Side Of Paralysis Research Articles

A comparative analysis of laryngeal nerve damage in patients with idiopathic vocal cord paralysis exhibiting different paralytic sides.

To assess the extent of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) damage in patients with idiopathic vocal cord paralysis (IVCP) exhibiting different paralytic sides. A total of 84 IVCP cases were evaluated using stroboscopic laryngoscopy, voice analysis, and laryngeal electromyography (LEMG). The results were compared between patients with left-sided paralysis and right-sided paralysis based on different disease courses (less than or more than 3 months). Initially, the average age and disease progression of IVCP patients were found to be similar regardless of the side of paralysis (p > .05). Additionally, there were no significant variations in voice indicators, such as MPT, DSI, and VHI, between IVCP patients with left and right vocal cord paralysis (p > .05). Furthermore, no disparities were detected in the latencies and amplitudes of the paralyzed RLN and SLN, as well as the durations and amplitudes of the action potentials in the paralyzed TM and PCM, among IVCP patients with left and right vocal cord paralysis (p > .05). Notably, the amplitudes of the left paralytic CM were significantly lower than those of the right paralytic CM (0.45 vs. 0.53, Z = -2.013, p = .044). In addition, no disparities were observed in APDs and amplitudes between the ipsilateral PCM and TM, either for patients with left or right vocal fold paralysis (p > .05). Finally, all the IVCP patients were subdivided into two subgroups according to different disease course (less than or more than 3 months), and in each subgroup, the comparison of voice indicators and LEMG results in IVCP patients with left or right vocal fold paralysis were similar with the above findings (p > .05). Overall, the degree of RLN and SLN damage appeared to be similar in IVCP patients with left and right vocal cord paralysis, provided that the disease course was comparable. 4.

Pathophysiological Mechanisms Underlying Unilateral Vocal Fold Paralysis in Female Patients: An Ultrasonographic Study.

Laryngeal ultrasonography (LUS) has been suggested as an alternative diagnostic tool for unilateral vocal fold paralysis (UVFP). The present study applied LUS and quantitative laryngeal electromyography (LEMG) in female UVFP patients to investigate the pathophysiologic mechanisms of UVFP. In this cross-sectional study, vocal fold (VF) length parameters included resting and phonating VF length measured using B-mode LUS, and color Doppler vibrating length (CDVL) measured using the color Doppler mode. Forty female patients with UVFP were enrolled, among whom 11 and 29 were assigned to the thyroarytenoid (TA) muscle+cricothyroid (CT) muscle group (with CT involvement) and the TA (without CT involvement) group, respectively. In the TA group, the turn frequency in thyroarytenoid-lateral cricoarytenoid (TA-LCA) on the paralyzed side, as observed through LEMG, correlated with the VF length during the resting phase (R=0.368, P=0.050) and CDVL values (R=0.627, P=0.000) on the paralyzed side. In the TA+CT group, the turn ratio in the CT muscle correlated with the normalized phonatory vocal length change (nPLC; R=0.621, P=0.041) on the paralyzed side. CDVL and nPLC are two parameters that can be utilized to predict the turn frequencies of TA-LCA in UVFP cases without CT involvement, and the turn ratio of CT in cases of UVFP with CT involvement, respectively. The findings suggest that LUS, as a noninvasive tool, can serve as an alternative method for assessing the severity of laryngeal nerve injury and offer valuable insights into the pathophysiology of UVFP.

Abstract TP69: Change Over Time Feature Of A Range Of The Recruited Motor Unit In The Recovery Period Of Hemispheric Stroke

The paralysis after the stroke makes loss adjustment of the force in the voluntary movement and disturbs the physical activity. The voluntary force is regulated by the motor unit (MU) recruitment and firing rate. Therefore, we should evaluate MU firing patterns to understand a part of the mechanism of the force adjustment disorders of the paralysis side. It might be possible to evaluate the change of the force adjustment function on the paralysis side in the convalescence if we considered a range of the recruited MU over time. This pilot study hypothesizes that a range of the recruited MU spreads depending on a recovery stage. Two-stroke patients participated in this study. We measured the muscle activity of the biceps using surface EMG with three-time points during the recovery period after stroke. The raw EMG data were decomposed into motor unit action potential (MUAP). Then mean firing rate (MFR) and peak amplitude of MUAP were calculated by decomposed MUAP. Additionally, coefficients of the regression line were calculated by MFR and MUAP's peak amplitude. The coefficient of the linear regression line was adopted as the outcome to evaluate a range of the recruited MU size. We also analyzed the change over time of a range of the recruited MU size. The range of the recruited MU of the recovery stage changed over time but became wide during the recovery stage. These data showed that it varied from a restrictive style to a comprehensive recruitment style over time. Therefore, a range of the recruited MU with the stroke of the recovery stage was suggested to be a tendency to enlarge over time. Expanding the diachronic range of the recruited MU may let you enrich a variation of the force in the recovery process.

A Study of Otologic Symptoms and Prognosis in Patients With Ramsay Hunt Syndrome and Bell’s Palsy

Background and Objectives Although several studies have compared the characteristics of Ramsay Hunt syndrome (RHS) with Bell’s palsy (BP), the differences in comorbid symptoms and prognosis according to symptoms have not been determined. This study therefore evaluated the differences in otologic symptoms and prognosis between patients with these two conditions.Subjects and Method The medical records of 118 patients with RHS and 215 patients with BP were retrospectively reviewed. Factors compared in these two groups included otologic symptoms, general health condition, electroneurography (ENoG) and House-Brackmann grades.Results Age, sex, body mass index, lipid profiles, ENoG, rate of diabetes, and side of palsy did not differ significantly between patients with RHS and BP (p>0.05). The rates of hearing disturbance, tinnitus, vertigo, and postauricular pain were significantly higher in RHS (p<0.05 each). Hearing disturbance was more frequent in patients with severe Bell’s facial palsy than with moderate Bell’s facial palsy (p<0.05). The prognosis of patients with BP and RHS who had otologic symptoms did not differ from those who had not (p>0.05). Additionally, in patients with facial paralysis, diabetes was associated with hearing disturbance and vertigo symptoms and dyslipidemia was associated with postauricular pain (p<0.05 each).Conclusion Otologic symptoms were more common in RHS than in BP. However, the prognosis of RHS and BP were not related to otologic symptoms. In patients with facial palsy hearing disturbance and vertigo were associated with diabetes and hypertension. Also, dyslipidemia was associated with post auricular pain.

Facteurs prédictifs des séquelles de paralysie faciale idiopathique : suivi longitudinal

Facial palsy can be assessed using objective and subjective tools. The main purpose of this work was to use these tools to determine at 12months the percentage of patients with sequelae and to specify the type of sequelae. Twenty-three patients with facial palsy were followed in this prospective and longitudinal study. They have been evaluated every 3months during a year with the House and Brackmann grading scale and the Sunnybrook Facial Grading System. At 12months, group A was composed of patients with complete recovery and group B, patients with sequelae. At 3months, in patients of group B, the House-Brackmann grading scale (P=0.0134), the Sunnybrook Facial Grading System global score (P=0.0283) and dynamic score (P=0.0148) were lower than group A. Moreover, the movement "brow lift" (P=0.0181) seems to be relevant to predict follow-up. Synkinesis on "brow lift" (P=0.0270) and the treatment delay (P=0.0384) increased for group B. Sex, age, paralyzed side and recurrence of facial palsy had no influence. Objective and subjective tools determine thresholds and predictive scores of recovery with sequelae at 1year. Nevertheless, it is relevant to assess clinically specific facial movements, such as "brow lift", to specify a recovery potential and to predict sequelae a year after the onset of facial palsy. As the treatment delay influences recovery, drug treatment should be recommended as early as possible.

Predicting Resting Oral Commissure Tone Outcomes Following Masseter Nerve Transfer in Facial Reanimation.

Objective: To quantify the degree of oral commissure resting tone improvement in patients undergoing masseter to facial nerve transfer. Methods: A retrospective cohort study was completed in a tertiary academic medical practice. Consecutive cases of masseter nerve transfer patients within a patient database were evaluated from 6/2012 to 9/2017. Inclusion criteria were patients >18 years of age, with complete unilateral paralysis, receiving a masseter to facial nerve transfer, with at least 12 months of recovery, and possessing complete pre- and postoperative data. Patients were excluded if a simultaneous adjunctive procedure was performed so that tone could not be attributed to masseter transfer alone. The main outcome measure was the facial asymmetry index (FAI): the measured difference in distance between the medial canthus and oral commissure of the healthy and paralyzed sides. Results: Twenty-nine patients met inclusion and exclusion criteria and were further analyzed for this study. The oral commissure symmetry improved from 4.7 ± 2.8 mm preoperatively to 2.2 ± 2.3 mm postoperatively. In multivariate analysis, the preoperative FAI was the only significant predictive factor for improvement in commissure symmetry at rest (r = 0.589). This suggests that for each 1.0 mm of worse preoperatively oral commissure asymmetry, the improvement postoperatively was 0.6 mm. Age, gender, body mass index, side of paralysis, duration of paralysis, and recipient branch of facial nerve were not significant predictors in a multivariate analysis. Conclusion: Masseter to facial nerve transfer yields an estimated 60% correction in the oral commissure asymmetry. This estimation may be helpful in determining if adjunctive procedures should be utilized.

A Retrospective Study on Risk Factors for Urinary Tract Infection in Patients with Intracranial Cerebral Hemorrhage.

Objective This study aimed to explore the risk factors of urinary tract infection (UTI) in patients with intracranial cerebral hemorrhage (ICH). Design This is a retrospective study, and a total of 77 patients with ICH consecutively admitted to the First Affiliated Hospital of USTC (Anhui Provincial Hospital, Hefei, China) during the period of August 2015 to August 2017 were included. The patients were divided into an UTI group (24 cases) and a non-UTI group (53 cases); patients with UTI were diagnosed according to clinical manifestations, recent urinary routines, and urine culture results. The following information in these two groups was recorded: age, sex, course of disease, side of paralysis, location and type of cerebral hemorrhage, disturbance of consciousness or not, the Brunnstrom stage of paralysed lower limbs, number of basic diseases, whether there were complications (tracheotomy, retention catheterization, pulmonary infection, pressure sore, deep venous thrombosis, etc.), whether rehabilitation interventions were conducted, blood routine, biochemistry index, DIC complete set, urine routine, and urine culture data. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors of UTI in patients with ICH. Results Univariate analysis showed that age, side of paralysis, disturbance of consciousness, the Brunnstrom stage of lower limbs, tracheotomies, retention catheterization, pulmonary infection, leukocyte count, neutrophil proportion, sodium, uric acid, D-dimer, and fibrinogen may be related to UTI in patients with ICH (P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), Conclusions Increased age and high D-dimer are independent risk factors for UTI in patients with ICH, while right-sided paralysis is a protective factor for UTI in patients with ICH.

A Clinical Audit of the Investigation and Follow-up of Vocal Fold Paralysis at Rigshospitalet, Denmark

Vocal fold paralysis (VFP) due to damage to the recurrent laryngeal nerves can be caused by malignant tumors. Therefore, thorough investigation, including diagnostic imaging, followed by follow-up examinations is acquired when assessing patients with VFP. Patients with VFP, with no immediate etiology found, are referred to Rigshospitalet, Denmark, where the investigation follows guidelines made by the Danish Society of Otorhinolaryngology, Head and Neck Surgery (DSOHH). The aim of this study is to examine whether or not the investigation of VFP at Rigshospitalet, Denmark, is in accordance with guidelines appointed by DSOHH. This study included 50 patients referred to Rigshospitalet, Denmark, in a one-year period between 2015 and 2016. Baseline data were collected from patient records and included sex, age, smoking history, side of paralysis, diagnosis and data regarding the initial investigation and any possible follow-up period. Of the 50 patients referred to Rigshospitalet, 15 (30.0%) were diagnosed with a malignant disease. Diagnostic imaging was not performed nor recommended to 3 (8.1%) patients. Fifteen (42.9%) patients did not receive a follow-up examination of whom a significant part had a malignant diagnosis. All patients with idiopathic VFP were offered a follow-up examination, but repeated diagnostic imaging was not performed in the cases without remission. Future assessments of patients with VFP should include diagnostic imaging of all patients and follow-up as recommended by DSOHH guidelines, focusing especially on patients with a malignant diagnosis and patients with sustained idiopathic VFP.

Clinical prognostic factors in patients with idiopathic peripheral facial nerve paralysis (Bell’s palsy)

Objective. The aim of this study was to analyse the clinical prognostic factors that are associated with treatment outcomes in patients with idiopathic peripheral facial nerve paralysis (PFNP). Methods. The study was performed retrospectively with 80 patients in a tertiary medical center. All of the patients were treated and followed for idiopathic PFNP (Bell’s palsy). The patient charts were reviewed for patient demographics and characteristics. The comorbidities (hypertension, diabetes mellitus), the side, grade and duration of palsy, and the acoustic stapedius reflex were analysed. Results. Forty-three male and 37 female patients were diagnosed with idiopathic PFNP. Sixty-seven of patients had complete, 13 patients had partial recovery. Of the partial recoveries, 12 patients had Grade 2 and one patient Grade 3 PFNP at the end of primary treatment. Patients tended to have incomplete recovery if they have a diagnosis of diabetes mellitus, but the difference between groups was not statistically significant ( p =0.326). A positive stapedius reflex was associated with complete recovery ( p =0.023). Patients had much more risk of incomplete recovery if age is more than 40 years ( p =0.006). Conclusion. A detailed history and complete physical examination are very important in peripheral facial palsy. Co-morbid diseases and demographic features such as high blood pressure, diabetes mellitus and advanced age might influence the treatment outcomes.

Surgical planning and innervation in pontine gaze palsy with ipsilateral esotropia

To discuss surgical intervention strategies among patients with horizontal gaze palsy with concurrent esotropia. Five consecutive patients with dorsal pontine lesions are presented. Each patient had horizontal gaze palsy with symptomatic diplopia as a consequence of esotropia in primary gaze and an anomalous head turn to attain single binocular vision. Clinical findings in the first 2 patients led us to presume there was complete loss of rectus muscle function from rectus muscle palsy. Based on this assumption, medial rectus recessions with simultaneous partial vertical muscle transposition (VRT) on the ipsilateral eye of the gaze palsy and recession-resection surgery on the contralateral eye were performed, resulting in significant motility limitation. Sequential recession-resection surgery without simultaneous VRT on the 3rd patient created an unexpected motility improvement to the side of gaze palsy, an observation differentiating rectus muscle palsy from paresis. Recession combined with VRT approach in the esotropic eye was abandoned on subsequent patients. Simultaneous recession-resection surgery without VRT in the next 2 patients resulted in alleviation of head postures, resolution of esotropia, and also substantial motility improvements to the ipsilateral hemifield of gaze palsy without limitations in adduction and vertical deviations. Ocular misalignment and abnormal head posture as a result of conjugate gaze palsy can be successfully treated by basic recession-resection surgery, with the advantage of increasing versions to the ipsilateral side of the gaze palsy. Improved motility after surgery presumably represents paresis, not "paralysis," with residual innervation in rectus muscles.

Relationship between cutaneous temperature and hand edema and allodynia after stroke--the etiology of shoulder-hand syndrome

The etiology of shoulder-hand syndrome is as yet unknown. We hypothesized that it may be due to damaged unmyelinated fibers in front of the subscapular muscle. We examined the existence of edema and hypersensitivity to pain in the hands of stroke patients during the subacute stage and their relationships to cutaneous temperatures of the index fingertips in 75 hemiplegic patients (23 without edema, 32 with only edema, and 20 with edema plus allodynia). Patients were placed into two groups (comfortable and warm) depending on room temperature (22.2-25.6°C and 25.7-30°C, respectively). Of the patients with hand edema plus allodynia, 75% had a large lesion in the capsula, cortical white matter, and putamen. It was previously reported that the cutaneous temperature of the arm on the paralysis side of patients with lesions of the capsula or putamen was lower than that on the non-paralysis side. In the edema plus allodynia group, the temperature of the index fingertip on the affected side was higher than that of their contralateral fingers; the differences were smaller under warm conditions possibly due to blockade of the sympathetic nerves in the peripheral nerve. By contrast, in patients in the edema group, there were no differences in cutaneous temperatures of their two index fingers. Thus, it appears that patients with mild cases of shoulder-hand syndrome have conduction blocks in the posterior cord of the brachial plexus, while those with severe cases have both conduction blocks and neurogenic inflammation in both the lateral and posterior cords.

1P2-L07 脳卒中片麻痺患者のための起立トレーニング支援ロボットの開発

In recent years, stroke hemiplegia patients are increasing. On the other side, therapist is decreasing. Due to these reason the patient is doing the voluntary training. Therefore, we aim to realize a robot to perform the training instead of the therapists. It is confirmed that therapists change the center of gravity of the patient, and adjusts the load on the paralysis side leg during standing training. The robot we developed has two arms with three degrees of freedom. These arms hold the waist of the patient, and adjust the center of gravity during standing training. This paper describes the overview of rehabilitation training robot and the effect of the robot on examinee.

Is There a Relationship Between Bell's Palsy and Internal Auditory Canal?

In the present study, we evaluated the diameter of internal acoustic canal in patients with Bells palsy to investigate the role of anatomical differences of the temporal bone in etiology of Bell's palsy. Sixty-four patients who were diagnosed as Bells Palsy and temporal bone computed tomography imagings of them were included into the study group (Group 1). The control group (Group 2) was consisted of 35 healthy subjects without Bell's Palsy. All patients had temporal bone computed tomography imaging. The internal auditory canal inlet, mid-canal, outlet and canal lengths were measured at the most distinctive cross-section of the seventh and eighth cranial nerves bifurcation. In the study group, Bells palsy was on the right side in 26 patients (40.6%) and on the left side in 38 patients (59.4%). Initial House-Brackmann (HB) score was HB-2 in 29 patients (45.3%), HB-3 in 18 patients (28.1%), HB-4 in 13 patients (20.3%) and HB-5 in 4 patients (6.2%). At 6-month evaluation, HB-score of the patients were HB-1 in 37 patients (57.8%), HB-2 in 25 patients (39.1%) and HB-3 in 2 patients (3.1%). Internal auditory canal (IAC) measurements of the groups showed that there were no significant differences between the measurements of right-mid canal, right canal length; and left canal outlet and left canal length of the study and control groups. Right inlet and outlet; and left inlet and mid-canal values of the study group (Bell's palsy) were significantly lower than those of the control group. In Bell's palsy group, left inlet, outlet and canal length values were significantly higher than those of the right ones. Correlation analysis showed that there were no significant correlation between paralysis side; initial HB stage; and IAC measurement results. In patients with higher initial HB score, their 6-month later HB-score was also higher. In patients with higher 6-month HB score; R canal inlet, R mid-canal, L-canal inlet, and L-mid canal values were lower. Lower IAC inlet and mid-canal values were detected in patients with Bell's palsy. Therefore narrow IAC inlet and mid-canal values may be one of the risk factors for Bell's palsy.

Immediate effects of single-leg stance exercise on dynamic balance, weight bearing and gait cycle in stroke patients

Methods: Eighteen patients with hemiplegia participated in this study. There were twelve males and six females. This study investigated the effects of the single-leg stance exercise on dynamic balance, weight bearing, and gait ability compared with four conditions. Dynamic balance and weight bearing were measured using the step test (ST) of the affected side in stroke patients. In addition, gait parameters were measured using the optogait system for analysis of the spatial and temporal parameters of walking in stroke patients. Results: This study investigated the effect of the single leg stance exercise on the paralysis side. The ST showed significant findings for all conditions (p<0.05). Therefore, knee extension and flexion exercise on the affected side single-leg stance (condition 4) significantly improved dynamic balance and weight bearing on the affected side (p<0.05). In the condition of moving the knee joint in a single-leg stance was discovered that the stance phase time significantly increased more than in the condition of supporting the maximal voluntary weight on the affected side (p<0.05). Conclusions: Single-leg stance on the paralysis side with knee flexion and extension increased symmetry in weight bearing during stance phase time. This study suggests that single-leg stance exercises augments improved gait function through sufficient weight bearing in the stance phase of the affected side.

Prognostic factors of Bell’s palsy: prospective patient collected observational study

The purpose of this study was to evaluate various parameters potentially influencing poor prognosis in Bell's palsy and to assess the predictive value for Bell's palsy. A single-center prospective patient collected observation and validation study was conducted. To evaluate the correlation between patient characteristics and poor prognosis, we performed univariate and multivariate analyzes of age, gender, side of palsy, diabetes mellitus, hypertension, and facial grading score 1 week after onset. To evaluate the accuracy of the facial grading score, we prepared a receiver operating characteristic (ROC) curve and calculated the area under the ROC curve (AUROC). We also calculated sensitivity, specificity, positive/negative likelihood ratio, and positive/negative predictive value. We included Bell's palsy patients who attended Ehime University Hospital within 1 week after onset between 1977 and 2011. We excluded patients who were less than 15 years old and lost-to-follow-up within 6 months. The main outcome was defined as non-recovery at 6 months after onset. In total, 679 adults with Bell's palsy were included. The facial grading score at 1 week showed a correlation with non-recovery in the multivariate analysis, although age, gender, side of palsy, diabetes mellitus, and hypertension did not. The AUROC of the facial grading score was 0.793. The Y-system score at 1 week moderate accurately predicted non-recovery at 6 months in Bell's palsy.

Course, Predictors of Diaphragm Recovery After Phrenic Nerve Injury During Pediatric Cardiac Surgery

Hemidiaphragm paralysis from phrenic nerve injury is a known complication of congenital cardiac surgery. Return of diaphragm function has been reported; however, prior studies on this subject have been limited by small numbers, static assessment methods, or observation of plicated or non-plicated patients alone. To describe return of function, we reviewed fluoroscopy and ultrasonography in all diagnosed cases of diaphragmatic paralysis. Surgical cases at our institution between 1991 and 2010 were identified for patients with postoperative hemidiaphragm paralysis diagnosed by chest X-ray, ultrasound, or fluoroscopy. Follow-up ultrasound and fluoroscopic studies were reviewed for return of diaphragm function. Seventy-two cases of postoperative hemidiaphragm paralysis were identified. Forty cases were plicated prior to discharge. Plicated patients were younger at time of diagnosis (median 46 days average 3.6 months; p=0.025) and had a larger proportion of single ventricle diagnoses (48% vs 16%) compared with non-plicated patients. Twenty-six patients with paralysis were excluded in follow-up due to lack of studies documenting diaphragm function after the diagnostic study. Of the remaining 46 cases, median follow-up was 353 days (range: 6 days to 17 years). Plicated and non-plicated patients regained function at similar frequency (60% and 54.8%, respectively). Plication status, Risk Adjustment for Congenital Heart Surgery (RACHS) 1 score, age at diagnosis, and side of paralysis did not predict failure of recovery. In the current era, return of diaphragm function after phrenic nerve injury sustained during congenital cardiac surgery is a known occurrence; however, predicting recovery continues to be difficult.

Acquired unilateral vocal fold paralysis: Retrospective analysis of a single institutional experience

Background:Vocal cord paralysis continues to be an important issue in laryngology and is considered as a sign of underlying disease; the etiologies of this problem are varied and changing.Aims:The study was to carry out a retrospective analysis of patients with unilateral vocal fold paralysis diagnosed.Materials and Methods:The medical records of 53 patients diagnosed and treated for unilateral vocal fold paralysis were studied retrospectively. Data regarding age, sex, duration of symptoms, etiology, and side of paralysis were recorded.Results:Out of the 53 cases, 36 were females and 17 males with a ratio of 2.1:1. The age of the patients ranged from 17-75 years. In 18.9% the cause was idiopathic. Surgical trauma (iatrogenic) problems was the most encountered etiology (66%), others included malignancy (non laryngeal) (7.5%), central (3.8%), external neck trauma (1.9%) and radiation therapy 1.9%. Thyroid surgery was the most commonly reported neck surgery in 50.9%.Conclusions:Thyroidectomy continues to be the single most common surgical procedure responsible for unilateral vocal cord paralysis. For this reason, routine pre and postoperative laryngoscopy should be considered in all patients undergoing surgeries with a potential risk for recurrent nerve paralysis to reduce the postoperative morbidity.

Prediction of nonrecovery in Bell's palsy using sunnybrook grading

To develop a clinical prognostic model to identify Bell's palsy patients with risk for nonrecovery at 12 months. Data from a prospective, randomized, double-blind, placebo-controlled, multicenter study. There were 829 patients with Bell's palsy randomized in a factorial fashion to treatment with prednisolone or no prednisolone. Facial function was assessed with the Sunnybrook grading scale. Univariate and multivariate logistic regression analyses at different time points were used to identify factors predicting nonrecovery, defined as Sunnybrook <70 at 12 months. Variables studied were age, gender, time to inclusion, prednisolone treatment, side of palsy, pain at inclusion, and Sunnybrook scores. Factors of predictable significance were used to construct prognostic models at baseline, days 11 to 17, and at 1 month. Receiver operating characteristics curves were created to test the predictive capacity of the models. At baseline, treatment with prednisolone or no prednisolone (P = .0005), age (P = .04) and the Sunnybrook score (P = .0002) were significant factors for predicting nonrecovery. The receiver operating characteristics area under the curve at baseline for these three variables was 0.74 (sensitivity 0.83, specificity 0.57). At days 11 to 17 and at 1 month, the Sunnybrook score was the only significant predictive variable. The respective areas under the curves for the Sunnybrook score at these time points were 0.83 (sensitivity 0.81, specificity 0.75) and 0.94 (sensitivity 0.91, specificity 0.85). Sunnybrook grading at 1 month most accurately predicts nonrecovery at 12 months in Bell's palsy.

Prevalence of Hemiplegic Shoulder Pain in Post-stroke Patients – A Hospital Based Study

Abstract Objectives To study the prevalence of hemiplegic shoulder pain (HSP) and its association with other factors like age, sex, side of paralysis, type of brain lesion, muscle tone, degree of functional recovery in upper limb and glenohumeral subluxation (GHS). Methodology Prospective study based on all the hemiplegic 140 patients admitted in the physical medicine and rehabilitation ward in two consecutive years. Tools Assessment of HSP was done by using a structured questionnaire known as “Shoulder Q”. Modified Ashworth scale (MAS) was used for spasticity assessment and functional independence measure (FIM) to document the severity of disability. Follow-up at intervals of 1, 3 and 6 months from the date of discharge for all cases were attempted and even cases with at least one follow-up around 3 months were also included in the study. Analysis was done on 109 patients as 31 patients lost to follow-up. Results Out of the 109 patients, 61.5% were males with a mean age of 58.9 ± 10.9 years. Cerebral infarct represents 53.2% of patients. HSP was present in 47.7% (n= 52) of patients. The prevalence of HSP on left and right sides was comparable though involvement was more on the left side (58.8%). Glenohumeral subluxation was present in 32.7% (n=17) of 52 cases with HSP and 33.3% (n=19) of 57 cases without HSP. Mean FIM score at admission for patients with HSP was 54.5 ± 17.6 and 56.6 ± 19.5 among cases without HSP. Again, mean FIM scores at last follow-up were 80.0 ± 16.4 and 79.9 ± 18.9 respectively for both cases with HSP and without it. Among the compliers, patients with tone more than MAS=1 were more likely to develop HSP. Conclusion Prevalence rate of HSP among post-stroke hemiplegic patients admitted during two years was 47.7%. There was no association of HSP with factors like age, sex, side of paralysis, type of lesion and GHS. Correlation between HSP and muscle tone or degree of functional recovery was significant.

Unilateral Vocal Cord Palsy: An Etiopathological Study

ABSTRACT Objective The incidence of various causes of unilateral vocal cord palsy (UVCP) has been found to change over time and place. To arrive at the correct diagnosis is important in determining the prognosis as well as the time and mode of intervention. This study intends to evaluate the current etiological profile of unilateral vocal cord palsy in our center and compare it with the previous studies. Methods A retrospective study of case records of all consecutive patients with a diagnosis of UVCP presented to Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, South India in the period between September 2002 and May 2009 was conducted. The exclusion criteria were all laryngeal and hypopharyngeal malignancies, intubation injuries and cricoarytenoid joint ankylosis. Factors taken for analysis were age, gender, side of palsy and etiology. Results A total of 121 cases including 88 males and 33 females in the age range of 2 to 86 years were studied. 61.1% patients had left-sided palsy and 38.8% had right-sided palsy. The incidence of various etiologies were idiopathic (42.1%), surgical trauma (22.3%), nonsurgical trauma (6.61%), nonlaryngeal malignancy (6.61%), central (12.4%) and other benign lesions (9.09%). The incidence of all nonthyroidectomy surgeries together (59.3%) was more than that of thyroidectomy (40.7%). The most common individual surgical procedure was still thyroidectomy (11 cases, 40.7%) followed by coronary artery bypass grafting (CABG) (7 cases, 25.9%). Conclusion Idiopathic vocal cord palsy constituted the major subgroup. Thyroidectomy continues to be the single most common surgical procedure responsible for vocal cord palsy. Cardiac surgeries, trauma and cerebrovascular accidents are also increasingly causing vocal cord palsy, which is suggestive of the changing trend in life style and life expectancy. The right recurrent laryngeal nerve is not at higher risk than the left in thyroid surgery. Benign thyroid swellings also contribute significantly to UVCP.