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2.  Long term effects of locomotor training in spinal humans 
The long term effects of locomotor training in patients with spinal cord injury (SCI) were studied. In patients with complete or incomplete SCI coordinated stepping movements were induced and trained by bodyweight support and standing on a moving treadmill. The leg extensor muscle EMG activity in both groups of patients increased significantly over the training period, associated with improved locomotor ability in those with incomplete SCI. During a period of more than 3 years after training, the level of leg extensor EMG remained about constant in incomplete SCI in those who regularly maintained locomotor activity. By contrast the EMG significantly fell in those with complete SCI. The results suggest a training induced plasticity of neuronal centres in the isolated spinal cord which may be of relevance for future interventional therapies.


doi:10.1136/jnnp.71.1.93
PMCID: PMC1737473  PMID: 11413270
3.  Gait disorders 
doi:10.1136/jnnp.70.3.288
PMCID: PMC1737231  PMID: 11181847
4.  Prognosis and recovery in ischaemic and traumatic spinal cord injury: clinical and electrophysiological evaluation 
OBJECTIVES—To compare prognostic factors and functional recovery between paraplegic patients with either ischaemic (28 patients) or traumatic (39 patients) spinal cord injury (SCI).
METHODS—On admission to the spinal injury centre and 6 months later the patients underwent clinical (following the guidelines set down by the American Spinal Injury Association) and electrophysiological (tibial and pudendal somatosensory evoked potentials) examinations in parallel. The degree of ambulatory capacity was assessed after discharge from the rehabilitation programme or at least 6 months after trauma.
RESULTS—At the acute stage of either ischaemic or traumatic SCI similar motor and sensory deficits and pathological SSEP recordings were present. Both patient groups recovered to similar degrees with respect to motor, sensory, and ambulatory capacity. The clinical examination in both patient groups was the most sensitive prognostic factor of functional recovery irrespective of the aetiology of the SCI. In the ischaemic patients only the tibial SSEP whereas in the traumatic patients both the pudendal and tibial SSEP were of value in predicting recovery.
CONCLUSIONS—Although the two patient groups are pathophysiologically different, the severity and extent of neurological deficits and rate of recovery are quite similar. In both ischaemic and traumatic SCI clinical and electrophysiological examinations are of prognostic value for the functional recovery.


PMCID: PMC1736605  PMID: 10519858
5.  Genetic variation in Pneumocystis carinii isolates from different geographic regions: implications for transmission. 
Emerging Infectious Diseases  2000;6(3):265-272.
To study transmission patterns of Pneumocystis carinii pneumonia (PCP) in persons with AIDS, we evaluated P. carinii isolates from patients in five U.S. cities for variation at two independent genetic loci, the mitochondrial large subunit rRNA and dihydropteroate synthase. Fourteen unique multilocus genotypes were observed in 191 isolates that were examined at both loci. Mixed infections, accounting for 17.8% of cases, were associated with primary PCP. Genotype frequency distribution patterns varied by patients' place of diagnosis but not by place of birth. Genetic variation at the two loci suggests three probable characteristics of transmission: that most cases of PCP do not result from infections acquired early in life, that infections are actively acquired from a relatively common source (humans or the environment), and that humans, while not necessarily involved in direct infection of other humans, are nevertheless important in the transmission cycle of P. carinii f. sp. hominis.
PMCID: PMC2640877  PMID: 10827116
6.  National surveillance for infection with Cryptosporidium parvum, 1995-1998: what have we learned? 
Public Health Reports  2000;115(4):358-363.
OBJECTIVE: Infection with Cryptosporidium parvum generally causes a self-limiting diarrheal illness. Symptoms can, however, last for weeks and can be severe, especially in immunocompromised individuals. In 1994, the Council of State and Territorial Epidemiologists (CSTE) recommended that cryptosporidiosis be a nationally notifiable disease. Forty-seven states have made infection with C. parvum notifiable to the Centers for Disease Control and Prevention (CDC), and laboratories in the three remaining states report cases to state health departments, which may report them to the CDC. To see what the data show about patterns of infection, the authors reviewed the first four years of reports to the CDC. METHODS: The authors analyzed reports of laboratory-confirmed cases of cryptosporidiosis for 1995-1998. RESULTS: During 1995-1998, 11,612 laboratory-confirmed cases of cryptosporidiosis were reported to the CDC. All ages and both sexes were affected. An increase in case reporting was observed in late summer during each year of surveillance for people <20 years of age. CONCLUSION: The first national data on laboratory-confirmed cryptosporidiosis cases, although incomplete, provide useful information on the burden of disease in the nation as well as provide baseline data for monitoring of future trends.
PMCID: PMC1308577  PMID: 11059430
7.  Food-related illness and death in the United States. 
Emerging Infectious Diseases  1999;5(5):607-625.
To better quantify the impact of foodborne diseases on health in the United States, we compiled and analyzed information from multiple surveillance systems and other sources. We estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths. Overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.
PMCID: PMC2627714  PMID: 10511517
8.  Assessment of autonomic dysreflexia in patients with spinal cord injury. 
OBJECTIVES AND METHODS: To assess the impairment of supraspinal control over spinal sympathetic centres and the occurrence of autonomic dysreflexia in patients with spinal cord injury. Autonomic dysreflexia is caused by the disconnection of spinal sympathetic centres from supraspinal control and is characterised by paroxysmal hypertensive episodes caused by non-specific stimuli below the level of the lesion. Therefore, patients with spinal cord injury were examined clinically and by different techniques to assess the occurrence of autonomic dysreflexia and to relate disturbances of the sympathetic nervous system to episodes of autonomic dysreflexia. RESULTS: None of the paraplegic patients, but 59% (13/22) of tetraplegic patients (91% of the complete, 27% of the incomplete patients) presented signs of autonomic dysreflexia during urodynamic examination. Only 62% of the tetraplegic patients complained about symptoms of autonomic dysreflexia. Pathological sympathetic skin responses (SSRs) of the hands were related to signs of autonomic dysreflexia in 93% of cases. No patient with preserved SSR potentials of the hands and feet showed signs of autonomic dysreflexia, either clinically or during urodynamic examination. Ambulatory blood pressure measurements (ABPMs) indicated a loss of circadian blood pressure rhythm (sympathetic control) but preserved heart rate rhythm (parasympathetic regulation) only in patients with complete tetraplegia. Pathological ABPM recordings were seen in 70% of patients with symptoms of autonomic dysreflexia. CONCLUSIONS: The urodynamic examination was more sensitive in indicating signs of autonomic dysreflexia in patients with spinal cord injury, whereas SSR allowed the assessment of the degree of disconnection of the sympathetic spinal centres from supraspinal control. Using ABPM recordings the occurrence of episodes of autonomic dysreflexia over 24 hours and the effectiveness of therapeutical treatment can be assessed.
PMCID: PMC486854  PMID: 9153603
9.  Influence of spinal cord injury on cerebral sensorimotor systems: a PET study. 
OBJECTIVES: To assess the effect of a transverse spinal cord lesion on cerebral energy metabolism in view of sensorimotor reorganisation. METHODS: PET and 18F-fluorodeoxyglucose were used to study resting cerebral glucose metabolism in 11 patients with complete paraplegia or tetraplegia after spinal cord injury and 12 healthy subjects. Regions of interest analysis was performed to determine global glucose metabolism (CMRGlu). Statistical parametric mapping was applied to compare both groups on a pixel by pixel basis (significance level P = 0.001). RESULTS: Global absolute CMRGlu was lower in spinal cord injury (33.6 (6.6) mumol/100 ml/min (mean (SD)) than in controls (45.6 (6.2), Mann-Whitney P = 0.0026). Statistical parametric mapping analysis disclosed relatively increased glucose metabolism particularly in the supplementary motor area, anterior cingulate, and putamen. Relatively reduced glucose metabolism in patients with spinal cord injury was found in the midbrain, cerebellar hemispheres, and temporal cortex. CONCLUSIONS: It is assumed that cerebral deafferentiation due to reduction or loss of sensorimotor function results in the low level of absolute global CMRGlu found in patients with spinal cord injury. Relatively increased glucose metabolism in brain regions involved in attention and initiation of movement may be related to secondary disinhibition of these regions.
PMCID: PMC486696  PMID: 9010401
11.  Patients with spastic hemiplegia at different recovery stages: evidence of reciprocal modulation of early/late reflex responses. 
Reflex electromyographic (EMG) muscle responses were recorded from abductor pollicis brevis (APB) and tibialis anterior (TA) muscles of fifty patients with spastic hemiplegia. Responses in the muscles were evoked during voluntary muscle contraction (about 20% of maximum voluntary effort) by submaximal but suprathreshold electrical stimulation of the median (at the wrist) and common peroneal (at the neck of the fibula) nerves respectively. Three EMG peaks (R1, R2 and R3) could be recorded after the direct muscle response (M). There was only a slight difference in R1-R2 latency interval of about 5 ms between upper and lower limbs on the unaffected side of the patients making it unlikely that this late response of the lower limb involves a long loop pathway, although this possibility cannot be discounted for the later, R3, response. Reflex behaviour was analysed for three clinical identifiable recovery stages of voluntary movements in the spastic limbs (synergistic, isolated and useful movements). The major finding was that an increase in the amplitude of the early response "R1" was associated with a decreased amplitude and delayed latency of the late response "R2" on the spastic side. The amplitude of R1 in the three different recovery stages decreased significantly, whereas the amplitude of R2 increased significantly with improvement of the functional stage of the limb. A significant negative linear correlation was found between R1 and R2 amplitude changes in upper as well as lower limbs. A refractoriness of the motor neuron pool as a possible explanation for the decreased R2 amplitude could be discounted. These findings together with recent work on reflex development in children support the hypothesis of reciprocal modulation of early and late reflex signals by supraspinal motor centers.
PMCID: PMC1014956  PMID: 8482959
12.  Spastic paresis: impaired spinal reflexes and intact motor programs. 
Leg muscle EMG responses evoked by short treadmill acceleration impulses applied during stance were analysed in patients with spastic hemiparesis. The compensatory reactions on the unaffected side consisted of a diphasic pattern of leg muscle activation. The first response could best be described as a polysynaptic spinal stretch reflex response. This response was absent on the spastic side, except for its later, declining component. This remainder of the first response and the following activation of the antagonistic muscle was identical on both the unaffected and the spastic side. This part of the pattern is assumed to be centrally programmed (at the spinal level) and triggered by the termination of the acceleration impulse.
PMCID: PMC1032976  PMID: 3379431
14.  Tension development and muscle activation in the leg during gait in spastic hemiparesis: independence of muscle hypertonia and exaggerated stretch reflexes. 
In 15 patients with spastic hemiparesis the development of tension of calf muscles in relation to their electrical activation and their stretching period was studied on both sides during locomotion. Only in the spastic leg did isolated small biphasic potentials appear in the gastrocnemius E.M.G. with monosynaptic latency at the beginning of the stance phase, while the remaining gastrocnemius activation was reduced compared to the unaffected side. Perturbations of gait were followed in the spastic leg by a large monosynaptic response, while the polysynaptic reflex response was reduced. In the unaffected leg only a strong polysynaptic response appeared, which suggests a reciprocal modulation of monosynaptic and polysynaptic reflex responses. Tension development paralleled the gastrocnemius E.M.G. in the unaffected leg, while in the spastic leg tension was more closely correlated to muscle stretch. It is concluded that in spasticity the exaggerated monosynaptic reflexes represent only a small part of leg extensor activation during gait and that the tension development does not depend on these reflexes.
PMCID: PMC1028009  PMID: 6090590
15.  Balancing as a clinical test in the differential diagnosis of sensory-motor disorders. 
During balancing on a seesaw normal individuals have a mean sway oscillation of 4.3 Hz, which is significantly lower (3.3 Hz) in patients with peroneal muscular atrophy. It is assumed that the oscillations in both cases are generated by spinal stretch reflexes and that the lower frequency in patients with peroneal muscular atrophy is due to their slower nerve conduction velocity. The balancing movements are altered when spinal stretch reflex activity is reduced by ischaemia but are normal in patients with a dorsal column lesion despite a similar sensory loss. The analysis of balancing movements can be a diagnostic tool in differentiating several sensory-motor disturbances.
PMCID: PMC490567  PMID: 7420091
16.  Correlation between tremor, voluntary contraction, and firing pattern of motor units in Parkinson's disease 
Patients with tremor of Parkinsonism show three characteristics of motor unit activity: rhythmic spontaneous resting discharge, abnormally low firing rates during voluntary contraction, and consistent differences in firing pattern between small and large motor units. Smaller units discharge once per tremor beat at weak contractions but change into bursts of two or three spikes per beat at stronger forces. Large units are later recruited and fire preferentially once per beat. The large tremor amplitudes can be partly explained by synchronization of unfused twitches of low frequency units which summate more powerfully than the partially fused contractions during physiological tremor, which is about twice as rapid. Tremor is strongly influenced by the force of voluntary contraction. It is strongest at rest or during weak muscular effort and with increasing force becomes continuously of higher frequency and smaller amplitude. Both changes are the consequence of increasing discharge rates of motoneurones at stronger contractions.
PMCID: PMC494807  PMID: 4419618
17.  Spinal Cord Lesion: Effects of and Perspectives for Treatment 
Neural Plasticity  2001;8(1-2):83-90.
Following central motor lesions, two forms of adaptation can be observed which lead to improved mobility: (1) the development of spastic muscle tone, and (2) the activation of spinal locomotor centers induced by specific treadmill training. Tension development during spastic gait is different from that during normal gait and appears to be independent of exaggerated monosynaptic stretch reflexes. Exaggerated stretch reflexes are associated with an absence or reduction of functionally essential polysynaptic reflexes. When supraspinal control of spinal reflexes is impaired, the inhibition of monosynaptic reflexes is missing in addition to a reduced facilitation of polysynaptic reflexes. Therefore, overall leg muscle activity becomes reduced and less well modulated in patients with spasticity. Electrophysiologicai and histological studies have shown that a transformation of motor units takes place following central motor lesions with the consequence that regulation of muscle tone is achieved at a lower level of neuronal organization which in turn enables the patient to walk. Based on observations of the locomotor capacity of the spinal cat, recent studies have indicated that spinal locomotor centers can be activated and trained in patients with complete or incomplete paraplegia when the body is partially unloaded. However, the level of electromyographic activity in the gastrocnemius (the main antigravity muscle during gait) is considerably lower in the patients compared to healthy subjects. During the course of a daily locomotor training program, the amplitude of gastrocnemius, electromyographic activity increases significantly during the stance phase, while inappropriate tibialis anterior activation decreases. Patients with incomplete paraplegia benefit from such training programs such that their walking ability on a stationary surface improves. The pathophysiology and functional significance of spastic muscle tone and the effects of treadmill training on the locomotor pattern underlying new attempts to improve the mobility of patients with paraplegia are reviewed.
doi:10.1155/NP.2001.83
PMCID: PMC2565388  PMID: 11530890

Results 1-17 (17)