Quantitative assessment of retropulsion of the hip,excessive hip external rotation,and excessive lateral shift of the trunk over the unaffected side in hemiplegia using three-dimensional treadmill gait analysis

Background: Gait assessment is important to determine the most effective strategy to regain gait function during stroke rehabilitation. To understand the mechanisms that cause abnormal gait patterns, it is useful to objectively identify and quantify the abnormal gait patterns. Objective assessment also helps evaluate the efficacy of treatments and can be used to provide suggestions for treatment.

Objective: To evaluate the validity of quantitative indices for retropulsion of the hip, excessive hip external rotation, and excessive lateral shift of the trunk over the unaffected side in hemiplegic patients.

Methods: Forty-six healthy control subjects and 112 hemiplegic patients participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the three abnormal gait patterns was calculated from the three-dimensional coordinate data. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment by three physical therapists with expertise in gait analysis.

Results: Strong correlation was observed between the index value and the median observational rating for all three abnormal gait patterns (?0.56 to ?0.74). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects.

Conclusions: The proposed indices are useful for clinical gait analysis. Our results encourage a more detailed analysis of hemiplegic gait using a motion analysis system.     

Classification of gait patterns in spastic hemiplegia and spastic diplegia: a basis for a management algorithm

Classifications of gait and postural patterns in spastic hemiplegia and spastic diplegiía are presented, based on the work of previous authors. The classifications are used as a biomechanical basis, linking spasticity, musculoskeletal pathology in the lower limbs, and the appropriate intervention strategies. The choice of target muscles for spasticity management, the muscle contractures requiring lengthening and the choice of orthotics are then linked to the underlying gait pattern.     

CatWalk步态分析系统评价构建膀胱反射弧对下肢功能的影响

目的 通过CatWalk步态分析系统评价离断L5脊神经根对下肢功能的影响,以明确将其用于构建膀胱反射弧的可行性. 方法 选择SD雄性大鼠11只,以大鼠右侧为手术侧,将其L5脊神经前、后根截断,左侧不做处理作为对照侧.术后1d3只大鼠行麦芽凝集素辣根过氧化物酶(WGA-HRP)神经示踪实验验证模型是否构建成功,应用CatWalk步态分析系统测试大鼠脊神经离断术前1d及术后3月一般性参数、个体化肢体参数、疼痛相关性参数、协调相关性参数的变化.结果 神经示踪实验结果显示实验侧L5节段脊髓前、后角均未见阳性神经元及神经纤维,对照侧L5节段脊髓前角、后角均可见阳性神经元及神经纤维,从而证实模型构建成功;术后3月大鼠的一般性参数、个体化肢体参数、疼痛相关性参数等与术前1d比较差异无统计学意义(P＜0.05),但协调相关性参数中规律性参数(RJ)及右后-左前联动与术前1d相比下降,差异有统计学意义(P＜0.05). 结论 离断L5脊神经后仅影响下肢行走的协调性,对其余步态相关参数无影响,因而可用于膀胱反射弧的构建.     

The assessment of gait disorders in patients with Parkinson's disease using the three-dimensional motion analysis system Vicon

BACKGROUND AND PURPOSE: Gait disorders are a common symptom of Parkinson's disease (PD) and can occur in the early stage of the disease. The most characteristic gait disorders in that disease affect pace and cadence. This study was designed to assess spatiotemporal and kinematic gait parameters of patients with PD using the three-dimensional motion analysis system Vicon. MATERIAL AND METHODS: 32 patients (14 women and 18 men; age range: 50-75) treated for PD in the Department of Neurology were studied. The control group consisted of 32 healthy persons (13 women and 19 men, age range: 52-77). Gait analysis using the Vicon 3D system took place in the Biokinetics Laboratory in the Academy of Physical Education in Kraków. The Vicon 3D system enables computerized registration and analysis of motion in three-dimensional space. RESULTS: The analysis of basic spatiotemporal parameters of gait revealed that PD patients had considerably lower walking speed, stride length and cadence and longer time of double support than controls. The assessment of kinematic gait parameters showed that PD patients had decreased motion range in the joints of the lower limbs and began the double support phase earlier and delayed the swing phase when compared to healthy controls. CONCLUSION: Our study shows a difference between PD patients and healthy controls at similar age both in angle changes and in spatiotemporal parameters of gait.     

The relation between spasticity and muscle behavior during the swing phase of gait in children with cerebral palsy

There is much debate about how spasticity contributes to the movement abnormalities seen in children with spastic cerebral palsy (CP). This study explored the relation between stretch reflex characteristics in passive muscles and markers of spasticity during gait. Twenty-four children with CP underwent 3D gait analysis at three walking velocity conditions (self-selected, faster and fastest). The gastrocnemius (GAS) and medial hamstrings (MEHs) were assessed at rest using an instrumented spasticity assessment that determined the stretch-reflex threshold, expressed in terms of muscle lengthening velocity. Muscle activation was quantified with root mean square electromyography (RMS-EMG) during passive muscle stretch and during the muscle lengthening periods in the swing phase of gait. Parameters from passive stretch were compared to those from gait analysis.In about half the children, GAS peak muscle lengthening velocity during the swing phase of gait did not exceed its stretch reflex threshold. In contrast, in the MEHs the threshold was always exceeded. In the GAS, stretch reflex thresholds were positively correlated to peak muscle lengthening velocity during the swing phase of gait at the faster (r = 0.46) and fastest (r = 0.54) walking conditions. In the MEHs, a similar relation was found, but only at the faster walking condition (r = 0.43). RMS-EMG during passive stretch showed moderate correlations to RMS-EMG during the swing phase of gait in the GAS (r = 0.46–0.56) and good correlations in the MEHs (r = 0.69–0.77) at all walking conditions. RMS-EMG during passive stretch showed no correlations to peak muscle lengthening velocity during gait.We conclude that a reduced stretch reflex threshold in the GAS and MEHs constrains peak muscle lengthening velocity during gait in children with CP. With increasing walking velocity, this constraint is more marked in the GAS, but not in the MEHs. Hyper-activation of stretch reflexes during passive stretch is related to muscle activation during the swing phase of gait, but has a limited contribution to reduced muscle lengthening velocity during swing. Larger studies are required to confirm these results, and to investigate the contribution of other impairments such as passive stiffness and weakness to reduced muscle lengthening velocity during the swing phase of gait.     

Spatiotemporal organization of alpha-motoneuron activity in the human spinal cord during different gaits and gait transitions

Here we studied the spatiotemporal organization of motoneuron (MN) activity during different human gaits. We recorded the electromyographic (EMG) activity patterns in 32 ipsilateral limb and trunk muscles from normal subjects while running and walking on a treadmill (3–12 km/h). In addition, we recorded backward walking and skipping, a distinct human gait that comprises the features of both walking and running. We mapped the recorded EMG activity patterns onto the spinal cord in approximate rostrocaudal locations of the MN pools. The activation of MNs tends to occur in bursts and be segregated by spinal segment in a gait-specific manner. In particular, sacral and cervical activation timings were clearly gait-dependent. Swing-related activity constituted an appreciable fraction (> 30%) of the total MN activity of leg muscles. Locomoting at non-preferred speeds (running and walking at 5 and 9 km/h, respectively) showed clear differences relative to preferred speeds. Running at low speeds was characterized by wider sacral activation. Walking at high non-preferred speeds was accompanied by an 'atypical' locus of activation in the upper lumbar spinal cord during late stance and by a drastically increased activation of lumbosacral segments. The latter findings suggest that the optimal speed of gait transitions may be related to an optimal intensity of the total MN activity, in addition to other factors previously described. The results overall support the idea of flexibility and adaptability of spatiotemporal activity in the spinal circuitry with constraints on the temporal functional connectivity of hypothetical pulsatile burst generators.     

Quantitative, three-dimensional analysis of granule cell dendrites in the rat dentate gyrus

The three-dimensional organization of dentate granule cell dendritic trees has been quantitatively analyzed with the aid of a computerized microscope system. The dendrites were visualized by iontophoretic injection of horseradish peroxidase into individual granule cells in the in vitro hippocampal slice preparation. Selection criteria insured that the analyzed cells were completely stained and that only neurons with two or fewer cut dendrites in the distal portion of the molecular layer were analyzed. Twenty-nine of the 48 sampled granule cells had no cut dendrites. The granule cells had between one and four primary dendrites. Granule cell dendritic branches were covered with spines and most extended to the hippocampal fissure or pial surface. The mean total dendritic length was 3,221 microns with a range from 2,324 microns to 4,582 microns. The dendrites formed an elliptical plexus with the transverse spread averaging 325 microns and the spread in the septotemporal axis averaging 176 microns. On individual neurons, the maximum branch order ranged from four to eight and the number of dendritic segments ranged from 22 to 40. Approximately 63% of the dendritic branch points occurred in a zone that included the granule cell layer and the inner one-third of the molecular layer. The dendritic tree was organized so that, on average, 30% of the length was in the granule cell layer and proximal third of the molecular layer, 30% was in the middle third, and 40% was in the distal third. Comparisons were made between the dendrites of granule cells in the suprapyramidal and infrapyramidal blades of the dentate gyrus. Suprapyramidal cells had a significantly greater total dendritic length than infrapyramidal cells, their transverse spread was higher, and they had a greater number of dendritic segments. When neurons in the suprapyramidal blade were further subdivided on the basis of somal position within the depth of the cell body layer, superficial neurons were found to have a greater number of primary dendrites, more elliptical trees, and larger transverse spreads of their dendrites. There were no significant differences in dendritic segment number or total dendritic length between superficial and deep cells.     

Intersession reliability of the interpolated twitch technique applied during isometric,concentric, and eccentric actions of the human knee extensor muscles

Introduction: Although it has been shown that voluntary activation (%VA) of the knee extensors during isometric contractions can be reliably assessed with the interpolated twitch technique, little is known about the reliability of %VA during concentric and eccentric muscle actions. Therefore, relative and absolute intersession reliability of quadriceps muscle's %VA during different contraction modes was determined. Methods: After a familiarization session, 21 participants (17 males, 25 ± 2 yrs) completed two testing sessions. Paired supramaximal electrical stimuli were administered to the femoral nerve during isometric, concentric, eccentric MVCs, and at rest to assess %VA (stimuli were applied at 70° knee flexion). Results and discussion: Data indicate that %VA of the knee extensors can be reliably measured during isometric [intraclass correlation coefficient (ICC) = 0.89, coefficient of variation (CV) = 4.1%], concentric (ICC = 0.87, CV = 6.6%), and eccentric muscle actions (ICC = 0.86, CV = 7.0%). Muscle Nerve 56 : 324–327, 2017     

Quantitative assessment of brain shifting in the late phase postevacuation in unilateral and bilateral chronic subdural hematomas

Aim of the study: Recurrence is more common in bilateral chronic subdural hematomas (CSDHs) than in unilateral. Our aim was to quantitatively compare the late phase of brain shifting postevacuation in unilateral and bilateral CSDHs. Materials and Methods: We reviewed computed tomography (CT) scans and medical records of consecutive patients with CSDHs who underwent burr hole drainage. CT scan images (preoperative and postoperative days [PODs] 30 and 60) were imported to Adobe Photoshop, and temporal and spatial changes in brain shifting between PODs 30 and 60, and also the subdural space on POD 60, were analyzed. Results: The bilateral group exhibited a significantly greater late phase of brain shifting than the unilateral group between PODs 30 and 60 (P < 0.001). The median late phase of brain shifting of the bilateral group was 8.9 mm (interquartile range [IQR]: 8.3–9.0 mm) between PODs 30 and 60, while that of the unilateral group was 1.8 mm (IQR: 1.3–2.5 mm). Conclusions: The postevacuation late phase of brain shifting is statistically greater in bilateral CSDHs than in unilateral CSDHs, which might facilitate bridging vein tearing and consequent rebleeding. This may be one factor accounting for the higher recurrence rate of bilateral CSDHs.     

Amplitude, frequency, and phase analysis of hippocampal theta during sensorimotor processing in a jump avoidance task

In the current study, rats implanted with hippocampal recording electrodes were trained to avoid shock in a jump avoidance task, using three separate heights, 28, 33, and 38 cm. The objectives were to measure the progression of Type 2 (immobility-related) hippocampal theta amplitude and frequency recorded during jump avoidances at each of the levels, and determine if there was a consistent relationship between the phase of the Type 1 (movement related) theta jump wave and the moment of movement initiation at each of the jump heights. The results demonstrated that the immobility period prior to the execution of the jump could be divided into two components: a sensory processing period and a movement preparation period. Comparing these two periods, average amplitudes were higher while frequency remained relatively constant during the sensory processing period. During the movement preparation period there was a negative correlation between amplitude and frequency: amplitude declined rapidly and frequency increased rapidly. During the execution of the jump, theta amplitude (Type 1) and frequency were positively correlated, both reaching peak values. The separate analyses of the individual jump heights provided further support for the precise relationships between theta parameters and the magnitude of the required movements. A significant phase preference was demonstrated for the highest jump height, with movement initiation occurring around the trough of theta recorded from the stratum moleculare of the dentate region. The findings supported the conclusion that the generation of hippocampal theta band oscillation and synchrony was related to sensorimotor processing and integration.     

Quantitative analysis of neural plate thickness and cell density during gastrulation in the chick embryo

We quantitatively analyzed the developing prospective neural and non-neural ectoderm during chicken gastrulation on semithin transverse sections. At stage PS8 (primitive streak stage 8 of Lopez-Sanchez et al. [C. Lopez-Sanchez, L. Puelles, V. Garcia-Martinez, L. Rodriguez-Gallardo, Morphological and molecular analysis of the early developing chick requires an expanded series of primitive streak stages, J. Morphol. 264 (2005) 105-116.], equivalent to stage HH4), the thickest area of the ectoderm agrees in extent with the fate-mapped neural plate we had reported previously. The thickness of the median ectoderm is constantly higher up to a distance of 250mum from Hensen's node, and thickness decreases along a mediolateral gradient with a further drop at the prospective lateral border of the neural plate. A higher cell density of the developing ectoderm also coincided with the prospective neural plate. We observed that cell death does not play an important role in the spatial definition of the neural plate.     

急性期血压血糖血脂水平与脑卒中靶器官损伤预后的相关性

目的 探讨急性期血压、血糖、血脂水平与脑卒中靶器官损伤预后的相关性.方法 选择急性期脑卒中患者96例,根据靶器官损伤情况分为单纯脑卒中组31例,脑、心损伤组42例,脑、心、肾损伤组23例,分析各组的血压、血糖、血脂水平差异以及治疗后的神经评分情况.结果 不同靶器官损伤组NSBP、NDBP、NPP差异有统计学意义;脑、心、肾损伤组DDBP明显低于单纯脑卒中组和脑、心损伤组;脑、心、肾损伤组FPG、HbA1c、BUN与单纯脑卒中组和脑、心损伤组差异有统计学意义;不同靶器官损伤组TG、LDL差异有统计学意义;单纯脑卒中组Barthel和NIHSS改善率明显优于脑、心损伤组和脑、心、肾损伤组;脑、心损伤组Barthel改善率明显优于脑、心、肾损伤组.结论 高血压、高血糖、高血脂水平会导致急性期脑卒中患者的多个靶器官发生损伤,且病情重、预后差,合并多个靶器官损伤的患者治疗后的神经评分改善率低.     

Quantitative assessment of field strength,total intracranial volume,sex, and age effects on the goodness of harmonization for volumetric analysis on the ADNI database

When analyzing large multicenter databases, the effects of multiple confounding covariates increase the variability in the data and may reduce the ability to detect changes due to the actual effect of interest, for example, changes due to disease. Efficient ways to evaluate the effect of covariates toward the data harmonization are therefore important. In this article, we showcase techniques to assess the “goodness of harmonization” of covariates. We analyze 7,656 MR images in the multisite, multiscanner Alzheimer's Disease Neuroimaging Initiative (ADNI) database. We present a comparison of three methods for estimating total intracranial volume to assess their robustness and correct the brain structure volumes using the residual method and the proportional (normalization by division) method. We then evaluated the distribution of brain structure volumes over the entire ADNI database before and after accounting for multiple covariates such as total intracranial volume, scanner field strength, sex, and age using two techniques: (a) Zscapes, a panoramic visualization technique to analyze the entire database and (b) empirical cumulative distributions functions. The results from this study highlight the importance of assessing the goodness of data harmonization as a necessary preprocessing step when pooling large data set with multiple covariates, prior to further statistical data analysis.     

Combination strategies for repair, plasticity, and regeneration using regulation of gene expression during the chronic phase after spinal cord injury

Although recovery after spinal cord injury (SCI) is rare in humans, recent literature indicates that some patients do recover sensorimotor function years after the trauma. This study seeks to elucidate the genetic underpinnings of SCI repair through the investigation of neurodegenerative and regenerative associated genes involved in the response to SCI during the chronic phase in adult rats. Intervention on the level of gene regulation focused on enhancing naturally attempting SCI regenerative genes has the potential to promote SCI repair. Our aim was to analyze gene expression characteristics of candidate genes involved in the neuro-degenerative and -regenerative processes following various animal models of SCI. We compiled data showing gene expression changes after SCI in adult rats and created a chronological time-line of candidate genes differentially expressed during the chronic phase of SCI. Compiled data showed that SCI induced a transient upregulation of endogenous neuro-regenerative genes not only within a few hours but also within a few days, weeks, and months after SCI. For example, gene controlling growth-associated protein-43 (GAP-43), brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), and others, showed significant changes in mRNA accumulation in SCI animals, from 48 hours to 12 weeks after SCI. Similarly, inhibitory genes, such as RhoA, LINGO-1, and others, were upregulated as late as 4 to 14 days after injury. This indicates that gene specific regulation changes, corresponding to repair and regenerative attempts, are naturally orchestrated over time after injury. These delayed changes after SCI give ample time for therapeutic gene modulation through upregulation or silencing of specific genes responsible for the synthesis of the corresponding biogenic proteins. By following the examination of differential gene regulation during the chronic phase, we have determined times, successions, co-activations, interferences, and dosages for potential therapeutic synchronized interventions. Finally, local cellular specificities and their neuropathophysiologies have been taken into account in the elaboration of the combination treatment strategy we propose. The interventions we propose suggest the delivery of exogenous therapeutic agents to upregulate or downregulate chosen genes or the expression of the downstream proteins to revert the post-traumatic stage of SCI during the chronic phase. The proposed combination and schedule of local cell-specific treatment should enhance intrinsic regenerative machinery and provide a promising strategy for treating patients sustaining chronic SCI.     

Comprehensive dissection of the medial temporal lobe in AD: measurement of hippocampus, amygdala, entorhinal, perirhinal and parahippocampal cortices using MRI

Background Early pathological involvement of specific medial temporal lobe areas is characteristic for Alzheimer’s disease (AD). Objective To determine the extent of regional medial temporal lobe atrophy, including hippocampus, amygdala, and entorhinal, perirhinal, and parahippocampal cortices in mild AD patients and healthy controls, and to compare diagnostic accuracy across volumetric markers. Methods We studied 34 patients with clinically probable AD and 22 healthy elderly control subjects. Regional volumetric measures were obtained from volumetric T1–weighted MRI scans after accounting for global brain atrophy using affine transformation into standard space. Results Volumes of medial temporal lobe structures were significantly smaller in AD patients than in controls with exception of the left entorhinal cortex. The degree of atrophy was comparable between all structures. Diagnostic accuracy (number of correctly allocated cases divided by number of all cases) was highest for the right parahippocampal cortex with 85%, but only slightly lower for the right hippocampus and right entorhinal cortex with 82% and 84%. Using a linear combination of markers, the unilateral volumes of the right hippocampus, parahippocampal cortex and perirhinal cortex yielded an accuracy of 93%. Conclusion Extent of atrophy is similar between the different regions of the medial temporal lobe in mild AD.Volume measurements of medial temporal lobe structures in addition to the hippocampus only yield improved diagnostic accuracy if a combination of these structures is used.     

Intolerance of uncertainty,anxiety sensitivity,and health anxiety during the COVID-19 pandemic: Exploring temporal relationships using cross-lag analysis

Intolerance of uncertainty (IU) and anxiety sensitivity (AS) have been widely discussed and explored as factors that may contribute to health anxiety. We propose that IU and AS are salient issues for many during the COVID-19 pandemic, and may play a role in the development or exacerbation of health anxiety during the pandemic. Studies have examined links between IU and AS with health anxiety during the pandemic, but these relationships have not been tested together using a longitudinal study design. In the present study, measures of IU, AS, and health anxiety were collected from 301 adults at two time points 6 months apart during (early stages of) the COVID-19 pandemic using an online survey platform. Cross-lagged analysis was utilized to simultaneously estimate cross-sectional and longitudinal associations between these three variables. Robust cross-sectional associations were observed, and IU prospectively predicted changes in both health anxiety and AS. No other statistically significant prospective associations emerged. Present findings support the putative role of IU in health anxiety, suggesting that some observed links between AS and health anxiety could be driven by shared variance with IU. IU may be an important factor to monitor and target in health anxiety interventions during the pandemic.     

Volume estimation of the gastric antrum and the gallbladder in patients with non-ulcer dyspepsia and erosive prepyloric changes, using three-dimensional ultrasonography

Abstract Background: Two-dimensional ultrasonography has shown a widened gastric antrum in patients with non-ulcer dyspepsia (NUD) and erosive prepyloric changes (EPC).
Methods: In this study, volumes of gastric antrum and gallbladder were estimated with three-dimensional (30) ultrasonography before and after ingestion of 500 ml meat soup in 17 NUD with EPC patients and in 18 healthy subjects. A mechanical ultrasound scanner, coupled to a stepping motor, tilted the transducer through an angle of 51° or 88° while recording a total of 95 or 81 images, respectively. Volume estimation was performed digitally after interactive manual contour tracing and organ reconstruction in three dimensions.
Results: Antral volumes were larger in NUD patients than in healthy controls (P = 0.001). Fasting gallbladder volumes were similar in the two groups. Postprandial antral filling was more pronounced in patients than in healthy subjects (P = 0.02). whereas gallbladder emptying was more pronounced in healthy subjects than in patients (P = 0.05). The soup induced dyspeptic symptoms in 15 NUD patients, but only had this effect in two healthy subjects (P < 0.001).
Conclusion: Patients with NUD and EPC are characterized by abnormal antral filling, reduced gallbladder emptying, and dyspeptic symptoms in response to ingestion of meat soup.     

Area-specific laminar distribution of cortical feedback neurons projecting to cat area 17: Quantitative analysis in the adult and during ontogeny

Corticocortical pathways can be classified as feedback and feedforward, in part according to the laminar distribution of the parent cell bodies. Here, we have developed exhaustive sampling procedures to determine unambiguously this laminar distribution. This shows that individual extrastriate areas in the adult cat have highly stereotyped proportions of supragranular layer neurons with respect to the total population of neurons back-projecting to area 17. During development, these adult laminar patterns emerge from an initially uniform radial distribution through a process of selective reorganization, which is highly specific to each area. Injections of fluorescent retrograde tracers were made in area 17. In areas 19, 20, posteromedial lateral suprasylvian area, and anteromedial lateral suprasylvian area, we defined a projection zone as the region containing retrogradely labeled neurons. In the neonate, counts of labeled neurons throughout the projection zones show constant percentages of 40% in the supragranular layers. During development, there is an area-specific reduction in the percentage of supragranular labeled neurons generating the laminar distributions characteristic of each area. Numbers of labeled neurons were estimated at different eccentricities of the projection zone. This finding indicates that during development there is a relative decrease in the numbers of labeled neurons of the periphery of the projection zone in the supragranular layers but not in the infragranular layers. This decrease is accompanied by a relative decrease in the dimensions of the supragranular projection zone with respect to the infragranular projection zone. These findings suggest that each extrastriate area precisely adjusts the proportions of supragranular layer neurons back-projecting to striate cortex in part by developmental changes in the divergence-convergence values of individual neurons. This shaping of corticocortical connectivity occurs relatively late in postnatal development and could, therefore, be under epigenetic control. J. Comp. Neurol. 396:493–510, 1998. © 1998 Wiley-Liss, Inc.