Neuromotor Conditions Research Articles

Exploring the Behavioral Traits of Male Mutant Crup Mice as an Experimental Neurodegenerative Disease Model

The congenic BALB/c-crup (‘crup’ meaning ‘cruza-pernas’ in Portuguese or cross legs in English), a homozygous recessive mutant mouse derived from N-ethyl-N-nitrosourea mutagenesis, exhibits a unique phenotype characterized by hindlimb crossing when the mouse is suspended by its tail, along with age-related neuromotor issues. The study aimed to identify the genetic mutation causing the BALB/c-crup phenotype and evaluate the behavioral responses of the mice. Open field test, elevated plus maze, and elevated beam experiments were conducted to evaluate general activity, motor function, as well as sensorimotor and autonomic nervous systems. Genetic mapping and exome analysis identified a nonsynonymous (missense mutation), a single nucleotide variant, in the Taf15 gene. This mutation results in the p.G55S substitution, where glycine is replaced by serine at position 55 in the gene product. Longitudinal assessment by the open field test revealed altered locomotion, decreased mobility, and reduced rearing and grooming frequency in mutant mice. Sensorimotor function declines were observed through reduced surface righting reflex scores, grip strength, and increased hindquarter angle. In the elevated beam test, mutants exhibited tail hypotonia and aversion to traversing the beam. The elevated plus maze revealed altered behavior in closed arms, suggesting increased anxiety-like behavior or sensorimotor impairment. Our findings provide insights into neurologic and behavioral anomalies associated with a Taf15 gene mutation. The altered locomotion, sensory impairments, and disorientation observed in the crup phenotype indicate a progressive neuromotor condition, potentially serving as a novel mouse model for neurodegenerative diseases.

Commentary on "Movement as a Gateway to Participation for Individuals With Neuromotor Conditions: A Scoping Review".

Commentary on "Movement as a Gateway to Participation for Individuals With Neuromotor Conditions: A Scoping Review".

Human lower leg muscles grow asynchronously.

Muscle volume must increase substantially during childhood growth to generate the power required to propel the growing body. One unresolved but fundamental question about childhood muscle growth is whether muscles grow at equal rates; that is, if muscles grow in synchrony with each other. In this study, we used magnetic resonance imaging (MRI) and advances in artificial intelligence methods (deep learning) for medical image segmentation to investigate whether human lower leg muscles grow in synchrony. Muscle volumes were measured in 10 lower leg muscles in 208 typically developing children (eight infants aged less than 3 months and 200 children aged 5 to 15 years). We tested the hypothesis that human lower leg muscles grow synchronously by investigating whether the volume of individual lower leg muscles, expressed as a proportion of total lower leg muscle volume, remains constant with age. There were substantial age-related changes in the relative volume of most muscles in both boys and girls (p < 0.001). This was most evident between birth and five years of age but was still evident after five years. The medial gastrocnemius and soleus muscles, the largest muscles in infancy, grew faster than other muscles in the first five years. The findings demonstrate that muscles in the human lower leg grow asynchronously. This finding may assist early detection of atypical growth and allow targeted muscle-specific interventions to improve the quality of life, particularly for children with neuromotor conditions such as cerebral palsy.

Design of pediatric robot to simulate infant biomechanics for neuro-developmental assessment in a sensorized gym.

Infants at risk for developmental delays often exhibit postures and movements that may provide a window into potential impairment for cerebral palsy and other neuromotor conditions. We developed a simple 4 DOF robot pediatric simulator to help provide insight into how infant kinematic movements may affect the center of pressure (COP), a common measure thought to be sensitive to neuromotor delay when assessed from supine infants at play. We conducted two experiments: 1) we compared changes in COP caused by limb movements to a human infant and 2) we determined if we could predict COP position due to limb movements using simulator kinematic pose retrieved from video and a sensorized mat. Our results indicate that the limb movements alone were not sufficient to mimic the COP in a human infant. In addition, we show that given a robot simulator and a simple camera, we can predict COP measured by a force sensing mat. Future directions suggest a more complex robot is needed such as one that may include trunk DOF.

Research Summit V: Optimizing Transitions From Infancy to Early Adulthood in Children With Neuromotor Conditions.

The purpose of this executive summary is to review the process and outcomes of the Academy of Pediatric Physical Therapy Research Summit V, "Optimizing transitions from infancy to young adulthood in children with neuromotor disabilities: biological and environmental factors to support functional independence." An interdisciplinary group of researchers, representatives from funding agencies, and individuals with neuromotor disabilities and their parents participated in an intensive 2.5-day summit to determine research priorities to optimize life transitions for children with neuromotor disabilities. Recommended priorities for research included (1) promoting self-determination and self-efficacy of individuals with neuromotor disabilities and their families, (2) best care at the right time: evidence-based best practice care, led and navigated by families seamlessly across the lifespan, (3) strengthening connections between developmental domains to enhance function and participation, and (4) optimal dosing and timing to support adaptive bone, muscle, and brain plasticity across the lifespan.

Comparison of the Gait Biomechanical Constraints in Three Different Type of Neuromotor Damages.

Background and ObjectiveAbsolute angle represents the inclination of a body segment relative to a fixed reference in space. This work compares the absolute and relative angles for exploring biomechanical gait constraints.MethodsGait patterns of different neuromotor conditions were analyzed using 3D gait analysis: normal gait (healthy, H), Cerebral Palsy (CP), Charcot Marie Tooth (CMT) and Duchenne Muscular Dystrophy (DMD), representing central and peripheral nervous system and muscular disorders, respectively. Forty-two children underwent gait analysis: 10 children affected by CP, 10 children by CMT, 10 children by DMD and 12 healthy children. The kinematic and kinetic parameters were collected to describe the biomechanical pattern of participants’ lower limbs. The absolute angles of thigh, leg and foot were calculated using the trigonometric relationship of the tangent. For each absolute series, the mean, range, maximum, minimum and initial contact were calculated. Kinematic and kinetic gait data were studied, and the results were compared with the literature.ResultsStatistical analysis of the absolute angles showed how, at the local level, the single segments (thigh, leg and foot) behave differently depending on the pathology. However, if the lower limb is studied globally (sum of the kinematics of the three segments: thigh, leg and foot), a biomechanical constraint emerges.ConclusionEach segment compensates separately for the disease deficit so as to maintain a global biomechanical invariance. Using a model of inter-joint co-variation could improve the interpretation of the clinical gait pattern.

What is QOL in children and adolescents with physical disabilities? A thematic synthesis of pediatric QOL literature.

Many neuromotor conditions affect children from a young age through to adulthood, impacting their quality of life (QOL). For QOL to be accurately measured in these children, pediatric QOL must first be conceptualized. Some theoretical models and definitions have been proposed to understand QOL, but they were not developed for the pediatric population. The purpose of this review is to build on existing frameworks of QOL and develop a framework and definition of pediatric QOL for measurement purposes, by integrating the findings of multiple qualitative studies involving children and adolescents with physical disabilities. A systematic search was conducted on four databases. Inclusion criteria were qualitative studies with participants with common neurological and neuromuscular conditions. The content of studies had to involve the lived experiences of children and adolescents with disabilities. Thematic synthesis was conducted. 48 studies were included. Results generated a schema of the causes and the mitigators of QOL. This consisted of casual indicators of QOL, mitigators, and components of QOL. Themes under QOL included thoughts and feelings, fitting in, self-image, about the future, and independence. A new framework and definition of pediatric QOL were proposed. In conclusion, pediatric QOL for children with disabilities is formed by their thoughts and feelings, being accepted by society, being able to forge an identity that is beyond their disability, having autonomy, and having a hope for the future. The resulting QOL framework proposed here can also aid future development of QOL measures in children with physical disabilities.

MonParLoc: A Speech-Based System for Parkinson’s Disease Analysis and Monitoring

Patients suffering from Parkinson's Disease (PD) manifest relevant changes in their speech, consisting of specific landmarks in articulation, phonation, fluency, and prosody. Usually, phonation and articulation changes are estimated and evaluated using different methods and statistical frameworks. Speech is especially relevant as a vehicular mechanism to monitor neurological evolution using well-known features extracted from sustained phonations (mainly vowels), diadochokinetic exercises, or running speech. Recent studies have shown that acoustic neurostimulation using binaural beats influences the cognitive and neuromotor conditions of patients with PD, at least temporarily after stimulation. The aim of this study is to describe an added-value solution considering the cooperation of both previously mentioned methods: speech analysis-based monitoring called within the project, Monitoring Parkinson using Locution (MonParLoc), and acoustical neurostimulation, called within project neuro-Acoustic-stimulation Parkinson (AcousticPar). The applications designed in both projects are embedded into a global solution denominated Teca-Park which consists of four main activities: speech evaluation, neurostimulation, motor symptom longitudinally, and questionnaires. This framework is conceived to be a powerful tool for treating and monitoring longitudinally remotely and contact-free. MonParLoc was tested and validated in real scenarios involving patient associations. Validation results produced in these associations demonstrating the utility of this approach are given in the study, particularly in reference to protocol vulnerability and robustness. This paper proposes a complete framework (a mobile app and a scorecard solution) including different services for Parkinson's clinical monitoring and patient management using speech, movement, and acoustic stimulation.

Gait Nonlinear Patterns Related to Parkinson’s Disease and Age

Gait and posture are regular activities which are fully controlled by the sensorimotor cortex. In this paper, the complexity of fluctuations in human walking stride records is analyzed to assess gait in healthy young, healthy older adults, and patients affected with Parkinson’s disease (PD). In this regard, a nonlinear analysis of gait reliability is performed by measuring long-range dependence, chaos, and information content in walking stride records. We seek to test if changes in these measures of gait nonlinear patterns occur with age and pathology. The inferential analyses were conducted by employing various statistical tests. The obtained results show a strong evidence of significant group differences in the measured gait nonlinear patterns. More importantly, values of all the three complexity measures increase with age and occurrence of pathology. In addition, age and PD significantly affect gait nonlinear dynamics. In particular, age shapes randomness, while PD alters regularity and stability. Complexity measures considered in this paper provide new insights to better understand the biomechanics of walk due to aging. In addition, they appear to be valuable tools that can highlight differences in gait nonlinear dynamics with respect to PD patients. In this regard, the measurement of gait nonlinear patterns may possibly afford pertinent clinical information on neuromotor conditions, characterization of some neurological disorders, and rehabilitation.

Studies on a Robotic Device that Minimizes End-Point Vibrations for Parkinson Tremor

Parkinson tremor is a neuromotor condition that produces involuntary oscillation movements in some parts of the body, especially at the upper limbs. This disease affects more than 10 million people in the world and around 150 thousand people in Turkey, according to the report by the World Health Organization. This work focuses on simulating a robotic device in the shape of a glass for drinking liquids, which is an ordinary action for a normal person but can be very difficult for a Parkinson patient. This robotic device can minimize end-point vibrations when it is manipulated by people suffering from tremor. The work makes use of real-time data gathered from a patient, presents studies to characterize the main frequency of the tremor, and employs this information for designing an active control method. The proposed control method is based on the inverse dynamics of the vibrating system to damp the tremor’s first vibrational frequency component. The work consists of three stages: data acquisition, characterization and simulation of the control action. The first stage involves acceleration sensors based movement analysis to identify the frequencies and the behavior of the tremor; followed by a signal processing approach is developed using the fast Fourier transform. The studies indicate that the tremor could be represented by a harmonic signal in which the first frequency mode is the most representative. This assumption allows for simplifying our control strategy: inverse dynamics in an open-loop control along with proportional-derivative closed-loop controller are performed. The experimental data acquisition, signal analysis and control simulations were realized via Matlab/Simulink. The results illustrate the system performance validating our assumptions and the success of the control method we propose, which could lead to the design of a device to minimize vibrations at the end-point of the glass.

Changes in Trunk Compensation and Reaching Performance as a Result of a Novel Virtual Reality–Based Intervention for People With Chronic Stroke

Abstract Date Presented 4/20/2018 A virtual reality (VR) tool designed to provide compensation-related feedback during reaching practice was implemented with a small cohort of people with stroke. Results show that this tool may be a novel way to reduce maladaptive compensatory movements for people with neuromotor conditions. Primary Author and Speaker: Matthew Foreman Contributing Authors: Jack R. Engsberg

Cerebral Palsy, Developmental Coordination Disorder, Visual and Hearing Impairments in Infants Born Preterm

Motor disabilities and neurosensory impairments are common in survivors of prematurity, and significantly affect quality of life. Cerebral palsy occurs with a much higher prevalence in preterm survivors compared with term infants; however, another less severe but important neuromotor condition is developmental coordination disorder. Visual and hearing impairments are less common, but significantly compound physical disabilities. Early identification and referral for services are important to optimize functioning, learning, and community supports for these children. This article provides a review of prevalence, at-risk factors, presenting signs and symptoms, and management strategies for these conditions.

Systematic review and evidence-based clinical recommendations for dosage of supported standing programs for adults with neuromotor conditions

Systematic review and evidence-based clinical recommendations for dosage of supported standing programs for adults with neuromotor conditions

Stochastic modelling of muscle recruitment during activity.

Muscle forces can be selected from a space of muscle recruitment strategies that produce stable motion and variable muscle and joint forces. However, current optimization methods provide only a single muscle recruitment strategy. We modelled the spectrum of muscle recruitment strategies while walking. The equilibrium equations at the joints, muscle constraints, static optimization solutions and 15-channel electromyography (EMG) recordings for seven walking cycles were taken from earlier studies. The spectrum of muscle forces was calculated using Bayesian statistics and Markov chain Monte Carlo (MCMC) methods, whereas EMG-driven muscle forces were calculated using EMG-driven modelling. We calculated the differences between the spectrum and EMG-driven muscle force for 1-15 input EMGs, and we identified the muscle strategy that best matched the recorded EMG pattern. The best-fit strategy, static optimization solution and EMG-driven force data were compared using correlation analysis. Possible and plausible muscle forces were defined as within physiological boundaries and within EMG boundaries. Possible muscle and joint forces were calculated by constraining the muscle forces between zero and the peak muscle force. Plausible muscle forces were constrained within six selected EMG boundaries. The spectrum to EMG-driven force difference increased from 40 to 108 N for 1-15 EMG inputs. The best-fit muscle strategy better described the EMG-driven pattern (R (2) = 0.94; RMSE = 19 N) than the static optimization solution (R (2) = 0.38; RMSE = 61 N). Possible forces for 27 of 34 muscles varied between zero and the peak muscle force, inducing a peak hip force of 11.3 body-weights. Plausible muscle forces closely matched the selected EMG patterns; no effect of the EMG constraint was observed on the remaining muscle force ranges. The model can be used to study alternative muscle recruitment strategies in both physiological and pathophysiological neuromotor conditions.

Short-term, intensive neurodevelopmental treatment program experiences of parents and their children with disabilities.

Parents' perspectives on intervention and functional changes in children were investigated following an intensive neurodevelopmental treatment (NDT) program of 1 to 2 weeks (5 consecutive days per week; 2-4 h/d). Thirteen parents and their children (aged 1-17 years) with neuromotor conditions participated in a short-term, intensive program conducted by NDT certified pediatric therapists. A mixed-method design was used: a qualitative phenomenological approach of inquiry for parent perspectives and a pre/posttest quasi-experimental design for weekly intervention changes using Goal Attainment Scaling and the Canadian Occupational Performance Measure. Through interviews, parents reported positive experiences with the intensive NDT program. Child participants demonstrated significant improvements in Goal Attainment Scaling (P < .001) and Canadian Occupational Performance Measure (P < .001) scores pre- to postintervention. A short-term, intensive NDT program was perceived by parents as beneficial and supported functional improvements. Valued were expert, compassionate therapists; collaboration; objective goals; home programming; and individualized intervention. Scheduling, financial support, and fatigue were difficulties.

The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia

Background and objectiveThe aim of the study was to determine the correlation of hypoxic-ischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at the age of 1-year. Materials and methodsIn total, 125 full-term neonates (78 subjects of case group and 47 subjects of control group) were studied. During the first five days of life, the subjects daily underwent cerebral USG and DS. At the age of 1-year the neuromotor condition and mental development was evaluated. ResultsThe HI injury groups detected during USG significantly correlated with the mental development groups (r=0.3; P=0.01) and the neurological evaluation groups (r=0.3; P<0.001). In the presence of brain swelling (edema) and thalamus and/or basal ganglia (E/T/BG) injury, USG demonstrated high accuracy values when prognosticating spastic quadriparesis and severe mental development impairment in 1-year-old subjects: sensitivity – 100%, specificity – 93–100%, positive predictive value (PPV) – 60–100%, and NPV – 100%.In subjects with spastic quadriparesis, mean end-diastolic velocity (Vd) values were significantly higher (P≤0.05), and mean resistive index (RI) values were significantly lower (P<0.05) than those in subjects with normal neuromotor development. In subjects with severe mental retardation, mean Vd values in ACA were statistically significantly higher, and mean RI values in ACA and ACM were statistically significantly lower than those in subjects with normal mental development. ConclusionsHypoxic-ischemic brain changes detected during ultrasonography and cerebral blood flow parameters associated with long-term outcomes of mental and neuromotor development at the age of 1-year.

Computational tools for calculating alternative muscle force patterns during motion: A comparison of possible solutions

Comparing the available electromyography (EMG) and the related uncertainties with the space of muscle forces potentially driving the same motion can provide insights into understanding human motion in healthy and pathological neuromotor conditions. However, it is not clear how effective the available computational tools are in completely sample the possible muscle forces. In this study, we compared the effectiveness of Metabolica and the Null-Space algorithm at generating a comprehensive spectrum of possible muscle forces for a representative motion frame. The hip force peak during a selected walking trial was identified using a lower-limb musculoskeletal model. The joint moments, the muscle lever arms, and the muscle force constraints extracted from the model constituted the indeterminate equilibrium equation at the joints. Two spectra, each containing 200,000 muscle force samples, were calculated using Metabolica and the Null-Space algorithm. The full hip force range was calculated using optimization and compared with the hip force ranges derived from the Metabolica and the Null-Space spectra. The Metabolica spectrum spanned a much larger force range than the NS spectrum, reaching 811N difference for the gluteus maximus intermediate bundle. The Metabolica hip force range exhibited a 0.3—0.4 BW error on the upper and lower boundaries of the full hip force range (3.4—11.3 BW), whereas the full range was imposed in the NS spectrum. The results suggest that Metabolica is well suited for exhaustively sample the spectrum of possible muscle recruitment strategy. Future studies will investigate the muscle force range in healthy and pathological neuromotor conditions.

Cognition and Motor Impairment Correlates with Exercise Test Performance after Stroke

Exercise not only benefits physical and cardiovascular function in older adults with multiple chronic conditions but may also improve cognitive function. Peak HR, a physiological indicator for maximal effort, is the most common and practical means of establishing and monitoring exercise intensity. In particular, in the absence of graded maximal exercise test (GXT) results, age-predicted maximal HR values are typically used. Using individuals with stroke as a model for examining older adults with coexisting cardiovascular and neuromotor conditions, the purpose of this article was to examine the determinants associated with achieving age-predicted maximal HR on a GXT, with respect to neurological, cognitive, and lower limb function. Forty-seven participants with stroke (age, 67 ± 7 yr; 4 ± 3 yr poststroke (mean ± SD)) performed GXT. The peak values for gas exchange, HR, and RPE were noted. Logistic regression analysis was performed to examine determinants (neurological impairment, leg motor impairment, Montreal Cognitive Assessment score, and walking ability) associated with the ability to achieve age-predicted maximal HR on the GXT. V˙O2peak was 16.5 ± 6 mL·kg·min. Fourteen (30%) participants achieved ≥100% of age-predicted maximal HR. Logistic regression modeling revealed that the ability to achieve this threshold was associated with less leg motor impairment (P = 0.02; odds ratio, 2.3) and higher cognitive scores (P = 0.048; odds ratio, 1.3). These results suggest that noncardiopulmonary factors such as leg motor impairment and cognitive function are important contributors to achieving maximal effort during exercise tests. This study has important implications for poststroke exercise prescription, whereby training intensities that are based on peak HR from GXT may be underestimated among individuals with cognitive and physical impairments.

QUALITY AND SAFETY OF ART THERAPIES

Introduction: The effect of in vitro fertilization (IVF) on neurodevelopmental outcome is unclear. Probably, IVF does not affect traditional measures of neurological development in infancy, but little is known on long-term effects. Recently a new video-based instrument to evaluate neuromotor development was developed. The Infant Motor Profile (IMP) evaluates neuromotor condition in infants in terms of the quality of spontaneous motor behaviour. The IMP does not only assess traditional neuromotor domains, such as performance, symmetry and movement fluency, but also two novel domains: variation and variability. Movement variation denotes the size of the child's movement repertoire. Previous studies demonstrated that reduced movement variation is associated with early lesions of the periventricular white matter and - more generally - reflects the integrety of cortical connectivity. In addition, reduced variation during infancy is associated with neurodevelopmental disorders in later life and reduced intelligence at school age. Variability denotes the child's ability to select from the repertoire of movements the strategy that suits the situation best. In this prospective, assessor-blinded cohort study, we address the question whether ovarian hyperstimulation and/or the in vitro procedure affect movement variation during infancy. Material and Methods: Singletons born following IVF with conventional controlled ovarian hyperstimulation (COH-IVF, n = 68), following IVF in a modified natural cycle (MNC-IVF, n = 57) and following natural conception born to subfertile couples (Sub-NC, n = 90) were assessed with the IMP at 4, 10 and 18 months. The assessment resulted in a total IMP score and 5 domain scores: variation (i.e. the size of movement repertoire), variability (i.e. the ability to select motor strategies), symmetry, fluency and performance. Primary outcome was the domain score variation. Outcome variables were analyzed with a mixed effects model. Results: The mixed model indicated an overall effect of treatment on variation (p Conclusions: The preliminary data suggest that ovarian hyperstimulation may be associated with reduced movement variation in infancy. These findings stress the need to carefully monitor neurodevelopment in IVF offspring.

Using articulatory likelihoods in the recognition of dysarthric speech

Millions of individuals have congenital or acquired neuro-motor conditions that limit control of their muscles, including those that manipulate the vocal tract. These conditions, collectively called dysarthria, result in speech that is very difficult to understand both by human listeners and by traditional automatic speech recognition (ASR), which in some cases can be rendered completely unusable. In this work we first introduce a new method for acoustic-to-articulatory inversion which estimates positions of the vocal tract given acoustics using a nonlinear Hammerstein system. This is accomplished based on the theory of task-dynamics using the TORGO database of dysarthric articulation. Our approach uses adaptive kernel canonical correlation analysis and is found to be significantly more accurate than mixture density networks, at or above the 95% level of confidence for most vocal tract variables. Next, we introduce a new method for ASR in which acoustic-based hypotheses are re-evaluated according to the likelihoods of their articulatory realizations in task-dynamics. This approach incorporates high-level, long-term aspects of speech production and is found to be significantly more accurate than hidden Markov models, dynamic Bayesian networks, and switching Kalman filters.