Specific Motor Research Articles

Estimation of Average and Maximum Daily-Life Mobility Performance Using the Timed Up-and-Go: Exploring the Added Value of an Instrumented Timed Up-and-Go

Introduction: The association between specific motor capacity variables obtained in a laboratory and parameters of daily-life mobility performance (MP) obtained via wearables is still unclear. The Timed Up-and-Go (TUG) test is a widely used motor capacity tests available either as traditional hand-stopped TUG or as instrumented TUG (iTUG), providing specific information about its subphases. This study aimed to: (1) estimate the association between the TUG and specific parameters reflecting average and maximum daily-life MP, (2) estimate the benefits of the iTUG in terms of explaining MP in daily life compared to the TUG. Methods: The present study was a cross-sectional analysis using baseline data of 294 older persons (mean age: 76.7 ± 5.3 years). Univariate linear regression analysis was performed to delineate the coefficient of determination between TUG time and participants’ MP. MP variables containing mean cadence (MCA) to represent average performance and the 95th percentile of mean cadence of walks with more than three steps (p95>3stepsMCA) to represent maximum performance. To determine whether the iTUG variables give more information about MP, a stepwise multivariate regression analysis between iTUG variables and the p95>3stepsMCA variable to represent maximum performance was conducted. Results: The univariate regression models revealed associations of the TUG with MCA (adjusted R2 = 0.078, p < 0.001) and p95>3stepsMCA (adjusted R2 = 0.199, p < 0.001). The multivariate stepwise regression models revealed a total explanation of maximum daily-life MP (p95>3stepsMCA) of the TUG (adjusted R2 = 0.199, p < 0.001) versus iTUG (adjusted R2 = 0.278, p < 0.010). Discussion/Conclusion: This study shows that the TUG better reflects maximum daily-life MP than average daily-life MP. Moreover, we demonstrate the added value of the iTUG for a more accurate estimation of daily MP compared to the traditional TUG. The iTUG is recommended to estimate maximum daily-life MP in fall-prone older adults. The study is a step toward a specific assessment paradigm using capacity variables from the iTUG to estimate maximum daily-life MP.

Advanced Force Coordination of Lower Extremities During Visuomotor Control Task in Soccer Players

ABSTRACT Purpose: This study is aimed to determine specific bilateral lower extremity motor performances and coordination patterns in soccer players with healthy controls using the bilateral force control paradigm. We hypothesized that soccer players would show more advanced bilateral force control performances than untrained controls. Methods: Participants were 13 university soccer players and 13 healthy controls. Each group performed bilateral ankle dorsiflexion force control tasks across two vision conditions (i.e., vision and no-vision) and two targeted force levels (i.e., 10% and 40% maximum voluntary contraction). We calculated force accuracy, variability, and symmetry to assess force control performances. To estimate bilateral force coordination, we calculated Pearson’s correlation coefficients between feet-within a single trial and considered uncontrolled manifold variables across multiple trials. In the no-vision condition, we performed secondary analyses for initial force control patters after removal of visual feedback. Results: There were no significant group differences in bilateral force accuracy and variability but, compared to the control group, soccer players showed higher force symmetry between left and right ankle dorsiflexion forces. For force coordination between feet, soccer players revealed more negative values of the correlation coefficient and greater good variability from the uncontrolled manifold analysis than those for the control group. The secondary analysis revealed no significant group differences in the time until force drift and amount of force adjustments. Conclusions: Soccer players have more compensatory and flexible interlimb force coordination strategies between feet.

Multi-site lumbar transcutaneous spinal cord stimulation: When less is more

BackgroundTranscutaneous spinal stimulation (TSS) has become a valuable tool for facilitating rehabilitation in individuals with neurological deficits. A significant constraint arises from the need for precise knowledge of stimulation locations to effectively apply TSS for targeted functional enhancement. MethodsIn this study, we investigate whether single-site or simultaneous multi-site stimulation over the lumbar spinal cord is advantageous for recruitment of specific motor pools projecting to lower limb muscles and generates higher leg extensor forces in neurologically intact individuals. Tests were performed in a supine position. TSS was delivered at T10-T11, T11-T12, T12-L1, and L1-L2 intervertebral spaces individually, then through all four locations simultaneously. The peak-to-peak amplitude of spinally evoked motor potentials and the forces generated by lower limb muscles were compared at the common motor threshold intensity level across all stimulation conditions. ResultsRecruitment of motor pools projecting to proximal and distal lower limb muscles followed their topographical rostro-caudal arrangement along the lumbosacral enlargement. Single-site stimulation, apart from the T10-T11 location, resulted in larger responses in both proximal and distal muscles while also generating higher knee-extension and plantarflexion forces when compared to multi-site stimulation. ConclusionsBoth motor response and force generation were reduced when using multi-site TSS when compared to single-site stimulation. This demonstrates that the segmental effects of TSS are important to consider when performing multi-site TSS.

Visuomotor tracking strategies in children: associations with neurodevelopmental symptoms

Children with neurodevelopmental disorders (NDDs) often display motor problems that may impact their daily lives. Studying specific motor characteristics related to spatiotemporal control may inform us about the mechanisms underlying their challenges. Fifty-eight children with varying neurodevelopmental symptoms load (median age: 5.6 years, range: 2.7–12.5 years) performed an interactive tablet-based tracking task. By investigating digit touch errors relative to the target’s movement direction, we found that a load of neurodevelopmental symptoms was associated with reduced performance in the tracking of abrupt alternating directions (zigzag) and overshooting the target. In contrast, reduced performance in children without neurodevelopmental symptoms was associated with lagging behind the target. Neurodevelopmental symptom load was also associated with reduced flexibility in correcting for lateral deviations in smooth tracking (spiral). Our findings suggest that neurodevelopmental symptoms are associated with difficulties in motor regulation related to inhibitory control and reduced flexibility, impacting motor control in NDDs.

Predictive value of General Movements Assessment for developmental delay at 18 months in children with complex congenital heart disease

BackgroundInfants with complex congenital heart disease are at increased risk of impaired fetal brain growth, brain injury, and developmental impairments. The General Movement Assessment (GMA) is a valid and reliable tool to predict cerebral palsy (CP), especially in preterm infants. Predictive properties of the GMA in infants with complex congenital heart disease (CCHD) are unknown. AimTo evaluate predictive properties of the GMA to predict developmental outcomes, including cerebral palsy (CP), at 18-months corrected age (CA) in children with CCHD undergoing heart surgery in the first month of life. MethodsA prospective cohort of 56 infants with CCHD (35 males, 21 females) was assessed with GMA at writhing age (0–6 weeks CA) and fidgety age (7–17 weeks CA) and the Bayley Scales of Infant Development at 18 months. GMA focused on markedly reduced GM-variation and complexity (definitely abnormal (DA) GM-complexity) and fidgety movements. Predictive values of GMA for specific cognitive, language and motor delay (composite scores <85th percentile) and general developmental delay (delay in all domains) were calculated at 18 months. ResultsAt fidgety age, all infants had fidgety movements and no child was diagnosed with CP. DA GM-complexity at fidgety age predicted general developmental delay at 18 months (71 % sensitivity, 90 % specificity), but predicted specific developmental delay less robustly. DA GM-complexity at writhing age did not predict developmental delay, nor did it improve prediction based on DA GM-complexity at fidgety age. ConclusionsIn infants with CCHD and fidgety movements, DA GM-complexity at fidgety age predicted general developmental delay.

The effect of uneven surfaces on inter-joint coordination during walking in children with cerebral palsy

Clinical gait analysis on uneven surfaces contributes to the ecological assessment of gait deviations of children with spastic cerebral palsy (CP). Walking on uneven surfaces requires specific motor strategies, which can be assessed by lower-limb kinematic and inter-joint coordination analyses. This study aimed to assess and compare kinematics and inter-joint coordination between children with CP and their typically developing (TD) peers when walking on even and two levels of uneven surfaces (medium and high). A total of 17 children with CP and 17 TD children (11.5 ± 3.5 and 10.4 ± 4.5 years old, respectively) were asked to complete 6–8 gait trials on a 4-m walkway of each surface (n = 3) in randomized blocks while fit with retro-reflective markers on their lower-limbs. Children with CP showed proximal gait adaptations (i.e., hip and knee) on uneven surfaces. Compared with the TD group, the CP group showed decreased hip extension during late stance (49–63%, d = 0.549, p < 0.001), and a more in-phase knee-hip coordination strategy during swing phase (75–84% of gait cycle, d = 1.035, p = 0.029 and 92–100%, d = 1.091, p = 0.030) when walking on an uneven (high), compared to even surface. This study provides a better understanding of kinematic strategies employed by children with spastic CP when facing typical daily life gait challenges. Further studies are needed to evaluate the benefits of integrating uneven surfaces in rehabilitation care.

Monipar: movement data collection tool to monitor motor symptoms in Parkinson's disease using smartwatches and smartphones.

Parkinson's disease (PD) is a neurodegenerative disorder commonly characterized by motor impairments. The development of mobile health (m-health) technologies, such as wearable and smart devices, presents an opportunity for the implementation of clinical tools that can support tasks such as early diagnosis and objective quantification of symptoms. This study evaluates a framework to monitor motor symptoms of PD patients based on the performance of standardized exercises such as those performed during clinic evaluation. To implement this framework, an m-health tool named Monipar was developed that uses off-the-shelf smart devices. An experimental protocol was conducted with the participation of 21 early-stage PD patients and 7 healthy controls who used Monipar installed in off-the-shelf smartwatches and smartphones. Movement data collected using the built-in acceleration sensors were used to extract relevant digital indicators (features). These indicators were then compared with clinical evaluations performed using the MDS-UPDRS scale. The results showed moderate to strong (significant) correlations between the clinical evaluations (MDS-UPDRS scale) and features extracted from the movement data used to assess resting tremor (i.e., the standard deviation of the time series: r = 0.772, p < 0.001) and data from the pronation and supination movements (i.e., power in the band of 1-4 Hz: r = -0.662, p < 0.001). These results suggest that the proposed framework could be used as a complementary tool for the evaluation of motor symptoms in early-stage PD patients, providing a feasible and cost-effective solution for remote and ambulatory monitoring of specific motor symptoms such as resting tremor or bradykinesia.

EFFECT OF ANTHROPOMETRIC CHARACTERISTICS AND MOTOR ABILITIES ON THE EXPLOSIVE FORCE AND COORDINATION IN STUDENT ATHLETES

Abstract With the aim of examining the influence of anthropometric characteristics and motor skills on the manifestation of specific motor skills of explosive strength and coordination, an experimental study was organized on a sample of 160 student athletes in Prizren. For the purposes of this research, 18 variables (8 anthropometric and 10 motor) were applied, which made up the predictor system of variables, and 4 specific motor ability tests that made up the criteria system of variables. The data were processed with descriptive and regression analyses. Based on the results of the research, it can be concluded that the anthropometric characteristics that were applied in the research did not have a significant impact on motor skills , coordination, while the applied predictor anthropometric variables showed that they had a significant impact on the criteria system of motor abilities of explosive power in student athletes, the results of the research also show that the predictor system of motor variables applied in the research has a significant impact on the criterion system of motor skills of coordination i explosive strength in student athletes. Key words : Regression analysis, anthropometric characteristics, motor abilities, student athletes.

Measuring and assessing motor skills of selected Croatian U12, U14 and U16 tennis players

Purpose: The aim of this research is to analyse and to determine the differences between tennis players in younger age categories (U12, U and U16) in certain motor skills.Methods: A total of 60 tennis players ranked in the rankings of the Croatian Tennis Federation were measured by using 10 tests for assessing explosive strength in jump, speed, agility, and trunk strength. The tennis players were divided into three groups of 20 respondents, depending on the age category in which they compete. Statistically significant differences (p &amp;lt; 0.05) between all age categories were found in indicators of frontal and lateral agility, running speed in the 20-m shuttle run test, and explosive strength in jump and repetitive trunk strength.Results: The results of the conducted tests indicate a linear development trend for the mentioned skills in relation with the increase of chronological age of the tennis players. Statistically significantly better results were shown between test subjects under 14 years compared to test subjects under 12 years in tests for the assessment of agility (SST,A9-3-6-3-9), in the 20 m sprint test, in tests of explosive strength of lower extremities (CMJ, CMJmax,SJ) and in the test of repetitive trunk strength (TF). Subjects under 16 years achieved significantly better results compared to subjects under 14 years in tests for assessing agility (SST, A9-3-6-3-9), speed (SRT5m, SRT10m, SRT20m) and explosiveness (CMJ, CMJmax, SJ). Players under 16 years recorded significantly better results in all tests for assessing agility (SST,A9-3-6-3-9), speed (SRT5m, SRT10m, SRT20m), explosiveness of the lower extremities (CMJ, CMJmax, SJ) and in the test for assessing repetitive trunk strength (TF). Statistically significant differences were not detected in tests of running speed in the 5-m and 10-m shuttle run tests among U12 and U14 tennis players, nor between U14 and U16 tennis players in the 60-s trunk flexion test. The highest heterogeneity of results in a single age category was determined in the test for assessing isometric trunk strength, and thus tennis players of different age categories do not differ significantly in this skill.Conclusion: The results of this research point to the development of specific motor skills in accordance with the increase of game demands and chronological age, however, also refer to the problem of muscle imbalance between front and back trunk musculature. Physical conditioning of young tennis players should be multilaterally directed in order to enable injury prevention and adjustment of tennis players to competitive demands.

Mobility and self-care outcomes in patients with a bariatric comorbidity during inpatient rehabilitation.

First, we describe the characteristics and functional outcomes of obese and bariatric patients in an inpatient rehabilitation facility (IRF). Second, we assessed differences in functional outcomes for bariatric, obese, and standard weight body mass index (BMI) groups. Third, we explored whether these characteristics differ between time periods and diagnostic groups. A retrospective study comparing electronic medical record data collected in 2016 and 2018, using a repeated cross-sectional cohort design. IRF. Individuals ≥18 years of age diagnosed with brain injury, medical complexity, general neurology, orthopedic, spinal cord injury (SCI), and stroke. Participants grouped as standard (BMI <30 kg/m2), obese (BMI 30-39 kg/m2), and bariatric (BMI ≥40 kg/m2) weights. (N = 2015 in 2016, N = 2768 in 2018.) INTERVENTIONS: Patients received standard inpatient rehabilitation. In 2018, clinicians had access to new weight-appropriate equipment. Discharge destination; length of stay (LOS) by BMI group and medical diagnoses; item-specific functional independence measure (FIM) change scores. Sixty-four percent to 67% of all BMI groups achieved a home discharge. The bariatric BMI group had a longer LOS (21 days) than the standard or obese groups. There was a significant interaction in a linear regression analysis between diagnosis and LOS, where LOS was longer in medically complex patients with bariatric BMI (19.3 days compared to 16.1 days) but shorter in bariatric patients with SCI (20.6 days) compared to standard weight patients (26.2 days). In 2018, the bariatric BMI group had greater average FIM change scores for bathing, lower body dressing, toilet transfers, and bed transfers. Patient BMI is associated with LOS in the IRF, although affected by diagnosis. Patients with higher BMIs can make changes in specific individual motor FIM items. For patients with bariatric BMIs, FIM change scores were higher in 2018, possibly due to the use of equipment and facilities designed for higher weight capacities.

Spinal ependymoma in adults: from molecular advances to new treatment perspectives

Ependymomas are rare glial tumors with clinical and biological heterogeneity, categorized into supratentorial ependymoma, posterior fossa ependymoma, and spinal cord ependymoma, according to anatomical localization. Spinal ependymoma comprises four different types: spinal ependymoma, spinal ependymoma MYCN-amplified, myxopapillary ependymoma, and subependymoma. The clinical onset largely depends on the spinal location of the tumor. Both non-specific and specific sensory and/or motor symptoms can be present. Owing to diverse features and the low incidence of spinal ependymomas, most of the current clinical management is derived from small retrospective studies, particularly in adults. Treatment involves primarily surgical resection, aiming at maximal safe resection. The use of radiotherapy remains controversial and the optimal dose has not been established; it is usually considered after subtotal resection for WHO grade 2 ependymoma and for WHO grade 3 ependymoma regardless of the extent of resection. There are limited systemic treatments available, with limited durable results and modest improvement in progression-free survival. Thus, chemotherapy is usually reserved for recurrent cases where resection and/or radiation is not feasible. Recently, a combination of temozolomide and lapatinib has shown modest results with a median progression-free survival (PFS) of 7.8 months in recurrent spinal ependymomas. Other studies have explored the use of temozolomide, platinum compounds, etoposide, and bevacizumab, but standard treatment options have not yet been defined. New treatment options with targeted treatments and immunotherapy are being investigated. Neurological and supportive care are crucial, even in the early stages. Post-surgical rehabilitation can improve the consequences of surgery and maintain a good quality of life, especially in young patients with long life expectancy. Here, we focus on the diagnosis and treatment recommendations for adults with spinal ependymoma, and discuss recent molecular advances and new treatment perspectives.

Effectiveness of a 5-Week Virtual Reality Telerehabilitation Program for Children With Duchenne and Becker Muscular Dystrophy: Prospective Quasi-Experimental Study.

Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are neuromuscular diseases. DMD is the most prevalent in children. It affects dystrophin production, reducing the patient's mobility and quality of life. New technologies have become a part of physical therapy in DMD and BMD. During the COVID-19 pandemic, conducting telerehabilitation through virtual reality-based games could help these children maintain their physical abilities. This study examined if the use of a virtual platform in a multimodal intervention program changes the results of the 6-minute walk test (6MWT) in children with DMD and BMD. The main objective was to test whether children with DMD and BMD obtain different results on the 6MWT after completing 10 telerehabilitation treatment sessions. The secondary objective was to measure whether other specific motor scales also produce different results after the 10 defined sessions. This was a descriptive, open, and quasi-experimental study with a prospective A-B (control-intervention) design. A sample of 12 participants who fulfilled the inclusion criteria followed the program for 5 weeks with 10 telerehabilitation sessions. During the sessions, the participants used virtual reality glasses to train for the treatment goals. All participants were assessed in person before and after the intervention. Analysis was performed using R software according to the different functional assessments performed for each test. The participants showed a 19.55-meter increase in the 6MWT. Motor function also remained stable according to other scales used to assess it. The North Start Ambulatory Assessment scores were stable in both treatment conditions (P=.20). Furthermore, the timed up and go test results were 0.1 seconds faster in the telerehabilitation condition, and the Motor Function Measure in all of the 3 dimensions showed no significant differences (P=.08). Finally, the Effort Perception Infant scale showed that during the training, fatigue increased in the middle and decreased by the end of the sessions, but the perception throughout the sessions was lower even as the exercise intensity increased. There were no differences between conventional and telerehabilitation treatments, so the telerehabilitation tool could be used without harming children with DMD and BMD, facilitating their access to therapies and stimulating learning to maintain their functional capacity. Therefore, telerehabilitation in general may be helpful in maintaining motor function in children with DMD and BMD. The learning effect helped reduce the feeling of fatigue in the children during the program.

Detecting early signs in Duchenne muscular dystrophy: comprehensive review and diagnostic implications.

Despite the early onset of clinical signs suggestive of Duchenne muscular dystrophy (DMD), a diagnosis is often not made until four years of age or older, with a diagnostic delay of up to two years from the appearance of the first symptoms. As disease-modifying therapies for DMD become available that are ideally started early before irreversible muscle damage occurs, the importance of avoiding diagnostic delay increases. Shortening the time to a definite diagnosis in DMD allows timely genetic counseling and assessment of carrier status, initiation of multidisciplinary standard care, timely initiation of appropriate treatments, and precise genetic mutation characterization to assess suitability for access to drugs targeted at specific mutations while reducing the emotional and psychological family burden of the disease. This comprehensive literature review describes the early signs of impairment in DMD and highlights the bottlenecks related to the different diagnostic steps. In summary, the evidence suggests that the best mitigation strategy for improving the age at diagnosis is to increase awareness of the early symptoms of DMD and encourage early clinical screening with an inexpensive and sensitive serum creatine kinase test in all boys who present signs of developmental delay and specific motor test abnormality at routine pediatrician visits.

How mothers help children learn to use everyday objects.

Children must learn specific motor actions to use everyday objects as their designers intended. However, designed actions are not obvious to children and often are difficult to implement. Children must know what actions to do and how to execute them. Previous work identified a protracted developmental progression in learning designed actions-from nondesigned exploratory actions, to display of the designed action, to successful implementation. Presumably, caregivers can help children to overcome the challenges in discovering and implementing designed actions. Mothers of 12-, 18- to 24-, and 30- to 36-month-olds (N=74) were asked to teach their children to open containers with twist-off or pull-off lids. Mothers' manual and verbal input aligned with the developmental progression and with children's actions in the moment, pointing to the role of attuned social information in helping children learn to use objects for activities of daily living. However, mothers sometimes "overhelped" by implementing designed actions for children instead of getting children to do it themselves, highlighting the challenges of teaching novices difficult motor actions.

Methadone maintenance treatment and impulsivity: premature responding

ABSTRACT Introduction Previous research showed that methadone maintenance treatment (MMT) is linked to impulsivity, with higher impulsivity levels being associated with for example, increased drug use. One aspect of impulsivity, most commonly studied in rodent research, is premature responding, the failure to wait for a starting signal. Premature responding is of high translational significance since it predicts the development of addiction-like behaviors in rodents. Methods We assessed 45 MMT patients and 46 demographically matched (age, sex, education, and handedness) healthy volunteers (HVs) on premature responding alongside action and inhibition of instructed and intentional trials using the Intentional Hand Task (IHT). Results The results showed markedly enhanced premature responses in the MMT vs. the HV group, which correlated positively with methadone dosage in the MMT patients. Throughout the task, MMT patients were faster across all trial parts and less accurate in response to instructed trials compared to HVs. Conclusions The increase in premature motor reactions during variable waiting periods alongside increased motion speed and lower accuracy might reflect a specific motor inhibition deficit in MMT, a subcomponent of impulsivity not previously assessed in MMT. Incorporating an experimentally defined measure of impulsivity, such as premature responding, into existing test batteries used by clinicians might enable more tailored treatments addressing the increased impulsivity levels and associated dysfunctional behaviors in MMT.

Socially Mediated Shift in Neural Circuits Activation Regulated by Synergistic Neuromodulatory Signaling.

Animals exhibit context-dependent behavioral decisions that are mediated by specific motor circuits. In social species these decisions are often influenced by social status. Although social status-dependent neural plasticity of motor circuits has been investigated in vertebrates, little is known of how cellular plasticity translates into differences in motor activity. Here, we used zebrafish (Danio rerio) as a model organism to examine how social dominance influences the activation of swimming and the Mauthner-mediated startle escape behaviors. We show that the status-dependent shift in behavior patterns whereby dominants increase swimming and reduce sensitivity of startle escape while subordinates reduce their swimming and increase startle sensitivity is regulated by the synergistic interactions of dopaminergic, glycinergic, and GABAergic inputs to shift the balance of activation of the underlying motor circuits. This shift is driven by socially induced differences in expression of dopaminergic receptor type 1b (Drd1b) on glycinergic neurons and dopamine (DA) reuptake transporter (DAT). Second, we show that GABAergic input onto glycinergic neurons is strengthened in subordinates compared with dominants. Complementary neurocomputational modeling of the empirical results show that drd1b functions as molecular regulator to facilitate the shift between excitatory and inhibitory pathways. The results illustrate how reconfiguration in network dynamics serves as an adaptive strategy to cope with changes in social environment and are likely conserved and applicable to other social species.

The Effect of Motor Relearning Program on Daily Living Activity and Dynamic Balance in Non-Hemorrhagic Post Stroke Hemiparese Patients at Grandmed Lubuk Pakam Hospital

Stroke is a functional disorder of the brain that can occur suddenly or abruptly with focal or global neurological signs that can last 24 hours or more (if no surgery or death occurs) without any signs of non-vascular causes, which include signs of subarachnoid hemorrhage, intracerebral hemorrhage, ischemia or cerebral infarction. This can cause disturbances in vital brain functions such as coordination disorders, balance disorders, posture control disorders, sensation disorders and movement reflex disorders, thereby reducing the ability to carry out daily living activities and balance disorders. The motor relearning program method is a program for retraining specific motor controls by avoiding unnecessary or wrong movements that involve cognitive processes, the application of motor and psychological science, training, understanding of nervous anatomy and physiology and is not based on the theory of normal development (neuro development). The research aims to determine the effect of the motor relearning program on daily living activities and dynamic balance disorders in post-stroke patients. The method used in this research is a quasi experiment with one group pretest and post test design. The research sample consisted of 9 people. The samples will be observed and adjusted to the specified criteria so that they do not cause problems. Each respondent was measured 2 (two) times, namely before and after the intervention. Test the hypothesis using the Wilcoxon test. The research results obtained a value of p = 0.000 (p=&lt;0.05), which means there is a significant influence of the motor relearning program intervention on daily living activities and dynamic balance disorders in post-stroke patients. The results of this research can be concluded that the motorbike relearning program can improve daily living activities and dynamic balance disorders in patients after non-hemorrhagic stroke. It is hoped that the results of this research can contribute to health services for the community in overcoming the problems of daily living activities and dynamic balance disorders in post-stroke patients.

Parkinsonism and Its Clinical Subtypes - An Observational Study in a Tertiary Care Hospital

Background: The term Parkinsonism is defined by any combination of six specific motor features: tremors at rest, bradykinesia, rigidity, loss of postural reflexes, flexed posture, and the freezing phenomenon (where the feet are transiently “glued to the ground”). Not all six of these cardinal features need be present, but at least two should be before the diagnosis of Parkinsonism is made, with at least one of them being tremors at rest or bradykinesia. This study is a hospital based Observational study to understand the prevalence and rank order of subtypes of Parkinsonism. Material and Method: Subjects are enrolled after written and informed consent. Details were recorded in a predesigned proforma after detailed history and clinical examination. If the patient was found to have akinetic rigid state/features of Parkinsonism, detailed history relevant to various Parkinsonian syndromes were taken to know the kind of Parkinsonian syndrome he/she belongs to. Standard criteria of each of the Parkinsonian syndromes are applied to confirm about the type of Parkinsonian syndrome the patient is suffering with. Data entered and analysed in Microsoft Excel 2007 and presented in the form of frequencies and percentages. Results: The prevalence of Parkinsonism in this study is 42 per 10000 population. The different types of Parkinsonism in the order high to low are Idiopathic Parkinson’s Disease (62.50%), Progressive Supranuclear Palsy (16.67%), Vascular Parkinsons Disease (12.50%), Multi System Atrophy (3.33%), Cortico-Basal Degeneration (2.50%), Drug induced Parkinsons Disease (1.67%) and Dementia with LewyBodies (0.83%). Conclusions: A total of 120 patients were found to have features of Parkinsonism out of 28800 patients. The prevalence of Parkinsonism in this study is 42 per 10000 population.

Degenerative cervical myelopathy: establishing severity thresholds for neuromotor dysfunction in the aging spine using the NIH Toolbox Assessment Scale.

Degenerative cervical myelopathy (DCM) is a leading cause of age-related non-traumatic spinal cord disorders resulting from chronic degeneration of the cervical spine. While traditional clinical assessments rely on patient-reported measures, this study used the NIH Toolbox Motor Battery (NIHTBm) as an objective, quantitative measure to determine DCM severity. The objective is to define NIHTBm cutoff values that can accurately classify the severity of DCM neuromotor dysfunction. A case-controlled pilot study of patients with DCM and age-matched controls. The focus was an in-depth quantitative motor assessment using the NIHTBm to understand the severity of neuromotor deficits due to degenerative spine disease. Motor assessments, dexterity, grip strength, balance, and gait speed were measured in 45 DCM patients and 37 age-matched healthy subjects (HC). Receiver operating curve (ROC) analysis determined cutoff values for mild and moderate-to-severe myelopathy which were validated by comparing motor assessment scores with disability scores. The ROC curves identified thresholds for mild dexterity impairment (T-score range 38.4 - 33.5, AUC 0.77), moderate-to-severe dexterity impairment (< 33.5, AUC 0.70), mild grip strength impairment (47.4 - 32.0, AUC 0.80), moderate-to-severe grip strength impairment (< 32.0, AUC 0.75), mild balance impairment (36.4 - 33.0, AUC 0.61), and moderate-to-severe balance impairment (< 33.0, AUC 0.78). Mild gait speed impairment was defined as 0.78-0.6m/sec (AUC 0.65), while moderate-to-severe gait speed impairment was < 0.6m/sec (AUC 0.65). The NIHTB motor score cutoff points correlated negatively with the DCM neck disability index (NDI) and showed balance and dexterity measures as independent indicators of DCM dysfunction. The use of NIHTB allows for precise delineation of DCM severity by establishing cutoff values corresponding to mild and moderate-to-severe myelopathy. The use of NIHTB in DCM allows enhanced clinical precision, enabling clinicians to better pinpoint specific motor deficits in DCM and other neurological disorders with motor deficits, including stroke and traumatic brain injury (TBI). Furthermore, the utility of objective assessment, NIHTB, allows us to gain a better understanding of the heterogeneity of DCM, which will enhance treatment strategies. This study serves as a foundation for future research to facilitate the discovery of innovative treatment strategies for DCM and other neurological conditions.

Transcriptional control of motor pool formation and motor circuit connectivity by the LIM-HD protein Isl2.

The fidelity of motor control requires the precise positional arrangement of motor pools and the establishment of synaptic connections between them. During neural development in the spinal cord, motor nerves project to specific target muscles and receive proprioceptive input from these muscles via the sensorimotor circuit. LIM-homeodomain transcription factors are known to play a crucial role in successively restricting specific motor neuronal fates. However, their exact contribution to limb-based motor pools and locomotor circuits has not been fully understood. To address this, we conducted an investigation into the role of Isl2, a LIM-homeodomain transcription factor, in motor pool organization. We found that deletion of Isl2 led to the dispersion of motor pools, primarily affecting the median motor column and lateral LMC (LMCl) populations. Additionally, hindlimb motor pools lacked Etv4 expression, and we observed reduced terminal axon branching and disorganized neuromuscular junctions in Isl2-deficient mice. Furthermore, we performed transcriptomic analysis on the spinal cords of Isl2-deficient mice and identified a variety of downregulated genes associated with motor neuron (MN) differentiation, axon development, and synapse organization in hindlimb motor pools. As a consequence of these disruptions, sensorimotor connectivity and hindlimb locomotion were impaired in Isl2-deficient mice. Taken together, our findings highlight the critical role of Isl2 in organizing motor pool position and sensorimotor circuits in hindlimb motor pools. This research provides valuable insights into the molecular mechanisms governing motor control and its potential implications for understanding motor-related disorders in humans.