Nancy Byl

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Microelectrode Studies of Basal Ganglia and VA, VL and VP Thalamus in Patients With Dystonia: Dystonia-Related Activity and Somatic Sensory Reorganization

Springer eBooks, 2001

Dystonia is a movement disorder characterized by sustained muscle contractions leading to twistin... more Dystonia is a movement disorder characterized by sustained muscle contractions leading to twisting movements and abnormal postures (Fahn, 1988). It is usually assumed that dystonia is driven by abnormal activity arising in the basal ganglia (Marsden et al., 1985; Hallett, 1997; Vitek et al., 1998). Additionally, there is indirect evidence that neuronal activity in a cerebellar relay nucleus of the human thalamus (Ventral intermediate - Vim) and in a pallidal relay nucleus (Ventral oral posterior - Vop) is related to dystonic movements. Lesions in Vim and Vop relieve dystonia (Laitinen, 1970; Cooper, 1976; Gros et al., 1976; Andrew et al., 1983; Tasker et al., 1988b; Tasker et al., 1988a; Cardoso et al., 1995) and stimulation of Vim and Vop can increase (Tasker et al., 1982) or decrease dystonic movements (Benabid et al., 1996). The effects of thalamic lesioning and stimulation may be related to abnormalities in sensory processing observed in the central nervous system of patients with dystonia (Tempel and Perlmutter, 1990; Reilly et al., 1992; Tempel and Perlmutter, 1995).

A Perspective: Has Masking, Hand Washing, Distancing and Sheltering in Place for the COVID-19 Pandemic Adequately Addressed Immunity?

Online journal of complementary & alternative medicine, Jan 29, 2021

Around the world, 2020 will be remembered as the year challenged by the coronavirus. Some people ... more Around the world, 2020 will be remembered as the year challenged by the coronavirus. Some people continue to ask: "Is the coronavirus really that serious?" If casinos, theaters and churches are closed, heaven and hell have apparently agreed on the same thing: the coronavirus is serious! Despite the early warnings in China in December of 2019, the United States was not successful in reducing the incidence, prevalence or fatalities due to COVID 19.

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Repetitive Stress Pathology

Loss of Trunk Repositioning Sense and Its Relation to Postural Control Functions in People Post-Stroke

Journal of Neurologic Physical Therapy, Dec 1, 2006

Focal Hand Dystonia

Elsevier eBooks, 2011

The Neural Consequences of Repetition

Neurology report, 2000

P2.121 Enhancing safe mobility in patients with Parkinson's disease: effect of dual task training during aerobic and moderate exercise

Parkinsonism & Related Disorders, Dec 1, 2009

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Short Term Technology-Assisted-Aerobic Exercise (AlterGR, GlideTrakTM, Vasper) in a Community Fitness Center for Patients with Mild to Moderate Parkinson’s Disease: Subjective Perceptions and Motor Effects

HSOA journal of community medicine & health care, Dec 23, 2015

Background: Physical inactivity is a significant health risk, particularly in the growing populat... more Background: Physical inactivity is a significant health risk, particularly in the growing population of elders with chronic neurodegenerative conditions like Parkinson's Disease (PD). Purpose: Determine if individuals with mild to moderate PD can achieve aerobic levels of exercise using novel rehabilitative technology (AlterGR, GlideTrakTM, Vasper) and if short term aerobic training is associated withmobility performance and subjective perceptions. Methodology: Two quality assurance, pre-post test design studies were carried out with individuals with PD (Hoehn and Yahr I-III) involved in physical therapy in a health and wellness center. In study I, with a 3 month cross over delay, 12 participants were randomly assigned to daily training (5 days, 40 minutes/session) on two novel body weight supported treadmill systems (Alter-GR and GlideTrakTM). In study II, ten participants trained for 5 weeks (2x/week, 20 minutes/session) on the recumbent NuStepTMT5XR

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Community Medicine & Public Health Care

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Is the timed up and go (TUG) sensitive to differentiating patients with mild to moderate PD compared to age matched controls: a descriptive pilot study

International Physical Medicine & Rehabilitation Journal

Background: As the population ages, an increasing number of individuals are diagnosed with Parkin... more Background: As the population ages, an increasing number of individuals are diagnosed with Parkinson's Disease (PD), a complex, progressive, neurodegenerative motor and nonmotor disorder which can compromise quality of life/ independence. Given there are no laboratory tests to rule in the disorder, the diagnosis may be delayed until 85% of the dopamine neurons are degenerated. Could the clinical Timed Up and Go (TUG) test serve as an inexpensive, clinical biomarker to help physicians make a diagnosis of PD? Methods: This descriptive, cross sectional evaluation study included 30 participants (15 with mild to moderate PD [Hoehn and Yahr I-II] and 15 age matched controls. Dependent variables included gender, age, self-reported motor and non-motor impairments paired with standardized measurements of mobility, balance (TUG) and cognition. Seventy percent of participants returned to be tested with the instrumental, dual task TUG (i TUG), the Five Times Sit to Stand Test (FTSTS) and 360o turning. Dependent variables were described (mean and standard deviation) and group differences tested for significance with the Two Sample T Test (P<0.05). Results: TUG performance was within normal limits with no significant differences between the two groups (7.28 seconds age matched controls and 7.60 seconds PD). In addition, no significant differences were found between the two groups relative to gender, age, pain, fall history or gait speed. However, age matched controls were significantly less depressed, had better balance confidence but reported significantly less physical activity, more medical problems and more prescription medications. Discussion & conclusion: The TUG was not a clinically sensitive biomarker to distinguish age matched healthy participants from those with mild-moderate PD who exercised aggressively. The dual task instrumental iTUG variant of the TUG may be more sensitive as a clinical biomarker for distinguishing individuals with early PD from age matched controls.

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Master Adaptive Learning as a Framework for Physical Therapist Professional Education: A Call to Action

Physical Therapy

Evidence-based review of central consequences of repetitive overuse of the hand : etiology of occupational hand cramps : aberrant learning

ee front matter Publish bmt.2005.12.001 76 0736; fax: +415 476 3 ess: byl@itsa.ucsf.edu. Summary ... more ee front matter Publish bmt.2005.12.001 76 0736; fax: +415 476 3 ess: byl@itsa.ucsf.edu. Summary Stressful, repetitive use of the upper limb in work, sports, or musical performance can lead to acute, pain and loss of function. The evidence for tissue mircrotrauma as the underpinnings of this pain is convincing and explains why rest, anti-inflammatory medications, change in movement biomechanics and good ergonomics are usually effective treatment modalities. Unfortunately, some repetitive strain injuries become chronic with degenerative changes found in tendons and muscles, scarring restricting soft tissue and joint mobility and compression of peripheral nerves causing strain and limiting excursion. In other cases, involuntary co-contractions of flexors and extensors lead to painless, uncontrollable, end range twisting movements that interfere with the performance of target tasks. This movement dysfunction is referred to as occupational hand cramps, focal hand dystonia (FHd), golfers...

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Review for "Late cortical disinhibition in focal hand dystonia

When Excessive Repetition Interferes with Target Specific Motor Control of the Hand: Do Behavioral Brain Retraining Strategies Facilitate Functional Recovery from Focal Hand Dystonia?

Journal of Physical Medicine, Rehabilitation and Disabilities, 2020

Classification of Neurological Gait Disorders Using Multi-task Feature Learning

2017 IEEE/ACM International Conference on Connected Health: Applications, Systems and Engineering Technologies (CHASE), 2017

As our population ages, neurological impairments and degeneration of the musculoskeletal system y... more As our population ages, neurological impairments and degeneration of the musculoskeletal system yield gait abnormalities, which can significantly reduce quality of life. Gait rehabilitative therapy has been widely adopted to help these patients maximize community participation and living independence. To further improve the precision and efficiency of rehabilitative therapy, more objective methods need to be developed based on sensory data. In this paper, an algorithmic framework is proposed to provide classification of gait disorders caused by two common neurological diseases, stroke and Parkinson's Disease (PD), from ground contact force (GCF) data. An advanced machine learning method, multi-task feature learning (MTFL), is used to jointly train classification models of a subject's gait in three classes, post-stroke, PD and healthy gait. Gait parameters related to mobility, balance, strength and rhythm are used as features for the classification. Out of all the features used, the MTFL models capture the more important ones per disease, which will help provide better objective assessment and therapy progress tracking. To evaluate the proposed

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A Review and Perspective on Maximizing Brain Plasticity: Priming the Nervous System to Learn

International Physical Medicine & Rehabilitation Journal, 2017

Although we know the central nervous system is adaptable and can respond to learning based behavi... more Although we know the central nervous system is adaptable and can respond to learning based behavioral training to recover from trauma, disease or aging, in the clinic the effectiveness of recovery can be limited. Part of this limitation in recovery is due to the severity of the brain insult but part of this incomplete recovery is due to the conditions surrounding the individual patient that may need to be addressed to maximize plasticity. In this brief review, a perspective on the need to prime the nervous system to learn is provided for consideration and reflection.

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Effectiveness of physical therapy for Achilles tendinopathy: An evidence based review of eccentric exercises

Isokinetics and Exercise Science, 2006

This review assessed the effectiveness of eccentric exercise training for patients with Achilles ... more This review assessed the effectiveness of eccentric exercise training for patients with Achilles tendinopathy. The authors concluded that eccentric exercise training resulted in modest but significant post-treatment clinical benefits. Owing to the uncertain quality of the included studies and the poor reporting of some of the review processes, these conclusions should be interpreted with caution. Authors' objectives To determine whether eccentric exercise training is effective in the treatment of patients with Achilles tendinopathy. Searching The authors searched the following internet sources and websites: PubMed, the Cochrane Library, PEDro, Evidence-Based Medicine and Hooked on Evidence. They also searched the reference lists of key research studies. The searches were restricted to clinical studies published within the last 10 years and basic science research published within the last 15 years. The authors did not state whether any language restrictions were applied. Study selection Study designs of evaluations included in the review Clinical studies of any design and basic science research were eligible for inclusion in the review. Specific interventions included in the review Studies that assessed eccentric exercise training, a physical therapy intervention, were eligible for inclusion. The patients in the included studies were given eccentric exercises, eccentric overload, eccentric/concentric stretching, or eccentric exercises and a splint for 12 weeks' duration. The control interventions, where present, were rest/surgery, exercise without pain, night splint and concentric exercises. Participants included in the review Studies of patients with Achilles tendinopathy were eligible for inclusion. Where reported, the studies included patients who were minimally active, were recreational athletes, or were active in competitive sports. In the included studies, the average age of the patients ranged from 44 to 51 years and the duration of their symptoms ranged from over 4 weeks to 20 years, where reported. Outcomes assessed in the review The outcomes of interest were pain reduction, return to normal activity in the short term, rehabilitation of the tendon, and prevention of re-injury in the long term. The included studies assessed concentric plantar flexion, pain, pain at rest, pain with activity, pain on palpation, toe raise, tendon thickness and tendon volume. Pain was assessed using a visual analogue scale or by scoring from 1 to 6 or 0 to 100. Tendon thickness was measured using ultrasound, while tendon volume was measured using magnetic resonance imaging.

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The Journal of Neuroscience, 1998

This paper concerns the characterization of performance and perceptual learning of somatosensory ... more This paper concerns the characterization of performance and perceptual learning of somatosensory interval discrimination. The purposes of this study were to define (1) the performance characteristics for interval discrimination in the somatosensory system by naive adult humans, (2) the normal capacities for improvement in somatosensory interval discrimination, and (3) the extent of generalization of interval discrimination learning. In a two-alternative forced choice procedure, subjects were presented with two pairs of vibratory pulses. One pair was separated in time by a fixed base interval; a second pair was separated by a target interval that was always longer than the base interval. Subjects indicated which pair was separated by the target interval. The length of the target interval was varied adaptively to determine discrimination thresholds. After initial determination of naive abilities, subjects were trained for 900 trials per day at base intervals of either 75 or 125 msec f...

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A Wireless Human Motion Monitoring System for Smart Rehabilitation

Journal of Dynamic Systems, Measurement, and Control, 2016

In this paper, a wireless human motion monitoring system is presented for gait analysis and visua... more In this paper, a wireless human motion monitoring system is presented for gait analysis and visual feedback in rehabilitation training. The system consists of several inertial sensors and a pair of smart shoes with pressure sensors. The inertial sensors can capture lower-extremity joint rotations in three dimensions and the smart shoes can measure the force distributions on the two feet during walking. Based on the raw measurement data, gait phases, step lengths, and center of pressure (CoP) are calculated to evaluate the abnormal walking behaviors. User interfaces are developed on both laptops and mobile devices to provide visual feedback to patients and physical therapists. The system has been tested on healthy subjects and then applied in a clinical study with 24 patients. It has been verified that the patients are able to understand the intuitive visual feedback from the system, and similar training performance has been achieved compared to the traditional gait training with phy...

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Upper limb bilateral symmetric training with robotic assistance and clinical outcomes for stroke

International Journal of Intelligent Computing and Cybernetics, 2016

Purpose – The purpose of this paper is to evaluate the physiotherapeutic benefits of bilateral sy... more Purpose – The purpose of this paper is to evaluate the physiotherapeutic benefits of bilateral symmetric training (BST) for stroke survivors affected by hemiparesis. Design/methodology/approach – Other studies have investigated symmetric physiotherapy. A key difficulty in previous work is in maintaining mirror-imaged trajectories between the affected and less-affected limbs. This obstacle was overcome in this work by using a two-armed robotic exoskeleton to enforce symmetry. In total, 15 subjects, > 6 months post stroke were, randomly assigned to bilateral symmetric robotic training, unilateral robotic training, and standard physical therapy. Findings – After 12 training sessions (90 minutes/session), the bilateral training group had the greatest intensity of movement training. They also had the greatest improvement in range of motion at the shoulder. The unilateral training group showed the greatest reduction in spasticity. Research limitations/implications – The rationale for s...

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