Visual stimulation rehabilitation for cortical blindness after vertebral artery interventional surgery: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Cortical blindness (CB) after vertebral artery interventional surgery is not a frequently reported complication. In this study, the efficacy of visual stimulation rehabilitation consisting of visual recovery training and repetitive transcranial magnetic stimulation (rTMS) for cortical blindness was investigated by clinical evaluation, ophthalmologic examination, and electroencephalography (EEG). CASE PRESENTATION: This study reports on a 55-year-old male who showed partial bilateral posterior cerebral artery cortical branch occlusion after timely embolectomy due to thrombus dislodgement during right vertebral artery opening, stenting resulting in basilar artery tip occlusion. The lesions were mainly located in the right cerebellar hemisphere and bilateral occipital lobes, and the patient suffered from bilateral loss of vision, with only light perception preserved. The patient began to receive visual recovery training and 15 sessions of right occipital high-frequency transcranial magnetic stimulation 5 days after the onset. CLINICAL DISCUSSION: After treatment, the patient's capacity to identify things improved, allowing him to watch television, as did the precision and fluency of random hand movements, walking, and self-care. CONCLUSION: Visual stimulation rehabilitation composed of visual recovery training and rTMS is a promising therapy option for cortical blindness, and our case report provides clinical experience with vision recovery for patients with cortical blindness.

Long-Term Lower Limb Motor Function Correlates with Middle Cerebellar Peduncle Structural Integrity in Sub-Acute Stroke: A ROI-Based MRI Cohort Study.

Crossed cerebellar diaschisis (CCD) has been widely investigated in patients with supratentorial stroke. However, the role of CCD in lower limb recovery after stroke is still unknown. In this study, using a region-of-interest-based analysis of diffusion tensor imaging (DTI), a total of 44 cases of stroke within 3 months onset were enrolled for assessment of the cerebral peduncle (CP) and middle cerebellar peduncles (MCP) in CCD. Compared with the control group, the fractional anisotropy ratio (rFA) and laterality index (LI) of the CP and MCP in the stroke group significantly decreased. The rFA of the MCP (unaffected side/affected side) showed a more significant correlation with 1-year paresis grading (PG), lower extremity PG, upper extremity PG, National Institutes of Health Stroke Scale (NIHSS), and functional independence measure (FIM) motor item score, in comparison to the rFA of the CP (affected side/unaffected side) (r = -0.698 vs. r = -0.541, r = -0.651 vs. r = -0.386, r = -0.642 vs. r = -0.565, r = -0.519 vs. r = -0.403, and r = 0.487 vs. r = 0.435, respectively). Furthermore, the LI of the CP had a more significant association with 1-year Brunel Balance Assessment (BBA), upper extremity PG, and Modified Rankin Scale (mRS) as compared to the LI of the MCP (r = 0.573 vs. r = 0.452; r = -0.554 vs. r = -0.528; and r = -0.494 vs. r = -0.344, respectively). We set the cutoff point for the MCP rFA at 0.925 (sensitivity: 79% and specificity: 100%) for predicting lower extremity motor function prognosis and found the receiver operating characteristic (ROC) curve of MCP rFA was larger than that of CP rFA (0.893 vs. 0.737). These results reveal that the MCP may play a significant role in the recovery of walking ability after stroke.

Comparison of the efficacy and safety of sacral root magnetic stimulation with transcutaneous posterior tibial nerve stimulation in the treatment of neurogenic detrusor overactivity: an exploratory randomized controlled trial.

Background: Both repetitive sacral root magnetic stimulation (rSMS) and transcutaneous posterior tibial nerve stimulation (TTNS) have demonstrated clinical benefits for lower urinary tract dysfunction. However it still remains unclear that which method is more effective and safer to treat neurogenic detrusor overactivity (NDO). Methods: From December 2020 to December 2021, 50 patients (31 men and 19 women, aged 47.9±12.4 years) with NDO secondary to suprasacral spinal cord injury (SCI) were enrolled and randomly allocated to the rSMS or TTNS group based on a computer-generated random numbers table. The stimulation was applied continuously 5 times per week for 20 sessions. Urodynamic test was conducted at baseline and the day after the final 20th treatment session. The primary outcome was the individual change (Δ) in maximum cystometric capacity (MCC) from baseline to post-treatment. Secondary outcomes included changes (Δ) for the following parameters: volume at 1st involuntary detrusor contraction (1st IDCV), maximal detrusor pressure (Pdetmax), bladder compliance (BC), postvoid residual (PVR) volume, and bladder voiding efficiency (BVE). Additionally, adverse reactions including pain and skin irritation during stimulation were observed and recorded as safety outcomes. Results: Finally 47 patients completed the study (23 in rSMS and 24 in TTNS group). A per-protocol (PP) analysis was performed, and Mann-Whitney U test and unpaired t-test were used for statistical analysis. Compared with the efficacy of TTNS, rSMS showed statistically greater ΔMCC [median +43 mL (IQR, 22-62 mL) vs. +20 mL (IQR, 15-25 mL), P=0.001, with a between-group difference of +22 mL (95% CI: +7 to +35 mL)] and ΔBVE [median +10.0% (IQR, 3.8-15.7%) vs. +3.5% (IQR, 0.0-7.8%), P=0.003, with a between-group difference of +5.9% (95% CI: +1.2% to +9.7%)]. No significant differences were found in Δ1st IDCV (P=0.40), ΔPdetmax (P=0.67), ΔBC (P=0.79) and ΔPVR (P=0.92) between the two groups. Meanwhile, patients exhibited high tolerance to both protocols, and no adverse reactions were observed. Conclusions: RSMS may be more effective to improve urodynamics in the treatment for NDO than TTNS, cause it led to a statistical improvement in bladder capacity and voiding efficiency, without any side effects. RSMS is thus worthy of further clinical promotion. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100050663.

Early physical therapy for a patient affected by coronavirus disease 2019 (COVID-19) on awake veno-venous extracorporeal membrane oxygenation: a case report.

Since December 8, 2019, an acute respiratory illness has spread rapidly in China, causing 3,097 people to die as of March 7, and it has become a global crisis. The common symptoms are fever, fatigue, dry cough, myalgia, and dyspnea. This case report presents a 36-year-old male who was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected pneumonia on February 2, 2020. This patient received veno-venous extracorporeal membrane oxygenation (V-V ECMO) last for 10 days as salvage treatment as his condition became critical in the acute setting. As soon as his status became stable, he began to receive an early rehabilitation program performed by our rehabilitation team. After 43 days of treatment under the efforts of our teamwork, the patient was able to walk 800 meters, and then was discharged the next day. To our knowledge, this is the first report of early physical therapy for a patient with coronavirus disease 2019 (COVID-19) who was receiving extracorporeal membrane oxygenation (ECMO) whilst awake. This case indicates that early physical rehabilitation is safe and feasible and resulted in an expedited recovery using ECMO whilst awake. The goals for physiotherapy management include avoiding atelectasis, airway clearance, weaning and increasing the functional level. This report may contribute to the current literature on early physical therapy rehabilitation programs for awake ECMO patients.

Abnormal deviation in the measurement of residual urine volume using a portable ultrasound bladder scanner: a case report.

In addition to being suitable for the assessment of residual urine volume, the use of a portable bladder scanner can also assist medical staff in developing a reasonable urination plan. Portable scanners can help medical personnel to estimate the height and/or relaxation of the bladder neck for pelvic floor muscle training, assist in the efficacy evaluation of muscarinic antagonists in patients with neurogenic detrusor overactivity, and even determine whether the urine in the bladder of pediatric patients meets the criteria for catheterization to obtain urine samples. However, in the case described herein, we encountered abnormal deviation between the data measured by a portal bladder scanner and actual catheterization. The patient was a 65-year-old male suffering spinal nerve dysfunction due to tuberculous meningitis. He had functional dysuria and a history of liver cirrhosis, accompanied by a large amount of ascites. We therefore deduced that the deviation in the scanning data was attributable to the ascites. After the patient's ascites had resolved, the residual urine volume obtained via scanning evaluation was comparable to that obtained through catheterization. Our case shows that in the event of abnormal deviation in portable bladder scanner measurements, clinical judgements should be made based on the patient's condition rather than the scanning results alone.

Exercise Programs for Muscle Mass, Muscle Strength and Physical Performance in Older Adults with Sarcopenia: A Systematic Review and Meta-Analysis.

Sarcopenia is an age-related condition that is characterized by progressive and generalized loss of muscle mass and function. Exercise treatment has been the most commonly used intervention among elderly populations. We performed a systematic review and meta-analysis to evaluate the available literature related to the effects of exercise interventions/programs on muscle mass, muscle strength and physical performance in older adults with sarcopenia. We searched PubMed, EMBASE, MEDLINE and the Web of Science for randomized controlled trials and controlled clinical trials exploring exercise in older adults with sarcopenia published through July 2019 without any language restrictions. Pooled analyses were conducted using Review Manager 5.3, with standardized mean differences (SMDs) and fixed-effect models. A total of 3898 titles and abstracts were initially identified, and 22 studies (1041 individuals, 80.75% females, mean age ranged from 60.51 to 85.90 years) were included in the meta-analysis. The exercise programs in the studies consisted of 30 to 80 min of training, with 1 to 5 training sessions weekly for 6 to 36 weeks. Muscle strength (grip strength [SMD 0.57, 95 % CI 0.42 to 0.73, P <0.00001] and timed five chair stands [SMD -0.56, 95 % CI -0.85 to -0.28, P < 0.0001]) and physical performance (gait speed [SMD 0.44, 95 % CI 0.26 to 0.61, P < 0.00001] and the timed up and go test [SMD -0.97, 95 % CI -1.22 to -0.72, P < 0.00001]) showed significant improvement following exercise treatment, while no differences in muscle mass (ASM [SMD 0.15, 95 % CI -0.05 to 0.36, P = 0.15] and ASM/height2 [SMD 0.21, 95 % CI -0.05 to 0.48, P = 0.12]) were detected. Exercise programs showed overall significant positive effects on muscle strength and physical performance but not on muscle mass in sarcopenic older adults.