In Multiple Sclerosis (MS) abnormalities of autonomic nervous system and cardiac parameters have ... more In Multiple Sclerosis (MS) abnormalities of autonomic nervous system and cardiac parameters have been reported separately. Our objectives were to investigate whether MS patients with moderate disability and autonomic dysfunction presented alterations in cardiac function under stress and to see whether these changes contribute to MS fatigue. In 33 MS patients we examined the cardiovascular autonomic system and the echocardiographic parameters (stroke volume and ejection fraction) at rest and under stress. Fatigue has been assessed by a self-reported measure, the Fatigue Severity Scale. We have found a statistically significant correlation between the findings of cardiovagal tests and changes in cardiac parameters under stress with the degree of self-evaluated fatigue. Our results suggest that a relationship between the autonomic dysfunction and blunted cardiac response under stress might exist and can contribute to perception of fatigue. This physiopathological mechanism may be one a...
Fig. 1: Representation of a trial. (a) The virtual object (blue ball in the starting-point), the ... more Fig. 1: Representation of a trial. (a) The virtual object (blue ball in the starting-point), the required path (hatched-line, not visualized during the experiment), and the goal-point (red cross); (b) yellow flashed arrow (i.e. target) indicating the required direction of the movement of the ball towards the goal-point; (c) the P300 is elicited by the target stimulus and is recognised by the system; (d) movement of the ball following P300 recognition.
European journal of physical and rehabilitation medicine, Jan 6, 2017
Wallenberg's syndrome (WS) is known as posterior inferior cerebellar artery syndrome. Dysphag... more Wallenberg's syndrome (WS) is known as posterior inferior cerebellar artery syndrome. Dysphagia has been reported from 51% to 94% of the patients, ranging from mild to severe. We reported a case of a patient (Male; 52yrs) with WS. MRI showed an intense hypodense area in the dorsolateral part of the ponto-medullary junction. The clinical signs were severe dysphagia, fed by PEG (FOIS 1; PAS 7), sialorrhea, trismus and ataxia. Dysphagia was treated by botulinum toxin tipe A (BoNT-A), which was injected into the parotid and submandibular salivary glands, temporalis and masseter muscles, cricopharyngeal muscle associated with specific swallowing exercise and food trails. The 3-months follow-up showed significant saliva reduction and improvement of swallowing to from PEG feeding to consistent oral intake of food (FOIS 3, PAS 5). The treatment with BoNT-A combined with swallowing rehabilitation was fundamental in order to restore the swallowing functions.
Introduction: The ‘broken escalator phenomenon’ describes the unusual sensation and transient imb... more Introduction: The ‘broken escalator phenomenon’ describes the unusual sensation and transient imbalance experienced when walking onto a stationary escalator. Experimentally, stepping onto a stationary platform that was previously moving elicits a locomotor aftereffect characterised by inappropriately fast gait velocity, a forward trunk displacement and increased leg EMG activity. Objective: We examine the effect of bihemispheric tDCS on the the ‘broken escalator’ locomotor aftereffect in 30 healthy volunteers. Methods: Subjects completed 5 baseline trials walking onto a stationary sled (BEFORE condition). Subjects then received either sham stimulation or tDCS stimulation (2 mA) for 15 minutes at rest. For bilateral stimulation of primary motor cortex leg areas and prefrontal cortex, the stimulating (anodal) electrode was placed across the scalp to cover a region 10 20% in front of Cz (international 10 20 EEG system). Subjects then walked onto a moving platform (MOVING or adaptation condition), and then again onto a stationary sled (AFTER condition). We measured gait velocity, forward trunk displacement, foot contact timing, and EMG of the ankle flexorextensor muscles. Results: Both tDCS and sham groups showed a locomotor aftereffect in the AFTER trial with inappropriately high gait velocity, forward trunk displacement and increased EMG activity in the legs. In addition, the tDCS group showed a significantly larger trunk displacement in the 1st AFTER trial compared to sham, and a persistence of the locomotor aftereffect into the second AFTER trial. Discussion: Our results suggest that tDCS applied to motor cortex leg areas may enhance motor learning of a gait task. Application of DC stimulation prior to the motor learning task may prime the motor cortex and thus facilitate the acquisition and consolidation of new muscle synergies. These findings raise the possibility of using non-invasive brain stimulation in patients with gait disturbances as a therapeutic tool.
Our objective was to assess the autonomic function of ALS patients with and without bulbar signs ... more Our objective was to assess the autonomic function of ALS patients with and without bulbar signs to characterize dysautonomia in ALS disease. Standard autonomic tests and spectral analysis of heart rate variability (HRV), reflecting changes in the sympathovagal balance, were examined in 33 ALS patients (14 with bulbar signs) and 30 controls. Results showed that in the supine position, ALS patients had significantly lower total power and absolute values of high-frequency power indicating a depressed sinus arrhythmia. Patients with bulbar signs showed more marked autonomic alterations at rest. Tilting did not induce the expected increase in low-frequency and decrease in high-frequency power of HRV in all patients. No correlation was found between autonomic tests and clinical parameters. Our findings suggest an early subclinical involvement of the autonomic system in ALS, particularly affecting parasympathetic cardiac control. Patients with prominent bulbar signs show a more severe autonomic dysfunction under resting conditions.
In Multiple Sclerosis (MS) abnormalities of autonomic nervous system and cardiac parameters have ... more In Multiple Sclerosis (MS) abnormalities of autonomic nervous system and cardiac parameters have been reported separately. Our objectives were to investigate whether MS patients with moderate disability and autonomic dysfunction presented alterations in cardiac function under stress and to see whether these changes contribute to MS fatigue. In 33 MS patients we examined the cardiovascular autonomic system and the echocardiographic parameters (stroke volume and ejection fraction) at rest and under stress. Fatigue has been assessed by a self-reported measure, the Fatigue Severity Scale. We have found a statistically significant correlation between the findings of cardiovagal tests and changes in cardiac parameters under stress with the degree of self-evaluated fatigue. Our results suggest that a relationship between the autonomic dysfunction and blunted cardiac response under stress might exist and can contribute to perception of fatigue. This physiopathological mechanism may be one a...
Fig. 1: Representation of a trial. (a) The virtual object (blue ball in the starting-point), the ... more Fig. 1: Representation of a trial. (a) The virtual object (blue ball in the starting-point), the required path (hatched-line, not visualized during the experiment), and the goal-point (red cross); (b) yellow flashed arrow (i.e. target) indicating the required direction of the movement of the ball towards the goal-point; (c) the P300 is elicited by the target stimulus and is recognised by the system; (d) movement of the ball following P300 recognition.
European journal of physical and rehabilitation medicine, Jan 6, 2017
Wallenberg's syndrome (WS) is known as posterior inferior cerebellar artery syndrome. Dysphag... more Wallenberg's syndrome (WS) is known as posterior inferior cerebellar artery syndrome. Dysphagia has been reported from 51% to 94% of the patients, ranging from mild to severe. We reported a case of a patient (Male; 52yrs) with WS. MRI showed an intense hypodense area in the dorsolateral part of the ponto-medullary junction. The clinical signs were severe dysphagia, fed by PEG (FOIS 1; PAS 7), sialorrhea, trismus and ataxia. Dysphagia was treated by botulinum toxin tipe A (BoNT-A), which was injected into the parotid and submandibular salivary glands, temporalis and masseter muscles, cricopharyngeal muscle associated with specific swallowing exercise and food trails. The 3-months follow-up showed significant saliva reduction and improvement of swallowing to from PEG feeding to consistent oral intake of food (FOIS 3, PAS 5). The treatment with BoNT-A combined with swallowing rehabilitation was fundamental in order to restore the swallowing functions.
Introduction: The ‘broken escalator phenomenon’ describes the unusual sensation and transient imb... more Introduction: The ‘broken escalator phenomenon’ describes the unusual sensation and transient imbalance experienced when walking onto a stationary escalator. Experimentally, stepping onto a stationary platform that was previously moving elicits a locomotor aftereffect characterised by inappropriately fast gait velocity, a forward trunk displacement and increased leg EMG activity. Objective: We examine the effect of bihemispheric tDCS on the the ‘broken escalator’ locomotor aftereffect in 30 healthy volunteers. Methods: Subjects completed 5 baseline trials walking onto a stationary sled (BEFORE condition). Subjects then received either sham stimulation or tDCS stimulation (2 mA) for 15 minutes at rest. For bilateral stimulation of primary motor cortex leg areas and prefrontal cortex, the stimulating (anodal) electrode was placed across the scalp to cover a region 10 20% in front of Cz (international 10 20 EEG system). Subjects then walked onto a moving platform (MOVING or adaptation condition), and then again onto a stationary sled (AFTER condition). We measured gait velocity, forward trunk displacement, foot contact timing, and EMG of the ankle flexorextensor muscles. Results: Both tDCS and sham groups showed a locomotor aftereffect in the AFTER trial with inappropriately high gait velocity, forward trunk displacement and increased EMG activity in the legs. In addition, the tDCS group showed a significantly larger trunk displacement in the 1st AFTER trial compared to sham, and a persistence of the locomotor aftereffect into the second AFTER trial. Discussion: Our results suggest that tDCS applied to motor cortex leg areas may enhance motor learning of a gait task. Application of DC stimulation prior to the motor learning task may prime the motor cortex and thus facilitate the acquisition and consolidation of new muscle synergies. These findings raise the possibility of using non-invasive brain stimulation in patients with gait disturbances as a therapeutic tool.
Our objective was to assess the autonomic function of ALS patients with and without bulbar signs ... more Our objective was to assess the autonomic function of ALS patients with and without bulbar signs to characterize dysautonomia in ALS disease. Standard autonomic tests and spectral analysis of heart rate variability (HRV), reflecting changes in the sympathovagal balance, were examined in 33 ALS patients (14 with bulbar signs) and 30 controls. Results showed that in the supine position, ALS patients had significantly lower total power and absolute values of high-frequency power indicating a depressed sinus arrhythmia. Patients with bulbar signs showed more marked autonomic alterations at rest. Tilting did not induce the expected increase in low-frequency and decrease in high-frequency power of HRV in all patients. No correlation was found between autonomic tests and clinical parameters. Our findings suggest an early subclinical involvement of the autonomic system in ALS, particularly affecting parasympathetic cardiac control. Patients with prominent bulbar signs show a more severe autonomic dysfunction under resting conditions.
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