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Age differences in the expression of manual asymmetry.

Manual dexterity declines in older adults; however, the degree to which the decline is symmetrical in the two hands is less clear. In this investigation the differences between young (aged 18 to 24) and old (aged 62 to 72) men and women in the expression of manual asymmetry across several motor tasks were examined. Five motor tasks provided a broad measurement of several motor characteristics necessary for instrumental activities of daily living. The main effect of sex was not significant; therefore data from men and women were pooled. Little support was found for generalized asymmetrical performance in old adults compared to young adults across motor tasks. An age-by-hand group analysis indicated that age was related to preferred hand performance on two tasks, but when a within-subject analysis of hand differences was performed, and the speed accuracy trade-off considered, differential asymmetry was seen only in the most complex, speeded task.

Activities of Daily Living↗

Neuroplasticity, learning and recovery after stroke: a critical evaluation of constraint-induced therapy.

Constraint-induced movement therapy (CIMT) has been hailed as a radical new approach to stroke rehabilitation. The guiding theory is that impairment of hand function is exacerbated by learned non-use and that this in turn leads to a loss of cortical representation of the upper limb. It is claimed that these processes can be reversed by two weeks of constraint of the unaffected limb combined with intensive practice in use of the paretic hand, and numerous small-scale studies have suggested that CIMT can lead to large improvements in function more than a year after stroke. However, the theory of learned non-use is open to question and there is uncertainty about the nature of the improvements induced by CIMT. The greatest effect seems to be increased spontaneous use of the hand, either through reduction of learned non-use or by overcoming the sense of effort during movement. There is also evidence of some improvement on dexterity tests but no studies have analysed in detail whether this reflects reduction of basic motor impairment or learning of compensatory movement strategies. The current weight of evidence is in favour of compensatory learning. Cortical changes detected by transcranial magnetic stimulation (TMS) or functional imaging may reflect this compensatory motor skill learning rather than restoration of representations lost due to the infarct or non-use of the limb. If future studies confirm this then the clinical implication is that direct teaching of unimanual or bimanual compensatory strategies might be a more productive approach than constraint.

Brain↗

Accelerating the return to work (RTW) chances of coronary heart disease (CHD) patients: part 1--development and validation of a training programme.

PURPOSE: Conventional phase II cardiac rehabilitation (CR) programmes have not resulted in an improvement in returning coronary heart disease (CHD) patients to work in over 35 years. This 4 year field-initiated research, sponsored by the National Institute on Disability and Rehabilitation Research, compares conventional CR programmes with a low-intensity CR programme that simulates elements of work (job-simulated CR programme) in terms of return to work (RTW) and physiological conditioning. The effect of training on physical capabilities of patients participating in the job-simulated CR programme was also of equal interest. METHOD: Thirty patients (15 bypass and 15 angioplasty; 15 males and 15 females) participated in a conventional CR programme (control group). The job-simulated CR programme included 15 male and 2 female bypass and angioplasty patients (experimental group). Patients in the control group underwent regular aerobic exercise training (treadmill and bicycle). Experimental group patients participated in a series of low-intensity exercises such as progressive time exercises, flexibility exercises, and dexterity exercises. RESULTS: All patients participating in the low-intensity job-simulated CR programme returned to the same job they held at the onset of myocardial infarction (MI). In contrast, only 60% of the control group patients returned to work; at least one-third of these did not go back to the same job they held at the onset of M1. Patients in both groups achieved the same level of physiological conditioning. The physical functional capabilities of the experimental group patients improved significantly throughout training. CONCLUSION: The results of this field-study lead to the conclusion that a low-intensity phase II cardiac rehabilitation programme that simulates elements of work may be far superior to conventional endurance exercise-based cardiac rehabilitation programmes in terms of returning patients to work. Such a programme also strengthens patients, improving their physical capabilities, without compromising their physiological conditioning.

Adult↗

The Hematopoietic Microenvironment: Phylogeny and Ontogeny of the Hematopoietic Microenvironment.

Although there is no formalized area of study called phylogeny or ontogeny of the hematopoietic microenvironment, new models and molecular tools are now available for such studies. The concept of a hematopoietic microenvironment has developed from the need to answer basic questions about migration, control of proliferation and differentiation of lymphohematopoietic cells; e.g. how are cells with the same genes induced to express different sets of these genes which lead to differentiation. These questions were first approached when cells could only be identified morphologically. The ontogeny of hematopoiesis was traced from the blood islands of the embryonic yolk sac, to the fetal liver, spleen, and bone marrow. Cells with reticular morphology were associated with areas of hematopoiesis and, in the embryo, they were thought to give rise to both hematopoietic and supportive cells. In the 1960's the classic work of McCulloch, Till and Siminovitch led the study of hematopoietic precursors which have no distinctive morphological identity and are too infrequent to study microscopically. These cells were identified by their functions; e.g. colony formation in culture in the presence of certain factors, production of spleen colonies or rescue of lethally irradiated mice. Cells with these functions were also found sequentially in the yolk sac blood islands, in the aorta/mesonephros, fetal liver, spleen, and bone marrow during development. The question remained, what regulates the proliferation and differentiation of these cells and why do they home to different sites in different stages of development? Among the laboratories studying spleen colonies, a controversy arose as to whether differentiation decisions were stochastic or induced by extra cellular factors. Dexter and Greenberger developed the long-term bone marrow culture system which has aided in studying the roles of factors such as cell-cell contact and extracellular matrix in hematopoietic differentiation. The molecular identification of ligand/receptor pairs such as ckit and KL as well as transactivating factors that control whole sets of lineage related genes such as the GATAs and Ikaros, may lead to clarification of the stochastic versus induced differentiation issue. Chimeric bird and frog embryos and analysis of mutations effecting hematopoiesis in frogs and zebrafish have helped to trace the earliest hematopoietic development in the embryo and to determine what influences it. The identification of genes that alter development of hematopoiesis opens the possibility of comparing microenvironmental control mechanisms in various present day organisms and relating these to evolutionary events. Many basic questions relevant to the interaction between hematopoietic cells and their microenvironment can be addressed by studying "simple" organisms in which the answers may be more easily determined than in mice or humans. Examples of possibly useful organisms, range from the teliosts such as zebrafish to algae such as Volvox, a two cell organism, to Dictyostelium which change from 1 to many cell types and in the process, migrate, adhere and differentiate.

Journal Article↗

Effect of rhGM-CSF on the kinetics of hematopoiesis in long-term marrow cultures from patients with acute myelogenous leukemia.

In the present study, we have assessed the effects of recombinant human Granulocyte-Macrophage Colony-Stimulating Factor (rhGM-CSF) in Dexter-type long-term marrow cultures (LTMC) from patients with acute myelogenous leukemia (AML). Addition of rhGM-CSF to AML LTMC resulted in a significant increase in the number of total nucleated cells (1.3-4.3-fold, as compared to untreated cultures). However, a simultaneous decrease in the numbers of myeloid progenitor cells (CFU) was observed. Interestingly, there was a selective stimulation of the growth of leukemic progenitors (AML-CFU). Indeed, whereas on day 0 these cells were detected in only 2 patients, between weeks 1 and 5 they were detected in 10 of the 14 patients included in the study. It is noteworthy that around 50% of the cells detected in the non-adherent fraction of rhGM-CSF-treated AML LTMC were blasts, whereas in untreated cultures, blasts corresponded to only 23% of the non-adherent cells, and the majority corresponded to cells of the monocyte-macrophage lineage. These results indicate that rhGM-CSF is a cytokine with a significant stimulatory activity for the in vitro growth of AML progenitor andblast cells, and, together with previous reports in the literature, suggest that the use of rhGM-CSF in clinical settings must be taken with caution since this cytokine, although beneficial in reducing the risk of infections after chemotherapy, may induce the reappearance of the disease after treatment. Further studies should be encouraged to understand in greater detail the effects of rhGM-CSF, and other cytokines, on the hematopoietic system of AML patients.

Adolescent↗

In vitro proliferation and expansion of hematopoietic progenitors from patients with diffuse large B-cell lymphoma before and after chemotherapy.

We have previously demonstrated that when cultured in Dexter-type Long-Term Marrow Cultures (LTMC), hematopoietic progenitor cells (HPC) from patients with Diffuse Large B-Cell Lymphoma (DLBCL) show a defective proliferation, as compared to HPC from normal marrow. In that study it was also demonstrated that functional alterations were present in the hematopoietic microenvironment developed in culture; thus, it was not clear whether such a defective proliferation in vitro was due to an intrinsic defect in the HPC compartment of DLBCL patients, or to an altered microenvironment, or both. In order to address this question, in the present study we have assessed the proliferation and expansion potentials of HPC present in bone marrow from patients with DLBCL, in cytokine-supplemented liquid cultures initiated with a cell population enriched for CD34+ Lin- cells, in the absence of stromal cells and in the presence of reduced numbers of accessory cells. Our results demonstrated that bone marrow-derived HPC from patients with DLBCL, both before and right after chemotherapy, possessed reduced proliferation and expansion potentials in vitro, as compared to their normal counterparts. Interestingly, in patients analyzed 18 months after treatment the proliferation and expansion levels were similar to those of normal HPC, indicating a complete restoration of the hematopoietic function. Although the reason for these observations is not clear, our results suggest the possibility that primitive CD34+ progenitor cells present in bone marrow, which show deficient proliferation and expansion potentials in vitro, are involved in the origin/progression of DLBCL.

Adult↗

Effects of constraint-induced movement therapy in adolescents with hemiplegic cerebral palsy: a day camp model.

This study examined whether restraining the dominant hand during an intensive training period could provide a means by which to improve adolescents' hemiplegic hand function. Nine adolescents with hemiplegic CP between the ages of 13 and 18 years were enrolled at a two-week day camp, of 7 hours/day. They were restricted in the use of their dominant hand in various daily and recreational activities by wearing a glove-like splint. The basis for intervention was built upon the adolescents' own motivation, and the activities were chosen to be challenging and specifically to provide opportunities for repetition. The treatment approach used was an adapted model of Constraint Induced Movement Therapy. Assessments took place before and after intervention as well as at a 5-month follow-up. The results revealed that hand function did improve and was sustained at follow-up for dexterity, coordination and precision, and manipulative abilities. The performance of tasks that had been trained specifically showed major improvements.

Adolescent↗

Development of micro-active forceps for future microsurgery.

A new eye microsurgical system is proposed. The final goal of our research project has been not only to improve surgical instruments, but also to establish a total surgical system applicable to today's most difficult microsurgery, within the eye. The new prototype micro-forceps, which have a joint that enlarges the surgical area and a built-in thin optical fibrescope to increase the dexterity of retinal microsurgery, was designed as the first step in a long-term research plan. The micro-active forceps is equipped with a thin optical fibre inside the stem, giving a lateral view of the retina and a drastic improvement in fine operations. Moreover, this new tool, with an active joint and an end-effector, could find application in other microsurgical fields, such as in the brain, ear, nose and throat.

Journal Article↗

Robotic stabilisation assisting cardiac surgery on beating hearts.

Minimally invasive direct coronary artery bypass (MIDCAB) requires precise work on beating hearts and demands of surgeons' manual dexterity and mental concentration. We propose a surgical robot system that compensates for motions of organs during operations. The motion-cancelling robot system consists of three technologies: visual synchronisation, motion synchronisation and master-slave control. In this paper, we verify the effectiveness of the prototype system by an in vivo experiment.

Journal Article↗

Development of a model for training and evaluation in subfascial endoscopic perforator surgery (SEPS).

We describe a training method with objective evaluation that enhances video-assisted surgical skills. Training is via a simulator for subfascial endoscopic perforator surgery (SEPS) and can assess whether specific training exercises are helpful in the acquisition of skills for video-assisted surgical techniques. Twenty-five surgeons, with or without experience in video-assisted surgical techniques, were asked to perform standardised drills connected with the SEPS technique. The SEPS simulator consisted of an artificially constructed subfascial space in a leg, in which false perforator veins had to be localised, clipped and cut. The participants performed two sequences of actions three times, in order to improve their dexterity. The time required to perform each sequence was recorded. All trainees showed a steady improvement in skill-acquisition of the SEPS technique; the difference was statistically significant (p < 0.004). Despite its obvious importance in teaching programmes, the assessment and training of technical ability has not been fully developed. If virtual reality simulators are to become more important in the future, simulation models will have to approximate more closely the real operating theatre, and thus will become more valid in the training and evaluation of surgical technique.

Journal Article↗

The revolution of computer-aided surgery - the dawn of robotic surgery.

Endoscopic surgery has rapidly changed the performance of surgical procedures in a wide range of surgical specialities, but difficulties with endoscopic manipulation remain. The next step in the revolution initiated by the introduction of endoscopic surgery will be achieved by the introduction of robotics, tele-mentoring systems and telepresence surgery. Primary capabilities brought to surgery by robotic manipulators can be summarised as surgical assistance, image-guided therapy and dexterity enhancement. Using computer-aided systems, such as robotics and image-guided surgery, the next generation of surgical systems will be more sophisticated, and will permit surgeons to perform surgical procedures beyond the current limitation of human performance — on the microscale, or on moving organs. Industry is focusing currently on developing manipulators for endoscopic microsurgery, and several devices have already entered clinical use. Taking advantage of one such robotic system, we have developed a new method of endoscopic cholecystectomy, which is performed without leaving foreign bodies and using a procedure that prevents adhesions after surgery. Some new endoscopic procedures have also become feasible, although these are currently performed only by open surgery, without this system. It seems to be highly probable that master–slave manipulators will soon be in routine surgical use for selected indications.

Journal Article↗

Manipulators and integrated OR systems - requirements and solutions.

Videoendoscopic (laparoscopic and thoracoscopic) surgery is characterized by challenges for the whole OR team. Additional equipment must be monitored and managed by the surgeon and the nurses in a rather dark environment. The surgeon is using long-shafted instruments that reduce the degrees of freedom of the possible instrument movements, thus limiting the dexterity for the surgeon. The use of trocars results in a pivot point effect when moving the instruments, which needs some experience on the surgeon's side to move the instruments adequately and into the right direction. Finally the hand-eye-coordination is dependent on the camera position relative to the instruments and a stable image of the situs shown at the monitor. To overcome these challenges, several new technologies have been developed and introduced into the OR by the industry, also using robotics to help the surgeon perform the procedure. Integrated OR systems enable the OR team to control virtually all devices in the OR from a centralized panel; scope-positioning systems provide the surgeon with a stable image under his own control and manipulators for the instruments allow fine movements with additional degrees of freedom. This article gives a short overview of currently available technologies, describing the design requirements and the functionality of the different systems.

Journal Article↗

Mechanical manipulator for intuitive control of endoscopic instruments with seven degrees of freedom.

Performing complex tasks such as vascular anastomosis in minimally invasive surgery (MIS) is demanding due to a disturbed hand-eye co-ordination, the application of non-ergonomic instruments with limited number of degrees of freedom (DOFs) and a lack of three-dimensional perception. Robotic tele-manipulatory systems enhance surgical dexterity by providing up to seven DOFs. They allow the surgeon to operate in an ergonomically favourable position with more intuitive manipulation of the instruments. Robotic systems, however, are very bulky, expensive and do not provide any force feedback from the tissue. The aim of our study is to develop a simple mechanical manipulator for MIS. The Minimally Invasive Manipulator (MIM) is a purely mechanical device. When manipulating the handle of the MIM, the surgeon's wrist and grasping movements, which are essential for suturing, are directly transmitted to the deflectable instrument tip in seven DOFs. It gives the surgeon direct control of the instrument tip. First phantom experience indicates that the system functions properly. The MIM provides force feedback to improve safety. A set of MIMs seems to be an economical and compact alternative to robotic systems and will offer more surgeons the capability to perform complex MIS and to shorten their learning curve.

Journal Article↗

VSOne, a virtual reality simulator for laparoscopic surgery.

The introduction of computer-based training systems for laparoscopic surgery has increased the training quality and made the learning effect measurable with objective criteria. This paper introduces VSOne as a fully-featured virtual reality training system for laparoscopic surgery. VSOne utilizes the state-of-the-art in virtual reality techniques, soft tissue simulation and haptic device control and guarantees realistic training possibilities for various laparoscopic procedures. An authoring software helps to create individual simulation models easily within the shortest time based on real patient data using standardized data formats. We have developed several Basic Task Training (BTT) modules to improve dexterity and complex Surgical Procedure Task (SPT) modules for full training of laparoscopic procedures such as cholecystectomy, tubal sterilization and myomectomy. VSOne has been evaluated in a comparative study with classic training methods and has shown the typical learning curves for inexperienced trainees and the transferability of the learning effect to the real-world situation.

Journal Article↗

Amyotrophic lateral sclerosis (ALS) and mirror movements in a patient with polymicrogyria.

We report on a case of polymicrogyria with benign childhood epilepsy and amyotrophic lateral sclerosis (ALS). While performing dexterity tasks with either hand, strong unsustained mirror movements of the unintended hand were observed. The patient was seen over a period of three years and, as often seen in ALS, there was a moderate progress of the motor neuron disease affecting the upper and lower motor neuron in an asymmetrical manner. In addition, more rapidly progressive bulbar symptoms could be observed by the clinical and neurophysiological examination. MRI revealed polymicrogyria of the right frontal lobe with irregular bumpy inner and outer surface and abnormally thick and smooth cortex, dysplastic insular cortex and asymmetrically widened Sylvial fissure. No signs of atrophy, especially of the motorcortex and corticospinal tract were observed. The corpus callosum was completely developed and of normal size. We hypothesize an enrolment of the dysplastic right frontal lobe pathophysiology of the observed mirror movements.

Amyotrophic Lateral Sclerosis↗

Behavioural aspects of cerebellar function in adults with Asperger syndrome.

Aside from social deficits, Asperger and autistic individuals also exhibit motor control abnormalities such as impaired gait, balance, manual dexterity and grip. One brain area that has consistently been reported on autopsy and imaging studies to be abnormal in such individuals is the cerebellum. As the cerebellum controls sensorimotor coordination and lesions here typically cause hypotonia, dysmetria and dyscoordination, we performed a series of quantitative tests aimed at investigating cerebellar function in Asperger individuals. Tests examining visually guided movement (rapid pointing), speeded complex movement (finger tapping, rapid hand turning), muscle tone (catching dropped weight), prediction, coordination and timing (balance, grip force and interval timing) were conducted on 12 Asperger subjects and 12 age and IQ matched controls. In comparison to control subjects, Asperger subject's demonstrated: (i) decreased pointing accuracy and rate, (ii) increased postural instability, and (iii) decreased timing accuracy. IQ was found to co-vary with some parameters of each of these tasks and no further impairments were found on the remaining tests. We suggest that these specific deficits reflect impairment in the ability to integrate sensory input with appropriate motor commands and are consistent with cerebellar dysfunction in Asperger syndrome.

Adolescent↗

Deposition and clearance of labeled cigarette smoke particles in rat respiratory and digestive tract.

In this investigation 160 8-wk-old Sprague-Dawley rats inhaled smoke from 14C-labeled cigarettes in a Hamburg II smoking machine. The research cigarettes were labeled with [16,17-14C]dotriacontane. Eighty of the rats were acclimatized to smoke from nonlabeled research cigarettes for 21 d before inhaling labeled cigarette smoke. The investigation was divided into four experiments. In experiment I all rats were killed immediately after exposure to the 14C-labeled smoke from 30 cigarettes (10 muCi per cigarette) and the organs of the respiratory and digestive tracts were measured for 14C activity. These animals showed high activity in the apex nasi, fundus nasi, and larynx. The highest activity was found in the lobus dexter caudalis and the lobus sinister of the lung. The lungs contained four-fifths of the condensate inhaled into the respiratory tract. In experiment II three animals were killed immediately after smoking, three after 6 h, and four after 24 h. No activity was found after 6 h in apex, fundus nasi, larynx, and trachea. The lungs showed no clearance at all. The activity in the digestive tract was highest in the stomach and the esophagus immediately after cessation of smoking. These values decreased rapidly after 6 h. In experiment III the animals were killed after 7, 21, and 42 d. Clearance from the upper respiratory tract was fast, whereas clearance from the lungs was slow. Clearance from all lung lobes was faster in the nonacclimatized animals. In experiment IV the rats inhaled the smoke from 14C-labeled cigarettes (2 muCi per cigarette) on 5 successive days. The animals were killed 7, 14, and 21 d after the last smoke inhalation. Clearance from the lungs was slower in acclimatized and non-acclimatized animals than in experiment III.

Animals↗

Glove use and the relative risk of acute hand injury: a case-crossover study.

The purpose of this study was to investigate the relationship between glove use and acute traumatic occupational hand injury. We used a case-crossover, within-subject study design to control for differences between individuals such as occupation, injury history, age, gender, risk-taking behavior, manual dexterity, and muscle strength. A total of 1166 hand-injured workers were interviewed regarding the use of gloves at the time of the injury. The self-reported average duration of glove use in the previous work month was the measure of expected exposure to wearing gloves. Nineteen percent of subjects reported wearing gloves at the time of the injury. The expected exposure to glove use in the past work month was 27.9%. Glove use was associated with a lower risk of lacerations and punctures but not crush, fractures, avulsions, amputations, dislocations; the risk of the former two injury types was estimated to be 60-70% lower while wearing gloves. Glove use is only one component of a comprehensive hand injury prevention approach that might include the identification and elimination of sharp hazards, engineering controls, safety warnings, training in high-risk situation awareness, and proper selection and timing of glove use.

Acute Disease↗