Effects of movement imitation training in Parkinson's disease: A virtual reality pilot study

BackgroundHypometria is a clinical motor sign in Parkinson's disease. Its origin likely emerges from basal ganglia dysfunction, leading to an impaired control of inhibitory intracortical motor circuits. Some neurorehabilitation approaches include movement imitation training; besides the effects of motor practice, there might be a benefit due to observation and imitation of un-altered movement patterns. In this sense, virtual reality facilitates the process by customizing motor-patterns to be observed and imitated.ObjectiveTo evaluate the effect of a motor-imitation therapy focused on hypometria in Parkinson's disease using virtual reality.MethodsWe carried out a randomized controlled pilot-study. Sixteen patients were randomly assigned in experimental and control groups. Groups underwent 4-weeks of training based on finger-tapping with the dominant hand, in which imitation was the differential factor (only the experimental group imitated). We evaluated self-paced movement features and cortico-spinal excitability (recruitment curves and silent periods in both hemispheres) before, immediately after, and two weeks after the training period.ResultsMovement amplitude increased significantly after the therapy in the experimental group for the trained and un-trained hands. Motor thresholds and silent periods evaluated with transcranial magnetic stimulation were differently modified by training in the two groups; although the changes in the input–output recruitment were similar.ConclusionsThis pilot study suggests that movement imitation therapy enhances the effect of motor practice in patients with Parkinson's disease; imitation-training might be helpful for reducing hypometria in these patients. These results must be clarified in future larger trials.     

Cross-cultural adaptation and evaluation of the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S)

ObjectiveTo cross-culturally adapt and evaluate the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S) in Chilean runners with a running-related injury.DesignCross-cultural adaptation and validation study, following the Consensus-based Standards for selecting health Measurement Instruments (COSMIN) recommendations.SettingOutpatient sports medicine clinic and running clubs.ParticipantsUWRI was forward and backward translated, and culturally adapted. Thirty-one runners participated in the content validity of the UWRI-S; and fifty-seven in the assessment of psychometric properties.Main outcome measuresRunners seeking care from a physiotherapist completed the UWRI-S (baseline and after 48–72 h for reliability), Lower Extremity Functional Scale (LEFS), Patient Specific Functional Scale (PSFS), Global Rating of Change scale (GROC), and Numeric Pain Rating Scale (NPRS).ResultsSuggestions about accuracy of wording and understanding of items were incorporated. UWRI-S showed a positive moderate correlation with LEFS (r = 0.6; p < 0.05), positive fair with GROC (r = 0.5, p < 0.05), negative fair with NPRS (r = −0.4; p < 0.05) and no correlation with PSFS (r = 0.3; p = 0.1). UWRI-S demonstrated acceptable internal consistency (α = 0.87) and test-retest reliability (ICC = 0.87).ConclusionUWRI-S is a valid and reliable measure to evaluate running ability of Chilean runners during recovery from a running-related injury.     

Surgical strategy for the management of sacral giant cell tumors: a 32-case series

Background contextSurgical treatment of sacral giant cell tumors (GCTs) is associated with a high rate of complications, and there is controversy over which type of surgical treatment is optimal.PurposeTo develop an optimal treatment strategy for sacral GCTs.Study design/settingRetrospective/academic medical center.Patient sampleA total of 32 patients (18 women and 14 men) with sacral GCT who underwent surgery between August 1996 and August 2008.Outcome measuresLocal recurrence rate, surgical margins, blood loss, sacral nerve root preservation, and complications.MethodsThe medical charts of 32 patients were reviewed.ResultsPatients underwent either wide resection (n=2), marginal resection (n=11), marginal resection plus curettage (n=12), or curettage alone (n=7). The curettage group and the wide resection group had the highest and lowest amounts of blood loss (4,500 vs. 1,300 mL, respectively). During follow-up (median, 42 months), 12 patients (37.5%) had local recurrence, including five of seven in the curettage group. The recurrence rate was significantly lower in the marginal excision group compared with that in the curettage group (18.2% vs. 71.4%, respectively; p=.049). Five patients had bladder dysfunction, and two patients had bowel dysfunction. Four patients who underwent marginal resection had lower limb dysfunction. Overall survival was 93.6%, and 2-year recurrence-free survival was 84.4%.ConclusionsChoosing an optimal surgical margin in the treatment of sacral GCTs is of great importance for local recurrence control and sacral nerve root preservation. Curettage alone should not be used to treat sacral GCT.     

Screening for Falls and Osteoporosis: Prevention Practice for the Hand Therapist

Fractures of the upper extremity are considered a hallmark of underlying osteopenia or osteoporosis and strong predictors of subsequent fractures. Falling is the strongest single risk factor for fractures in older adults. Studies have shown that interventions to prevent falls can significantly reduce this risk factor. Hand therapists working with patients with an upper extremity injury from a fall cannot assume that screening for osteoporosis or the likelihood of falls has been addressed by other health care professionals. The purposes of this article are to 1) summarize osteoporosis and falls risk screening, 2) describe how fall prevention strategies can be integrated into hand therapy practice, and 3) present evidence for federal and professional organizational support of prevention practice.     

Learning Markov random walks for robust subspace clustering and estimation

Markov Random Walks (MRW) has proven to be an effective way to understand spectral clustering and embedding. However, due to less global structural measure, conventional MRW (e.g., the Gaussian kernel MRW) cannot be applied to handle data points drawn from a mixture of subspaces. In this paper, we introduce a regularized MRW learning model, using a low-rank penalty to constrain the global subspace structure, for subspace clustering and estimation. In our framework, both the local pairwise similarity and the global subspace structure can be learnt from the transition probabilities of MRW. We prove that under some suitable conditions, our proposed local/global criteria can exactly capture the multiple subspace structure and learn a low-dimensional embedding for the data, in which giving the true segmentation of subspaces. To improve robustness in real situations, we also propose an extension of the MRW learning model based on integrating transition matrix learning and error correction in a unified framework. Experimental results on both synthetic data and real applications demonstrate that our proposed MRW learning model and its robust extension outperform the state-of-the-art subspace clustering methods.     

Dynamic neural network-based robust observers for uncertain nonlinear systems

A dynamic neural network (DNN) based robust observer for uncertain nonlinear systems is developed. The observer structure consists of a DNN to estimate the system dynamics on-line, a dynamic filter to estimate the unmeasurable state and a sliding mode feedback term to account for modeling errors and exogenous disturbances. The observed states are proven to asymptotically converge to the system states of high-order uncertain nonlinear systems through Lyapunov-based analysis. Simulations and experiments on a two-link robot manipulator are performed to show the effectiveness of the proposed method in comparison to several other state estimation methods.     

Evaluating health education for oral rehydration therapy at a rural Nigerian Clinic: Part II

An oral rehydration therapy (ORT) unit at a clinic or health centre provides both treatment for children and education for their mothers. This unit concept is an opportunity to develop patient education for diarrhoea management. Such a programme in a rural Nigerian town used interactive small group methods and participatory demonstration to teach mothers how to prepare salt-sugar solution (SSS) as a home-made rehydrative drink. Compared to control mothers who have not been to the unit, the attenders recorded greater awareness, knowledge, skill, and usage of SSS solution and other diarrhoea management concepts. This compares favourably with other oral rehydration education programmes which have relied on mass media, home demonstrations or large group clinic instruction. The core of mothers who have attended the unit can form a foundation for future community outreach effects.