INTRODUCTION: Patients who have sustained extensive burns frequently exhibit substantial damage to skeletal muscle and associated complications. The rehabilitation of these patients can be challenging due to the nature of the injury and the subsequent complications. Nevertheless, there is a possibility that functional proprioceptive stimulation (illusory movements) may facilitate effective rehabilitation in patients with limited physiotherapy options. Nevertheless, this approach has yet to be tested in patients with burn injuries. MATERIAL AND METHODOLOGY: A prospective, randomised, crossover trial was conducted at a burn centre in a tertiary teaching hospital. The objective was to assess the effects of illusory movements on energy metabolism, insulin sensitivity, and skeletal muscle biology in adult critically ill patients with deep burns covering 30 % or more of the total body surface area. Two 30-minute daily sessions of functional proprioceptive stimulation were administered in addition to the standard physical therapy or physical activity regimen. Subsequently, the patients proceeded to the next stage of the trial, which involved a two-week crossover period. MEASUREMENTS AND MAIN RESULTS: Daily indirect calorimetry and calculation of nitrogen balance. Skeletal muscle biopsies from vastus lateralis for high resolution respirometry and euglycemic clamps to assess whole body glucose disposal were performed three times: at baseline and then fortnightly after each intervention period. The intervention was feasible and well tolerated in both early and late stages of burn disease. It did not change energy expenditure (mean change -33 [95 % CI: -292;+227] kcal .24 h-1, p = 0.79), nitrogen balance (+2.0 [95 % CI: -3.1;+7.1] g N .1.73 m-2 BSA .24 h-1), or insulin sensitivity (mean change of insulin-mediated glucose disposal -0.33 [95 % CI: -1.18;+0.53] mmol.h-1). At the cellular level, the intervention increased the capacity of mitochondria to synthesize ATP by aerobic phosphorylation and tended to increase mitochondrial coupling. Functional capacities of fatty acid oxidation and electron transfer chain complexes I, II, and IV were unaffected. CONCLUSIONS: Compared to physical therapy alone, two daily sessions of functional proprioceptive stimulation in addition to usual physical therapy in patients with extensive burns did not change energy expenditure, insulin sensitivity, nitrogen balance, or energy substrate oxidation. At cellular level, the intervention improved the capacity of aerobic phosphorylation in skeletal muscle mitochondria. Clinical effects remain to be demonstrated in adequately powered trials.

• MeSH
• Adult MeSH
• Energy Metabolism * physiology   MeSH
• Insulin Resistance physiology   MeSH
• Cross-Over Studies * MeSH
• Muscle, Skeletal * metabolism   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Calorimetry, Indirect MeSH
• Burns * metabolism   therapy   rehabilitation   physiopathology   complications   MeSH
• Body Surface Area MeSH
• Proprioception physiology   MeSH
• Prospective Studies MeSH
• Physical Therapy Modalities MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

Jednou ze základních funkcí mozku, spolu s celým nervovým systémem, je řídit a produkovat chování, jehož zásadní složkou je pohyb. Ačkoliv se již neakceptuje názor, že pohyb je vždy iniciován z vnějšího prostředí jako pouhá odpověď na senzorickou stimulaci, je za fyziologických okolností pro zahájení a provádění pohybu naprosto zásadní aferentní informace, zejména pak proprioceptivní. O pohybu je tedy potřeba hovořit vždy jako o senzori-motorické aktivitě, přičemž produkci cíleného pohybu předchází vyhodnocení aktuální senzorické situace. Dobře dnes známe funkci jednotlivých smyslových systémů, ale teprve poslední dekády výzkumu ukazují, jakým způsobem tyto systémy spolupracují, vzájemně se ovlivňují a v některých případech i zastupují. Děj, který vystihuje problematiku sdílení informací mezi smysly, označujeme multisenzorickou integrací (MSI). Jedná se o naprosto zásadní proces zpracování smyslových dat, jehož porucha se nutně odrazí v některé oblasti chování jedince. Toto sdělení přináší základní vymezení pojmů týkajících se MSI, posuzuje vývoj této schopnosti a nastiňuje její současné terapeutické využití v rehabilitaci.

One of the very basic functions of the brain and the entire nervous system is controlling and producing the body’s reactions, the fundamental component of which is movement. Even though the idea of the external initiation of movement as a pure result of sensory stimulation is obsolete, afferent proprioceptive information has a crucial role in initiation and in performing the movement under physiological conditions. Movement must be addressed as sensory-motor activity, bearing in mind that every production of purposeful movement is preceded by an evaluation of the current sensory situation. The function of the individual senses is broadly acknowledged, but only in recent decades has research shown the extent of cooperation among these systems, how they interact, influence each other, and in some cases even substitute for each other. The process that explains the sharing of the information among the senses is called multisensory integration (MSI). It is crucial process in processing sensory data, and its dysfunction is inevitably reflected in one’s behaviour. The presented work explains basic MSI terminology, evaluates the evolution of this capacity and reflects its possible use in therapeutic interventions.

INTRODUCTION: Hypokinetic dysarthria (HD) is a common symptom of Parkinson's disease (PD) which does not respond well to PD treatments. We investigated acute effects of repetitive transcranial magnetic stimulation (rTMS) of the motor and auditory feedback area on HD in PD using acoustic analysis of speech. METHODS: We used 10 Hz and 1 Hz stimulation protocols and applied rTMS over the left orofacial primary motor area, the right superior temporal gyrus (STG), and over the vertex (a control stimulation site) in 16 PD patients with HD. A cross-over design was used. Stimulation sites and protocols were randomised across subjects and sessions. Acoustic analysis of a sentence reading task performed inside the MR scanner was used to evaluate rTMS-induced effects on motor speech. Acute fMRI changes due to rTMS were also analysed. RESULTS: The 1 Hz STG stimulation produced significant increases of the relative standard deviation of the 2nd formant (p = 0.019), i.e. an acoustic parameter describing the tongue and jaw movements. The effects were superior to the control site stimulation and were accompanied by increased resting state functional connectivity between the stimulated region and the right parahippocampal gyrus. The rTMS-induced acoustic changes were correlated with the reading task-related BOLD signal increases of the stimulated area (R = 0.654, p = 0.029). CONCLUSION: Our results demonstrate for the first time that low-frequency stimulation of the temporal auditory feedback area may improve articulation in PD and enhance functional connectivity between the STG and the cortical region involved in an overt speech control.

• MeSH
• Speech Acoustics MeSH
• Dysarthria diagnostic imaging   etiology   physiopathology   MeSH
• Parahippocampal Gyrus diagnostic imaging   physiopathology   MeSH
• Connectome * MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Motor Cortex diagnostic imaging   physiopathology   MeSH
• Nerve Net diagnostic imaging   physiopathology   MeSH
• Parkinson Disease complications   diagnostic imaging   physiopathology   MeSH
• Aged MeSH
• Feedback, Sensory physiology   MeSH
• Temporal Lobe diagnostic imaging   physiopathology   MeSH
• Transcranial Magnetic Stimulation * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Musculoskeletal Diseases rehabilitation   MeSH
• Nerve Block MeSH
• Proprioception MeSH
• Rehabilitation methods   MeSH
• Muscle Stretching Exercises MeSH

• Conspectus
• Fyzioterapie. Psychoterapie. Alternativní lékařství
• Učební osnovy. Vyučovací předměty. Učebnice
• NML Fields
• rehabilitační a fyzikální medicína
• rehabilitační a fyzikální medicína
• ortopedie
• NML Publication type
• učebnice vysokých škol
• kolektivní monografie

• MeSH
• Clinical Medicine MeSH
• Rehabilitation MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• rehabilitační a fyzikální medicína
• NML Publication type
• kolektivní monografie

Converging data on focal dystonias suggest a widespread disorder of somatosensory processing. The aims of our study were, first, to assess somatosensory activation patterns in cervical dystonia (CD) beyond the representation of the affected body parts and, second, to search for task-related activation changes induced by botulinum toxin type-A (BoNT-A) therapy. Functional magnetic resonance imaging (MRI) during electrical median nerve stimulation was employed in seven CD patients and nine controls; the examination was repeated 4 weeks after BoNT-A application to dystonic neck muscles. The pretreatment activation map of patients showed activation in the contralateral primary somatosensory cortex, but missing activation in the secondary somatosensory cortex and insula, in contrast to controls and patients after treatment. Clinically significant effect of BoNT-A therapy was associated with a significant increase of BOLD response in the contralateral secondary somatosensory, insular, and inferior parietal cortices. The posttreatment somatosensory maps of patients did not significantly differ from controls. This study has brought evidence of widespread disruption of somatosensory processing in CD and its modification with BoNT-A therapy.

• MeSH
• Botulinum Toxins, Type A pharmacology   therapeutic use   MeSH
• Adult MeSH
• Injections, Intramuscular methods   MeSH
• Neck Muscles drug effects   innervation   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neuromuscular Agents pharmacology   therapeutic use   MeSH
• Somatosensory Cortex physiopathology   MeSH
• Somatosensory Disorders drug therapy   physiopathology   MeSH
• Torticollis drug therapy   physiopathology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Úvod: Cieľom práce bolo štúdium reflexov zo svalov dolných končatín a očných pohybov, v kontexte posturálnych synergií, ktoré boli evokované vibráciou zadného krčného svalstva. Metodika: Vyšetrili sme 12 zdravých osôb. Zaznamenávali sme elektromyografiu (EMG) z dolných končatín, náklonovú dráhu (posturografia), pozíciu segmentov tela a elektrookulografiu v náväznosti na pulzy vibrácie zadných krčných svalov, ktoré trvali 2 sekundy. Hodnotili sa spriemernené odpovede. Výsledky: Posturálna odpoveď na vibráciu zadného krčného svalstva pozostáva z krátkeho fázického posunu centra oporných síl dozadu, na ktorý nadväzuje dlhšie trvajúci posun dopredu. Telo sa počas tejto fázy pohybuje dopredu. Prvá fáza začína svalovými reakciami, ktorých latencie sú porovnateľné s posturálnymi reflexami vyvolanými galvanickou stimuláciou vestibulárneho aparátu, ktoré sú známe z minulosti (krátkoa strednelatenčné reflexy). Podkladom druhej fázy sú dlhšie trvajúce zmeny svalovej aktivácie. Narozdiel od zdravých probandov, už publikované práce ukázali, že pacienti s bilaterálnou vestibulárnou afunkciou majú len druhú časť odpovede a aj tá má len „lokálny“ charakter (extenzia hlavy). Väčšina probandov mala počas svalovej vibrácie pomalý fázický pohyb očí smerom dolu. Záver: Naša práca osvetľuje úlohu krčnej propriocepcie v regulácii vzpriameného postoja, ktorej správne fungovanie vitálne závisí na integrite vestibulárneho systém. Celkový vzorec pohybov tela a očí nie je možné jednoducho vysvetliť vestibulo-okulárnymi a cerviko-okulárnymi reflexami. Predpokladáme, že sú skôr pozostatkom tonických krčných reflexov, ktorá sa objavujú u ľudských dojčiat a zvierat.

Introduction: The aim of this study was to explore, in the context of postural synergies, reflexes from lower limb muscles and ocular movements induced by posterior neck muscle vibration. Methods: We examined 12 healthy subjects. We recorded lower limb EMG, sway path (posturography), the position of body segments, and the eye movements (electrooculography) during 2 seconds lasting pulses of posterior neck muscle vibration. The response means were evaluated. Results: Postural response to posterior neck vibration consists of a short phasic backward shift of the centre of foot pressure, which initiates a more prolonged anterior shift. The body moves forward during this second phase. The first phase is initiated by muscular reactions comparable to previously described postural reflexes elicited by galvanic vestibular stimulation (short and medium latency reflexes). The second phase is based on longer-lasting changes to muscular activation. In contrast to healthy subjects, previous studies showed that patients with total vestibular loss produce the second response only. Moreover, this reaction is “local” (head extension). In the majority of subjects, a slowly downward drifting movement of the eyes was observed during neck muscle vibration. Conclusion: Our study elucidates the role of neck proprioception in upright stance control, the correct functioning of which vitally depends on the integrity of the vestibular system. Oculomotor responses observed in this study were more probably part of a general postural synergy and not of the cervico-ocular reflex, and could be interpreted as a remnant of the tonic postural reflex.

• MeSH
• Biomechanical Phenomena MeSH
• Lower Extremity MeSH
• Adult MeSH
• Electromyography MeSH
• Electrooculography MeSH
• Cervical Vertebrae MeSH
• Humans MeSH
• Young Adult MeSH
• Eye Movements MeSH
• Posture MeSH
• Proprioception MeSH
• Muscles MeSH
• Vibration MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH

• MeSH
• Infant MeSH
• Laryngomalacia etiology   MeSH
• Feedback, Sensory MeSH
• Check Tag
• Infant MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• otorinolaryngologie
• genetika, lékařská genetika
• pediatrie
• NML Publication type
• studie

We investigated how postural responses to galvanic vestibular stimulation were affected by standing on a translating support surface and by somatosensory loss due to diabetic neuropathy. We tested the hypothesis that an unstable surface and somatosensory loss can result in an increase of vestibulospinal sensitivity. Bipolar galvanic vestibular stimulation was applied to subjects who were standing on a force platform, either on a hard, stationary surface or during a backward platform translation (9 cm, 4.2 cm/s). The intensity of the galvanic stimulus was varied from 0.25 to 1 mA. The amplitude of the peak body CoP displacement in response to the galvanic stimulus was plotted as a function of stimulus intensity for each individual. A larger increase in CoP displacement to a given increase in galvanic current was interpreted as an increase of vestibulospinal sensitivity. Subjects with somatosensory loss in the feet due to diabetes showed higher vestibulospinal sensitivity than healthy subjects when tested on a stationary support surface. Control subjects and patients with somatosensory loss standing on translating surface also showed increased galvanic response gains compared to stance on a stationary surface. The severity of the somatosensory loss in the feet correlated with the increased postural sensitivity to galvanic vestibular stimulation. These results showed that postural responses to galvanic vestibular stimulus were modified by somatosensory information from the surface. Somatosensory loss due to diabetic neuropathy and alteration of somatosensory input during stance on translating support surface resulted in increased vestibulospinal sensitivity.

• MeSH
• Diabetic Neuropathies physiopathology   MeSH
• Adult MeSH
• Electric Stimulation MeSH
• Middle Aged MeSH
• Humans MeSH
• Posture physiology   MeSH
• Aged MeSH
• Sensory Thresholds physiology   MeSH
• Somatosensory Disorders physiopathology   MeSH
• Vestibule, Labyrinth physiopathology   MeSH
• Vestibular Function Tests MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

Pozitivní vliv zpožděné zpětné sluchové vazby na řeč koktavých je znám od roku 1951 (tzv. Lee-efekt podle jména objevitele, či DAF z anglického Delayed Auditory Feedback). Předpokládá se nesoulad mezi zpětnou proprioceptivní a sluchovou vazbou, který se právě vlivem zpožděné akustické aferentace vyrovnává. Jako optimální délka zpoždění se udává délka 55 ms, v naší studii jsme použili i zpoždění kratší (dříve totiž nebylo možné z technických důvodů tato zpoždění vyšetřovat). Náš soubor obsahoval 41 pacientů. Zjistili jsme, že u 16 pacientů (39 %) došlo ke zlepšení plynulosti řeči při délce zpoždění 55 ms, což je ve shodě s předchozími studiemi. U osmi pacientů (19 %) však došlo k výraznému zlepšení plynulosti řeči i pod vlivem délky zpoždění 40 ms, zejména pak ve skupině balbutiků do 15 let. Plynulost řeči tedy lze zlepšit i při užití zpoždění kratších než 55 ms. U 13 pacientů (32 %) byl zaznamenán pozitivní vliv až do délky zpoždění 110 ms a u čtyř pacientů jsme nezaznamenali zlepšení plynulosti řeči pod vlivem DAF. Zajímavé je, že ne vždy dochází ke shodě mezi subjektivním hodnocením samotného pacienta a hodnocením objektivním. Lee-efekt se využívá nejen k diagnostickým, ale i terapeutickým účelům.

Stuttering is a serious health and social problem, which is reflected in socialising processes and job opportunities. It is a generalised discoordinative disorder of muscle groups, that take part in motor realisation of speech. The prevalence in population differs according to various authors from 1 % to 3%, of which men prevail. The opinions on etiology and therapy differ a lot, causes can be either somatic, functional or psychogenic. A positive effect of delayed auditory feedback (DAF) on speech in stutterers has been known since 1951 (so called Lee effect, named after its discoverer). There is supposed to be a disharmony between proprioceptive and auditory feedback, which is corrected by delayed auditory feedback. The optimal interval of DAF should be 55 ms. Considering that the former technologies were not able to study shorter intervals, we focused our study on intervals shorter than 55 ms and we tried to find an optimal interval of DAF. Most of previous research studied the influence of DAF on reading. Considering that severity of fluency disorder is usually smaller when reading than in spontaneous speech, we decided to study the influence of DAF using description of standard pictures. Our group of patients consisted of 41 stutterers (35 women and 6 men), aged from 8 to 35, the mean age was 15 years. We found out that 16 patients (39%) improved in speech fluency under the influence of DAF with delay speed 55 ms, which is in good accord with previous studies. However, in 8 patients (19%) speech fluency was improved using delay speed 40 ms especially in patients aged up to 15 years.We proved then that speech fluency in stutterers can be improved by using intervals shorter than 55 ms. In 13 patients (32%) we observed positive effect from delay 110 ms, mostly in patients with severe form of stuttering. Four patients (10%) did not improve at all. Normal fluency under the influence of DAF was reached by 10 patients (24%) who had mild or medium stuttering. We also observed self evaluation of patients which is not always in accordance with objective evaluation. From the group of 23 patients the accordance was reached in 7 patients, another delay interval was subjectively more pleasant in 10 patients, for 5 patients DAF was not pleasant at all and one patient was not able to assess subjectively improving or worsening. We can use the positive effect of DAF in treatment. At present there exist not only large- sized devices using DAF but also miniature devices that look like behind the ear hearing aids.We usually use table devices as an aid during speech therapy.

• MeSH
• Acoustic Stimulation MeSH
• Stuttering classification   therapy   MeSH
• Humans MeSH
• Prospective Studies MeSH
• Feedback MeSH
• Check Tag
• Humans MeSH