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Bruttini C, Esposti R, Pece A, Maione G, Cavallari P. Comparison of central corneal thickness measured by automatic and manual analysis of optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-023-06354-0. [PMID: 38206413 DOI: 10.1007/s00417-023-06354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/14/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To compare central corneal thickness (CCT) measured with optical coherence tomography (OCT) using an automatic algorithm (A-OCT) vs. manual measurements (M-OCT) with respect to the gold standard ultrasound pachymetry (USP). METHODS CCT measurements were performed on both eyes of 28 healthy subjects at four times of the day. A-OCT used an automatic software analysis of the corneal image, M-OCT was performed by two operators by setting a digital calliper on the corneal borders, and USP was performed after corneal anesthesia. Measurements were compared using a three-way repeated measures ANOVA. Bland-Altman plots were used to evaluate the agreement between OCT measurements and USP. RESULTS Both A-OCT and M-OCT significantly underestimated the USP measures, with the mean difference, i.e., the systematic error, being larger for A-OCT (- 19.0 µm) than for M-OCT (- 6.5 µm). Good reproducibility between the two operators was observed. Bland-Altman plots showed that both OCT methods suffered from proportional errors, which were not affected by time and eye. CONCLUSIONS Measuring CCT with OCT yielded lower values than USP. Therefore, clinicians should be aware that corneal thickness values may be influenced by the measurement method and that the various devices should not be used interchangeably in following up a given patient. Intriguingly, M-OCT had less systematic error than A-OCT, an important outcome that clinicians should consider when deciding to use an OCT device.
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Affiliation(s)
- Carlo Bruttini
- University Eye Clinic, IRCCS, Policlinico San Matteo, Pavia, Italy.
- Eye Clinic, Melegnano Hospital, Via Pandina, 1, 20077, Vizzolo Predabissi, Italy.
| | - Roberto Esposti
- Human Physiology Section of the DePT, Università Degli Studi Di Milano, Milan, Italy
| | - Alfredo Pece
- Eye Clinic, Melegnano Hospital, Via Pandina, 1, 20077, Vizzolo Predabissi, Italy
| | - Giulio Maione
- Eye Clinic, Melegnano Hospital, Via Pandina, 1, 20077, Vizzolo Predabissi, Italy
| | - Paolo Cavallari
- Human Physiology Section of the DePT, Università Degli Studi Di Milano, Milan, Italy
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Vercellin AV, Harris A, Belamkar A, Zukerman R, Carichino L, Szopos M, Siesky B, Quaranta L, Bruttini C, Oddone F, Riva I, Guidoboni G. Physiology-Enhanced Data Analytics to Evaluate the Effect of Altitude on Intraocular Pressure and Ocular Hemodynamics. Photonics 2022; 9:158. [PMID: 36777090 PMCID: PMC9912910 DOI: 10.3390/photonics9030158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Altitude affects intraocular pressure (IOP); however, the underlying mechanisms involved and its relationship with ocular hemodynamics remain unknown. Herein, a validated mathematical modeling approach was used for a physiology-enhanced (pe-) analysis of the Mont Blanc study (MBS), estimating the effects of altitude on IOP, blood pressure (BP), and retinal hemodynamics. In the MBS, IOP and BP were measured in 33 healthy volunteers at 77 and 3466 m above sea level. Pe-retinal hemodynamics analysis predicted a statistically significant increase (p < 0.001) in the model predicted blood flow and pressure within the retinal vasculature following increases in systemic BP with altitude measured in the MBS. Decreased IOP with altitude led to a non-monotonic behavior of the model predicted retinal vascular resistances, with significant decreases in the resistance of the central retinal artery (p < 0.001) and retinal venules (p = 0.003) and a non-significant increase in the resistance in the central retinal vein (p = 0.253). Pe-aqueous humor analysis showed that a decrease in osmotic pressure difference (OPD) may underlie the difference in IOP measured at different altitudes in the MBS. Our analysis suggests that venules bear the significant portion of the IOP pressure load within the ocular vasculature, and that OPD plays an important role in regulating IOP with changes in altitude.
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Affiliation(s)
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA
| | - Aditya Belamkar
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Ryan Zukerman
- Department of Ophthalmology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Lucia Carichino
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - Marcela Szopos
- MAP5 UMR CNRS 8145, Université de Paris, 75006 Paris, France
| | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA
| | - Luciano Quaranta
- Department of Ophthalmology, Centro Oculistico Italiano, 25122 Brescia, Italy
| | - Carlo Bruttini
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Ivano Riva
- Department of Ophthalmology, Istituto Clinico Sant’Anna, 25127 Brescia, Italy
| | - Giovanna Guidoboni
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA
- Department of Mathematics, University of Missouri, Columbia, MO 65211, USA
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Quaranta L, Micheletti E, Carassa R, Bruttini C, Fausto R, Katsanos A, Riva I. Efficacy and Safety of PreserFlo ® MicroShunt After a Failed Trabeculectomy in Eyes with Primary Open-Angle Glaucoma: A Retrospective Study. Adv Ther 2021; 38:4403-4412. [PMID: 34251652 PMCID: PMC8342380 DOI: 10.1007/s12325-021-01811-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 02/03/2023]
Abstract
Introduction To evaluate the efficacy and safety of PreserFlo® MicroShunt in primary open angle glaucoma (POAG) eyes after a single failed trabeculectomy. Methods Retrospective review of POAG eyes with a failed trabeculectomy that underwent PreserFlo® MicroShunt implantation from March 2019 to November 2019, in two Italian glaucoma centers. Pre- and postoperative data were collected and compared. Results A total of 31 surgeries in 31 patients were reviewed. Mean preoperative IOP and mean preoperative number of medications were 24.12 ± 3.14 mmHg and 3.29 ± 0.64, respectively, and decreased to 12.56 ± 2.64 mmHg and 0.46 ± 0.77 at the 12-month postoperative follow-up visit (p < 0.01). The most frequent adverse events were transient hypotony (6 eyes, 19.3%) and choroidal effusion (3 eyes, 9.6%). In all cases spontaneous resolution was observed, with no intervention. Conclusion In POAG eyes with a single failed trabeculectomy, the PreserFlo® MicroShunt was safe and effective in reducing the IOP after a 12-month follow-up. The PreserFlo® MicroShunt may represent a viable choice as a second surgery.
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Riva I, Micheletti E, Fausto R, Bruttini C, De Angelis G, Ceccuzzi R, Quaranta L. Human recombinant nerve growth factor (Cenegermin) in a patient affected by primary congenital glaucoma with neurotrophic keratopathy. Eur J Ophthalmol 2021; 32:NP78-NP81. [PMID: 33657894 DOI: 10.1177/1120672121999344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a case of neurotrophic keratopathy (NK) in a patient affected by primary congenital glaucoma (PCG) who undergone glaucoma drainage implant surgery. NK was successfully treated with human recombinant Nerve Growth Factor (Cenegermin) eye drops. CASE REPORT DESCRIPTION A 46-years-old patient affected by primary congenital glaucoma underwent Ahmed glaucoma valve implantation in the right eye, after several unsuccessful surgeries to control intraocular pressure (IOP) since the age of three. Surgical intervention was performed without complications, and IOP was well-controlled post-operatively. However, 1 month after surgery, he developed NK with stromal ulceration, initially treated with a topical combination of preservative-free artificial tears and antibiotic ointment. As NK did not resolve, a new treatment with Cenegermin 20 µg/ml eye drops, 6 times daily, was started. OUTCOME NK completely resolved after 8 weeks of Cenegermin treatment, with complete restoration of corneal integrity and improvement of corneal sensitivity and transparency. Visual acuity in the operated eye reverted to the pre-operative value. CONCLUSION Cenegermin was extremely effective in restoring corneal integrity in this PCG patient with NK.
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Affiliation(s)
- Ivano Riva
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eleonora Micheletti
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Riccardo Fausto
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Carlo Bruttini
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Giovanni De Angelis
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Roberto Ceccuzzi
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Luciano Quaranta
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Quaranta L, Bruttini C, Micheletti E, Konstas AGP, Michelessi M, Oddone F, Katsanos A, Sbardella D, De Angelis G, Riva I. Glaucoma and neuroinflammation: An overview. Surv Ophthalmol 2021; 66:693-713. [PMID: 33582161 DOI: 10.1016/j.survophthal.2021.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
Glaucoma is an optic neuropathy characterized by well-defined optic disc morphological changes (i.e., cup enlargement, neuroretinal border thinning, and notching, papillary vessel modifications) consequent to retinal ganglion cell loss, axonal degeneration, and lamina cribrosa remodeling. These modifications tend to be progressive and are the main cause of functional damage in glaucoma. Despite the latest findings about the pathophysiology of the disease, the exact trigger mechanisms and the mechanism of degeneration of retinal ganglion cells and their axons have not been completely elucidated. Neuroinflammation may play a role in both the development and the progression of the disease as a result of its effects on retinal environment and retinal ganglion cells. We summarize the latest findings about neuroinflammation in glaucoma and examine the connection between risk factors, neuroinflammation, and retinal ganglion cell degeneration.
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Affiliation(s)
- Luciano Quaranta
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
| | - Carlo Bruttini
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eleonora Micheletti
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Anastasios G P Konstas
- 1st and 3rd University Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | | | - Giovanni De Angelis
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia - IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Quaranta L, Rovida F, Riva I, Bruttini C, Brambilla I, Baldanti F, De Angelis G, Marseglia GL. Identification of SARS-CoV-2 RNA in the conjunctival swab of an Italian pediatric patient affected with COVID-19: A case report. Eur J Ophthalmol 2020; 32:1120672120977822. [PMID: 33267605 PMCID: PMC8935152 DOI: 10.1177/1120672120977822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/10/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION To report a case of identification of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) RNA in ocular specimen in a pediatric patient affected with Coronavirus disease 2019 (COVID-19) with no signs of ocular involvement. CASE DESCRIPTION A 11-year old male patient with confirmed COVID-19 infection was hospitalized at the Pediatric Clinic Clinic of the IRCCS Foundation and Hospital San Matteo, Pavia, Italy. Three days after hospital admission, because of the patient complaining very mild ocular symptoms, an ophthalmological evaluation was performed. No signs related to conjunctivitis or keratitis were found but a conjunctival swab was collected as well, based on patient's medical history. The specific SARS-CoV-2 reverse transcription PCR (RT-PCR) was performed, unearthing the presence of viral RNA from the swab. On day 25 from hospitalization, the conjunctival swab was repeated, giving negative result. CONCLUSIONS This is the first report of the identification of SARS-CoV-2 RNA in ocular specimen in a pediatric patient without signs of ocular involvement. However, despite the transmission through tears is theoretically possible, it is still unclear whether this could be considered as an important route for the spread of SARS-CoV-2.
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Affiliation(s)
- Luciano Quaranta
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesca Rovida
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | | | - Carlo Bruttini
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Ilaria Brambilla
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Fausto Baldanti
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Giovanni De Angelis
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Surgical and Clinical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Bruttini C, Verticchio Vercellin A, Klersy C, De Silvestri A, Tinelli C, Riva I, Oddone F, Katsanos A, Quaranta L. The Mont Blanc Study: The effect of altitude on intra ocular pressure and central corneal thickness. PLoS One 2020; 15:e0237343. [PMID: 32764811 PMCID: PMC7413504 DOI: 10.1371/journal.pone.0237343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/23/2020] [Indexed: 11/18/2022] Open
Abstract
The aim of the Mont Blanc Study was to investigate the relationship between intraocular pressure (IOP), central corneal thickness (CCT), and altitude in healthy subjects. Thirty-three eyes of 33 healthy volunteers (mean age: 24.8 years, 17 females) had their IOP measured with Perkins and I-Care tonometers and their CCT using ultrasound pachymetry at three locations in Italy with different altitudes: Pavia, (PV), 77 meters above sea level (a.s.l); Courmayeur (CM), 1300 meters a.s.l; Pointe Helbronner (PH), 3466 meters a.s.l.). The measurements were performed at 9 am, 11 am, 1 pm and 3 pm (±30’) in indoor settings (mean temperature of 19°C) in PV and PH. At 9 am, CCT and IOP were measured outdoor (mean temperature of -1.4°C) at PH. The mean values of the IOP curve decreased from PV to PH with the Perkins (p = 0.02) and I-Care tonometers (p = 0.001). Instead, CCT increased upon ascension from PV to PH (p = 0.01), and from CM to PH (p = 0.002). When exposed to sub-zero temperature, the IOP increased (p<0.001), while the CCT did not change (p = 0.30). The results suggest that IOP significantly decreased and CCT significantly increased upon ascension from the sea level to higher altitudes.
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Affiliation(s)
- Carlo Bruttini
- University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Verticchio Vercellin
- University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,IRCCS-Fondazione G.B. Bietti, Rome, Italy.,Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, United States of America
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmine Tinelli
- Clinical Epidemiology and Biometry Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ivano Riva
- IRCCS-Fondazione G.B. Bietti, Rome, Italy
| | | | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - Luciano Quaranta
- University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bruttini C, Pallone C, Verticchio Vercellin A, Acerbi G, Baschetti S, Bruttini P, Riva I, Quaranta L. Pre-operative conjunctival flora in patients with local and/or systemic risk factors for post cataract surgery infection in Northern Italy. Eur J Ophthalmol 2020; 31:1002-1006. [PMID: 32552180 DOI: 10.1177/1120672120934991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the pre-operative conjunctival flora in patients undergoing cataract surgery with major local and/or systemic risk factors for developing post-operative infection. METHODS A total of 83 patients underwent bacterial culture and sensitivity testing of conjunctival swabs obtained from both eyes because of local risk factors at the pre-operative visit (i.e. chronic blepharitis, conjunctivitis, or lacrimal system disease), and/or systemic risk factors (i.e. autoimmune or skin disorders) for developing post-operative infection. If the swab was found positive, an antimicrobial susceptibility test was performed, and a specific antibiotic therapy was administered. Surgery was performed when a repeat conjunctival swab (after antibiotic treatment) showed negative cultures. RESULTS Cultures were found positive in 25.3% of patients. Staphylococcus aureus (18%) and Staphylococcus epidermidis (15%) were the most frequently isolated microorganisms. Gram-negative bacteria, including Pseudomonas aeruginosa, were present in nine cases (8%). CONCLUSION Present results showed a low rate of swab positivity compared to previous published data, and slightly different microbial flora. The differences observed may be caused by geographical factors and/or to the specific characteristics of the subgroup of studied patients. Considering that the surface microbial flora is one of the major causes of endophthalmitis, this information may be useful in selecting antibacterial regimens to prevent serious ocular infections, and restrain the increasing problem of antibiotic resistance.
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Affiliation(s)
- Carlo Bruttini
- University Eye Clinic, IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Carlotta Pallone
- University Eye Clinic, IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Alice Verticchio Vercellin
- University Eye Clinic, IRCCS, Policlinico San Matteo, Pavia, Italy.,IRCCS, Fondazione G.B. Bietti, Rome, Italy.,Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Giovanni Acerbi
- Ophthalmology Department, San Carlo Clinic, Paderno Dugnano, Italy
| | | | | | - Ivano Riva
- IRCCS, Fondazione G.B. Bietti, Rome, Italy
| | - Luciano Quaranta
- University Eye Clinic, IRCCS, Policlinico San Matteo, Pavia, Italy
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Bolzoni F, Esposti R, Bruttini C, Zenoni G, Jankowska E, Cavallari P. Direct current stimulation modulates the excitability of the sensory and motor fibres in the human posterior tibial nerve, with a long-lasting effect on the H-reflex. Eur J Neurosci 2017; 46:2499-2506. [PMID: 28892581 DOI: 10.1111/ejn.13696] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 02/06/2023]
Abstract
Several studies demonstrated that transcutaneous direct current stimulation (DCS) may modulate central nervous system excitability. However, much less is known about how DC affects peripheral nerve fibres. We investigated the action of DCS on motor and sensory fibres of the human posterior tibial nerve, with supplementary analysis in acute experiments on rats. In forty human subjects, electric pulses at the popliteal fossa were used to elicit either M-waves or H-reflexes in the Soleus, before (15 min), during (10 min) and after (30 min) DCS. Cathodal or anodal current (2 mA) was applied to the same nerve. Cathodal DCS significantly increased the H-reflex amplitude; the post-polarization effect lasted up to ~ 25 min after the termination of DCS. Anodal DCS instead significantly decreased the reflex amplitude for up to ~ 5 min after DCS end. DCS effects on M-wave showed the same polarity dependence but with considerably shorter after-effects, which never exceeded 5 min. DCS changed the excitability of both motor and sensory fibres. These effects and especially the long-lasting modulation of the H-reflex suggest a possible rehabilitative application of DCS that could be applied either to compensate an altered peripheral excitability or to modulate the afferent transmission to spinal and supraspinal structures. In animal experiments, DCS was applied, under anaesthesia, to either the exposed peroneus nerve or its Dorsal Root, and its effects closely resembled those found in human subjects. They validate therefore the use of the animal models for future investigations on the DCS mechanisms.
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Affiliation(s)
- Francesco Bolzoni
- Human Physiology Section of the De.P.T., Università degli Studi di Milano, Via Mangiagalli 32, I-20133, Milan, Italy.,Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roberto Esposti
- Human Physiology Section of the De.P.T., Università degli Studi di Milano, Via Mangiagalli 32, I-20133, Milan, Italy
| | - Carlo Bruttini
- Human Physiology Section of the De.P.T., Università degli Studi di Milano, Via Mangiagalli 32, I-20133, Milan, Italy
| | - Giuseppe Zenoni
- Human Physiology Section of the De.P.T., Università degli Studi di Milano, Via Mangiagalli 32, I-20133, Milan, Italy
| | - Elzbieta Jankowska
- Department of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Paolo Cavallari
- Human Physiology Section of the De.P.T., Università degli Studi di Milano, Via Mangiagalli 32, I-20133, Milan, Italy
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Cavallari P, Bolzoni F, Esposti R, Bruttini C. Cough-Anal Reflex May Be the Expression of a Pre-Programmed Postural Action. Front Hum Neurosci 2017; 11:475. [PMID: 29021750 PMCID: PMC5624195 DOI: 10.3389/fnhum.2017.00475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/12/2017] [Indexed: 01/23/2023] Open
Abstract
When coughing, an involuntary contraction of the external anal sphincter occurs, in order to prevent unwanted leakages or sagging of the pelvis muscular wall. Literature originally described such cough-anal response as a reflex elicited by cough, therefore identifying a precise cause-effect relationship. However, recent studies report that the anal contraction actually precedes the rise in abdominal pressure during cough expiratory effort, so that the sphincter activity should be pre-programmed. In recent years, an important family of pre-programmed muscle activities has been well documented to precede voluntary movements: these anticipatory actions play a fundamental role in whole body and segmental postural control, hence they are referred to as anticipatory postural adjustments (APAs). On these basis, we searched in literature for similarities between APAs and the cough-anal response, observing that both follow the same predictive homeostatic principle, namely that anticipatory collateral actions are needed to prevent the unwanted mechanical consequences induced by the primary movement. We thus propose that the cough-anal response also belongs to the family of pre-programmed actions, as it may be interpreted as an APA acting on the abdominal-thoracic compartment; in other words, the cough-anal response may actually be an Anticipatory Sphincter Adjustment, the visceral counterpart of APAs.
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Affiliation(s)
- Paolo Cavallari
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
| | - Francesco Bolzoni
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
| | - Roberto Esposti
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
| | - Carlo Bruttini
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di MilanoMilan, Italy
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Esposti R, Bruttini C, Bolzoni F, Cavallari P. Anticipatory Postural Adjustments associated with reaching movements are programmed according to the availability of visual information. Exp Brain Res 2017; 235:1349-1360. [DOI: 10.1007/s00221-017-4898-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 01/30/2017] [Indexed: 12/26/2022]
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Cavallari P, Bolzoni F, Bruttini C, Esposti R. The Organization and Control of Intra-Limb Anticipatory Postural Adjustments and Their Role in Movement Performance. Front Hum Neurosci 2016; 10:525. [PMID: 27807411 PMCID: PMC5069406 DOI: 10.3389/fnhum.2016.00525] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/04/2016] [Indexed: 12/17/2022] Open
Abstract
Anticipatory Postural Adjustments (APAs) are commonly described as unconscious muscular activities aimed to counterbalance the perturbation caused by the primary movement, so as to ensure the whole-body balance, as well as contributing to initiate the displacement of the body center of mass when starting gait or whole-body reaching movements. These activities usually create one or more fixation chains which spread over several muscles of different limbs, and may be thus called inter-limb APAs. However, it has been reported that APAs also precede voluntary movements involving tiny masses, like a flexion/extension of the wrist or even a brisk flexion of the index-finger. In particular, such movements are preceded by an intra-limb APA chain, that involves muscles acting on the proximal joints. Considering the small mass of the moving segments, it is unlikely that the ensuing perturbation could threaten the whole-body balance, so that it is interesting to enquire the physiological role of intra-limb APAs and their organization and control compared to inter-limb APAs. This review is focused on intra-limb APAs and highlights a strict correspondence in their behavior and temporal/spatial organization with respect to inter-limb APAs. Hence it is suggested that both are manifestations of the same phenomenon. Particular emphasis is given to intra-limb APAs preceding index-finger flexion, because their relatively simple biomechanics and the fact that muscular actions were limited to a single arm allowed peculiar investigations, leading to important conclusions. Indeed, such paradigm provided evidence that by granting a proper fixation of those body segments proximal to the moving one APAs are involved in refining movement precision, and also that APAs and prime mover activation are driven by a shared motor command.
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Affiliation(s)
- Paolo Cavallari
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano Milan, Italy
| | - Francesco Bolzoni
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano Milan, Italy
| | - Carlo Bruttini
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano Milan, Italy
| | - Roberto Esposti
- Human Motor Control and Posture Lab, Section Human Physiology of the Department of Pathophysiology and Transplantation, Università degli Studi di Milano Milan, Italy
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Bruttini C, Esposti R, Bolzoni F, Cavallari P. Higher Precision in Pointing Movements of the Preferred vs. Non-Preferred Hand Is Associated with an Earlier Occurrence of Anticipatory Postural Adjustments. Front Hum Neurosci 2016; 10:365. [PMID: 27486394 PMCID: PMC4947585 DOI: 10.3389/fnhum.2016.00365] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022] Open
Abstract
It is a common experience to exhibit a greater dexterity when performing a pointing movement with the preferred limb (PREF) vs. the non-preferred (NON-PREF) one. Here we provide evidence that the higher precision in pointing movements of the PREF vs. NON-PREF hand is associated with an earlier occurrence of the anticipatory postural adjustments (APAs). In this aim, we compared the APAs which stabilize the left or the right arm when performing a pen-pointing movement (prime mover flexor carpi radialis (FCR)). Moreover, we analyzed the elbow and wrist kinematics as well as the precision of the pointing movement. The mean kinematics of wrist movement and its latency, with respect to prime mover recruitment, were similar in the two sides, while APAs in triceps brachii (TB), biceps brachii (BB) and anterior deltoid (AD) were more anticipated when movements were performed with the PREF than with the NON-PREF hand (60–70 vs. 20–30 ms). APAs amplitudes were comparable in the muscles of the two sides. Earlier APAs in the preferred limb were associated with a better fixation of the elbow, which showed a lower excursion, and with a less scattered pointing error (PREF: 10.1 ± 0.8 mm; NON-PREF: 16.3 ± 1.7). Present results suggest that, by securing the more proximal joints dynamics, an appropriate timing of the intra-limb APAs is necessary for refining the voluntary movement precision, which is known to be scarce on the NON-PREF side.
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Affiliation(s)
- Carlo Bruttini
- Human Motor Control and Posture Laboratory, Human Physiology Section of the DePT, Università degli Studi di Milano Milan, Italy
| | - Roberto Esposti
- Human Motor Control and Posture Laboratory, Human Physiology Section of the DePT, Università degli Studi di Milano Milan, Italy
| | - Francesco Bolzoni
- Human Motor Control and Posture Laboratory, Human Physiology Section of the DePT, Università degli Studi di Milano Milan, Italy
| | - Paolo Cavallari
- Human Motor Control and Posture Laboratory, Human Physiology Section of the DePT, Università degli Studi di Milano Milan, Italy
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Bolzoni F, Bruttini C, Esposti R, Castellani C, Cavallari P. Transcranial direct current stimulation of SMA modulates anticipatory postural adjustments without affecting the primary movement. Behav Brain Res 2015; 291:407-413. [PMID: 26055201 DOI: 10.1016/j.bbr.2015.05.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/20/2015] [Accepted: 05/25/2015] [Indexed: 12/14/2022]
Abstract
Recent works provide evidences that anticipatory postural adjustments (APAs) are programmed with the prime mover recruitment as a shared posturo-focal command. However the ability of the CNS to adjust APAs to changes in the postural context implies that the postural and voluntary components should take different pathways before reaching the representation of single muscles in the primary motor cortex. Here we test if such bifurcation takes place at the level of the supplementary motor area (SMA). TDCS was applied over the SMA in 14 subjects, who produced a brisk index-finger flexion. This activity is preceded by inhibitory APAs, carved in the tonic activity of Biceps Brachii and Anterior Deltoid, and by an excitatory APA in Triceps Brachii. Subjects performed a series of 30 flexions before, during and after 20 min of tDCS in CATHODAL, ANODAL or SHAM configuration. The inhibitory APA in Biceps and the excitatory APA in Triceps were both greater in ANODAL than in SHAM and CATHODAL configurations, while no difference was found among the latter two (ANODAL vs. SHAM: biceps +26.5%, triceps +66%; ANODAL vs. CATHODAL: biceps +20.5%, triceps: +63.4%; for both muscles, ANOVA p<0.02, Tukey p<0.05). Instead, the APA in anterior deltoid was unchanged in all configurations. No changes were observed in prime mover recruitment and index-finger kinematics. Results show that the SMA is involved in modulating APAs amplitude. Moreover, the differential effect of tDCS observed on postural and voluntary commands suggests that these two components of the motor program are already separated before entering SMA.
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Affiliation(s)
- Francesco Bolzoni
- Section of Human Physiology of the DePT, Università degli Studi di Milano, Via Mangiagalli 32, 20133 Milano, Italy.
| | - Carlo Bruttini
- Section of Human Physiology of the DePT, Università degli Studi di Milano, Via Mangiagalli 32, 20133 Milano, Italy.
| | - Roberto Esposti
- Section of Human Physiology of the DePT, Università degli Studi di Milano, Via Mangiagalli 32, 20133 Milano, Italy.
| | - Carlotta Castellani
- Section of Human Physiology of the DePT, Università degli Studi di Milano, Via Mangiagalli 32, 20133 Milano, Italy.
| | - Paolo Cavallari
- Section of Human Physiology of the DePT, Università degli Studi di Milano, Via Mangiagalli 32, 20133 Milano, Italy.
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Bruttini C, Esposti R, Bolzoni F, Vanotti A, Mariotti C, Cavallari P. Temporal disruption of upper-limb anticipatory postural adjustments in cerebellar ataxic patients. Exp Brain Res 2014; 233:197-203. [PMID: 25245658 DOI: 10.1007/s00221-014-4103-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/06/2014] [Indexed: 11/28/2022]
Abstract
Voluntary movements induce postural perturbations, which are counteracted by anticipatory postural adjustments (APAs) that preserve body equilibrium. Little is known about the neural structures generating APAs, but several studies suggested a role of sensory-motor areas, basal ganglia, supplementary motor area and thalamus. However, the role of the cerebellum still remains an open question. The aim of this present paper is to shed further light on the role of cerebellum in APAs organization. Thus, APAs that stabilize the arm when the index finger is briskly flexed were recorded in 13 ataxic subjects (seven sporadic cases, four dominant ataxia type III and two autosomal recessive), presenting a slowly progressive cerebellar syndrome with four-limb dysmetria, and compared with those obtained in 13 healthy subjects. The pattern of postural activity was similar in the two groups [excitation in triceps and inhibition in biceps and anterior deltoid (AD)], but apparent modifications in timing were observed in all ataxic subjects in which, on average, triceps brachii excitation lagged the onset of the prime mover flexor digitorum superficialis by about 27 ms and biceps and AD inhibition were almost synchronous to it. Instead, in normal subjects, triceps onset was synchronous to the prime mover and biceps and AD anticipated it by about 40 ms. The observed disruption of the intra-limb APA organization confirms that the cerebellum is involved in APA control and, considering cerebellar subjects as a model of dysmetria, also supports the view that a proper APA chain may play a crucial role in refining movement metria.
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Affiliation(s)
- Carlo Bruttini
- Sezione di Fisiologia Umana - DePT, Università degli Studi di Milano, Via Mangiagalli 32, 20133, Milan, Italy
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Bruttini C, Esposti R, Bolzoni F, Cavallari P. Ischemic block of the forearm abolishes finger movements but not their associated anticipatory postural adjustments. Exp Brain Res 2014; 232:1739-50. [PMID: 24531642 DOI: 10.1007/s00221-014-3866-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
Abstract
Voluntary movement is known to induce postural perturbations that are counteracted by unconscious anticipatory postural adjustments (APAs). Thus, for every movement, two motor commands are dispatched: a voluntary command recruiting the prime mover and a postural command driving the APAs. These commands are classically thought to be separated; this study investigates whether they could be instead considered as two elements within the same motor program. We analyzed the APAs in biceps brachii, triceps brachii and anterior deltoid that stabilize the arm when briskly flexing the index finger (prime mover flexor digitorum superficialis). APAs and prime mover activation were recorded before, under and after ischemic block of the forearm. Ischemia paralyzed the prime mover, thus suppressing the finger movement and the ensuing postural perturbation. If the two commands had been separated, it would have been expected that after a few failed attempts to flex the index finger, the APAs were suppressed too, being purposeless without postural perturbation. APAs were still present under ischemia even after 60 movement trials. No significant changes were found in APA amplitude in biceps and triceps among different conditions, or in the average APA latency. Inhibitory APA in anterior deltoid was reduced but still present under ischemia. In addition, the pharmacologic block of the sole median nerve produced similar effects. APAs were instead almost abolished when applying a fixation point to the wrist. The observation that APAs remained tailored to the expected perturbation even when that perturbation did not occur supports the idea of a functionally unique motor command driving both the prime mover and the muscles of the APA chain.
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Affiliation(s)
- Carlo Bruttini
- Sezione di Fisiologia Umana-DePT, Università degli Studi di Milano, Via Mangiagalli 32, 20133, Milan, Italy
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Caronni A, Bolzoni F, Esposti R, Bruttini C, Cavallari P. Accuracy of pointing movements relies upon a specific tuning between anticipatory postural adjustments and prime mover activation. Acta Physiol (Oxf) 2013; 208:111-24. [PMID: 23398738 DOI: 10.1111/apha.12081] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 01/31/2013] [Accepted: 02/07/2013] [Indexed: 11/26/2022]
Abstract
AIM Equilibrium-perturbing forces associated with a voluntary upper-limb movement can be strong enough to displace the whole-body centre of mass. In this condition, anticipatory postural adjustments (APAs), developing in muscles other than the prime mover, are essential in maintaining the whole-body balance. Here, we test the hypothesis that APAs preceding an upper-limb target-reaching movement could play a role also in controlling the movement accuracy. METHODS Standing subjects (10) were asked to flex the right shoulder and touch with the index fingertip the centre of a target positioned in front of them. The reaching task was also performed while wearing and after doffing prismatic lenses (shifting the eye field rightward). EMGs from different upper- and lower-limb muscles and the mechanical actions to the ground were recorded. RESULTS (i) Before wearing prisms, subjects were very accurate in hitting the target, and the pointing movements were accompanied by APAs in quadriceps (Q) and tibialis anterior (TA) of both sides, and in right hamstrings (H) and soleus (SOL). (ii) After donning prisms, rightward pointing errors occurred, associated with a significant APA increase in right Q and TA, but without changes in the recruitment of right anterior deltoid (prime mover) and biceps brachii. (iii) These pointing errors were progressively compensated in about 10 trials, indicating a sensorimotor adaptation, and APAs returned to values recorded before wearing prisms. (iv) After doffing prisms, pointing errors occurred in the opposite direction but changes in APAs did not reach significance. CONCLUSION We propose that, besides preserving the whole-body balance, APAs are also tailored to obtain an accurate voluntary movement.
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Affiliation(s)
- A. Caronni
- Human Physiology Section of the DePT; Università degli Studi di Milano; Milan; Italy
| | - F. Bolzoni
- Human Physiology Section of the DePT; Università degli Studi di Milano; Milan; Italy
| | - R. Esposti
- Human Physiology Section of the DePT; Università degli Studi di Milano; Milan; Italy
| | - C. Bruttini
- Human Physiology Section of the DePT; Università degli Studi di Milano; Milan; Italy
| | - P. Cavallari
- Human Physiology Section of the DePT; Università degli Studi di Milano; Milan; Italy
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Bolzoni F, Bruttini C, Esposti R, Cavallari P. Hand immobilization affects arm and shoulder postural control. Exp Brain Res 2012; 220:63-70. [PMID: 22618470 DOI: 10.1007/s00221-012-3115-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 04/27/2012] [Indexed: 11/24/2022]
Abstract
It is a common experience, immediately after the removal of a cast or a splint, to feel motor awkwardness, which is usually attributed to muscular and joint immobilization. However, the same feeling may also be perceived after a brief period of immobilization. We provide evidence that this last effect stems from changes in the cortical organization of the focal movement as well as in the associated anticipatory postural adjustments. Indeed, these two aspects of the motor act are strongly correlated, although scaled in different manners. In fact, they are both shaped in the primary motor cortex, they both undergo similar amplitude and latency modulation and, as we will show, they are both impaired by the immobilization of the lone prime mover. Neuromuscular effects of limb immobilization are well known; however, most papers focus on changes occurring in the pathways projecting to the prime mover, which acts on the immobilized joint. Conversely, this study investigates the effect of immobilization on anticipatory postural adjustments. Indeed, we show that 12 h of wrist and fingers immobilization effectively modify anticipatory postural adjustments of the elbow and the shoulder, that is, those joints not immobilized within the fixation chain. Accordingly, the motor impairment observed after short-term immobilization most likely stems from the unbalance between anticipatory postural adjustments and the focal movement.
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Affiliation(s)
- Francesco Bolzoni
- Dipartimento di Fisiologia Umana, Università degli Studi di Milano, Via Mangiagalli 32, 20133 Milan, Italy
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