Motor Function Research Articles

Improving Motor Function in Adults with Parkinson’s Disease through Occupational Therapy and Rehabilitation

Improving Motor Function in Adults with Parkinson’s Disease through Occupational Therapy and Rehabilitation

Effect of inspiratory and expiratory muscle training on respiratory function and decannulation outcome in patients with tracheostomy after stroke: a randomized controlled trial

ABSTRACT Background This study aimed to evaluate the clinical efficacy and safety of inspiratory and expiratory muscle training (IEMT) for patients who underwent tracheostomy after stroke. Methods The study was an investigator-initiated, single-center, two-arm, evaluator-blinded, randomized clinical trial conducted at West China Hospital of Sichuan University, China, from January 2022 to June 2022. The patients were randomly divided into the intervention group and control group. Patients in both groups received conventional clinical, rehabilitation treatment and usual care. The intervention group also received IEMT for three weeks. There were three primary outcomes including maximal inspiratory pressure (MIP, cmH2O), maximal expiratory pressure (MEP, cmH2O) and decannulation outcome after intervention (n, %). The secondary outcomes were other respiratory function outcomes, motor function, activities of daily living (ADL), quality of life (QoL) and the new pulmonary infection rate after the intervention at three weeks. Results A total of 50 participants were enrolled [25 in each group; 39 (78%) were men; mean (SD) age, 55.94 (11.97) years]. At three weeks, significant differences were found in the MIP [control vs IEMT: 39.04 (6.21) vs 56.28 (10.41), p < 0.001]; MEP [43.48 (5.36) vs 62.16 (10.18), p < 0.001], and tracheal tube extraction success rate [2 (8%) vs 9 (36%), p = 0.019] between the two groups. In addition, the new pulmonary infection rate in the intervention groups were significantly different (all p < 0.05) from those in the control group. Conclusions IEMT can improve respiratory function, decannulation outcome, among patients with tracheostomy after stroke.

C2230, a preferential use- and state-dependent CaV2.2 channel blocker, mitigates pain behaviors across multiple pain models.

Antagonists (e.g., Ziconotide, Gabapentin) of the CaV2.2 (N-type) calcium channels are used clinically as analgesics for chronic pain. However, their use is limited by narrow therapeutic windows, difficult dosing routes (Ziconotide), misuse and overdoses (Gabapentin), as well as a litany of adverse effects. Expansion of novel pain therapeutics may emerge from mechanism-based interrogation of CaV2.2. Here we report the identification of C2230, an aryloxy-hydroxypropylamine, as a CaV2.2 blocker. C2230 trapped and stabilized inactivated CaV2.2 in a slow-recovering state and accelerated the open-state inactivation of the channel, conferring an advantageous use-dependent inhibition profile. C2230 inhibited CaV2.2 during high-frequency stimulation, while sparing other voltage-gated ion channels. C2230 inhibited CaV2.2 in dorsal root and trigeminal ganglia neurons from rats, marmosets, and humans in a G-protein-coupled receptor-independent manner. Further, C2230 reduced evoked excitatory postsynaptic currents and excitatory neurotransmitter release in the spinal cord, leading to relief of neuropathic, orofacial, and osteoarthritic pain-like behaviors via three different routes of administration. C2230 also decreased fiber photometry-based calcium responses in the parabrachial nucleus, mitigated aversive behavioral responses to mechanical stimuli after neuropathic injury, and preserved protective pain responses, all without affecting motor or cardiovascular function. Finally, site-directed mutation analysis demonstrated that C2230 binds differently than other known CaV2.2 blockers, making it a promising lead compound for analgesic development.

Treatments for RYR1-related disorders.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective To analyse the benefits and harms of pharmacological or other interventions (e.g. special diet, exercise programme) compared with placebo or standard care for RYR1-related disorders, including both permanent myopathies and intermittent (episodic) presentations (exertional myalgia and rhabdomyolysis), with the aim to improve motor and respiratory function and/or to reduce the frequency of episodes, respectively. Secondary objectives To assess whether the interventions, compared with placebo or standard of care, change the outcome of RYR1-related diseases. To assess whether the interventions, compared with placebo or usual care, change the expression of the disease state in patients with RYR1-related diseases. To identify a set of standardised outcome tools to be used in future studies.

Bacopaside-I ameliorates motor dysfunction and neurodegeneration in rat model of Parkinson's disease.

Chronic administration of Bacopa monnieri extract exerts neuroprotective potential in multiple animal models of neurodegenerative disorders such as Parkinson's disease (PD), Alzheimer's disease (AD), depression, and other cognitive impairments. However, the underlying mechanism of action remained unclear. Rotenone model of PD holds a great potential for investigating PD pathology and motor and nonmotor symptoms. Herein, we evaluated the neuroprotective effect of Bacopaside-I (BS-I), a major triterpenoid saponin of Bacopa monnieri extract, against rotenone-induced in vivo model of PD and explored the possible molecular mechanism. Rats were exposed to rotenone (2mg/kg body weight) for a period of 4 consecutive weeks to induce PD-like behavior. BS-I (5, 15, and 45mg/kg) was administered orally. Behavioral data (rotarod, foot printing, and grip strength test) suggest that BS-I plays a significant role in attenuating the motor function deficit. Exposure to rotenone reduces the dopamine level and increases oxidative stress, while BS-I treatment reversed these changes. Furthermore, chronic administration of BS-I increased the expression levels of dopamine transporter (DAT) and vesicular monoamine transporter (VMAT) genes and the numbers of tyrosine hydroxylase (TH)-positive neurons as compared to rotenone-exposed animals. Our study established the neuroprotective role of BS-I in PD model and laid the foundation for further evaluation of BS-I-based drug in future studies.

The anesthetic and recovery profiles of low-dose hypobaric mepivacaine and bupivacaine for spinal anesthesia in total hip and knee arthroplasty: a prospective observational study.

Same-day mobilization and early hospital discharge is increasingly emphasized following hip and knee arthroplasty. One challenge of spinal anesthesia in this setting is achieving adequate block height while avoiding excessively large local anesthetic doses and prolonged motor and sensory blockade. Using a hypobaric local anesthetic solution is one potential strategy, as its intrathecal distribution can be reliably manipulated by patient positioning to achieve adequate block height independent of dose. We conducted a prospective observational study to determine the clinical characteristics of spinal anesthesia with low-dose hypobaric mepivacaine and bupivacaine in patients undergoing hip and knee arthroplasty. Thirty patients scheduled for same-day discharge received 51mg of hypobaric 1.5% mepivacaine and 30 patients scheduled for inpatient stay received 10mg of hypobaric 0.33% bupivacaine. The mean (standard deviation) time to achieve sensory blockade at or above L1 and T10 in the operative limb was 5.7 (1.8) and 7.3 (3.3) min with mepivacaine and 6.2 (2.6) and 8.1 (4.8) min with bupivacaine, respectively. Anesthesia was adequate for surgical commencement in all patients regardless of spinal injection level. Four patients required anesthetic supplementation for surgical completion. Sensory block duration at or above T10 and L1 in the operative limb was 97 (27) and 115 (37) min with mepivacaine and 127 (32) and 161 (34) min with bupivacaine, respectively. Motor function returned by 145 (37) and 217 (43) min in mepivacaine and bupivacaine groups, respectively. The anesthetic profiles of low-dosehypobaric mepivacaine and bupivacaine were favorable for fast-track hip and knee arthroplasty with short and predictable operating times.

Pain in Children and Adolescents with Cerebral Palsy: A Cross-sectional Survey Study.

This study aims to investigate the prevalence, intensity, and location of pain in children and adolescents with cerebral palsy (CP) and analyze pain-related symptoms and participation restrictions. Children and adolescents aged 2 to 16 years diagnosed with CP were invited to participate in a pain survey. The questionnaire was based on the German Pain Questionnaire for Children, Adolescents and Parents (DSF-KJ). It was administered to children (2-11 years) by their caregivers, while adolescents (12-16 years) were asked to complete the questionnaire themselves or with the help of their caregivers. Fifty-seven of 133 children and adolescents with CP (43%) reported having pain in the past 12 months, of whom 17 (30%) reported chronic pain. Patients with Gross Motor Function Classification System (GMFCS) IV-V reported more frequent pain (p = 0.003) and higher pain intensity (p = 0.011). Lower extremity pain was the most common. Twenty-three percent of participants with pain did not receive any treatment. Pain often restricted participation, specifically by reducing sports activity in patients with GMFCS I-III, focusing attention on patients with GMFCS IV-V, and activities with the family in both GMFCS level categories. Pain is common in children and adolescents with CP and frequently restricts their participation. Therefore, it must be consistently recorded and addressed during the consultation. The goal of treatment should be not only to reduce pain but above all to increase participation.

Chemotherapy-Induced Neuropathy Affecting the Gastrointestinal Tract.

Cancer is a major global cause of morbidity and mortality. Survivorship is increasing, bringing new challenges. Cancer treatment, including chemotherapeutic drugs, immunotherapy, and radiotherapy, can have severe and impactful gastrointestinal side effects occurring shortly after treatment (acute toxicity) or persisting for years after treatment ends (late/chronic toxicity). The aim of this article is to review the neurotoxic effects of chemotherapy on the enteric nervous system (ENS) and the gut extrinsic innervation. These effects could contribute to the development of long-term gastrointestinal dysfunctions. Research, primarily conducted in animal models, indicates that antitumoral drugs can lead to chemotherapy-induced enteric neuropathy (CIEN). Studies, mainly performed in the myenteric plexus, show that CIEN is characterized by a reduced density of nerve cells and fibers, as well as an imbalanced representation of neuronal subpopulations or their markers, with enteric glial cells also affected. These alterations underlie changes in neuronal activity and gastrointestinal motor function. Although research on the submucosal plexus remains limited, evidence suggests that CIEN affects the entire ENS. Furthermore, scarce studies show that CIEN also occurs in humans. Moreover, emerging experimental data on chemotherapy-induced alterations in visceral sensitivity suggest that the extrinsic innervation of the gut is also affected, but this has received little attention thus far. Nevertheless, this could contribute to the development of chemotherapy-induced brain-gut axis (BGA) disorders in the long term. Cancer chemotherapy (and probably also immunotherapy and radiotherapy) seems to cause neuropathic effects on the intrinsic and extrinsic innervation of the gastrointestinal tract, with an important impact on gastrointestinal and BGA functions. This is a relatively neglected area deserving further investigation.

Erythropoietin to Treat Spinal Cord Injury: Evaluation of Different Doses and Magnitudes of Trauma in Rats.

Experimental spinal cord lesion study. To evaluate the effects of erythropoietin at different doses on neural regeneration in rats undergoing spinal cord injury. Anesthetized Wistar rats were submitted to standardized spinal cord injury and randomized into eight groups, receiving different magnitudes of trauma and single or repeated doses of intraperitoneal erythropoietin (500 or 5000IU/kg of body weight). We evaluated motor function using BBB scores and sensorimotor behavior by observing the rats walking on a horizontal ladder (at 2, 4, and 6weeks) and performed histological analysis of the spinal cord after euthanasia. We compared the scores between groups using analysis of variance (ANOVA) and Bonferroni multiple comparisons. The experiments were conducted with 10 animals per group (n = 80), none of which died or were excluded. BBB scores increased over time (meaning recovery) in all groups (P < 0.001 for all). From the fourth week, animals receiving lower trauma and higher erythropoietin doses had higher BBB scores than those receiving lower doses. The total number of steps and correct steps taken on the horizontal ladder increased, and slips decreased over time with treatment in all groups. Although the number of errors was different between moments (P < 0.001), it was not different between groups (P = 0.707). Rats receiving higher impact lesions had more spinal cord necrosis and worse recovery of neuronal fibers than the rest. Animals receiving a higher dose of erythropoietin and suffering minor trauma showed better and faster neurological recovery. Repeating erythropoietin after a week showed no benefit.

Cross-cultural validation in Greek and reliability of the Eating and Drinking Ability Classification System in children with cerebral palsy.

To investigate the reliability and validity of the Greek version of the Eating and Drinking Ability Classification System (EDACS) in children with cerebral palsy (CP). The sample of the study included children with CP, aged 3-18 years and classified into Levels I-V of the Gross Motor Function Classification System (GMFCS). Parents of children with CP and speech and language therapists (SLTs) with a minimum of 5 years of clinical experience were recruited. Inter-rater reliability (IRR) between SLTs and between SLT and parent was evaluated using intraclass correlation coefficient (ICC). Validity was evaluated by investigating the potential association between the EDACS and Communication Function Classification System (CFCS) and GMFCS, using ordinal logistic regression. One hundred twenty-one children with CP (mean age 8.2 ± 4.1), 72 males, GMFCS Levels I-V were included in the study. Ninety-one parents of children with CP (mean age 8.8 ± 4.2), 54 males and 8 experienced SLTs, assessed the eating and drinking abilities of the children. The IRR between SLTs was excellent (ICC = 0.94), and between SLTs and parents was high (ICC = 0.90). Both CFCS and GMFCS were positive predictors for EDACS. The Greek version of EDACS is a valid and reliable tool and it can be used to classify eating and drinking ability in Greek children with CP.

Incidence of Avascular Necrosis of the Femoral Head Post Hip Reduction Surgery in Children With Cerebral Palsy.

Avascular necrosis (AVN) of the femoral head confers a risk of morbidity amongst cerebral palsy (CP) patients. Meanwhile, the proportion who develop AVN posthip reduction surgery is unclear, and the risk factors are not established. To estimate the incidence and risk factors for AVN post hip reduction surgery in CP patients, we reviewed and analysed literature from Medline, Embase, and Web of Science repositories between January 1, 1990, and August 31, 2024. The included publications were reviewed for the incidence and risk factors in this cohort of patients. Findings were appraised using the methodological index for non-randomised studies, and scores and results were descriptively analysed. Given the marked heterogeneity of retrieved data, results were reported as standardised values, including the mean weighted incidence rate. A total of 1619 hip reduction surgeries were performed on 1045 CP patients across 12 retrospective studies with 424 cases of AVN. The mean age at surgery ranged from 7.3 to 16.2 across studies. The mean incidence was 0.482% ± 0.06945 per person-year. Most patients were in gross motor function classification system V, with a preoperative mean Reimers index of 54.11-80%. The average methodological items for non-randomised studies score was 10.08/16 ± 0.28 for all studies (n=12). AVN has a definite relationship with hip reductionsurgery. The low methodological quality of reviewed studies informs the need for well-designed prospective randomised controlled studies to understand the mechanics of this relationship in terms of age of surgery and Reimers hip migration index, guide surgical timing, and patient selection.

Behavioral Alterations in Mice Exposed to Manganese via Drinking Water: Effects of Sex and a Lipopolysaccharide Challenge.

Manganese (Mn) is an essential and important metal; however, overexposures lead to adverse neurological outcomes. Nonoccupational Mn overexposure occurs primarily through consumption of Mn-contaminated drinking water (DW). Sex differences in terms of nervous and immune systems' responsiveness to excessive Mn in the DW are understudied. Thus, this study investigated behavioral and sex differences in response to Mn DW treatment (0.4 g Mn/L for up to 8 weeks) and a lipopolysaccharide (LPS) challenge of adult C57BL/6 mice with GFP-tagged monocytes/microglia. After 6 weeks, in motor function tests, Mn exposure resulted in decreased activity and gait deficits. In two different mood tests (open field test [OFT]/elevated zero maze), Mn-exposed mice exhibited decreased fear/anxiety-like behavior. Two weeks after behavioral assessment, when mice were challenged with LPS, circulating inflammatory cytokines, and acute phase proteins increased in both sexes. After 8 weeks of Mn exposure, liver and brain Mn levels were increased, but Mn alone did not affect circulating cytokines in either sex. Notably, Mn-exposed/LPS-challenged males had potentiated plasma cytokine output, whereas the reverse was seen in females. Males, but not females, continued to exhibit increased fearlessness (i.e., increased OFT center time), even when challenged with LPS. Overall, our results show that Mn DW exposure increases brain Mn levels and it leads to behavioral alterations in both sexes. However, males might be more susceptible to the effect of Mn on mood, and this effect is recalcitrant to an inflammagen challenge. Mn augmented post-LPS cytokine production only in males, further indicating that important Mn effects are sex-biased.

Motor functioning during early recovery after childhood Arterial ischemic stroke is associated with intellectual abilities

Motor impairments are one of the most common adverse outcomes after childhood arterial ischemic stroke (C-AIS), yet their relationship with intellectual abilities is not yet well understood. This study examined associations between intellectual abilities and motor functioning and clinical features associated with motor impairment. Participants were 34 children with C-AIS. Motor functioning was assessed with the Pediatric Stroke Outcome Measure sensorimotor subscale at two timepoints: early recovery (between 30 days post-stroke and 1 year) and closest to time of neuropsychological testing. Intellectual abilities were measured using the Wechsler Intelligence Scale for Children 4th or 5th edition. Motor functioning during early recovery was significantly associated with intellectual functioning, verbal abilities, perceptual reasoning abilities, and processing speed. Motor functioning closest to time of neuropsychological testing was associated with processing speed. There were more children with subcortical lesions with no/mild motor deficit, whereas there were more children with cortical + subcortical lesions with moderate/severe motor deficits. Associations between motor functioning during early stroke recovery and intellectual abilities may be related to neuroplastic changes post-injury, resulting in early motor deficits and affecting subsequent development of intellectual abilities through hierarchical maturational processes, whereas motor functioning closer to neuropsychological testing reflects maturational recovery processes augmented by intervention.

The effects of telerehabilitation-based motor imagery training on motor imagery ability, motor function and physical performance in Duchenne muscular dystrophy

Purpose To explore the effects of telerehabilitation-based motor imagery (Tele-MI) training on motor imagery ability (MI), motor function, and performance in children with Duchenne muscular dystrophy (DMD). Methods The research involved twenty-three children with DMD and twelve healthy children. DMD cohort were randomized into two groups: treatment [Tele-MI training and telerehabilitation-based physiotherapy program (Tele-PTP), n = 12] and control (Tele-PTP, n = 11). MI ability [Kinesthetic and Visual Imagery Questionnaire-10 (KVIQ-10), Motor Imagery Questionnaire for Children (MIQ-C), mental chronometry tests], motor function [Motor Function Measure (MFM), North Star Ambulation Assessment, Four Square Step Test] and timed performance were assessed at baseline and after 8-week training. Results MI ability scores of DMD cohort were lower than healthy children. A large interaction effect was found for KVIQ-10 visual and total, MIQ-C internal visual and kinesthetic scores, and delta time of 10–meter walk test of mental chronometry (η2 > 0.14). The small-medium interaction effect was found in motor function and ambulation results (η2<0.14). Conclusions This study demonstrated that Tele-MI training improved MI ability of DMD cohort. The small-to-medium effects of Tele-MI training on motor function, particularly those involving the trunk, have demonstrated its potential as a complementary approach in rehabilitation to improve motor functions in children with DMD. Clinical Trial Registration Number and URL NCT06109103 (https://clinicaltrials.gov/study/NCT06109103?term=merve%20bora%20zereyak&rank=1)

Revising the Motion Control Parameter Optimization Research of a Two-Wheel Differential Car

This paper proposes a solution based on the particle swarm optimization algorithm to address the issue of Proportional Integral Derivative parameter selection in the motion control of a two-wheel differential car. The mathematical motion model is established based on the driving principle of a two-wheel differential car. The transfer function of the DC motor is derived in detail, based on Kirchhoff’s law and the Laplace transform. The pose renewal equation and error renewal equation of the car are based on the mathematical motion model. Finally, a numerical simulation and experimental analysis were conducted using MATLAB R2022a, Simulink 9.1 (part of R2018a), VOFA 1.3.10 software, an STM32 microcontroller, an L298N driver chip, and other hardware components. The results indicate that the particle swarm optimization algorithm enables the rapid acquisition of optimal Proportional Integral Derivative parameters. The optimized parameter of the motor speed convergence time is set to 10 ms, with an overshoot of 1 r/min and an enhanced anti-interference ability. The optimized parameters effectively regulate the car’s motion, ensuring a maximum error control of approximately 0.003 m.

Effects of tDCS on glutamatergic pathways in epilepsy: neuroprotective and therapeutic potential.

Epilepsy is a chronic neurological disease characterized by recurrent seizures caused by abnormal electrical activity in the brain. The aim of our study was to investigate the effect of tDCS on oxidative stress, Ca2+, glutamate, GABA, AMPAR1, and NMDAR1 levels in kindling-induced epilepsy model. Behavioral tests evaluated motor and cognitive functions, while assessing oxidative stress, Ca2+, glutamate, GABA, AMPAR1, and NMDAR1 levels in hippocampal tissue. tDCS stimulation therapy demonstrates a neuroprotective effect on motor and cognitive function postepilepsy. Our study reveals an increase in TOC, Ca2+, glutamate, GABA, AMPAR1, and NMDAR1 levels and a decline in total antioxidant capacity (TAC) following PTZ-induced seizures. However, tDCS treatment led to a significant decrease of Ca2+, total oxidant capacity (TOC), glutamate, GABA, AMPAR1, and NMDAR1 levels in the epilepsy cohorts, while simultaneously causing a spike in TAC levels. The study's results showed that tDCS treatment could have a therapeutic effect on oxidative stress, Ca2+, TOC, glutamate, GABA, AMPAR1, NMDAR1, and TAC in both acute and chronic kindling epilepsy models.

Plantar sensory stimulation and its impact on gait and lower limb motor function in individuals with stroke: A systematic review and meta-analysis.

Stroke frequently leads to motor impairments, with almost half of the affected individuals experiencing diminished sensation, impacting their overall quality of life and autonomy. Rehabilitation efforts, however, often overlook somatosensory functions of the lower limbs. While plantar sensory stimulation activates receptors in the foot sole, its precise impact on the motor functions and gait of individuals with stroke is yet to be ascertained. This systematic review and meta-analysis aimed to examine the effects of sensory interventions on gait and lower limb motor function in individuals with stroke. We searched eight databases from inception to December 2023 for randomized controlled trials that investigated sensory interventions targeting gait or lower limb motor function in stroke patients. The primary outcomes included changes in gait and motor function, reported as standardized mean differences (SMD) and assessed heterogeneity (I2). A total of [number] studies were included, covering different sensory modalities such as textured insoles, plantar vibration, and cognitive sensorimotor exercises. The interventions showed varying effectiveness, with plantar vibration therapy exhibiting a large effect size (SMD = 2.03 [1.13, 2.94]) for improving lower limb motor function, while textured insoles showed moderate effectiveness (SMD = 0.58 [0.24, 0.92]) with no heterogeneity (I2 = 0%). For gait, significant enhancement was seen with plantar vibration (SMD = 3.17 [2.05, 4.29]) and cognitive sensorimotor training (SMD = 2.85 [1.69, 4.02]). However, overall heterogeneity was moderate to high (I2 = 65% for motor function, 85% for gait), indicating variability across different studies and intervention types. The findings of this review and meta-analysis suggest that plantar somatosensory stimulation has the potential to improve lower limb motor function and gait in people with stroke. However, to firmly establish its efficacy as a rehabilitative tool, larger-scale and high-quality studies are requisite.

Bloodletting at the ear apex for acute stroke: A systematic review and meta-analysis of randomized controlled trials.

Stroke is a major cause of death and disability worldwide. Despite innovative developments in acute stroke treatment techniques in modern society, many stroke survivors still experience complications, leading to a demand for complementary and alternative medicines, including traditional medicine. Bloodletting at the ear apex (BLEA) is a nonpharmacological intervention used for various diseases, including acute stroke, in traditional medicine in East Asian countries, including China and Korea. This study aimed to evaluate the clinical efficacy of BLEA for acute stroke recovery. We searched PubMed, Embase, CENTRAL, AMED, CNKI, KoreaMed, ScienceOn, and OASIS databases for randomized controlled trials (RCTs) evaluating the effect of BLEA on acute stroke recovery. We systematically reviewed the literature published in academic journals up to September 8, 2024 and synthesized the data extracted from the final selected literature. The results of the meta-analysis are presented as mean differences (MDs) with 95% confidence intervals (CIs). The Cochrane Risk of Bias 2 tool and GRADE methodology were used for quality assessment. Six RCTs with 530 participants were included in this meta-analysis. In patients with acute stroke receiving conventional Western medical treatment, the addition of BLEA significantly improved neurological deficits assessed by the National Institute of Stroke Scale (MD, -2.83; 95% CIs, -4.48 to -1.17), consciousness impairment measured by the Glasgow Coma Scale (MD, 2.75. 95% CIs, 1.72 to 3.78), and motor function assessed by the Fugl-Meyer Assessment (MD, 5.31. 95% CIs, 3.04 to 7.58). It also significantly reduced the length of hospital stay (MD, -7.39; 95% CIs. -8.85 to -5.93). BLEA may be a promising intervention that provides additional benefits to patients with acute stroke receiving standard western medical care. However, the supporting evidence comes from a few small studies with a high risk of bias and low reporting quality. Future studies with appropriate population sizes and more rigorous methodology are warranted.

Differences in oral hypofunction prevalence and category measures across age groups and sex in Japan: a pilot study

ObjectivesThe deterioration of oral function to a state of oral hypofunction (OHF) has been associated with malnutrition and frailty. This cross-sectional pilot study investigated for differences in OHF prevalence and its category measures across age groups and sex, as well as their associations with physical function.MethodsA total of 155 healthy adults (median age: 55 years, range: 22–89 years) participated in this study after providing informed consent. The cohort was age and sex matched. Seven oral function measures based on the concept of OHF were assessed: oral hygiene (Hygiene), oral dryness, maximum occlusal force (MOF), lip-tongue motor function (LTMF), maximum tongue pressure (MTP), masticatory function, and swallowing function. Hand grip strength (HGS) was also measured. The participants were divided into the young (20–39 years), middle (40–64 years), and old (≥ 65 years) age groups for linear regression analysis of differences in oral and physical function. Differences in OHF prevalence were tested by the chi-square test.ResultsThe prevalence of OHF was significantly higher in the old group than in the young and middle groups. Such OHF measures as Hygiene, MTP, LTMF, and MOF were significantly worse in the old group as well. The measures of Hygiene and LTMF showed a moderate correlation with age in the multiple regression model (standardized partial regression coefficient, β = 0.24 and -0.19, respectively). HGS was significantly associated with MTP (β = 0.58, p < 0.001) and LTMF (β = 0.38, p = 0.002) in both male and female participants.ConclusionsOur findings suggest that OHF prevalence increases with age, especially after 65 years old. However, the pathological route may vary among OHF categories.

Neurophysiological identification and differentiation between the motor and sensory roots in pediatric spinal cord lipoma surgery

BackgroundRadical resection of spinal cord lipomas reduces the rate of re-tethering. Current conventional neurophysiological mapping techniques are not able to differentiate between crucial motor nerve roots and sensory roots. Enhanced differentiation could contribute to complete resection. We present our experience with a double-train paradigm to differentiate between motor and sensory roots.MethodsIn children undergoing spinal cord lipoma resection, the double-train mapping paradigm was used with an inter-train interval of 60 ms. Given the longer recovery time due to the H-reflex, a single muscle response was presumed to be elicited from a sensory root, and a double muscle response from a motor root. The primary endpoint was postoperative neurological outcome and bladder function at discharge.ResultsWe included 8 children undergoing 10 lipoma resections between 2016 and 2023. Double-train mapping was used in all cases. Motor and sensory roots were clearly differentiated in 6 cases and altered the course of surgery in 4 cases.Post-surgery, no sensory and motor function worsened within 3 months. Bladder function was stable in six and improved in two children. In two patients, bladder function worsened slightly at 3 months and 6 months, at which point one patient was re-operated on for re-tethering.ConclusionIntraoperative mapping with the double-train paradigm reliably differentiated between motor and sensory nerve roots. Informing the surgeon on the specific function of a tethering root may help to maximize resection without risking major neurological deficits.