Driving Performance in Patients With Idiopathic Cervical Dystonia; A Driving Simulator Pilot Study.

Objective: To explore driving performance and driving safety in patients with cervical dystonia (CD) on a simulated lane tracking, intersections and highway ride and to compare it to healthy controls. Design: This study was performed as an explorative between groups comparison. Participants: Ten CD patients with idiopathic CD, 30 years or older, stable on botulinum toxin treatment for over a year, holding a valid driver's license and being an active driver were compared with 10 healthy controls, matched for age and gender. Main outcome measures: Driving performance and safety, measured by various outcomes from the simulator, such as the standard deviation of the lateral position on the road, rule violations, percentage of line crossings, gap distance, and number of collisions. Fatigue and driving effort were measured with the Borg CR-10 scale and self-perceived fitness to drive was assessed with Fitness to Drive Screening. Results: Except for a higher percentage of line crossings on the right side of the road by controls (median percentage 2.30, range 0.00-37.00 vs. 0.00, range 0.00-9.20, p = 0.043), no differences were found in driving performance and driving safety during the simulator rides. Fatigue levels were significantly higher in CD patients just before (p = 0.005) and after (p = 0.033) the lane tracking ride (patients median fatigue levels before 1.5 (range 0.00-6.00) and after 1.5 (range 0.00-7.00) vs. controls median fatigue levels before and after 0.00 (no range). No significant differences were found on self-perceived fitness to drive. Conclusion: In patients with CD there were no indications that driving performance or driving safety were significant different from healthy controls in a simulator. Patients reported higher levels of fatigue both before and after driving compared to controls in accordance with the non-motor symptoms known in CD.

A systematic review into the effectiveness of hand exercise therapy in the treatment of rheumatoid arthritis.

Hand exercises are often part of the treatment of hand rheumatoid arthritis; however, it is still unclear whether and what type of exercises is effective in the treatment of this condition. Therefore, a systematic review into the effectiveness of hand exercises in the treatment of hand rheumatoid arthritis has been performed. Studies were identified in the literature databases by predefined search criteria. The eight included studies are peer-reviewed studies published between 2000 and 2014. Hand exercises differed between studies, but always included resistance and/or active range of motion exercises. Grip strength in various grip types (power grip, key pinch, precision pinch and tripod pinch) was found to improve by hand exercise therapy without having adverse effects on pain or disease activity. Adaptations in the range of motion in response to hand exercise therapy were less pronounced. There appears to be some transfer from the improvements on the body functioning level to the level of daily functioning, with the largest improvements found on grip ability. With regard to the intervention content, there was some evidence in favour of a longer therapy duration and a higher therapy intensity. No conclusions could be drawn on the effectiveness of the different types of exercises. Collectively, the studies indicate that hand exercises may have positive effects on strength and some aspects of daily functioning without aggravating disease activity or pain, although caution should be taken for subjects in the exacerbation period.

Early control of reaching: effects of experience and body orientation.

Although research suggests that experience may be a better indicator of the acquisition of certain abilities by infants than age, little work addresses this issue in the development of reaching movements in particular. This longitudinal study fills this gap by verifying the effect of practice time on more- and less-skilled reachers of the same age group in different body orientations. Less- (n=6) and more-skilled (n=4) reachers were evaluated at the acquisition of reaching and again after 1 month of spontaneous practice. Kinematic analyses examined 3D wrist motion during reaching trials in supine (0 degrees ), reclined (45 degrees ) and seated (70 degrees ) orientations. The results indicated that skill level was a relevant factor in dealing with gravitational constraints imposed by different body orientations. Time of practice affected the way less- and more-skilled reachers explored and adapted the kinematic parameters of reaching to constraints imposed by body orientations. These findings suggest that not only age, but also experience and body orientations are important constraints that should be taken into account when examining infant reaching development.

Catching optical information for the regulation of timing.

Recent research almost unambiguously refutes the hypothesis that the timing of interceptive actions is solely based on the relative rate of expansion [i.e. tau(psi)]. The aim of the present experiment was to evaluated the merits of eight alternative informational variables that recently have been proposed in the literature (i.e. psi, theta, delta, tau(psi), tau(theta), tau(delta), tau(psi, theta), zeta). Participants (n=7) were required to regulate the spatio-temporal characteristics of their reach and grasp to catch a ball approaching on a constant spatial trajectory. To identify the information used to regulate the timing of the catch we examined the qualitative effects of ball speed (0.5, 1.0, 1.5, 2.0, and 2.5 m/s) and viewing (monocular versus binocular) on the kinematics of the catch. Subsequently, we directly assessed the quantitative relationship between informational variables and the timing of reach onset and hand closure. The findings raised serious doubts against the use of variables that specified the time-to-contact between the ball and the point of observation (i.e. relative rate of expansion and disparity). Further, optical variables solely confined to the trajectory of the ball (i.e. the absolute rate of expansion) did yield positive results for the timing of reach onset but not for the timing of hand closure. Only variables that were related to the closure of the gap between hand and ball were found to contribute to the timing of hand closure. These results suggest that information related to the constriction of the optical gap between end-effector and ball becomes more important with approach, whereas the contribution of the absolute rate of expansion becomes less leading.