UWOMJ Volume 34

Schulich School of Medicine & Dentistryhttps://ir.lib.uwo.ca/uwomj/1008/thumbnail.jp

Swayed by sound: sonic guidance as a neurorehabilitation strategy in the cerebellar ataxias

Cerebellar disease leads to problems in controlling movement. The most common difficulties are dysmetria and instability when standing. Recent understanding of cerebellar function has expanded to include non -motor aspects such as emotional, cognitive and sensory processing. Deficits in the acquisition and processing of sensory information are one explanation for the movement problems observed in cerebellar ataxia. Sensory deficits result in an inability to make predictions about future events; a primary function of the cerebellum. A question therefore, is whether augmenting or replacing sensory information can improve motor performance in cerebellar disease. This question is tested in this thesis by augmenting sensory information through the provision of an auditory movement guide.A variable described in motor control theory (tau) was used to develop auditory guides that were continuous and dynamic. A reaching experiment using healthy individuals showed that the timing of peak velocity, audiomotor coordination accuracy, and velocity of approach, could be altered in line with the movement parameters embedded in the auditory guides. The thesis then investigated the use of these sonic guides in a clinical population with cerebellar disease. Performance on neurorehabilitation exercises for balance control was tested in twenty people with cerebellar atrophy, with and without auditory guides. Results suggested that continuous, predictive, dynamic auditory guidance is an effective way of improving iii movement smoothness in ataxia (as measured by jerk). In addition, generating and swaying with imaginary auditory guides was also found to increase movement smoothness in cerebellar disease.Following the tests of instantaneous effects, the thesis then investigated the longterm consequences on motor behaviour of following a two -month exercise with auditory guide programme. Seven people with cerebellar atrophy were assessed pre - and post -intervention using two measures, weight -shifting and walking. The results of the weight -shifting test indicated that the sonic -guide exercise programme does not initiate long -term changes in motor behaviour. Whilst there were minor, improvements in walking, because of the weight -shifting results, these could not be attributed to the sonic guides. This finding confirms the difficulties of motor rehabilitation in people with cerebellar disease.This thesis contributes original findings to the field of neurorehabilitation by first showing that on -going and predictive stimuli are an appropriate tool for improving motor behaviour. In addition, the thesis is the first of its kind to apply externally presented guides that convey continuous meaningful information within a clinical population. Finally, findings show that sensory augmentation using the auditory domain is an effective way of improving motor coordination in some forms of cerebellar disease

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery