Limb Movements In Patients Research Articles

Development of a Gait Analysis Application for Assessing Upper and Lower Limb Movements to Detect Pathological Gait.

Pathological gait in patients with Hakim's disease (HD, synonymous with idiopathic normal-pressure hydrocephalus; iNPH), Parkinson's disease (PD), and cervical myelopathy (CM) has been subjectively evaluated in this study. We quantified the characteristics of upper and lower limb movements in patients with pathological gait. We analyzed 1491 measurements of 1 m diameter circular walking from 122, 12, and 93 patients with HD, PD, and CM, respectively, and 200 healthy volunteers using the Three-Dimensional Pose Tracker for Gait Test. Upper and lower limb movements of 2D coordinates projected onto body axis sections were derived from estimated 3D relative coordinates. The hip and knee joint angle ranges on the sagittal plane were significantly smaller in the following order: healthy > CM > PD > HD, whereas the shoulder and elbow joint angle ranges were significantly smaller, as follows: healthy > CM > HD > PD. The outward shift of the leg on the axial plane was significantly greater, as follows: healthy < CM < PD < HD, whereas the outward shift of the upper limb followed the order of healthy > CM > HD > PD. The strongest correlation between the upper and lower limb movements was identified in the angle ranges of the hip and elbow joints on the sagittal plane. The lower and upper limb movements during circular walking were correlated. Patients with HD and PD exhibited reduced back-and-forth swings of the upper and lower limbs.

Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer.

General anesthesia is commonly used in the surgical management of gastrointestinal tumors; however, it can lead to emergence agitation (EA). EA is a common complication associated with general anesthesia, often characterized by behaviors, such as crying, struggling, and involuntary limb movements in patients. If treatment is delayed, there is a risk of incision cracking and bleeding, which can significantly affect surgical outcomes. Therefore, having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia, which is beneficial for improving patient prognosis. To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer. Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital (January 2020 to December 2023) was conducted. Post-surgery, the Richmond Agitation-Sedation Scale was used to evaluate EA presence, noting EA incidence after general anesthesia. Patients were categorized by EA presence postoperatively, and the influencing factors were analyzed using logistic regression. A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves. EA occurred in 51 (25.5%) patients. Multivariate analysis identified advanced age, American Society of Anesthesiologists (ASA) grade III, indwelling catheter use, and postoperative pain as risk factors for EA (P < 0.05). Conversely, postoperative analgesia was a protective factor against EA (P < 0.05). The area under the curve of the nomogram was 0.972 [95% confidence interval (CI): 0.947-0.997] for the training set and 0.979 (95%CI: 0.951-1.000) for the test set. Hosmer-Lemeshow test showed a good fit (χ 2 = 5.483, P = 0.705), and calibration curves showed agreement between predicted and actual EA incidence. Age, ASA grade, catheter use, postoperative pain, and analgesia significantly influence EA occurrence. A nomogram constructed using these factors demonstrates strong predictive accuracy.

Periodic limb movements in patients with suspected obstructive sleep apnea without comorbid conditions.

Periodic limb movement disorder (PLMD) and obstructive sleep apnea (OSA) are overlapping clinical syndromes with common risk factors. However, current literature has failed to establish a clear pathophysiological link between them. Thus, little is known about periodic limb movements (PLM) in otherwise healthy patients with suspected OSA. We performed a retrospective analysis of 112 patients (age: 44.5 ± 12.0 years, 14.3% female) with suspected OSA who underwent full night polysomnography for the first time. Patients with chronic diseases of any kind, recent infections, malignancies, or daily or regular use of any type of medication were excluded. Group comparisons were made based on the severity of OSA (using the apnea hypopnea index, AHI) or the periodic limb movement index (PLMI). Both, PLMI and the total number of periodic limb movements during sleep (PLMS), showed a significant increase in patients with severe OSA. In addition, AHI and apnea index (AI) were significantly higher in patients with PLMI >15/h, with a similar trend for hypopnea index (HI) (p < 0.001, p < 0.001, and p > 0.05, respectively). PLMI was significantly positive correlated with AHI, AI, and HI (r = 0.392, p < 0.001; r = 0.361, p < 0.001; and r = 0.212, p < 0.05, respectively). Patients with PLMI >15/h were significantly older (p < 0.001). There was no significant association between body mass index (BMI) and PLMI >15/h. We found a significant association between the severity of OSA and PLM in our study population with suspected OSA but without other comorbidities. PLMI and PLMS were significantly increased in patients with severe OSA. Future prospective studies with larger collectives should verify the presented results and should include mechanistic aspects in their evaluation.

Comparison of different rhythmic auditory stimuli on prefrontal cortex cortical activation during upper limb movement in patients with Parkinson's disease: a functional near-infrared spectroscopy study.

A large number of literatures show that rhythmic auditory stimulation (RAS) can effectively improve Parkinson's disease (PD) patients' gait speed, frequency and speed. Its application and curative effect on upper limb motor function is relatively few. By studying the immediate effect of RAS with different rhythms on the prefrontal cortex (PFC) blood oxygen response during upper limb movement in PD patients, this study discusses the potential neurophysiological mechanism of RAS on upper limb movement in PD patients, which is expected to provide guidance for patients with upper limb dysfunction such as Parkinson's disease. In this study, 31 PD patients with upper limb static tremors were recruited to complete the nail board task on the healthy upper limb under the baseline rhythm, slow rhythm and fast rhythm provided by the therapist. At the same time, fNIRS was used to observe the blood oxygen response of PFC. There was no significant main effect onsidein all brain regions (p > 0.05), and there was no interaction between rhythm and side (p > 0.05); Except lPFC, the main effect of rhythm in other brain regions was significant (p < 0.05), and ΔHbO increased with the change of rhythm. Paired analysis showed that there were significant differences in ΔHbO between slow rhythm and baseline rhythm, between fast rhythm and baseline rhythm, and between slow rhythm and fast rhythm (p < 0.05); The ΔHbO of rPFC, lDLPFC and rDLPFC were significantly different between slow rhythm and fast rhythm (p < 0.05); there were significant differences in the ΔHbO of BA8 between slow rhythm and baseline rhythm, and between slow rhythm and fast rhythm (p < 0.05). RAS may be a useful upper limb rehabilitation strategy for PD patients with upper limb dysfunction. At the same time, RAS with different rhythms also have different responses to PFC blood oxygen during upper limb movement in PD patients, so that we can design interventions for this kind of cortical mechanism. Identifying the neurophysiological mechanism of RAS on upper limb movement in PD patients may help clinicians customize rehabilitation methods for patients according to clues, so as to highly personalize upper limb training and optimize its effect.

A health monitoring system based on flexible triboelectric sensors for intelligence medical internet of things and its applications in virtual reality

The Internet of Medical Things (IoMT) is a platform that combines Internet of Things (IoT) technology with medical applications, enabling the realization of precision medicine, intelligent healthcare, and telemedicine in the era of digitalization and intelligence. However, the IoMT faces various challenges, including sustainable power supply, human adaptability of sensors and the intelligence of sensors. In this study, we designed a robust and intelligent IoMT system through the synergistic integration of flexible wearable triboelectric sensors and deep learning-assisted data analytics. We embedded four triboelectric sensors into a wristband to detect and analyze limb movements in patients suffering from Parkinson's Disease (PD). By further integrating deep learning-assisted data analytics, we actualized an intelligent healthcare monitoring system for the surveillance and interaction of PD patients, which includes location/trajectory tracking, heart monitoring and identity recognition. This innovative approach enabled us to accurately capture and scrutinize the subtle movements and fine motor of PD patients, thus providing insightful feedback and comprehensive assessment of the patients’ conditions. This monitoring system is cost-effective, easily fabricated, highly sensitive, and intelligent, consequently underscores the immense potential of human body sensing technology in a Health 4.0 society.

Transposition of functioning muscles in complex treatment of adult patients with injuries of the bracheric plexus (literature review)

Introduction. Injuries to the brachial plexus are one of the most severe types of injuries to the nerves of the upper limb, and variants with the separation of the roots from the spinal cord represent a very difficult category of injuries to treat. Among patients who have received such injuries, there is a very high incidence of disability, since it is possible to achieve only partial restoration of the function of the upper limb. Recently, the method of transposition of functioning muscles has been growing in popularity due to its reliability and relatively short recovery time of function.The purpose of the work is to analyze the literature data on the possibility of using the method of transposition of functioning muscles in the complex treatment of victims with brachial plexus injuries.The authors have searched PubMed and RSCI databases over the past 25 years for keywords: peripheral nerve damage, tendon transposition, transposition of functioning muscles, nerve injury, brachial plexus injury, spinal cord root avulsion. In the selected 23 most relevant papers, the muscles used for transposition, indications and timing of operations, results and complications were analyzed, compared with other methods of surgical treatment of brachial plexus injuries. The analysis of studies has shown that the transposition of functioning muscles allows in most cases to restore the target movement to the useful level of M3–M4 on the MRC scale, is a more reliable method and allows achieving better results, especially in patients with severe complete injuries of the brachial plexus. An important disadvantage of free hip thin muscle transplantation operations is the risk of microanastomosis thrombosis, which requires detailed preoperative planning and good microsurgical technique of the operating team.Conclusion. Free transplantation of 2 functioning muscles is currently the method of choice for restoring upper limb movements in patients with complete brachial plexus injuries.

Pharmacological responsiveness of periodic limb movements in patients with restless legs syndrome: a systematic review and meta-analysis.

Periodic limb movements during sleep (PLMS) are a frequent finding in restless legs syndrome, but their impact on sleep is still debated, as well the indication for treatment. We systematically reviewed the available literature to describe which drug categories are effective in suppressing PLMS, assessing their efficacy through a meta-analysis, when this was possible. The review protocol was preregistered on PROSPERO (CRD42021175848), and the systematic search was conducted on and EMBASE (last searched on March 2020). We included original human studies, which assessed PLMS modification on drug treatment with a full-night polysomnography, through surface electrodes on each tibialis anterior muscle. When at least 4 studies were available on the same drug or drug category, we performed a random-effect model meta-analysis. Dopamine agonists like pramipexole and ropinirole resulted the most effective, followed by l-dopa and other dopamine agonists. Alpha2delta ligands are moderately effective as well opioids, despite available data on these drugs are much more limited than those on dopaminergic agents. Valproate and carbamazepine did not show a significant effect on PLMS. Clonazepam showed contradictory results. Perampanel and dypiridamole showed promising but still insufficient data. The same applies to iron supplementation. Dopaminergic agents are the most powerful suppressors of PLMS. However, most therapeutic trials in restless legs syndrome do not report objective polysomnographic findings, there is a lack of uniformity in presenting results on PLMS. Longitudinal polysomnographic interventional studies, using well-defined and unanimous scoring criteria and endpoints on PLMS are needed. Riccardi S, Ferri R, Garbazza C, Miano S, Manconi M. Pharmacological responsiveness of periodic limb movements in patients with restless legs syndrome: a systematic review and meta-analysis. J Clin Sleep Med. 2023;19(4):811-822.

Impact of the Interdisciplinary Chronic Pain Rehabilitation Programme in patients with and without sleep disorders

Sleep disorders and chronic pain are linked to each other bidirectionally. Both are related to affective disorders, fatigue, depression, anxiety and drug abuse, and have a significant effect on quality of life. The Interdisciplinary Pain Programme (IDP) aims to relieve the patients' pain and improve their functionality by incorporating healthy postural, sleep and nutritional habits, relaxation techniques, physical exercise and cognitive-behavioural mechanisms. A retrospective, observational, cross-sectional study was conducted. A total of 323 patients with chronic pain who completed the IDP were examined. They were assessed at the beginning and at the end of the programme with pain, depression, quality of life and insomnia scales, and were then compared between groups with and without insomnia, that is, with an insomnia severity index (ISI) less than 15 versus greater than or equal to 15. Fifty-eight patients were studied by means of polysomnography. A significant improvement (p < 0.0001) in pain, depression and quality of life, as assessed by the visual analogue scale (VAS), the Beck inventory and the Short Form-36 (SF-36) questionnaire was observed in chronic pain patients with an ISI below 15 and in those with an ISI greater than or equal to 15. The results were superior in the group of patients with insomnia. The presence of a high apnoea and hypopnoea index and periodic lower limb movements in patients was not related to improvements on the Beck, SF-36, ISI and VAS scales. In conclusion, IDP benefits patients with chronic non-cancer-induced pain in several affected areas, in addition to pain, due to a comprehensive treatment. Polysomnography can help diagnose specific pathologies and individualise pharmacological treatment.

Quantification of Upper Limb Movements in Patients with Hereditary or Idiopathic Ataxia

Assessment of ataxic movements is usually based on clinical judgment. Technical devices can be employed in the quantification of ataxic movements in addition to clinical evaluation. The effect of maximal speed in upper limb movements in ataxia patients has not been quantified. The aim was to quantify upper limb movements in patients with hereditary or idiopathic ataxia and to find features of movement that are characteristic for ataxia. We examined 19 patients with degenerative ataxia and 21 healthy controls. An ad hoc system comprising a touch screen, an accelerometer, and a gyroscope was used to measure speed, angular acceleration, consistency, and accuracy of upper limb movements. The movements were quantified during finger-to-nose test that the patients were asked to perform at their own pace and as fast as possible. Disease severity was estimated by using the Scale for the Assessment and Rating of Ataxia (SARA). The mean SARA score of the patients was 13.5. Compared to the controls the performance of the patients was slow (p < 0.001) and arrhythmic (p < 0.001), but end-point accuracy on the touch screen was intact. The SARA score correlated with the standard deviation of amplitude of angular acceleration in Z-axis (F(1,17) = 15.00, p < 0.001 with R2 = 0.47). Upper limb movements of the patients with degenerative ataxia were slower and more arrhythmic than those in the controls. The patients retained spatial end-point accuracy.

Upper limb movement during locomotion in patients with neurological disorders: a wearable-based approach

The contribution of upper limbs during walking is crucial in maintaining balance and stability: humans, in fact, swing each upper limb in phase with contra-lateral lower limb at their comfortable walking speed, with a ratio of 1:1 [1], thus counteracting the angular momentum, reducing the energy expenditure, and improving the overall gait efficiency [2,3]. In people who suffer from neurological disorders, like Multiple Sclerosis (MS) or Traumatic Brain Injury (TBI), upper limb function is often impaired, resulting in differences in arm swing frequency, amplitude, symmetry, as well as in the ratio between step and arm swing frequency, compared to healthy people [2]. Although it is known that a neurological rehabilitation program should focus on the recovery of a proper gait also emphasizing the contribution of upper limbs [1], few studies analyzed the contribution of the upper arms during locomotion in people with neurological disorders. The aim of this study is to explore a wearable sensor-based protocol for the assessment of the upper limb movement in patients with MS and TBI compared to healthy participants. Thirty-three patients suffering from MS (24 F; 49.8±9.3 y; EDSS 4.0±1.6), 8 patients suffering from TBI (2 F; 32.3±14.1 y; DGI 18.3±5.9), and 20 healthy adults (HC) (9 F; 37.0±19.9 y) were enrolled in this study (CE/PROG.700). Each participant performed a 10-meter Walking Test (10mWT) while wearing 5 synchronized inertial measurement units (IMUs) located at sternum, both wrists and distal tibiae level. Stride segmentation was performed using tibiae-mounted IMUs and the following parameters were estimated from wrist- and sternum-mounted IMUs [4]: arm oscillation frequency, peak and range of the angular velocity norm, as well as step to arm oscillation frequency ratio for the right (RW) and left (LW) wrists (freq, gyro peak, gyro range, Step-freq ratio). The range of the sternum cranio-caudal angular velocity was also obtained (sternum gyro range), together with a measure of symmetry (Symmetry Index [5]) between RW and LW angular velocity ranges. After checking for data normality, a one-way ANOVA was used to test for significant differences among MS, TBI, and HC. Post-hoc analysis was performed using Bonferroni-Holmes correction for multiple comparisons. Results are depicted in Fig. 1 (the larger the spider, the better the performance). Significant differences were found in frequency, symmetry, and angular velocity parameters among the MS, TBI, and HC. Patients with TBI seem to be characterized by a reduced performance with respect to MS, except for the step to arm swing ratio. The proposed assessment protocol demonstrates a potential clinical value in discriminating not only patients with neurological disorders from HC, but also patients with MS from TBI, who showed significant differences in terms of swing frequency, angular velocity range, and symmetry. This information could be useful in tailoring rehabilitation treatments involving the upper limbs during gait exercises [1]. Although in the present study, no significant difference was found among the three populations walking speed, the effect of the latter on the proposed metrics should be better investigated in further studies.

Vibrotactile Perception for Sensorimotor Augmentation: Perceptual Discrimination of Vibrotactile Stimuli Induced by Low-Cost Eccentric Rotating Mass Motors at Different Body Locations in Young, Middle-Aged, and Older Adults.

Sensory augmentation technologies are being developed to convey useful supplemental sensory cues to people in comfortable, unobtrusive ways for the purpose of improving the ongoing control of volitional movement. Low-cost vibration motors are strong contenders for providing supplemental cues intended to enhance or augment closed-loop feedback control of limb movements in patients with proprioceptive deficits, but who still retain the ability to generate movement. However, it remains unclear what form such cues should take and where on the body they may be applied to enhance the perception-cognition-action cycle implicit in closed-loop feedback control. As a step toward addressing this knowledge gap, we used low-cost, wearable technology to examine the perceptual acuity of vibrotactile stimulus intensity discrimination at several candidate sites on the body in a sample of participants spanning a wide age range. We also sought to determine the extent to which the acuity of vibrotactile discrimination can improve over several days of discrimination training. Healthy adults performed a series of 2-alternative forced choice experiments that quantified capability to perceive small differences in the intensity of stimuli provided by low-cost eccentric rotating mass vibration motors fixed at various body locations. In one set of experiments, we found that the acuity of intensity discrimination was poorer in older participants than in middle-aged and younger participants, and that stimuli applied to the torso were systematically harder to discriminate than stimuli applied to the forearm, knee, or shoulders, which all had similar acuities. In another set of experiments, we found that older adults could improve intensity discrimination over the course of 3 days of practice on that task such that their final performance did not differ significantly from that of younger adults. These findings may be useful for future development of wearable technologies intended to improve the control of movements through the application of supplemental vibrotactile cues.

The Effect of Virtual Reality on Motor Anticipation and Hand Function in Patients with Subacute Stroke: A Randomized Trial on Movement-Related Potential.

Background Impaired cognitive ability to anticipate the required control for an upcoming task in patients with stroke may affect rehabilitation outcome. The cortical excitability of task-related motor anticipation for upper limb movement induced by virtual reality (VR) training remains unclear. Aims To investigate the effect of VR training on the cortical excitability of motor anticipation when executing upper limb movement in patients with subacute stroke. Methods A total of thirty-six stroke survivors with upper limb hemiparesis resulting from the first occurrence of stroke within 1 to 3 months were recruited. Participants were randomly allocated to the VR intervention group or conventional therapy group. Event-related potentials (ERPs) and electromyography (EMG) were used to simultaneously record the cortical excitability and muscle activities during palmar grasp motion. Outcome measures of the contingent negative variation (CNV) latency and amplitude, EMG reaction time, Upper Limb Fugl-Meyer Assessment (UL-FMA), Action Research Arm Test (ARAT), and National Institutes of Health Stroke Scale (NIHSS) were recorded pre- and postintervention. The between-group difference was analysed by mixed model ANOVA. Results The EMG onset time of the paretic hand in the VR group was earlier than that observed in the control group (t = 2.174, p = 0.039) postintervention. CNV latency reduction postintervention was larger in the VR group than in the control group (t = 2.411, p = 0.021) during paretic hand movement. The reduction in CNV amplitude in the VR group was larger in the VR group than in the control group (p < 0.001 for all electrodes except for C3) when executing paretic hand movement. ARAT and UL-FMA scores were significantly higher in the VR group than in the control group (p = 0.019 and p = 0.037, respectively) postintervention. No significant difference in the reduction in NIHSS was found between the VR and control groups (p = 0.072). Conclusions VR intervention is superior to conventional therapy to improve the cognitive neural process of motor anticipation and reduce the excessive compensatory activation of the contralesional hemisphere. The improvements observed in the cognitive neural process corroborated with the improvements in hand function.

Bradykinesia in patients with valproate-induced tremor

Valproate is one of the most effective treatments for epilepsy. Among its side effects, tremor and parkinsonism have been reported. Earlier neurophysiological observations showed bradykinesia (movement slowness) during upper limb movement in patients with valproate-induced tremor. However, the pathophysiological mechanisms of this movement abnormality are unclear. Objective: To investigate the possible occurrence of bradykinesia in patients with valproate-induced tremor during finger movements and possible distinguishing features with bradykinesia in Parkinson's disease.

Periodic limb movements in patients with obstructive sleep apnea syndrome

The aim of the study was to assess the factors associated with periodic limb movements during sleep (PLMS) among obstructive sleep apnea syndrome (OSAS) patients and identify the role of PLMS in patients with OSAS. 303 adult patients with OSAS were included in the study. All patients completed physical examination, Epworth sleepiness scale (ESS), and polysomnography. Diagnosis of PLMS was made if the periodic leg movements index (PLMI) was ≥ 15. Chi-square test, ANOVA, univariate and multivariate logistic regression analyses were conducted to identify factors associated with PLMS among OSAS patients. Statistical analyses were performed with SPSS 26.0 for mac. Statistically significant difference was considered if P value < 0 .05. Among the 303 adult patients with OSAS, 98 patients had significant PLMS and the other 205 had no significant PLMS. Compared with OSAS patients without PLMS, OSAS patient with PLMS were older, had shorter REM duration and greater apnea–hypopnea index (AHI) (P < 0.05). The study suggests that PLMS is a matter of concern among patients with OSAS. A better understanding of the role of PLMS among OSAS patients could be useful in better recognition, intervention and treatment of OSAS.

Study on the regulation function of spinal cord micro-stimulation signal parameters on hind limb movement in rats

Functional electrical stimulation of the spinal cord can evoke limb movement in patients with motor dysfunction caused by injury or pathology. Research question: However, the adjustment function of micro-stimulation signal parameters in the spinal cord on the motion of hind limbs about rodents has not been identified. The amplitude, frequency and pulse width of the spinal cord micro-stimulation signal were adjusted to quantitatively analyze the changes of the joint angles when the hindlimb produced extension and flexion responses. When the rat’s extension and flexion responses are induced, the optimal stimulus signal amplitudes are 40 µA and 90 µA respectively. At the same time, the optimal stimulation signal frequency range is (35±5) Hz and the best pulse width of the stimulation signal is 200 µs. The results can provide a further reference for the development of spinal cord stimulator for hindlimb regulation.

Changes in heart rate related to rhythmic masticatory muscle activities and limb movements in patients with sleep bruxism.

Most sleep bruxism (SB) episodes are accompanied by an increase in sympathetic tone and heart rate (HR). To characterise heart rate (HR) changes in relation to rhythmic masticatory muscle activities (RMMAs) in SB patients, polysomnographic recordings were performed on 10 SB patients and 11 normal controls. The duration of movement events, amplitude and duration of HR increases, and time to reach HR peak associated with RMMAs and limb movements (LMs) were determined, and the relationships of the parameters of HR increases with types of movements and RMMAs were analysed. All of the parameters of HR increases associated with three types of movements (RMMAs, RMMAs+LMs and LMs) and masseter activities (phasic, tonic and mixed) were significantly different (two-way ANOVA, P<.001 for all) in both SB patients and controls. The duration of RMMAs/LMs was positively correlated with the parameters (SB patients: R2 =.24-.85, P<.0001; controls: R2 =.23-.68, P<.0001). The amplitude of HR increases was also positively correlated with respiration changes in the SB patients (R2 =.3258, P<.0001) and controls (R2 =.09469, P<.05). The proportions of phasic RMMAs associated with awakenings, microarousals and no cortical arousals were significantly different and so were the proportions of tonic and mixed RMMAs (Friedman's tests, P<.05-.001). The HR increases associated with RMMAs may be intrinsic to the cortical arousal response and autonomic activation, and differences in HR increases associated with different types of movements and RMMAs might be related to the changes in respiration and differences in cortical arousal levels.

P24 Cortical signatures of repetitive finger movement and transition to freezing in upper limb movement in patients with Parkinson’s disease

P24 Cortical signatures of repetitive finger movement and transition to freezing in upper limb movement in patients with Parkinson’s disease

Regional estimates of cortical thickness in brain areas involved in control of surgically restored limb movement in patients with tetraplegia

Context/Objective: Spinal cord injury (SCI) causes atrophy of brain regions linked to motor function. We aimed to estimate cortical thickness in brain regions that control surgically restored limb movement in individuals with tetraplegia. Design: Cross-sectional study. Setting: Sahlgrenska University hospital, Gothenburg, Sweden. Participants: Six individuals with tetraplegia who had undergone surgical restoration of grip function by surgical transfer of one elbow flexor (brachioradialis), to the paralyzed thumb flexor (flexor pollicis longus). All subjects were males, with a SCI at the C6 or C7 level, and a mean age of 40 years (range = 31–48). The average number of years elapsed since the SCI was 13 (range = 6–26). Outcome measures: We used structural magnetic resonance imaging (MRI) to estimate the thickness of selected motor cortices and compared these measurements to those of six matched control subjects. The pinch grip control area was defined in a previous functional MRI study. Results: Compared to controls, the cortical thickness in the functionally defined pinch grip control area was not significantly reduced (P = 0.591), and thickness showed a non-significant but positive correlation with years since surgery in the individuals with tetraplegia. In contrast, the anatomically defined primary motor cortex as a whole exhibited substantial atrophy (P = 0.013), with a weak negative correlation with years since surgery. Conclusion: Individuals with tetraplegia do not seem to have reduced cortical thickness in brain regions involved in control of surgically restored limb movement. However, the studied sample is very small and further studies with larger samples are required to establish these findings.

Kinematic Parameters of Movement at the Shoulder Joint in Normal Gait in Humans

Study objective: to determine the kinematic parameters of the shoulder joint in the normal human gait. Materials and methods. A Vicon programmable system for motion capture and analysis was used to study 10 selected men with near-absolute symmetry of upper limb movements. Results. Quantitative measures of kinematic movement parameters at the shoulder joint in the arm transfer cycle during walking were obtained. Flexion-extension and abduction of the upper limbs during the stepping cycle were symmetrical and coincided with the minimal internal rotation only in the middle of the cycle. Swinging of the arms during walking can be compared with the movements of a pendulum with its center at the shoulder joint with a movement amplitude of 24.6 ± 2.4°. Conclusions. The data obtained here serve as standards and provide for comparative analysis of upper limb movements in patients with arm locomotion disorders, and are also of value in prosthetization and robotics.

Companion of oral movements with limb movements in patients with sleep bruxism: preliminary findings

BackgroundSleep bruxism (SB) patients show a higher incidence of leg movements than normal subjects. Study objectivesThe study aimed to characterize SB episodes and their relationships with limb movements (LMs). Materials and methodsPolysomnographic (PSG) recordings were performed on eight SB patients. The intervals between the onsets of adjacent SB episodes and LMs were determined and linear correlation analyses were used to estimate the relationship between the SB index and SB episodes in clusters. The Pearson χ2 and partitions of χ2 tests were used to analyze the differences in incidence of SB episodes and clusters in different sleep stages. ResultsA majority of SB episodes (85.05%) were found to be accompanied by LMs and among them, 70.52% SB episodes occurred with movements of both upper and lower limbs and most of LMs (70.54%) occurred before the onset of SB episodes. Most of SB episodes especially those accompanied by LMs occurred with microarousals or awakenings. Linear correlation analysis showed a positive correlation between the SB index and SB episodes in clusters (r2 = 0.7027, P = 0.0093). In addition, the percentage of SB episodes in clusters accompanied by LMs was significantly smaller than that of SB episodes not accompanied by LMs (χ2 test, P < 0.001) and the percentage of SB episodes in clusters during REM sleep was significantly smaller than that during NREM sleep (χ2 test, P < 0.0001). ConclusionsMost SB episodes might not be isolated events, but rather a part of a series of movements second to changes in arousal level.