Pathological Upper Limb Synergies of Patients with Poststroke Hemiparesis
This review presents current data on possible mechanisms forming synergies in health, particularly at the
cortical level. The mechanisms of formation of pathological synergies, taking account of the anatomical
and physiological characteristics of the upper limbs and the hypothesis, that synergistic patterns are transformed
in patients with spastic hemiparesis are discussed. Current views of the pathophysiological bases
of the formation of pathological synergies based on neuroimaging and neurophysiological study data are
presented, along with a method for noninvasive stimulation of the brain. The question of the correction and
transformation of pathological synergies in rehabilitation practice is discussed. Particular attention is paid to
clinical and instrumented evaluation of synergies and the use of validated clinical scales and instrumented
methods such as video movement analysis, electromyography, magnetic and contactless tracking systems,
and virtual reality technologies.
Transcranial magnetic stimulation (TMS) is a modern non-invasive approach to study brain organization in humans. In TMS a time-varying magnetic fields generate induced electrical currents in the targeted brain regions with focal location of its maximum. Using of MRI navigation systems allows to fully realizing the advantages of TMS focality for brain mapping purposes. Due to this development, nowadays motor and speech nTMS mapping is becoming a routinely used procedure in neurosurgery. However, nTMS mapping for dynamic cortical assessment, for example, to study neuroplastic changes is still limited. An important reason for that is a lack of a standardized methodology for nTMS mapping results assessment. Here we propose TMSmap – a standalone graphical interface software for quantative analysis of the results of motor nTMS mapping (http://tmsmap.ru/), which allows considering both standard parameters like the size of the cortical muscle representation, the hotspot and the center of gravity location, as well as the additional ones such as the volume of the representation, the profile of the muscle cortical area and the overlap between the cortical representations and other user-defined parameters. The input data includes coordinates of the coil position and the response in each point of stimulation and individual structural MRI data.
Despite being a routine technique for presurgical motor assessment, transcranial magnetic stimulation (TMS) mapping is underused for probing of neuroplastic brain changes. We investigated the test-retest reproducibility of the TMS cortical maps of several hand muscles using both standard and alternative parameters of the cortical representation.Pilot study results for four healthy right-handed male volunteers (19-33y.o.) are presented. Two TMS mapping sessions with the stimulation of the left motor cortex were performed within 5-10 days (Day1 and Day2). Day2 points repeated an exact order of the Day1. For quantative comparison of 3D profiles similarities earth mover's distance metrics was used. Analysis of nTMS maps was performed using custom-made software TMSmap (http://tmsmap.ru).The between-days difference in the area of cortical representation for four analyzed subjects was 14.5-30.4% for one and 3.9-11.2% for five repetitions of each cortical point. Considering 3D profiles of cortical representation, higher similarity was shown for the same muscles’ representations and their overlaps compared to the representations of the different muscles. The study is ongoing, further analyzed results will be present.
TMSmap software was developed for quantative analysis of the results of motor nTMS mapping, which allows to consider not only standard parameters like the size of the cortical muscle representation and hotspot and center of gravity location, but as well the volume of the representation considering the amplitude of MEPs in each stimulation spot, the shape of the area, the profile/landscape of the muscle cortical representation and the overlap between representations.
We investigated the time-course of cortical activation during comprehension of literal and idiomatic sentences using MEG and anatomically guided distributed source analysis. Previous fMRI work had shown that the comprehension of sentences including action-related words elicits somatotopic semantic activation along the motor strip, reflecting meaning aspects of constituent words. Furthermore, idioms more strongly activated temporal pole and prefrontal cortex than literal sentences. Here we show that, compared to literal sentences, processing of idioms in a silent reading task modulates anterior fronto-temporal activity very early-on, already 150-250 ms after the sentences' critical disambiguating words ("kick the habit"). In parallel, the meaning of action words embedded in sentences is reflected by somatotopic activation of precentral motor systems. As neural reflections of constituent parts of idiomatic sentences are manifest at the same early latencies as brain indexes of idiomatic vs. literal meaning processing, we suggest that within ¼ of a second, compositional and abstract context-driven semantic processes in parallel contribute to the understanding of idiom meaning.
We here investigate whether the well-known laterality of spoken language to the dominant left hemisphere could be explained by the learning of sensorimotor links between a word's articulatory program and its corresponding sound structure. Human-specific asymmetry of acoustic-articulatory connectivity is evident structurally, at the neuroanatomical level, in the arcuate fascicle, which connects superior-temporal and frontal cortices and is more developed in the left hemisphere. Because these left-lateralised fronto-temporal fibres provide a substrate for auditory-motor associations, we hypothesised that learning of acoustic-articulatory coincidences produces laterality, whereas perceptual learning does not. Twenty subjects studied a large (n=48) set of novel meaningless syllable combinations, pseudowords, in a perceptual learning condition, where they carefully listened to repeatedly presented novel items, and, crucially, in an articulatory learning condition, where each item had to be repeated immediately, so that articulatory and auditory speech-evoked cortical activations coincided. In the 14 subjects who successfully passed the learning routine and could recognize the learnt items reliably, both perceptual and articulatory learning were found to lead to an increase of pseudoword-elicited event-related potentials (ERPs), thus reflecting the formation of new memory circuits. Importantly, after articulatory learning, pseudoword-elicited ERPs were more strongly left-lateralised than after perceptual learning. Source localisation confirmed that perceptual learning led to increased activation in superior-temporal cortex bilaterally, whereas items learnt in the articulatory condition activated bilateral superior-temporal auditory in combination with left-pre-central motor areas. These results support a new explanation of the laterality of spoken language based on the neuroanatomy of sensorimotor links and Hebbian learning principles.
This prototype development explains the challenges encountered during the ISO/IEEE 11073 standard implementation process. The complexity of the standard and the consequent heavy requirements, which have not encouraged software engineers to adopt the standard. The developing complexity evaluation drives us to propose two possible implementation strategies that cover almost all possible use cases and eases handling the standard by non-expert users. The first one is focused on medical devices (MD) and proposes a low-memory and low-processor usage technique. It is based on message patterns that allow simple functions to generate ISO/IEEE 11073 messages and to process them easily. MD act as X73 agent. Second one is focused on more powerful device X73 manager, which do not have the MDs' memory and processor usage constraints. The protocol between Agent and Manager is point-to-point and we can distribute the functionality between devices.
Developed both implementation X73 Agent and Manager will cut developing time for applications based on ISO/EEE 11073.
In the internal medicine wide spectrum the gastroenterology is one of the chapters, less enlightened by the scientific evidence. It does not mean that the practice of the grasntroenterology may ot be improved by the systematic use of the approaches of the evidence based medicine