Anton-Babinski Syndrome in a Recurrent Ischemic Stroke Patient: A Case Report.

Anton-Babinski syndrome (ABS) is a rare neuropsychiatric condition characterized by visual anosognosia (denial of vision loss) and confabulation in the presence of intact anterior visual tracts. The most common cause of ABS is a cerebrovascular accident involving bilateral occipital lobe injuries with varying degrees of cortical blindness. In this report, we present the case of a woman with suspected ABS following a recurrent ischemic stroke in Malaysia. Establishing a proper diagnosis of stroke is crucial for modifying rehabilitation goals to ensure improved functional outcomes.

Photobiomodulation Therapy in Carpal Tunnel Release: A Randomized Controlled Trial.

Background: Carpal tunnel release (CTR) is widely accepted as an effective treatment for carpal tunnel syndrome. However, the recovery is often delayed and incomplete. Photobiomodulation therapy (PBMT) produces a nonthermal effect on living tissues; it promotes healing, remodels and reduces inflammation of an injured nerve. The purpose of this study was to compare the outcome of CTR between patients who underwent postoperative PBMT and without PBMT. Materials and methods: We recruited 105 patients who had open CTR from January 2019 to January 2021. Fifty-six patients fulfilled the study criteria and were randomized into two groups: with PBMT (n = 28) and without PBMT (n = 28). Demographic and clinical data were obtained preoperatively. The PBMT group had ten 3-min sessions over 3 weeks using 808 nm, 50 mW PBMT to deliver 9 J per session to the CTR incision scar. Clinical outcomes were assessed at 1, 3, and 6 months postoperatively. Data analysis was performed with SPSS software. Results: There were significant improvements in the Functional Status Scale in the Boston Carpal Tunnel Questionnaire (p = 0.018) and pain (visual analogue scales) in the morning (p = 0.019) at 1 month postoperatively in the PBMT group compared with the non-PBMT group. Improvement of tip pinch strength at 3 months (p = 0.022) and 6 months (p = 0.024), lateral pinch strength at 1 month (p = 0.042) and 3 months (p = 0.05), and tripod pinch strength at 3 months (p = 0.005) was significantly better in the PBMT group. Thumb 2-point discrimination (2PD) at 3 months (p = 0.018) and 6 months (p = 0.016) and index finger 2PD at 3 months (p = 0.039) were also significantly improved in the PBMT group. There were no side effects of PBMT reported. Conclusions: Patients who underwent PBMT post-CTR had better outcomes. PBMT may be a valuable adjunct to post-CTR care.

Adductor canal block versus intra-articular steroid and lidocaine injection for knee osteoarthritis: a randomized controlled study

Background@#This study aimed to assess the efficacy of the adductor canal block (ACB) in comparison to intra-articular steroid-lidocaine injection (IASLI) to control chronic knee osteoarthritis (KOA) pain. @*Methods@#A randomized, single-blinded trial in an outpatient rehabilitation clinic re-cruiting chronic KOA with pain ≥ 6 months over one year. Following randomization,subjects received either a single ACB or IASLI under ultrasound guidance. Numerical rating scale (NRS) scores for pain, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were recorded at baseline, 1 hour, 1 month, and 3 months postinjection. @*Results@#Sixty-six knees were recruited; 2 were lost to follow-up. Age was normally distributed (P = 0.463), with more female subjects in both arms (P = 0.564). NRS scores improved significantly for both arms at 1 hour, with better pain scores for the IASLI arm (P = 0.416) at 1st month and ACB arm at 3rd month (P = 0.077) with larger effect size (Cohen’s d = 1.085). Lower limb function improved significantly in the IASLI arm at 1 month; the ACB subjects showed greater functional improvement at 3 months (Cohen’s d = 0.3, P = 0.346). Quality of life (QoL) improvement mirrored the functional scores whereby the IASLI group fared better at the 1st month (P = 0.071) but at the 3rd month the ACB group scored better (Cohen’s d = 0.08, P = 0.710). @*Conclusions@#ACB provides longer lasting analgesia which improves function and QoL in chronic KOA patients up to 3 months without any significant side effects.

Design and development of a wheelchair seating pressure relief reminder system for pressure ulcer prevention among paraplegics.

Individuals with paraplegia spend their time on the wheelchair for life. Adapting to prolonged wheelchair seating for almost all activities of daily living is challenging. The loss of abilities to sense any pain or excessive seating pressure cause them to remain seated on the wheelchair without any pressure relief activities. This situation leads to secondary complications including pressure ulcer which further degrades the individual's health. To overcome this, a wheelchair seating pressure relief training system (WSETs) was developed. Optimal placement of the force sensitive resistors (FSR) as seating pressure sensors on the cushion were determined, and their responses were investigated with 5 paraplegics. Two different FSR orientations, A and B, were compared. Each paraplegic sat in resting position and then performed pressure relief activities (PRA) which included whole body push-up, left and right lean and forward lean, before returning to resting position. Orientation B, with more forward positioned FSRs, showed higher sensitivity, implying better capture of high-risk area of pressure ulcer development. The FSR sensor readings were significantly different among pressure relief activities in all subjects (p < 0.05) indicating the validity of FSR measures for the intended application. In conclusion, the WSETs system was proven suitable as a training tool for new paraplegics to habituate themselves in performing PRA.

The utility of ALS staging systems in a multi-ethnic patient cohort.

Objective: To compare two ALS staging systems, King's clinical staging and Milano-Torino (MiToS) functional staging, using prospective data from a multi-ethnic cohort of ALS patients. Methods: The stages of disease were determined prospectively based on existing definitions. The two systems were compared for timing of stages using box plots, correspondence using chi-square tests and association using Spearman's rank correlation. Results: The distribution of stages differed between the two systems. The proportions of disease stages of the King's staging system were more evenly distributed whereas in MiToS, there was greater weight seen at the later stages of disease. At the early stages, patients moved consecutively in the MiToS staging system but not in the King's staging system where patients tended to skip stages to reach later stages. Both systems had good correlation (Spearman's rho = 0.869) and the King's stage 4 most frequently corresponded to MiToS stage 2. Conclusion: We found the King's staging was helpful in determining the stages of disease burden, whereas both were helpful in determining the time to functional dependence with MiToS further refining the levels of dependence.

Photobiomodulation After Neurotization (Oberlin Procedure) in Brachial Plexus Injury: A Randomized Control Trial.

Objective: To investigate effect of photobiomodulation (PBM) on nerve regeneration after neurotization with the Oberlin Procedure (ulnar fascicle to motor branch to biceps) to restore elbow flexion in patients with brachial plexus injury. Materials and methods: This prospective randomized controlled trial was conducted with 14 patients with high brachial plexus injury who underwent neurotization with the Oberlin Procedure to restore elbow flexion. The patients were randomly allocated to two groups of equal numbers: control group and PBM group. In this study, the PBM used has a wavelength of 808 nm, 50 mW power, continuous mode emission, 4 J/cm2 dosimetry, administered daily for 10 consecutive days, with an interval of 2 days (weekends). The outcome of surgery was assessed after 1, 2, 3, and 6 months. The nonparametric Mann-Whitney U-test and chi-square test were utilized to compare the results between both groups. Results: After 3 months postoperatively, more patients in the PBM group had demonstrated signs of reinnervation and the mean muscle power was significantly higher in the PBM group. No adverse effects resulted from the administration of PBM. Conclusions: PBM is a treatment modality that can improve nerve regeneration after neurotization with the Oberlin Procedure.

Foot ulcers and their association with diabetic Charcot foot complications.

BACKGROUND AND OBJECTIVES: Diabetic Charcot foot (DCF) can cause gross structural deformities of the foot and ankle. The main objective of this study was to identify complications of DCF and its associated factors. METHOD: This is a retrospective cohort study. Data on medical background, previous DCF treatment and complications were obtained. Multiple logistic regression analysis was performed to measure factors related to various complications of DCF. RESULTS: Ninety-eight patient records were retrieved. Of the 83 patients who were still alive, 75.9% (n = 63) had recurrent ulcers, 53.0% (n = 44) had undergone foot surgery and 45.8% (n = 38) had undergone amputation. Patients with a history of recurrent ulcers have the highest predilection to amputation (odds ratio: 8.5; 95% confidence interval: 1.8, 39.1). DISCUSSION: In terms of DCF complications, foot ulcers are an independent predictor of recurrent foot ulcers, foot surgery and amputation. Regular foot assessment of patients with DCF to prevent ulcers is strongly recommended.

A Comparative Study of Two Modalities in Pain Management of Patients Presenting with Chronic Brachial Neuralgia.

Objectives: The study aims to assess, evaluate, and compare the efficacy of acupressure and hypnotherapy in the management of pain in patients presenting with chronic brachial neuralgia (CBN). Design: Randomized controlled trial. Settings/location: Department of Orthopaedic Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia. Subjects: Forty patients with CBN following traumatic brachial plexus injury from 2012 to 2017. Intervention: Therapy for a duration of 1 month in two groups; subjects in the hypnotherapy group received a weekly session of clinical hypnotherapy (total of four times) using a standardized protocol, while subjects in the acupressure group were guided by an acupuncturist during the initial session, received 2 month take home supply of acupressure patches, and were reviewed fortnightly. Outcome measures: The Visual Analog Scale, the Brief Pain Inventory, and the SF-36v2® Health Survey were recorded at different time points; 1 month pretreatment (week 0), pretreatment (week 4), post-treatment (week 8), and 4 months post-treatment (week 20). Results: There was a statistically significant improvement in the average pain intensity from pretreatment to post-treatment score in both groups. The pain intensity increased 4 months later; however, the pain intensity was still significantly reduced in comparison with pretreatment scores. The study suggests that both treatment outcomes are effective in terms of alleviating pain and improving quality of life in subjects with CBN, to a different degree. Conclusion: Overall, both therapies were able to improve the pain intensity and quality of life significantly during the treatment period. Hypnotherapy was observed to have a better carryover effect compared to acupressure, especially in terms of improving quality of life and the mental component score.

Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre.

INTRODUCTION: This study aimed to determine the risk factors of diabetic Charcot arthropathy of the foot among diabetic patients with and without foot problems. METHODS: This was a case-control study involving diabetic patients attending the Diabetic Foot Care and Wound Management Clinic at University Malaya Medical Centre, Kuala Lumpur, Malaysia, from June 2010 to June 2011. Data on sociodemographic profiles, foot factors and diabetes characteristics was collected and analysed. RESULTS: A total of 48 diabetic patients with Charcot arthropathy of the foot were identified. Data from these 48 patients was compared with those of 52 diabetic patients without foot problems. Up to 83.3% of patients with diabetic Charcot arthropathy presented with unilateral Charcot foot, most commonly located at the midfoot (45.8%). Patients with a history of foot problems, including foot ulcer, amputation, surgery or a combination of problems, had the highest (26-time) likelihood of developing Charcot arthropathy (odds ratio 26.4; 95% confidence interval 6.4-109.6). Other significant risk factors included age below 60 years, more than ten years' duration of diabetes mellitus and the presence of nephropathy. CONCLUSION: A history of prior diabetic foot problems is the greatest risk factor for developing diabetic Charcot arthropathy, compared with other risk factors such as diabetes characteristics and sociodemographic profiles. Preventive management of diabetic foot problems in the primary care setting and multidisciplinary care are of paramount importance, especially among chronic diabetic patients.

A comparison of pressure distributions between two types of sockets in a bulbous stump.

BACKGROUND: This article describes a total surface bearing prosthetic socket for a patient (25-year-old female) with a bulbous stump. CASE DESCRIPTION AND METHODS: The subject had unstable excessive soft tissue at the distal end of the residuum. After 2 years of prosthetic use, she experienced several problems, including pain in the residual limb and knee joint. Pressure distribution was evaluated during ambulation. We also designed a total surface bearing socket with Velcro as suspension system to distribute the load evenly on the residual limb, and to facilitate donning procedure. FINDINGS AND OUTCOMES: The main site of weight bearing in the old prosthesis (patellar tendon bearing) was anterior proximal region of the residual limb, especially the patellar tendon. The pressure was almost 10 times higher than the distal region during level walking. Pressures were distributed more evenly with the total surface bearing socket design, and the donning was much easier. CONCLUSION: Pressure distribution within the socket could be affected by socket design and suspension system. Using the total surface bearing socket and Velcro as suspension system might facilitate donning of prosthesis and reduce traction at the end of residual limb during the swing phase of gait. CLINICAL RELEVANCE: Proper socket design and suspension system based on the amputees' need can facilitate rehabilitation process and lead to the amputee's satisfaction. The pressure is distributed more uniformly over the residual limb by the total surface bearing socket compared to the patellar tendon bearing socket for lower limb amputees with unusual stump shape.

Ability to return to driving after major lower limb amputation.

OBJECTIVE: The aims of this study were to examine the ability of patients to return to driving cars and riding motorcycles after lower limb amputation, and to explore the factors that significantly affect such ability. DESIGN: A sample of 90 participants, mean age 55.2 years (standard deviation 12.5), were recruited from a tertiary hospital. Inclusion criteria were: age over 18 years; unilateral or bilateral major lower limb amputation; and having been driving cars and/or riding motorcycles 6 months prior to amputation. Data collected via a structured questionnaire revealed that the most common cause of amputation was diabetic foot complications (75.6%). RESULTS: Nearly half (45.6%) of the participants returned to driving/riding within 1-72 months post-amputation. Males (p<0.05) and those wearing prostheses (p<0.001) significantly returned to driving/riding. The main reasons for not driving/riding were family members' concerns, other medical illnesses, and lack of confidence of the patient. CONCLUSION: The rate of return to driving/riding among patients with lower limb amputation is low. Clinicians should address family members' concerns and patient's level of confidence in their rehabilitation services.