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1.
Medicine (Baltimore) ; 99(19): e20032, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384463

RESUMO

RATIONALE: Spontaneous spinal subdural hematoma (SSDH) is a rare disease that can cause severe permanent neurological dysfunction. Here we present a case of spontaneous SSDH, in which a series of magnetic resonance images (MRIs) taken through the course of the disease facilitated understanding of the resolution process of the hematoma and the diagnosis of SSDH. PATIENT CONCERNS: A 59-year-old male presented with sudden severe back pain and rapid onset of paraplegia. This symptom had continued developing while he was transferred to the emergency department. Initial physical examination showed flaccid paralysis of both lower limbs with areflexia and loss of all sensation below T6 bilaterally. MRI images showed an anterior subdural hematoma from C7 to T7 with spinal cord compression. DIAGNOSIS: Based on MRI findings, the diagnosis was SSDH. INTERVENTIONS: We chose conservative treatment of 1-week bed rest and intensive rehabilitation for the patient due to the presence of sacral sparing and the slight motor recovery at 24 hours after the onset. OUTCOMES: Frequent MRI images demonstrated that the spinal cord compression was surprisingly mitigated only 2 days and mostly absorbed 4 days after the onset. The patient's motor function was recovered completely and he was discharged after 8 weeks of hospitalization. LESSONS: Our chronological MRI findings provide crucial information for diagnosing SSDH and also suggest that spinal surgeons should consider the potential option of a conservative approach for treating SSDH. Although prompt selection of a therapeutic strategy for SSDH could be challenging, the surgeons could observe the course of the patient's neurological status for a few days to detect signs of spontaneous recovery.


Assuntos
Tratamento Conservador/métodos , Hematoma Subdural Espinal , Imagem por Ressonância Magnética/métodos , Paraplegia , Canal Vertebral/diagnóstico por imagem , Hematoma Subdural Espinal/complicações , Hematoma Subdural Espinal/diagnóstico , Hematoma Subdural Espinal/fisiopatologia , Hematoma Subdural Espinal/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Exame Neurológico/métodos , Paraplegia/etiologia , Paraplegia/fisiopatologia , Paraplegia/reabilitação , Recuperação de Função Fisiológica , Remissão Espontânea , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(17): e19558, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332604

RESUMO

This 2-group study was carried out to determine the inter-practitioner difference of nerve conduction studies with standardized techniques.56 normal subjects of 19 to 49 year-old were recruited, 29, and 27 in the 2 labs respectively. Tests were carried out unilaterally on: 5 motor nerve distal latency, conduction velocities (MNCV) and minimum latency of F wave, 3 sensory nerves with negative amplitude, onset, and peak distal latency, sensory nerve distal latency.T-test disclosed 4(15.4%) attributes with statistical significance (P < .05). They were 2 of 4 (50%) compound motor action potentials, which were ulnar and tibial nerve, and 2 of 6 (33.3%) MNCVs, which were elbow-to-wrist MNCV of median nerve and cross-fibula MNCV of peroneal nerve. No differences were disclosed in motor nerve distal latencys, minimum latency of F waves and all sensory attributes.Inconsistency pattern of certain attributes were found. This could be explained with the insufficient definition of related techniques.


Assuntos
Condução Nervosa/fisiologia , Exame Neurológico/métodos , Padrões de Prática Médica , Potenciais de Ação , Adulto , Fatores Etários , Pesos e Medidas Corporais , Feminino , Humanos , Masculino , Nervo Mediano/fisiologia , Pessoa de Meia-Idade , Nervo Fibular/fisiologia , Fatores Sexuais , Nervo Tibial/fisiologia , Nervo Ulnar/fisiologia , Adulto Jovem
3.
Int Heart J ; 61(2): 295-300, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32173702

RESUMO

Many patients are transferred to hospital due to out-of-hospital cardiac arrest (OHCA), and, unfortunately, most suffer from cerebral damage. Currently, it is difficult to predict the recovery of neurological function after return of spontaneous circulation (ROSC) in the acute phase. Increased intracellular Ca2+ induces cell death in the acute phase. Accordingly, we predicted that serum adjusted Ca2+ will decrease following Ca2+ influx into cells. Consequently, serum adjusted Ca2+ in the acute phase may be able to predict recovery of neurological function in patients with ROSC from OHCA. This is a retrospective and observational study from 2 centers. A total of 190 consecutive patients with ROSC from OHCA were recruited, with 33 patients meeting the inclusion criteria. The relationship between serum adjusted Ca2+ within 48 hours after ROSC and neurological function at discharge (as evaluated by the Glasgow-Pittsburgh cerebral performance category) was examined. Serum adjusted Ca2+ was measured every 4 hours within a 48-hour period after ROSC. There were no significant differences in hemodynamical state and laboratory data between the 2 groups. However, lowest serum adjusted Ca2+ within 48 hours after ROSC was significantly lower in the poor neurological outcome group (0.96 ± 0.06 versus 1.02 ± 0.06 mmol/L, P = 0.011). Thus, lowest serum adjusted Ca2+ within 48 hours after ROSC may be a predictive factor for recovery of neurological function at discharge in patients with ROSC from OHCA.


Assuntos
Cálcio/sangue , Parada Cardíaca Extra-Hospitalar/sangue , Adulto , Idoso , Doenças do Sistema Nervoso Central/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/diagnóstico , Prognóstico , Estudos Retrospectivos
4.
Internist (Berl) ; 61(3): 235-242, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32095894

RESUMO

The diagnosis of polyneuropathy (PNP) is based on the anamnesis and description of complaints of the patient and clinical findings. The type of distribution as well as known diseases and drug toxic factors can provide indications. Electromyography and electroneurography can be used to differentiate between axonal and demyelinating PNP. The laboratory examinations are initially directed towards frequent and treatable causes. These are then expanded depending on the suspected diagnosis. Analysis of cerebrospinal fluid (CSF) is facultative and should be carried out when there is a suspicion of a certain form of PNP with CSF findings indicative of the diagnosis. Nerve biopsy is indicated when the etiology of a severe or progressive PNP cannot be clarified by less invasive means and can have consequences for the treatment. A genetic investigation can be meaningful with a positive family anamnesis or with typical signs of hereditary PNP. Depending on the neuropathy and context, the diagnostic approach is structured differently. The special diagnostics for small fiber neuropathy and amyloid neuropathy as well as for diabetes and alcohol abuse are dealt with in detail in this article. Numerous cases of polyneuropathy remain unexplained and regularly have a favourable prognosis.


Assuntos
Neuropatias Amiloides/diagnóstico , Eletromiografia/métodos , Exame Neurológico/instrumentação , Polineuropatias/diagnóstico , Neuropatia de Pequenas Fibras/diagnóstico , Biópsia , Humanos
5.
Ideggyogy Sz ; 73(1-2): 60-64, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32057206

RESUMO

Myasthenia gravis (MG) and Guillain-Barré syndrome (GBS) are autoimmune disorders that may cause weakness in the extremities. The coexistence of MG and GBS in the same patient has rarely been reported previously. A 52-year-old male presenting with ptosis of the left eye that worsened with fatigue, especially toward evening, was evaluated in our outpatient department. His acetylcholine receptor antibody results were positive, supporting the diagnosis of MG. His medical history revealed a post-infectious acute onset of weakness in four extremities, difficulty in swallowing and respiratory failure, which was compatible with a myasthenic crisis; however, his nerve conduction studies and albuminocytologic dissociation at the time were compatible with GBS. With this case report, we aimed to mention this rare coincidental state, discuss possible diagnoses and review all other similar cases in the literature with their main features.


Assuntos
Síndrome de Guillain-Barré , Miastenia Gravis , Autoanticorpos , Fadiga , Síndrome de Guillain-Barré/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/diagnóstico , Exame Neurológico
6.
Am J Nurs ; 120(3): 48-54, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32079799

RESUMO

The National Institutes of Health Stroke Scale (NIHSS) is considered the standard for assessing neurologic status after an acute stroke. Currently, there is no guideline for when this assessment should be completed, nor is there consensus on how frequently or for how long.We initiated a quality improvement project that sought first to determine when and how often nurses at a variety of institutions in our multisite health care system completed the NIHSS assessment and then to identify the minimum frequency at which nurses should complete the assessment. After reviewing the literature and current practices and observing internal and external benchmarks, we set a new standard for all institutions in the system to follow.The new assessment frequency was based on patient condition and level of care, although that frequency would change if a patient showed new or worsening neurologic changes. The new standard was successfully implemented at all the primary and comprehensive certified stroke centers in our network. Ongoing monitoring confirmed that the frequency of NIHSS assessment met the needs of our patients and ensured staff adherence to the new practice.


Assuntos
Exame Neurológico/enfermagem , Padrões de Prática em Enfermagem/normas , Acidente Vascular Cerebral/enfermagem , Benchmarking/métodos , Humanos , National Institutes of Health (U.S.) , Melhoria de Qualidade , Inquéritos e Questionários , Estados Unidos
7.
Am Fam Physician ; 101(2): 95-108, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31939642

RESUMO

Although the prevalence of muscle weakness in the general population is uncertain, it occurs in about 5% of U.S. adults 60 years and older. Determining the cause of muscle weakness can be challenging. True muscle weakness must first be differentiated from subjective fatigue or pain-related motor impairment with normal motor strength. Muscle weakness should then be graded objectively using a formal tool such as the Medical Research Council Manual Muscle Testing scale. The differential diagnosis of true muscle weakness is extensive, including neurologic, rheumatologic, endocrine, genetic, medication- or toxin-related, and infectious etiologies. A stepwise approach to narrowing this differential diagnosis relies on the history and physical examination combined with knowledge of the potential etiologies. Frailty and sarcopenia are clinical syndromes occurring in older people that can present with generalized weakness. Asymmetric weakness is more common in neurologic conditions, whereas pain is more common in neuropathies or radiculopathies. Identifying abnormal findings, such as Chvostek sign, Babinski reflex, hoarse voice, and muscle atrophy, will narrow the possible diagnoses. Laboratory testing, including electrolyte, thyroid-stimulating hormone, and creatine kinase measurements, may also be helpful. Magnetic resonance imaging is indicated if there is concern for acute neurologic conditions, such as stroke or cauda equina syndrome, and may also guide muscle biopsy. Electromyography is indicated when certain diagnoses are being considered, such as amyotrophic lateral sclerosis, myasthenia gravis, neuropathy, and radiculopathy, and may also guide biopsy. If the etiology remains unclear, specialist consultation or muscle biopsy may be necessary to reach a diagnosis.


Assuntos
Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Exame Neurológico/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Humanos , Músculos/fisiopatologia , Doenças Musculares/diagnóstico , Exame Neurológico/métodos , Neurologia/normas
8.
World Neurosurg ; 136: 394-398.e5, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954905

RESUMO

BACKGROUND: The aim of this study was to observe the improvement in patients with dopa-responsive dystonia (DRD) after deep brain stimulation (DBS) of the globus pallidus internus (GPi). CASE DESCRIPTION: A 27-year-old woman with a 22-year history of DRD underwent GPi DBS. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Hamilton Anxiety Scale (HAMA), and the Hamilton Depression Scale (HAMD) were used to regularly assess changes in the patient's condition after DBS treatment. CONCLUSIONS: After 6 months of GPi DBS treatment, the total BFMDRS score of the patient was 5, a 94.28% improvement over the preoperative baseline score. In addition, the MMSE, MOCA, HAMA, and HAMD scores of the patient were 30, 30, 1, and 2, respectively. Intelligence and cognitive levels of the patient did not change significantly compared with the preoperative baseline level, whereas anxiety and depression status of the patient improved compared with the preoperative status. GPi DBS treatment can significantly improve the symptoms of systemic dystonia in patients with DRD, and to a certain extent improve the anxiety and depression status of these patients. Therefore, we conclude that GPi DBS is an alternative safe and effective treatment for patients with DRD.


Assuntos
Estimulação Encefálica Profunda , Distúrbios Distônicos/tratamento farmacológico , Distúrbios Distônicos/terapia , Adulto , Distúrbios Distônicos/diagnóstico por imagem , Eletrodos Implantados , Feminino , Globo Pálido , Humanos , Imagem por Ressonância Magnética , Exame Neurológico , Procedimentos Neurocirúrgicos , Resultado do Tratamento
9.
J Clin Psychiatry ; 81(2)2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31995677

RESUMO

OBJECTIVE: A nominal group process followed by a modified Delphi method was used to survey expert opinions on best practices for tardive dyskinesia (TD) screening, diagnosis, and treatment and to identify areas lacking in clinical evidence. PARTICIPANTS: A steering committee of 11 TD experts met in nominal group format to prioritize questions to be addressed and identify core bibliographic materials and criteria for survey panelists. Of 60 invited experts, 29 (23 psychiatrists and 6 neurologists) agreed to participate. EVIDENCE: A targeted literature search of PubMed (search term: tardive dyskinesia) and recommendations of the steering committee were used to generate core bibliographic material. Inclusion criteria were as follows: (1) review articles, meta-analyses, guidelines, or clinical trials; (2) publication in English between 2007 and 2017; (3) > 3 pages in length; and (4) publication in key clinical journals with impact factors ≥ 2.0. Of 29 references that met these criteria, 18 achieved a score ≥ 5 (calculated as the number of steering committee votes multiplied by journal impact factor and number of citations divided by years since publication) and were included. CONSENSUS PROCESS: Two survey rounds were conducted anonymously through electronic media from November 2017 to January 2018; responses were collected, collated, and analyzed. Respondent agreement was defined a priori as unanimous (100%), consensus (75%-99%), or majority (50%-74%). For questions using a 5-point Likert scale, agreement was based on percentage of respondents choosing ≥ 4 ("agree completely" or "agree"). Round 1 survey included questions on TD screening, diagnosis, and treatment. Round 2 questions were refined per panelist feedback and excluded Round 1 questions with < 25% agreement and > 75% agreement (unless feedback suggested further investigation). CONCLUSIONS: Consensus was reached that (1) a brief, clinical assessment for TD should be performed at every clinical encounter in patients taking antipsychotics; (2) even mild movements in 1 body area may represent possible TD; (3) management requires an overall evaluation of treatment, including reassessment of antipsychotics and anticholinergics as well as consideration of vesicular monoamine transporter 2 (VMAT2) inhibitors; and (4) informed discussions with patients/caregivers are essential.


Assuntos
Antipsicóticos , Antagonistas Colinérgicos , Programas de Rastreamento/métodos , Conduta do Tratamento Medicamentoso/normas , Exame Neurológico/métodos , Discinesia Tardia , Antipsicóticos/administração & dosagem , Antipsicóticos/efeitos adversos , Antagonistas Colinérgicos/administração & dosagem , Antagonistas Colinérgicos/efeitos adversos , Consenso , Técnica Delfos , Monitoramento de Medicamentos/métodos , Monitoramento de Medicamentos/normas , Humanos , Guias de Prática Clínica como Assunto , Medição de Risco/métodos , Discinesia Tardia/induzido quimicamente , Discinesia Tardia/diagnóstico , Discinesia Tardia/terapia , Proteínas Vesiculares de Transporte de Monoamina/antagonistas & inibidores
10.
J Clin Psychiatry ; 81(2)2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31995679

RESUMO

Valbenazine and deutetrabenazine are FDA-approved as treatment for tardive dyskinesia (TD). Both medications are vesicular monoamine transporter type 2 (VMAT2) inhibitors, and both are effective for reducing TD symptoms. Clinicians need to be aware of the adverse effects of valbenazine and deutetrabenazine, as well as other key differences between the two, in order to individualize treatment. Using the Abnormal Involuntary Movement Scale assists clinicians in assessing progress for each patient. Treating TD effectively with these new medications will reduce the burden of the condition for patients.


Assuntos
Exame Neurológico/métodos , Discinesia Tardia , Tetrabenazina/análogos & derivados , Valina/análogos & derivados , Proteínas Vesiculares de Transporte de Monoamina/antagonistas & inibidores , Monitoramento de Medicamentos/métodos , Humanos , Conduta do Tratamento Medicamentoso , Moduladores de Transporte de Membrana/administração & dosagem , Moduladores de Transporte de Membrana/efeitos adversos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Psiquiatria/educação , Discinesia Tardia/induzido quimicamente , Discinesia Tardia/diagnóstico , Discinesia Tardia/tratamento farmacológico , Tetrabenazina/administração & dosagem , Tetrabenazina/efeitos adversos , Resultado do Tratamento , Valina/administração & dosagem , Valina/efeitos adversos
12.
Br J Sports Med ; 54(2): 94-101, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31331944

RESUMO

OBJECTIVES: To determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment . DESIGN: Systematic review and meta-analysis using individual participant data (IPD). DATA SOURCES: The search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Studies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition of a secondary cognitive task; spatiotemporal, kinematic or kinetic outcome variables were reported, and; included studies comprised an observational study design with case-control matching. DATA EXTRACTION AND SYNTHESIS: Our review is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analyses-IPD Statement. We implemented the Risk of Bias Assessment tool for Non-randomised Studies to undertake an outcome-level risk of bias assessment using a domain-based tool. Study-level data were synthesised in one of three tiers depending on the availability and quality of data: (1) homogeneous IPD; (2) heterogeneous IPD and (3) aggregate data for inclusion in a descriptive synthesis. IPD were aggregated using a 'one-stage', random-effects model. RESULTS: 26 studies were included. IPD were available for 20 included studies. Consistently high and unclear risk of bias was identified for selection, detection, attrition, and reporting biases across studies. Individuals with a recent sports concussion walked with slower average walking speed (χ2=51.7; df=4; p<0.001; mean difference=0.06 m/s; 95% CI: 0.004 to 0.11) and greater frontal plane centre of mass displacement (χ2=10.3; df=4; p=0.036; mean difference -0.0039 m; 95% CI: -0.0075 to -0.0004) than controls when evaluated using a dual-task assessment up to 2 months following concussion. SUMMARY/CONCLUSIONS: Our IPD evidence synthesis identifies that, when evaluated using a dual-task assessment, individuals who had incurred a sports concussion exhibited impairments in gait that persisted beyond reported standard clinical recovery timelines of 7-10 days. Dual-task assessment (with motion capture) may be a useful clinical assessment to evaluate recovery after sports concussion. PROTOCOL PRE-REGISTRATION: This systematic review was prospectively registered in PROSPERO CRD42017064861.


Assuntos
Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Exame Neurológico/métodos , Velocidade de Caminhada , Fenômenos Biomecânicos , Humanos , Equilíbrio Postural , Análise e Desempenho de Tarefas
13.
Int J Radiat Oncol Biol Phys ; 106(2): 261-268, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31628959

RESUMO

PURPOSE: In patients with spinal instability, cord compression, or neurologic deficits, the standard of care is surgery followed by radiation therapy (RT). Recurrence rates after conventional RT remain high. The purpose of this study is to prospectively examine the efficacy of postoperative stereotactic body RT (SBRT) in patients who have undergone surgical intervention for spine metastases. We hypothesize that postoperative SBRT to the spine would be associated with higher local control than historical rates after conventional RT. METHODS AND MATERIALS: Thirty-five adult patients with a Karnofsky Performance Status score ≥40 and spine metastases from solid tumors with no prior overlapping RT and target volumes ≤3 consecutive vertebral levels were enrolled. Thirty-three patients were treated. Two patients underwent treatment to 2 target volumes for a total of 35 target volumes. All patients received SBRT 30 Gy in 5 fractions. Patients were followed with neurological examinations and computed tomography and/or magnetic resonance imaging every 3 months. Neurologic function was assessed at the same time points using the American Spinal Injury Association (ASIA) impairment score. Pain was rated according to the 10-point visual analogue scale and MD Anderson Cancer Center brief pain index. Toxicity was recorded according to National Cancer Institute Common Toxicity Criteria for Adverse Events Version 4. The primary objective was the rate of radiographic local recurrence at 12 months after completion of SBRT. RESULTS: Patient characteristics were as follows: 34.3% had radioresistant primaries; 71.4% were ASIA E and the remainder ASIA D; and the median baseline Karnofsky Performance Status score was 70 (range, 50-100). Radiographic and symptomatic local control at 1 year were 90% (95% confidence interval, 76%-98%). The median time to recurrence in these 3 patients was 3.5 months (range, 3.4-5.8 months), all had radiosensitive tumors, and all recurrences were epidural. No patients experienced wound dehiscence, hardware failure, or spinal cord myelopathy. The median time to return to systemic therapy was 0.5 months (range, 0-9.4 months). CONCLUSIONS: This prospective study of postoperative spine SBRT demonstrates excellent local control with low toxicity. These data suggest superior rates of local control compared with conventional RT; however, a formal comparative study is warranted.


Assuntos
Recidiva Local de Neoplasia , Radiocirurgia/métodos , Neoplasias da Coluna Vertebral/radioterapia , Neoplasias da Coluna Vertebral/secundário , Adulto , Idoso , Dor do Câncer/diagnóstico , Progressão da Doença , Fracionamento da Dose de Radiação , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Exame Neurológico/estatística & dados numéricos , Medição da Dor/métodos , Período Pós-Operatório , Estudos Prospectivos , Tolerância a Radiação , Radiocirurgia/efeitos adversos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Dev Neurorehabil ; 23(1): 39-49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31726906

RESUMO

Objective: The aim of the present review was to identify the motor scales currently used to assess individuals with Down Syndrome (DS).Method: PubMed, WOS and BVS databases were systematically searched to identify the most relevant published studies that used motor scales in the evaluation of individuals with DS.Results: Of the 99 studies that met the eligibility criteria in this process, 20 experimental and observational studies were found to fully meet the eligibility criteria.Conclusion: We identified several motor scales including the Alberta Infant Motor Scale (AIMS), Test of Infant Motor Performance (TIMP), BAYLEY, Peabody Gross Motor Scale (PGMS-PDMS-GM), Gross Motor Function Measure (GMFM), Movement Assessment Battery for Children (MABC) and Pediatric Evaluation of Disability Inventory (PEDI).


Assuntos
Síndrome de Down/fisiopatologia , Movimento , Exame Neurológico/normas , Criança , Pré-Escolar , Avaliação da Deficiência , Feminino , Humanos , Lactente , Masculino , Destreza Motora
17.
Muscle Nerve ; 61(1): 74-80, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31588568

RESUMO

BACKGROUND: Nephropathic cystinosis is a lysosomal storage disorder. Patient survival years after renal transplantation has revealed systemic complications including distal myopathy and dysphagia. METHODS: We evaluated 20 adult patients with nephropathic cystinosis using patient-reported and clinical outcome measures. Standard motor measures, video fluoroscopy swallow studies, and tests of respiratory function were performed. We also used Rasch analysis of an initial survey to design a 16-item survey focused on upper and lower extremity function, which was completed by 31 additional patients. RESULTS: Distal myopathy and dysphagia were common in patients with nephropathic cystinosis. Muscle weakness ranges from mild involvement of intrinsic hand muscles to prominent distal greater than proximal weakness and contractures. CONCLUSIONS: In addition to further characterization of underlying dysphagia and muscle weakness, we propose a new psychometrically devised, disease specific, functional outcome measures for distal myopathy in patients with nephropathic cystinosis.


Assuntos
Cistinose/complicações , Miopatias Distais/diagnóstico , Adulto , Cistinose/psicologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Miopatias Distais/etiologia , Miopatias Distais/psicologia , Extremidades/fisiopatologia , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Músculo Esquelético/fisiopatologia , Exame Neurológico , Psicometria , Testes de Função Respiratória , Autorrelato , Resultado do Tratamento , Adulto Jovem
18.
Muscle Nerve ; 61(1): 44-51, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31613996

RESUMO

INTRODUCTION: We assess whether improvement in control of type 1 diabetes mellitus (T1DM) with continuous subcutaneous insulin infusion (CSII) can protect peripheral nerve function. METHODS: Twelve patients with T1DM treated with multiple daily insulin injections were assessed with nerve excitability testing prior to and 3 months after initiation of CSII. RESULTS: Although commencing treatment with CSII for 3 months improved mean glycosylated hemoglobin, it did not significantly alter nerve excitability or glycemic variability (GV). In four patients, some deterioration in GV was observed, while eight patients had improvement in SD and mean amplitude of glycemic excursions. For these eight patients, there was normalization of depolarizing and hyperpolarizing threshold electrotonus and recovery cycle superexcitablity. DISCUSSION: When CSII initiation is able to reduce glycemic variability in T1DM, reversal of axonal dysfunction is seen, likely due to normalization of sodium-potassium pump function and restoration of transaxonal membrane potential.


Assuntos
Axônios/patologia , Glicemia/análise , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/tratamento farmacológico , Neuropatias Diabéticas/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Insulina/uso terapêutico , Adulto , Diabetes Mellitus Tipo 1/patologia , Neuropatias Diabéticas/patologia , Eletrodiagnóstico , Feminino , Hemoglobina A Glicada/análise , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neurônios Motores , Exame Neurológico , Fármacos Neuroprotetores , Resultado do Tratamento , Adulto Jovem
19.
Artigo em Russo | MEDLINE | ID: mdl-31793542

RESUMO

AIM: To evaluate the efficacy of a proprietary method based on stimulation of the hindfoot when lifting the foot from the surface of the support and bringing it forward in the treatment of walking disorders in patients with Parkinson's disease (PD). MATERIAL AND METHODS: The study included 19 patients with walking disorders, akinetic-rigid and mixed form of PD. The stage of the disease on the Hoehn-Yahr scale at the time of the study was 2.56±0,41. During the treatment of walking disorders using the proprietary method, correction of anti-parkinsonian therapy was not carried out. Correction of walking disorders was carried out by using 'activating platforms', which allow mechanical stimulation of the hindfoot at the moment of lifting the foot from the surface of the support. Neurological examination, computer stabilometry (CS), gait function evaluation by means of the LA-1 laser analyzer of kinematic parameters of gait, Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Unified Parkinson's Disease Rating Scale (UPDRS) were used before and after treatment. RESULTS: A significant decrease in core values of LA-1 and positive dynamics on BBS, DGI, UPDRS was revealed after treatment. CONCLUSION: The original method based on stimulation of foot lifting from the surface and moving the foot forward, effectively improves the pattern of walking in patients with PD and can be recommended as a non-pharmacological method of treatment of impaired walking at the third stage of PD.


Assuntos
Transtornos Neurológicos da Marcha , Doença de Parkinson , Caminhada , Terapia por Exercício , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Exame Neurológico , Doença de Parkinson/complicações
20.
Isr Med Assoc J ; 12(21): 773-778, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814338

RESUMO

BACKGROUND: Falls are a common complication in persons with stroke (PwS). Reliable assessment of balance responses to unexpected loss of balance has the potential to identify risk for falls. OBJECTIVES: To examine inter-observer reliability of balance responses to unannounced surface perturbations in PwS and to explore the concurrent validity of a balance recovery assessment protocol. METHODS: Two observers evaluated balance recovery strategies and fall threshold (a fall into a harness system) in 15 PwS and 15 healthy adults who were exposed to forward, backward, right, and left unannounced surface translations in six increasing intensities while standing. RESULTS: Observer agreement was 100% for the fall threshold. Kappa coefficients for step strategies were 0.960-0.988 in PwS and 0.886-0.938 in healthy adults, 0.905-0.988 for arm reactions in PwS and 0.754-0.926 in healthy adults. Significant correlations were found between fall threshold and Berg Balance Scale (r = 0.691), 6-minute walk test (r = 0.599), and fall efficacy scale-international (r= -0.581). CONCLUSIONS: A trained examiner can reliably classify reactive balance responses to surface perturbations. The high frequency of falls observed in PwS highlights the importance of assessing reactive balance responses to different directions and intensities of surface translations.


Assuntos
Acidentes por Quedas/prevenção & controle , Exame Neurológico/métodos , Equilíbrio Postural , Posição Ortostática , Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/métodos , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Medição de Risco/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Teste de Caminhada/métodos
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