Hemiparetic Research Articles

The association of dynamic spinal alignment on gait endurance of patients with adult spinal deformity: a cross-sectional study.

The purpose of this study was to evaluate the gait posture of patients with adult spinal deformity (ASD) using a 3-dimensional motion analysis system (3DMAS) and to investigate whether it affects gait endurance. Fifty-one patients with ASD aged 50years or older who were admitted to our hospital between March 2016 and March 2018 were included in the study. The subjects completed the 6-min walking test, which is an indicator of gait endurance. Static standing posture was assessed by whole-spine x-ray examination (coronal cobb angle, CCA; sagittal vertical axis, SVA; pelvic tilt, PT; and pelvic incidence minus lumbar lordosis, PI-LL). In addition, the gait posture was evaluated by a 3DMAS (dynamic trunk tilt angle, DTA; and dynamic pelvic tilt angle, DPA). The relationship between standing and gait postures and gait endurance was investigated by multivariable analysis. In univariable analysis, SVA, PI-LL, and DTA were associated with gait endurance. Furthermore, in the multivariable analysis, DTA showed the strongest association among the static and dynamic parameters (R2 = 0.61, β = - 0.35, P < 0.05). An association was found between gait posture and gait endurance in patients with ASD. These findings can be useful to health care providers treating patients with ASD. It is advisable to assess the gait posture of patients with ASD because they present postural abnormalities during gait.

Improvement in sagittal alignment and mechanical low-back pain following deep brain stimulation for Parkinson's disease: illustrative case.

BACKGROUNDParkinson’s disease (PD) is a common neurogenerative disease marked by the characteristic triad of bradykinesia, rigidity, and tremor. A significant percentage of patients with PD also demonstrate postural abnormalities (camptocormia) that limit ambulation and accelerate degenerative pathologies of the spine. Although deep brain stimulation (DBS) is a well-established treatment for the motor fluctuations and tremor seen in PD, the efficacy of DBS on postural abnormalities in these patients is less clear.OBSERVATIONSThe authors present a patient with a history of PD and prior lumbosacral fusion who underwent bilateral subthalamic nucleus DBS and experienced immediate improvement in sagittal alignment and subjective relief of mechanical low-back pain.LESSONSDBS may improve postural abnormalities seen in PD and potentially delay or reduce the need for spinal deformity surgery.

Suitability of Automated Writing Measures for Clinical Trial Outcome in Writer's Cramp.

Writer's cramp (WC) dystonia is a rare disease that causes abnormal postures during the writing task. Successful research studies for WC and other forms of dystonia are contingent on identifying sensitive and specific measures that relate to the clinical syndrome and achieve a realistic sample size to power research studies for a rare disease. Although prior studies have used writing kinematics, their diagnostic performance remains unclear. This study aimed to evaluate the diagnostic performance of automated measures that distinguish subjects with WC from healthy volunteers. A total of 21 subjects with WC and 22 healthy volunteers performed a sentence-copying assessment on a digital tablet using kinematic and hand recognition softwares. The sensitivity and specificity of automated measures were calculated using a logistic regression model. Power analysis was performed for two clinical research designs using these measures. The test and retest reliability of select automated measures was compared across repeat sentence-copying assessments. Lastly, a correlational analysis with subject- and clinician-rated outcomes was performed to understand the clinical meaning of automated measures. Of the 23 measures analyzed, the measures of word legibility and peak accelerations distinguished subjects with WC from healthy volunteers with high sensitivity and specificity and demonstrated smaller sample sizes suitable for rare disease studies, and the kinematic measures showed high reliability across repeat visits, while both word legibility and peak accelerations measures showed significant correlations with the subject- and clinician-rated outcomes. Novel automated measures that capture key aspects of the disease and are suitable for use in clinical research studies of WC dystonia were identified. © 2022 International Parkinson and Movement Disorder Society.

Measurement Issue in Antecollis.

Background:Antecollis is defined as an involuntary forward flexion of the neck. Previous reports have measured the neck flexion angles based on the line perpendicular to the ground. This led to an inflation of the neck flexion angles in patients who had combined forward truncal flexions, especially upper camptocormia.Methods:We examined the neck flexion angles and the upper camptocormia angle in the published photographs of antecollis. MEDLINE search was conducted using the following search terms: antecollis OR anterocollis. Lateral-view photographs of patients diagnosed with antecollis were collected. Neck flexion angles were measured with the classic ‘perpendicular method’ and the ‘antecollis method’ we developed.Results:Nine patient photographs were identified. While antecollis was the only described postural abnormality in eight cases, these patients exhibited upper camptocormia angles of 45° or larger. The mean neck flexion angle measured with the antecollis method was 49.7°, while the perpendicular method yielded 103.4°.Discussion:Upper camptocormia should be considered in the evaluation of antecollis. We propose a new method to measure neck flexion in relation to the torso, instead of the vertical line.

Prevalence of chronic non-specific low back pain among caregivers of stroke survivors in Kano, Nigeria and factors associated with it: A cross-sectional study.

PurposeLow back pain (LBP) may have a specific or non-specific cause such as abnormal posture or repetitive tasks. For instance, lifting and transferring patients during caregiving for stroke survivors may predispose the caregivers to LBP.ObjectivesThe aim of this study is to determine the prevalence of chronic non-specific LBP and factors associated with it in caregivers of stroke survivors.MethodThe research design used is cross-sectional study design. Participants of the study were caregivers of stroke survivors in Kano, Nigeria who were at least 18 years old. They were included if they had at least one-month experience with caregiving for at least 1 h per day. Presence of LBP and level of disability were assessed using participants' self-report and Rolland Morris Low Back Pain Disability Questionnaire respectively. The data collected was analyzed using descriptive, Chi-square statistics and Binary Logistics Regression.ResultThree hundred caregivers with mean age, 33.24 ± 10.32 years in which 207 and 93 were males and females respectively, participated in the study. The results showed that, there was a high prevalence (64.7%) of LBP among the caregivers. The prevalence was significantly associated with gender (p < 0.001), age (p = 0.029), occupation (p < 0.001) and duration of caregiving (p < 0.001) of the study participants. In addition, the result of the regression model showed that, being a female (p = 0.001), a civil servant (p = 0.031), a trader (p = 0.013), and a complete caregiver (0.001); and caregiving for a duration of 5 h or more per day (p = 0.024) are significant predictors of having LBP. Similarly, level of disability due to the presence of LBP among the study participants was significantly associated with gender (p < 0.001), occupation (p < 0.001), duration of caregiving (p = 0.025), and the nature of the caregiving (p < 0.001).ConclusionInformal caregiving for stroke survivors may result in developing chronic non-specific LBP, especially among females, Civil servants, traders, complete caregivers and those with long duration of caregiving. This can add an additional burden on the family in terms of cost of care, result in reduced quality of caregiving and cause psychological stress. Thus, it is important the health of the caregivers of stroke survivors is considered during stroke rehabilitation.

Voice Alterations, Dysarthria, and Respiratory Derangements in Patients With Parkinson's Disease.

Almost 90% of people with Parkinson's disease (PD) develop voice and speech disorders during the course of the disease. Ventilatory dysfunction is one of the main causes. We aimed to evaluate relationships between respiratory impairments and speech/voice changes in PD. At Day 15 from admission, in consecutive clinically stable PD patients in a neurorehabilitation unit, we collected clinical data as follows: comorbidities, PD severity, motor function and balance, respiratory function at rest (including muscle strength and cough ability), during exercise-induced desaturation and at night, voice function (Voice Handicap Index [VHI] and acoustic analysis [Praat]), speech disorders (Robertson Dysarthria Profile [RDP]), and postural abnormalities. Based on an arbitrary RDP cutoff, two groups with different dysarthria degree were identified-moderate-severe versus no-mild dysarthria-and compared. Of 55 patients analyzed (median value Unified Parkinson's Disease Rating Scale Part II 9 and Part III 17), we found significant impairments in inspiratory and expiratory muscle pressure (&gt; 90%, both), exercise tolerance at 6-min walking distance (96%), nocturnal (12.7%) and exercise-induced (21.8%) desaturation, VHI (34%), and Praat Shimmer% (89%). Patients with moderate-severe dysarthria (16% of total sample) had more comorbidities/disabilities and worse respiratory pattern and postural abnormalities (camptocormia) than those with no-mild dysarthria. Moreover, the risk of presenting nocturnal desaturation, reduced peak expiratory flow, and cough ability was about 11, 13, and 8 times higher in the moderate-severe group. Dysarthria and respiratory dysfunction are closely associated in PD patients, particularly nocturnal desaturation and reduced cough ability. In addition, postural condition could be at the base of both respiratory and voice impairments. https://doi.org/10.23641/asha.21210944.

DELAYED CEREBRAL VENOUS SINUS THROMBOSIS (CSVT) AFTER AN INVASIVE MENINGIOMA RESECTION: AN UNCOMMON PRESENTATION OF A COMMON COMPLICATION

DELAYED CEREBRAL VENOUS SINUS THROMBOSIS (CSVT) AFTER AN INVASIVE MENINGIOMA RESECTION: AN UNCOMMON PRESENTATION OF A COMMON COMPLICATION

PO014 / #468 PRE AND POST OPERATIVE CLINICAL ASSESSMENT OF PATIENTS SUFFRING FOR DYSTONIA: E-POSTER VIEWING

Dystonia is a syndrome characterized by involuntary sustained muscle contractions that result in twisting, repetitive movement and abnormal posture. Dystonia is typically classified by age of onset, origin, and affected body region. When the cause is not defined or unknown, the dystonia is referred to as idiopathic or primary dystonia. Primary dystonia can be familial. Deep brain stimulation is an effective treatment of generalized dystonia.

Bilateral pallidotomy for acquired or heredodegenerative generalized dystonia in children.

Dystonias are relatively rare disorders characterized by sustained or intermittent muscle contractions causing abnormal movements or postures. Generalized dystonia is a therapeutic challenge because medications are unable to control dystonia adequately in most patients. These patients may be candidates for surgical therapy. The commonly used surgical procedures in these patients are pallidotomy and deep brain stimulation. Limited studies are available on the role of pallidotomy in children with acquired/heredodegenerative generalized dystonia. The objective of this study was to describe the authors' experience with bilateral pallidotomy in this group of patients. The authors retrospectively reviewed all pediatric patients (less than 18 years of age) with acquired/heredodegenerative generalized dystonia who underwent bilateral simultaneous pallidotomy at their center between January 2014 and January 2021. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores before and after surgery were recorded. Complications arising after the procedure were recorded as well. Ten patients (8 male and 2 female) with a mean (range) age of 11.1 (5-17) years were included in this study. The mean duration between disease onset and surgical intervention was 3.9 years. Two patients presented in status dystonicus. The mean ± SD (range) preoperative BFMDRS score of the patients without status dystonicus (n = 8) was 80 ± 18.9 (59.5-108). The mean ± SD BFMDRS score at the time of discharge from the hospital after surgery was 58.8 ± 37.9. Three patients had more than 20% change in BFMDRS score at the time of discharge from the hospital. The mean improvement was 25.5% at the end of 1 year. Of 5 surviving patients in the non-status dystonicus group, 3 patients had more than 40% change in BFMDRS score while the other 2 patients developed recurrence at the last follow-up (4.5 years). Status dystonicus abated after bilateral pallidotomy in both patients. Permanent bulbar complications were seen in 2 patients. Bilateral pallidotomy may result in clinically significant improvement in children with acquired/heredodegenerative generalized dystonia, although the benefits should be closely weighed against the risk of irreversible bulbar dysfunction. It is a viable option for children in resource-limited settings.

Effect of Interactive Virtual Reality Device on Cervical Pain and Neck Function in Forward Head Posture

One of the most prevalent postural abnormalities, forward head posture (FHP), is affecting 66% of the population of patients. Bad interaction between bodily components results in poor posture. These can result in muscle tightening and tension that will make it harder to move your joints properly and may even hurt

THE EVOLVING MANAGEMENT OF CYSTIC FIBROSIS

Introduction: Cystic fibrosis is a genetic pathological condition, affecting chromosome 7, which encodes the CFTR protein. This pathology is characterised by abundant mucus production, which in turn leads to blockage of the airways and blockage of the digestive tract. Objective: The aim of this literature review is to gather the largest available amount of information related to cystic fibrosis and analyse it in detail, indicating the results and expectations that have been had with the use of some drugs over time in patients with cystic fibrosis. It is also intended to mention updates of procedures and their effectiveness. Methodology: a systematic and complete search was carried out using the Cochrane Library database, with the term Cystic Fibrosis. The documents found were in Spanish and English. Some articles were excluded due to lack of updated information. Results: Inhalation Dornase alfa alfa is a useful drug for airway improvement and mucus viscosity reduction, as are bronchodilators. Pancreatic enzymes and ursodeoxycholic acid are beneficial in the gastrointestinal area, reducing intestinal symptomatology. In patients with diabetes, Insulin is preferred. Only glutathione has a beneficial effect in patients with cystic fibrosis. Rehabilitation and management of postural abnormalities is vital to improve patients lives. In patients with nutritional deficiencies, nasogastric tube placement or gastrostomy is preferred to improve their nutrition. Conclusions: Cystic fibrosis is a disease that has an inevitable progression. The treatments studied here show that they only help quality of life and pulmonary and gastrointestinal functions temporarily. Further studies are needed to determine therapies that can significantly improve patients, both physically and psychologically; and who knows, some therapy or therapies that may lead to a cure for this disease. KEYWORDS: Cystic fibrosis, exacerbation, rehabilitation, bronchodilators, antibiotics.

Evaluation of Rhesus Macaque Models for Cerebral Palsy.

Simple SummaryCerebral palsy (CP) is caused by a non-progressive injury that affects the central nervous system during early development. According to the World Health Organization, CP occurs in approximately 2–4 of 1000 newborns. Animal models, especially non-human primate models, have greatly assisted our understanding of CP, and have provided simulative objects for treatment. In this study, the rhesus macaque CP models were established by partial resection of the motor cortex and the intrathecal injection of bilirubin. We evaluated abnormal posture, motor dysfunction, gross and fine motor behavior, muscular tension of rhesus macaque CP models, and changes in the cerebral cortex and basal ganglia, the last of which were observed using magnetic resonance imaging. This model evaluation methodology may guide researchers through the model building process. The findings serve as a reference for establishing and assessing non-human primate CP models.Animal models play a central role in all areas of biomedical research. The similarities in anatomical structure and physiological characteristics shared by non-human primates (NHPs) and humans make NHPs ideal models with which to study human disorders, such as cerebral palsy (CP). However, the methodologies for systematically evaluating NHP models of CP have rarely been assessed, despite the long history of using NHP models to understand CP. Such models should be evaluated using multidisciplinary approaches prior to being used to research the diagnosis and treatment of CP. In this study, we evaluated rhesus macaque CP models established by partial resection of the motor cortex and intrathecal injection of bilirubin. Abnormal posture, motor dysfunction, gross and fine motor behavior, and muscular tension were evaluated, and changes in the cerebral cortex and basal ganglia were observed using 9.4 T magnetic resonance imaging. The results clearly demonstrated the utility of the established evaluation methodology for assessing CP models. This model evaluation methodology may guide researchers through the model building process.

Prevalence of axial postural abnormalities and their subtypes in Parkinson's disease: a systematic review and meta-analysis.

Axial postural abnormalities, mainly involving the spinal deformities, are disabling symptoms of Parkinson's disease (PD). However, the prevalence of axial postural abnormalities in PD and their clinical correlates remain unclear. The present study aimed to conduct a systematic review and meta-analysis of the prevalence of overall and subtypes of axial postural abnormalities in PD. PubMed, Embase, Web of Science and Cochrane databases were searched up to 31st March, 2022. We identified studies that reported the prevalence of axial postural abnormalities in PD. The pooled estimate of prevalence was calculated using a random effect model. Subgroup analysis and meta-regression were performed. There were 19 studies met the inclusion criteria. The overall prevalence of axial postural abnormalities in PD was 22.1% (95% CI 19.7-24.5%). The prevalence of each subtype of axial postural abnormalities was 19.6% for scoliosis (95% CI 10.6-28.7%), 10.2% for camptocormia (95% CI 7.7-12.7%), 8% for Pisa syndrome (95% CI 4.7-11.4%), and 7.9% for antecollis (95% CI 3.9-11.9%). Subgroup analysis showed that the measuring method of axial postural abnormalities exerted significant effects on prevalence estimates. Axial postural abnormalities in PD were associated with older age, longer disease duration, higher H-Y stage, greater levodopa equivalent daily dose, more severe motor symptoms, motor fluctuations, and akinetic-rigid subtype. Axial postural abnormalities, which include scoliosis, camptocormia, Pisa syndrome, and antecollis, are not uncommon in patients with PD. Future research on axial postural abnormalities should be based on uniform diagnostic criteria and measuring methods.

Making waves: The changing tide of cerebral palsy.

Cerebral palsy (CP) is a broad diagnosis unbound by aetiology and is based on a clinical examination demonstrating abnormalities of movement or posture. CP represents a static neurological condition, provided that neurodegenerative conditions, leukoencephalopathies and neuromuscular disorders are excluded. In paediatrics, the genetic conditions associated with CP are rapidly increasing, with primary and overlapping neurodevelopmental conditions perhaps better categorised by the predominant clinical feature such as CP, intellectual disability, autism spectrum disorder or epilepsy. Progress in molecular genetics may challenge what constitutes CP, but a genetic diagnosis does not negate the CP diagnosis. As clinicians working in the field, we discuss the changing tide of CP. Neuroimaging provides essential information through pattern recognition and demonstration of static brain changes. We present examples of children where a layered clinical diagnosis or dual aetiologies are appropriate. We also present examples of children with genetic causes of CP to highlight the challenges and limitations of neuroimaging to provide an aetiological diagnosis. In consultation with a geneticist, access to genomic testing (exome or genome sequencing) is now available in Australia under Medicare billing for children under the age of 10 with dysmorphic features, one or more major structural organ anomalies, (an evolving) intellectual disability or global developmental delay. We encourage the uptake of genomic testing in CP, because it can be difficult to tell whether a child has an environmental or genetic cause for CP. A specific genetic diagnosis may change patient management, reduce guilt and enable more distinctive research in the future to assist with understanding disease mechanisms.

Paradoxical worsening of bradycardia following atropine administration.

Bradyarrhythmias are a common entity in both emergency and out-of-hospital (OOH) medicine. In unstable bradycardic patients, paramedics will often initiate life-saving therapies in the OOH setting. Clinical guidelines for bradyarrhythmias are largely consistent across the globe, with intravenous (IV) atropine recommended as a first-line therapy, escalating to IV adrenaline or isoprenaline and transcutaneous pacing where atropine is unsuccessful. In this case report, we describe a case in the OOH setting of ventricular standstill following the administration of atropine to a patient with bradycardia and 2:1 heart block. The patient was a 77-year-old female presenting with a symptomatic 2:1 heart block. Following a single dose of 600 micrograms IV atropine, the patient deteriorated into ventricular standstill with a loss of consciousness and decorticate posturing. The patient was successfully managed with an IV infusion of adrenaline and subsequently received an implanted pacemaker in hospital. The paradoxical worsening of this patient's bradycardia following atropine administration may have been related to the location of the heart block. It has been shown that patients with atrioventricular blocks at the level of the His-Purkinje fibres (infranodal) are at an increased risk of adverse events following atropine administration, while those at the nodal level or secondary to increased vagal tone are more likely to respond favourably. Paramedics should be prepared to manage unexpected adverse events secondary to atropine administration in patients with heart block.

Quantitative behavioral evaluation of a non-human primate stroke model using a new monitoring system.

BackgroundRecently, the common marmoset (Callithrix jacchus) has attracted significant interest as a non-human primate stroke model. Functional impairment in non-human primate stroke models should be evaluated quantitatively and successively after stroke, but conventional observational assessments of behavior cannot fully fit this purpose. In this paper, we report a behavioral analysis using MarmoDetector, a three-dimensional motion analysis, in an ischemic stroke model using photosensitive dye, along with an observational behavioral assessment and imaging examination.MethodsIschemic stroke was induced in the left hemisphere of three marmosets. Cerebral infarction was induced by intravenous injection of rose bengal and irradiation with green light. The following day, the success of the procedure was confirmed by magnetic resonance imaging (MRI). The distance traveled, speed, activity time, and jumps/climbs were observed for 28 days after stroke using MarmoDetector. We also assessed the marmosets’ specific movements and postural abnormalities using conventional neurological scores.ResultsMagnetic resonance imaging diffusion-weighted and T2-weighted images showed hyperintense signals, indicating cerebral infarction in all three marmosets. MarmoDetector data showed that the both indices immediately after stroke onset and gradually improved over weeks. Neurological scores were the worst immediately after stroke and did not recover to pre-infarction levels during the observation period (28 days). A significant correlation was observed between MarmoDetector data and conventional neurological scores.ConclusionIn this study, we showed that MarmoDetector can quantitatively evaluate behavioral changes in the acute to subacute phases stroke models. This technique can be practical for research on the pathophysiology of ischemic stroke and for the development of new therapeutic methods.

The Incidence of Body Posture Abnormalities in Relation to the Segmental Body Composition in Early School-Aged Children.

Children are exposed to multiple factors that contribute to an increase in body mass and the development of posture defects. The aim of the study is to assess the relationship between the segmental distribution of fat mass and muscle mass and the incidence of body posture abnormalities in early school-aged children. A total of 190 children aged 7–9 were included in the research project. The examined children were divided according to age (class level) into three groups. Height, weight and body composition, BMI, and body posture were determined. Thoracic and lumbar spine abnormalities occurred most frequently in the examined children (7–95%, 8–92%, 9–89.5%). During the assessment of the segmental body composition, the lowest fat–fat-free index was found in the trunk. The number of abnormalities of the cervical spine, pelvis, and lower extremities increases with age. The number of abnormalities of the thoracic and lumbar spine, as well as of upper extremities and the pectoral girdle decreases with age. Body posture abnormalities are correlated with body composition and in particular with the fat mass percentage. The segmental body com-position analyzer can be used to screen for posture defects.

Postural limb abnormality: an unusual presentation of retroperitoneal Schwannoma

Schwannoma is a tumor of soft tissue originating from Schwann cells that rarely appears in the retroperitoneum. Presentation depends on the site of disease leading to mostly pressure symptoms, sometimes with distal manifestations. Because of its complex location, it has varied presentations and is always a diagnostic dilemma. We reported a rare case of retroperitoneal schwannoma having mild difficulty in walking due to flexion deformity of left hip joint as the only initial presenting symptoms. Following imaging studies, a retroperitoneal mass was found. Partial excision of the tumor was performed, with the histology finding consistent with the retroperitoneal schwannoma. Patient was followed up for the last 2 years and had no evidence of recurrence.

MRM2 variants in families with complex dystonic syndromes: evidence for phenotypic heterogeneity

BackgroundDystonia involves repetitive movements and muscle contractions leading to abnormal postures. We investigated patients in two families, DYAF11 and M, exhibiting dystonic or involuntary movement disorders.MethodsClinical investigations were performed for...

Association between the dysfunctions of the stomatognathic system and the disorders in the statics of the body

INTRODUCTION The stomatognathic system is a group of tissues and organs consisting of: the mandible, teeth (upper and lower), two temporomandibular joints, muscles, ligaments and numerous vessels: nerve, blood and lymph. We define the body posture as an individual, individual feature of each person, which is expressed by the figure. A defect of posture or a disorder of the body statics is any anomaly from the correct posture that may be congenital or acquired.&#x0D; OBJECTIVE The main aim of the study was to assess the relationship between dysfunctions of the stomatognathic system and disturbances in body statics. The research was conducted from January to February 2022 using the proprietary questionnaire, which was made available online (Google Forms).&#x0D; RESULTS At least one symptom of body statics disorders was noticeable in 77 people from the group of people with problems within the stomatognathic system (88,51%). Only 10 people with disorders of the masticatory system motor system did not report any postural abnormalities (11,49%). The results of the research show that there is a statistically significant relationship between the occurrence of dysfunctions within the stomatognathic system and disturbances in body statics (x2 = 28,11 &gt; x2 = 22,4570,001;6 - statistically significant relationship, rc = 0,304 - average strength of the relationship).&#x0D; CONCLUSIONS The complexity of the issue shows that focusing on only one problem may not produce the measured therapeutic effects. Only comprehensive and properly planned treatment brings the maximum therapeutic effect.