A comparison of the energy costs with use of different types of manual wheelchair in disabled persons.

SUMMARY: The energy cost of physical activity is a well-documented field of research both in non-disabled subjects and in subjects with physical disabilities, in particular spinal cord lesions. The aim of this study was, therefore, to investigate the energy cost and subjective fatigue in disabled persons who make daily use of a manual wheelchair by comparing three different types of wheelchair (standard, lightweight and ultra-light) in order to obtain indices useful for prescribing the most effective and appropriate wheelchairaid for the individual patient. The study was carried out on 18 patients affected by paraplegia or paraparesis due to spinal cord injury at different levels. Result revealed a significant difference across the three types of wheelchair, with the energy expenditure to cover 100 m increasing from the ultra-light (lowest expenditure) to the lightweight to the standard type (highest expenditure). The differences observed in the average energy consumed to cover a distance of 100 meters with the three types of wheelchair confirm the hypothesis that it is the weight of the wheelchair chosen by the rehabilitation team together with the patient that constitutes the fundamental criterion in making such a prescription. Obviously, in making the final choice, other factors as well need to be taken into account, such as the person's age and anthropometric characteristics, the nature of the disability and prognosis, the achievable degree of autonomy, functional capacities, personal preferences, the type of use (domestic or external), accessibility, reliability and durability, esthetic features, eventual accessories available, etc.

Effect on Passive Range of Motion and Functional Correlates After a Long-Term Lower Limb Self-Stretch Program in Patients With Chronic Spastic Paresis.

BACKGROUND: In current health care systems, long-duration stretching, performed daily, cannot be obtained through prescriptions of physical therapy. In addition, the short-term efficacy of the various stretching techniques is disputed, and their long-term effects remain undocumented. OBJECTIVE: To evaluate changes in extensibility in 6 lower limb muscles and in ambulation speed after a ≥1-year self-stretch program, the Guided Self-rehabilitation Contract (GSC), in individuals with chronic spastic paresis. DESIGN: Retrospective study. SETTING: Neurorehabilitation clinic. PARTICIPANTS: Patients diagnosed with hemiparesis or paraparesis at least 1 year before the initiation of a GSC and who were then involved in the GSC program for at least 1 year. INTERVENTIONS: For each patient, specific muscles were identified for intervention among the following: gluteus maximus, hamstrings, vastus, rectus femoris, soleus, and gastrocnemius. Prescriptions and training for a daily, high-load, prolonged, home self-stretching program were primarily based on the baseline coefficient of shortening, defined as CSH = [(XN -XV1)/XN] (XV1 = PROM, passive range of motion; XN = normally expected amplitude). MAIN OUTCOME MEASUREMENTS: Six assessments were performed per year, measuring the Tardieu XV1 or maximal slow stretch range of motion angle (PROM), CSH, 10-m ambulation speed, and its functional ambulation category (Perry's classification: household, limited, or full). Changes from baseline in self-stretched and nonself-stretched muscles were compared, with meaningful XV1 change defined as ΔXV1 >5° for plantar flexors and >10° for proximal muscles. Correlation between the composite XV1 (mean PROM for the 6 muscles) and ambulation speed also was evaluated. RESULTS: Twenty-seven GSC participants were identified (14 women, mean age 44 years, range 29-59): 18 with hemiparesis and 9 with paraparesis. After 1 year, 47% of self-stretched muscles showed meaningful change in PROM (ΔXV1) versus 14% in nonself-stretched muscles (P < .0001, χ2). ΔCSH was -31% (95% confidence interval [95% CI] -41.5 to -15.2) in self-stretched versus -7% (95% CI -11.9 to -2.1) in nonself-stretched muscles (P < .0001, t-test). Ambulation speed increased by 41% (P < .0001) from 0.81 m/s (95% CI 0.67-0.95) to 1.15 m/s (95% CI 1.01-1.29). Eight of the 12 patients (67%) who were in limited or household categories at baseline moved to a higher functional ambulation category. There was a trend for a correlation between composite XV1 and ambulation speed (r = 0.44, P = .09) in hemiparetic patients. CONCLUSION: Therapists should consider prescribing and monitoring a long-term lower limb self-stretch program using GSC, as this may increase muscle extensibility in adult-onset chronic paresis. LEVEL OF EVIDENCE: III.

Comparison of Psychomotor Development Screening Test and Clinical Assessment of Psychomotor Development

Numerous adverse factors are acting in the prenatal, perinatal and postnatal period of life and may be the cause of later mild or severe deviations from normal psychomotor development. Therefore, it is crucial to identify infants with neurological risk factors and infants that already have a delay from orderly development, in order to immediately initiate the rehabilitation process. The aim of this study was to determine whether there is difference in the assessment of psychomotor development in neurological risk children based on the psychomotor development test (Croatian, Razvoj psihomotorike, RPM test) and clinical evaluation of neuromotor development. RPM test is designed for rough estimate of psychomotor development in children in the first two years of life. The study included 15 full term children (8 male and 7 female) with clinical diagnosis of mild paraparesis and mild deviation from normal psychological and social development, and 15 full term children (8 male and 7 female) without neurological risk factors and deviations from normal psychomotor development, all at the age of 12-24 months. Of the 15 children diagnosed with mild paraparesis, none had delayed psychomotor development, 6.7% had suspect development and 93.3% had normal development on RPM test. All children in the control group had normal development on RPM test. According to the results, the RPM test is not sensitive enough to detect mild neurodevelopmental disorders.

Rare cause of paraparesis: bilateral obturator neuropathy after hysterosalpingectomy.

Bilateral obturator nerve injury during pelvic surgery is an infrequent cause of lower limb paraparesis. We report the case of a 45-year-old woman with a large uterine leiomyoma who underwent simple total hysterectomy and bilateral salpingectomy. At 24 h after the surgery, the patient noticed loss of muscle strength when adducting both legs. She had no problem with other movements and no sensory or sphincter abnormalities. Neurological examination confirmed that there was loss of strength only in the adductor muscles, with preserved sensory function and reflexes, suggesting bilateral obturator nerve involvement. Pelvic MRI showed a small postsurgical haematoma in the Douglas recess, but far from the obturator nerves. 2 weeks later, electromyography showed positive sharp waves and low motor unit recruitment in the adductor magnus muscles, confirming acute, bilateral obturator nerve neuropathy. The few cases of bilateral obturator neuropathy that have been reported were mostly related to abdominopelvic interventions.

Herida por arma de fuego y embolismo arterial periférico / Gun-shot wound and peripheral arterial embolism

No disponible

Paraparesis after Primary Percutaneous Coronary Intervention for ST-segment Elevation Myocardial Infarction: Combined Uncommon Complications of Acute Aortic Syndrome in a Patient.

Acute aortic syndrome complicated by both ST-segment elevation myocardial infarction (STEMI) and spinal ischemia is exceedingly rare. We herein report the case of a 66-year-old man who presented with paraparesis after primary percutaneous coronary intervention for STEMI. He was found to have an intramural hematoma of the ascending aorta and a severe dissection in the descending aorta, which led to both STEMI and paraparesis.

Severe flaccid paraparesis following spinal anaesthesia: a sine materia occurrence.

We report the case of a 45-year-old female patient who underwent spinal anaesthesia for a minor urological intervention, trying to correct her stress urinary incontinence. Hyperbaric bupivacaine was intrathecally injected and the surgical intervention ended uneventfully. Six hours after the operation a severe motor deficit of lower limbs was noted. The situation persisted and neurologists repeatedly checked on the patient; imaging of the lumbar spine was made but no pathological signal was registered. Somatosensory evoked potentials of the lower limbs showed bilaterally delayed latencies of the cortical components, with prolonging of interpeak latencies, suggestive of a suffering of the long somatosensory spinal tracts. Unable initially to walk or stand in erect position with almost no movements in both lower limbs, the patient was admitted in a rehabilitation facility and treated there for 4 months, with her condition substantially improving during this period.

Use of infliximab and other biologics in Behçet disease.

Behçet disease is a multisystem vasculitis characterised by recurrent oral ulceration in conjunction with other manifestations. Neurological involvement or neuro-Behçet disease is not common, but typically affects young men at its onset between the ages of 20 and 40 with significant long-term morbidity and mortality. There is substantial case literature to support the use of tumour necrosis factor antagonists, notably infliximab, in the treatment of neuro-Behçet disease.

Complications arising after thoracic aortic surgery: a case report on an unusual spinal cord infarction. Physiopathological and clinical considerations.

Even though new prevention techniques have been developed and are being used during thoraco-abdominal aortic repairs, spinal cord infarction remains a severe and relatively frequent complication of aortic surgery. Infarctions in the territory of the anterior spinal artery are considered the most common. Different clinical pictures related to spinal cord transverse extension wounds are drawn up. In this paper, we present a case report of a subject having presented an isolated motor deficit of the lower limbs and a favorable prognosis, suggesting selective involvement of the anterior horns of the spinal cord subsequent to surgical repair of an aortic dissection. We wish to review the relevant anatomical, clinical and diagnostic characteristics along with current techniques of spinal cord ischemia prevention during and after surgery.

Sarcoma de Ewing axial. A propósito de un caso / Axial Ewing's sarcoma. A case report

El sarcoma de Ewing (SE) axial es un tumor óseo y de tejidos blandos maligno, raro, con una tríada clínica característica de dolor, déficit neurológico y masa palpable. Típicamente presenta la translocación cromosómica t(11;22)(q24;q12). El tratamiento habitual del SE combina cirugía, radioterapia y quimioterapia. Se presenta el caso de una paciente de 40 años con clínica de lumbalgia aguda y paraparesia progresiva, que en el estudio radiológico realizado se objetiva una tumoración con morfología de reloj de arena, de localización primaria vertebral y sin metástasis, por lo que fue intervenida quirúrgicamente, y posteriormente realizó tratamiento quimioterápico y rehabilitador. Destacamos la importancia del caso clínico por la rareza de su edad de presentación y la localización vertebral primaria (AU)

Axial Ewing's sarcoma (ES) is a rare and malignant bone and soft tissue tumor, with a characteristic clinical triad of pain, neurological deficit and palpable mass. It typically presents the chromosome translocation t(11;22)(q24;q12). Its usual treatment combines surgery, radiotherapy and chemotherapy. A case report is presented of a 40-year old female patient with symptoms of acute low back pain and progressive paraparesis. The MRI study showed lumbar tumor with hourglass morphology, having a primary spinal location without metastases. The patient was operated on, after which chemotherapy and rehabilitation treatment were performed. We emphasize the importance of the clinical case due to its rarity of age of presentation and the primary spinal location (AU)

The effects of dynamic ankle-foot orthoses in chronic stroke patients at three-month follow-up: a randomized controlled trial.

OBJECTIVE: To investigate the short- and long-term effects of dynamic ankle foot orthoses on functional ambulation activities in chronic hemiparetic patients. DESIGN: Randomized controlled trial. SETTING: University's neurological rehabilitation outpatient clinic and orthotics department. SUBJECTS: Twenty-eight chronic hemiparetic patients of level 3-5 according to Functional Ambulation Classification and with a maximum spasticity level of 3 according to Modified Ashworth Scale, were randomly assigned to the study and control groups. INTERVENTIONS: The control group (n = 14) was assessed with tennis shoes whereas the study group (n = 14) was assessed initially with tennis shoes and after three months with dynamic ankle foot orthosis. MEASURES: Functional Reach, Timed Up and Go, Timed Up Stairs, Timed Down Stairs, gait velocity and Physiological Cost Index. RESULTS: In the initial assessment no difference was found between the groups for any of the measured parameters (P > 0.05). After three months, intergroup comparisons while the patients in the study group were wearing dynamic ankle-foot orthosis showed a significant difference in favour of the study group for Timed Up Stairs 12.00 (10.21) seconds study versus 15.00 (7.29) seconds control group; for gait velocity 0.99 (0.45) m/s study versus 0.72 (0.20) m/s control group and for Physiological Cost Index 0.12 (0.06) beats/min study versus 0.28 (0.13) beats/min control group (P < 0.05). No difference was found between the groups for Functional Reach, Timed Up and Go, Timed Down Stairs (P > 0.05). CONCLUSION: Chronic hemiparetic patients may benefit from using dynamic ankle-foot orthosis.

Complete paraparesis following resection of parasagittal meningioma: recovering function with an early intensive neurorehabilitation program.

Paraparesis can occur as a primary presentation of brain pathology at the motor strip along the parasagittal region. It could also occur as a neurological complication especially following resection of parasagittal meningioma with infiltration of the superior sagittal sinus (SSS). We report a case of a complete paraparesis immediately following resection of bilateral parasagittal meningioma with infiltration of the middle third of the SSS. A gradual improvement in neurological recovery and functional outcome was observed over a period of one year after undergoing an intensive neurorehabilitation program beginning from the acute inpatient phase post surgery.

The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of early and prolonged locomotor treatment with the use of a robotic-assisted gait training (RAGT) device (Lokomat; Hocoma Inc., Zurich, Switzerland) on the functional outcomes of patients after subacute stroke. DESIGN: A nonblinded prospective, randomized, controlled study. SETTING: Rehabilitation department in tertiary university medical center. PATIENTS: Sixty-seven patients in the first 3 months after subacute stroke were randomized into 2 groups as follows. Thirty-seven patients were treated with RAGT, and 30 were treated with regular physiotherapy. Inclusion criteria were first stroke, independent ambulation before the stroke, and neurological severity between 6 and 20 according to the National Institutes of Health Stroke Scale (NIHSS). INTERVENTION: RAGT treatment was administered 3 times a week for 30 minutes, combined with regular physiotherapy for 6 weeks. Control patients received the equivalent additional time of regular physiotherapy. MAIN OUTCOME MEASUREMENTS: The primary outcome was the ability to walk independently, as assessed by use of the functional ambulatory capacity scale. The secondary outcomes included the neurological status according to the NIHSS; functional motor assessment (determined by use of the stroke activity scale); and gait parameters, including gait velocity, endurance, and number of climbed stairs. RESULTS: In the intention-to-treat analysis, subjects in the RAGT group exhibited greater gains than the control group in their ability to walk independently, as expressed by a greater functional ambulatory capacity score (P < .01), and in their neurological status according to NIHSS (P < .01). Among those who achieved independent walking, nonsignificant differences between groups were noted according to secondary outcome measures of gait parameters except from step climbing. CONCLUSION: This controlled study showed, at the end of a 6-week trial, that locomotor therapy with the use of RAGT combined with regular physiotherapy produced promising effects on functional and motor outcomes in patients after subacute stroke as compared with regular physiotherapy alone.

The functioning of primary school learners with paraplegia/paraparesis in mainstream schools in the Western Cape, South Africa. An exploratory study.

PURPOSE: This study explores the reality of implementing policy guidelines that promote the inclusion of learners with disabilities in mainstream schools. According to the department of education in South Africa, learners who can satisfactorily be educated in an ordinary or mainstream school should be accommodated there. METHOD: The Craig handicap assessment and reporting technique were used to identify activity limitations and participation restrictions of learners with paraplegia/paraparesis in the mainstream school setting in the Western Cape, South Africa. The Craig hospital inventory of environmental factors identified contextual factors that facilitate or restrict the participation of learners. The views of the learners, teachers and parents were compared in order to identify the facilitators and barriers that influence the participation of physically disabled learners in mainstream schooling. The study population comprised 15 learners between the ages of 6 and 14 years old with paraplegia/paraparesis, their parents and relevant class teachers in 13 mainstream schools of the Western Cape, South Africa. RESULTS: Findings indicate that cognitive independence and mobility are the two areas that most restricted the participation of the learners in the school. Resource availability, social support and equality were critical to facilitating the inclusion of learners at mainstream schools. CONCLUSIONS: It is recommended that a comprehensive research project be undertaken. Teacher support and training is essential for keeping the educators motivated and informed. Physical assistance to the learners should be provided in a structured and appropriate way. Physical accessibility, transport and medical information should be addressed at the institutional (school) level and is not the responsibility of the parents or caregivers of the disabled learners.

Cerebral hemorrhage restricted to the corpus callosum.

We report a case of an 87-yr-old woman with hemorrhage restricted to the corpus callosum. After conservative treatment at an emergency hospital, she was admitted to our hospital presenting with bilateral lower limb weakness (paraparesis) and abnormal behavior in her left hand, such as pulling at dishes while eating and purposeless "floating" of the hand while walking. We believed these behaviors to represent disconnection syndrome. Six weeks after onset, her abnormal behavior while eating disappeared. The incomplete paraparesis also improved, and she regained the ability to walk, albeit with a T cane. These findings are compatible with previously reported cases. In cases of a corpus callosum lesion, careful observation from the outset is indispensable to avoid misdiagnosis.

The effect of joint angle on the timing of muscle contractions elicited by neuromuscular electrical stimulation.

Neuromuscular electrical stimulation was used to evoke isometric knee extension contractions in seven individuals with spinal cord injury (SCI) and the time for knee extension torque to rise and fall was measured across a range of knee angles. The stimulated muscles took more than twice as long to develop 50% of maximum torque at an angle of 15 degrees, compared to an angle of 90 degrees. This time difference comprised both an increased delay before torque rose above resting levels (31 +/- 3 ms at 90 degrees, 67 +/- 24 ms at 15 degrees), and a prolonged duration over which torque was rising (72 +/- 14 ms at 90 degrees, 140 +/- 62 ms at 15 degrees). There was no change, however, in the time taken for torque to fall after cessation of stimulation at different knee angles (58 +/- 5-ms delay, 60 +/- 11-ms fall time). The difference in torque rise time with joint angle has implications for modeling functional activities that differ greatly in their joint angles. This study provides regression equations whereby activation times for the quadriceps muscles of individuals with SCI can be predicted for specific angles of knee flexion.

Functional evaluation of vascular hemiparetics and traditional Japanese houses.

PURPOSE: To study the functional status of vascular hemiparetics in outpatient clinics in Japan. METHOD: Following five functional tasks were evaluated to (1) pick up a pencil from the floor, (2) stand up from the floor, (3) sit up straight, (4) squat, (5) ambulate as far as possible. Patients were asked whether they added handrails and used a bed or a Japanese Futon. RESULTS: Sixty-three of 85 patients were able to pick up a pencil from the floor and to stand up from the floor. Patients with poor motor recovery of the lower extremities were able get into and out of a bathtub as well as patients with good motor recovery. All patients who could not ambulate for more than 100 m and could not stand up from the floor began to use beds after their strokes. CONCLUSIONS: Ninety-five per cent of patients who could stand up from the floor were able to get into and out of bathtubs. All of the patients who could not stand up from the floor started to use beds.

[Long-term good results of surgical treatment for spontaneous epi- and subdural hematoma in a female patient on maintenance hemodialysis]. / Dlugotrwaly dobry wynik leczenia operacyjnego spontanicznego krwiaka nad- i podtwardówkowego u chorej objetej programem powtarzanych hemodializ.

Spontaneous intracranial hematoma is not rare, but with bad prognosis, complication in patients on maintenance hemodialysis (HD). Diagnostic difficulties result from a fact that symptoms of acute hematoma such as headaches,, nausea, vomitis, apathy, sleepiness, parestesia and seizures may also suggest dysequilibrium syndrome, dialytic dementia as well as hypertensive encephalopathy. We describe a case of female patient with 20-year interview data of hypertension on HD since 1981 because of end-stage renal failure in a course of chronic glomerulonephritis, who developed spontaneous epi- and subdural hematoma four year ago in 47 age of life. Performed CT examination confirmed diagnosis and on the same day the patient underwent right frontoparietotemporal craniotomy and the hematoma was removed. During postoperative period, HD sessions were performed without heparin. After surgery the patient developed transcient hypertonia, epileptic sizures and left-sided paresis. Currently, 48 months after craniotomy the patient is fully rehabilitated, with normal blood pressure, without epileptic sizures or palsy. Gradually we discontinued anticonvulsans and antihypertensives.