Focal dystonia and repetitive motion disorders

It commonly is observed that focal hand dystonias, such as writer's cramp or musician's cramp, are associated with repetitive movements, although definitive proof of a causal relationship is lacking. These focal dystonias are often task specific, with involuntary muscle contractions occurring only when patients perform specific acts such as writing or playing a musical instrument. Physiologic studies show deficiencies in spinal reciprocal inhibition and abnormalities of central sensory processing and motor output that may be related to reduced cortical inhibition. Recent studies in primates support the notion that repetitive motions can induce plasticity changes in the sensory cortex leading to degradation of topographic representations of the hand, and raise the possibility that sensory training may be beneficial. Current treatment options for focal dystonia include botulinum toxin injections, anticholinergics, baclofen, benzodiazepines, and occupational therapy.     

Gender and neurogenic variables in tendon biology and repetitive motion disorders

The incidence of repetitive motion disorders is increasing. Numerous studies have indicated that the incidence in females exceeds that in males. Some of the evidence regarding gender related factors in tendon biology is discussed and new data related to the regulation of gene expression in an animal model of tendon overuse, the determination of sex hormone receptors in tendons, and the influence of pregnancy associated factors on gene expression in four different tendons is provided. Furthermore, because neurogenic mechanisms may contribute to inflammatory conditions, new evidence is provided that supports the concept that neurotransmitters can influence expression of genes that could participate in such inflammation. By increasing our understanding of the regulation of tendon cellular and molecular biology, new approaches to preventing disease development and treatment of existing disease may evolve.     

Confusion surrounding repetitive strain injury highlighted at conference

Uncertainty about disorders that account for many of the claims related to job injury at work became clear during a recent meeting, when speakers referred to the same disorders by several different names, including repetitive strain injury. Speakers discussed different types of injuries and reasons why they appear to be coming more common.     

Cumulative trauma disorders and repetitive strain injuries. The future

Cumulative trauma disorders account for 56% of all occupational injuries. Currently, occupational injuries affect 15% to 20% of all Americans. The United States government predicts that by the year 2000, 50% of the American workforce will have occupational injuries annually and 50 cents of every dollar will be spent on cumulative trauma disorders. There is common agreement on the need for reduction of cumulative trauma disorders in the workplace. However, there is little agreement on the appropriate definition for musculoskeletal pain that occurs in the workplace, or the ergonomic and epidemiologic model for cumulative trauma disorders, or on the specific exposure relationships of the individual, by the job, and occurring in the workplace. The previous treatments for, and the natural history of, cumulative trauma disorders in other countries gives some insight into the possible future of cumulative trauma disorders for the United States. Until research can provide specific dose and exposure relationships for the individual, prevention remains the best treatment for cumulative trauma disorders in the workplace.     

Speech timing in ataxic disorders: sentence production and rapid repetitive articulation

We studied syllabic timing in patients with ataxia (10 with cerebellar atrophy, 6 with Friedreich's ataxia) under two conditions: in a "natural" sentence production context and in the context of a rapid syllable repetition task. The two tasks included comparable articulatory maneuvers. We measured syllable durations from the speech signal and analyzed variables describing average syllabic rate and within-trial variation of syllable durations. Among the observed measures, slowed syllable repetition was a particularly powerful predictor of the severity of dysarthric impairment. In sentence production, patients often performed at normal syllabic rates. Irregular pacing of syllable repetitions was frequent. Different patterns of between-articulator variation emerged in the two tasks. All patients except one were slower in rapid repetitive articulation than in sentence production. These data suggest that sentence production and rapid repetitive articulation are governed by basically different motor processes. The disproportionate slowing of ataxic patients in the repetitive task can be ascribed to adaptation to novel motor tasks being impaired in cerebellar disease.     

Muscle proton T2 relaxation times and work during repetitive maximal voluntary exercise

We studied the effects of progressive maximal voluntary handgrip contractions (MVCs) on muscle proton spin-spin (T2) relaxation times and work, measured as the integrated force vs. time curve (FTI). Six healthy volunteers performed 10, 20, 40, and 80 MVCs in a 0.35-T magnet on four separate occasions. Repeated measures analyses of variance of increases in T2 and FTI during successive bouts were significant (P < 0.005 and P < 0.001, respectively). FTI increased with successive bouts to a greater extent than did muscle T2 (P < 0.05). For T2, the Helmert contrast judged the 10-MVC response lower than the mean of the remaining responses (P < 0.005), and the differences between all others compared with the means of subsequent responses were not significant, indicating a "flattening" of the T2 response after the increase from 10 to 20 repetitions. For FTI, all the single degree of freedom Helmert contrasts were significant (P < 0.001), indicating a continual increase in response over increased MVCs. The curved nature of the T2 response conformed best to a hyperbolic function, suggesting that a limit of approximately 32% exists for the change in T2 during progressively longer bouts of MVCs. A limit in the T2 response is consistent with the existence of a limit in the amount of water that muscle can take up from the vasculature during exertion.     

Clomipramine treatment for stereotype and related repetitive movement disorders associated with mental retardation

The efficacy of the serotonin uptake inhibitor clomipramine in the treatment of stereotyped and related repetitive behavior disorders was tested in individuals with severe and profound mental retardation. A double-blind, placebo-controlled crossover trial of clomipramine was associated with significant reductions in the frequency and intensity of stereotyped behavior and teacher ratings of stereotypy, hyperactivity, and irritability as well as increased adaptive engagement and decreased staff intervention for nontargeted behavior problems. Adverse effects occurred in 3 of the 10 subjects. Of the 7 subjects who tolerated the drug, 6 exhibited a clinically significant improvement in one or more repetitive behaviors. Our results provide support for the hypothesis that clomipramine is effective in treating stereotyped and related behaviors associated with mental retardation.     

Muscle high-energy phosphates in central nervous system disorders. The phosphorus MRS experience

Phosphorus magnetic resonance spectroscopy (MRS) was used to study muscle phosphates metabolism in several brain disorders. Those with primary mitochondrial encephalomyopathies showed the typical pattern of impaired oxidative metabolism at rest and during recovery after exercise. In migraine, Parkinson's disease and alternating hemiplegia muscle MRS observations lend support to a possible mitochondrial dysfunction. Similar observations in multiple sclerosis are probably the result of secondary deconditioning. In post polio syndrome and in some of the hereditary ataxias, elevated intracellular inorganic phosphates may be the result of another, yet unknown, metabolic impairment. Thus, muscle phosphate metabolism may be altered in various central nervous system (CNS) disorders by different metabolic impairments. All these possibilities should be taken into account when evaluating MRS results in brain diseases.     

Cumulative trauma disorders in the upper extremities: reliability of the postural and repetitive risk-factors index

OBJECTIVE: To determine the extent to which incorporating fat-modified foods into a food frequency questionnaire influences the agreement of energy and nutrient estimates with estimates obtained from food records. DESIGN: Subjects completed four 2-day food records at 3-month intervals. At the end of the recording period, a food frequency questionnaire was administered to assess usual daily intake during the preceding year. SUBJECTS/SETTING: One hundred and three subjects selected from a population-based sample of adults participating in the Beaver Dam Eye Study. STATISTICAL ANALYSES PERFORMED: Subjects were categorized into three groups on the basis of their frequency of consumption of fat-modified foods. For each group, correlations were calculated between food record estimates and estimates obtained from the original food frequency questionnaire, the original with a low-fat option, and the fat-modified questionnaire. RESULTS: For persons categorized as high consumers of fat-modified foods, incorporating questions regarding the consumption of these products resulted in higher correlations with food record estimates (original vs fat-modified version) for percentage of energy from total fat (.32 vs .47), saturated fat (.20 vs .41), oleic acid (.32 vs .50), and linoleic acid (.40 vs .46). High consumers differed in several characteristics that could be associated with disease risk (eg, higher ratios of serum total cholesterol to high-density lipoprotein cholesterol). CONCLUSIONS: Failure to account for the consumption of fat-modified foods in epidemiologic studies may result in misclassification of fat exposures. Because patterns of misclassification could be different for those at risk for disease, results of epidemiologic studies could be biased if these foods are excluded. Thus, incorporating fat-modified foods into food frequency questionnaires will improve the ability of researchers to correctly classify fat exposures and to evaluate potentially important relationships between fat intake and disease risk.     

Muscle atrophy is prevented in patients with acute spinal cord injury using functional electrical stimulation

Severe muscle atrophy occurs rapidly following traumatic spinal cord injury (SCI). Previous research shows that neuromuscular or 'functional' electrical stimulation (FES), particularly FES-cycle ergometry (FES-CE) can cause muscle hypertrophy in individuals with chronic SCI (> 1 year post-injury). However, the modest degree of hypertrophy in these already atrophied muscles has lessened earlier hopes that FES therapy would reduce secondary impairments of SCI. It is not known whether FES treatments are effective when used to prevent, rather than reverse, muscle atrophy in individuals with acute SCI. This study explored whether unloaded isometric FES contractions (FES-IC) or FES-CE decreased subsequent muscle atrophy in individual with acute SCI (< 3 months post-injury). Twenty-six subjects, 14-15 weeks post-traumatic SCI, were assigned to control, FES-IC, or FES-CE against progessively increasing resistance. Subjects were involved in the study for 3 or 6 months. Total body lean body mass (TB-LBM), lower limb lean body mass (LL-LBM), and gluteal lean body mass (G-LBM) were determined before the study, and at 3 and 6 months using dual energy X-ray absorptiometry (DEXA). Controls lost an average of 6.1%, 10.1%, 12.4%, after 3 months and 9.5%, 21.4%, 26.8% after 6 months in TB-LBM, LL-LBM and G-LBM respectively. Subjects in the FES-IC group consistently lost less lean body mass than controls, however, only 6 month G-LBM loss was significantly attenuated in this group relative to the controls. In the FES-CE group, LL-LBM and G-LBM loss were prevented at both 3 and 6 months, and TB-LBM loss was prevented at 6 months. In addition, FES-CE significantly increased G-LBM and LL-LBM after 6 months of training relative to pre-training levels. Within the control group, there was no significant relationship between LL-LBM loss (3 and 6 months) and the number of days between injury and baseline measurement. In summary, this study shows that FES-CE, but not FES-IC, training prevents muscle atrophy in acute SCI after 3 months of training, and causes significant hypertrophy after 6 months. The magnitude of differences in regionalized LBM between controls and FES-CE subject raises hopes that such treatment may indeed be beneficial in preventing secondary impairments of SCI if employed before extensive post-injury atrophy occurs.     

Traumatic brain injury in children and adolescents: psychiatric disorders at two years

OBJECTIVE: To extend findings regarding predictive factors of psychiatric outcome from the first to the second year after traumatic brain injury (TBI) in children and adolescents. METHOD: Subjects were children aged 6 to 14 years at the time they were hospitalized after TBI. The study used a prospective follow-up design. Assessments of preinjury psychiatric, behavioral, adaptive functioning, family functioning and family psychiatric history status were conducted. Severity of injury was assessed by standard clinical scales and neuroimaging was analyzed. The outcome measure was the presence of a psychiatric disorder, not present before the injury ("novel"), during the second year after TBI. RESULTS: Fifty subjects enrolled, and the analyses focused on 42 subjects followed at 24 months. Severity of injury, preinjury family function, and preinjury lifetime psychiatric history predicted the development of a "novel" psychiatric disorder present in the second year. CONCLUSION: These data suggest that there are children, identifiable through clinical assessment, at increased risk for "novel" psychiatric disorders in the second year after TBI.     

Alphoid repetitive DNA in human chromosomes

The thesis describes the first extensive DNA sequence analysis that demonstrated that the tandemly repeated alphoid DNA in the centromere of the human chromosomes consists of distinct subfamilies and in a number equal to or exceeding the number of chromosomes. The expected presence of only one or a few distinct subfamily on individual chromosomes was supported by the characterization of an extremely well-defined subfamily specific for chromosome 7 and represented in the original collection of subfamilies. The pattern of chromosome-specificity breaks down among the acrocentric chromosomes where chromosomes 13 and 21 were found to share one and chromosomes 14 and 22 to share another specific subfamily. By in situ hybridization these subfamilies were shown not to be shared by other chromosomes. The remarkable pairwise pattern of sequence homogenization was present also in the chimpanzee genome raising the question of its biological role. However, the subfamilies on these human and chimpanzee chromosomes are not orthologous but were shown to originate from two evolutionarily different repeat families. It follows that dramatic sequence evolution has occurred in one or both species during or after separation. The sequence evolution might even occur at a higher rate in humans. This possibility was studied in orthologous alphoid sequences on the X chromosome of humans and the great apes. The analysis supports the general view that our closest relative is the chimpanzee and indicates that the rate of recombination is increased in the human repeat DNA. A "molecular clock" running faster in this DNA may have evolutionary implications. Finally, the usefulness of alphoid subfamilies as chromosome-specific markers is illustrated in a cytogenetic dissection of the centromeric region of Robertsonian translocations. The breakpoints were located to satellite III DNA leaving these chromosomes dicentric. The order of the different tandem DNAs on the p-arm of the acrocentric chromosomes could also be established.     

Transient and repetitive rises in blood pressure synchronized with plasma catecholamine increases after head injury. Report of two cases

This study included 13 cases of pleomorphic adenoma, representing 68.42% of all cases complaining of salivary gland tumours attending the Kuwait Dental Center in an 18-month period. The palate was the main site of occurrence of the lesion with a predominance in females. Microscopically, myxochondroid stroma and hyaline cells were seen in 8 cases (61.5%).     

Recovery from object substitution masking induced by transient suppression of visual motion processing: A repetitive transcranial magnetic stimulation study.

Object substitution masking is a form of visual backward masking in which a briefly presented target is rendered invisible by a lingering mask that is too sparse to produce lower image-level interference. Recent studies suggested the importance of an updating process in a higher object-level representation, which should rely on the processing of visual motion, in this masking. Repetitive transcranial magnetic stimulation (rTMS) was used to investigate whether functional suppression of motion processing would selectively reduce substitution masking. rTMS-induced transient functional disruption of cortical area V5/MT+, which is important for motion analysis, or V1, which is reciprocally connected with V5/MT+, produced recovery from masking, whereas sham stimulation did not. Furthermore, masking remained undiminished following rTMS over the region 2 cm posterior to V5/MT+, ruling out nonspecific effects of real stimulation and confirming regional specificity of the rTMS effect. The results suggest that object continuity via the normal function of the visual motion processing system might in part contribute to this masking. The relation of these findings to the reentrant processing view of object substitution masking and other visual phenomena is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oculomotor motion disorders: current imaging of cranial nerves 3, 4, and 6

The eye movements are controlled by the cranial nerves 3, 4, and 6 working in close cooperation under the supervision of the voluntary cortex. Clinically, the most common presentation of abnormal ocular motor motion is double vision. A thorough clinical examination can usually separate a local orbital cause which can produce a restriction of the muscles moving the eye from a neurogenic cause due to an abnormality of one of the three nerves or their association pathways. Recent articles in the scientific literature have described major advances in our understanding of the anatomy and vascular relationships of the three ocular motor nerves (cranial nerves 3, 4, and 6) and of the diagnosis and treatment of a variety of pathological processes that damage these nerves, including ischemia, inflammation, and compression.     

Evidence of enhanced kindling and hippocampal neuronal injury in immature rats with neuronal migration disorders

To clarify the characteristic features of nosocomial pneumonia in a community hospital, we performed a clinical analysis of 147 patients (155 episodes) with nosocomial pneumonia. The following results were obtained. 1, Regarding the risk factors for nosocomial pneumonia, factors such as the patient whose age was over 65 years, a duration of admission of over one month, performance status 4 and underlying respiratory diseases associated with the appearance of nosocomial pneumonia. 2, The causative microorganism isolated from the sputum of the patient with nosocomial pneumonia was frequently a multi-drug resistant microorganism such as Methicillin-resistant Staphylococcus aureus (MRSA). 3, regarding treatment, although several antibiotics were administered for a long time, mechanical ventilation was used on 31% of the patients, and steroid pulse therapy was carried out on 24%. The clinical efficacy was poor with a 50% mortality rate. The reason why treatment of nosocomial pneumonia was difficult is thought to be been related to the general condition of these inpatients and to the appearance of a multi-drug resistant, polymicrobial microorganisms.     

Inverted repetitive sequences in the human genome

A specific class of DNA sequences, the inverted repetitive sequences, forms hairpin-like structures in denatured DNA by the folding back of a single linear chain. The reassociation process of these sequences is unimolecular and the rate is extremely fast. Inverted repetitive sequences comprise 6% of the total human genome. They appear to be heterogeneous in length with an overall average length of 190 nucleotides. The inverted sequences are represented in almost all families of repetition frequencies, highly repetitive as well as very few copies per genome. They are not localized at unique sites on metaphase chromosomes. It is estimated that there are approximately 2 X 10(6) inverted repeats per haploid human genome. The biological function of this class of sequences is unknown.     

Muscle parameters in coxarthrosis

The aim of this study was to investigate the muscular condition around the hip joint in osteoarthritis (grades of reduction of motion range and muscle strength). We analyzed a group of 64 patients with diseased hips and definite clinical and radiological signs of degenerative hip alterations. The control group consisted of 32 persons with healthy hips who matched the examined group by age and sex. All subjects underwent the quantitative assessment of hip motion range and muscle strength. The study of comparative kineziometric parameters showed a decreased muscle function of all examined hip motions for all measured parameters, being the most distinctive in case of medial rotation of hip (73.48%). Mean values of muscle strength were also decreased in all examined muscles. The biggest value decrease was registered for abductors (musculus gluteus medius). In comparison with the control group results it was a decrease of 55.30%. The results we obtained in our study indicated the reduction of muscle performance in patients with osteoarthritic hips.     

Muscle changes in acromegaly

Muscle biopsy specimens were obtained from 18 patients with acromegaly of varying degrees of severity. Half the specimens showed hypertrophy of type 1 fibres, while atrophy was most often seen in type 2 fibres. A direct correlation between muscle appearances and growth hormone levels was not observed. The needle biopsy technique is particularly suitable for determining the natural history of acrometalic myopathy.     

Brief screening for psychological and substance abuse disorders in veterans with long-term spinal cord injury.

Objective: To determine rates of positive screens for psychological and substance use disorders in persons with long-term spinal cord injury (SCI). Study Design: A naturalistic cohort design wherein consecutive admissions during an 8-month period completed the screening battery. Setting: Veterans Affairs SCI Center. Participants: One hundred fifteen men, 2 women, mean age 57.4 years, injured an average of 20 years, readmitted for various reasons. Main Outcome Measures: The Alcohol Use Disorders Identification Test (AUDIT) and screening items for depression and anxiety disorders. Results: Rates of positive screens ranged from 6.2% for alcohol problems to over 40% for anxiety disorders. Positive screens for depression and anxiety correlated positively with the number of recent hospital admissions. Conclusions: Systematic brief screening for psychological and substance abuse disorders in this population revealed rates of positive screens at least equal to those in other medical patient populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)