Motor Disturbances In Patients Research Articles

Nordic walking in winter as the multitask training in patients with Parkinson's disease

To evaluate an influence of 8-week course of winter nordic walking as the multitask on the spatial-temporal characteristics of walking and motor disturbances in patients with Parkinson's disease (PD). Eleven patients (3 men and 8 women, mean age 66.82±3.97 years) with Hoehn and Yahr stage 1 to 2 PD were included in the study. Preliminary medical examination, including the anthropometric profile with the calculation of the body mass index (BMI), the grip strength on the right and left sides, spirometry, functional tests with the physical load (orthostatic test with the determination of systolic and diastolic blood pressure (SBP and DPB) and type of reaction (normal, hypertonic, hypotonic), the 6 Minute Walk Test, timed Up and Go test), was performed to evaluate the physical state. The evaluation of motor function was performed using the unified Parkinson's disease rating scale of the Movement Disorder Society (MDS UPDRS), part III. A 8-week course of nordic walking training was carried out at the certified track on the stadium localized outside of the city, in the wood and parks area in the winter. Compared to the first training, gait velocity increased at the 3rd session, the step length at the 6th. The improvement of the spatial-temporal characteristics of walking was accompanied by the improvement of the motor function as measured by MDS UPDRS, part III. Winter nordic walking as multitask is the effective measure of exercise treatment in patients with PD, because it improves the spatial-temporal characteristics of walking and the motor function.

A Case-Controlled Pilot Study on Rhythmic Auditory Stimulation-Assisted Gait Training and Conventional Physiotherapy in Patients With Parkinson's Disease Submitted to Deep Brain Stimulation.

Deep brain stimulation (DBS) is indicated when motor disturbances in patients with idiopathic Parkinson's disease (PD) are refractory to current treatment options and significantly impair quality of life. However, post–DBS rehabilitation is essential, with particular regard to gait. Rhythmic auditory stimulation (RAS)-assisted treadmill gait rehabilitation within conventional physiotherapy program plays a major role in gait recovery. We explored the effects of a monthly RAS–assisted treadmill training within a conventional physiotherapy program on gait performance and gait-related EEG dynamics (while walking on the RAS–aided treadmill) in PD patients with (n = 10) and without DBS (n = 10). Patients with DBS achieved superior results than those without DBS concerning gait velocity, overall motor performance, and the timed velocity and self-confidence in balance, sit-to-stand (and vice versa) and walking, whereas both groups improved in dynamic and static balance, overall cognitive performance, and the fear of falling. The difference in motor outcomes between the two groups was paralleled by a stronger remodulation of gait cycle–related beta oscillations in patients with DBS as compared to those without DBS. Our work suggests that RAS-assisted gait training plus conventional physiotherapy is a useful strategy to improve gait performance in PD patients with and without DBS. Interestingly, patients with DBS may benefit more from this approach owing to a more focused and dynamic re–configuration of sensorimotor network beta oscillations related to gait secondary to the association between RAS-treadmill, conventional physiotherapy, and DBS. Actually, the coupling of these approaches may help restoring a residually altered beta–band response profile despite DBS intervention, thus better tailoring the gait rehabilitation of these PD patients.

Dopamine receptor D4 (DRD4) polymorphisms with reduced functional potency intensify atrophy in syndrome-specific sites of frontotemporal dementia.

ObjectiveWe aimed to understand the impact of dopamine receptor D4 (DRD4) polymorphisms on neurodegeneration in patients with dementia. We hypothesized that DRD4dampened-variants with reduced functional potency would be associated with greater atrophy in regions with higher receptor density. Given that DRD4 is concentrated in anterior regions of the limbic and cortical forebrain we anticipated genotype effects in patients with a more rostral pattern of neurodegeneration.Methods337 subjects, including healthy controls, patients with Alzheimer's disease (AD) and frontotemporal dementia (FTD) underwent genotyping, structural MRI, and cognitive/behavioral testing. We conducted whole-brain voxel-based morphometry to examine the relationship between DRD4 genotypes and brain atrophy patterns within and across groups. General linear modeling was used to evaluate relationships between genotype and cognitive/behavioral measures.ResultsDRD4 dampened-variants predicted gray matter atrophy in disease-specific regions of FTD in anterior cingulate, ventromedial prefrontal, orbitofrontal and insular cortices on the right greater than the left. Genotype predicted greater apathy and repetitive motor disturbance in patients with FTD. These results covaried with frontoinsular cortical atrophy. Peak atrophy patterned along regions of neuroanatomic vulnerability in FTD-spectrum disorders. In AD subjects and controls, genotype did not impact gray matter intensity.ConclusionsWe conclude that DRD4 polymorphisms with reduced functional potency exacerbate neuronal injury in sites of higher receptor density, which intersect with syndrome-specific regions undergoing neurodegeneration in FTD.

Walking Disability in Patients with Pelvic Insufficiency Fracture after Radiotherapy for Uterine Cervical Cancer.

Radiotherapy is an essential component of curative or palliative therapy for patients with uterine cervical cancer. Although advances in radiotherapy have led to longer survival, survivors may consequently be at risk of pelvic insufficiency fracture (PIF). We retrospectively reviewed medical records and clinical outcomes to assess the impact of PIF on walking disability. Between January 2002 and December 2009, 145 uterine cancer patients treated with radiotherapy in our hospital were reviewed. Among these, 15 patients (10.3%) were diagnosed with PIF. The types of fractures were identified according to the AO/OTA classification system. Medical records were examined to establish the time to first diagnosis of PIF, the type of fracture, and clinical outcomes. Disability was assessed using Barthel index mobility scores. The median time to PIF detection was 16 months. Of the 15 patients with PIF, 14 had type B fractures (7 cases of B2 and 7 cases of B3) and 1 had a type C fracture. Among 11 patients with pelvic pain, 6 achieved pain control but 5 patients with bilateral lesions in the posterior arch or lateral compression of the sacrum developed pain that finally resulted in walking disability and a lower performance status. PIF causes severe motor disturbance in patients with unstable fracture types. Routine imaging checkups were useful during the 5 years after completion of radiotherapy; in nine patients the fracture progressed for longer than 1 year. In cancer rehabilitation for PIF patients, continuous assessment is essential for predicting walking disability.

J35 Clinical Forms Of Huntington's Disease In The Patients From Republic Of Bashkortostan

<h3>Background</h3> Motor disturbances in Huntington’s disease (HD) can be subdivided into hyperkinetic (choreatic) or hypokinetic-rigid form. Patients with juvenile HD (JHD) also have bradykinesia and dystonia at an early stage of the illness. In different populations the clinical characteristics of patients with HD are similar, but may be a difference in the incidence of clinical forms. <h3>Aim</h3> Our aim was to analyse motor disturbances in patients with HD from Republic of Bashkortostan of various ethnic origins. <h3>Materials and methods</h3> The population of Bashkortostan is 4.07 million people. The population of Bashkirs is 1.2 million (29.5%) according to the 2010 census. Two other big ethnic groups are Russians (36.0%) and Tatars (25.4%). The prevalence of HD in Bashkortostan is 3.6 per 100.000 that compared to other populations. <h3>Results</h3> The majority of patients with HD had the hyperkinetic form of the disease. All groups (patients with HD from Bashkir, Russian, Tatar ethnic groups) showed no differences in the motor age of onset (p &gt; 0.02). Cases of JHD were observed in two families: Russian and Tatar ethnicities. Cases of HD with hypokinetic-rigid form were often observed in Bashkir families with HD (motor age of onset ranged from 27 to 32 years of life, number of CAG-repeats in HTT-gene varied from 43–47). <h3>Conclusion</h3> Analysis of the clinical features of HD and DNA-diagnostics will help to early diagnosis and effective genetic counselling in the families with HD.

Application of Glycerin Poultice to the Semitendinous and Semimembranous above the Popliteal Fossa Improves Motor Disturbance in Parkinson Disease

It has been reported that application of glycerin poultice to the flexor digotorum profundus in the middle phalanx of the little finger improves motor disturbance of Parkinson disease. I investigated whether the application of glycerin poultice to the semitendinous and semimembranous above the popliteal fossa (GSSP) improved motor disturbance in Parkinson disease. Step length and diameter of the pupil in 20 patients with Parkinson disease and 20 control subjects was evaluated before and after application of GSSP. Motor disturbance in patients with Parkinson disease was evaluated before and after application of GSSP. The application of GSSP increased step length and constricted the pupil in all subjects, which means that application of GSSP caused the decreased tension of the semitendinous and semimembranous and lowered sympathetic nerve activity. With application of GSSP, motor disturbance in patients with Parkinson disease was improved, which is caused by reversing the mechanism of the muscle mechanosensitive reflex.

Gastric motor disturbances in patients with idiopathic rapid gastric emptying

The mechanisms of 'idiopathic' rapid gastric emptying, which are associated with functional dyspepsia and functional diarrhea, are not understood. Our hypotheses were that increased gastric motility and reduced postprandial gastric accommodation contribute to rapid gastric emptying. Fasting and postprandial (300kcal nutrient meal) gastric volumes were measured by magnetic resonance imaging (MRI) in 20 healthy people and 17 with functional dyspepsia; seven had normal and 10 had rapid gastric emptying. In 17 healthy people and patients, contractility was analyzed by spectral analysis of a time-series of gastric cross-sectional areas. Logistic regression models analyzed whether contractile parameters, fasting volume, and postprandial volume change could discriminate between health and patients with normal or rapid gastric emptying. While upper gastrointestinal symptoms were comparable, patients with rapid emptying had a higher (P=0.002) body mass index than normal gastric emptying. MRI visualized propagating contractions at ∼3cpm in healthy people and patients. Compared with controls (0.32±0.04, Mean±SEM), the amplitude of gastric contractions in the entire stomach was higher (OR 4.1, 95% CI 1.2-14.0) in patients with rapid (0.48±0.06), but not normal gastric emptying (0.20±0.06). Similar differences were observed in the distal stomach. However, the propagation velocity, fasting gastric volume, and the postprandial volume change were not significantly different between patients and controls. MRI provides a non-invasive and refined assessment of gastric volumes and contractility in humans. Increased gastric contractility may contribute to rapid gastric emptying in functional dyspepsia.

A novel method improving motor disturbance in Parkinson disease: Application of glycerin poultice to the flexor digitorum profundus in the middle phalanx of the little finger

To investigate whether the application of glycerin poultice to the flexor digitorum profundus in the middle phalanx of the little finger (GFML) improves motor disturbance in Parkinson Disease (PD). Dorsiflexion of the little finger and diameter of the pupil in 22 patients with PD and 23 control subjects was evaluated before and after application of GFML. Motor disturbance in patients with PD was evaluated before and after application of GFML. The application of GFML increased dorsiflexion of the little finger and constricted the pupil in all subjects, which suggests that application of GFML caused the decreased tension of the flexor digitorum profundus and lowered sympathetic nerve activity. With application of GFML, motor disturbance in patients with PD was improved. The application of GFML improves motor disturbance in PD which might be caused by reversing the mechanism of the muscle mechanosensitive reflex.

Eye movements as a marker for cerebellar damage in paraneoplastic neurological syndromes

Cerebellar disturbances can induce a variety of motor deficits, ranging from severe ataxia to mild deficits of fine motor control. Although motor disturbances appear as an important clinical feature in many neurological disorders, mild disturbances are often difficult to assess properly. Eye movement recordings using video-oculography in a group of patients with a paraneoplastic neurological disorder revealed subtle saccadic and smooth pursuit deficits when compared to controls. We conclude that an easy quantification of eye movement control may assist in the diagnosis and follow-up of mild motor disturbances in patients with neurological disorders, especially when such signs are not overt during clinical neurological examination.

Head retraction reflex in stiff-man syndrome and related disorders.

The head retraction reflex (HRR) is a vestigial withdrawal reflex of the face and is suppressed in healthy subjects. We investigated the prevalence and electrophysiological patterns of the HRR in patients suffering from stiff-man syndrome (SMS, n = 28) and related disorders, stiff-limb syndrome (SLS, n = 2), and progressive encephalomyelitis with rigidity and myoclonus (PERM, n = 20). In patients with a positive HRR, the electromyographic (EMG) pattern was analyzed with surface recordings from the orbicularis oculi, sternocleidomastoid, trapezius, and the paraspinal extensor muscles at midthoracic and lumbar levels. On clinical testing, 17 of 28 SMS patients, 10 of 20 PERM patients, and 0 of 2 SLS patients had a positive HRR, ranging from a brief contraction of the neck extensors to violent retropulsion of the upper body. In all muscles, EMG reflex patterns elicited by gentle taps to the face or by electrical stimulation of the trigeminal nerve branches consisted of two components: an early, synchronous, brief burst with the shortest latency in trapezius (12.5-20.0 msec) and a late, asynchronous, longer response with latencies between 44 and 70 msec. We conclude that the HRR is an abnormal cutaneomuscular brainstem reflex that occurs in a considerable proportion of patients with SMS and related disorders. Although neither specific nor particularly sensitive for SMS, presence of the HRR in a setting with otherwise unexplained stiffness and spasms might help to avoid the otherwise frequent misdiagnosis of a psychogenic motor disturbance in patients with SMS.

New developments in understanding the etiology of Parkinson's disease and in its treatment

Important recent advances have been made in understanding the etiology and pathogenesis of Parkinson's disease, as well as in developing novel treatments. Two newly identified genes, α- synuclein and parkin, have been linked to parkinsonism. In addition, disturbances to the normal basal ganglia circuits in Parkinson's patients are being described at both anatomical and physiological levels. These developments provide a strong scientific basis for novel medical and surgical strategies to treat the profound motor disturbances in patients with Parkinson's disease.

24-hour esophageal ambulatory manometry in patients with achalasia of the esophagus.

Absence of the peristaltic contractions in the esophageal body and the failure of the lower esophageal sphincter (LES) post-deglutitive relaxation are the major motor disturbances in patients with achalasia. These alterations are usually evidenced by means of stationary esophageal manometry, which is able to record changes over a brief period. The aim of this work has been to study the circadian esophageal motor activity of the esophageal body in patients with achalasia, using a non-perfused ambulatory manometry system. Ten patients with untreated esophageal achalasia (dilatation < or = 5 cm) had a 24-hour ambulatory esophageal manometry. The portable recording system consisted of a computerized data logger and a probe with four microtransducers 5 cm apart, the distal one being positioned 5 cm above the LES. A microtransducer, positioned 1 cm below the upper esophageal sphincter, recorded the swallow activity. Contractions frequency (n/min), mean amplitude (mmHg), mean duration of contraction (sec), percentage of contraction > 7 sec, percentage of multipeaked, repetitive and isolated contractions, and percentage of peristaltic and simultaneous sequences were evaluated and analysed during the following periods: meal-time (MT); upright (UP); supine night-time (NT). On the basis of the relationship with swallows the contraction events were classified as post-deglutitive or spontaneous. The data out of a group of 65 normal subjects were used as control. Student's t-test and Wilcoxon's rank-sum test were used for statistical analysis. Peristaltic sequences were detected in all patients, 27.8 +/- 12.6% of the total, and the 19.5 +/- 11.06% of these were complete. Moreover primary peristaltic sequences were present in 33.1 +/- 23.4% of all peristaltic sequences. In contrast to current trends, our results show surprisingly the presence of peristaltic activity in patients with achalasia (27.9% MT; 26.9% UP; 28.1% NT). We believe these results are related both to the use of an ambulatory system, which allows 24-hour monitoring and to the use of microtransducers, which are able to detect motor events with great accuracy. These motor events are usually not detectable by stationary perfused systems.

The motor syndrome associated with exaggerated inhibition within the primary motor cortex of patients with hemiparetic.

Following transcranial magnetic stimulation (TMS) at stimulation strength of 1.5 times the resting motor threshold, a silent period (SP) of approximately 180 ms duration can be observed in surface EMG-registrations of tonically activated small hand muscles. This SP is believed to be generated cortically and can be prolonged in stroke patients, but it is not known whether a prolongation of the SP has any functional significance. In order to answer the question of whether enhanced cortical inhibition can contribute to pathophysiology of motor dysfunction we studied stroke patients with clearly prolonged SP durations in the first dorsal interosseus muscle (> 2 times that of the intact side), but with normal magnetically evoked motor potentials. Sixteen patients out of a cohort of 174 consecutive patients presenting with acute hemiparetic stroke fulfilled the inclusion criteria. Serial TMS investigations were performed for up to 2 years post-stroke. In all patients, the SP duration decreased in parallel with clinical improvement. In two patients, intermittent clinical deterioration was accompanied by an increase in the SP duration. In four patients, in addition to a markedly prolonged SP duration, the phenomenon of a complete inability to initiate voluntary muscle activity for several seconds, following TMS, could be observed in a number of trials ('motor arrest'). Detailed clinical analysis revealed that, in addition to hemiparesis, distinct motor disturbances in patients with SP prolongation could be observed. These motor disturbances resembled those of motor neglect and were characterized by motivationally dependent under-utilization of the affected arm, impairment of movement initiation, inability to maintain a constant force level and to scale forces, and impairment of individual finger movements. In 12 of the 16 patients at least one additional behavioural manifestation of neglect was present. We suggest that in stroke patients severe motor dysfunction may be caused by hyperactivity of cortical inhibitory interneurons rather than by direct lesions of descending motor tracts. Cortical hyperinhibition may, in turn, result from damage to any of a number of afferent pathways to the motor cortex which modulate local interneuronal activity.