Integrated motor cortical control of task-related muscles during pointing in humans.
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A large body of compelling but indirect evidence suggests that the motor cortex controls the different forelimb segments as a whole rather than individually. The purpose of this study was to obtain physiological evidence in behaving human subjects on the mode of operation of the primary motor cortex during coordinated movements of the forelimb. We approached this problem by studying a pointing movement involving the shoulder, elbow, wrist, and index finger as follows. Focal transcranial magnetic stimulation (TMS) was used to measure the input-output (I/O) curves-a measure of the corticospinal pathway excitability-of proximal (anterior deltoid, AD, and triceps brachii, TB) and distal muscles (extensor carpi radialis, ECR, and first dorsal interosseus, 1DI) during isolated contraction of one of these muscles or during selective co-activation with other muscles involved in pointing. Compared to an isolated contraction of the ECR, the plateau-level of the ECR sigmoid I/O curve increased markedly during co-activation with the AD while pointing. In contrast, the I/O curve of AD was not influenced by activation of the more distal muscles involved in pointing. Moreover, the 1DI I/O curve was not influenced by activation of the more proximal muscles. Three arguments argue for a cortical site of facilitation of ECR motor potentials. First, ECR motor potentials evoked by a near threshold TMS stimulus were facilitated when the AD and ECR were co-activated during pointing but not those in response to a near threshold anodal electrical stimulus. Second, the ECR H reflex was not found to be task dependent, indicating that the recruitment gain of the ECR alpha-motoneuron pool did not differ between tasks. Finally, in comparison with an isolated ECR contraction, intracortical inhibition tested at the ECR cortical site was decreased during pointing. These results suggest that activation of shoulder, elbow, and wrist muscles involved in pointing appear to involve, at least in part, common motor cortical circuits. In contrast, at least in the pointing task, the motor cortical circuits involved in activation of the 1DI appear to act independently. (+info)
Early surgical management for heterotopic ossification about the elbow presenting as limited range of motion associated with ulnar neuropathy.
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BACKGROUND: The formation of heterotopic ossification (HO) about the elbow after traumatic injury has been well documented in the literature. The optimal treatment, however, for ectopic bone associated with restricted range of motion and ulnar nerve entrapment syndrome has not been established. METHODS: Seven elbows with HO in 7 patients admitted to Chang Gung Memorial Hospital from April 1998 to January 1999 presented with limited range of motion and associated ulnar nerve neuropathy. All of these patients received early surgical excision of HO combined with release of the encased ulnar nerve and anterior transposition, followed by early gentle passive physical therapy and active exercise within the pain-free range of motion postoperatively. RESULTS: Almost full range of motion and complete functional ability following surgery were recovered in 6 of the 7 patients, while I patient who suffered from multiple traumatic injuries had limited improvement from 45 degrees ankylosis to 10 degrees approximately 90 degrees of a flexion-extension motion arc. CONCLUSION: Our results suggest that early surgical management combined with gentle physical therapy postoperatively is a feasible modality for treating patients with post-traumatic HO about the elbow presenting as limited range of motion and associated ulnar nerve compression syndrome. (+info)
Local field potential oscillations in primate cerebellar cortex: modulation during active and passive expectancy.
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Cerebellar local field potential (LFP) oscillations were recorded in the paramedian lobule of one hemisphere, while monkeys were in two behavioral conditions: actively performing an elbow flexion-extension or a lever-press task in response to an auditory or visual stimulus to get reward (active condition), or waiting quietly for the reward to come in the same time window after the appearance of the stimulus (passive condition). The oscillations in the paramedian lobule were first characterized in four monkeys, and they showed an idiosyncratic frequency for each monkey, between 13 and 25 Hz. The granule cell layer multi-unit activity was phase-locked with the negative phase of the LFP oscillations, while Purkinje cell simple spikes were also sometimes phase-locked with the LFP. Three monkeys were trained to perform the motor tasks: the LFP oscillations were modulated, in the active condition, in a systematic manner in relation to the lever-press or elbow flexion-extension tasks. During periods when the monkey was waiting to initiate movement, LFP oscillations appeared and then stopped with movement initiation. This modulation was valid for the task being executed with either hand. Surprisingly, the LFP oscillations were also systematically modulated during the passive condition; as the monkey was waiting for the usual time to get a reward passively, oscillations appeared stronger and were stopped by the end of the usual delay, whether the monkey was rewarded or not. This type of modulation was not affected by the length of the stimulus, as long as the reward window was known to the monkey. If the monkey had not been previously trained to the active condition, the modulation appeared in the passive condition. These results show that cerebellar LFP oscillations in the paramedian lobule are reliably present when the monkey is involved in a waiting period, whether this period ends with an active or passive event. This study provides electrophysiological evidence for a specific pattern of activity in the cerebellum for the expectancy of events that are known to be bound to happen, either externally, or from voluntary action. (+info)
Elbow fistulas using autogeneous vein: patency rates and results of revision.
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BACKGROUND: The provision and maintenance of vascular access remains a major cost to end stage renal failure programmes. There are few reports regarding the surgical revision of the failing native elbow arteriovenous fistula (AVF). PATIENTS AND METHODS: A retrospective case note review was performed on all patients identified from the hospital vascular access database as having undergone construction of an autogeneous vein elbow AVF. Over a seven year period 282 autogeneous vein AVFs were fashioned in 232 patients using the brachial artery as the in-flow conduit. Of these 208 were brachiocephalic fistulas, or a variant thereof, and 74 were fashioned using the transposed autologous basilic vein (136 male: 96 female; median age 60 years, range 14-94 years). RESULTS: Of 282 elbow fistulas 197 were successfully used for dialysis (70%). Cumulative primary patency of elbow fistulas using autogeneous vein in this series was 68%, 54%, and 44% at one, two, and three years respectively. A further 34 revision procedures were performed on 28 fistulas to maintain fistula function, and cumulative secondary patency after surgical revision was 75%, 60%, and 46% at one, two, and three years. Overall 21 out of 34 procedures (62%) successfully restored fistula function and cumulative primary patency of the revised fistulas was 56% at one year. Eighteen AVFs (brachiocephalic, n=12; autologous basilar vein, n=6) required revision for access dysfunction secondary to a short stenoses within 4 cm of the arteriovenous anastomoses. Of these 18 AVFs eight were revised by excision of the stenosed segment and either primary anastomoses of the two cut ends of arterialised vein or reanastomoses of the proximal venous limb proximally on the brachial artery. In another nine fistulas the excised segment was replaced with a short interposition graft (polytetrafluoroethylene, n=7; native basilic vein, n=1; bovine carotid artery, n=1). One fistula with postanastomotic stenoses and a more proximal needle site stenoses was revised using two vein patches. Overall 100% were patent at 24 hours, 13 provided successful dialysis (72%), and cumulative primary patency was 67% and 50% at six months and one year respectively. CONCLUSIONS: Successful surgical revision of failing native elbow fistulas can restore patency and improve cumulative secondary patency with potential benefits in terms of patient morbidity and mortality. These results compare favourably to published patency rates after fistula salvage using interventional radiological techniques. (+info)
Reproducibility of primary motor cortex somatotopy under controlled conditions.
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BACKGROUND AND PURPOSE: The somatotopic organization of the contralateral primary motor cortex (M1) and its intra- and intersubject reproducibility has been the subject of many investigations and controversies. A potential explanation for a least some of the conflicting results could be the lack of movement control in the studies performed. The purpose of this study was to investigate these issues under controlled experimental conditions. METHODS: Functional MR imaging was performed in 12 healthy volunteers performing hand, finger, wrist, elbow, foot, and tongue movements. Two experimental sessions were separated by 2 weeks. Controlled conditions were achieved by means of a custom-designed arm and hand manipulandum providing standardization of the movements within and across subjects. RESULTS: The experiments revealed a clear large-scale somatotopy of the contralateral M1 with distinct subregions controlling the foot, arm, and tongue. Despite considerable overlap of the volumes, geometric centers of gravity (COGs) showed statistically significant differences in coordinates between the elbow, wrist, fingers, and hand. COGs showed a high degree of intra- and interindividual reproducibility, particularly for the upper limb movements, in contrast to the activation volumes that proved to be unreliable parameters, despite the controlled conditions. CONCLUSION: These findings support the existence of a gross-scale somatotopic organization yet also demonstrate a clear, fine-scale somatotopy of the within-arm representations. Furthermore, they reveal high reproducibility of the COGs when standardized conditions are applied. This observation highlights the need for movement control to allow for intra- and intersubject comparison. (+info)
Changes in muscle activation can prolong the endurance time of a submaximal isometric contraction in humans.
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Fourteen young subjects (7 men and 7 women) performed a fatiguing isometric contraction with the elbow flexor muscles at 20% of maximal voluntary contraction (MVC) force on three occasions. Endurance time for session 3 [1,718 +/- 1,189 (SD) s] was longer than for session 1 (1,225 +/- 683 s) and session 2 (1,410 +/- 977 s). Five men and four women increased endurance time between session 1 and 3 by 60 +/- 28% (responders), whereas two men and three women did not (-3 +/- 11%; nonresponders). The MVC force was similar for the responders and nonresponders, both before and after the fatiguing contraction. Fatiguing contractions were characterized by an increase in the electromyogram (EMG) amplitude and number of bursts during the fatiguing contractions. The responders achieved a similar level of EMG at exhaustion but a reduced rate of increase in the EMG across sessions. The rate of increase in EMG across sessions declined for the nonresponders, but it remained greater than that of the responders. The increase in burst rate during the contractions declined across sessions with a negative relation between burst rate and endurance time (r = -0.42). Normalized force fluctuations increased during the fatiguing contractions, and there was a positive relation (r = 0.60) between the force fluctuations and burst rate. Changes in mean arterial pressure and heart rate during the fatiguing contraction were similar for the responders and nonresponders across the three sessions. The results indicate that those subjects who increased the endurance time of a submaximal contraction across three sessions did so by altering the level and pattern of muscle activation. (+info)
Evaluation of a bio-impedance method for measuring human arm movement.
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This study proposes a new method for measuring upper limb movement using a bio-impedance technique. Bio-impedance and joint angle were simultaneously measured during the wrist and elbow movements of 12 normal subjects. The joint angles of the wrist and elbow were estimated by measuring the bio-impedances of the forearm and upper arm, respectively. Although the measured bio-impedances on upper limbs varied among individuals, changes in the bio-impedances and joint angles of the wrist and elbow during their extension and flexion were very highly correlated, having correlation coefficients of 0.96 +/- 0.04 and -0.98 +/- 0.02, respectively. The reproducibilities of wrist and elbow bio-impedance changes were 2.1 +/- 1.0% and 1.8 +/- 1.0%, respectively. Since the proposed method is not restricted by size or the duration of measurements, it is expected to be useful for the analysis of athletic movement. (+info)
Examination of and intervention for a patient with chronic lateral elbow pain with signs of nerve entrapment.
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BACKGROUND AND PURPOSE: Lateral elbow pain has several causes, which can make diagnosis difficult. The purpose of this case report is to describe the examination of and the intervention for a patient with chronic lateral elbow pain who had signs of nerve entrapment. CASE DESCRIPTION: The patient was a 43-year-old woman who had right lateral elbow pain for about 4 months, which she attributed to extensive keyboard work on a computer. She had a reduction in joint passive range of motion during "neural tension testing," an examination procedure to detect nerve entrapment. This sign, in combination with other findings, suggested that the patient had a mild entrapment of the deep radial nerve (radial tunnel syndrome). The patient was treated 14 times over a 10-week period with "neural mobilization techniques," which are designed to free nerves for movement; ultrasound; strengthening exercises; and stretching. OUTCOMES: The patient had minimal symptoms at discharge, was pain-free, and had resumed all activities at a 4-month follow-up visit. DISCUSSION: Neural tension testing may be a useful examination procedure and mobilization may be useful for intervention for patients who have lateral elbow pain. (+info)