1/8. Hyper-reflexia without spasticity after unilateral infarct of the medullary pyramid.Whether or not a lesion confined to the pyramidal tract produces spasticity in humans remains an unresolved controversy. We have studied a patient with an ischemic lesion of the right medullary pyramid, using objective measures of hyper-reflexia, spasticity, and weakness. Electromyographic activity (EMG) of the biceps muscles was recorded under the following conditions: (1) in response to a tendon tap with an instrumental reflex hammer, (2) in response to imposed quick stretch with motion analysis, and (3) during an isometric holding task. Hyper-reflexia of the involved arm in response to tendon tap was shown to be due primarily to an increase in the gain of the reflex arc. No velocity-dependent increase in the response to quick stretch of the involved arm was present. This was consistent with the absence of detectable spasticity on the clinical exam. These findings suggest that a lesion confined to the medullary pyramid can give rise to weakness and hyper-reflexia without causing spasticity. Moreover, these findings suggest that different anatomical substrates may underlie the clinical phenomena of hyper-reflexia and spasticity.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/8. Chronic subdural hematoma with vasogenic edema in the cerebral hemisphere--case report.An 80-year-old male with a history of hypertension presented with chronic subdural hematoma manifesting as progressive consciousness disturbance and left hemiparesis. T1-weighted and fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging showed a fresh hematoma in the right subdural space with a midline shift of 15 mm. FLAIR and diffusion-weighted imaging showed a hyperintense area in the right paraventricular white matter compressed by the hematoma. Apparent diffusion coefficients (ADCs) corresponding to the hyperintense area in the central area of the affected cerebral hemisphere on FLAIR images were measured before and one month after the operation. The motion probing gradient was applied in the right-left direction to the body axis. Since the central area in the cerebrum includes nerve fibers perpendicular to the direction of the gradient, the measured ADC appeared to be anisotropic. Preoperative ADC in the right paraventricular white matter was anisotropic and greater than in age-matched normal subjects, so the edema was identified as the vasogenic type. The edema in the right paraventricular white matter resolved promptly with improvement of the midline shift and normalization of the ADC.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/8. "Fou rire prodromique" as the presentation of pontine ischaemia secondary to vertebrobasilar stenosis."Fou rire prodromique" (prodrome of crazy laughter) is a rare form of pathological laughter of uncertain pathophysiology. A patient is presented with pathological laughter as the first manifestation of pontine ischaemia due to vertebrobasilar stenosis. A 65 year old man developed uncontrollable and unemotional laughter for almost an hour followed by transient right facial-brachial paresis. He had fluctuation of laughter, right facial brachial paresis, and occasional crying. magnetic resonance imaging, magnetic resonance angiogram (MRA), and an angiogram showed small left pontine and cerebellar infarcts, left vertebral artery occlusion, and right vertebral and basilar artery stenosis. His condition deteriorated to bilateral brain stem infarction and he died. Necropsy confirmed the extensive brain stem infarction. Pathological laughter can be the very first presenting manifestation of ischaemia of the ventrotegmental junction of the upper pons. It is hypothesised that the pathological laughter in this patient was secondary to ischaemic ephaptic stimulation of the descending corticopontine/ bulbar pathways.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/8. BalanceReTrainer: a new standing-balance training apparatus and methods applied to a chronic hemiparetic subject with a neglect syndrome.In this paper we present a mechanical apparatus and methods named BalanceReTrainer for standing-balance training in neurologically impaired individuals. BalanceReTrainer provides an impaired individual with a fall-safe balancing environment, where the balancing efforts of a standing individual are augmented by stabilizing forces acting at the level of pelvis in the sagittal and frontal planes of motion, assisting the balancing activity ankle and hip muscles and at the level of shanks, assisting the knee extensor muscles. A range of different levels of supporting forces is generated by passive, compliant means. Additionally, movement in the sagittal and frontal planes, acquired by transducers is fed to an electronic interface which transforms the current inclinations into a computer mouse signals, which are interfaced to a personal computer (PC) where balance training and evaluation program is running. The level of stiffness support and level of difficulty of computer task can be selected according to current balancing abilities of the impaired individual. We further present results of a case study where an ambulatory chronic hemiparetic subject with neglect syndrome received ten days of balance training on BalanceReTrainer. Biomechanical evaluation of weight-shifting activity before and after treatment shows a substantial functional improvement.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/8. Simulation of bilateral movement training through mirror reflection: a case report demonstrating an occupational therapy technique for hemiparesis.In rehabilitation for hemiparesis, one of the goals of an occupational therapist is to practice upper extremity tasks with the recovering individual. The practice is intended to strengthen muscles and refine movements. It also provides examples for the recovering body and brain as they attempt to reestablish the now delicate cognitive and neural connections mediating voluntary behavior. However, the paresis significantly limits the movement sequence possibilities that may be physically practiced. We outline a method for using simulation of movement, which is intended to provide a means for experiencing a range of smooth and controlled movements completed by a paretic limb. The simulation provides a compelling perceptual experience of bilateral motion beyond the current capabilities of the affected limb. The benefits of this technique after a 3-week course of the simulation practice are exemplified by the presented case study that reveals improved function as demonstrated by increases in Fugl-Meyer scores and faster movement speeds as demonstrated by decreased movement times for the Jebsen test of hand function.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/8. Motor imagery for gait rehabilitation in post-stroke hemiparesis.BACKGROUND AND PURPOSE: Reports have described the contribution of motor imagery (MI) practice for improving upper-extremity functions in patients with hemiparesis following stroke. The purpose of this case report is to describe the use of MI practice to attempt to improve walking in an individual with hemiparesis. CASE DESCRIPTION: A 69-year-old man with left hemiparesis received MI gait practice for 6 weeks. Intervention focused on task-oriented gait and on impairments of the affected lower limb. Preintervention, midterm, postintervention, and follow-up measurements of temporal-distance stride parameters and sagittal kinematics of the knee joint were taken. MAIN OUTCOMES: At 6 weeks postintervention, the patient had a 23% increase in gait speed and a 13% reduction in double-support time. An increase in range of motion of the knees also was observed. No changes in gait symmetry were noted. DISCUSSION: The outcomes suggest that MI may be useful for the enhancement of walking ability in patients following stroke. Because improvement was mainly in temporal-distance gait variables and knee movement, imagery practice probably should focus on its specific impairments during gait in order to affect the performance of the paretic lower extremity.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/8. Negative emotions and anosognosia.patients with anosognosia fail to acknowledge, or feel distressed by, their disability. Given the recent suggestion that right (frontal) systems are selectively involved in negative emotions, it might be claimed that anosognosia results from a disruption in negative emotions. This is not consistent with the finding that some anosognosic patients exhibit substantial fluctuations in emotion, including the experience of negative emotions such as sadness. The present study investigates a patient (IW) with a right convexity lesion and anosognosia. He reported being frequently overcome by powerful emotions, especially sadness. IW was assessed on a self-report emotion questionnaire, where his reports were typically of higher levels of emotion than the control group. He was also assessed on the more indirect measure of Affective Story Recall. Here his pattern of emotional experience was similar to that of two control groups, one of which consisted of non-anosognosic patients with hemiparesis. His performance on Story Recall was notable in that he directed his emotions to a different 'object' to that of controls (other vs. self, respectively). These findings are not consistent with any claim that anosognosia results from an absence of negative emotions.- - - - - - - - - - ranking = 14keywords = motion (Clic here for more details about this article) |
8/8. paraparesis associated with mild congenital kyphoscoliosis in an adult.A 48-year-old man suffering from paraparesis had congenital kyphoscoliosis due to fused wedged vertebrae between T2 and T4. The kyphoscoliosis consisted of left convex scoliosis measuring 26 degrees and kyphosis measuring 27 degrees. On CT-myelograms and axial MR images, the dura and spinal cord were deviated anterolaterally to the concave side of the curve around its apex. The spinal cord was stuck and flattened against the posterolateral margin of the vertebral body to the base of the pedicle with the posterior subarachnoid space preserved. Anterior decompression from the concave side through a transthoracic approach resulted in a remarkable neurological improvement. The paraparesis may have been caused by compression of the spinal cord through a tethering effect due to its developmental tightness around the apical vertebra and the additional tension created by motions of the neck.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |