Satisfaction and Occupational Performance in Patients with Functional Movement Disorder

Background: Behavioral Shaping Therapy (BeST) is a program that uses a multidisciplinary approach to treat patients diagnosed with functional movement disorder (FMD). While this diagnosis is classified as a psychological disorder by the Diagnostic and Statistical Manual of Mental Disorders, the BeST program focuses on treating the physical manifestations of FMD. Occupational therapists are an integral part of the multidisciplinary team, employing a variety of cognitive behavioral and motor reprogramming techniques to normalize movement patterns. Method: Patients 18 years of age or older with a confirmed diagnosis of FMD participated in this study. This retrospective chart review used the Canadian Occupation Performance Measure to examine the patients’ satisfaction and perceived change in task performance on discharge from the program. Results: Results from the dependent t-test indicated a positive outcome after participating in the BeST program, with a mean change in performance of 3.4 and a mean change in satisfaction of 4.7. Discussion: This study shows that occupational therapy can have a positive effect on patients diagnosed with FMD

Case Report: Optimizing Daily Function for People with Below-elbow Limb Deficiency with the SoftHand Pro

Background: Innovation in prosthetic devices for adults with upper limb loss is necessary to meet the demand for effective devices to optimize participation in daily activity. We evaluate the SoftHand Pro (SHP) as a terminal device to determine the application of this biologically-inspired prosthetic hand for use for a person with transradial limb deficiency. Method: This case study describes and measures the first use of the SHP by an individual with transradial limb deficiency in their home environment. This paper reports the features and functionality of the SHP prototype and provides recommendations for changes to further optimize function. Results: The participant found the simple mechanics, durability, and ease of use of the SHP to be beneficial. She praised the SHP’s positive impact on quality of life and suggested areas for optimization. Objective assessments of dexterity and function showed improvements. Conclusion: Using a biologically-inspired myoelectric hand provides an opportunity for intuitively controlled grasp of common large and small objects. The simplicity of use and the lightweight, durable design of the SHP has the potential to provide a positive impact on quality of life, and this case study has provided valuable feedback to further improve the hand and enable larger at-home trials

The SoftHand Pro: Translation from Robotic Hand to Prosthetic Prototype

This work presents the translation from a humanoid robotic hand to a prosthetic prototype and its first evaluation in a set of 9 persons with amputation. The Pisa/IIT SoftHand is an underactuated hand built on the neuroscientific principle of motor synergies enabling it to perform natural, human-like movements and mold around grasped objects with minimal control input. These features motivated the development of the SoftHand Pro, a prosthetic version of the SoftHand built to interface with a prosthetic socket. The results of the preliminary testing of the SoftHand Pro showed it to be a highly functional design with an intuitive control system. Present results warrant further testing to develop the SoftHand Pro

The SoftHand Pro: Functional evaluation of a novel, flexible, and robust myoelectric prosthesis

Roughly one quarter of active upper limb prosthetic technology is rejected by the user, and user surveys have identified key areas requiring improvement: function, comfort, cost, durability, and appearance. Here we present the first systematic, clinical assessment of a novel prosthetic hand, the SoftHand Pro (SHP), in participants with transradial amputation and age-matched, limb-intact participants. The SHP is a robust and functional prosthetic hand that minimizes cost and weight using an underactuated design with a single motor. Participants with limb loss were evaluated on functional clinical measures before and after a 6-8 hour training period with the SHP as well as with their own prosthesis; limb-intact participants were tested only before and after SHP training. Participants with limb loss also evaluated their own prosthesis and the SHP (following training) using subjective questionnaires. Both objective and subjective results were positive and illuminated the strengths and weaknesses of the SHP. In particular, results pre-training show the SHP is easy to use, and significant improvement in the Activities Measure for Upper Limb Amputees in both groups following a 6-8 hour training highlights the ease of learning the unique features of the SHP (median improvement: 4.71 and 3.26 and p = 0.009 and 0.036 for limb loss and limb-intact groups, respectively). Further, we found no difference in performance compared to participant's own commercial devices in several clinical measures and found performance surpassing these devices on two functional tasks, buttoning a shirt and using a cell phone, suggesting a functional prosthetic design. Finally, improvements are needed in the SHP design and/or training in light of poor results in small object manipulation. Taken together, these results show the promise of the SHP, a flexible and adaptive prosthetic hand, and pave a path forward to ensuring higher functionality in future

Satisfaction and Occupational Performance in Patients with Functional Movement Disorder

Background: Behavioral Shaping Therapy (BeST) is a program that uses a multidisciplinary approach to treat patients diagnosed with functional movement disorder (FMD). While this diagnosis is classified as a psychological disorder by the Diagnostic and Statistical Manual of Mental Disorders, the BeST program focuses on treating the physical manifestations of FMD. Occupational therapists are an integral part of the multidisciplinary team, employing a variety of cognitive behavioral and motor reprogramming techniques to normalize movement patterns. Method: Patients 18 years of age or older with a confirmed diagnosis of FMD participated in this study. This retrospective chart review used the Canadian Occupation Performance Measure to examine the patients’ satisfaction and perceived change in task performance on discharge from the program. Results: Results from the dependent t-test indicated a positive outcome after participating in the BeST program, with a mean change in performance of 3.4 and a mean change in satisfaction of 4.7. Discussion: This study shows that occupational therapy can have a positive effect on patients diagnosed with FMD

Antagonism of sphingosine-1-phosphate receptors by FTY720 inhibits angiogenesis and tumor vascularization.

FTY720, a potent immunomodulator, becomes phosphorylated in vivo (FTY-P) and interacts with sphingosine-1-phosphate (S1P) receptors. Recent studies showed that FTY-P affects vascular endothelial growth factor (VEGF)-induced vascular permeability, an important aspect of angiogenesis. We show here that FTY720 has antiangiogenic activity, potently abrogating VEGF- and S1P-induced angiogenesis in vivo in growth factor implant and corneal models. FTY720 administration tended to inhibit primary and significantly inhibited metastatic tumor growth in a mouse model of melanoma growth. In combination with a VEGFR tyrosine kinase inhibitor PTK787/ZK222584, FTY720 showed some additional benefit. FTY720 markedly inhibited tumor-associated angiogenesis, and this was accompanied by decreased tumor cell proliferation and increased apoptosis. In transfected HEK293 cells, FTY-P internalized S1P1 receptors, inhibited their recycling to the cell surface, and desensitized S1P receptor function. Both FTY720 and FTY-P apparently failed to impede VEGF-produced increases in mitogen-activated protein kinase activity in human umbilical vascular endothelial cells (HUVEC), and unlike its activity in causing S1PR internalization, FTY-P did not result in a decrease of surface VEGFR2 levels in HUVEC cells. Pretreatment with FTY720 or FTY-P prevented S1P-induced Ca2+ mobilization and migration in vascular endothelial cells. These data show that functional antagonism of vascular S1P receptors by FTY720 potently inhibits angiogenesis; therefore, this may provide a novel therapeutic approach for pathologic conditions with dysregulated angiogenesis

Inhibition of multiple vascular endothelial growth factor receptors (VEGFR) blocks lymph node metastases but inhibition of VEGFR-2 is sufficient to sensitize tumor cells to platinum-based chemotherapeutics

Vascular endothelial growth factor receptors (VEGFR) have important roles in cancer, affecting blood and lymphatic vessel functionality as well as tumor cells themselves. We compared the efficacy of a VEGFR tyrosine kinase inhibitor, PTK787/ZK222584 (PTK/ZK), which targets the three VEGFRs, with blocking antibodies directed against VEGFR-2 (DC101) or VEGF-A (Pab85618) in a metastatic melanoma model. Although all inhibitors exerted comparable effects on primary tumor growth, only PTK/ZK significantly reduced lymph node metastasis formation. A comparable decrease in lymphatic vessel density following blockade of VEGFR-2 (DC101) or the three VEGFRs (PTK/ZK) was observed in the metastases. However, the functionality of lymphatics surrounding the primary tumor was more significantly disrupted by PTK/ZK, indicating the importance of multiple VEGFRs in the metastatic process. The antimetastatic properties of PTK/ZK were confirmed in a breast carcinoma model. B16/BL6 tumor cells express VEGF ligands and their receptors. Blockade of a VEGFR-1 autocrine loop with PTK/ZK inhibited tumor cell migration. Furthermore, the tumor cells also showed enhanced sensitivity to platinum-based chemotherapy in combination with PTK/ZK, indicating that autocrine VEGFRs are promoting tumor cell migration and survival. In summary, our results suggest that, in addition to blocking angiogenesis, combined inhibition of the three VEGFRs may more efficiently target other aspects of tumor pathophysiology, including lymphatic vessel functionality, tumor cell dissemination, survival pathways, and response to chemotherapeutic compounds

A novel potent oral series of VEGFR2 inhibitors abrogate tumor growth by inhibiting angiogenesis

This paper describes the identification of 6-(pyrimidin-4-yloxy)-naphthalene-1-carboxamides as a new class of potent and selective human vascular endothelial growth factor receptor 2 (VEGFR2) tyrosine kinase inhibitors. In biochemical and cellular assays the compounds exhibit single digit nanomolar potency toward VEGFR2. Compounds of this series show good exposure in rodents when dosed orally. They potently inhibit VEGF-driven angiogenesis in a chamber model and rodent tumor models at daily doses of less than 3 mg/kg by targeting the vasculature as demonstrated by ELISA for TIE-2 in lysates, or by immunohistochemical analysis. This novel series of compounds shows potential for the treatment of solid tumors and other diseases where angiogenesis plays an important role

A Novel Potent Oral Series of VEGFR2 Inhibitors Abrogate Tumor Growth by Inhibiting Angiogenesis

This paper describes the identification of 6-(pyrimidin-4-yloxy)-naphthalene-1-carboxamides as a new class of potent and selective human vascular endothelial growth factor receptor 2 (VEGFR2) tyrosine kinase inhibitors. In biochemical and cellular assays, the compounds exhibit single-digit nanomolar potency toward VEGFR2. Compounds of this series show good exposure in rodents when dosed orally. They potently inhibit VEGF-driven angiogenesis in a chamber model and rodent tumor models at daily doses of less than 3 mg/kg by targeting the tumor vasculature as demonstrated by ELISA for TIE-2 in lysates or by immunohistochemical analysis. This novel series of compounds shows a potential for the treatment of solid tumors and other diseases where angiogenesis plays an important role