Level Of Motor Impairment Research Articles

Easily Conducted Tests During the First Week Post-stroke Can Aid the Prediction of Arm Functioning at 6 Months.

Background: Prognostic models can estimate the recovery of arm functioning after stroke, guide the selection of individual training strategies, and inform patient selection in clinical trials. Several models for early prediction of arm recovery have been proposed, but their implementation has been hindered by insufficient external validation, limited evidence of their impact on patient outcomes, and reliance on predictors that are not feasible in regular clinical practice.Objectives: To determine the predictive value of new and previously reported tests that can be easily conducted in regular clinical settings for early prognosis of two levels of favorable arm recovery at 6 months post-stroke.Methods: We performed a secondary analysis of merged data (n = 223) from two Scandinavian prospective longitudinal cohorts. The candidate predictors were seven individual tests of motor function and the sensory function measured by the Fugl-Meyer Assessment of Upper Extremity within 7 days post-stroke, and the whole motor section of this assessment. For each candidate predictor, we calculated the adjusted odds ratio (OR) of two levels of residual motor impairment in the affected arm at 6 months post-stroke: moderate-to-mild (≥32 points on the motor section of the Fugl-Meyer Assessment of Upper Extremity, FMA-UE) and mild (FMA-UE ≥ 58 points).Results: Patients with partial shoulder abduction (OR 14.6), elbow extension (OR 15.9), and finger extension (OR 9.5) were more likely to reach FMA-UE ≥ 32. Patients with full function on all individual motor tests (OR 5.5–35.3) or partial elbow extension, pronation/supination, wrist dorsiflexion and grasping ability (OR 2.1–18.3) were more likely to achieve FMA-UE ≥ 58 compared with those with absent function. Intact sensory function (OR 2.0–2.2) and moderate motor impairment on the FMA-UE (OR 7.5) were also associated with favorable outcome.Conclusions: Easily conducted motor tests can be useful for early prediction of arm recovery. The added value of this study is the prediction of two levels of a favorable functional outcome from simple motor tests. This knowledge can be used in the development of prognostic models feasible in regular clinical settings, inform patient selection and stratification in future trials, and guide clinicians in the selection of individualized training strategies for improving arm functioning after stroke.Clinical Trial Registration: ClinicalTrials.gov: NCT02250365, NCT01115348.

Implications of the putamen in pain and motor deficits in complex regional pain syndrome.

Complex regional pain syndrome (CRPS) develops after-limb injury, with persistent pain and deficits in movement frequently co-occurring. The striatum is critical for mediating multiple mechanisms that are often aberrant in CRPS, which includes sensory and pain processing, motor function, and goal-directed behaviors associated with movement. Yet, much remains unknown with regards to the morphological and functional properties of the striatum and its subregions in this disease. Thus, we investigated 20 patients (15 female, age 58 ± 9 years, right-handed) diagnosed with chronic (6+ months of pain duration) CRPS in the right hand and 20 matched, healthy controls with anatomical and resting-state, functional magnetic resonance imaging. In addition, a comprehensive clinical and behavioral evaluation was performed, where each participant's pain, motor function, and medical history were assessed. Complex regional pain syndrome patients harbored significant abnormalities in hand coordination, dexterity, and strength. These clinical pain- and movement-related findings in CRPS patients were concomitant with bilateral decreases in gray matter density in the putamen as well as functional connectivity increases and decreases among the putamen and pre-/postcentral gyri and cerebellum, respectively. Importantly, higher levels of clinical pain and motor impairment were associated with increased putamen-pre-/postcentral gyri functional connectivity strengths. Collectively, these findings suggest that putaminal alterations, specifically the functional interactions with sensorimotor structures, may underpin clinical pain and motor impairment in chronic CRPS patients.

Visual impairment in children with cerebral palsy: Croatian population-based study for birth years 2003-2008

AimTo evaluate visual impairment (VI) in children with cerebral palsy (CP).MethodsThis population-based study included 419 children from the Surveillance of Cerebral Palsy in Europe (SCPE) C28 RCP-HR – Register of Cerebral Palsy of Croatia born 2003-2008. Vision in children with CP (according to SCPE) was classified as normal or impaired, with the subcategory of severe VI. The proportion of children with VI was assessed in groups with different CP type/subtype, gross and fine motor function, and gestational age (GA).ResultsA total of 266 children had some degree of VI (266/400; 66.5%), 134 had normal vision, and data on VI were unknown for 19 children. Severe VI was present in 44 children (44/400; 11%). The proportion of children with VI and severe VI increased with the Gross Motor Function Classification System and Bimanual Fine Motor Function levels. Children with bilateral spastic CP had the highest frequency of severe VI (14.9%). The percentage of severe VI in children with bilateral spastic CP was 53.8% in the group born <28 weeks of GA, 13.3% in the group born 28-31 weeks of GA, 11.1% in the group born 32-36 weeks of GA, and 24.4% in the group born >36 weeks of GA (λ2 = 4.95; df = 6; P < 0.001).ConclusionChildren with CP have a high prevalence of VI and severe VI, which is increasing with the level of motor impairment. Severe VI is significantly more common in children with bilateral spastic CP, especially among extremely premature infants.

Effect of Robot-Assisted Gait Training in a Large Population of Children With Motor Impairment Due to Cerebral Palsy or Acquired Brain Injury

ObjectiveTo evaluate retrospectively the effect of robotic rehabilitation in a large group of children with motor impairment; an additional goal was to identify the effects in children with cerebral palsy (CP) and acquired brain injury (ABI) and with different levels of motor impairment according to the Gross Motor Function Classification System. Finally, we examined the effect of time elapsed from injury on children’s functions. DesignA cohort, pretest-posttest retrospective study was conducted. SettingHospitalized care. ParticipantsA total of 182 children, 110 with ABI and 72 with CP and with Gross Motor Function Classification System (GMFCS) levels I-IV, were evaluated retrospectively. InterventionsPatients underwent a combined treatment of robot-assisted gait training and physical therapy. Main Outcome MeasuresAll the patients were evaluated before and after the training using the 6-minute walk test and the Gross Motor Function Measure. A linear mixed model with 3 fixed factors and 1 random factor was used to evaluate improvements. ResultsThe 6-minute walk test showed improvement in the whole group and in both ABI and CP. The Gross Motor Function Measure showed improvement in the whole group and in the patients with ABI but not in children with CP. The GMFCS analysis showed that all outcomes improved significantly in all classes within the ABI subgroup, whereas improvements were significant only for GMFCS III in children with CP. ConclusionsChildren with motor impairment can benefit from a combination of robotic rehabilitation and physical therapy. Our data suggest positive results for the whole group and substantial differences between ABI and CP subgroups, with better results for children with ABI, that seem to be consistently related to time elapsed from injury.

Level of motor, sensory and functional impairment from stroke at admission and hospital discharge in Brazil

ABSTRACTPrimary Objective: To compare the level of motor, sensory and functional impairment of individuals hospitalized in a stroke unit in Brazil at the time of admission and the profile observed at hospital discharge.Design: Observational and longitudinal outcome study.Methods and Procedure: We assessed 41 patients with ischemic stroke at admission and hospital discharge by using the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Physical Performance Scale (FM), Functional Independence Measure (FIM) and Modified Rankin Scale (mRS) and divided in the group that received or not the thrombolytic therapy. Were used wilcoxon and spearman tests.Results: Significant differences were found between admission and hospital discharge assessment (p < .0001) indicating clinical improvement for individuals submitted to thrombolytic treatment. A moderate correlation was observed for total FM and total FIM (ρ = 0.729; p value<.0001); total FM and motor FIM (ρ = 0.705; p value<.0001); and a moderate negative correlation for NIHSS and total FM (ρ = −0.709; p value<.0001). Strong correlation between motor FIM and total FIM was also observed (ρ = 0.972; p value<.0001).Conclusions: Clinical severity was softened along the hospitalization period. The clinical, motor, sensory and functional characterization enlarges the understanding of the stroke sequelae, besides monitoring the deficits and the level of disability in this population in Brazil.

Effects of a Brain-Computer Interface With Virtual Reality (VR) Neurofeedback: A Pilot Study in Chronic Stroke Patients.

Rehabilitation for stroke patients with severe motor impairments (e.g., inability to perform wrist or finger extension on the affected side) is burdensome and difficult because most current rehabilitation options require some volitional movement to retrain the affected side. However, although these patients participate in therapy requiring volitional movement, previous research has shown that they may receive modest benefits from action observation, virtual reality (VR), and brain-computer interfaces (BCIs). These approaches have shown some success in strengthening key motor pathways thought to support motor recovery after stroke, in the absence of volitional movement. The purpose of this study was to combine the principles of VR and BCI in a platform called REINVENT and assess its effects on four chronic stroke patients across different levels of motor impairment. REINVENT acquires post-stroke EEG signals that indicate an attempt to move and drives the movement of a virtual avatar arm, allowing patient-driven action observation neurofeedback in VR. In addition, synchronous electromyography (EMG) data were also captured to monitor overt muscle activity. Here we tested four chronic stroke survivors and show that this EEG-based BCI can be safely used over repeated sessions by stroke survivors across a wide range of motor disabilities. Finally, individual results suggest that patients with more severe motor impairments may benefit the most from EEG-based neurofeedback, while patients with more mild impairments may benefit more from EMG-based feedback, harnessing existing sensorimotor pathways. We note that although this work is promising, due to the small sample size, these results are preliminary. Future research is needed to confirm these findings in a larger and more diverse population.

O DESEMPENHO DA MARCHA DE HEMIPARÉTICOS CRÔNICOS E A CORRELAÇÃO COM A RECUPERAÇÃO E O NÍVEL DE COMPROMETIMENTO MOTOR FUNCIONAL

As a result of stroke, impairments such as hemiparesis, gait deficits, impaired motor function and physical deconditioning can occur. In which, gait is one of the most important functional limitations and this way the evaluation becomes important to determine the functional profile and consequently to develop an appropriate treatment. The objective of this study was to evaluate and correlate functional capacity with the level of motor and functional impairment in chronic hemiparetic. This is a cross-sectional study using the Six-Minute Walking Test (6MWT) to assess functional capacity and the Fugl Meyer Protocol (FM) to assess the level of motor and functional impairment. Twelve hemiparetic subjects were included. Statistical analysis revealed no significant correlation between the 6MWT and FM. We conclude that the present study revealed a non-correlation between functional capacity and motor impairment in chronic hemiparetic.

Adult dyskinetic cerebral palsy: Upper limb movement and muscle function.

The aim of this study was to characterize upper limb motor function during a comparative analysis of electromyographic and upper limb movement analysis during drinking between healthy adults and individuals with DCP. Fifteen healthy individuals (CG) and fifteen individuals with DCP (DG) participated in the study. Upper limb function was analyzed during drinking and consisted of a task divided into three phases: the going, the adjustment, and the return. Electromyographic analysis revealed a lower activity of the anterior deltoid, posterior deltoid, and biceps brachii muscles in the DG. When comparing the interactions between groups and phases, only biceps brachii shower lower muscle activity during going and adjustment phases. The DG presented a smaller range of motion (ROM) for the shoulder, elbow, forearm and wrist movements. An interaction between groups and phases showed smaller ROM for the flexion and internal rotation of the shoulder, elbow flexion, forearm pronation, and ulnar deviation in the return phase compared to CG. The results may contribute positively to the quantification of the level of motor impairment and may be used as a reference for the development of therapeutic interventions for patients with DCP.

Abstract WP193: Genetic Polymorphisms Negatively Impact Upper Limb Motor Recovery After Stroke - A Meta-analysis

Upper limb (UL) hemiparesis is one of the most disabling consequences of a stroke. In addition to spontaneous recovery, post-stroke motor recovery is associated with adaptive neuroplasticity and motor learning. Factors affecting motor learning and adaptive neuroplasticity include the presence of genetic polymorphisms. Evidence is emerging that these polymorphisms can influence UL motor recovery. However, the implications of these polymorphisms on rehabilitation are unclear. Using a systematic review and meta analysis, we examined the influence of genetic polymorphisms on post-stroke UL motor recovery. We conducted a systematic review of the published literature in English language. The Down’s and Black checklist helped evaluate the quality of the published studies. We compared changes in UL motor impairment and activity levels between groups with and without the polymorphisms using standardized mean differences and derived summary effect sizes. Seven studies that examined the effects of genetic polymorphisms on UL motor recovery were obtained. The studies examined the effects of polymorphisms (presence of met alleles) in brain derived neurotrophic factor (BDNF, 5 studies) and Catechol- O -Methyltransferase (COMT, 1 study). One study assessed the effects of Apolipoprotein polymorphism (ApoE ε4). The Fugl Meyer Assessment and Wolf Motor Function Test outcomes assessed motor impairment and activity levels respectively. The quality of the published studies ranged from fair to good. The meta analysis revealed that presence of met allele in BDNF negatively influenced the recovery of motor impairment (moderate effect size -0.47). In addition, recovery of activity levels for people with moderate and high levels of motor ability (effect sizes -1.39 and -7.37 respectively) were also negatively impacted by the presence of met allele in BDNF. The met allele in COMT also negatively influenced recovery of motor impairment (effect size -2.66). Presence of ApoE ε4 did not influence UL motor recovery. In conclusion, the presence of genetic polymorphisms negatively influences the recovery of UL motor impairment and activity. These factors need to be considered while selecting rehabilitation interventions to maximize levels of UL motor recovery post-stroke.

Effect of a 10-Week Aquatic Exercise Training Program on Gross Motor Function in Children With Spastic Cerebral Palsy.

Introduction. Cerebral palsy (CP) is caused by an injury to the developing brain, and abnormal gross motor function is a hallmark of CP. Properly structured exercises on land have been reported to be effective in improving functional performance in children with CP while only few have been documented on aquatic therapy. Objective. To investigate the effect of a 10-week aquatic exercise training program on gross motor function in children with spastic CP. Methods. Thirty participants aged 1 to 12 years were randomized into the experimental and control groups. Both groups received manual passive stretching and functional training exercises, depending on their level of motor impairment, either in water (temperature 28°C to 32°C) or on land. Each exercise training session lasted for about 1 hour 40 minutes, twice per week for 10 weeks in both groups. Measurement of gross motor function was done using Gross Motor Function Measure (GMFM-88) at baseline and after 4 weeks, 8 weeks, and 10 weeks of intervention. Both groups were compared for differences in change in gross motor function using Mann-Whitney U test. The level of significance was set at P < .05. Results. Only the experimental group showed significant improvement (P < .05) in all dimensions of gross motor function except for walking, running, and jumping (P = .112). Statistically significant difference (P < .05) was found between both groups for all dimensions of gross motor function after 10 weeks of intervention. Conclusion. Aquatic exercise training program is effective in the functional rehabilitation of children with spastic CP.

The dose-dependent psychomotor effects of intravenous delta-9-tetrahydrocannabinol (Δ9-THC) in humans.

Binding studies have demonstrated that levels of the cannabinoid receptor type-1 are highest in the basal ganglia and cerebellum, two areas critical for motor control. However, no studies have systematically examined the dose-related effects of intravenous delta-9-tetrahydrocannabinol, the primary cannabinoid receptor type-1 partial agonist in cannabis, on broad domains of psychomotor function in humans. Therefore, three domains of psychomotor function were assessed in former cannabis users (cannabis abstinent for a minimum of three months; n=23) in a three test-day, within-subject, double-blind, randomized, cross-over, and counterbalanced study during which they received intravenous delta-9-tetrahydrocannabinol (placebo, 0.015 mg/kg, and 0.03 mg/kg). Gross motor function was assessed via the Cambridge Neuropsychological Test Automated Battery Motor Screening Task, fine motor control via the Lafayette Instrument Grooved Pegboard task, and motor timing via a Paced Finger-Tapping Task. In addition, the Cambridge Neuropsychological Test Automated Battery Rapid Visual Processing Task was utilized to determine whether delta-9-tetrahydrocannabinol-induced motor deficits were confounded by disruptions in sustained attention. Delta-9-tetrahydrocannabinol resulted in robust dose-dependent deficits in fine motor control (Grooved Pegboard Task) and motor timing (Paced Finger-Tapping Task), while gross motor performance (Motor Screening Task) and sustained attention (Rapid Visual Processing Task) were unimpaired. Interestingly, despite the observed dose-dependent increases in motor impairment and blood levels of delta-9-tetrahydrocannabinol, subjects reported similar levels of intoxication in the two drug conditions. These data suggest that while several domains of motor function are disrupted by delta-9-tetrahydrocannabinol, subjective feelings of intoxication are dissociable from cannabinoid-induced psychomotor effects. Results are discussed in terms of the potential neural mechanisms of delta-9-tetrahydrocannabinol in motor structures.

Risk Factors for Mental Health Problems in Children with Cerebral Palsy and Spina Bifida

Children with cerebral palsy (CP) and spina bifida (SB) are at an increased risk for mental health problems. Aim of this study was to correlate disease specific and psychosocial risk factors with characteristic mental health problems. 271 children with CP and 84 with SB aged 3-17 years were included in a cross sectional study of 15 centers. Parents answered the Strengths and Difficulties Questionnaire (SDQ) for mental health problems, rated social participation of their children and gave data to their own educational and professional level. IQ and motor impairment were tested or rated by the caring pediatricians. Abnormal Total-Difficulties Scores were found in CP (30,2%) and SB (18,1%) as compared to the norm (10,0%). Increased prevalences persisted after controlling for IQ as covariate. In both groups, moderate correlations between externalizing problems and levels of cognitive and motor impairment were found. Emotional problems correlated with participation irrespective of level of impairment. Weak correlations were found with age and gender in both groups. After controlling for IQ as covariate mental health problems showed no systematic difference between both groups. Mental health problems in children and youth with CP and SB are frequent. They correlated with various risk factors (IQ, motor impairment, age, gender, participation). Early recognition, participation and psychotherapeutic facilities should be strengthened.

Effect of TDCS on reaching kinematics in subacute stroke patients

Upper limb (UL) paresis after stroke often leads to poor functional outcome. Application of transcranial direct current stimulation (tDCS) can modulate intra- and inter-hemispheric dynamics and promote treatment-related adaptive neural plasticity. However, the optimal stimulation mode for a patient with a given lesion pattern and a given level of motor impairment is unknown. Here we aimed to assess the likelihood of obtaining improvements in endpoint kinematics of the paretic UL, using different tDCS modes in stroke patients with variant residual motor functioning. Twenty-eight subacute stroke patients performed planar point-to-point reaching movements with the paretic upper limb, before and after anodal-tDCS (excitatory), cathodal-tDCS (inhibitory) and sham-tDCS, in a randomized order. tDCS was applied over the left and right M1 hand area (C3, C4). Spatio-temporal kinematic variables derived from the minimum-jerk model were analyzed before and after training, comparing the 3 stimulation modes one with each other. a-tDCS had a larger effect when applied on the lesioned hemisphere. Number of peaks, straight-line deviation and movement time improved (only the former two reached statistical significance). The Fugl Meyer (FM) score at baseline correlated negatively with the magnitude of improvement post-anodal stimulation of the contralesional hemisphere. This was reflected in number of peaks and in movement time. a-tDCS applied on the lesioned hemisphere combined with motor training shows immediate positive effects on path smoothness (less fragmented paths) and path straightness (shorter paths). Higher FM scores at baseline likely imply smaller corticospinal damage in the affected hemisphere, and thus, greater likelihood that perilesional re-mapping will be the dominant mechanism underlying recovery. In the presence of higher corticospinal reserve, one would expect anodal (excitatory) stimulation of the contralesional hemisphere to exert a detrimental effect on function. It remains to be shown whether such stimulation is beneficial in the absence of corticospinal reserve.

Noncommunicable disease and multimorbidity in young adults with cerebral palsy.

PurposeIndividuals with cerebral palsy (CP) are at increased risk for frailty and chronic disease due to factors experienced throughout the lifespan, such as excessive sedentary behaviors and malnutrition. However, little is known about noncommunicable diseases (NCDs) and multimorbidity profiles in young adults with CP. The study objective was to compare NCD and multimorbidity profiles between young adults with and without CP.MethodsA clinic-based sample of adults (18–30 years) with (n=452) and without (n=448) CP was examined at the University of Michigan Medical Center. The prevalence and predictors of 13 NCDs were evaluated, including existing diagnoses or historical record of musculoskeletal, cardiometabolic, and pulmonary morbidities. The level of motor impairment was determined by the Gross Motor Function Classification System (GMFCS) and stratified by less vs more severe motor impairment (GMFCS I–III vs IV–V). Logistic regression was used to determine the odds of NCD morbidity and multimorbidity in adults with CP compared to adults without CP, and for GMFCS IV–V compared to GMFCS I–III in those with CP, after adjusting for age, sex, body mass index, and smoking.ResultsAdults with CP had a higher prevalence of osteopenia, osteoporosis, hypertension, myocardial infarction, hyperlipidemia, asthma, and multimorbidity compared to adults without CP, and higher odds of musculoskeletal (odds ratio [OR]: 6.97) and cardiometabolic morbidity (OR: 1.98), and multimorbidity (OR: 2.67). Adults with CP with GMFCS levels IV–V had a higher prevalence of osteopenia/osteoporosis, osteoarthritis, hypertension, other cardiovascular conditions, pulmonary embolism, and multimorbidity, and higher odds of musculoskeletal (OR: 3.41), cardiometabolic (OR: 2.05), pulmonary morbidity (OR: 1.42), and multimorbidity (OR: 3.45) compared to GMFCS I–III.ConclusionYoung adults with CP have a higher prevalence of chronic NCDs and multimorbidity compared to young adults without CP, which is pronounced in those with more severe motor impairment. These findings reiterate the importance of early screening for prevention of NCDs in CP.

Discriminant ability and criterion validity of the Trunk Impairment Scale for cerebral palsy

Aims: To compare the performance of children with mild and moderate-to-severe cerebral palsy (CP) on the Trunk Impairment Scale (TIS), Gross Motor Function Measure (GMFM), and on center-of-pressure variables; to establish the discriminant ability of these tools to predict severity of motor impairment in CP; and to investigate the criterion validity of the TIS.Methods: Children with mild (n = 18, 11 males, 7 females, mean age = 9.5 ± 2.9 years, Gross Motor Function Classification System I–II) and moderate-to-severe (n = 18, 11 males, 7 females, mean age = 9.2 ± 229, Gross Motor Function Classification System III–IV) CP were tested using the TIS and the GMFM, and during static sitting on force-plate.Results: Children with mild CP showed better trunk (median; 95% confidence interval = 22.5; 21.29–22.59 vs. 13; 11.97–14.8; p < 0.001) and gross motor (60; 57.73–59.3 vs. 40; 38.96–46.25; p < 0.001) scores, and better postural control (lower center of pressure (CoP) displacement [anterior–posterior: (0.42; 0.32–1.11 vs. 0.89; 0.70–1.65; p = 0.022); medial–lateral: (0.42; 0.31–1.08 vs. 0.91; 0.65–1.17; p = 0.044)], and lower area of sway, (0.05; −0.15–0.97 vs. 0.44; 0.23–0.90; p = 0.008) than the moderate-to-severe group. Trunk control and gross motor function explained 81.5% of the variance in the severity of motor condition. Correlations between the TIS and the GMFM were excellent (ρ = 0.944, p < 0.001); correlations between the TIS and CoP variables were low (anterior–posterior displacement: ρ = −0.411, p < 0.05; medial–lateral displacement: ρ = −0.327, p < 0.05); area of sway: ρ = −0.430, p < 0.05; velocity of sway: ρ = −0.308, p < 0.05).Conclusions: The TIS is able to differentiate levels of trunk control across various levels of motor impairments in CP. It is a valid tool to assess trunk control, showing very high concurrent validity with the GMFM sitting dimension.Implications for RehabilitationTrunk Impairment Scale (TIS) can be used by rehabilitation professionals to differentiate levels of trunk control across levels of motor impairment.TIS showed concurrent validity with Gross Motor Function Measure and should be used to assess trunk control in children with cerebral palsy (CP) in clinical settings.The use of TIS allows a reliable assessment of postural control in children with CP in clinical settings.

Behavioral Assessment of Mice with Mitochondrial CaMKII Inhibition

Oxidative stress is thought to be the common underlying mechanism that leads to cellular dysfunction and demise in Parkinson's disease. Recent studies indicate that mitochondrial CaMKII (mtCamKII) activation is responsible for excess Ca2+ uptake under stress conditions, which ultimately leads to increased levels of cell death due to over‐production of reactive oxygen species. Inhibition of mtCaMKII, by CaMKIIN, has been established to decrease cell death under stress conditions in tissues such as the heart. It remains unidentified if inhibition of mtCaMKII in the Substantia nigra can counteract the loss of dopaminergic neurons, a hallmark of Parkinson's disease. To start addressing this interrogant, we utilized the 6‐OHDA unilateral lesion of the Substantia nigra model in mice expressing CaMKIIN, the inhibitor of mtCaMKII. Assessment of cell viability, using the Trypan blue exclusion test of cell viability, as well as confocal imaging of mitochondrial shape of SH‐SY5Y cell line, was performed to validate functionality of 6‐ OHDA. After 2 weeks, training motor impairment assays including rotarod, pole descent, inverted grid and footprint analysis were performed. Preliminary results validated the detrimental effects of 6‐OHDA on SH‐SY5Y cells and showed that mtCaMKIIN‐expressing mice were slower in the pole descent test. Thus, the 6‐OHDA unilateral lesion of the Substantia nigra model in mice shows great promise to assess level of motor impairment in mice expressing mtCaMKIIN, that way, assessing if inhibition of mtCaMKII is protective against cell death.Support or Funding InformationSpecial thanks to the lab's of Dr.'s Amy Lee, Ryan Boudreau and Nandakumar Narayanan, the Interdisciplinary Summer Undergraduate Research Program (ISURP), the PRISE program and the CCOM Office of Cultural Affairs and Diversity Initiatives. This project was supported by NIH (AL: NS084190, DC009433) and a Carver MRIG (MAJ).This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Disrupted functional network integrity and flexibility after stroke: Relation to motor impairments

Previous studies investigating brain activation present during upper limb movement after stroke have greatly detailed activity alterations in the ipsi- and contralesional primary motor cortices (M1). Despite considerable interest in M1, investigations into the integration and coordination of large-scale functional networks subserving motor, sensory, and cognitive control after stroke remain scarce. The purpose of this study was to assess non-static functional connectivity within whole-brain networks involved in the production of isometric, visually-paced hand grips. Seventeen stroke patients and 24 healthy controls underwent functional MRI while performing a series of 50 isometric hand grips with their affected hand (stroke patients) or dominant hand (control subjects). We used task-based multivariate functional connectivity to derive spatial and temporal information of whole-brain networks specifically underlying hand movement. This technique has the advantage of extracting within-network commonalities across groups and identifying connectivity differences between these groups. We further used a nonparametric statistical approach to identify group differences in regional activity within these task-specific networks and assess whether such alterations were related to the degree of motor impairment in stroke patients. Our whole-brain multivariate analysis revealed group differences in two networks: (1) a motor network, including pre- and postcentral gyri, dorsal and ventral premotor cortices, as well as supplementary motor area, in which stroke patients showed reduced task-related activation compared to controls, and (2) a default-mode network (DMN), including the posterior cingulate cortex, precuneus, and medial prefrontal cortex, in which patients showed less deactivation than controls. Within-network group differences revealed decreased activity in ipsilesional primary sensorimotor cortex in stroke patients, which also positively correlated with lower levels of motor impairment. Moreover, the temporal information extracted from the functional networks revealed that stroke patients did not show a reciprocal DMN deactivation peak following activation of their motor network. This finding suggests that allocation of functional resources to motor areas during hand movement may impair their ability to efficiently switch from one network to another. Taken together, our study expands our understanding of functional reorganization during motor recovery after a stroke, and suggests that modulation of ipsilesional sensorimotor activity may increase the integrity of a whole-brain motor network, contribute to better motor performance, and optimize network flexibility.

The spasticity in the motor and functional disability in adults with post-stroke hemiparetic

Abstract Introduction: Spasticity acts as a limiting factor in motor and functional recovery after Stroke, impairing the performance of daily living activities. Objective: To analyze the influence of spasticity on main muscle groups and to associate it with motor impairment and functional level of chronic hemiparetic patients after stroke. Methods: Twenty-seven chronic hemiparetic patients of both sexes were selected at the Physical Therapy and Occupational Therapy Service of the Unicamp Clinics Hospital. Assessments were carried out in two sessions, in the first one the motor impairment (Fugl-Meyer Assessment - FM) and functional impairment (Barthel Index - BI) were evaluated, and in the second, the degree of spasticity of the main muscle groups (Modified Ashworth Scale - MAS). Results: A negative correlation was detected between upper limb spasticity and motor and functional impairment. No muscle group evaluated in the lower limbs showed correlation between muscle tone and the level of impairment of the lower extremity on FM and the functional level measured by BI. Conclusion: Spasticity has been shown to be a negative influence factor in the level of motor and functional impairment of the upper limbs of chronic hemiparetic patients after stroke.

Proprioceptive assessment in clinical settings: Evaluation of joint position sense in upper limb post-stroke using a robotic manipulator.

Proprioception is a critical component for motor functions and directly affects motor learning after neurological injuries. Conventional methods for its assessment are generally ordinal in nature and hence lack sensitivity. Robotic devices designed to promote sensorimotor learning can potentially provide quantitative precise, accurate, and reliable assessments of sensory impairments. In this paper, we investigate the clinical applicability and validity of using a planar 2 degrees of freedom robot to quantitatively assess proprioceptive deficits in post-stroke participants. Nine stroke survivors and nine healthy subjects participated in the study. Participants’ hand was passively moved to the target position guided by the H-Man robot (Criterion movement) and were asked to indicate during a second passive movement towards the same target (Matching movement) when they felt that they matched the target position. The assessment was carried out on a planar surface for movements in the forward and oblique directions in the contralateral and ipsilateral sides of the tested arm. The matching performance was evaluated in terms of error magnitude (absolute and signed) and its variability. Stroke patients showed higher variability in the estimation of the target position compared to the healthy participants. Further, an effect of target was found, with lower absolute errors in the contralateral side. Pairwise comparison between individual stroke participant and control participants showed significant proprioceptive deficits in two patients. The proposed assessment of passive joint position sense was inherently simple and all participants, regardless of motor impairment level, could complete it in less than 10 minutes. Therefore, the method can potentially be carried out to detect changes in proprioceptive deficits in clinical settings.

Cognitive functioning in dyskinetic cerebral palsy: Its relation to motor function, communication and epilepsy.

Cerebral palsy (CP) is a disorder of motor function often accompanied by cognitive impairment. There is a paucity of research focused on cognition in dyskinetic CP and on the potential effect of related factors. To describe the cognitive profile in dyskinetic CP and to assess its relationship with motor function and associated impairments. Fifty-two subjects with dyskinetic CP (28 males, mean age 24y 10mo, SD 13y) and 52 typically-developing controls (age- and gender-matched) completed a comprehensive neuropsychological assessment. Gross Motor Function Classification System (GMFCS), Communication Function Classification System (CFCS) and epilepsy were recorded. Cognitive performance was compared between control and CP groups, also according different levels of GMFCS. The relationship between cognition, CFCS and epilepsy was examined through partial correlation coefficients, controlling for GMFCS. Dyskinetic CP participants performed worse than controls on all cognitive functions except for verbal memory. Milder cases (GMFCS I) only showed impairment in attention, visuoperception and visual memory. Participants with GMFCS II-III also showed impairment in language-related functions. Severe cases (GMFCS IV-V) showed impairment in intelligence and all specific cognitive functions but verbal memory. CFCS was associated with performance in receptive language functions. Epilepsy was related to performance in intelligence, visuospatial abilities, visual memory, grammar comprehension and learning. Cognitive performance in dyskinetic CP varies with the different levels of motor impairment, with more cognitive functions impaired as motor severity increases. This study also demonstrates the relationship between communication and epilepsy and cognitive functioning, even controlling for the effect of motor severity.