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PubMed1992

[Covering the foot sole and heel with pedicled and free transplants].

Thirty patients suffering from defects of the weight-bearing areas of the sole and heel were analyzed employing various methods. Sensibility was analyzed quantitatively. The level of sensibility of the flaps was found to be variable, but it had no effect on soft-tissue stability. Sensory recovery in the flaps was slow and unpredictable. Gait analysis showed that patients supplied with footwear walked relatively symmetrically even though there was a tendency to protect the flap by decreased weight-bearing. Postural control as analyzed by a sway plate was impaired only in patients with flaps having very poor sensibility. Thin skin flaps were found to be most suitable for degloving defects and muscle flaps with split-skin coverage for deep defects. The scapular flap was often too thick and was prone to develop superficial ulcerations on the weight-bearing areas.

Foot↗

PubMed2001

[Significance of spontaneous motor activity and visual information processing for developmental diagnosis in infancy].

The neurodevelopmental examination during the first years of life is very often confronted with the problem of differentiating between normal variability and pathology of development. Recent research provides evidence about the clinical relevance of the systematic observation and examination of spontaneous movements, of postural control as well as of visual information processing in toddlers.

Developmental Disabilities↗

PubMed2003

Falls in the elderly--clinician's approach.

Fall is an involuntary event producing a change in posture resulting in the individual adopting an unplanned supine position. Globally more than one-third of persons 65 years of age or older fall each year and in half of such cases the falls are recurrent. Several predisposing factors for such falls have been recognised like age related changes in posture control, reduced visual acuity, anxiety, drugs, environmental hazards and underlying neurological diseases. It is the interplay of predisposing and precipitating factors that really matter and not exactly a single cause. Evidence based interventions have been suggested from recent clinical trials and certain preventive guidelines are present to reduce the rate of falling, provided a periodic targeted approach is followed.

Accidental Falls↗

PubMedDate not supplied

[Prognosis of cognition in congenital hypothyroidism following early treatment. Double effect hypothesis].

INTRODUCTION: The prevention of mental retardation due to congenital hypothyroidism by treating it at an early stage is one of the great achievements of contemporary preventive medicine. Nevertheless, the children suffering from this disease are affected by selective cognitive deficits whose origin remains a controversial issue. PATIENTS AND METHODS: We describe the results from a cohort of 100 children who have been diagnosed as suffering from congenital hypothyroidism in La Havana since 1989 and whose cognitive performance has since been periodically evaluated. The mean age at each evaluation was as follows: 1.1 years (mean and typical deviation: 0.3) and 8.2 years (mean and typical deviation: 1.2). RESULTS: During the first two years of life the developmental quotients are within the normal range of values, although fine oculomotor coordination is significantly diminished. The duration of fetal hypothyroidism is linked to postural control, and the initial biochemical severity of the disease is associated to language development. Oculomotor coordination is not linked to any variable concerning the severity of the disease or with the effectiveness of therapy. At school age, intelligence quotients (IQ) are also within the normal range of values. A multiple regression analysis indicated that the total IQ can be predicted from the scores in oculomotor coordination during the first two years of life and from the initial doses of levothyroxine. CONCLUSIONS: The relations between the variables capable of forecasting intellectual development in these children are analysed and we also discuss the hypothesis which suggests that some of the persisting neurocognitive deficits are probably due to genetic influences that exist regardless of the effectiveness of the therapy.

Child↗

PubMedDate not supplied

H-reflex testing to determine the neural basis of movement disorders of neurologically impaired individuals.

The H-reflex is an indirect measure of the excitability levels of alpha motoneurons. The authors have developed an adaptation of H-reflex testing which allows the continuous monitoring of human alpha motoneuron activity during movement. The technique differs from previously used H-reflex testing techniques in that it utilizes a 5 Hz stimulation to elicit the H-reflex. This allows for continuous and concomitant H- and M-wave recordings during a movement. This is an improvement over past single stimulus techniques in that the time and discomfort associated with this type of experimentation is greatly decreased. The repetitive stimulation technique enables H-reflex testing to be used clinically with neurologically impaired patient populations. Thus far, the authors have used the repetitive H-reflex testing procedures to assess alpha motoneuron activation and reciprocal inhibition of antagonist musculature during voluntary movement and anticipatory postural control responses of non-disabled individuals and of individuals with cerebral palsy. This paper describes the methodology involved in this technique and reports the results obtained.

Adolescent↗

PubMed2002

Personalized biomechanical modeling of Boston brace treatment in idiopathic scoliosis.

The aim of this study was to describe how the Boston brace modify the scoliotic curvatures using a finite element (FE) model and experimental measurements. The experimental protocol, applied on 12 scoliotic girls, was composed of the pressure measurement at the brace-torso interface followed by two radiographic acquisitions of the patient's torso with and without brace. A 3D FE model of the trunk was built for each unbraced patient. The brace treatment was represented by two different modeling approaches: 1) using equivalent forces calculated from the measured pressures; 2) by an explicit personalized FE model of the brace (hexahedral elements) and its interface with the torso (contact elements). In the first model, measured brace forces less than 40N and up to 113N induced respectively less than 21% and up to 87% of real correction. Thoracic forces induced the main correction, affecting partially both lumbar and thoracic curves, in agreement with the literature. In the second model, the brace closing reduced the curves up to 35% of real correction. Contact reaction forces (16-79N) were similar to real brace forces (11-72N). The results suggested that other mechanisms than brace pads contribute to the equilibrium of the patients. Postural control by the muscular system remains a problem to address in a future study. The second model represented more realistically the load transfer from the brace to the spine than external forces application. With such model, it is expected to predict the effect of a brace before its design and manufacturing, and also to improve its design.

Adolescent↗

PubMed2002

[Rehabilitation for osteoarthritis].

Osteoarthritis (OA) limits activities of daily living due to symptoms such as pain, joint contracture and muscle weakness, and impairs the quality of life. As one of the rehabilitative approaches, physical therapy is important to decrease disability associated with OA and prevent progression of the disease. Previous studies have reported muscle- strengthening exercises as particularly effective. However, some authors have emphasized the importance of neuromuscular coordination training to improve postural control in addition to increasing muscular strength. Furthermore, both generalized exercise for weight control and education of patients to avoid overloading the affected joints are important.

English Abstract↗

PubMed2005

[A magnetic resonance imaging research of upper airway and surrounding tissues of 83 non-snoring males].

OBJECTIVE: To obtain the data about morphology of upper airway and surrounding tissues of non-snoring males from three age groups. METHODS: Through questionnaires and clinic examinations, 83 non-snoring males (20-60 years) were selected from 453 volunteers and involved in the following research. There were 30 volunteers aged from 22 to 29 (mean 23.60+/-2.58 years), 31 volunteers aged from 36 to 45 (mean 40.10+/-2.64 years) and 22 volunteers aged from 46 to 57 (mean 49.55+/-3.45 years). Magnetic resonance imaging (MRI) of upper airway of each volunteer was acquired under strict posture-control conditions. The dimensions and cross-section area of nasopharynx, velopharynx, glossopharynx, hypopharynx and whole upper airway with its surrounding tissues were measured with MRI intrinsic software. Volumes of upper airway and surrounding tissues were also calculated. RESULTS: There were 93 items about morphology of the upper airway and surrounding tissues of non-snoring males from the three age groups. With increase in age, some nasopharynx items showed increase tendency, while little change showed in velopharynx, glossopharynx and hypopharynx. Fat volume, tongue volume, anterior and posterior pharyngeal dimension showed age-related increase tendency, but fat deposition rate slowed down in elder age in non-snoring males, which supplies the reason why non-snoring males avoided becoming sleep apnea patients. CONCLUSION: We provide age-related reference data of upper airway and its surrounding tissues for further sleep and respiration research.

Adult↗

PubMed1992

Effects of microinjection of vasopressin in dorsal pontine reticular structures on the gain of vestibulospinal reflexes in decerebrate cats.

1. The possibility that vasopressin (VP) acts on the dorsal pontine reticular formation (pRF) and the related medullary inhibitory reticulospinal (RS) system to control posture as well as the vestibulospinal reflexes has been investigated by injecting small doses of VP in precollicular decerebrate cats. 2. Unilateral microinjection of VP (0.25 microliters at the concentration of 10(-11) micrograms/microliters saline) in the pRF decreased the extensor rigidity in the ipsilateral limbs, while that of the contralateral limbs either decreased or increased. The same injection also produced a moderate or a prominent increase in gain of the multiunit EMG responses of the ipsilateral triceps brachii to roll tilt of the animal (t-test, P less than 0.001 for either group of responses). In the first instance the response gain of the contralateral triceps brachii to animal tilt slightly increased, while the pattern of response remained always of the alpha-type, as shown for the ipsilateral responses (increased EMG activity during ipsilateral tilt and decreased activity during contralateral tilt). In the second instance, however, the response gain showed only slight changes, while the pattern of responses reversed from the alpha- to the beta-type. These findings occurred 5-20 min after the injection, fully developed within 30-60 min and disappeared in about 2-3 hours. 3. The structures responsible for the postural and reflex changes described above were located in the dorsal pontine tegmental region immediately ventral to the LC, and included the peri-LC alpha and the surrounding dorsal pRF. The induced effects depended upon the injected neuropeptide, since previous injection of an equal volume of saline stained by the pontamine sky blue dye into the same dorsal pontine area was ineffective. 4. We postulated that VP exerts an excitatory influence on ipsilateral dorsal pRF neurons. The increased discharge of these neurons and the related medullary inhibitory RS neurons would lead to a decreased postural activity in the ipsilateral limbs. However, since these inhibitory RS neurons fire out of phase with respect to the excitatory vestibulospinal neurons, it appears that the higher the firing rate of the RS neurons in the animal at rest, the greater the disinhibition that affects the limb extensor motoneurons during ipsilateral tilt. These motoneurons would then respond more efficiently to the same excitatory volleys elicited by given parameters of stimulation, thus leading to an increased gain of the EMG responses.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMedDate not supplied

Postural performance and strategy in the unipedal stance of soccer players at different levels of competition.

CONTEXT: Sport training enhances the ability to use somatosensory and otolithic information, which improves postural capabilities. Postural changes are different according to the sport practiced, but few authors have analyzed subjects' postural performances to discriminate the expertise level among highly skilled athletes within a specific discipline. OBJECTIVE: To compare the postural performance and the postural strategy between soccer players at different levels of competition (national and regional). DESIGN: Repeated measures with 1 between-groups factor (level of competition: national or regional) and 1 within-groups factor (vision: eyes open or eyes closed). Dependent variables were center-of-pressure surface area and velocity; total spectral energy; and percentage of low-, medium-, and high-frequency band. SETTING: Sports performance laboratory. PATIENTS OR OTHER PARTICIPANTS: Fifteen national male soccer players (age = 24 +/- 3 years, height = 179 +/- 5 cm, mass = 72 +/- 3 kg) and 15 regional male soccer players (age = 23 +/- 3 years, height = 174 +/- 4 cm, mass = 68 +/- 5 kg) participated in the study. INTERVENTION(S): The subjects performed posturographic tests with eyes open and closed. MAIN OUTCOME MEASURE(S): While subjects performed static and dynamic posturographic tests, we measured the center of foot pressure on a force platform. Spatiotemporal center-of-pressure measurements were used to evaluate the postural performance, and a frequency analysis of the center-of-pressure excursions (fast Fourier transform) was conducted to estimate the postural strategy. RESULTS: Within a laboratory task, national soccer players produced better postural performances than regional players and had a different postural strategy. The national players were more stable than the regional players and used proprioception and vision information differently. CONCLUSIONS: In the test conditions specific to playing soccer, level of playing experience influenced postural control performance measures and strategies.

Journal Article↗

PubMed2001

Dual-task methodology: applications in studies of cognitive and motor performance in adults and children.

PURPOSE: The purpose of this article is to review the literature related to the application of dual-task methodology in adults and children, particularly in the areas of gait and postural stability. SUMMARY OF KEY POINTS: The interaction between cognitive factors and motor performance recently has received considerable attention in physical therapy research. Researchers often use dual-task methodology to investigate the attentional demands of motor tasks or the effects of concurrent tasks on motor performance. The attentional demands of a task and the interference effects of concurrent tasks are influenced by a number of factors, including the performer's age, level of skill, and the nature of the tasks involved. Even highly practiced activities, such as walking and postural control, are attention-demanding, especially in individuals with impairments. CONCLUSIONS: An understanding of how attentional demands and other cognitive factors influence motor performance may be helpful to physical therapists in structuring intervention activities and in identifying children who have particular difficulty under dual-task conditions. By modifying both cognitive and motor task demands, therapists can tailor their interventions to provide appropriate challenges for children at different skill levels.

Journal Article↗

PubMed1991

[Analysis of L-threo-3, 4-dihydroxyphenylserine effect on motor and psychological symptoms in Parkinson's disease].

Improvement of motor and psychological symptoms by L-DOPS (L-threo-3,4-dihydroxyphenylserine) in totally 20 cases with Parkinson's disease (PD), including 5 cases of juvenile or early onset parkinsonism (JP) and one case of pure akinesia was analysed. Improvement was obtained in about two thirds of the cases on symptoms of freezing in gait, difficulty of postural control, depressive mood and bradyphrenia. Severity of freezing in gait and that of the depressive mood were graded in five stage (from 0 to 4) scale and the improvement was evaluated by A (three stage improvement), B (two stage improvement), C (one stage improvement) and D (no change or worsened). Improvement of psychological symptoms was seen parallel to that of motor symptoms. It seems important that marked effect on both motor and psychological symptoms was obtained mostly in PD cases but not in the cases of JP. In MMPI test, depressive score (D) and hypochondriac score (Hs) were normalized in PD cases but not changed in JP, indicating differences in psychological traits between two groups. It was suggested that JP is a condition of mainly DA deficiency in nigro striatum but PD presents wider spectrum of symptoms covering both DA and NE deficiency. Importance of the role of aging of the brain in each individual patient is discussed and interpreted in relation to the difference of clinical pictures.

Aged↗

PubMed1991

Anterior-cruciate-insufficient knees treated with physiotherapy. A three-year follow-up study of patients with late diagnosis.

To evaluate a functional neuromuscular training program focusing on strength, endurance, postural control, and agility, 26 patients with a rupture of the anterior cruciate ligament (ACL) diagnosed late were examined before starting a training period and then followed for three years. During the study period, four of the patients had an ACL reconstruction. Twenty-two patients treated without surgery were satisfied with the improvement in their knee function and activity level after three to six months of physiotherapy. Compliance with the rehabilitation program was good and the improvement achieved on completion of the training period was maintained for three years in this group of recreational sportsmen and women. Quadriceps strength, functional knee score, activity level, and functional performance were all improved after training and were maintained during the follow-up period.

Adolescent↗

PubMed1986

Short and long term prognostic significance of neurological anomalies of the first year in very low birthweight infants.

The short and long term, prognostic significance of early neuromotor anomalies was assessed in infants with birthweight under 1500 g (VLBW infants), who have a high risk of developing cerebral palsy (CP) but who also have transient neurological anomalies. The series comprises 35 VLBW infants born between 1 January 1978 and 31 March 1980 with regular neurological follow-up until the second year of life: 10 with CP of varying severity and 25 without CP. The latter were examined in the first year of school by means of an age-specific method designed to elicit minor neurological dysfunctions (MND). Analysis of neuromotor development in the first year of life identified important grounds for clinical suspicion in the first semester of corrected age, especially on the basis of a global neurological assessment including optimal neurological items score at presumed term age and the combination of two or more major neurological signs in the first semester. The diagnosis of CP cannot be established until the 2nd semester of life, in 70% of cases by the end of the 3rd trimester. It rests on the following criteria: persistence of two or more major neurological signs (abnormalities of limb tone, axial tone and of movement), specific pathological pattern of limb tone, always associated with retarded postural control. Neurological examination at school age revealed a significantly higher frequency of MND in the VLBW children than in a group of normal controls. The quantity of MND correlated significantly with the severity and duration of the first year neurological anomalies but not with the obstetric and postnatal neurological risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Attention Deficit Disorder with Hyperactivity↗

PubMed1988

Maternal handling and motor development: an intracultural study.

Citing a distinction between informal and formal routines used by mothers in handling their infants, we examined formal handling routines, in which the caregiver acts in a pedagogical manner; these routines are widespread in many non-Western countries. We hypothesised that formal handling serves to facilitate gross motor development during early infancy. To examine this hypothesis, the effects of a Jamaican formal handling routine on a broad range of developmental outcomes was examined. Results showed that the effects were specific to early gross motor development and in particular to postural control along the vertical axis of the body. Information is also provided on other aspects of Jamaican child care. It seems that the handling routine forms part of a folk (developmental) medicine system and may serve not only to promote child health but also as a sort of developmental neurological examination.

Adolescent↗

PubMed1986

[Relations between the basal ganglia and the thalamus of the primate. New morphologic data. New physiopathologic interpretations].

Considerable progress has been made over the last few years in our knowledge of the thalamus and basal ganglia and their relationships to the cerebral cortex. More detailed topographic studies in the macaque have demonstrated the separation, in the lateral region of the thalamus, between afferent cerebellar and basal ganglia territories. These territories fail to correlate with the subdivision between ventral and dorsal elements or the limits of a single cytoarchitectonic nucleus. The cerebellar territory corresponds to VIL (or VPLo) which projects towards the primary cortex, and to VIM (or area X) and DI (or VLc) which project towards premotor cortex. The nigral (and tectal) territory corresponds to VOM (or VAmc) and to some parts of the medial nucleus and projects mainly towards the oculomotor area, supplementary motor area and prefrontal cortex. In return, the oculomotor area and substantia nigra project towards the colliculus superior. Several thalamic nuclei constitute the pallidal territory: VOL (or VLo) projects mainly towards supplementary motor area, LPo (or VApc) and Do towards the prefrontal cortex. The median center, which receives afferents from pallidum and motor cortex, projects towards the striatum but also the motor cortex. The parafascicular nucleus projects towards the striatum and premotor cortex. It is still not possible to transpose data acquired in the macaque to man, but functional reinterpretations are possible. A system which involves the median pallidum, VOL and supplementary motor area could control motor initiative and flow of movement. A second system, involving the substantia nigra, colliculus superior, thalamic relay and oculomotor area could control posture. The pallidum and substantia nigra, anterior part of lateral mass, medial nucleus and prefrontal cortex could elaborate motor programmes.

Animals↗

PubMed1987

Plasma volume changes and cardiovascular responses associated with weight lifting.

Ten experienced weight lifters were studied to determine the influence of strenuous, free-weight, squat lift exercise on changes in plasma volume, mean arterial pressure, and the rate pressure product. After a 40-min postural adjustment prior to upright exercise, each subject completed eight sets of eight repetitions of the squat exercise at 55% of the one-repetition maximum. Electrocardiogram heart rate was monitored throughout the test, and blood pressure was determined at the completion of each exercise set. Arterialized capillary blood was drawn during sitting and standing pre-exercise and at the end of the second, fourth, sixth, and eighth sets for the measurement of hemoglobin, hematocrit, and plasma protein concentration, and after the last set for blood lactate. Five additional subjects participated in a postural control comparison. The results of the ANOVA showed a significant loss in plasma volume over the trials which was 2 1/2 times greater than for the control subjects (17.9 vs 7.7% loss) over the same period of time. Exercise rate pressure product increased by 2.85 times resting while only 1.1 times resting for the control subjects. An elevation in mean arterial pressure was found to be correlated to changes in plasma volume, r = -0.98. This study found that plasma volume is reduced while the rate pressure product is increased during the squat lift exercise.

Adult↗

PubMed1985

The female athlete's knee.

Available data have established that the female athlete is particularly vulnerable to various stress syndromes and noncontact ligament sprains of the knee. Although anatomic differences such as decreased muscle mass and increased joint laxity exist, the primary reason for this disparity appears to be an inadequate level of basic motor skills. The average female athlete has less training and conditioning than the male and has paid less attention to preparticipation fitness. Normal motor function has been defined in terms of required flexibility and coordination so that simple clinical testing can be performed. Normal flexibility may be defined as the unimpeded range of motion at each joint required for running. Coordination is normal when posture and movement are efficient and self-protective. This results from the action of primary neuromuscular mechanisms, which are anthropologic developments to support the unique posture of humans. Poor motor training or reflex inhibition causes secondary, less efficient mechanisms to be substituted for the primary ones, resulting in faulty coordination. These changes can be detected on clinical examination. Assessment of flexibility and coordination are the most important parts of the evaluation of the female athlete, since they relate directly to her most common injury patterns. The underlying neuromuscular physiology governing postural control and movement needs to be considered in planning therapeutic measures.

Athletic Injuries↗