Partner bereavement when parenting dependent children: What factors influence adjustment?

Little is known about those who are widowed while raising dependent children. This study aimed to explore the factors which influence adjustment to partner death. Seven fathers and five mothers were interviewed, and constructivist grounded theory was used. Three interrelated themes were identified: Interpersonal influences, Intrapersonal influences, and Contextual influences. Dependent children meant sole responsibility and increased demands, yet ultimately provided widowed parents a purpose. Participants highlighted the need for increased awareness of young widowhood at a systemic and cultural level, to improve communication around death and young widowhood. Implications included social, financial and therapeutic interventions.

New imaging tools to measure nephron number in vivo: opportunities for developmental nephrology

The mammalian kidney is a complex organ, requiring the concerted function of up to millions of nephrons. The number of nephrons is constant after nephrogenesis during development, and nephron loss over a life span can lead to susceptibility to acute or chronic kidney disease. New technologies are under development to count individual nephrons in the kidney in vivo. This review outlines these technologies and highlights their relevance to studies of human renal development and disease.

Genotyping of the Galactosemia GALT 591 A>G Mutation by Pyrosequencing

Introduction/Objective

This project aimed to design a pyrosequencing assay capable of genetically analyzing the presence of GALT 591 A>G mutation for the diagnosis of galactosemia. Galactosemia is an autosomal recessive disorder that affects enzyme activity of galactose-1-phosphate uridylytransferase (GALT). This enzyme is responsible for proper processing of galactose to glucose; if not broken down the accumulation of galactose in the body results in developmental delays, clouding of the eyes, speech difficulties, and intellectual disabilities. Pyrosequencing offers a valuable platform in assessing whether patients are wild type unaffected (A:A), heterozygous carrier (A:G), or homozygous affected (G:G) at the alleles within the GALT 591 locus by measuring percentage of the wild type A allele and the mutant G allele.

Methods

PCR primers were designed for the mutation locus, and PCR amplification was optimized for the target 77 bp product, with verification by gel electrophoresis. The pyrosequencing assay was designed and validated on the Qiagen PyroMark Q24 instrument. Control samples included commercially purchased DNA from the Coriell Cell Repository.

Results

One hundred and thirty-three reactions were utilized to establish the following assay validation parameters: accuracy (100% for G:G, 95% for A:G and A:A), precision (determined by mean and standard deviation with a standard deviation of 0.6 for G:G, 4.55 for A:G and 4.85 for A:A), and limit of detection (10 ng DNA pre-PCR and 2 µL of PCR product loaded). Twenty-six blinded samples were utilized to test assay clinical performance, as compared against a high resolution melt curve assay.

Conclusion

It was determined that detection of GALT 591 A>G via pyrosequencing is highly sensitive and specific with a clinical sensitivity of 100% and a clinical specificity of 95.83%. It was concluded that this assay could be applied in a clinical environment for GALT 591 A>G genotyping to aid in galactosemia diagnosis.

Safety and acceptability of an organic light-emitting diode sleep mask as a potential therapy for retinal disease

PurposeThe purpose of the study was to study the effect of an organic light-emitting diode sleep mask on daytime alertness, wellbeing, and retinal structure/function in healthy volunteers and in diabetic macular oedema (DMO).Patients and methodsHealthy volunteers in two groups, 18-30 yrs (A), 50-70 yrs (B) and people with DMO (C) wore masks (504 nm wavelength; 80 cd/m² luminance; ≤8 h) nightly for 3 months followed by a 1-month recovery period. Changes from baseline were measured for (means): psychomotor vigilance task (PVT) (number of lapses (NL), response time (RT)), sleep, depression, psychological wellbeing (PW), visual acuity, contrast sensitivity, colour, electrophysiology, microperimetry, and retinal thickness on OCT.ResultsOf 60 participants, 16 (27%) withdrew, 8 (13%) before month 1, due to sleep disturbances and mask intolerance. About 36/55 (65%) who continued beyond month 1 reported ≥1 adverse event. At month 3 mean PVT worsened in Group A (RT (7.65%, P<0.001), NL (43.3%, P=0.005)) and mean PW worsened in all groups (A 28.0%, P=0.01, B 21.2%, P=0.03, C 12.8%, P<0.05). No other clinically significant safety signal was detected. Cysts reduced/resolved in the OCT subfield of maximal pathology in 67% Group C eyes. Thinning was greater at 3 and 4 months for greater baseline thickness (central subfield P<0.001, maximal P<0.05).ConclusionSleep masks showed no major safety signal apart from a small impairment of daytime alertness and a moderate effect on wellbeing. Masks were acceptable apart from in some healthy participants. Preliminary data suggest a beneficial effect on retinal thickness in DMO. This novel therapeutic approach is ready for large clinical trials.

The emerging role of MRI in quantitative renal glomerular morphology

Techniques to measure morphological parameters, such as glomerular (and thereby nephron) number, glomerular size, and kidney volume, have been vital to understanding factors contributing to chronic kidney disease (CKD). These techniques have also been important to understanding the associations between CKD and other systemic and cardiovascular diseases and have led to the identification of developmental risk factors for these pathologies. However, existing techniques in quantitative kidney morphology are resource- and time-consuming and are destructive to the organ. This review discusses the emerging generation of techniques to study kidney morphology quantitatively using magnetic resonance imaging (MRI) using the intravenous injection of the superparamagnetic nanoparticle cationic ferritin, which binds to the glomerular basement membrane. A primary advantage of MRI over previously established techniques is the ability to quantify morphology in the intact organ with minimal sample preparation. We highlight areas of research where MRI-based morphological measurements will be helpful in animal models and possibly diagnostic clinical nephrology, discuss technical challenges in light of the progress in MRI techniques to date, and identify novel measurements that may be possible using MRI, both ex vivo and in vivo.

Coping, depressive feelings and gender differences in late life widowhood

The study investigated the relationship between depressive feelings and coping amongst older widowed men and women. Participants were interviewed about their affective experiences of widowhood and completed two depression questionnaire assessments, the Symptoms of Anxiety and Depression Scale (SAD) and the Hospital Anxiety and Depression Scale (HADS). Participants were assessed as either coping or not coping. The results showed that both measures were effective at differentiating those who coped (Copers) from those who did not (Non-Copers) in the sample as a whole. Amongst the widows the HADS significantly differentiated the two groups. Amongst men, neither measure significantly distinguished Copers from Non-Copers. However, an examination of the interviews suggested that widowers reported depressive feelings significantly more often than widows. The results suggest that depressive feelings are associated with non-coping in older widowed people. There is also evidence to suggest that widows and widowers respond differentially to assessment measures.

A four-year experience with patient individualized heparin and protamine dosing using the Hemochron RxDx system

Cardiac surgical case histories, collected over 4 years at Huntsville Hospital in Alabama, were reviewed for 2,293 patients. Patients were separated into two dosing groups for both heparin and protamine, hospital empirically dosed and Hemochron RxDx dosed. Review of the heparin dosing information found that incomplete data were collected for 47 patients, leaving 2,246 patients eligible to be evaluated for heparin dose comparison. Both RxDx recommended and empirically calculated doses were recorded, as well as the actual dose given. Of the 2,246 patients, 1671 were administered heparin according to the RxDx calculated dose, and the remaining 575 patients were dosed according to the hospital's empirical protocol. The average RxDx calculated heparin dose was 17% greater then the empirically calculated heparin dose (350 U/kg) (p < .001). Anticoagulation to target ACT (480 sec) was achieved in 92% of the patients dosed according to the RxDx recommended dose; whereas, in the empirically dosed patient group only 80% of the patients reached the target ACT after initial heparin bolus dose. Incomplete protamine dosing data was recorded for 336 patients, leaving a total of 1,957 patients available for protamine dose evaluation. All patients had an RxDx protamine calculation, empirical protamine calculation, and actual amount of protamine dosed recorded. Of the 1,953 patients, 1,764 were dosed according to the RxDx recommended dose, with the remaining 189 patients dosed empirically (1 mg protamine/100 U of heparin). In both the RxDx and the empirical groups, 96% of the patients returned to baseline following initial protamine infusion. The overall RxDx dose (293 mg) was 16% lower than the average empirical dose (348 mg). The RxDx system has been shown to be an effective method for determining patient-specific dosing for both heparin and protamine. This long-term clinical experience demonstrates the consistency and reliability of patient maintenance using this individualized dosing system, which has been shown, in other independent evaluations, to lead to improved patient outcomes.

Interference from distractors in reach-to-grasp movements

Descriptions of interference effects from non-relevant stimuli are extensive in visual target detection and identification paradigms. To explore the influence of features of non-relevant objects on reach-to-grasp movements, we instructed healthy normal controls to reach for and pick up a cylinder (target) placed midsagittally 30 cm from the starting position of the hand. In Experiment 1, the target was presented alone, or accompanied by a narrower, wider, or same-size distractor positioned to the left or right of the target. In Experiment 2, the target was presented alone or accompanied by a distractor, which was slanted at a different orientation to the target. Reflective markers were placed on the wrist, thumb, and index finger of the right hand, and infra-red light-detecting cameras recorded their displacement through a calibrated 3-dimensional working space. Kinematic parameters were derived and analysed. Consistent changes in the expression of peak velocity, acceleration, and deceleration were evident when the distractor was narrower or wider than the target. The impact of the orientation of the distractor, conversely, was not marked. We discuss the results in the context of physiological findings and models of selective attention.

The reach-to-grasp movement in Parkinson's disease before and after dopaminergic medication

The aim of the present study was to assess the effects of dopaminergic medication on the organisation of the reach-to-grasp movement in Parkinson's disease. A three-dimensional kinematic system (ELITE, B/T/S Italy) was used to record reach-to-grasp movements to objects of either small (0.7 cm) or large (8 cm) diameter placed at a reaching distance of either 20 or 30 cm. Vision of the reaching limb and target was also manipulated. Parkinson's disease participants (N = 14) were assessed in 'OFF' (12 h without medication) and 'ON' (1-2 h post-administration of medication) states. In the 'ON' state, movement duration and the time spent in arm deceleration were significantly less than in the 'OFF' state. The amplitudes of peak reaching velocity, acceleration and deceleration were all higher in the 'ON' than in the 'OFF' state. Further, in the 'ON' state, the acceleration profile no longer exhibited small irregular adjustments, the number of significant correlations between parameters measured from the transport and manipulation components was greater, and the movement was more direct in both the mediolateral horizontal and vertical planes. These results indicate that dopaminergic medication is of benefit in reducing bradykinesia and in fine-tuning kinematic parameterisation of a selected reach-to-grasp action.

Sudden and gradual presentation of distractor objects: differential interference effects

In solving the selection-for-action problem, it is believed that attentional mechanisms enable dominance of target over non-target objects. However, under some conditions, information from non-target objects "interferes" with the action to a relevant target. We investigated the possibility that this interference may result when the irrelevant object activates a specific subset of visuomotor pathways. Participants reached to grasp three-dimensional stimuli while actively attending to a nearby flanker object. The means by which the flanker was presented was manipulated. This relevant object was illuminated either abruptly or gradually. The parvocellular pathway in early visual processing is equally activated in both conditions. The magnocellular pathway is strongly activated by abrupt presentation and weakly activated with gradual presentation of the flanker object. Kinematics of the reach-to-grasp action to the target showed signs of interference only in the sudden illumination condition. This suggests a dissociation between dorsal and ventral cortical streams in terms of relevance for action. Our data suggests that this effect is not due to early visual-pathway differences, but instead reveals a property of a transient object-based visual attention mechanism.

Covert orienting and focusing of attention in children with attention deficit hyperactivity disorder

Performance on the covert visuo-spatial attentional functions of orienting and focusing by a group of ADHD children (n = 20) was compared to that of age and sex-matched control children. In Experiment 1, responses were given to cued targets at valid and invalid locations. In Experiment 2, responses were given to targets presented in small, medium-sized or large visual field locations. For both experiments, the hypotheses that reaction times of ADHD children would be greater than those of control children and that performance would be asymmetrical, were supported. For Experiment 1, ADHD children showed bilaterally greater 'benefits' from having directed attention to the cued location and greater 'costs' in having to relocate the attentional focus than controls. In Experiment 2, the hypothesis that the function of focusing attention by ADHD children may show breakdown in the usual pattern of an increase in reaction time with focus area was partly supported by the finding of similar reaction times to targets presented in medium-sized and large regions of the left visual hemifield. These results have been interpreted as reflecting a stronger anchorage of attention by ADHD children upon a cued location and an inability to shift covert attention easily to an alternative location. The breakdown of the focusing function suggests adoption of similar time response sets across focus area size by the more compromised right hemisphere.

Gender and longitudinal changes in physical activities in later life

OBJECTIVES

to describe gender differences in levels of, and longitudinal changes in, habitual physical activity among older people.

DESIGN

longitudinal study.

PARTICIPANTS

sub-groups of survivors (with sample sizes dependent on the availability of complete datasets, ranging from 303-344) assessed on three occasions: 1985, 1989 and 1993 in Nottingham, UK. All were 65 years and over in 1985.

METHODS

descriptive presentation (median and range values) of quantitative longitudinal data by gender across five activity categories assessed in a recall-based questionnaire.

MAIN OUTCOME MEASURES

participation in walking, shopping, indoor, outdoor and leisure activities.

RESULTS

while levels of indoor and outdoor activities were marked by decline for both sexes, gender differentials were maintained over the 8 years of the study, with women showing higher levels of activity participation indoors and men showing higher levels of activity participation outdoors. In levels of walking/shopping activity, however, there was evidence of gender differentials reducing over time.

CONCLUSIONS

within these cohorts of older people traditional gender roles continue to exert a strong influence on levels and types of habitual physical activity well into later life. In some areas of activity, however, temporal changes provide some evidence of gender convergence consistent with late-life transitions in marital status and dependency.

The effect of unilateral posteroventral pallidotomy on the kinematics of the reach to grasp movement

OBJECTIVE

To assess postoperative effects of unilateral posteroventral pallidotomy on the organisation of upper limb movement.

METHODS

A three dimensional kinematic system (ELITE, B/T/S/ Italy) was used to record reach to grasp movements to objects of either small (0.7 cm) or large (8 cm) diameter placed at a reaching distance of either 20 or 30 cm. Four patients with Parkinson's disease were assessed in "off" (12 hours without medication) and "on" (1 hour after administration of medication) preoperatively and postoperatively.

RESULTS

Duration of the movement and the time spent in arm deceleration were significantly reduced after surgery. However, movement patterning according to object size was adversely affected. Postoperatively, all four patients showed an abnormal pattern of a longer movement duration, and three showed a longer time of reaching arm deceleration, for reach to grasp movements to the large object than for those to the small object.

CONCLUSION

Posteroventral pallidotomy seems to be beneficial in reducing bradykinesia of upper limb movements but may have "costs" to movement patterning, particularly for reach to grasp movements to objects of differing sizes. This study raises interesting questions about the role of the globus pallidus interna in coordinating stimulus bound visual information with appropriate motor patterning.

Customary physical activity and gender as precursors for late life personal disturbance

OBJECTIVES

To examine whether customary physical activity (CPA) and gender are precursors for personal disturbance in later life.

DESIGN

The study was part of a longitudinal study, with data collected in 1985 and 1989. Measures of CPA were obtained in men and women who by 1989 had developed elevated levels of personal disturbance. A case-control design was used: the cases were matched with controls on their 1985 levels of personal disturbances, gender and age.

METHODS

Levels of personal disturbance were measured using the Symptoms of Anxiety and Depression (SAD) Scale. CPAs were assessed using five continuous and two discrete measures of physical activity, including indoor productive activity, outdoor productive activity and flexibility. The cases were 26 women and 11 men and the controls were 26 women and 11 men.

RESULTS

Both CPA and gender were found to be precursors for later elevated personal disturbance. Specifically, indoor and outdoor productive activity and activities requiring flexibility were precursors for elevated personal disturbance. The effects of gender were even more specific: a main effect for gender was found for indoor productive activity (women doing more than men); and an interaction effect was observed between personal disturbance and gender for outdoor productive activity (the difference between depressed and non-depressed men is greater than between depressed and non-depressed women).

CONCLUSIONS

The study found that both CPA and gender were precursors for elevated levels of personal disturbance. However, the effects of both CPA and gender were quite specific.

Upper limb movement differentiation according to taxonomic semantic category

The size or shape of an object, its perceptual features, determine the patterning of an arm and hand action involving that object. Little is known about the role played by the taxonomic semantic attributes of an object for perceptuomotor processing. In this study we investigated whether the semantic relationship between two target stimuli influences the kinematics of a bilateral reach-to-grasp action. The results showed that reach-to-grasp movements preceding the action of putting living-thing pairs together were faster, and showed earlier settings of reach and grasp temporal parameters, than movements involving pairs of non-living things. It is hypothesized that this reflects the recruitment of different categorical perceptuomotor pathways.

The bilateral reach-to-grasp movement of Parkinson's disease subjects

The performance of simultaneous movements is said to be disrupted in Parkinson's disease, yet there are some indications that this dysfunction is less evident for bilateral inter-limb actions, as opposed to unilateral simultaneous actions. Focussing specifically upon natural actions, this study uses a three-dimensional kinematics system (ELITE) to assess the movement kinematics of a bilateral non-homologous reach-to-grasp action. The target device consisted of a large cylinder (diameter 8 cm) to which a handle (diameter 0.8 cm) was attached. The task was to reach and grasp the cylinder with one hand (gross grasp) while reaching to grasp the handle with the contralateral hand (precision grasp). Overall the results indicated that Parkinson's disease subjects, like controls, showed independent and appropriate kinematic parameterization of each limb. For example, and as a reflection of task precision requirements, the time taken to decelerate upon the item to be grasped was longer for the limb grasping the handle than for the limb grasping the cylinder. Subtle indications of compensatory mechanisms, in response to left upper limb inadequacies of Parkinson's disease subjects, were suggested by findings of an earlier timing of maximum hand grip aperture for the left than for the right hand, and adjustments to the final transport phase of the left arm under bilateral conditions. It is proposed that left-right hand differences are more evident with basal ganglia dysfunction, but that these differences are compensated for by CNS mechanisms so that natural non-homologous reach-to-grasp actions are performed in a functional, coordinated and appropriate manner.

A longitudinal study of wellbeing in widowed women

Changes in mental and physical health, morale and social functioning were assessed in a random sample of elderly women widowed during the course of an 8-year study, compared with never-married and still-married controls. The sample as a whole showed age-related declines in mental and physical health. As a function of ageing there were increases in personal disturbance and in physical health problems and declines in both morale and social engagement. However, over and above these age-related changes the windows showed significant changes in mental health. There were decreases in morale after widowhood, followed by slight increases in morale in the longer term. Similarly, there were increases in personal disturbance following widowhood, with slight decreases later. The results confirm that, even after several years, widowhood has differential effects on wellbeing and morale.

Three-dimensional covert attentional functions in Parkinson's disease subjects

This study assessed the ability of mildly affected Parkinson's disease (PD) subjects (n = 16) to perform attentional cognitive tasks within a three-dimensional object. A hollow cube was displayed on a computer screen and the subject was required to respond as quickly as possible to the highlighting of one of the cube angles by pressing the spacebar of the keyboard. Prior to the appearance of this imperative stimulus, the same ("valid" trials) or an alternative ("invalid" trials) angle was highlighted. For the invalid trials this meant that the subject oriented attention to the cued angle but, on imperative stimulus appearance, was unexpectedly required to redirect attention to another angle, which could be on a different cube face to that which had been cued. For one experimental session the cube was stationary, that is, object-centred and viewer-centred coordinates of a cube angle corresponded. For another session, the cube rotated such that the viewer-centred coordinates of an angle changed between appearance of the cue and appearance of the stimulus, but the angle's object-centred coordinates remained constant. The finding of lower reaction times for the valid than for the invalid trials, even when the cube was rotating, indicated that PD subjects could operate attention using an object-centred coordinate system. However, PD subjects showed exaggerated reaction times when the stimulus appeared in a cube face that was opposite to, rather than the same as, that of the invalidly cued angle. It is suggested that this reflects a dysfunction in the grouping of the structural components of the whole object at an attentional level.

Corticomotoneuronal contribution to the fractionation of muscle activity during precision grip in the monkey

1. During independent finger movements, the intrinsic muscles of the hand show a fractionated pattern of activity in which the timing and amplitude of electromyographic (EMG) activity varies considerably from one muscle to another. It has been suggested that, in the macaque monkey, corticomotoneuronal (CM) cells that produce postspike facilitation (PSF) of EMG in these muscles contribute to this fractionation. To test this hypothesis, we have investigated the relationship between the pattern of PSF exerted by a CM cell and the pattern of activity shown by the cell and by its target muscles. 2. The activity of 15 identified CM cells was recorded from two monkeys that performed a precision grip task. Spike-triggered averaging of rectified EMG during the hold period of this task showed that each cell produced PSF in at least two intrinsic hand muscles. 3. Segments of data were selected from the initial movement period of the task in which the EMG activity in one target muscle was substantially greater than that of the other, and the mean firing rate of each CM cell was determined for these periods. 4. CM cells showed bursts of activity in the movement period. Most of them (13/15) had a significantly (P < 0.001) higher firing rate when one of its target muscles was more active than the other. For nine of these cells (identified as set A), this muscle was the one receiving the larger PSF. In four cases (set B), the reverse was true. Two cells (set C), which produced PSF of equal size in their target muscles, showed no change in firing rate across the periods of fractionated EMG activity. 5. All set A and set B cells fired at significantly (P < 0.001) higher rates during the movement period, in association with fractionation of EMG activity, than in the hold period, in which a cocontracted pattern of muscle activity was observed. 6. There were pronounced differences in the strength of PSF exerted by the CM cells on their target muscles during the fractionation periods. One CM cell exerted PSF of a muscle during one period of fractionation, but postspike suppression of the same muscle during the other period. 7. It is suggested that changes in the firing rate of a CM cell and in the degree of facilitation it exerts could both contribute to the fractionation of activity in its target muscles. Cells of set A appear to be specifically recruited in a manner that directly reflects the pattern of facilitation they exert on the sampled target muscles. These results may explain why the CM system is so important for the performance of relatively independent finger movements.

How perceived object dimension influences prehension

A kinematic study assessed the effects of the perceived dimensions of an object upon the patterning of a prehension movement involving that object. If an apple was perceived as two-dimensional, subjects utilized a large precision grip between the index finger and thumb. If the apple was perceived as three-dimensional, whole hand prehension involving all the digits was utilized. A visual perturbation from perceived two-dimensional to three-dimensional at movement onset resulted in a transition from the 2D precision grip pattern to the 3D whole hand prehension. These results suggest that visual mechanisms for interpreting the dimension of an object directly influence motor selection pathways, and do not necessarily access a three-dimensional central nervous system representation of the object.

Habitus and hip fracture revisited: skeletal size, strength and cognition rather than thinness?

In a prospective study, 50 consecutive women with fractured hips were compared for body mass, skeletal size, handgrip strength and the 12-point information/orientation CAPE score with 50 age-matched women who had never broke their hips. Women were excluded from both groups if they lived in institutions or were severely disoriented. Although weight and skeletal size were significantly lower in the patients than in the controls, weights when corrected for skeletal size were not significantly different. Handgrip was significantly lower in the cases than in the controls. Both handgrip strength and CAPE score were significant correlates of hip fracture in multiple regression analysis. After exclusion of heavily dependent patients, hip fracture may be associated with reduced muscle strength rather than reduced body mass or fat.

The drinking action of Parkinson's disease subjects

Using the ELITE system, a kinematic analysis was performed of the upper limb drinking action of nine Parkinson's disease patients and nine control subjects. The aim was to use a natural task to investigate the reported Parkinson's disease dysfunction in the performance of simultaneous and sequential movements. Subjects were required to reach 28 cm, grasp a half-filled glass and then take a sip of water. Dysfunction for simultaneous movements was supported by the finding that, in both absolute and relative terms, Parkinson's disease subjects often began to open the hand later than control subjects. Dysfunction for sequential movements was supported by the finding that Parkinson's disease subjects often showed a pause between the first ('reach-grasp') and second ('take-to-lips') parts of the drinking action. Despite these delays and pauses, the proportional organization of the action was similar for both groups. This suggested that Parkinson's disease subjects were able to compensate for the problem in activating the different components of the drinking action. The results are discussed in relation to the influence of the abnormal basal ganglia input to cortical motor regions.

Reorganization of prehension components following perturbation of object size

This study provides a kinematic comparison of the response of 12 older persons (ages 60-70) and 12 young persons (ages 20-26) to a perturbation of object size during a reach-to-grasp movement. For 80 out of 100 trials, each participant reached to grasp an illuminated cylinder of either small or large diameter (0.7 and 8.0 cm, respectively). For 20 out of 100 trials, a visual perturbation occurred at movement onset. This perturbation consisted of a switch of illumination from 1 to the other cylinder. For the switch from large to small cylinder, participants changed the distal grasp from whole-hand prehension to precision grip. For the opposite switch, participants changed from precision grip to whole-hand prehension. The older participants successfully adapted to these perturbations but showed a more conservative approach. Generally the approach time as the hand neared the object was prolonged, and the coordination between transport and manipulation components was maintained when comparing perturbed with nonperturbed trials. Young participants showed a more flexible pattern with a decrease or loss of temporal coupling between the components. It is hypothesized that the more rigid movement pattern of older participants to unanticipated motor requirements could be a contributory factor to the higher incidence of accidents for this group.

Reorganization of prehension components following perturbation of object size

This study provides a kinematic comparison of the response of 12 older persons (ages 60-70) and 12 young persons (ages 20-26) to a perturbation of object size during a reach-to-grasp movement. For 80 out of 100 trials, each participant reached to grasp an illuminated cylinder of either small or large diameter (0.7 and 8.0 cm, respectively). For 20 out of 100 trials, a visual perturbation occurred at movement onset. This perturbation consisted of a switch of illumination from 1 to the other cylinder. For the switch from large to small cylinder, participants changed the distal grasp from whole-hand prehension to precision grip. For the opposite switch, participants changed from precision grip to whole-hand prehension. The older participants successfully adapted to these perturbations but showed a more conservative approach. Generally the approach time as the hand neared the object was prolonged, and the coordination between transport and manipulation components was maintained when comparing perturbed with nonperturbed trials. Young participants showed a more flexible pattern with a decrease or loss of temporal coupling between the components. It is hypothesized that the more rigid movement pattern of older participants to unanticipated motor requirements could be a contributory factor to the higher incidence of accidents for this group.

Covert visuospatial attentional mechanisms in Parkinson's disease

Orienting and focusing of attention were assessed in 32 Parkinson's disease and 32 control subjects. No differences were found in the covert orienting of attention, suggesting that the Parkinson's disease subjects of the current study were not impaired in the ability to orient attention towards an expected source of stimulation. However, with the process of modulating the attentional focus or of managing more than one attentional task, dysfunction in Parkinson's disease subjects became apparent. The observed results are explained in terms of deficits in the relationship between task-related distribution of attentional resources and time efficiency of processing.

Parkinson's disease: reorganization of the reach to grasp movement in response to perturbation of the distal motor patterning

This study assessed the kinematic changes to the reach to grasp movement in response to a perturbation of object size in 15 Parkinson's disease (PD) and 15 control subjects. For non-perturbed trials subjects reached 35 cm to grasp and lift either an illuminated small (0.7 cm) or large (8 cm) diameter cylinder. For perturbed trials (20%), illumination shifted unexpectedly from the small to the large or from the large to the small cylinder at the onset of the reach. For Condition One trials subjects were given no instructions as to which grasp to use. With perturbation, they thus naturally changed grasp from precision grip to whole hand prehension or vice versa. The results for the PD subjects indicated a slowness at the transition from one to another grasp. This contrasted to the smooth transitions when perturbation required only a change of grasp aperture (precision grip--Condition Two; whole hand prehension--Condition Three). PD subjects thus showed dysfunction in the suppression/activation of different grasp programs rather than deficits in the on-line modification of an operating program.

The influence of single monkey cortico-motoneuronal cells at different levels of activity in target muscles

1. This study assessed the facilitation by cortico-motoneuronal (CM) cells of hand and forearm muscles at different levels of EMG activity. 2. Twenty-three CM cells were recorded in six hemispheres of four trained monkeys. CM cells were identified by the presence of post-spike facilitation (PSF) in spike-triggered averages (STAs) of their target muscles. Cell and muscle activity was recorded during performance of a low force (0.2-1.5 N) precision grip task between the index finger and thumb. The hold periods of this task lasted 1-1.5 s and provided segments of steady EMG activity. 3. The discharge activity of each CM cell, and the amplitude of the PSF produced in one or two target muscles, were compared across two to six different levels of EMG activity during the hold periods. 4. Of the forty-two CM cell-muscle combinations tested, twenty (48%) showed a significant increase in CM cell discharge rate with increased target muscle EMG activity (P < 0.001); three (7%) showed significant negative correlation; and no correlation was found for nineteen combinations (45%). 5. From a low to a high level of EMG activity (0.3-8.65% of the maximum EMG activity recorded), the absolute amount of facilitation produced by each CM cell increased by a factor of 1.2-32 (median value 3.7). This increase in facilitation occurred irrespective of the presence or absence of correlation between CM cell discharge rate and target muscle activity. 6. For thirty cell-muscle combinations in which a significant PSF could be measured at more than one level of EMG activity, the relative degree of facilitation remained constant in nine, increased in thirteen and decreased in seven combinations. In some cases saturation effects were evident. For ten combinations PSF was observed at high but not at low levels of EMG activity. 7. The changes in PSF amplitude with level of EMG activity were also present in STAs compiled from only those spikes with long interspike intervals (20-25 ms or greater). The results suggested that spikes with short interspike intervals did not make a significant contribution to the increase in PSF amplitude observed at the higher levels of EMG activity. 8. The changes in PSF amplitude with target muscle activity are probably explained best by changes at the spinal motoneuronal level, which set the response to the CM input. These changes may also reflect differences in the strength of synaptic connectivity made by a CM cell within the motoneurone pool of the target muscle.

Reach to grasp: changes with age

This study provides the first known kinematic assessment of the reach-to-grasp movement in elderly subjects. Twelve subjects (aged 60-71) were compared to gender-matched younger subjects (aged 18-25). Subjects reached 35 cm to grasp either a small (0.7 cm) or a large (8 cm) diameter cylinder. Precision grip was naturally adopted for the small cylinder, and whole hand prehension for the large cylinder. The displacements of active infrared markers (wrist and hand) were recorded with an Optotrak system. Movement initiation time, movement duration, and kinematic parameters of the reach-and-grasp components were computed. Older subjects showed slower, longer movements with a prolonged approach phase. However, the patterning and coordination of this movement, with respect to the utilization of a precision grip or whole hand prehension, were similar for both groups. Subtle changes with age thus appear to reflect a strategy that develops to compensate for deterioration in other systems such as visual or proprioceptive.

The reach to grasp movement of blind subjects

The importance of vision for the processing and coordination of the transport and manipulation components of a reach to grasp movement was assessed. Four blind volunteers (two men, two women; aged 25-40) were compared with matched control groups: (1) blindfolded and (2) full vision. Subjects reached 20 or 30 cm for a large or small diameter (6 cm or 0.7 cm, respectively) cylinder. For condition 1 trials they were given no instruction as to the type of grasp to adopt; for condition 2 they were instructed to consistently use a precision grip; while for condition 3 they were required to use whole had prehension. Blind subjects demonstrated a double grip pattern and either a low-velocity phase (20 cm) or a double transport movement (30 cm). However, their pattern of prehension with respect to intrinsic (size) and extrinsic (distance) cylinder properties was similar to that of the control groups. Grip aperture was appropriately scaled and, when greater precision was required, deceleration time was prolonged. Temporal coupling was evident between the two components. It was concluded that experience of vision is not necessary for the coordination or patterning of the basic reach to grasp movement. It does allow, however, for a movement consisting of only one opening and closing of the hand.

The bilateral reach to grasp movement

This study investigated the kinematic organization of bilateral reach to grasp movements. In Experiment 1 non-homologous bilateral movements were performed. One limb reached to grasp an object using whole hand prehension; the contralateral limb simultaneously reached to grasp an object using precision grip. Corresponding unilateral movements were assessed. Movement duration for each limb in the bilateral condition was similar. However, with earlier temporal settings for peak wrist acceleration and velocity, the limb performing precision grip showed a longer approach (deceleration) phase to the object. Unilateral precision grip movements showed a longer movement duration and deceleration phase than unilateral whole hand prehension movements. In Experiment 2 homologous bilateral movements were assessed. Both limbs performed either a reach and whole hand prehension or a reach and precision grip. Again the precision grip movements showed longer movement and deceleration times. Experiment 3 consisted of bilateral non-homologous pointing movements and a pointing movement with one limb while reaching to grasp with the contralateral limb. It was found that the earlier temporal settings of peak acceleration and velocity with the precision grip limb of the non-homologous bilateral task (Expt. 1) were largely due to the performance of distal grasping actions. It is concluded that a kinematic parameterization which is independent to each limb is evident for bilateral tasks which require functionally independent actions.

A kinematic study of the reach to grasp movement in a subject with hemiParkinson's disease

The kinematic organization of a reach to grasp movement in a left hemiParkinson subject is compared to that of a control subject. Subjects used the right and left limbs to reach 15, 27 or 40 cm for the grasp of cylinders of 0.7 or 8 cm diameter. In general, the kinematics of the affected limb of the hemiParkinson subject differed from that of the unaffected limb. However, for both arms the hemiParkinson subject showed a delay in the onset of the manipulation component. The subtle dysfunction in the activation of near-simultaneous or sequential movements is thus bilateral, despite unilateral clinical symptomatology.

Perturbation of the grasp component of a prehension movement in a subject with hemiParkinson's disease

The response to perturbation of the manipulation component during prehension was assessed for both hands of a hemiParkinson and of a Control subject. With perturbed trials, the hemiParkinson showed the same pattern as the Control: a reorganization of kinematic parameters and no increase of movement time. However, for both limbs of the hemiParkinson subject there was a transition phase from precision grip to whole hand prehension--this was more pronounced for the affected limb. The manipulation component did not show a delay of activation [2]. Thus the global dysfunction in the performance of sequential movement patterns was related to aspects of task predictability.

Reach to grasp: the natural response to perturbation of object size

This study assessed the reach to grasp movement and its adaptive response to a perturbation of object size. In blocked trials, subjects (n = 12) were instructed to reach 35 cm to grasp and lift a small- (0.7 cm) or large-diameter (8 cm) cylinder. Under an unconstrained condition (condition 1), no instructions as to the type of grasp to adopt were given. Subjects thus naturally used a precision grip (PG) for the small cylinder and whole hand prehension (WHP) for the large cylinder. Under condition 2, subjects were instructed to utilize a PG for grasps of both the large and small cylinders. For condition 3, the instruction was to use WHP irrespective of object size. Kinematic organization was determined with analysis of the recordings of active markers placed on the wrist, thumb, and three fingers. For condition 1 the results showed a temporal arrangement of both components (transport and manipulation) which differed from that of conditions 2 and 3. In perturbed trials, illumination shifted from the small to large cylinder or vice versa. With condition 1, subjects automatically switched from one grasp to another with no or little increase of movement duration. This was generally achieved by an earlier temporal setting of peak wrist deceleration. For conditions 2 and 3, where a change of aperture was required, movement duration was prolonged without adaptation of earlier transport component parameters. It is concluded that the adaptive responses to a change of distal patterning also affect the organization of the proximal component. Assessment of grasps constrained by instructions may lead to interpretations of central control of the reach to grasp movement which differ from those obtained by assessing more natural prehensile patterns.

Contribution of the monkey corticomotoneuronal system to the control of force in precision grip

1. The contribution of 33 corticomotoneuronal (CM) cells, recorded in the primary motor cortex, to the production of precision grip force has been investigated in four monkeys (Macaca nemestrina). These CM cells were shown, by spike-triggered averaging, to facilitate electromyographic (EMG) activity of hand and forearm muscles. 2. Single-cell recordings were obtained as the monkey performed a low force precision grip task under either isometric or auxotonic conditions. The monkey had to produce independent control of the forces exerted by the thumb and index finger and maintain them for 1-1.5 s. Steady force segments of data were selected trial-by-trial from these hold periods. For each segment the following mean values were determined: 1) CM cell firing rate, 2) EMG activity of facilitated muscles, and 3) index finger, thumb, and total force. 3. Of the 33 CM cells, 18 had a phasic-tonic pattern of discharge during the task, 7 were tonic, 5 had a ramplike increase, and 3 were deactivated during the hold period. 4. Of the 33 cells analyzed, 11 showed a significant positive (P < 0.05) correlation of their mean firing rate with static force; 4 of them had high correlation coefficients (P < 0.001). There was a considerable trial-by-trial variability in the cells' activity-force relationship. Six CM cells had significant negative correlations between their activity and isometric force (5 at the P < 0.001 level), showing lower firing rates with higher forces. 5. The force sensitivity of the CM cells, calculated from the rate-force slopes, was higher for either the thumb or the index finger force. Under isometric conditions the mean rate-force slopes, calculated from the best correlated digit force, was 32.4 Hz/N for eight positively correlated cells and -21.3 Hz/N for the cells with a negative correlation. 6. Correlation between CM cell spike activity and force was more common among neurons with slowly conducting axons (4/6 correlated) than for those with fast axons (13/27). 7. Significant correlations between target muscle EMG and force were always positive. The correlations between CM cell firing rate and target muscle EMG were comparable with those found between firing rate and force. Three of the CM cells with a negative correlation to force also had a negative correlation with EMG in one of their target muscles. 8. Each CM cell facilitated the EMG activity of one to five target muscles; postspike facilitation (PSF) was most common among intrinsic hand muscles (68/82 CM cell/muscle combinations).(ABSTRACT TRUNCATED AT 400 WORDS)

Does the type of prehension influence the kinematics of reaching?

Kinematic studies have indicated that when a subject reaches to grasp an object, the movement consists of two primary components: (a) a transport phase whereby the hand is brought towards the object and (b) a grip phase whereby the hand changes shape in anticipation of the grasp. Using a visual perturbation paradigm, we investigated the effect of different grip component strategies upon the transport phase. The distal strategy was determined by the size of the object to be grasped: for the small object (1.5 cm o.d.) subjects naturally adopted a precision grip between the index finger and thumb; for the large object (6 cm o.d.) subjects used a whole hand prehensile grip. During 20% of the reaching trials the perturbation was introduced by unexpectedly changing the object size. The results showed that corrections to the distal program in response to the perturbation were preceded by changes in the deceleration phase of the proximal component. The data supported previous findings of two visuo-motor channels for this prehensile movement but indicated that when unanticipated shifts of only the distal program are required, both channels show modifications.

Therapeutic exercise

Physical activity provides the biologic stimulus for a number of body adaptive mechanisms and therefore is a potent force in both prevention and treatment of sports injury. It has been shown, however, that therapeutic exercise must be prescribed with precision and care if it is to be of optimal value. There are no "general" effects of exercise. The effects of exercise on the cellular structure of muscle, connective tissue, and the nervous system are specific to the intensity, duration, and frequency of exercise and dependent on the length of time after injury.

Monoclonal antibody analysis of lipopolysaccharide from Neisseria gonorrhoeae and Neisseria meningitidis

A hybridoma produced by the polyethylene glycol fusion of the NS-1 variant of the P3x63Ag8 BALB/c plasmacytoma to splenocytes harvested from a BALB/c mouse immunized with whole gonococci was found to be producing antibody to a common region on gonococcal lipopolysaccharide (LPS). Enzyme-linked immunosorbent assay inhibition systems were established by utilizing this antibody, designated 3F11, and 100% inhibition occurred with both LPS and the LPS-LPS and LPS-derived polysaccharides partially inhibited the enzyme-linked immunosorbent assay, whereas similar preparations isolated from Escherichia coli O:111, the J-5 mutant of this strain, and Salmonella minnesota Re595 failed to inhibit the assay. Studies utilizing whole gonococcal strains 4505 and the isogenic variant 4505r, which lacks both the LPS serotype and common determinants as inhibitors, demonstrated that the determinant recognized by the 3F11 antibody was present on the surface of 4505 and absent on 4505r. Inhibition studies were performed with beta-glucose, beta-galactose, D-glucosamine, D-galactosamine, heptose, 2-keto-3-deoxyoctanoate, N-acetylglucosamine, N-acetylgalactosamine, alpha-lactose, and beta-lactose. Complete inhibition of the enzyme-linked immunosorbent assay occurred with D-galactosamine, and partial inhibition was achieved with both alpha-lactose and beta-lactose. Based on these observations, the 3F11 antibody recognizes a site common to gonococcal LPS which is partially shared by meningococcal LPS. The chemical structure of the determinant appears to be a D-galactosamine-O-D-galactopyranosyl-(1-4)-D-glucopyranose. Additional specificity may be conferred by the steric relationship of the determinant on the intact LPS.