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Biomedical subjects

J Drukker

Publications and source records attributed to J Drukker.

At least 19 recordsLinked to original sources

The effect of seat tilting on pelvic position, balance control, and compensatory postural muscle use in paraplegic subjects.

OBJECTIVE: To study the effect of seat tilting on pelvic tilt, balance control, and postural muscle use in persons with a thoracic spinal cord injury (SCI). DESIGN: Cross-sectional group study. SETTING: Rehabilitation centers and rehabilitation hospital departments. PATIENTS: Ten complete high thoracic SCI (level T2-8) patients, 10 complete low thoracic SCI (level T9-12) patients, and 10 matched able-bodied controls. INTERVENTION: A 10 degrees forward inclination of the seat. MAIN OUTCOME MEASURES: Pelvic tilt, center of pressure displacement, and muscle activity. RESULTS: Anterior tilting of the pelvis as a result of forward inclination of the seat could not be shown, either in persons with or without SCI. Balance control was not influenced by forward inclination of the seat. Participants' overall muscle activity decreased while they were seated in the chair with the forwardly inclined seat. CONCLUSIONS: Evidence provided by the kinematic and electromyographic data is not sufficient to develop a protocol for wheelchair prescription on the basis of pelvic positioning.

Adult↗

[Terminologia anatomica: a new reference work for anatomy].

The Nomina anatomica (6th edition in 1989) was the standard anatomical nomenclature until recently. It has been succeeded by the Terminologia anatomica (TA) by resolution of the International Federation of Associations of Anatomists in 1999. By now the TA has been published as a book and on cd-rom. The objective of the TA is to further uniformize the anatomical terminology, also internationally, and especially to democratize it, i.e. to ensure that it accommodates the needs of clinicians and medical scientists. The number of anatomical terms listed has grown to more than 7500. The increase is caused mainly by the insertion of clinical anatomical and neuro-anatomical names. A number of incorrect or misleading terms have been replaced. Each Latin term has a unique code number and is supplied with an English equivalent (International anatomical terminology; IAT) the spelling of which in either UK English or American English is considered equally correct. Based on the TA every language can formulate its own anatomical nomenclature. The nomenclature is presented per system or organ tract. An alphabetic index follows TA as well as the English IAT list. The use of eponyms is discouraged, but a list of well-known ones is appended to facilitate accessibility of older literature. Relevant suggestions about amendments are eagerly awaited and a broad basis of endorsement among the medical scientific world is hoped for. This journal will adopt the TA/IAT from now on as the work of reference regarding anatomical terms.

Anatomy↗

Stapedius muscle fibre composition in the rat.

The stapedius muscle (SM) is supposed to prevent cochlear damage by noise. Consequently functional demands are the ability of fast contraction with long endurance. This implies the presence of a large fraction of myosin type II fibres with an appreciable oxidative capacity. We determined the myosin composition of SM fibres using consecutive complete SM cross-sections (6 week old rats) which were processed by enzyme histochemistry (EHC) to determine acid/alkali lability of myofibrillar adenosine triphosphatase (mATPase) or by immunohistochemistry (IHC) using myosin heavy chain (MyHC) antibodies. Method accuracy was determined in co-processed extensor digitorum longus (EDL). Four hundred SM and 200 EDL fibres were assigned to mATPase type I, IIA, IIB, IIX or 'miscellaneous' ('Misc') categories. Per mATPase category the fibres were attributed to groups with specific MyHC composition. In the EDL, mATPase type I and IIB fibres expressed only MyHC I and IIB respectively, whereas about 10% of the type IIA and 40% of the type IIX fibres expressed more than one MyHC. Thus IHC detects amounts of myosin isoforms which are not detected by EHC. The mATPase IIX category criterion leaves the possibility that this category contains fibres with myosin type IIA and/or IIB in larger amounts. The criteria of the mATPase categories type I, IIA or IIB preclude assignment to these categories of fibres which also contain other myosin isoforms in larger amounts. Such fibres were classified in one of the mATPase 'Misc' categories. Thus in the EDL the capability of the EHC criteria to select 'pure' fibres in terms of myosin differs per mATPase category. None of the SM fibres were assigned to the mATPase type I or IIB categories, about 25% to the type IIA, 60% to type IIX and 15% (including most fibres which expressed MyHC I) to a 'Misc' category. All SM fibres expressed two or more MyHC isoforms, MyHC IIB occurring in all fibres and substantial amounts of MyHC IIA and/or IIX in most. These findings confirm the hypothesis that such fibres have the capacity to contract fast and have the better fatigue resistance.

Animals↗

Chair configuration and balance control in persons with spinal cord injury.

OBJECTIVE: To study whether chair configuration influences sitting balance in persons with spinal cord injury (SCI). DESIGN: Cross-sectional group study. SETTING: Rehabilitation centers and hospital rehabilitation departments. PATIENTS: Ten complete high thoracic SCI (level T2-T8) patients, 10 complete low thoracic SCI (T9-T12) patients, and 10 matched able-bodied controls. SCI participants had completed their active rehabilitation at least 6 months before the study. INTERVENTIONS: A balance-changing (forward) reaching task while seated in four differently configured chairs. Tilt angle (7 degrees and 12 degrees) and reclination angle (22 degrees) were varied relative to a standard chair configuration (10 degrees reclination). MAIN OUTCOME MEASURES: Maximal unsupported reaching distance, center-of-pressure displacement and muscle activity. RESULTS: Although no significant difference in actively controllable reach was found in controls or in subjects with low SCI, sitting balance improved in all chairs relative to the standard chair. Ability to control displacement of arms and trunk during reaching improved. No apparent need for additional postural muscle activity was found. Persons with high SCI did not improve their sitting balance. They were unable to control a shift in body mass larger than the one induced by arm movement. However, they had less muscle activity after backrest reclination or tilting the chair backwards. CONCLUSIONS: The tested chairs had an overall positive effect. However, for individually tailored chair configurations factors other than those investigated should be considered.

Adult↗

Surface EMG of proximal leg muscles in neuromuscular patients and in healthy controls. Relations to force and fatigue.

In an effort to find parameters to evaluate patients with neuromuscular disorders, surface electromyography (SEMG) of proximal leg muscles was performed in 33 patients with myotonic dystrophy (MyD), 29 patients with Charcot-Marie-Tooth (CMT) disease and 20 healthy controls. The root mean square (RMS) of the SEMG amplitude (microV) was calculated at different torque levels. Endurance (seconds) and median frequency (Fmed) of the SEMG power spectrum, used as parameters of fatigue, were determined at 80% of MVC. Maximum voluntary contraction (MVC) was found to be decreased in patients; the ratio between RMS values of antagonists and agonists was increased and torque-EMG ratios (Nm/microV) were decreased. These differences with respect to controls were more pronounced in MyD than in CMT. The initial Fmed value was lowest in CMT. The greatest decrease in Fmed was found in MyD. SEMG data in relation to force have not been determined before in groups of MyD or CMT patients. In both disorders, parameters differed from controls, which means that adding SEMG to strength measurements could be useful in studying the progress of the disorder and the effects of interventions.

Adult↗

Progressive resistance training in neuromuscular patients. Effects on force and surface EMG.

In a randomized clinical trial the efficacy of strength training was studied in patients with myotonic dystrophy (n = 33) and in patients with Charcot-Marie-Tooth disease (n = 29). Measurements were performed at the start and after 8, 16 and 24 weeks of progressive resistance training. Surface electromyography (SEMG) of proximal leg muscles was recorded during isometric knee extension at maximum voluntary contraction (MVC) and at 20, 40, 60 and 80% of MVC. Changes in MVC, maximum electrical activity and torque-EMG ratios (TER) were calculated. Fatigue was studied by determining the changes in endurance and in the decline of the median frequency (Fmed) of the SEMG during a sustained contraction at 80% MVC. These parameters showed no significant changes after the training in either of the diagnostic groups. Only the Charcot-Marie-Tooth training group showed a gradual significant increase in mean MVC over the whole training period (21%). After 24 weeks, the increase in mean RMS was similar (25%), but this was mainly due to a sharp rise during the first 8 weeks of training (20%). The findings indicate that the initial strength increase was due to a neural factor, while the subsequent increase was mainly due to muscle hypertrophy.

Adult↗

Postural muscle responses in the spinal cord injured persons during forward reaching.

To compensate for postural muscle function loss spinal cord injured (SCI) people have to use parts of the sensorimotor system which are still intact. In this study, postural control was investigated in high and low thoracic SCI people and in able-bodied controls, using a bimanual forward-reaching task. Muscle activity was recorded bilaterally from the erector spinae (ES) at level L3, T9 and T3, latissimus dorsi (LD), ascending part of the trapezius muscle (TPA), serratus anterior (SA), sternocostal head of the pectoralis major (PM) and the oblique abdominal muscles (OA) by means of surface electromyography. Sitting balance was monitored by measuring the changes in the location of the centre of pressure (CP) using a force platform. Muscle activity analyzed in different phases of the movement showed that SCI people adopt different postural adjustments to face the balance changes due to the reaching movement. SCI people make alternative use of non-postural muscles like the LD and TPA to maintain their sitting balance.

Adaptation, Physiological↗

Role of differential cell proliferation in the tail bud in aberrant mouse neurulation.

In the mouse mutant curly tail, the phenotypes spina bifida and curled tail result from a delay in closure of the posterior neuropore (PNP). At the developmental stage when this delay can first be recognized, the caudal region of the embryo demonstrates a transiently enhanced curvature of the body axis which likely inhibits elevation, convergence, and fusion of the neural folds. The enhanced curvature is thought to be the result of a decreased proliferation in the ventrally located gut endoderm and notochord, together with a normal proliferation of the overlying neuroepithelium of the PNP. However, the proliferation defect and the enhanced curvature were originally demonstrated at the same developmental stage, while it is expected that reduced proliferation should precede enhanced curvature and delayed PNP closure. The caudal region originates from the tail bud and we therefore propose that the enhanced curvature is induced by a disturbed dorso-ventral proliferation pattern in the tail bud. Using flow cytometry, proliferation patterns were determined separately for the dorsal and ventral halves of the tail bud of curly tail and of control embryos as well as of recombinant embryos having the curly tail phenotype with a genetic background which is matched to the BALB/c control strain. In general, it appeared that about half of the cell cycle duration in tail bud cells was occupied by S phase, about 40% by G0/G1 and the rest by G2/M. For the control embryos, no dorso-ventral differences in relative phase duration were demonstrated. However, curly tail and recombinant embryos at the 21-25 somite stage, prior to the onset of enhanced curvature, exhibited ventrally a higher proportion of G0/G1 phase cells than dorsally, and a complementary relationship for S phase cells. We interpret these observations as indicating a prolonged G1 phase at the ventral side of the tail bud, resulting in a prolongation of the cell cycle and thus a decreased proliferation. In 26-30 somite stage embryos, prior to the normalization of curvature in curly tail embryos, the dorso-ventral proliferation balance was re-established. We conclude that a reduced proliferation in the ventral part of the tail bud of the curly tail embryo precedes both the onset of enhanced curvature and the previously observed reduction in proliferation of the hindgut and notochord, and is a likely candidate for an early event in the pathogenetic sequence leading to the curly tail phenotype.

Animals↗

Differences in axial curvature correlate with species-specific rate of neural tube closure in embryos of chick, rabbit, mouse, rat and human.

Studies on the mouse strain curly tail, a mutant for neural tube defects, have indicated that axial curvature is an important factor in neural tube closure. Previously reported results from experimental interventions in both mouse and chick embryos indicated that curvature along the craniocaudal axis and closure of the posterior neuropore (PNP) are inversely related, a correlation that is also proposed for the rabbit embryo. It was hypothesized that this relationship is a sign of a more general mechanism. Therefore, in the present report the number of species in which axial curvature is described along the craniocaudal axis was extended to include the rat and human. Next, the closure rate of the neural tube as well as the curvature of the PNP region was determined morphometrically for embryos of the following species: chick, rabbit, mouse, rat and human. Although the relationship between neural tube closure and axial curvature appeared specific for each species in the comparative analysis, a general association of increased rate of closure with a decreased curvature emerged. It is concluded that axial curvature is an important factor in neurulation.

Animals↗

Development of new muscle synergies in postural control in spinal cord injured subjects.

The development of new patterns of postural control in patients with a complete thoracic spinal cord injury (SCI) during their active clinical rehabilitation was studied. Especially the role of non-postural muscles, like the latissimus dorsi (LD) and the trapezius pars ascendens (TPA), in maintaining and restoring sitting balance during standardized bimanual task performance was investigated. Twelve patients, diagnosed with an acute complete thoracic SCI between spinal cord level T2 and T12, participated in a longitudinal experimental study. Changes in the centre of pressure (CP) and electromyographic activity of the erector spinae (ES) at level L3, T9 and T3, the LD, the TPA, the pectoralis major (PM), the serratus anterior and the oblique abdominal muscles were investigated at several moments in the rehabilitation process. Results show a gradual development of specific muscle activation patterns for both high and low thoracic SCI patients. These patterns seem to be related to a combination of restoration of function of the ES-L3 and ES-T9 in the low thoracic SCI subjects and increased compensatory muscle use of the LD, TPA and PM in high SCI patients. The range in which low thoracic SCI patients can actively vary their CP increased slightly during rehabilitation.

Adolescent↗

Postural motor programming in paraplegic patients during rehabilitation.

One of the basic aims in the rehabilitation of thoracic spinal cord injured (SCI) patients concerns the regaining of sitting posture control. This implies the development of new postural strategies requiring the adjustment of motor programming processes. The aim of this study was to investigate the time course of postural reorganization during active, clinical rehabilitation of thoracic SCI patients with different SCI levels. Thus changes in motor programming in sitting balance control were investigated in two groups of complete low or high thoracic SCI patients. At several stages during the rehabilitation process an experiment was held in which sitting posture was perturbed systematically using submaximal reaching movements over four reaching distances. This bimanual reaching task was presented as a visual precue choice reaction time (RT) task in which reaching distance (i.e. grade of postural perturbation) was precued. Results indicated that in both high and low thoracic SCI patients RTs in movements involving postural perturbation became shorter during the course of the rehabilitation period. However, low thoracic SCI patients were generally slower in the programming of balance perturbing movements than high thoracic SCI patients, a phenomenon that did not change over time. Furthermore, initial differences in RTs as a function of grade of postural perturbation disappeared in both groups in the course of the rehabilitation phase. Precue benefit, equally large for both groups, did not change as a function of rehabilitation time. It is concluded that the observed phenomena signify the gradual development of new central postural control processes in both SCI groups during rehabilitation. Low thoracic SCI patients, having more residual sensorimotor functions, seem to adopt more complex strategies in maintaining and restoring sitting balance that take longer to specify and to programme. High thoracic SCI patients seem to rely on simpler strategies using more passive postural support.

Adolescent↗

Quadriceps strength and timed motor performances in myotonic dystrophy, Charcot-Marie-Tooth disease, and healthy subjects.

BACKGROUND AND PURPOSE: The leading hypothesis was that a relation exists between muscular strength and functional abilities. Therefore a study was undertaken to quantify such a relationship in a population of subjects with different muscular strengths. This population consisted of healthy subjects and subjects with slowly progressive neuromuscular disorders. METHODS: The study included 33 patients with myotonic dystrophy, 29 patients with Charcot-Marie-Tooth disease and 20 healthy subjects. Isokinetic and isometric knee torques were measured on an isokinetic dynamometer at various velocities. The following activities were timed: descending and ascending stairs, rising from a chair, rising from supine, walking at natural speed and walking at maximum speed. RESULTS: The population covered a wide range of the variables: whereas the healthy subjects performed best (i.e. had the highest knee torques and performed the activities most quickly), the myotonic dystrophy group included the subjects with the lowest knee torques. The natural logarithms (In) of isokinetic extension torque at the highest velocity (120 degrees/s) and those of the time taken to perform the described activities showed the highest levels of correlation. It was found that after correction for age and weight, 56% (walking at natural speed) to 73% (descending stairs) of the variance in the In of the time taken could be attributed to the variance in the In of the torques. CONCLUSION AND DISCUSSION: A strong relation between quadriceps strength and timed motor performances were demonstrated. The impact of strength reduction on time taken was most obvious in subjects with considerably decreased strength. Therefore, it is feasible to try to influence muscle strength in patients with relevant strength reduction in order to achieve better functional ability.

Adolescent↗

Spatio-temporal curvature pattern of the caudal body axis for non-mutant and curly tail mouse embryos during the period of caudal neural tube closure.

During the period of early organogenesis the mouse embryo has a curved body shape, which is thought to interact with ongoing developmental processes. Curly tail is a mouse mutant causing spina bifida, in which aberrant axial curvature is considered to be responsible for a delay in the closure of the posterior neuropore (PNP). Since detailed descriptions of axial curvature have never been made in either the normal or the mutant embryo, the onset and development of the aberrant axial curvature in the curly tail embryo are unknown. In the present study, axial curvature and segmental growth during closure of the PNP are described using circle segments at each somite level in two non-mutant mouse strains. Using the radius and angle of the segments as parameters, CD-1 and Balb/c mouse embryos showed maxima of curvature at the levels of the limb buds. Throughout development, a general axial unbending occurred that was due to a level-specific combination of general outgrowth and other factors. A marked additional decrease in the axial curvature was spatially and temporally related to the final closure of the PNP, indicating that this decrease of curvature facilities the final closure of the PNP. In the curly tail embryo the segment parameter radius was used to relate the axial curvature to an aberrant neural tube closure pattern. These embryos exhibited an enhanced curvature over the entire neuropore region as soon as a delay in the PNP closure could be distinguished. A steep decrease in curvature during final closure of the PNP did also occur, but at a more caudal level. Both the axial level of straightening and the rate of curvature were normalized at advanced developmental stages. The aberrant spatio-temporal curvature pattern in the curly tail mouse embryo indicates that both the rate of curvature and the axial level of unbending are important for a correct PNP closure.

Animals↗

Strength training in patients with myotonic dystrophy and hereditary motor and sensory neuropathy: a randomized clinical trial.

A randomized clinical trial on the effects of strength training was performed in myotonic dystrophy (MyD) patients and patients with hereditary motor and sensory neuropathy (HMSN). Training and most measurement tools involved the proximal lower extremity muscles. The participants trained 3 times a week for 24 weeks with weights adapted to their force. Strength was evaluated by isokinetically measured knee torque. Fatiguability was assessed by the time an isometric contraction could be sustained. Functional performance was measured by timed motor performance and by questionnaires on functional performance. Serum myoglobin (Mb) levels were determined to detect changes in muscle fiber membrane permeability. The MyD group included 33 participants, and the HMSN group included 29 participants. Within each diagnostic group, patients were individually matched and subsequently randomized for treatment allocation. In the MyD patients, none of the measurement techniques showed any training effect. Neither were there signs of deterioration caused by the training. In the HMSN group, knee torques increased. Timed motor performance did not change, although the questionnaires showed an improvement on items related to upper-leg function. Mb levels did not change significantly as a result of the training. In conclusion, the MyD group showed neither positive nor negative effects of the training protocol, whereas the training produced a moderate increase in strength and leg-related functional performance in the HMSN group.

Activities of Daily Living↗

Deterioration of motor function in myotonic dystrophy and hereditary motor and sensory neuropathy.

In order to obtain more information about the deterioration of motor function in patients with myotonic dystrophy and in patients with hereditary motor and sensory neuropathy, changes in strength and functionality were determined at one year intervals, over a follow-up period of 1 to 5 years. Twenty-five myotonic dystrophy patients and 16 hereditary motor and sensory neuropathy patients participated. Strength measurements were restricted to knee extension and flexion torques measured isokinetically on a dynamometer at two velocities (120 and 60 degrees/s). Functionality was measured as scaled time scores for rising from sitting, rising from supine, walking and stair climbing. Myotonic dystrophy patients showed a reduction of knee extension torques at 60 degrees/sec (mean decrease per year 5.7 Nm, or 9%) as well as a decrease in functionality. Hereditary motor and sensory neuropathy patients showed no statistically significant changes in torques or functionality. The correlation between isokinetically measured knee extension torques and functional scores was statistically significant in myotonic dystrophy but not in hereditary motor and sensory neuropathy. No correlation was found between changes in torques and changes in functional scores.

Adolescent↗

Reduction of knee torques and leg-related functional abilities in hereditary motor and sensory neuropathy.

Our purpose was to evaluate a test battery for measuring progress and the effect of interventions in patients with hereditary motor and sensory neuropathy (HMSN types I and II). For this purpose differences in upper leg strength and functional abilities between patients and healthy persons were quantified. Twenty patients participated in the study. They were matched with healthy control subjects with respect to gender, age, body weight, and height. Because of the high reproducibility and sensitivity of the method, muscle strength was quantified as isokinetic and isometric knee torques on an isokinetic dynamometer. Isokinetic knee extension and flexion torques were recorded for three movement velocities (120, 60, and 30 degrees/sec). An extension endurance test was performed at 80% of maximum voluntary contraction. Time scored activities (for instance, stair climbing) that are mainly related to leg function were measured to determine functional abilities. The torques were lower (p < 0.009) and endurance was less (p = 0.03) for patients than for controls. Time scores were higher (p < 0.013) in patients. A strength reduction in the knee extensors and flexors and a decrease in functional abilities was found even in mildly affected patients. Torques and time scores were correlated, although correlation coefficients were rather low. Our results indicate that both types of test are useful for monitoring lower limb function in HMSN patients.

Adolescent↗