Levodopa-Induced Changes in Electromyographic Patterns in Patients with Advanced Parkinson's Disease

Levodopa medication is the most efficient treatment for motor symptoms of Parkinson's disease (PD). Levodopa significantly alleviates rigidity, rest tremor, and bradykinesia in PD. The severity of motor symptoms can be graded with UPDRS-III scale. Levodopa challenge test is routinely used to assess patients' eligibility to deep-brain stimulation (DBS) in PD. Feasible and objective measurements to assess motor symptoms of PD during levodopa challenge test would be helpful in unifying the treatment. Twelve patients with advanced PD who were candidates for DBS treatment were recruited to the study. Measurements were done in four phases before and after levodopa challenge test. Rest tremor and rigidity were evaluated using UPDRS-III score. Electromyographic (EMG) signals from biceps brachii and kinematic signals from forearm were recorded with wireless measurement setup. The patients performed two different tasks: arm isometric tension and arm passive flexion-extension. The electromyographic and the kinematic signals were analyzed with parametric, principal component, and spectrum-based approaches. The principal component approach for isometric tension EMG signals showed significant decline in characteristics related to PD during levodopa challenge test. The spectral approach on passive flexion-extension EMG signals showed a significant decrease on involuntary muscle activity during the levodopa challenge test. Both effects were stronger during the levodopa challenge test compared to that of patients' personal medication. There were no significant changes in the parametric approach for EMG and kinematic signals during the measurement. The results show that a wireless and wearable measurement and analysis can be used to study the effect of levodopa medication in advanced Parkinson's disease.Peer reviewe

Vuosiluokan yli siirron kauneus on katsojan silmissä:narratiivinen tutkimus vuosiluokan yli siirtämisestä

Tiivistelmä. Pro gradu tutkielmamme tavoitteena on selvittää, miten lahjakkaat oppilaat ovat kokeneet vuosiluokan yli siirtämisen ja minkälaisia vaikutuksia sillä on ollut heidän elämäänsä. Tarkastelemme myös sitä, kuinka koulussa työskennelleet ihmiset, jotka ovat uransa aikana olleet mukana ainakin yhdessä vuosiluokan yli siirtämis -tapauksessa, ovat kokeneet siirrot. Näitä kokemuksia keräsimme haastattelujen ja kirjoitelmien avulla. Vuosiluokan yli siirtämisestä ei kuule käytävän keskustelua, eikä aiheesta ole juuri tehty aiempaa tutkimusta Suomen kontekstissa. Vuosiluokan yli siirtäminen on kuitenkin edelleen käytössä oleva lahjakkaan lapsen tukimuoto, joka vaikuttaa moneen asiaan siirretyn lapsen elämässä. Vaikka siirtoprosessit ovatkin aina tapauskohtaisia, on siirroissa kuitenkin usein paljon yhteneväisyyksiä, kuten tutkimuksessamme tuli ilmi. Tutkimuksestamme voisivatkin näin hyötyä tulevaisuudessa siirtoa harkitsevat ihmiset, joihin me itse saatamme myös tulevaisuuden opettajina kuulua. Tutkimuksessamme tutkimme nimenomaan ihmisten kokemuksia vuosiluokan yli siirrosta, ja siksi metodologisena lähestymistapana oli luontevaa käyttää narratiivista tutkimusta, jossa korostuu ihmisläheisyys. Narratiivisen tutkimuksen käyttö oli myös perusteltua, sillä muistuttivathan aineistonamme käyttämät kirjoitelmat ja haastattelut jo itsessään tarinoita. Emme varsinaisesti noudattaneet mitään yhtä, tiettyä analyysimenetelmää aineistoa käsitellessämme, vaan rakensimme omamme yhdistelemällä erilaisia menetelmiä. Tämä on perusteltua, sillä tapoja tehdä narratiivista tutkimusta on monenlaisia ja niinpä myös tapoja toteuttaa sen analysointia. Aineistosta muodostui lopulta neljä teemaa: tunteet ja tuntemukset, siirron kehitys, haasteet sekä muutokset. Teoreettinen viitekehyksemme koostuu lahjakkuuteen sekä itse siirtoprosessiin liittyvistä teorioista. Vuosiluokan yli siirtämisen taustalla nähdään yleensä olevan lahjakkuus ja siksi päätimme avata lahjakkuuden monisyistä käsitettä tarkemmin tutkimuksessamme. Siirtoprosessi -luvussa kerromme muun muassa siirtoprosessin vaiheista sekä siihen osallistuvien tahojen yhteistyöstä. Tutkimuksemme perusteella näyttää siltä, että vuosiluokan yli siirto on koettu päällisin puolin toimivana lahjakkaan lapsen tukimuotona. Siirtoihin liittyi aineistomme perusteella myös haasteita ja negatiivisia muistoja, erityisesti ikään liittyvissä asioissa, kuten murrosiässä ja täysi-ikäisyyden yhteydessä. Rikas aineisto antoi myös mahdollisuuden tutkia sitä, miten itse siirtoprosessi on kehittynyt vuosikymmenien myötä. Vuosiluokan yli siirron hyödyllisyyttä ei voida yleistää, sillä jokainen siirto on ainutlaatuinen. Se on kuitenkin perusteltua silloin kun sille oikeasti on tarvetta ja eriyttäminen omassa luokassa ei enää riitä. Tällöin tulee kuitenkin taata se, että lapsi on oikeasti valmis siirtoon sekä tiedoiltaan, taidoiltaan että muulta kehitykseltään

Changes in elbow flexion EMG morphology during adjustment of deep brain stimulator in advanced Parkinson's disease

Publisher Copyright: © 2022 Ruonala et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Objective Deep brain stimulation (DBS) is an effective treatment for motor symptoms of advanced Parkinson's disease (PD). Currently, DBS programming outcome is based on a clinical assessment. In an optimal situation, an objectively measurable feature would assist the operator to select the appropriate settings for DBS. Surface electromyographic (EMG) measurements have been used to characterise the motor symptoms of PD with good results; with proper methodology, these measurements could be used as an aid to program DBS. Methods Muscle activation measurements were performed for 13 patients who had advanced PD and were treated with DBS. The DBS pulse voltage, frequency, and width were changed during the measurements. The measured EMG signals were analysed with parameters that characterise the EMG signal morphology, and the results were compared to the clinical outcome of the adjustment. Results The EMG signal correlation dimension, recurrence rate, and kurtosis changed significantly when the DBS settings were changed. DBS adjustment affected the signal recurrence rate the most. Relative to the optimal settings, increased recurrence rates (median ± IQR) 1.1 ± 0.5 (-0.3 V), 1.3 ± 1.1 (+0.3 V), 1.7 ± 0.4 (-30 Hz), 1.7 ± 0.8 (+30 Hz), 2.0 ± 1.7 (+30 μs), and 1.5 ± 1.1 (DBS off) were observed. With optimal stimulation settings, the patients' Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) score decreased by 35% on average compared to turning the device off. However, the changes in UPRDS-III arm tremor and rigidity scores did not differ significantly in any settings compared to the optimal stimulation settings. Conclusion Adjustment of DBS treatment alters the muscle activation patterns in PD patients. The changes in the muscle activation patterns can be observed with EMG, and the parameters calculated from the signals differ between optimal and non-optimal settings of DBS. This provides a possibility for using the EMG-based measurement to aid the clinicians to adjust the DBS.Peer reviewe

Efficacy of six months neuromuscular exercise on lumbar movement variability : a randomized controlled trial

Introduction: Lumbar movement variability during heavy, repetitive work may be a protective mechanism to diminish the progression of lumbar disorders and maintain neuromuscular functional integrity. The effect of neuromuscular exercise (NME) on the variability of lumbar movement is still to be determined. Methods: A randomised controlled trial was conducted on a population of nursing personnel with subacute LBP. Following randomization, the NME group participants completed an NME program of six months duration. The participants in the control group only attended the assessment sessions. The outcomes were assessed at: baseline; after six months intervention; 12 months. The primary outcome was lumbar movement variability based on angular displacement and velocity. Results: A positive treatment effect on lumbar movement variability was seen after six months of NME intervention. Angular displacement improved, and angular velocity remained constant. At the 12-month follow up, however, the effect faded in the NME group. Lumbar movement variability worsened in the control group over all time periods. Conclusion: NME may improve lumbar movement variability in the short term and may indicate improved neuromuscular functional integrity. The design of an optimal NME program to achieve long-term improvement in lumbar movement variability is a subject worthy of further research

Does Childhood Temperamental Activity Predict Physical Activity and Sedentary Behavior over a 30-Year Period? Evidence from the Young Finns Study

We examined associations between childhood temperamental activity, physical activity (PA), and television (TV) viewing over a 30-year period. The participants (1220 boys and 1237 girls) were aged 3, 6, 9, and 12 years in 1980 and were followed until 2011. Temperamental activity was evaluated by participants' mothers at baseline. The PA was assessed based on maternal ratings of the child from ages 3 to 6 and via self-report age from the age of 9 across all measurements. TV viewing was assessed using self-reports taken from 2001 to 2011. The associations between temperamental activity and the level and change of PA and TV viewing were determined using linear growth modeling stratified by gender and age group. High temperamental activity assessed from ages 9 to 12 was associated with high levels of childhood PA in both genders, but with a steeper decline in PA levels during the first 9 years of follow-up in boys. High temperamental activity assessed from ages 3 to 6 was associated with the decline of PA from childhood to youth in girls. High childhood temperamental activity was associated with decreased levels of PA in adulthood in men, but not in women. The associations between childhood temperamental activity and TV viewing during adulthood seemed to be positive but not consistently significant in all age and gender groups. High temperamental activity may contribute to the development of a physically inactive lifestyle. More evidence is needed with regard to gender differences among participants in similar study settings.Peer reviewe

Associations of Leisure-Time Physical Activity Trajectories with Fruit and Vegetable Consumption from Childhood to Adulthood: The Cardiovascular Risk in Young Finns Study

A physically active lifestyle and a diet rich in vegetables and fruits have a central role in promoting health. This study examined the associations between leisure-time physical activity (LTPA) trajectories and fruit and vegetable consumption (FVC) from childhood to middle age. The data were drawn from the Cardiovascular Risk in Young Finns Study with six age cohorts. Participants were 9 to 18 years (n = 3536; 51% females) at baseline in 1980 and 33 to 48 years at the last follow-up in 2011. LTPA and FVC were self-reported. LTPA trajectories were identified using latent profile analyses, after which the mean differences in FVC across the trajectories were studied. Active, low-active, decreasingly and increasingly active trajectories were identified for both genders. An additional trajectory describing inactivity was identified for females. Those who were persistently active or increased their LTPA had higher FVC at many ages when compared to their inactive or low-active counterparts (p < 0.05). In females prior to age 42 and in males prior to age 24, FVC was higher at many ages in those with decreasing activity than in their inactive or low-active counterparts (p < 0.05). The development of LTPA and FVC from childhood to middle age seem to occur in tandem.</p

Fatigue-induced changes of impedance and performance in target tracking

Kinematic variability is caused, in part, by force fluctuations. It has been shown empirically and numerically that the effects of force fluctuations on kinematics can be suppressed by increasing joint impedance. Given that force variability increases with muscular fatigue, we hypothesized that joint impedance would increase with fatigue to retain a prescribed accuracy level. To test this hypothesis, subjects tracked a target by elbow flexion and extension both with fatigued and unfatigued elbow flexor and extensor muscles. Joint impedance was estimated from controlled perturbations to the elbow. Contrary to the hypothesis, elbow impedance decreased, whereas performance, expressed as the time-on-target, was unaffected by fatigue. Further analysis of the data revealed that subjects changed their control strategy with increasing fatigue. Although their overall kinematic variability increased, task performance was retained by staying closer to the center of the target when fatigued. In conclusion, the present study reveals a limitation of impedance modulation in the control of movement variability

Preventing stroke in people with atrial fibrillation: a cross-sectional study.

The annual stroke rate in atrial fibrillation is around 5 per cent with increased risk in those with hypertension, diabetes, left ventricular dysfunction and other cardiovascular risk factors. This study set out to identify the patients with atrial fibrillation and modifiable risk factors for stroke