Stretch-reflex threshold modulation during active elbow movements in post-stroke survivors with spasticity

Publication date: Available online 3 August 2017
Source:Clinical Neurophysiology
Author(s): Nicolas A. Turpin, Anatol G. Feldman, Mindy F. Levin
ObjectivesVoluntary movements post-stroke are affected by abnormal antagonist activation due to exaggerated stretch reflexes (SRs). We examined the ability of post-stroke subjects to regulate SRs in spastic muscles.MethodsElbow flexor and extensor EMGs and angle were recorded in 13 subjects with chronic post-stroke spasticity. Muscles were either stretched passively (relaxed arm) or actively (antagonist contraction) at different velocities. Velocity-dependent SR thresholds were defined as angles where stretched muscle EMG exceeded 3SDs of baseline. Sensitivity of SRs to stretch velocity was defined as µ. The regression through thresholds was interpolated to zero velocity to obtain the tonic SR threshold (TSRT) angle.ResultsCompared to passive stretches, TSRTs during active motion occurred at longer muscle lengths (i.e., increased in flexors and decreased in extensors by 10-40°). Values of μ increased by 1.5-4.0. Changes in flexor TSRTs during active compared to passive stretches were correlated with clinical spasticity (r=-0.68) and arm motor impairment (r=0.81).ConclusionsSpasticity thresholds measured at rest were modulated during active movement. Arm motor impairments were related to the ability to modulate SR thresholds between the two states rather than to passive-state values.Significance. Relationship between spasticity and movement disorders may be explained by deficits in SR threshold range of regulation and modifiability, representing a measure of stroke-related sensorimotor deficits.



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Cortical involvement in myopathies: insights from transcranial magnetic stimulation

Publication date: Available online 3 August 2017
Source:Clinical Neurophysiology
Author(s): Raffaele Nardone, Viviana Versace, Luca Sebastianelli, Francesco Brigo, Stefan Golaszewski, Monica Christova, Eugen Gallasch, Leopold Saltuari, Eugen Trink
OBJECTIVEThere is increasing evidence that an involvement of central nervous system (CNS) can occur in several myopathies. Transcranial magnetic stimulation (TMS) may represent a valuable tool for investigating important neurophysiological and pathophysiological aspects of cortical involvement in neuromuscular disorders. In this review paper we aimed to perform a systematic search of the studies employing TMS techniques in subjects suffering from myopathies.METHODSA literature search was conducted using PubMed and Embase. We identified and reviewed 9 articles matching the inclusion criteria. One hundred twenty patients were included in these studies, which have applied TMS in patients with muscle disorders.RESULTSTo date, a few studies using TMS have been performed in myopathic patients and detected subclinical abnormalities in cortical reactivity and plasticity. The most consistent finding was a decrease in intracortical inhibition, which likely represents a non-specific compensatory mechanism of the CNS in an attempt to overcome the muscle deficit through an increase of the motor cortex output to deficient muscles.CONCLUSIONSApplication of TMS to characterize the pathophysiology of the CNS in these subjects appears to be safe and may lead to the development of valuable biomarkers. Well-defined motor cortical excitability patterns can be identified in the different muscle diseases, even if preliminary findings should be confirmed in future studies in larger cohorts of patients.SIGNIFICANCETMS studies may shed new light on the physiological and pathophysiological mechanisms underlying the cortical involvement in muscle disorders.



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Wake County EMS driver training

Operating an ambulance on the highway is usually fairly straight forward. But navigating tight neighborhoods while patients are being cared for in the back can be a little tricky. Academy members spend time exercising vehicle operations drills.

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Using Achievement Goal Theory in Motor Skill Instruction: A Systematic Review

Abstract

Background

Over the past two decades, achievement goal theory (AGT) has been used as a theoretical framework to design and implement motor skill programming in young children.

Objective

The purpose of this systematic review was to examine the effects of AGT in motor skill interventions and programming in children aged 0–12 years.

Methods

This systematic literature search was conducted using three databases: Google Scholar, PubMed, and EBSCOhost. Studies were included if they met the following four inclusion criteria: (1) had an intervention with a gross motor outcome, (2) used an intervention grounded in AGT, (3) included young children (aged 0–12 years), and (4) were written in English. Studies were rated according to methodological reporting quality. All literature searches and reporting were consistent with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol.

Results

A total of 12 studies met all inclusion criteria and were included in the sample. All studies reported that AGT motor skill interventions were effective for improving motor skills in young children. Studies varied in regard to intervention groups, duration, dosage, and the personnel responsible for implementing the intervention. None of the included studies met the requirements to be considered as having high methodological quality.

Conclusions

Based on these findings, AGT is an effective theoretical approach for designing and implementing motor skill interventions for young children.

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Alternative technique or mitigating strategy for sevoflurane-induced neurodegeneration: a randomized controlled dose-escalation study of dexmedetomidine in neonatal rats

Abstract

Background. Brain injury in newborn animals from prolonged anaesthetic exposure has raised concerns for millions of children undergoing anaesthesia every yr. Alternative anaesthetic techniques or mitigating strategies are urgently needed to ameliorate potentially harmful effects. We tested dexmedetomidine, both as a single agent alternative technique and as a mitigating adjuvant for sevoflurane anaesthesia.Methods. Neonatal rats were randomized to three injections of dexmedetomidine (5, 25, 50, or 100 µg kg⁻¹ every 2 h), or 6 h of 2.5% sevoflurane as a single agent without or with dexmedetomidine (1, 5, 10, or 20 µg kg⁻¹ every 2 h). Heart rate, oxygen saturation, level of consciousness, and response to pain were assessed. Cell death was quantified in several brain regions.Results. Dexmedetomidine provided lower levels of sedation and pain control than sevoflurane. Exposure to either sevoflurane or dexmedetomidine alone did not cause mortality, but the combination of 2.5% sevoflurane and dexmedetomidine in doses exceeding 1 µg kg⁻¹ did. Sevoflurane increased apoptosis in all brain regions; supplementation with dexmedetomidine exacerbated neuronal injury, potentially as a result of ventilatory or haemodynamic compromise. Dexmedetomidine by itself increased apoptosis only in CA2/3 and the ventral posterior nucleus, but not in prefrontal cortex, retrosplenial cortex, somatosensory cortex, subiculum, lateral dorsal thalamic nucleaus, or hippocampal CA1.Conclusions. We confirm previous findings of sevoflurane-induced neuronal injury. Dexmedetomidine, even in the highest dose, did not cause similar injury, but provided lesser degrees of anaesthesia and pain control. No mitigation of sevoflurane-induced injury was observed with dexmedetomidine supplementation, suggesting that future studies should focus on anaesthetic-sparing effects of dexmedetomidine, rather than injury-preventing effects.

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Prevalence and Risk of Moderate Stunting Among a Sample of Children Aged 0–24 Months in Brunei

Abstract

Objectives Globally, one-fifth of the world's children are stunted, however this statistic may be an underestimate as many countries lack comprehensive monitoring of height-for-age. Until a recent national health survey, Negara Brunei Darussalam has lacked the data to offer a comprehensive assessment of height-for-age among children. The aim of this study is to determine the prevalence of and factors associated with stunting among children aged 0–24 months in Negara Brunei Darussalam (Brunei). Methods A cross-sectional analyses of 396 children aged <24 months. Demographic, dietary and anthropometric measurements were recorded. Multivariate logistic regression was used to analyse factors associated with moderate stunting. Results Almost one-quarter of infants (24%) were stunted. Male children and children who were preterm (<37 weeks gestation) were more than twice as likely to be stunted as their counterparts, respectively (OR 2.48; 95% CI 1.49–4.12; OR 2.14; 95% CI 1.06–4.33, respectively). Those who were born low birth weight (<2.5 kg) were three times more likely to be stunted than those born normal birth weight (OR 2.99; 95% CI 1.44–6.17). Conclusions for Practice This study presents data on prevalence of stunting in Brunei based upon the World Health Organization's growth charts. In addition it is also the first time that the factors associated with stunting among infants aged <24 months have been examined in Brunei. The stunting prevalence in Brunei is of concern due to the reported short and long-term negative impact on health later in life. The authors recommend close monitoring of pregnant women who are at risk of delivering low birth weight infants and frequent monitoring of low birth weight infants in line with World Health Organization nutrition goals. Existing height-for-age data should be integrated into global databases.

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Complete mucosal healing of distal lesions induced by twice-daily budesonide 2-mg foam promoted clinical remission of mild-to-moderate ulcerative colitis with distal active inflammation: double-blind, randomized study

Abstract

Background

Budesonide foam is used for the topical treatment of distal ulcerative colitis. This phase III study was performed to confirm mucosal healing and other therapeutic effects of twice-daily budesonide 2-mg foam in patients with mild-to-moderate ulcerative colitis including left-sided colitis and pancolitis.

Methods

This was a multicenter, randomized, placebo-controlled, double-blind trial. A total of 126 patients with mild-to-moderate ulcerative colitis with active inflammation in the distal colon were randomized to two groups receiving twice-daily budesonide 2 mg/25 ml foam or placebo foam. The primary endpoint was the percentage of complete mucosal healing of distal lesions (endoscopic subscore of 0) at week 6. Some patients continued the treatment through week 12. Drug efficacy and safety were evaluated.

Results

The percentages of both complete mucosal healing of distal lesions and clinical remission were significantly improved in the budesonide as compared with the placebo group (p = 0.0003 and p = 0.0035). Subgroup analysis showed similar efficacy of budesonide foam for complete mucosal healing of distal lesions and clinical remission regardless of disease type. The clinical remission percentage tended to be higher in patients achieving complete mucosal healing of distal lesions than in other patients. There were no safety concerns with budesonide foam.

Conclusions

This study confirmed for the first time complete mucosal healing with twice-daily budesonide 2-mg foam in mild-to-moderate ulcerative colitis with distal active inflammation. The results also indicated that complete mucosal healing of distal lesions by budesonide foam promotes clinical remission of ulcerative colitis. Clinical trial registration no.: Japic CTI-142704.

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