Faculty Bibliography

Introduction: Quantifying upper extremity (UE) motor impairment after stroke is impractical, limiting our ability to tailor rehabilitation training in real time. The current gold-standard measure of impairment, the Fugl-Meyer Assessment (FMA), is time-consuming and requires a trained assessor. The FMA furthermore does not assess functional motions in real-world contexts, which is exactly where we aim our rehabilitation interventions. Here, we took initial steps to develop an approach to automatically quantify UE motor impairment during functional task performance.
Method(s): We studied 51 chronic stroke patients (28F:23M; 57.7 (21.3-84.3) years old; 28L:23R paretic; FMA 43.1 (8-65)).We recorded upper body motion with 9 inertial measurement units (IMUs) while patients performed the FMA and a functional task (moving an object on a horizontal 8-target array). We trained a long short-term memory (LSTM) deep learning model to estimate FMA scores from the recorded motion (training set n=40; test set n=11; 4 LSTM layers with between-layer batch normalization; IMU data windows of 4s with slide of 1s). LSTM-generated impairment scores were computed from FMA motions or from functional motions. To ascertain the accuracy of the approach, we calculated the root mean square error (RMSE) and the Spearman correlation coefficient (rho) between the LSTM scores and the FMA scores from a trained expert. We also examined whether the performance of particular classes of functional primitives (i.e. reach, transport, or reposition) would be sufficient to accurately estimate impairment.
Result(s): Using motions from the FMA performance, our approach estimated FMA scores within 1.1 points of a trained assessor. Using motions from the functional task performance, our approach estimated FMA scores within 1.6 points. Correlation values between the FMA scores and LSTM scores were rho = 0.98 for FMA motions and rho = 0.96 for functional motions. Among the three functional primitives, reaches were the most informative for estimating the impairment scores (RMSE: 1.9 points), followed by transports (RMSE: 2.1 points), and repositions (RMSE: 2.8 points).
Discussion(s): We present a new approach that uses sensor-based motion capture and deep learning to automatically estimate UE motor impairment. This approach has high accuracy and shows high concurrent validity with the FMA, even when it assesses unrelated functional motions. Thus, it may be possible to directly measure impairment from performance of real-world functional tasks, which the FMA does not offer. Estimating impairment during stroke rehabilitation would enable clinicians to tailor treatment strategy in real time.

Background: MOG antibody disorder (MOGAD) is associated with diverse clinical phenotypes, including recurrent and bilateral optic neuritis, acute disseminated encephalomyelitis, and longitudinally extensive transverse myelitis with a predilection for the conus medullaris. Spinal nerve root involvement in this disease has rarely been described.
Objective(s): To describe a case of MOG antibody disorder with an unusual radiographic presentation.
Method(s): A case is described and review of the literature was performed.
Result(s): A 53-year-old previously healthy man presented to our hospital with three weeks of numbness and pain involving his right arm, bilateral lower extremities, and perineum. Neurologic exam was notable for decreased sensation in his right hand and left leg, hyperreflexia in bilateral lower extremities, and an extensor plantar response on the left. MRI spine was notable for multifocal short-segment T2 hyperintense lesions consistent with demyelination. There was also contrast enhancement of the cauda equina nerve roots and focal lobular enhancement of the left S1 nerve root. MRI brain showed several small T2 hyperintense brainstem lesions. He was started on pulse dose intravenous steroids while undergoing extensive work-up for inflammatory, infectious, and neoplastic causes. Serology was notable for mildly elevated ACE. CSF showed elevated protein. Given these laboratory and radiographic findings, an inflammatory etiology such as neurosarcoidosis was initially felt to be most likely. CT chest was negative for evidence of pulmonary sarcoid. He demonstrated clinical improvement with steroids and was discharged on a slow taper. MOG antibody in the serum (by cell-based assay) resulted positive at 1:100, suggestive of demyelination in the setting of MOGAD. The patient opted for monthly IV immunoglobulin (IVIG) maintenance therapy and has been clinically stable. Repeat MRI two months later showed stable areas of spinal nerve root enhancement and decrease in some of the cord lesions.
Conclusion(s): Our case demonstrates that MOGAD should be a diagnostic consideration when MRI shows spinal nerve root enhancement in the appropriate clinical context, especially with the additional presence of CNS lesions that are typical of demyelination. MOGAD can manifest clinically and radiographically in both the central and peripheral nervous system

Significant immunological, physical and neurological benefits of breastfeeding in infancy are well-established, but to what extent these gains persist into later childhood remain uncertain. This study examines the association between breastfeeding duration and subsequent domain-specific cognitive performance in a diverse sample of 9-10-year-olds enrolled in the Adolescent Brain Cognitive Development (ABCD) Study®. The analyses included 9,116 children that attended baseline with their biological mother and had complete neurocognitive and breastfeeding data. Principal component analysis was conducted on data from an extensive battery of neurocognitive tests using varimax-rotation to extract a three-component model encompassing General Ability, Executive Functioning, and Memory. Propensity score weighting using generalized boosted modeling was applied to balance the distribution of observed covariates for children breastfed for 0, 1-6, 7-12, and more than 12 months. Propensity score-adjusted linear regression models revealed significant association between breastfeeding duration and performance on neurocognitive tests representing General Ability, but no evidence of a strong association with Executive Function or Memory. Benefits on General Ability ranged from a 0.109 (1-6 months) to 0.301 (>12 months) standardized beta coefficient difference compared to those not breastfed. Results indicate clear cognitive benefits of breastfeeding but that these do not generalize to all measured domains, with implications for public health policy as it pertains to nutrition during infancy.