Interhemispheric transmission time in persons with Down syndrome

Perspectives on pain in Down syndrome

Down syndrome (DS) or trisomy 21 is a genetic condition often accompanied by chronic pain caused by congenital abnormalities and/or conditions, such as osteoarthritis, recurrent infections, and leukemia. Although DS patients are more susceptible to chronic pain as compared to the general population, the pain experience in these individuals may vary, attributed to the heterogenous structural and functional differences in the central nervous system, which might result in abnormal pain sensory information transduction, transmission, modulation, and perception. We tried to elaborate on some key questions and possible explanations in this review. Further clarification of the mechanisms underlying such abnormal conditions induced by the structural and functional differences is needed to help pain management in DS patients.

Brain circuit pathology in Down syndrome: from neurons to neural networks

Down syndrome (DS), a genetic pathology caused by triplication of chromosome 21, is characterized by brain hypotrophy and impairment of cognition starting from infancy. While studies in mouse models of DS have elucidated the major neuroanatomical and neurochemical defects of DS, comparatively fewer investigations have focused on the electrophysiology of the DS brain. Electrical activity is at the basis of brain functioning. Therefore, knowledge of the way in which brain circuits operate in DS is fundamental to understand the causes of behavioral impairment and devise targeted interventions. This review summarizes the state of the art regarding the electrical properties of the DS brain, starting from individual neurons and culminating in signal processing in whole neuronal networks. The reported evidence derives from mouse models of DS and from brain tissues and neurons derived from individuals with DS. EEG data recorded in individuals with DS are also provided as a key tool to understand the impact of brain circuit alterations on global brain activity.

Sequential aiming in pairs: the multiple levels of joint action

The task constraints imposed upon a co-actor can often influence our own actions. Likewise, the observation of somebody else's movements can involuntarily contaminate the execution of our own movements. These joint action outcomes have rarely been considered in unison. The aim of the present study was to simultaneously examine the underlying processes contributing to joint action. We had pairs of participants work together to execute sequential aiming movements between two targets-the first person's movement was contingent upon the anticipation of the second person's movement (leader), while the second person's movement was contingent upon the direct observation of the first person's movement (follower). Participants executed separate blocks of two-target aiming movements under different contexts; that is, solely on their own using one (2T1L) and two (2T2L) of their upper limbs, or with another person (2T2P). The first movement segment generally indicated a more abrupt approach (shorter time after peak velocity, greater displacement and magnitude of peak velocity), which surprisingly coincided with lower spatial variability, for the 2T2P context. Meanwhile, the second segment indicated a similar kinematic profile as the first segment for the 2T2P context. The first movement of the leader appeared to accommodate the follower for their movement, while the second movement of the follower was primed by the observation of the leader's movement. These findings collectively advocate two distinct levels of joint action including the anticipation (top-down) and mapping (bottom-up) of other people's actions.

Lexical decision performance using the divided visual field technique following training in adults with intellectual disabilities with and without Down syndrome

Studies of brain lateralization in individuals with non-specific intellectual disability and Down syndrome suggest atypical brain lateralization to speech perception. According to the biological dissociation model, the right hemisphere (RH) mediates speech perception and the left hemisphere (LH) mediates motor control in Down syndrome. The current study aimed to test, for the first time, brain lateralization in both non-specific intellectual disability and Down syndrome, compared to individuals with typical development. Furthermore, bilateral word presentation was utilized to assess interhemispheric communication. Twenty adults with non-specific intellectual disability, 14 adults with Down syndrome, and 30 adults with typical development participated in the study. Participants in the non-specific intellectual disability and Down syndrome groups were trained to perform the task prior to the experiment. The results showed that whereas hemispheric lateralization did not differ between individuals with non-specific intellectual disability and typical development, individuals with DS showed reduced brain lateralization in comparison to adults with typical development. All three groups showed no significant difference between words presented to the LH and bilaterally. Our results also show that individuals with intellectual disabilities can benefit from training programmes and that they may perform equally as fast as their typically developing peers.

Self-Reported Presence and Experience of Pain in Adults with Down Syndrome

Objective

The aim was to examine whether the presence of pain (based on physical conditions and participants' report) and self-reported pain experience in adults with Down syndrome (DS) differ from general population controls.

Design

Cross-sectional study of 224 adults with DS (mean age = 38.1 years, mild-severe intellectual disabilities) and 142 age-matched controls (median age = 40.5 years, mean estimated IQ = 105.7) in the Netherlands.

Methods

File-based medical information was evaluated. Self-reported presence and experience of pain were assessed in rest and after movement during a test session (affect with facial affective scale (FAS: 0.04-0.97), intensity assessed with numeric rating scale (NRS: 0-10).

Results

Compared with controls, more DS participants had physical conditions that may cause pain and/or discomfort ( p  = .004, 50% vs 35%), but fewer DS participants reported pain during the test session ( p  = .003, 58% vs 73%). Of the participants who indicated pain and comprehended self-reporting scales ( n  = 198 FAS, n  = 161 NRS), the DS group reported a higher pain affect and intensity than the controls ( p  < .001, FAS: 0.75-0.85 vs 0.50-0.59, NRS: 6.00-7.94 vs 2.00-3.73).

Conclusions

Not all adults with DS and painful/discomforting physical conditions reported pain. Those who did indicated a higher pain experience than adults from the general population. Research into spontaneous self-report of pain, repeated pain assessment, and acute pain is needed in people with DS for more insight into pain experience and mismatches between self-report and medical information.

Response abilities of children with Down Syndrome and other intellectual developmental disorders

Efficiency with which a task is performed results from the precise timing and force with which the task is executed. We aimed at assessing the influence of change in task constructs on the response abilities of children who are known to have impaired perceptual motor control. To answer this question, we assessed the response abilities in terms of response time(RT) and response force(RF) among children with Down Syndrome(DS), intellectual developmental disorders(IDD) and those who are typically developing. A response analyzer was used to assess their response abilities across a variety of task constructs namely while performing a simple response task, dual task (i.e. passive and active dual tasks), force modulation task and choice response task. Across all tasks, it was seen that their RT increased while RF decreased as the tasks became more complex in nature. The number of participants in the DS and IDD group diminished as the task complexity increased, reflecting their inherent difficulty in learning new tasks and executing a common expected response under different task conditions. The response abilities of the DS and IDD group was comparable across tasks and varied significantly from the TDC group. The study enables us to understand the influence of task difficulties on the response abilities and participation across groups of children with and without disabilities. The results of the study necessitate the need to evaluate and find methods to train the response abilities of children with DS and IDD, which has considerable implications towards the performance of their daily life skills.

Pain sensitivity of children with Down syndrome and their siblings: quantitative sensory testing versus parental reports

AIM

The aim of this study was to compare thermal detection and pain thresholds in children with Down syndrome with those of their siblings.

METHOD

Sensory detection and pain thresholds were assessed in children with Down syndrome and their siblings using quantitative testing methods. Parental questionnaires addressing developmental age, pain coping, pain behaviour, and chronic pain were also utilized.

RESULTS

Forty-two children with Down syndrome (mean age 12y 10mo) and 24 siblings (mean age 15y) participated in this observational study. The different sensory tests proved feasible in 13 to 29 (33-88%) of the children with Down syndrome. These children were less sensitive to cold and warmth than their siblings, but only when measured with a reaction time-dependent method, and not with a reaction time-independent method. Children with Down syndrome were more sensitive to heat pain, and only 6 (14%) of them were able to adequately self-report pain, compared with 22 (92%) of siblings (p<0.001).

INTERPRETATION

Children with Down syndrome will remain dependent on pain assessment by proxy, since self-reporting is not adequate. Parents believe that their children with Down syndrome are less sensitive to pain than their siblings, but this was not confirmed by quantitative sensory testing.

Pain perception in people with Down syndrome: a synthesis of clinical and experimental research

People with an intellectual disability experience both acute and chronic pain with at least the same frequency as the general population. However, considerably less is known about the pain perception of people with Down syndrome. In this review paper, we evaluated the available clinical and experimental evidence. Some experimental studies of acute pain have indicated that pain threshold was higher than normal but only when using a reaction time method to measure pain sensitivity. However, when reaction time is not part of the calculation of the pain threshold, pain sensitivity in people with Down syndrome is in fact lower than normal (more sensitive to pain). Clinical studies of chronic pain have shown that people with an intellectual disability experience chronic pain and within that population, people with Down syndrome also experience chronic pain, but the precise prevalence of chronic pain in Down syndrome has yet to be established. Taken together, the literature suggests that people with Down syndrome experience pain, both acute and chronic, with at least the same frequency as the rest of the population. Furthermore, the evidence suggests that although acute pain expression appears to be delayed, once pain is registered, there appears to be a magnified pain response. We conclude by proposing an agenda for future research in this area.

Can response time be trained with bilateral limb training in children with Down syndrome?

Aims:

Response time (RT), that is, the time taken to respond is known to be delayed in children with Down syndrome (DS). We performed a pilot study to evaluate whether bilateral limb training can be used to train RT, in children with DS.

Settings and Design:

10 children with DS (5 males) were recruited from a special school in a suburban region using convenience sampling.

Subjects and Methods:

Response time was measured using an indigenously developed RT Analyzer, before and after intervention, from right and left hand. Structured bilateral limb training was given for a period of 4 weeks, using low-cost, locally available materials, in community settings.

Statistical Analysis Used:

The Wilcoxon signed ranks test was used for statistical analysis.

Results:

Significant improvements in RT following 4 weeks of intervention were seen in the left hand (P = 0.006) but not in the right hand (P = 0.104).

Conclusions:

Response time can be trained in children with DS using 4 weeks of bilateral limb training activities using low-cost, locally available materials.

Bimanual coordination in typical and atypical infants: movement initiation, object touching and grasping

The development of bimanual actions reflects perceptual, motor and cognitive processes, as well as the functional connectivity between brain hemispheres. We investigated the development of uni- and bimanual actions in typically-developing (TD) infants and infants with Down syndrome (DS) while they reached for objects with varying sizes. Eight TD infants and seven infants with DS (ages 4-8 months) were tested at several stages of reaching experience. Movement strategies at movement initiation, object touching and grasping were recorded. With reaching experience, typical infants increased ability to anticipate reaching strategies, and independent use of the hands according to task demands. Strategies used by infants with DS were mostly compensatory rather than anticipatory, and showed a weaker tendency for interlimb coupling at early ages. These differences may underlie functional limitations, and should be subject to early intervention.

Sequential aiming movements and the one-target advantage in individuals with Down syndrome

Research has revealed that individuals with Down syndrome (DS) have elevated reaction times, longer movement times, and greater movement errors during single-target single-limb actions compared to their typically developing (TD) peers. These perceptual-motor impairments have been attributed to both central processes and the physical phenotype associated with DS. The purpose of the present study was to directly investigate these possible central and peripheral deficits by examining how individuals with DS plan and execute more complex movements. Three groups (DS, TD, and individuals with an undifferentiated intellectual disability; UID) of 8 participants completed a single target movement, a two-target movement performed by a single arm, and a two-target movement where the first movement was performed with one arm and the second movement performed with the other arm. For all groups and all conditions, movement times revealed a one-target advantage (OTA). Specifically, times to the first target were longer in the two-target responses compared to the single-target response. In general, the OTA finding reveals that persons with DS utilise planning strategies similar to their TD peers when performing sequential actions involving two targets and two arms. Furthermore, because the OTA was observed in both the single- and two-arm two-target responses the interference in movement one associated with having to make a subsequent movement is not due to peripheral processes associated with single limb constraints. Rather, individuals with DS treat movements within a sequence as functionally dependent. Thus, the central processes associated with timing the implementation of the second element of the movement appear to be responsible for the interference that leads to the OTA.

Avaliação das habilidades funcionais e de auto cuidado de indivíduos com síndrome de Down pertencentes a uma oficina terapêutica

OBJETIVO: avaliar as habilidades funcionais e de auto cuidado de indivíduos com Síndrome de Down em uma oficina interdisciplinar terapêutica. MÉTODO: investigação prospectiva, exploratória, comparativa, de corte transversal e abordagem quantitativa com amostra de um grupo teste(T), com síndrome de Down (N=17) e, grupo controle (C) sem a síndrome (n= 20). O instrumento utilizado foi o Inventario de avaliação pediátrica (PEDI) que avalia aspectos funcionais do desempenho de crianças. RESULTADOS: a amostra foi pareada (idade média 5 a 7 ½ anos,desvio padrão 1a 6 meses). O grupo T apresentou um repertório de habilidades funcionais na área de autocuidado inferior aos participantes do grupo C (p<0,05). Nas áreas de mobilidade e função social apesar de apresentarem escores menores não houve diferença estatística entre os grupos. CONCLUSÃO: a monitoração contínua em atividades coletivas no formato de oficinas pode ser útil no conhecimento sobre o impacto destas atividades no perfil funcional destas crianças.

Preferência podal em lactentes com síndrome de Down: fatores extrínsecos e intrínsecos

Durante o processo de aquisição do chute em lactentes, a preferência podal pode ser influenciada de forma diferente pelos fatores extrínsecos e intrínsecos. O objetivo foi comparar a preferência podal e verificar a influência do peso adicional e do Reflexo Tônico Cervical Assimétrico (RTCA) na preferência podal entre lactentes com síndrome de Down e típicos. Participaram do estudo cinco lactentes com síndrome de Down e cinco típicos aos três e quatro meses de idade. O experimento foi subdividido em quatro condições experimentais: Treinamento, Linha de Base, Peso e Pós-Peso. Os lactentes com síndrome de Down apresentaram preferência à esquerda ou indefinida e os típicos, preferência à direita. O RTCA influenciou na preferência podal em ambos os grupos, indicando que o lado de rotação da cabeça orientou o chute do mesmo lado. Nos lactentes com síndrome de Down a correlação entre RTCA e chutes foi positiva, sendo forte aos três meses e moderada aos quatro meses. Para os lactentes típicos foi observada correlação positiva fraca aos três meses, e aos quatro meses a correlação não foi estatisticamente significativa. Lactentes com síndrome de Down apresentam preferência podal contrária aos lactentes típicos. O RTCA exerce influência na preferência podal por um período mais longo em lactentes com síndrome de Down em comparação aos lactentes típicos.

Transcallosal transfer of information and functional asymmetry of the human brain

The corpus callosum is the largest commissure in the brain and acts as a "bridge" of nerve fibres connecting the two cerebral hemispheres. It plays a crucial role in interhemispheric integration and is responsible for normal communication and cooperation between the two hemispheres. Evolutionary pressures guiding brain size are accompanied by reduced interhemispheric and enhanced intrahemispheric connectivity. Some lines of evidence suggest that the speed of transcallosal conduction is limited in large brains (e.g., in humans), thus favouring intrahemispheric processing and brain lateralisation. Patterns of directional symmetry/asymmetry of transcallosal transfer time may be related to the degree of brain lateralisation. Neural network modelling and electrophysiological studies on interhemispheric transmission provide data supporting this supposition.