Frontal ataxia: historical aspects and clinical definition / Ataxia frontal: aspectos históricos e definição clínica

Abstract Frontal ataxia, originally described by Bruns, is characterized by the presence of signs of frontal lobe dysfunction, such as perseveration, paratonia, frontal release signs, cognitive changes, and urinary difficulty, associated with imbalance, slow gait, broad-based, the presence of postural instability and falls, retropulsion, and bradykinesia in the lower limbs. The goal of the present study is to recall the historical aspects of this condition, to draw attention to the importance of this clinical finding for the differential diagnosis of ataxias and to review the main semiological differences between primary ataxias (frontal, cerebellar, and sensory ataxia).

Resumo A ataxia frontal, originalmente descrita por Bruns, caracteriza-se pela presença de sinais de disfunção do lobo frontal, como perseveração, paratonia, sinais de liberação frontal, alterações cognitivas e dificuldade urinária, associados a desequilíbrio, marcha lenta, base ampla, presença de instabilidade postural e quedas, retropulsão e bradicinesia em membros inferiores. O objetivo do presente trabalho é recordar os aspectos históricos desta condição, ressaltar a importância deste achado clínico para o diagnóstico diferencial das ataxias e revisar as principais diferenças semiológicas entre as ataxias primárias (ataxia frontal, cerebelar e sensitiva).

Clinical value of changes of gait characteristics in the progression of Parkinson′s disease / 中华神经科杂志

Objective:To determine the evolution of gait impairment over the course of Parkinson′s disease (PD) by assessing the changes of gait characteristics in different disease stages, which could be helpful for disease monitoring.Methods:A total of 276 PD patients [PD group, Hoehn-Yahr (H-Y) stage 1-3] and 63 healthy controls (control group) enrolled in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to September 2021 were included in this cross-sectional study. The gait spatiotemporal variables were recorded by a portable inertial measurement unit system. Exploratory factor analysis was performed to obtain gait domains representing different gait characteristics. One way analysis of variance was used to evaluate the differences of gait variables and gait domains among the control group and 3 different H-Y stages of the PD group, as well as the differences among the control group and 2 motor subtypes of PD in different stages. The sensitivity of different gait variables and gait domains in evaluating the severity of gait impairments at different disease stages was compared.Results:Eleven gait spatiotemporal variables were grouped in 4 gait domains: pace (step length, gait speed and stride length), rhythm/phase (cadence, stride time and double support time), pace-related variability/asymmetry [step length coefficient of variation (CV), gait speed CV and step length asymmetry] and rhythm/phase-related variability/asymmetry (swing time CV and swing time asymmetry). As the disease progresses, most evolution trends of the 4 gait domains in the tremor-dominant PD patients were consistent with those in the non-tremor-dominant subtype. Compared with the control group, PD patients at H-Y stage 1 began to show the mild impairment of rhythm/phase-related variability/asymmetry (effect size 0.42; standardized score -0.03±0.69 vs -0.33±0.49, P<0.05), especially swing time asymmetry in tremor-dominant patients; the pace domain was damaged moderately in PD patients at H-Y stage 2 (effect size 0.64; standardized score 0.12±0.80 vs 0.64±0.81, P<0.05), especially in non-tremor-dominant PD patients, but not in PD patients at H-Y stage 1 ( P>0.05). Pace-related variability/asymmetry showed great impairment in PD patients at H-Y stage 3 (effect size 0.62; standardized score 0.27±1.12 vs -0.27±0.52, P<0.05), but not in PD patients at H-Y stages 1 and 2 ( P>0.05). Conclusions:The characteristic impairments of gait in PD evolve in the process of disease progression. The rhythm/phase-related variability/asymmetry domain may be a marker to distinguish early PD from healthy controls. The pace domain and the pace-related variability/asymmetry domain are important markers to evaluate the progression of PD.

Research progress of Parkinson's frozen gait / 中国医师杂志

Parkinson's disease is a neurodegenerative disease characterized by static tremor, myoto-nia, motor retardation and abnormal posture and gait. Freezing of gait ( FOG) is a common symptom of ad-vanced Parkinson's disease. At present, the pathogenesis of frozen of gait is not clear, and treatment is still difficult. This article reviews the latest progress and treatment of frozen gait in Parkinson's disease patients and makes a prospect.

Correlation between plantar pressure and walking ability in hemiplegic stroke survivors / 中华物理医学与康复杂志

Objective To explore the correlation between plantar pressure and walking function in hemiplegic stroke patients.Methods Thirty hemiplegic patients with stroke (a hemiplegic group) and thirty age-matched healthy persons (a control group) were recruited.Gait and balance function training and assessment system (model:AL-600) were used to quantify the walking velocity,peak plantar pressure at heel-strike and push-off periods and displacement of center of pressure (DCOP) of all subjects during walking.The asymmetry of gait was calculated.Two independent sample t-test were used to compare the walking velocity,peak plantar pressure and DCOP for the two groups.Pearson correlation coefficients were applied to analyze the correlation between the walking velocity and peak plantar pressure and DCOP.Results The walking velocity,the peak plantar pressure at heel-strike and push-off periods and DCOP of the hemiplegic group were significantly lower than the control group.In the hemiplegic group,the asymmetry of peak plantar pressure and DCOPx significantly increased,while that of DCOPy became bigger without significant difference.Moreover,the walking capacity of the hemiplegic group was positively correlated with the peak plantar pressure and DCOP.Conclusion Among hemiplegic stroke patients,both the peak plantar pressure at heel-strike and push-off periods lower in a way.Their capacity of weight transfer decreases,which is closely related to their walking velocity.

Relationships among measures of gait recovery and community integration index in people with brain injury / 中国基层医药

Objective To examine the relationships among measures of gait recovery and community integra-tion index in people with brain injury.Methods 142 brain injured patients were chosen in this study.Community Balance and Mobility Scale,Dynamic Gait Index,Ten-Meter Walk Test for gait speed,and the Community Integration Questionnaire (CIQ) was measured.Results Average walk speed was 0.31-5.30 (1.36 ±0.88)m/s;DGI score was 5-24 (18.6 ±5.44) points;CMBS score was 0 -96 (54.1 ±25.3) points;CIQ subscale 6 -29 (16.2 ± 5.1)points,CIQ family subscale was 0-10 (4.8 ±3.0)points;CIQ society subscale was 4-12(8.2 ±2.1)points;CIQ productivity subscale was 0-7(3.8 ±2.2).The correlation between age and Ten-Meter Walk Test was nega-tive significantly (r=-0.50,P<0.05).All 3 balance/gait measures correlated significantly with the CIQ Productiv-ity subscale (r=0.35-0.58,P<0.05).Conclusion The ability of people with brain injury to engage in work/school/volunteer activity may be reduced by impairments in balance and mobility.

Relationship between cognitive impairment and the other clinical features of subcortical damage in patients with subcortical ischemic vascular disease / 中华老年医学杂志

Objective To investigate the relationship between cognitive impairment and the other clinical features of subcortical damage in patients with magnetic resonance imaging(MRI)-defined subcortical ischemic vascular disease(SIVD).Methods The cohort for this study included 110 SIVD patients who were divided into 3 groups according to cognitive status:patients with noncognition impairment(SIVD-NCI group,n=34),patients with mild cognitive impairment(SIVD-MCI group,n =47) and patients with vascular dementia (SIVD-VaD group,n =29).The cognitive functions were evaluated by the mini-mental state examination (MMSE) and Montreal cognitive assessment(MoCA),the Cambridge cognitive examination-Chinese version(CAMCOG-C),activity of daily living scale(ADL) and clock drawing task(CDT),etc.Depression symptoms were assessed by the geriatric depression scale (GDS),while the other clinical features of subcortical damage were assessed by the timedGet-Up and Go test,etc.Results There were statistically significant differences in the MMSE,MoCA,CAMCOG-C,CDT and ADL scores among the three groups(H=85.36,F=50.32,55.03,H=27.39,40.87,respectively,all P＜0.05).Gait disturbance,urinary disorder,pseudobulbar palsy,depression and falls were statistically significantly different among the threegroups(x2=21.69,21.41,25.51,6.91,21.87,all P＜0.05).In addition,gait disturbance was increasingly aggravated with the severity of cognitive impairment.In SIVD-MCI group,urinary disorder,pseudobulbar palsy and falls were significantly increased as compared with SIVD-NCI group (x2 =15.57,16.31,8.92,both P＜0.017).Depression was statistically significant different between SIVD-NCIandSIVD-VaD group(x2 =6.90,P＜0.017).Among the three groups,there was no significant difference in the feature of emotional incontinence.Conclusions With the decline in cognitive function,the patients with SIVD can present with different clinical features of subcortical damage.Gait disturbance is gradually aggravated with the decline in cognitive function.Urinary disorder,pseudobulbar palsy,and falls can reflect the cognitive impairment from normal to mild on the other hand.Depression can be used as one of the signs that show cognitive impairment reached to dementia.

Gait analysis in cerebral palsy children / 中国组织工程研究

BACKGROUND:Abnormal gaits are very common in children with cerebral palsy, and how to improve the gait is the focus of rehabilitation therapy. OBJECTIVE:To analyze the biomechanical parameters of gaits in cerebral palsy children and to observe the effects of brace control on the exercise capacity of dyskinetic cerebral palsy children. METHODS:In this paper, we compared the biomechanical parameters of children with cerebral palsy and normal children in the initial process of walking and during walking. Biomechanical parameters in the initial process of walking include spatial and temporal parameters, kinematic and kinetic parameters of the range of motion of the knee and ankle. Biomechanical parameters during walking include spatial and temporal parameters. With the aid of hand brace, dyskinetic cerebral palsy received postural control, gait training, and sling exercise therapy for 3 months. The Gross Motor Function Measure (GMFM-88) assessment and video control were conducted for evaluation of therapeutic efficiency. RESULTS AND CONCLUSION:Biomechanical parameters in the initial process of walking showed significant differences between children with cerebral palsy and normal children except for the peak of ground reaction force at frontal axis with the right foot to start walking. Biomechanical parameters during walking showed that the stance phase and bipedal stance phase were prolonged, while the step length and stride length were shortened in the children with cerebral palsy compared with the normal children. For cerebral palsy children with brace control, the GMFM-88 scores were significantly decreased after treatment, involuntary movements were reduced shown on the video, the neck and body were stable, and life skil s were improved. Children with epilepsy and cognitive impairment or who had imaging changes in the basal ganglia showed a little improvement, and children with dance-athetoid type and dystonia type had a better progress than those with athetoid spasm.

Ataxia aguda em idade pediátrica? revisão retrospectiva de cinco anos / Acute ataxia in childhood? a five year retrospective review

Objetivos: Caracterizar os casos de ataxia aguda internados em um Serviço de Pediatria e avaliar a sua abordagem no Departamento de Urgência.Métodos: Análise retrospectiva dos registos clínicos das crianças internadas entre janeiro de 2006 e dezembro de 2010 com quadro clínico de alteração da marcha e/ou dos movimentos motores finos com início dentro das últimas 72 horas.Resultados: Foram incluídas 82 crianças, 44 do sexo feminino. A mediana de idade foi de 4 anos. Trinta crianças apresentaram pródromos e 18 tinham história de infecção prévia. Os sintomas concomitantes mais frequentes foram sonolência (46 casos), vômitos (18 casos) e irritabilidade (14 casos). O exame físico não mostrou alterações em dois terços dos casos. Setenta crianças foram sujeitas a pelo menos um exame complementar de diagnóstico. As principais causas identificadas foram intoxicações (53 casos) e ataxia pós-infecciosa (15 casos). Só 16% necessitaram de tratamento específico e a maioria das internações foi de curta duração. Foram referenciados para seguimento em consulta hospitalar 32 casos. Registrou-se uma evolução benigna na maioria dos casos.Conclusões: A atitude face a uma criança com ataxia aguda deve ser ponderada e individualizada, tornando-se difícil a implementação de um protocolo de abordagem uniforme. A maioria dos casos tem um curso benigno e autolimitado, com internação de curta duração e apenas tratamento de suporte. No entanto, causas mais graves devem ser devidamente excluídas. História clínica minuciosa, exame físico e neurológico completos e internação visando a vigilância da evolução clínica são aspectos fundamentais.

Aims: To characterize the cases of acute ataxia hospitalized in a Pediatric Department and to evaluate its approach in the Emergency Department.Methods: Retrospective analysis of medical records of children admitted between January 2006 and December 2010 with clinical gait and/or fine motor movements with onset within the last 72 hours.Results: We included 82 children, 44 girls. The median age was 4 years. Thirty children had prodromes and 18 had a history of previous infection. The most frequent accompanying symptoms were somnolence (46 cases), vomiting (18 cases) and irritability (14 cases). Physical examination showed no changes in two thirds of cases. Seventy children have been subjected to at least one further diagnostic examination. The main causes were poisoning (53 cases) and post-infectious ataxia (15 cases). Only 16% needed specific treatment and most admissions were of short duration. Thirty-two cases were referred for follow-up consultation. The course was benign in most cases.Conclusions: The attitude towards a child with acute ataxia should be careful and individualized, making it difficult to implement a uniform protocol for approach. Most cases have a benign and self-limiting course, with short duration admission and only supportive care. However, serious causes must be properly excluded. Detailed clinical history, complete physical and neurological examination, and hospitalization for monitoring of clinical course are crucial.

The effects of walking training assisted by electromyographic biofeedback on motor recovery of the lower limb of subacute stroke patients with foot drop / 中华物理医学与康复杂志

Objective To explore the effects of walking training assisted by electromyographic biofeedback (EMGBF) on the lower limb function of subacute stroke patients with foot drop. Methods Forty subacute stroke patients with foot drop were randomly divided into an EMGBF training group (n =20 ) and a routine rehabilitation training group ( n =20 ).Both groups received routine rehabilitation training.The EMGBF training group also received walking training assisted by three stages of EMGBF.The subjects were treated for 40 min twice per day,5 days a week for 6 weeks.Clinical and functional evaluations such as surface electromyogram (sEMG) signals from the anterior tibial muscle,active ankle dorsiflexion range of motion ( AROM ),scores on the modified Ashworth scale (MAS),results of the modified Lovett manual muscle test (mMMT),pace and step length,Berg balance scale (BBS) scores,Fugl-Meyer movement function scale (FMA) assessments,modified Barthel index (MBI) scores and Holden walking function test results were observed before treatment,after 6 weeks of treatment and at follow-up 6 weeks after the end of treatment. Results Before treatment there was no significant difference between the two groups.There were significant differences in all of the assessment results in the EMGBF training group after treatment compared with before treatment and compared with the routine rehabilitation training group after treatment.At followup 6 weeks after training,average pace (69.75 ± 35.09 m/min),step length (60.98 ± 14.09 cm),FMA score (32.5 ± 6.34 ) and MBI score (88.65 ± 14.13 ) in the EMGBF training group were all significantly better than in the routine rehabilitation group.At follow up,5 patients in the EMGBF training group achieved grade 5 in the Holden walking function test versus only 1 patient in the routine rehabilitation group. Conclusion Walking training assisted by EMGBF is effective in improving lower limb motor function in subacute stroke patients with foot drop.

Gait disorders in patients with subcortical ischemic vascular disease / 国际脑血管病杂志

Subcortical ischemic vascular disease (SIVD) is a group of ischemic cerebrovascular diseases caused by small-vessel disease,and the major pathological damage is multiple subcortical lacunar infarction and white matter lesions.SIVD is the most major cause of resulting in vascular cognitive impairment.It can also have gait disorders,such as Parkinsonlike gait,frontal gait,ataxia,or frequent fall without obvious inducement,etc.Several studies have shown that the gait abnormalities in the elderly may be the early signs of vascular dementia.This article reviews SIVD caused pathomechanisms,clinical features,clinical significance,analysis and evaluation and treatment of gait disorders.

An initial report of transplantation of the adductor brevis and gracilis to treat scissors gait of spastic cerebral palsy / 中华骨科杂志

Objective To evaluate the effects of transplant adductor brevis and gracilis to correct scissors gait in spastic cerebral palsy. Methods From July 2000 to December 2004, 73 patients with scissors gait of spastic cerebral palsy were treated with transplantation of adductor brevis and gracilis, 47 were males and 26 were females, with the average of 12.06 years old. According to Ashworth's standard, the muscle tension was evaluated before surgery. 12 cases were in degree Ⅰ, 38 cases were in degreeⅡ, 18 cases in degree Ⅲ and 5 cases in degree Ⅳ. The end of adductor brevis was cut off and sutured with tensor fasciae latae through the tunnel under the skin, the end of gracilis was cut off and transplanted to the lateral condylus of femur through the back of the knee. Some certain surgery completed at the same time, the semitendious and biceops muscle was transplanted to the front of the knee(37 cases) and extended(13 cases), the soft tissue was released in hip joint(55 cases), the gastrocnemius cut off (32 cases), the Achilles's tendon extended(30 cases) and tibialis anterior lateral transplantation (31 cases), only peroneus longus lateral transplantation (8 cases). After operation the lower limbs was fixed with plaster cast for 6 weeks, then the plaster cast was removedassociating with functional exercise. The orthopaedic results were evaluated on the function of hip, knee, foot-malleoious and the gait, then classified four grades. Results All patients were followed up an average of 24.4 months. The scissors gait was corrected completely, 61 cases were excellent, 10 cases were good, 2 cases were fair. The majority symptom of whem was the knee flexure, but can be relieved by medicine. There were significant differences compared pre-operation with post-operation in four groups, and also between degree Ⅳ group and degree Ⅰand Ⅱgroup(P