The mechanism underlying mirrored activity/movements in normal individuals is unknown. To investigate this, we studied 11 adults and 39 children who performed sequential finger–thumb opposition or ...repetitive index finger abduction. Surface electromyographic (EMG) activity recorded from the left and right first dorsal interosseous muscles (1DI) during unilateral sequential finger–thumb opposition (voluntarily activated muscle, 1DIvol) showed mirrored EMG activity (homologous muscle of the opposite hand, 1DImm) that decreased with increasing age. The time of onset of involuntary compared with voluntary EMG activity was variable but could start at the same time. A significant increase in E2 (transcortical component) size of the cutaneomuscular reflex recorded from the 1DImm indicated increased excitability of the motor cortex ipsilateral to the 1DIvol during active index finger abduction compared with the 1DIvol relaxed. Transcranial magnetic stimulation, using the Bistim technique, indicated that the transcallosal inhibitory pathway in children may not operate in the same way as in the adult. Cross‐correlation analysis did not detect shared synaptic input to motoneuron pools innervating homologous left and right hand muscles. We conclude that the mirrored movements/activity observed in healthy adults and children are produced by simultaneous activation of crossed corticospinal pathways originating from both left and right motor cortices. Ann Neurol 1999;45:583–594
Background
Delivering and monitoring residential rehabilitation services for pupils with acquired brain injuries (ABI) is challenging because of variability in aetiology, age and pre‐morbid ...characteristics. Therapists and educators in this residential rehabilitation setting identified the need for a comprehensive tool which would capture the pupils' ability to participate in typical, everyday, school‐based functional activities. This study aimed to explore the ability of the School Function Assessment (SFA) to identify levels of participation in school‐based functional tasks and demonstrate progress for pupils with an ABI in a residential rehabilitation setting.
Methods
The SFA was conducted on admission and discharge for pupils with ABI receiving residential rehabilitation between January 2007 and October 2011. Data analysis used Kruskal–Wallis to determine between‐group differences in age, time post injury and weeks in rehabilitation. Linear mixed effects modelling was used to establish differences between admission and discharge scores. Case vignettes demonstrated how the SFA was used with individual pupils.
Results
Seventy pupils were identified (31 traumatic brain injury; 29 non‐traumatic and 10 anoxic) 42 boys and 28 girls whose age at injury was 4.5–17.2 years (median 12.8). The SFA demonstrated that 54/70 pupils had made progress with their ability to participate in school activities. Significant differences were found between admission and discharge SFA scores for participation, physical and cognitive assistance and adaptation and activity performance (P < 0.05). There was wide variability between individual profiles reflecting the heterogeneity of ABI.
Conclusions
The SFA determined levels of participation in school‐based functional tasks for these residential pupils with an ABI and demonstrated progress both at the group and individual level in this residential rehabilitation setting. It identified the amount of support a pupil would need when they return to their local school and their strengths and needs in relation to participation in physical and cognitive school‐based functional activities.
Possible mechanisms underlying the pathological mirror movements that are seen in the majority of patients with X-linked Kallmann's syndrome have been investigated using neurophysiological ...techniques. An EMG was recorded from the first dorsal interosseous muscle (1DI) during voluntary self-paced abduction of one indexed finger; EMG activity could also be recorded simultaneously from the contralateral 1DI. There was no significant difference between the time of onset of the bursts of voluntary and involuntary mirroring EMG. Focal magnetic stimulation of the hand area of the motor cortex revealed the presence of fast conducting bilateral corticospinal projections from each motor cortex in all subjects. However, both inter- and intra-subject differences exist when considering the ratio of ipsilaterally to contralaterally projecting axons. Cross-correlation analysis of multi-unit EMGs recorded during simultaneous voluntary sustained activation of homologous left and right pairs of distal upper limb muscles was performed. A short duration central peak was seen in the cross-correlograms indicating the presence of a common drive to left and right homologous motor neuron pools. This common drive may result from the synchronous activation of intermingled ipsilaterally and contralaterally projecting corticospinal neurons in the motor cortex. Cutaneomuscular reflexes were recorded from the 1DI following stimulation of the digital nerves of the index finger. Typically each reflex comprises spinal and longer latency trans-cortical components. In these subjects, the long latency components of the reflex response could, in addition, be recorded from the 1DI of the non-stimulated side. We conclude that these subject have a novel ipsilateral at least in part, for the pathological mirroring.
X‐linked Kallmann’s (XKS) subjects, who display mirror movements, have abnormal corticospinal tracts which innervate motoneurons of the left and right distal muscles of the upper limb. The size of ...the abnormal ipsilateral projection is variable. We have used coherence and cumulant analysis between EEG and first dorsal interosseous muscle (1DI) EMG to explore mechanisms underlying mirror movements in three XKS subjects. Results are compared with those of three normal subjects. We argue that significant coherence is functionally relevant when associated with a negative cumulant at an appropriate lag. Given this, normal subjects showed coherence at ∼22 Hz between the EEG recorded over the sensori‐motor cortex contralateral to the voluntarily moved hand and the 1DI EMG of this hand. No significant coherence was seen between 1DI EMG and the sensori‐motor cortex ipsilateral to the muscle activity. In contrast, two of the XKS subjects (K2 and K4) had significant coherence at 22 Hz, together with a negative cumulant at an appropriate lag, between the ipsilateral cortical EEG and the 1DI EMG of the voluntarily activated hand. This implies that activity in the abnormal ipsilateral corticospinal projection can contribute to the voluntary drive. For these two subjects, the ipsilateral corticospinal projection was greater than the contralateral projection, as revealed using magnetic brain stimulation. In one of these subjects, K4, significant 22 Hz coherence and negative cumulant was also seen between the EMG of the voluntarily activated hand and the cortex contralateral to this hand. In the third subject, K4a, coherence and negative cumulant was detected between the EMG of the voluntary side and the cortical activity contralateral to this hand. The contralateral cortico spinal projection of this subject was greater than the ipsilateral projection. Regarding the mirroring hand of the XKS subjects, coherence (with negative cumulant at an appropriate lag) was seen in all three subjects between the EMG recorded from the mirroring hand and cortical EEG ipsilateral to this hand. This provides evidence that activity in the aberrant ipsilateral projection is involved in producing the drive that results in mirror movements. In one subject, K4, coherence and negative cumulant was also seen between the EMG of the mirroring hand and motor cortical activity contralateral to this hand. Thus, in this subject, activity in the corticospinal projection contralateral to the mirroring hand also contributed to the mirror movements. In conclusion, this study has provided further evidence that the 22 Hz coherence seen between EEG and EMG is dependent upon corticospinal activity and has furthered our understanding of mechanisms underlying mirror movements.
The movement disorder of cerebral palsy (CP) is expressed in a variety of ways and to varying degrees in each individual. The condition has become more complex over the last 20 years with the ...increasing survival of children born at less than 28 to 30 weeks gestational age. Impairments present in children with CP as a direct result of the brain injury or occurring indirectly to compensate for underlying problems include abnormal muscle tone; weakness and lack of fitness; limited variety of muscle synergies; contracture and altered biomechanics, the net result being limited functional ability. Other contributors to the motor disorder include sensory, cognitive and perceptual impairments. In recent years understanding of the motor problem has increased, but less is known about effects of therapy. Evidence suggests that therapy can improve functional possibilities for children with cerebral palsy but is inconclusive as to which approach might be most beneficial. The therapist requires an understanding of the interaction of all systems, cognitive/perceptual, motor, musculoskeletal, sensory and behavioral, in the context of the development and plasticity of the CNS. It is necessary to understand the limitations of the damaged immature nervous system, but important to optimize the child's functional possibilities.
The aim of this study was to examine the pathophysiological mechanisms underlying co-contraction in patients with dystonia (n = 6) and writer's cramp (n = 5). Multi-unit needle and surface EMGs were ...recorded from extensor carpi radialis (ECR) and flexor carpi radialis (FCR) muscles during motor tasks that elicited dystonia or writer's cramp. The EMGs from ECR and FCR were recorded simultaneously and analysed using cross-correlation analysis. Similar recordings were obtained from healthy age- and sex-matched control subjects (n = 8). Despite co-contraction of the muscles, cross-correlograms from the healthy subjects did not reveal evidence of motor unit synchronization. Cross-correlograms from the dystonic subjects revealed a central peak with a median duration of 37 ms, indicating broad-peak motor unit synchronization. Cross-correlograms from patients with writer's cramp were either flat or modulated by a 11-12-Hz tremor. Frequency-domain analysis of ECR and FCR EMGs demonstrated significant coherence in the patients with dystonia and writer's cramp. These results indicate that co-contraction in dystonia is neurophysiologically distinct from voluntary co-contraction and is produced by abnormal synchronization of presynaptic inputs to antagonist motor neuron pools. ECR and FCR co-contraction in writer's cramp may be a compensatory process under voluntary control.
The current recommended developmental Bobath practice within the Bobath Clinical Reasoning Framework (BCRF) can be conceptualized using the lens of systems science, thereby providing a holistic ...perspective on the interrelatedness and interconnectedness of the variables associated with childhood‐onset disability. The BCRF is defined as an in‐depth clinical reasoning framework that can be applied to help understand the relationships between the domains of the International Classification of Functioning, Disability and Health, how those domains can be influenced, and how they impact each other. The BCRF is a transdisciplinary observational system and practical reasoning approach that results in an intervention plan. This provides a holistic understanding of the complexity of situations associated with disorders such as cerebral palsy (CP) and the basis for the lifelong management and habilitation of people living with neurological disorders. The clinical reasoning used by the BCRF draws on the important contextual factors of the individual and their social environment, primarily the family unit. It is rooted in an understanding of the interrelationships between typical and atypical development, pathophysiology (sensorimotor, cognitive, behavioural), and neuroscience, and the impact of these body structure and function constructs on activity and participation. The systems science model integral to the BCRF is a useful way forward in understanding and responding to the complexity of CP, the overarching goal being to optimize the lived experience of any individual in any context.
This review describes a model of recommended Bobath paediatric practice, the Bobath Clinical Reasoning Framework (BCRF), and explains how this knowledge contributes to the field of habilitation in paediatric disorders.
Systems science provides a new way of conceptualizing cerebral palsy (CP) as a complex condition. It has been applied to the BCRF to illustrate a holistic perspective on the interrelatedness and interconnectedness of the variables associated with CP.
The systems science model adopted by the BCRF is a promising way forwards in constructing a comprehensive framework which encompasses the complexity of CP and will enable more robust research.
This invited review is commented on by Blomme, Damiano et al., and Coughlan et al. on pages 667, 668, and 669–670 respectively.
Resumen
La actual práctica de desarrollo Bobath recomendada dentro del Marco de Razonamiento Clínico Bobath (BCRF) puede conceptualizarse utilizando la visión de la ciencia de los sistemas. ...Proporciona, así, una perspectiva holística de la interrelación e interconexión de las variables asociadas con la discapacidad aparecida durante la infancia. El BCRF se define como un marco exhaustivo de razonamiento clínico que puede aplicarse para ayudar a comprender las relaciones entre los dominios de la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud, cómo se puede influir en esos dominios y cómo influyen entre sí. El BCRF es un sistema de observación transdisciplinario y de razonamiento práctico que da lugar a un plan de intervención. Esto proporciona una comprensión holística de la complexidad de las situaciones asociadas a trastornos como la parálisis cerebral (PC) y la base para la gestión y habilitación a lo largo de la vida de personas que viven con trastornos neurológicos. El razonamiento clínico utilizado por el BCRF se basa en los importantes factores contextuales del individuo y su entorno social, principalmente la unidad familiar. Se basa en la comprensión de las interrelaciones entre el desarrollo típico y atípico, la fisiopatología (sensoriomotora, cognitiva, conductual) y la neurociencia, así como el impacto de funciones y estructuras corporales sobre la actividad y la participación. El modelo de ciencia de sistemas del BCRF es una forma útil de comprender y responder a la complejidad de la parálisis cerebral, con el objetivo global de optimizar la experiencia vivida de todo individuo en cualquier contexto.
Özet
Bobath Klinik Gerekçelendirme Çerçevesi (BKGÇ) içerisindeki önerilen güncel gelişimsel Bobath uygulaması sistemler bilimi merceği kullanılarak kavramsallaştırılabilir ve bunu çocukluk çağı ...engelliliği ile ilişkilendirilen değişkenlerin birbirine bağlılığı ve etkileşimine bütüncül bir bakış açısıyla sağlar. BKGÇ, İşlevsellik, Yetiyitimi ve Sağlığın Uluslararası Sınıflandırması (ICF)’nın alt boyutları arasındaki ilişkiyi ve bu alt boyutların birbirini nasıl etkilediğini anlamak için uygulanabilen derinlemesine bir klinik gerekçelendirme çerçevesi olarak tanımlanmaktadır. BKGÇ, bir tedavi planı ile sonuçlanan klinik gerekçelendirme ve transdisipliner gözlemsel bir sistemdir. Bu sistem ise, serebral palsi (SP) gibi bozuklukların karmaşıklığını anlamak için bütüncül bir anlayış sunar ve nörolojik bozukluğu olan bireylerin yaşam boyu tedavisi ve rehabilitasyonu için temel oluşturur. BKGÇ tarafından kullanılan klinik gerekçelendirme, başta aile birimi olmak üzere bireyin ve sosyal çevresinin önemli bağlamsal faktörlerine dayanmaktadır. Tipik ve atipik gelişim, patofizyoloji (sensorimotor, bilişsel, davranışsal) ve sinirbilim arasındaki karşılıklı ilişkilerin ve bu vücut yapı ve fonksiyonlarının aktivite ve katılım üzerindeki etkisinin anlaşılmasına dayanır. BKGÇ'nin ayrılmaz bir parçası olan sistemler bilimi modeli, SP'nin karmaşıklığını anlamak ve buna yanıt vermek için yararlı bir yoldur; kapsayıcı hedef, herhangi bir bağlamda herhangi bir bireyin yaşadığı deneyimi optimize etmektir.
Bu derlemede önerilen Bobath pediatrik uygulama modeli olan Bobath Klinik Gerekçelendirme Çerçevesi (BKGÇ) tanımlanmakta ve bu bilginin pediatrik bozukluklarda habilitasyon alanına nasıl katkıda bulunduğu açıklanmaktadır.
Sistemler bilimi, serebral palsiyi karmaşık bir durum olarak kavramsallaştırmanın yeni bir yolunu sağlamaktadır. SP ile ilişkili değişkenlerin birbiriyle ilişkisi ve birbirleriyle bağlantıları hakkında bütüncül bir bakış açısını göstermek için BKGÇ'ye uygulanmıştır.
BCRF tarafından benimsenen sistemler bilimi modeli, SP'nin karmaşıklığını kapsayan ve daha nitelikli araştırmalara olanak sağlayacak kapsamlı bir çerçeve oluşturma konusunda ileriye dönük umut verici bir yoldur.
A prática de desenvolvimento Bobath recomendada atualmente dentro do Quadro de Raciocínio Clínico Bobath (BCRF) pode ser conceptualizada usando a abordagem de ciência de sistemas, proporcionando ...assim uma perspetiva holística sobre a inter‐relação e interconexão das variáveis associadas às deficiências iniciadas na infância. O BCRF é definido como um quadro de raciocínio clínico aprofundado que pode ser aplicado para ajudar a compreender as relações entre os domínios da Classificação Internacional de Funcionalidade, Incapacidade e Saúde, como esses domínios podem ser influenciados e como podem ter impacto uns nos outros. O BCRF é um sistema de observação transdisciplinar e uma abordagem de raciocínio prático que resulta num plano de intervenção. Isso proporciona uma compreensão holística da complexidade das situações associadas a distúrbios como a paralisia cerebral (PC) e a base para a gestão e habilitação de pessoas que vivem com distúrbios neurológicos ao longo da vida. O raciocínio clínico usado pelo BCRF baseia‐se nos importantes fatores contextuais do indivíduo e no seu ambiente social, principalmente o meio familiar. Está enraizado na compreensão das inter‐relações entre o desenvolvimento típico e atípico, a fisiopatologia (sensoriomotora, cognitiva, comportamental) e a neurociência, e o impacto destas conceções de estrutura e função corporal na atividade e participação. O modelo de ciência de sistemas integrado no BCRF é uma maneira útil de avançar na compreensão e resposta à complexidade da PC, sendo o objetivo principal otimizar a experiência de vida de qualquer indivíduo em qualquer contexto.
Esta revisão descreve um modelo de prática pediátrica recomendada do Bobath, o Quadro de Raciocínio Clínico Bobath (QRCB), e explica como esse conhecimento contribui para a área de habilitação em distúrbios pediátricos.
A ciência de sistemas proporciona uma nova maneira de concetualizar a paralisia cerebral como uma condição complexa. Ela foi aplicada ao QRCB para ilustrar uma perspetiva holística sobre a inter‐relação e interconexão das variáveis associadas à PC.
O modelo de ciência de sistemas adotado pelo QRCB é uma forma promissora de construir uma estrutura abrangente que engloba a complexidade da PC e possibilitará pesquisas mais robustas.
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