Are hand biomechanics affected following radial forearm flap harvest? A systematic review and meta-analysis

Donor site morbidity following radial forearm flap (RFF) harvest remains a controversial issue. The aim of this meta-analysis was to answer the question “Are the range of wrist movements (range of motion, ROM) and hand strength affected after RFF harvesting?” The PubMed, Embase, Scopus, and Cochrane Library electronic databases were systematically searched (to December 2019). Self-controlled studies evaluating hand biomechanics after RFF harvest were included. Weighted mean differences with 95% confidence intervals were calculated using the random-effects model. The outcome variables were ROM, forearm movements, grip, and pinch strengths. Thirteen studies involving a total of 335 patients were included. With the exception of grip strength and supination, which showed statistically significant reductions of about 2.40 kg and 2.86° (P < 0.05), all other ROM, forearm movements, and pinch strengths showed an insignificant difference when the operated hand was compared to the non-operated hand (P > 0.05). Regression analysis showed that the method of donor site closure and size of the donor site defect had an insignificant impact on hand biomechanics. This study confirms the lack of discernible biomechanical morbidity after RFF transfer. The minimal reduction in hand biomechanics after RFF is considered to be clinically negligible.     

全身运动质量评估指导高危儿早期干预的研究

目的 通过比较全身运动(GMs)评估正常的高危儿单纯家庭康复训练与家庭康复训练联合药物干预的预后,分析GMs对高危儿早期干预的指导意义。方法 选取2016年2月-2017年2月于潍坊市妇幼保健院康复科就诊并接受GMs评估正常的183例高危儿,随机分组为观察组和对照组,观察组为单纯家庭康复训练组89例,对照组为家庭康复训练联合药物干预组94例。采用Peabody运动发育量表对两组患儿分别于纠正月龄6、9、12个月龄进行评估,对Peabody运动发育量表中各指标应用SPSS 21.0进行统计分析。结果 干预后,纠正月龄6、9、12个月龄时,观察组和对照组Peabody运动发育量表中粗大运动商(GMQ)、精细运动商(FMQ)、总运动商(TMQ)比较,差异无统计学意义(P>0.05),重复测量方差分析发现观察组和对照组的GMQ、FMQ、TMQ评分的组间效应差异无统计学意义(P>0.05),时间效应差异有统计学意义(P<0.05),干预因素与时间因素不存在交互作用(P>0.05)。结论 GMs评估对高危儿早期干预具有指导意义。GMs评估正常者,家庭康复训练可达到促进高危儿运动功能发育的目的 ,避免仅因系高危儿而采取“过度干预”。     

Mirror movements in progressive hemifacial atrophy

Mirror movements are simultaneous, involuntary, identical movements occurring during contralateral voluntary movements. These movements are considered as soft neurologic signs seen uncommonly in clinical practice. The mirror movements are described in various neurological disorders which include parkinsonism, cranio veretebral junction anamolies, and hemiplegic cerebral palsy. These movements are intriguing and can pose significant disability. However, no such observation regarding mirror movements in progressive hemifacial atrophy have been reported previously. We are reporting a teenage girl suffering from progressive hemifacial atrophy and epilepsy with demonstrable mirror movements in hand.     

Pseudoathetosis: report of three patients.

We report on 3 patients with pseudoathetosis, which are involuntary, slow, writhing movements due to loss of proprioception.     

Saccadic reaction times in acute and remitted schizophrenics

Summary Schizophrenics are known to have various disturbances of the visuomotor system. Whereas smooth pursuit eye movement disorders have been repeatedly confirmed, there are relatively few reports regarding possible disturbances of the saccadic system. In this study, the saccadic reaction times of 47 schizophrenic inpatients were investigated upon admission and later in the remitted state; 28 age- and sex-matched normal volunteers were tested as controls. Psychopathology and outcome were evaluated according to the Brief Psychiatric Rating Scale and the Prognostic Scale. Light stimuli were presented at random direction, location (ranging from 0° to 20°) and duration (800, 1000, and 1200 ms). The eye movements were recorded by electro-oculography. Compared with the control group, schizophrenics revealed prolonged saccadic reaction times, which correlated with pronounced negative symptoms and an unfavourable course of the illness. The saccadic reaction times remained prolonged in schizophrenic patients. These findings suggest attentional deficits in schizophrenics.This article was presented in part at the Symposium on Eye Movements and Psychopathology, Berlin, 23–24 June 1988     

The modular architecture of the neglect syndrome: Implications for action control in visual neglect

In our recent review of action control deficits in hemispatial neglect we concluded that many patients with the disorder have deficits in visuomotor control [Coulthard, E., Parton, A., & Husain, M. (2006). Action control in visual neglect. Neuropsychologia, 44(13), 2717-2733]. This conclusion has been questioned and it has been argued instead that there are no action deficits in neglect [Himmelbach, M., Karnath, H.-O., & Perenin, M.-T. (2007). Action control is not affected by spatial neglect: A comment on Coulthard et al. Neuropsychologia, 45(8), 1979-1981]. We proposed that rather than being specific to the neglect syndrome, action control deficits are more likely to relate to lesion location. Although many of these impairments may contribute to the manifestation of neglect, they may also occur in brain-damaged patients without the condition. In this article, we explore this framework further, discussing how neglect behaviour may emerge from damage to a set of visuomotor or cognitive modules, or their connections. Central to our view is the idea that the critical combination of deficits leading to neglect varies considerably between cases, and that visuomotor or cognitive modules disrupted in the syndrome may not, in fact, be specific to neglect.     

Analysis of saccadic short-term plasticity in three dimensions

The capacity for short-term adaptation is a well-established property of the horizontal (H) and vertical (V) components of saccades. It allows these directional components, which clearly serve the goal of foveation, to maintain their precision even under changing circumstances. Torsional (T) saccade components, on the other hand, which deal with the orientation of the target on the fovea, have hardly been investigated in adaptation experiments. They appear to be severely restricted by Listing's law during fixations and saccades. The main purpose of Listing's law is far from obvious but could be visual or oculomotor. Better knowledge of the adaptive capacity of the saccadic system in the torsional direction could throw new light on the functional significance of this interesting neural strategy. To study short-term plasticity in the torsional components of saccades, binocular 3D-eye positions were measured, using magnetic search foils. Five normal human subjects were instructed to make uni-directional refixation saccades, while they viewed a large visual scene. To induce a change in the torsional component, the complete stimulus was rapidly rotated during these saccades. We thoroughly investigated the torsional responses of the saccadic system, to see if any short-term adaptive response in torsional direction was induced, in which case the notion of a visual purpose for Listing's law would be strengthened. In none of our experiments, however, did we find any clear adaptive response in torsional direction. To further investigate the reliability of this result and to ascertain that our experimental conditions allowed classical gain adaptation, we also did experiments designed to achieve a combination of torsional adaptation and classic gain shortening in one of the directional components. While gain adaptation was very obvious, none of the experiments provided evidence for a short-term effect in torsion. We conclude that our experiments do not support a purely visual basis for Listing's law.     

Time to contact and the control of manual prehension

In the present study, a kinematic analysis was made of unconstrained, natural prehension movements directed toward an object approaching the observer on a conveyor belt at one of three constant velocities, from one of three different directions (head-on or along the fronto-parallel plane coming either from the subject′s left or right). Subjects were required to grasp the object when it reached a target located 20 cm directly in front of the hand′s start position. The kinematic analysis revealed that both the transport and grasp components of the movement changed in response to the experimental manipulations, but did so in a manner that guaranteed that, for objects approaching from a given direction, hand closure would begin at a constant time prior to object contact (regardless of the object’s approach speed). The kinematic analysis also revealed, however, that the onset of hand closure began earlier with objects approaching from the right than from other directions – an effect which would not be predicted if time to contact was the key variable controlling the onset of hand closure. These results, then, lend only partial support to the theory that temporal coordination between the transport and grasp components of prehension is ensured through their common dependence on time to contact information. Received: 20 September 1996 / Accepted: 16 June 1997     

Human cyclovergence as a function of stimulus frequency and amplitude

Summary By the use of scleral search coils a continuous record of human cyclovergence was obtained while two identical 80° textured patterns, presented dichoptically, oscillated in the frontal plane in counterphase through 1, 3 and 6° of cyclorotation at frequencies between 0.05 and 2 Hz. The amplitude and gain of the response decreased exponentially with increasing stimulus frequency. As stimulus amplitude increased, response amplitude also increased but gain was highest for low-amplitude cyclorotations. For an amplitude of 1° and a frequency of 0.05 Hz the gain reached 0.87 for two subjects. The phase lag increased from a few degrees at a frequency of 0.05 Hz to over 100° at a frequency of 2 Hz. These results suggest that cyclovergence is designed to correct for small, slow drifts in the stereoscopic alignment of the images in the two eyes. Although the disparity in the textured display was not interpreted as slant, it provided a strong stimulus for cyclovergence. The cyclovergence caused a transfer of cyclodisparity into a superimposed vertical line, which was then perceived as slanting in depth.     

Sensory and motor aspects of saccade control

Summary The oculomotor reactions have recently attracted increasing attention for diagnostic purposes. This is in line with the view that the oculomotor system is one of the simpler, machine-like sensorimotor systems. This paper presents two examples to demonstrate that the complexity of sensorimotor processing may be higher than expected from the outcome of experiments under rather restricted stimulus conditions. In the first part it is shown that complex preprocessing including the evaluation of spatial gradients of visual structure is an integral part of the programming of reflex-like saccades. The second part concerns adaptivity of saccadic eye movements. The data demonstrate that saccadic gain control is highly specific to the direction of the saccade. It is suggested that many central deficits may be hidden as a consequence of the effect of specific adaptive mechanisms.This article was presented in part at the Symposium on Eye Movements and Psychopathology, Berlin, 23–24 June 1988