El aprendizaje motor: un problema epigenético / Motor learning: an epigenetic problema

El presente trabajo pone en tela de juicio no solo los resultados de la investigación tradicional del aprendizaje motor sino, más radicalmente, los métodos utilizados para establecerlos. La cuestión metodológica cobra, entonces, una importancia singular, en tanto los estudios clásicos han logrado conocer, en todo caso, los factores orgánicos del aprendizaje motor, los sistemas intervinientes, pero no han aportado nada al conocimiento del aprendizaje motor mismo. La investigación clásica se esfuerza en aprehender los mecanismos íntimos de las respuestas motrices recurriendo a la neurofisiología, o en establecer cuáles son los aprendizajes que es preciso alcanzar en cada etapa del desarrollo para lograr el modelo “maduro’. De este modo, la investigación del aprendizaje motor se desplaza hacia la investigación de la Motricidad Humana, pero no explica (y en esto consiste siempre el trabajo de la ciencia) el acto, o el proceso, de aprendizaje de una habilidad o de un conjunto de habilidades, menos aún de una configuración de habilidades como, por ejemplo, un deporte. Por otra parte, los estudios clásicos convierten al sujeto en objeto de estudio, expropiándolo de toda posibilidad de condición particular, al mismo tiempo que encajan por la fuerza la heterogeneidad de las prácticas de aprendizaje en las restricciones que aseguran el control, la estabilidad y la uniformidad de los resultados, dejando fuera de la investigación, por tanto, todo el universo real de las prácticas.

This work calls into question not only the results of traditional research in motor learning but, more radically, the methods used to establish them. The methodological question becomes, then, a particular importance in both classical studies have come to know, in any case, organic factors of motor learning, the systems involved, but have not contributed anything to the knowledge of motor learning itself. The classic research strives to grasp the intimate mechanisms of motor responses using neurophysiology, or to establish what the lessons we need to be achieved are in each development stage to achieve the “mature” model. Thus, motor learning research is shifted to the investigation of Human Movement, but does not explain (which is always the science work) the act or process of learning a skill or a set of skills, even less a configuration of skills, such as a sport. On the other hand, classical studies makes the subject under study dispossessed of any possibility of special status, while forcibly fit the diversity of learning practices in the restrictions that ensure control, stability and uniformity of results, leaving out the research and, consequently, the whole world of real practice.

Prognostic Factors in Patients with Severe Head Injury

OBJECTIVE: To elucidate the problems that must be dealt with in the prognosis of patients with severe head injury and to find out the prognosis factors related to severe head injury. METHODS: A clinical analysis was carried out retrospectively with 292cases of severe head- injured patients (Glasgow coma scale score 3-8) admitted to the our department for 10 years from January 1987 to December 1996. RESULTS: Patients who were classified as having severe brain injury belonged to 13.1% of all craniocerebral trauma cases among which sixty-three cases had diffuse brain injury. The causes of head injuries were motor vehicle accident, falls from heights, bicycle and other causes in order of frequency. Pediatric patients showed better outcome(51.4%), compared with only 28.1% of all adult cases(p<0.0001). The patients with high initial GCS score(6-8, 47.9%) had significantly better outcome than the patients with low initial GCS socre(3-5, 16.9%) (p<0.0001). Fifty point three percents of patients with good motor response had good outcome, whereas only 15.8 percent in patients with poor motor response. The cases with diffuse head injury without basal cistern compression had significantly higher percentage of good outcome(74.0%) than those with basal cistern compression(16.9%, p<0.0001). The cases with normal pupillary reaction had significantly higher percentage of good outcome(50.3%) than those with bilateral oculomotor nerve palsy(18.4%, p<0.0001). The patients with skull fracture had good outcome(48.1%), compare to 20.3% of patients without skull fracture(p<0.0017). CONCLUSION: The good prognostic factors in this study were young age, initial high Glasgow coma scale, good motor response, diffuse brain injury type I, II, bilaterally intact light reflex, with skull fracture. Individual prognostic factor is significant to indicate the patient's outcome and may be utilized for assessing the relative efficacy of the alternative treatment and prognosis.

Variations in Motor Nerve Conduction Latency According to Different Recording Electrodes

OBJECTIVE: To explore the effects of different recording electrodes on motor nerve conduction latencies. METHOD: Median motor conduction study was performed in 10 healthy subjects. Motor conduction latency was determined by placing different recording electrodes (surface disc, monopolar needle and concentric needle) at the motor point of the left abductor pollicis brevis muscle, and reference electrodes on the proximal interphalangeal joint of the thumb. Motor nerve conduction recording was performed by using a surface disc, monopolar needle, and concentric needle. For the intramuscular recordings, needles were inserted both superficially and deep. The stimulus electrodes were secured 8 cm proximal to the recording electrodes, and the same intensity was applied throughout the tests. RESULTS: Deep intramuscular monopolar and concentric needle electrodes recorded the shorter latencies, 3.0+/-0.4 ms and 3.0+/-0.3 ms, respectively. Superficial concentric needle electrode recorded the longest latency of 3.4+/-0.3 ms. Motor nerve conduction latencies using a surface disc and superficial monopolar electrode were 3.2+/-0.3 ms and 3.2+/-0.3 ms, respectively. CONCLUSION: We conclude that the distal motor nerve conduction latency is variable depending on the type of recording electrodes.

Severe Head Injury:Clinical Prognostic Factors

A clinical analysis was carried out retrospectively with 54 cases of severe head injured patients(Glasgow Coma Scale score 3 to 8) to identify prognostic factors. Unawareness for over 1 month, abnormal papillary reaction, abnormal motor response pattern, and diffuse head injury with basal cisternal compression prove to be the most reliable predictors. Individual predictions of outcome provide a powerful too for assessing the relative efficacy of alternative treatments.

Clinical Analysis of Severe Head Injury

The authors have analyzed retrospectively a series of 102 consecutive patient with severe head injury who were admitted to the department of Neurosurgery, Dong Guk Univ. Hosp. between January, 1989, and December, 1989. All patients, after appropriate cardiopulmonary resuscitation, diagnostic measure, and, when required, surgical treatment, were managed in ICU with usual care method. The outcome has been analyzed 4 month later. The overall mortality rate was 36%. Of the survivors, 65% made good recovery or moderate disability, 22% remained severely disabled, and 14% were in a persistent vegetative state. Mortality rates at the variable GCS scores were 82% at 3-4, 25% at 5-6, and 14% at 7-8. The most reliable predictive factors were : Glasgow coma scale, motor response, pupillary reflex at admission.