Racial/Ethnic Differences in Self-Reported Upper Limb Limitations among U.S. Older Adults

BACKGROUND

The development of disability related to activities of daily living (ADL) is of great concern in the aging population, particularly for Hispanic and Non-Hispanic (NH) Black older adults, where disability prevalence is greater compared to NH Whites. ADL-disability is typically measured across many functional tasks without differentiating upper- versus lower-limb limitations, hindering our understanding of disability burden. Despite the importance of the upper limbs for completing ADL and known age-related declines in function, racial/ethnic differences in upper limb function remain largely unknown.

METHODS

We identified 4,292 NH White, NH Black, and Mexican American older adults (≥65) from the 2011-2018 waves of the National Health and Nutrition Examination Survey (NHANES). We classified participants as having a limitation based on their ability to complete five upper limb tasks (preparing meals, eating, dressing, reaching overhead, grasping small objects) and compared limitation rates across racial/ethnic groups.

RESULTS

Compared to NH Whites, NH Black older adults had significantly greater odds of reporting difficulties preparing meals (OR: 1.36, 95% CI: 1.01, 1.86) and dressing (OR: 1.55, 95% CI: 1.19, 2.02), while Mexican Americans had greater difficulty preparing meals (OR: 1.70, 95% CI: 1.12, 2.58), dressing (OR: 1.63, 95% CI: 1.12, 2.36), and grasping small objects (OR: 1.48, 95% CI: 1.06, 2.07).

CONCLUSIONS

Our results demonstrate differences in self-reported upper limb ADL-disability across racial/ethnic groups, particularly for Mexican American older adults. Such findings underscore the need for routine monitoring of upper limb function throughout adulthood to identify limitations and target therapeutic interventions before independence is compromised.

Quantifying Patient-Initiated Upper Extremity Movement After Surgical Reconstruction for Adult Pan-Brachial Plexus Injury

BACKGROUND AND OBJECTIVES

Determining functional recovery in adult patients with traumatic pan-brachial plexus injury (pBPI) is hampered by the fact that most outcome measures are collected in the clinical setting and may not reflect arm use in the real world. This study's objectives were to demonstrate the feasibility of using wearable motion sensor technology to quantify spontaneous arm movement in adult patients with pBPI after surgical reconstruction and report the time and intensity with which the affected arm was used.

METHODS

Twenty-nine patients with pBPI who underwent surgical reconstruction at least 2 years prior were included in this study. Study participants wore an accelerometer on bilateral arms for 7 days. The vector time (VT) and magnitude with which each arm moved were collected and divided by the same values collected from the uninjured arm to generate a ratio (VT and vector magnitude [VM], respectively) to quantify differences between the arms. Correlations between VT, VM, and patient demographic and physician-elicited clinical measures were calculated. Patients were enrolled at Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan, and data analysis was performed at the University of Michigan.

RESULTS

Twelve patients had pan-avulsion injuries, and 17 patients had C5 rupture with C6-T1 avulsion injuries. All underwent nerve reconstruction with contralateral C7 or ipsilateral C5 nerve roots as donors. At mean 7.3 years after surgery, the mean VT ratio was 0.54 ± 0.13 and the mean VM ratio was 0.30 ± 0.13. Both VT and VM ratios were significantly correlated with patient employment and movements at the elbow and forearm.

CONCLUSION

Wearable motion detection technology can capture spontaneous, real-world movements of the arm in patients who have undergone surgical reconstruction for pBPI. Despite severe injuries, these patients are able to use their affected arm 50% of the time and with 30% of the intensity of their unaffected arm, which is positively correlated with return to work after injury. These data support the use of surgical reconstruction for pBPI.

Recovery of Shoulder, Elbow, and Forearm Movement After Nerve Reconstruction for Neonatal Brachial Plexus Palsy

BACKGROUND AND OBJECTIVES

There is a relative dearth of published data with respect to recovery of upper extremity movement after nerve reconstruction for neonatal brachial plexus palsy (NBPP). This study aimed to demonstrate long-term recovery of active range of motion (AROM) at the shoulder, elbow, and forearm after nerve reconstruction for NBPP and to compare that with patients managed nonoperatively.

METHODS

We interrogated a prospectively collected database of all patients evaluated for NBPP at a single institution from 2005 to 2020. AROM measurements for shoulder, elbow, and forearm movements were collected at every visit up to 5 years of follow-up and normalized between 0 and 1. We used generalized estimated equations to predict AROM for each movement within local age windows over 5 years and compared the operative and nonoperative cohorts at each age interval.

RESULTS

In total, >13 000 collected datapoints representing 425 conservatively and 99 operatively managed children were included for analysis. At 5 years, absolute recovery of AROM after nerve reconstruction was ∼50% for shoulder abduction and forward flexion, ∼65% for shoulder external rotation, and ∼75% for elbow flexion and forearm supination, with ∼20% loss of elbow extension AROM. Despite more limited AROM on presentation for the operative cohort, at 5 years, there was no significant difference between the groups in AROM for shoulder external rotation, elbow extension, or forearm supination, and, in Narakas grade 1-2 injury, shoulder abduction and forward flexion.

CONCLUSION

We demonstrate recovery of upper extremity AROM after nerve surgery for NBPP. Despite more severe presenting injury, operative patients had similar recovery of AROM when compared with nonoperative patients for shoulder external rotation, elbow extension, forearm supination, and, for Narakas grade 1-2 injury, shoulder abduction and forward flexion.

Early referral to multidisciplinary specialty centers to optimize outcomes in children with neonatal brachial plexus palsy

AIM

To demonstrate the trajectory of long-term recovery of upper-extremity movement and determine optimal timing of evaluation at multidisciplinary specialty centers in children with neonatal brachial plexus palsy (NBPP).

METHOD

All children with conservatively managed NBPP seen at one institution from 2005 to 2020 were considered for inclusion. The cohort was divided according to age at formal evaluation (≤30 or > 30 days). Active range of motion (AROM) for shoulder and elbow movements collected at each appointment were compared in local age windows between early and late cohorts. Locally estimated scatterplot smoothing was used to demonstrate the trajectory of recovery for the overall cohort.

RESULTS

More than 13 000 prospectively collected data points for 429 children (220 males, 209 females) were analysed. Elbow flexion improved to nearly full AROM for both groups over the course of the study. Shoulder abduction, forward flexion and external rotation, and forearm supination improved for the entire cohort, although greater absolute improvement, particularly at the shoulder, was seen in the early cohort (age at formal evaluation ≤30 days). AROM for elbow extension remained roughly stable for the early cohort but decreased for the late cohort (age at formal evaluation >30 days). AROM for forearm pronation decreased over time for both cohorts.

INTERPRETATION

Our data demonstrate good long-term functional recovery for children with conservatively managed NBPP. However, early referral to multispecialty brachial plexus centers may optimize outcomes.

WHAT THIS PAPER ADDS

Many children with conservatively managed neonatal brachial plexus palsy have good long-term shoulder and elbow outcomes. Early referral to multidisciplinary clinics may maximize long-term shoulder and elbow recovery and optimize outcomes.

Use of a Novel Theory-Based Pragmatic Tool to Evaluate the Quality of Instructor-Led Exercise Videos to Promote Youth Physical Activity at Home: Preliminary Findings

BACKGROUND

Exercise videos that work to minimize cognitive load (the amount of information that working memory can hold at one time) are hypothesized to be more engaging, leading to increased PA participation.

PURPOSE

To use a theory-based pragmatic tool to evaluate the cognitive load of instructor-led exercise videos associated with the Interrupting Prolonged Sitting with ACTivity (InPACT) program.

METHODS

Exercise videos were created by physical education teachers and fitness professionals. An evaluation rubric was created to identify elements each video must contain to reduce cognitive load, which included three domains with four components each [technical (visual quality, audio quality, matching modality, signaling), content (instructional objective, met objective, call-to-action, bias), and instructional (learner engagement, content organization, segmenting, weeding)]. Each category was scored on a 3-point scale from 0 (absent) to 2 (proficient). A video scoring 20-24 points induced low cognitive load, 13-19 points induced moderate cognitive load, and less than 13 points induced high cognitive load. Three reviewers independently evaluated the videos and then agreed on scores and feedback.

RESULTS

All 132 videos were evaluated. Mean video total score was 20.1 ± 0.7 points out of 24. Eighty-five percent of videos were rated low cognitive load, 15% were rated moderate cognitive load, and 0% were rated high cognitive load. The following components scored the highest: audio quality and matching modality. The following components scored the lowest: signaling and call-to-action.

CONCLUSIONS

Understanding the use of a pragmatic tool is a first step in the evaluation of InPACT at Home exercise videos. Our preliminary findings suggest that the InPACT at Home videos had low cognitive load. If future research confirms our findings, using a more rigorous study design, then developing a collection of instructor-led exercise videos that induce low cognitive load may help to enhance youth physical activity participation in the home environment.

Enhanced Street Crossing Features are Associated with Higher Post-Stroke Physical Quality of Life

BACKGROUND

Features of the physical environment may affect post-stroke recovery, but empirical evidence is limited. This study examines associations between features of the physical environment and post-stroke physical quality of life (PH-QOL).

METHODS

The study sample included stroke survivors enrolled in the Caring for Adults Recovering from the Effects of Stroke project, a prospective cohort. Features of the physical environment surrounding participants' home addresses were audited using Google Earth. Audits captured information about crossings (e.g. curb-cuts; range 0-4), street segments (e.g. sidewalks; range 0-17.5), and a route (e.g. parks; range 0-27) near participants' home. Summary scores were categorized into tertials representing "few," "some," and "many" pedestrian-friendly features. Post-stroke PH-QOL was measured by the SF-12 (range 0-100) around 6 to 12-, 18-, 27-, and 36-months post-stroke. Linear mixed models were used to estimate PH-QOL over time. Chained multiple imputation was used to account for missing data.

RESULTS

Two hundred and seventy-five participants were eligible, among whom 210 had complete data. Most participants lived in areas with "few" features to promote outdoor mobility. Participants living in environments with "some" crossing features had a 4.90 (95% CI: 2.32, 7.48) higher PH-QOL score across the observation period in comparison to participants living in environments with "few" crossing features. Features of the physical environment along street segments and routes were not associated with post-stroke PH-QOL.

CONCLUSION

Crossing features are associated with post-stroke PH-QOL. Modifying features of the physical environment at nearby crossings, such as curb-cuts, may be a promising strategy for increasing PH-QOL.

The Relationship Between Environmental Exposures and Post-Stroke Physical Activity

INTRODUCTION

Post-stroke physical activity has widespread health benefits. Environmental exposures may shape post-stroke physical activity behavior. This study investigates the relationships between environmental exposures and post-stroke physical activity.

METHODS

Stroke survivors (n=374) from a cohort of Black and White adults with post-stroke accelerometer data (2009-2013) were eligible for this study. Participants' home addresses were linked with secondary data to capture environmental characteristics, including annual density of neighborhood resources (e.g., parks, physical activity facilities, and intellectual stimulation destinations), 2010 neighborhood SES, 2010 neighborhood crime, and daily information on extremely cold days. Post-stroke light physical activity and moderate-to-vigorous physical activity were captured using accelerometers over a 7-day period. Linear regression and 2-part/hurdle models were used to estimate the relationship between the density of neighborhood resources with light physical activity and with moderate-to-vigorous physical activity, respectively. Analyses were conducted in 2021.

RESULTS

A 10% increase in the number of extremely cold days was associated with 6.37 fewer minutes of daily light physical activity (95% CI= -11.37, -1.37). A 1-SD increase in neighborhood SES was associated with greater odds (OR=1.10, 95% CI=1.02, 1.19) of doing any moderate-to-vigorous physical activity. Among participants obtaining any moderate-to-vigorous physical activity, a 1-unit (count/km²) increase in destinations for intellectual stimulation was associated with 0.99 (95% CI=0.02, 1.97) more minutes of daily moderate-to-vigorous physical activity. All other environmental exposures were not associated with post-stroke light physical activity or moderate-to-vigorous physical activity.

CONCLUSIONS

Environmental exposures may facilitate physical activity participation among stroke survivors. This study found that weather, neighborhood SES, and proximity to destinations for intellectual stimulation were associated with physical activity over and above individual factors.

"Well in in this neighborhood I have walked, not at all": Stroke survivors lived experience in the outdoor environment

Stroke survivors face unique challenges in the outdoor environment when returning to their home community following a stroke. Challenges include navigating uneven terrain, social stigma, and adapting to changes in functioning. Outdoor environments may serve as potential points of intervention to promote independence and participation post stroke. This study aimed to understand lived post-stroke experience in the outdoor environment as it pertains to independent mobility.

METHODS

Qualitative semi-structured interviews were conducted with 20 stroke survivors (8 males, 12 females; mean age 64.2 years: range 45 years-90 years). Participants were eligible if they were over the age of 45, could communicate in English, lived outside a nursing home, able to walk safely outdoors, were a minimum of six-months post stroke, and had no severe cognitive impairment. Interviews with participants were tape recorded, audio files were transcribed verbatim, codes were created and applied to transcripts, and themes were generated using interpretative phenomenological analysis.

RESULTS

Post-stroke experiences in the outdoor environment were multidimensional. Three themes emerged from the stroke survivors' description of personal experiences in the outdoor environment. These themes included feelings of vigilance, employing adaptation strategies, and management of dynamic relations between the self and context.

DISCUSSION

The findings highlight the post-stroke experience traversing the outdoor environment. Investing in the public outdoor environment to remove barriers and install facilitators could reduce feelings of apprehension and hypervigilance while walking in the outdoor environment. Future research is needed to evaluate the role of environmental interventions on hypervigilance in the outdoor environment post stroke.

Quantifying long-term upper-limb activity using wearable motion sensors after nerve reconstruction for neonatal brachial plexus palsy

OBJECTIVE

Standard, physician-elicited clinical assessment tools for the evaluation of function after nerve reconstruction for neonatal brachial plexus palsy (NBPP) do not accurately reflect real-world arm function. Wearable activity monitors allow for the evaluation of patient-initiated, spontaneous arm movement during activities of daily living. In this pilot study, the authors demonstrate the feasibility of using body-worn sensor technology to quantify spontaneous arm movement in children with NBPP 10 years after nerve reconstruction and report the timing and magnitude of recovered arm movement.

METHODS

Eight children with NBPP who underwent brachial plexus reconstruction approximately 10 years prior were recruited to take part in this single-institution prospective pilot study. Per the treatment protocol of the authors' institution, operated patients had severe, nonrecovering nerve function at the time of surgery. The patients were fitted with an activity monitoring device on each of the affected and unaffected arms, which were worn for 7 consecutive days. The duration (VT) and power (VM) with which each arm moved during the patient's normal daily activities were extracted from the accelerometry data and ratios comparing the affected and unaffected arms were calculated. Demographic data and standard physician-elicited clinical measures of upper-extremity function were also collected.

RESULTS

Three children underwent nerve grafting and transfer and 5 children underwent graft repair only. The mean (± SD) active range of motion was 98° ± 53° for shoulder abduction, 130° ± 24° for elbow flexion, and 39° ± 34° for shoulder external rotation. The median Medical Research Council grade was at least 2.5 for all muscle groups. The median Mallet grade was at least 2 for all categories, and 13.5 total. The VT ratio was 0.82 ± 0.08 and the VM ratio was 0.53 ± 0.12.

CONCLUSIONS

Wearable activity monitors such as accelerometers can be used to quantify spontaneous arm movement in children who underwent nerve reconstruction for NBPP at long-term follow-up. These data more accurately reflect complex, goal-oriented movement needed to perform activities of daily living. Notably, despite severe, nonrecovering nerve function early in life, postsurgical NBPP patients use their affected arms more than 80% of the time that they use their unaffected arms, paralleling results in patients with NBPP who recovered spontaneously. These data represent the first long-term, real-world evidence to support brachial plexus reconstruction for patients with NBPP.

Measuring hand sensory function and force control in older adults: Are current hand assessment tools enough?

BACKGROUND

The ability to grasp and manipulate objects is essential for performing activities of daily living. However, there is limited information regarding age-related behavioral differences in hand sensorimotor function due, in part, to the lack of assessment tools capable of measuring subtle but important differences in hand function. The purpose of this study was to demonstrate performance differences in submaximal force control and tactile pattern recognition in healthy older adults using two custom-designed sensorimotor assessment tools.

METHODS

Sensorimotor function was assessed in 13 healthy older adults (mean age 72.2 ±5.5y, range: 65-84y) and 13 young adults (mean age 20 ±1.4y, range: 19-23y). Clinical assessments included the Montreal Cognitive Assessment (MoCA), monofilament testing, maximum voluntary contraction (MVC), and Grooved Pegboard Test. Sensorimotor assessments included submaximal (5, 20% MVC) grip force step-tracking and tactile pattern recognition tasks.

RESULTS

Clinical assessments revealed no or minimal group differences in MVC, monofilament thresholds, and MoCA. However, sensorimotor assessments showed that older adults took longer to discriminate tactile patterns and had poorer accuracy than young adults. Older adults also produced submaximal forces less smoothly than young adults at the 20% force level while greater variability in force maintenance was seen at 5% but not 20% MVC.

CONCLUSIONS

These results demonstrate the ability to integrate higher-order tactile information and control low grip forces is impaired in older adults despite no differences in grip strength or cognition. These findings underscore the need for more sensitive evaluation methods that focus on sensorimotor ability reflective of daily activities.

Reduced Facilitation of Parietal-Motor Functional Connections in Older Adults

Age-related changes in cortico-cortical connectivity in the human motor network in older adults are associated with declines in hand dexterity. Posterior parietal cortex (PPC) is strongly interconnected with motor areas and plays a critical role in many aspects of motor planning. Functional connectivity measures derived from dual-site transcranial magnetic stimulation (dsTMS) studies have found facilitatory inputs from PPC to ipsilateral primary motor cortex (M1) in younger adults. In this study, we investigated whether facilitatory inputs from PPC to M1 are altered by age. We used dsTMS in a conditioning-test paradigm to characterize patterns of functional connectivity between the left PPC and ipsilateral M1 and a standard pegboard test to assess skilled hand motor function in 13 young and 13 older adults. We found a PPC-M1 facilitation in young adults but not older adults. Older adults also showed a decline in motor performance compared to young adults. We conclude that the reduced PPC-M1 facilitation in older adults may be an early marker of age-related decline in the neural control of movement.

Quantifying Real-World Upper-Limb Activity Via Patient-Initiated Movement After Nerve Reconstruction for Upper Brachial Plexus Injury

BACKGROUND

A critical concept in brachial plexus reconstruction is the accurate assessment of functional outcomes. The current standard for motor outcome assessment is clinician-elicited, outpatient clinic-based, serial evaluation of range of motion and muscle power. However, discrepancies exist between such clinical measurements and actual patient-initiated use. We employed emerging technology in the form of accelerometry-based motion detectors to quantify real-world arm use after brachial plexus surgery.

OBJECTIVE

To evaluate (1) the ability of accelerometry-based motion detectors to assess functional outcome and (2) the real-world arm use of patients after nerve transfer for brachial plexus injury, through a pilot study.

METHODS

Five male patients who underwent nerve transfer after brachial plexus injury wore bilateral motion detectors for 7 d. The patients also underwent range-of-motion evaluation and completed multiple patient-reported outcome surveys.

RESULTS

The average age of the recruits was 41 yr (±17 yr), and the average time from operation was 2 yr (±1 yr). The VT (time of use ratio) for the affected side compared to the unaffected side was 0.73 (±0.27), and the VM (magnitude ratio) was 0.63 (±0.59). VT strongly and positively correlated with shoulder flexion and shoulder abduction: 0.97 (P = .008) and 0.99 (P = .002), respectively.

CONCLUSION

Accelerometry-based activity monitors can successfully assess real-world functional outcomes after brachial plexus reconstruction. This pilot study demonstrates that patients after nerve transfer are utilizing their affected limbs significantly in daily activities and that recovery of shoulder function is critical.

Oberlin transfer compared with nerve grafting for improving early supination in neonatal brachial plexus palsy

OBJECTIVE The use of nerve transfers versus nerve grafting for neonatal brachial plexus palsy (NBPP) remains controversial. In adult brachial plexus injury, transfer of an ulnar fascicle to the biceps branch of the musculocutaneous nerve (Oberlin transfer) is reportedly superior to nerve grafting for restoration of elbow flexion. In pediatric patients with NBPP, recovery of elbow flexion and forearm supination is an indicator of resolved NBPP. Currently, limited evidence exists of outcomes for flexion and supination when comparing nerve transfer and nerve grafting for NBPP. Therefore, the authors compared 1-year postoperative outcomes for infants with NBPP who underwent Oberlin transfer versus nerve grafting. METHODS This retrospective cohort study reviewed patients with NBPP who underwent Oberlin transfer (n = 19) and nerve grafting (n = 31) at a single institution between 2005 and 2015. A single surgeon conducted intraoperative exploration of the brachial plexus and determined the surgical nerve reconstruction strategy undertaken. Active range of motion was evaluated preoperatively and postoperatively at 1 year. RESULTS No significant difference between treatment groups was observed with respect to the mean change (pre- to postoperatively) in elbow flexion in adduction and abduction and biceps strength. The Oberlin transfer group gained significantly more supination (100° vs 19°; p < 0.0001). Forearm pronation was maintained at 90° in the Oberlin transfer group whereas it was slightly improved in the grafting group (0° vs 32°; p = 0.02). Shoulder, wrist, and hand functions were comparable between treatment groups. CONCLUSIONS The preliminary data from this study demonstrate that the Oberlin transfer confers an advantageous early recovery of forearm supination over grafting, with equivalent elbow flexion recovery. Further studies that monitor real-world arm usage will provide more insight into the most appropriate surgical strategy for NBPP.

Home-based movement therapy in neonatal brachial plexus palsy: A case study

STUDY DESIGN

Case report.

INTRODUCTION

The value of movement-based therapy in peripheral nerve injury conditions such as neonatal brachial plexus palsy (NBPP) is unclear.

PURPOSE OF THE STUDY

To determine the effectiveness of a home-based movement therapy program in a 17 year old female patient with a right NBPP pan-plexopathy.

METHODS

Home training consisted of arm reaching and object manipulation tasks using devices which recorded performance. Training occurred for 1 h/day, 5 days/week for 6 weeks with periodic webcam supervision. Pre- and post clinical, functional and kinematic assessments were performed in a laboratory setting.

RESULTS

Following training, shoulder flexion and elbow extension active range of motion increased by 13° and 9°, respectively, and functional ability also improved. Reach movement duration decreased significantly with a concomitant improvement in movement coordination.

CONCLUSIONS

These results demonstrate that movement therapy has the potential to improve motor function in NBPP years after the initial insult.

LEVEL OF EVIDENCE

4.

Hand Sensorimotor Function in Older Children With Neonatal Brachial Plexus Palsy

BACKGROUND

Routine sensory assessments in neonatal brachial plexus palsy are infrequently performed because it is generally assumed that sensory recovery exceeds motor recovery. However, studies examining sensory function in neonatal brachial plexus palsy have produced equivocal findings. The purpose of this study was to examine hand sensorimotor function in older children with neonatal brachial plexus palsy using standard clinical and research-based measures of tactile sensibility.

METHODS

Seventeen children with neonatal brachial plexus palsy (mean age: 11.6 years) and 19 age-matched controls participated in the study. Functional assessments included grip force, monofilament testing, and hand dexterity (Nine-Hole Peg, Jebsen-Taylor Hand Function). Tactile spatial perception involving the discrimination of pin patterns and movement-enhanced object recognition (stereognosis) were also assessed.

RESULTS

In the neonatal brachial plexus palsy group, significant deficits in the affected hand motor function were observed compared with the unaffected hand. Median monofilament scores were considered normal for both hands. In contrast, tactile spatial perception was impaired in the neonatal brachial plexus palsy group. This impairment was seen as deficits in both pin pattern and object recognition accuracy as well as the amount of time required to identify patterns and objects. Tactile pattern discrimination time significantly correlated with performance on both functional assessment tests (P < 0.01).

DISCUSSION

This study provides evidence that tactile perception deficits may accompany motor deficits in neonatal brachial plexus palsy even when measures of tactile registration (i.e., monofilament testing) are normal. These results may reflect impaired processing of somatosensory feedback associated with reductions in goal-directed upper limb use and illustrate the importance of including a broader range of sensory assessments in neonatal brachial plexus palsy.

Integrated Trauma Treatment in Drug Court: Combining EMDR Therapy and Seeking Safety

Trauma and co-occurring substance use disorders are disproportionately prevalent in individuals involved in the criminal justice system. The Thurston County Drug Court Program (TCDCP) in Washington State conducted a preliminary study with 220 participants arrested for nonviolent, felony drug-related crimes. All TCDCP participants were required to engage in a structured 12- to 18-month 3-phase program referred to as Program as Usual (PAU). Data was collected from 2004 to 2009 to investigate the efficacy of adding an “Integrated Trauma Treatment Program” (ITTP) component for those endorsing a Criterion A trauma history (68% of TCDCP). The ITTP combined 2 empirically supported trauma therapies in a phased, integrated approach: mandatory Seeking Safety groups followed by voluntary, individual eye movement desensitization and reprocessing (EMDR) therapy. The investigators hypothesized that trauma-specific treatment might improve existing program outcomes, including higher graduation rates and lower postprogram recidivism. One hundred twelve of the initial 150 participants endorsing trauma completed the Seeking Safety groups and were offered individual EMDR therapy. Of those 112, those who selected EMDR therapy (n = 65) graduated at a rate of 91%; those who declined (n = 47) graduated at 57%. Recidivism rates also differed among TCDCP graduates: PAU, 10%; graduates selecting EMDR therapy, 12%; and graduates declining EMDR, 33%. This article summarizes the literature, describes the ITTP program, reports on graduation rates and recidivism outcomes, and discusses possible differences between those who selected and those who declined EMDR therapy. The authors discuss the benefits of including EMDR therapy in drug court programs with recommendations for future research.

Effects of task context during standing reach on postural control in young and older adults: a pilot study

Reaching is an important component of daily activities with goals to interact and acquire objects in the environment. The task context of reaching, as determined by the behavioral goal and the properties of the object, can influence the control of posture and movements. This study examined age differences in postural stability during a forward reach under two task contexts, grasping versus pointing to a target. Young and older participants living in the community performed the tasks from the standing position. They reached forward, grasped or pointed to a target, and then returned to an upright posture as fast as possible. Postural stability was analyzed using the center of pressure (COP) during two phases of the task: the reaching movement phase and the returning movement phase. In the grasping context, the COP path deviations were significantly larger in older compare to young participants during both the reach and the return movement phases. In addition, during the return movement phase, only older participants showed a context-dependent increase in COP path deviations after grasping compared to pointing. The results highlight the impact of task context on postural stability during standing reach in young and older adults. Interventions for older adults with balance problems should consider incorporating activities that involve the interaction with objects of various properties in the environment. Future studies are necessary to investigate the factors underlying the person-environment interplay of postural control and the adaptation of anticipatory postural control associated with object interaction during functional tasks in older adults.

Deficits in elbow position sense in neonatal brachial plexus palsy

BACKGROUND

In neonatal brachial plexus palsy, sensory recovery is thought to exceed motor recovery with little attention paid to long-term assessment of proprioceptive ability. However, there is growing evidence that reduced somatosensory function frequently accompanies motor deficits as a result of activity-dependent changes in the central nervous system. Given the importance of proprioception in everyday motor activities, this study was designed to investigate position sense about the elbow joint in neonatal brachial plexus palsy.

METHODS

A convenience sample of seven individuals with neonatal brachial plexus palsy aged 9-17 years and in seven control individuals aged 10-16 years were recruited for the study. An elbow position matching task was used in which passive displacement of the forearm (reference arm) was reproduced with the same or opposite arm. In both conditions, matching was performed in the absence of vision and required utilization of position-related proprioceptive feedback.

RESULTS

Position-matching errors were significantly greater for the affected versus the unaffected arm when reproducing a reference position with the same arm. When matching was performed using the opposite arm, errors were dependent upon which arm served as the reference arm. When the unaffected arm served as the reference position, affected arm matching errors were not significantly different from control values. However, in the reverse situation, in which the unaffected arm relied on reference feedback from the affected arm, matching errors doubled compared with control values.

CONCLUSIONS

These results provide evidence that position sense is impaired in neonatal brachial plexus palsy and illustrate the importance of assessing proprioception in this population.

Age differences in the control of postural stability during reaching tasks

Reaching tasks are commonly performed during daily activities and require anticipatory postural adjustments (APAs) to ensure a stable posture during movement execution. Age-related changes in APAs may impact dynamic balance and cause postural instability during reaching tasks made from standing. The present study examined age differences in postural control during reaching to targets located at different heights. Fourteen young adults (aged 20.0±1.5 yrs) and 16 community-dwelling older adults (aged 73.4±5.3 yrs) participated in the study. The task involved reaching forward to grasp a cylinder, and returning to an upright position as fast and accurately as possible. Postural control was analyzed using the center of pressure (COP) during four phases of the task: COP displacement during APA production, COP trajectory smoothness during the reach and return phases, and COP path length during the recovery phase following movement. APA amplitude measured by COP displacement and COP path length during the recovery phase was larger in older compared to young adults. Dynamic balance represented by COP trajectory smoothness was reduced with age. In both age groups, APA amplitude was largest and COP trajectory smoothness the least during low target reaches. The results demonstrate that, while older adults can alter APAs in order to maintain postural stability, control of COP during movement execution, particularly during low target reaches, is compromised with aging. These findings have clinical implications for both the assessment of dynamic balance and the development of balance training programs.

Home-based telerehabilitation shows improved upper limb function in adults with chronic stroke: a pilot study

OBJECTIVE

This pilot study investigates the use of telerehabilitation to improve upper limb performance in chronic stages of stroke recovery.

DESIGN

Intervention study with pre/post/one month follow-up tests.

METHODS

Seven adults with chronic stroke participated in the study. Tests consisted of lab-based clinical and kinematic assessments. Participants completed the Upper Limb Training and Assessment (ULTrA) program at home. Training was 5 days/week, 60 min/day for 6 weeks with intermittent supervision of participants.

RESULTS

Participants showed improvements in the training program tasks as well as clinical and kinematic assessments. Results also suggest there may be auxiliary benefits in cognitive function.

CONCLUSIONS

A home-based telerehabilitation program is a viable approach to provide rehabilitation in chronic stages of stroke.

Mouse strain-dependent variation in obesity and glucose homeostasis in response to high-fat feeding

AIMS/HYPOTHESIS

Metabolic disorders are commonly investigated using knockout and transgenic mouse models. A variety of mouse strains have been used for this purpose. However, mouse strains can differ in their inherent propensities to develop metabolic disease, which may affect the experimental outcomes of metabolic studies. We have investigated strain-dependent differences in the susceptibility to diet-induced obesity and insulin resistance in five commonly used inbred mouse strains (C57BL/6J, 129X1/SvJ, BALB/c, DBA/2 and FVB/N).

METHODS

Mice were fed either a low-fat or a high-fat diet (HFD) for 8 weeks. Whole-body energy expenditure and body composition were then determined. Tissues were used to measure markers of mitochondrial metabolism, inflammation, oxidative stress and lipid accumulation.

RESULTS

BL6, 129X1, DBA/2 and FVB/N mice were all susceptible to varying degrees to HFD-induced obesity, glucose intolerance and insulin resistance, but BALB/c mice exhibited some protection from these detrimental effects. This protection could not be explained by differences in mitochondrial metabolism or oxidative stress in liver or muscle, or inflammation in adipose tissue. Interestingly, in contrast with the other strains, BALB/c mice did not accumulate excess lipid (triacylglycerols and diacylglycerols) in the liver; this is potentially related to lower fatty acid uptake rather than differences in lipogenesis or lipid oxidation.

CONCLUSIONS/INTERPRETATION

Collectively, our findings indicate that most mouse strains develop metabolic defects on an HFD. However, there are inherent differences between strains, and thus the genetic background needs to be considered carefully in metabolic studies.

Compromised encoding of proprioceptively determined joint angles in older adults: the role of working memory and attentional load

Perceiving the positions and movements of one's body segments (i.e., proprioception) is critical for movement control. However, this ability declines with older age as has been demonstrated by joint angle matching paradigms in the absence of vision. The aim of the present study was to explore the extent to which reduced working memory and attentional load influence older adult proprioceptive matching performance. Older adults with relatively HIGH versus LOW working memory ability as determined by backward digit span and healthy younger adults, performed memory-based elbow position matching with and without attentional load (i.e., counting by 3 s) during target position encoding. Even without attentional load, older adults with LOW digit spans (i.e., 4 digits or less) had larger matching errors than younger adults. Further, LOW older adults made significantly greater errors when attentional loads were present during proprioceptive target encoding as compared to both younger and older adults with HIGH digit span scores (i.e., 5 digits or greater). These results extend previous position matching results that suggested greater errors in older adults were due to degraded input signals from peripheral mechanoreceptors. Specifically, the present work highlights the role cognitive factors play in the assessment of older adult proprioceptive acuity using memory-based matching paradigms. Older adults with LOW working memory appear prone to compromised proprioceptive encoding, especially when secondary cognitive tasks must be concurrently executed. This may ultimately result in poorer performance on various activities of daily living.

Age-related declines in the detection of passive wrist movement

Age-related changes in proprioceptive ability and their contributions to postural instability have been well documented. In contrast, and despite the known importance of proprioceptive feedback in the control of coordinated arm and hand movement, studies focusing on upper limb proprioception in older populations are few and equivocal in their findings. This study focused on kinesthetic awareness about the wrist joint in healthy young and older adults. Passive movement detection thresholds (PMDTs) were twice as high in older compared to young participants. In contrast to previous findings demonstrating asymmetries in static position sense, PMDT did not differ between the dominant and non-dominant wrist joints nor did direction of joint displacement affect PMDT as has been reported for the lower limb. Preliminary analysis indicated that PMDT was significantly higher in older adults categorized as sedentary while active older adults were able to detect passive movement as well as young adults. These findings demonstrate that upper limb kinesthesia is impaired in older adults although the degree of impairment may be influenced by one's level of physical activity.

The effects of Internet-based home training on upper limb function in adults with cerebral palsy

BACKGROUND

While adults with hemiplegic cerebral palsy (CP) can have significant upper limb dysfunction, the effects of movement-based training has not been investigated.

OBJECTIVE

This uncontrolled trial assessed the effects of a home and internet-based upper limb intervention program targeting motor and sensory function.

METHODS

Twelve adults, aged 21 to 57 yrs, GMFCS levels I-III with asymmetric upper limb involvement participated in the Upper Limb Training and Assessment (ULTrA) program. Clinical and functional measures included the Motor Activity Log (MAL), the Nine-Hole Peg test, and grip strength. An upper limb training system consisting of a laptop, webcam, target light board, and hand manipulation/ discrimination devices was installed in each participant's home. Training occurred 40 min/day, 5 days/wk for 8 wks and included both unilateral and bilateral reach movements as well as a series of hand sensorimotor tasks such as card turning, stereognosis, and tactile discrimination. Data generated during each session were transmitted to the laboratory via the Internet.

MAIN OUTCOME MEASURES

were movement time, interlimb delay time, and performance on hand sensorimotor tasks.

RESULTS

Following training, affected limb reach movement time decreased significantly for unilateral and bilateral tasks. Interlimb delay during sequential reaching also decreased. Significant improvement in hand manipulation tasks was also seen. Compliance was excellent and there were no adverse effects.

CONCLUSION

The ULTrA program had beneficial effects for adults with CP and is safe and convenient to use. This system contrasts sharply with programs with similar intent that require participant travel and hours of therapist-based intervention.

A review of medication reconciliation issues and experiences with clinical staff and information systems

Medication reconciliation was developed to reduce medical mistakes and injuries through a process of creating and comparing a current medication list from independent patient information sources, and resolving discrepancies. The structure and clinician assignments of medication reconciliation varies between institutions, but usually includes physicians, nurses and pharmacists. The Joint Commission has recognized the value of medication reconciliation and mandated implementation in 2006; however, a variety of issues have prevented simple, easy, and universal implementation. This review references issues related to the development and the implementation of medication reconciliation including: - the need of a system or standard for accurate drug identification to create a definitive 'gold standard' patient medication list, - identifying stakeholders of medication reconciliation within the institution and contrasting staff interest and participation with institutional resources, - observations and opportunities of integrating medication reconciliation with the electronic patient health record, and - summarizing a series of institutions experiences developing and implementing medication reconciliation. Last, as medication reconciliation becomes a regular process within medical centers, key concepts for effective implementation are discussed.

Influence of task on interlimb coordination in adults with cerebral palsy

OBJECTIVE

To examine movement time and kinematic properties of unilateral and bilateral reaching movements in adults with cerebral palsy (CP), focusing on how different types of bilateral movements, simultaneous or sequential, may influence interlimb coordination.

DESIGN

Quantitative study using between-group repeated-measures analyses.

SETTING

Motor control laboratory at a research university.

PARTICIPANTS

Adults with hemiplegic CP (n=11; mean age ± SD, 33±10y; 4 men) and age-matched controls (mean age ± SD, 32±9y; 4 men).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Movement time (MT), maximum deviation from a straight trajectory to the target, and peak speed.

RESULTS

Although adults with hemiplegic CP showed strong unilateral deficits, bilateral simultaneous reaching movements were temporally and spatially coupled. Movement of the less affected arm slowed to match the movement of the more affected arm. In contrast, bilateral sequential movements improved MTs of the less affected and more affected arms.

CONCLUSIONS

Bilateral sequential movements were conducive to faster MT compared with unilateral or bilateral simultaneous movements. Training that includes bilateral sequential movements may be beneficial to adults with hemiplegic CP. Upper-limb movements are coordinated in a variety of ways to perform routine bilateral tasks. Some bilateral tasks, such as stacking boxes, require more symmetric movements of the upper limbs. Other bilateral tasks, such as opening the refrigerator with 1 hand while placing an item on the shelf with the other hand, emphasize coordinated sequential action between upper limbs. Despite the prevalence of integrative upper-limb use, the control of different forms of bilateral movement is not well understood. A more comprehensive knowledge of upper-limb bilateral movements may hold important implications for developing more effective upper-limb movement therapies.

Upper limb asymmetries in the perception of proprioceptively determined dynamic position sense

Recent studies of position-related proprioceptive sense have provided evidence of a nonpreferred left arm advantage in right-handed individuals. The present study sought to determine whether similar asymmetries might exist in "dynamic position" sense. Thirteen healthy, right-handed adults were blindfolded and seated with arms placed on instrumented manipulanda. In Part 1, subjects performed dynamic position matching of 3 target elbow amplitudes determined with the preferred or nonpreferred arm, and then matched during movement of the same or opposite elbow. In Part 2, a similar paradigm was used, but with varying target determination speeds to account for the so called "tau effect." Overall, it was found that errors were smaller when the matching phase involved the nonpreferred arm, especially for larger target amplitudes. This asymmetry was independent of the tau effect and likely reflects specialization of the right hemisphere/left arm for proprioceptive feedback processing that is either position- or dynamic position-related.

Where was my arm again? Memory-based matching of proprioceptive targets is enhanced by increased target presentation time

Our sense of proprioception is vital for the successful performance of most activities of daily living, and memory-based joint position matching (JPM) tasks are often utilized to quantify such proprioceptive abilities. In the present study we sought to determine if matching a remembered proprioceptive target angle was influenced significantly by the length of time given to develop a neural representation of that position. Thirteen healthy adult subjects performed active matching of passively determined elbow joint angles (amplitude = 20 degrees or 40 degrees extension) in the absence of vision, with either a relatively "short" (3 s) or "long" (12 s) target presentation time. In the long condition, where subjects had a greater opportunity to develop an internal representation of the target elbow joint angle, matching movements had significantly smaller variable errors and were associated with smoother matching movement trajectories of a shorter overall duration. Taken together, these findings provide an important proprioceptive corollary for previous results obtained in studies of visually-guided reaching suggesting that increased exposure to target sensory stimuli can improve the accuracy of matching performance. Further, these results appear to be of particular importance with respect to the estimation of proprioceptive function in individuals with disability, who typically have increased noise in their proprioceptive systems.

Characterization of Amylolytic Enzymes, Having Both alpha-1,4 and alpha-1,6 Hydrolytic Activity, from the Thermophilic Archaea Pyrococcus furiosus and Thermococcus litoralis

Extracellular pullulanases were purified from cell-free culture supernatants of the marine thermophilic archaea Thermococcus litoralis (optimal growth temperature, 90 degrees C) and Pyrococcus furiosus (optimal growth temperature, 98 degrees C). The molecular mass of the T. litoralis enzyme was estimated at 119,000 Da by electrophoresis, while the P. furiosus enzyme exhibited a molecular mass of 110,000 Da under the same conditions. Both enzymes tested positive for bound sugar by the periodic acid-Schiff technique and are therefore glycoproteins. The thermoactivity and thermostability of both enzymes were enhanced in the presence of 5 mM Ca, and under these conditions, enzyme activity could be measured at temperatures of up to 130 to 140 degrees C. The addition of Ca also affected substrate binding, as evidenced by a decrease in K(m) for both enzymes when assayed in the presence of this metal. Each of these enzymes was able to hydrolyze, in addition to the alpha-1,6 linkages in pullulan, alpha-1,4 linkages in amylose and soluble starch. Neither enzyme possessed activity against maltohexaose or other smaller alpha-1,4-linked oligosaccharides. The enzymes from T. litoralis and P. furiosus appear to represent highly thermostable amylopullulanases, versions of which have been isolated from less-thermophilic organisms. The identification of these enzymes further defines the saccharide-metabolizing systems possessed by these two organisms.

Purification and characterization of a highly thermostable glucose isomerase produced by the extremely thermophilic eubacterium, Thermotoga maritima

Thermotoga maritima, among the most thermophilic eubacteria currently known, produces glucose isomerase when grow in the presence of xylose. The purified enzyme is a homotetramer with submit molecular Wight of about 45,000. It has a number of features in common with previously described glucose isomerases-pH optimum of 6.5 to 7.5, presence of active-site histidine, requirement for metal cations such as Co(2+) and Mg(2+), and preference for xylose as substrate. In addition, it has significant sequence/structural homology with other glucose isomerases, as shown by both N-terminal sequencing and immunological crossreactivity. The T. maritima enzyme is distinguished by its extreme thermostability-a temperature optimum of 105 to 110 degrees C, and an estimated half-life of 10 minutes at 120 degrees C, pH 7.0. The high degree of thermostability, coupled with a neutral to slightly acid pH optimum, reveal this enzyme to be a promising candidate for improvement of the industrial glucose isomerization process.

Timing and the control of rhythmic upper-limb movements

Accurate timing of limb displacement is crucial for effective motor control. The authors examined the effects of movement velocity, duration, direction, added mass, and auditory cueing on timing, spatial, and trajectory variability of single- and multijoint rhythmic movements. During single-joint movements, increased velocity decreased timing and spatial variability, whereas increased movement duration increased timing variability but decreased spatial variability. For multijoint movements, regardless of condition, increasing velocity decreased joint timing, spatial, and trajectory variability, but all hand variabilities were unaffected by velocity, duration, load, or direction. Timing, spatial, and trajectory variability was greater at the shoulder compared with the elbow and minimal at the hand, supporting the notion that reaching movements are planned in hand space as opposed to joint space.

Differential effects of acute and repeat dosing with the H3 antagonist GSK189254 on the sleep-wake cycle and narcoleptic episodes in Ox-/- mice

BACKGROUND AND PURPOSE

Histamine H3 receptor antagonists are currently being evaluated in clinical trials for a number of central nervous system disorders including narcolepsy. These agents can increase wakefulness (W) in cats and rodents following acute administration, but their effects after repeat dosing have not been reported previously.

EXPERIMENTAL APPROACH

EEG and EMG recordings were used to investigate the effects of acute and repeat administration of the novel H3 antagonist GSK189254 on the sleep-wake cycle in wild-type (Ox+/+) and orexin knockout (Ox-/-) mice, the latter being genetically susceptible to narcoleptic episodes. In addition, we investigated H3 and H1 receptor expression in this model using radioligand binding and autoradiography.

KEY RESULTS

In Ox+/+ and Ox-/- mice, acute administration of GSK189254 (3 and 10 mg x kg(-1) p.o.) increased W and decreased slow wave and paradoxical sleep to a similar degree to modafinil (64 mg x kg(-1)), while it reduced narcoleptic episodes in Ox-/- mice. After twice daily dosing for 8 days, the effect of GSK189254 (10 mg x kg(-1)) on W in both Ox+/+ and Ox-/- mice was significantly reduced, while the effect on narcoleptic episodes in Ox-/- mice was significantly increased. Binding studies revealed no significant differences in H3 or H1 receptor expression between Ox+/+ and Ox-/- mice.

CONCLUSIONS AND IMPLICATIONS

These studies provide further evidence to support the potential use of H3 antagonists in the treatment of narcolepsy and excessive daytime sleepiness. Moreover, the differential effects observed on W and narcoleptic episodes following repeat dosing could have important implications in clinical studies.

Characterization of histamine H3 receptors in Alzheimer's Disease brain and amyloid over-expressing TASTPM mice

BACKGROUND AND PURPOSE

Histamine H3 receptor antagonists are currently being evaluated for their potential use in a number of central nervous system disorders including Alzheimer's Disease (AD). To date, little is known about the state of H3 receptors in AD.

EXPERIMENTAL APPROACH

In the present study we used the radiolabelled H3 receptor antagonist [3H]GSK189254 to investigate H3 receptor binding in the amyloid over-expressing double mutant APPswe x PSI.MI46V (TASTPM) transgenic mouse model of AD and in post-mortem human AD brain samples.

KEY RESULTS

No significant differences in specific H3 receptor binding were observed between wild type and TASTPM mice in the cortex, hippocampus or hypothalamus. Specific [3H]GSK189254 binding was detected in sections of human medial frontal cortex from AD brains of varying disease severity (Braak stages I-VI). With more quantitative analysis in a larger cohort, we observed that H3 receptor densities were not significantly different between AD and age-matched control brains in both frontal and temporal cortical regions. However, within the AD group, [3H]GSK189254 binding density in frontal cortex was higher in individuals with more severe dementia prior to death.

CONCLUSIONS AND IMPLICATIONS

The maintenance of H3 receptor integrity observed in the various stages of AD in this study is important, given the potential use of H3 antagonists as a novel therapeutic approach for the symptomatic treatment of AD.

Dynamic proprioceptive target matching behavior in the upper limb: effects of speed, task difficulty and arm/hemisphere asymmetries

Although proprioception consists of static (i.e. position) and dynamic (i.e. movement) components, most studies regarding the matching of proprioceptive targets have focused only on position. Further, these position-matching studies have recently indicated that proprioceptive ability is influenced by several factors including task difficulty and arm preference. The purpose of the present study, therefore, was to quantify the matching of dynamic proprioceptive target arm movements under different matching conditions. Using torque motor-driven manipulanda, 11 blindfolded, right-handed adults experienced triangular velocity profiles at 2 different peak speeds (30 degrees /s or 60 degrees /s) with the preferred and non-preferred elbow. Subjects then matched the dynamics of these target movements with either the same (ipsilateral remembered) or opposite (contralateral remembered) elbow. Matching errors were generally larger for the more difficult, contralateral remembered versus ipsilateral remembered task, and for greater target speed conditions. One arm difference was found indicating a non-preferred arm advantage for the matching of average target acceleration in the ipsilateral remembered condition. Overall, these results demonstrate that dynamic proprioceptive feedback-matching performance is influenced by several factors including peak speed, task difficulty and limb preference.

A case of paraneoplastic cerebellar ataxia secondary to renal cell carcinoma

A 64-year-old female patient presented with acute cerebellar ataxia. After ruling out vascular, infectious, metastatic, demyelinating, and medication etiologies, a paraneoplastic origin for her illness was determined. A renal mass was discovered and found to be renal cell carcinoma. Her symptoms resolved after a radical nephrectomy. Physicians should consider the diagnosis of paraneoplastic neurologic syndromes whenever a thorough evaluation fails to explain neurologic abnormalities.

Upper Limb Asymmetries in the Matching of Proprioceptive Versus Visual Targets

The purpose of the current study was to determine the extent to which “sensory dominance” exists in right-handers with respect to the utilization of proprioceptive versus visual feedback. Thirteen right-handed adults performed two target-matching tasks using instrumented manipulanda. In the proprioceptive matching task, the left or right elbow of blindfolded subjects was passively extended by a torque motor system to a target position and held for 3 s before being returned to the start position. The target angle was then matched with either the ipsilateral or contralateral arm. In the second task, visual matching, circular targets were briefly projected to either side of a visual fixation point located in front of the subject. Subjects then matched the target positions with a laser pointer by moving either the ipsilateral or contralateral arm. Overall, marked arm differences in accuracy were seen based on the type of sensory feedback used for target presentation. For the proprioceptive matching task errors were smaller for the nonpreferred left arm, whereas during the visual matching task smaller errors were found for the preferred right arm. These results suggest a left arm/right hemisphere advantage for proprioceptive feedback processing and a right arm/left hemisphere advantage for visual information processing. Such asymmetries may reflect fundamental differences between the two arm/hemisphere systems during the performance of bimanual tasks where the preferred arm requires visual guidance to manipulate an object, whereas the nonpreferred stabilizes that object on the basis of proprioceptive feedback.

Discovery of a novel indole series of EP1 receptor antagonists by scaffold hopping

We describe the medicinal chemistry approach that generated a novel indole series of EP(1) receptor antagonists. The SAR of this new template was evaluated and culminated in the identification of compound 12g which demonstrated in vivo efficacy in a preclinical model of inflammatory pain.

Age-related differences in upper limb proprioceptive acuity

Although upper limb movements are known to be slower and more variable in elderly persons, the extent to which these changes are associated with deficits in movement-related sensory feedback is poorly understood, despite the importance of proprioception in the control of skilled movement. Age-related changes were examined with 22 participants (10 of M age 27 years and 12 of M age 75 years) in performance of an elbow position-matching task which varied in terms of interhemispheric transfer and/or the need to retrieve memory-based proprioceptive information. Matching errors were significantly greater, and movements more prolonged, and irregular in their time course in the elderly group than in the young group. Impaired performance in conditions requiring interhemispheric transfer and retrieval of memory-based proprioceptive information reflected the importance of cognitive processing during complex sensorimotor tasks. This novel matching paradigm provided a sensitive means of manipulating the demands of the task and may be an effective method for as sessing both cognitive and sensorimotor declines associated with aging.