Lower Extremity Motor Function Research Articles

Impaired Isometric Force Matching in Upper and Lower Limbs Revealed by Quantitative Motor Assessments in Huntington's Disease.

Assessment of motor symptoms in Huntington's disease (HD) is based on the Unified-HD-Rating-Scale-Total-Motor-Score (UHDRS-TMS). Its categorical and rater-dependent nature reduces the ability to detect subtle changes and often placebo effects have been observed in trials. We have previously shown that impairments in isometric force matching can be detected by quantitative motor (Q-Motor) assessments of tongue protrusion forces (glossomotography) in HD. We aimed to investigate whether similar impairments in isometric force matching can be detected in tasks assessing hand and foot force coordination and whether correlations with clinical measures and the disease burden score can be found. Using a pre-calibrated force transducer, the ability of subjects to generate and maintain isometric forces at different target levels displayed on a monitor was assessed. Target forces applied in the hand were 1.5 and 5 Newton [N] and in feet 1, 5, and 10 N. Subjects with HD (n = 31) and age-matched controls (n = 22) were recruited from the HD out-patient clinic. All paradigms distinguished controls from HD. The static coefficient of variability (%) was the most robust measure across all matching tasks. Correlations with clinical measures, such as the UHDRS-TMS, TFC, and the DBS were found. Assessment of hand and foot force matching tasks was feasible and provided quantitative objective measures for severity of motor phenotype in HD. Since both upper and lower extremity motor function are relevant for everyday activities, these measures should be further assessed as candidates for developing functionally meaningful quantitative motor tasks.

Therapeutic effects of rehabilitation training methods on spinal cord injury: a meta-analysis

BackgroundSpinal cord injury (SCI) is a lesion of neural elements of spinal cord. Frequently, there is motor incomplete injury and locomotor disability. Robot assisted locomotor training, functional electrical stimulation (FES) devices, and repetitive transcranial magnetic stimulation (rTMS) devices are commonly used to improve motor control and gait of patients with SCI. The efficacies of different interventions for SCI have not been reported comprehensively, and a full comparison of these strategies may benefit clinicians who apply these techniques in the rehabilitation of patients with SCI. This study aimed to comprehensively evaluate the efficacies of different interventions for SCI. MethodsWe did a systematic review and meta-analysis by searching for publications using PubMed, Embase, the Cochrane Database, the database of the US National Institutes of Health, and the WHO International Clinical Trials Registry Platform on Dec 30, 2018. Randomised controlled trials and controlled trials that compared interventions with usual care or a no exercise control, and that were published in English, were selected for our meta-analysis. The primary outcomes included functional independence (assessed using the functional independence measure, SCI independence measure, American Spinal Injury Association [ASIA] upper extremity motor score [UEMS] or lower extremity motor score [LEMS], and other hand function tests), walking speed (10 m walking test [10MWT]) and walking distance (6 min walking test [6MWT]), walking capacity (walking index for spinal cord injuries version II [WISCI II]), spasticity (modified Ashworth scale [MAS]), and quality of life of patients with SCI. The secondary outcomes included patient dropout and adverse events during intervention. Weighted mean differences and 95% CIs were used to measure intervention efficacy, and the OR was used for analysis of adverse events. Physiotherapy Evidence Database (PEDro) scale scores were used for quality assessment of the included studies. Meta-analysis was performed using Revman 5.0 software. FindingsOur initial search yielded 1410, 1643, and 452 English articles reporting the effectiveness of rTMS or FES, exercise or training, and robot assisted locomotor treadmill training on functional recovery after SCI. Of these articles, 27 randomised controlled trials and three controlled trials, including 1020 patients with SCI, were included for meta-analysis. Four articles were available for evaluating rTMS versus control (81 participants), six for FES (174 participants), nine for massed practice or treadmill training (218 participants), and 11 for robot assisted treadmill training (547 participants). rTMS improved walking speed (mean absolute difference [MD] 0·09, 95% CI 0·01–0·16, p=0·03, 10MWT) and lower extremity motor function (4·41, 1·55–7·27, p=0·003, ASIA LEMS) compared with control (sham rTMS plus gait training), but not spasticity and walking index. FES significantly increased upper extremity independence (2·92, 0·37–5·48, p=0·03) compared with control (conventional occupational therapy [COT] or resistance and aerobic training), but not upper extremity or lower extremity function and quality of life. Activity-based therapy (massed practice and treadmill training) showed no benefit to nerve injury and functional rehabilitation compared with control (no intervention, overground mobility therapy, self-regulated exercises, or conventional rehabilitation program), whereas robot assisted treadmill training significantly improved ASIA LEMS scores (5·00, 3·44–6·56, p<0·00001) and lower extremity independence (3·73, 2·53–4·92, p<0·00001) compared with control interventions (no intervention, cycling and walking), but not walking capacity (10MWT and 6MWT). No difference was seen in the incidence of adverse events in pairwise comparison of robot assisted treadmill training with control and activity-based therapy with control. InterpretationrTMS, FES, and robot assisted treadmill training are effective in rehabilitating patients with SCI. The efficacies of rTMS and robot assisted treadmill training were relatively consistent among articles. The combination of rTMS and robot assisted treadmill training was effective in the rehabilitation of patients with SCI. FundingNone.

Recovery Process After Anterior Cervical Decompression in Patients With Cervical Spondylotic Myelopathy With Different Natural History.

An observational prospective cohort study. To investigate the influence of natural history on the recovery of patients with cervical spondylotic myelopathy (CSM) after anterior cervical decompression. The natural history of CSM has not been clearly elucidated, it remains unclear whether the natural history of CSM is associated with the recovery process after surgical treatment. Patients with CSM (n=117) after anterior cervical decompression were stratified variously on the basis of natural history features. Baseline and postoperative neurological functions were rated using the Japanese Orthopaedic Association (JOA) and patient-based self-evaluation (PBSE) scores. The minimum and maximum recovery times for sensory function, and motor functions of the upper and lower extremities were analyzed separately at time points 1-60 months after surgery. In all patients, the postoperative JOA and PBSE scores were significantly improved relative to baseline, in which sensory function recovered most quickly, followed by upper-extremity and lower-extremity motor functions. However, when compared with patients whose first symptom onset at the lower extremity, patients with the first onset at the upper extremity required less time to recover lower-extremity motor function, but more time to recover upper-extremity motor function. Patients with rapid progression had significantly lower preoperative and final JOA and PBSE scores compared with patients whose progression was steady or stepwise. Patients with preoperative symptoms ≥1 year had longer recovery time and poorer functional outcomes compared with those symptoms <1 year. In patients with CSM, the location of first symptom onset, progressive velocity of symptom, and duration of preoperative symptoms significantly influenced the recovery process after anterior cervical decompression. Level 2-observational prospective study.

Skillful Cycling Training Induces Cortical Plasticity in the Lower Extremity Motor Cortex Area in Healthy Persons.

Cycling exercise is commonly used in rehabilitation to improve lower extremity (LE) motor function and gait performance after stroke. Motor learning is important for regaining motor skills, suggesting that training of motor skills influences cortical plasticity. However, the effects of motor skill learning in dynamic alternating movements of both legs on cortical plasticity remain unclear. Here, we examined the effects of skillful cycling training on cortical plasticity of the LE motor area in healthy adults. Eleven healthy volunteers participated in the following three sessions on different days: skillful cycling training, constant-speed cycling training, and rest condition. Skillful cycling training required the navigation of a marker up and down curves by controlling the rotation speed of the pedals. Participants were instructed to fit the marker to the target curves as accurately as possible. Amplitudes of motor evoked potentials (MEPs) and short-interval intracortical inhibition (SICI) evoked using transcranial magnetic stimulation (TMS) were assessed at baseline, after every 10 min of the task (a total of 30 min), and 30 min after the third and final trial. A decrease in tracking errors was representative of the formation of motor learning following skillful cycling training. Compared to baseline, SICI was significantly decreased after skillful cycling training in the tibialis anterior (TA) muscle. The task-induced alterations of SICI were more prominent and lasted longer with skillful cycling training than with the other conditions. The changes in SICI were negatively correlated with a change in tracking error ratio at 20 min the task. MEP amplitudes were not significantly altered with any condition. In conclusion, skillful cycling training induced long-lasting plastic changes of intracortical inhibition, which corresponded to the learning process in the LE motor cortex. These findings suggest that skillful cycling training would be an effective LE rehabilitation method after stroke.

The effect of mirror therapy combined with motor imagery therapy on lower extremity motor function and balance early after ischemic stroke

Objective To investigate the effect of the mirror therapy (MT) combined with motor imagery therapy (MIT) on the lower limb motor performance, balance and ability in the activities of daily living of ischemic stroke patients soon after a stroke. Methods Forty hospitalized ischemic stroke patients were randomly allocated to an MT+ MIT group (n=20) or an MIT only group (n=20). In addition to routine rehabilitation, the MIT group exercised practicing knee extension and ankle dorsiflexion 30 minutes a day, five days a week for 8 weeks following motor imagery therapy protocols, while the MT+ MIT group accepted MIT combined with mirror therapy. The Fugl-Meyer lower extremity assessment (FMA-LE), Berg Balance scores (BBSs) and the Modified Barthel index (MBI) were used to evaluate the effects of the treatment before the treatment and after 4 and 8 weeks of therapy. Results Before the intervention there was no significant difference between the two groups in terms of their average FMA, BBS and MBI ratings. After 4 weeks of treatment a significant improvement was observed in the MT+ MIT group′s average FMA-LE and BBS scores and in the flat walking component of the MBI. In the MIT group only the average bed/wheelchair transfer and flat walking scores in the MBI were significantly improved. After 8 weeks the MT+ MIT group′s average FMA-LE and BBS scores had improved significantly, along with its average scores in the feeding, dressing, grooming, bathing, urination, bed/wheelchair transfer, walking up and down stairs and flat walking components of the MBI. In the MIT group the average FMA-LE and BBS scores had improved significantly, along with those for bed/wheelchair transfer, walking up and down stairs and flat walking in the MBI. After both 4 and 8 weeks, the MT+ MIT group′s average scores were consistently significantly better than those of the MT group. Conclusion Mirror therapy can significantly enhance the effectiveness of motor imagery therapy when they are combined in the rehabilitation of ischemic stroke patients in the early post-stroke stage. Key words: Mirror therapy; Motor imagery therapy; Ischemic stroke; Motor control

Bimanual Gesture Imitation Links to Cognition and Olfaction.

Given the need to detect subclinical changes in brain health that sometimes occur with aging in apparently healthy older adults, we assessed whether bimanual gesture imitation performance, simple to assess clinically, can detect age effects and alterations in cognition, olfaction, and movement. Cross-sectional study. Baltimore Longitudinal Study of Aging. Men and women, aged 22 to 101 years, without cognitive impairment, dementia, stroke, Parkinson disease, resting tremor, abnormal muscle tone, or abnormal coordination (N = 507). Bimanual gesture imitation was measured using a test validated in older adults. We assessed (1) cognition, including verbal memory, executive function, attention, visuospatial ability, visuoperceptual speed, and language; (2) manual dexterity with the Purdue Pegboard Test; (3) olfaction, using the 16-item Sniffin' Sticks Identification Test; (4) upper extremity motor function, using a computer-based finger tapping test; and (5) lower extremity motor function, including 6-meter usual and rapid gait speeds, 400-meter walk time, Health ABC Physical Performance Battery, and total standing balance time. Cross-sectional associations between bimanual gesture imitation performance and each measure were examined using linear regression after adjustment for age, sex, race, education, and body mass index. Models with mobility measures also adjusted for height. Higher gesture imitation performance was associated with younger age. After adjustment, a worse score was associated with worse olfaction, executive function, and visuospatial ability. Gesture imitation score was not associated with other cognitive measures or motor function. In persons without clinically detectable neurological conditions, poor bimanual gesture imitation is associated with other indicators of brain health, including olfaction and selected cognitive function domains. Bimanual gesture imitation may be useful clinically to detect subtle brain changes in apparently healthy older adults. J Am Geriatr Soc 67:2581-2586, 2019.

A Novel Approach to Evaluate Brain Activation for Lower Extremity Motor Control.

The purpose of this study was to assess the consistency of a novel MR safe lower extremity motor control neuroimaging paradigm to elicit reliable sensorimotor region brain activity. Participants completed multiple sets of unilateral leg presses combining ankle, knee, and hip extension and flexion movements against resistance at a pace of 1.2 Hz while lying supine in a 3T MRI scanner. Regions of Interest (ROI) consisted of regions primarily involved in lower extremity motor control (right and left primary motor cortex, primary somatosensory cortex, premotor cortex, secondary somatosensory cortex, basal ganglia, and the cerebellum). The group analysis based on mixed effects paired samples t-test revealed no differences for brain activity between sessions (P>.05). Intraclass correlation coefficients in the sensorimotor regions were good to excellent for average percent signal change (.621 to .918) and Z-score (.697 to .883), with the exception of the left secondary somatosensory cortex percent signal change (.165). These results indicate that a loaded lower extremity force production and attenuation task that simulates the range of motion of squatting, stepping, and landing from a jump is reliable for longitudinal neuroimaging applications and support the use of this paradigm in further studies examining therapeutic interventions and changes in dynamic lower extremity motor function.

Spastik Serebral Palsili Çocuklarda Gövde Eğitiminin Gövde, Üst ve Alt Ekstremite Motor Fonksiyonları Üzerine Etkisi: Tabakalı Randomize Kontrollü Çalışma

Objective: The aim of this study was to investigate the effects of trunk training on the trunk, upper and lower limb motor functions of children with bilateral spastic Cerebral Palsy. Methods: 36 children were recruited for this study; 19 children were included in the trunk training group and 17 children were included in the control group. Motor functions of the children were assessed by the Trunk Control Measurement Scale, Gross Motor Function Measurement, Quality of Upper Extremity Skills Test, Pediatric Balance Scale, Gillette Functional Assessment Scale, Functional Independence Measure for Children and Impact on Family Scale at baseline and after an 8 week of intervention period. Wilcoxon Signed-Rank Test and Mann–Whitney U Test were used to assess the differences. Results: The Trunk Control Measurement Scale (p=0.008), Gross Motor Function Measurement (p=0.047), Quality of Upper Extremity Skills Test (p=0.032), Pediatric Balance Scale (p=0.006), Gillette Functional Assessment Scale (p=0.011) and Functional Independence Measure for Children (p=0.03) scores improved in favor of the trunk training group (p&amp;lt;0.05). Conclusion: Individually structured trunk training is a promising method to improve trunk, upper and lower extremity motor functions and activity levels of children with bilateral spastic Cerebral Palsy.

Effects of mirror therapy on lower extremity motor function and activities of daily living after stroke: A meta-analysis

Objective To meta-analyze the effect of mirror therapy on the lower limb motor function and activities of daily living of stroke survivors so as to evaluate its clinical efficacy. Methods Medline, PubMed, OT seeker, the Cochrane library, the Wanfang database, the VIP database and the CNKI were searched for reports of randomized and controlled trials (RCTs) of the effect of mirror therapy on the lower limb motor function and activities of daily living of stroke survivors published between December 2008 and December 2018. Strict inclusion and exclusion criteria were applied, and the quality of the documents was comprehensively assessed according to version 5.1.0 of the Cochrane manual. The results were analyzed using version 5.2 of the RevMan software suite. Results Fourteen trials were included. Meta-analysis showed that mirror therapy had been shown to improve the patients′ scores of Fugl-Meyer assessment (FMA), functional ambulance category (FAC) and modified Barthel index (MBI). Conclusion Mirror therapy can improve the motor function of the affected lower extremities of stroke survivors and their ability in the activities of daily living. Key words: Stroke; Mirror therapy; Lower extremities; Motor function; Activities of daily living; Meta-analyses

Application of endoscopic selective posterior rhizotomy in the treatment of limb spasticity following brain injury

Objective To evaluate the efficacy and safety of endoscopic selective posterior/dorsal rhizotomy (SPR) in the treatment of limb spasticity following brain injury in adults. Methods A total of 88 patients with limb spasticity following brain injury treated with SPR from January 2015 to August 2016 at Department of Neurosurgery, Xinxiang Central Hospital were retrospectively enrolled into this study. Russman-Gage standard and Ashworth standard were used to evaluate the degree of limb spasticity and muscle tension after operation. Surface electromyography (SMG) and evoked potential (EP) were used to measure the sensory and motor nerve conduction velocities of affected limbs 3 weeks after operation. Lower extremity motor function was assessed with the Fugl-Meyer scale in lower extremity (FMA-L) at 3 and 8 weeks after operation. Walking ability was assessed with the Functional ambulation category (FAC) scale, and parameters of patients' stride, stride distance, stride speed and toe deflection angle distance were measured. All patients were followed up clinically after operation. The follow-up included observing the remission of limb spasticity and reviewing the lumbar spine radiographs. Results The spasticity of extremities was alleviated in 88 patients after operation. Three weeks after operation, the integrated electromyogram (iEMG) of tibialis anterior muscle in 88 patients was higher than that before operation (1.5±0.2 mV vs. 0.5±0.2 mV, P<0.001), while the gastrocnemius muscle was lower than that before operation (0.7±0.3 mV vs. 1.2±0.2 mV, P<0.001). After detection, latency of cortical somatosensory evoked potential (SEEP) in the dorsomedian part of the head(39.7±3.1 ms) and L2 (18.5±3.5 ms) was longer than that before operation (34.9 ±3.5 ms, 13.3 ±2.3 ms, both P<0.001). The sensory nerve conduction velocities in head (4.9±1.1 cm/ms) and popliteal region to L2(4.8±1.3 cm/ms) region were lower than those before operation (6.6±1.4 cm/ms, 6.3±1.5 cm/ms, both P<0.001). At 3-8 weeks post operation, the scores of FMA-L and FAC scales, stride length, stride distance and stride speed of 88 patients were higher than those before operation (all P<0.05), while the deflection angle of toes was lower (P<0.01). The rising trend time of 88 patients ranged from 6.2 to 26.6 months, with an average of 12.2±6.4 months. There were 83 (83/88, 94.3%) patients who had relief of spasticity in lower limbs and 74 (74/79, 93.7%) whose Achilles tendon reflex disappeared. No spinal deformity was found in the reexamination. Conclusion The neuroendoscopic SPR treatment for limb spasticity after brain injury could effectively relieve the symptoms of limb spasticity and promote the recovery of motor function. It seems safe and worthy of clinical application and promotion. Key words: Natural orifice endoscopic surgery; Craniocerebral trauma; Muscle spasticity; Extremities; selective posterior/dorsal rhizotomy

Acute Effects of Assisted Cycling Therapy on Post-Stroke Motor Function: A Pilot Study.

Background Stroke is the most common cause of long-term disability in the United States (US). Assisted Cycling Therapy (ACT) at cadences of about 80 rpm has been associated with improvements in motor and clinical function in other clinical populations. The acute effects of ACT on motor function of persons with stroke have not been investigated. Objectives The primary purpose of this cross-over trial was to compare the effects of ACT, voluntary cycling (VC), and no cycling (NC) on upper (Box and Blocks Test) and lower extremity motor function (Lower Extremity Motor Coordination Test) in adults with chronic stroke (age: 60 ± 16 years; months since stroke: 96 ± 85). The secondary purpose was to examine average cycling cadence and ratings of perceived exertion as predictors of change in motor function following the exercise session. Methods Twenty-two participants (female = 6, male = 16) completed one 20-min session each of ACT (mean cadence = 79.5 rpm, VC (mean cadence = 51.5 rpm), and NC on separate days in quasi-counterbalanced fashion). Results Main effects of intervention did not differ between ACT and VC. Within-intervention analyses revealed significant (p < 0.05) pre- to posttest changes in all outcome measures for ACT but only in the Lower Extremity Motor Coordination Test on the non-paretic side for VC. Trend analyses revealed a positive relationship between average ACT cadences and improvements in upper and lower extremity motor function (p < 0.05). A positive relationship between average VC cadences and lower extremity function was also revealed (p < 0.05). Conclusion ACT and VC produced similar acute improvements in paretic and non-paretic lower extremity motor function whereas changes in upper extremity motor function were more limited. Faster cycling cadences seem to be associated with greater acute effects.

The effect of body weight supported treadmill training and muscle tone on motor function of lower extremities of stroke survivors

Objective To observe the effect of body weight supported treadmill training (BWSTT) on function of lower extremities in stroke survivors, and analyze the influence of quadriceps femoris muscle tone on the therapeutic effect of BWSTT. Methods Thirty-six stroke survivors were randomly divided into a BWSTT group and a conventional therapy group (CT group) according to a random number table, each of 18. Both groups were given routine rehabilitation training, while the BWSTT group was additionally provided with BWSTT for 4 weeks. Before and after the treatment, Fugl-Meyer assessment for lower extremity (FMMS-LE), Berg balance scale (BBS) and Holden walking function rating scale (Holden) were used to assess the motor function of lower extremities, balance function and walking ability of both groups. Meanwhile, the patients in BWSTT group were further divided into a mild-spasm subgroup and a seriously-spasm subgroup according to the modified Ashworth scale assessment result of quadriceps muscle, and the results of their efficacy indexes were further compared. Results No significant difference was found in the average FMMS-LE, Berg and Holden scores between the BWSTT group and CT group before the treatment (P>0.05). However, significantly improvement was found in all the above measurements of both groups after the treatment (P 0.05). The change of FMMS (△FMMS) and Holden (△Holden) after treatment in the mild-spasm subgroup increased more significantly compared with those in the seriously-spasm subgroup, but no significant differences were observed regarding the change of Berg (△Berg) between the two subgroups. Conclusions BWSTT can significantly improve the motor function of lower extremities, balance function and walking ability of stroke survivors. However, hypertone of quadriceps femoris might have adverse effects on the therapeutic effect of BWSTT. Key words: Stroke; Body weight supported treadmill training; Motor function; Muscle tension

Simultaneous stimulation in bilateral leg motor areas with intermittent theta burst stimulation to improve functional performance after stroke: a feasibility pilot study

Intermittent theta burst stimulation (iTBS) was widely used in stroke rehabilitation and was more efficient than repetitive transcranial magnetic stimulation in terms of inducing larger motor evoked potential and producing longer effects. To our knowledge, the outcomes are not available combining rehabilitation and iTBS for improving motor function of lower extremities in patients with stroke. To evaluate the feasibility and effectiveness of intermittent theta burst stimulation aiming to stimulate bilateral leg motor cortex and promote functional improvements. A single blind, randomized controlled pilot study. Rehabilitation ward. Twenty patients with chronic stroke finally enrolled for analyzed. Participants were randomized into two groups to receive 10 sessions of iTBS group and sham group over a 5-week period. The iTBS was delivered over the midline of skull to stimulate bilateral leg motor cortex. The outcome measures included balance, mobility, and leg motor functions were measured before and after interventions. Within-group differences were significant in the Berg Balance Scale for both groups (Z=-2.442, P=0.015 in iTBS group; Z=-2.094, P=0.036 in sham group), in the Fugl-Meyer Assessment (Z=-2.264, P=0.024) and Overall Stability Index of Biodex Balance System of iTBS group (Z=-2.124, P=0.034). However, no significant between-group differences were found. There was no powerful evidence to support the effectiveness of iTBS group better than sham control group. Some essential technical issues should be considered for future studies applying iTBS to stimulate bilateral leg motor cortex. iTBS combined with stroke rehabilitation are probably expected to be useful to promote brain plasticity and functional performance but some technical issues should be carefully considered.

Treatment of posterior longitudinal ligament ossification of thoracic spine with posterior transforaminal spinal decompression

Objective To explore the safety, efficacy and outcomes of posterior transforaminal spinal cord reduction in the treatment of severe thoracic ossification of the posterior longitudinal ligament. Methods Since May 2010 to May 2016, 21 patients with thoracic spinal stenosis with ossification of the posterior longitudinal ligament and embedding rate of more than 50% underwent posterior circular decompression, 12 males and 9 females; age 42-71 years old, with an average of 63.3±1.6 years old. There were severe spinal cord compression symptoms before surgery. The operation was from the posterior median approach. First, the pedicle screw tract was preset in the upper and lower segments where decompression was required, and then the posterior wall of the spinal canal was removed by the uncovering method to complete the posterior decompression. Through the superior and inferior articular joints, the joints were removed, the intercostal nerves were pushed outward, the extracorporeal intervertebral space and intervertebral disc tissue were revealed, and the vertebral cancellous bone of the lower vertebral body was removed. Separate the adhesion of the dura mater, use the special tool to cut the upper and lower edges of the posterior longitudinal ligament, collapse, remove the posterior longitudinal ligament ossification block, and complete the decompression of the front of the spinal cord through one or both sides. Finally, the pedicle screw fixation and the intervertebral bone graft were completed. Postoperative follow-up (mean 38.5 months) CT and MRI scans were performed to observe the patency of the spinal canal and the state of the internal fixation. The Frankel graded evaluation function was restored, the JOA score was used to evaluate the neurological function, the Otani evaluation system was used to evaluate the surgical outcome, the clinical excellent rate was calculated, and the treatment effect was evaluated. Results Nineteen cases recovered after operation, and 1 case showed a transient decrease in unilateral lower extremity motor function on the second day after surgery. It returned to normal after dehydration and neurotrophic support treatment, and 1 case had bilateral lower limbs on the day after surgery. Muscle strength was transiently lost, feeling recovered after 6 hours, and exercise resumed after 48 hours. The operation time was 180-300 min, with an average of 240±23 min. The intraoperative blood loss was 168±12 ml. Postoperative spinal cord function recovered significantly. At the last follow-up, Frankel graded F in 8 cases and grade E in 13 cases. Preoperative average JOA score was 3.5, and the JOA score of the follow-up was increased from 3.5±0.98 points to 9.0±0.9 points. The improvement rate of JOA score was excellent in 14 cases, good in 5 cases, and fair in 2 cases. According to Otani system there was excellent in 14 cases, good in 6 cases, and fair in 1 case. The excellent and good rate was 95.24%. Cerebrospinal fluid leakage occurred in 3 cases and healed after symptomatic treatment. No chest occurred during the follow-up period. The vertebral instability, internal fixation loose, broken. Conclusion Posterior transforaminal spinal decompression of posterior longitudinal ligament ossification of thoracic spine can be finished using self-developed special surgical tools, which is safe, effective and can achieve full decompression of spinal cord. Key words: Thoracic vertebrae; Spinal stenosis; Ossification of posterior longitudinal ligament; Decompression, surgical; Spinal fusion

Baicalin effects on rats with spinal cord injury by anti‐inflammatory and regulating the serum metabolic disorder

Baicalin had neuroprotective effects on inhibiting neuronal cell apoptosis induced by spinal cord ischemic injury. This study aimed to explore the protective effects of Baicalin on rats with spinal cord injury (SCI) and its mechanism of action. The recovery of spinal cord nerve function in rats was evaluated by the Basso, Beattie, and Bresnahan (BBB) score and the combine behavioral score (CBS). The expressions of cytokines tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and IL-6 were detected by the enzyme-linked immunosorbent assay method. Expressions of inflammation-related proteins were detected by Western blot. Multivariate statistical analysis was performed for serum metabolites. The BBB and CBS score results showed that Baicalin had a certain improvement on rats with SCI. SCI symptoms were significantly improved in low-dose and high-dose groups. The levels of TNF-α, IL-1β, and IL-6 in the SCI group were significantly increased. The expressions of NF-κB p65, NF-κB p50, p-IκBα, and IKKα in the SCI group showed the opposite trend compared with the low-dose and high-dose groups. Compared with the sham group, glutamine, levels of 3-OH-butyrate, N-acetylaspartate, and glutathione were significantly reduced, and the levels of glutamate and betaine were significantly increased in the SCI group. When Baicalin was administered, the contents of glutamine synthase (GS) and glutaminase (GLS) were significantly reduced, indicating that Baicalin had the effect of improving GS and GLS. Baicalin has protective effects on improving SCI and lower extremity motor function, has a significant anti-inflammatory effect, and regulates the serum metabolic disorder caused by SCI in rats.

Lower Extremity Motor Function Following Complex Adult Spinal Deformity Surgery: Two-Year Follow-up in the Scoli-RISK-1 Prospective, Multicenter, International Study.

Background:The reported neurologic complication rate following surgery for complex adult spinal deformity (ASD) is variable due to several factors. Most series have been retrospective with heterogeneous patient populations and use of nonuniform neurologic assessments. The aim of this study was to prospectively document lower extremity motor function by means of the American Spinal Injury Association (ASIA) lower extremity motor score (LEMS) before and through 2 years after surgical correction of complex ASD.Methods:The Scoli-RISK-1 study enrolled 272 patients with ASD, from 15 centers, who had undergone primary or revision surgery for a major Cobb angle of ≥80°, corrective osteotomy for congenital spinal deformity or as a revision procedure for any type of deformity, and/or a complex 3-column osteotomy.Results:One of 272 patients lacked preoperative data and was excluded from the analysis, and 62 (22.9%) of the remaining 271 patients, who were included, lacked a 2-year postoperative assessment. Patients with no preoperative motor impairment (normal LEMS group; n = 203) had a small but significant decline from the mean preoperative LEMS value (50) to that at 2 years postoperatively (49.66 [95% confidence interval = 49.46 to 49.85]; p = 0.002). Patients who did have a motor deficit preoperatively (n = 68; mean LEMS, 43.79) had significant LEMS improvement at 6 months (47.21, p < 0.001) and 2 years (46.12, p = 0.003) postoperatively. The overall percentage of patients (in both groups combined) who had a postoperative LEMS decline, compared with the preoperative value, was 23.0% at discharge, 17.1% at 6 weeks, 9.9% at 6 months, and 10.0% at 2 years.Conclusions:The percentage of patients who had a LEMS decline (compared with the preoperative score) after undergoing complex spinal reconstructive surgery for ASD was 23.0% at discharge, which improved to 10.0% at 2 years postoperatively. These rates are higher than previously reported, which we concluded was due to the prospective, strict nature of the LEMS testing of patients with these challenging deformities.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Jul 2018This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.03.119AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 200(1), pp. 1–2 References 1 : The relationship between sleep disorders and lower urinary tract symptoms: results from the NHANES. J Urol2018; 200: 161. Link, Google Scholar 2 : Long-term outcome of a single intervention population based prostate cancer screening study. J Urol2018; 200: 82. Link, Google Scholar 3 : Comparison of pathological stage in patients treated with and without neoadjuvant chemotherapy for high risk upper tract urothelial carcinoma. J Urol2018; 200: 68. Link, Google Scholar 4 : Volitional voiding of the bladder after spinal cord injury: validation of bilateral lower extremity motor function as a key predictor. J Urol2018; 200: 154. Link, Google Scholar 5 : National imaging trends after percutaneous nephrolithotomy. J Urol2018; 200: 147. Link, Google Scholar 6 : Role of magnetic resonance imaging targeted biopsy in detection of prostate cancer harboring adverse pathological features of intraductal carcinoma and invasive cribriform carcinoma. J Urol2018; 200: 104. Link, Google Scholar 7 : The impact of immediate salvage surgery on corporeal length preservation in patients presenting with penile implant infections. J Urol2018; 200: 171. Link, Google Scholar 8 : Evolving use of prebiopsy prostate magnetic resonance imaging in the Medicare population. J Urol2018; 200: 89. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 200Issue 1July 2018Page: 1-2 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Volitional Voiding of the Bladder after Spinal Cord Injury: Validation of Bilateral Lower Extremity Motor Function as a Key Predictor

In many individuals with spinal cord injury a return of volitional bladder voiding is considered more important than regaining motor function. Recently a predictive model using only composite bilateral lower extremity motor scores for levels L2-S1 (range 0 to 50) was proposed by the EMSCI (European Multicenter Study about Spinal Cord Injury) group. The model showed exceptional predictive power with an AUC of 0.912. We sought to further validate the EMSCI model in a national spinal cord injury cohort. We created models of volitional voiding using the United States NSCID (National Spinal Cord Injury Database) for 2007 to 2016. In addition to testing lower extremity motor scores, we evaluated other patient variables that we hypothesized might affect volitional voiding. Volitional voiding was present in 1,333 of the cohort of 4,327 individuals (30.8%) at 1-year followup. While younger age, female gender, increased sacral sparing, improved AIS (American Spinal Injury Association Impairment Scale) classification and a more caudal sensory level predicted volitional voiding, lower extremity motor scores were most predictive (AUC 0.919). Adding the other patient characteristics did little to improve model performance (full model AUC 0.932). Further analysis of the predictive power of lower extremity motor scores suggested that while the AUC appeared to decrease in persons who were most likely to void volitionally, the performance of the predictive model remained outstanding with a combined AIS C and D AUC of 0.792. Our study verifies the validity of the EMSCI predictive model of volitional voiding after spinal cord injury. The differing performance of lower extremity motor scores in various AIS classifications should be noted.

Is the proportional recovery rule applicable to the lower limb after a first-ever ischemic stroke?

ObjectiveTo investigate (a) the applicability of the proportional recovery rule of spontaneous neurobiological recovery to motor function of the paretic lower extremity (LE); and (b) the presence of fitters and non-fitters of this prognostic rule poststroke. When present, the clinical threshold for fitting nor non-fitting would be determined, as well as within-subject generalizability to the paretic upper extremity (UE).MethodsProspective cohort study in which the Fugl-Meyer Assessment (FMA)-LE and FMA-UE were measured <72 hours and 6 months poststroke. Predicted maximum potential recovery was defined as [FMA-LEmax−FMA-LEinitial = 34 –FMA-LEinitial]. Hierarchical clustering in 202 first-ever ischemic stroke patients distinguished between fitting and not fitting the rule. Descriptive statistics determined whether fitters and non-fitters for LE were the same persons as for UE.Results175 (87%) patients fitted the FMA-LE recovery rule. The observed average improvement of the fitters was ~64% of the predicted maximum potential recovery. In the non-fitter group, the maximum initial FMA-LE score was 13 points. Fifty-one out of 78 patients (~65%) who scored below the identified 14-point threshold at baseline fitted the FMA-LE rule. Non-fitters were more severely affected than fitters. All non-fitters of the FMA-LE rule did also not fit the proportional recovery rule for FMA-UE.ConclusionsProportional recovery seems to be consistent within subjects across LE and UE motor impairment at the hemiplegic side in first-ever ischemic hemispheric stroke subjects. Future studies should investigate prospectively distinguishing between fitters and not-fitters within the subgroup of patients who have initial low FMA-LE scores. Subsequently, patients could be stratified based on fitting or not fitting the recovery rule as this would impact rehabilitation management and trial design.

Structural validity of Balance Evaluation Systems Test assessed using factor and Rasch analyses in patients with stroke.

[Purpose] The Balance Evaluation Systems Test (BESTest) is a comprehensive assessment tool, although it is not confined for use in stroke patients. This study aimed to determine the structural validity of the BESTest in self-ambulatory patients with stroke using both factor and Rasch analyses. [Participants and Methods] This retrospective study included 140 self-ambulatory patients with stroke. The structural validity of the BESTest was analyzed according to principal component, exploratory factor, Rasch, confirmatory factor, and correlation analyses. [Results] The analytical results supported a four-factor model comprising 25 items. The four factors included dynamic postural control with gait, static postural control, stepping reaction, and stability limits in sitting. Evidence of high structural validity and reliable internal consistency suggested that the 25-item BESTest is valid and reliable. Each factor was significantly correlated with lower extremity motor function and walking ability. [Conclusion] Eleven items in the BESTest were poorly correlated, and the remaining 25 items were grouped into four factors that demonstrated good structural validity for patients with stroke. Further studies should validate the applicability of the 25-item BESTest four-factor model in a larger sample of patients with stroke in a clinical setting.