Relationship between motor FIM and muscle strength in lower cervical-level spinal cord injuries.

STUDY DESIGN: Retrospective analysis. OBJECTIVES: The objectives of this research were to, in subjects with lower cervical spinal cord injury (SCI), examine the relationship between strength of muscle groups as measured by the manual muscle test (MMT) and function (reflected as burden of care) as measured by individual functional independence measure (FIM) motor tasks, and investigate the extent to which MMT scores explain the variance of the motor FIM scores. SETTING: Acute rehabilitation hospitals, Boston, MA, USA. METHODS: Retrospective pilot study of 20 in-patients, age 18-62 years, with an SCI between C5 and C7. Discharge demographic variables, MMT and motor FIM scores were analyzed. Descriptive statistics, Spearman's rank correlation coefficients, stepwise regressions were performed. RESULTS: MMT scores for elbow flexion followed by shoulder flexion and wrist extension correlated with the greatest number of FIM tasks. MMT scores explained some part of the variance in the eight of 12 motor FIM tasks. In six of eight tasks, one key muscle explained a large portion of the variance. CONCLUSION: Key muscles relative to FIM tasks can be identified. These findings may help focus therapeutic interventions aimed at achievement in these tasks.

Relationship among balance impairments, functional performance, and disability in people with peripheral vestibular hypofunction.

BACKGROUND AND PURPOSE: Physical therapy interventions are often based on assumed relationships among impairments, functional performance, and disability. The purposes of this study were (1) to describe balance impairments, functional performance, and disability in subjects with unilateral peripheral vestibular hypofunction (UVH) and bilateral peripheral vestibular hypofunction (BVH), (2) to examine the relationship among these factors, and (3) to determine whether disability can be explained by commonly used tests of balance and functional performance. SUBJECTS: Participants were 85 subjects (mean age=62.5 years, SD=16.5) with UVH (n=41) or BVH (n=44) diagnosed by vestibular function tests and clinical examination. METHODS: Each subject completed the Dizziness Handicap Inventory (DHI) to obtain a measure of disability. Functional performance was measured with a modified Timed Up & Go Test (TUG). Balance impairments were measured with computerized posturography and balance tests. Descriptive statistics, correlational analyses, and stepwise regressions were performed. RESULTS: Subjects with BVH had poorer balance but similar TUG scores and perceived levels of disability, as compared with subjects with UVH. Weak to moderate correlations existed among balance measurements, TUG scores, and DHI scores. Balance impairments and TUG scores together explained 78% of the variance in DHI scores of the subjects with BVH, whereas balance impairments alone explained 13% of the variance in DHI scores of the subjects with UVH. CONCLUSION AND DISCUSSION: Balance impairments and functional performance appear to be more closely related to disability in individuals with BVH as compared with those with UVH. Clinical tests of balance impairments and functional performance appear to be useful in explaining disability.

Postnatal development of acetylcholinesterase in, and cholinergic projections to, the cat superior colliculus.

The postnatal development of cholinergic afferents to the superior colliculus in neonatal cats was studied by using acetylcholinesterase (AChE) histochemistry, choline acetyltransferase (ChAT) immunohistochemistry, and retrograde transport of horseradish peroxidase (HRP). In the adult cat, the pattern of AChE staining was laminar specific. AChE was distributed continuously in the stratum griseum superficiale (SGS) but was organized as patches in the stratum griseum intermediate (SGI). Diffuse AChE staining also was present in the stratum griseum profundum (SGP) and the dorsolateral periaqueductal gray (PAG). At birth, however, AChE staining was barely detectable in the SGS and, aside from a few isolated labeled neurons, was absent from the SGI, SGP, and PAG. By 7 days postnatal (dpn), staining in the SGS was more apparent but did not change appreciably in the deeper laminae. A substantial increase in AChE staining occurred in the SGS at 14 dpn (several days after eye opening), at which time patches in the SGI first became apparent. By 28 dpn, the complete laminar-specific adult AChE staining pattern was present, though the staining intensity did not reach the adult level until 56 dpn. A protracted maturation of both AChE staining and ChAT immunoreactivity also was observed in the sources of cholinergic afferents to the superior colliculus, which include the parabigeminal nucleus, and the pedunculopontine (PPN) and lateral dorsal tegmental (LDTN) nuclei. AChE and ChAT-immunoreactive staining in each nucleus was weak at birth but increased during the ensuing 2 weeks. At 21 dpn, however, ChAT immunoreactivity virtually disappeared in the parabigeminal nucleus and significantly decreased in PPN and LDTN. The ChAT immunoreactivity in these nuclei then gradually increased reaching maximum levels by 28 dpn. At 35 dpn, AChE staining showed a significant, though temporary (4 weeks), decrease in the parabigeminal nucleus, but not in the PPN and LDTN, that subsequently increased to the adult level of staining at 70 dpn. The absence of AChE in the SGI in neonatal animals was correlated, at least in part, with a paucity of neurons in the brainstem cholinergic cell groups labeled by retrograde transport of HRP from the superior colliculus. Injections of HRP into the superior colliculus retrogradely labeled many neurons in the parabigeminal nucleus, but few, if any, neurons in the PPN or LDTN at 1 dpn. Retrogradely labeled neurons also were observed in the substantia nigra pars reticulata, albeit fewer in neonates than in adults.(ABSTRACT TRUNCATED AT 400 WORDS)

The cholinergic innervation of the rat substantia nigra: a light and electron microscopic immunohistochemical study.

Putative cholinergic axons and synaptic endings were demonstrated in the substantia nigra (SN) of the rat by light and electron microscopy on the basis of the localization of choline acetyltransferase (ChAT) immunoreactivity. The distribution of ChAT immunoreactivity in the SN as demonstrated by light microscopy revealed a modest network of ChAT-immunoreactive beaded axons in the SNc, in comparison to a relatively sparse distribution in the SNr. These axonal profiles were most dense in the middle of the rostral-caudal extent of the SNc and appeared to be concentrated in the middle third of the medial-lateral extent. By electron microscopy, unmyelinated, small diameter (0.25 micron) ChAT-immuno-reactive axons were observed interspersed among numerous other non-immunoreactive axons in the SNc. ChAT-immunoreactive synaptic endings were observed in juxtaposition to small caliber (0.5 micron) non-immunoreactive dendrites, and contained numerous spheroidal synaptic vesicles and occasional mitochondria. Synaptic contact zones were characterized by an accumulation of synaptic vesicles along the presynaptic membrane, and a prominent postsynaptic densification producing an asymmetrical pre-/postsynaptic membrane profile typical of excitatory synapses. These findings provide direct evidence for a cholinergic innervation of the SN, and suggest that this input may have an excitatory effect on neuronal elements in the SNc.

A cholinergic projection to the rat substantia nigra from the pedunculopontine tegmental nucleus.

This study demonstrates the pedunculopontine tegmental nucleus (PPN) to be the source of a major cholinergic projection to the rat substantia nigra (SN). Neurons of the PPN were double-labeled utilizing choline acetyltransferase immunocytochemistry combined with retrograde transport of horseradish peroxidase (HRP). The cholinergic projection to the SN originates from neurons located in predominately the ipsilateral and rostral portions of the PPN. Other cholinergic neurons that were also retrogradely labeled with HRP were located in the caudal PPN and in the lateral dorsal tegmental nucleus. A non-cholinergic projection from this region was also identified. These findings indicate that the PPN may be topographically organized with respect to its efferent projections. In addition, this study provides evidence for an extrinsic source of acetylcholine to the basal ganglia and implicates the PPN as a source of potentially significant influence over basal ganglia function.

A cholinergic projection to the rat superior colliculus demonstrated by retrograde transport of horseradish peroxidase and choline acetyltransferase immunohistochemistry.

Acetylcholinesterase (AChE) has been localized by histochemistry in the superior colliculus and in the tegmentum of the caudal midbrain and rostral pons of the rat. The pattern of AChE localization in the superior colliculus was characterized by homogeneous staining in the superficial layers and patchlike staining in the intermediate gray layer. In the tegmentum, AChE was localized in the pedunculopontine nucleus (PPN), beginning rostrally at the caudal pole of the substantia nigra and extending caudally to the level of the parabrachial nuclei, and in the lateral dorsal tegmental nucleus (LDTN) of the central gray. The localization of AChE in these nuclei overlapped the distribution of neurons stained by immunohistochemistry using an antibody to choline acetyltransferase (ChAT), the synthesizing enzyme of the neurotransmitter acetylcholine. Other neighboring areas that were stained with AChE, but that did not contain ChAT-immunoreactive neurons, included the microcellular tegmental nucleus and the ventral tegmental nucleus. Neurons in the PPN and LDTN were determined to be potential sources of the cholinergic projection to the intermediate gray layer of the rat superior colliculus by double labelling with retrograde transport of horseradish peroxidase (HRP) combined with the immunohistochemical localization of ChAT. Three populations of neurons were identified. A predominantly ipsilateral ChAT-immunoreactive population was located in the pars compacta subdivision of PPN (PPNpc). Retrograde HRP-labelled neurons in the pars dissipata subdivision of the PPN (PPNpd), located ventral to the superior cerebellar peduncle (SCP) at the level of the inferior colliculus, composed a second population that was predominantly contralateral but was not ChAT immunoreactive. A third population of retrogradely labelled neurons was predominantly ipsilateral and ChAT immunoreactive and was located in the LDTN. These findings compared favorably with the full extent of the projection from this tegmental region revealed by retrograde transport of HRP from the superior colliculus when more compatible fixation and chromogen procedures were used. The results suggest that the PPN and the LDTN are two sources of the cholinergic input to the superior colliculus. Since the PPN also has extensive efferent, and afferent, connections with basal-ganglia-related structures, this cholinergic excitatory input to the superior colliculus, like the GABA-ergic inhibitory input from the substantia nigra pars reticulata, may provide the basis for an additional influence of the basal ganglia on visuomotor behavior.