Dynamics of brain-muscle networks reveal effects of age and somatosensory function on gait

Walking is a complex motor activity that requires coordinated interactions between the sensory and motor systems. We used mobile EEG and EMG to investigate the brain-muscle networks involved in gait control during overground walking in young people, older people, and individuals with Parkinson's disease. Dynamic interactions between the sensorimotor cortices and eight leg muscles within a gait cycle were assessed using multivariate analysis. We identified three distinct brain-muscle networks during a gait cycle. These networks include a bilateral network, a left-lateralized network activated during the left swing phase, and a right-lateralized network active during the right swing. The trajectories of these networks are contracted in older adults, indicating a reduction in neuromuscular connectivity with age. Individuals with the impaired tactile sensitivity of the foot showed a selective enhancement of the bilateral network, possibly reflecting a compensation strategy to maintain gait stability. These findings provide a parsimonious description of interindividual differences in neuromuscular connectivity during gait.

Latarjet's muscular alterations increase glenohumeral joint stability: A theoretical study

The surgical Latarjet procedure aims to stabilise the glenohumeral joint following anterior dislocations. Despite restoring joint stability, the procedure introduces alterations of muscle paths which likely modify the shoulder dynamics. Currently, these altered muscular functions and their implications are unclear. Hence, this work aims to predict changes in muscle lever arms, muscle and joint forces following a Latarjet procedure by using a computational approach. Planar shoulder movements of ten participants were experimentally assessed. A validated upper-limb musculoskeletal model was utilised in two configurations, i.e., a baseline model, simulating normal joint, and a Latarjet model simulating its related muscular alterations. Muscle lever arms and differences in muscle and joint forces between models were derived from the experimental marker data and static optimisation technique. Lever arms of most altered muscles, hence their role, were substantially changed after Latarjet. Altered muscle forces varied by up to 15% of the body weight. Total glenohumeral joint force increased by up to 14% of the body weight after Latarjet, mostly due to increase in compression force. Our simulation indicated that the Latarjet muscular alterations lead to changes in the muscular recruitment and contribute to the stability of the glenohumeral joint by increasing compression force during planar motions.

Statistical Quantification of the Effects of Marker Misplacement and Soft-Tissue Artifact on Shoulder Kinematics and Kinetics

The assessment of shoulder kinematics and kinetics are commonly undertaken biomechanically and clinically by using rigid-body models and experimental skin-marker trajectories. However, the accuracy of these trajectories is plagued by inherent skin-based marker errors due to marker misplacements (offset) and soft-tissue artifacts (STA). This paper aimed to assess the individual contribution of each of these errors to kinematic and kinetic shoulder outcomes computed using a shoulder rigid-body model. Baseline experimental data of three shoulder planar motions in a young healthy adult were collected. The baseline marker trajectories were then perturbed by simulating typically observed population-based offset and/or STA using a probabilistic Monte-Carlo approach. The perturbed trajectories were then used together with a shoulder rigid-body model to compute shoulder angles and moments and study their accuracy and variability against baseline. Each type of error was studied individually, as well as in combination. On average, shoulder kinematics varied by 3%, 6% and 7% due to offset, STA or combined errors, respectively. Shoulder kinetics varied by 11%, 27% and 28% due to offset, STA or combined errors, respectively. In conclusion, to reduce shoulder kinematic and kinetic errors, one should prioritise reducing STA as they have the largest error contribution compared to marker misplacements.

Lower knee flexion and hip extension rate of torque development in athletes with previous hamstring strain injury

Persistent deficits in strength and voluntary activation have been observed in athletes with a history of hamstring strain injury. The mechanisms contributing to these deficits are poorly understood and consequently may not be appropriately addressed during rehabilitation. This study aimed to investigate the impact of intended knee flexor contraction mode (concentric, eccentric or isometric) on the rate of torque development and surface electromyography (sEMG) rise in athletes with and without a history of unilateral hamstring strain injury. The impact of the previous injury on hip extensor rate of torque development was also investigated. Previously injured limbs exhibited a slower rate of torque development (mean difference = -31%, p = 0.02, Cohen's d = 0.62) and biceps femoris rate of sEMG rise (mean difference = -181% · s^-1, p = 0.003, Cohen's d = 1.10) during intended eccentric knee flexor contractions compared with control limbs. Previously injured (mean difference = -29%, p = 0.01, Cohen's d = 0.85) and contralateral uninjured limbs (mean difference = -31%, p = 0.007, Cohen's d = 0.73) exhibited a slower rate of torque development during isometric hip extensor contractions compared with control limbs. These findings may highlight lower levels of descending input to hamstring motoneurons in previously injured athletes.

Melanopsin Cell Dysfunction is Involved in Sleep Disruption in Parkinson’s Disease

Background: Melanopsin-expressing intrinsically photosensitive retinal ganglion cells (ipRGCs) signal the environmental light to mediate circadian photoentrainment and sleep-wake cycles. There is high prevalence of circadian and sleep disruption in people with Parkinson’s disease, however the underlying mechanisms of these symptoms are not clear. Objective: Based on recent evidence of anatomical and functional loss of melanopsin ganglion cells in Parkinson’s disease, we evaluate the link between melanopsin function, circadian, and sleep behavior. Methods: The pupil light reflex and melanopsin-mediated post-illumination pupil response were measured using chromatic pupillometry in 30 optimally medicated people with Parkinson’s disease and 29 age-matched healthy controls. Circadian health was determined using dim light melatonin onset, sleep questionnaires, and actigraphy. Ophthalmic examination quantified eye health and optical coherence tomography measured retinal thickness. Results: The melanopsin-mediated post-illumination pupil response amplitudes were significantly reduced in Parkinson’s disease (p < 0.0001) and correlated with poor sleep quality (r2 = 33; p < 0.001) and nerve fiber layer thinning (r2 = 0.40; p < 0.001). People with Parkinson’s disease had significantly poorer sleep quality with higher subjective sleep scores (p < 0.05) and earlier melatonin onset (p = 0.01). Pupil light (outer retinal) response metrics, daily light exposure and outer retinal thickness were similar between the groups (p > 0.05). Conclusion: Our evidence-based data identify a mechanism through which inner retinal ipRGC dysfunction contributes to sleep disruption in Parkinson’s disease in the presence of normal outer retinal (rod-cone photoreceptor) function. Our findings provide a rationale for designing new treatment approaches in Parkinson’s disease through melanopsin photoreceptor-targeted light therapies for improving sleep-wake cycles.

Reliability of recurrence quantification analysis of postural sway data. A comparison of two methods to determine recurrence thresholds

Ageing affects balance control resulting in a greater amplitude of sway and alterations in structure of the sway time series. Recurrence quantification analysis (RQA) has been used to determine the structure of center-of-pressure (CoP; a measure that reflects standing postural control) data as a means to quantify how CoP repeats itself / recurs below a certain threshold. This study aimed to determine how the method of threshold determination, below which a recurrence is defined, affects the within-session reliability of RQA in an elderly population. Within-session reliability of RQA of CoP motion in the anterior-posterior and mediolateral directions was assessed in 267 individuals (>65 years old) when standing on firm or foam surface with eyes open or closed for each of two recurrence threshold methods. One threshold method sets the recurrence threshold level such that the recurrence rate is fixed to 5%, the other method sets the recurrence threshold based on 27% of the mean distance between all points from which recurrences are quantified. Reliability across four 30-s balance trials within each of four balance conditions (firm vs. foam, eyes open vs. closed) was determined using intra-class correlation, standard error of measurement and minimal detectable change. ICCs were better, the standard error of measurement and minimal detectable change were smaller when the recurrence threshold was set to 5% using the fixed recurrence threshold. Fixing recurrence rate improves the within session reliability of RQA and could increase sensitivity to identify fall risk.

Dance improves symptoms, functional mobility and fine manual dexterity in people with Parkinson disease: a quasi-experimental controlled efficacy study

BACKGROUND

Clinically, individuals diagnosed with Parkinson disease (PD) present several symptoms that impact on their functional independence and quality of life. While there is accumulating evidence supporting dance as an effective symptom management option, few studies have objectively assessed these benefits, particularly related to the Dance for Parkinson's Disease^® (DfPD^®) program.

AIM

The aim of this study was to explore the effects of DfPD^®-based dance classes on disease-related symptoms, fine-manual dexterity and functional mobility in people with PD.

DESIGN

A quasi-experimental controlled efficacy study, with pre and post testing of two parallel groups (dance versus control).

SETTING

Community.

POPULATION

Thirty-three participants with PD allocated to one of two groups: dance group (DG; N.=17; age=65.8±11.7 years) or control group (CG: N.=16; age=67.0±7.7 years). They were cognitively intact (Addenbrooke's Score: DG=93.2±3.6, CG=92.6±4.3) and in early-stage of disease (Hoehn & Yahr: DG=1.6±0.7, CG=1.5±0.8).

METHODS

The DG undertook a one-hour DfPD^®-based class, twice weekly for 12 weeks. The CG had treatment as usual. Both groups were assessed at baseline and after 12 weeks on disease-related symptom severity (MDS-Unified Parkinson Disease Rating Scale: MDS-UPDRS), fine-manual dexterity (Perdue Peg Board), measures of functional mobility (Timed Up & Go: single & dual task, Tinetti, Berg, Mini-BESTest) and self-rated balance and gait questionnaires (Activities Balance Confidence Scale: ABC-S; Gait and Falls: G&F-Q; Freezing of Gait: FOG).

RESULTS

Compared to the CG, there was significantly greater improvement in the DG pre-post change scores on measures of symptom severity MDS-UPDRS, dexterity, six measures of functional mobility, and the ABC-S, G&F-Q, FOG questionnaires.

CONCLUSIONS

DfPD^®-based dance classes improved disease-related symptom severity, fine-manual dexterity, and functional mobility. Feasibility of the approach for a large scale RCT was also confirmed.

CLINICAL REHABILITATION IMPACT

DfPD^® could be an effective supportive therapy for the management of symptoms and functional abilities in PD.

Impacts of dance on cognition, psychological symptoms and quality of life in Parkinson's disease

BACKGROUND

While dance may improve motor features in Parkinson's disease (PD), it is not yet clear if the benefits extend to non-motor features.

OBJECTIVE

To determine whether dance classes based on Dance for PD®, improve cognition, psychological symptoms and Quality of Life (QoL) in PD.

METHODS

Participants were allocated to a Dance Group (DG; n = 17) or Control Group (CG: n = 16). Participants had early-stage PD (Hoehn & Yahr: DG = 1.6±0.7, CG = 1.5±0.8) with no cognitive impairment (Addenbrooke's score: DG = 93.2±3.6, CG = 92.6±4.3). The DG undertook a one-hour class, twice weekly for 12 weeks, while the CG had treatment as usual. Both groups were assessed for disease severity (MDS-UPDRS), cognition (NIH Toolbox® cognition battery, Trail Making Test), psychological symptoms (Hospital Anxiety and Depression Scale, MDS-UPDRS-I) and QoL (PDQ-39, MDS-UPDRS-II).

RESULTS

Group comparison of pre-post change scores showed that selected cognitive skills (executive function and episodic memory), psychological symptoms (anxiety and depression) as well as QoL (PDQ-39 summary index) were significantly improved by the intervention (DG > CG, p's < 0.05, Cohen's d > 0.8).

DISCUSSIONS AND CONCLUSION

Dance classes had a clear benefit on psychological symptoms, QoL and a limited cognitive benefit. Follow-up assessment is required to confirm the durability of these effects.

Could Heat Therapy Be an Effective Treatment for Alzheimer's and Parkinson's Diseases? A Narrative Review

Neurodegenerative diseases involve the progressive deterioration of structures within the central nervous system responsible for motor control, cognition, and autonomic function. Alzheimer's disease and Parkinson's disease are among the most common neurodegenerative disease and have an increasing prevalence over the age of 50. Central in the pathophysiology of these neurodegenerative diseases is the loss of protein homeostasis, resulting in misfolding and aggregation of damaged proteins. An element of the protein homeostasis network that prevents the dysregulation associated with neurodegeneration is the role of molecular chaperones. Heat shock proteins (HSPs) are chaperones that regulate the aggregation and disaggregation of proteins in intracellular and extracellular spaces, and evidence supports their protective effect against protein aggregation common to neurodegenerative diseases. Consequently, upregulation of HSPs, such as HSP70, may be a target for therapeutic intervention for protection against neurodegeneration. A novel therapeutic intervention to increase the expression of HSP may be found in heat therapy and/or heat acclimation. In healthy populations, these interventions have been shown to increase HSP expression. Elevated HSP may have central therapeutic effects, preventing or reducing the toxicity of protein aggregation, and/or peripherally by enhancing neuromuscular function. Broader physiological responses to heat therapy have also been identified and include improvements in muscle function, cerebral blood flow, and markers of metabolic health. These outcomes may also have a significant benefit for people with neurodegenerative disease. While there is limited research into body warming in patient populations, regular passive heating (sauna bathing) has been associated with a reduced risk of developing neurodegenerative disease. Therefore, the emerging evidence is compelling and warrants further investigation of the potential benefits of heat acclimation and passive heat therapy for sufferers of neurodegenerative diseases.

Assessment of abduction motion in patients with rotator cuff tears: an analysis based on inertial sensors

Background

Reduced range of motion in the shoulder can be a source of functional limitation. The use of inertial sensors to quantify movement in addition to more common clinical assessments of the shoulder may allow clinicians to understand that they are potentially unnoticed by visual identification. The aim of this study was to generate an explanatory model for shoulder abduction based on data from inertial sensors.

Method

A cross-sectional study was carried out to generate an explanatory model of shoulder abduction based on data from inertial sensors. Shoulder abduction of thirteen older adults suffering from shoulder dysfunction was recorded with two inertial sensors placed on the humerus and scapula. Movement variables (maximum angular mobility, angular peak of velocity, peak of acceleration) were used to explain the functionality of the upper limb assessed using the Upper Limb Functional Index (ULFI). The abduction movement of the shoulder was explained by six variables related to the mobility of the shoulder joint complex. A multivariate analysis of variance (MANOVA) was used to explain the results obtained on the functionality of the upper limb.

Results

The MANOVA model based on angular mobility explained 69% of the variance of the ULFI value (r-squared = 0.69). The most relevant variables were the abduction-adduction of the humerus and the medial/lateral rotation of the scapula.

Conclusions

The method used in the present study reveals the potential importance of the analysis of the scapular and humeral movements for comprehensive evaluation of the upper limb. Further research should include a wider sample and may seek to use this assessment technique in a range of potential clinical applications.

Dynamics of corticospinal motor control during overground and treadmill walking in humans

Increasing evidence suggests cortical involvement in the control of human gait. However, the nature of corticospinal interactions remains poorly understood. We performed time-frequency analysis of electrophysiological activity acquired during treadmill and overground walking in 22 healthy, young adults. Participants walked at their preferred speed (4.2, SD 0.4 km/h), which was matched across both gait conditions. Event-related power, corticomuscular coherence (CMC), and intertrial coherence (ITC) were assessed for EEG from bilateral sensorimotor cortices and EMG from the bilateral tibialis anterior (TA) muscles. Cortical power, CMC, and ITC at theta, alpha, beta, and gamma frequencies (4-45 Hz) increased during the double support phase of the gait cycle for both overground and treadmill walking. High beta (21-30 Hz) CMC and ITC of EMG was significantly increased during overground compared with treadmill walking, as well as EEG power in theta band (4-7 Hz). The phase spectra revealed positive time lags at alpha, beta, and gamma frequencies, indicating that the EEG response preceded the EMG response. The parallel increases in power, CMC, and ITC during double support suggest evoked responses at spinal and cortical populations rather than a modulation of ongoing corticospinal oscillatory interactions. The evoked responses are not consistent with the idea of synchronization of ongoing corticospinal oscillations but instead suggest coordinated cortical and spinal inputs during the double support phase. Frequency-band dependent differences in power, CMC, and ITC between overground and treadmill walking suggest differing neural control for the two gait modalities, emphasizing the task-dependent nature of neural processes during human walking. NEW & NOTEWORTHY We investigated cortical and spinal activity during overground and treadmill walking in healthy adults. Parallel increases in power, corticomuscular coherence, and intertrial coherence during double support suggest evoked responses at spinal and cortical populations rather than a modulation of ongoing corticospinal oscillatory interactions. These findings identify neurophysiological mechanisms that are important for understanding cortical control of human gait in health and disease.

Center of Pressure Motion After Calf Vibration Is More Random in Fallers Than Non-fallers: Prospective Study of Older Individuals

Aging is associated with changes in balance control and elderly take longer to adapt to changing sensory conditions, which may increase falls risk. Low amplitude calf muscle vibration stimulates local sensory afferents/receptors and affects sense of upright when applied in stance. It has been used to assess the extent the nervous system relies on calf muscle somatosensory information and to rapidly change/perturb part of the somatosensory information causing balance unsteadiness by addition and removal of the vibratory stimulus. This study assessed the effect of addition and removal of calf vibration on balance control (in the absence of vision) in elderly individuals (>65 years, n = 99) who did (n = 41) or did not prospectively report falls (n = 58), and in a group of young individuals (18-25 years, n = 23). Participants stood barefoot and blindfolded on a force plate for 135 s. Vibrators (60 Hz, 1 mm) attached bilaterally over the triceps surae muscles were activated twice for 15 s; after 15 and 75 s (45 s for recovery). Balance measures were applied in a windowed (15 s epoch) manner to compare center-of-pressure (CoP) motion before, during and after removal of calf vibration between groups. In each epoch, CoP motion was quantified using linear measures, and non-linear measures to assess temporal structure of CoP motion [using recurrence quantification analysis (RQA) and detrended fluctuation analysis]. Mean CoP displacement during and after vibration did not differ between groups, which suggests that calf proprioception and/or weighting assigned by the nervous system to calf proprioception was similar for the young and both groups of older individuals. Overall, compared to the elderly, CoP motion of young was more predictable and persistent. Balance measures were not different between fallers and non-fallers before and during vibration. However, non-linear aspects of CoP motion of fallers and non-fallers differed after removal of vibration, when dynamic re-weighting is required. During this period fallers exhibited more random CoP motion, which could result from a reduced ability to control balance and/or a reduced ability to dynamically reweight proprioceptive information. These results show that non-linear measures of balance provide evidence for deficits in balance control in people who go on to fall in the following 12 months.

Impact of exercise selection on hamstring muscle activation

OBJECTIVE

To determine which strength training exercises selectively activate the biceps femoris long head (BF_LongHead) muscle.

METHODS

We recruited 24 recreationally active men for this two-part observational study. Part 1: We explored the amplitudes and the ratios of lateral (BF) to medial hamstring (MH) normalised electromyography (nEMG) during the concentric and eccentric phases of 10 common strength training exercises. Part 2: We used functional MRI (fMRI) to determine the spatial patterns of hamstring activation during two exercises which (1) most selectively and (2) least selectively activated the BF in part 1.

RESULTS

Eccentrically, the largest BF/MH nEMG ratio occurred in the 45° hip-extension exercise; the lowest was in the Nordic hamstring (Nordic) and bent-knee bridge exercises. Concentrically, the highest BF/MH nEMG ratio occurred during the lunge and 45° hip extension; the lowest was during the leg curl and bent-knee bridge. fMRI revealed a greater BF_(LongHead) to semitendinosus activation ratio in the 45° hip extension than the Nordic (p<0.001). The T2 increase after hip extension for BF_LongHead, semitendinosus and semimembranosus muscles was greater than that for BF_ShortHead (p<0.001). During the Nordic, the T2 increase was greater for the semitendinosus than for the other hamstring muscles (p≤0.002).

SUMMARY

We highlight the heterogeneity of hamstring activation patterns in different tasks. Hip-extension exercise selectively activates the long hamstrings, and the Nordic exercise preferentially recruits the semitendinosus. These findings have implications for strategies to prevent hamstring injury as well as potentially for clinicians targeting specific hamstring components for treatment (mechanotherapy).

Effects of Resistance Training on Measures of Muscular Strength in People with Parkinson's Disease: A Systematic Review and Meta-Analysis

OBJECTIVE

The aim of this systematic review and meta-analysis was to determine the overall effect of resistance training (RT) on measures of muscular strength in people with Parkinson's disease (PD).

METHODS

Controlled trials with parallel-group-design were identified from computerized literature searching and citation tracking performed until August 2014. Two reviewers independently screened for eligibility and assessed the quality of the studies using the Cochrane risk-of-bias-tool. For each study, mean differences (MD) or standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for continuous outcomes based on between-group comparisons using post-intervention data. Subgroup analysis was conducted based on differences in study design.

RESULTS

Nine studies met the inclusion criteria; all had a moderate to high risk of bias. Pooled data showed that knee extension, knee flexion and leg press strength were significantly greater in PD patients who undertook RT compared to control groups with or without interventions. Subgroups were: RT vs. control-without-intervention, RT vs. control-with-intervention, RT-with-other-form-of-exercise vs. control-without-intervention, RT-with-other-form-of-exercise vs. control-with-intervention. Pooled subgroup analysis showed that RT combined with aerobic/balance/stretching exercise resulted in significantly greater knee extension, knee flexion and leg press strength compared with no-intervention. Compared to treadmill or balance exercise it resulted in greater knee flexion, but not knee extension or leg press strength. RT alone resulted in greater knee extension and flexion strength compared to stretching, but not in greater leg press strength compared to no-intervention.

DISCUSSION

Overall, the current evidence suggests that exercise interventions that contain RT may be effective in improving muscular strength in people with PD compared with no exercise. However, depending on muscle group and/or training dose, RT may not be superior to other exercise types. Interventions which combine RT with other exercise may be most effective. Findings should be interpreted with caution due to the relatively high risk of bias of most studies.

Improved nutritional status is related to improved quality of life in Parkinson's disease

Background

Quality of life is poorer in Parkinson’s disease than in other conditions and in the general population without Parkinson’s disease. Malnutrition also results in poorer quality of life. This study aimed at determining the relationship between quality of life and nutritional status.

Methods

Community-dwelling people with Parkinson’s disease >18 years old were recruited. The Patient-Generated Subjective Global Assessment (PG-SGA) assessed nutritional status. The Parkinson’s Disease Questionnaire 39 (PDQ-39) measured quality of life. Phase I was cross-sectional. The malnourished in Phase I were eligible for a nutrition intervention phase, randomised into 2 groups: standard care (SC) with provision of nutrition education materials only and intervention (INT) with individualised dietetic advice and regular weekly follow-up. Data were collected at baseline, 6 weeks, and 12 weeks.

Results

Phase I consisted of 120 people who completed the PDQ-39. Phase II consisted of 9 in the SC group and 10 in the INT group. In Phase I, quality of life was poorer in the malnourished, particularly for mobility and activities of daily living domains. There was a significant correlation between PG-SGA and PDQ-39 scores (Phase I, r_s = 0.445, p = .000; Phase II, r_s = .426, p = .002). In Phase II, no significant difference in the PDQ-39 total or sub-scores was observed between the INT and SC groups; however, there was significant improvement in the emotional well-being domain for the entire group, X²(2) = 8.84, p = .012.

Conclusions

Malnourished people with Parkinson’s disease had poorer quality of life than the well-nourished, and improvements in nutritional status resulted in quality of life improvements. Attention to nutritional status is an important component of quality of life and therefore the total care of people with Parkinson’s disease.

Trial registration

ACTRN12610000819022

Effects of textured insoles on balance in people with Parkinson's disease

Background

Degradation of the somatosensory system has been implicated in postural instability and increased falls risk for older people and Parkinson’s disease (PD) patients. Here we demonstrate that textured insoles provide a passive intervention that is an inexpensive and accessible means to enhance the somatosensory input from the plantar surface of the feet.

Methods

20 healthy older adults (controls) and 20 participants with PD were recruited for the study. We evaluated effects of manipulating somatosensory information from the plantar surface of the feet using textured insoles. Participants performed standing tests, on two different surfaces (firm and foam), under three footwear conditions: 1) barefoot; 2) smooth insoles; and 3) textured insoles. Standing balance was evaluated using a force plate yielding data on the range of anterior-posterior and medial-lateral sway, as well as standard deviations for anterior-posterior and medial-lateral sway.

Results

On the firm surface with eyes open both the smooth and textured insoles reduced medial-lateral sway in the PD group to a similar level as the controls. Only the textured insole decreased medial-lateral sway and medial-lateral sway standard deviation in the PD group on both surfaces, with and without visual input. Greatest benefits were observed in the PD group while wearing the textured insoles, and when standing on the foam surface with eyes closed.

Conclusions

Data suggested that textured insoles may provide a low-cost means of improving postural stability in high falls-risk groups, such as people with PD.

Markers of disease severity are associated with malnutrition in Parkinson's disease

OBJECTIVE

In Parkinson's disease (PD), commonly reported risk factors for malnutrition in other populations commonly occur. Few studies have explored which of these factors are of particular importance in malnutrition in PD. The aim was to identify the determinants of nutritional status in people with Parkinson's disease (PWP).

METHODS

Community-dwelling PWP (>18 years) were recruited (n = 125; 73M/52F; Mdn 70 years). Self-report assessments included Beck's Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI), Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT), Modified Constipation Assessment Scale (MCAS) and Freezing of Gait Questionnaire (FOG-Q). Information about age, PD duration, medications, co-morbid conditions and living situation was obtained. Addenbrooke's Cognitive Examination (ACE-R), Unified Parkinson's Disease Rating Scale (UPDRS) II and UPDRS III were performed. Nutritional status was assessed using the Subjective Global Assessment (SGA) as part of the scored Patient-Generated Subjective Global Assessment (PG-SGA).

RESULTS

Nineteen (15%) were malnourished (SGA-B). Median PG-SGA score was 3. More of the malnourished were elderly (84% vs. 71%) and had more severe disease (H&Y: 21% vs. 5%). UPDRS II and UPDRS III scores and levodopa equivalent daily dose (LEDD)/body weight (mg/kg) were significantly higher in the malnourished (Mdn 18 vs. 15; 20 vs. 15; 10.1 vs. 7.6 respectively). Regression analyses revealed older age at diagnosis, higher LEDD/body weight (mg/kg), greater UPDRS III score, lower STAI score and higher BDI score as significant predictors of malnutrition (SGA-B). Living alone and higher BDI and UPDRS III scores were significant predictors of a higher log-adjusted PG-SGA score.

CONCLUSIONS

In this sample of PWP, the rate of malnutrition was higher than that previously reported in the general community. Nutrition screening should occur regularly in those with more severe disease and depression. Community support should be provided to PWP living alone. Dopaminergic medication should be reviewed with body weight changes.

Nutritional status in Parkinson's disease patients undergoing deep brain stimulation surgery: a pilot study

OBJECTIVES

People with Parkinson's disease (PD) are at higher risk of malnutrition due to PD symptoms and pharmacotherapy side effects. When pharmacotherapy is no longer effective for symptom control, deep-brain stimulation (DBS) surgery may be considered. The aim of this study was to assess the nutritional status of people with PD who may be at higher risk of malnutrition related to unsatisfactory symptom management with optimised medical therapy.

DESIGN

This was an observational study using a convenience sample.

SETTING

Participants were seen during their hospital admission for their deep brain stimulation surgery.

PARTICIPANTS

People with PD scheduled for DBS surgery were recruited from a Brisbane neurological clinic (n=15).

MEASUREMENTS

The Patient-Generated Subjective Global Assessment (PG-SGA), weight, height and body composition were assessed to determine nutritional status.

RESULTS

Six participants (40%) were classified as moderately malnourished (SGA-B). Eight participants (53%) reported previous unintentional weight loss (average loss of 13%). On average, participants classified as well-nourished (SGA-A) were younger, had shorter disease durations, lower PG-SGA scores, higher body mass (BMI) and fat free mass indices (FFMI) when compared to malnourished participants (SGA-B). Five participants had previously received dietetic advice but only one in relation to unintentional weight loss.

CONCLUSION

Malnutrition remains unrecognised and untreated in this group despite unintentional weight loss and presence of nutrition impact symptoms. Improving nutritional status prior to surgery may improve surgical outcomes.

Malnutrition in a sample of community-dwelling people with Parkinson's disease

Objective

Malnutrition results in poor health outcomes, and people with Parkinson’s disease may be more at risk of malnutrition. However, the prevalence of malnutrition in Parkinson’s disease is not yet well defined. The aim of this study is to provide an estimate of the extent of malnutrition in community-dwelling people with Parkinson’s disease.

Methods

This is a cross-sectional study of people with Parkinson’s disease residing within a 2 hour driving radius of Brisbane, Australia. The Subjective Global Assessment (SGA) and scored Patient Generated Subjective Global Assessment (PG-SGA) were used to assess nutritional status. Body weight, standing or knee height, mid-arm circumference and waist circumference were measured.

Results

Nineteen (15%) of the participants were moderately malnourished (SGA-B). The median PG-SGA score of the SGA-B group was 8 (4–15), significantly higher than the SGA-A group, U = 1860.5, p<.05. The symptoms most influencing intake were loss of appetite, constipation, early satiety and problems swallowing.

Conclusions

As with other populations, malnutrition remains under-recognised and undiagnosed in people with Parkinson’s disease. Regular screening of nutritional status in people with Parkinson’s disease by health professionals with whom they have regular contact should occur to identify those who may benefit from further nutrition assessment and intervention.

Enhanced somatosensory information decreases postural sway in older people

The somatosensory system plays an important role in balance control and age-related declines in somatosensory function have been implicated in falls incidence. Different types of insole devices have been developed to enhance somatosensory information and improve postural stability. However, they are often too complex and expensive to integrate into daily life and textured insole surfaces may provide an inexpensive and accessible means to enhance somatosensory input. This study investigated the effects of textured insole surfaces on postural sway in ten younger and seven older participants performing standing balance tests on a force plate under three insole surface conditions: (1) barefoot; (2) with hard; and (3), soft textured insole surfaces. With each insole surface, participants were tested under two vision conditions (eyes open, closed) on two standing surfaces (firm, foam). Four 30s trials were collected for different combinations of insole surface, standing surface and vision. Centre of pressure measurements included the range and standard deviation of anterior-posterior and medial-lateral displacement, path length and the 90% confidence elliptical area. Results revealed a significant Group*Surface*Insole interaction for five of the dependent variables. Compared to younger individuals, postural sway was greater in older people on both standing surfaces in the barefoot condition. However, both textured insole surfaces reduced postural sway for the older group especially in the eyes closed condition on a foam surface. These findings suggest that textured insole surfaces can reduce postural sway in older people, particularly during more challenging balance tasks. Textured insole surfaces may afford a low-cost means of decreasing postural sway, providing an important intervention in falls prevention.

Risk of falls, injurious falls, and other injuries resulting from visual impairment among older adults with age-related macular degeneration

PURPOSE

Age-related macular degeneration (AMD) is the leading cause of irreversible visual impairment among older adults. This study explored the relationship between AMD, fall risk, and other injuries and identified visual risk factors for these adverse events.

METHODS

Participants included 76 community-dwelling individuals with a range of severity of AMD (mean age, 77.0 ± 6.9 years). Baseline assessment included binocular visual acuity, contrast sensitivity, and merged visual fields. Participants completed monthly falls and injury diaries for 1 year after the baseline assessment.

RESULTS

Overall, 74% of participants reported having either a fall or a non-fall-related injury. Fifty-four percent of participants reported a fall and 30% reported more than one fall; of the 102 falls reported, 63% resulted in an injury. Most occurred outdoors (52%), between late morning and late afternoon (61%) and when navigating on level ground (62%). The most common non-fall-related injuries were lacerations (36%) and collisions with an object (35%). Reduced contrast sensitivity and visual acuity were associated with increased fall rate, after controlling for age, sex, cognitive function, cataract severity, and self-reported physical function. Reduced contrast sensitivity was the only significant predictor of non-fall-related injuries.

CONCLUSIONS

Among older adults with AMD, increased visual impairment was significantly associated with an increased incidence of falls and other injuries. Reduced contrast sensitivity was significantly associated with both increased rates of falls and other injuries, while reduced visual acuity was only associated with increased fall rate. These findings have important implications for the assessment of visually impaired older adults.

Falls in Parkinson's disease: evidence for altered stepping strategies on compliant surfaces

BACKGROUND

Real-world environments comprise surfaces of different textures, densities and gradients, which can threaten postural stability and increase falls risk. However, there has been limited research that has examined how walking on compliant surfaces influences gait and postural stability in older people and PD patients.

METHODS

PD patients (n = 49) and age-matched controls (n = 32) were assessed using three-dimensional motion analysis during self-paced walking on both firm and foam walkways. Falls were recorded prospectively over 12 months using daily falls calendars.

RESULTS

Walking on a foam surface influenced the temporospatial characteristics for all groups, but PD fallers adopted very different joint kinematics compared with controls. PD fallers also demonstrated reduced toe clearance and had increased mediolateral head motion (relative to walking velocity) compared with control participants.

CONCLUSIONS

Postural control deficits in PD fallers may impair their capacity to attenuate surface-related perturbations and control head motion. The risk of falling for PD patients may be increased on less stable surfaces.

Falls in Parkinson's disease: kinematic evidence for impaired head and trunk control

Changes in stride characteristics and gait rhythmicity characterize gait in Parkinson's disease and are widely believed to contribute to falls in this population. However, few studies have examined gait in PD patients who fall. This study reports on the complexities of walking in PD patients who reported falling during a 12-month follow-up. Forty-nine patients clinically diagnosed with idiopathic PD and 34 controls had their gait assessed using three-dimensional motion analysis. Of the PD patients, 32 (65%) reported at least one fall during the follow-up compared with 17 (50%) controls. The results showed that PD patients had increased stride timing variability, reduced arm swing and walked with a more stooped posture than controls. Additionally, PD fallers took shorter strides, walked slower, spent more time in double-support, had poorer gait stability ratios and did not project their center of mass as far forward of their base of support when compared with controls. These stride changes were accompanied by a reduced range of angular motion for the hip and knee joints. Relative to walking velocity, PD fallers had increased mediolateral head motion compared with PD nonfallers and controls. Therefore, head motion could exceed "normal" limits, if patients increased their walking speed to match healthy individuals. This could be a limiting factor for improving gait in PD and emphasizes the importance of clinically assessing gait to facilitate the early identification of PD patients with a higher risk of falling.

Predictors of future falls in Parkinson disease

Background: Falls are a major health and injury problem for people with Parkinson disease (PD). Despite the severe consequences of falls, a major unresolved issue is the identification of factors that predict the risk of falls in individual patients with PD. The primary aim of this study was to prospectively determine an optimal combination of functional and disease-specific tests to predict falls in individuals with PD.

Methods: A total of 101 people with early-stage PD undertook a battery of neurologic and functional tests in their optimally medicated state. The tests included Tinetti, Berg, Timed Up and Go, Functional Reach, and the Physiological Profile Assessment of Falls Risk; the latter assessment includes physiologic tests of visual function, proprioception, strength, cutaneous sensitivity, reaction time, and postural sway. Falls were recorded prospectively over 6 months.

Results: Forty-eight percent of participants reported a fall and 24% more than 1 fall. In the multivariate model, a combination of the Unified Parkinson's Disease Rating Scale (UPDRS) total score, total freezing of gait score, occurrence of symptomatic postural orthostasis, Tinetti total score, and extent of postural sway in the anterior-posterior direction produced the best sensitivity (78%) and specificity (84%) for predicting falls. From the UPDRS items, only the rapid alternating task category was an independent predictor of falls. Reduced peripheral sensation and knee extension strength in fallers contributed to increased postural instability.

Conclusions: Falls are a significant problem in optimally medicated early-stage PD. A combination of both disease-specific and balance- and mobility-related measures can accurately predict falls in individuals with PD.

Predictors of driving assessment outcome in Parkinson's disease

This study evaluated selected clinical and functional tests as predictors of driving safety outcomes in Parkinson's disease (PD) patients. A total of 25 PD patients and 21 age-matched controls, all regular drivers, underwent neurological evaluation and assessment of cognitive, visual, and motor function and a standardized, on-road driving assessment. The capacity of the tests to predict pass/fail driving outcomes was determined by selecting a subset with the highest predictive value from each domain and then subjecting these subsets to discriminant function analysis. Accuracy, sensitivity, specificity, and positive and negative predictive values were determined. Three relatively simple tests from the larger battery predicted passes with relatively high sensitivity (PD, 72.7%; controls, 93.8%; both combined, 85.2%); and moderate specificity (PD, 64.3%; controls, 60.0%; both combined. 63.2%). These tests assessed motor performance (Purdue Pegboard test), contrast sensitivity (Pelli-Robson test), and cognitive function (verbal version of Symbol Digit Modalities test). Adding time since diagnosis for the PD group increased sensitivity to 90.9% and specificity to 71.4%. These simple tests confer more objectivity and predictive power to clinical recommendations for driving, they reflect distinct functions that are necessary for safe driving, and they may be especially useful when on-road assessments are not feasible.

Skeletal muscle phenotype is associated with exercise tolerance in patients with peripheral arterial disease

OBJECTIVE

To better understand the association between skeletal muscle and exercise intolerance in peripheral arterial disease (PAD), we assessed treadmill-walking performance and gastrocnemius muscle phenotype in healthy control subjects and in patients with PAD. We hypothesized that gastrocnemius muscle characteristics would be altered in PAD compared with control subjects and that exercise tolerance in patients PAD would be related to muscle phenotype.

METHODS

Sixteen patients with PAD and intermittent claudication and 13 healthy controls of the same age participated. Each subject completed a graded treadmill-walking test and underwent a resting muscle biopsy. Muscle biopsy samples were obtained from the medial gastrocnemius muscle of the most ischemic limb in PAD and a limb chosen at random in controls. Samples were analyzed for fiber type and cross-sectional area, capillary-to-fiber ratio, the number of capillaries in contact with each fiber type, and the optical density of glycogen within each fiber by using histochemical procedures. Total muscle glycogen content was determined biochemically.

RESULTS

Exercise capacity measured on the incremental walking test in the PAD group was only 30% to 40% of that observed in controls. The PAD group had a lower proportion of type I muscle fibers (P < .05), fewer capillaries per muscle fiber (P < .05), and tended to have smaller fiber areas (P = .08). The relative area of type I fibers, the capillary-to-fiber ratio, capillary contacts with type I and IIa fibers, and the optical density of glycogen in type I fibers were all positively correlated with exercise tolerance in the PAD group (P < .05) but not controls.

CONCLUSIONS

These data suggest that muscle phenotype is altered in PAD and that such alterations are associated with the exercise intolerance in these patients. In light of these findings, therapies such as resistance training or electrical stimulation that target skeletal muscle in PAD may prove beneficial, and further investigation of such therapies is warranted.

Velocity perception and proprioception

Proprioceptive information related to position and velocity reaches conscious perception and appears to be processed simultaneously via separate perceptual channels. Determining the fidelity of velocity perception is difficult, however, because of the interaction of distance and timing information in its derivation. There is also a complex relationship between receptor discharge and kinematic variables and thresholds for detection of proprioceptive information are increased during movement. Experiments determined the discrimination thresholds for different movement velocities when i) movement distance remained constant and duration varied; ii) movement duration remained constant and distance varied; iii) movement distance and duration were randomly varied. Discrimination thresholds increased as movement velocity increased. Velocity perception was more accurate when distance and timing cues were available, particularly at higher velocities. These results indicate that all available cues are used to make judgements of movement velocity.

Proprioception and stimulus-response compatibility

Sixteen subjects pressed a left or right key in response to lateralized visual stimuli, in uncrossed (left index finger on left key, right finger on right key) and crossed conditions (left finger on right key and vice versa), with varying finger separations. Visual, tactile, or "efference copy" cues about relative finger positions were unavailable. Subjects had to press the key on the same side as (compatible group) or opposite side to the stimulus (incompatible group). Separate proprioceptive judgements of the relative finger positions were obtained. Findings of an overall reaction time (RT) advantage for compatible instructions and for uncrossed hands were replicated. With decreasing finger separation the RT advantage for compatible instructions decreased, and the probability of responding with either hand increased. The compatibility effect disappeared completely at the 6-cm crossed position, not at the position that was hardest to judge proprioceptively. This suggests that two forms of neural activation are summed: automatic activation of the anatomically same-side limb, and an integrated, rule-based activation. The results further demonstrate that independent proprioceptive cues from each limb, unassociated with skin contact between the limbs, can mediate the determination of relative position for response selection in stimulus-response compatibility tasks.

A numerical simulation of muscle spindle ensemble encoding during planar movement of the human arm: correlation sensitivity and parameter dependence

We extend the analysis developed in the preceding paper in which we correlated kinematic parameters of planar movements of the human arm made by subjects moving to a visual target with numerical estimates of the ensemble encoding of muscle spindles within some of the muscles of this limb. Three possible models for the inclusion of noise in the calculations of the ensemble encodings are considered: (i) random errors in the angular coordinates from which muscle fascicle, and hence spindle length are calculated, (ii) variability of spindle discharge rates, and (iii) variability in the calculation of the ensemble encoding. In each case the correlations between kinematic variables of the movements and the resultant ensemble encodings decrease as the contribution of the noise term to the calculation of the encodings increases. Subject to the constraint that the magnitude of the noise term remains within physiologically realistic limits, however, the observed correlations persist at statistically significant levels. We also investigate the dependence of the observed correlations on the choice of model parameters, namely (i) the absolute and relative contributions made by simulated spindle primary and secondary afferents to the ensemble encoding, (ii) the inclusion of explicit length-related terms in the model of muscle spindle discharge, and (iii) the fractional power of velocity experienced by the model spindles during movement. The resulting correlations are approximately independent of both the fractional power of velocity and absolute firing levels of both the primary and secondary afferents of the spindle model. The inclusion of explicit length-dependent terms in the model does result in differences in the observed correlation coefficients. In this case, however, the magnitudes of the differences are small. On the basis of these findings we conclude that the correlations between kinematic variables of movement and the associated ensemble encodings are robust with regard to both the choice of model parameters and noise inherent at all stages of the transduction and processing of proprioceptive information. The findings of the present study provide further evidence, therefore, to support the hypothesis that motor structures capable of deriving such an ensemble encoding would be provided with information regarding ongoing movements in both intrinsic (body-centered) and extrinsic (Cartesian) coordinate systems.

A numerical simulation of muscle spindle ensemble encoding during planar movement of the human arm

We address the issue of what proprioceptive information, regarding movement of the human arm, may be provided to the central nervous system by proprioceptors located within muscles of this limb. To accomplish this we developed a numerical simulation which could provide estimates of the length regimes experienced by a set of model receptors located within some of the principal muscles of the human arm during planar movement of this limb. These receptors were assumed to have characteristics analogous to those associated with a simple model of muscle spindle signalling of movement. To this end each spindle had proprioceptive 'channels' associated with it. These corresponded to primary and secondary spindle afferent fibers which could provide independent afferent output regarding the parent muscle the spindle monitored. The angles of the shoulder and elbow joints attained by subjects performing a task requiring movement of the right arm in a horizontal plane to a static visual target were recorded. For this angular data the lengths and rates of change of lengths experienced by muscle fascicles, and hence the model spindles, during movement were calculated by means of the numerical simulation. The discharge rates of the simulated spindles during the movement were calculated to derive a measure of the depth of modulation, induced by the movement, for each spindle. These values were then summed for all spindles to provide a first-order approximation of spindle ensemble coding of the movement. Significant correlations (P < 0.0001, Spearman's rank order) were found between the resulting ensemble encodings and, in order of significance, the angular velocity of the shoulder joint (rS = 0.945), the tangential velocity of the hand (rS = 0.942), and the angular velocity of the elbow joint (rS = 0.917). Correlations between the angular positions of the shoulder (rS = -0.623) and elbow (rS = 0.628) were lower. These findings indicate that the ensemble profiles of the simulated muscle spindles, encode information regarding kinematic parameters of movements related to both intrinsic and extrinsic coordinate systems. This suggests that motor structures capable of deriving such an ensemble encoding would be in a position to perform the sensory-motor transformations between intrinsic and extrinsic frames of reference necessary for controlling movements planned in extrinsic coordinates.

Proprioceptive consequences of tendon vibration during movement

1. Previous studies have used tendon vibration to investigate kinesthetic illusions in the isometric limb and end point control in the moving limb. These previous studies have shown that vibration distorts the perceptions of static joint angle and movement and causes systematic errors in the end point of movement. In this paper we describe the effects of tendon vibration during movement while human subjects performed a proprioceptively coordinated motor task. In an earlier study we showed that the CNS coordinates this motor task-a movement sequence-with proprioceptive information related to the dynamic position and velocity of the limb. 2. When performing this movement sequence, each subject sat at a table and opened the right hand as the right elbow was passively rotated in the extension direction through a prescribed target angle. Vision of the arm was prevented, and the movement velocity was changed randomly from trial to trial, leaving proprioception as the only useful source of kinematic information with which to perform the task. 3. In randomly occurring trials, vibration was applied to the tendon of the biceps brachii, a muscle that lengthens during elbow extension. In some experiments the timing of tendon vibration was varied with respect to the onset of elbow rotation, and in other experiments the frequency of vibration was varied. In each experiment we compared the accuracy of the subject's response (i.e., the elbow angle at which the subject opened the hand) in trials with tendon vibration with the accuracy in trials without tendon vibration. 4. The effect of tendon vibration depended on the frequency of vibration. When the biceps tendon was vibrated at 20 Hz, subjects opened the hand after the elbow passed through the target angle ("overshooting"). Overshooting is consistent with an underestimate of the actual displacement or velocity of the elbow. Vibration at 30 Hz had little or no effect on the elbow angle at hand opening. Vibration at 40 Hz caused subjects to open the hand before the elbow reached the target angle ("undershooting"). Undershooting is consistent with an overestimate of the actual displacement or velocity of the elbow. The size of the error depended on the velocity of the passively imposed elbow rotation. 5. The effect of tendon vibration also depended on the timing of vibration. If 40-Hz vibration began at the onset of movement, the subject undershot the target. If 40-Hz vibration started 5 s before movement onset and continued throughout the movement, the undershoot error increased in magnitude. However, if 40-Hz vibration started 5 s before movement onset and then stopped at movement onset, the subject overshot the target. When vibration was shut off during movement, a transition occurred from an over-shooting error to an undershooting error at a time that depended on the velocity of elbow rotation. 6. In a separate experiment, subjects were instructed to match either the perceived dynamic position or the perceived velocity of rotation imposed on the right elbow by actively rotating the left elbow. In both matching tasks, tendon vibration produced oppositely directed errors depending on the frequency of vibration. Vibration at 20 Hz produced a perception of decreased elbow velocity and a bias in dynamic position in the flexion direction, and vibration at 40 Hz produced the opposite perceptions. 7. We conclude that muscle spindle afferents, which are activated by tendon vibration, are an important source of the dynamic position and velocity information that the CNS uses to coordinate this movement sequence task. The observed effects of vibration timing and frequency suggest that perceptual changes evoked by vibration cannot be explained by the simple summation of sensory input evoked by movement and by vibration. Rather, the bias in perception produced by vibration appears to be related to the difference between vibration- and movement-evoked activity in muscle spindle afferents.

Proprioceptive coordination of movement sequences: role of velocity and position information

1. Recent studies have shown that the CNS uses proprioceptive information to coordinate multijoint movement sequences; proprioceptive input related to the kinematics of one joint rotation in a movement sequence can be used to trigger a subsequent joint rotation. In this paper we adopt a broad definition of "proprioception," which includes all somatosensory information related to joint posture and kinematics. This paper addresses how the CNS uses proprioceptive information related to the velocity and position of joints to coordinate multijoint movement sequences. 2. Normal human subjects sat at an experimental apparatus and performed a movement sequence with the right arm without visual feedback. The apparatus passively rotated the right elbow horizontally in the extension direction with either a constant velocity trajectory or an unpredictable velocity trajectory. The subjects' task was to open briskly the right hand when the elbow passed through a prescribed target position, similar to backhand throwing in the horizontal plane. The randomization of elbow velocities and the absence of visual information was used to discourage subjects from using any information other than proprioceptive input to perform the task. 3. Our results indicate that the CNS is able to extract the necessary kinematic information from proprioceptive input to trigger the hand opening at the correct elbow position. We estimated the minimal sensory conduction and processing delay to be 150 ms, and on the basis of this estimate, we predicted the expected performance with different degrees of reduced proprioceptive information. These predictions were compared with the subjects' actual performances, revealing that the CNS was using proprioceptive input related to joint velocity in this motor task. To determine whether position information was also being used, we examined the subjects' performances with unpredictable velocity trajectories. The results from experiments with unpredictable velocity trajectories indicate that the CNS extracts proprioceptive information related to both the velocity and the angular position of the joint to trigger the hand movement in this movement sequence. 4. To determine the generality of proprioceptive triggering in movement sequences, we estimated the minimal movement duration with which proprioceptive information can be used as well as the amount of learning required to use proprioceptive input to perform the task. The temporal limits for proprioceptive processing in this movement task were established by determining the minimal movement time during which the task could be performed.(ABSTRACT TRUNCATED AT 400 WORDS)

Ocular limit cycles induced by delayed retinal feedback

Lisberger's and Robinson's models of smooth pursuit predict very different results from altering retinal feedback delay. We have therefore investigated the effects of increasing the retinal feedback time delay in three normal human subjects by means of an artificial feedback paradigm. When additional delays were incorporated into the retinal feedback path a threshold was reached beyond which the eye exhibited sustained self-excited oscillations or "limit cycles". The oscillation period increased linearly (as the added delay was increased) with slopes ranging from 1.41 to 1.6 with zero-delay intercepts of between 212 and 306 ms. Contrary to our experimental findings the Robinson and Lisberger models predict that the plot of oscillation period against added delay should have a slope of 3.4 and 2.7 and an intercept of 479 and 554 ms, respectively. Neither model produced comparable limit cycles, both being unstable at delays greater than 280 ms. Our results imply that the models of smooth pursuit need to incorporate predictive control.

The effect of electromagnetic stimulation of the posterior parietal cortex on eye movements

The posterior parietal cortex probably plays a central role in the sensorimotor transformations needed to make an accurate saccadic eye movement to a visual target. In an attempt to disrupt the normal programming of saccades, we magnetically stimulated the posterior parietal cortex in human volunteers, 80 ms after a small target moved 5 degrees horizontally from the centre of a VDU screen. Saccadic eye movements were recorded and experimental trials were compared with control, unstimulated trials. Magnetic stimulation was triggered in 70% of the trials selected randomly. The main effects of stimulation were: increased divergence of the eyes before each saccade, greater latency of saccade onset, and a tendency to undershoot the target. These results support the hypothesis that the posterior parietal cortex is involved in the programming of accurate saccades to visual targets.

A biomechanical analysis of the sticking region in the bench press

The performance of ten elite powerlifters were analyzed in a simulated competition environment using three-dimensional cinematography and surface electromyography while bench pressing approximately 80% of maximum, a maximal load, and an unsuccessful supramaximal attempt. The resultant moment arm (from the sagittal and transverse planes) of the weight about the shoulder axis decreased throughout the upward movement of the bar. The resultant moment arm of the weight about the elbow axis decreased throughout the initial portion of the ascent of the bar, recording a minimum value during the sticking region, and subsequently increased throughout the remainder of the ascent of the bar. The electromyograms produced by the prime mover muscles (sternal portion of pectoralis major, anterior deltoid, long head of triceps brachii) achieved maximal activation at the commencement of the ascent phase of the lift and maintained this level essentially unchanged throughout the upward movement of the bar. The sticking region, therefore, did not appear to be caused by an increase in the moment arm of the weight about the shoulder or elbow joints or by a minimization of muscular activity during this region. A possible mechanism which envisages the sticking region as a force-reduced transition phase between a strain energy-assisted acceleration phase and a mechanically advantageous maximum strength region is postulated.