Severe Disabled Patients Research Articles

Problems with classification of polineuropaties severity in case of hereditary ones – review of literature

Evaluation of neuropathy severity is still a challenge for a modern medicine. Many scales were made to resolve this problem but each of them has limitations. It is known that in case of many patients there is no relation between clinical status and nerve conduction studies (NCS) results. Severe disabled patients with neuropathies can have nerve conduction study result mild impaired and conversely relation is also often observed. Many screening instruments with numerous composite scores are used to evaluate neuropathy. Most of them involved sensory perception, motor functions and reflexes like Neuropathy Disability Score (NDS), Neuropathy Impairment Score (NIS), Thoronto Clinical Neuropathy Scoring System. Electrophysiological parameters are also useful in classification of disease types especially in Charcot-Marie-Tooth one. There were many attempts of discovering new scores especially in diabetic neuropathies, involving mainly clinical features. There is lack of easy, reliable and precise scores that could improve neuropathy classification and monitoring disease progression especially in case of hereditary polyneuropathy.

Reconstruction of paralyzed arm function in patients with hemiplegia through contralateral seventh cervical nerve cross transfer: a multicenter study and real-world practice guidance.

SummaryBackgroundA previous randomized controlled trial showed contralateral seventh cervical nerve (CC7) cross transfer to be safe and effective in restoring the arm function of spastic arm paralysis patients in a specified population. Guidance on indications, safety and expected long-term improvements of the surgery are needed for clinical practice.MethodsThis is a retrospective, multicenter, propensity score-matched cohort study. All patients registered between 2013 and 2019 with unilateral spastic arm paralysis over 1 year who were registered at one of five centers in China and South Korea were included. Patients received CC7 cross transfer or rehabilitation treatment in each center. Primary outcome was the change in the upper-extremity Fugl–Meyer (UEFM) score from baseline to 2-year follow-up; larger increase indicated better functional improvements.FindingsThe analysis included 425 eligible patients. After propensity score matching, 336 patients who were 1:1 matched into surgery and rehabilitation groups. Compared to previous trial, patient population was expanded on age (< 12 and > 45 years old), duration of disease (< 5 years) and severity of paralysis (severe disabled patients with UEFM < 20 points). In matched patients, the overall increases of UEFM score from preoperative evaluation to 2-year follow-up were 15.14 in the surgery group and 2.35 in the rehabilitation group (difference, 12.79; 95% CI: 12.02–13.56, p < 0.001). This increase was 16.58 at 3-year and 18.42 at 5-year follow-up compared with the surgery group baseline. Subgroup analysis revealed substantial increase on UEFM score in each subgroup of age, duration of disease, severity of paralysis and cause of injury. No severe complication or disabling sequela were reported in the surgery group.InterpretationThis study showed that CC7 cross transfer can provide effective, safe and stable functional improvements in long-term follow-up, and provided evidences for expanding the indications of the surgery to a wider population of patients with hemiplegia.

Effects of tiotropium and formoterol on dynamic hyperinflation and exercise endurance in COPD

It is currently unclear whether the additive effects of a long-acting beta(2)-agonist (LABA) and the antimuscarinic tiotropium bromide (TIO) on resting lung function are translated into lower operating lung volumes and improved exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). On a double-blind and cross-over study, 33 patients (FEV(1) = 47.4 +/- 12.9% predicted) were randomly allocated to 2-wk formoterol fumarate 12 microg twice-daily (FOR) plus TIO 18 microg once-daily or FOR plus placebo (PLA). Inspiratory capacity (IC) was obtained on constant-speed treadmill tests to the limit of tolerance (Tlim). FOR-TIO was superior to FOR-PLA in increasing post-treatment FEV(1) and Tlim (1.34 +/- 0.42 L vs. 1.25 +/- 0.39 L and 124 +/- 27% vs. 68 +/- 14%, respectively; p < 0.05). FOR-TIO slowed the rate of decrement in exercise IC compared to FOR-PLA (Deltaisotime-rest = -0.27 +/- 0.40 L vs. -0.45 +/- 0.36 L, p < 0.05). In addition, end-expiratory lung volume (% total lung capacity) was further reduced with FOR-TIO (p < 0.05). Of note, patients showing greater increases in Tlim with FOR-TIO (16/26, 61.6%) had more severe airways obstruction and lower exercise capacity at baseline. Improvement in Tlim with FOR-TIO was also related to larger increases in FEV(1) (p < 0.05). Compared to FOR monotherapy, FOR-TIO further improved effort-induced dynamic hyperinflation and exercise endurance in patients with moderate-to-severe COPD. These beneficial consequences were more likely to be found in severely-disabled patients with larger resting functional responses to the combination therapy. Clinicaltrials.gov Identifier: NCT00680056 [ClinicalTrials.gov].

Cognitive impairment and neurophysiological correlates in MS

Cognitive impairment in multiple sclerosis (MS) has received considerable interest over the last decades. Heterogeneous patterns of cognitive dysfunction have been reported in literature in relation to the subtype of the disease and the severity of specific cognitive domains affected. Event related potentials (ERPs), especially P300, have been employed to evaluate the cognitive decline in MS and neurophysiological findings agree with data obtained by neuropsychological testing. The objectivity, the reliability and the easy administration are the main features of ERP technique but more specific attention and memory tasks are needed to enhance the clinical value of the methodology. Moreover, ERP recording has the advantage of being feasible even in severe disabled patients. Finally, longitudinal ERP studies are required to investigate the natural course of cognitive dysfunction in MS, to estimate the prognostic value of subclinical defects in different clinical form of the disease and to evaluate clinical benefits of therapeutic and rehabilitative interventions.

重症くも膜下出血の急性期治療 重症くも膜下出血の分類と治療成績：続報

Our prior studies revealed that favorable outcome occurred in 54% of WFNS Grade IV and 14% of Grade V patients with subarachnoid hemorrhage (SAH). To predict the outcome in patients with severe SAH, we assessed the outcome of the 192 poor-grade patients admitted to Asahikawa Red-Cross Hospital who suffered aneurysmal subarachnoid hemorrhage in the period of 1994 to 2001. Preoperative GCS with 3 and 6 presented approximately 20% of favorable outcome. None of the patients with preoperative GCS 4 or 5 presented favorable outcome. Seventy-nine patients were rated as SD (severely disabled) in GOS (Glasgow outcome scale). Three of 79 patients were rated SD because of focal sigh, such as aphasia or hemiparesis. The remaining cases revealed variable degrees of post SAH dementia. Using multivariate analysis, we found that the age (p<0.001) and postoperative GCS (p<0.01) correlated with the outcome in SD patients. We conclude that aggressive management can benefit patients with GCS 3 or 6 even in Grade V. The outcome of the Grade V can be rated as “acceptable” in 28% when we include SD patients with acceptable deficit. In elderly patients 75 years old and older, our preliminary data suggest preoperative GCS with 8 or better may be the borderline to expect favorable outcome.

Can Young Severely Disabled Patients Regain the Ability to Walk Independently More than Three Months after a Stroke?

Can Young Severely Disabled Patients Regain the Ability to Walk Independently More than Three Months after a Stroke?

Sliding Board for Severely Disabled Patients

Sliding Board for Severely Disabled Patients

Sliding Board for Severely Disabled Patients

Sliding Board for Severely Disabled Patients