ABSTRACT
Gravity compensation (GC) of the arm is used to facilitate arm movements in conventional therapy as well as in robot-assisted rehabilitation of neurologically impaired persons. Positive effects of GC on Range of Motion (ROM) have been demonstrated in stroke. In Multiple Sclerosis (MS), research regarding this topic is lacking. Since an active participation of the patient is required for effective training, full support of the arm might not be advisable. The present study reports on the development of a procedure to measure actively the individual need for GC and to estimate the influence of GC on ROM during reaching, lifting and transporting in severely affected Persons with MS (PwMS). Ten PwMS were tested with the procedure for determination of GC. Maximal reaching movements were performed in a 3D space in three conditions: No support (NS), with GC by the HapticMaster (GC-HM) and with GC by the HapticMaster combined with a sling suspension system (GC-HMS). For the total sample, significant correlations were found between the amount of GC and clinical tests for upper limb function. In four subjects with severe arm dysfunction it was found that mean ROM is larger in the GC-HMS condition compared to the GC-HM condition, and in the GC-HM condition compared to the NS condition, suggesting positive effects of GC on active ROM in PwMS. Therefore, GC could have a positive effect on arm rehabilitation by enabling the PwMS to actively reach a larger ROM during training.
Subject(s)
Arm/physiology , Multiple Sclerosis/rehabilitation , Paresis/rehabilitation , Robotics/instrumentation , Robotics/methods , Aged , Female , Gravitation , Humans , Male , Middle AgedABSTRACT
Patients with Parkinson's disease (PD) exhibit impairments in the execution of highly practiced and skilled motor actions such as handwriting. The analysis of kinematic aspects of handwriting movements has demonstrated that size, speed, acceleration and stroke duration are affected in PD. Although beneficial effects of dopaminergic therapy in regard to execution of movements have been reported, the effects of pharmacological therapy on these measures have not been examined in detail. The present study has compared kinematic aspects of handwriting movements of 27 healthy subjects and 27 patients with PD both on their usual dopaminergic treatment and following withdrawal of dopaminergic medication. Healthy subjects were matched with PD patients according to age, sex, handedness and education level. A digitising tablet was used for the assessment of handwriting movements. Subjects were asked to perform a simple writing task. Movement time, distance, velocity, acceleration and measures of fluency of handwriting movements were measured. Compared with healthy subjects, the kinematics of handwriting movements in PD patients were markedly disturbed following withdrawal of dopaminergic medication. Although dopaminergic treatment in PD patients resulted in marked improvements in the kinematics of handwriting movements, PD patients did not reach an undisturbed level of performance. The results suggest that dopamine medication results in partial restoration of automatic movement execution.
Subject(s)
Antiparkinson Agents/pharmacology , Handwriting , Motor Skills/drug effects , Movement/drug effects , Parkinson Disease/physiopathology , Aged , Antiparkinson Agents/therapeutic use , Biomechanical Phenomena/methods , Chi-Square Distribution , Female , Humans , Male , Middle Aged , Motor Skills/physiology , Movement/physiology , Parkinson Disease/drug therapyABSTRACT
Groups of patients with Parkinson's disease (PD), striatonigral degeneration-type multiple system atrophy (MSA) or progressive supranuclear palsy (PSP) with motor disability stages II and III according to Hoehn and Yahr, and a healthy control group were compared using neuropsychological tests of executive functions. The results indicate that all three patient groups were impaired in the tests of executive functions. In comparison with healthy subjects, the three patient groups showed impaired performance regarding verbal fluency, problem solving and verbal and figural working memory. Patients with PD differed significantly from healthy subjects in a test of verbal recency, while patients with MSA or PSP were unimpaired. The comparison of patient groups revealed no differences between PD and MSA patients. However, patients with PSP showed greater impairment in both phonemic and semantic fluency than patients with PD or MSA. Using discriminant function analysis, it was found that variables derived from four verbal fluency tasks (simple and alternate semantic and phonemic fluency) discriminated among the three patient groups at a level significantly exceeding chance. Over 90% of patients with PSP were correctly classified. Patients with PD and MSA were correctly classified in over 70% of cases. These results suggest that verbal fluency tasks may be sensitive measures in the differential diagnosis of PD, MSA and PSP.
Subject(s)
Cognition Disorders/diagnosis , Multiple System Atrophy/diagnosis , Parkinsonian Disorders/diagnosis , Speech Disorders/diagnosis , Supranuclear Palsy, Progressive/diagnosis , Aged , Cognition/physiology , Cognition Disorders/etiology , Cognition Disorders/physiopathology , Diagnosis, Differential , Female , Humans , Male , Memory, Short-Term/physiology , Middle Aged , Multiple System Atrophy/complications , Multiple System Atrophy/physiopathology , Neuropsychological Tests , Parkinson Disease/complications , Parkinson Disease/diagnosis , Parkinson Disease/physiopathology , Parkinsonian Disorders/complications , Parkinsonian Disorders/physiopathology , Speech Disorders/etiology , Speech Disorders/physiopathology , Supranuclear Palsy, Progressive/complications , Supranuclear Palsy, Progressive/physiopathology , Verbal Behavior/physiologyABSTRACT
OBJECTIVES: Administration of botulinum neurotoxin A (BONT/A) is a common and effective treatment of blepharospasm. There is, however, no information regarding the emotional and social well-being of patients with blepharospasm and patient acceptance of BONT/A therapy. The purpose of this study was to investigate aspects of quality of life of patients with blepharospasm and level of patient satisfaction with treatment. MATERIAL AND METHODS: Fifty-one patients with blepharospasm who had been treated with BONT/A for years completed a questionnaire providing information about quality of life. RESULTS: Results revealed reductions in social and emotional well-being of patients but, nonetheless, good acceptance of BONT/A therapy. The positive effects of BONT/A therapy were, however, accompanied by fear of a decreasing effect of BONT/A injections. CONCLUSION: Although the objective findings following BONT/A injections in the treatment of blepharospasm are appreciated by the patients, their well-being is affected by fears and depression.
