INFECTIOUS MOTOR PARALYSIS IN YOUNG RABBITS

1. The attempt to infect young rabbits and guinea pigs with material containing in all probability the virus of human infantile paralysis failed. 2. Failure to infect the primary animals almost of necessity brought failure with the secondary flea-bitten animals. It is, however barely conceivable that a non-infectious form of an organism might circulate in the blood of the primary animal and that this form, through development in an intermediate host, the flea, might become virulent for the secondary flea-bitten animal. 3. Incidentally, and presumably accidentally, a paralytic disease was observed in young rabbits associated with the presence of an organism showing certain definite characters. So far as we know this paralysis and the associated organism have not been previously described. 4. This organism is found widely distributed in the organs of the affected animals and can be demonstrated in the urine. The active destruction by the organism of the nerve cells of the spinal cord is particularly striking, and gives complete explanation for the paralysis observed clinically. 5. With the organism present in the urine the spread of the disease by contact can be easily understood. 6. The transfer of the infection from animal to animal by fleabites is possible but not probable. 7. The nature of the observed organisms is in doubt. They represent probably an intermediate stage in the life history of some protozoan parasite.     

BONE QUALITY IN ADULTS WITH SEVERE MOTOR AND INTELLECTUAL DISABILITIES

ObjectiveTo determine bone quality in adults with severe motor and intellectual disabilities.DesignA retrospective cohort study.PatientsBone quality of 60 patients with severe motor and intellectual disabilities (28 men, 32 women; mean age 57 years) at a long-term care facility for adults was examined retrospectively.MethodsQuantitative ultrasonography was used to measure the stiffness index, T-score and Z-score of the calcaneus. A multiple linear regression model, including sex, age, anti-epileptic drug use, tube-feeding status, and current and peak physical abilities, was used to identify significant predictors of T-scores.ResultsQuantitative ultrasonography revealed that all patients had lower bone quality (based on T-scores, Z-scores, and stiffness index), and all patients had T-scores with standard deviations (SD) below 1.8. Current physical ability, age, and anti-epileptic drug use were significant factors in T-score determination, while tube-feeding and peak physical ability were not. The ability to walk without assistance was the most significant predictor in quantitative ultrasonography.ConclusionSeverely low bone quality is observed in patients with severe motor and intellectual disabilities; and it is strongly associated with current physical activity. It is important that patients with severe motor and intellectual disabilities preserve their physical abilities to prevent osteoporosis- related fractures.LAY ABSTRACTFractures are common in adults with severe motor and intellectual disabilities. This study assessed the bone quality of 60 individuals from young adult to advanced age. All patients had low bone quality from a young age, and current physical ability, age, and anti-epileptic drug use were factors affecting bone quality, while tube-feeding and peak physical ability were not. Severely low bone quality in patients with severe motor and intellectual disabilities is strongly associated with current physical activity levels. It is very important for patients with severe motor and intellectual disabilities to increase and preserve their physical activities and abilities, respectively, to prevent osteoporosis-related fractures.Key words: osteoporosis, disabled person, physical ability, ageing, bone quality, fracture, anti-epileptic drug, ultrasound

The high rate of osteoporosis in children and adults with severe motor and intellectual disabilities (SMID) is an established problem, with a reported yearly incidence of fractures of approximately 2–3% among institutionalized patients, with differences among institutions (1,2). In cases involving primary osteoporosis, lower levels of female hormones during the postmenopausal stage in female patients increase the rate of bone resorption, resulting in decreased bone density (3). In patients with SMID, bone quality examined by quantitative ultrasonography (QUS) does not increase with growth and remains low throughout the person’s lifetime (4).Use of anti-epileptic drugs, palsy type, gait dysfunction, and low bone density have been reported as risk factors for fractures in patients with cerebral palsy (CP) (5). Stevenson et al. observed that higher body fat, gastrostomy, and previous fractures also increased the risk of future fractures (6). Mergler et al. observed that eating disorders, previous fractures, and thinness of subcutaneous fat were risk factors for fractures in patients with CP (7). Secondary osteoporosis in the context of SMID is modulated by factors other than those affecting primary osteoporosis; the most probable cause of low bone quality in such patients is physical ability related to skeletal unloading (8).Progressive medical advances and increasing knowledge of the management of CP have helped individuals with CP to live longer with their impairments (9, 10). The mean age of patients with SMID in Japan has increased steadily as a result of patient ageing under the advanced medical care that became well-established in many institutions in the 1960s, although the individual survival rate of patients housed in public and private institutions in Japan has not improved since the 1960s (11). Throughout an individual’s lifespan, physical abilities change, not only in the growth stage, but also in the ageing stage. This suggests the need to consider possible changes in the bone quality of patients with SMID.There is limited research on osteoporosis in elderly patients with SMID. The aim of this study was to measure the bone quality of elderly adults with SMID and identify factors associated with bone quality, in order to determine the appropriate treatment approach to prevent fractures in patients with SMID.     

EFFECTIVENESS OF A MOTOR CONTROL THERAPEUTIC EXERCISE PROGRAM COMBINED WITH MOTOR IMAGERY ON THE SENSORIMOTOR FUNCTION OF THE CERVICAL SPINE: A RANDOMIZED CONTROLLED TRIAL

Background

Motor control therapeutic exercise (MCTE) for the neck is a motor relearning program that emphasizes the coordination and contraction of specific neck flexor, extensor, and shoulder girdle muscles. Because motor imagery (MI) improves sensorimotor function and it improves several motor aspects, such as motor learning, neuromotor control, and acquisition of motor skills, the authors hypothesized that a combination of MCTE and MI would improve the sensorimotor function of the cervical spine more effectively than a MCTE program alone.

Purpose

The purpose of this study was to investigate the influence of MI combined with a MCTE program on sensorimotor function of the craniocervical region in asymptomatic subjects.

Study Design

This study was a single‐blinded randomized controlled trial.

Methods

Forty asymptomatic subjects were assigned to a MCTE group or a MCTE+MI group. Both groups received the same MCTE program for the cervical region (60 minutes), but the MCTE+MI group received an additional intervention based on MI (15 minutes). The primary outcomes assessed were craniocervical neuromotor control (activation pressure value and highest pressure value), cervical kinesthetic sense (joint position error [JPE]), and the subjective perception of fatigue after effort.

Results

Intra‐group significant differences were obtained between pre‐ and post interventions for all evaluated variables (p<0.01) in the MCTE+MI and MCTE groups, except for craniocervical neuromotor control and the subjective perception of fatigue after effort in the MCTE group. In the MCTE+MI group a large effect size was found for craniocervical neuromotor control (d between ‐0.94 and ‐1.41), cervical kinesthetic sense (d between 0.97 and 2.14), neck flexor muscle endurance test (d = ‐1.50), and subjective perception of fatigue after effort (d = 0.79). There were significant inter‐group differences for the highest pressure value, joint position error (JPE) extension, JPE left rotation, and subjective perception of fatigue after effort.

Conclusion

The combined MI and MCTE intervention produced statistically significant changes in sensorimotor function variables of the craniocervical region (highest pressure value, JPE extension and JPE left rotation) and the perception of subjective fatigue compared to MCTE alone. Both groups showed statistically significant changes in all variables measured, except for craniocervical neuromotor control and the subjective perception of fatigue after effort in the MCTE group

Level of Evidence

1b     

运动皮层电刺激治疗卒中后中枢性疼痛的疗效分析

目的:评价运动皮层电刺激(motor cortex stimulation,MCS)治疗卒中后中枢性疼痛(central post stroke pain,CPSP)的疼痛缓解情况及生活质量改善情况。方法:随访2005年2月至2013年7月于首都医科大学宣武医院功能神经外科行MCS治疗的CPSP患者17例,记录患者术前及术后2周的疼痛视觉模拟评分(Visual Analogue Scale,VAS)和术后2周、3月、6月、1年及最后随访时间的疼痛缓解率(0%~100%);采用SF-36生活质量评分量表(Short Form-36)来评价患者手术前后的生活质量情况;疼痛缓解≥25%认为手术有效。结果:术前患者VAS评分为9.3±0.6,术后2周时为4.9±2.3,术后较术前相比有显著差异(P<0.001);手术后2周时有效的患者占82.4%,3月时有效的患者占64.7%,6月时有效的患者占56.3%,1年时有效的患者占40.0%,最后随访时间时有效的患者占33.3%;随访到9例患者完整的生活质量情况,术后较术前有显著改善(P=0.02)。结论:MCS治疗CPSP有效,并能改善大部分患者的生活质量;MCS具有创伤小、并发症少等优点;术后刺激参数的调节对疗效的影响至关重要。     

DIAPHRAGMATIC PARALYSIS IN MOTOR NEURONE DISEASE: USE OF NON-INVASIVE INVESTIGATIVE AND THERAPEUTIC TECHNIQUES

SUMMARY Two cases of bilateral diaphragmatic weakness are described in which the condition was the presenting feature of motor neurone disease. Inspiratory muscle strength was assessed by a non-invasive technique involving measurements of pressures generated within the mouth. One patient with severe inspiratory muscle weakness is being treated with domiciliary nasal ventilation and has returned to a good-quality life. The other patient with less severe weakness has thus far required no ventilatory support.     

INHIBITION OF THE COLONIC MOTOR RESPONSE TO EATING BY PINAVERIUM BROMIDE IN IRRITABLE BOWEL SYNDROME PATIENTS

The effect of pinaverium bromide on the colonic motor response to eating was investigated in 10 irritable bowel syndrome patients, by means of an intraluminal probe supporting 8 groups of electrodes. At each site examined from transverse to sigmoid colon, the electromyograms exhibited 2 kinds of spike bursts: short spike bursts (SSB) localized at one electrode, and long spike bursts (LSB), isolated, propagated orally or aborally over a few centimeters, or aborally propagated over the whole length of the colon investigated (migrating long spike bursts, MLSB). Recordings were continuously performed over 24 hr. Each patient received at 7.00 p.m. on day 1 and at noon on day 2 an 800-1000 Kcal meal preceded by IV administration of pinaverium bromide (4 mg) or placebo. After placebo administration, the duration of LSB activity and the number of MLSB were significantly increased over 3 postprandial hr by comparison with the 2 hr preceding the meal. After pinaverium injection no significant postprandial change in LSB and MLSB activity was noted. The SSB activity was not modified after the meals preceded by placebo or pinaverium injection. These results suggest that the inhibitory action of pinaverium bromide on postprandial colonic motility may support the clinical efficacy of this agent in the treatment of the irritable bowel syndrome.     

MANOMETRIC STUDY OF THE ACTIVITY OF ALIZAPRIDE ON THE MOTOR FUNCTION OF THE HUMAN SPHINCTER OF ODDI

Alizapride is a potent antiemetic, acting as a dopamine receptor antagonist on the chemoreceptor trigger zone with few gastrokinetic properties. Little is known of its activity on the human sphincter of Oddi (SO). The aim of this study was to assess the effect of alizapride on SO motor function and to evaluate a possible use of alizapride in premedication for endoscopy of the upper digestive tract. We selected ten patients who underwent retrograde cholangiopancreaticography, but had no evidence of biliary or pancreatic disease. Endoscopic manometry was applied before and for 10 min after administration of alizapride 100 mg i.v. No significant modification of basal pressure or phasic activity was observed. Alizapride can be proposed as an antiemetic in patients with biliary disorders.