Modulation of Stretch Reflexes of the Finger Flexors by Sensory Feedback from the Proximal Upper Limb Poststroke

Neural coupling of proximal and distal upper limb segments may have functional implications in the recovery of hemiparesis after stroke. The goal of the present study was to investigate whether the stretch reflex response magnitude of spastic finger flexor muscles poststroke is influenced by sensory input from the shoulder and the elbow and whether reflex coupling of muscles throughout the upper limb is altered in spastic stroke survivors. Through imposed extension of the metacarpophalangeal (MCP) joints, stretch of the relaxed finger flexors of the four fingers was imposed in 10 relaxed stroke subjects under different conditions of proximal sensory input, namely static arm posture (3 different shoulder/elbow postures) and electrical stimulation (surface stimulation of biceps brachii or triceps brachii, or none). Fast (300°/s) imposed stretch elicited stretch reflex flexion torque at the MCP joints and reflex electromyographic (EMG) activity in flexor digitorum superficialis. Both measures were greatest in an arm posture of 90° of elbow flexion and neutral shoulder position. Biceps stimulation resulted in greater MCP stretch reflex flexion torque. Fast imposed stretch also elicited reflex EMG activity in nonstretched heteronymous upper limb muscles, both proximal and distal. These results suggest that in the spastic hemiparetic upper limb poststroke, sensorimotor coupling of proximal and distal upper limb segments is involved in both the increased stretch reflex response of the finger flexors and an increased reflex coupling of heteronymous muscles. Both phenomena may be mediated through changes poststroke in the spinal reflex circuits and/or in the descending influence of supraspinal pathways

Effect of Sensory Feedback from the Proximal Upper Limb on Voluntary Isometric Finger Flexion and Extension in Hemiparetic Stroke Subjects

This study investigated the potential influence of proximal sensory feedback on voluntary distal motor activity in the paretic upper limb of hemiparetic stroke survivors and the potential effect of voluntary distal motor activity on proximal muscle activity. Ten stroke subjects and 10 neurologically intact control subjects performed maximum voluntary isometric flexion and extension, respectively, at the metacarpophalangeal (MCP) joints of the fingers in two static arm postures and under three conditions of electrical stimulation of the arm. The tasks were quantified in terms of maximum MCP torque [MCP flexion (MCPflex) or MCP extension (MCPext)] and activity of targeted (flexor digitorum superficialis or extensor digitorum communis) and nontargeted upper limb muscles. From a previous study on the MCP stretch reflex poststroke, we expected stroke subjects to exhibit a modulation of voluntary MCP torque production by arm posture and electrical stimulation and increased nontargeted muscle activity. Posture 1 (flexed elbow, neutral shoulder) led to greater MCPflex in stroke subjects than posture 2 (extended elbow, flexed shoulder). Electrical stimulation did not influence MCPflex or MCPext in either subject group. In stroke subjects, posture 1 led to greater nontargeted upper limb flexor activity during MCPflex and to greater elbow flexor and extensor activity during MCPext. Stroke subjects exhibited greater elbow flexor activity during MCPflex and greater elbow flexor and extensor activity during MCPext than control subjects. The results suggest that static arm posture can modulate voluntary distal motor activity and accompanying muscle activity in the paretic upper limb poststroke

Direct Detection of the Close Companion of Polaris with the Hubble Space Telescope

Polaris, the nearest and brightest classical Cepheid, is a single-lined spectroscopic binary with an orbital period of 30 years. Using the High Resolution Channel of the Advanced Camera for Surveys onboard the Hubble Space Telescope (HST) at a wavelength of ~2255\AA, we have directly detected the faint companion at a separation of 0\farcs17. A second HST observation 1.04 yr later confirms orbital motion in a retrograde direction. By combining our two measures with the spectroscopic orbit of Kamper and an analysis of the Hipparcos and FK5 proper motions by Wielen et al., we find a mass for Polaris Aa of 4.5^{+2.2}_{-1.4} M_\odot--the first purely dynamical mass determined for any Cepheid. For the faint companion Polaris Ab we find a dynamical mass of 1.26^{+0.14}_{-0.07} M_\odot, consistent with an inferred spectral type of F6 V and with the flux difference of 5.4 mag observed at 2255\AA. The magnitude difference at the V band is estimated to be 7.2 mag. Continued HST observations will significantly reduce the mass errors, which are presently still too large to provide critical constraints on the roles of convective overshoot, mass loss, rotation, and opacities in the evolution of intermediate-mass stars. Our astrometry, combined with two centuries of archival measurements, also confirms that the well-known, more distant (18") visual companion, Polaris B, has a nearly common proper motion with that of the Aa,Ab pair. This is consistent with orbital motion in a long-period bound system. The ultraviolet brightness of Polaris B is in accordance with its known F3 V spectral type if it has the same distance as Polaris Aa,Ab.Comment: 31 pages, 12 figures, 6 tables; accepted for publication in the Astronomical Journa

Polaris B, an optical companion of Polaris (alpha UMi) system: atmospheric parameters, chemical composition, distance and mass

We present an analysis of high-resolution spectroscopic observations of Polaris B, the optical companion of the Polaris Ab system. The star has a radial velocity V_r of -16.6km/s to -18.9km/s, and a projected rotational velocity vsini=110 km/s. The derived atmospheric parameters are: Teff=6900K; logg=4.3; V_t=2.5km/s. Polaris B has elemental abundances generally similar to those of the Cepheid Polaris A (Usenko et al. 2005a), although carbon, sodium and magnesium are close to the solar values. At a spectral type of F3V Polaris B has a luminosity of 3.868L_sun, an absolute magnitude of +3.30mag, and a distance of 109.5pc. The mass of the star is estimated to be 1.39M_sun, close to a mass of 1.38+/-0.61M_sun for the recently-resolved orbital periods companion Polaris Ab observed by Evans et al. (2007).Comment: 6 pages, 3 figures, 1 tabl

Mg II h + k emission lines as stellar activity indicators of main sequence F-K stars

The main purpose of this study is to use the IUE spectra in the analysis of magnetic activity of main sequence F-K stars. Combining IUE observations of MgII and optical spectroscopy of Ca II, the registry of ctivity of stars can be extended in time. We retrieved all the high-resolution spectra of F, G, and K main sequence stars observed by IUE (i.e. 1623 spectra of 259 F to K dwarf stars). We obtained the continuum surface flux near the Mg II h+k lines near 2800 \AA and the MgII line-core surface flux from the IUE spectra. We obtained a relation between the mean continuum flux near the MgII lines with the colour $B-V$ of the star. For a set of 117 nearly simultaneous observations of Mg II and Ca II fluxes of 21 F5 to K3 main sequence stars, we obtained a colour dependent relation between the Mount Wilson CaII S-index and the MgII emission line-core flux. As an application of this calibration, we computed the Mount Wilson index for all the dF to dK stars which have high resolution IUE spectra. For some of the most frequently observed main sequence stars, we analysed the Mount Wilson index S from the IUE spectra, together with the ones derived from visible spectra. We confirm the cyclic chromospheric activity of epsilon Eri (HD 22049) and beta Hydri (HD 2151), and we find a magnetic cycle in alpha Cen B (HD 128621). Complete abstract in the paper.Comment: 10 pages, accepted for publication in Astronomy and Astrophysic

Does oral sodium bicarbonate therapy improve function and quality of life in older patients with chronic kidney disease and low-grade acidosis (the BiCARB trial)? Study protocol for a randomized controlled trial

Date of acceptance: 01/07/2015 © 2015 Witham et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acknowledgements UK NIHR HTA grant 10/71/01. We acknowledge the financial support of NHS Research Scotland in conducting this trial.Peer reviewedPublisher PD

Communication style and exercise compliance in physiotherapy (CONNECT). A cluster randomized controlled trial to test a theory-based intervention to increase chronic low back pain patients’ adherence to physiotherapists’ recommendations: study rationale, design, and methods

Physical activity and exercise therapy are among the accepted clinical rehabilitation guidelines and are recommended self-management strategies for chronic low back pain. However, many back pain sufferers do not adhere to their physiotherapist’s recommendations. Poor patient adherence may decrease the effectiveness of advice and home-based rehabilitation exercises. According to self-determination theory, support from health care practitioners can promote patients’ autonomous motivation and greater long-term behavioral persistence (e.g., adherence to physiotherapists’ recommendations). The aim of this trial is to assess the effect of an intervention designed to increase physiotherapists’ autonomy-supportive communication on low back pain patients’ adherence to physical activity and exercise therapy recommendations. \ud \ud This study will be a single-blinded cluster randomized controlled trial. Outpatient physiotherapy centers (N =12) in Dublin, Ireland (population = 1.25 million) will be randomly assigned using a computer-generated algorithm to either the experimental or control arm. Physiotherapists in the experimental arm (two hospitals and four primary care clinics) will attend eight hours of communication skills training. Training will include handouts, workbooks, video examples, role-play, and discussion designed to teach physiotherapists how to communicate in a manner that promotes autonomous patient motivation. Physiotherapists in the waitlist control arm (two hospitals and four primary care clinics) will not receive this training. Participants (N = 292) with chronic low back pain will complete assessments at baseline, as well as 1 week, 4 weeks, 12 weeks, and 24 weeks after their first physiotherapy appointment. Primary outcomes will include adherence to physiotherapy recommendations, as well as low back pain, function, and well-being. Participants will be blinded to treatment allocation, as they will not be told if their physiotherapist has received the communication skills training. Outcome assessors will also be blinded. \ud \ud We will use linear mixed modeling to test between arm differences both in the mean levels and the rates of change of the outcome variables. We will employ structural equation modeling to examine the process of change, including hypothesized mediation effects. \ud \ud This trial will be the first to test the effect of a self-determination theory-based communication skills training program for physiotherapists on their low back pain patients’ adherence to rehabilitation recommendations. Current Controlled Trials ISRCTN63723433\u

The 3D Structure of N132D in the LMC: A Late-Stage Young Supernova Remnant

We have used the Wide Field Spectrograph (WiFeS) on the 2.3m telescope at Siding Spring Observatory to map the [O III] 5007{\AA} dynamics of the young oxygen-rich supernova remnant N132D in the Large Magellanic Cloud. From the resultant data cube, we have been able to reconstruct the full 3D structure of the system of [O III] filaments. The majority of the ejecta form a ring of ~12pc in diameter inclined at an angle of 25 degrees to the line of sight. We conclude that SNR N132D is approaching the end of the reverse shock phase before entering the fully thermalized Sedov phase of evolution. We speculate that the ring of oxygen-rich material comes from ejecta in the equatorial plane of a bipolar explosion, and that the overall shape of the SNR is strongly influenced by the pre-supernova mass loss from the progenitor star. We find tantalizing evidence of a polar jet associated with a very fast oxygen-rich knot, and clear evidence that the central star has interacted with one or more dense clouds in the surrounding ISM.Comment: Accepted for Publication in Astrophysics & Space Science, 18pp, 8 figure

Desarrollo de un guante ortótico para proveer asistencia en la extensión de los dedos a pacientes que han sufrido derrame cerebral

An externally actuated glove, controlled by a microprocessor, is being developed to assist fi nger extension in stroke survivors. The goal of this device is to allow repeated practice of specifi c tasks for hand therapy in the home environment. The device allows the user three control modes: voice recognition, electromyography or manual. These modes can be used either independently or combined according to the needs of the user. Both position and force feedback are available for control and safety. Initial testing of the prototype has shown promising performance.Se presenta el desarrollo de un guante activado externamente y controlado por un microprocesador para asistir la extensión de los dedos en pacientes con derrame cerebral. La meta del dispositivo es permitir la repetición de tareas específi cas para realizar terapia de la mano en un ambiente casero. El usuario puede controlar el dispositivo por tres medios diferentes: reconocimiento de voz, electromiografía o manualmente. Estos medios pueden ser usados tanto independientemente como en combinación según las necesidades del paciente. Para el control y la seguridad, se tiene retroalimentación de posición y de fuerza. Las pruebas iniciales del prototipo han demostrado un desempeño prometedo

Low-value care in musculoskeletal health care:Is there a way forward?

Background: Low-value care that wastes resources and harms patients is prevalent in health systems everywhere. Methods: As part of an invited keynote presentation at the Pain in Motion IV conference held in Maastricht, Holland, in May 2022, we reviewed evidence for low-value care in musculoskeletal conditions and discussed possible solutions. Results: Drivers of low-value care are diverse and affect patients, clinicians, and health systems everywhere. We show that low-value care for back pian, neck pain, and osteoarthritis is prevalent in all professional groups involved in caring for people who seek care for these conditions. Implementation efforts that aim to reverse low-value care seem to work better if designed using established conceptual and theoretical frameworks. Conclusion: Low-value care is prevalent in the care of people with musculoskeletal conditions. Reducing low-value care requires behaviour change among patients and clinicians as well as in health systems. There is evidence that behaviour change can be facilitated through good conceptual and theoretical frameworks but not convincing evidence that it changes patient outcomes.</p