Postmastectomy Functional Impairments.

PURPOSE OF REVIEW: This narrative review aims to offer a thorough summary of functional impairments commonly encountered by breast cancer survivors following mastectomy. Its objective is to discuss the factors influencing these impairments and explore diverse strategies for managing them. RECENT FINDINGS: Postmastectomy functional impairments can be grouped into three categories: neuromuscular, musculoskeletal, and lymphovascular. Neuromuscular issues include postmastectomy pain syndrome (PMPS) and phantom breast syndrome (PBS). Musculoskeletal problems encompass myofascial pain syndrome and adhesive capsulitis. Lymphovascular dysfunctions include lymphedema and axillary web syndrome (AWS). Factors such as age, surgical techniques, and adjuvant therapies influence the development of these functional impairments. Managing functional impairments requires a comprehensive approach involving physical therapy, pharmacologic therapy, exercise, and surgical treatment when indicated. It is important to identify the risk factors associated with these conditions to tailor interventions accordingly. The impact of breast reconstruction on these impairments remains uncertain, with mixed results reported in the literature.

Radial motor nerve conduction studies recorded from triceps brachii and extensor carpi radialis longus: Techniques and reference values.

INTRODUCTION/AIMS: Optimal timing of nerve transfer surgery in cervical spinal cord injury (SCI) depends upon the integrity of lower motor neurons (LMNs) in recipient nerves, which is best predicted by compound muscle action potential (CMAP) amplitude. There are no established techniques for obtaining the CMAP in two recipient muscles: triceps brachii and extensor carpi radialis longus (ECRL). This study aimed to develop recording techniques for radial motor studies to triceps and ECRL, and to determine reference values for CMAP amplitudes in healthy volunteers. METHODS: This was a prospective observational study of healthy adults aged 18 years and older. Motor nerve conduction studies were performed, stimulating the radial nerve in the axilla, over the axillary pulse at the pectoralis major insertion. Recording was from triceps (long head) and ECRL. CMAP amplitude, area, latency, and stimulus intensity were recorded. Reference values (RV) were calculated for CMAP amplitudes using a value 2 standard deviations below the mean. Cube root or logarithmic transformations were used to correct for non-normal distributions. RESULTS: Twenty-five healthy subjects participated. Triceps mean CMAP amplitude was 15.5 mV (SD 4.19), with an RV of 8.1 mV. ECRL mean CMAP amplitude was 11.5 mV (SD 3.54), with an RV of 6.2 mV. CMAP amplitude at ECRL was 75% (95% confidence interval 50%-100%) of that at triceps. DISCUSSION: We describe a technique for recording radial motor NCS from triceps and ECRL. Knowledge of normal CMAP amplitudes will help identify LMN injury in patients with cervical SCI being considered for nerve transfers.

Fatigue scores in patients receiving palliative radiotherapy for painful bone metastases.

INTRODUCTION: The purpose of this study was to examine changes in fatigue scores for patients receiving radiation therapy for bone metastases and its impact on quality of life (QOL). METHODS: Fatigue and QOL scores were prospectively collected in patients for up to 3 months following radiation therapy for bone metastases using three questionnaires: group 1, Edmonton Symptom Assessment System (ESAS) (0-10); group 2, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30); and Core 15 Palliative (EORTC QLQ-C15-PAL) (1-4). RESULTS: Average fatigue score in group 1 (399 patients) was 4.72 at baseline, 5.08 at month 1, 5.01 at month 2, and 4.95 at month 3, and was 2.40, 2.39, 2.56, and 2.70 in group 2 (482 patients), respectively. Thirty-five percent of patients in group 1 had fatigue score increase ≥2 points at month 1, 36% at month 2, and 36% at month 3. Twenty-one percent of patients in group 2 had fatigue score increase ≥1 at month 1, 27% at month 2, and 40% at month 3. There was a statistically significant increase in fatigue score from baseline to all 3 months in group 1 only. In both groups, there was a highly significant negative correlation between fatigue and overall QOL scores at baseline and any follow-up month. CONCLUSIONS: There was a statistically significant worsening in fatigue in group 1 only. Up to one third had increased fatigue of clinical significance. Patients with less fatigue symptoms reported better overall QOL.

Behavior profiles of children with autism spectrum disorder in kindergarten: Comparison with other developmental disabilities and typically developing children.

Monitoring behavior patterns that may be specific to autism spectrum disorder (ASD) at a population level has the potential to improve the allocation of intervention strategies and reduction of the burden of the disease. In Ontario, Canada, developmental data are regularly collected for all kindergarten children with the Early Development Instrument (EDI), a teacher-completed questionnaire that provides information on children's status in five domains: physical, social, emotional, language/cognitive, and communication/general knowledge. Our main research questions are: (a) are there differences in kindergarten EDI domain scores between children who are diagnosed with ASD by Grade 3 and those who develop typically or have other disabilities?; (b) do these differences show a different pattern in relation to an early (by kindergarten) or late (by Grade 3) diagnosis?; and (c) are there specific subdomains on the EDI that demonstrate a consistent pattern of differences? EDI domain and subdomain scores were compared among groups using multivariate analysis of variance controlling for age, gender, EDI year, and EDI year by age interaction. Children with ASD, regardless of timing of identification, had significantly lower scores on all domains of the EDI than typically developing children. Children with later ASD diagnosis had higher scores in kindergarten in cognitive areas but lower scores in social-emotional areas than children with other disabilities. These findings support the potential of the EDI to monitor ASD-like behaviors at the population level. Autism Res 2018, 11: 410-420. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Identifying behavior patterns among kindergarten children that may be specific to autism spectrum disorder (ASD) at a population level has the potential to improve intervention strategies and thus reduce the burden of the disease. In Ontario, Canada, developmental data are regularly collected with the Early Development Instrument (EDI) for all kindergarten children. The behavior in kindergarten of a sub-population of children diagnosed with developmental disabilities by age 9 is investigated here for patterns that may distinguish children with ASD from those with other disorders. Children with later ASD diagnosis had higher scores in kindergarten in cognitive areas but lower scores in social-emotional areas than children with other disabilities, indicating meaningful differences between those groups even before diagnosis. These results support the potential of using the EDI to monitor ASD-like behaviors at the population level.