1/3. Motor unit involvement in spastic paresis. Relationship between leg muscle activation and histochemistry.In 4 patients with spastic hemiparesis the electromyograms (EMG) of leg muscles were recorded during walking and the gastrocnemius medialis on both sides was investigated by histochemistry and morphometry. During walking a reciprocal mode of muscle activation was preserved on the spastic side, but the EMG amplitude was reduced. In one patient the discharge behaviour of single motor units was investigated during stance. The mean discharge rate on both the spastic and the unaffected side amounted to about 5.5 Hz. Modification of this rate over a wider range by manoeuvres of the trunk was only observed on the unaffected side. Histochemistry and morphometry of the spastic muscle revealed: Increased levels of muscle fibre atrophy (especially type II); A predominance of type I fibres during later stages, when spasticity was established; Structural changes, such as the appearance of target fibres, mainly in type I fibres. These results suggest that the low level of tonic activation in spastic muscle develops tension enough during the stance phase of gait to support the body. The histopathological profile of the spastic gastrocnemius muscle is considered to be indicative of denervation, due to the combined effects of an impaired supraspinal control of the lower motoneurone and a concurrent transsynaptic muscle membrane dysfunction, muscle cell atrophy and fibre type transformation.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/3. head-position training through biofeedback: prosthetic or cure?This report investigates the effectiveness of biofeedback in the treatment of poor head-positioning in patients with cerebral palsy. Four patients were given feedback of head-position trainer: two were given 20 sessions, the other two were given 10 sessions followed by 10 sessions of social reinforcement. It was found that biofeedback produced significant changes in head control during therapy but that these did not transfer well to other situations, nor did it result in long-term positive improvement. The use of social reinforcement produced excellent and long-term gains. These results are discussed in terms of stimulus properties and reinforcement conditions. General implications of this study in relation to the generalisation and maintenance of behaviour change are also discussed.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/3. Late cognitive and behavioural improvement following treatment of disabling orthopaedic complications of a severe closed head injury.Interactions of physical, emotional, cognitive and behavioural impairments after severe closed head injury (CHI) remain poorly understood. A 47-year-old man was referred to our department 13 months after a severe CHI. He demonstrated severe left hemiplegia and disabling orthopaedic complications (left hip infectious arthritis, after surgical treatment for heterotopic ossification). His hip was blocked and extremely painful. He was totally dependent for daily-life activities (Functional Independence Measure (FIM) score = 18). Moreover he exhibited severe cognitive and behavioural troubles, which had been stable for many months beforehand, e.g. complete disorientation for time and place, major memory disorders, agitation, anxiety, depression, irritability, disinhibition, aggressiveness and lack of initiative. pain disappeared within a few weeks after treatment. Progressively, functional improvement occurred (sitting position, transfers, walking between parallel bars). The FIM score increased to 63. Aggressiveness, irritability and agitation disappeared. Surprisingly, neuropsychological assessment demonstrated parallel improvement of cognitive functions, especially in regard to orientation, and to a lesser degree attention and memory. Such an observation should encourage use of active treatment of physical disabilities, even in patients presenting with an apparently poor cognitive prognosis at a late stage of severe CHI.- - - - - - - - - - ranking = 6keywords = behaviour (Clic here for more details about this article) |