Subacute Phase Research Articles

The Czech Fugl-Meyer assessment for post-stroke sensorimotor function: translation and cross-cultural adaptation and validation.

To ensure wider use of the internationally recommended Fugl-Meyer Assessment (FMA) of sensorimotor function for people with stroke, official translations of the scale are needed. This study aimed to perform a translation and cross-cultural adaptation/validation of the FMA into the Czech language. Translation and cross-cultural adaptation/validation. Five clinical experts and 1 external expert participated as reviewers; 11 individuals with stroke in the early subacute phase were included in the pilot testing. A standardized process using forward-backward translations, expert panel reviews, and pilot testing between and within the raters (inter- and intra-rater reliability) were employed to ensure conceptual, semantic, and operational validity of the new Czech FMA. Agreement between raters was assessed in 11 individuals with stroke on 2 consecutive days at University Hospital Olomouc by using Svensson's rank-based statistics. Percentage of agreement between and within raters ranged between 70-100% and 55-100%, respectively. Systematic disagreements, found in 7 out of 96 FMA items, were discussed and revised in the final version. The Czech FMA offers a more unified and standardized assessment of sensorimotor impairment in clinical and research settings. This will improve stroke rehabilitation care and allow for wider international collaboration.

A case report of Kounis syndrome presenting with coronary angina pectoris and coronary microcirculatory disturbance, resulting in takotsubo cardiomyopathy-like changes

Abstract Background Kounis syndrome is an allergic syndrome leading to acute coronary syndromes (ACS). It includes coronary spasm angina (CSA), plaque erosion or rupture, and coronary stent thrombosis. Takotsubo cardiomyopathy is a myocardial disease without significant stenosis of the coronary arteries and is said to include coronary microvascular dysfunction (CMD) and CSA in its background. Case Summary A 63-year-old woman was urgently brought to our hospital due to chest tightness and loss of consciousness after the appearance of generalized urticaria. She was in anaphylactic shock and her ECG suggested ACS. Emergency coronary angiography showed no significant stenosis and left ventriculography showed takotsubo cardiomyopathy-like wall motion. The diagnosis of Kounis syndrome type I was made. The simultaneous binuclear cardiac scintigraphy of 99mTc-tetrofosmin and 123I-BMIPP showed atypical images of takotsubo cardiomyopathy. The evaluation of coronary microvascular function showed CMD and the ACh stress test showed multivessel CSA. We started a calcium channel blocker, isosorbide mononitrate, and antihistamines. She was discharged from the hospital after cardiac function improved and has remained stable without any recurrence during one year of outpatient follow-up. Discussion There are few reports of an invasive evaluation in the subacute phase of Takotsubo cardiomyopathy-like clinical presentation. We report a case of takotsubo-like wall motion abnormality due to CSA and CMD in a patient with Kounis syndrome. Simultaneous binuclear myocardial scintigraphy, assessment of the coronary microcirculation, and ACh stress test were useful in the diagnosis, and the coexistence of CSA and CMD suggested her clinical images similar to takotsubo cardiomyopathy.

Effect of tibialis anterior focal muscle vibration for gait rehabilitation in hemiplegic individuals during the subacute phase after stroke: the NEUROVIB-AVC study protocol - a multicentric randomised controlled trial.

Gait recovery remains one of the most determining factors in social participation for poststroke individuals, in whom ankle dorsiflexor function is closely related to gait speed. Focal muscle vibration has shown promising neurophysiological and clinical effects in neuromotor recovery. However, it remains to be determined whether tibialis anterior focal muscle vibration applied to the paretic limb could improve walking speed when implemented in early rehabilitation after stroke occurrence. This study describes a multicentric randomised controlled trial in which 70 participants will be randomly assigned in a 1:1 ratio to the tibialis anterior focal muscle vibration group or the sham group, in addition to their conventional rehabilitation. Participants will receive 100 Hz vibration/sham for 30 min, five times per week, for 8 weeks. The primary outcome will be gait speed, as assessed through a 10 m walking test and will be compared between groups at the end of the intervention. Secondary outcomes will include gait abilities, neuromuscular clinical evaluations and neurophysiological measures. Outcomes will be assessed at baseline and across five visits during and after the intervention, until 16 weeks of follow-up. Ethics approval was obtained from the French Ethics Committee 'Protection des Personnes Nord Ouest III' in 30 May 2023 (IDRCB: 2023-A00489-36). The results will be published in a peer-reviewed journal and presented at scientific conferences. NCT05945212.

Stereotactic Evacuation Performed During the Subacute Phase Improves Functional Independence Measurement Scores in Patients With Putaminal Hemorrhage

Stereotactic Evacuation Performed During the Subacute Phase Improves Functional Independence Measurement Scores in Patients With Putaminal Hemorrhage

Writing and drawing tilts after right hemisphere stroke are signs of a wrong verticality representation.

Writing and drawing tilts after right hemisphere stroke are signs of a wrong verticality representation.

Aortic Dissection Presenting as Paraplegia Complicated with Pulmonary Embolism

Aortic dissection and pulmonary embolism are serious and potentially life-threatening cardiovascular diseases. Paraplegia is one of the most life-threatening complication of aortic dissection. The risk of venous thromboembolism increases in patients with paraplegia. The coexistence of aortic dissection, paraplegia, deep vein thrombosis and pulmonary embolism are very rare. This paper reports a case of an 81-year-old male patient, developing paraplegia related to spinal cord ischemia due to acute type I aortic dissection, in the subacute phase, complicated with deep vein thrombosis and pulmonary embolism.

Body weight-supported treadmill training reduces glial scar overgrowth in SCI rats by decreasing the reactivity of astrocytes during the subacute phase

BackgroundSpinal cord injury is followed by glial scar formation, which was long seen mainly as a physical barrier preventing axonal regeneration. Glial scar astrocytes lead to glial scar formation and produce inhibitory factors to prevent axons from growing through the scar, while inhibiting the conversion of reactive astrocytes into glial scar-forming astrocytes may represent an ideal treatment for CNS injury. Exercise is a non-invasive and effective therapeutic intervention for clinical rehabilitation of spinal cord injury. However, its precise therapeutic mechanisms still need to be continuously explored.Methods30 rats were randomly assigned to three groups (Sham, SCI, SCI + BWSTT; n = 10 rats per group). In this study, we employed the BBB scales and gait analysis system to examine the behavioral functions of the rats in each group. Furthermore, we utilized immunoblotting of spinal cord tissue at the injury site, in addition to histological staining and immunofluorescence staining, to explore glial scar aggregation and axonal regeneration in each group of rats.ResultsOur results revealed that hindlimb motor function was significantly improved in SCI rats after a sustained subacute period of BWSTT, accompanied by the promotion of histological repair and nerve regeneration. Subsequent immunofluorescence staining and immunoblotting showed diminished astrocyte reactivity in the region surrounding the spinal cord injury as well as reduced expression and distribution of collagen fibers near the lesion after BWSTT. Additionally, a significant decrease in the expression of MMP-2/9, which is closely related to astrocyte migration, was observed in the vicinity of spinal cord tissue lesions.ConclusionOur study demonstrates that a sustained BWSTT intervention during the subacute phase of spinal cord injury can effectively reduce astrocyte reactivity and glial scarring overgrowth, thereby facilitating functional recovery after SCI.

Effect of intensive nutritional support on functional recovery in subacute stroke: A randomized, multicenter, single-blinded trial.

Effect of intensive nutritional support on functional recovery in subacute stroke: A randomized, multicenter, single-blinded trial.

Quantitative Ischemic Lesions of Portable Low-Field Strength MRI Using Deep Learning-Based Super-Resolution.

Deep learning-based synthetic super-resolution magnetic resonance imaging (SynthMRI) may improve the quantitative lesion performance of portable low-field strength magnetic resonance imaging (LF-MRI). The aim of this study is to evaluate whether SynthMRI improves the diagnostic performance of LF-MRI in assessing ischemic lesions. We retrospectively included 178 stroke patients and 104 healthy controls with both LF-MRI and high-field strength magnetic resonance imaging (HF-MRI) examinations. Using HF-MRI as the ground truth, the deep learning-based super-resolution framework (SCUNet) was pretrained using large-scale open-source data sets to generate SynthMRI images from LF-MRI images. Participants were split into a training set (64.2%) to fine-tune the pretrained SCUNet, and a testing set (35.8%) to evaluate the performance of SynthMRI. Sensitivity and specificity of LF-MRI and SynthMRI were assessed. Agreement with HF-MRI for Alberta Stroke Program Early Computed Tomography Score in the anterior and posterior circulation (diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score and diffusion-weighted imaging-posterior circulation Alberta Stroke Program Early Computed Tomography Score) was evaluated using intraclass correlation coefficients (ICCs). Agreement with HF-MRI for lesion volume and mean apparent diffusion coefficient (ADC) within lesions was assessed using both ICCs and Pearson correlation coefficients. SynthMRI demonstrated significantly higher sensitivity and specificity than LF-MRI (89.0% [83.3%-94.6%] versus 77.1% [69.5%-84.7%]; P<0.001 and 91.3% [84.7%-98.0%] versus 71.0% [60.3%-81.7%]; P<0.001, respectively). The ICCs of diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score between SynthMRI and HF-MRI were also better than that between LF-MRI and HF-MRI (0.952 [0.920-0.972] versus 0.797 [0.678-0.876], P<0.001). For lesion volume and mean apparent diffusion coefficient within lesions, SynthMRI showed significantly higher agreement (P<0.001) with HF-MRI (ICC>0.85, r>0.78) than LF-MRI (ICC>0.45, r>0.35). Furthermore, for lesions during various poststroke phases, SynthMRI exhibited significantly higher agreement with HF-MRI than LF-MRI during the early hyperacute and subacute phases. SynthMRI demonstrates high agreement with HF-MRI in detecting and quantifying ischemic lesions and is better than LF-MRI, particularly for lesions during the early hyperacute and subacute phases.

Temporal Proteome Profiling of Anterior Cruciate Ligament Tear Remnants: Secretory Proteins in the Acute Phase Potentially Promote Tissue Repair.

Previous studies reported that preserving the anterior cruciate ligament (ACL) remnants following ACL rupture during reconstruction surgery could promote graft healing. However, the temporal proteomic expression of ACL remnants remains unclear. Based on previous reports, we have redefined the initial 6 weeks following ACL rupture as the acute phase and the subsequent 6 weeks to 6 months as the subacute phase. High-throughput proteomic sequencing on ACL remnants from the two groups was utilized. Our study unveiled a total of 381 differential expression proteins (DEPs), with 136 upregulated and 245 downregulated proteins in the acute phase. By intersecting these findings with secretory protein databases, we identified 26 upregulated secretory proteins and 19 downregulated in the acute phase. The upregulation of MMP9 and VTN and the downregulation of COL1A1 and POSTN in the acute phase were further confirmed by immunohistochemistry. These findings suggest that the elevated expression of secretory proteins in the acute phase may play crucial roles in promoting cell proliferation, angiogenesis, and tissue repair of the graft. This study not only enhances our understanding of repair mechanisms in ACL remnant preservation but also provides a theoretical foundation for guiding rational clinical surgical timing.

Preventing chronic low back pain: investigating the role of Pilates in subacute management—a randomized controlled trial

Abstract Background Subacute low back pain (LBP) is a critical phase that can determine long-term patient outcomes. Exercise therapy, including Pilates, is widely used to manage LBP, but its effectiveness in the subacute phase remains underexplored. This randomized controlled trial aims to compare the effects of an 8-week Pilates-based intervention versus a home exercise program on pain intensity, functional disability, and quality of life in patients with subacute LBP. Methods Sixty-six participants with subacute LBP were randomized into two groups: a supervised Pilates group and a home exercise group. Pain intensity (Visual Analog Scale), functional disability (Roland-Morris Disability Questionnaire), and quality of life (Short Form-36) were assessed at baseline, post-intervention, and 3-month follow-up. Results Both groups exhibited significant improvements in all outcome measures (p &lt; 0.001). However, the Pilates group showed superior reductions in pain intensity (p = 0.010 post-treatment, p = 0.002 at follow-up) and functional disability (p = 0.009 and p = 0.002). Additionally, quality of life scores improved more significantly in the Pilates group, particularly in physical function (p = 0.031 and p = 0.025) and general health (p = 0.005 and p = 0.012). Conclusions Pilates-based rehabilitation was more effective than a home exercise program in improving pain, disability, and quality of life in patients with subacute LBP. These findings support the inclusion of Pilates in early-stage rehabilitation to prevent chronicity. Trial registration Clinical Trials Number: NCT06699511.

SGK1 upregulation in GFAP+ neurons in the frontal association cortex protects against neuronal apoptosis after spinal cord injury

Spinal cord injury (SCI) casts devastating and long-lasting impacts on the well-being of patients. Cognitive deficits and emotional disorders are common in individuals with SCI, yet the underlying mechanisms are not completely understood. Astrogliosis and glial scar formation occur during the subacute phase post-injury, playing complicated roles in remyelination and neurite regrowth. Therefore, we constructed a GFAP-IRES-Venus-AkaLuc knock-in mouse model for the corresponding studies. Surprisingly, complete spinal cord transection (SCT) surgery led to earlier and more prominent augmentation of bioluminescence in the brain than in the spinal cord. Bulk RNA sequencing revealed the activation of apoptotic signaling and the upregulation of serum and glucocorticoid-regulated kinase 1 (SGK1). The pattern of GFAP signals changed throughout the brain after SCT, as indicated by tissue clearing and immunostaining. Specifically, GFAP signals were intensified in the frontal association cortex (FrA), an encephalic region involved in associative learning and recognition memory processes. Further exploration unraveled that intensified GFAP signals in the FrA were attributed to apoptotic neurons with SGK1 upregulation, which was induced by sustained high glucocorticoid levels after SCT. The introduction of SGK1 silencing vectors confirmed that SGK upregulation in these FrA neurons exerted anti-apoptotic effects through NRF2/HO-1 signaling. In addition, SGK1 knockdown in FrA neurons aggravated the post-SCI depressive-like behaviors. Thus, ectopic SGK1 expression designated for limbic neurons could serve as a promising therapeutic target for the future development of treatments for spinal cord injuries.

Effects of Cerebellar Transcranial Magnetic Stimulation on the Motor Function of Patients With Stroke: A Systematic Review and Meta-Analysis.

As the core of motor control and learning, the cerebellum is crucial for maintaining posture, regulating muscle tone, and coordinating movement. In recent years, there has been an increase in the number of studies on the application of cerebellar transcranial magnetic stimulation (cTMS) to motor dysfunction in patients with stroke. This review aims to analyze cTMS efficacy for stroke patients and further explore the specific effects of different stages of the disease, stimulation modes, stimulation intensity, and treatment duration. Six databases were searched comprehensively-CNKI, Wanfang, Web of Science, PubMed, The Cochrane Library, and Embase-to collect randomized controlled trials (RCTs) up to October 2024 that investigated the improvement of physical motor dysfunction in stroke patients using cTMS. Two researchers screened the literature, extracted data, and independently assessed the quality and risk of bias of the included studies using the PEDro scale and the Cochrane Risk of Bias Assessment Tool 2. Meta-analysis was performed using RevMan 5.4. A total of 20 RCTs with 812 participants were included. Meta-analysis and sensitivity analysis revealed that cTMS significantly improved BBS (Random, MD = 5.19, 95%CI = 3.66-6.72, p < 0.00001), enhanced FMA-LE scores (Random, MD = 1.88, 95%CI = 0.76-3.01, p = 0.001), shortened the TUG (Fix, MD = -1.64, 95%CI = -2.60 to -0.68, p = 0.0008), and 10MWT durations (Fix, MD = -7.66, 95%CI = -12.33 to -2.99, p = 0.001), and increased MEP amplitudes (Fix, MD = 0.45, 95%CI = 0.04-0.87, p = 0.03). Subgroup analysis of the BBS showed that cTMS had a significant effect on patients with stroke in the subacute phase (p < 0.00001), with improvements observed using HF-rTMS (p < 0.0001), iTBS (p < 0.00001), and intensities ≤ 80%RMT (< 80% RMT, p < 0.0001; 80% RMT, p < 0.00001). cTMS consistently demonstrated superior effects compared to controls across different intervention durations (5-10 sessions, p = 0.009; 11-20 sessions, p < 0.00001; > 20 sessions, p < 0.00001). cTMS effectively improves motor function in patients with stroke, particularly during the subacute phase with excitatory stimulation and moderate intensities (≤ 80%RMT). PROSPERO number: CRD42024540604.

VEGF-E Attenuates Injury After Ischemic Stroke by Promoting Reparative Revascularization.

The angiogenic response after stroke correlates with mild injury and an improved recovery. Stimulation of post-stroke angiogenesis using vascular endothelial growth factor (VEGF)-A is associated with an increased risk of vascular destabilization, leading to life-threatening complications. The non-mammalian VEGF-A homolog, VEGF-E, stimulates stable cutaneous vascularization and promotes wound healing. Herein, we posit that VEGF-E represents a potential mediator of reparative revascularization after ischemic stroke. C57BL6/J wildtype mice were subjected to experimental stroke, and VEGF-E or VEGF-A were intranasally delivered during the subacute phase. Our results indicate that VEGF-E improves neurological recovery and increases vascular density without compromising permeability, more efficiently than VEGF-A. We show that VEGF-E-mediated revascularization correlates with normal restoration of brain perfusion, whereas VEGF-A induces cerebral hyperperfusion, indicative of vascular dysfunction. Furthermore, VEGF-E reduces microvascular stalls, increases the density of angiogenic vasculature, and improves the interaction of brain endothelial cell with pericytes, which is critical for vascular stabilization. Using cell-based assays, we demonstrate that stimulation of brain endothelial cells with VEGF-E, but not with VEGF-A, increases the expression of platelet-derived growth factor (PDGF)-D, a potent ligand of PDGFRβ that plays critical roles in regulating the survival and functions of perivascular cells, including pericytes. These effects are associated with activation of extracellular signal-regulated kinase (ERK)1/2 and P38 mitogen-activated protein kinase (MAPK). Finally, we confirm that the secretome of VEGF-E-stimulated brain endothelial cells ameliorates pericyte migration required for vascular recruitment. Our study indicates that VEGF-E promotes a stable and functional revascularization after ischemic stroke, outlining its promises for therapeutic purposes.

Early Pro- and Anti-Inflammatory Immune Response Induced by Probiotic Treatment After Th9 Compression: The Interplay Between Spinal Cord and Jejunum.

The aim of our study was to limit the inflammatory response after spinal cord injury (SCI) using the probiotic strain Lacticaseibacillus paracasei Ž2 (5 × 109, CFU/mL). The relationship between pro- and anti-inflammatory markers was studied in a rat model after Th9 compression (40 g/15 min) and daily application (7 or 14 days) of probiotics. The probiotic treatment strongly reduced pro-inflammatory markers specific for microglia/macrophages (CD11b), microglia (CD68, IL-6, and iNOS), astrocytes (C1q), and TLR/NF-κB signaling pathway at lesion site and to a lesser extent cranially and caudally (0.3 cm) 7 days postinjury. In the spinal cord segments, 2-week probiotic therapy affected the expression of these targets depending on the intensity of their damage (cranially > caudally > lesion site). It was also noted that the impact of 14-day probiotic therapy in the jejunum was more pronounced than after a shorter treatment. Additionally, probiotic therapy significantly boosted the neuroprotective and anti-inflammatory milieu in the spinal cord tissues. Seven days post-SCI probiotic therapy had the potential to modulate the unfavorable environment around the injury site by increasing the anti-inflammatory microglial (IL-4Rα, TGF-β, and SOCS3) and astroglial (Ptx3) transcripts and by overexpression of immunoregulatory (TLR9 and IFN-γ) markers leading to functional remodeling and mitigation of hematuria. Longer post-SCI probiotic treatment upregulates the neuroprotective molecules at the injury site and simultaneously regulates the anti-inflammatory response in the jejunum. Herein we show that probiotic strain L. paracasei Ž2 has the potential to manage inflammation induced by SCI in both the gut and affected spinal cord within both subacute phases.

Long-Term Seizure Outcomes in Autoimmune Encephalitis

Introduction Seizures are common in autoimmune encephalitis (AE), but identifying patients at risk of chronic epilepsy in the post-acute phase remains challenging. This study aims to identify risk factors of treatment-resistant postencephalitic epilepsy. Methods This retrospective cohort study included patients with AE who experienced new-onset seizures within one year of symptom onset from two tertiary care centers in New York. EEG findings were analyzed separately based on whether the EEG recording was obtained in the acute (&lt;3 months from symptom onset) or subacute phase. A multivariate logistic regression model was used to identify independent predictors of postencephalitic epilepsy. Results Eighty-nine patients were included (median age: 33 years). Neural antibodies were present in 73% of patients (NMDAR: 35, LGI1: 19, GAD65: 9, Hu: 1, AGNA-1: 1). Over a median follow-up of 4.9 years, 29.2% developed treatment-resistant postencephalitic epilepsy. Independent predictors of postencephalitic epilepsy included focal slowing on acute EEG (OR 0.15, CI 0.02-0.90), interictal epileptiform discharges (IEDs) or periodic discharges (PDs) on subacute EEG (OR 20.01, CI 1.94-206.44), and cell surface antibodies (OR 0.21, CI 0.05-0.89). Immunotherapy within three months of onset was associated with decreased epilepsy development in patients with neural antibodies (OR 4.16, CI 1.11-16.30). Conclusions Nearly one-third of patients with AE and acute seizures developed treatment-resistant postencephalitic epilepsy, with significant predictors including absence of focal slowing on acute EEG, presence of IEDs and PDs on subacute EEG, absence of cell surface antibodies, and absence of early immunotherapy treatment of patients with positive neural antibodies.

Comparison of prognoses of patients with type A aortic dissection treated with surgery in acute, subacute and chronic phases

Comparison of prognoses of patients with type A aortic dissection treated with surgery in acute, subacute and chronic phases

'Time is of the essence': upper-body aerobic exercise to improve cardiovascular health during inpatient rehabilitation within the first year following spinal cord injury - protocol for a randomised clinical trial.

Individuals with spinal cord injury (SCI) face heightened cardiovascular disease (CVD) risks. While general exercise guidelines are promoted for SCI individuals, when and how to incorporate exercise during the subacute phase post-SCI remains unclear. Consequently, early aerobic exercise to reduce CVD risks is not standard practice in subacute SCI care, potentially missing an opportunity for optimal cardiovascular rehabilitation, especially given observed reductions in cardiac structure and function within the first year post-SCI. Addressing this gap could improve long-term cardiovascular health and health-related quality of life (HRQOL) for individuals with SCI. Early intervention might prevent worsening cardiovascular function and establish beneficial exercise habits. However, few studies have evaluated the effectiveness of early exercise interventions in this population. This study aims to provide insight into the impact of moderate-intensity arm-crank exercise training (ACET) on cardiometabolic, HRQOL, functional and fitness parameters in individuals with subacute (<12 months postinjury) SCI. We will conduct a single-centre, two-group, single-blind randomised controlled trial with 42 participants who have sustained a cervical or thoracic SCI within the past year. The non-intervention group will receive hospital standard of care (control group) while the intervention group will receive hospital standard of care plus moderate-intensity ACET for 10 weeks in line with the SCI-specific exercise guidelines to improve cardiometabolic health. The primary outcome measure will be central arterial stiffness (carotid-to-femoral pulse wave velocity). Secondary outcomes include assessments of (1) blood biomarkers linked to CVD, (2) cardiac structure and function, (3) extracranial vasculature, (4) HRQOL, (5) cognitive function, (6) physical activity level, (7) cardiorespiratory fitness, (8) motor function and (9) feasibility outcomes. Assessments will occur at baseline (rehabilitation centre admission, -2 weeks), preintervention (0 weeks), postintervention (10 weeks) and follow-up (6 months after postintervention), for HRQOL outcomes only. Ethical approval was obtained from the Wales Research Ethics Committee (HREC 22/WA/0329). Outcome data will be presented at international conferences, patient advocacy groups, health professional networks and community health events. Findings will be published in peer-reviewed journals and widely disseminated through strategic channels to reach researchers, healthcare providers, patients and the public. ISRCTN99941302.

Unstable Upper Cervical Spine Injury with Concomitant Bilateral Ponticulus Posticus: A Case Report

AbstractPonticulus posticus (PP), also known as arcuate foramen, is an anatomical variation of the atlas (C1), which is an ossification of the posterior atlanto-occipital membrane and through which the V3 segment of the vertebral artery (VA) runs. Placement of a polyaxial screw in the C1 lateral mass is considered risky in those with PP because of possible risk for VA injury. We report a case with bilateral PP in which posterior fixation for unstable upper cervical spine injury was performed. The patient, a 70-year-old man, sustained a fall-induced unstable upper cervical spine injury (traumatic C2 spondylolisthesis with unilateral dislocation of the C3-4 facet joint). Following initial conservative treatment, a posterior fixation surgery was performed in the subacute phase. Preoperative images revealed the presence of bilateral PP. Therefore, an original plan to place the screws in the C1 lateral mass was discarded, and instead, placement of the laminar hook on one side and placement of the screw into the C1 posterior arch on the other side was performed. His postoperative course was uneventful, and he was transferred to a rehabilitation hospital 27 days after the injury. In cases of upper cervical spine instability with concomitant PP, it is essential to consider the fixation method based on the extent of the injury and the course of the VA on a case-by-case basis.

Quantifying Impairments in the Subacute Phase of Whiplash Associated Disorders-A Cross-Sectional Study.

Whiplash-Associated Disorders (WADs) often result from traffic accidents, leading to persistent symptoms, including neck pain, disability, dizziness, and central sensitization (CS). A key concern is cervical range of motion (cROM) impairment and sensorimotor dysfunction, which contribute to prolonged disability. This study assessed functional performance in individuals with subacute (>1, <3 months) WADs (n = 122) compared to healthy controls (n = 45). Clinical measures included cROM, movement control (Butterfly test), and position sense (Head-Neck Relocation Test, HNRT). Patient-reported outcomes included neck disability, pain intensity, central sensitization, and dizziness. Mixed and linear models evaluated group differences and the influence of demographic and symptom-related factors. WAD patients had significantly reduced cROM and impaired movement control (p < 0.001). Neck disability (p < 0.001) and pain intensity (p = 0.015) affected cROM within the WAD group. Interaction effects revealed greater amplitude accuracy (AA) impairments at greater difficulty levels (p = 0.043), while time on target (TOT) differences decreased (p < 0.001). Dizziness was associated with increased undershoot (p < 0.001), while pain negatively impacted both AA (p = 0.003) and TOT (p = 0.037). Position sense did not differentiate WAD patients from controls. Findings suggest task-dependent sensorimotor deficits, highlighting the need for multimodal assessment. Early CS screening may optimize rehabilitation and prevent chronic disability.