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The multidisciplinary care of neuromuscular disabled patients is reviewed. Described are the activities of occupational and vocational therapists, social workers, clinical psychologists and speech pathologists that are directed toward the major effects of spinal cord injuries, amputations, stroke, cerebral palsy, and rheumatoid arthritis.
Rancho Los Amigos Hospital is a 1100-bed teaching hospital that is primarily oriented toward rehabilitation. The individual services that deal with neuromuscular disorders are categorically disease entity oriented: They are directed toward the major problems, such as spinal cord injuries, amputations, stroke, cerebral palsy, and rheumatoid arthritis. The services at Rancho cross many traditional medical specialty barriers.
Developments in applying aerospace medical technology to the design and production of medical equipment and instrumentation are reported. Projects described include intercranial pressure transducers, leg negative pressure devices, a synthetic speech prosthesis for victims of cerebral palsy, and a Doppler blood flow instrument. Commercialization activities for disseminating and utilizing NASA technology, and new biomedical problem areas are discussed.
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In high-performance aircraft, the need for total environmental awareness coupled with high-g loading (often with abrupt onset) creates a predilection for cervical spine injury while the pilot is performing routine movements within the cockpit. In this study, the prevalence and severity of cervical spine injury are assessed via a modified cross-sectional survey of pilots of multiple aircraft types (T-38 and F-14, F-16, and F/A-18 fighters). Ninety-five surveys were administered, with 58 full responses. Fifty percent of all pilots reported in-flight or immediate post-flight spine-based pain, and 90% of fighter pilots reported at least one event, most commonly (> 90%) occurring during high-g (> 5 g) turns of the aircraft with the head deviated from the anatomical neutral position. Pre-flight stretching was not associated with a statistically significant reduction in neck pain episodes in this evaluation, whereas a regular weight training program in the F/A-18 group approached a significant reduction (mean = 2.492; p < 0.064). Different cockpit ergonomics may vary the predisposition to cervical injury from airframe to airframe. Several strategies for prevention are possible from both an aircraft design and a preventive medicine standpoint. Countermeasure strategies against spine injury in pilots of high-performance aircraft require additional research, so that future aircraft will not be limited by the human in control.
DNA triplet repeats, 5'-d(CTG)n and 5'-d(CAG)n, are present in genes which have been implicated in several neurodegenerative disorders. To investigate possible stable structures formed by these repeating sequences, we have examined d(CTG)n, d(CAG)n and d(CTG).d(CAG)n (n = 2 and 3) using NMR and UV optical spectroscopy. These studies reveal that single stranded (CTG)n (n > 2) forms stable, antiparallel helical duplexes, while the single stranded (CAG)n requires at least three repeating units to form a duplex. NMR and UV melting experiments show that the Tm increases in the order of [(CAG)3]2 < [(CTG)3]2 << (CAG)3.(CTG)3. The (CTG)3 duplex is stable and exhibits similar NMR spectra in solutions containing 0.1-4 M NaCl and at a pH range from 4.6 to 8.8. The (CTG)3 duplex, which contains multiple-T.T mismatches, displays many NMR spectral characteristics similar to those of B-form DNA. However, unique NOE and 1H-31P coupling patterns associated with the repetitive T.T mismatches in the CTG repeats are discerned. These results, in conjunction with recent in vitro studies suggest that longer CTG repeats may form hairpin structures, which can potentially cause interruption in replication, leading to dynamic expansion or deletion of triplet repeats.
No abstract available
Astronauts have begun to spend increasingly longer periods in space, putting themselves in foreign environments in order to explore the unknown. Space radiation is one of the largest health risks faced by astronauts on their missions. The space radiation environment has the ability to cause high levels of irreversible damage. Multiple sources of charged particle radiation exist in the space environment that may increase risk of carcinogenesis, degeneration of bodily tissue (e.g. gastrointestinal, cardiovascular, or pulmonary), acute radiation syndromes, and acute and late central nervous system (CNS) disorders. In order to help inform an understanding of the risk of degenerative CNS disease due to radiation exposure, an initial step is presented here to develop an adverse outcome pathway from radiation exposure focused on Alzheimer’s disease.
No abstract available
No abstract available
We outline the use of Drosophila in space-research by leveraging the current information and an autonomous hardware to further our knowledge of molecular responses to space, aiding in countermeasure and biomarker development for deep-space habitation.
Introduction: In an effort to determine the human performance limits for vibration in spacecraft being developed by NASA, astronauts were evaluated during a simulated launch profile in a centrifuge/vibration environment and separate vibration-only simulation. Current USAF and Army standards for return to flight following centrifuge exposures require 12-24 hours to pass before a crewmember may return to flying duties. There are no standards on vibration exposures and return to flying duties. Based on direct observation and provocative neurological testing of the astronauts, a new standard for return to flying duties following centrifuge and/or vibration exposures was established. Methods: 13 astronaut participants were exposed to simulated launch profiles in a + 3.5 Gx bias centrifuge/vibration environment and separately on a vibration table at the NASA-Ames Research Center. Each subject had complete neurological evaluations pre- and post-exposure for the centrifuge/vibration runs with the NASA neurological function rating scale (NFRS). Subjects who participated in the vibration-only exposures had video oculography performed with provocative maneuvers in addition to the NFRS. NFRS evaluations occurred immediately following each exposure and at 1 hour post-run. Astronauts who remained symptomatic at 1 hour had repeat NFRS performed at 1 hour intervals until the crewmember was asymptomatic. Results: Astronauts in the centrifuge/vibration study averaged a 3-5 point increase in NFRS scores immediately following exposure but returned to baseline 3 hours post-run. Subjects exposed to the vibration-only simulation had a 1-3 point increase following exposure and returned to baseline within 1-2 hours. Pre- and post- vibration exposure video oculography did not reveal any persistent ocular findings with provocative testing 1 hour post-exposure. Discussion: Based on direct observations and objective measurement of neurological function in astronauts following simulated launch profiles, asymptomatic individuals are allowed to return to flying duties within 3 hours following centrifuge/vibration and 2 hours after vibration-only exposures.
This communication provides an update of our understanding of the neurological bases for the close association between balance control and anxiety. New data suggest that a vestibulo-recipient region of the parabrachial nucleus (PBN) contains cells that respond to body rotation and position relative to gravity. The PBN, with its reciprocal relationships with the extended central amygdaloid nucleus, infralimbic cortex, and hypothalamus, appears to be an important node in a primary network that processes convergent vestibular, somatic, and visceral information processing to mediate avoidance conditioning, anxiety, and conditioned fear responses. Noradrenergic and serotonergic projections to the vestibular nuclei also have parallel connections with anxiety pathways. The coeruleo-vestibular pathway originates in caudal locus coeruleus (LC) and provides regionally specialized noradrenergic input to the vestibular nuclei, which likely mediate effects of alerting and vigilance on the sensitivity of vestibulo-motor circuits. Both serotonergic and nonserotonergic pathways from the dorsal raphe nucleus and the nucleus raphe obscurus also project differentially to the vestibular nuclei, and 5-HT(2A) receptors are expressed in amygdaloid and cortical targets of the PBN. It is proposed that the dorsal raphe nucleus pathway contributes to both (a) a tradeoff between motor and sensory (information gathering) aspects of responses to self-motion and (b) a calibration of the sensitivity of affective responses to aversive aspects of motion. This updated neurologic model continues to be a synthetic schema for investigating the neurological and neurochemical bases for comorbidity of balance disorders and anxiety disorders.
Potential contributions of NASA technology to enable the neurologically handicapped to cope with a normal environment are outlined. Research and development in the area of man's responses and accommodations to environmental stress are closely related to medical aspects of technological assistance devices for the neurologically handicapped.
The importance of objective measurements is discussed as a means of assessing the efficacy of physical and occupational therapy programs applied to patients recovering from neurological diseases. Considered are three primary categories of neurologically injured patients: patients with hemiplegia, patients with spinal cord injuries, and the heterogeneous group of cerebral palsy patients.
Control theory, including manual control theory, and a review of some previous physiological and neurological applications of control theory and associated engineering concepts are reported. The discussion includes a specially tailored battery of critical control tasks that are being developed to monitor astronaut performance in long term orbital flight. The application of these concepts and tasks to patients with various neurological disorders is considered.
Caloric and rotation tests were applied to the study of the vestibular analyser in 84 patients in the residual state of traumatic disease of the brain. Vestibular disturbances of different degree revealed in 79 patients were as a rule accomplished by cochlear derangement. In the majority of patients the vestibular syndrome was supratentorial with the involvement of the diencephal-hypothalmic, subcortical, and cortical levels of the brain. Vestibular dysfunction correlated with such factors as severity of the sustained craniocerebral traum, duration of the posttraumatic period, and, particularly, with the character of the residual neurological syndrome. In accordance with the latter, it is recommended that vestibular disturbances be treated in the residual period of closed craniocerebral injuries with due regard for the principal pathophysiological mechanisms of the underlying neurological syndrome.
Experimentally obtained dynamics of time-optimal, horizontal head rotations have previously been simulated by a sixth order, nonlinear model driven by rectangular control signals. Electromyography (EMG) recordings have spects which differ in detail from the theoretical rectangular pulsed control signal. Control signals for time-optimal as well as sub-optimal horizontal head rotations were obtained by means of an inverse modelling procedures. With experimentally measured dynamical data serving as the input, this procedure inverts the model to produce the neurological control signals driving muscles and plant. The relationships between these controller signals, and EMG records should contribute to the understanding of the neurological control of movements.