Palsy Research Articles

Notice biographique sur le Dr Achille Delmas (1879–1947). Deuxième partie : la maison de santé d’Ivry et fin de carrière à la « Médico »

From 1911 to 1947, Dr Achille Delmas was the medical director of one of the most well-known mental health facilities in the Paris area, “la maison de santé d’Ivry-sur-Seine”, founded by J.-E. Esquirol. With his younger brother Paul, he treated numerous – sufficiently wealthy – patients, whose pathologies ranged from terminal forms of General Paralysis, as in the case of the writers Charles Carrington and Louis Chadourne, to perversion, as in the case of the soon-to-be infamous Dr Petiot, as well as psychosis, as in the case of Lucia Joyce, James’ daughter, who spent ten years at this facility. Achille Delmas was a bedrock of the Société Médico-Psychologique, serving as its president from 1941 to 1942. In his speeches, he remained true to his conservative positions, staying faithful to the obsolete diagnosis of Dementia Praecox, and, above all, remained steadfastly convinced that bipolar disorders (such as a cycloidal temperament) were frequently misdiagnosed. In his eulogy, Professor Minkowski implied that Achille Delmas was himself affected by such a temperament.

Comparison of Surgical Outcomes of Anterior and Posterior Fusion Surgeries for K-line (-) Cervical Ossification of the Posterior Longitudinal Ligament: A Prospective Multicenter Study.

A prospective multicenter study. To compare the surgical outcomes of anterior and posterior fusion surgeries in patients with K-line (-) cervical ossification of the posterior longitudinal ligament (OPLL). Although laminoplasty is effective for patients with K-line (+) OPLL, fusion surgery is recommended for those with K-line (-) OPLL. However, whether the anterior or posterior approach is preferable for this pathology has not been effectively determined. A total of 478 patients with myelopathy due to cervical OPLL from 28 institutions were prospectively registered from 2014 to 2017 and followed up for 2 years. Of the 478 patients, 45 and 46 with K-line (-) underwent anterior and posterior fusion surgeries, respectively. After adjusting for confounders in baseline characteristics using a propensity score-matched analysis, 54 patients in both the anterior and posterior groups (27 patients each) were evaluated. Clinical outcomes were assessed using the cervical Japanese Orthopaedic Association and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Both approaches showed comparable neurological and functional recovery. The cervical range of motion was significantly restricted in the posterior group because of the large number of fused vertebrae compared with the anterior group. The incidence of surgical complications was comparable between the cohorts, but the posterior group demonstrated a higher frequency of segmental motor paralysis, whereas the anterior group more frequently reported postoperative dysphagia. Clinical improvement was comparable between anterior and posterior fusion surgeries for patients with K-line (-) OPLL. The ideal surgical approach should be informed based on the balance between the surgeon's technical preference and the risk of complications.

WINGED SCAPULA CAUSED BY PARSONAGE-TURNER SYNDROME AFTER BNT162B2 MRNA COVID-19 VACCINATION.

Parsonage-Turner syndrome (PTS), also referred to as idiopathic brachial plexopathy or neuralgic amyotrophy, is characterized by acute onset of unilateral upper extremity pain.PTS often results in a winged scapula due to paralysis of the long thoracic nerve.PTS should be considered in patients with post-neuralgic motor paralysis of the unilateral upper extremity, which can occur after COVID-19 vaccination.

Upper Limb Function Recovery by Combined Repetitive Transcranial Magnetic Stimulation and Occupational Therapy in Patients with Chronic Stroke According to Paralysis Severity.

Repetitive transcranial magnetic stimulation (rTMS) with intensive occupational therapy improves upper limb motor paralysis and activities of daily living after stroke; however, the degree of improvement according to paralysis severity remains unverified. Target activities of daily living using upper limb functions can be established by predicting the amount of change after treatment for each paralysis severity level to further aid practice planning. We estimated post-treatment score changes for each severity level of motor paralysis (no, poor, limited, notable, and full), stratified according to Action Research Arm Test (ARAT) scores before combined rTMS and intensive occupational therapy. Motor paralysis severity was the fixed factor for the analysis of covariance; the delta (post-pre) of the scores was the dependent variable. Ordinal logistic regression analysis was used to compare changes in ARAT subscores according to paralysis severity before treatment. We implemented a longitudinal, prospective, interventional, uncontrolled, and multicenter cohort design and analyzed a dataset of 907 patients with stroke hemiplegia. The largest treatment-related changes were observed in the Limited recovery group for upper limb motor paralysis and the Full recovery group for quality-of-life activities using the paralyzed upper limb. These results will help predict treatment effects and determine exercises and goal movements for occupational therapy after rTMS.

Risk Factors for Early Mortality in Older Patients with Traumatic Cervical Spine Injuries-A Multicenter Retrospective Study of 1512 Cases.

For older patients with decreased reserve function, traumatic cervical spine injuries frequently lead to early mortality. However, the prognostic factors for early mortality remain unclear. This study included patients aged ≥65 years and hospitalized for treatment of traumatic cervical spine injuries in 78 hospitals between 2010 and 2020. Early mortality was defined as death within 90 days after injury. We evaluated the relationship between early mortality and the following factors: age, sex, body mass index, history of drinking and smoking, injury mechanisms, presence of a cervical spine fracture and dislocation, cervical ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, American Spinal Injury Association Impairment Scale, concomitant injury, pre-existing comorbidities, steroid administration, and treatment plan. Overall, 1512 patients (mean age, 75.8 ± 6.9 years) were included in the study. The early mortality rate was 4.0%. Multivariate analysis identified older age (OR = 1.1, p < 0.001), male sex (OR = 3.7, p = 0.009), cervical spine fracture (OR = 4.2, p < 0.001), complete motor paralysis (OR = 8.4, p < 0.001), and chronic kidney disease (OR = 5.3, p < 0.001) as risk factors for early mortality. Older age, male sex, cervical spine fracture, complete motor paralysis, and chronic kidney disease are prognostic factors for early mortality in older patients with traumatic cervical spine injuries.

Akute hepatische Porphyrien

Acute porphyrias are caused by rare hereditary disorders of hepatic heme biosynthesis. Episodes of accumulating neurotoxic metabolites lead to multisystemic symptoms such as visceral pain, autonomic dysregulation, neurocognitive impairment, hyponatremia, and occasionally motor paralysis. In addition to protracted non-emergency courses, acute life-threatening crises can occur, often triggered by infection, medication, fasting, or hormonal stimuli. Since the clinical presentation is nonspecific and multifaceted, many patients have gone through along odyssey until they receive adiagnosis. Acute attacks often lead to presenting initially to the emergency department, where acute hepatic porphyria (AHP) is easily overlooked in the differential diagnosis. Establishing the diagnosis requires ahigh level of genuine suspicion (e.g., cluster of signs and symptoms along with certain patterns of health care resource utilization). The initial diagnostic work-up requires the measurement of metabolites in the urine. Emergency management consists of infusions of glucose and heme arginate along with symptomatic therapy. However, porphyrinogenic agents must be strictly avoided ( www.drugs-porphyria.org ). After initial diagnosis, athorough work-up should be done at aporphyria center (confirming the diagnosis, education, genetic counselling) and issuance of an emergency identification card is mandatory. If the frequency of relapses is high, new targeted prophylactic therapies have proven effective. Patients with known porphyria require special attention in any acute medical condition in order to avoid porphyrinogenic triggers and to exclude threatening differential diagnosis (e.g., sepsis) by consistent basic diagnostics.

Stem Cell Therapies for Functional Recovery After Spinal Cord Injury: Mechanisms, Challenges, and Applications

Context: Spinal cord injury (SCI), a debilitating and catastrophic condition, leads to sensory motor impairments, paralysis, and high mortality. It consists of initial physical insult and secondary injury. Despite much research on SCI treatment, it is still one of the incurable damages because of its complex pathophysiology and limited neuronal regeneration ability. In recent years, stem cell therapy has been a promising and exciting strategy for SCI treatment. Evidence Acquisition: In this review, the articles published in PubMed, Google Scholar, Science Direct, and Scopus from 2000 to 2022 were collected using keywords such as spinal cord injury, stem cell therapy, neuroprotection, neuroregeneration, neurotrophic factors, anti-inflammatory cytokines, and neural cell death. The articles whose full texts were available and met the inclusion criteria were examined. According to the inclusion criteria, 30 articles were analyzed. Results: Stem cell therapy can promote neuroplasticity and neuroregeneration in the damaged spinal cord. Grafted cells can reconstruct nerves and create new circuits after SCI. Stem cell transplantation can also replace lost oligodendrocytes, thus promoting axon remyelination. Many neurotrophic factors and anti-inflammatory cytokines are secreted by transplanted stem cells to decrease secondary injury and neural cell death, thus inhibiting the glial scar formation after SCI. Stem cells also have antioxidant, anti-inflammatory, immunomodulatory, and anti-apoptotic effects. Grafted stem cells can block microglial activation and astrocyte reactivity and enhance revascularization. Conclusions: Stem cells isolated from different tissues can be promising candidates and attractive options for treating the injured spinal cord. Despite remarkable progress in animal studies, cell transplantation's clinical efficacy and adequacy for SCI remain limited and dubitable. Many essential challenges must be considered in translation to the clinic. It is hoped that the invention of new methods and the anti-inflammatory, anti-apoptotic, antioxidant, and neuronal repair properties of stem cells can effectively improve the sensorimotor function of patients with SCI.

VITAMIN D STATUS IN CHILDREN WITH PARALITIC SYNDROMS.

The aim: Determination of serum 25(OH)D in the children with paralytic syndromes and its distribution depending on age, sex, taking anticonvulsant drugs, nutritional status for a period of one year (autumn-spring) of one center. Materials and methods: There were recruited of 77 children with paralytic syndromes and 73 health children for the same period aged from 1 till 18 years. The study included a scrutiny of medical history and analysis of medical documents, assessment of motor dysfunction by GMFCS, and nutritional status. Results: Among children with paralytic syndromes there were spastic tetraparesis 59.7%, malnutrition 92%, IV-V level of gross motor disfunction 80.5%, antiseizure medications 59.7% and cognitive impairment 77.9%. The variation of serum 25(OH)D is from 6.1 to 76.7 ng/mL with median 18.3 ng/mL in healthy children. The variation of serum 25(OH)D is from 2.2 to 83.0 ng/mL with median 14.8 ng/mL in children with paralytic syndromes (p=0.0103). Vitamin status among them is the following: insufficiency (21-29 ng/mL)-28.7% vs 16.8%; deficiency (<20 ng/mL)-56.1 vs 72.2% (p=0.0300). The 25.9% children with paralytic syndromes and those who have deficiency demonstrate severe deficiency (<10 ng/mL) compare 10.9% in healthy children (p=0.00189). There is a tendency to decrease of serum 25(OH)D in children with paralytic syndrome older 7 years. Conclusions: We failed to record a significant difference in the 25(ОН)D between males and females, between different level of GMFCS, and anticonvulsants using. Deficiency of vitamin D in 2.25 times higher in children with paralytic syndromes and severe malnutrition. Additional researches with specific items are need in perspective.

MANAGEMENT OF GUILLAIN BARRE SYNDROME THROUGH AYURVEDA – A CASE STUDY.

Guillain Barre Syndrome is acute paralysis neuropathy. It is evolving reflexes motor paralysis with or without sensory disturbances. Characterised by rapidly developing motor weakness. It is autoimmune in nature and trigger by preceding infections. A 47year female patient was came in OPD of kayachikitsa in our institute with complaining of generalised body weakness, tingling sensation in both hands and legs with bilateral exaggerated reflexes and decrease muscle tone and power. Patient had history of Guillain Barre Syndrome 4 years ago. For this she had taken allopathic medicine like Intra Venous Immunoglobulin in government hospital. Patient started complaint about same symptoms, for this she started Ayurvedic treatment. In Ayurveda Guillain Barre Syndrome is not explain by name hence it is taken under the name of vata vyadhi like sarvangagat vata. While thoroughly understanding Guillain Barre Syndrome through modern as well as Ayurvedic aspect Guillain Barre Syndrome considered as sarvangagata vata vyadhi and managed by Ayurvedic treatment on the basis of basic principles, and found better improvement in this case. Due to Ayurvedic treatment and internal medicine with 15 days with follows up treatment for 1 months gives significant relief in all motor and sensory reflex with increase muscle tone and power

Oxygen Therapy for the Treatment of Experimental Autoimmune Encephalomyelitis

Background Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system (CNS). Experimental autoimmune encephalomyelitis (EAE) is a widely used animal model of MS. Oxygen therapy, such as hyperbaric oxygen (HBO) or normobaric oxygen (NBO), has been advanced as a potential treatment option to allay the motor and sensory deficits associated with MS. However, it is unclear whether any therapeutic benefits derived from treatment are a result of pressurized oxygen or simply pure oxygen administration. This study aimed to explore whether pressurized oxygen (HBO) or sea-level oxygen (NBO) would attenuate the motor and sensory deficits associated with EAE. Methods Forty-two male Harlan Lewis rats were randomly assigned to one of four conditions: MBP/HBO, MBP/NBO, MBP/no treatment, or a vehicle group. Injections of MBP or vehicle were administered on day 1, and animals were allowed one-week to recover. Following recovery, animals were administered HBO at 2.0 atmospheres absolute (ATA) or sea-level oxygen for 60-minutes daily. Mechanical paw withdrawal threshold (MPWT) testing was conducted on the first day and every alternate day after the start of treatment to assess the development of tactile allodynia. Motor impairment tests were performed twice daily (immediately prior to and after oxygen treatment) to assess for the presence of motor deficits or paralysis. Results On days 14 through 18, animals injected with MBP had a greater level of motor impairment compared to the vehicle control group. Interestingly, results also indicated that NBO was as effective as HBO in attenuating EAE symptoms. Conclusion In conclusion, these results underscore the need for further research to determine the ideal parameters of oxygen treatment, particularly whether pressurization is necessary to attenuate symptoms of EAE.

Feasibility and acceptability of novel functional electronic stimulated rehabilitation application for treatment in patients with cerebrovascular disorders: the FRAT study protocol

BackgroundThe prognosis of patients with cerebrovascular disorders is poor owing to their high residual rate of hemiplegia. Delayed withdrawal from synkinesis is a major cause of prolonged hemiplegia; however, effective rehabilitation has not been established. This single-arm, open-label study aims to evaluate the influence of a low-frequency treatment device on canceling synkinesis in patients with incomplete paralysis and cerebrovascular disorders.MethodsEligible participants will include patients aged 20 years or older with incomplete paralysis, defined as upper limb Brunnstrom stage (BRS) of 2–4, who are within 1 month of onset of a cerebrovascular disorder. Qualified patients will be assigned to the novel rehabilitation treatment with IVES+ for 4 weeks. The primary endpoint of the study is the change from baseline in the upper-limb Fugl-Meyer Assessment (FMA) 2 weeks after the start of treatment. The secondary endpoints are changes in the amount of Functional Independence Measure, changes in the amount of upper-limb BRS, and changes in the amount of Barthel Index (BI) compared to the pre-intervention value at weeks 2 and 4; changes in the upper-limb FMA scores at 1, 3, and 4 weeks; changes in grip strength compared to the pre-intervention values at 1, 2, 3, and 4 weeks; and changes in upper-limb strength (manual muscle test) compared to the pre-intervention values at 1, 2, 3, and 4 weeks.DiscussionThis study will explore the usefulness of IVES+ for recovery from motor paralysis in patients with cerebrovascular disorders.Trial registrationJapanese Clinical Registry, jRCTs052180226. Date of registration: February 1, 2022

테트라민 중독 사망사례 분석

Tetramethylammonium(TMA, tetramine) is a toxic quaternary ammonium compound, consisting of four methyl groups attached to a central nitrogen atom. TMA has been detected in a number of marine organism that are eaten by humans. In the past, most cases of TMA intoxication have occurred through eating seafood containing TMA, such as carnivorous gastropods. Nowadays, TMA hydroxide(TMAH) that decomposes to produce TMA is used widely in the manufacture of semiconductors and liquid crystal displays (LCDs). As a result, the case of TMA intoxication is increasing. TMA acts directly on nicotinic and muscarinic receptors that are responsible for depolarization and, at high doses, blockage of depolarization. TMA may cause nausea, vomiting, headache, impaired vision, temporary blindness, salivation, lacrimation, fasciculation and convulsion and motor paralysis. The symptoms of TMA intoxication generally are mild and transient because of rapid elimination of TMA from the body. However, in severe cases, paralysis of the respiratory muscles can occur and this causes death. In this study, we analyzed TMA in femoral blood, heart blood and gastric contents of victim. The concentrations of TMA in femoral blood and heart blood were 7.95 mg/L and 13.1 mg/L, respectively. This case can be considered as a good reference when studying the relationship between TMA-induced death and blood concentration.

Malaria therapy for general paralysis of the insane at the Sunbury Hospital for the Insane in Australia, 1925-6.

This paper, drawing on the published medical literature and unpublished medical record archives, provides an in-depth account of the introduction of malaria therapy for general paralysis of the insane into Australia in 1925-6, at Victoria's Sunbury Hospital for the Insane. This study reveals a complex and ambiguous picture of the practice and therapeutic impact of malaria therapy in this local setting. This research highlights a number of factors which may have contributed to some physicians overestimating malaria therapy's effectiveness. It also shows that other physicians of the era held a more sceptical attitude towards malaria therapy. Finally, this paper discusses the relevance of this history to contemporary psychiatry.

Study Protocol for a Multicenter, Randomized Controlled Trial to Improve Upper Extremity Hemiparesis in Chronic Stroke Patients by One-to-One Training (NEURO®) with Repetitive Transcranial Magnetic Stimulation.

During recovery from upper limb motor paralysis after stroke, it is important to (1) set the exercise difficulty level according to the motor paralysis severity, (2) provide adequate exercises, and (3) motivate the patient to achieve the goal. However, these factors have not been well-formulated. This multicenter, randomized controlled trial study aims to examine the therapeutic effects of these three factors on patients undergoing a novel intervention using repetitive transcranial magnetic stimulation and intensive one-to-one training (NEURO®) and to formulate a corresponding research protocol. The control group will receive conventional NEURO® occupational therapy. In the intervention group, four practice plans will be selected according to the Fugl-Meyer assessment (FMA-UE) scores of the upper extremity. The goal is to predict the post-treatment outcomes based on the pre-treatment FMA-UE scores. Based on the degree of difficulty and amount of practice required, we can formulate a practice plan to promote upper limb motor recovery. This occupational therapy plan will be less influenced by the therapist's skill, facilitating effective rehabilitation. The study findings may be utilized to promote upper limb motor paralysis recovery and provide a basis for proposing activities of daily living adapted to upper limb function.

Miller–Fisher syndrome after first dose of Oxford/AstraZeneca coronavirus disease 2019 vaccine: a case report

IntroductionMiller-Fisher Syndrome (MFS) is a variant of Guillain–Barré syndrome (GBS), an acute immune-mediated neuropathy, which manifests as a rapidly evolving areflex motor paralysis. This syndrome presents as a classic triad: ophthalmoplegia, areflexia, and ataxia. MFS is usually benign and self-limited.Case reportA Caucasian patient was admitted to our hospital with the flu, loss of bilateral strength in the lower limbs and upper limbs and sudden-onset ataxia 7 days after receiving a first dose of the Oxford/AstraZeneca COVID-19 vaccine. On neurological examination, the patient had Glasgow Coma Scale score of 15, with absence of meningeal signs; negative Babinski sign; grade 2 strength in the lower limbs and grade 4 strength in the upper limbs; axial and appendicular cerebellar ataxia; and peripheral facial diparesis predominantly on the right, without conjugate gaze deviation. Cerebrospinal fluid (CSF) was collected on admission, and analysis revealed albuminocytological dissociation with CSF protein of 148.9 mg/dL; leukocytes, 1; chlorine, 122; glucose, 65 mg/mL; red cells, 2; and non-reactive venereal disease research laboratory test result. The COVID-19 IgG/IgM rapid immunological test was negative. Electroneuromyography revealed a recent moderate-grade and primarily sensory and motor demyelinating polyneuropathy with associated proximal motor block.Discussion and conclusionMiller-Fisher Syndrome may be related to events other than infections prior to neuropathy, as in the case reported here. The patient presented strong correlations with findings for MFS reported in the literature, such as the clinical condition, the results of electroneuromyography, and results of the CSF analysis typical for MFS. When treatment was provided as proposed in the literature, the disease evolved with improvement. Ultimately, the diagnosis of incomplete MFS was made, including acute ataxic neuropathy (without ophthalmoplegia).

Guillain Barre Syndrome - Acute Inflammatory Demyelinating Polyneuropathy with Unusual Descending Paralysis

Guillain-Barré syndrome (GBS) is a rare autoimmune, acute fulminant polyradiculoneuropathy. Incidence is between 1- 4 cases per 100,000 per year. It can affect age groups such as both young and old. The distribution depending on age-specificity appears to be bimodal, and has high rates in young adults as well as the elderly. Mostly manifests as rapidly evolving areflexic motor paralysis with a usual ascending type of paralysis. Autonomic involvement is common with usual manifestations of loss of vasomotor control such as BP fluctuations, postural hypotension, and arrhythmias. Deep tendon reflexes are diminished or disappear in the first few days of disease onset. Several cases have been reported with descending type of paralysis, but they were patients of Miller Fischer syndrome variant of GBS. Only 15% of the cases were reported regarding descending type of paralysis in AIDP variant of GBS. Our patient presented with unusual descending paralysis, starting with the upper limbs and progressively involving weakness of the lower limbs. The patient did not have any comorbid illnesses rather than recent gastrointestinal infections. In the progress of the disease, he developed respiratory complications for which he needed ventilator support and with all supportive care and keen monitoring, the patient was weaned off from the ventilator, a tracheostomy done, and improved. Thus presenting a case of Guillain Barre syndrome with an unusual descending type of paralysis and with all other typical symptoms of this condition, who have been treated with high dose IV immunoglobulin, creates awareness in view of diagnosing the disease even with unusual presentation would save the life of the patient, instead presenting the usual case scenario or rare disease case.

Reliability and validity of the public transportation use assessment form for individuals after stroke

Purpose To examine the reliability and validity of the public transportation use assessment form (PTAF), which was developed for assessing the performance of tasks during public transportation use. Materials and methods Fifty consecutive patients admitted after a stroke to a convalescent rehabilitation hospital and received field-based practice for public transportation use were enrolled. A physical therapist (PT) and an occupational therapist (OT) independently evaluated actual participant performance using the PTAF. Its internal consistency, inter-rater reliability, and construct validity were examined against other clinical measures related to the ability to use public transportation. Results Cronbach’s coefficient alpha for the internal consistency for overall PTAF was 0.84 and 0.88 for PTs and OTs, respectively. Cohen’s weighted κ coefficient for the inter-rater reliability for each item ranged from 0.61 to 0.83. Intraclass correlation coefficients for the inter-rater reliability for the mean scores of the items comprising the PTAF were 0.90 for all 14 items, 0.76 for items required for train use only, and 0.88 for items required for bus use only. The correlation coefficients for the construct validity between PTAF and clinical measures ranged from 0.38 to 0.59 (p < 0.05). Conclusions The PTAF showed sufficient internal consistency, intra-rater reliability, and construct validity. Implications for rehabilitation This study illustrated the inter-rater reliability of the public transportation use assessment form (PTAF), indicating that the PTAF can be used for reliable assessment independent of the rater. The PTAF showed good internal consistency, indicating that each item in the PTAF consistently assessed the ability of patients with stroke to use public transportation. The PTAF correlated with assessment tools such as walking ability, balance, motor paralysis, intelligence, and activities of daily living, indicating that it reflects the functions and abilities necessary to use public transportation.

A prospective clinical study on the mechanisms underlying critical illness myopathy-A time-course approach.

Critical illness myopathy (CIM) is a consequence of modern critical care resulting in general muscle wasting and paralyses of all limb and trunk muscles, resulting in prolonged weaning from the ventilator, intensive care unit (ICU) treatment and rehabilitation. CIM is associated with severe morbidity/mortality and significant negative socioeconomic consequences, which has become increasingly evident during the current COVID-19 pandemic, but underlying mechanisms remain elusive. Ten neuro-ICU patients exposed to long-term controlled mechanical ventilation were followed with repeated muscle biopsies, electrophysiology and plasma collection three times per week for up to 12days. Single muscle fibre contractile recordings were conducted on the first and final biopsy, and a multiomics approach was taken to analyse gene and protein expression in muscle and plasma at all collection time points. (i) A progressive preferential myosin loss, the hallmark of CIM, was observed in all neuro-ICU patients during the observation period (myosin:actin ratio decreased from 2.0 in the first to 0.9 in the final biopsy, P<0.001). The myosin loss was coupled to a general transcriptional downregulation of myofibrillar proteins (P<0.05; absolute fold change >2) and activation of protein degradation pathways (false discovery rate [FDR] <0.1), resulting in significant muscle fibre atrophy and loss in force generation capacity, which declined >65% during the 12day observation period (muscle fibre cross-sectional area [CSA] and maximum single muscle fibre force normalized to CSA [specific force] declined 30% [P<0.007] and 50% [P<0.0001], respectively). (ii) Membrane excitability was not affected as indicated by the maintained compound muscle action potential amplitude upon supramaximal stimulation of upper and lower extremity motor nerves. (iii) Analyses of plasma revealed early activation of inflammatory and proinflammatory pathways (FDR<0.1), as well as a redistribution of zinc ions from plasma. The mechanical ventilation-induced lung injury with release of cytokines/chemokines and the complete mechanical silencing uniquely observed in immobilized ICU patients affecting skeletal muscle gene/protein expression are forwarded as the dominant factors triggering CIM.

CHARACTERISTICS OF THE PSYCHO-EMOTIONAL STATE OF PARENTS OF CHILDREN WITH PARALYTIC SYNDROMES AND ITS CHANGES DURING REHABILITATION MEASURES

Abstract. The current strategy for the treatment of chronic pain in children with paralytic syndromes and neurological lesions, defined by the WHO recommendations in 2012. These recommendations provide a multimodal approach of analgesia for the chronic pain treatment, including the widespread use of non-pharmacological methods and pharmacological therapy. Aim. Assessing the subjective vision of parents of children with paralytic syndromes regarding the impact of physical rehabilitation on chronic pain and their psycho-emotional state. Materials and methods. Data from 64 children and their mothers (64 persons) were included in the study. The age of the children ranged from 1 to 6 years, the median age was 3 years and 3 months. Results. The changed psycho-emotional state of parents of children with paralytic syndromes is determined. If the child has chronic pain, the parents: "Concern about the treatment of the child" is doubled (RR=2.1; p=0.0024), "Hyperopia of the child" - twice (RR=1.9; p=0.0094), "Intolerance to observe the suffering of the child" - one and a half times (RR=1.6; p=0.0017), and increases one and a half times "Sadness and anger when a child cries" (RR=1.5; p=0.0122), "Internal tension" (RR=1.5; p=0.0029), "Insomnia" (RR=1.5; p=0.0215), "Inability of the child to lead a normal image life "(RR=1.5; p=0.0035), "Search for compassion or understanding" (RR=1.5; p=0.0446), "Inner anxiety, feeling of possible trouble" (RR=1.5; p=0.0074). After receiving rehabilitation measures, the psycho-emotional state of the parents of children with paralytic syndromes was determined to decrease: "It is intolerable to observe the child's condition" decreased by 31.3% (p=0.0012); "Feelings of inner anxiety" decreased by 24.5% (p=0.0125); "I fall asleep badly due to the child's condition" decreased by 20.6% (p=0.0109); "Internal tension" decreased by 19.6% (p=0.0269); "Sleepless nights due to the condition of the child" decreased by 18.6% (p=0.0401). Conclusion.The authors consider that physical rehabilitation in children with paralytic syndromes reduces the incidence of moderate chronic pain and improves the emotional state of parents. So, we think that new approaches to rehabilitation should be applied with daily management of the children with paralytic syndromes’ needs and their families with increased psychological and social support. Perhaps the searching for new approaches that optimize more intensive and effective rehabilitation strategies using the family reserve will provide the potential for adaptability of nerve plasticity and recovery in such a contingent of children and prospects for the future.

Changes in corticospinal and spinal reflex excitability through functional electrical stimulation with and without observation and imagination of walking.

Functional electrical stimulation (FES), a method for inducing muscle contraction, has been successfully used in gait rehabilitation for patients with deficits after neurological disorders and several clinical studies have found that it can improve gait function after stroke and spinal cord injury. However, FES gait training is not suitable for patients with walking difficulty, such as those with severe motor paralysis of the lower limbs. We have previously shown that action observation combined with motor imagery (AO + MI) of walking induces walking-related cortical activity. Therefore, we combined FES, which alternately generates dorsiflexion and plantar flexion, with AO + MI as an alternative to gait training. The present study investigates the transient effects of 20-min of FES simultaneously with and without AO + MI of walking on corticospinal and spinal reflex excitability in able-bodied participants. We measured motor evoked potentials and Hoffmann-reflexes to assess corticospinal and spinal reflex excitability at rest before and after the 20-min FES with and without the AO + MI. Our results show that FES without AO + MI did not change excitability (p > 0.05), while FES with AO + MI facilitated corticospinal excitability (p < 0.05). This facilitation likely occurred due to the synchronization of sensory inputs from FES and cortical activity during AO + MI. Facilitation was observed only in the dorsiflexor but not the plantar flexor muscle (p < 0.05), suggesting muscle specificity of the facilitation. These results demonstrate the effectiveness of combining FES with AO + MI and pave the way for novel neurorehabilitation strategies for patients with neurological gait deficits.