Referred sensations in patients with complex regional pain syndrome type 1.
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OBJECTIVES: This study sought to explore and characterize referred sensations (RS) in patients with complex regional pain syndrome (CRPS) type 1 and test the hypothesis that pain in CRPS is associated with central sensory changes. METHODS: Subjects underwent standardized neurological examination involving light touch, pinprick and vibration sense with eyes closed and then with eyes open. The subjects described the location and sensation emanating from the stimulated site and whether they experienced any sensations (similar or different) elsewhere. RESULTS: Five of 16 subjects recruited demonstrated RS. These were experienced in real time, were modality specific (touch and pinprick) and were located on the body part immediately adjacent, on Penfield's cortical homunculus, to the stimulated site. The RS were diminished or absent when the subject visualized the stimulated area. They disappeared when stimulation ceased and on clinical improvement. CONCLUSIONS: This is the first report of RS in CRPS and provides further evidence of central reorganization in what was previously thought to be a peripheral disorder. (+info)
Adolescent pain sensitivity is associated with cardiac autonomic function and blood pressure over 8 years.
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Low pain sensitivity has been reported in hypertensive subjects as well in groups deemed to be at increased risk of development of the disorder. However, it is uncertain whether individual differences in pain sensitivity are associated prospectively with increases in blood pressure. In the current study, 24-hour blood pressure and heart rate variability were recorded in 110, 22-year-old men previously assessed at age 14 years for casual blood pressure and pain sensitivity (mechanical finger pressure). Significant correlations were observed between pain tolerance in 14-year-olds and current 24-hour systolic blood pressure (r=0.37, P<0.01) and diastolic blood pressure (r=0.36, P<0.01). Hierarchical multiple regression analyses indicated that information regarding pain tolerance improved prediction of systolic and diastolic blood pressure at age 22 years beyond that afforded by differences in blood pressure, parental history of hypertension, and body mass index at age 14 years. Similar analyses revealed that average pain sensitivity at age 14 was also associated with 24-hour high-frequency heart rate variability (r=0.28, P<0.01) and low-frequency/high-frequency heart rate variability at age 22 (r=-0.35, P<0.01), suggesting increased sympathetic and reduced parasympathetic tone among individuals less sensitive to pain. These results provide further evidence that blood pressure related hypoalgesia might be related to processes involved in blood pressure regulation as well as in the development of sustained high blood pressure. (+info)
Impairments of trunk movements following left or right hemisphere lesions: dissociation between apraxic errors and postural instability.
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Stroke patients present with apraxic or postural deficits involving trunk movements. Praxis and posture control have been associated with the functions of the left and the right hemisphere, respectively. For the first time, in this study the occurrence of apraxic and postural components in trunk movement deficits following right and left hemisphere lesions were investigated in the same participants. Twenty-three patients with left (L/pt), 12 with right (R/pt) hemisphere lesion, and 30 healthy controls were evaluated with a 21-item test assessing the imitation of meaningless, symbolic and reaching movements presented twice on visual or proprioceptive modality. Erroneous, motor responses of the trunk were classified as postural (compensations to overcome stability or asymmetry deficits) or apraxic (execution errors not due to biomechanical constraints). Postural instability reactions were significantly more frequent among the R/pts, whilst apraxic responses were overwhelming within the L/pts. The findings are consistent with the view that the left hemisphere is dominant for praxis and suggest that this dominance be extended to trunk praxis. The results also support the hypothesis that trunk postures are coded in relation to the environment by a representational system. A widespread network, mainly sitting in the right hemisphere, subserves this postural system. The distinction between praxic and postural deficits in executing trunk movements should be kept in mind when evaluating trunk movement difficulties shown by stroke patients, in following up their recovery or when tailoring rehabilitation programmes. (+info)
Age-dependent impairment of somatosensory response in the amyloid precursor protein 23 transgenic mouse model of Alzheimer's disease.
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Quantitative functional magnetic resonance imaging was applied to characterize brain function in amyloid precursor protein 23 (APP23) transgenic mice, which reproduce the neuropathological alterations associated with Alzheimer's disease. Electrical stimulation of the paw led to cerebral blood volume increases in the contralateral somatosensory cortex. In APP23 mice this hemodynamic response decreased with increasing age of the animal and with increasing stimulus amplitude as compared with wild-type animals. The age-dependent dysfunction in APP23 mice may be attributed in part to a compromised cerebrovascular reactivity. Quantitative functional brain mapping that uses standardized sensory inputs should allow for assessment of disease progression and therapy response (e.g., passive immunization against beta-amyloid) in patients also. (+info)
The long-term health outcomes of childhood abuse. An overview and a call to action.
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While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical health including some of the potential pathways, and (2) to call for collaborative action among clinicians, psychosocial and biomedical researchers, social service agencies, criminal justice systems, insurance companies, and public policy makers to take a comprehensive approach to both preventing and dealing with the sequelae of childhood abuse. (+info)
How predictive is grip force control in the complete absence of somatosensory feedback?
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Grip force control relies on accurate internal models of the dynamics of our motor system and the external objects we manipulate. Internal models are not fixed entities, but rather are trained and updated by sensory experience. Sensory feedback signals relevant object properties and mechanical events, e.g. at the skin-object interface, to modify motor commands and update internal representations automatically. Here we prove that intact sensory feedback is essential for predictive grip force regulation. The efficiency and precision of grip force adjustments to load fluctuations arising from vertical and horizontal point-to-point arm movements with a hand-held object were analysed in a chronically deafferented subject (G.L.) and three healthy control subjects. Point-to-point movements started and ended with the object being held stationary. G.L. and healthy controls produced similar accelerations of the grasped object and consequently similar load magnitudes during vertical and horizontal movements. Compared with healthy controls, G.L. employed inefficiently high grip forces when holding and moving the object, indicating inaccurate force scaling to object weight and inertial loads. For healthy controls, the grip force profile was precisely timed to the movement-induced load fluctuations during vertical and horizontal movements. However, G.L.'s grip force profile was not processed to match differential loading requirements of movement direction. We conclude that predictive grip force control requires at least intermittent sensory feedback to signal the effectiveness of descending motor commands and to update internal models. (+info)
Perceptual deficits in clumsy children: inter- and intra-modal matching approach--a window into clumsy behavior.
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This article will focus on the underlying perceptual deficits that might lead to inadequacies in motor performance in children. Two lines of enquiry have dominated the literature: visual-perceptual deficit and/or visual-motor deficits and proprioceptive deficits. The theoretical and methodological shortcomings in these approaches are discussed. Then attention is primarily directed toward the concept of inter- and intra-modal matching (sensory integration), particularly with respect to vision and proprioception, an ability deemed to underlie many real-life motor skills. Such an approach allows parallels to be drawn between behavioral manifestations of motor impairment and potential underlying neurological information-processing disorders, particularly as these relate to hemispheric competence. (+info)
OBJECTIVE: To apply the lesion method to assess neuroanatomical substrates for judgments of forearm orientation from proprioceptive cues in humans. METHODS: Participants were 15 subjects with chronic unilateral brain lesions and stable behavioural deficits, and 14 neurologically normal controls. Subjects aligned the forearm to earth fixed vertical and trunk fixed anterior-posterior (A-P) axes ("straight ahead"), with the head aligned to the trunk and with head and shoulder orientations varied on each trial. RESULTS: Most subjects with posterior parietal lobe lesions made larger variable errors than controls in aligning the forearm to the earth fixed vertical axis and the trunk A-P axes, whether the head was held upright or oriented in different positions. Lesion subjects and controls made similar constant errors for aligning the forearm to gravitational vertical. Variable error magnitude correlated positively with greater lesion volume of right and left superior parietal lobules (SPL), but not with lesions in other brain areas. Larger variable errors for aligning the forearm to the trunk fixed A-P axis were also correlated with the volume of SPL lesions, but constant error magnitude correlated with larger volume lesions in premotor areas, inferior parietal lobules, and posterior regions of the superior temporal gyri, but not with SPL lesion volume. CONCLUSIONS: The findings suggest that the right and left superior and inferior parietal lobules, posterior superior temporal gyri, and premotor areas play a role in defining higher level coordinate systems for specifying orientation of the right and left forearm. (+info)