A web based decision support system for status assessment in advanced parkinson

The purpose of this work is to develop a web based decision support system, based onfuzzy logic, to assess the motor state of Parkinson patients on their performance in onscreenmotor tests in a test battery on a hand computer. A set of well defined rules, basedon an expert’s knowledge, were made to diagnose the current state of the patient. At theend of a period, an overall score is calculated which represents the overall state of thepatient during the period. Acceptability of the rules is based on the absolute differencebetween patient’s own assessment of his condition and the diagnosed state. Anyinconsistency can be tracked by highlighted as an alert in the system. Graphicalpresentation of data aims at enhanced analysis of patient’s state and performancemonitoring by the clinic staff. In general, the system is beneficial for the clinic staff,patients, project managers and researchers.

A home environment test battery for status assessment in patients with motor fluctuations

Background and aims Evaluating status in patients with motor fluctuations is complex and occasional observations/measurements do not give an adequate picture as to the time spent in different states. We developed a test battery to assess advanced Parkinson patients' status consisting of diary assessments and motor tests. This battery was constructed and implemented on a handheld computer with built-in mobile communication. In fluctuating patients, it should typically be used several times daily in the home environment, over periods of about one week. The aim of this battery is to provide status information in order to evaluate treatment effects in clinical practice and research, follow up treatments and disease progression and predict outcome to optimize treatment strategy. Methods Selection of diary questions was based on a previous study with Duodopa® (DIREQT). Tapping tests (with and without visual cueing) and a spiral drawing test were added. Rapid prototyping was used in development of the user interface. An evaluation with two pilot patients was performed before and after receiving new treatments for advanced disease (one received Duodopa® and one received DBS). Speed and proportion missed taps were calculated for the tapping tests and entropy of the radial drawing velocity was calculated for the spiral tests. Test variables were evaluated using non-parametric statistics. Results Post-treatment improvement was detected in both patients in many of the test variables. Conclusions Although validation work remains, preliminary results are promising and the test battery is currently being evaluated in a long-term health economics study with Duodopa® (DAPHNE).

A web application for follow-up of results from a mobile device test battery for parkinson’s disease patients

Background: A test battery consisting of self-assessments and motor tests (tapping and spiral drawing) was developed for a hand computer with touch screen in a telemedicine setting. Objectives: To develop and evaluate a web-based system that delivers decision support information to the treating clinical staff for assessing PD symptoms in their patients based on the test battery data. Methods: The test battery is currently being used in a clinical trial (DAPHNE, EudraCT No. 2005-002654-21) by sixty five patients with advanced Parkinson’s disease (PD) on 9991 test occasions (four tests per day during in all 362 week-long test periods) at nine clinics around Sweden. Test results are sent continuously from the hand unit over a mobile net to a central computer and processed with statistical methods. They are summarized into scores for different dimensions of the symptom state and an ‘overall test score’ reflecting the overall condition of the patient during a test period. The information in the web application is organized and presented graphically in a way that the general overview of the patient performance per test period is emphasized. Focus is on the overall test score, symptom dimensions and daily summaries. In a recent preliminary user evaluation, the web application was demonstrated to the fifteen study nurses who had used the test battery in the clinical trial. At least one patient per clinic was shown. Results: In general, the responses from nurses were positive. They claimed that the test results shown in the system were consistent with their own clinical observations. They could follow complications, changes and trends within their patients. Discussion: In conclusion, the system is able to summarise the various time series of motor test results and self-assessments during test periods and present them in a useful manner. Its main contribution is a novel and reliable way to capture and easily access symptom information from patients’ home environment. The convenient access to current symptom profile as well as symptom history provides a basis for individualized evaluation and adjustment of treatments.

The role of self-control strength in the development of state anxiety in test situations

Self-control strength may affect state anxiety because emotion regulation is impaired in individuals whose self-control strength has been temporarily depleted. Increases in state anxiety were expected to be larger for participants with depleted compared to nondepleted self-control strength, and trait test anxiety should predict increases in state anxiety more strongly if self-control strength is depleted. In a sample of 76 university students, trait test anxiety was assessed, self-control strength experimentally manipulated, and state anxiety measured before and after the announcement of a test. State anxiety increased after the announcement. Trait test anxiety predicted increases in state anxiety only in students with depleted self-control strength, suggesting that increased self-control strength may be useful for coping with anxiety.

Sensor fault-resilient control of interior permanent-magnet synchronous motor drives

In a conventional ac motor drive using field-oriented control, a dc-link voltage, speed, and at least two current sensors are required. Hence, in the event of sensor failure, the performance of the drive system can be severely compromised. This paper presents a sensor fault-tolerant control strategy for interior permanent-magnet synchronous motor (IPMSM) drives. Three independent observers are proposed to estimate the speed, dc-link voltage, and currents of the machine. If a sensor fault is detected, the drive system isolates the faulty sensor while retaining the remaining functional ones. The signal is then acquired from the corresponding observer in order to maintain the operation of the drive system. The experimental results provided verify the effectiveness of the proposed approach.

Computational approaches to motor control.

This review will focus on four areas of motor control which have recently been enriched both by neural network and control system models: motor planning, motor prediction, state estimation and motor learning. We will review the computational foundations of each of these concepts and present specific models which have been tested by psychophysical experiments. We will cover the topics of optimal control for motor planning, forward models for motor prediction, observer models of state estimation arid modular decomposition in motor learning. The aim of this review is to demonstrate how computational approaches, as well as proposing specific models, provide a theoretical framework to formalize the issues in motor control.

A kinesin motor in a force-producing conformation.

BACKGROUND: Kinesin motors hydrolyze ATP to produce force and move along microtubules, converting chemical energy into work by a mechanism that is only poorly understood. Key transitions and intermediate states in the process are still structurally uncharacterized, and remain outstanding questions in the field. Perturbing the motor by introducing point mutations could stabilize transitional or unstable states, providing critical information about these rarer states. RESULTS: Here we show that mutation of a single residue in the kinesin-14 Ncd causes the motor to release ADP and hydrolyze ATP faster than wild type, but move more slowly along microtubules in gliding assays, uncoupling nucleotide hydrolysis from force generation. A crystal structure of the motor shows a large rotation of the stalk, a conformation representing a force-producing stroke of Ncd. Three C-terminal residues of Ncd, visible for the first time, interact with the central beta-sheet and dock onto the motor core, forming a structure resembling the kinesin-1 neck linker, which has been proposed to be the primary force-generating mechanical element of kinesin-1. CONCLUSIONS: Force generation by minus-end Ncd involves docking of the C-terminus, which forms a structure resembling the kinesin-1 neck linker. The mechanism by which the plus- and minus-end motors produce force to move to opposite ends of the microtubule appears to involve the same conformational changes, but distinct structural linkers. Unstable ADP binding may destabilize the motor-ADP state, triggering Ncd stalk rotation and C-terminus docking, producing a working stroke of the motor.

Spiral drawing during self-rated dyskinesia is more impaired than during self-rated off

Background: A mobile device test battery, consisting of a patient diary collection section with disease-related questions and a fine motor test section (including spiral drawing tasks), was used by 65 patients with advanced Parkinson's disease (PD)(treated with intraduodenal levodopa/carbidopa gel infusion, Duodopa®, or candidates for this treatment) on 10439 test occasions in their home environments. On each occasion, patients traced three pre-drawn Archimedes spirals using an ergonomic stylus and self-assessed their motor function on a global Treatment Response Scale (TRS) ranging from -3 = very 'off' to 0 = 'on' to +3 = very dyskinetic. The spirals were processed by a computer-based method that generates a "spiral score" representing the PD-related drawing impairment. The scale for the score was based on a modified Bain & Findley rating scale in the range from 0 = no impairment to 5 = moderate impairment to 10 = extremely severe impairment. Objective: To analyze the test battery data for the purpose to find differences in spiral drawing performance of PD patients in relation to their self-assessments of motor function. Methods: Three motor states were used in the analysis; OFF state (including moderate and very 'off'), ON state ('on') and a dyskinetic (DYS) state (moderate and very dyskinetic). In order to avoid the problem of multiple test occasions per patient, 200 random samples of single test occasions per patient were drawn. One-way analysis of variance, ANOVA, test followed by Tukey multiple comparisons test was used to test if mean values of spiral test parameters, i.e. the spiral score and drawing completion times (in seconds), were different among the three motor states. Statistical significance was set at p<0.05. To investigate changes in the spiral score over the time-of-day test sessions for the three motor states, plots of statistical summaries were inspected. Results: The mean spiral score differed significantly across the three self-assessed motor states (p<0.001, ANOVA test). Tukey post-hoc comparisons indicate that the mean spiral score (mean ± SD; [95% CI for mean]) in DYS state (5.2 ± 1.8; [5.12, 5.28]) was higher than the mean spiral score in OFF (4.3 ± 1.7; [4.22, 4.37]) and ON (4.2 ± 1.7; [4.17, 4.29]) states. The mean spiral score was also significantly different among individual TRS values of slightly 'off' (4.02 ± 1.63), 'on' (4.07 ± 1.65) and slightly dyskinetic (4.6 ± 1.71), (p<0.001). There were no differences in drawing completion times among the three motor states (p=0.509). In the OFF and ON states, patients drew slightly more impaired spirals in the afternoon whereas in the DYS state the spiral drawing performance was more impaired in the morning. Conclusion: It was found that when patients considered themselves as being dyskinetic spiral drawing was more impaired (nearly one unit change in a 0-10 scale) compared to when they considered themselves as being 'off' and 'on'. The spiral drawing at patients that self-assessed their motor state as dyskinetic was slightly more impaired in the morning hours, between 8 and 12 o'clock, a situation possibly caused by the morning dose effect.

Efeito sinérgico entre a dexmedetomidina e a ropivacaína 0,75% na anestesia peridural

BACKGROUND. This study aimed to evaluate clinical characteristics of epidural anesthesia performed with 0.75% ropivacaine associated with dexmedetomidine. METHODS. Forty patients scheduled for hernia repair or varicose vein surgeries under epidural anesthesia participated in this study. They were assigned to: Control Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg); and Dexmedetomidine Group (n = 20), 0.75% ropivacaine, 20 ml (150 mg), plus dexmedetomidine, 1 μg.kg -1. The following variables were studied: total analgesic block onset time, upper level of analgesia, analgesic and motor block duration time, intensity of motor block, state of consciousness, hemodynamics, postoperative analgesia and incidence of side-effects. RESULTS. Epidural dexmedetomidine did not affect onset time or upper level of anesthesia (p > 0.05) however it prolonged sensory and motor block duration time (p < 0.05) and postoperative analgesia (p < 0.05), and also resulted in a more intense motor block, 1 (p < 0.05). Values of bispectral index were lower in Dexmedetomidine Group (p < 0.05). There was no difference in incidence of hypotension and bradycardia (p > 0.05). Occurrence of side-effects (shivering, vomiting and SpO 2 < 90%) was low and similar between groups (p > 0.05). CONCLUSION. There is clear synergism between epidural dexmedetomidine and ropivacaine, further this drug association does not bring about additional morbidity.

Intellectual outcome, motor skills and BMI of children with congenital hypothyroidism: a population-based study

AIM: To evaluate intellectual outcome, motor skills and anthropometric data of children with congenital hypothyroidism (CH). METHODS: Children with permanent CH who were born in 1999 in Bavaria were eligible for this prospective, population-based study. Cognitive performance was evaluated by the Kaufman Assessment Battery for Children and motor skills were assessed by the motor test, Motoriktest für vier-bis sechsjahrige Kinder (MOT) 4-6. RESULTS: Eighteen of 21 eligible children participated (86%). Median age of the children was 5.5 years (range 4.9-5.8). Treatment with levothyroxine was started after a median of 7.2 days (range 4-15) with a median dose of 12.0 microg/kg (range 7.2-17.0). Mean intelligence quotient (IQ) of the children was 100.4 (standard deviation [SD] 10.1): no children had IQ values below the normal range. Reactivity and speed of movement were significantly reduced in children with CH. Children with an initial thyroid-stimulating hormone (TSH) value of >200 mU/L performed significantly worse than children with TSH value of motor skills could be shown, whereas the intellectual development was normal.

Relationships among multiple intelligences, motor performance and academic achievement in secondary school children

This study examines the relationships between multiple intelligences, academic achievement and motor performance in a group of secondary school children. Four hundred and eighty schoolchildren participated in this study (171 female and 309 male) with an average age of 13.33 years (SD: 1.41). The Revised self-efficacy Inventory for Multiple Intelligences (IAIM-R) and the motor test Sportcomp were applied, and the average results of the academic year they had made were obtained. The analysis of the results showed how female scored significantly higher on the Linguistic, Spatial and Interpersonal intelligences, and older pupils scored significantly higher on the linguistic and naturalistic intelligences. It was the logical-mathematical intelligence which showed significant relationships with academic performance and it was the intelligence that better predicted this achievement. It was the bodily-kinesthetic intelligence that was significantly related to motor competence and the best intelligence that predicted its achievement. Finally, indicate that schoolchildren with better scores in the motor test were those who scored higher in both academic achievement and all the multiple intelligences, with the exception of musical intelligence.

State laws on mopeds and motorized bicycles.

National Highway Traffic Safety Administration, Washington, D.C.

State vehicle programs : a special report.

October 1979.

Évaluation neurobiologique des souris spontanément hypertendues : Du vieillissement à la génomique comparative

Le but de cette thèse est premièrement d’évaluer l’effet du vieillissement sur les fonctions psychomotrices des souches de souris sélectionnées génétiquement en fonction de leur tension artérielle (TA); deuxièmement, de localiser les déterminants génétiques des phénotypes psychophysiologiques à partir de souches recombinantes congéniques (RCS). Ces travaux ont mené à la publication de 4 articles. Le premier article décrit l’évaluation des fonctions psychomotrices des souches avec une tension artérielle élevée (HBP), basse (LBP) et normale (NBP). La performance aux épreuves d’exploration, d’habiletés motrices et d’apprentissage spatial, a été mesurée sur deux cohortes âgées respectivement de 12 mois et de trois mois. Indépendamment de l’âge, les HBPs sont hyperactives dans l’open-field (OF), mais pas dans le test d’exploration de trous. Inversement, les LBP explorent moins d’espaces que les NBP et, à trois mois seulement, sont hypoactives dans l’OF. Par ailleurs, les HBPs et les LBP présentent des déficits précoces de coordination motrice et des fonctions visuo-motrices. Le second article concerne l’évaluation longitudinale de la coordination motrice, de l’anxiété et de l’apprentissage spatial des souches HBP, LBP et NBP, à l’âge de deux mois et de 12 mois. Le vieillissement accentue l’hyperactivité des HBPs dans l’OF. Par contre, l’hypoactivité des souris LBP est détectable seulement à l’âge de deux mois. Indépendamment de l’âge, les souris HBP et LBP montrent une perception réduite du danger dans l’épreuve d’anxiété et des dysfonctions visuo-motrices au labyrinthe aquatique. Enfin, des déficits précoces de coordination motrice se manifestent seulement chez les HBPs. Il reste à déterminer si les déficits observés sont liés à des déterminants génétiques indépendants ou secondaires aux altérations de la tension artérielle. Le troisième article présente la comparaison entre les souches consanguines A/J et C57Bl/6J (B6) aux épreuves de l’OF, de la planche à trous, du labyrinthe aquatique et du cintre (coordination motrice). Les B6 explore d’avantage l’OF et la planche à trous. Les B6 sont moins rapides sur le cintre, mais supérieurs aux A/J dans le labyrinthe aquatique, avec une plate-forme invisible ou visible. Ces résultats démontrent l’implication de déterminants génétiques. Cette thèse se termine par un quatrième article sur la localisation des déterminants génétiques de la susceptibilité au stress dans les RCS, dérivées de A/J et B6, et présentant un agencement spécifique de 12.5% du génome. La réactivité émotionnelle est évaluée dans l’OF et le plus-maze; la réponse de stress est mesurée par radio télémétrie de la température interne pendant le stress d’immobilisation (SI) sous diète régulière et riche en sel; l’excrétion des électrolytes urinaires est dosée après 24 heures de diète salée. Les loci les plus significatifs sont situés dans les régions suivantes: de l’émotionalité dans l’OF (Emo1) sur le chr. 1 (LOD=4.6) correspondant à la région homologue impliquée dans la cohorte d’hypertension familiale du Saguenay; de la dopa décarboxylase (ddc) sur le chr. 11 pour l’émergence du plus-maze (LOD=4.7); de la protéine liant l’endotoxine (lbp) sur le chr. 2 pour l’hypothermie initiale en réponse au SI (LOD=4); et de HSP90 sur le chr. 12 pour l’excrétion de Ca++ (LOD=4.6). Des banques de données sont ensuite interrogées pour recenser les polymorphismes des régions régulatrices ou codantes des gènes candidats chez les souches ancestrales A/J et B6, dont les séquences sont disponibles pour le génome entier. Des utilitaires web permettent de dévoiler les changements dans la structure secondaire de l’ARNm, l’interférence avec des microARN ou avec d’autres motifs de liaison. Plusieurs SNPs fonctionnels ont été identifiés pour le QTL du chr. 1, particulièrement dans les éléments de régulation; ceux-ci impliquant des gènes reliés avec les réponses inflammatoire/immunitaire ou avec le système cardiovasculaire. La quantification par la PCR confirme une régulation à la baisse d’atp1a2 dans le cœur et le cerveau des souches susceptibles à l’anxiété. Ces résultats confirment l’intrication des altérations de la susceptibilité au stress et de la régulation de la TA.

Aspectos psicodiagnósticos en la oligofrenia.

1) Considerar la estrecha vinculación que existe entre el desarrollo motor y psíquico en las oligofrenias. 2) Establecer la posibilidad de un diagnóstico a través del desarrollo motor, en concreto de la lateralidad. 45 niños de edades comprendidas entre 12 y 14 años, cuyo cociente intelectual no es superior de 75 ni inferior de 50. Expone los conceptos generales relacionados con la oligofrenia, estudia la etiología general de la misma, explica los tipos más comunes de oligofrenia, analiza la relación entre el desarrollo motor y el desarrollo psíquico, y realiza un trabajo práctico para establecer un diagnóstico en función del desarrollo motor. Test de trazado IIIc. La prueba se utiliza para obtener el diagnóstico de la lateralidad, por considerar que si el niño domina el uso de su cuerpo, puede aprender los elementos de su entorno y establecer relaciones entre ellos, es decir, desarrollar la inteligencia. 1) El índice de lateralidad obtenido, manifiesta la diferenciación de potenciales entre ambas manos a nivel intraindividual, permitiéndonos así el diagnóstico de la lateralidad. 2) El índice de lateralidad, su intensidad y sentido se define por las diferencias existentes entre la eficacia de la mano derecha e izquierda. Si el valor relativo de la diferencia es menor que cero es sintomático de dominancia izquierda, si es mayor que cero es significativo de dominancia derecha, considerando siempre, que la diferencias cero, viene a significar la normal dominancia derecha. 3) En relación a la normalidad formal, se evidencia una clara discrepancia de este grupo inversamente lateralizado, desde cero como media normal de diferencias este grupo tiene una media de menos once. 4) El índice de lateralidad es función no sólo de la evolución general del niño, sino también del sentimiento que llega a tener de si mismo, lo que contribuye al establecimiento de su esquema corporal y a su toma de conciencia del mundo circundante. 5) Existen entre los débiles mentales casi con la misma proporción que en los normales, trastornos de la lateralidad, aunque tienen más dificultades para superarlos. 6) La consideración de la lateralidad va pareja con la orientación del esquema corporal, pues es condición indispensable, para la organización del esquema corporal, elemento básico en el niño para la construcción de su personalidad, que exista una lateralidad bien definida y afirmada. 1) Un retraso en la asimetría o una lateralidad mal afirmada, supone la no elaboración de un correcto esquema corporal e implica una desorganización espacio-temporal en la personalidad del sujeto. En condiciones normales estos factores son superables, pero en casos en los que existe un sustrato de deficiencia, nos sirven de baremo para establecer dicho diagnóstico. 2) La oligofrenia constituye una deficiencia del desarrollo, representa una reducción de la potencialidad del crecimiento a consecuencia de la cual la velocidad de una maduración está retardada y el nivel máximo que alcanza la conducta es bajo. Existe una conexión de causa-efecto entre estructura neuronal y conducta, toda alteración sobre la estructura se verá reflejada en el comportamiento, de ahí que en la mayoría de los casos el déficit intelectual se acompaña de trastornos y alteraciones orgánicas y funcionales en la vida sensorial, motriz y de relación.