The presymptomatic stages of frontotemporal dementia (FTD) are still poorly defined and encompass a long accrual of progressive biological (preclinical) and then clinical (prodromal) changes, ...antedating the onset of dementia. The heterogeneity of clinical presentations and the different neuropathological phenotypes have prevented a prior clear description of either preclinical or prodromal FTD. Recent advances in therapeutic approaches, at least in monogenic disease, demand a proper definition of these predementia stages. It has become clear that a consensus lexicon is needed to comprehensively describe the stages that anticipate dementia. The goal of the present work is to review existing literature on the preclinical and prodromal phases of FTD, providing recommendations to address the unmet questions, therefore laying out a strategy for operationalizing and better characterizing these presymptomatic disease stages.
Non-ambulatory people with severe motor impairments due to chronic neurological diagnoses are forced into a sedentary lifestyle. The purpose of this scoping review was to understand the type and ...amount of physical activity interventions performed in this population as well as their effect.
PubMed, Cochran and CINAHL Complete were systematically searched for articles describing physical activity interventions in people with a chronic, stable central nervous system lesion. The outcome measures needed to include physiological or psychological variables, measures of general health or quality of life.
Of the initial 7554 articles, 34 were included after the title, abstract, and full-text screening. Only six studies were designed as randomized-controlled trials. Most interventions were supported by technologies, mainly functional electrical stimulation (cycling or rowing). The duration of the intervention ranged from four to 52 weeks. Endurance and strength training interventions (and a combination of both) were performed and over 70% of studies resulted in health improvements.
Non-ambulatory people with severe motor impairments may benefit from physical activity interventions. However, the number of studies and their comparability is very limited. This indicates the need for future research with standard measures to develop evidence-based, specific recommendations for physical activity in this population.
Key messages
Physical activity interventions can have health benefits in non-ambulatory people with severe motor impairments.
Even simple, low-tech interventions allow for health-enhancing training.
Purpose:
Cross-cultural adaptation of the Pediatric Balance Scale (PBS) into Greek.
Methods:
The PBS was forward-back translated and evaluated for content equivalence. The Greek PBS (PBS
GR
) was ...administered to children with movement impairments by 2 pediatric physical therapists. The scale was readministered to the same children after 3 weeks (test-retest reliability) and to children with typical development for discriminant validity. The 1-minute walk test was administered to test the scale's concurrent validity.
Results:
Psychometric testing was completed on 26 children with movement impairments. The scale had excellent interrater and test-retest reliability and internal consistency. Moderate correlation was observed between PBS
GR
and 1-minute walk. Children with movement impairment had significantly lower PBS
GR
scores than children with typical development.
Conclusions:
Acceptable reliability, concurrent validity, and discriminant validity were observed for the PBS
GR
.
Per- and polyfluoroalkyl substances (PFAS) are believed to impair early neurodevelopment and disrupt thyroid hormone (TH) levels. However, there are limited epidemiological data on the ...neurodevelopmental effects in infancy of prenatal PFAS exposure and the potential mediating effects of TH.
To evaluate potential associations between prenatal PFAS exposure and early neurodevelopmental deficiencies, and assess mediator effects of TH.
From 2010 to 2013, 274 mother-infant pairs were recruited to the Laizhou Wan Birth Cohort in China. Ten PFAS and five TH were measured in cord serum. Developmental quotient (DQ) from 5 domains (adaptive, social, language, gross and fine motor) was assessed using Gesell Developmental Schedules for each child at 1 year of age. The associations between PFAS and DQs were evaluated using multivariable linear regressions. TH-mediated effects of PFAS on DQs were calculated by mediation analyses.
Among our study population, PFAS exposures were common and associated with DQ decrement in infants. For each 10-fold increase in PFBS concentrations, gross motor and adaptive DQ decreased by 8.56 (95%CI: −15.15, −1.97) and 5.87 (95%CI: −8.07, −3.67) points, respectively. TSH mediated 12.90% of the association of PFBS with gross motor DQ and FT4 explained 19.63% of the association of PFBS with adaptive DQ. The negative association was also found between PFHxS exposure and gross motor DQ (β = 8.14, 95%CI: −15.39, −0.98).
PFBS and PFHxS were negatively associated with early neurodevelopment, especially consistent in gross motor domain. The associations were partly explained by TSH and FT4.
•The relationship between PFAS exposure, thyroid hormones and infant neurodevelopment were assessed in a Chinese birth cohort.•Prenatal PFHxS and PFBS exposure were associated with lower gross motor DQ, especially in males.•TSH and FT4 partly mediated the association of PFBS with DQ in several neurodevelopmental domains at 1 year of life.
Acute alcohol responses such as tolerance to alcohol-induced motor impairment and heightened sensitivity to alcohol-induced disinhibition are associated with heavier drinking. Additionally, certain ...cognitive characteristics may also indicate problem-drinking. For example, cognitive and emotional preoccupation (CEP) with alcohol is associated with heavier drinking. However, it is not clear if cognitive markers have value as predicators of heavier drinking beyond that of well-established alcohol response markers. The current study sought to test the predictive potential of CEP in the context of two well-documented alcohol response markers of heavy drinking.
Data aggregated from three studies comprised a sample of 94 young adult drinkers with no history of alcohol use disorder. Participants’ motor coordination (grooved pegboard) and behavioral disinhibition (cued go/no-go) were assessed following consumption of 0.65g/kg alcohol and a placebo. CEP was measured via the Temptation and Restraint Inventory (TRI).
Drinkers who expressed both alcohol response markers reported drinking higher doses regardless of their level of CEP. Among drinkers who expressed low sensitivity to both disinhibition and motor impairment, higher CEP was associated with higher typical quantities. Low sensitivity to motor impairment functioned as a standalone marker of heavier drinking.
The findings suggest that a combination of tolerance to motor impairment and high alcohol-induced disinhibition may be sufficient to promote heavier consumption even in the absence of cognitive markers associated with problem drinking. Results also suggest that cognitive characteristics may drive early drinking and contribute to the development of tolerance to acute alcohol effects.
•Co-expression of cognitive and alcohol response markers linked to drinking habits.•High disinhibition and low motor impairment associated with heavier drinking.•This was true even in the absence of cognitive and emotional preoccupation (CEP).•For drinkers with low sensitivities, higher CEP was linked to heavier drinking.•CEP may increase drinking and contribute to later expression of response markers.
This Joel A. DeLisa Lecture on endovascular brain-computer interfaces was presented by Dr Thomas Oxley on February 23, 2023, at the Association of Academic Physiatrists Annual Scientific Meeting. The ...lecture described how brain-computer interfaces replace lost physiological function to enable direct communication between the brain and external digital devices, such as computers, smartphones, and robotic limbs. Specifically, the potential of a novel endovascular brain-computer interface technology was discussed. The brain-computer interface uses a stent-electrode array delivered via the jugular vein and is permanently implanted in a vein adjacent to the motor cortex. In a first-in-human clinical trial, participants with upper limb paralysis who received the endovascular brain-computer interface could use the system independently and at home to operate laptop computers for various instrumental activities of daily living. A Food and Drug Administration-approved trial of the endovascular brain-computer interface in the United States is in progress. Future development of the system will provide recipients with continuous autonomy through digital access with minimal caregiver assistance. Physiatrists and occupational therapists will have a vital role in helping people with paralysis achieve the potential of implantable brain-computer interfaces.
Outcome measurement fidelity within and between sites of multi-site, randomized, clinical trials is an essential element to meaningful trial outcomes. As important are the methods developed for ...randomized, clinical trials that can have practical utility for clinical practice. A standardized measurement method and rater training program were developed for the total Fugl-Meyer motor and sensory assessments; inter-rater reliability was used to test program effectiveness.
Fifteen individuals with hemiparetic stroke, 17 trained physical therapists across 5 regional clinical sites, and an expert rater participated in an inter-rater reliability study of the Fugl-Meyer motor (total, upper extremity, and lower extremity subscores) and sensory (total, light touch, and proprioception subscores) assessments.
Intra-rater reliability for the expert rater was high for the motor and sensory scores (range, 0.95-1.0). Inter-rater agreement (intraclass correlation coefficient, 2, 1) between expert and therapist raters was high for the motor scores (total, 0.98; upper extremity, 0.99; lower extremity, 0.91) and sensory scores (total, 0.93; light touch, 0.87; proprioception, 0.96).
Standardized measurement methods and training of therapist assessors for a multi-site, rehabilitation, randomized, clinical trial resulted in high inter-rater reliability for the Fugl-Meyer motor and sensory assessments. Poststroke sensorimotor impairment severity can be reliably assessed for clinical practice or rehabilitation research with these methods.
Cognitive impairment is among the most frequent non-motor symptoms in Parkinson's disease (PD). To clear the characteristics of cognitive impairment in patient with PD may be critical for the ...planning of effective rehabilitation interventions. However, a few studies have sought to investigate relationship between cognitive impairment and motor functions. The purpose of this study was to compare cognitive impairment of PD patients in relation to the motor impairment severity according to Hoehn and Yahr (HY) stages.
The subjects of this study were 78 patients with PD (33 males and 45 females). The Cognitive function was assessed using the Wechsler Adult Intelligent Scale-III (WAIS-III) and Wechsler Memory Scale-Revised (WMS-R). The HY scale was used to evaluate the motor impairment severity as I (no disability, n=11), II (mild, n=34), III (moderate, n=26), or IV–V (severe, n=7). The Kruskal–Wallis test was used to compare the cognitive impairment the between HY groups.
The difference in performance intelligence quotient (PIQ) of WAIS-III (I: 105.6±8.6, II: 94.9±17.7, III: 91.5±14.3, IV–V: 82.9±8.2) and general memory quotient (GMQ) of WMS-R (I: 105.5±14.4, II: 91.8±15.6, III: 90.0±18.2, IV–V: 86.1±13.0) between groups were significant, scores of IV-V stage were lowest. There were statistically significant differences in processing speed index and verbal memory quotient among the groups. The difference in other measurements was not significant the between groups.
Our present findings indicated that the cognitive impairment was observed in deterioration of the motor impairment in PD patients. Specifically, in the factor scale level, the low processing speed index and the low verbal memory quotient reduced each of the PIQ and GMQ in the lowest HY group patients. Therefore, we suggest that a careful assessment of cognitive impairments, especially processing speed and verbal memory, is important in identifying appropriate interventions for PD with severe stage.
Background. Upper-limb impairment in patients with chronic stroke appears to be partly attributable to an upregulated reticulospinal tract (RST). Here, we assessed whether the impact of corticospinal ...(CST) and RST connectivity on motor impairment and skill-acquisition differs in sub-acute stroke, using transcranial magnetic stimulation (TMS)–based proxy measures. Methods. Thirty-eight stroke survivors were randomized to either reach training 3-6 weeks post-stroke (plus usual care) or usual care only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and contralesional cortical connectivity (surrogates for CST and RST connectivity, respectively) to weak pre-activated triceps and deltoid muscles with single pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity Index) and synergies (Fugl-Meyer upper-limb score). Results. Strength and presence of synergies were associated with ipsilesional (CST) connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar reaching skill beyond that expected from spontaneous recovery and occurred for both weak and strong ipsilesional tract integrity. Reaching ability, presence of synergies, skill-acquisition and strength were not affected by either the presence or absence of contralesional (RST) connectivity. Conclusion. The degree of ipsilesional CST connectivity is the main determinant of proximal dexterity, upper-limb strength and synergy expression in sub-acute stroke. In contrast, there is no evidence for enhanced contralesional RST connectivity contributing to any of these components of impairment. In the sub-acute post-stroke period, the balance of activity between CST and RST may matter more for the paretic phenotype than RST upregulation per se.
PDF
