Retroform Cervical Dystonia: Target Muscle Selection and Efficacy of Botulinum Toxin Injection

IntroductionRetroform cervical dystonia (RCD), which includes retrocaput and retrocollis, is a rare form of cervical dystonia. Few reports have been published on RCD. The present study aimed to characterize the target muscles involved in RCD and the efficacy of botulinum toxin type A (BTX-A) injection.MethodsPatients with consecutive cervical dystonia with RCD as the most problematic feature were retrospectively analyzed over a 10-year period. Target muscles were screened and confirmed based on clinical evaluation, single-photon emission computed tomography, and electromyography. In addition, efficacy and adverse events following BTX-A injection in patients with RCD were evaluated.ResultsA total of 34 patients with RCD were included, 18 of whom presented with retrocaput and 16 with retrocollis. The most frequently injected muscles in RCD were splenius capitis (SPCa, 97.1%) and semispinalis capitis (SSCa, 97.1%), followed by levator scapulae (LS, 50.0%), rectus capitis posterior major (RCPM, 47.1%), trapezius (TPZ, 41.2%), and sternocleidomastoid muscle (SCM, 41.2%). Besides cervical muscles, the erector spinae was also injected in 17.6% of patients. Most muscles were predominantly bilaterally injected. The injection schemes of retrocaput and retrocollis were similar, possibly because in patients with retrocollis, retrocaput was often combined. BTX-A injection achieved a satisfactory therapeutic effect in RCD, with an average symptom relief rate of 69.0 ± 16.7%. Mild dysphagia (17.6%) and posterior cervical muscle weakness (17.6%) were the most common adverse events.ConclusionSPCa, SSCa, LS, RCPM, LS, and SCM were commonly and often bilaterally injected in RCD. Patients with RCD could achieve satisfactory symptom relief after BTX-A injection

A sequential learning model with GNN for EEG-EMG-based stroke rehabilitation BCI

IntroductionBrain-computer interfaces (BCIs) have the potential in providing neurofeedback for stroke patients to improve motor rehabilitation. However, current BCIs often only detect general motor intentions and lack the precise information needed for complex movement execution, mainly due to insufficient movement execution features in EEG signals.MethodsThis paper presents a sequential learning model incorporating a Graph Isomorphic Network (GIN) that processes a sequence of graph-structured data derived from EEG and EMG signals. Movement data are divided into sub-actions and predicted separately by the model, generating a sequential motor encoding that reflects the sequential features of the movements. Through time-based ensemble learning, the proposed method achieves more accurate prediction results and execution quality scores for each movement.ResultsA classification accuracy of 88.89% is achieved on an EEG-EMG synchronized dataset for push and pull movements, significantly outperforming the benchmark method's performance of 73.23%.DiscussionThis approach can be used to develop a hybrid EEG-EMG brain-computer interface to provide patients with more accurate neural feedback to aid their recovery

Subject-independent EEG classification based on a hybrid neural network

A brain-computer interface (BCI) based on the electroencephalograph (EEG) signal is a novel technology that provides a direct pathway between human brain and outside world. For a traditional subject-dependent BCI system, a calibration procedure is required to collect sufficient data to build a subject-specific adaptation model, which can be a huge challenge for stroke patients. In contrast, subject-independent BCI which can shorten or even eliminate the pre-calibration is more time-saving and meets the requirements of new users for quick access to the BCI. In this paper, we design a novel fusion neural network EEG classification framework that uses a specially designed generative adversarial network (GAN), called a filter bank GAN (FBGAN), to acquire high-quality EEG data for augmentation and a proposed discriminative feature network for motor imagery (MI) task recognition. Specifically, multiple sub-bands of MI EEG are first filtered using a filter bank approach, then sparse common spatial pattern (CSP) features are extracted from multiple bands of filtered EEG data, which constrains the GAN to maintain more spatial features of the EEG signal, and finally we design a convolutional recurrent network classification method with discriminative features (CRNN-DF) to recognize MI tasks based on the idea of feature enhancement. The hybrid neural network proposed in this study achieves an average classification accuracy of 72.74 ± 10.44% (mean ± std) in four-class tasks of BCI IV-2a, which is 4.77% higher than the state-of-the-art subject-independent classification method. A promising approach is provided to facilitate the practical application of BCI

Current Rehabilitation Therapies in Parkinson’s Disease

Rehabilitation is one of the important non-pharmacological interventions for Parkinson’s disease (PD). At the time of diagnosis, an appropriate exercise regimen can be prescribed based on the patient’s symptoms. Rehabilitative therapies should be continued throughout the disease course. This chapter summarized the standard specifications and research progression on PD from perspectives of assessment and treatment of rehabilitation. The physical therapy, occupational therapy, speech-language therapy, and neuromodulation therapy are the focus of the introduction. Accurate and comprehensive functional assessment is the premise of rehabilitation plan. Various approaches are used individually or in combined targeted at one or more dysfunction. Although there is still no consensus about the optimal approach about intensity, the frequency of treatment sessions, and complexity, rehabilitation is proved to be able to induce short-term, but clinically important benefits, particularly for gait and balance. The rehabilitative program for PD should be targeted to practicing and learning specific activities in the core areas and be tailored to the individual patients’ characteristics. In addition to improving patient’s performance, environmental modification and alleviation of caregivers are also included in rehabilitation intervention. Innovative techniques have been recently proposed: virtual reality and exergaming, motor imagery and action observation, robot-assisted physiotherapy, and nonconventional therapies

Feasibility of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability: a randomized controlled trial

BackgroundTreadmill training shows advantages in the specificity, amount, and intensity of gait and balance practice for the rehabilitation of stroke patients.ObjectiveTo investigate the feasibility and effectiveness of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability.MethodsFor this randomized controlled trial (Chinese Clinical Trials.gov registration number ChiCTR-IOR-16009536) with blinded testers, we recruited 33 ambulatory stroke participants with restricted community ambulation capacity and randomly assigned them into two groups: the experimental group with 2 week treadmill speed-dependent gait training combined with 2 week treadmill perturbation-induced balance training (EXP) or the control group with traditional gait and balance training (CON). Various variables were recorded during EXP training, including the rating of perceived exertion, heart rate, causes of pauses, treadmill speed, and perturbation intensity. Outcome measures were examined before training and at 2 and 4 weeks after training. They included gait velocity during five-meter walk test at comfortable and fast speed and reactive balance ability in the compensatory stepping test as primary outcome measures, as well as dynamic balance ability (timed up-and-go test and 5 times sit-to-stand test) and balance confidence as secondary outcome measures.ResultsAll participants completed the study. The treadmill speed and perturbation intensity significantly increased across training sessions in the EXP group, and no adverse effects occurred. The normal and fast gait velocities showed significant time and group interaction effects. They significantly increased after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05). Likewise, dynamic balance ability measured using the timed up-and-go test at a fast speed significantly improved after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05), although without a significant time and group interaction effect. Surprisingly, the reactive balance ability did not show improvement after treatment in the EXP group (p > 0.05).ConclusionChallenging treadmill speed-dependent gait and treadmill perturbation-induced balance training is feasible and effective to improve ambulation function in chronic stroke patients with low ambulation ability

Considerable effects of lateralization and aging in intracortical excitation and inhibition

IntroductionFindings based on the use of transcranial magnetic stimulation and electromyography (TMS-EMG) to determine the effects of motor lateralization and aging on intracortical excitation and inhibition in the primary motor cortex (M1) are inconsistent in the literature. TMS and electroencephalography (TMS-EEG) measures the excitability of excitatory and inhibitory circuits in the brain cortex without contamination from the spine and muscles. This study aimed to investigate the effects of motor lateralization (dominant and non-dominant hemispheres) and aging (young and older) and their interaction effects on intracortical excitation and inhibition within the M1 in healthy adults, measured using TMS-EMG and TMS-EEG.MethodsThis study included 21 young (mean age = 28.1 ± 3.2 years) and 21 older healthy adults (mean age = 62.8 ± 4.2 years). A battery of TMS-EMG measurements and single-pulse TMS-EEG were recorded for the bilateral M1.ResultsTwo-way repeated-measures analysis of variance was used to investigate lateralization and aging and the lateralization-by-aging interaction effect on neurophysiological outcomes. The non-dominant M1 presented a longer cortical silent period and larger amplitudes of P60, N100, and P180. Corticospinal excitability in older participants was significantly reduced, as supported by a larger resting motor threshold and lower motor-evoked potential amplitudes. N100 amplitudes were significantly reduced in older participants, and the N100 and P180 latencies were significantly later than those in young participants. There was no significant lateralization-by-aging interaction effect in any outcome.ConclusionLateralization and aging have independent and significant effects on intracortical excitation and inhibition in healthy adults. The functional decline of excitatory and inhibitory circuits in the M1 is associated with aging

A Communal Catalogue Reveals Earth\u27s Multiscale Microbial Diversity

Our growing awareness of the microbial world\u27s importance and diversity contrasts starkly with our limited understanding of its fundamental structure. Despite recent advances in DNA sequencing, a lack of standardized protocols and common analytical frameworks impedes comparisons among studies, hindering the development of global inferences about microbial life on Earth. Here we present a meta-analysis of microbial community samples collected by hundreds of researchers for the Earth Microbiome Project. Coordinated protocols and new analytical methods, particularly the use of exact sequences instead of clustered operational taxonomic units, enable bacterial and archaeal ribosomal RNA gene sequences to be followed across multiple studies and allow us to explore patterns of diversity at an unprecedented scale. The result is both a reference database giving global context to DNA sequence data and a framework for incorporating data from future studies, fostering increasingly complete characterization of Earth\u27s microbial diversity

Naturalization of the microbiota developmental trajectory of Cesarean-born neonates after vaginal seeding

Early microbiota perturbations are associated with disorders that involve immunological underpinnings. Cesarean section (CS)-born babies show altered microbiota development in relation to babies born vaginally. Here we present the first statistically powered longitudinal study to determine the effect of restoring exposure to maternal vaginal fluids after CS birth.This work was partially supported by the C&D Research Fund, the Emch Fund for Human Microbiome Studies, and CIFAR FS20-078 #125869 (to M.G.D.-B.); Chilean CONICYT PIA/ANILLO grant ACT172097 and Chilean SOCHIPE Project 022019 (to P.R.H.); and the Norwegian Institute of Public Health (2019-0350), the Emerald Foundation, an NIH Pioneer award (1DP1AT010885), the National Institute of Justice (2016-DN-BX-4194), the San Diego Digestive Diseases Research Center (NIDDK 1P30DK120515), Janssen Pharmaceuticals (20175015)Peer reviewe

American Gut: an Open Platform for Citizen Science Microbiome Research

McDonald D, Hyde E, Debelius JW, et al. American Gut: an Open Platform for Citizen Science Microbiome Research. mSystems. 2018;3(3):e00031-18