Unaffected Limbs Of Patients Research Articles

Long-term disuse of the hand affects motor imagery ability in patients with complete brachial plexus palsy.

The purpose of this study was to examine motor imagery ability in patients with peripheral nerve disorder using the hand mental rotation task. Five patients with left total avulsion brachial plexus palsy (BPP) and 16 healthy age-matched adults participated in this study. The mean±SD time from the injury was 103.6±49.7 months. Participants performed a hand mental rotation task as the motor imagery task; outcome measures included the reaction time from cognizing hand stimuli to the judgment of hand laterality (right or left) and the error rate. Patients also completed the Hand 20 questionnaire to assess the use of their affected limb. Log-transformed reaction times of the affected limb in patients with BPP were significantly higher than those of the unaffected limb and the left-sided limb of the healthy participants. Log-transformed reaction times of the unaffected limb in patients were significantly higher than those of the right-sided limb in healthy participants. Log-transformed error rate did not differ between patients and healthy participants. According to the results of the Hand 20 questionnaire, patients with BPP hardly used their affected limb because of severe sensory-motor dysfunction. Motor imagery ability of the affected and unaffected limbs in patients with complete BPP may be decreased owing to long-term disuse. These findings suggest that long-term disuse in those with severe peripheral nerve disorders could affect motor imagery ability of both the affected and unaffected limbs.

Dermal nerve fibre and mast cell density, and proximity of mast cells to nerve fibres in the skin of patients with complex regional pain syndrome.

An interaction between cutaneous nerves and mast cells may contribute to pain in complex regional pain syndrome (CRPS). To explore this, we investigated the density of dermal nerve fibres, and the density and proximity of mast cells to nerve fibres, in skin biopsies obtained from the affected and unaffected limbs of 57 patients with CRPS and 28 site-matched healthy controls. The percentage of the dermis stained by the pan-neuronal marker protein gene-product 9.5 was lower in the affected limb of patients than in controls (0.12 ± 0.01% vs 0.22 ± 0.04%, P < 0.05), indicating a reduction in dermal nerve fibre density. This parameter did not correlate with CRPS duration. However, it was lower in the affected than unaffected limb of patients with warm CRPS. Dermal mast cell numbers were similar in patients and controls, but the percentage of mast cells less than 5 µm from nerve fibres was significantly lower in the affected and unaffected limbs of patients than in controls (16.8 ± 1.7%, 16.5 ± 1.7%, and 31.4 ± 2.3% respectively, P < 0.05). We confirm previous findings of a mild neuropathy in CRPS. Our findings suggest that this either develops very early after injury or precedes CRPS onset. Loss of dermal nerve fibres in CRPS might result in loss of chemotactic signals, thus halting mast cell migration toward surviving nerve fibres. Failure of normal nerve fibre-mast cell interactions could contribute to the pathophysiology of CRPS.

Microvascular Response in Patients with Complex Regional Pain Syndrome as Measured by Laser Doppler Imaging.

ObjectivesOur aim was to investigate the hypothesis that microvascular dysfunction occurs in patients with CRPS. Specifically, whether there were functional differences in either deeper cutaneous blood vessels or more superficial nutritive vessels between the affected and unaffected limb in patients with CRPS, and between CRPS patients and healthy control subjects.MethodsTwenty‐two patients with CRPS (five male; mean age 45 years; eight upper limb involvement, 14 lower limb) and 23 healthy control subjects (one male; 43 years) were recruited. Microvascular flow at affected and unaffected contralateral sites was measured, following local heating, using laser Doppler imaging (red/green wavelengths). Corresponding sites were imaged in healthy controls. Maximum flux level and area under the curve (first 20 scans, AUC20) were measured.ResultsVasodilator responses to heat were similar in affected and unaffected limbs, and in healthy controls. For example, median (IQR) “red” AUC20 in CRPS was 138.6 (120.0–152.9)% change from baseline in affected limb and 135.0 (120.7–166.8)% in unaffected limb, and (in healthy controls) 133.1 (117.2–145.9)% and 139.1% (126.0–162.1) in limb 1 and 2.ConclusionsWe found no impairment of vasodilation in cutaneous microvessels in CRPS. The vasomotor changes in CRPS may relate to larger vessel dysfunction.

Sensory and Knee Range of Motion Responses of Slump Test on Unaffected and Radiculopathy Affected Limb in Patients with Lumbar Disk Herniation

ABSTRACT Background Disk herniation is common—it is seen in up to a quarter of magnetic resonance imaging (MRI) and can be detected even in asymptomatic adults. The slump test has become widely advocated as a neural tissue provocation test for clinical assessment of patients with spinal and lower limb pain. The purpose of this study was to determine the sensory and terminal knee extension limitation responses produced during slump test on radiculopathy affected and unaffected limb in patients with lumbar disk herniation. Objectives To compare the sensory and knee range of motion (ROM) responses produced during slump test on affected and unaffected limb. Materials and methods Fifty patients, 25 to 45 years of age chronic disk herniation patients with unilateral radiculopathy with/without lower backache. Patient underwent standardized history and physical examination followed by slump test. Outcomes included terminal knee extension limitations and sensory response produced in terms of intensity numeric rating scale (NRS), nature and location (pain drawings). Results During slump test end position, NRS score and restricted terminal knee ROM comparative results were highly significant (p &lt; 0.001). Based on nature and location of sensory response, maximum number of subjects in affected limb had pain in center of lower back radiating to whole lower limb and for unaffected limb stretch at back of knee. Conclusion In this study, it was suggested that though sensory and knee ROM responses are present in both affected and unaffected limb but the radiculopathy affected limb was more affected in terms of intensity of pain and limitation of motion. How to cite this article Aggarwal A, Jayakrishnan S, Singh A. Sensory and Knee Range of Motion Responses of Slump Test on Unaffected and Radiculopathy Affected Limb in Patients with Lumbar Disk Herniation. J Postgrad Med Edu Res 2016;50(1): 1-4.

Analysis of Vertical Ground Reaction Force Variables Using Foot Scans in Hemiplegic Patients.

ObjectiveTo analyze the differences in the vertical ground reaction force (GRF) variables of hemiplegic patients compared with a control group, and between the affected and unaffected limbs of hemiplegic patients using foot scans.MethodsPatients (n=20) with hemiplegia and healthy volunteers (n=20) underwent vertical force analysis. We measured the following: the first and second peak forces (F1, F2) and the percent stances at which they occurred (T1, T2); the vertical force impulse (VFI) and stance times. The GRF results were compared between the hemiplegic patients and control individuals, and between the affected and unaffected limbs of hemiplegic patients. Additionally, we analyzed the impulse of the unaffected limb according to the motor assessment scale (MAS), Brunnstrom stage, and a Timed Up and Go Test.ResultsThe F1s and F2s of the affected and unaffected limbs were significantly less than those of the normal control individuals (p<0.05). The T1s of both the affected and unaffected limbs of the patients were greater than control individuals, whilst the T2s were lower (p<0.05). Greater impulses and stance times were recorded on both sides of the patients than in the limbs of the control individuals (p<0.05). The MAS, Brunnstrom stage and Timed Up and Go Test results were significantly correlated with the VFI of the unaffected limbs (p<0.05).ConclusionThe high impulse values of the unaffected limb were associated with complications during gait rehabilitation. Therefore, these results suggest that unaffected limbs should also be taken into consideration in these patients.

Effect of Demyelinating Ulnar Nerve Injury on Strength and Fatigue

Conduction block (CB) from focal neuropathy is often associated with weakness and fatigue in affected muscles. Ulnar neuropathy at the elbow (UNE) provides an excellent model to examine the relationships between electrophysiologically defined CB and quantitative measurement of weakness and fatigue. Eight healthy control subjects (47 ± 14 years) and nine patients (53 ± 3 years) with clinical and electrophysiological features of UNE with CB were studied. All underwent bilateral, ulnar motor nerve conduction studies recording from the first dorsal interosseous muscle as well as quantitative measurement of strength and fatigue of the first dorsal interosseous with a custom dynamometer. Strength and fatigue were similar in the dominant and nondominant hands of control subjects and unaffected limb in patients. Varying degrees of conduction block (14-62%, mean 36%) and conduction slowing (31 m/s ± 7) were observed in those with UNE. CB was associated with significant reductions in strength (42%) and fatigue (23%) on a timed fatigue task. The reductions in strength (r = 0.74) and fatigue (r = 0.60) were strongly correlated with the degree of CB. CB in UNE defined by electrophysiological criteria was strongly correlated with weakness and fatigue in the first dorsal interosseous. Fatigue may be simply related to the reduction in strength, but activity or frequency dependent CB may also contribute.

Effect of the degree of hip osteoarthritis on equilibrium ability after sudden changes in direction

This research addressed the effect of hip osteoarthritis severity on equilibrium ability after sudden changes in direction among 20 healthy elderly people, 20 with moderate hip osteoarthritis (mOA), and 20 with severe hip osteoarthritis (sOA). The Lehr’s damping ratio calculated from testing while standing on both limbs ( D elderly both = 0.466 ± 0.033 ; D mOA both = 0.436 ± 0.055 ; ( D sOA both = 0.346 ± 0.055 ) did not differ significantly from results of testing while standing on the dominant limb in healthy subjects ( D elderly dom = 0.413 ± 0.036 ) and on the unaffected limb in patients with varying degrees of osteoarthritis ( D mOA dom = 0.408 ± 0.064 , D sOA dom = 0.309 ± 0.060 ). Results from testing during standing on the non-dominant limb in healthy subjects ( D elderly non - dom = 0.302 ± 0.039 ) and on the affected limb in patients with osteoarthritis ( D mOA affected = 0.219 ± 0.068 , D sOA affected = 0.135 ± 0.071 ) differed significantly from the results of the other two scenarios, indicating that the healthy side is dominant. In cases of sOA, equilibrium ability decreased with standing on both limbs or on the healthy limb compared to the control group and to the patients with mOA. Furthermore, an increased degree of hip osteoarthritis significantly decreased equilibrium ability on the affected side after sudden changes in direction, based on a comparison of the affected side in patients with sOA to the affected side in patients with mOA. Deterioration of equilibrium ability may indicate an increased risk of falling.

Facilitated neurogenic inflammation in unaffected limbs of patients with complex regional pain syndrome

Pain, edema, increased skin temperature, reddening and trophic changes characterize complex regional pain syndrome (CRPS). Recently, we have been able to show facilitated neurogenic inflammation on the affected limb. In the current study unaffected limbs were examined after resolution of the CRPS symptoms to assess possible generalized changes predisposing to CRPS. In 12 patients and in 12 healthy volunteers dermal microdialysis in combination with electrical C-fiber stimulation was employed to induce neuropeptide release. Dialysate protein concentration and axon reflex vasodilation were measured. Neither in patients nor in controls did electrical stimulation lead to protein extravasation, while axon reflex vasodilation was significantly enhanced even on the patients' unaffected limbs ( P<0.05). Our results support the hypothesis that facilitated neurogenic inflammation is a predisposing factor for CRPS. The lack of protein extravasation indicates that an initiating trauma is necessary to induce neuropeptide up-regulation in primary afferents.

Quadriceps muscle weakness following acute hemiplegic stroke.

To determine whether quadriceps muscle weakness develops on the side ipsilateral to the brain lesion in the first week following acute ischaemic hemiplegic stroke. A prospective study of muscle strength. Acute stroke unit (ASU) in a teaching hospital. Ten patients admitted within 48 hours of stroke onset, and 10 healthy age-matched controls. Repeat nonvolitional measurements of quadriceps muscle strength of the unaffected limb in patients and the right leg in normal subjects using magnetic femoral nerve stimulation (MS), prospectively one week apart. In addition the level of voluntary activation was assessed during a maximum voluntary contraction (MVC) manoeuvre. The Trunk Control Test (TCT) was measured in the patients. The median (95% confidence interval, (CI)) baseline quadriceps twitch tension (Tw Q) and MVC in the control group were 9.4 kg (6.1-12.5 kg) and 37.2 kg (23.8-54.6 kg), and in the stroke group were 7.6 kg (4.4-9.9 kg) and 12.15 kg (7.9-30.8 kg). The median (95% CI) change in Tw Q and MVC respectively between baseline and one week later were 1.75% (-9.8 to 8%) and 5.45% (-15.1 to 22.7%) (NS) in the control group and -16.2% (-6 to -25.9%) and -30.45% (0 to -78.6%) (p < 0.01) in the stroke patients. There was a significant correlation between the percentage fall in Tw Q and both change in TCT (rs = 0.83, p < 0.01) and percentage change in body weight (rs = 0.83, p < 0.01). In the first week after acute hemiplegic stroke, weakness develops in the unaffected leg.

α‐adrenergic supersensitivity of the sudomotor nerve in complex regional pain syndrome

alpha-Adrenoreceptor supersensitivity in many tissues has been described in patients with complex regional pain syndrome type I (CRPS I). Because excessive sweating of the affected limb is an important feature of CRPS I, we investigated whether this supersensitivity also occurs in the sudomotor system. We compared the sweat response to iontophoresis of an alpha-adrenergic agent (phenylephrine) in 4 patients with acute CRPS I and 3 patients with resolved CRPS I with that in 9 control subjects using the methodology of the quantitative sudomotor axon reflex test (QSART). A significantly higher sweat response was observed in the affected limb of patients with acute CRPS I compared to their unaffected limb (p = 0.03), to control subjects (p > 0.018), and to the affected or unaffected limbs of patients with resolved CRPS I (p = 0.02), whose sweat response was not significantly different from that of control subjects. We conclude that the abnormal response in patients with acute CRPS I is most likely mediated by an axon reflex and that alpha-adrenoreceptor supersensitivity occurs in the presynaptic portion of the postganglionic sudomotor axon. This supersensitivity is reversed when CRPS I resolves.