scholarly journals A Conceptual Blueprint for Making Neuromusculoskeletal Models Clinically Useful

2021 ◽  
Vol 11 (5) ◽  
pp. 2037
Author(s):  
Benjamin J. Fregly
Keyword(s):  
Clinical Utility ◽  
Positive Impact ◽  
Limb Amputation ◽  
Personal Perspective ◽  
Model Fidelity ◽  
Time Period ◽  
Cord Injury ◽  
Neuromusculoskeletal Model ◽  
Clinical Potential ◽  
Neuromusculoskeletal Modeling

The ultimate goal of most neuromusculoskeletal modeling research is to improve the treatment of movement impairments. However, even though neuromusculoskeletal models have become more realistic anatomically, physiologically, and neurologically over the past 25 years, they have yet to make a positive impact on the design of clinical treatments for movement impairments. Such impairments are caused by common conditions such as stroke, osteoarthritis, Parkinson’s disease, spinal cord injury, cerebral palsy, limb amputation, and even cancer. The lack of clinical impact is somewhat surprising given that comparable computational technology has transformed the design of airplanes, automobiles, and other commercial products over the same time period. This paper provides the author’s personal perspective for how neuromusculoskeletal models can become clinically useful. First, the paper motivates the potential value of neuromusculoskeletal models for clinical treatment design. Next, it highlights five challenges to achieving clinical utility and provides suggestions for how to overcome them. After that, it describes clinical, technical, collaboration, and practical needs that must be addressed for neuromusculoskeletal models to fulfill their clinical potential, along with recommendations for meeting them. Finally, it discusses how more complex modeling and experimental methods could enhance neuromusculoskeletal model fidelity, personalization, and utilization. The author hopes that these ideas will provide a conceptual blueprint that will help the neuromusculoskeletal modeling research community work toward clinical utility.

scholarly journals Aerobic fitness is a potential crucial factor in protecting paralympic athletes with locomotor impairments from atherosclerotic cardiovascular risk

2020 ◽  
Author(s):  
Marco Bernardi ◽  
Silvio Romano ◽  
Maria Rosaria Squeo ◽  
Emanuele Guerra ◽  
Paolo Emilio Adami ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Aerobic Fitness ◽  
Health Conditions ◽  
Limb Amputation ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cord Injury ◽  
Sport Type ◽  
Locomotor Impairment ◽  
Prevalence Of Obesity

Abstract Purpose To test the hypothesis that aerobic fitness is inversely related to the risk of atherosclerotic cardiovascular disease (ACVD) in athletes with locomotor impairments deriving from health conditions, such as spinal cord injury (SCI), lower limb amputation, cerebral palsy, poliomyelitis, and other health conditions different from the previous ones. Methods A total of 68 male athletes who competed in either summer or winter Paralympic games were divided in two health conditions groups (35 with SCI, mean age 37.2 ± 8.0 years, and 33 with different health conditions, mean age 37.8 ± 9.9 years) and in four sport type groups (skill, power, intermittent—mixed metabolism—and endurance). They were evaluated through anthropometric and blood pressure measurements, laboratory blood tests, and graded cardiopulmonary maximal arm cranking exercise test, with oxygen uptake peak (VO2peak) measurement. Cardiovascular risk profile was assessed in each athlete. Results The prevalence of ACVD-risk factors in the overall population was 20.6% for hypertension; 47% and 55.9% for high values of total and LDL cholesterol, respectively; 22.1% for reduce glucose tolerance; and 8.8% for obesity. No difference was found between athletes with and without SCI, while the prevalence of obesity was significantly higher in those practicing skill sports (22.7%, p = 0.035), which was the sport type group with Paralympic athletes with the lowest VO2peak (22.5 ± 5.70 ml kg−1 min−1). VO2peak was lower in athletes with SCI than those with different health conditions (28.6 ± 10.0 vs 33.6 ± 8.9 ml kg−1 min−1p = 0.03), and in those with 3–4 risk factors (19.09 ± 5.34 ml kg−1 min−1) than those with 2 risk factors (27.1 ± 5.50 ml kg−1 min−1), 1 risk factor (31.6 ± 8.55 ml kg−1 min−1), or none (36.4 ± 8.76 ml kg−1 min−1) (p < 0.001). Conclusions The present study suggests that having higher VO2peak seems to offer greater protection against ACVD in individuals with a locomotor impairment. Prescribing physical exercise at an intensity similar to that of endurance and intermittent sports should become a fundamental tool to promote health among people with a locomotor impairment.

scholarly journals Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110040
Author(s):  
Kuen Su Lee ◽  
Yoo Kyung Jang ◽  
Gene Hyun Park ◽  
In Jae Jun ◽  
Jae Chul Koh
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Therapeutic Potential ◽  
Case Series ◽  
Limb Amputation ◽  
Intractable Pain ◽  
Limb Pain ◽  
Cord Injury ◽  
Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

scholarly journals Brain fMRI during orientation selective epidural spinal cord stimulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Antonietta Canna ◽  
Lauri J. Lehto ◽  
Lin Wu ◽  
Sheng Sang ◽  
Hanne Laakso ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Stimulation ◽  
Pain Treatment ◽  
Positive Impact ◽  
Sensory Information ◽  
Activation Patterns ◽  
Promising Tool ◽  
Cord Injury ◽  
Epidural Spinal Cord Stimulation ◽  
Brain Fmri

AbstractEpidural spinal cord stimulation (ESCS) is widely used for chronic pain treatment, and is also a promising tool for restoring motor function after spinal cord injury. Despite significant positive impact of ESCS, currently available protocols provide limited specificity and efficiency partially due to the limited number of contacts of the leads and to the limited flexibility to vary the spatial distribution of the stimulation field in respect to the spinal cord. Recently, we introduced Orientation Selective (OS) stimulation strategies for deep brain stimulation, and demonstrated their selectivity in rats using functional MRI (fMRI). The method achieves orientation selectivity by controlling the main direction of the electric field gradients using individually driven channels. Here, we introduced a similar OS approach for ESCS, and demonstrated orientation dependent brain activations as detected by brain fMRI. The fMRI activation patterns during spinal cord stimulation demonstrated the complexity of brain networks stimulated by OS-ESCS paradigms, involving brain areas responsible for the transmission of the motor and sensory information. The OS approach may allow targeting ESCS to spinal fibers of different orientations, ultimately making stimulation less dependent on the precision of the electrode implantation.

Subacute posttraumatic ascending myelopathy in a 15-year-old boy

2014 ◽  
Vol 21 (3) ◽  
pp. 454-457 ◽  
Author(s):  
Timothy J. Kovanda ◽  
Eric M. Horn
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Rare Event ◽  
Fracture Dislocation ◽  
Secondary Injury ◽  
Spinal Cord Trauma ◽  
Rare Occurrence ◽  
Time Period ◽  
Cord Injury ◽  
Complete Spinal Cord Injury

Secondary injury following initial spinal cord trauma is uncommon and frequently attributed to mismanagement of an unprotected cord in the acute time period after injury. Subacute posttraumatic ascending myelopathy (SPAM) is a rare occurrence in the days to weeks following an initial spinal cord injury that is unrelated to manipulation of an unprotected cord and involves 4 or more vertebral levels above the original injury. The authors present a case of SPAM occurring in a 15-year-old boy who sustained a T3–4 fracture-dislocation resulting in a complete spinal cord injury, and they highlight the imaging findings and optimum treatment for this rare event.

Bad Tests Die Slowly: The Myelin Basic Protein Example

2019 ◽  
Vol 5 (1) ◽  
pp. 136-141
Author(s):  
Lisa M Johnson ◽  
Sandra K White ◽  
Dina N Greene ◽  
Robert L Schmidt
Keyword(s):  
Myelin Basic Protein ◽  
Clinical Utility ◽  
Basic Protein ◽  
Practice Variation ◽  
Oligoclonal Bands ◽  
Reference Laboratory ◽  
Variation Analysis ◽  
Time Period ◽  
Medium Strength ◽  
Before And After

Abstract Background Our national reference laboratory sought to improve stewardship for multiple sclerosis (MS) testing, which included orders for myelin basic protein (MBP) and oligoclonal bands (OCB). From 2011 to 2012, we performed 2 interventions for MS testing: one gentle-strength intervention of a publication designed to educate others about the lack of utility for MBP results and a second medium-strength intervention that included removal of MBP from the panel of MS tests. The ordering trends and practice variation were examined for OCB and MBP to retrospectively observe the effect of the interventions. Methods Data from clients within academic and community hospitals were examined (n = 1710 clients). Ordering patterns for OCB and MBP were investigated from 2008 to 2018 by calculating the %OCB: %OCB = (OCB)/(OCB + MBP). Practice variation was examined by comparing the distribution of clients with different %OCB statistics before and after the interventions in 5-year blocks (2008–2012 vs 2014–2018). Results From 2000 to 2011, the %OCB was approximately 50%, but gradually increased to 67% in 2018. For practice variation, analysis of the distribution of clients by %OCB also demonstrated a shift toward clients favoring OCB alone vs OCB + MBP for MS testing for the later time period of 2014–2018. Conclusion Our 2 interventions had a measurable, beneficial effect on ordering trends for MS testing over a 10-year period at a single reference laboratory. However, given that MBP has questionable clinical utility, stronger interventions are likely needed to bring about larger changes in ordering behavior.

scholarly journals Mental Practice for Relearning Locomotor Skills

2010 ◽  
Vol 90 (2) ◽  
pp. 240-251 ◽  
Author(s):  
Francine Malouin ◽  
Carol L. Richards
Keyword(s):  
Motor Imagery ◽  
Lower Limb ◽  
Clinical Work ◽  
Mental Practice ◽  
Limb Amputation ◽  
Imagery Ability ◽  
Healthy Individuals ◽  
Body Movements ◽  
Behavioral Studies ◽  
Cord Injury

Over the past 2 decades, much work has been carried out on the use of mental practice through motor imagery for optimizing the retraining of motor function in people with physical disabilities. Although much of the clinical work with mental practice has focused on the retraining of upper-extremity tasks, this article reviews the evidence supporting the potential of motor imagery for retraining gait and tasks involving coordinated lower-limb and body movements. First, motor imagery and mental practice are defined, and evidence from physiological and behavioral studies in healthy individuals supporting the capacity to imagine walking activities through motor imagery is examined. Then the effects of stroke, spinal cord injury, lower-limb amputation, and immobilization on motor imagery ability are discussed. Evidence of brain reorganization in healthy individuals following motor imagery training of dancing and of a foot movement sequence is reviewed, and the effects of mental practice on gait and other tasks involving coordinated lower-limb and body movements in people with stroke and in people with Parkinson disease are examined. Lastly, questions pertaining to clinical assessment of motor imagery ability and training strategies are discussed.

Phenotypic adaptations in human muscle fibers 6 and 24 wk after spinal cord injury

2002 ◽  
Vol 92 (1) ◽  
pp. 147-154 ◽  
Author(s):  
R. J. Talmadge ◽  
M. J. Castro ◽  
D. F. Apple ◽  
G. A. Dudley
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Vastus Lateralis ◽  
Muscle Fibers ◽  
Early Time ◽  
Mhc I ◽  
Time Period ◽  
Plasmic Reticulum ◽  
Cord Injury ◽  
Mhc Iia

10.1152/japplphysiol.000247.2001.—The effects of spinal cord injury (SCI) on the profile of sarco(endo) plasmic reticulum calcium-ATPase (SERCA) and myosin heavy chain (MHC) isoforms in individual vastus lateralis (VL) muscle fibers were determined. Biopsies from the VL were obtained from SCI subjects 6 and 24 wk postinjury ( n = 6). Biopsies from nondisabled (ND) subjects were obtained at two time points 18 wk apart ( n = 4). In ND subjects, the proportions of VL fibers containing MHC I, MHC IIa, and MHC IIx were 46 ± 3, 53 ± 3, and 1 ± 1%, respectively. Most MHC I fibers contained SERCA2. Most MHC IIa fibers contained SERCA1. All MHC IIx fibers contained SERCA1 exclusively. SCI resulted in significant increases in fibers with MHC IIx (14 ± 4% at 6 wk and 16 ± 2% at 24 wk). In addition, SCI resulted in high proportions of MHC I and MHC IIa fibers with both SERCA isoforms (29% at 6 wk and 54% at 24 wk for MHC I fibers and 16% at 6 wk and 38% at 24 wk for MHC IIa fibers). Thus high proportions of VL fibers were mismatched for SERCA and MHC isoforms after SCI (19 ± 3% at 6 wk and 36 ± 9% at 24 wk) compared with only ∼5% in ND subjects. These data suggest that, in the early time period following SCI, fast fiber isoforms of both SERCA and MHC are elevated disproportionately, resulting in fibers that are mismatched for SERCA and MHC isoforms. Thus the adaptations in SERCA and MHC isoforms appear to occur independently.

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