Electrophysiological Studies of Spinal Reflex Pathways From Group II Muscle Afferents

This thesis has investigated aspects of the circuitry located in the spinal cord by which signals originating fronn group II muscle afferents are processed. Studies have focused on two main problems: Part 1. The organisation of neuronal systems mediating group II reflex actions in the lumbar enlargement of the rat spinal cord have been investigated and compared with that in the cat with the aim of determining whether general principles of the organisation of these systems are common to different mammalian species. Group II afferents of different hind-limb muscle nerves were found to evoke cord dorsum and field potentials in particular segments of the spinal cord. Group II afferents of the quadriceps and deep peroneal nerves evoked synaptic potentials mainly at the rostral end of the lumbar enlargement (L1-rostral L3 segments) while the group II afferents of the gastrocnemius-soleus and hamstring muscle nerves produced their synaptic actions mainly at the caudal end of the lumbar enlargement (caudal L5). Group II afferents of the tibialis posterior and flexor digitorum longus nerves produced their synaptic actions mainly in the central lumbar segments (caudal L3 - L4). These results show that in principal the topographical organisation of neurones in group II reflex pathways of the rat is similar to that of the cat. Part 2. The actions of group II muscle afferents on neurones within the lower-lumbar segments of the cat spinal cord have been investigated with the aim of locating candidate last-order interneurones in group II reflex pathways. Only group II afferents of the tibialis posterior nerve produced large cord dorsum potentials comparable to those evoked by other group II afferents in midlumbar and sacral segments. However, field potentials evoked by group II muscle afferents of the quadriceps, tibialis-posterior, gastrocnemius- soleus, flexor digitorum longus, posterior biceps-semitendinosus and popliteus were encountered throughout the L6 and L7 segments. Group II potentials were evoked in both the dorsal horn (laminae V-VI) and intermediate zone (laminae V-VI I) at latencies compatible with monosynaptic actions of the fastest conducting group II muscle afferents. The properties of interneurones receiving excitatory input from group II muscle afferents have been investigated using both extracellular and intracellular recordings. Almost half the sample of interneurones (38 of 76) were characterised by an ipsilateral ascending projection within the lateral funiculus to the L4 level. Both L4-projecting and non-projecting interneurones were located mainly in an area dorsal and lateral to the main region in which interneurones with input from group I muscle afferents are located. Group II afferents of quadriceps and deep peroneal muscle nerves provided the most effective excitation (discharging 70-80% of neurones) while group II afferents of tibialis postenor, posterior biceps-semitendinosus and gastrocnemius-soleus were also effective sources of excitation (discharging 45- 55% of neurones). At least some of the group II EPSPs were monosynaptic. Input to individual interneurones was multimodal and characterised by considerable convergence. Seventy-five percent of interneurones were discharged by group II afferents of two or more muscle nerves and 43% by group II afferents of three or more nerves. In addition, group I muscle afferents evoked small EPSPs in over one quarter of the interneurones and virtually all were strongly excited by cutaneous afferents. Evidence of excitatory input from joint, interosseous and group III muscle afferents was also obtained but inhibition was rarely observed. These interneurones are considered likely to function as last-order interneurones in group II reflex pathways

Effects of Abnormal Oral Reflexes on Speech Articulation in Persian Speaking Children with Spastic Cerebral Palsy

How to Cite This Article: Dadgar H, HadianMR, Lira OA. Effects of Abnormal Oral Reflexes on Speech Articulation in Persian Speaking Children with Spastic Cerebral Palsy. Iran J Child Neurol. Summer 2016; 10(3):28-34.AbstractObjectiveThe purpose of this study was to investigate the relationship between the presence of abnormal oral reflexes and speech sound production in children with severe cerebral palsy.Materials&Methods Seven oral reflexes such as, rooting, mouth-opening, biting, chewing, lip, tongue, and suckling were examined in 52Persian-speaking monolingual children with spastic cerebral palsy (ages 5-10 yr).Phonetic information tests were administered to investigate their ability for articulation of the speech sounds.ResultsA significant relationship between three (i.e. the chewing, lip, and biting reflexes) out of the seven abnormal oral reflexes and the speech articulation was noticed. The presence of the chewing reflex was associated with deficits in production of /s, z, š,č/ sounds. The lip reflex was associated with deficits in the production of /p, m, r, j, f, č/ sounds. The biting reflex was associated with deficits in the production of /z, l, y and š/ sounds. No significant relationship was found between the rooting, mouth-opening, tongue, and suckling reflexes and sound articulation.ConclusionThe presence of abnormal reflexes in the children with spastic cerebral palsy would suggest a correlation between these reflexes and sound articulation in Iranian children with spastic cerebral palsy. Hence, these observations might suggest some disturbances in normal speech development. References Surveillance of Cerebral Palsy in Europe (SCPE) Collaborative Group. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol 2000; 42:816–24.Karen W Krigger. Cerebral Palsy: An Overview. American Family Physician 2006; 73, 1; 91-100.O’Shea Michael T. Cerebral palsy in very preterm infants: New epidemiological insights. Mental retardation and developmental disabilities research. Reviews2002; 8: 135–145.Krageloh-Mann AIngeborg, Cans B Christine. Cerebral palsy updates. Brain & Development 2009;31 537–544.Andersen GL, Irgens LM, Haagaas I, Skranes JS, Meberg AE, Vik T. Cerebral palsy in Norway: Prevalence, subtypes and severity. Eur J Paediatr Neurol. 2008 Jan;12(1):4-13.Nordmark E, H gglund G, Lagergren J. Cerebral palsy in southern Sweden: Prevalence and clinical features, ActaPaediatrica 2001; 90: 271 – 1276.Pfeifer LI, Silva DB, Funayama CA, Santos JL. Classification of CerebralPalsy: Association between gender, age, motor type, topography and Gross Motor Function. Arq Neuropsiquiatr2009; 67(4):1057-1061.Hagberg B. Nosology and classification of cerebral palsy. Giorn Neuropsich Eta Evol Suppl 1989; 4:12–17.Otapowicz D, Sobaniec W, Kułak W, Sendrowski K. Severity of dysarthric speech in children with infantile cerebral palsy in correlation with the brain CT and MRI. Adv Med Sci 2007; Vol. 52 • Suppl. 1Selassie GR, Viggedal G, Olsson I, Jennische M. Speech, language, and cognition in preschool children with epilepsy. Dev Med Child Neurol 2008; 50: 432–438.Bjornson KF, McLaughlin JF, Loeser JD, Nowak-Cooperman KM, Russel M, Bader KA, Desmond SA.Oral motor, communication, and nutritional status of children during intrathecal baclofen therapy: a descriptive pilot study. Arch Phys Med Rehabil2003; 84:500-6.Mysak ED. Neuro speech therapy for the cerebral palsy (3rd ed). New York: Teacher college Press;1980.p.87-8,p.110-112.Sheppard JJ, Mysak ED. Ontogeny of infantile oral reflexes and emerging chewing. Child Dev 1984; 55:831-843.Sheppard JJ. Cranio-oropharyngeal motor patterns in dysarthria associated with cerebral palsy. J speech Hear Res 1964; 7:373-380.International Phonetic Alphabet: Handbook of the International Phonetic Association: A guide to the use of the International Phonetic AlphabetCambridge, U.K. & New York, NY: Cambridge University Press.1999.Damerchi Z, Jalilehvand N, Bakhtiari B, Keyhani MR.Development of Phonetic inventory in 2-to-6 year-old Farsi speaking children. Research in Rehabilitation Sciences2010;5:1.42-47. (In Persian).Dos Santos MT, Nogueira ML. Infantile reflexes and their effects on dental caries and oral hygiene in cerebral palsy individuals. J Oral Rehabil2005; 32; 880–885.Love RJ, Hagerman EL, Taimi EG. Speech performance, dysphagia and oral reflexes in cerebral palsy. J Speech Hear Disord 1980; 45(1):59-75.Platt LJ, Andrews G,Young M, Quinn PT. Dysarthria of adult cerebral palsy: Intelligibility and articulatory impairment. J Speech Hear Res 1980; 23(1):28-40.McFarland DH, Baum SR. Incomplete compensation to articulatory perturbation. J AcoustSoc Am1995; 97:1865-1873.Irwin OC. Communication variables of cerebral palsy and mentally retarded children. Springfield,IL: C.C. Thomas 1972.Shelley I, Velleman, Marilyn m, Vihman, phonology development in infancy and early childhood: implications for theories of language learning. In: Martha C. Pennington,editors. Phonology in Context. Basingstoke: Palgrave Macmillan;2006.p.34.Ingram TT. Clinical significance of the infantile feeding reflexes. Dev Med Child Neurol 1992; 4:159–169.Hixon T, Hardy J. Restricted motility of speech articulation in cerebral palsy. J Speech Hearing Dis1964; 29:293-306.Dubner R, Sessle BJ, Storey AT. The neural basis of oral and facial function. New York: Plenum Press. 1978.p.483.

The effect of forward head posture on cervical joint position sense

A number of studies have investigated the effect of age, trauma, disease and fatigue on cervical joint position sense. However, there is an absence in data regarding the role of posture on proprioception. The aim of the current study was to investigate the effect of Forward Head Posture (FHP) on cervical joint position sense. Twenty Forward Head Posture volunteers (14 women, 6 men), with the mean age of 23.94 (SD=3.26) years, and 17 normal head posture volunteers (8 women, 9 men) with the mean age of 23.50 (SD=2.68) years were asked to perform the Cervicocephalic relocation test (CRT) to the neutral head position (NHP). The aim of this test was to evaluate the participants' ability to relocate the head to neutral position after they actively rotated it to left and right sides. Three trials were performed for each rotation to the left and right. In order to assess cervical joint repositioning accuracy, Absolute, Constant and Variable errors were used. No significant difference in repositioning errors was observed between experimental and control group in absolute and constant errors (P>0.05); however, compared to normal group, Forward Head Posture subjects manifested significantly higher levels of variable errors (P<0.05). Forward Head Posture can significantly affect the positioning consistency of cervical proprioception. Nonetheless, further investigation on the effect of Forward Head Posture on cervical proprioception in altered situations is recommended.

Compare the Effect of Traditional and Virtual Reality Training on Subjective-sense of Instability and Balance in Basketball-players with Functional Ankle Instability: Matched Randomized Clinical Trial

Background: Functional ankle instability (FAI) is a common injury. Traditional training improved the reported balance impairment and subjective sense of instability in athletes with FAI. Objective: This study aims to compare the effects of traditional and virtual reality training on a subjective sense of instability and balance in athlete with FAI. Material and Methods: In this single-blinded matched randomized clinical trial design, Fifty-four basketball players were randomly assigned in the virtual reality (n=27) or control (n=27) groups. All athletes performed 12 sessions Wii exercises or traditional training in the virtual reality and the control group, respectively, for three days a week. To assess the subjective-sense of instability and balance, we used Cumberland Ankle Instability Tool (CAIT) and Star Excursion Balance Test (SEBT), respectively. Measures were taken at pre- and post-test and one month after training as a follow-up. The between-group comparisons were done by the analysis of Covariance. Results: At the pre-test, the CAIT score was 22.37, 22.04 in the control and virtual reality groups, respectively and at the post-test, these scores increased to 26.63, 27.26. The involved limb showed significant differences in posteromedial and posterior directions of the SEBT and CAIT score in the post-test and in the posterior direction and CAIT score in the follow-up. The virtual reality group had better performance than the control group but the effect size is small (cohen’s d<0.2).  Conclusion: Based on our results, both training protocols were effective in reducing the subjective-sense of instability and improved balance in athletes with FAI. Moreover, virtual reality training was very attractive for the participants

The Effect of Avoiding Cognitive Errors through Narrative Therapy on Depression and Dysfunctional Attitude in Primary School Girls

Introduction: The present study was conducted to investigate the effect of teaching to avoid cognitive errors through narrative therapy on depression and dysfunctional attitude in primary-school girls.  Methods: This experimental study was conducted with a pretest-posttest design and a one-month follow-up. The assessment tool consisted of the Depression Self-Rating Scale (DSRS), and DAS-C and clinical interviews were used to evaluate dysfunctional attitude among the students. The sample population consisted of 36 fourth- and fifth-grade, female, primary-school students with depression in Shiraz. The experimental group was exposed to narrative therapy, the placebo group to selective stories (without educational content on avoiding cognitive errors) and the control group received no treatment. The ANCOVA was used to analyze the data.  Results: The three groups were not different in terms of their depression score in the posttest (F=2.36, P=0.11), but the difference between them was significant in the follow-up stage (F=5.53, P=0.009). Significant differences were observed among the groups in terms of dysfunctional attitude and depression in the posttest (F=4.84, P=0.001) and the follow-up (P=0.0001, F=12.08).  Conclusion: Narrative therapy was found to be effective in reducing depression and dysfunctional attitude in the students.  Declaration of Interest: None.

Anti-inflammatory effect of AMPK signaling pathway in rat model of diabetic neuropathy

Abstract Diabetic neuropathy (DN) is characterized as Hyperglycemia activates thdisturbed nerve conduction and progressive chronic pain. Inflammatory mediators, particularly cytokines, have a determinant role in the pathogenesis of neuropathic pain. The activity of adenosine monophosphate protein kinase (AMPK), an energy charge sensor with neuroprotective properties, is decreased in diabetes. It has been reported that activation of AMPK reduces the systemic inflammation through inhibition of cytokines. In this study, we aimed to investigate the probable protective effects of AMPK on DN in a rat of diabetes. DN was induced by injection of streptozotocin (65 mg/kg, i.p.). Motor nerve conduction velocities (MNCV) of the sciatic nerve, as an electrophysiological marker for peripheral nerve damage, were measured. Plasma levels of IL-6, TNF-a, CRP were assessed as relevant markers for inflammatory response. Also, the expression of phosphorylated AMPK (p-AMPK) and nonphosphorylated (non-p-AMPK) was evaluated by western blotting in the dorsal root ganglia. Histopathological assessment was performed to determine the extent of nerve damage in sciatic nerve. Our findings showed that activation of AMPK by metformin (300 mg/kg) significantly increased the MNCV and reduced the levels of inflammatory cytokines. In addition, we showed that administration of metformin increased the expression of p-AMPK as well as decline in the level of non p-AMPK. Our results demonstrated that co-administration of dorsomorphin with metformin reversed the beneficial effects of metformin. In conclusion, the results of this study demonstrated that the activation of AMPK signaling pathway in diabetic neuropathy might be associated with the anti-inflammatory response

Effect of 670 Nm Laser Beam on the Action Potentials of Sural Nerve in Healthy Individuals

Introduction: Low Level Laser (LLL) is being used in physiotherapy for pain relief in various pathologies and particularly on peripheral nerve entrapments. In the present study, the effect of LLL on the electrophysiological parameters of sural in humans was investigated. The results might be used as a basis for further clinical research in abnormal conditions. Methods and Materials: Thirty-eight normal men voluntarily participated in the current study and 670 nm LLL beam was applied to the left sural nerve at 5 points for 10 sessions. The electrophysiological parameters such as onset latency, peak latency, negative peak amplitude, peak to peak amplitude, and duration were measured before and after the application of LLL (0.5, 1.5 &amp; 2.5 J/cm² energy density). Results: Overall, 670 nm laser beam increased the latency and reduced the nerve conduction velocity (NCV). In addition, LLL beam decreased the amplitude of action potentials. Among the various values of energy densities, application of 2.5 J/cm² had the most effective results (P &lt; 0.001). Conclusion: These results might suggest that 670 nm laser beam could affect the latency and reduce the NCV in sural nerve of human. Probably, LLL affects the bioelectric and bioenergetic properties of the neural biomembrane. These findings might have clinical signlificance in non-surgical treatment of entrapment syndromes, such as carpal, tarsal syndromes and trigeminal entrapment in human. Further investigations are needed to elucidate the effects of LLL beam on the human peripheral nerves in pathological conditions.Keywords: Low-level laser, Sural nerve, Electrophysiology, Pai

Effects of a Designed Discharge Plan on Anxiety and Length of Hospital Stay in Patients Undergoing Heart Valve Replacement

Background & Objective: Anxiety is the most common issue in the candidates of surgical heart valve replacement. The length of hospital stay in these patients is economically and organizationally important as a predictor of their recovery from acute physical conditions. The present study aimed to assess the effects of a designed discharge plan on anxiety and length of hospital stay in patients undergoing heart valve replacement. Materials and Methods: This clinical trial was conducted on 65 candidates of heart valve replacement in Chamran Hospital in Isfahan, Iran, who were randomly divided into the intervention and control groups. In the intervention group, the designed discharge plan was implemented and continued one month after discharge via phone follow-up. Length of hospital stay and anxiety were analyzed before the intervention and one and three months after discharge in both groups in SPSS. Results: ANOVA indicated that the mean anxiety in the study groups was significantly different at different times (P0.05). Conclusion: The designed discharge plan reduced anxiety in the patients, while its effect on the length of hospital stay requires further investigation. Therefore, it is recommended that the discharge program be used as an effective approach to maintaining care in patients undergoing heart valve replacement. Keywords: Discharge Plan, Anxiety, Hospitalization, Heart Valve Replacemen

Comparison of Immediate Effect of High-Power Pain Threshold Ultrasound and Deep Transverse Friction Massage on Active Myofascial Trigger Points

Introduction: The study was conducted to compare the immediate effect of high-power pain threshold ultrasound (HPPTUS) and deep transverse friction massage (DTFM) as a traditional technique on the treatment of upper trapezius active myofascial trigger points in male patients with mechanical neck pain. Materials and Methods: In this parallel single-blind randomized clinical trial study, 60 men with mechanical neck pain (mean age: 30.57±6.19 years) who met the inclusion and exclusion criteria were randomly assigned to HPPTUS and DTFM as the control group. A visual analog scale (VAS), pain pressure threshold (PPT), and range of motion (ROM) of cervical lateral flexion (CLF) were assessed before and after treatment. Results: Analysis of pre- and post-treatment findings showed that the VAS (P<0.01), PPT (P<0.01), and ROM of CLF (P<0.01) improved significantly in both groups while ROM of CLF increased significantly more in the HPPTUS group. An indirect correlation was found between the pre-treatment ROM of CLF and ROM of CLF improvement in both groups. A significant indirect correlation was observed between pre-treatment VAS and ROM of CLF improvement in the HPPTUS group. In the DTFM group a significant indirect correlation was found between pre-treatment ROM of CLF and VAS improvement. Conclusion: The results showed that HPPTUS can be used as an effective treatment for active trigger points (TP). It seems that this method is more effective than deep transverse friction massage