Recovery Of Limb Function Research Articles

Abdominal muscle strength and the recovery of upper extremity function in stroke patients: a study using propensity score matching

Purpose The purpose of this study was to understand the relationship between abdominal muscle strength and recovery of upper limb function, after adjusting for various confounding factors, such as age, gender, and sensory function. Methods We retrospectively analyzed data of 78 sub-acute stroke patients with mild-to-moderate upper limb dysfunction. Participants were divided into two groups, strong and weak, according to the abdominal muscle strength. The improvement of scores on the Simple Test for Evaluating Hand Function was compared between the groups. We employed propensity score matching to adjust for numerous relevant variables, including age, affected side, duration from onset, upper limb function, grip strength, sensory function, visuospatial perception, motivation, and cognitive function at admission. Results The improvement of scores on the Simple Test for Evaluating Hand Function of the strong group was significantly larger than the weak one, both before and after matching. This trend was noted in the subgroup analysis of participants with moderate dysfunction on admission; however; the trend was not clearly noticeable in participants with mild dysfunction. Conclusions Our results suggest that abdominal muscle strength is significantly associated with the recovery of upper limb function in sub-acute stroke patients, especially in those with moderate upper limb dysfunction. Implications for Rehabilitation Abdominal muscle strength is associated with the recovery of upper limb function in subacute stroke patients with moderate upper limb dysfunction. Abdominal muscle strength can be used as a predictive factor for the prognosis of upper limb function in stroke patients.

Limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation

Objective: To explore the limb salvage strategies for patients with high voltage electric burns of extremities on the verge of amputation. Methods: From January 2003 to March 2019, 61 patients with high voltage electric burns of extremities on the verge of amputation were treated in our hospital. All of them were male, aged 15-58 years, including 49 cases of upper limbs and 12 cases of lower limbs. The wound area after thorough debridement ranged from 15 cm×11 cm to 35 cm×20 cm. Emergency surgery for reconstruction of the radial artery with saphenous vein graft under eschar was performed in 5 cases. The arteries of 36 patients (including 7 cases with simultaneous ulnar artery and radial artery reconstruction) were reconstructed with various forms of blood flow-through after debridement, among them, the radial artery of 13 cases, the ulnar artery of 8 cases, the brachial artery of 8 cases, and the femoral artery of 2 cases were reconstructed with saphenous vein graft; the radial artery of 3 cases and the ulnar artery of 7 cases were reconstructed with the descending branch of the lateral circumflex femoral artery graft; the radial artery of 2 cases were reconstructed with greater omentum vascular graft; the reflux vein of 3 cases with wrist and forearm annular electric burns were reconstructed with saphenous vein graft. According to the actual situation of the patients, 12 cases of latissimus dorsi myocutaneous flap, 6 cases of paraumbilical flap, 28 cases of anterolateral thigh flap, 10 cases of abdominal combined axial flap, 5 cases of greater omentum combined with flap and/or skin grafts were used to repair the wounds after debridement and cover the main wounds as much as possible. Some cases were filled with muscle flap in deep defect at the same time. The area of tissue flaps ranged from 10 cm×10 cm to 38 cm×22 cm. For particularly large wounds and annular wounds, the latissimus dorsi myocutaneous flap, the paraumbilical flap, the abdominal combined axial flap, and the greater omentum combined with flap and/or skin grafts were used more often. Donor sites of three patients were closed directly, and those of 58 patients were repaired with thin and medium split-thickness skin or mesh skin grafts. The outcome of limb salvage, flap survival, and follow-up of patients in this group were recorded. Results: All the transplanted tissue flaps survived in 61 patients. Fifty-six patients had successful limb salvage, among them, 31 limbs were healed after primary surgery; 20 limbs with flap infection and tissue necrosis survived after debridement and flap sutured in situ; 5 limbs with flap infection, radial artery thrombosis, and hand blood supply crisis survived after debridement and radial artery reconstruction with saphenous vein graft. Five patients had limb salvage failure, among them, 3 patients with wrist electric burns had embolism on the distal end of the transplanted blood vessels, without condition of re-anastomosis, and the hands gradually necrotized; although the upper limb of one patient was salvaged at first, due to the extensive necrosis and infection at the distal radius and ulna and the existence of hand blood supply under flap, considering prognostic function and economic benefits, amputation was required by the patient; although the foot of one patient was salvaged at first, due to the repeated infection, sinus formation, extensive bone necrosis of foot under flap, dullness of sole and dysfunction in walking for a long time, amputation was required by the patient. During the follow-up of 6 months to 5 years, 56 patients had adequate blood supply in the salvaged limbs, satisfied appearance of flaps, and certain recovery of limb function. Conclusions: Timely revascularization, early thorough debridement, and transplantation of large free tissue flap, combined tissue flap, or blood flow-through flap with rich blood supply are the basic factors to get better limb preservation and recovery of certain functions for patients with high voltage electric burns of limbs on the verge of amputation.

Recovery of upper limb function is greatest early after stroke but does continue to improve during the chronic phase: a two-year, observational study

ObjectivesInvestigate upper limb (UL) capacity and performance from <14-days to 24-months post stroke. DesignLongitudinal study of participants with acute stroke, assessed ≤14-days, 6-weeks, 3-, 6-, 12-, 18-, and 24-months post stroke. SettingTwo acute stroke units. Main outcome measuresExamination of UL capacity using Chedoke McMaster Stroke Assessment (combined arm and hand scores, 0–14), performance using Motor Activity Log (amount of movement and quality of movement, scored 0–5), and grip strength (kg) using Jamar dynamometer. Random effects regression models were performed to explore the change in outcomes at each time point. Routine clinical imaging was used to describe stroke location as cortical, subcortical or mixed. ResultsThirty-four participants were enrolled: median age 67.7 years (IQR 60.7–76.2), NIHSS 11.5 (IQR 8.5–16), female n=10 (36%). The monthly rate of change for all measures was consistently greatest in the 6-weeks post baseline. On average, significant improvements were observed to 12-months in amount of use (median improvement 1.81, 95% CI 1.35 to 2.27) and strength (median improvement 8.29, 95% CI 5.90 to 10.67); while motor capacity (median improvement 4.70, 95% CI 3.8 to 5.6) and quality of movement (median improvement 1.83, 95% CI 1.37 to 2.3) improved to 18-months post stroke. Some individuals were still demonstrating gains at 24-months post stroke within each stroke location group. ConclusionThis study highlights that the greatest rate of improvement of UL capacity and performance occurs early post stroke. At the group level, improvements were evident at 12- to 18-months post stroke, but at the individual level improvements were observed at 24-months. Clinical trial registrationACTRN12612000123842.

Transient pelvic limb neuropathy following proximal metatarsal and tarsal magnetic resonance imaging in seven horses

Pelvic limb neuropathy is a rare post-anaesthetic complication. In the authors' experiences, the incidence of post-anaesthesia neuropathy is increased following MRI of the proximal metatarsus and tarsal regions when compared with previously reported incidences of post-anaesthetic neuropathy. This study reports the incidence, diagnosis, treatment and outcome of seven horses with post-anaesthesia neuropathy following proximal metatarsal and tarsal MRI. Retrospective case series. Case record review of horses receiving general anaesthesia for MRI between 1 January 2012 and 31 December 2017. A total of 1134 MRI procedures were performed and reviewed for analysis. Eight cases of neuropathy were identified in 1088 limb scans (0.74%). Of these cases, one was subsequent to thoracic limb imaging (1/834; 0.12%) and seven were subsequent to imaging of proximal metatarsal and/or tarsal structures (7/181; 3.9%). Following proximal metatarsal and/or tarsal MRI, transient nondependent limb femoral neuropathy developed in six of the seven affected horses, with one additional horse developing peroneal neuropathy of the dependent limb. Recovery of pelvic limb function occurred within 72h and 9days in six and one horse, respectively. Anaesthetic protocol and neuropathy treatment for the affected horses were not standardised. Though an uncommon complication in horses, transient neuropathy may occur more frequently following MRI of the proximal metatarsal and tarsal structures when compared with other MRI scans. This may be due to patient positioning and the requirement for limb traction for MRI of more proximal regions. Supportive care facilitates rapid return to function.

GSK-3 Inhibitor Promotes Neuronal Cell Regeneration and Functional Recovery in a Rat Model of Spinal Cord Injury.

The reparative process following spinal cord injury (SCI) is extremely complicated. Cells in the microenvironment express multiple inhibitory factors that affect axonal regeneration over a prolonged period of time. The axon growth inhibitory factor glycogen synthase kinase-3 (GSK-3) is an important factor during these processes. TDZD-8 (4-benzyl-2-methyl-1,2,4-thiadiazolidine-3,5-dione) is the most effective and specific non-ATP-competitive inhibitor of GSK-3. Here, we show that administering TDZD-8 after SCI was associated with significantly inhibited neuronal apoptosis, upregulated GAP-43 expression, increased density of cortical spinal tract fibers around areas of injury, and increased Basso, Beattie, and Bresnahan (BBB) scores in the lower limbs. These findings support the notion that GSK-3 inhibitors promote neuronal cell regeneration and lower limb functional recovery.

Evidence-based practice ‘on-the-go’: using ViaTherapy as a tool to enhance clinical decision making in upper limb rehabilitation after stroke, a quality improvement initiative

Recovery of upper limb function after stroke is currently sub-optimal, despite good quality evidence showing that interventions enabling repetitive practice of task-specific activity are effective in improving function. Therapists need...

Repair effect of bFGF combined with bone marrow mesenchymal stem cells on spinal cord injury in rats

To observe the repair effect of bone marrow mesenchymal stem cells (BMSCs) combined with basic fibroblast growth factor (bFGF) on spinal cord injury in rats and explore its mechanism. SD rat BMSCs were obtained by serum culture technique. Eighty healthy 6-week-old male SD rats(weight about 240 g) were randomly divided into 4 groups with 20 each. The sham operation group underwent simple laminectomy without damaging spinal cord and was kept in the same condition as the other 3 groups. The other 3 groups underwent left T9 spinal cord hemisection to establish spinal cord injury model. After 9 days of modeling the local transplantation was performed. The Control group was implanted with gelatin sponge containing normal saline. The BMSCs transplantation group was implanted with gelatin sponge containing BMSCs. The bFGF+BMSCs transplantation group was implanted with gelatin sponge containing bFGF+BMSCs. After 4 and 8 weeks, the expression of NF-200 and GFAP in injured spinal cord tissue was analyzed by Western blotting and the recovery of hind limb function was evaluated by Basso Beattie Bresnahan(BBB) motor function score scale. The BBB scores of BMSCs transplantation group and bFGF+BMSCs transplantation group were better than control group at 4 and 8 weeks after operation (P<0.05) and there was significant difference between bFGF+BMSCs transplantation group and BMSCs transplantation group (P<0.05). After 4 and 8 weeks postoperatively, NF-200 expression was minimal in control group and only a small amount was expressed in BMSCs transplantation group while in bFGF+BMSCs transplantation group NF-200 was highly expressed(P<0.05). GFAP expression was high in control group, middle in BMSCs transplantation group and low in bFGF BMSCs transplantation group(P<0.05). There was significant difference between bFGF+BMSCs transplantation group, BMSCs transplantation group and control group(P<0.05). The combined transplantation of BMSCs and bFGF can repair the spinal cord injury in rats. The mechanism may be related to the decrease of GFAP expression and the increase of NF-200 expression.

Lesion location impact on functional recovery of the hemiparetic upper limb.

The effect of stroke topography on the recovery of hemiparetic upper limb (HUL) function is unclear due to limitations in previous studies–examination of lesion effects only in one point of time, or grouping together patients with left and right hemispheric damage (LHD, RHD), or disregard to different lesion impact on proximal and distal operations. Here we used voxel-based lesion symptom mapping (VLSM) to investigate the impact of stroke topography on HUL function taking into consideration the effects of (a) assessment time (subacute, chronic phases), (b) side of damaged hemisphere (left, right), (c) HUL part (proximal, distal). HUL function was examined in 3 groups of patients—Subacute (n = 130), Chronic (n = 66), and Delta (n = 49; patients examined both in the subacute and chronic phases)–using the proximal and distal sub-divisions of the Fugl-Meyer (FM) and the Box and Blocks (B&B) tests. HUL function following LHD tended to be affected in the subacute phase mainly by damage to white matter tracts, the putamen and the insula. In the chronic phase, a similar pattern was shown for B&B performance, whereas FM performance was affected by damage only to the white matter tracts. HUL function following RHD was affected in both phases, mainly by damage to the basal ganglia, white matter tracts and the insula, along with a restricted effect of damage to other cortical structures. In the chronic phase HUL function following RHD was affected also by damage to the thalamus. In the small Delta groups the following trends were found: In LHD patients, delayed motor recovery, captured by the B&B test, was affected by damage to the sensory-motor cortex, white matter association fibers and parts of the perisilvian cortex. In the RHD patients of the Delta group, delayed motor recovery was affected by damage to white matter projection fibers. Proximal and distal HUL functions examined in LHD patients (both in the subacute and chronic phases) tended to be affected by similar structures—mainly white matter projection tracts. In RHD patients, a distinction between proximal and distal HUL functions was found in the subacute but not in the chronic phase, with proximal and distal HUL functions affected by similar subcortical and cortical structures, except for an additional impact of damage to the superior temporal cortex and the retro-lenticular internal capsule only on proximal HUL function. The current study suggests the existence of important differences between the functional neuroanatomy underlying motor recovery following left and right hemisphere damage. A trend for different lesion effects was shown for residual proximal and distal HUL motor control. The study corroborates earlier findings showing an effect of the time after stroke onset (subacute, chronic) on the results of VLSM analyses. Further studies with larger sample size are required for the validation of these results.

Removal of an endometrioma passing through the left greater sciatic foramen using a concomitant laparoscopic and transgluteal approach: case report

BackgroundThe combination of intrapelvic and extrapelvic endometriosis is a very rare condition in gynecology. Patients with endometriosis involving the sciatic nerve are easily misdiagnosed because they usually present with atypical symptoms of endometriosis. Here, we present a rare case of an endometrioma passing through the left greater sciatic foramen. Removal of the endometriotic lesion was performed with a concomitant laparoscopic and transgluteal approach through the cooperation of gynecologists and orthopedic (neuro)surgeons.Case presentationA 20-year-old woman presented with complaints of severe dysmenorrhea lasting for more than 6 years and dysfunction of her left lower limb lasting for approximately 4 months. Both CT and MRI demonstrated a suspected intrapelvic and extrapelvic endometriotic cyst (7.3 cm × 8.1 cm × 6.5 cm) passing through the left greater sciatic foramen. Laparoscopic exploration showed a cyst full of dark fluid occupying the left obturator fossa and extending outside the pelvis. A novel combination of transgluteal laparoscopy was performed for complete resection of the cyst and decompression of the sciatic nerve. Postoperative pathology confirmed the diagnosis of endometriosis. Long-term follow-up observation showed persistent pain relief and lower limb function recovery in the patient.Discussion and conclusionsWhen a woman complains of unexplained unilateral sciatica, especially a woman suffering from dysmenorrhea, endometriosis of the sciatica nerve should be considered as a potential etiology. Complete excision of the endometriotic lesion and adequate neurolysis (or decompression) of the sciatic nerve through the multidisciplinary cooperation of experienced gynecologists with proper training in laparoscopic pelvic (neuro)surgery and orthopedic (neuro)surgeons is effective.

The effectiveness of virtual reality therapy in relieving upper limb hemiparesis after stroke: A meta-analysis of randomized and controlled trials

Objective To analyze the clinical efficacy of using virtual reality (VR) to improve the upper limb function of hemiplegic persons. Methods A search was conducted in the PubMed, Cochrane Library, EMBASE, CNKI and Wanfang Data as well as VIP for reports of randomized and controlled studies of using VR in training upper limb function after stroke. A meta-analysis was then performed using version 5.3 of the Review Manager software. Results Ninety studies involving 879 patients were found and analyzed. The data showed that VR was significantly more effective than conventional training in improving Fugl-Meyer assessment scores. It was not superior, however, in improving average Functional Independence Measure scores or performance in the box and blocks test. Conclusion VR is superior to conventional training in promoting the recovery of upper limb function after a stroke. Key words: Stroke; Hemiplegia; Virtual reality; Upper extremities; Meta-analyses

Time course of sensorimotor cortex reorganization during upper extremity task accompanying motor recovery early after stroke: An fNIRS study.

The acute phase of stroke is accompanied by functional changes and interplay of both hemispheres. However, our understanding of how the time course of upper limb functional motor recovery is related to the progression of brain reorganization in the sensorimotor areas remains limited. This study aimed to assess the time course of hemodynamic patterns of cortical sensorimotor areas using functional near infrared spectroscopy (fNIRS) and motor recovery within three months after a stroke. Eight right-handed first ischemic/hemorrhagic stroke patients (60±8 years, 3 women) with mild to severe hemiparesis were examined with repetitive fNIRS measurements and motor recovery tests (Fugl-Meyer score) during two months. Hemodynamic changes over the ipsilesional and contralesional sensorimotor areas were collected from a multi-channel fNIRS system during intermittent isometric muscle contractions at self-selected submaximal force levels for each arm. Lateralization index was computed to evaluate the changes in the interhemispheric balance between the cortical sensorimotor areas. Lateralization index values during non-paretic arm movements showed no significant changes over time in patients and were comparable to those observed in eight healthy controls. Paretic-arm movements were associated early with a bilateral cortical activity before shifting to ipsilesional patterns (p < 0.01). Progressive lateralization observed over the two months (p < 0.05) evolved concomitantly with an increase in the Fugl-Meyer score (p < 0.001). Cortical reorganization monitoring using fNIRS during the first weeks after stroke may be applied for assessing progressive brain plasticity in addition to clinical measures of performance.

Application of individualized health education on limb function recovery in patients with intracranial tumor

Objective To explore the value of individualized health education in early rehabilitation therapy after surgery in patients with intracranial tumor and its effects on patients' limb function recovery. Methods Totally 88 patients with intracranial tumor treated in the First Affiliated Hospital of Hainan Medical University from June 2015 to November 2017 were selected by cross-sectional sampling and divided into the treatment group (n=44) and the control group (n=44) according to the random number table. All the patients received surgery. Patients in the control group received conventional nursing intervention, while patients in the treatment group received individualized health education. Short Form 36 Questionnaire (SF-36) and Simplified Fugl-Meyer Assessment of Motor Recovery (SFMA) were used to evaluate the quality of life and limb function recovery of the two groups after nursing care. Results The quality of life score of the treatment group was (90.47±5.67) , better than that of the control group, which was (79.84±4.77) , and there was statistically significant difference between the two groups (P<0.05) after nursing care. The limb function score of the treatment group was (89.68±5.77) , better than that of the control group, which was (80.10±4.02) , and there was statistically significant difference between the two groups (P<0.05) after nursing care. Conclusions Individualized health education provided as early as possible for patients with intracranial tumor is of great significance in improving patients' quality of life and limb function recovery, which is worth promoting in clinical practice. Key words: Intracranial neoplasms; Quality of life; Individualized health education; Limb function

Combined transplantation of bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery for the reconstruction of large area tissue defects of upper limbs

Objective To explore the feasibility and clinical efficacy of combined transplantation of bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery for the reconstruction of large area tissue defects of upper limbs. Methods From January 2014 to June 2018, 22 patients with large area skin and soft tissue defects of upper extremities were treated with bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery. The donor site was closed directly. The wound involved upper arm, forearm, hand and elbow stump. The area of defect ranged from 16 cm×13 cm to 40 cm×15 cm. Results Twenty-one cases (95.45%) of the combined flaps survived completely. One case had partial necrosis of the distal part of the flap, which was healed by second-stage skin grafting. The donor sites of the flaps were closed directly and achieved primary healing without complications. The follow-up period ranged from 3 to 38 months with an average of 20 months. All the cases had good wound healing and limb functional recovery. Conclusion The combined transplantation of bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery is an effective method for repairing large skin and soft tissue defects of upper extremities. The operation is simple, the perforator vessel is reliable and the flaps can be cut in large area with less damage to donor site. Key words: Upper extremity; Surgical flaps; Descending branch of lateral circumflex femoral artery; Upper extremity reconstruction

Closed reduction combined with Taylor three-dimensional space stent fixation for supracondylar femoral fracture in children

To explore the effectiveness and safety of closed reduction combined with Taylor three-dimensional space stent fixation in treatment of supracondylar femoral fractures in children. Between July 2008 and July 2016, 20 patients with supracondylar femoral fractures were treated with closed reduction combined with Taylor three-dimensional space stent fixation. There were 14 males and 6 females, with an average age of 10.3 years (range, 6-14 years). The cause of injury was traffic accident in 5 cases, falling from high place in 6 cases, and falling in 9 cases. All fractures were closed fractures. Among them, 12 cases were flexion type and 8 cases were straight type. According to AO classification, 12 cases were rated as type A1 and 8 cases as type A2. The fractures were over 0.5-5.0 cm (mean, 2.5 cm) of the epiphysis line. The time from injury to surgery was 2-8 days (mean, 3.5 days). Postoperative knee joint function was evaluated based on the Kolment evaluation criteria. All children were followed up 6-24 months (mean, 18.1 months). There was no complication such as nail infection, vascular nerve injury, external fixation looseing, fracture displacement, or re-fracture. All fractures healed and the fracture healing time was 4-6 weeks with an average of 4.5 weeks. The stent removal time was 8-12 weeks (mean, 9.5 weeks). The gait and knee function recovered, and there was no abnormality of the epiphysis. At last follow-up, the knee joint function were excellent in 18 cases and good in 2 cases according to the Kolment evaluation criteria, and the excellent and good rate was 100%. Closed reduction combined with Taylor three-dimensional space stent fixation is an effective treatment for the children with supracondylar femoral fractures, with small trauma and rapid recovery. It can avoid damaging the tarsal plate, be high fracture healing rate, and promote the recovery of limb function.

Application of deep femoral artery third perforating artery flap for reconstruction of soft tissue defect in lower limles

Objective To investigate the feasibility and clinical effects of deep femoral artery third perforating artery perforator flap for reconstruction of soft tissue defect in lower limbs. Methods From September, 2008 to October, 2016, 8 cases of soft tissue defect in lower limbs which were repaired by deep femoral artery third perforating artery perforator flap, including 4 cases of traffic accident trauma, 2 cases of chronic ulcer, 1 case of a fall injury, 1 case of the scar after fracture operation. The area of wounds was 8.0 cm×7.0 cm-19.0 cm×8.0 cm. Seven patients were accompanied by different degrees of infections. The deep femoral artery third perforating artery perforator flap was designed to repair, including 5 cases of pedicled flaps and 3 cases of free flaps. The flap’s appearance, color, texture, infection recurrence and the recovery of lower limb function were recorded at 1, 3, 6, 9 and 12 months followed-up. Results One flap suffered partial necrosis due to cross-zone backflow disorder, the ipsilateral medial sural artery pedicled perforator flap was used to repair. The rest of the flaps survived successfully. Skin graft was used to close the donor site in 1 case, and other donor sites were closed directly. All patients had no postoperative hematoma or secondary infection. The followed-up periods ranged from 2 to 28 months (mean, 8.1 months). All flaps had satisfied appearance and texture. There were no complications such as paresthesia and numbness in the donor sites. And no motion limitations in hip and knee joint of the operated leg. Conclusion Deep femoral artery third perforating artery perforator flap can be used for both free flaps and pedicled flaps, which is a feasible method to repair soft tissue defect in lower limbs. Key words: Perforator flap; Deep femoral artery; Third perforating artery; Lower limb; Soft tissue defect

Predictive value of dynamic F-wave In surgical treatment of Hirayama disease

Objective To investigate the predictive value of dynamic F wave in the treatment of Hirayama disease (HD) after anterior cervical fusion and internal fixation. Methods From February 2014 to January 2016, thirty-six patients with HD were included in this study (age: 17.9±2.6 years, height: 173.1±6.2 cm, disease duration: 20.1±13.1 months; male to female ratio: 35∶1), and all of these 36 patients underwent anterior cervical autogenous iliac fusion and internal fixation. All of these patients underwent bilateral dynamic F-wave detection (The F-wave was tested on the cervical standard position and at least 30 minutes after cervical flexion) on the median nerve before operation and 3-5 days after operation. The latency and maximum amplitude of M-wave, the persistence of F-wave, the shortest latency of F-wave, the ratio of F/M and the persistence of repeated F-wave were measured. Dynamic F-wave abnormalities were defined when repeated F-wave was only found during neck flexion or the standard-flexion difference of each measurements of F-wave was more than 2 standard deviations from the normal value (the shortest latency of F-wave: 0.6±0.5 ms, persistence of F-wave: 7.3%±5.7%, the ratio of F/M: 1.1±1.0). Furthermore, these patients with HD accepted both bilateral grip strength and hand function score (disabilities of arm, shoulder and hand, DASH) before and 1 year after operation. According to the presence of abnormal dynamic F-wave before operation, patients were divided into abnormal dynamic F-wave group and normal dynamic F-wave group. Fisher exact test was used to compare the percentage of the patient with improved DASH score in both patient groups after operation. Both DASH score and bilateral grip strength were analyzed by paired sample t test before and after operation. Results Before operation, eleven (11/36, 30.6%) patients with HD had abnormal dynamic F-wave, and there was no significant difference of age (t=-0.849, P=0.412), duration (t=1.110, P=0.282), DASH scores (t=2.002, P=0.055) and handgrips (more-symptomatic side: t=-0.673, P=0.507; symptomatic side: t=-1.729, P=0.094) between the patients with or without preoperative dynamic F-wave abnormalities. One-year follow-up demonstrated that significantly greater number of the patients presented with reduced DASH scores in the patients with preoperative dynamic F-wave abnormalities (10/11, 90.9% vs 12/25, 48.0%; P=0.025). Compared with the patients without preoperative dynamic F-wave abnormalities, the patients with preoperative dynamic F-wave abnormalities showed reduced DASH scores after operation (t=2.347, P=0.041). Furthermore, abnormal dynamic F-waves disappeared soon after operation in ten patients (90.9%, 10/11) with preoperative dynamic F-wave abnormalities, and DASH scores reduced significantly in these ten patients after operation (4.4±3.8 vs 1.5±0.4, t=3.094, P=0.013), and the DASH score in another patient whose dynamic F wave did not disappear after operation increased significantly one year after operation (preoperative vs. postoperative: 6.66 vs 9.87). Conclusion Dynamic F-wave can be used as a preoperative evaluation method for HD to predict the recovery of upper limb function after operation. At the same time, the comparison of dynamic F-wave before and after operation is an effective and immediate method to evaluate the effectiveness of surgical treatment of HD. Key words: Cervical vertebrae; Spinal cord compression; Upper extremity; Muscular atrophy; Spinal fusion; Electromyography

A suite of automated tools to quantify hand and wrist motor function after cervical spinal cord injury

BackgroundCervical spinal cord injury (cSCI) often causes chronic upper extremity disability. Reliable measurement of arm function is critical for development of therapies to improve recovery after cSCI. In this study, we report a suite of automated rehabilitative tools to allow simple, quantitative assessment of hand and wrist motor function.MethodsWe measured range of motion and force production using these devices in cSCI participants with a range of upper limb disability and in neurologically intact participants at two time points separated by approximately 4 months. Additionally, we determined whether measures collected with the rehabilitative tools correlated with standard upper limb assessments, including the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP) and the Jebsen Hand Function Test (JHFT).ResultsWe find that the rehabilitative devices are useful to provide assessment of upper limb function in physical units over time in SCI participants and are well-correlated with standard assessments.ConclusionsThese results indicate that these tools represent a reliable system for longitudinal evaluation of upper extremity function after cSCI and may provide a framework to assess the efficacy of strategies aimed at improving recovery of upper limb function.

Treatment of upper limb bone defects with autogenous cancellous bone graft wrapped by femoral fascia

Objective To explore the feasibility and effect of autogenous cancellous bone graft wrapped by femoral fascia in the treatment of upper limb bone defects. Methods From June 2011 to December 2016, 12 patients with upper limb bone defects were treated with femoral fascia wrapping autogenous cancellous bone graft and internal fixation. Bone defect site: 3 cases in humerus, 5 cases in radius, and 4 cases in ulna. The length of bone defects ranged from 2.5 to 6.0 cm, with an average of 4.0 cm. Results Delayed wound healing occurred in 1 case and complications occurred in 2 cases. All the patients were follow-up for 12 to 36 months with an average of 19 months. Bone union occurred in all the patients. The clinical healing time ranged from 2.5 to 4.0 months, with an average of 2.9 months. No delayed union or nonunion occurred. The healing rate was 100%. There were no deep infection, internal fixation fracture and re-fracture in the transplantation area. At the last follow-up, limb function recovery was evaluated by DASH upper limb function questionnaire. The results were rated as excellent in 6 cases, good in 5 cases and fair in 1 case. Conclusion Femoral fascia has abundant sources and is convenient for harvesting. Femoral fascia wrapping autogenous cancellous bone graft for the treatment of upper limb bone defects is effective for small and large segmental defects. It has the advantages of simple operation, low cost, fast bone healing, high healing rate and satisfactory functional recovery. Key words: Upper extremity; Bone transplantation; Bone defects; Cancellous bone; Femoral fascia

Targeted Vagus Nerve Stimulation for Rehabilitation After Stroke.

Stroke is a leading cause of disability worldwide, and in approximately 60% of individuals, upper limb deficits persist 6 months after stroke. These deficits adversely affect the functional use of the upper limb and restrict participation in day to day activities. An important goal of stroke rehabilitation is to improve the quality of life by enhancing functional independence and participation in activities. Since upper limb deficits are one of the best predictors of quality of life after stroke, effective interventions targeting these deficits may represent a means to improve quality of life. An increased understanding of the neurobiological processes underlying stroke recovery has led to the development of targeted approaches to improve motor deficits. One such targeted strategy uses brief bursts of Vagus Nerve Stimulation (VNS) paired with rehabilitation to enhance plasticity and support recovery of upper limb function after chronic stroke. Stimulation of the vagus nerve triggers release of plasticity promoting neuromodulators, such as acetylcholine and norepinephrine, throughout the cortex. Timed engagement of neuromodulators concurrent with motor training drives task-specific plasticity in the motor cortex to improve function and provides the basis for paired VNS therapy. A number of studies in preclinical models of ischemic stroke demonstrated that VNS paired with rehabilitative training significantly improved the recovery of forelimb motor function compared to rehabilitative training without VNS. The improvements were associated with synaptic reorganization of cortical motor networks and recruitment of residual motor neurons controlling the impaired forelimb, demonstrating the putative neurobiological mechanisms underlying recovery of motor function. These preclinical studies provided the basis for conducting two multi-site, randomized controlled pilot trials in individuals with moderate to severe upper limb weakness after chronic ischemic stroke. In both studies, VNS paired with rehabilitation improved motor deficits compared to rehabilitation alone. The trials provided support for a 120-patient pivotal study designed to evaluate the efficacy of paired VNS therapy in individuals with chronic ischemic stroke. This manuscript will discuss the neurobiological rationale for VNS therapy, provide an in-depth discussion of both animal and human studies of VNS therapy for stroke, and outline the challenges and opportunities for the future use of VNS therapy.

"Stem cell therapy to promote limb function recovery in peripheral nerve damage in a rat model" - Experimental research.

BackgroundOptimizing nerve regeneration and mitigating muscle atrophy are the keys to successful outcomes in peripheral nerve damage. We investigated whether mesenchymal stem cell (MSC) therapy can improve limb function recovery in peripheral nerve damage.Materials and methodsWe used sciatic nerve transection/repair (SNR) and individual nerve transection/repair (INR; branches of sciatic nerve - tibial, peroneal, sural) models to study the effect of MSCs on proximal and distal peripheral nerve damages, respectively, in male Lewis rats. Syngeneic MSCs (5 × 106; passage≤6) or saline were administered locally and intravenously. Sensory/motor functions (SF/MF) of the limb were assessed.ResultsRat MSCs (>90%) were CD29+, CD90+, CD34−, CD31− and multipotent. Total SF at two weeks post-SNR & INR with or without MSC therapy was ∼1.2 on a 0–3 grading scale (0 = No function; 3 = Normal); by 12 weeks it was 2.6–2.8 in all groups (n ≥ 9/group). MSCs accelerated SF onset. At eight weeks post-INR, sciatic function index (SFI), a measure of MF (0 = Normal; −100 = Nonfunctional) was −34 and −77 in MSC and vehicle groups, respectively (n ≥ 9); post-SNR it was −72 and −92 in MSC and vehicle groups, respectively. Long-term MF (24 weeks) was apparent in MSC treated INR (SFI -63) but not in SNR (SFI -100). Gastrocnemius muscle atrophy was significantly reduced (P < 0.05) in INR. Nerve histomorphometry revealed reduced axonal area (P < 0.01) but no difference in myelination (P > 0.05) in MSC treated INR compared to the naive contralateral nerve.ConclusionMSC therapy in peripheral nerve damage appears to improve nerve regeneration, mitigate flexion-contractures, and promote limb functional recovery.