Changes in sensory function and force production in adults with type II diabetes

Introduction: The purpose of this study was to evaluate the relationship among sensory function, disease severity, and upper extremity force production in adults with type II diabetes (T2D) as compared with healthy age‐ and gender‐matched controls. Methods: Ten adults with T2D and 10 healthy age‐ and gender‐matched control subjects underwent a battery of sensory and motor function evaluations. Data on disease severity and duration were also collected. Results: The T2D group exhibited sensory deficits and altered force production as compared with healthy controls. Sensory function correlated with disease severity, as did signal predictability of kinetic output during submaximal force production tasks. Maximal force production tasks were associated with altered output in T2D, but these data did not correlate with disease severity or sensory dysfunction. Conclusions: Some, not all, motor performance deficits in T2D are associated with sensory dysfunction. Mechanisms responsible for these changes in adult‐onset T2D are described. Muscle Nerve 50: 984–990, 2014     

The post-stroke upper limb improvement effort survey (IMPETUS): a survey of individuals with chronic stroke

Background: There is a considerable literature on arm/hand dysfunction post stroke, but little information on the participants’ opinions about perceived and desired arm/hand strength, recovery, and function.

Objective: The objective of this study was to examine the perceptions of individuals with stroke about arm/hand function and training devices.

Methods: A 69-item survey was developed addressing: activity before and after stroke, involved arm/hand function, willingness to use a training device, and important device characteristics. The survey included items from the Hand Function and Strength Subscales of the Stroke Impact Scale (SIS). Face validity was established by physical therapists and individuals with stroke. The survey was administered via phone and online.

Results: 852 registry participants were recruited. Ninety-seven responded; 83 completed the survey. Subjects were 51 males, 31 females; mean age: 65 (25–95); meantime since stroke: 13 years (1–34; SD 6.678). There was a statistically significant difference between perceived and desired arm/hand strength, recovery, and function p<0.0001. Impairment factors, such as weakness and spasticity were greater barriers to recovery than socio-economic ones. Most participants (94%) were willing to use a device; functional gains during/following use were the most important characteristics.

Limitations: Participants had greater arm impairment and were more chronic than other studies.

Conclusions: Participants desired more arm/hand strength, function, and recovery that they perceived they had achieved. Impairment – level factors posed more barriers to arm recovery than socioeconomic ones. Most participants were interested in using arm/hand training devices; the most important device characteristic is functional gain.     

Effect of object transport on grasp coordination in multiple system atrophy.

We examined the effects of the parkinsonian variant of multiple-system atrophy (MSA-P) on grasp and forward transport and release of an object. Twelve patients with MSA-P and 10 age-matched control subjects performed the task with each of three object weights (200, 400, 800 gm). Subjects moved at a self-selected pace using a precision grip. The grip (normal) and load (tangential) forces and the object position were recorded. Results indicate subjects with MSA-P have temporal and force coordination deficits. Temporal delays were seen in all subjects with MSA-P, leading to prolonged overall movement times compared to control subjects. These delays occurred throughout the task, with significantly longer transport phases and delays releasing the object. Despite demonstrating an appropriate anticipatory scaling of forces, with increasing grip and load forces for heavier weights, force coordination was compromised in subjects with MSA-P. These subjects generated significant negative load forces prior to transporting the object. In addition, during the transport phase, subjects with MSA-P generated highly variable grip forces. Overall, the results indicate that subjects with MSA-P demonstrate bradykinesia and difficulty coordinating components of an object transport task.     

Changes in motor function in the unaffected hand ol stroke patients should not be ignored

Motor function changes in the unaffected hand of stroke patients with hemiplegia. These changes are often ignored by clinicians owing to the extent of motor disability of the affected hand. Finger tapping frequency and Lind-mark hand function score showed that the motor function of unaffected hands in stroke patients was poorer than that of a healthy control hand. After 2 weeks of rehabilitation treatment, motor function of the unaffected hand of stroke patients was obviously improved. Therefore, attention should also be paid to motor function in the unaffected hand of stroke patients with hemiplegia during rehabilitation.     

Dance-based exergaming for upper extremity rehabilitation and reducing fall-risk in community-dwelling individuals with chronic stroke. A preliminary study

Background: Post-stroke, individuals demonstrate persistent upper extremity (UE) motor impairments that impact functional movements and change-in-support strategies essential for recovery from postural instability. OBJECTIVES: This study primarily aims to quantify the effect of dance-based exergaming (DBExG) intervention on improving paretic UE movement control. The secondary aim is to assess if these improvements in UE movement control if observed, could partially account for improved fall-risk.

Methods: Thirteen adults with chronic stroke received DBExG training using the commercially available Kinect dance gaming “Just Dance 3”. Surface electromyography of shoulder muscle activity during the stand-reaching task and UE shoulder kinematics for a dance trial were recorded. Changes in balance control were determined using the Activities-specific Balance Confidence scale [ABC] and Timed-Up-and-Go test [TUG].

Results: Post-training, participants demonstrated improvements in shoulder muscle activity in the form of performance (reaction time, burst duration, and movement time) and production outcomes (peak acceleration) (p < .05). There was also a post-training increase in shoulder joint excursion (Ex) and peak joint angles (∠) during dance trials (p < .05). Participants exhibited positive post-intervention correlations between ABC and shoulder joint Ex [R² of 0.43 (p < .05)] and between TUG and peak joint ∠ [R² of 0.51 (p < .05)]. CONCLUSION: Findings demonstrated the beneficial effect of DBExG for improving UE movement and the training-induced gains were also positively correlated with improvements in fall-risk measures in people with chronic stroke. Thus, DBEx training could be used as a meaningful clinical application for this population group.     

Botulinum toxin type A injections in the spastic upper extremity of children with hemiplegia: child characteristics that predict a positive outcome

Evidence is increasing to suggest that botulinum toxin type A (BTX-A) plays a role in the management of upper extremity spasticity in the paediatric population. However, little information is available on the clinical characteristics of the child that predict a response to this intervention. Our research group previously published a randomized controlled trial demonstrating that BTX-A injection improves function of the upper extremity of children with spastic hemiplegia. In the present paper, we evaluate the child characteristics that predict a positive response to the BTX-A injections in the randomized treatment group. The treatment group was divided into positive functional responders and nonresponders using a cut score of a change of 10 points on the Quality of Upper Extremity Skills Test (QUEST). A two-way analysis of variance procedure was done comparing the following baseline characteristics: function as scored on the QUEST and the Pediatric Evaluation of Disability Inventory (PEDI) self-care domain, grip strength, upper extremity spasticity and age. Grip strength was significantly higher in responders with a P -value of 0.001. Young age approached significance with a P -value of 0.05. Correlation of change scores on the QUEST with baseline characteristics in the treatment group yielded similar results. BTX-A causes a reduction in spasticity and strength; we postulate that if the hand is weak initially, BTX-A can decrease hand function. Two case reports are presented that highlight the importance of grip strength and age.     

Patient reported outcomes of hand function three years after stroke

Objective: To comprehensively describe hand function and associated factors among stroke survivors by means of the Michigan Hand Outcomes Questionnaire (MHQ; 6 domains; score 0–100, worst–best).

Methods: In this cross-sectional study, stroke patients were invited to complete a set of questionnaires on hand function, socio-demographic characteristics, mental functioning, daily activities, quality of life, and caregiver strain. Stroke characteristics were collected retrospectively from medical records. Multiple linear regression analysis adjusted for age, sex, and duration of follow-up was used to identify factors associated with MHQ score.

Results: 207 out of 576 eligible patients responded (36%); mean age 63.8 years (SD14.2), 125 males (60.4%). Mean time since stroke was 36.3 months (SD9.9). In 85% of the patients, the MHQ Total score was less than 100 points (median 79.9, IQR 63.0–95.8). The median scores of the domains were: overall hand function 75.0, daily activities 90.5, work 85.0, pain 100, appearance 93.8, and satisfaction with hand function 83.3. A lower MHQ Total score was significantly associated with a lower Barthel Index at hospital discharge, a lower level of education, a supratentorial stroke and with unfavorable outcomes regarding physical and mental functioning, quality of life, and caregiver strain.

Conclusion: Patients can perceive limitations on several domains with respect to hand function 2–5 years after stroke. Problems related to the appearance of the hand and satisfaction with hand function can be relevant and should be considered accordingly. Persistent hand problems after stroke are related to a more severe, supratentorial stroke in lower educated patients.     

Manual and hemispheric asymmetries in the execution of actual and pantomimed prehension

Impairments of the ipsilesional hand after brain damage have been reported in goal-directed motor acts and in pantomimes; the relationship between both movement conditions is largely unknown. In the presented study, pantomimed and actual prehension was examined in 29 stroke patients with left brain damage (LBD) or right brain damage (RBD) as well as in 21 control subjects. Kinematic analyses revealed various performance differences between the conditions of movement execution and the subject groups. The differences depended on the hand tested and on the side of the brain lesion. During actual prehension deviations from normal performance were obvious in the peak velocity of the transport component of the movement, which was reduced in RBD patients, and in the duration of the final adjustment phase, which was prolonged in both patient groups. Pantomime changed various features of movement execution. The transport component was particularly altered in the groups performing with the right hand. Hand aperture was significantly smaller during pantomime than during actual movement execution in all groups. However, this effect was particularly obvious in LBD patients, in whom the hand aperture was even completely absent during many of their pantomimes. Actual movement execution immediately preceding the pantomimes did not change the characteristic features of pantomimes. Thus, the cerebral processes for actually executed and pantomimed motor acts differ. Actual movements seem to be governed by external affordances and constraints; whereas, pantomimes may represent a symbolic act. During prehension, differences in grip formation reveal most directly this dichotomy. We argue that the left hemisphere plays a special role in the generation of the symbolic act; a lesion may abolish grip formation and causes the clinical symptom of apraxia.     

Hand tremor and orofacial dyskinesia: Clinical manifestations of glutaric aciduria type I in a young girl

A 16‐year‐old girl with a history of postural hand tremor was investigated. Magnetic resonance imaging, biochemical, enzymatic, and molecular studies demonstrated glutaric aciduria type I (GA1). Now, at 19 years of age, focal dystonia and oral dyskinesia are also present. This is the first reported case of GA1 with such clinical phenotype. © 2003 Movement Disorder Society     

Patients with hyperhidrosis have changed grip force, coefficient of friction and safety margin

Objective –  To evaluate whether subjects with palmar hyperhidrosis have functional problems with the handgrip caused by the wet slippery surface of palm and fingertips. We used two different dosages of botulinum toxin to explore its impact on sweating and on muscle strength in the hand.
Method –  Using an object equipped with force sensors we measured the muscle strength and calculated the coefficients of friction and safety margin (SM) in the precision grip before and 2, 4, 6, 8 10–12 weeks and 6 months after treatment of 13 patients with two different doses of botulinum toxin. Sweat evaporation was measured simultaneously.
Results –  A significant decrease in evaporation and a parallel reduction of grip force in the dominant hand of the patients were observed. The SM used by the patients was significantly lower after the treatment, and increased gradually when sweating reappeared.
Conclusion –  These measurements showed, for the first time, that hyperhidrosis of the palms may cause an objective perturbation of the hand function which may be partially corrected by botulinum toxin treatment.     

Functional and cognitive variables predicting successful use of chopsticks or a spoon by the paretic upper extremity in patients following stroke: a cross-sectional study

Background: The factors necessary for successful use of chopsticks or a spoon, by patients with a paretic upper extremity (UE) following stroke are unknown.

Objectives: We identified the functional capacities and interactions related to chopsticks or spoon use in patients with right hemiplegia following stroke.

Methods: Participants were 139 stroke patients with right hemiplegia who required rehabilitation, divided into the following three categories: able to use chopsticks, able to use a spoon, or unable to use a spoon. We collected sociodemographic data, medical data, physical and cognitive function data, and functional grades associated with chopsticks or spoon use by the paretic dominant UE while eating. We identified a complex interaction of variables relating to functional use of chopsticks or a spoon using a classification and regression tree analytic process.

Results: Patients with UE Brunnstrom recovery stage (BRS) >IV, and a Hasegawa Dementia Scale – Revised (HDS-R) score >16 had a 91.3% probability of being able to use chopsticks. Moreover, patients with a UE BRS of >IV, and the HDS-R score ≤16 had a 66.7% probability of being able to use a spoon. By contrast, patients with a UE BRS of ≤IV had a 90.5% probability of not being able to use a spoon.

Conclusions: The interaction of BRS as a measure of UE function and HDS-R score as a measure of cognitive function affect the ability of patients with stroke histories to functionally use the paretic UE to operate chopsticks or a spoon.     

POWER training in chronic stroke individuals: differences between responders and nonresponders

Background: Lower extremity muscle weakness is a primary contributor to post-stroke dysfunction. Resistance training is an effective treatment for hemiparetic weakness and improves walking performance. Post-stroke subject characteristics that do or do not improve walking speed following resistance training are unknown.

Objective: The purpose of this paper was to describe baseline characteristics, as well as responses to training, associated with achieving a minimal clinically important difference (MCID) in walking speed (≥0.16 m/s) following Post-stroke Optimization of Walking Using Explosive Resistance (POWER) training.

Methods: Seventeen participants completed 24 sessions of POWER training, which included intensive progressive leg presses, jump training, calf raises, sit-to-stands, step-ups, and over ground fast walking. Outcomes included SSWS, FCWS, DGI, FMA-LE, 6-MWT, paretic knee power, non-paretic knee power, and paretic step ratio.

Results: Specific to those who reached MCID in SSWS (e.g. “responders”), significant improvements in SSWS, FCWS, 6-MWT, paretic knee power, and non-paretic knee power was realized. Paretic knee power and non-paretic knee power significantly improved in those who did not achieve MCID for gait speed (e.g. “non-responders”).

Conclusion: The potential for POWER training to enhance general locomotor function was confirmed. Baseline paretic knee strength/power may be an important factor in how an individual responds to this style of training. The lack of change within the non-responders emphasizes the contribution of factors other than lower extremity muscle power improvement to locomotor dysfunction.     

精神分裂症免疫功能与血清5-羟色胺的研究

目的:研究阴性型和阳性型精神分裂症患者免疫功能和神经生化物质改变情况及其变化规律.方法:选择阴性型和阳性型精神分裂症患者各20例以及20名正常对照者,抽取静脉血检测T细胞亚群,主要免疫球蛋白和补体C3、C4水平,和血清5-羟色胺(5-HT)水平.结果:阴性型精神分裂症患者CD 3下降,阳性型CD 3、CD 4则升高;IgG、IgA水平2种类型精神分裂症患者均显著降低;5-HT水平阳性型精神分裂症患者显著升高,阴性型精神分裂症患者显著降低.结论:精神分裂症患者伴随有免疫功能的改变,不同类型的精神分裂症其免疫应答参与机制也有不同.     

Validating accelerometry as a measure of physical activity and energy expenditure in chronic stroke

Background: Accelerometers can objectively measure steps taken per day in individuals without gait deficits, but accelerometers also have the ability to estimate frequency, intensity, and duration of physical activity. However, thresholds to distinguish varying levels of activity intensity using the Actical brand accelerometer are standardized only for the general population and may underestimate intensity in stroke.

Objective: To derive Actical activity count thresholds specific to stroke disability for use in more accurately gauging time spent at differing activity levels.

Methods: Men (n = 18) and women (n = 10) with chronic hemiparetic gait (4 ± 2 years latency, 43% Caucasian, 56% African-American, ages of 47–83 years, BMI 19–48 kg/m²) participated in the study. Actical accelerometers were placed on the non-paretic hip to obtain accelerometry counts during eight activities of varying intensity: (1) watching TV; (2) seated stretching; (3) standing stretching; (4) floor sweeping; (5) stepping in place; (6) over-ground walking; (7) lower speed treadmill walking (1.0 mph at 4% incline); and (8) higher speed treadmill walking (2.0 mph at 4% incline). Simultaneous portable monitoring (Cosmed K4b2) enabled quantification of energy cost for each activity in metabolic equivalents (METs, or oxygen consumption in multiples of resting level). Measurements were obtained for 10 min of standard rest and 5 min during each of the eight activities.

Results: Regression analysis yielded the following new stroke-specific Actical minimum thresholds: 125 counts per minute (cpm) for sedentary/light activity, 667 cpm for light/moderate activity, and 1546 cpm for moderate/vigorous activity.

Conclusion: Our revised cut points better reflect activity levels after stroke and suggest significantly lower thresholds relative to those observed for the general population of healthy individuals. We conclude that the standard, commonly applied Actical thresholds are inappropriate for this unique population.     

Fine motor function and neuropsychological deficits in individuals at risk for schizophrenia

Deficits in fine motor function and neuropsychological performance have been described as risk factors for schizophrenia. In the Basel FEPSY study (Früherkennung von Psychosen; English: Early Detection of Psychosis) individuals at risk for psychosis were identified in a screening procedure (Riecher–Rössler et al. 2005). As a part of the multilevel assessment, 40 individuals at risk for psychosis and 42 healthy controls matched for age, sex and handedness were investigated with a fine motor function test battery and a neuropsychological test battery. Individuals at risk showed lower performances in all subtests of the fine motor function tests, predominantly in dexterity and velocity (wrist/fingers and arm/hand). In the neuropsychological test battery, individuals at risk performed less well compared to healthy controls regarding sustained attention, working memory and perseveration. The combined evaluation of the two test batteries (neuropsychological and fine motor function) separates the two groups into individuals at risk and healthy controls better than each test battery alone. A multilevel approach might therefore be a valuable contribution to detecting beginning schizophrenia.     

奥氮平和氯氮平对慢性精神分裂症的认知功能的影响

目的了解奥氮平和氯氮平对慢性精神分裂症患者的认知功能的影响。方法78例经典型抗精神病药物治疗疗效不显著或不能耐受不良反应的慢性精神分裂症患者随机替换为奥氮平及氯氮平治疗,分别在入组前、12周、6个月进行PANSS量表评定、认知功能测定,包括言语学习、记忆、注意、执行功能、精神运动。结果奥氮平组32例和氯氮平组34例完成了6个月的治疗,这些患者疗程结束时均显示精神症状显著改善,认知功能显著提高,表现为言语流畅性、言语学习、言语视觉记忆、执行功能方面。二者之间无显著差异。结论奥氮平和氯氮平均可改善慢性精神分裂症的认知功能,且二者的疗效相似。     

大鼠癫痫持续状态后认知功能变化模式及海马脑红蛋白表达水平的实验研究

目的观察大鼠癫痫持续状态(SE)后学习记忆功能改变情况及海马组织脑红蛋白(NGB)表达水平,探讨癫痫发作对认知功能影响的可能机制。方法健康成年雄性SD大鼠40只,随机分为对照组(n=5)、癫痫模型实验组(n=35),模型组再依据观察时间分为:0 h、1 h、3 h、12 h、24 h、10 d、30 d。应用氯化锂-匹罗卡品(Li-Pilo)建立SE模型,观察致痫期间大鼠行为学变化;采用Nissl染色检测神经元损伤情况;SABC免疫组化法检测NGB表达水平。同时随机选取同期相同品系SD大鼠40只,在造模前及造模后第5d、10 d、15 d、25 d、35 d进行RMT-100迷宫实验,以评价大鼠SE前后学习记忆功能变化情况。结果大鼠SE后,海马CA1、CA3区和DG区均出现不同程度神经元细胞损伤坏死,且NGB表达上调,而海马CA1和CA3区神经元存活数与NGB表达水平呈正相关(r=0.206,P=0.015;r=0.306,P=0.011)。迷宫实验显示工作记忆错误(WME)和参照记忆错误(RME)次数随SE后时间延长均呈递增趋势。相关性分析证实RME次数与CA1和CA3区神经元存活数呈负相关(r=-0.579,P=0.000;r=-0.454,P=0.002),WME次数与CA1和CA3区神经元存活数也呈负相关(r=-0.470,P=0.001;r=-0.507,P=0.000)。结论 SE后NGB表达上调,且与海马组织神经元存活数呈正相关,提示其可能是SE所致缺血缺氧损害的一种代偿神经保护机制。SE后可导致明显认知功能损害,其可能与SE所致海马组织神经元的病理改变相关。     

Disentangling the contribution of the paretic and non-paretic ankle to balance control in stroke patients

During stroke recovery, restoration of the paretic ankle and compensation in the non-paretic ankle may contribute to improved balance maintenance. We examine a new approach to disentangle these recovery mechanisms by objectively quantifying the contribution of each ankle to balance maintenance. Eight chronic hemiparetic patients were included. Balance responses were elicited by continuous random platform movements. We measured body sway and ground reaction forces below each foot to calculate corrective ankle torques in each leg. These measurements yielded the Frequency Response Function (FRF) of the stabilizing mechanisms, which expresses the amount and timing of the generated corrective torque in response to sway at the specified frequencies. The FRFs were used to calculate the relative contribution of the paretic and non-paretic ankle to the total amount of generated corrective torque to correct sway. All patients showed a clear asymmetry in the balance contribution in favor of the non-paretic ankle. Paretic balance contribution was significantly smaller than the contribution of the paretic leg to weight bearing, and did not show a clear relation with the contribution to weight bearing. In contrast, a group of healthy subjects instructed to distribute their weight asymmetrically showed a one-on-one relation between the contribution to weight bearing and to balance. We conclude that the presented approach objectively quantifies the contribution of each ankle to balance maintenance. Application of this method in longitudinal surveys of balance rehabilitation makes it possible to disentangle the different recovery mechanisms. Such insights will be critical for the development and evaluation of rehabilitation strategies.