Evaluation of the impotent patient.
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Erectile Dysfunction↗
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Results for “REFLEX, PROPRIOCEPTIVE”
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Human reflexology and motor preparation.
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Afferent Pathways↗
Coccidioidomycosis in the llama: case report and epidemiologic survey.
An 8-year-old nongravid female llama with a 1-month history of progressive posterior paresis was referred because of suspected degenerative myelopathy secondary to copper deficiency or plant poisoning. Neurologic examination revealed loss of conscious proprioception and slightly depressed bilateral patellar reflexes. Electromyographic examination of hindlimb flexors and extensors did not elicit evidence of lower motor neuron disease. Possible fragmentation and mottling of the 10th thoracic vertebral body were noted radiographically. Results of a lumbar CSF tap, complete blood count, and fecal flotation were not diagnostic. In the face of poor prognosis, the llama was euthanatized. Postmortem and histologic evaluation revealed, in addition to disseminated visceral granulomas, an extradural pyogranulomatous mass compressing the cord laterally at the level of T-10. Large numbers of Coccidioides immitis were dispersed throughout the granulomas. Complement fixing antibody tests in 11 other herd members showed evidence of C immitis infection in three.
Animals↗
Caloric tests on platform: "paradoxical responsiveness".
This paper deals with the abnormal responsiveness of the paradoxical stabilizing type (SR) occurring after caloric tests (CALT) performed on a passive force platform. The normal response after CALT (cold/warm, monaurally performed) consists of transient ataxia and body sway towards the side of the nystagmic slow phase induced by a similar CALT. Quantitatively the vestibular responsiveness to CALT is defined as the quotient of lengths QL calculated with measures of recordings after CALT (cold and warm responses averaged) versus recordings at rest. A normal vestibular responsiveness is defined as 1.5 < QL < 2.5; a vestibular lesion corresponds to QL around 1.0 (0.8-1.2); the paradoxical stabilizing responsiveness SR-CALT corresponds to QL < 0.65 and represents a particular type of lesional response. We observed SR-CALT in 23 patients from a total of 135 patients with similar lesions (SR excepted) after CALT at the vestibulo-ocular and vestibulo-spinal levels. SR-CALT appeared unilaterally in 11 patients, bilaterally in 12 patients. About half of the patients were followed up (1-4 years) and later exhibited total lesions but no more SR-type responses. All the patients had chronic- or bilateral vestibular lesions, with acute worsening of vertigo complaints and a spell-like lesional evolutivity, due to Meniére's disease or evolutive lesions of diverse origin. Additionally other tests, particularly those involving the neck-vestibular interactions, could induce SR-type responses in these patients. The significance of SR-CALT is discussed and we hypothesize that SR possibly represents a particular kind of vestibular "decompensation" at the vestibulospinal level in cases of chronic but recent evolutive vestibular lesion.
Adolescent↗
The role of joint afferents in sensory processing in osteoarthritic knees.
OBJECTIVE: To test the role of joint receptors for proprioception in patients with bilateral knee osteoarthritis (OA) and patients who had undergone unilateral total knee arthroplasty (TKA). METHODS: Nine patients were tested bilaterally with a conventional movement detection paradigm that evaluated conscious detection perception and a newly developed hunting paradigm that measured maximal sensory performance (hunting perception). RESULTS: For detection perception, patients exhibited a slightly lower threshold on the arthritic side than on their TKA side. For hunting perception, the patients showed threshold values that were an order of magnitude smaller than for the conventional paradigm in both knees. Performance was much better on prosthetic knees than on OA knees. CONCLUSION: The joint receptors of OA knees might have an adverse effect on the maximal proprioceptive performance, being important for the normal reflexive knee joint functions. These deficits may be overcome by joint receptor removal during knee replacement.
Knee Joint↗
Assessment of clinical criteria to diagnose scrapie in Italy.
A reliable ante-mortem test for the detection of scrapie in all genotypes has not yet been developed and clinical diagnosis remains a useful tool for surveillance purposes. This paper describes the results of a three-year study in which clinical signs consistent with scrapie were recorded according to standardized criteria in 245 sheep from 21 outbreaks in Italy in order to identify helpful criteria for the diagnosis of the disease. Thirty-seven sheep were scrapie-positive at post-mortem rapid testing, 23 showed weight loss, 20 had proprioceptive deficits, 17 demonstrated ataxia and nibble reflex, and some sheep had a combination of signs. Six scrapie-positive sheep were asymptomatic. The clinical protocol was easy to handle and appears to be a useful tool for improving passive surveillance. The data suggested that positive clinical history, nibble, and nibble combined with proprioceptive positioning deficit have a quite high negative predictive value. The protocol will be proposed as a tool for field inspection in passive surveillance in Italy.
Animals↗
Dynamic and static subjective visual vertical with aging.
OBJECTIVE: Our vestibular function is gradually deteriorating during aging, although, its behavioral consequences are not easily recognized due to a substitution process by other sensory modalities as visual or proprioceptive inputs. METHODS: To reveal such a hidden substitution process by visual signals, the measurement of the static as well as the dynamic subjective visual vertical (SVV) was performed among 63 healthy subjects of different age. RESULTS: The static SVV was found to be stable among all subjects, whereas the shift of the dynamic SVV during rotation of a background scene gradually increased with age. CONCLUSION: This result indicates that the substitution process identified as a function of age in a perceptual test may have its counterpart in postural stabilizing reflex.
Adult↗
[Age dependence of the interaction between proprioception and vision--a posturographic study].
BACKGROUND: The influence of fixation on the vestibulo-ocular reflex and the synergistic stabilising effect of vision on the body equilibrium are well known. In this study interactions between the visual and the proprioceptive systems in patients of different ages are analysed. We tried to find out whether body equilibrium reactions, recorded by posturography, are influenced qualitatively and quantitatively by visual inputs. METHODS AND PATIENTS: 349 neurotologic patients aged between 3 and 80 years were included in this study. We applied different optical patterns by means of a videoscreen to the patients standing on a posturographic platform. The patients were asked to follow the pattern with their centre of the gravity, which was also shown on the video screen. The patterns consisted of a line that had to be followed in the anterior-posterior and in the lateral plane and of a circle which had to be followed clockwise and counterclockwise. RESULTS: We recognised definite age-related changes in all tests used. The precision to follow a visual target with the body equilibrium increased with increasing age to the age of forty. With the beginning fifth decade this postural ability decreases slowly and decreases particularly markedly in patients of over 70 years of age. CONCLUSIONS: Posturography in combination with visual feedback is a valuable technique for testing visual-proprioceptive interactions. It can be employed over a large age bracket.
Adolescent↗
Visual and vestibular contributions to pitch sway stabilization in the ankle muscles of normals and patients with bilateral peripheral vestibular deficits.
Vestibular, visual, and proprioceptive influences on muscle activity correcting for backwards body tilt were investigated in normals and patients with bilateral peripheral vestibular deficits. Body tilt was induced by a dorsi-flexion rotation of the feet about the ankle joints while the subject stood on a force measuring platform. Ankle muscle activity and torque were monitored as upright stance was reestablished, and correlated with head angular accelerations and neck muscle activity. In normals with eyes closed, soleus stretch reflex activity at 50-80 ms was followed by two bursts of tibialis anterior (TA) EMG activity at ca 80 and 125 ms from the onset of 36 deg/s, 3 deg amplitude platform rotations. Neck muscle activity rotated the head backwards at the same time as TA activity rotated the body forwards about the ankle joints. Under the influence of vision, i.e. eyes open, slight increases in the second burst of TA activity, and ankle torque were observed. When the subjects sat, and were instructed to activate TA rapidly on onset of the platform movement, TA EMG activity increased gradually at ca. 150 ms and not as a burst. In patients with long-lasting bilateral vestibular deficits, both bursts of TA activity were significantly less than normal with eyes closed. Consequently sway correcting torques were abnormally low and all but one of the patients fell over backwards. With eyes open, TA activity was slightly less than, and ankle torques were approximately equal to normal values. In contrast to normals, TA responses obtained in standing and sitting positions were not significantly different. Neck EMG activity varied from normal, consisting of a long burst 100 ms in duration. The present data indicate that a coordinated pattern of ankle, and neck muscle activity occurs during the first 150 ms following induced backward tilt. Ankle muscle activity corrects for the body sway, and neck muscle activity attempts to stabilise the head with respect to earth fixed coordinates. It is proposed that the vestibulo-spinal reflex system predominantly underlies the genesis and coordination of this muscle activity.
Adult↗
Cruciate ligament reflexes.
The idea of muscular reflexes elicited from sensory nerves of the cruciate ligaments is more than 100 years old, but the existence of such reflexes has not been proven until the recent two decades. First in animal experiments, a muscular excitation could be elicited in the hamstrings when the anterior cruciate ligament (ACL) was pulled, and tension in the ligament caused activity of the gamma motor neurones of the muscles around the knee. Impulses from the sensory nerves in ACL were activated during motion of the knee, in particular overstretching and combined extension and rotation. In humans, proprioception in the knee is decreased after ACL rupture. By mechanical or electrical stimulation of the ACL, an excitation in the hamstrings muscles can be elicited. During muscular activity, stimulation of the ACL or PCL results in a clear inhibition of the ongoing activity, both during static isometric and isokinetic muscle work, and also during dynamic activity (gait). This inhibitory reflex subjectively resembled giving way. The latency of the reflex was short in animals (about 3 ms) and long in humans (60-120 ms), probably caused by differences in the experimental setup and between species. The long latency in humans makes it unlikely that it is a directly protective reflex. Instead it may be involved in the updating of motor programs. Further research may characterize the reflex in details and map its pathways. The existence of this reflex indicate that the cruciate ligaments have an afferent function, which influences knee dynamics.
Animals↗
Ia presynaptic inhibition after muscle twitch in the arm.
Contraction of upper limb muscles in healthy subjects was used to investigate presynaptic inhibition at spinal level. The H reflex recorded in the forearm flexor muscles in response to median nerve stimulation was depressed in amplitude from 400 ms to 1 s after a muscle twitch induced by transcranial stimulation, root stimulation, direct biceps stimulation, and triceps tendon tap. Stimulation of the cutaneous branch of musculocutaneous nerve, ipsilateral triceps and contralateral biceps, and biceps tendon tap did not alter H-reflex size. Forearm flexor H-reflex amplitude is therefore related to changes in proprioceptive inflow secondary to the biceps muscle twitch. Root and direct muscle stimulation both failed to reduce the size of the motor evoked potential (MEP) after transcranial magnetic stimulation, suggesting that the inhibition acts at presynaptic level. Attenuation of H-reflex amplitude was related to the size of the muscle twitch and was less pronounced during an isometric twitch than during free joint movement. Our results suggest that the biceps muscle twitch produces long-lasting inhibition of the Ia afferents from forearm flexor muscles. This is an important and a simple mechanism for suppressing proprioceptive input during movement.
Adult↗
Muscular responses and movement strategies during stumbling over obstacles.
Although many studies have investigated reflexes after stimulation of either cutaneous or proprioceptive afferents, much less is known about responses after more natural perturbations, such as stumbling over an obstacle. In particular, the phase dependency of these responses and their relation to the stumbling behavior has received little attention. Hence response strategies during stumbling reactions after perturbations at different times in the swing phase of gait were studied. While subjects walked on a treadmill, a rigid obstacle unexpectedly obstructed the forward sway of the foot. All subjects showed an "elevating strategy" after early swing perturbations and a "lowering strategy" after late swing perturbations. During the elevating strategy, the foot was directly lifted over the obstacle through extra knee flexion assisted by ipsilateral biceps femoris (iBF) responses and ankle dorsiflexion assisted by tibialis anterior (iTA) responses. Later, large rectus femoris (iRF) activations induced knee extension to place the foot on the treadmill. During the lowering strategy, the foot was quickly placed on the treadmill and was lifted over the obstacle in the subsequent swing. Foot placement was actively controlled by iRF and iBF responses related to knee extension and deceleration of the forward sway. Activations of iTA mostly preceded the main ipsilateral soleus (iSO) responses. For both strategies, four response peaks could be distinguished with latencies of approximately 40 ms (RP1), approximately 75 ms (RP2), approximately 110 ms (RP3), and approximately 160 ms (RP4). The amplitudes of these response peaks depended on the phase in the step cycle. The phase-dependent modulation of the responses could not be accounted for by differences in stimulation or in background activity and therefore is assumed to be premotoneuronal in origin. In mid swing, both the elevating and lowering strategy could occur. For this phase, the responses of the two strategies could be compared in the absence of phase-dependent response modulation. Both strategies had the same initial electromyographic responses till approximately 100 ms (RP1-RP2) after perturbation. The earliest response (RP1) is assumed to be a short-latency stretch reflex evoked by the considerable impact of the collision, whereas the second (RP2) has features reminiscent of cutaneous and proprioceptive responses. Both these responses did not determine the behavioral response strategy. The functionally important response strategies depended on later responses (RP3-RP4). These data suggest that during stumbling reactions, as a first line of defense, the CNS releases a relatively aspecific response, which is followed by an appropriate behavioral response to avoid the obstacle.
Adult↗
[Movement disorders in weightlessness].
The system MONIMIR has been developed to study the coordination of eye, head and arm movements as well as spinal reflexes in microgravity and was used during three spaceflights on board of the station MIR. The following investigations in the course of the experiment MONIMIR were performed: (1) slow head movements in three planes, (2.3) fast pointing movements of eyes, head and arm to acoustic and visual targets, (4) tracking movements of eyes, head and arm to visual targets, (5) head and arm movements based on short term memory and (6) patellar-tendon-reflex. In microgravity different functions and effectors showed different nature and degree of disturbance and different courses in adaptation; in most of the tests exactness and velocity of head and arm movement was decreased; head movements were more disturbed than arm movements; fast pointing movements were more severely affected than slow tracking movements which partly improved; visual controlled movements showed better adaptation as only proprioceptive controlled movements; the patellar-tendon-reflex was highly increased. Disturbances were most pronounced in the early stage of the spaceflights; at later stages most of the performances improved. Methods and results can be used not only for improvement of election and health control of cosmonauts/astronauts for future longterm space missions but also for diagnostics and research of adaptational processes in course of diseases or extreme conditions on earth.
Extraterrestrial Environment↗
Magnetic resonance imaging of presumptive lumbosacral discospondylitis in a dog.
A three-year-old male Boxer dog had hyperesthesia, symmetrical epaxial, gluteal and hind limb muscular atrophy and rear limb ataxia. Neurological deficits included decreased conscious proprioception of the left hind limb, decreased withdrawal and increased patellar reflexes of both hind limbs. The dog had a urinary tract infection with positive culture for Staphylococcus intermedius. On survey radiography of the lumbosacral spine there was active bone proliferation spanning the L7 S1 intervertebral disc space with an epidural filling defect at the ventral aspect of the vertebral canal on epidurography. On magnetic resonance imaging (MRI), findings were similar to those described for human diskospondylitis including altered signal intensity and nonuniform contrast enhancement of the L7-S1 intervertebral disc, adjacent vertebral end plates and epidural and sublumbar soft tissues. Although skeletal radiography is usually sufficient to reach a diagnosis of discospondylitis, MRI of this patient made it possible to reach a presumptive diagnosis of discospondylitis prior to development of definitive radiographic abnormalities.
Animals↗
[Generators of walking movements in humans: spinal mechanisms of their activation].
The paper is focused on spinal generation of walking movements in patients afflicted with loss of supraspinal control consequent to back trauma. The author cites literature on methods of initiation of walking movements with pharmacological and proprioceptive stimulation. On his own experimental investigations with epidural electrical stimulation of the spinal marrow dorsal surface he proves existence of walking generators in the human. There is evidence that the walking pattern in extensors is formed through amplitude modulation of monosynaptic reflexes, whereas in flexors it is established through switching of the reflex paths from the monosynaptic reflex to the polysynaptic neuron network. Investigations of the functional deafferentation of lower extremities showed that walking movements as a result of epidural stimulation are intraspinal by origin and adjusted by way of peripheral feedback. A hypothetical sequence of activation of walking generators through the propriospinal system of dorsolateral and ventrilateral funiculi has been put forward.
Animals↗
[The influence of dorsal neck proprioceptive inputs on vestibular compensation--by three-dimensional analysis of neck-induced nystagmus].
The influence of dorsal neck proprioceptive inputs on vestibular compensation was investigated in 21 patients with unilateral vestibular dysfunction. Subjects neither had history of spontaneous nystagmus nor of disequilibrium, indicating that they were in a good compensated stage. However, marked nystagmus was induced by applying vibratory stimulation to the dorsal neck of the patients, using a vibrator with a frequency of 110 Hz. The nystagmus was three-dimensional as analyzed by applying computerized eye movement analysis system. Twelve of 21 patients (57%) demonstrated three components of eye movement. All subjects showed a horizontal component directed towards the contralateral side of the vestibular lesion. Vertical and torsional components of the nystagmus were exhibited by 18 and 14 subjects, respectively. The average percentages of slow phase velocity of the horizontal, vertical and torsional components were 57%, 23% and 20%, respectively. No tendency towards any of the three components was observed. Furthermore, in order to investigate the relation between dorsal neck proprioceptive inputs and vestibular outputs, especially semicircular canal outputs, the author compared the direction of the nystagmus with the orientation of the semicircular canals. Normalized average velocity vectors of the nystagmus were calculated. In most subjects, the velocity vectors of the nystagmus were related to the horizontal semicircular canal. These results suggest that by controlling the neck proprioceptive inputs, neck vibration can cause discompensation in vestibularly well-compensated subjects with unilateral dysfunction secondary to vestibular lesion, and that neck proprioceptive inputs have a great influence on the horizontal vestibulo-ocular reflex pathways. However, in a few subjects the average vectors of the nystagmus were related to the vertical semicircular canals. This suggests that the proprioceptive inputs may also be related to the vertical vestibulo-ocular reflex pathways.
Adult↗
Segmental neurophysiological mechanisms in scoliosis.
Segmental spinal reflexes (stretch reflexes) were studied in patients with scoliosis. The proprioceptive responses to the phasic stretch of the paraspinal muscles were asymmetric in all patients, and were increased on the convex side. The asymmetry was more pronounced when the patients were standing. The observed asymmetry of the reflex responses was taken to indicate asymmetry in the tone and postural activity of the superficial layer of the paraspinal muscles. A reciprocal relationship was found in the segmental reflex organisation between the superficial and deep layers of the paraspinal muscles. The increase in reflex response of the superficial muscles on the convex side can be due to diminished reciprocal inhibition from weak, deep muscles. Thus a segmental neurogenic disorder involving predominantly the deep paraspinal muscles of the convexity of the curve may be the primary lesion responsible for the development of scoliosis.
Adolescent↗
H-reflex latency and sensory conduction in the assessment of neuropathy in patients of chronic obstructive lung disease.
H-reflex latency, proximal conduction velocity and distal proprioceptive conduction velocity were studied along with distal motor and sensory conduction in 38 patients of chronic obstructive lung disease grouped according to age and duration of the disease, as well as in 35 age-matched smoker controls and 14 non-smoker controls. The mean values of all the parameters studied in all the patient groups were significantly different from those of the non-smoker control group. Smoker controls also showed significant abnormality in all the parameters except motor conduction velocity. Among the patients, significant abnormality (mean +/- greater than 2 SD) was seen in 44.7% in motor conduction, 86.8% in sural nerve distal latency, 97% in Ia conduction velocity, 78.9% in H-reflex latency and 60.5% in proximal conduction velocity, as compared to the non-smoker control values. Among the old patients with more than 10 years of the disease, 62.5% had all the parameters significantly abnormal. More than one parameter was affected in 97.4% of the patients. The intra-group and inter-group differences in all the parameters studied, except motor conduction velocity, were statistically significant indicating that age, chronicity of the disease and smoking can produce nerve conduction defects independently and collectively. It is suggested that though all parameters studied are highly sensitive to neuropathies, proximal H-latency studies are best suited for grading conduction defects in patients of chronic obstructive lung disease, since in many patients sural nerve action potential (52.63%) and distal H-reflex response for Ia conduction studies (81.52%) could not be elicited.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗