Dr. Beth  Fisher  Do image

Dr. Beth Fisher Do

124 Sleepy Hollow Dr Suite 203
Middletown DE 19709
302 493-3030
Medical School: Other - Unknown
Accepts Medicare: No
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Participates In PQRS: No
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License #: C20003601
NPI: 1689651747
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The Role of the Dorsolateral Prefrontal Cortex in Context-Dependent Motor Performance. - The European journal of neuroscience
Context-dependent motor performance is a phenomenon in which people perform better in the environmental context where they originally practiced a task. Some animal and computer simulation studies suggested that context-dependent performance may be associated with neural activation of the dorsolateral prefrontal cortex (DLPFC). This study aimed to determine the role of the DLPFC in context-dependent motor performance by perturbing the neural processing of the DLPFC with repetitive transcranial magnetic stimulation (rTMS) in healthy adults. Thirty healthy adults were recruited into the Control, rTMS DLPFC, and rTMS Vertex groups. The participants practiced three finger sequences associated with a specific incidental context (a colored circle and a location on the computer screen). One day following practice, the rTMS groups received 1 Hz rTMS prior to the testing conditions in which the sequence-context associations remained the same as practice (SAME) or changed (SWITCH). All three groups improved significantly over practice on day one. The second day testing results showed that the DLPFC group demonstrated significantly less decrement in motor performance under the SWITCH condition than the Control and Vertex groups. This finding suggests a specific role of the DLPFC in context-dependent motor performance. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.
Physical Therapy Residency and Fellowship Education: Reflections on the Past, Present, and Future. - Physical therapy
The physical therapy profession continues to respond to the complex and changing landscape of health care to meet the needs of patients and the demands of patient care. Consistent with this evolution is the rapid development and expansion of residency and fellowship post-professional programs. With the interested number of applicants exceeding the number of residency and fellowship slots available, a "critical period" in the educational process is emerging.The purpose of this perspective paper is to analyze the state of residency and fellowship education within the profession, identify best practice elements from other health professions that are applicable to PT residency and fellowship education, and propose a working framework grounded in common domains of competence to be used as a platform for dialogue, consistency, and quality across all residency and fellowship programs.Seven domains of competence are proposed to theoretically ground residency and fellowship programs and facilitate a more consistent approach to curricular development and assessment. While the recent proliferation of residency and fellowship programs attempts to meet the demand of physical therapists seeking advanced educational opportunities, it is imperative that these programs are consistently delivering high quality education with a common focus on delivering health care in the context of societal needs.© 2015 American Physical Therapy Association.
Improvement in Paretic Arm Reach-to-Grasp following Low Frequency Repetitive Transcranial Magnetic Stimulation Depends on Object Size: A Pilot Study. - Stroke research and treatment
Introduction. Low frequency repetitive transcranial magnetic stimulation (LF-rTMS) delivered to the nonlesioned hemisphere has been shown to improve limited function of the paretic upper extremity (UE) following stroke. The outcome measures have largely included clinical assessments with little investigation on changes in kinematics and coordination. To date, there is no study investigating how the effects of LF-rTMS are modulated by the sizes of an object to be grasped. Objective. To investigate the effect of LF-rTMS on kinematics and coordination of the paretic hand reach-to-grasp (RTG) for two object sizes in chronic stroke. Methods. Nine participants received two TMS conditions: real rTMS and sham rTMS conditions. Before and after the rTMS conditions, cortico-motor excitability (CE) of the nonlesioned hemisphere, RTG kinematics, and coordination was evaluated. Object sizes were 1.2 and 7.2 cm in diameter. Results. Compared to sham rTMS, real rTMS significantly reduced CE of the non-lesioned M1. While rTMS had no effect on RTG action for the larger object, real rTMS significantly improved movement time, aperture opening, and RTG coordination for the smaller object. Conclusions. LF-rTMS improves RTG action for only the smaller object in chronic stroke. The findings suggest a dissociation between effects of rTMS on M1 and task difficulty for this complex skill.
Brain Connectivity Associated with Muscle Synergies in Humans. - The Journal of neuroscience : the official journal of the Society for Neuroscience
The human brain is believed to simplify the control of the large number of muscles in the body by flexibly combining muscle coordination patterns, termed muscle synergies. However, the neural connectivity allowing the human brain to access and coordinate muscle synergies to accomplish functional tasks remains unknown. Here, we use a surprising pair of synergists in humans, the flexor hallucis longus (FHL, a toe flexor) and the anal sphincter, as a model that we show to be well suited in elucidating the neural connectivity underlying muscle synergy control. First, using electromyographic recordings, we demonstrate that voluntary FHL contraction is associated with synergistic anal sphincter contraction, but voluntary anal sphincter contraction occurs without FHL contraction. Second, using fMRI, we show that two important medial wall motor cortical regions emerge in relation to these tasks: one located more posteriorly that preferentially activates during voluntary FHL contraction and one located more anteriorly that activates during both voluntary FHL contraction as well as voluntary anal sphincter contraction. Third, using transcranial magnetic stimulation, we demonstrate that the anterior region is more likely to generate anal sphincter contraction than FHL contraction. Finally, using a repository resting-state fMRI dataset, we demonstrate that the anterior and posterior motor cortical regions have significantly different functional connectivity with distinct and distant brain regions. We conclude that specific motor cortical regions in humans provide access to different muscle synergies, which may allow distinct brain networks to coordinate muscle synergies during functional tasks.How the human nervous system coordinates activity in a large number of muscles is a fundamental question. The brain and spinal cord are believed to simplify the control of muscles by grouping them into functional units called muscle synergies. Motor cortex is involved in activating muscle synergies; however, the motor cortical connections that regulate muscle synergy activation are unknown. Here, we studied pelvic floor muscle synergies to elucidate these connections in humans. Our experiments confirmed that distinct motor cortical regions activate different muscle synergies. These regions have different connectivity to distinct brain networks. Our results are an important step forward in understanding the cortical control of human muscles synergies, and may also have important clinical implications for understanding movement dysfunction.Copyright © 2015 the authors 0270-6474/15/3514708-09$15.00/0.
Context-Dependent Learning in People With Parkinson's Disease. - Journal of motor behavior
Context-dependent learning is a phenomenon in which people demonstrate superior performance in the context in which they originally learned a skill but perform less well in a novel context. This study investigated context-dependent learning in people with Parkinson's disease (PD) and age-matched nondisabled adults. All participants practiced 3 finger sequences, each embedded within a unique context (colors and locations on a computer screen). One day after practice, the participants were tested either under the sequence-context associations remained the same as during practice, or the sequence-context associations were changed (SWITCH). Compared with nondisabled adults, people with PD demonstrated significantly greater decrement in performance (especially movement time) under the SWITCH condition, suggesting that individuals with PD are more context dependent than nondisabled adults.
Force Variability during Dexterous Manipulation in Individuals with Mild to Moderate Parkinson's Disease. - Frontiers in aging neuroscience
Parkinson's disease (PD) is a progressive neurodegenerative disease affecting about 1-2% of the population over the age of 65. Individuals with PD experience gradual deterioration of dexterous manipulation for activities of daily living; however, current clinical evaluations are mostly subjective and do not quantify changes in dynamic control of fingertip force that is critical for manual dexterity. Thus, there is a need to develop clinical measures to quantify those changes with aging and disease progression. We investigated the dynamic control of fingertip forces in both hands of 20 individuals with PD (69.0 ± 7.4 years) using the Strength-Dexterity test. The test requires low forces (<3 N) to compress a compliant and slender spring prone to buckling. A maximal level of sustained compression is informative of the greatest instability the person can control, and thus is indicative of the integrity of the neuromuscular system for dexterous manipulation. Miniature sensors recorded fingertip force (F) during maximal sustained compressions. The force variability during sustained compression was quantified in two frequency bands: low (<4 Hz, F_LF) and high (4-12 Hz, F_HF). F_LF characterizes variability in voluntary fluctuations, while F_HF characterizes variability in involuntary fluctuations including tremor. The more-affected hand exhibited significantly lower F and lower F_LF than those in the less-affected hand. The more-affected hand showed significant negative correlations between F_LF and the Unified Parkinson's Disease Rating Scale motor scores for both total and hand-only, suggesting that greater force variability in the voluntary range was associated with less clinical motor impairment. We conclude the nature of force variability in the voluntary range during this dynamic and dexterous task may be a biomarker of greater motor capability/flexibility/adaptability in PD. This approach may provide a more quantitative clinical assessment of changes of sensorimotor control in individuals with PD.
Evaluation of central and peripheral fatigue in the quadriceps using fractal dimension and conduction velocity in young females. - PloS one
Over the past decade, linear and non-linear surface electromyography descriptors for central and peripheral components of fatigue have been developed. In the current study, we tested fractal dimension (FD) and conduction velocity (CV) as myoelectric descriptors of central and peripheral fatigue, respectively. To this aim, we analyzed FD and CV slopes during sustained fatiguing contractions of the quadriceps femoris in healthy humans.A total of 29 recreationally active women (mean age±standard deviation: 24±4 years) and two female elite athletes (one power athlete, age 24 and one endurance athlete, age 30 years) performed two knee extensions: (1) at 20% maximal voluntary contraction (MVC) for 30 s, and (2) at 60% MVC held until exhaustion. Surface EMG signals were detected from the vastus lateralis and vastus medialis using bidimensional arrays.Central and peripheral fatigue were described as decreases in FD and CV, respectively. A positive correlation between FD and CV (R=0.51, p<0.01) was found during the sustained 60% MVC, probably as a result of simultaneous motor unit synchronization and a decrease in muscle fiber CV during the fatiguing task.Central and peripheral fatigue can be described as changes in FD and CV, at least in young, healthy women. The significant correlation between FD and CV observed at 60% MVC suggests that a mutual interaction between central and peripheral fatigue can arise during submaximal isometric contractions.
The geochemical transformation of soils by agriculture and its dependence on soil erosion: An application of the geochemical mass balance approach. - The Science of the total environment
Agricultural activities alter elemental budgets of soils and thus their long-term geochemical development and suitability for food production. This study examined the utility of a geochemical mass balance approach that has been frequently used for understanding geochemical aspect of soil formation, but has not previously been applied to agricultural settings. Protected forest served as a reference to quantify the cumulative fluxes of Ca, P, K, and Pb at a nearby tilled crop land. This comparison was made at two sites with contrasting erosional environments: relatively flat Coastal Plain in Delaware vs. hilly Piedmont in Pennsylvania. Mass balance calculations suggested that liming not only replenished the Ca lost prior to agricultural practice but also added substantial surplus at both sites. At the relatively slowly eroding Coastal Plain site, the agricultural soil exhibited enrichment of P and less depletion of K, while both elements were depleted in the forest soil. At the rapidly eroding Piedmont site, erosion inhibited P enrichment. In similar, agricultural Pb contamination appeared to have resulted in Pb enrichment in the relatively slowly eroding Coastal Plain agricultural soil, while not in the rapidly eroding Piedmont soils. We conclude that agricultural practices transform soils into a new geochemical state where current levels of Ca, P, and Pb exceed those provided by the local soil minerals, but such impacts are significantly offset by soil erosion.Copyright © 2015 Elsevier B.V. All rights reserved.
Pressure-controlled treadmill training in chronic stroke: a case study with AlterG. - Journal of neurologic physical therapy : JNPT
Body-weight-supported treadmill training has been shown to be an effective intervention to improve walking characteristics for individuals who have experienced a stroke. A pressure-controlled treadmill utilizes a sealed chamber in which air pressure can be altered in a controlled manner to counteract the effects of gravity. The focus of this case study was to assess the immediate and short-term impact of a pressure-controlled treadmill to improve gait parameters, reduce fall risk, improve participation, and reduce the self-perceived negative impact of stroke in an individual with chronic stroke.The subject was an 81-year-old man (14.5 months poststroke). He had slow walking speed, poor endurance, and multiple gait deviations.The subject trained 4 times per week for 4 weeks (40 minutes per session) on a pressure-controlled treadmill (AlterG M320) to counter the influence of gravity on the lower extremities.Following training, self-selected gait speed increased from 0.50 m/s to 0.96 m/s, as measured by the 10-meter walk test. Stride length increased from 0.58 m to 0.95 m after training and to 1.00 m at 1-month follow-up. Peak hip flexion increased from 3.7° to 24.6° after training and to 19.4° at 1-month follow-up. Peak knee flexion increased from 19.4° to 34.3° after training and to 42.7° at 1-month follow-up. Measures of endurance, fall risk, and percentage of perceived recovery also were found to improve posttraining.Training with a pressure-controlled treadmill may be a viable alternative to traditional body-weight-supported treadmill training for persons poststroke. Additional studies with larger sample sizes are needed to elucidate the role of pressure-controlled treadmill training in this population. Video abstract available for more insights from the authors (see Supplemental Digital Content 1,
Cortical activation associated with muscle synergies of the human male pelvic floor. - The Journal of neuroscience : the official journal of the Society for Neuroscience
Human pelvic floor muscles have been shown to operate synergistically with a wide variety of muscles, which has been suggested to be an important contributor to continence and pelvic stability during functional tasks. However, the neural mechanism of pelvic floor muscle synergies remains unknown. Here, we test the hypothesis that activation in motor cortical regions associated with pelvic floor activation are part of the neural substrate for such synergies. We first use electromyographic recordings to extend previous findings and demonstrate that pelvic floor muscles activate synergistically during voluntary activation of gluteal muscles, but not during voluntary activation of finger muscles. We then show, using functional magnetic resonance imaging (fMRI), that a region of the medial wall of the precentral gyrus consistently activates during both voluntary pelvic floor muscle activation and voluntary gluteal activation, but not during voluntary finger activation. We finally confirm, using transcranial magnetic stimulation, that the fMRI-identified medial wall region is likely to generate pelvic floor muscle activation. Thus, muscle synergies of the human male pelvic floor appear to involve activation of motor cortical areas associated with pelvic floor control.Copyright © 2014 the authors 0270-6474/14/3413811-08$15.00/0.

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