Walking Disorder Research Articles

Sensory-Motor Polyneuropathy in an 11-year- old Girl with a Pathogenic Variant in SMC1A: A Case Report.

Pathogenic variants in the SMC1A gene are often dominant-negative and cause an X-linked form of Cornelia de Lange syndrome (CdLS) with growth retardation and typical facial features. However, rare SMC1A variants cause a developmental and epileptic encephalopathy (DEE) with intractable early-onset epilepsy that is absent in CdLS. Here we describe an 11-year-old girl with epilepsy, walking disorder, and neurodevelopmental disorder. A neurophysiological examination of nerve conduction velocity showed a mixed, sensory-motor, chronic 4-limb polyneuropathy. Whole-exome sequencing identified the variant c.3145C > T p.(Arg1049*) in SMC1A (NM_006306.3), which can be classified as pathogenic. To the best of our knowledge, among 79 individuals with SMC1A-related DEE reported in the literature, altered peripheral nerve conduction has never been described. In this article, we propose that severe sensory-motor polyneuropathy could be an expansion of the SMC1A-related phenotype.

Clozapine-Induced Somnambulism in a 55-year-old Lady with Psychotic Depression: A Case Report

Sleep walking disorder or somnambulism is a parasomnia that occurs in non-rapid eye movement sleep (NREM) characterized by an individual arising from bed and ambulating without fully awakening. It is known to be associated with multiple medications and has been reported with atypical antipsychotics. Here, we report a case of sleep walking induced by clozapine; before this, there have only been two reported cases of clozapine induced somnambulism.

De novo mutation of NAXE (APOAIBP)-related early-onset progressive encephalopathy with brain edema and/or leukoencephalopathy-1: A case report

Early-onset progressive encephalopathy with brain edema and/or leukoencephalopathy-1 (PEBEL1) is a rare autosomal recessive severe neurometabolic disease. The aim of this study was to investigate the clinical characteristics and genetic pathogenicity of PEBEL1 caused by rare NAXE (or APOA1BP)-related defects. The patient was a girl aged 2 years and 10 mo. She was hospitalized due to walking disorder for > 40 d. The clinical manifestations were ataxia, motor function regression, hypotonia, and eyelid ptosis. Within 1 mo of hospitalization, she developed sigh breathing, respiratory failure, cerebellar edema and brain hernia, and finally she died. Changes were found in cranial imaging, including cerebellar edema accompanied by symmetrical myelopathy. Through whole exome sequencing, we detected NAXE compound heterozygous variation (NM 144772.3) c.733A>C (p. Lys245Gln, dbSNP: rs770023429) and novel variation c.370G>T (p.Gly124Cys) in the germline gene. The clinical features and core phenotypes of this case were consistent with 18 previously reported cases of PEBEL1. This is the first case of NAXE-related PEBEL1 with severe clinical phenotype in Mainland China. The p.Gly124Cys mutation discovered in this case has enriched the pathogenic variation spectrum of NAXE.

Stabilotraining in Motor Rehabilitation of Patients after Stroke: a Prospective Randomized Study

INTRODUCTION. Proprioceptive deficits are one of the common sensory impairments after stroke and have a negative impact on motor activity. AIM. Evaluation of the effect of stabilization training on the dynamics of clinical and functional indices and the efficiency of motor rehabilitation in patients after stroke. MATERIAL AND METHODS. The dynamics of motor (motor functions, activity) and non-motor (cognitive and emotional volitional) consequences of stroke, as well as the quality of life under the influence of complex application of stabilization training with the use of scales (National Institutes of Health Stroke Scale, Medical Research Council Scale, Modified Ashworth Scale of muscle spasticity, «Memory for images» and «10 words», Schulte-Platonov Table, Lusher Color Test, The Hospital Anxiety and Depression Scale), International Classification of Functioning (ICF), EQ-5D questionnaire and stabilography method. The effectiveness of motor rehabilitation was evaluated by the dynamics of the integral index of health level. RESULTS AND DISCUSSION. After complex rehabilitation in stroke patients the regression of neurological disorders was detected (almost half of patients after rehabilitation showed mild degree of impairment, in 6 % of cases full recovery of paretic leg muscle strength was achieved, the share of patients with severe and moderate paresis decreased, hypertonicity of paretic muscles decreased). Complementing the complex of motor rehabilitation with stable exercise led to a decrease in the degree of functional limitations (in 48.5 % of patients after rehabilitation the Hauser walking index indicated a mild degree of walking disorder, patients became able to walk around the room without using aids, reduced dependence on others in everyday life), improved quality of balance function and quality of life, a positive impact on the psychoemotional state of patients and increased effectiveness of rehabilitation measures. CONCLUSION. Stabilotraining application in the complex of motor rehabilitation of patients allowed to improve walking and balance functions, psycho-emotional state of patients, to increase their quality of life and, accordingly, to increase the effectiveness of rehabilitation measures after stroke.

Experience of using rhythmic transcranial magnetic stimulation, extracorporeal shock wave therapy and botulinotherapy in individual motor recovery programs in patients with spastic paresis of the lower limb

Walking disorder is one of the most frequent consequences of stroke and traumatic brain injury, occurring in 80% of cases. Spastic paresis of the muscles of the lower extremity is the cause formed in 20-40% of patients within a few weeks after brain damage. In this case, a complex of symptoms occurs: motor deficiency (muscle paresis), increased muscle tone (spasticity), biomechanical changes in muscles, joints and surrounding tissues, contractures. Recovery of walking is a difficult task due to the peculiarities of its organization in the norm. At the same time, changes occurring in the muscles of the lower limb after a stroke, their modular reorganization, the formation of various pathological patterns, violation of the regulation of movements by the central nervous system, rapidly occurring changes in muscles, ligaments, complicate this process. Improving walking is one of the most important priorities of rehabilitation. Already at the second (stationary) stage of rehabilitation, patients have a lack of proper support on the lower limb, which inevitably leads to excessive load on the second limb, a change in the body scheme, incorrect foot placement, violation of the mechanics of walking (moving from heel to toe) due to plantar flexion / turn of the foot, etc. All this makes patients dependent on outside help, and walking unsafe, increases the risk of falls and complications (arthropathy, contracture, etc.). In this regard, it is important to timely diagnose the totality of changes in the lower limb and create optimal comprehensive rehabilitation programs using highly effective treatment methods aimed at reducing the severity of the motor defect, reducing spasticity and preventing complications. The article discusses the place of rhythmic transcranial magnetic stimulation, extracorporeal shock wave therapy and botulinum therapy during rehabilitation in patients with spastic paresis of the lower limb after a stroke. The results of the protocol of clinical approbation «Complex rehabilitation of patients with lower limb spasticity after focal brain damage at the second stage of medical rehabilitation» are presented.

Evaluation of Surgical Treatment Effect on Idiopathic Normal Pressure Hydrocephalus

Background:We aimed to observe the long-term effectiveness and safety of the ventriculoperitoneal (VP) shunt in treating idiopathic normal pressure hydrocephalus (iNPH).MethodsA total of 65 patients with iNPH were retrospectively analyzed. All the patients were treated with VP shunt and the clinical efficacy was assessed using follow-up questionnaire, the Modified Rankin Scale (mRS), and iNPH grading scale (iNPHGS) after operation.ResultsThe mean mRS and iNPHGS scores were 1.18 ± 0.83 points and 2.98 ± 1.96 points, respectively, which were statistically significantly different from those before operation [(2.89 ± 0.92) points and (6.49 ± 2.30) points, respectively]. Besides, the patients were divided into the non-improvement group (n = 8, 12.3%), the improvement group (n = 16, 24.6%), and the marked improvement group (n = 41, 63.1%) based on the preoperative and postoperative mRS scores and the total effective rate of the VP shunt was 87.7%. Next, seven patients with negative cerebrospinal fluid tap test (tap test) received the active VP shunt and the score on walking disorder was 2.71 ± 0.76 points before operation and 1.86 ± 0.90 points after operation, showing a statistically significant difference. Moreover, 12 (18.4%) patients had complications after operation, among whom 5 (7.7%) patients manifested ameliorated symptoms after replacing shunt tube and receiving anti-infection treatment, but 3 (4.6%) patients showed no alleviation following pressure adjustment due to advanced age and multiple complications. Six (9.2%) cases of death were recorded during follow-up and only 1 (1.5%) case of sudden death occurred within 2 weeks after operation. In addition, it was found through more than 5 years of follow-up after operation that 12 out of the 23 (52.2%) patients had a good effect at 5 years after operation, 1 (4.3%) patient had been confined to bed due to advanced age and pulmonary infection, and 1 (4.3%) patient died of pulmonary infection and heart failure.ConclusionThe VP shunt is effective in treating iNPH and it results in a preferable long-term prognosis.

Effect of mild moxibustion on pain and expression of LC3 and Bax in spinal cord in cervical spondylotic radiculopathy rats

To observe the effect of mild moxibustion (Moxi) at "Dazhui" (GV14) on neuropathic pain, expression of autophagy and apoptosis factor LC3 and Bax proteins and mRNAs in the spinal cord tissue in rats with cervical spondylotic radiculopathy (CSR), so as to explore its underlying mechanism underlying relief of CSR-induced pain. Forty rats (half male half female) were randomly divided into blank control, model, Moxi, Moxi+autophagy inhibitor 3-methyladenine (3-MA, Moxi+3-MA) groups, with 10 rats in each group. The CSR model was established by loose ligature of the local cervical nerve roots. Three days after modeling, mild Moxi was applied to GV14 for 10 min, once daily for 7 days. Rats of the Moxi+3-MA group received intraperitoneal injection of 3-MA(1 mL, 15 mg/kg+ saline) before Moxi, once daily for 7 consecutive days. Rats of the model and Moxi groups were also given normal saline (i.p., 1 mL), once daily for 7 days. The gait behavior score (1-3 points) was scaled according to the rats' pain reaction and foot paw contracture produced walking disorder and the mechanical pain threshold (MPT) was detected before and after the treatment. The expression of spinal cord LC3 and Bax proteins and mRNAs were detected by immunohistochemistry and quantitative RT-PCR, respectively. Compared with the blank control group, the gait disorder score, and percentage of Bax positive cells and expression of Bax mRNA were significantly increased (P<0.01, P<0.05), and MPT was markedly decreased in the model group (P<0.01). After the treatment, the gait disorder score, percentage of Bax positive cells and Bax mRNA expression were significantly down-regulated (P<0.01, P<0.05), while the MPT and percentage of LC3 positive cells and LC3 mRNA expression were considerably increased (P<0.01, P<0.05) in both Moxi and Moxi+3-MA groups. The therapeutic effects of mild Moxi were remarkably superior to those of Moxi+3-MA in downregulating gait disorder score, Bax positive cell percentage and Bax mRNA expression, and in up-regulating MPT, LC3 positive cell percentage and LC3 mRNA expression (P<0.05), suggesting a reduction of the function of mild Moxi after administration of 3-MA. Mild Moxi at GV14 can relieve neuropathic pain in CSR rats, which may be related to its functions in up-regulating LC3 autophagy, thereby inhibiting the expression of Bax pro-apoptotic protein in spinal cord to reduce apoptosis and to repair nerve injury.

Normal Pressure Hydrocephalus Overshadowed by Traumatic and Degenerative Spinal Diseases: A New Assessment Proposal.

Normal pressure hydrocephalus (NPH) is a rare disorder among the elderly, characterized by gait disorder, dementia, and urinary incontinence. Considering the rareness of NPH and a lot of other pathologies, such as Parkinson's disease, lumbar spinal stenosis, and even aging cause similar symptoms, NPH is an underdiagnosed entity. However, the percentage of misdiagnosis is not given in the literature. In this study, patients diagnosed with NPH were retrospectively screened between 2015 and May 2019 in our clinical database and Ste-P formula was applied. Example cases showed that some of the patients receive inaccurate medical and surgical treatments before being diagnosed with NPH. As a result of the study was seen that a few out of 29 patients confused dizziness with trunkal ataxia or imbalance due to gait abnormality. As the time between onset of complaints and diagnosis increased, the value approached "zero", and diagnosis became difficult. Every unnecessary operation carries serious risks that may threaten the life of the patient and decrease the quality of life. These surgeries and instrumentation materials used may also result to additional financial cost. Similarly, long-term use of Parkinson's and dementia medications has a serious economical burden on the insurance systems and is detrimental to the patient's health. Considering all these diagnoses and physiological conditions that can be easily confused with each other, we recommend in this article a new formula to reduce the possibility of misdiagnosis and treatment in patients with walking disorder.

Сomplex rehabilitation of walking function in central paresis of the lower limb using neuroprosthetic technology

Disability after a stroke is most often associated with decreased patient activity due to walking disorder. In case of severe paresis, the function of the limb in the early stages of recovery is advisable to support with the help of partial prosthetics, using methods that provide functional stimulation. The complex treatment of central paresis includes botulinum therapy, which is due to the high incidence of spasticity.&#x0D; Aim: of the study: evaluation of the efficacy of functional electrical stimulation in a complex of multimodal effects in restoring movement in stroke patients with lower limb paresis.&#x0D; Materials and methods: Stimulation and neuroprosthetic methods (Bioness L300) were used as the main therapeutic program of rehabilitation treatment for patients with motor disorders of the lower limb after an ischemic stroke (n = 70). The median period of stroke was 21 [11; 47] days, median age 54 [42; 65] years. Scales and questionnaires were used to assess the loss of strength and volume of movement disorders, spasticity, walking speed and self-care (Medical Research Council Weakness Scale (1981, MRC), Barthel Index (1965), Modified Ashworth Scale (MAS), 10-meter test).&#x0D; Results: The effectiveness of personalized therapy with the use of a neuroprothesis (Bioness L300) in patients in the acute and early recovery period of ischemic stroke was shown. The additional use of botulinum toxin made it possible to eliminate the inhibitory effect of spasticity, which expanded the possibility of using intensive methods of physical rehabilitation. There was an increase in daily activity, walking speed, and the level of self-care of patients in 90 % of cases.&#x0D; Conclusion: The use of a complex of stimulating personalized techniques in the acute period of a stroke is justified and safe. The functional electrical stimulation helps to overcome power paresis, increases the overall level of physical activity of patients after a stroke, motivation for recovery and improves the quality of life. (1 figure, 2 tables, bibliography: 9 refs)

Therapy of spinal cord injury by zinc modified gold nanoclusters via immune-suppressing strategies.

BackgroundSpinal cord injury (SCI) is damage to the central nervous system (CNS) that causes devastating complications from chronic pain to breathing problems. Unfortunately, few effective and safe treatments are known to relieve the damages of SCI. Nanomedicines are used for the treatment of SCI with relatively few side effects, but only depending on the delivery of additional drugs, which increase complexity to the treatment. Considering the urgent need for saving SCI patients, it is important to develop promising nanobiotechnology for relieving their pains.MethodsThe clinical survey was used to investigate SCI patients, thereafter the therapy plan was designed. The receiver-operating characteristics (ROC) curves of the prediction model were built to find symptoms after SCI. The treatment plan (i.e. immunosuppressive strategy) was designed by manufacturing therapies based on gold nanoclusters (AuNCs). The response of the immune cells (macrophages) was studied accordingly. The western blot, reactive oxygen species (ROS) activity assay, enzyme-linked immunosorbent assay (ELISA), quantitative real-time PCR (RT-qPCR), and immunochemical staining were used for evaluation of the in vivo and in vitro therapeutic effects.ResultsWe found increased monocytes/macrophages (M/Ms) levels in 114 SCI subjects (44.7% with severe SCI complications) by the clinical survey. Additionally, the enhanced macrophage level was found to be closely related to the walking disorder after SCI. Since macrophages were central effector cells of the immune system, we assumed that the immune-suppressing strategies could be used for SCI therapy. Thereafter, AuNCs were stabilized by dihydrolipoic acid (DHLA) enantiomers (including DL-DHLA, R-DHLA; A racemic mixture (R and S) was denoted as DL; R and S refer to Rectus and Sinister), obtaining DL-DHLA-AuNCs and R-DHLA-AuNCs, respectively. In addition, zinc-modified DL-DHLA and R-DHLA stabilized AuNCs (i.e., DL-DHLA-AuNCs-Zn and R-DHLA-AuNCs-Zn) were investigated. Among these AuNCs, R-DHLA-AuNCs-Zn showed the most remarkable therapeutic effect for promoting the polarization of pro-inflammatory macrophages and reducing neuronal ROS-induced apoptosis and inflammation in vitro and in vivo; the lesion size was decreased and the survival rate of ventral neurons is higher.ConclusionsR-DHLA-AuNCs-Zn have comprehensive therapeutic capabilities, especially the immune-suppressing effects for the therapy of SCI, which is promising to relieve the pain or even recover SCI for the patients.Graphical abstract

Assessment of walking disorder in community-dwelling Japanese middle-aged and elderly women using an inertial sensor.

BackgroundDecreased walking speed has been revealed to be related to many negative events. Several researchers support the importance of triceps surae function as a cause of decreased walking speed. The purpose of this study was to investigate the relationship between walking speed and plantar flexor power during the terminal stance of gait in community-dwelling middle-aged and elderly women using an inertial sensor.MethodsOne hundred thirty-six healthy female middle-aged to elderly community-dwelling women were included in this study. We measured two-step score, grip strength, walking speed and accelerometer data from which we estimated ankle power (estimated ankle power) during walking using an inertial sensor. All participants were classified into the four different age strata, fifties (50–59), sixties (60–69), seventies (70–79) and eighties (80–89). The differences in each parameter between the four age groups were compared using repeated analysis of variance and post-hoc Bonferroni corrections for multiple comparisons to establish significance. Multiple regression analysis was carried out using a stepwise method to determine the correlations with comfortable walking speed. Comfortable walking speed was considered a dependent variable.ResultsThe normalized estimated ankle power of the eighties group was significantly decreased in comparison with seventies age groups and fifties age groups (P < 0.05), but there were no significant differences in normalized estimated ankle power between the sixties and eighties age-groups. The results of stepwise multiple regression analysis revealed that the normalized estimated ankle power, two-step value and body weight were highly-significant partial regression coefficients (adjusted R2 = 0.57).

Cerebellar Syndrome Revealing a Giant Postero Inferior Cerebellar Artery Aneurysm: A Case Report and a Review of Literature

Context: Cerebellar syndrome caused by disturbances of balance and coordination is not an uncommon neurological disorder. It has varied etiologies usually caused by tumor processes or suppurative collections. Vascular causes remain very rare, especially when it is a giant aneurysm of PICA representing 1% of intracranial aneurysms. Treating giant PICA aneurysms is a very difficult task for neurosurgeons because the surgical dissection can lead to severe damage due to the intimate relationship of PICA with the brainstem or nerve structures. We report a case of giant PICA aneurysm responsible for cerebellar syndrome successfully treated with surgery. The objective of this work is to draw the attention of practitioners to this unusual cause which can lead to diagnosis wandering and a lack of planning at the time of management. Case report: A 65 years old hypertensive patient was seen for a progressive disturbance of balance and walking disorder, but worsened in the last three months with no notion of fever. On admission, the patient was lucid, oriented in time and space and presented with static and kinetic cerebellar syndrome. Brain CT-scan without and with contrast revealed a tissular mass in the posterior fossa suggesting a tumor process, however, CT angiography showed a giant aneurysm of the PICA after reconstruction. A careful microdissection by a sub-occipital approach was decided. Opening the large cistern made it possible to visualize the aneurysm sack surrounded by a yellowish gliosis. The reclining and microdissection revealed the neck of the aneurysm, which was clipped to exclude the giant aneurysm in block. Postoperative follow-up was simple with progressive improvement in the cerebellar syndrome and walking over three months. Conclusion: Giant aneurysm of the PICA is rare. The localization in the posterior cerebral fossa can be confusing. Microsurgery gives a good result.

Manipulation of Human Brain Oscillation to Control Neuron Network Dynamics and its Clinical Application

Electroencephalographic recordings of human brain oscillations have been performed over approximately a century. Noninvasive methods for manipulation of brain oscillations are currently available. Reportedly, the manipulation of brain oscillations alters human behavior and cognition and is also used for "oscillotherapy" to treat many neurological diseases. In this review, we summarize the physiological mechanisms of brain oscillations, human behavioral and cognitive changes, and oscillotherapy; we have focused on our recent findings of the manipulation of human brain oscillations during bipedal walking and gait disorder recovery.

Multiple Sclerosis Walking Scale-12 (MSWS-12) and its Relationship With Fatigue in People With Multiple Sclerosis

Background and Objectives: Walking disorder is one of the most important manifestations of multiple sclerosis (MS), and indicates the progression of the disease. Fatigue and walking are considered as key symptoms affecting the patient’s quality of life. Therefore, this study aimed to investigate the relationship between walking status and fatigue, in people with MS. Methods: A total number of 60 Iranian patients with MS completed the Persian version of the Multiple Sclerosis Walking Scale-12 (MSWS-12), the Modified Fatigue Impact Scale, and the Hospital Anxiety and Depression Scale. Data were analyzed using SPSS V. 20 software. The multivariate correlation and linear regression analyses were conducted to investigate the relationship between fatigue, anxiety, depression, demographic characteristics, and MSWS-12 scores. Results: Gait problems were observed in 46.7% of the study participants. Also, the MSWS-12 scores were significantly associated with fatigue severity (P=0.001), in these patients. Moreover, depression, cognitive status, anxiety, and gait status were the most important factors affecting fatigue. Conclusion: According to the present results, the presence of depression, cognitive problems, anxiety, and gait disorders are the most important factors affecting fatigue, in patients with MS.

Recurrence and influencing factors of diabetic foot ulcer in patients with type 2 diabetes mellitus

Objective: To investigate the recurrence and influencing factors of diabetic foot ulcer in patients with type 2 diabetes mellitus. Methods: Totally 185 type 2 diabetes patients with new-onset of diabetic foot ulcers admitted to Fuyang People's Hospital of Anhui Province from January 2011 to December 2015 were enrolled in this study, including 120 males and 65 females, aged 40-79 years. All the patients were followed up for 3 years, and their clinical data were retrospectively analyzed by the case-control study. The Kaplan-Meier cumulative recurrence curve was drawn according to the 3-year cumulative recurrence rate of diabetic foot ulcers. The time to visit, toe involvement, and amputation of involved toes in patients with recurrent diabetic foot ulcer were counted at the initial onset and the recurrence of the ulcers, respectively, and the data were statistically analyzed with t test and chi-square test. According to the recurrence of diabetic foot ulcers, the patients were divided into foot ulcer recurrence group and foot ulcer non-recurrence group. The gender, age, course of diabetes mellitus, length of hospital stay, visit time, body mass index, glycosylated hemoglobin HbA1c, total bilirubin, albumin, creatinine, cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides, hemoglobin, white blood cell count, toe involvement, toe amputation, ankle-brachial index, diabetic retinopathy (DR), diabetic peripheral neuropathy (DPN), diabetic nephropathy (DN), history of hypertension, cardio-cerebrovascular disease, smoking, residence, solitary life, and walking disorder of patients between the two groups were compared, and the data were statistically analyzed with t test and chi-square test. Log-rank test was performed on the indexes with P<0.1 in comparison between two groups, and the indexes with statistically significant differences in Log-rank test were analyzed by multivariate Cox regression analysis to screen the influencing factors of recurrence of diabetic foot ulcer. Results: (1) The 3-year cumulative recurrence rate of diabetic foot ulcers in 185 patients with type 2 diabetes mellitus was 47.0% (87/185). (2) For 87 patients with diabetic foot ulcer recurrence, compared with that at the initial onset of the ulcers, the visit time was significantly shorter (t=10.593, P<0.01), the toe amputation rate was significantly increased (χ(2)=5.118, P<0.05), but there was no obvious change in toe involvement at the recurrence of the ulcers. (3) There were statistically significant differences in age, course of diabetes mellitus, length of hospital stay, body mass index, glycosylated hemoglobin HbA1c, total bilirubin, albumin, creatinine, cholesterol, LDL, HDL, hemoglobin, white blood cell count, gender, toe amputation, ankle-brachial index, DR, history of cardio-cerebrovascular disease, solitary life, and walking disorder of patients between foot ulcer recurrence group (87 patients) and foot ulcer non-recurrence group (98 patients) (t=5.123, 4.242, 5.324, -24.572, 6.102, -1.984, -9.747, 3.226, 3.076, 3.646, -4.683, -7.502, 8.095, χ(2)=5.621, 18.433, 4.546, 5.785, 9.655, 7.625, 7.886, P<0.05 or P<0.01), while the rest of the indexes of patients between the two groups were similar. Log-rank test showed that the two groups had statistically significant differences in age, course of diabetes mellitus, length of hospital stay, glycosylated hemoglobin HbA1c, total bilirubin, albumin, creatinine, ankle-brachial index, DPN, and walking disorder (χ(2)=210.046, 44.837, 34.107, 98.685, 66.532, 294.451, 260.554, 5.012, 6.818, 11.160, P<0.05 or P<0.01). Age, total bilirubin, albumin, DPN, and walking disorder were the influencing factors for the recurrence of diabetic foot ulcers in patients with type 2 diabetes mellitus (hazard ratio=1.024, 0.678, 0.849, 2.335, 4.099, 95% confidence interval=1.001-1.047, 0.558-0.823, 0.797-0.904, 1.280-4.258, 2.044-8.223, P<0.05 or P<0.01). Conclusions: The 3-year cumulative recurrence rate of diabetic foot ulcers in patients with type 2 diabetes mellitus is relatively high, with the influencing factors being age, total bilirubin, albumin, DPN, and walking disorder.

Wearable Inertial Measurement Units for Assessing Gait in Real-World Environments.

BackgroundWalking patterns can provide important indications of a person’s health status and be beneficial in the early diagnosis of individuals with a potential walking disorder. For appropriate gait analysis, it is critical that natural functional walking characteristics are captured, rather than those experienced in artificial or observed settings. To better understand the extent to which setting influences gait patterns, and particularly whether observation plays a varying role on subjects of different ages, the current study investigates to what extent people walk differently in lab versus real-world environments and whether age dependencies exist.MethodsThe walking patterns of 20 young and 20 elderly healthy subjects were recorded with five wearable inertial measurement units (ZurichMOVE sensors) attached to both ankles, both wrists and the chest. An automated detection process based on dynamic time warping was developed to efficiently identify the relevant sequences. From the ZurichMOVE recordings, 15 spatio-temporal gait parameters were extracted, analyzed and compared between motion patterns captured in a controlled lab environment (10 m walking test) and the non-controlled ecologically valid real-world environment (72 h recording) in both groups.ResultsSeveral parameters (Cluster A) showed significant differences between the two environments for both groups, including an increased outward foot rotation, step width, number of steps per 180° turn, stance to swing ratio, and cycle time deviation in the real-world. A number of parameters (Cluster B) showed only significant differences between the two environments for elderly subjects, including a decreased gait velocity (p = 0.0072), decreased cadence (p = 0.0051) and increased cycle time (p = 0.0051) in real-world settings. Importantly, the real-world environment increased the differences in several parameters between the young and elderly groups.ConclusionElderly test subjects walked differently in controlled lab settings compared to their real-world environments, which indicates the need to better understand natural walking patterns under ecologically valid conditions before clinically relevant conclusions can be drawn on a subject’s functional status. Moreover, the greater inter-group differences in real-world environments seem promising regarding the sensitive identification of subjects with indications of a walking disorder.

La hanche chez l’enfant de 0 à 17 ans

In children, hip diseases are revealed by a walking disorder or limping, which requires physical examination and imaging by ultrasound, radiography and, depending on the case, MRI. The diagnoses differ according to age and the inflammatory or mechanical nature of the symptoms. Before the age of two, two diagnoses are encountered: septic arthritis (therapeutic emergency) and hip dysplasia, which must be systematically screened. After two years the most common cause of acute hip arthritis is transient hip synovitis; juvenile idiopathic arthritis may be revealed by an initial hip injury (especially in the case of spondyloarthropathies); cases of villo-nodular synovitis and osteochondromatosis are rare; bone may also be involved (recurrent multifocal osteitis, osteoid osteoma or much more rarely malignant tumor). Mechanical hip pain is more common in boys: osteochondritis (Legg-Perthes-Calvé disease) occurs between 4 and 8years of age, epiphysiolysis is observed later at around 13/14years of age in boys often overweight; it can be complicated by chondrolysis. Apophysitis in the greater trochanter, iliac spines or ischium can also cause hip pain in children aged 12 to 15years old practicing many sports.

Rare manifestations of lyme neuroborreliosis

Lyme disease is an endemic infection in many European countries and Russia, including North-West region. Neurological manifestations are reported in about 10%-25% of patients. Lyme neuroborreliosis (LNB) can includes polyradiculoneuritis, meningoradiculitis, meningitis and encephalitis in adults. Two cases of LNB are presented. Patient one: a 46-yrs old man was admitted with a history of dizziness, fever and walking disorder after four months of fishing in endemic ( tick-borne infections) area. On examination patient showed dysarthria, ataxia and hemianopsia. CSF showed mild pleocytosis and elevated total protein. Serological methods (including Western blot test) were positive for LNB. Brain MRI showed subacute ischemic lesions on T2-weighted and T2-FLAIR images on vertebrobasilar territory. Patient two was a 52-yrs old man, hospitalized with general stiffness after two months after tick bite without erythema migrans and fever. Neurological examination revealed a dysarthria, bradykinesia and right sided rigidity. Serological studies were positive for LNB. The CSF total protein content was 0,89 g/l. MRI images showed multifocal lesions of white matter (demyelination, typically seen in inflammatory). Both patients were diagnosed and treated successfully for LNB: they received a 21-day course of 2 g per day ceftriaxone, then benzathine benzylpenicillin every 14 days for 3 months and every 28 days for another 3 months. Corticosteroids and platelet aggregation inhibitors in case one and dopaminergic medications (case two) were also prescribed. A year after treatment patients were free of neurological symptoms. The cases suggest that LNB can manifest rare clinical forms as cerebral vasculitis and parkinsonism.

Research progress on compliant characteristics of lower extremity exoskeleton robots

The lower extremity exoskeleton robot is a wearable device designed to help people suffering from a walking disorder to regain the power of the legs and joints to achieve standing and walking functions. Compared with traditional robots that include rigid mechanisms, lower extremity exoskeleton robots with compliant characteristics can store and release energy in passive elastic elements while minimizing the reaction force due to impact, so it can improve the safety of human-robot interaction. This paper reviews the compliant characteristics of lower extremity exoskeleton robots from the aspects of compliant drive and compliant joint, and introduces the augmentation, assistive, rehabilitation lower extremity exoskeleton robots. It also prospect the future development trend of lower extremity exoskeleton robots.

Rapidly progressive tetraplegia and cognitive deterioration during rehabilitation: A case of neurodegenerative disease

Human prion diseases are fatal, progressive neurodegenerative disorders caused by neurolytic pathogen proteins, called prions. The most common human prion disease is sporadic Creutzfeldt-Jakob disease, with an approximate annual prevalence of 0.5-1 per million. The symptoms and signs include rapidly progressive dementia, ataxia, myoclonic seizures, akinetic mutism and other neurological and neurobehavioral disorders. The clinical spectrum of Creutzfeldt-Jakob disease is highly variable; therefore it can be difficult to diagnose premortem. This article describes a 78-year-old woman who initially presented with difficulty walking and balance disorder. As a result of the evaluation, the patient was transferred to rehabilitation clinic, with a diagnosis of cervical spinal stenosis. During hospitalization, she showed progressive decline in gait and balance and deteriorated rapidly. The patient was considered to be probable sporadic Creutzfeldt-Jakob disease after further investigations.