The Conventional Gait Model’s Sensitivity to Lower-limb Marker Placement

Clinical gait analysis supports treatment decisions for patients with motor disorders. Measurement reproducibility is affected by extrinsic errors such as marker misplacement—considered the main factor in gait analysis variability. However, how marker placement affects output kinematics is not completely understood. The present study aimed to evaluate the Conventional Gait Model’s sensitivity to marker placement. Using a dataset of kinematics for 20 children, eight lower-limb markers were virtually displaced by 10 mm in all four planes, and all the displacement combinations were recalculated. Root-mean-square deviation angles were calculated for each simulation with respect to the original kinematics. The marker movements with the greatest impact were for the femoral and tibial wands together with the lateral femoral epicondyle marker when displaced in the anterior–posterior axis. When displaced alone, the femoral wand was responsible for a deviation of 7.3° (± 1.8°) in hip rotation. Transversal plane measurements were affected most, with around 40% of simulations resulting in an effect greater than the acceptable limit of 5°. This study also provided insight into which markers need to be placed very carefully to obtain more reliable gait data.

Sedation-Paralysis as Cornerstone on Rabies Management (Milwaukee Protocol)

Rabies is a viral infection involving the central nervous system that is almost always fatal without proper post exposure prophylaxis. Here, we present a 38 years-old male with dog-bite and late attention whom, managed in intensive care unit. After 21 days, the disease progressed to serious neurologic and hemodynamic damage including motor disorders and imbalance in blood pressure and cardiac rhythm. Clinical management of the patient consisted of antiviral agents (Amantadine and Ribavirin), neuroprotection, sedation-paralysis and supportive care. Patient was survived 43 days from the clinical disease onset. Although our patient died in spite of intensive care, advances in the use of sedation-paralysis and early prescription of antiviral agents raised hopes that it may eventually be possible to save rabies patients.

Aberrant Auditory and Visual Memory Development of Children with Upper Limb Motor Disorders

The current study aimed to compare differences in the cognitive development of children with and without upper limb motor disorders. The study involved 89 children from 3 to 15 years old; 57 children with similar upper limb motor disorders and 32 healthy children. Our results showed that motor disorders could impair cognitive functions, especially memory. In particular, we found that children between 8 and 11 years old with upper limb disorders differed significantly from their healthy peers in both auditory and visual memory scales. These results can be explained by the fact that the development of cognitive functions depends on the normal development of motor skills, and the developmental delay of motor skills affects cognitive functions. Correlation analysis did not reveal any significant relationship between other cognitive functions (attention, thinking, intelligence) and motor function. Altogether, these findings point to the need to adapt general habilitation programs for children with motor disorders, considering the cognitive impairment during their development. The evaluation of children with motor impairment is often limited to their motor dysfunction, leaving their cognitive development neglected. The current study showed the importance of cognitive issues for these children. Moreover, early intervention, particularly focused on memory, can prevent some of the accompanying difficulties in learning and daily life functioning of children with movement disorders.

Economic Costs of Delayed Diagnosis of Functional Motor Disorders: Preliminary Results From a Cohort of Patients of a Specialized Clinic

Background: Functional motor disorders (FMDs) are prevalent and highly disabling conditions in young adults that can result in reduced independence. Despite advances in diagnosis and treatment, the economic burden of FMDs is largely unknown.Objective: This pilot retrospective study provides a real-world overview of the economic costs related to delayed diagnosis of FMDs from a cohort of patients of a specialized clinic in Italy, based on Italian healthcare costs.Methods: Sociodemographic data, clinical history, healthcare service utilization, and associated direct costs were collected for a period of up to 5 years before a definite diagnosis of FMDs in 40 patients.Results: The mean time lag between the onset of FMDs symptoms and diagnosis was 6.63 years (±8.57). The mean annual use of recourses per patient was three specialist visits (95% CI 2.4–3.4) and three diagnostic examinations (95% CI 2.2–3.6) that made up a total of six investigations and over seven (95% CI 5.5–9.7) rehabilitation contacts per year per patient were used before a diagnosis of FMDs was established. In more than 50% of the cases, patients had been hospitalized or made an ER visit at least once before receiving the correct diagnosis. The average annual costs for delayed diagnosis, taking into account only direct healthcare costs (without medications), was about €2,302 (CI 95% €1,570–2,830) per patient [€1,524 covered by the NHS (CI 95% €1,214–1,834) and € 778 by the patient (CI 95% €606–960)]. Hospitalization accounted for €916 (CI 95% €670–1,160) per patient per year, followed by rehabilitation €493 (CI 95% €345–641) and diagnostic tests € 387 (CI 95% €314–460).Conclusion: These preliminary results shed some light on the high healthcare services volume and direct healthcare costs from clinic to clinic for visits, unnecessary tests, and prescribed treatments in a real-world overview from a cohort of patients of a specialized clinic in Italy. It may represent a starting point for future studies to statistically test and quantify cost reduction after implementing appropriate healthcare pathways.

Comparative Cohort Study of the Use of Immersive Technologies in the Complex Psychological Rehabilitation of Patients with Motor Disorders

Background. Successful correction of the psychological consequences of motor disorders is the key to improving the effectiveness of medical rehabilitation. The literature data on the use of immersive technologies in the correction of psychoemotional disorders of various origins suggest that they can also be effective in the context of psychorehabilitation of patients with motor disorders. However, at the moment there is no scientific and methodological base that allows for the widespread introduction of high-tech VR and AR tools into the practical work of a medical psychologist in a rehabilitation hospital. Aims evaluation of the effectiveness of the inclusion of immersive technologies in the complex psychological rehabilitation of patients with motor disorders. Materials and methods. The design was planned as a controlled empirical randomized open study conducted during 1 calendar year on the basis of a medical rehabilitation hospital, which involved 336 patients with motor function disorders that occurred as a result of a previous stroke or against the background of chronically occurring degenerative-dystrophic diseases of large joints and spine. The results were compared in three groups for each studied high-tech tool the main, comparison and control. 81 patients were included in the study of the effectiveness of the use of the Visual Medicine program in patients with stroke. The effectiveness of the inclusion of the HTC Vive Focus Plus EEA virtual Reality System in the psychological correction of pain syndrome against the background of degenerative and dystrophic diseases was studied in 130 patients. The study of the possibility of using the PRAK hardware and software complex included 125 people with motor disorders: the consequences of stroke (n = 65) and the consequences of chronic degenerative-dystrophic diseases (n = 60). The basis for assessing the stability of indicators of higher efficiency of psychocorrective measures with the inclusion of immersive technologies in comparison with the comparison groups and control groups was the reliability of the results obtained at p 0.05. Results. With a high degree of confidence recorded a positive trend in relation to recovery all kinds of praxis in patients with movement disorders due to stroke, by using the Visual Medicine program; in the case of psychological correction of neuropathic and mixed pain in patients with chronic flowing RSD with the application of the HTC Vive Focus Plus EEA virtual Reality System; to achieve a stable positive dynamics in the correction of the psychoemotional state of patients with impaired motor functions-when the PRAK hardware and software complex is included in the relaxation mode in the complex of psychological rehabilitation. Conclusions. The clinical effectiveness of the use of immersive technologies in relation to the psychological consequences of motor disorders is shown, which makes a significant contribution to solving the problem of optimizing the work of a medical psychologist in a rehabilitation hospital.

Non-motor manifestations in patients with Parkinson's disease

Objective: to study the structure of NMS, their frequency and clinical significance at all stages of PD; to conduct a comparative analysis of the structure of NMS in PD, depending on the stage, form of the disease and gender characteristics of patients.Material and methods: examined 100 patients with PD, 31 patients as the control, and 11 patients as the comparison with Parkinson’s syndrome. The severity of movement disorders was assessed using the Hen and Yar scale. All patients with PD were also clinically assessed according to the UPDRS scale (parts II, III). Cognitive functions were assessed according to the Montreal CI scale (MOCA). The patients’ neuropsychological status was assessed using the Hospital Anxiety and Depression Scale (HADS).Results: vegetative disorders are a frequent manifestation of PD; they differ significantly depending on the gender of the patient and on the stage of the disease. In 20% of patients with PD clinically pronounced depression and severe cognitive impairment were revealed. Conclusion: non‑motor disorders are distinguished by a wide variety of manifestations and combinations, and their structure changes significantly from early to late stages of PD. The presence of NMS is an obligatory sign of PD. Although the structure of non‑motor manifestations of the disease is not specific, attention is drawn to the combination of more than ten different NMS in most patients, which does not occur with natural aging.

Prevalence of non-motor disorders in Parkinson`s disease

(1) Background: to reveal the prevalence of non-motor disorders in Parkinson’s disease (PD), we analyzed both Russian and international studies on the issue of PD-associated non-motor disorders in Caucasian patients; (2) Methods: We have carried out a search for full-text Englishand Russian-language articles published during the last ten years (from 2010 to 2020) in PubMed, Scopus, Web of Science, Springer, Clinical case, and E-library databases using multiple versions of keywords and their combinations. (3) Results: General prevalence of PD-associated non-motor disorders proved to be high. At the same time, we did not find significant differences between the prevalence of cognitive, affective, or behavioral disorders in PD patients. However, depression was found to be more common in PD patients in the Russian Federation; (4) Conclusions: According to the results of our review, cognitive and affective disorders in PD represent the issues of major concern.

Central Ocular Motor Disorders: Clinical and Topographic Anatomical Diagnosis, Syndromes and Underlying Diseases

The key to the diagnosis of ocular motor disorders is a systematic clinical examination of the different types of eye movements, including eye position, spontaneous nystagmus, range of eye movements, smooth pursuit, saccades, gaze-holding function, vergence, optokinetic nystagmus, as well as testing of the function of the vestibulo-ocular reflex (VOR) and visual fixation suppression of the VOR. This is like a window which allows you to look into the brain stem and cerebellum even if imaging is normal. Relevant anatomical structures are the midbrain, pons, medulla, cerebellum and rarely the cortex. There is a simple clinical rule: vertical and torsional eye movements are generated in the midbrain, horizontal eye movements in the pons. For example, isolated dysfunction of vertical eye movements is due to a midbrain lesion affecting the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), with impaired vertical saccades only or vertical gaze-evoked nystagmus due to dysfunction of the Interstitial nucleus of Cajal (INC). Lesions of the lateral medulla oblongata (Wallenberg syndrome) lead to typical findings: ocular tilt reaction, central fixation nystagmus and dysmetric saccades. The cerebellum is relevant for almost all types of eye movements; typical pathological findings are saccadic smooth pursuit, gaze-evoked nystagmus or dysmetric saccades. The time course of the development of symptoms and signs is important for the diagnosis of underlying diseases: acute: most likely stroke; subacute: inflammatory diseases, metabolic diseases like thiamine deficiencies; chronic progressive: inherited diseases like Niemann-Pick type C with typically initially vertical and then horizontal saccade palsy or degenerative diseases like progressive supranuclear palsy. Treatment depends on the underlying disease. In this article, we deal with central ocular motor disorders. In a second article, we focus on clinically relevant types of nystagmus such as downbeat, upbeat, fixation pendular, gaze-evoked, infantile or periodic alternating nystagmus. Therefore, these types of nystagmus will not be described here in detail.