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Marsico P, Meier L, van der Linden ML, Mercer TH, van Hedel HJA. Are tactile function and body awareness of the foot related to motor outcomes in children with upper motor neuron lesions? Front Rehabil Sci 2024; 5:1348327. [PMID: 38496778 PMCID: PMC10940356 DOI: 10.3389/fresc.2024.1348327] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024]
Abstract
Introduction Somatosensory function can be reduced in children with Upper Motor Neuron (UMN) lesions. Therefore, we investigated relationships between somatosensory functions of the foot and motor outcomes in children with UMN lesions. Method In this cross-sectional study, we assessed the Tactile Threshold (TT) with monofilaments and body awareness with Tactile Localisation Tasks for spatial-related action (TLTaction) and structural-related perception (TLTperception) body representation at the foot sole. Furthermore, we assessed four motor outcomes: the Selective Control Assessment of the Lower Extremity (SCALE), the modified Timed Up and Go test (mTUG), the Gillette Functional Assessment Questionnaire (FAQ), and the Functional Mobility Scale (FMS). Spearman's correlations (ρ) were applied to assess relationships between the somatosensory function of the foot sole and the applied motor outcomes. Results Thirty-five children with UMN lesions, on average 11.7 ± 3.4 years old, participated. TLTperception correlated significantly with all lower limb motor outcomes (|ρ|=0.36-0.57; p < 0.05), but TLTaction (|ρ|=0.00-0.27; p = 0.15-0.97, and TT did not (|ρ|=0.01-0.83; p = 0.73-0.94). TLTperception correlated strongly with the Gross Motor Function Classification System (|ρ|=0.62; p = 0.001) in children with cerebral palsy (n = 24). Discussion Assessing structural body representation of the foot sole should be considered when addressing lower limb motor impairments, including gait, in children with upper motor neuron lesions. Our results suggest that the assessment of tactile function and spatial body representation may be less related to lower limb motor function.
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Affiliation(s)
- Petra Marsico
- Research Department, Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center CRC, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland
| | - Lea Meier
- Research Department, Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center CRC, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Thomas H. Mercer
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland
| | - Hubertus J. A. van Hedel
- Research Department, Swiss Children’s Rehab, University Children’s Hospital Zurich, Affoltern am Albis, Switzerland
- Children’s Research Center CRC, University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, Scotland
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Özden F, Uysal İ, Tümtürk İ, Özyer F. Investigation of Reaction Time, Proprioception, and Shaped Pathway Walking Performance in Older Patients with Total Knee Arthroplasty. J Am Med Dir Assoc 2024; 25:112-117. [PMID: 37926428 DOI: 10.1016/j.jamda.2023.09.032] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The existing literature on total knee arthroplasty (TKA) does not provide clear data on step reaction time and proprioception and gait in shaped pathways. This study investigated the relationship between proprioception and reaction time with walking performance in shaped pathways in older patients undergoing TKA. DESIGN A cross-sectional observational study. SETTING AND PARTICIPANTS An orthopedic outpatient clinic with 103 older patients with TKA after a minimum of 6 months after surgery. METHODS Participants were evaluated with Figure-of-8 Walk Test (F8WT), L Test, Tinnetti Gait Test (TGT), proprioception measurement with an app-based inclinometer, and step reaction time (SRT) test. The same assessor carried out all evaluations. RESULTS F8WT showed a strong correlation with SRT-right, SRT-left, and Tinetti Gait Test (TGT), respectively (r1 = 0.628, r2 = 0.619, r3 = -0.615, P < .01). In addition, F8WT was moderately correlated with Right Leg Proprioception Test (RLPT) and Left Leg Proprioception Test (LLPT), respectively (r1 = 0.487, r2 = 0.439, P < .01). There was a moderate correlation between L Test with RLRT, LLRT, and TGT, respectively (r1 = 0.597, r2 = 0.584, r3 = -0.542, P < .01). Besides, there was a weak positive correlation between L Test with RLPT and LLPT, respectively (r1 = 0.394, r2 = 0.335, P < .01). A regression model showed that the L test was related to RLRT, LLRT, and TGT (R2 = 0.432, P < .001). The higher ability of the L test was weakly associated with higher levels of TGT (standardized β = -0.28, P = .0012). Besides, regression analysis also proved that F8WT was related to RLRT, LLRT, and TGT (R2 = 0.522, P < .001). The most highly associated parameter was LLRT (standardized β = 0.958, P = .003). CONCLUSIONS AND IMPLICATIONS Gait in shaped pathways is associated with proprioception, reaction time, and balance ability in older patients with TKA. Therefore, proprioception, reaction time, and balance should be considered to improve the shaped pathway walking performance of patients after bilateral, right, or left TKA surgery.
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Affiliation(s)
- Fatih Özden
- Department of Health Care Services, Köyceğiz Vocational School of Health Services, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - İsmail Uysal
- Department of Health Care Services, Fethiye Vocational School of Health Services, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - İsmet Tümtürk
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Süleyman Demirel University, Isparta, Turkey
| | - Fatih Özyer
- Department of Orthopaedics and Traumatology, Fethiye State Hospital, Muğla, Turkey
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Eitner L, Maier C, Brinkmann F, Schlegtendal A, Knoke L, Enax-Krumova E, Lücke T. Somatosensory abnormalities after infection with SARS-CoV-2 - A prospective case-control study in children and adolescents. Front Pediatr 2022; 10:977827. [PMID: 36263148 PMCID: PMC9574195 DOI: 10.3389/fped.2022.977827] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Long-term neurological complaints after SARS-CoV-2 infection occur in 4-66% of children and adolescents. Controlled studies on the integrity of the peripheral nerve system are scarce. Therefore, we examined the somatosensory function in children and adolescents after SARS-CoV-2 infection in a case-control study compared with age-matched individuals. MATERIALS AND METHODS Eighty-one subjects after SARS-CoV-2 infection (n = 44 female, 11.4 ± 3.5 years, n = 75 SARS-CoV-2 seropositive, n = 6 PCR positive during infection and SARS-CoV-2 seronegative at the time point of study inclusion, n = 47 asymptomatic infection) were compared to 38 controls without SARS-CoV-2 infection (26 female, 10.3 ± 3.4 years, n = 15 with other infection within last 6 months). After standardised interviews and neurological examinations, large fibre (tactile and vibration detection thresholds) and small fibre (cold and warm detection thresholds, paradoxical heat sensation) functions were assessed on both feet following a validated protocol. After z-transformation of all values, all participants were compared to published reference values regarding the number of abnormal results. Additionally, the mean for all sensory parameters values of both study groups were compared to an ideal healthy population (with z-value 0 ± 1), as well as with each other, as previously described. Statistical analyses: t-test, Chi-squared test, and binominal test. FINDINGS None of the controls, but 27 of the 81 patients (33%, p < 0.001) reported persistent complaints 2.7 ± 1.9 (0.8-8.5) months after SARS-CoV-2 infection, most often reduced exercise capacity (16%), fatigue (13%), pain (9%), or paraesthesia (6%). Reflex deficits or paresis were missing, but somatosensory profiles showed significantly increased detection thresholds for thermal (especially warm) and vibration stimuli compared to controls. Approximately 36% of the patients after SARS-CoV-2, but none of the controls revealed an abnormal sensory loss in at least one parameter (p < 0.01). Sensory loss was characterised in 26% by large and 12% by small fibre dysfunction, the latter appearing more frequently in children with prior symptomatic SARS-CoV-2 infection. Myalgia/paraesthesia was indicative of somatosensory dysfunction. In all eight re-examined children, the nerve function recovered after 2-4 months. INTERPRETATION This study provides evidence that in a subgroup of children and adolescents previously infected with SARS-CoV-2, regardless of their complaints, the function of large or small nerve fibres is presumably reversibly impaired.
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Affiliation(s)
- Lynn Eitner
- Department of Neuropediatrics, University Children's Hospital, Ruhr University Bochum, Bochum, Germany.,University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Maier
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Folke Brinkmann
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Anne Schlegtendal
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Leona Knoke
- University Children's Hospital, Ruhr University Bochum, Bochum, Germany
| | - Elena Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil gGmbH, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Lücke
- Department of Neuropediatrics, University Children's Hospital, Ruhr University Bochum, Bochum, Germany.,University Children's Hospital, Ruhr University Bochum, Bochum, Germany
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Liang X, Koh CL, Yeh CH, Goodin P, Lamp G, Connelly A, Carey LM. Predicting Post-Stroke Somatosensory Function from Resting-State Functional Connectivity: A Feasibility Study. Brain Sci 2021; 11:brainsci11111388. [PMID: 34827387 PMCID: PMC8615819 DOI: 10.3390/brainsci11111388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Accumulating evidence shows that brain functional deficits may be impacted by damage to remote brain regions. Recent advances in neuroimaging suggest that stroke impairment can be better predicted based on disruption to brain networks rather than from lesion locations or volumes only. Our aim was to explore the feasibility of predicting post-stroke somatosensory function from brain functional connectivity through the application of machine learning techniques. Somatosensory impairment was measured using the Tactile Discrimination Test. Functional connectivity was employed to model the global brain function. Behavioral measures and MRI were collected at the same timepoint. Two machine learning models (linear regression and support vector regression) were chosen to predict somatosensory impairment from disrupted networks. Along with two feature pools (i.e., low-order and high-order functional connectivity, or low-order functional connectivity only) engineered, four predictive models were built and evaluated in the present study. Forty-three chronic stroke survivors participated this study. Results showed that the regression model employing both low-order and high-order functional connectivity can predict outcomes based on correlation coefficient of r = 0.54 (p = 0.0002). A machine learning predictive approach, involving high- and low-order modelling, is feasible for the prediction of residual somatosensory function in stroke patients using functional brain networks.
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Affiliation(s)
- Xiaoyun Liang
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
- Victorian Infant Brain Studies (VIBeS) Group, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Correspondence:
| | - Chia-Lin Koh
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chun-Hung Yeh
- Imaging Division, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-H.Y.); (A.C.)
- Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Peter Goodin
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
| | - Gemma Lamp
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Alan Connelly
- Imaging Division, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-H.Y.); (A.C.)
| | - Leeanne M. Carey
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
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Tsuzuki K, Kawakami M, Nakamura T, Oshima O, Hijikata N, Suda M, Yamada Y, Okuyama K, Tsuji T. Do somatosensory deficits predict efficacy of neurorehabilitation using neuromuscular electrical stimulation for moderate to severe motor paralysis of the upper limb in chronic stroke? Ther Adv Neurol Disord 2021; 14:17562864211039335. [PMID: 34471424 PMCID: PMC8404636 DOI: 10.1177/17562864211039335] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Various neurorehabilitation programs have been developed to promote recovery from motor impairment of upper extremities. However, the response of patients with chronic-phase stroke varies greatly. Prediction of the treatment response is important to provide appropriate and efficient rehabilitation. This study aimed to clarify whether clinical assessments, such as motor impairments and somatosensory deficits, before treatment could predict the treatment response in neurorehabilitation. Methods: The data from patients who underwent neurorehabilitation using closed-loop electromyography (EMG)-controlled neuromuscular electrical stimulation were retrospectively analyzed. A total of 66 patients with chronic-phase stroke with moderate to severe paralysis were included. The changes from baseline in the Fugl-Meyer Assessment–Upper Extremity (FMA-UE) and the Motor Activity Log-14 (MAL-14) of amount of use (AOU) and quality of movement (QOM) were used to assess treatment response, and multivariate logistic regression analysis was performed using the extracted candidate predictors, such as baseline clinical assessments, to identify predictors of FMA-UE and MAL-14 improvement. Results: FMA-UE and MAL-14 scores improved significantly after the intervention (FMA-UE p < 0.01, AOU p < 0.01, QOM p < 0.01). On multivariate logistic regression analysis, tactile sensory (p = 0.043) and hand function (p = 0.030) were both identified as significant predictors of FMA-UE improvement, tactile sensory (p = 0.047) was a significant predictor of AOU improvement, and hand function (p = 0.026) was a significant predictor of QOM improvement. The regression equations explained 71.2% of the variance in the improvement of FMA-UE, 69.7% of AOU, and 69.7% of QOM. Conclusion: Both motor and tactile sensory impairments predict improvement in motor function, tactile sensory impairment predicts improvement in the amount of paralytic hand use, and motor impairment predicts improvement in the quality of paralytic hand use following neurorehabilitation treatment in patients with moderate to severe paralysis in chronic-phase stroke. These findings may help select the appropriate treatment for patients with more severe paralysis and to maximize the treatment effect.
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Affiliation(s)
- Keita Tsuzuki
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takuya Nakamura
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Osamu Oshima
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Nanako Hijikata
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Mabu Suda
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Yuka Yamada
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Kohei Okuyama
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, School of Medicine, Keio University, Tokyo, Japan
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Jessen J, Özgül ÖS, Höffken O, Schwenkreis P, Tegenthoff M, Enax-Krumova EK. Somatosensory dysfunction in patients with posttraumatic headache: A systematic review. Cephalalgia 2021; 42:73-81. [PMID: 34404271 DOI: 10.1177/03331024211030496] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Aim of the review is to summarize the knowledge about the sensory function and pain modulatory systems in posttraumatic headache and discuss its possible role in patients with posttraumatic headache. BACKGROUND Posttraumatic headache is the most common complication after traumatic brain injury, and significantly impacts patients' quality of life. Even though it has a high prevalence, its origin and pathophysiology are poorly understood. Thereby, the existing treatment options are insufficient. Identifying its mechanisms can be an important step forward to develop target-based personalized treatment. METHODS We searched the PubMed database for studies examining pain modulation and/or quantitative sensory testing in individuals with headache after brain injury. RESULTS The studies showed heterogenous alterations in sensory profiles (especially in heat and pressure pain perception) compared to healthy controls and headache-free traumatic brain injury-patients. Furthermore, pain inhibition capacity was found to be diminished in subjects with posttraumatic headache. CONCLUSIONS Due to the small number of heterogenous studies a distinct sensory pattern for patients with posttraumatic headache could not be identified. Further research is needed to clarify the underlying mechanisms and biomarkers for prediction of development and persistence of posttraumatic headache.
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Affiliation(s)
- Julia Jessen
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Özüm S Özgül
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Oliver Höffken
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Peter Schwenkreis
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
| | - Elena K Enax-Krumova
- Department of Neurology, BG University Hospital Bergmannsheil GmbH, Ruhr-University Bochum, Germany
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Zarkou A, Lee SCK, Prosser L, Hwang S, Franklin C, Jeka J. Foot and ankle somatosensory deficits in children with cerebral palsy: A pilot study. J Pediatr Rehabil Med 2021; 14:247-255. [PMID: 33896853 DOI: 10.3233/prm-190643] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To investigate foot and ankle somatosensory function in children with cerebral palsy (CP). METHODS Ten children with spastic diplegia (age 15 ± 5 y; GMFCS I-III) and 11 typically developing (TD) peers (age 15 ± 10 y) participated in the study. Light touch pressure and two-point discrimination were assessed on the plantar side of the foot by using a monofilament kit and an aesthesiometer, respectively. The duration of vibration sensation at the first metatarsal head and medial malleolus was tested by a 128 Hz tuning fork. Joint position sense and kinesthesia in the ankle joint were also assessed. RESULTS Children with CP demonstrated significantly higher light touch pressure and two-point discrimination thresholds compared to their TD peers. Individuals with CP perceived the vibration stimulus for a longer period compared to the TD participants. Finally, the CP group demonstrated significant impairments in joint position sense but not in kinesthesia of the ankle joints. CONCLUSIONS These findings suggest that children with CP have foot and ankle tactile and proprioceptive deficits. Assessment of lower extremity somatosensory function should be included in clinical practice as it can guide clinicians in designing more effective treatment protocols to improve functional performance in CP.
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Affiliation(s)
- Anastasia Zarkou
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | - Samuel C K Lee
- Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA.,Department of Physical Therapy, University of Delaware, Newark, DE, USA.,Research Department, Shriners Hospital for Children, Philadelphia, PA, USA
| | - Laura Prosser
- Division of Rehabilitation Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sungjae Hwang
- Department of Kinesiology, University of Maryland Eastern Shore, Princess Anne, MD, USA
| | - Corinna Franklin
- Research Department, Shriners Hospital for Children, Philadelphia, PA, USA
| | - John Jeka
- Department of Kinesiology, University of Delaware, Newark, DE, USA
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Ballardini G, Carlini G, Giannoni P, Scheidt RA, Nisky I, Casadio M. Tactile-STAR: A Novel Tactile STimulator And Recorder System for Evaluating and Improving Tactile Perception. Front Neurorobot 2018; 12:12. [PMID: 29681809 PMCID: PMC5897626 DOI: 10.3389/fnbot.2018.00012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/05/2018] [Indexed: 11/13/2022] Open
Abstract
Many neurological diseases impair the motor and somatosensory systems. While several different technologies are used in clinical practice to assess and improve motor functions, somatosensation is evaluated subjectively with qualitative clinical scales. Treatment of somatosensory deficits has received limited attention. To bridge the gap between the assessment and training of motor vs. somatosensory abilities, we designed, developed, and tested a novel, low-cost, two-component (bimanual) mechatronic system targeting tactile somatosensation: the Tactile-STAR-a tactile stimulator and recorder. The stimulator is an actuated pantograph structure driven by two servomotors, with an end-effector covered by a rubber material that can apply two different types of skin stimulation: brush and stretch. The stimulator has a modular design, and can be used to test the tactile perception in different parts of the body such as the hand, arm, leg, big toe, etc. The recorder is a passive pantograph that can measure hand motion using two potentiometers. The recorder can serve multiple purposes: participants can move its handle to match the direction and amplitude of the tactile stimulator, or they can use it as a master manipulator to control the tactile stimulator as a slave. Our ultimate goal is to assess and affect tactile acuity and somatosensory deficits. To demonstrate the feasibility of our novel system, we tested the Tactile-STAR with 16 healthy individuals and with three stroke survivors using the skin-brush stimulation. We verified that the system enables the mapping of tactile perception on the hand in both populations. We also tested the extent to which 30 min of training in healthy individuals led to an improvement of tactile perception. The results provide a first demonstration of the ability of this new system to characterize tactile perception in healthy individuals, as well as a quantification of the magnitude and pattern of tactile impairment in a small cohort of stroke survivors. The finding that short-term training with Tactile-STAR can improve the acuity of tactile perception in healthy individuals suggests that Tactile-STAR may have utility as a therapeutic intervention for somatosensory deficits.
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Affiliation(s)
- Giulia Ballardini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Giorgio Carlini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Psiche Giannoni
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Robert A. Scheidt
- Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Division of Civil, Mechanical and Manufacturing Innovation, National Science Foundation, Alexandria, VA, United States
| | - Ilana Nisky
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beersheba, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
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Abstract
This chapter covers balance, gait, and falls in individuals with spinal cord injury (SCI) from a clinical perspective. First, the consequences of an SCI on functioning are explained, including etiology, clinical presentation, classification, and epidemiologic data. Then, the specific aspects of balance disorders, gait disorders, and falls are discussed with respect to motor complete (cSCI) and incomplete (iSCI) SCI. Typically, these activities are affected by impaired afferent and efferent nerves, but not by central nervous processing. Performance of daily life activities in cSCI depends on the ability to control the interaction between the center of mass and the base of support or limits of stability. In iSCI, impaired proprioception and muscle strength are important factors for completing balancing tasks and for walking. Falls are common in patients with SCI. Subsequent sections describe therapy approaches aimed at modifying balance, gait, and the risk for falls by means of therapeutic exercises, assistive devices like robots or functional electric stimulation, and environmental adaptations. The last part covers recent developments and future directions. These encompass interventions for maximizing residual neural function and regeneration of axons, as well as technical solutions like epidural or intraspinal electric stimulation, powered exoskeletons, and brain computer interfaces.
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Affiliation(s)
- Markus Wirz
- Institute of Physiotherapy, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland.
| | - Hubertus J A van Hedel
- Rehabilitation Center Affoltern am Albis, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland
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Liepert J, Büsching I, Sehle A, Schoenfeld MA. Mental chronometry and mental rotation abilities in stroke patients with different degrees of sensory deficit. Restor Neurol Neurosci 2016; 34:907-914. [PMID: 27689548 DOI: 10.3233/rnn-160640] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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
BACKGROUND Motor imagery is used for treatment of motor deficits after stroke. Clinical observations suggested that motor imagery abilities might be reduced in patients with severe sensory deficits. This study investigated the influence of somatosensory deficits on temporal (mental chronometry, MC) and spatial aspects of motor imagery abilities. METHODS Stroke patients (n = 70; <6 months after stroke) were subdivided into 3 groups according to their somatosensory functions. Group 1 (n = 31) had no sensory deficits, group 2 (n = 27) had a mild to moderate sensory impairment and group 3 (n = 12) had severe sensory deficits. Patients and a healthy age-matched control group (n = 23) participated in a mental chronometry task (Box and Block Test, BBT) and a mental rotation task (Hand Identification Test, HIT). MC abilities were expressed as a ratio (motor execution time-motor imagery time/motor execution time). RESULTS MC for the affected hand was significantly impaired in group 3 in comparison to stroke patients of group 1 (p = 0.006), group 2 (p = 0.005) and healthy controls (p < 0.001). For the non-affected hand MC was similar across all groups. Stroke patients had a slower BBT motor execution than healthy controls (p < 0.001), and group 1 executed the task faster than group 3 (p = 0.002). The percentage of correct responses in the HIT was similar for all groups. CONCLUSION Severe sensory deficits impair mental chronometry abilities but have no impact on mental rotation abilities. Future studies should explore whether the presence of severe sensory deficits in stroke patients reduces the benefit from motor imagery therapy.
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Affiliation(s)
- Joachim Liepert
- Department of Neurorehabilitation, Kliniken Schmieder, Allensbach, Germany
| | - Imke Büsching
- Department of Neurorehabilitation, Kliniken Schmieder, Allensbach, Germany
| | - Aida Sehle
- Department of Neurorehabilitation, Kliniken Schmieder, Allensbach, Germany
| | - Mircea Ariel Schoenfeld
- Department of Behavioural Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
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11
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Abstract
There have been no studies reported on the difference in cortical activation during use of volar and dorsal hand splints. We attempted to investigate the difference in cortical activation in the somatosensory cortical area during use of volar and dorsal hand splints by functional magnetic resonance imaging (fMRI). We recruited eight healthy volunteers. fMRI was performed while subjects who were fitted with volar or dorsal hand splints performed grasp-release movements. Regions of interest were placed on the primary motor cortex (M1), primary somatosensory cortex (S1), posterior parietal cortex (PPC), and secondary somatosensory cortex (S2). Results of group analysis of fMRI data showed that the total numbers of activated voxels in all ROIs were significantly higher during use of volar hand splint (3,376) compared with that (1,416) during use of dorsal hand splint. In each ROI, use of volar hand splint induced greater activation in all ROIs (M1: 1,748, S1: 1,455, PPC: 23, and S2: 150) compared with use of dorsal hand splint (M1: 783, S1: 625, PPC: 0, and S2: 8). The peak activated value was also higher during use of volar hand splint (t-value: 17.29) compared with that during use of dorsal hand splint (t-value: 13.11). Taken together, use of volar hand splint induced greater cortical activation relevant to somatosensory function than use of dorsal hand splint. This result would be important for the physiatrist and therapist to apply appropriate somatosensory input in patients with brain injury.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, South Korea
| | - Woo Hyuk Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, South Korea
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12
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Shen H, Shao S, Zhang J, Wang Z, Lv D, Chen W, Svensson P, Wang K. Fixed orthodontic appliances cause pain and disturbance in somatosensory function. Eur J Oral Sci 2015; 124:26-32. [PMID: 26715259 DOI: 10.1111/eos.12234] [Citation(s) in RCA: 9] [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] [Accepted: 11/04/2015] [Indexed: 01/02/2023]
Abstract
This study aimed to assess the short-term effects of orthodontic pain on quantitative sensory testing (QST) in subjects receiving fixed orthodontic treatment. Twenty patients and 12 healthy volunteers (as controls) participated. All 20 patients had bonded AO self-ligating brackets, with a 0.014 super elastic nickel-titanium arch wire placed in the brackets. Pain [self-reported on a visual analog scale (VAS)], and thermal and mechanical thresholds, were tested at six time points--before (baseline), and 2 h, 24 h, 7 d, 14 d, and 30 d after, force application--in the treatment group. The attached gingiva adjacent to the left upper central incisor (21 gingiva) was hypersensitive to cold stimuli (i.e. increased cold detection thresholds were detected) in the treatment group. The pressure pain thresholds of the left upper central incisor (21) and 21 gingiva were significantly reduced. Our results suggest clear signs of sensitization of the trigeminal nociceptive system up to 1 month after force application and orthodontic pain. Quantitative assessment of somatosensory function may help to provide a better understanding and profiling of the underlying neurobiological mechanisms related to orthodontic pain.
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Affiliation(s)
- Huijie Shen
- Orofacial Pain and TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Institute of Stomatology and Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Sheng Shao
- Orofacial Pain and TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Institute of Stomatology and Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Jinglu Zhang
- Orofacial Pain and TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Zhendong Wang
- Orofacial Pain and TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Institute of Stomatology and Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Dong Lv
- Orofacial Pain and TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Institute of Stomatology and Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Wenjing Chen
- Orofacial Pain and TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Institute of Stomatology and Department of Orthodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, School of Dentistry, Aarhus University, Aarhus, Denmark.,Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Kelun Wang
- Orofacial Pain and TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.,Center for Sensory-Motor Interaction (SMI) Aalborg University, Aalborg, Denmark
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13
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Puts NAJ, Harris AD, Crocetti D, Nettles C, Singer HS, Tommerdahl M, Edden RAE, Mostofsky SH. Reduced GABAergic inhibition and abnormal sensory symptoms in children with Tourette syndrome. J Neurophysiol 2015; 114:808-17. [PMID: 26041822 PMCID: PMC4533064 DOI: 10.1152/jn.00060.2015] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/28/2015] [Indexed: 11/22/2022] Open
Abstract
Tourette Syndrome (TS) is characterized by the presence of chronic tics. Individuals with TS often report difficulty with ignoring (habituating to) tactile sensations, and some patients perceive that this contributes to a "premonitory urge" to tic. While common, the physiological basis of impaired tactile processing in TS, and indeed tics themselves, remain poorly understood. It has been well established that GABAergic processing plays an important role in shaping the neurophysiological response to tactile stimulation. Furthermore, there are multiple lines of evidence suggesting that a deficit in GABAergic transmission may contribute to symptoms found in TS. In this study, GABA-edited magnetic resonance spectroscopy (MRS) was combined with a battery of vibrotactile tasks to investigate the role of GABA and atypical sensory processing in children with TS. Our results show reduced primary sensorimotor cortex (SM1) GABA concentration in children with TS compared with healthy control subjects (HC), as well as patterns of impaired performance on tactile detection and adaptation tasks, consistent with altered GABAergic function. Moreover, in children with TS SM1 GABA concentration correlated with motor tic severity, linking the core feature of TS directly to in vivo brain neurochemistry. There was an absence of the typical correlation between GABA and frequency discrimination performance in TS as was seen in HC. These data show that reduced GABA concentration in TS may contribute to both motor tics and sensory impairments in children with TS. Understanding the mechanisms of altered sensory processing in TS may provide a foundation for novel interventions to alleviate these symptoms.
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Affiliation(s)
- Nicolaas A J Puts
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland;
| | - Ashley D Harris
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Deana Crocetti
- Center for Neurodevelopment and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland
| | - Carrie Nettles
- Center for Neurodevelopment and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland
| | - Harvey S Singer
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark Tommerdahl
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; F. M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland
| | - Stewart H Mostofsky
- Center for Neurodevelopment and Imaging Research, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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14
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Giampietro PF. SNPping away at the genetic basis of adolescent idiopathic scoliosis. Ann Transl Med 2015; 3:S26. [PMID: 26046072 DOI: 10.3978/j.issn.2305-5839.2015.02.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/20/2015] [Indexed: 11/14/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a genetically complex disorder of spine development, defined by a lateral curvature of the spine of 10º or greater which affects children during their pubertal growth spurt. Prior linkage and candidate gene approaches to elucidating the genetic basis of AIS have been of limited use for identification of candidate genes for this condition. Genome wide association studies (GWAS) have recently identified single nucleotide polymorphisms (SNPs) in LBX1 and G protein-coupled receptor 126 (GPR126) that contribute to AIS occurrence. These discoveries support prior etiologic hypotheses regarding altered somatosensory function and skeletal growth in AIS. However, these loci account for a small percentage of the phenotypic variance associated with AIS, indicating the vast majority of the genetic causes of AIS remain to be delineated. A major translational application regarding understanding the genetic contributions to AIS relates to bracing efficacy.
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Affiliation(s)
- Philip F Giampietro
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
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15
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Jang SH, Seo JP. Differences of the medial lemniscus and spinothalamic tract according to the cortical termination areas: A diffusion tensor tractography study. Somatosens Mot Res 2014; 32:67-71. [PMID: 25365478 DOI: 10.3109/08990220.2014.966899] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We investigated differences of the medial lemniscus and its thalamocortical pathway (ML), and the spinothalamic tract and its thalamocortical pathway (STT) according to the cortical termination areas. We found that the ML and STT terminated in the motor cortex and the somatosensory cortex. The ML may be closely related to the motor cortex for motor planning and execution, while the STT may be closely related to the cerebral cortex for somatosensory function and motor execution.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University , Namku, Taegu , Republic of Korea
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16
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Abstract
BACKGROUND Back and neck pain are common conditions that have a high burden of disease. Changes in somatosensory function in the periphery, the spinal cord and the brain have been well documented at the time when these conditions have become chronic. It is unknown, however, how early these changes occur, what the timecourse is of sensory dysfunction and what the specific nature of these changes are in the first 12 weeks after onset of pain. In this paper, we describe the protocol for a systematic review of the literature on somatosensory dysfunction in the first 12 weeks after pain onset. METHODS AND DESIGN We will conduct a comprehensive search for articles indexed in the databases Ovid MEDLINE, Ovid Embase, Ovid PsycINFO and Cochrane Central Register of Controlled Trial (CENTRAL) from their inception to August 2013 that report on any aspect of somatosensory function in acute or subacute neck or back pain. Two independent reviewers will screen studies for eligibility, assess risk of bias and extract relevant data. Results will be tabulated and a narrative synthesis of the results conducted. DISCUSSION Currently, there is a gap in our knowledge about the timing of somatosensory changes in back and neck pain. The systematic review outlined in this protocol aims to address this knowledge gap and inform developments in diagnostic tools and pain mechanism-based treatments. TRIAL REGISTRATION Our protocol has been registered on PROSPERO, CRD42013005113.
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Affiliation(s)
- Anna Marcuzzi
- Discipline of Physiotherapy, Faculty of Human Sciences, 75 Talavera Rd, Macquarie University, North Ryde, New South Wales 2109, Australia.
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