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V Dietz

Publications and source records attributed to V Dietz.

At least 37 records · Page 2Linked to original sources
PubMed2003

Perceived horizontal body position in healthy and paraplegic subjects: effect of centrifugation.

The perception of body position is mainly mediated by otolith information and visual cues. It has been shown, however, that proprioceptive sources are also involved. To distinguish between the contributions of the vestibular and nonvisual extra-vestibular information to graviception, we tested the effects of a stimulus that leaves the vestibular input unchanged but modifies the information from sense organs located more caudal along the trunk. This was achieved by bringing subjects into a horizontal ear-down position and rotating them around an earth-vertical axis that coincided with the interaural axis. In this paradigm, through centrifugal force, the stimulation of the vestibular and the putative extravestibular graviceptive organs in the body becomes dissociated. Healthy subjects (n = 14) and paraplegic patients with lesions between T4 and T8 (n = 7) adjusted themselves to the perceived horizontal right-ear down body position under two conditions: one with constant velocity rotation (ROT, velocity =120 degrees /s) around the earth-vertical axis of the turntable, and one without rotation (BASE). Among healthy subjects, the individual differences between BASE and ROT varied widely in both the feet-up or feet-down direction. In contrast, adjustments in paraplegic patients during ROT were always in the feet-down direction compared with BASE. A model with two extravestibular graviceptive sensors could explain our results: one sensor is located rostral to T4, and the other is caudal to T8. A load on the rostral graviceptor is interpreted as a tilt of the body in the feet-up direction and shifts the adjustments of perceived body position feet-down; a load on the caudal receptor is interpreted as a tilt in the feet-down direction and shifts the perceived body position feet-up. During ROT, healthy subjects solve the discrepant inputs of both extravestibular graviceptors in a highly variable manner, while paraplegic subjects show less variability because they are restricted to only the rostral graviceptor.

Adult↗
PubMed2003

Obstacle avoidance during human walking: H-reflex modulation during motor learning.

The goal of this study was to investigate changes of H-reflex amplitudes during a motor learning task. Subjects with reduced vision were instructed to step over an obstacle on a treadmill as low as possible, while the soleus H-reflex was elicited. Acoustic warning and feedback signals about performance were provided. Performance improvement was associated with a decrease of muscle activity, needed to step over the obstacle (rectus femoris, biceps femoris, tibialis anterior and gastrocnemius medialis muscles), and of foot clearance, while joint angle trajectories from knee and ankle became more stable. The experiment consisted of five runs, three with normal treadmill walking and two with randomly stepping over the obstacle (100 times). H-reflexes were elicited at early and late stance phase before stepping over the obstacle. H/M ratio, latency and duration were determined. The values of these measures were calculated for the onset and end of a run and their course over time was evaluated using a correlation coefficient. The largest adaptations with a significant increase of reflex amplitude occurred during the first obstacle run. This increase lasted only briefly and the reflex amplitudes decreased to their previous values. During the later obstacle run, no H-reflex modulation occurred. It is concluded that a motor learning task causes adaptational effects not only on performance, but also on H-reflex responses. The results indicate that most of the modulation of H-reflexes is probably due to supraspinal influences on reflex transmission. The observations made are probably less specific for this motor task (stepping over the obstacle), but rather associated with the increased attention required by the motor learning task during the first obstacle run.

Adult↗
PubMed2003

Reduction of myocardial infarct size by fluvastatin.

Statins have a variety of cardioprotective properties following chronic treatment. In contrast, little is known about the acute effects. Reperfusion acutely injures the heart by activation of neutrophils as well as endothelial cells. Because statins are known to influence the processes pathogenetically involved, we hypothesized that acute application of statins attenuates the sequelae of cardiac reperfusion. In rats, myocardial infarction (MI) was induced by ligature of the left coronary artery followed by reperfusion. Myocardial blood flow (MBF) was determined by H2 clearance and regional myocardial function (fractional thickening, FT) by pulsed Doppler. MI size was measured by triphenyltetrazolium chloride (TTC) staining, neutrophil extravasation by determination of myeloperoxidase (MPO) activity, and nitric oxide generation via measurement of cGMP. Treatment with fluvastatin, administered intravenously 20 min before the onset of ischemia, significantly attenuated the decline of FT and MBF at the end of the reperfusion period and significantly reduced MI size. Furthermore, fluvastatin induced a significant reduction of MPO activity and an increase of cGMP level compared with the control group. The effect of fluvastatin was completely abolished following pretreatment of NG-nitro-l-arginine methyl ester (l-NAME). These findings suggest that acute application of fluvastatin reduces MI size and attenuates reperfusion injury. We propose that the underlying mechanism is at least partially an inhibition of inflammation and endothelial dysfunction by preventing the activation and extravasation of neutrophils.

Animals↗
PubMed2003

Spinal cord pattern generators for locomotion.

It is generally accepted that locomotion in mammals, including humans, is based on the activity of neuronal circuits within the spinal cord (the central pattern generator, CPG). Afferent information from the periphery (i.e. the limbs) influences the central pattern and, conversely, the CPG selects appropriate afferent information according to the external requirement. Both the CPG and the reflexes that mediate afferent input to the spinal cord are under the control of the brainstem. There is increasing evidence that in central motor diseases, a defective utilization of afferent input, in combination with secondary compensatory processes, is involved in typical movement disorders, such as spasticity and Parkinson's disease. Recent studies indicate a plastic behavior of the spinal neuronal circuits following a central motor lesion. This has implications for any rehabilitative therapy that should be directed to take advantage of the plasticity of the central nervous system. The significance of this research is in a better understanding of the pathophysiology underlying movement disorders and the consequences for an appropriate treatment.

Animals↗
PubMed2002

Obstacle avoidance during human walking: transfer of motor skill from one leg to the other.

The aim of this study was to evaluate whether a newly acquired locomotor skill can be transferred to the mirror condition. Subjects were trained to step over an obstacle on a treadmill, the appearance of which was signalled by an acoustic stimulus, while visual information was prevented. Feedback information about foot clearance was provided by acoustic signals. During two successive runs (each consisting of 100 steps over the obstacle) the same leg was leading (i.e. the leg crossing the obstacle first). In the following third run, the leading and trailing legs were changed. During each of the three successive runs the adaptational changes were analysed by recording leg muscle electromyographic (EMG) activity, joint angle trajectories and foot clearance over the obstacle. The training effect gained between the first and second runs and the transfer to the mirror condition (third run) were evaluated. Adaptational changes of all measures, except ankle joint trajectory, could to a significant extent be transferred to the mirror condition. No side-specific differences in the amount of transfer were found, neither from the right to the left side, nor vice versa. These observations are at variance with adaptational changes observed during split-belt walking or one-legged hopping on a treadmill, where no transfer to the mirror condition occurred. It is assumed that this might be due to the specific requirements of the tasks and the leg muscles involved. While in the split-belt and hopping experiments leg extensor muscles are mainly involved, leg flexors predominate in the performance of the present task. It is hypothesised that the learning effects observed in the present experiments are mediated at a higher level (e.g. brainstem) of locomotor control.

Adaptation, Physiological↗
PubMed2002

Socio-economic outcome of paraplegia compared to lower limb amputation.

STUDY DESIGN: The socio-economic outcome was retrospectively compared between patients with traumatic lower limb amputation and those with paraplegia due to a spinal cord injury (SCI). OBJECTIVE: To evaluate the effect of specific rehabilitative procedures on the socio-economic outcome. SETTING: Paraplegic Centre at the University Hospital in Zurich, Switzerland. METHODS: Accidents occurring in a collective of 1.9 million persons in Switzerland over 3 years were included in the study. Fifty-six persons with unilateral amputation of lower limbs were compared with 54 persons with paraplegia. The follow-up was assessed over 5 years. RESULTS: The following data was obtained in patients with amputations compared to those with SCI (median values): (1) hospital stay: 150 versus 164 days; (2) the work was taken up after 689 versus 616 days; (3) the global average case costs amounted to SFr. 491.000 versus SFr. 606.000 during the first 5 years after injury; (4) the permanent degree of disability was determined to 40% versus 42%. Except for the global costs, all differences were not significant. CONCLUSIONS: There are only a few differences between the socio-economic outcomes between patients with lower limb amputations and those with paraplegia. It remains unclear if the highly specialised rehabilitation services provided for patients with SCI accounts for the similarity since individuals with SCI have additional neurogenic dysfunction of the bladder and bowel. Alternatively, the data may suggest a need for greater rehabilitation services for amputees or may reflect a threshold effect in rehabilitation outcomes.

Adolescent↗
PubMed2002

Differential effect of spinal cord injury and functional impairment on human brain activation.

Reorganization of human brain function after spinal cord injury (SCI) has been shown in electrophysiological studies. However, it is less clear how far changes of brain activation in SCI patients are influenced by the extent of SCI (neuronal lesion) or the consequent functional impairment. Positron emission tomography ([15O]-H2O-PET) was performed during an unilateral hand movement in SCI patients and healthy subjects. SCI patients with paraplegia and normal hand function were compared to tetraplegic patients with impaired hand movements. Intergroup comparison between paraplegic patients and healthy subjects showed an increased activation of contralateral sensorimotor cortex (SMC), contralateral thalamus, ipsilateral superior parietal lobe, and bilateral cerebellum. In contrast to this, tetraplegic patients with impaired upper limb function revealed only a significant activation of supplementary motor area (SMA). Correlational analysis in the tetraplegic patients showed that the strength of hand movement was related to the activation of contralateral SMC. However, the severity of upper limb sensorimotor deficit was related to a reduced activation of contralateral SMA and ipsilateral cerebellum. The findings suggest that in paraplegic patients with normal hand function the spinal neuronal lesion itself induces a reorganization of brain activation unrelated to upper limb function. Compared to this, in tetraplegic patients changes of brain activation are related to the impaired upper limb function. Therefore, in patients with SCI a differential impact of spinal lesion and functional impairment on brain activation can be shown. The effect of impaired afferent feedback and/or increased compensatory use of non-impaired limbs in SCI patients needs further evaluation.

Adult↗
PubMed2001

Proprioceptive input overrides vestibulo-spinal drive during human locomotion.

The aim of this study was to evaluate the influence of vestibulo-spinal drive on the performance of various locomotor-like movements. The extent of body rotation was assessed during walking (1 Hz and 2 Hz), running and hopping in place after vestibular stimulation (10 body rotations; 0.5 Hz). Compared to the controls, body rotations with eyes closed were larger during hopping than while running and smallest during walking independent of stepping frequency. A close correlation existed between the absolute duration of stance phase of the two legs and the rotation of the body. It is suggested that the amount of proprioceptive feedback from the legs determines the influence of vestibulo-spinal input on body movement.

Adult↗
PubMed2001

Obstacle avoidance during human walking: learning rate and cross-modal transfer.

1. The aim of this study was to investigate the significance of specific afferent information during motor learning. Blindfolded subjects stepped over an obstacle on a treadmill while different stimuli (acoustic (ACU), somatosensory (SOM) and light flash (LED)) signalled the approaching obstacle. The effect of the above stimuli was then evaluated and compared to full vision (VIS) locomotion. In the non-visual conditions feedback information about the performance was provided by an acoustic signal. 2. Using each of the different stimuli for information the level of subject performance was assessed by noting foot clearance and analysing both leg muscle electromyographic activity and movement trajectories during three successive runs. Each of these runs consisted of 100 steps over the obstacle. 3. The best performance at the onset of the first run was achieved during the VIS condition. When the VIS condition (run 1 + 2) was followed by ACU or SOM information or when the ACU condition (run 1 + 2) was followed by LED, little cross-modal transfer (CMT) occurred, i.e. adaptation in run 3 started again at a low level of performance. In contrast, if adaptation started with ACU stimuli followed by SOM stimuli, almost full CMT occurred. The absolute level of performance achieved after the second or third runs was similar in the VIS and non-VIS conditions. 4. In conclusion, the course of motor learning depends on specific afferent information, and feedforward control has a special influence on the performance only at the onset of the experiment but not on the rate of learning. The fact that little CMT occurs from visual to non-visual stimuli and from ACU to LED suggests that visual afferent input is processed in a different way to non-visual stimuli.

Acoustic Stimulation↗
PubMed2001

Locomotor recovery in spinal cord-injured rats treated with an antibody neutralizing the myelin-associated neurite growth inhibitor Nogo-A.

The limited plastic and regenerative capabilities of axons in the adult mammalian CNS can be enhanced by the application of a monoclonal antibody (mAb), IN-1, raised against the myelin-associated neurite growth inhibitor Nogo-A. The aim of the present study was to investigate the effects of this treatment on the functional recovery of adult rats with a dorsal over-hemisection of the spinal cord. Directly after injury, half of the animals were implanted with mAb IN-1-secreting hybridoma cells, whereas the others received cells secreting a control antibody (anti-HRP). A broad spectrum of locomotor tests (open field locomotor) score, grid walk, misstep withdrawal response, narrow-beam crossing) was used to characterize locomotor recovery during the 5 weeks after the injury. In all behavioral tests, the recovery in the mAb IN-1-treated group was significantly augmented compared with the control antibody-treated rats. EMG recordings of flexor and extensor muscles during treadmill walking confirmed the improvement of the locomotor pattern in the mAb IN-1-treated rats; step-cycle duration, rhythmicity, and coupling of the hindlimbs were significantly improved. No differences between the two groups with regard to nociception were observed in the tail flick test 5 weeks after the operation. These results indicating improved functional recovery suggest that the increased plastic and regenerative capabilities of the CNS after Nogo-A neutralization result in a functionally meaningful rewiring of the motor systems.

Animals↗
PubMed2001

Postural responses to combinations of head and body displacements: vestibular-somatosensory interactions.

Postural responses to head displacements are triggered by the vestibular system; responses to body displacements are triggered by the somatosensory system. We examined the interaction of responses to combinations of head and support surface perturbations. Head displacements were always in the opposite direction of body displacements. The time between head and support surface perturbations was varied. We measured amplitude and latency of gastrocnemius and tibialis anterior EMGs for various head backward/body forward and head forward/body backward displacement combinations. These responses were compared to head-only or body-only displacement trials, which served as controls. Relative to controls, the latency of somatosensory-evoked responses to body displacement was longer and vestibular-evoked responses were absent or of low amplitude for combinations where head and support surface perturbations were presented closely in time (10-50 ms apart). These results illustrate complex integration of vestibular and somatosensory information, suggesting that the vestibulospinal and somatosensory-spinal pathways are not two isolated systems independently driving motor neurons. Rather, these pathways may influence one another at premotoneuronal levels where common circuitry may be shared by both systems.

Adult↗
PubMed2001

Reflex adaptations during treadmill walking with increased body load.

Load dependent reflex adaptations were studied in healthy subjects walking on a split-belt treadmill. Compensatory reflex responses were elicited in the right leg extensor muscles during mid-stance by a short acceleration of the right treadmill belt. Electromyographic activity (EMG) was recorded from the right medial gastrocnemius (GMR), soleus (SO) and tibialis anterior (TA) muscles of the right leg as well as from the gastrocnemius of the left unperturbed leg (GML). To study the adaptational reflex behavior, multiple measurements were taken during walking with normal (control) and increased body load and after removing the load. In most experiments the compensatory EMG response in the GMR consisted of a short inhibitory and a subsequent excitatory component. Both reflex components were larger when the body was loaded. During the course of continuous loading, divergent reflex adaptations of different degrees and directions were observed in the subjects. In one group of subjects the reflex response increased to a higher level of EMG activity. In a second group EMG activity first increased and afterwards decreased to baseline level. A subsequent removal of body loading resulted in a slow adaptation to the control reflex values in both groups. Neither the EMG activity in the GM nor the reflex responses in the GMR after increasing the load changed differently in the two groups. Our results suggest that load information is not simply used in a fixed input/output relationship of the actual biomechanical conditions of a subject. Load information is rather used to slowly modify the reflex response, to achieve the desired posture during walking.

Adaptation, Physiological↗
PubMed2001

Arm to leg coordination in humans during walking, creeping and swimming activities.

In walking humans, arm to leg coordination is a well established phenomenon. The origin of this coordination, however, remains a matter for debate. It could derive from the intrinsic organisation of the human CNS, but it could also consist of a movement induced epiphenomenon. In order to establish which of these alternatives applies, we recorded arm and leg movements as well as their muscle activities during walking, creeping on all fours and swimming. The relationship between arm and leg cycle frequency observed under these various conditions was then investigated. We found that during walking, creeping on all fours or swimming, arm and leg movements remain frequency locked with a fixed relationship of 1/1, 2/1, 3/1, 4/1 or 5/1. When movements of the legs are slowed by flippers, the frequency relationship may skip to a different value, but the coordination is preserved. Furthermore, minimising the mechanical interactions between the limbs does not abolish coordination. These findings demonstrate that the arm to leg coordination observed in the walking human is also present during other human locomotor activities. The characteristics of this coordination correspond to those of a system of two coupled oscillators like that underlying quadruped locomotion.

Adult↗
PubMed2001

Improving axonal growth and functional recovery after experimental spinal cord injury by neutralizing myelin associated inhibitors.

Injuries of the spinal cord often result in an irretrievable loss of motor and sensory functions of all body parts situated below the lesion site. Functional recovery is restricted mainly due to the limited regeneration and plasticity of injured axons in the adult central nervous system. Over the last few years different experimental approaches have led to axonal growth and functional benefits in animal models. This review focuses on the effects of the neutralization of myelin-associated neurite growth inhibitors, in particular Nogo-A, using the monoclonal antibody IN-1. Acute mAb IN-1 treatment of adult CNS lesioned rats results in extensive plastic changes of neuronal connections and regenerative fiber growth. In two different lesion paradigms (i.e. pyramidal tract lesion and incomplete spinal cord lesion in adult rats), the mAb IN-1-treated animals always showed a higher degree of recovery in various behavioral tests. These observations, together with electrophysiological results, suggest that neuronal CNS circuits of mAb IN-1-treated animals can be rearranged, and that sprouting and regenerating axons form functionally meaningful connections.

Animals↗
PubMed2001

Driven gait orthosis for improvement of locomotor training in paraplegic patients.

DESIGN: Single cases. OBJECTIVE: To compare the effects of manually assisted locomotor training in paraplegic patients with the automated training by a driven gait orthosis. SETTING: ParaCare, University Hospital Balgrist in Zurich, Switzerland. METHODS: Treadmill training with manual assistance and by a driven gait orthosis was applied to two spinal cord injured patients. The first patient had an incomplete lesion at C3, the second a complete lesion at C5. They were selected by convenience sample. The EMG activity of the leg muscles rectus femoris, biceps femoris, gastrocnemius medials (GM) and tibialis anterior (TA) was visually compared for the two training methods. GM and TA activity was also quantified by calculating the variation ratio between the EMG of the patients and a set of healthy subjects. RESULTS: No significant difference between the two training methods was found according to the leg muscle EMG activity. CONCLUSION: Neuronal centers in the spinal cord become activated in a similar way by the manually assisted and the automated locomotor training. With the driven gait orthosis training sessions can be prolonged and workload of therapists can be reduced, and therefore, the automated training represents an alternative to the conventional therapy.

Automation↗
PubMed2001

Functional electrical stimulation for grasping and walking: indications and limitations.

This review describes the state of art in the field of Functional Electrical Stimulation (FES) and its impact on improving grasping and walking functions in acute and chronic Spinal Cord Injured (SCI) patients. It is argued that during the early rehabilitation period the FES systems with surface stimulation electrodes should be used to assist training of hand and leg movements in SCI patients. Our clinical trials have shown that a number of acute SCI patients with impaired walking and grasping functions could improve these functions due to training with an adjustable FES system to the point that they finally did not need the FES system to carry out these tasks. Other acute SCI patients, who did not recover the desired function, were enabled to perform either walking or grasping with the FES assistance. We believe that the subjects who can perform grasping or walking with the help of FES, and still use the neuroprosthesis 6 months after being subjected to the FES training, should consider the FES system as a prosthetic device in Activities of Daily Living (ADL). Despite the significant technical progress achieved in the last 10 to 15 years in the FES field, there is a general consensus that these systems are not sufficiently advanced and that they need further development. The limited acceptance of the FES technology can be in part explained by the fact that it is not completely mature and that the patients still require daily assistance to use the FES systems. Nevertheless the present FES treatments combined with conventional occupational and physical therapy still remain the most promising approach in rehabilitating SCI patients. In this review, advantages and limitations of different FES systems that are used to restore grasping and walking functions are discussed.

Electric Stimulation Therapy↗