Biomedical subjects

J A Bradshaw

Publications and source records attributed to J A Bradshaw.

At least 19 recordsLinked to original sources

PubMed2006

Impact of gestational age on the clinical presentation and surgical outcome of necrotizing enterocolitis.

OBJECTIVE: This investigation tests the hypothesis that the clinical presentation and the outcome of necrotizing enterocolitis (NEC) vary with gestational age (GA). METHODS: All infants admitted to our center between October 1991 and September 2003 were evaluated weekly to identify confirmed cases of NEC. Based upon GA, these infants were divided into five groups: Extremely premature (EP, 23 to 26 weeks), very premature (VP, 27 to 29 weeks), moderately premature (MP, 30 to 34 weeks), near-term (NT, 35 to 36 weeks), and term (T, 37 to 42 weeks). RESULTS: A total of 202 infants developed NEC. The most common sign of NEC among EP infants was ileus (77%), followed by abdominal distention (71%), emesis (58%), pneumoperitoneum (54%), fixed intestinal loop (52%), gasless abdomen (42%) and bloody stools (17%). Intramural gas was detected in 100% of T but was present in only 29% of EP infants (P < 0.0001). Similarly, portal venous gas was common in T but infrequent in the EP infants (47 vs 10%, P < 0.0001). Despite a higher peritoneal drain insertion rate (31 vs 5%, P < 0.001) and a higher mortality rate (33 vs 10%, P = 0.05) in EP compared to T infants, other clinical outcomes were not different. CONCLUSIONS: The clinical presentation of NEC is different in EP compared to more mature infants; however, outcome among NEC survivors is similar across all GA. Reliance solely on observation of intramural or on portal venous gas in EP infants may lead to a delay or failure in the diagnosis.

Enterocolitis, Necrotizing↗

PubMed2000

Movement sequencing in children with Tourette's syndrome and attention deficit hyperactivity disorder.

Little research has been conducted to examine sequential motor functioning of children with Tourette's syndrome (TS) and attention deficit hyperactivity disorder (ADHD). Movement sequencing performance for a group of 12 children with TS and 24 children with ADHD children (12 taking and 12 not taking stimulant medication) and matched control subjects was examined using a serial choice reaction time button-pressing procedure. Aspects of movement preparation and execution were measured for 10 sequential two-way choice points along a response board that extinguished the illuminated target buttons at certain specific times contingent on the previous button press or release. The level of advance information was systematically reduced to provide three levels of reduction of advance information, including no reduction, moderate reduction, and high reduction. Children with TS and ADHD (unmedicated) showed larger increases in down time, reflecting aspects of movement preparation, for the highest level of reduction of advance information than did their respective control groups. These deficits are suggestive of underlying frontostriatal dysfunction. Furthermore, the normalization of performance for children with ADHD taking stimulant medication assists in the confirmation of the validity of such a clinical diagnosis and seems to add to the clinical efficacy of this form of treatment, which has previously been associated with improvements for predominantly attentional and inhibitory symptoms of ADHD.

Analysis of Variance↗

PubMed2000

Use of advance information in patients with schizophrenia.

To document possible motor disturbance in schizophrenia, we examined the ability to use advance information (or cues) to plan movements in a sequential button pressing task in 12 Clozapine medicated patients. Programming of movements under various cues revealed that patients with schizophrenia, relative to controls, initiated movements slower to the right than left, providing possible evidence for right hemineglect (left hemisphere dysfunction). Additionally, patients with schizophrenia had difficulty in the initiation of movements in the absence of a cue, suggesting internal cue generation difficulty for movement related to some form of fronto-striatal disturbance. Motor abnormalities were predominantly observed at the level of movement initiation, but not execution, contrary to basal ganglia disorders such as Parkinson's and Huntington's disease.

Adult↗

PubMed1998

The effects of competition and motor reprogramming on visuomotor selection in unilateral neglect.

Patients with unilateral neglect following right hemisphere damage may have difficulty in moving towards contralesional targets. To test the hypothesis that this impairment arises from competing motor programs triggered by irrelevant ipsilesional stimuli, we examined 16 right hemisphere patients, eight with left visual neglect and eight without, in addition to eight healthy control subjects. In experiment 1 subjects performed sequences of movements using their right hand to targets on the contralesional or ipsilesional side of the responding limb. The locations of successive targets in each sequence were either predictable or unpredictable. In separate blocks of trials, targets appeared either alone or with a simultaneous distractor located at the immediately preceding target location. Neglect patients were significantly slower to execute movements to contralesional targets, but only for unpredictable movements and in the presence of a concurrent ipsilesional distractor. In contrast, healthy controls and right hemisphere patients without neglect showed no directional asymmetries of movement execution. In experiment 2 subjects were required to interrupt a predictable, reciprocating sequence of leftward and rightward movements in order to move to an occasional, unpredictable target that occurred either in the direction opposite to that expected, or in the same direction but twice the extent. Neglect patients were significantly slower in reprogramming the direction and extent of movements towards contralesional versus ipsilesional targets, and they also made significantly more errors when executing such movements. Right hemisphere patients without neglect showed a similar bias in reprogramming direction (but not extent) for contralesional targets, whereas healthy controls showed no directional asymmetry in either condition. On the basis of these findings we propose that neglect involves a competitive bias in favour of motor programs for actions directed towards ipsilesional versus contralesional events. We suggest that programming errors and increased latencies for contralesional movements arise because the damaged right hemisphere can no longer effectively inhibit the release of inappropriate motor programs towards ipsilesional events.

Aged↗

PubMed1996

Bradykinesia and movement precision in Huntington's disease.

To determine whether bradykinesia in patients with Huntington's disease (HD) reflects impaired force production or an increased requirement for terminal visual guidance, 11 HD patients and matched controls performed drawing movements with varying precision requirements. Participants used an electronic pen upon a WACOM SD420 graphics tablet to join targets of either 10 or 20 mm diameter which were separated by a distance of 62.5 or 125 mm. While HD patients had slower movements, exhibiting more cycles of acceleration and deceleration, patients were not disproportionately affected by variations in target size or separation. Bradykinesia did not seem to be a product of impaired force production or increased reliance upon terminal visual guidance, since neither accelerative or decelerative phases were specifically affected by HD. However, movements of HD patients were of less consistent duration, implying variability associated with internal cues regulating movement.

Adult↗

PubMed1995

Reliance on advance information and movement sequencing in Huntington's disease.

To identify the focus of impairment in the performance of sequential movements in Huntington's disease (HD) patients, the extent of their reliance on external advance information was examined. Twelve patients with HD and their age-matched controls performed a series of button-presses at sequential choice points along a response board. A sequential pathway was designated, and with each successive button press, advance visual information was systematically reduced to various extents in advance of each move. HD patients, like previously studied parkinsonian patients, were particularly disadvantaged with high levels of reduction in advance information, and as a consequence, both their initiation and execution of movements progressively slowed with each successive element in the response sequence. The pattern of results was not affected whether or not patients were taking neuroleptic medication, nor did performance on a variety of cognitive measures correlate with motor performance. Control subjects' performance, on the other hand, remained constant in terms of both initiation and execution with each of the three levels of reduction in advance information. We conclude that HD patients, like parkinsonian patients, who also suffer from a basal ganglia (BG) disorder, require external visual cues to sequence motor programs effectively. Our findings suggest that with HD there may be abnormalities in a central mechanism that controls switching between movement segments within an overall motor plan. The BG, which provide internal cues necessary for component sequencing, may be disrupted, thereby impairing the ability to use such internally generated cues to guide movement.

Adult↗

PubMed1995

Contingent and non-contingent auditory cueing in Parkinson's disease.

Parkinson's disease (PD) patients and their normal controls performed two experiments involving a sequential movement task, depressing a series of buttons at choice points along a response board. Visual or auditory cues were presented prior to each move according to various contingencies. PD, a disorder characterised by degeneration of the basal ganglia (BG), typically manifests with poor execution of motor sequences. We found that external cueing facilitated motor sequencing in PD patients. In particular, auditory cues which occurred late in the movement cycle maximally facilitated switching between subcomponents of a sequence. Based on physiological findings reported in the primate literature [Brotchie et al., Brain 114, 1685-1702, 1978; Schultz and Romo, Exp. Brain Res. 1, 363-384, 1992], it is suggested that external cues enhance performance by replacing defective, internally generated cues (discharges) of the BG. This has implications for the use of physical training strategies in the treatment of PD.

Acoustic Stimulation↗

PubMed1995

The effects of unilateral visuospatial neglect on perception of Müller-Lyer illusory figures.

Left visuospatial neglect after right hemisphere damage is a lateralised disorder of spatial perception and cognition. A study is reported of the extent to which patients with left visuospatial neglect are susceptible to the illusory effects normally elicited by Müller-Lyer figures, in which inducing fins are located on one end or on both ends of a horizontal line. Seven patients with left visuospatial neglect and seven normal controls were tested on a task of horizontal-line bisection in which stimuli consisted of plain lines of three lengths (100, 150, and 200 mm), randomly interleaved with lines with unilateral or bilateral fins. As a group, normals made accurate bisection judgments in the baseline (no-fins) condition, and exhibited significant illusory effects in both the unilateral-fin and the bilateral-fin conditions. In contrast, patients made substantial rightward errors in the baseline condition, consistent with their neglect of the left end of the line. However, as a group, patients still exhibited significant illusory effects with left-sided outward-projecting fins on 100 mm lines and with left-sided inward-projecting fins on 150 mm lines. Moreover, at least one patient exhibited consistent illusory effects both for inward-projecting and for outward-projecting left-sided fins at all line lengths. Normal illusory effects in patients were also obtained with stimuli containing unilateral right-sided and bilateral fins. The existence of such effects with inducing elements on the contralesional extremity of horizontal line stimuli suggests preservation of low-level, perhaps preattentive, perceptual mechanisms responsible for coding elementary visual features. The results may be relevant for an understanding of the influence of attentional factors on illusory perception.

Adult↗

PubMed1995

The Simon effect and attention deficits in Gilles de la Tourette's syndrome and Huntington's disease.

Tourette's syndrome and Huntington's disease have long been clinically associated with attentional deficits. In this study, we aimed to determine the nature and quantify the extent of such deficits. A technique was devised to ascertain the efficiency with which Tourette's syndrome and Huntington's disease patients could shift and direct attention away from naturally expected stimulus-response (S-R) linkages. This was done by varying the relationships formed between stimulus and response location. Attentional efficiency was indicated by relative speed of responding to relevant (congruent) and irrelevant (incongruent) stimuli, in a paradigm developed from the Simon effect. There were five conditions progressively increasing in complexity. The stimuli consisted of left and right pointing arrows and, in some cases, various conditionality manipulations were also employed, such that in the presence of a certain symbol (i.e. 'x') the nature of the response had to be reversed, whereas in the presence of an alternative symbol (i.e. '='), the response was compatible with the direction of the arrow. As predicted, Tourette's syndrome and Huntington's disease patients, regardless of medication or depression status and unlike controls, were particularly disadvantaged in responding to various conflicting S-R configurations. Tourette's syndrome and Huntington's disease patients may experience difficulties in making attentional shifts, or in inhibiting inappropriate responses; they may also be more susceptible (than controls) to the conflict that can arise when the spatial code formed for the stimulus is irrelevant for selecting the appropriate response. We conclude that our findings support the notion that cognitive deficits in Tourette's syndrome and Huntington's disease may stem from abnormalities of the major pathways interconnecting the basal ganglia and the frontal lobes.

Adult↗

PubMed1995

Advance information and movement sequencing in Gilles de la Tourette's syndrome.

Tourette's syndrome is a chronic neurological disorder manifested by involuntary motor tics and vocalisations. Because the basal ganglia have been implicated in the pathology underlying Tourette's syndrome, the present two procedures, both involving sequential movements, sought to determine the extent to which patients with Tourette's syndrome were reliant on, and could utilise different levels of advance information. Patients with Tourette's syndrome were found to be more reliant than controls on external visual cues to execute rather than to initiate a motor programme. When there was a high level of reduction in advance information--that is, a visual pathway to be followed was extinguished well in advance of each successive movement--executions progressively slowed as the sequence was traversed. Similarly, if no advance information was provided before each move, movement execution was slower than that of controls. The movement initiation times of patients with Tourette's syndrome were, however, similar to those of controls, as were their movement execution times when advance visual information was available. It seems that patients with Tourette's syndrome, like parkinsonian patients who are known to have a basal ganglia disorder, require external sensory cues to sequence a motor programme effectively. The present study found evidence consistent with the hypothesis that patients with Tourette's syndrome, like patients with Parkinson's disease, may be dysfunctional in internal switching mechanisms. Alternatively, with limited visual guidance, patients with Tourette's syndrome, regardless of medication or depression state, may require more time to plan and programme each next submovement, and under such conditions may require external visual cues to direct attention effectively to given targets. Although the underlying pathogenesis is still speculative, it is concluded that there is much to support the notion that Tourette's syndrome may stem from abnormalities of the major pathways between the basal ganglia and the frontal lobes.

Adolescent↗

PubMed1994

Characteristics of handwriting of patients with Huntington's disease.

Patients with Huntington's disease exhibit poorer-quality handwriting, sometimes clinically exhibiting macrographia, an increase in the size of handwriting. To characterize deficits in handwriting of patients with Huntington's disease, we compared the writing of 12 young, 12 age-matched controls, and 12 patients with Huntington's disease. Subjects were asked to write the letter "l" four times, at a constant length, on a graphics tablet that sampled pen position at 200 Hz. Huntington's disease causes chorea (involuntary movement), akinesia (difficulty in initiating voluntary movement), and bradykinesia (slowness and difficulty in maintaining voluntary movement). To distinguish changes in handwriting quality due to involuntary movement from impairments of voluntary movement, handwriting samples with obvious choreic movements were analyzed separately from other handwriting samples. Several measures of quality of handwriting were considered, based on: the regularity and consistency of handwriting, the efficiency of movement trajectories, and the proportions of movement occurring at specific frequencies. Results suggested that Huntington's disease increases variability of movement parameters, and causes problems in producing smooth movements. Choreic movement was best characterized by the number of zero crossings in the velocity function relative to the prescribed number of writing strokes. We hypothesize that macrographia in Huntington's disease occurs when chorea predominates over bradykinesia. Comparisons were made between the handwriting of patients with Huntington's and Parkinson's diseases.

Adolescent↗

PubMed1994

Effects of hand and age upon abductive and adductive movements: a kinematic analysis.

Older and younger dextral subjects performed targeting movements to left and right with their preferred and nonpreferred hands upon a computer graphics tablet. Kinematic analysis revealed that older subjects produced larger constant errors than younger, paused more, and differed from younger individuals in a number of ways with respect to adductive/abductive asymmetries. The right hand was associated with shorter stroke durations and higher peak velocities, and both shorter times to peak velocity and from peak velocity to zero, suggesting superior ballistic preprogramming by the preferred right hand which was also more accurate. While both hands showed small abductive superiorities in terms of peak velocity and time from peak to zero, the largest directional asymmetries, stroke duration, showed leftward superiorities by both hands. We cannot therefore conclude either that experience with the rightward patterns of writing or that a reported tendency towards mirror-symmetrical movements by the two hands can account for the present results. Rather a right-hemisphere mediation of visually directed movements into left hemispace, along with a left-hemisphere mediation of fast, precise, temporal sequencing may jointly determine observable asymmetries. These may appear as a vector representing the opposing contributions of the two specialized hemispheres.

Adolescent↗

PubMed1994

Hand-hemispace spatial compatibility, precueing, and stimulus-onset asynchrony.

The role of attention and the resolution of coding conflicts in hand-hemispace spatial-compatibility effects was examined in a precueing experiment in which visual and vibrotactile precues, with various stimulus-onset asynchronies (SOAs), were presented in blocked and random order. It was expected that precues at the shorter SOAs would fail to facilitate the shifting of attention, as they occur too close to the imperative stimulus to be informative. The task would therefore approximate one of choice reaction time (RT), resulting in a hand-hemispace spatial-compatibility effect. Conversely, the longer SOAs would provide the subject with sufficient time in which to shift attention fully, and would therefore result in a task more like that of simple reaction time (SRT). It was expected that the hand-hemispace spatial-compatibility effect would then be absent. As was expected, this effect was present at the shorter SOAs, and absent at the longer SOAs. In Experiments 2 and 3, provision of a visual precue further facilitated attentional deployment, as did blocking the presentation of various SOAs in Experiment 3. Vibrotactile and visual precues did not differ in their ability to direct attention, implying that these modalities orient attention and precue location in essentially similar ways. These findings are discussed within the context of the mechanisms though to underlie the time course of spatial compatibility and the dissipation of a fading trace of interfering spatial codes.

Adult↗

PubMed1994

Can task specific perceptual bias be distinguished from unilateral neglect?

The present study examined visuoperceptual bias in 12 right hemisphere damaged patients, eight of whom showed left unilateral neglect on standard clinical tests, and in 30 normal controls. In the chimeric faces task, subjects were required to judge which of a pair of faces appeared happier. Stimuli comprising each pair were mirror images, with the smiling half on the left of one face and on the right of the other. In the grey scales task, subjects were required to indicate which of two shaded rectangles appeared to be darker overall. Again, stimuli were mirror images, with the darker end appearing either on the left or on the right. Patients exhibited a significant rightward bias on both experimental tasks, in contrast to the significant leftward bias exhibited by controls. There was no significant correlation between patients' performances on standard clinical tests and the extent of bias on the two experimental tasks, suggesting that such patients exhibit distinct impairments of spatial cognition which are differentially indexed by the two types of task. Moreover, for both patients and controls, scores obtained on the two perceptual bias tasks were unrelated, suggesting that they may engage stimulus-specific processes which have different underlying patterns of asymmetrical processing. These data provide further support for models which propose that the heterogeneity of disorders of spatial cognition arise from disruption of distinct neural mechanisms.

Adult↗

PubMed1994

Allocation of attention to programming of movement sequences in Parkinson's disease.

The allocation of attention to the programming and execution of movement sequences was examined in Parkinson's disease (PD). The time taken to initiate and execute sequences of one, three, and five button taps was examined, while also varying the hand used (left or right) and the attentional resources that could be allocated to sequencing (using single- versus dual-task conditions). These results showed that performance anomalies in PD were most apparent with the preferred right hand under single-rather than dual-task conditions. Subjects suffering from PD may tend to divert attention from the right hand under single-task conditions, and perhaps with short sequences, as well as being less likely to prepare sequences of more than three movements in advance with that hand. These effects were unlikely to reflect asymmetric pathology. If the right hand of such subjects has in some respects now come to behave more like a "clumsy" left hand, this may reflect a deliberate strategic choice in an attempt to cope with a movement impairment.

Aged↗

PubMed1994

Recovery from directional hypokinesia and bradykinesia in unilateral neglect.

Patients with acute right hemisphere (RH) damage and left unilateral neglect may exhibit slowness in both the initiation and execution of goal-directed movements toward the contralesional side (respectively, directional hypokinesia and directional bradykinesia). We retested 13 patients with RH damage, who on initial testing 1 year earlier had shown these impairments on a visually cued sequential movement task. Initiation and execution times were measured separately for leftward and rightward movement sequences, performed in either hemispace and across the body midline. Patients with anterior/subcortical lesions exhibited directional hypokinesia and bradykinesia on initial testing, but no longer showed either after 12 months. It is suggested that the recovery exhibited by these patients was determined conjointly by residual functioning of flexible anterior/subcortical structures involved in response production, in addition to the resolution of transient secondary dysfunction (i.e., diaschisis) of posterior (parietal) areas responsible for attentional orienting and target selection. In contrast, patients with posterior (parietal) lesions continued to exhibit directional hypokinesia after 12 months, probably as a result of permanent damage to a region whose dedicated or specialised functions cannot readily be compensated by other brain areas. These results support the notion that spatial attention and goal-directed movement are subserved by a distributed network involving separate but interconnected brain regions. Distinct functional losses may be predicted, in both the acute and chronic stages postinjury, on the basis of temporary or permanent dysfunction of discrete components of this network.

Adult↗

PubMed1994

Age-related motor slowness: simply strategic?

BACKGROUND: While older adults typically exhibit slower hesitant movements, this may simply reflect a preference for a cautious movement strategy, rather than any pathological process. METHOD: To separate strategic preferences from any impairment in the coordination of movement, the present experiment trained older adults to move at the preferred speed of younger adults (and vice versa) in a simple zigzag drawing task on a digitizing tablet which sampled pen position at 200 Hz. Twelve older adults (mean age 69 yrs 8 mo) and 12 young adults (mean age 21 yrs) joined 9 targets 125 mm apart, of either 5, 10 or 20 mm diameter. Once the age groups were matched for movement duration, movement kinematics were examined to determine whether there were differences in the quality or accuracy of their movements. RESULTS: When strategic differences are controlled for, older adults performed the task with comparable overall accuracy, but exhibited greater hesitancy and more submovements. CONCLUSION: The results suggest a decline in motor coordination rather than any simple strategic preference for caution in movement. The hesitancy of movement to some extent parallels that seen in Parkinson's disease.

Adolescent↗

PubMed1994

Horizontal visual motion modulates focal attention in left unilateral spatial neglect.

Patients with unilateral spatial neglect are impaired in directing focal attention toward the contralesional side of space. Provision of static spatial cues on the neglected side has previously been shown to help overcome this deficit. Common movement of visual stimuli may also guide the allocation of spatial attention, although such effects have not been examined in patients with unilateral spatial neglect. Eleven patients with right hemisphere damage and clinical evidence of left unilateral spatial neglect, and 11 matched, healthy controls were tested on a task of horizontal line bisection. Lines were presented on a computer display, with a neutral, static, or slowly drifting, random dot background. Under conditions of motion, background stimuli drifted either leftward or rightward, across the full width of the display, at speeds that did not elicit optokinetic nystagmus or perceptual aftereffects. Controls were accurate in all conditions, and showed minimal effects of background conditions. By contrast, patients with left unilateral spatial neglect were sensitive to leftward background motion, showing a significant leftward shift in bisection error, relative to neutral, static, and rightward moving backgrounds. There was no significant effect of rightward motion in comparison with the neutral and static conditions. The extent to which patients were susceptible to the effects of background motion was not related to severity of unilateral spatial neglect, as measured by clinical tests. The benefits of leftward motion may reflect activity of preserved motion processing mechanisms, which provide input to an otherwise dysfunctional attentional network. The use of visual motion to assist in contralesionally guiding focal attention may be useful in the rehabilitation of unilateral spatial neglect.

Adult↗