The effects of Robotic-Assisted Locomotor training on spasticity and volitional control

We studied the effects of Robotic-Assisted Locomotor (LOKOMAT) Training on spasticity and volitional control of the spastic ankle in persons with incomplete Spinal Cord Injury (SCI). LOKOMAT training was performed 3 days/week during a 1-hr period including set-up time with up to 30 minutes of training during a single session. The training was provided for 4 weeks and subjects were evaluated before and after 1, 2, and 4 weeks of training. Spasticity was charterized in terms of neuromuscular abnormalities associated with the spastic joint. A system identification technique was used to quantify the effects of LOKOMAT training on these neuromuscular abnormalities. The effect of LOKOMAT training on volitional control was determined by measuring isometric maximum voluntary contraction (MVC) of ankle extensor and flexor muscles. Our results indicated that the reflex stiffness, abnormally increases in SCI, was significantly reduced (up to 65%) following 4-weeks of LOKOMAT training. Similarly, intrinsic (muscular) stiffness, which also abnormally increases in SCI, decreased significantly (up to 60%). MVCs were increased substantially (up to 93% in extensors and 180% in flexors) following 4-week training. These findings demonstrate that LOKOMAT training is effective in reducing spasticity and improving volitional control in SCI.

Robotic-assisted locomotor training impact on neuromuscular properties and muscle strength in spinal cord injury

We studied the effects of Robotic-Assisted Locomotor (LOKOMAT) Training on neuromuscular properties and muscle strength of the spastic ankle in persons with incomplete Spinal Cord Injury (SCI). LOKOMAT training was performed 3 days/week during a 1-hr period including set-up time. The training was provided for 4 weeks and subjects were evaluated before and after 1, 2, and 4 weeks of training. A system identification technique was used to quantify the effects of LOKOMAT training on neuromuscular abnormalities. The effect of LOKOMAT training on muscle strength was determined by measuring isometric maximum voluntary contraction (MVC) of ankle extensor and flexor muscles. Our results indicated that the reflex stiffness, abnormally increases in SCI, was significantly reduced (up to 65%) following 4-weeks of LOKOMAT training. Similarly, intrinsic (muscular) stiffness, which also abnormally increases in SCI, decreased significantly (up to 60%). MVCs were increased substantially (up to 93% in extensors and 180% in flexors) following 4-week training. These findings demonstrate that LOKOMAT training is effective in reducing spasticity and improving muscle strength in SCI.

The effect of robot-assisted lokomotor training on gait recovery: a multivariate analysis

To explore the effect of LOKOMAT and LOKOMAT+Tizanidine on the improvement of walking capacity for people with spinal cord injury (SCI), 20 SCI subjects with hypertonia spasticity at their ankle joints participated in a 12-session Lokomat training; among them, 10 subjects received Tizanidine. 1-hour LOKOMAT training was provided 3 times per week for 4-weeks. Subjects were evaluated 4 times for Timed-Up-and-Go, 10-Meter-Walking, and 6-Minute-Walking testings, at the baseline, 1-, 2- and 4-weeks after training. Latent Class Growth model was used to classify the LOKOMAT training speed, and clinical walking evaluations. Subjects in each treatment group could be classified into two subclasses for training speed and clinical evaluation. It was found that the training speed increased in all treatment group, while the subjects in LOKOMAT+Tizanidine presented a significant improvement of their training speed from the training session. The clinical evaluations classified subjects similarly, and no significant improvement of clinical measurements was observed for either treatment. The MVC dorsiflexion torque at the ankle joint was able to predict the class memberships of subjects for their walking capacity and can be used as a significant predictor for therapeutic functional recovery after spinal cord injury.

The centrality of community dynamics in the socio-economic recovery of devastated communities

OBJECTIVE

To assess and explore the health and socio-economic outcomes of Jubilee, a community on the Caribbean island of Grenada hit by Hurricane Ivan in 2004 and to identify remaining barriers to recovery.

METHODS

The assessment consisted of a mixed methods approach employing observations, household surveys, in-depth interviews and focus groups.

RESULTS

Eighty-five per cent of the residents live in a single-family home type dwelling which is occupied by multiple families. Twenty-seven per cent of the respondents depended on a river or stream for water and 83% utilized an outdoor pit latrine. Construction accounted for 28% of the employment while 16% reported having no occupation. Public and private transportation was limited and 48% of the residents lived on less than one United States of America (US) dollar per day. Access to healthcare was reported by 89% and the prevalence of diabetes and hypertension was identified by 13% and 30% of the residents respectively. Social fragmentation within the community represents a barrier that keeps the community from developing common goals leading to full economic recovery.

CONCLUSION

Jubilee has not fully recovered from the effects of Hurricane Ivan, but progress has been made in the reconstruction effort. These efforts have addressed the most immediate and basic needs of the community, mainly utility service infrastructure and home repairs. However issues related to the community's economic recovery are still unresolved.

Conserved epitopes in the protein tyrosine phosphatase family of diabetes autoantigens

IA2 and phogrin are important targets of humoral and cell-mediated autoimmunity in type 1 diabetes in man. They belong to a conserved subfamily of transmembrane protein tyrosine phosphatases (PTPs) associated with the regulatory pathway of secretion. To examine potential cross-reactivity between PTP family members we tested sera from T1D patients for reactivity to IA2, and the Drosophila (FLYDA) and C. elegans (IDA) orthologs using radioimmunoprecipitation assays of (35)S Met-labeled in vitro translated products of the cytosolic domains of these proteins. Approximately 80% of sera reacted with at least one probe. Of these, 82.5% showed reactivity to human IA2, 74.1% to FLYDA, and 33.7% to IDA. The majority of sera that bound FLYDA and/or IDA also recognized IA2. This raises the possibility that in some cases reactivity to IA2 may have arisen by molecular mimicry.

Near lethal endometriosis and a massive (64 kg) endometrioma: case report and review of the literature

A 51-year-old morbidly obese, hypertensive, anemic, and amenorrheic female presented with anuria and respiratory symptoms. The patient had a distinctly massive abdomen with necrotic anterior abdominal wall, and laboratory findings revealed a leukocytosis, profound anemia, coagulopathy and renal failure. An abdominal sonogram showed a large, complex intra-abdominopelvic mass and ascites. At surgery, a massive, cystic left ovarian mass, 37 1 of ascitic/cyst fluid, and several peritoneal nodules were removed--a total of 64 kg of tumorous tissue. Histopathological evaluation of the mass revealed an endometrioma. We present this rare case of severe endometriosis in a morbidly obese patient who presented with an exceptionally large endometrioma (64 kg), multifactorial respiratory and renal failure, coagulopathy, and profound anemia.

Phase II study of bevacizumab in combination with docetaxel and radiation in locally advanced squamous cell cancer of the head and neck (SCCHN)

6068

Background: VEGF expression has been shown to be up regulated in SCCHN, representing a promising therapeutic target. Bevacizumab is an anti-VEGF monoclonal antibody that may potentiate the efficacy of concurrent radiation and docetaxel. This trial represents the first attempt, to the best of our knowledge, to establish the efficacy and toxicities of the addition of bevacizumab to concurrent radiation with docetaxel in patients with locally advanced SCCHN. Methods: Patients with previously untreated stage III-IVb SCCHN receive standard once-daily radiation (70.2Gy, 1.8Gy/day), weekly docetaxel (20 mg/m2/week for the duration of radiation) and biweekly bevacizumab (5 mg/kg/two weeks) during and for up to one year following radiation. A total of 30 patients will be enrolled in this study. Results: Twelve of 30 planned patients (11 males), mean age 58 years (range 49–66), all with stage IV disease have been enrolled. Primary site: pharynx (n=8) and larynx (n=4). 10 patients have completed concurrent chemoradiation. After a median followup of 9 months (range: 0 –13), 9 patients remain in complete response, 1 patient developed metastatic disease. 6/10 patients underwent planned neck dissection and they all had a pathologic complete response. 6/9 patients, in complete response, are currently receiving adjuvant bevacizumab. The remaining 3 patients are currently off adjuvant bevacizumab treatment for area of radiation necrosis of larynx (n=1), pharyngoesophageal stenosis (n=1), status post cholecystectomy with pathology revealing acute hemorrhagic cholecystitis with transmural gangrenous necrosis (n=1). Conclusions: For patients with locally advanced SCCHN, preliminary data suggest that the addition of bevacizumab to concurrent radiation with docetaxel is feasible, safe and active. Supported in part by Genentech, NIH grants P30 CA43703 and M01 RR-000080 Clinicaltrials.gov identifier: NCT00281840

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