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Neurorehabilitation and Neural Repair Jul 2024Movement disorders in children and adolescents with dyskinetic cerebral palsy (CP) are commonly assessed from video recordings, however scoring is time-consuming and...
BACKGROUND
Movement disorders in children and adolescents with dyskinetic cerebral palsy (CP) are commonly assessed from video recordings, however scoring is time-consuming and expert knowledge is required for an appropriate assessment.
OBJECTIVE
To explore a machine learning approach for automated classification of amplitude and duration of distal leg dystonia and choreoathetosis within short video sequences.
METHODS
Available videos of a heel-toe tapping task were preprocessed to optimize key point extraction using markerless motion analysis. Postprocessed key point data were passed to a time series classification ensemble algorithm to classify dystonia and choreoathetosis duration and amplitude classes (scores 0, 1, 2, 3, and 4), respectively. As ground truth clinical scoring of dystonia and choreoathetosis by the Dyskinesia Impairment Scale was used. Multiclass performance metrics as well as metrics for summarized scores: absence (score 0) and presence (score 1-4) were determined.
RESULTS
Thirty-three participants were included: 29 with dyskinetic CP and 4 typically developing, age 14 years:6 months ± 5 years:15 months. The multiclass accuracy results for dystonia were 77% for duration and 68% for amplitude; for choreoathetosis 30% for duration and 38% for amplitude. The metrics for score 0 versus score 1 to 4 revealed an accuracy of 81% for dystonia duration, 77% for dystonia amplitude, 53% for choreoathetosis duration and amplitude.
CONCLUSIONS
This methodology study yielded encouraging results in distinguishing between presence and absence of dystonia, but not for choreoathetosis. A larger dataset is required for models to accurately represent distinct classes/scores. This study presents a novel methodology of automated assessment of movement disorders solely from video data.
Topics: Humans; Adolescent; Cerebral Palsy; Male; Female; Child; Dystonia; Video Recording; Athetosis; Lower Extremity; Machine Learning
PubMed: 38842031
DOI: 10.1177/15459683241257522 -
Sensors (Basel, Switzerland) May 2024Underarm throwing motions are crucial in various sports, including boccia. Unlike healthy players, people with profound weakness, spasticity, athetosis, or deformity in...
Underarm throwing motions are crucial in various sports, including boccia. Unlike healthy players, people with profound weakness, spasticity, athetosis, or deformity in the upper limbs may struggle or find it difficult to control their hands to hold or release a ball using their fingers at the proper timing. To help them, our study aims to understand underarm throwing motions. We start by defining the throwing intention in terms of the launch angle of a ball, which goes hand-in-hand with the timing for releasing the ball. Then, an appropriate part of the body is determined in order to estimate ball-throwing intention based on the swinging motion. Furthermore, the geometric relationship between the movements of the body part and the release angle is investigated by involving multiple subjects. Based on the confirmed correlation, a calibration-and-estimation model that considers individual differences is proposed. The proposed model consists of calibration and estimation modules. To begin, as the calibration module is performed, individual prediction states for each subject are updated online. Then, in the estimation module, the throwing intention is estimated employing the updated prediction. To verify the effectiveness of the model, extensive experiments were conducted with seven subjects. In detail, two evaluation directions were set: (1) how many balls need to be thrown in advance to achieve sufficient accuracy; and (2) whether the model can reach sufficient accuracy despite individual differences. From the evaluation tests, by throwing 20 balls in advance, the model could account for individual differences in the throwing estimation. Consequently, the effectiveness of the model was confirmed when focusing on the movements of the shoulder in the human body during underarm throwing. In the near future, we expect the model to expand the means of supporting disabled people with ball-throwing disabilities.
Topics: Humans; Movement; Shoulder; Biomechanical Phenomena; Male; Adult; Algorithms
PubMed: 38793826
DOI: 10.3390/s24102972 -
European Journal of Paediatric... May 2024Impaired upper limb movements are a key feature in dyskinetic cerebral palsy (CP). However, information on how specific movement patterns relate to manual ability,...
The relationship between manual ability, dystonia and choreoathetosis severity and upper limb movement patterns during reaching and grasping in children and young adults with dyskinetic cerebral palsy.
INTRODUCTION
Impaired upper limb movements are a key feature in dyskinetic cerebral palsy (CP). However, information on how specific movement patterns relate to manual ability, performance and underlying movement disorders is lacking. Insight in these associations may contribute to targeted upper limb management in dyskinetic CP. This study aimed to explore associations between deviant upper limb movement patterns and (1) manual ability, (2) severity of dystonia/choreoathetosis, and (3) movement time/trajectory deviation during reaching and grasping.
PARTICIPANTS/METHODS
Participants underwent three-dimensional upper limb analysis during reaching forwards (RF), reaching sideways (RS) and reach-and-grasp vertical (RGV) as well as clinical assessment. Canonical correlation and regression analysis with statistical parametric mapping were used to explore associations between clinical/performance parameters and movement patterns (mean and variability).
RESULTS
Thirty individuals with dyskinetic CP participated (mean age 16±5 y; 20 girls). Lower manual ability was related to higher variability in wrist flexion/extension during RF and RS early in the reaching cycle (p < 0.05). Higher dystonia severity was associated with higher mean wrist flexion (40-82 % of the reaching cycle; p = 0.004) and higher variability in wrist flexion/extension (31-75 %; p < 0.001) and deviation (2-14 %; p = 0.007/60-73 %; p = 0.006) during RF. Choreoathetosis severity was associated with higher elbow pro/supination variability (12-19 %; p = 0.009) during RGV. Trajectory deviation was associated with wrist and elbow movement variability (p < 0.05).
CONCLUSION
Current novel analysis of upper limb movement patterns and respective timings allows to detect joint angles and periods in the movement cycle wherein associations with clinical parameters occur. These associations are not present at each joint level, nor during the full movement cycle. This knowledge should be considered for individualized treatment strategies.
Topics: Humans; Male; Female; Cerebral Palsy; Adolescent; Upper Extremity; Child; Young Adult; Dystonia; Severity of Illness Index; Hand Strength; Athetosis; Movement
PubMed: 38614013
DOI: 10.1016/j.ejpn.2024.04.001 -
Sleep and Biological Rhythms Jan 2024Paroxysmal Hypnogenic Dyskinesia (PHD) is a rare movement disorder characterized by involuntary movements, including chorea, athetosis, ballismus, and dystonia, which...
UNLABELLED
Paroxysmal Hypnogenic Dyskinesia (PHD) is a rare movement disorder characterized by involuntary movements, including chorea, athetosis, ballismus, and dystonia, which occur during the Non-Rapid Eye Movement (NREM) sleep stage. Therefore, the diagnosis of PHD is highly crucial due to the presence of differential diagnoses such as epilepsy and other sleep disorders. Although numerous mutations have been identified, the etiology of PHD, which arises from dysregulation in basal ganglia functions, remains unclear. We wanted to present a case of a nineteen-year-old girl diagnosed with PHD to draw attention to the diagnosis, etiology, and treatment of PHD.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s41105-023-00499-5.
PubMed: 38476853
DOI: 10.1007/s41105-023-00499-5 -
Movement Disorders Clinical Practice Apr 2024
Topics: Humans; Spinal Cord Compression; Spinal Cord Diseases; Neck
PubMed: 38293744
DOI: 10.1002/mdc3.13983 -
Toxics Nov 2023Nitrous oxide abuse may cause functional cobalamin deficiency and subsequent damage to the peripheral nerves, the spinal cord, and the brain, a symptom complex best...
Nitrous oxide abuse may cause functional cobalamin deficiency and subsequent damage to the peripheral nerves, the spinal cord, and the brain, a symptom complex best described by the term cobalamin neuropathy. Here, we report a case of cobalamin neuropathy with uncommon cerebral symptomatology following nitrous oxide intoxication and contextualize the symptomatology. A 22-year-old male with a history of mixed drug dependency presented at the emergency room after inhaling six 615 g cylinders, equal to ~1800 L, of nitrous oxide daily for two weeks. His main complaints were rapidly progressing paresthesias and gait difficulties, but he was also found to suffer from memory impairment and signs of extrapyramidal pathology in the form of dystonic posturing and athetosis. Neuroimaging demonstrated spinal cord hyperintensities consistent with subacute combined degeneration. The patient had low serum cobalamin and high plasma homocysteine, suggesting cobalamin neuropathy. After commencing treatment with parenteral hydroxocobalamin, plasma homocysteine normalized. The extrapyramidal symptoms disappeared during the first days of treatment, whereas the cognitive and peripheral symptoms only partially resolved over the following 20 days. This case highlights how neurological symptoms such as hyperkinetic movements and memory impairment may be associated with chronic nitrous oxide abuse. It is unclear to what extent these and other symptoms of cobalamin neuropathy are reversible, which underscores the public health concern.
PubMed: 38133360
DOI: 10.3390/toxics11120959 -
Journal of Functional Morphology and... Dec 2023Football for people with cerebral palsy is a para-sport involving ambulant athletes with impairments, such as hypertonia, ataxia, or athetosis. The objective of the...
Football for people with cerebral palsy is a para-sport involving ambulant athletes with impairments, such as hypertonia, ataxia, or athetosis. The objective of the present study was to describe the somatotype of a representative sample of international football players according to different functional profiles of cerebral palsy, including spastic diparesis, athetosis/ataxia, spastic hemiparesis, and minimum impairment criteria, and to compare it with non-disabled football players. A total of 144 international para-footballers and 39 non-disabled footballers participated in the study, and their somatotype was calculated using anthropometric measurements. A Kruskal-Wallis test was used to compare the groups to determine and assess the differences between the different functional profiles, and the analysis of anthropometric variables and body composition showed no differences. Regarding somatotype, a predominance of the mesomorphic component was observed in all subgroups, and differences in somatotype were also found between non-disabled footballers and para-footballers with spastic hemiparesis and minimum impairment criteria. This study suggests that there may be a degree of homogeneity in terms of somatotype among footballers with or without physical impairments, such as hypertonia, athetosis, or ataxia. Furthermore, it provides reference values of international-level para-football players for the different sport classes, which can help coaches and trainers monitor athletes' physical conditions.
PubMed: 38132721
DOI: 10.3390/jfmk8040166 -
Expert Opinion on Drug Safety Nov 2023Our research aimed to identify previously undocumented adverse events (AEs) in the gemcitabine drug insert with the goal of informing clinical practice.
BACKGROUND
Our research aimed to identify previously undocumented adverse events (AEs) in the gemcitabine drug insert with the goal of informing clinical practice.
METHODS
We extracted adverse events associated with gemcitabine use through 2023 using the Food and Drug Administration Adverse Event Reporting System (FAERS) database. Four algorithms (Reporting Odds Ratio, Proportional Reporting Ratio, Bayesian Confidence Propagation Neural Network, and Empirical Bayesian Geometric Mean) were employed to detect new AE signals. AEs were considered positive signals only if they were detected by all four algorithms.
RESULTS
From 2014 to 2023, a total of 42,360 AEs were reported in 14,905 individuals following gemcitabine use. These AEs totaled 437 preferred terms (PTs) across 20 system organ classes (SOCs). We identified unexpected AEs related to the ocular disorders, the nervous system, and the ear and the labyrinth. The ocular organ system will present with retinopathy, purtscher retinopathy, choroidal effusion, amaurosis, necrotizing scleritis, etc. The nervous system may experience reversible posterior encephalopathy syndrome, cerebellar syndrome, cauda equina syndrome, athetosis, transverse myelitis, etc. The ears and labyrinth may exhibit ototoxicity.
CONCLUSION
Our study identified previously undetected signals following gemcitabine treatment, thereby providing new insights for future medication guidance.
PubMed: 37974405
DOI: 10.1080/14740338.2023.2284989 -
Tremor and Other Hyperkinetic Movements... 2023Movement disorders, particularly chorea, are uncommon in inborn errors of metabolism, but their identification is essential for improved clinical outcomes. In this... (Review)
Review
BACKGROUND
Movement disorders, particularly chorea, are uncommon in inborn errors of metabolism, but their identification is essential for improved clinical outcomes. In this context, comprehensive descriptions of movement disorders are limited and primarily derived from single cases or small patient series, highlighting the need for increased awareness and additional research in this field.
METHODS
A systematic review was conducted using the MEDLINE database and GeneReviews. The search included studies on inborn errors of metabolism associated with chorea, athetosis, or ballismus. The review adhered to PRISMA guidelines.
RESULTS
The systematic review analyzed 76 studies out of 2350 records, encompassing the period from 1964 to 2022. Chorea was observed in 90.1% of the 173 patients, followed by athetosis in 5.7%. Various inborn errors of metabolism showed an association with chorea, with trace elements and metals being the most frequent. Cognitive and developmental abnormalities were common in the cohort. Frequent neurological features included seizures, dysarthria, and optic atrophy, whereas non-neurological features included, among others, facial dysmorphia and failure to thrive. Neuroimaging and biochemical testing played crucial roles in aiding diagnosis, revealing abnormal findings in 34.1% and 47.9% of patients, respectively. However, symptomatic treatment efficacy for movement disorders was limited.
DISCUSSION
This study emphasizes the complexities of chorea in inborn errors of metabolism. A systematic approach with red flags, biochemical testing, and neuroimaging is required for diagnosis. Collaboration between neurologists, geneticists, and metabolic specialists is crucial for improving early detection and individualized treatment. Utilizing genetic testing technologies and potential therapeutic avenues can aid in the improvement of patient outcomes.
Topics: Humans; Chorea; Athetosis; Metabolism, Inborn Errors; Movement Disorders; Dyskinesias
PubMed: 37810989
DOI: 10.5334/tohm.801