therefore conceivable that a large lenticular lesion produces an unsteadying effect in innervation must be regarded as an impression carried over from his clinical studies rather than a justifiable conclusion drawn from the results of his experiments. Lewy 2 made bilateral lesions in the lentiform nucleus of monkeys by inserting a knife