Visual stimulation affects the perception of voluntary leg movements during walking

When a limb is used for locomotion, patterns of afferent and efferent activity related to its own motion are present as well as visual, vestibular, and other proprioceptive information about motion of the whole body. A study is reported in which it was asked whether visual stimulation present during whole-body motion can influence the perception of the leg movements propelling the body. Subjects were tested in conditions in which the stepping movements they made were identical but the amount of body displacement relative to inertial space and to the visual surround varied. These test conditions were created by getting the subjects to walk on a rotatable platform centered inside a large, independently rotatable, optokinetic drum. In each test condition, subjects, without looking at their legs, compared, against a standard condition in which the floor and drum were both stationary, their speed of body motion, their stride length and stepping rate, the direction of their steps, and the perceived force they exerted during stepping. When visual surround motion was incompatible with the motion normally associated with the stepping movements being made, changes in apparent body motion and in the awareness of the frequency, extent, and direction of the voluntary stepping movements resulted.     

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.     

Aspects of body self-calibration

The representation of body orientation and configuration is dependent on multiple sources of afferent and efferent information about ongoing and intended patterns of movement and posture. Under normal terrestrial conditions, we feel virtually weightless and we do not perceive the actual forces associated with movement and support of our body. It is during exposure to unusual forces and patterns of sensory feedback during locomotion that computations and mechanisms underlying the ongoing calibration of our body dimensions and movements are revealed. This review discusses the normal mechanisms of our position sense and calibration of our kinaesthetic, visual and auditory sensory systems, and then explores the adaptations that take place to transient Coriolis forces generated during passive body rotation. The latter are very rapid adaptations that allow body movements to become accurate again, even in the absence of visual feedback. Muscle spindle activity interpreted in relation to motor commands and internally modeled reafference is an important component in permitting this adaptation. During voluntary rotary movements of the body, the central nervous system automatically compensates for the Coriolis forces generated by limb movements. This allows accurate control to be maintained without our perceiving the forces generated.     

The 9th annual INDUS-EM 2013 Emergency Medicine Summit, “Principles,Practices, and Patients,” a level one international meeting,Kerala University of Health Sciences and Jubilee Mission Medical College and Research Institute,Thrissur, Kerala,India, October 23–27, 2013

INDUS-EM is India’s only level one conference imparting and exchanging quality knowledge in acute care. Specifically, in general and specialized emergency care and training in trauma, burns, cardiac, stroke, environmental and disaster medicine. It provides a series of exchanges regarding academic development and implementation of training tools related to developing future academic faculty and residents in Emergency Medicine in India. The INDUS-EM leadership and board of directors invited scholars from multiple institutions to participate in this advanced educational symposium that was held in Thrissur, Kerala in October 2013.     

Perceived self-motion elicited by postrotary head tilts in a varying gravitoinertial force background

We measured the effects of postrotary head tilts on the perceived duration and the apparent axis of illusory self-rotation experienced following counterclockwise body rotation in high (1.8 G), normal (1 G), and low (0 G) gravitoinertial force environments. In the absence of head movements, the duration of illusory afterrotation was shorter in 0 G and 1.8 G than in 1 G, and it was further shortened by 40 degrees pitch-back head movements in 1 G and 1.8 G. Clockwise illusory afterrotation about the torso's vertical z-axis was always experienced in trials without postrotary head tilts. In trials with head movements, half the subjects experienced no change in this pattern; however, half experienced transient rightward roll of the torso's z-axis, which remained the rotation axis. The duration and extent of apparent roll were greater in 0 G and smaller in 1.8 G than in 1 G. We provide a functional explanation for the tendency for perceived self-rotation to be determined relative to the torso and to the gravitoinertial vertical rather than solely in relation to head position and head-fixed angular velocity sensors.