Haemodynamic, hormonal and urinary responses to postural change in tetraplegic and paraplegic man

We have studied the haemodynamic, hormonal and urinary effects of postural change in 6 tetraplegic patients, 6 paraplegic patients and 6 normal subjects. Measurements of blood pressure and heart rate, plasma renin activity, plasma aldosterone, urine volume and electrolyte excretion were made for 60 minutes while sitting and 60 minutes while recumbent. In tetraplegics the blood pressure was lower when sitting and rose during recumbency, unlike paraplegics and normal subjects. Plasma renin activity and aldosterone were higher in tetraplegics when sitting compared to normal subjects and did not fall during recumbency. Urine output increased significantly after recumbency in tetraplegics, but not in paraplegics or normal subjects. Both urinary sodium and potassium excretion were lower in tetraplegics and higher in paraplegics compared to normal subjects when sitting. In paraplegics the fall in both sodium and potassium excretion did not appear to be related to change in posture. Our observations indicate that recumbency induces a diuresis in tetraplegics but not in paraplegics or in normal subjects. The diuresis in tetraplegics may be related to the accompanying haemodynamic and hormonal changes induced by recumbency.     

Ankle dorsiflexion fMRI in children with cerebral palsy undergoing intensive body-weight-supported treadmill training: a pilot study

This pilot study investigated the feasibility of using functional magnetic resonance imaging (fMRI) as a physiological marker of brain plasticity before and after an intensive body-weight-supported treadmill training (BWSTT) program in children with cerebral palsy (CP). Six ambulatory children (four males, two females; mean age 10y 6mo, age range 6-14y) with spastic CP (four hemiplegia, two asymmetric diplegia, all Gross Motor Function Classification System Level I) received BWSTT twice daily for 2 weeks. All children tolerated therapy; only one therapy session was aborted due to fatigue. With training, over ground mean walking speed increased from 1.47 to 1.66m/s (p=0.035). There was no change in distance walked for 6 minutes (pre-: 451m; post-: 458m;p 0.851). In three children, reliable fMRIs were taken of cortical activation pre- and post-intervention. Post-intervention increases in cortical activation during ankle dorsiflexion were observed in all three children. This study demonstrates that children with CP between 6 and 14 years of age can tolerate intensive locomotor training and, with appropriate modifications, can complete an fMRI series. This study supports further studies designed to investigate training-dependent plasticity in children with CP.     

Haemodynamic actions of clonidine in tetraplegia--effects at rest and during urinary bladder stimulation

We studied the haemodynamic effects of clonidine (2 micrograms/kg/iv) in 7 tetraplegics and 7 normal subjects. Measurements of blood pressure, stroke volume, cardiac output and digital (finger) skin blood flow were made before and after clonidine for 60 minutes. Blood pressure, stroke volume and cardiac output did not fall in tetraplegics, unlike normals. Resting digital skin blood flow was higher in tetraplegics and fell after clonidine. In normal subjects however, an increase in digital skin blood flow occurred after clonidine. The pressor and digital vasoconstrictor responses to bladder stimulation were attenuated after clonidine. The inability of clonidine to induce a fall in blood pressure, stroke volume, cardiac output and cause peripheral vasodilation in tetraplegics is consistent with its central sympatholytic effects. Attenuation of the responses to bladder stimulation suggest an effect on spinal sympathetic neurones.     

Conditioned modification of locomotion in Hermissenda crassicornis: analysis of time-dependent associative and nonassociative components

The contribution of associative and nonassociative factors to the conditioned modification of phototactic behavior in Hermissenda was examined after varying the number of conditioning trials and the time between training and testing. Five or 10 conditioning trials did not produce significant changes in phototactic behavior when tested immediately after training. Both 5 and 10 conditioning trials resulted in significant short-term nonassociative changes in behavior (resembling sensitization) when the time between training and testing was 15 min or longer. Following 50 conditioning trials (single session training), nonassociative effects made the major contribution to the change in behavior when the post-training test interval was 30 min. These nonassociative changes decremented during a 1-hr period following training. Significant associative effects were observed 45 min after 50 conditioning trials; however, significant associative effects were not observed when the same animals were tested 24 hr after training. With 3 days of training (multiple session training-150 trials), associative effects were found 30 min after training and nonassociative effects again showed a rapid decrement during the 1-hr period following the end of training. The associative effects observed soon after training were persistent during the retention period and showed significant effects 24 hr after training. These data indicate that (1) the behavioral effects found after single session training (5 and 10 trials) are nonassociative, and (2) these nonassociative effects do not increase significantly over the course of multiple session training.(ABSTRACT TRUNCATED AT 250 WORDS)     

Reversal of adaptive left ventricular atrophy following electrically-stimulated exercise training in human tetraplegics.

Left ventricular (LV) myocardial atrophy and diminished cardiac function have been shown to accompany chronic human tetraplegia. These changes are attributable both to physical immobilisation and abnormal autonomic circulatory regulation imposed by a spinal cord injury (SCI). To test whether exercise training increases LV mass following chronic SCI, 8 neurologically complete quadriplegic males at 2 SCI rehabilitation and research centres underwent one month of electrically-stimulated quadriceps strengthening followed by 6 months of electrically-stimulated cycling exercise. Resting M-mode and 2-D echocardiograms were measured before and after exercise training to quantify the interventricular septal and posterior wall thicknesses at end-diastole (IVSTED and PWTED, respectively), and the LV internal dimension at end-diastole (LVIDED). LV mass was computed from these measurements using standard cube function geometry. Results showed a 6.5% increase in LVIDED following exercise training (p less than 0.02), with increases in IVSTED and PWTED of 17.8 (p less than 0.002) and 20.3% (p less than 0.01), respectively. Computed LV mass increased by 35% following exercise training (p = 0.002). These data indicate that myocardial atrophy is reversed in tetraplegics following electrically-stimulated exercise training, and that the changes in cardiac architecture are likely to be the result of both pressure and volume challenge to the heart imposed by exercise.     

Peer-mediated social skills training program for young children with high-functioning autism

One of the most prevailing characteristics of children with autism is their deficit in social communication skills. The purpose of this study was to evaluate the effectiveness of a peer-mediated social skills training (SST) program combined with video feedback, positive reinforcement and token system in increasing social communication skills in young children with high-functioning autism. Four boys with high-functioning autism, ages 6-7 years, participated in the study. The social skills training, lasting 12 weeks, targeted six communication skills, selected after parent interviews and behavioral observation during a pre-training assessment period. One SST session was conducted each week, each session lasted 90min and had six structured activities. The training effectiveness was evaluated through direct observation of a structured interaction period, using an observational coding system. Improvement was observed in three out of four children, although individual differences among children were seen for changes in two global scales as well as subscales. These results suggest that the social skills training was effective in improving social communication skills for some children with high-functioning autism. Clinical and research implications and future directions for social skills training as well as this study's limitations are discussed.     

Twenty weeks of computer-training improves sense of agency in children with spastic cerebral palsy

Children with cerebral palsy (CP) show alteration of perceptual and cognitive abilities in addition to motor and sensory deficits, which may include altered sense of agency. The aim of this study was to evaluate whether 20 weeks of internet-based motor, perceptual and cognitive training enhances the ability of CP children to determine whether they or a computer are responsible for the movement of a visually observed object. 40 CP children (8-16 years) were divided into a training (n:20) and control group (n:20). The training group trained 30 min each day for 20 weeks. The ability of the children to judge whether they themselves or a computer were responsible for moving an object on a computer screen was tested before and after the 20-week period. Furthermore, we included a healthy age-matched group to determine a normal functional level of performance. Our results showed a significantly larger increase in the number of correct subjective reporting for the training group (p<0.001). In accordance with this, the training group was also less fooled by computer-induced movements given by a decreased curvature which indicated a compensatory motor strategy when drawing the line to hit the target following the training than the control group (p=0.018). These findings suggest that sense of agency may be altered, and that training of sense of agency may help to increase the outcome of training programmes in children with CP.     

The effect of respiratory muscle endurance training in patients with myasthenia gravis

We tested the effect of a home-based respiratory muscle endurance training in patients with mild to moderate generalized myasthenia gravis (MG) on Besinger score, lung function and respiratory muscle endurance. Ten patients performed respiratory muscle endurance training in form of normocapnic hyperpnea training at 50-60% of their maximal voluntary ventilation over 4-6 weeks. MG score, lung function and respiratory endurance were assessed before and after training period. The training significantly increased respiratory endurance from 8.4+/-0.9 min to 17.1+/-1.3 min (p<0.001) and total ventilatory volume from 555+/-87 L to 1081+/-127 L (p=0.004). About 25% of this gain was lost after 3-5 months of detraining. The remaining 75% gain might result from improved neuromuscular coordination rather than muscular training. MG score and lung function, however, did not change. Patients assessed the training effects on physical fitness and respiration as positive. In conclusion, respiratory muscle endurance training can be useful for MG patients as it is enhancing respiratory muscle endurance.     

Antagonism of muscarinic M1 receptors by dicyclomine inhibits the consolidation of morphine-associated contextual memory

M1 muscarinic receptor has been shown to be involved in cognitive functions of the brain. Conditioned place preference (CPP) paradigm involves memory for the association between environmental stimuli and the rewarding properties produced by a treatment. Using a balanced CPP design, we studied the possible involvement of M1 muscarinic receptors on the acquisition, expression and consolidation of morphine place conditioning in male mice. Subcutaneous administration of morphine sulphate-induced CPP in a dose-dependent manner. Using a 6-day schedule of conditioning, it was found that dicyclomine, an M1 muscarinic antagonist, significantly reduced the time spent by mice in the morphine compartment when given immediately, but not 6 h, after each conditioning session (consolidation). It had no effect when administered 30 min before each conditioning session during CPP training period (acquisition) or 30 min before testing for place preference in the absence of morphine (expression). It is concluded that M1 muscarinic receptors may play a time-dependent role in the consolidation of reward-related memory of morphine.     

The effects of moderate exercise on chronic stress-induced intestinal barrier dysfunction and antimicrobial defense

The purpose of this study was to examine the effect of moderate exercise on repeated restraint stress (RRS)-induced intestinal barrier dysfunction and explore possible mechanisms in a mouse model. Male Balb/c mice (6 weeks) were randomized into 7 groups: CON functioned as controls with no intervention; RRS was subjected to 6 h per day RRS for 7 consecutive days; RRS+SWIM received 30 min per day of swimming prior to RRS; CON+SWIM only received 30 min per day of swimming; and the other groups received one session of 30 min swimming prior to sacrifice at 1-, 3- and 6 h recovery. Intestinal permeability was quantified with FITC-dextran. Bacterial translocation was determined by quantification of bacterial colony forming units (CFUs) in cultured mesenteric lymph nodes (MLN), and with fluorescence in situ hybridization (FISH). Antimicrobial related gene expression at baseline and 1 h after one session of 30 min swimming was tested by quantitative real-time polymerase chain reaction (Q-PCR) in small intestinal segments. Protein expression of 5 genes with statistically significant increase was measured at baseline, and 1-, 3- and 6 h post-swimming using enzyme-linked immunosorbent assay (ELISA). Thirty minutes per day of swimming before RRS attenuated bacterial translocations and maintained intestinal permeability. Gene expression and protein levels for four antimicrobial peptides (α-defensin 5, β-defensin 1, RegIIIβ and RegIIIγ) were significantly increased after one 30 min swimming session. In conclusion, moderate exercise attenuated chronic stress-induced intestinal barrier dysfunction in mice, possibly due to augmentation of antimicrobial responses in the small intestine.     

Efficacy of alertness training in a case of brainstem encephalitis: Clinical and theoretical implications

Although attention functions are often impaired after stroke, traumatic brain injury or inflammatory diseases, little is known about the time course and the long-term efficacy of training-induced improvement. The present single case study evaluates the time course and longitudinal stability of attention improvement after alertness training by repeatedly testing the subject between individual training sessions as well as one and seven months after the end of the training. The outpatient (M.P.) trained developed severe alertness deficits following brainstem encephalitis in 2003 without signs of cortical damage, and since then had not achieved full recovery. In 2008, M.P. participated in 15 treatment sessions on 15 separate working days over a period of three weeks. In each session a 45-minute alertness training task was administered, using the CogniPlus ALERT computer training program. Attention performance was assessed by neuropsychological tests four years, one year, and immediately before the therapy after every third training session and three times after the termination of therapy. Furthermore, a self-report questionnaire measured subjective experience of attention in everyday life situations. In order to compare the performance between training sessions, a procedure specialised for psychometric single-case diagnosis was used to analyse the data. Surprisingly, even after three consecutive training sessions, M.P. showed immense improvement in alertness. Furthermore, after two weeks she felt more energetic and more able to concentrate. Six months after the end of the training the improvement remained stable. The unexpectedly fast time course of recovery induced by the training, as well as the stable long-term effects, probably depend on intact cortical structures. In M.P. it appeared that top-down control of the alertness network on impaired brainstem arousal structures had been re-activated by the training procedure and had remained stable across a long time period.     

Lateral asymmetry as a function of motor practice type of complex upper- and lower-limb movement in young children

The influence of different motor practice types on lateral asymmetry of performance was investigated in 40 preschool children. Lateral preference was measured prior the experiment. For the purpose of present study dribbling a ball with a hand and foot was used to assess lateral asymmetry of performance before and after three different motor practice types. Motor practice with the non-dominant, dominant, and both (contralateral) limbs took place in the indoor facility 4 times/week for 6 weeks. Each session lasted 30–40?min. Our results showed that unilateral practice of dribbling is more beneficial for diminishing lateral asymmetry of performance in comparison to bilateral practice. Moreover, participants who practiced with their dominant limb diminished lateral asymmetry of performance the most and made the largest overall improvement. We did not find important differences between acquisitions of dribbling with upper- and lower-extremity. In this sense, the results support the notion of lateral asymmetry of performance to be task-specific.     

Efficacy of alertness training in a case of brainstem encephalitis: clinical and theoretical implications

Although attention functions are often impaired after stroke, traumatic brain injury or inflammatory diseases, little is known about the time course and the long-term efficacy of training-induced improvement. The present single case study evaluates the time course and longitudinal stability of attention improvement after alertness training by repeatedly testing the subject between individual training sessions as well as one and seven months after the end of the training. The outpatient (M.P.) trained developed severe alertness deficits following brainstem encephalitis in 2003 without signs of cortical damage, and since then had not achieved full recovery. In 2008, M.P. participated in 15 treatment sessions on 15 separate working days over a period of three weeks. In each session a 45-minute alertness training task was administered, using the CogniPlus ALERT computer training program. Attention performance was assessed by neuropsychological tests four years, one year, and immediately before the therapy after every third training session and three times after the termination of therapy. Furthermore, a self-report questionnaire measured subjective experience of attention in everyday life situations. In order to compare the performance between training sessions, a procedure specialised for psychometric single-case diagnosis was used to analyse the data. Surprisingly, even after three consecutive training sessions, M.P. showed immense improvement in alertness. Furthermore, after two weeks she felt more energetic and more able to concentrate. Six months after the end of the training the improvement remained stable. The unexpectedly fast time course of recovery induced by the training, as well as the stable long-term effects, probably depend on intact cortical structures. In M.P. it appeared that top-down control of the alertness network on impaired brainstem arousal structures had been re-activated by the training procedure and had remained stable across a long time period.     

Repeated acupuncture treatment affects leukocyte circulation in healthy young male subjects: a randomized single-blind two-period crossover study

Acupuncture is the most popular component of traditional Chinese medicine in western countries, which has been widely used in the treatment of numerous medical conditions, e.g., pain, emesis or asthma. However, the effects of acupuncture on neuroendocrine and immune functions in humans remain unclear. Therefore, the present study was performed to analyse whether acupuncture treatment affects leukocyte circulation as well as plasma levels of cortisol and norepinephrine in humans. Ten healthy young male subjects were enrolled in a randomized single-blind two-period crossover study. Each period contained three sessions of either acupuncture or sham acupuncture (placebo) treatment. After randomisation, the group 1 (n=5) received acupuncture treatment at acu-points ST36, LI11, SP10, and GV14, while sham acupuncture was performed for group 2 (n=5). Two weeks later, each group received the alternative treatment. Blood samples were taken before needling, 10 min after, and 30 min after removing the needles in the first and the third session. In addition, blood pressure and heart rate were determined simultaneously. Although acupuncture treatment did not affect leukocyte circulation in peripheral blood after the first session, we observed a significant decrease in leukocyte and lymphocyte values after the third session. In contrast, cortisol and norepinephrine plasma levels remained unchanged by acupuncture. These data indicate that repeated acupuncture treatment can affect leukocyte circulation in healthy humans by still unknown mechanisms.     

Skill-memory consolidation in the striatum: critical for late but not early long-term memory and stabilized by cocaine

The sensorimotor striatum is important for procedural learning, including skill learning. Our previous findings indicate that this part of the striatum mediates the acquisition of a motor skill in a running-wheel task and that this skill learning is dependent on striatal D1 dopamine receptors. Here, we investigated whether the sensorimotor striatum is also involved in the consolidation of this skill memory and whether this consolidation is modified by the indirect dopamine receptor agonist cocaine. Rats were trained on a running wheel for 2 days (40 min/day) to learn a new motor skill, that is, the ability to control the movement of the wheel. Before each training session, the animals received an injection of vehicle or cocaine (25mg/kg, i.p.). Immediately following the training session, an intrastriatal infusion of 2% lidocaine (1 microl) or a sham infusion were administered. Wheel-skill performance was tested before and repeatedly after the training. Our results show that post-trial intrastriatal infusion of lidocaine disrupted late-stage long-term skill memory (post-training days 6-26), but spared early long-term memory (1 day after the training). Skill consolidation was more susceptible to such disruption in animals that practiced less during the training. Cocaine given pre-trial prevented this post-trial disruption of skill consolidation. These findings indicate that the sensorimotor striatum is critical for the consolidation of late but not early long-term skill memory. Furthermore, cocaine appeared to stabilize motor-memory formation by protecting consolidation processes after the training.     

Cardiovascular and hormonal responses to food ingestion in humans with spinal cord transection

In sympathetic denervation due to primary autonomic failure, ingestion of food causes a fall in blood pressure (BP) and exacerbates postural hypotension. It is not known whether these responses occur in tetraplegics with physiologically complete cervical spinal cord transection, who also have sympathetic dysfunction because of disruption of descending spinal sympathetic pathways. We, therefore, studied the effect of a liquid meal on BP, heart rate (HR) and neurohormonal levels in tetraplegics. Paraplegics with low lesions and without sympathetic dysfunction served as controls. After food ingestion, there was no fall in BP in tetraplegics or in controls. HR did not change in either group. After food, plasma noradrenaline was unchanged in tetraplegics, but rose in controls, while plasma renin activity (PRA) rose in tetraplegics but not in controls. The fall in BP and rise in HR on head-up tilt after the meal in tetraplegics was similar to that before the meal. There was no change in PRA following pre-prandial tilt in either group; postpprandial tilt raised levels in the tetraplegics, unlike in controls. Thus there is considerable variance in the responses to food between tetraplegics and paraplegic controls, and even greater differences when compared with published data in other autonomic disorders with sympathetic dysfunction; this may relate to the site and the nature of the sympathetic lesion and the ability to activate compensatory mechanism.     

Response of a brain protein fraction 24 hours after training in rats.

The aim of the study was to follow the amount and incorporation of 14C-valine into separate, soluble protein fractions of the hippocampus, thalamus, and visual cortex of rats from 0 to 72 hr after training. The behavioral test consisted of reversal of handedness with training twice daily for 25 min for 2 days, followed by a 5-day intermission without training, and a final session of 24 min. The animals were injected intraperitoneally with 14C-valine 30 min before sacrifice and taken 0, 24, 48, and 72 hr after last training. After 24 hr, and only at that time, double incorporation values and increased amounts were observed in a protein fraction, No. 6 from the front, in all three brain areas of the trained rats compared to active controls. At 48 hr this protein fraction was at control level.     

Reversible lesion of the rat's orbitofrontal cortex interferes with hippocampus-dependent spatial memory

In this study, tetrodotoxin (TTX) inactivation was employed to evaluate the involvement of the rat's orbitofrontal cortex (OFC) in hippocampus-dependent spatial memory using Morris water maze (MWM) and place avoidance learning (PAL) tasks. In Experiment 1, rats trained in MWM task with two blocks of four trials per day for 3 consecutive days received bilateral injections of either TTX or saline into the OFC 60 min before each daily training session. The acquisition of spatial memory was evaluated 24h after the last training day and it was shown an impairment by the TTX. In Experiment 2, bilateral intra-OFC injections of TTX or saline were made immediately after two blocks of four trials. Testing 24h later, it was revealed that TTX also impairs spatial memory consolidation. In Experiments 3 and 4, rats were trained in a single 30-min session to avoid a 60 degrees segment of the stable circular (80-cm diameter) arena, entering which was punished by a mild shock (PAL task) and retention was tested 24h later in a 30-min extinction session. Bilateral injections of TTX or saline were made into the OFC 60 min before training or immediately after training. Again, TTX impaired the place avoidance retention when it was injected into the OFC either before (acquisition phase) or after (consolidation phase) training. These findings indicate that functional integrity of the OFC is necessary for both the acquisition and the consolidation of hippocampus-dependent spatial memory in rats.     

功能性电刺激结合康复踏车训练对卒中急性期患者下肢功能的影响

目的 观察和探讨功能性电刺激（functional electrical stimulation,FES）结合康复踏车训练对卒中急性 期患者下肢功能的影响。 方法 将120例卒中急性期偏瘫患者采用随机数字表法分为对照组和观察组。两组均接受常规药物 治疗。对照组患者采用Bobath技术为主的常规康复训练,主要包括桥式训练、坐站训练、常规踝背屈 训练等,每日训练1次,每次45 min,每周训练5 d,训练2周。观察组患者在对照组康复治疗基础上给予 FES结合康复踏车系统训练,每次20 min,每周训练5 d,训练2周。分别于治疗前和治疗后采用功能性 步行量表（functional ambulation category,FAC）、Fugl-meyer下肢功能评定量表（Fugl-Meyer assessment, FMA）、Barthel指数评定量表进行评分并比较。 结果 ①治疗前,2组患者各项指标组间比较差异均无统计学意义;②治疗后,对照组和治疗组患者 的FAC评分、下肢FMA评分、Barthel指数评分均较本组治疗前有显著改善;治疗后,观察组上述指标显 著优于对照组（均P＜0.001）。 结论 功能性电刺激结合康复踏车训练能显著地提高卒中急性期患者下肢功能,从而提高患者日 常生活活动能力。     

Robot-assisted gait training using a very small-sized Hybrid Assistive Limb® for pediatric cerebral palsy: A case report

PurposeGait parameters and gross motor function improve after 12 sessions of small-sized Hybrid Assistive Limb® (S-HAL) training in adult cerebral palsy (CP) patients. However, there are no reports on repetitive robot-assisted gait training using the newly developed very small-sized HAL (2S-HAL). This study aimed to examine the effect of using 2S-HAL on a pediatric CP patient.MethodsThe subject was an 11-year-old boy (height = 138 cm, weight = 30 kg) with spastic quadriplegia due to periventricular leukomalacia, with Gross Motor Function Classification System level IV. HAL training was performed for 2–4 sessions/week for 20 min/session (i.e., 4-week period with 12 sessions). Outcome measures were walking ability, gross motor function, Canadian Occupational Performance Measure (COPM), and Pediatric Evaluation of Disability Inventory measured before, after, and at 1, 2, and 3 months after HAL-assisted gait training.ResultsAfter HAL intervention, gait speed, step length, cadence, 6-min walking distance (6MD), Gross Motor Function Measure (GMFM), and COPM increased and physiological cost index (PCI) declined compared to those before intervention.The peaks of gait speed, step length, and cadence were 2 month, 1 month, and 3 month, respectively. 6MD, PCI, and GMFM at 1–3 months post-intervention were maintained. COPM peaked at 1 month post-intervention but remained higher than that before intervention.ConclusionThis is the first report of repetitive intervention using 2S-HAL in a pediatric CP patient. Gait training using 2S-HAL may be effective in CP patients as it improves post-training walking ability and gross motor function.