Extremity Strength Research Articles

Determination of the Predictors with the Greatest Influence on Walking in the Elderly.

Background and Objectives: Previous studies have revealed that independent variables (lower extremity strength, postural control ability, and body composition) influence gait performance and variability, but the difference in the relative influence between these variables is unclear. Hence, this study determines the variable that is the most influential predictor of gait performance and variability among potential independent variables in the elderly. Materials and Methods: Seventy-eight subjects aged ≥60 years participated. For each subject, the gait variables and lower extremity muscle strength were measured using an accelerometer worn on both feet during a 6-minute walk and a manual force sensor, respectively. The static balance ability was measured through two force plates, and the body composition was measured by applying bioelectrical impedance analysis. Linear regression analyses were performed stepwise to determine whether these variables affect gait performance and variability. Results: After adjusting for sex and gait performance, the ankle strength, body fat mass, mean velocity in the medial-lateral direction, ankle plantar flexion strength, and girth were predictors of gait speed dorsiflexion, gait performance, swing width of the gait performance, walking speed, and gait variability, respectively. Conclusions: Overall, gait performance in the elderly is related to muscle strength, postural control, and body composition in a complex manner, but gait variability appears to be more closely related to ankle muscle strength. This study provides further evidence that muscle strength is important in motor function and stability.

Effect of Acupuncture on Sensorimotor Function and Mobility in Patients with Multiple Sclerosis: A Pilot Study.

Introduction: Multiple sclerosis (MS) is a progressive disease of the central nervous system that can result in highly variable effects on mobility and sensorimotor function. Persons with MS (pwMS) often use complementary and alternative approaches, such as acupuncture, to address these symptoms. However, studies of acupuncture on these symptoms have been hindered by methodologic flaws, which have limited the ability to draw conclusions about its efficacy. The purpose of this study was to examine the feasibility of an acupuncture intervention on a wide range of sensorimotor and mobility measurements in pwMS. Methods: Using a randomized crossover design, subjects experienced acupuncture or a no treatment control condition twice weekly for 4 weeks, followed by a 4-week washout period, and then crossed over to the other condition for 4 weeks. Strength, sensation, spasticity, gait, and balance were measured for all subjects, both before and after each condition. Results: Seven of the 12 subjects who started the program completed all phases. No subjects experienced adverse effects. No statistically significant changes were observed in the gait or balance measures. Small statistically significant changes were observed in upper extremity strength. Sensation and spasticity were unaffected. Discussion: The variability of MS suggests that a wide array of testing procedures be utilized, however, this may have led to difficulty with completing all phases of the study. Acupuncture did not result in changes in mobility in pwMS. Some improvements in upper extremity strength were observed. It is unclear whether these changes represent the effect of acupuncture or the inherent variability of MS.

Efficacy of proprioceptive neuromuscular facilitation in improving shoulder biomechanical parameters, functionality, and pain after axillary lymph node dissection for breast cancer: A randomized controlled study

PurposeAxillary lymph node dissection and radiotherapy have been associated with pain, physical symptoms, and decreased functional abilities in the upper extremity. This study aimed to evaluate the potential effects of the proprioceptive neuromuscular facilitation (PNF) technique on muscle strength, pain and functionality in this patient group in comparison with progressive resistance training (PRT). MethodsThe study was conducted with a randomized clinical trial design. Sixty-six women were included in the study and randomly divided into three groups: the PNF group (n = 22), the PRT group (n = 22), and the control group (n = 22). The participants were evaluated at the baseline and after eight weeks of treatment. Outcome measures were determined as pain (the Visual Analog Scale), upper extremity strength (isokinetic dynamometer), functionality (the Disabilities of the Arm, Shoulder and Hand questionnaire), and perception of change (the Global Rating of Change Scale). Trial registrationClinicalTrials.gov identifier: NCT05288036. ResultsThe results showed statistically significant changes in both treatment groups in terms of shoulder flexors/extensors, abductor/adductors, internal/external rotators strength/power/endurance measurement, pain, and functionality (p < 0.05). Concerning functionality and perception of change, the PNF group had a statistically significantly higher improvement compared to the remaining two groups (p < 0.05). ConclusionPNF is an effective technique in increasing upper extremity muscle strength, reducing pain during rest and activity, and improving functionality in patients receiving breast cancer treatment.

Effectiveness of home-based exercise delivered by digital health in older adults: a systematic review and meta-analysis.

regular physical exercise is essential to maintain or improve functional capacity in older adults. Multimorbidity, functional limitation, social barriers and currently, coronavirus disease of 2019, among others, have increased the need for home-based exercise (HBE) programmes and digital health interventions (DHI). Our objective was to evaluate the effectiveness of HBE programs delivered by DHI on physical function, health-related quality of life (HRQoL) improvement and falls reduction in older adults. systematic review and meta-analysis. community-dwelling older adults over 65years. exercises at home through DHI. physical function, HRQoL and falls. twenty-six studies have met the inclusion criteria, including 5,133 participants (range age 69.5 ± 4.0-83.0 ± 6.7). The HBE programmes delivered with DHI improve muscular strength (five times sit-to-stand test, -0.56s, 95% confidence interval, CI -1.00 to -0.11; P = 0.01), functional capacity (Barthel index, 5.01 points, 95% CI 0.24-9.79; P = 0.04) and HRQoL (SMD 0.18; 95% CI 0.05-0.30; P = 0.004); and reduce events of falls (odds ratio, OR 0.77, 95% CI 0.64-0.93; P = 0.008). In addition, in the subgroup analysis, older adults with diseases improve mobility (SMD -0.23; 95% CI -0.45 to -0.01; P = 0.04), and balance (SMD 0.28; 95% CI 0.09-0.48; P = 0.004). the HBE programmes carried out by DHI improve physical function in terms of lower extremity strength and functional capacity. It also significantly reduces the number of falls and improves the HRQoL. In addition, in analysis of only older adults with diseases, it also improves the balance and mobility.

PSAT356 Propranolol Improves Bulbar Dysfunction Seen in Hyperthyroidism

Abstract Background Many symptoms of hyperthyroidism are mediated by the augmented activity of the adrenergic central nervous system. Rarely, symptoms of bulbar dysfunction are seen with thyrotoxicosis such as dysphagia and dysarthria. Beta blockers can abort or reduce these symptoms before anti-thyroid drugs are used. Case A 59-year-old woman with hypertension and gout, presented to the emergency department with poor oral intake and difficulties swallowing. Symptoms initially started as hoarseness of voice for 3 weeks then progressed to Globus sensation, difficulties swallowing and aspiration of solids and liquids. She also reported generalized muscle weakness, palpitations, increased sweating, tremors and 20 pounds weight loss in the preceding 2 months. Physical exam showed an ill-appearing, catechetic woman. Luedde exophthalmometry showed an absence of proptosis measuring 15 mm bilaterally without lid lag or stare and extraocular muscles were intact. The skin was silky without edema. The strength in the lower extremities was decreased and she was unable to squat or raise from a seated position. Labs showed creatinine of 2.7 mg/dL (0.4–1 mg/dL), BUN 49 (6–20 mg/dL), potassium of 3.1 (3.5–5.1 mmol/L), TSH &amp;lt; 0.02 (0.34–5.60 uIU/mL), FT4: 3.72. CT of the neck was obtained and multiple sub-centimetric hypodense thyroid nodules with calcifications were noted in the left thyroid lobe. Intravenous potassium chloride was given without improvement of dysphagia. 10 milligrams (mg) of propranolol were ordered to be given every 8 hours. After the first dose and over the next 24 hours she reported rapid improvement in dysphagia and muscle weakness. She was discharged on 15 mg of methimazole twice daily and propranolol 10 mg thrice daily. TSI and TRAB were elevated at 1.03 (normal &amp;lt; 0.54 IU/L) and 2.20 (normal&amp;lt;1.75 IU/L) respectively and the diagnosis of Graves’ disease was made. At her 3 weeks follow up, TSH was &amp;lt;0.02 (0.34–5.60 uIU/mL) with normal FT4. She reported complete resolution of dysphagia and improvement in lower extremities weakness. Discussion Hyperthyroidism may exert powerful effects on the neuro-muscular system. The pathogenesis of myopathy in hyperthyroidism is not fully understood. In hyperthyroid periodic paralysis, hypokalemia is present, and paresis is corrected with potassium supplementation. Our patient's symptoms did not improve with potassium supplement but dramatically improved after propranolol use and before the thyroid function was normalized. This implies a role of adrenergic overactivity in myopathy of hyperthyroidism. A study1 was conducted to quantify muscular weakness in hyperthyroidism and assess the response to therapy concluded that propranolol improves muscular weakness. Conclusion Prior to normalization of thyroid function, the use of beta blockers can alleviate symptoms of bulbar dysfunction. (1)Olson BR, Klein I, Benner R, Burdett R, Trzepacz P, Levey GS. Hyperthyroid myopathy and the response to treatment. Thyroid. 1991;1(2): 137-41. doi: 10.1089/thy.1991.1.137. PMID: 1688015. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

ODP564 Hypercalcemia in the Setting of HTLV-1 Infection and Normal PTHrP Levels

Abstract A 53 year old male with history of HTLV-1 infection associated myelopathy but with unknown mode of transmission, presented with acute on chronic bilateral lower extremity weakness and numbness with no other deficits. Examination revealed decreased strength (grade 1/5) in lower extremities with normal bulk, tone and sensations. Initial blood work revealed hypercalcemia with corrected Calcium of 16.2mg/dl(8.5-11.5), Phosphorus of 2.7mg/dl (2.5- 4.5) and Alkaline Phosphatase of 126mg/dl(20-140). Workup for hypercalcemia revealed Parathyroid hormone (PTH) level of 14pg/ml (10-65), 25 hydroxy vitamin D at 19.6 ng/ml(30-100), 1,25 dihydroxy vitamin D at 6.7pg/ml(19.9-79.3) and TSH of 1.265 microIU/ml(0.5-5). The Parathyroid hormone related protein(PTHrP) level was low at &amp;lt; 2pmol/L while Lactate Dehydrogenase (LDH) was 433U/L(100-220). Urine calcium creatinine ratio was 0.388. Reverse Transcriptase PCR was positive for HTLV-1 but negative for HTLV-2. Smudge cells and atypical lymphocytes were noted on peripheral smear. Imaging revealed generalized lymphadenopathy with splenomegaly but no spinal cord compression. Flow cytometry showed 7.8% atypical helper T cells, positive for CD3, CD4, CD5 and CD45. Clonal T cell receptor gene rearrangements were found, suggesting an underlying T cell neoplasm. Lymph node biopsy confirmed ATLL. He received treatment with fluids, Calcitonin and Denosumab after which serum Calcium levels fell (nadir 7.7mg/dl) and then normalized. He developed another episode of hypercalcemia 5 weeks later which was treated similarly. Discussion Human T cell Lymphotropic Virus-1 (HTLV-1) is a retrovirus causing asymptomatic infections, symptomatic systemic disorders and adult T cell Leukemia and lymphoma(ATLL). HTLV-1 infections, whether in asymptomatic or symptomatic patients, and ATLL are rare but important causes of hypercalcemia and hypercalcemic crises. Individuals with ATLL have the highest incidence of hypercalcemia(50-70%) among all hematologic malignancies. Hypercalcemia is a poor prognostic factor and predicts lower overall survival. It is caused by increased bone resorption, mediated by various factors with the largest role being played by Receptor Activator of Nuclear Factor Kappa B ligand (RANKL), followed by PTHrP, Interleukins, Macrophage Inflammatory Protein 1 alpha and gp 46. RANKL expression is increased upon transactivation by the viral TAX gene product and mediates conversion of osteoclast precursors to mature osteoclasts engaging in bone resorption. PTHrP expression is variable among patients, relating to levels of the TAX gene product that transactivates the PTHrP gene promoter. Thus, a low level, like in our patient, does not rule out HTLV infection as the cause of hypercalcemia. Management of hypercalcemia is in keeping with guidelines for management of other causes of hypercalcemia but may be better responsive to monoclonal antibodies against RANKL than bisphosphonates given the role of the ligand in mediating hypercalcemia in these cases. It can also be used in the setting of poor renal function, which is commonly encountered in hypercalcemic patients. Presentation: No date and time listed

RF30 | PSAT134 Autosomal Dominant Hereditary Multiple Osteochondromas Misdiagnosed As Paget's Disease of Bone

Abstract Background Autosomal dominant hereditary multiple osteochondromas is a rare genetic disorder with variable clinical manifestations. We present the case of a patient misdiagnosed with Paget's disease of bone found to have hereditary multiple osteochondromas. Clinical Case We present a 55-year-old male with history of chronic back and hip pain who presented to endocrinology clinic for evaluation of Paget's disease of bone. He was diagnosed with Paget's disease at age 16 after a bike accident resulting in knee pain where a "knot" was removed from his knee. He reported multiple "knots" in bones throughout adulthood but never sought treatment. He had history of elevated alkaline phosphatase on prior chemistries. He developed debilitating back, hip, and thigh pain resulting in immobility and suffered vertebral osteomyelitis from MRSA requiring laminectomy at age 52. On physical exam, massive maxillary and mandibular tori were noted along with bilateral cataracts and decreased muscle strength in upper and lower extremities. He underwent evaluation by oral surgery for extensive tooth decay and was recommended for extraction of teeth #12, 14, 15, and 17 with restorative needs for teeth #2, 4, 5, 13, 28, 30, 32. Labs notable for serum calcium 10.1 (ref: 8.4-10.5 mg/dl), phosphorus 4.2 (ref: 2.3-4.7 mg/dl), magnesium 1.8 (ref: 1.6-2.6mg/dl), PTH 34 (ref: 16-77 pg/ml), 25-OH Vit D 28 (ref: 25-80 ng/ml), 1,25 dihydroxyvitamin D 45.9 (ref: 19.9-79.3pg/ml), alkaline phosphatase 199 (ref: 40-150 unit/L), bone-specific alkaline phosphatase 52.5 (ref: 6.5 - 20.1 mcg/L). 24-hr urine calcium 0.06 g/24hr (ref: 0.04-0.35) from an 850ml urine volume. Procollagen type 1 n-terminal propeptide 179 (ref 22-105 UG/L). Prior MRI right hip showed "abnormal appearance of pelvic bony ring and proximal femurs with heterogenous marrow signal and cortical thickening suspicious for Paget's disease", as well as a 1.2cm circumscribed cystic focus within proximal right femoral diaphysis. Prior bone scan demonstrated diffusely uptake in pelvis, uptake in proximal right femur, focally intense uptake in L5 vertebrae. Plain film imaging demonstrated severe diffuse degenerative changes in cervical, thoracic and lumbar vertebrae and sessile osteochondromas arising from both scapulae, mild thoracic levoscoliosis. Genetic testing demonstrated loss-of-function mutation in the EXT-1 gene, diagnostic of hereditary multiple osteochondromas. Currently, there are no FDA-approved treatments for osteochondromas though studies involving biologic therapy are ongoing. This patient was referred to orthopedic oncology and OMFS for dental extraction and decision for conservative treatment with observation. Conclusion This case demonstrates how the rare entity of hereditary multiple osteochondromas can have variable clinical presentations leading to its misdiagnosis and highlights the need for ongoing research into non-surgical treatment options. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 12:36 p.m. - 12:41 p.m.

PSAT053 An Unusual Case of Central Adrenal Insufficiency Following the Diagnosis of Presumed Neuro-Sarcoidosis

Abstract Background Central adrenal insufficiency develops due to inadequate ACTH secretion by the pituitary gland (secondary) or decreased corticotropin-releasing hormone (CRH) secretion by the hypothalamus (tertiary).1 The hallmark of central adrenal insufficiency is inappropriately low levels of ACTH in the setting of low cortisol levels.1 Central adrenal insufficiency can be caused by CNS processes affecting the hypothalamus or pituitary gland, such as infection, autoimmune disease, malignancy, or the abrupt cessation of steroids.1 Here we present a rare case of central adrenal insufficiency following the diagnosis of presumed neuro-sarcoidosis. Clinical Case A 69-year-old female presents with fatigue, weight loss, and diffuse bilateral weakness. Vital signs were within normal with a physical exam significant for 3/5 strength in bilateral upper and lower extremities. MRI brain revealed leptomeningeal and pituitary stalk enhancement. CSF studies showed CSF lymphocytic pleocytosis and an elevated CSF ACE level 5.8 U/L. The most common etiologies of an elevated CSF ACE level are neuro-sarcoidosis or malignancy, and patient had no imaging findings of malignancy. With the elevated CSF ACE level along with imaging findings, she was given a presumptive diagnosis of neuro-sarcoidosis. She was treated with three days of IV methylprednisolone with mild improvement in symptoms. After discharge, she continued to have symptoms of diffuse weakness, fatigue, nausea and was re-admitted a few weeks later. Vitals on this admission revealed hypotension to 93/55, heart rate 66, SpO2 99%. Repeat MRI brain revealed resolution of leptomeningeal and pituitary enhancements. Due to the hypotension, morning cortisol levels were drawn and returned low at 0.4 ug/dL. ACTH stimulation test showed cortisol at 0 minutes low at 0.5 ug/dL and cortisol at 60 minutes at 9.7 ug/dL. ACTH prior to stimulation test returned low at 1.6 pg/mL. With reduced ACTH levels in the setting of low cortisol levels, the patient was diagnosed with central adrenal insufficiency. She began hydrocortisone treatment with complete resolution of symptoms. Further pituitary hormones were tested with TSH returning low at 0.04 uIU/mL; free T4 normal at 0.8 ng/dL; T3 low-normal at 39 ng/dL; FSH low for a post-menopausal female at 2.8 mIU/mL. This multi-hormonal insufficiency suggested the presence of an intracranial process contributing to hypothalamic-pituitary dysfunction. With initial neuro-imaging findings and elevated CSF ACE, the intracranial process causing her central adrenal insufficiency was presumed to be neuro-sarcoidosis. Due to resolution of symptoms on hydrocortisone therapy, definitive histologic evidence of neuro-sarcoidosis was not pursued. Conclusion This is a case demonstrating a rare presentation of central adrenal insufficiency following the diagnosis of presumed isolated neuro-sarcoidosis, with symptoms and radiographic findings responding rapidly to steroid therapy. References Nicolaides, N. C., Chrousos, G. P., &amp; Charmandari, E. Adrenal Insufficiency. [Updated 2017]. In: Feingold KR, Anawalt B, Boyce A, et al., editors Endotext [Internet]. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

PSAT355 A Case Report Identifying Graves’ Ophthalmopathy in a Myasthenia Gravis Crisis and Response to Teprotumumab

Abstract Background Thyroid disease is relatively common in patients with Myasthenia Gravis (MG), affecting 5%–10% of patients, conversely, the prevalence of MG in patients with Graves’ disease is 0.14%. Of thyroid diseases seen in MG, Graves’ Disease (GD) is the most common. Graves ophthalmopathy (GO) is a known complication associated with GD, however, in patients with MG, its identification may be difficult, as both GD and MG may present with similar ocular signs and subtle differences. This case identifies GO in a MG crisis and its response to teprotumumab. Clinical Case A 53-year-old-woman with MG presented with one year of worsening bilateral eye and arm weakness, fatigue, eye pain, headaches and palpitations. Examination revealed bilateral ptosis, eyelid edema, and ⅘ bilateral upper extremity strength. Workup revealed suppressed TSH (&amp;lt;0.010, n 0.5-5.0 ml U/L) and elevated antibodies: Thyroid Stimulating Immunoglobulin (4.86, n &amp;lt;0.54 IU/L) and Thyrotropin Receptor Antibodies (TRAb) (8.08, n ≤1.75 IU/L). Thyroid ultrasound showed several bilateral cystic nodules and increased thyroid parenchyma vascularity without thyromegaly, suggestive of GD. Thyroid Uptake and Scan showed diffusely elevated 24-hour uptake (71%, n 10-30%) consistent with GD. Treatment was initiated with methimazole 5 mg daily. At follow up, she had symptoms of eyelid weakness, diplopia, headaches, and muscle weakness. Graves’ Ophthalmopathy Clinical Activity Score (CAS) was 5/10. Examination showed bilateral ptosis with eyelid edema, proptosis, conjunctival redness, and chemosis. Extraocular muscle movements intact without pain, normal pupils and visual fields. Ophthalmology review and orbital CT showed bilateral exophthalmos with extraocular muscle thickening consistent with thyroid eye disease (TED). The classic coke-bottle-sign of the anterior tendon of the inferior rectus muscles was noted. Given her presentation, clinical course and progression of TED, she commenced a teprotumumab treatment trial. Clinical improvement of GO was noted upon follow-up assessment after 5 doses of teprotumumab: CAS 2/10, decreasing proptosis on exam, and TRAb (3.86, n ≤1.75 IU/L). Conclusion This case highlights the potentially misleading clinical findings and difficult diagnoses of coexisting GO and MG. Although muscular weakness is common in GD, concomitant MG is rare and may cause profound additional morbidity. Ocular signs in both diseases may cause diagnostic confusion, although ptosis is more consistent with MG and lid retraction with GD alone. GO can mimic some of the neuromuscular and ophthalmologic signs of MG and can be easily missed or mistakenly attributed to either MG or GD. This may result in a delayed diagnosis/inappropriate treatment of GO, thus, clinicians should maintain suspicion for coexisting diagnoses. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Latissimus Dorsi Tendon Repair

Background: Latissimus dorsi tendon ruptures are rare injuries that can occur in overhead or throwing motions and are almost always sports related. Indications: Latissimus dorsi tendon ruptures are largely treated nonoperatively, although surgical repair is indicated for the young active patient looking to return to a high level of sport and for those with complete avulsion injuries or mid-substance tendon tears. Technique Description: Depending on the degree of tendon retraction, anteroinferior or posteroinferior axillary incision is made. After the tendon is mobilized, sutures are placed in a Krackow fashion through the bulk of the tendon, and the tendon footprint is prepared by gently decorticating the surface of the humerus, just anterior and inferior to the teres major insertion point. Two Arthrex Pec Buttons are then loaded into the superior and inferior limbs of the suture tape and 2 unicortical holes are drilled into the footprint of the insertion site. The superior button is placed first and then tensioned to allow the latissimus dorsi to be pulled to the bone. Next, the second button is placed, though this is not tensioned until later at the time of the biceps tenodesis. Finally, the procedure is visualized and well inspected to ensure appropriate location of the tendon and securing hardware. Results: After an appropriate rehabilitation protocol is followed for up to 6 months postoperatively, acute repair of a ruptured latissimus dorsi tendon allows for near to complete restoration of patient functionality and strength, with return to full activity possible within 6 to 8 months. Conclusion: Surgical repair of a ruptured latissimus dorsi tendon is effective in restoring upper extremity strength and functionality and is associated with high patient satisfaction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Prevalence and clinical association of sarcopenia among Thai patients with systemic sclerosis

Patients with systemic sclerosis (SSc) have some potential factors associated with an increased risk of sarcopenia. There has been currently no study to examine such associations in SSc patients. We aimed to determine the prevalence of sarcopenia among SSc patients and examine its association with clinical manifestations and laboratory tests. A cross-sectional study was conducted in 180 adult SSc patients at the Scleroderma Clinic, Khon Kaen University, Thailand, between July 2019 and April 2020. Clinical data, laboratory tests for inflammatory markers, serology, hormone, body composition by dual-energy X-ray absorptiometry, handgrip strength, functional lower extremity strength, and usual gait speed were collected and measured. Sarcopenia was defined according to the criteria of the Asian Working Group for Sarcopenia. One hundred and eighty patients were recruited. Ninety-four cases (52.2%) were the diffuse cutaneous SSc subset. The respective mean age and duration of disease was 58.8 ± 9.4 and 6.2 ± 5.3 years. Sarcopenia was revealed in 41 SSc patients for a prevalence of 22.8% (95% CI 12.1–34.8), while the prevalence was higher in patients with the diffuse cutaneous SSc (dcSSc) compared to the limited cutaneous SSc. BMI at the onset of SSc and C-reactive protein > 5 mg/dL were significantly associated with sarcopenia with a respective OR of 0.60 (95% CI 0.48–0.75) and 3.18 (1.06–9.54). Sarcopenia is common in patients with SSc, but the prevalence is more pronounced in the dcSSc. Inflammatory markers, particularly the CRP level, are strongly associated. BMI at the onset had a negative association with sarcopenia among SSc patients.

Common neural substrates of diverse neurodevelopmental disorders.

Neurodevelopmental disorders are categorized and studied according to their manifestations as distinct syndromes. For instance, congenital prosopagnosia and dyslexia have largely non-overlapping research literatures and clinical pathways for diagnosis and intervention. On the other hand, the high incidence of neurodevelopmental comorbidities or co-existing extreme strengths and weaknesses suggest that transdiagnostic commonalities may be greater than currently appreciated. The core-periphery model holds that brain regions within the stable core perceptual and motor regions are more densely connected to one another compared to regions in the flexible periphery comprising multimodal association regions. This model provides a framework for the interpretation of neural data in normal development and clinical disorders. Considering network-level commonalities reported in studies of neurodevelopmental disorders, variability in multimodal association cortex connectivity may reflect a shared origin of seemingly distinct neurodevelopmental disorders. This framework helps to explain both comorbidities in neurodevelopmental disorders and profiles of strengths and weaknesses attributable to competitive processing between cognitive systems within an individual.

Influence of sex on functional capacity, and muscle strength and fine motor skills of upper limbs in patients with multiple sclerosis

IntroductionMultiple Sclerosis (MS) is a neurodegenerative disease characterized by damage to the myelin sheath that covers neurons, and which shows differences between men and women in terms of susceptibility and disease progression related in turn to functional ability and quality of life. ObjectivesTo know the differences based on gender, assessing the functional capacity, muscle strength and fine motor skills of the upper extremities of patients with MS. Material and methodsA quantitativede, scriptive, cross-sectional study was conducted with a sample of 51 MS patients, that were assessed for functional capacity (DASH scale); static and dynamic balance (Berg scale), perceived balance (ABC); strenght (Jamar and dynamometer); and fine motor skills (NHPT). ResultsThe sample consisted of 15 men and 36 women, with a mean age of 47 ± 12 años. No differences were observed in functional capacity DASH (p = 0.616). In addition, men showed greater pincer strength (p < 0.001) and greater triceps strength (p < 0.05) in both arms. Regarding fine motor skills, it was better in women in both the dominant and non-dominant hands (p < 0.05). ConclusionsDespite not observing functional differences by sex, there are differences in the parameters of pincer and triceps strength, which is higher in men; and in manual dexterity of both hands, which is better in women.

The effects of Baduanjin exercise vs. brisk walking on physical fitness and cognition in middle-aged patients with schizophrenia: A randomized controlled trial.

ObjectivePatients with schizophrenia have deficits in physical and cognitive function that may become salient in their middle ages. These deficits need active intervention to prevent functional decline. Baduanjin and brisk walking show promise as interventions in patients with schizophrenia. This study investigated the effects of Baduanjin exercise vs. brisk walking in middle-aged patients with schizophrenia.MethodsIn this single-blind, 2-arm, parallel, randomized controlled trial, 48 participants aged older than 40 years were enrolled and assigned to the intervention group (Baduanjin) or the control group (brisk walking). The training of both groups took place twice a week, 60 min per session, for 12 weeks. The participants were evaluated with physical, cognitive, and functional outcomes at baseline, postintervention, and 4 weeks after the intervention.ResultsThe results of the study demonstrated significant time effects in walking distance (p = 0.035, η2 = 0.094) and lower extremity strength (p = 0.006, η2 = 0.152). Post-hoc analysis revealed both groups had significant improvement in changes from baseline to the postintervention assessment (ps < 0.05) and follow-up (ps < 0.05). The results demonstrated a significant group-by-time interaction in change scores of global cognition (F = 7.01, p = 0.011, η2 = 0.133). Post-hoc analysis revealed a significant improvement in the Baduanjin group from baseline to postintervention (p = 0.021), but the improvements were not maintained at the follow-up assessment (p = 0.070). The results also demonstrated significant group effects in balance function (p < 0.001, η2 = 0.283), motor dual-task performance (p = 0.026, η2 = 0.103), and cognitive dual-task performance (p < 0.001, η2 = 0.307). Post-hoc analysis revealed that the Baduanjin group improved more than the brisk walking group in the above outcomes (ps < 0.05).ConclusionThis study demonstrated the differential effects of Baduanjin exercise and brisk walking in middle-aged patients with schizophrenia. Baduanjin might be a beneficial regimen for improving physical and cognitive function in this population. Further research with a larger sample is warranted.Clinical trial registration[ClinicalTrials.gov], identifier [202000817B0C602].

INTRIGUING LUNG FUNCTION TESTS IN NEUROMUSCULAR WEAKNESS

INTRIGUING LUNG FUNCTION TESTS IN NEUROMUSCULAR WEAKNESS

S2794 An Unexpected Cause of Abdominal Pain in a Patient With Ulcerative Colitis

Introduction: Sickle cell crisis and Ulcerative Colitis (UC) can both present with abdominal pain, which can present a diagnostic challenge in patients with concomitant disease. Thorough work-up is required to appopriately achieve the diagnosis and guide treatment. Case Description/Methods: A 27 year old female with a history of UC presented to the ED with non-bloody diarrhea, diffuse abdominal pain, and right lower extremity pain. On exam, she was mildly hypotensive with decreased strength in bilateral lower extremities. CBC showed Hgb 7.6g/dL, and iron panel revealed: iron saturation 28%, elevated ferritin (580.5ng/mL), low haptoglobin ( < 30mg/dL), elevated reticulocyte count (7.47%), and reticulocyte index of 2.05. CT scan showed splenomegaly and diffuse bony infracts. Colonoscopy revealed Mayo 3 ulcerative pancolitis (FigureB and FigureC). Biopsy (FigureA) showed sickle cells in the capillaries and lamina propria with background features of chronic colitis. She was diagnosed with concomitant UC flare and sickle cell crisis. Her sickle cell crisis was managed with IV fluids, analgesics, and folic acid, and her UC was treated with IV solumedrol. She was discharged on a prednisone taper and initiated on infliximab infusions with significant improvement in her symptoms. Discussion: There is a rare predisposition of SCD to IBD, though the cause is not well elucidated [1]. In these patients, abdominal pain may be either due to SCD crisis or UC flare. Hence, elucidating the cause is important in guiding treatment. While acute pain due to vaso-occlusion often affects the extremities, it can also manifest as abdominal pain due to mesenteric vaso-occlusion. UC on the other hand, typically presents with left lower quadrant abdominal pain with associated diarrhea; however UC can also present with diffuse abdominal pain in the setting of pancolitis. Diarrhea and dehydration due to UC flares could presumably exacerbate SCD leading to more frequent crises. Dehydrated SCD patients, in the setting of travel, were more likely to be hospitalized for vaso-occlusive crises. Additional complications to consider in treating concurrent SCD and UC is avascular necrosis (AVN). AVN is an associated complication of SCD, as well as a side effect of long-term corticosteroid use. Due to the pro-thrombotic state associated with both diseases, prophylactic anticoagulation can also be considered in the setting of immobilization or hospitalization, and do not necessarily have to be stopped due to bloody diarrhea or anemia [3].Figure 1.: A: colonic biopsy demonstrating sickled red blood cells in the lamina propria and capillary. B and C depict Mayo 3 pancolitis.

Technology-based assessment of Short Physical Performance Battery in elderly population

The Short Physical Performance Battery (SPPB) is an objective evaluation of the lower extremity strength [1]. It has been proposed as a reliable method to assess the physical performance of elderly people (65+) through three simple tasks of daily life (gait, standing, chair stand) [2]. In clinical research, the SPPB is administered by research staff who are experienced in the standardized protocol of the examination, with each component measured manually by a stopwatch [3,4]. Therefore, these investigations may be subject to possible interrater and intrarater variabilities [5]. This work aims to validate an automatic method for the objective assessment of SPPB through the combination of wearable inertial and sEMG sensors. The present study included a sub-cohort of Salus in the Apulia Study of 137 old subjects, recruited consecutively from 2019 on a recall-based from an ongoing population-based prospective cohort comprising 2472 individuals aged 65+ and residents in Castellana Grotte, Puglia (Italy). Eligible participants were equipped with an inertial sensor (positioned around the subjets' waist, BTS G- SENSOR2, BTS SpA) and four surface electromyographic probes (BTS FREEEMG, BTS SpA) on Tibialis Anterior (TA) and Gastrocnemius Medialis (GAM) of both legs. The medical doctor instructed subjects to perform three different tasks: balance (stance phase, semi-tandem phase, and tandem phase), five repetition STS and 4-m walk. A stopwatch was used to measure the time required by the subject to complete each task and then assign the SPPB score according to the specific range (SPPB). Kinematics and EMG data of subjects were collected via BTS EMGAnalyzer and exported in MATLAB R2020a to calculate the technology-based SPPB (tSPPB). Descriptive statistics were used to describe the demographic characteristics and outcomes of the sample. The Spearman correlations were used to explore the relationship between the SPPB and tSPPB total score and the three-component scores. We compared the internal consistency of the SPPB and tSPPB using Cronbach’s alpha. Ninety-seven subjects (mean age [±SD] = 75.1 ± 5.53, female = 50.5%) were finally included in the analysis. The total SPPB (9.49 ± 2.55) and tSPPB (8.88 ± 2.51) scores were significantly different, yet highly correlated (r = 0.87, p < 0.01). The alpha coefficient for the SPPB score was high (0.93, 95% CI: 0.90 - 0.96), suggesting that the two methods have relatively high internal consistency. Technology-based assessment of SPPB represents a step forward in adapting the administration of objective measures of physical function to significantly expand the reach of research and clinical practice to assess populations at risk of functional decline.

Non-traumatic Spontaneous Spinal Subdural Hematoma in a Patient with Acute Paraplegia

Acute non-traumatic spinal subdural hematoma (SSDH) is a rare clinical condition in the emergency medicine practice and difficult to diagnose during the primary physical examination. It mostly occurs at thoracal vertebra levels due to trauma, use of anticoagulants, medical procedures such as acupuncture, arteriovenous malformations, hematological disorders or space-occupying lesions. Here, we discussed an elderly female patient who was not on anticoagulant and described sudden loss of muscle strength and sensation in both lower extremities. Initial laboratory and imaging including brain computerized tomography (CT) and magnetic resonance imaging (MRI) were in normal range. Her secondary examination revealed anesthesia under the T4 dermatome level. Cervical spine-MRI imaging revealed a subdural hematoma significantly compressing the spinal cord on the C7-T1 dermatome segments. Any emergency neurosurgical intervention was not considered and the patient was interned in the neurosurgical clinic for conservative treatment and further examination. Patient , with no progress seen in consecutive MRI scans, was discharged after offering an outpatient check-up. We recommend secondary physical examination in emergency department (ED). In the case of appearance of sensory deficits of certain dermatomes, spine-MR imaging may lead to put the diagnose early in ED.

DÜZENLİ YAPILAN SPOR TIRMANIŞIN ÜST EKSTREMİTE KUVVETİNE ETKİSİ

The presence of upper extremity strength can positively affect athletes physically, psychologically and mentally in sports climbing. The aim of this study is to examine the effect of regular sports climbing on upper extremity strength such as handgrip, finger and arm. This thesis was designed as an experimental study involving a control group. Within this scope, the control group consisted of 12 sedentary people, while the study group consisted of 12 sports climbers with medium level sports climbing skills and at least 2-3 years of experience. Age, height and weight measurements of the study and control groups were made before the research. Upper extract of the study and control group measurements were taken before the starting point of the study and at the end of 8 weeks. The study group regularly climbed 3 times a week for 2-4 hours for 8 weeks. Athletes practiced on the 17 m high climbing wall, which has negative slopes, too. During the climbs, the researchers were present at the application area for control. Jamar brand hydraulic finger dynamometer was used for finger strength measurement, Takei Grip-D brand digital hand dynamometer was used for handgrip strength and twisted arm hanging test was performed for arm endurance. SPSS 22.0 package program was used for data analysis and descriptive information. In our thesis study, there were increases in right- and left-hand grip strength, right and left finger strength and arm endurance, and statistically significant differences was found. There were also significant differences between the pre-test and post-test dissimilarities between the study group and the control group. As a result, it was concluded that regular sport climbing had a positive effect on hand grip strength, finger strength and arm endurance.

Intrinsic Risk Factors for First-Time Noncontact ACL Injury: A Prospective Study of College and High School Athletes.

A comprehensive understanding of the intrinsic risk factors for anterior cruciate ligament (ACL) disruption is important for identifying individuals at increased risk for suffering this trauma and developing interventions to mitigate risk. A variety of risk factors predispose athletes to first-time, noncontact ACL injury and some of these differ between male and female athletes. Prospective cohort study with nested case-control sampling. Level 2. Sport teams at 28 high schools and 8 colleges were monitored prospectively over 4 years, and 109 of 130 athletes who suffered their first noncontact ACL injury participated in the study. At the time of injury, matched control subjects were randomly selected from among the case's teammates and a total of 227 athletes participated. Demographic characteristics, joint laxity, lower extremity alignment, strength, and personality characteristics were measured. The association of each risk factor with injury risk was assessed by conditional logistic regression. The risk factors that were associated with ACL injury in both male and female athletes included having a parent with prior ACL injury and increases of the following variables: body weight, anterior displacement of the tibia relative to the femur, genu recurvatum, and generalized joint laxity. Risk factors that are unique to female athletes included increased body mass index, increased trunk flexion strength, and prior non-ACL knee injury. The risk factors specific to male athletes were decreased standing quadriceps angle, decreased hip adduction strength, and chronic disease. A diverse set of risk factors predispose both male and female athletes to ACL injury, whereas others appear to be sex-specific. Different approaches for assessing risk and preventing ACL injury are needed for male and female athletes. In addition, personalized prevention strategies may be needed to target the specific characteristics that place an individual at increased risk of suffering this trauma.