The purpose of the research described in this article is to study the effects of severe motor impairments on a person’s well-being, by attempting to throw light upon the inconsistencies found in the ...previous literature, which are due to problems of a conceptual and methodological nature. The data were gathered during the Tetrafigap survey on the long-term outcome of tetraplegic persons in France. This survey involved 1668 tetraplegic spinal cord injured people. We examine the relationships between the overall assessment of well-being as expressed by the people interviewed, and a range of clinical, social and psycho-social factors. A progressive approach, along with the use of adjustments via linear regressions, has allowed us to identify certain confounding factors, and to analyse the respective effects of the different types of variables studied. Thus current age, the age at which the impairment occurred and having or not having a professional activity do not have any direct links with the assessment of well-being, whereas the existence of pain and the subjective assessment of one’s own independence and of the severity of one’s disability are predictive factors. The functional independence indicators are only linked to well-being when they relate to situations in which the dependence creates embarrassment due to socio-cultural taboos. The loss of autonomy only affects well-being in as much as it imposes limits to social activity, whether they be relational or occupational. Living as a couple is a negative predictive factor if the couple were together prior to the impairment occurring. The overall results demonstrate the importance of moving beyond any conception of the impact of the impairments on well-being that is too exclusively focused on the individual, and of integrating the socio-cultural meanings of handicap situations and the dynamics of the interactions which take place therein.
The aim of this study was to develop an alternative computer mouse for disabled persons. The mouse developed is a flexible input device with a multi-click function, which can be attached to a ...selectable body part (eg head, arm, foot). The mouse has a MEMS-gyroscope as the motion sensor, which is both small and sensitive. A USB-interface with a HID-profile is used to make the installation easy, "plug & play", and to make it compatible for use on any modern computer, independent of the operating system (Windows, Linux, Mac etc.). The structure is modular to achieve a flexible functionality. The mouse has individually adapted click-functions with selectable click devices, in addition to which, it is possible to define individual settings of the mouse parameters. The functionality can be extended by adding further personal settings, thereby programming the mouse for individual optimal performance. The result is a reliable and useful computer mouse for people with disabilities. In the development process, 23 users have been interviewed, three of whom participated in a 6 month long-term test. The study shows that a computer mouse incorporating a MEMS-gyroscope is a good, flexible solution, providing a high performance technical aid with extremely good sensitivity at a modest cost.
The objective of this study was to compare the effects of two drugs on motor performance and analgesic efficacy in a rat model.
Rats were randomly divided into four groups as follows: propofol (600 ...μg/kg/min), dexmedetomidine (1 μg/kg/min), morphine (83 μg/kg/min) and control. The rats were placed on a rotating rod and tested at the slowest speed (5 rpm) and then at increasing increments from 5, 10, 15, 20, 25, 30, 35 to 40 rpm. The speed was set up again from 1 to 79 rpm within 4 and 10 min for the accelerod test, respectively. Pain reflexes in response to a thermal stimulus were measured at 0, 10, 20 and 60 min after the drug injection using the hot-plate test.
Dexmedetomidine injected rats showed an increased length of time compared to the propofol group at 20 rpm, 25 rpm, 35 rpm and 40 rpm speeds during the rotarod test. The latency times for the hot-plate test increased significantly for the propofol, at 0, 10 and 20 min compared to the control. At 10 min the latency times of the propofol group were longer than the dexmedetomidine group.
For long-term analgesic benefit propofol treatment seems to be better than the dexmedetomidine group. Dexmedetomidine may be preferable in day-case surgery and sedation applications in intensive care units as it provided a faster onset of recovery of motor coordination performance.
Background
Recent studies have linked cognitive impairment in amyotrophic lateral sclerosis to frontotemporal pathology.
Aim
We examined possible associations between behavior changes and regional ...gray matter volume in early amyotrophic lateral sclerosis, and assessed whether the volume changes were independent of physical impairments.
Methods
A total of 17 amyotrophic lateral sclerosis patients with Mini‐Mental State Examination score ≥ 24, no need for assistance in daily life and normal respiratory tests (respiratory function test and arterial blood gas analytes), and 11 age‐matched controls underwent structural magnetic resonance imaging. Behavioral changes were assessed with family‐rating Frontal Systems Behavior Scale. We applied voxel‐based morphometry to investigate the correlation between the Frontal Systems Behavior Scale and gray matter volume, and assessed the correlation of volume with amyotrophic lateral sclerosis Functional Rating Scale and respiratory tests.
Results
Current Frontal Systems Behavior Scale scores were significantly higher than retrospective scores assessing the status before onset, most notably in apathy. The volumes of right middle and left medial frontal gyri in amyotrophic lateral sclerosis were negatively correlated with the Frontal Systems Behavior Scale, whereas they were not correlated with amyotrophic lateral sclerosis Functional Rating Scale and respiratory tests. The volume of the right frontal cluster, but not the left medial frontal cluster, was significantly smaller than that of controls.
Conclusions
Regional atrophy within the frontal lobe was associated with behavioral dysfunction in early amyotrophic lateral sclerosis, this association was independent of physical factors.
Transgenic R6/1 mice incorporate a human genomic fragment containing promoter elements exon 1 and a portion of intron 2 of the
Huntingtin gene responsible for Huntington’s disease. They develop ...late-onset neurological deficits in a manner similar to the motor abnormalities of the disorder. As essential fatty acids are phospholipid components of cell membranes which may influence cell death and movement disorder phenotype, R6/1 and normal mice were randomised to receive a mixture of essential fatty acids or placebo on alternate days throughout life. Over mid-adulthood, topographical assessment of behaviour revealed R6/1 transgenics to evidence progressive shortening of stride length, with progressive reductions in locomotion, elements of rearing, sniffing, sifting and chewing, and an increase in grooming. These deficits were either not evident or materially diminished in R6/1 transgenics receiving essential fatty acids. R6/1 transgenics also showed reductions in body weight and in brain dopamine D
1-like and D
2-like quantitative receptor autoradiography which were unaltered by essential fatty acids.
These findings indicate that early and sustained treatment with essential fatty acids are able to protect against motor deficits in R6/1 transgenic mice expressing exon 1 and a portion of intron 2 of the
Huntingtin gene, and suggest that essential fatty acids may have therapeutic potential in Huntington’s disease.
We studied the effects of sildenafil, a selective inhibitor of PDE5, on the development and the expression of tolerance to diazepam (DZ)-induced motor impairment and sedation in mice. DZ-induced ...motor incoordination was assessed by the rotarod and chimney tests, and DZ-induced sedation was examined using a photocell apparatus. Sildenafil treatment enhanced the development of tolerance to the motor impairing effects, but not to the sedative effects, of DZ. Sildenafil treatment did not affect the expression of tolerance to DZ-induced motor impairment and sedation in mice. Our results suggest that sildenafil treatment, at least in part, affects the development of DZ tolerance.
Progressive cognitive decline develops in a nontrivial minority of stroke survivors. Although commonly used to identify cognitive decline in older stroke survivors, the usefulness of the Mini-Mental ...State Examination (MMSE) as a screening tool for post-stroke cognitive decline across a wider range of ages is not well established. This study therefore investigated the usefulness of the MMSE for this purpose.
Twenty-seven subjects, aged 18-82 years, with a single known remote stroke were assessed using the MMSE. The frequency of cognitive impairment was determined by comparison of MMSE scores with population-based norms. Relationships between cognitive performance, motor impairments, age, gender, handedness, stroke laterality, and time since stroke also were explored.
Age-adjusted MMSE scores identified mild cognitive impairment in 22.2% and moderate-to-severe cognitive impairment in 7.4% of subjects. Raw and age-adjusted MMSE scores were inversely correlated with time since stroke, but not with other patient or stroke characteristics.
A relationship between time since single known stroke and MMSE performance was observed in this study. The proportion of subjects identified as cognitively impaired in this group by Z-transformation of MMSE scores using previously published normative data for this measure comports well with the rates of late post-stroke cognitive impairment reported by other investigators. These findings suggest that the MMSE, when normatively interpreted, may identify cognitive decline in the late period following single known stroke. Additionally, the lack of a relationship between MMSE and Fugl-Meyer scores suggests that the severity of post-stroke motor impairments is unlikely to serve as a clinically useful indicator of the need for cognitive assessment. A larger study of stroke survivors is needed to inform more fully on the usefulness of normatively interpreted MMSE scores as a method of screening for post-stroke cognitive decline.
A new system is presented that enhances the interoperability between a video-oculographic (VOG) system for mouse movement control and an electromyographic (EMG) system for mouse click detection. The ...proposed VOG-EMG system combines gaze and muscle information to minimize the number of undesired clicks due to involuntary activations and environmental noise. We tested the system with 24 subjects, comparing three different configurations: one in which the VOG and EMG systems worked independently and two in which we used VOG gaze information to improve the EMG click detection. Results show that the number of false-positive click detections can be reduced when VOG and EMG information is combined. In addition, the third configuration, including extra processing, can reduce the activation delay produced because of the combined use of the VOG and EMG systems. The new VOG-EMG system is meant to be used in noisy environments in which the number of false clicks may impeach a reliable human-computer interaction.
Traditionally, ALS has been viewed as a disease of the motor neuron system, characterized by degeneration of both the upper and lower motor neurons, with no compromise to cognitive functions. ...However, recent studies have shown that structural and pathological changes are not confined to motor areas and that these changes correlate with cognitive dysfunction. Despite these findings, the nature and the extent of cognitive changes in ALS have not yet been clearly defined. Studies differ in their findings with regard to the identification of affected cognitive domains, frequency, and extent of the impairment. The problem of cognitive evaluation in patients with ALS, and a possible reason for disparities between studies, is motor impairment in patients with ALS: many standard neuropsychological tests used for the evaluation of cognitive functions rely on participants’ intact motor function, but most previous studies have not appropriately accounted for motor impairment in ALS. In this review we highlight the high prevalence and variability of cognitive change in ALS. Major neuropsychological findings in this field are summarized. We also outline the options and latest recommendations for neuropsychological evaluation of ALS patients’ cognitive change in the clinical setting. Special emphasis is given to the problem of motor impairment in ALS. We highlight the multilayer importance of reliable identification of cognitive change in this disease, including implications for clinical work.
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