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PubMed1988

Recovery of motor function after severe traumatic coma.

This paper describes the resumption of motor activity during the successive stages of recovery following severe traumatic coma and discusses the likely mechanisms of such resumption. Even in severe brain injury a considerable amount of motor recovery is possible and leads to a normal level of function in half of the cases. The impairment of voluntary movements is often transitory and recovers spontaneously but in cases of persistent deficits probably from direct lesion of the pyramidal tract re-education efforts are relatively inefficient. The disorders of reflex and semi-automatic motor activity subserving tonic adjustments, gait and locomotion are nearly constant and often severe. The recovery of this basal function is the most important to attain and to secure and this can be achieved through extensive and prolonged retraining of reflex activity. Presumably these disorders are not caused by direct lesions of brainstem structures but rather to a functional denervation akin to spinal shock. A resumption of function in the denervated groups of neurons should necessitate the reopening of silent synapses and/or a structural reorganisation of synaptic connections, this dynamic process being highly influenced by retraining.

Coma↗
PubMed1999

Effect of gastrin on proximal gastric motor function in humans.

UNLABELLED: The present study was performed to investigate the effect of gastrin on proximal gastric motor and sensory function. Ten healthy volunteers participated in three experiments performed in random order during: (A) continuous intravenous infusion of saline (control) or (B) gastrin (15 pmol kg-1 h-1) reaching postprandial serum gastrin levels or (C) gastrin infusion (15 pmol kg-1 h-1) preceded by acute acid inhibition with intravenous omeprazole. Proximal gastric function was evaluated using a barostat with stepwise pressure and volume distensions and volume measurements during set pressure (MDP + 2 mmHg). Gastrin significantly increased the intragastric volume compared to control during MDP + 2 mmHg (276 +/- 39 mL vs. 159 +/- 9 mL; P < 0.01) and reduced phasic slow volume wave frequency (from 1.4 +/- 0.1 to 0.7 +/- 0.1 per min; P < 0.01). During isobaric distensions gastrin increased gastric compliance (42 +/- 4 mL mmHg-1 vs. 31 +/- 3 mL mmHg-1; P < 0.05). These effects of gastrin infusion were completely abolished by pretreatment with omeprazole. Symptom perception decreased during gastrin infusion and was more dependent on pressure and wall tension than on volume. IN CONCLUSION: gastrin may have a role in regulating proximal gastric mechanics by inducing fundic relaxation and increasing gastric wall compliance. The effect of gastrin is dependent on acid secretion.

Adult↗
PubMed2002

Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury.

Changes in somatosensory input can remodel human cortical motor organization, yet the input characteristics that promote reorganization and their functional significance have not been explored. Here we show with transcranial magnetic stimulation that sensory-driven reorganization of human motor cortex is highly dependent upon the frequency, intensity, and duration of stimulus applied. Those patterns of input associated with enhanced excitability (5 Hz, 75% maximal tolerated intensity for 10 min) induce stronger cortical activation to fMRI. When applied to acutely dysphagic stroke patients, swallowing corticobulbar excitability is increased mainly in the undamaged hemisphere, being strongly correlated with an improvement in swallowing function. Thus, input to the human adult brain can be programmed to promote beneficial changes in neuroplasticity and function after cerebral injury.

Adult↗
PubMed1989

Impairment and recovery of ipsilateral sensory-motor function following unilateral cerebral infarction.

After unilateral cerebral hemisphere stroke, resulting in contralateral arm symptoms but largely sparing higher cerebral function, ipsilateral arm function is generally considered to be unaffected. In this study, 8 subjects with acute unilateral cerebral infarction (confirmed by CT scan) and primarily motor deficits underwent 11 computerized and 6 clinical assessments between 11 days and 12 months poststroke, and were compared with 12 normal subjects. Computerized tests comprised 3 pursuit tracking tasks (preview-random, step and a combination of these), designed to measure different aspects of integrated sensory-motor (S-M) function, and 12 tasks aimed at breaking tracking into various sensory, perceptual and motor components (joint movement sense, visual resolution, object perception, static and dynamic visuospatial perception, range of movement, grip and arm strength, reaction time, speed, static and dynamic steadiness). The asymptomatic arm was impaired on all but one of the computerized tests throughout the 12-month period, although to a lesser degree than the symptomatic arm. Grip strength was marginally impaired initially. Incomplete neurological recovery was seen in the asymptomatic arm for all functions except strength, speed and steadiness, possibly indicating their resistance to improvement. Clinical assessment detected no asymptomatic arm impairment and only a mild transient deficit of higher mental function. Our data suggest that (1) all cerebral hemisphere areas involved in S-M functions can exert some degree of bilateral motor control; (2) ipsilateral influence is never greater than contralateral influence, and is usually considerably less; and (3) the proportion of ipsilateral to contralateral control is closely related to the degree of continuous sensory feedback required by the particular task. The mechanism and degree of ipsilateral dysfunction can be explained by a 3-tier cerebral model of S-M integration comprising a lower level of functions with high contralateral specificity (somatosensory and motor), a middle level of non-limb-specific partially lateralized functions (ideomotor praxis and visuospatial perception) and an upper level of global mental activities (intellect, alertness, etc.).

Adult↗
PubMed1998

An evaluation of motor function in transverse colon transplants after total gastrectomy.

The motor activity of the isolated colon is understood less than that of any other part of the gastrointestinal viscus. Thus, the aim of the present study was to evaluate the motor activity of the interposed transverse colon following total gastrectomy through a study of 21 patients. Manometric studies were carried out with a 5-lumen, open-tipped catheter in the resting state, in response to dry swallows, and swallowing distilled water and a liquid meal. Contractile waves in the interposed colon grafts were divided into three types, namely, high-amplitude propagated contractions (HAPCs), low-amplitude propagated contractions (LAPCs), and low-amplitude nonpropagated contractions (LANPCs). No retrograde contractions were observed during the entire recording. Motor activity in the interposed colon increased to a greater extent after swallowing distilled water or liquid meals than during the resting period or after dry swallows; however, there was no significant difference between the effect of distilled water and liquid meals. The motor activity of the interposed colon was lower in patients with symptoms than in asymptomatic patients. These results suggest that the volume, rather than the composition, of the lumen contents is an important factor for inducing interposed colon graft contractions, and that contractions of the interposed colon can help to propel the contents of the colon into the duodenum and clear any duodenal juice if reflux should occur.

Anastomosis, Surgical↗
PubMed1985

Treatment strategies for emotional-motivational blocks to motor functioning in children.

This article presents causes of poor motor performance in children other than intrinsic physical disabilities and describes treatment of those problems involving behavioral barriers. Chief among these are motivational-emotional handicaps in the form of lack of confidence, dependence ("learned helplessness"), impulsivity, restlessness, and lethargy. An observational check list for the identification of these nonphysical sources of failure has recently been published as part of the revision of the Stott-Moyes-Henderson Test of Motor Impairment (TOMI-R). The affected children erect defenses against motor challenges by either a frightened refusal to attempt a task (inhibition) or unconscious avoidance strategies such as distractibility, or defeatism. We give guidelines for helping children overcome each of these drawbacks and illustrate in detail the procedures for four of the tasks used in the TOMI-R.

Child↗
PubMed2005

Motor cortex stimulation for central and neuropathic facial pain: a prospective study of 10 patients and observations of enhanced sensory and motor function during stimulation.

OBJECTIVE: For more than a decade, motor cortex stimulation has been used to treat difficult central and peripheral neuropathic pain syndromes. This prospective study uses the McGill Pain Questionnaire, a visual analog scale (VAS) score, and an inventory of drug consumption to review the results of treating patients with trigeminal neuropathic pain via motor cortex stimulation. METHODS: Ten patients underwent motor cortex stimulation between 1999 and 2002. Implantation was performed via intraoperative neuronavigation and cortical mapping for stimulation site targeting. Nine patients had trigeminal neuropathic pain from postherpetic neuralgia, surgical injury, or unknown cause, and one patient had pain of central origin. Patients were evaluated with multimodality scales before, immediately after, and at designated intervals after surgery. Eight patients underwent permanent implantation after a trial evaluation. In two patients, the stimulating electrodes were removed after an unsuccessful trial. One of these patients had a lateral medullary infarct leading to central pain, and in another patient, there was no explanation for the pain. RESULTS: The average duration of pain before surgery was 6 years. Postoperatively, there was an 88% rate of immediate pain relief (>50% on VAS) and a 75% rate of pain relief at mean follow-up of 10 months (range, 3-24 mo). Mean preoperative McGill Pain Questionnaire total pain rating index was 57 (higher than that observed in causalgia) for patients who did not undergo implantation and 53 for those who underwent implantation. Mean McGill Pain Questionnaire pain rating index at mean follow-up of 10 months was 24 (55% decrease). Mean VAS preoperatively was 9 in patients with stimulator implants and 8 in those whose stimulator was removed after the trial. Immediate postoperative mean VAS score was 1. This score stabilized 3 months after surgery. Patients with implanted stimulators reduced their pain medication dose by a mean of more than 50%. Three patients with facial weakness and sensory loss regained both strength and discriminative sensation during stimulation. In another patient, dysarthria improved. In a review of the literature, 29 (76%) of 38 patients with neuropathic facial pain treated with motor cortex stimulation achieved greater than 50% pain relief. CONCLUSION: These results provide further support for the use of motor cortex stimulation in facial neuropathic pain and document pain improvement as measured by multidimensional scales. Observations of motor and sensory improvements during stimulation suggest that stimulation alters cortical plasticity and inhibits thalamic hyperactivity.

Adult↗
PubMedDate not supplied

[Disorders of motor functions after removal of parasagittal meningiomas].

Specific features of motor activity disorders were studied in 87 patients before and after removal of a parasagittal meningioma. Motor disorders are most severe in localization of the tumor in the region of the middle third of the superior sagittal sinus and falx and less severe when the tumor is found in the posterior parts of the anterior third of the superior sagittal sinus. The disorders are more marked after operation with extensive resection of areas of the superior sagittal sinus involves in the tumor and with occlusion of the formed venous drainage passages. The motor disorders are particularly severe after removal of parasagittal meningiomas and are often bilateral with multiple components (including disturbances in the pyramidal and extrapyramidal systems, afferent regulation of movements, and coordinated work of both hemispheres in the formation of motor acts). Not only the direct effect of the pathological focus on the cerebral motor zones situated at different levels but disorders of cerebral and peripheral circulation are of importance in the pathogenesis of these disturbances.

Adult↗
PubMed1983

Respiratory alkalosis early after stroke: its relation to loco-motor function.

In 27 acute stroke patients with hemi-motor deficit blood gases (paO2, paCO2 and blood pH) were determined within 72 hours and related to level of consciousness, site of brain lesion, findings of haemorrhage into the cerebral spinal fluid, extent of motor impairment and concomitant medical disorders. Sixteen subjects were followed for three weeks with repeated blood-gas sampling and assessment of motor control. Respiratory alkalosis occurred in 37%, hypoxia in 7% but acidosis in none. Blood gas abnormalities were significantly and positively associated only with the extent of motor impairment. Only small changes in blood gases were found during the three weeks follow-up. Initial findings of respiratory alkalosis predicted poor motor recovery during the follow-up period.

Aged↗
PubMed1999

Tapping into spinal circuits to restore motor function.

Motivated by the challenge of improving neuroprosthetic devices, the authors review current knowledge relating to harnessing the potential of spinal neural circuits, such as reflexes and pattern generators. If such spinal interneuronal circuits could be activated, they could provide the coordinated control of many muscles that is so complex to implement with a device that aims to address each participating muscle individually. The authors' goal is to identify candidate spinal circuits and areas of research that might open opportunities to effect control of human limbs through electrical activation of such circuits. David McCrea's discussion of the ways in which hindlimb reflexes in the cat modify motor activity may help in developing optimal strategies for functional neuromuscular stimulation (FNS), by using knowledge of how reflex actions can adapt to different conditions. Michael O'Donovan's discussion of the development of rhythmogenic networks in the chick embryo may provide clues to methods of generating rhythmic activity in the adult spinal cord. Serge Rossignol examines the spinal pattern generator for locomotion in cats, its trigger mechanisms, modulation and adaptation, and suggests how this knowledge can help guide therapeutic approaches in humans. Hugues Barbeau applies the work of Rossignol and others to locomotor training in human subjects who have suffered spinal cord injury (SCI) with incomplete motor function loss (IMFL). Michel Lemay and Warren Grill discuss some of the technical challenges that must be addressed by engineers to implement a neuroprosthesis using electrical stimulation of the spinal cord, particularly the control issues that would have to be resolved.

Adaptation, Physiological↗
PubMed2006

Complex motor function in humans: validating and extending the postulates of Alexandr R. Luria.

OBJECTIVE: We used functional brain imaging to reevaluate Luria's postulates and to elaborate the neural circuitry underlying performance of complex motor tasks. BACKGROUND: The anatomic organization and physiologic functioning of the normal human motor system have great significance for understanding motor dysfunction and remediation in neurology. Working with victims of penetrating head injuries, noted Russian neuropsychologist Aleksandr R. Luria designed several tests of fine motor control to understand their difficulties with complex voluntary movements. This led to his postulates that such function involves the premotor cortices and their interaction with the parietal lobe. METHOD: Six healthy young adults performed the hand imitation, fist-scissors-gun, and piano key tasks during blood oxygen level-dependent functional magnetic resonance imaging at 3 T. RESULTS: All 3 tasks revealed activation of both premotor and parietal cortices. Furthermore, while hand Imitation relied more on the ventral premotor area and right parietal lobe, fist-scissors-gun and piano key relied more on the supplementary motor cortex. CONCLUSIONS: We postulate that differences in task-dependent activations across these tasks relate to degrees of sequential movement, pacing, and imitation. These results uphold Luria's original hypotheses, and extend that work by providing a further characterization of the motor areas involved in complex motor behaviors.

Adolescent↗
PubMed2000

Two novel flagellar components and H-NS are involved in the motor function of Escherichia coli.

A mutation in H-NS results in non-flagellation of Escherichia coli due to a reduced expression of the flhDC master operon. We found that the hns-negative strain restored its flagellation in the presence of flhDC, although the resulting strain was still non-motile. Since the intracelluar levels of motor components MotA, MotB, and FliG in the Deltahns strain were unaltered, the non-motility indicates that H-NS affects flagellar function as well as biogenesis. We obtained an insertion in ycgR, a putative gene encoding a protein of 244 amino acid residues, which suppresses the motility defect of hns-deficient cells. The abnormally low swimming speed of hns mutant cells was fully restored by an insertion in ycgR, as assessed with computer-assisted motion analysis. A similar suppressor phenotype was observed with a multicopy expression of yhjH, a putative gene encoding a polypeptide of 256 amino acid residues. Since the flagella of most hns-deficient cells were not rotating, except a few with reduced speed, the suppression appears to increase the number of rotating flagella as observed with tethered bacteria. The ycgR and yhjH genes contain the consensus sequence found among the class III promoters of the flagellar regulon, and their expression monitored with a lacZ fusion requires FlhDC. These findings suggest that ycgR and yhjH, together with H-NS, are involved in the motor function and constitute new members of the flagellar regulon.

Bacterial Proteins↗
PubMed2003

Restoration of functional motor units in a rat model of sphincter injury by muscle precursor cell autografts.

BACKGROUND: Urinary incontinence is a debilitating condition that affects primarily elderly individuals. One major mechanism results from chronic denervation of the striated urethral sphincter with associated fibrosis. The authors investigated the fate of muscle precursor cells (MPC) injected into a model of striated urethral sphincter injury that reproduces the histopathologic changes of sphincter insufficiency. METHODS: The striated urethral sphincter of older male rats was damaged by electrocoagulation. MPC were isolated from limb myofiber explants, infected with an adenovirus carrying the transgene encoding beta-galactosidase, and injected into the sphincter of the same animal 37 days after injury. Animals were killed 5 and 30 days after injection for assessment of sphincter function and the formation of motor units. RESULTS: Electrocoagulation resulted in an irreversible destruction of both sphincteric myofibers and nerve endings, with a functional incapacity of the damaged sphincter to sustain an increase in bladder pressure; atrophy and fibrosis developed after 1 month. Injection of MPC resulted in the formation of beta-galactosidase-expressing myotubes in the sphincter that persisted beyond 30 days. The regenerated myotubes carried acetylcholine receptors associated with a nerve ending and were thus considered to form anatomic motor units. Urodynamic studies confirmed the restoration of 41% of sphincter function 1 month after MPC injection. CONCLUSIONS: The authors showed that MPC isolated from limb muscles of an older animal can recapitulate a myogenic program when injected into an irreversibly injured sphincter. The maturation of MPC activates nerve regeneration and restores functional motor units.

Animals↗