The purpose of the study was to count and characterize the range of stereotypies – repetitive rhythmical, apparently purposeless movements – in developmentally impaired children with and without autism, and to determine whether some types are more prevalent and diagnostically useful in children with autism. We described each motor stereotypy recorded during 15 minutes of archived videos of standardized play sessions in 277 children (209 males, 68 females; mean age 4y 6mo [SD 1y 5mo], range 2y 11mo–8y 1mo), 129 with autistic disorder (DSM‐III‐R), and 148 cognitively‐matched non‐autistic developmentally disordered (NADD) comparison children divided into developmental language disorder and non‐autism, low IQ (NALIQ) sub‐groups. The parts of the body involved and characteristics of all stereotypies were scored blind to diagnosis. More children with autism had stereotypies than the NADD comparison children. Autism and, to a lesser degree, nonverbal IQ (NVIQ) <80, especially in females contributed independently to the occurrence, number, and variety of stereotypies, with non‐autistic children without cognitive impairment having the least number of stereotypies and children with autism and low NVIQ the most. Autism contributed independently to gait and hand/finger stereotypies and NVIQ <80 to head/trunk stereotypies. Atypical gazing at fingers and objects was rare but virtually limited to autism. Stereotypies are environmentally modulated movement disorders, some highly suggestive, but not pathognomonic, of autism. Their underlying brain basis and genetic correlates need investigation.

Rapid eye movement (REM) sleep behavior disorder (RBD) involves complex behavior and a loss of muscle atonia occurring during REM sleep. Half of these patients with RBD have an underlying neurologic disorder including dementia, olivopontocerebellar atrophy, subarachnoid hemorrhage, and cerebrovascular disease. Clonazepam is the drug of choice for RBD. RBD has been rarely reported to precede the onset of Parkinson's disease (PD). Three patients are presented here whose RBD preceded the onset of PD by several years, and both the symptoms of PD and RBD improved with levodopa treatment. It is postulated that levodopa ameliorates RBD by suppressing REM sleep, and it remains to be seen whether levodopa can be an alternative to clonazepam in idiopathic RBD without PD.

Stereotypies are patterned, repetitive, purposeless movements that are performed the same way each time. They are commonly seen in individuals with autism, schizophrenia, or mental retardation, and also occur as a feature of tardive dyskinesia and as movements in those with akathisia. We studied 10 children who had stereotypies but were not autistic or mentally retarded. Although most had an uneventful delivery, seven had mild to moderately delayed developmental milestones. Five had hyperactive behavior or attention-deficit problems. All appeared to be of normal intelligence. The median age of onset of stereotypies was 12 months. The stereotypies including arm flapping, arm and hand posturing, finger wiggling, body rocking, leg shaking, facial grimacing, involuntary noises, neck extension, and eye blinking. Of the 10 children, only two stopped having stereotypies eventually without medications.

Parkinson’s disease (PD) is a neurological disorder that is manifested in the form of both motor and non-motor symptoms such as resting tremor, bradykinesia, muscular rigidity, depression, and cognitive impairment. PD is progressive in nature, ultimately leading to debilitating disruption of activities of daily living. Recently, a myriad of research has been focused on non-pharmacological interventions to alleviate the motor and non-motor symptoms of the disease. However, while there is a growing body of evidence supporting exercise as a viable therapy option for the treatment of Parkinson’s disease, there is a lack of literature enumerating a specific exercise sequence for patients with PD. In this literature review, we analyze the success of specific modalities of exercise in order to suggest an optimal exercise regimen for Parkinson’s disease patients.

Background: Rapid administration of intravenous alteplase (IV tPA) for acute ischemic stroke leads to improved clinical and functional outcomes. However, several barriers delay or preclude patients from undergoing timely treatment, including delayed triage and evaluation in the emergency department (ED). Patients with acute ischemic stroke who arrive by emergency medical services (EMS) receive a higher level of care, but mode of arrival has not been specifically evaluated as a predictor of IV tPA door-to-needle (DTN) times. Hypothesis: Patients with acute ischemic stroke who arrive by EMS to the ED will be treated more quickly than patients who arrive by other means. Methods: This was a retrospective cohort study evaluating all adult patients presenting with suspected acute ischemic stroke to the ED of an academic hospital and New York State Department of Health-designated stroke center in Brooklyn, NY, who received IV tPA from June 2011 to June 2017. Using Get With the Guidelines - Stroke Program data, a stroke coordinator abstracted data on patient age, sex, NIHSS, arrival mode, emergency severity index (ESI), DTN time, and discharge disposition. Results: A total of 156 patients received IV tPA for suspected acute ischemic stroke in the ED during the study period. Baseline characteristics of the sample were mean age of 66 (SD 14.4) years, 48.5% were female, and mean DTN time 46 minutes. The majority of these patients (79.5%) arrived by EMS. The median DTN time in the EMS arrival group was 42.5 (IQR 34-54) minutes compared to 51.5 (IQR 44-58) minutes in the non-EMS arrival group ( P < 0.05). There was a trend toward more severe strokes in the EMS arrival group but this was not statistically significant (median NIHSS 10 [IQR 6-19] for EMS vs. 4 [IQR 3-5.25] for non-EMS, P = 0.05). While arrival mode was not a significant predictor of DTN time (χ 2 [2, N = 156] = 59.2, P = 0.32), NIHSS was significantly negatively correlated with DTN time (r = -0.20, P = 0.01). This may be due to less diagnostic uncertainty and faster clinical decision-making with more severe strokes. Conclusions: Arrival by ambulance to the ED is not associated with a significantly shorter DTN times in patients with acute ischemic stroke. However, there is a significant inverse correlation between NIHSS and DTN time.