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1.
Nat Commun ; 12(1): 657, 2021 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-33510158

RESUMO

The sensation of pressure allows us to feel sustained compression and body strain. While our understanding of cutaneous touch has grown significantly in recent years, how deep tissue sensations are detected remains less clear. Here, we use quantitative sensory evaluations of patients with rare sensory disorders, as well as nerve blocks in typical individuals, to probe the neural and genetic mechanisms for detecting non-painful pressure. We show that the ability to perceive innocuous pressures is lost when myelinated fiber function is experimentally blocked in healthy volunteers and that two patients lacking Aß fibers are strikingly unable to feel innocuous pressures at all. We find that seven individuals with inherited mutations in the mechanoreceptor PIEZO2 gene, who have major deficits in touch and proprioception, are nearly as good at sensing pressure as healthy control subjects. Together, these data support a role for Aß afferents in pressure sensation and suggest the existence of an unknown molecular pathway for its detection.


Assuntos
Canais Iônicos/fisiologia , Mecanorreceptores/fisiologia , Sensação/fisiologia , Tato/fisiologia , Adulto , Idoso , Feminino , Humanos , Canais Iônicos/genética , Masculino , Mecanorreceptores/metabolismo , Pessoa de Meia-Idade , Mutação , Bloqueio Nervoso/métodos , Pressão , Propriocepção/genética , Propriocepção/fisiologia , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/genética , Transtornos das Sensações/fisiopatologia , Pele/inervação , Pele/fisiopatologia , Adulto Jovem
2.
J Stroke Cerebrovasc Dis ; 29(9): 105038, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807450

RESUMO

BACKGROUND: Following a stroke, balance disturbances often persist despite full recovery of the paretic side. AIMS: The aims were to determine how long postural instability could be detected after stroke and the differences in post-stroke patients under and above 65 years of age. METHODS: Static and dynamic posturography (passing weights from hand to hand around the body) measurements were performed on 29 patients with stroke after 3 ± 2.4 years (≤65 years) and 4.7 ± 3.3 years. (> 65 years) compared with 38 controls. RESULTS: Only the pathway and the velocity assessed by dynamic posturography were significantly higher (p < 0.05) in the younger group of patients compared with the controls. The older group of patients had significantly elevated parameters measured by both static (p < 0.01) and dynamic posturography (p < 0.05). CONCLUSIONS: we conclude, using a sensitive and reproducible method to assess both static and dynamic adjustments to maintain balance, that postural instability is significantly greater in post-stroke patients than control subjects. This difference is demonstrable up to 4 years after stroke, despite full recovery of the affected side.


Assuntos
Equilíbrio Postural , Transtornos das Sensações/etiologia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Risco , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Fatores de Tempo
3.
J Stroke Cerebrovasc Dis ; 29(6): 104750, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32220556

RESUMO

Isolated pontine infarcts are common and are often associated with well-described syndromes that are classified based on their specific clinical presentation and arterial stroke territories. Here we present a case of acute combined diplopia and unilateral lower extremity sensory abnormality. Diffusion-weighted magnetic resonance imaging revealed a punctate area of acute ischemia in the right medial pontine mid-tegmentum. These findings suggest a unique pontine stroke syndrome characterized by acute ischemic injury at the intersection of the medial lemniscus and cranial nerve VI.


Assuntos
Doenças do Nervo Abducente/etiologia , Infartos do Tronco Encefálico/complicações , Diplopia/etiologia , Extremidade Inferior/inervação , Tegmento Pontino/irrigação sanguínea , Transtornos das Sensações/etiologia , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Diplopia/diagnóstico , Diplopia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Tegmento Pontino/diagnóstico por imagem , Valor Preditivo dos Testes , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Síndrome
4.
Phys Ther ; 100(1): 180-191, 2020 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-31581286

RESUMO

BACKGROUND: The Community Balance and Mobility Scale (CBM) has been shown to be reliable and valid for detecting subtle balance and mobility deficits in people who are 61 to 70 years of age. However, item redundancy and assessment time call for a shortened version. OBJECTIVE: The objective was to create and validate a shortened version of the CBM (s-CBM) without detectable loss of psychometric properties. DESIGN: This was a cross-sectional study. METHODS: Exploratory factor analysis with data from 189 young seniors (aged 61-70 years; mean [SD] age = 66.3 [2.5] years) was used to create the s-CBM. Sixty-one young seniors (aged 61-70 years; mean [SD] age = 66.5 [2.6] years) were recruited to assess construct validity (Pearson correlation coefficient) by comparing the CBM versions with Fullerton Advance Balance Scale, Timed Up-and-Go, habitual and fast gait speed, 8 Level Balance Scale, 3-m tandem walk, and 30-second chair stand test. Internal consistency (Cronbach α), ceiling effects, and discriminant validity (area under the curve [AUC]) between fallers and nonfallers, and self-reported high and low function (Late-Life Function and Disability Index) and balance confidence (Activities-Specific Balance Confidence Scale), respectively, were calculated. RESULTS: The s-CBM, consisting of 4 items, correlated excellently with the CBM (r = 0.97). Correlations between s-CBM and other assessments (r = 0.07-0.72), and CBM and other assessments (r = 0.06-0.80) were statistically comparable in 90% of the correlations. Cronbach α was .84 for the s-CBM, and .87 for the CBM. No CBM-version showed ceiling effects. Discriminative ability of the s-CBM was statistically comparable with the CBM (AUC = 0.66-0.75 vs AUC = 0.65-0.79). LIMITATIONS: Longitudinal studies with larger samples should confirm the results and assess the responsiveness for detecting changes over time. CONCLUSIONS: The psychometric properties of the s-CBM were similar to those of the CBM. The s-CBM can be recommended as a valid and quick balance and mobility assessment in young seniors.


Assuntos
Avaliação Geriátrica/métodos , Limitação da Mobilidade , Equilíbrio Postural , Transtornos das Sensações/diagnóstico , Acidentes por Quedas , Idoso , Estudos Transversais , Análise Discriminante , Análise Fatorial , Feminino , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Autorrelato , Velocidade de Caminhada
5.
Acta Otolaryngol ; 140(1): 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31709868

RESUMO

Background: Power-spectral analysis of the centre of pressure (CoP) frequencies of posturography provides exponentially approximated distributions, whereas logarithmic translation enables linear approximation.Objectives: Frequency analyses were adopted for posturography of healthy subjects and patients with spinocerebellar degeneration (SCD) using logarithmic translation to determine its clinical usefulness for managing the elderly and patients with disequilibrium.Material and methods: We included 172 healthy subjects and 47 SCD patients. Posturography was performed with the eyes fixated and closed, with and without foam rubber. The power-spectral data of the CoP were obtained with the maximum entropy method. Power-spectral data were logarithmically translated for quantitative evaluation.Results: For teenagers, high-frequency fluctuations were dominant and attributable to proprioceptive compensation due to immature postural control. In elderly populations, the increased frequency in the lateral direction was characterised by three peaks indicating postural disturbances attributed to three sensory inputs. The disappearance of one peak in the anteroposterior fluctuation indicates a decrease in vestibular contribution. The foam rubber and the closed-eye condition enhanced fluctuations in two peaks. There were differences in power-spectral distributions of two peaks between the healthy subjects and SCD patients.Conclusions: Logarithmic power-spectral data distribution could provide an age- and disease-specific novel and visually-comprehensible parameter.


Assuntos
Equilíbrio Postural/fisiologia , Transtornos das Sensações/diagnóstico , Degenerações Espinocerebelares/complicações , Degenerações Espinocerebelares/fisiopatologia , Adolescente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura/fisiologia , Transtornos das Sensações/epidemiologia , Testes de Função Vestibular , Adulto Jovem
7.
J Stroke Cerebrovasc Dis ; 29(2): 104500, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31818679

RESUMO

BACKGROUND: The prevalence of falls can be as high as 73% in the stroke population. Falls occur as a result of multiple factors. Factors such as balance impairments can be improved through physical therapy intervention. However, insurance payers limit the number of visits per patient. It is crucial to find other ways to assess balance after discharge from rehabilitation. PURPOSE: The purpose of this study is to determine if the Nintendo Wii Fit can be used as a fall risk assessment tool among the poststroke population. METHODOLOGY: A sample of 11 stroke survivors were recruited (mean age 63.36 years). Each participant completed a balance and fall risk assessment using the Berg Balance Scale, Timed Up & Go, Four Square Step Test, Five Times Sit-to-Stand and 8-Foot Walk Test. Bivariate correlation will examine the validity of the Nintendo Wii Fit as a fall risk assessment tool in this population. RESULTS: The Nintendo Wii Fit Balance Test was found to be correlated with gait speed measured by the 8-Foot Walk Test. There is no correlation between the Wii Fit Balance Tests and most common standardized fall risk measures. Standardized fall risk outcome measures also significantly correlate with each other. CONCLUSIONS: The study suggests that while there is a potential utility of the game system to be used at home by patient and caregivers, the Wii Fit Balance Test may not be an appropriate substitute to the standardized fall risk assessment tool for stroke patients in the clinical setting.


Assuntos
Acidentes por Quedas , Marcha , Exame Físico/instrumentação , Equilíbrio Postural , Transtornos das Sensações/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Jogos de Vídeo , Acidentes por Quedas/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Transtornos das Sensações/etiologia , Transtornos das Sensações/fisiopatologia , Transtornos das Sensações/terapia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral
8.
Occup Ther Int ; 2019: 8796042, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31866802

RESUMO

Background: Some children may encounter difficulties in processing sensory stimuli, which may affect their ability to participate in activities of daily living. Self-regulation abilities may also affect children on how to process different sensory experiences. The Sensory Processing and Self-Regulation Checklist (SPSRC) was developed as a single, parent-reported instrument for the examination of sensory processing and self-regulation difficulties in children. Aims: This study is aimed at evaluating the psychometric properties of the SPSRC and examine the patterns of self-regulation and sensory processing in children with and without autism spectrum disorder (ASD). Methods and Procedures: The contents of the SPSRC were validated by a group of experts, and a field test was subsequently conducted to examine the reliability and validity of this instrument in a sample of 997 typically developing children and 78 children with ASD. Outcomes and Results: The results of the validation and field test analyses suggest that the SPSRC exhibits high internal consistency, good intrarater reliability, and a valid ability to measure and discriminate sensory processing and self-regulation in children aged 3-8 years with and without ASD. Conclusions and Implications: The current results supported the reliability and validity of SPSRC to assess a child's sensory processing and self-regulation performance in activities of daily living. The study findings warrant further investigation to compare the performance of the SPSRC with laboratory-based tests, as this would better elucidate sensory responsivity in children with sensory modulation disorders from both clinical and research perspectives.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Lista de Checagem , Psicometria/instrumentação , Transtornos das Sensações/diagnóstico , Atividades Cotidianas , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
9.
Sci Rep ; 9(1): 16154, 2019 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-31695127

RESUMO

Numerous postural sway metrics have been shown to be sensitive to balance impairment and fall risk in individuals with MS. Yet, there are no guidelines concerning the most appropriate postural sway metrics to monitor impairment. This investigation implemented a machine learning approach to assess the accuracy and feature importance of various postural sway metrics to differentiate individuals with MS from healthy controls as a function of physiological fall risk. 153 participants (50 controls and 103 individuals with MS) underwent a static posturography assessment and a physiological fall risk assessment. Participants were further classified into four subgroups based on fall risk: controls, low-risk MS (n = 34), moderate-risk MS (n = 27), high-risk MS (n = 42). Twenty common sway metrics were derived following standard procedures and subsequently used to train a machine learning algorithm (random forest - RF, with 10-fold cross validation) to predict individuals' fall risk grouping. The sway-metric based RF classifier had high accuracy in discriminating controls from MS individuals (>86%). Sway sample entropy was identified as the strongest feature for classification of low-risk MS individuals from healthy controls. Whereas for all other comparisons, mediolateral sway amplitude was identified as the strongest predictor for fall risk groupings.


Assuntos
Acidentes por Quedas , Algoritmos , Aprendizado de Máquina , Esclerose Múltipla/fisiopatologia , Equilíbrio Postural/fisiologia , Transtornos das Sensações/etiologia , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Entropia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Medição de Risco , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia
10.
BMC Musculoskelet Disord ; 20(1): 537, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722701

RESUMO

BACKGROUND: Children and young people make up an age group most vulnerable to falls. Various stability disorders may become instrumental in sustaining more frequent falls and resultant fractures. Correct morphological structure impacts overall efficiency of the foot, as well as offers significant diagnostic potential. Even minor foot disorders may affect the entire bio kinematic chain, also impacting the foot's motility. Structural alterations within a foot may also impair balance in the standing position, and contribute to more frequent injuries. The study aimed to assess the relationship between feet deformities and postural stability deficits in schoolchildren prone to sustain accidental falls. METHODS: The study involved 200 children (101 girls and 99 boys) aged 10-15 years, randomly selected from primary schools. A 2D podoscan was used to assess the plantar part of the foot, while stabilometric examination was aided by the FreeMed dynamometric platform. RESULTS: Correlation between respective variables was reflected by Spearman's rank coefficient. The subjects' age negatively correlated with the COP range of movement along the Y axis, and the COP surface area, while their BMI negatively correlated with the COP trajectory's length. Step regression analysis indicated that the width of the left foot, the left foot Wejsflog index, the left foot Clark's angle, the hallux valgus angle were the essential predictors of stabilometric variables in girls. In boys, though, predictive value was associated with Clarke's angle of the left and right foot, Wejsflog index of the right foot, and the width of both the left and right foot. CONCLUSIONS: There is a statistically significant correlation between morphological variables of the foot and postural stability. When assessing the key variables of the foot and their interrelationship with postural stability, the Clarke's angle, Wejsflog index, hallux valgus angle, and foot width, should be granted due prominence in the girls. As regards the boys, the following variables were established as predictive in assessing postural stability: Clarke's angle, Wejsflog index, and foot width.


Assuntos
Acidentes por Quedas , Deformidades do Pé/complicações , Equilíbrio Postural , Transtornos das Sensações/etiologia , Adolescente , Fatores Etários , Criança , Feminino , Deformidades do Pé/diagnóstico por imagem , Deformidades do Pé/fisiopatologia , Humanos , Masculino , Medição de Risco , Fatores de Risco , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Fatores Sexuais
11.
Handb Clin Neurol ; 165: 365-381, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31727224

RESUMO

Tinnitus is the sensation of hearing a sound with no external auditory stimulus present. It is a public health issue correlated with multiple comorbidities and precipitating factors such as noise exposure, military service, and traumatic brain injury, migraine, insomnia, small vessel disease, smoking history, stress exposure, anxiety, depression, and socioeconomic status. Clinical experience and a recent literature review point at tinnitus as a neuropsychiatric condition involving both auditory and nonauditory cortical areas of the brain and affecting brain-auditory circuitry. In fact, brain-ear connections have been highlighted in different models. Forward management of this disorder should take this body of research into consideration as tinnitus remains a challenging condition to evaluate and treat with current management protocols still symptomatic at best. With a better understanding of the etiologic factors and comorbidities of tinnitus, additional research trials and new therapeutic approaches could see the light to tackle this public health disability bringing hope to patients and doctors.


Assuntos
Córtex Auditivo/fisiopatologia , Vias Auditivas/fisiopatologia , Rede Nervosa/fisiopatologia , Zumbido/diagnóstico , Zumbido/fisiopatologia , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/fisiopatologia , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia
12.
J Stroke Cerebrovasc Dis ; 28(12): 104418, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31585772

RESUMO

BACKGROUND: A concept of sensory tracts in the spinal cord has been established in relation to a dorsolateral pathway which is located in the posterior part of the lateral column and conveys the deep sense. METHODS: The clinical status at onset, neurological symptoms, and magnetic resonance imaging (MRI) findings in 13 patients of spinal cord infarction were studied. RESULTS: The clinical status was acute in 11 patients and subacute in 2 patients. Palsy of the extremities was noted in 11 patients. Segmental sensory disturbance was shown in all patients. One patient showed disturbance of all senses and paraplegia, which indicated transverse myelopathy. In the other 12 patients, 11 patients showed impairment of pain sense although joint position sense was preserved, excluding 1 patient whose sensory disturbance showed dysesthesia alone. In these 11 patients, soft touch and vibration senses were impaired in 7 patients. Abnormality of spinal cord MRI was detected 7 patients. The lesions were located in the cervical cord in 3 patients, cervical to thoracic cord in 1 patient, and thoracic cord in 3 patients. CONCLUSIONS: In the 11 patients in whom pain sense was impaired and joint position sense was preserved, involvement of the anterior spinal cord artery (ASCA) was the mainstay. Impairment of vibration sense was accompanied in 7 patients in patients of ASCA infarction. It was speculated that impairment of vibration sense can occur in patients with ASCA infarction whose ischemia spread to the dorsolateral pathway in the posterior part of the lateral column.


Assuntos
Infarto/diagnóstico , Imagem por Ressonância Magnética , Exame Neurológico , Transtornos das Sensações/diagnóstico , Sensação , Medula Espinal/irrigação sanguínea , Medula Espinal/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Infarto/diagnóstico por imagem , Infarto/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Limiar da Dor , Valor Preditivo dos Testes , Prognóstico , Propriocepção , Reprodutibilidade dos Testes , Transtornos das Sensações/diagnóstico por imagem , Transtornos das Sensações/fisiopatologia , Tato , Vibração
14.
J Stroke Cerebrovasc Dis ; 28(11): 104314, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31409536

RESUMO

BACKGROUND: Deterioration of balance is one of the most common and disabling physical-motor deficits in patients after a stroke that have a negative impact on quality of life and increase the risk of falls. Previous studies have evaluated the effectiveness of the exercises on specific aspects of balance. However, there is no structured exercise program divided by levels for balance impairment in poststroke patients. METHODS: Delphi method was used to design the exercise programme, and then a pilot study was performed. For the pilot study, we included 14 poststroke adults patients (n = 7 in each group), with balance impairment, without previous severe functional dependence, sensorial deficit or dementia. Our 4 weeks intervention (5 times/week) is based on 9 exercise of progressive difficulty, offering a multidimensional approach training (biomechanical constraints, stability limits, anticipatory, postural responses, and sensory orientation). Patients in the intervention arm received 45 minutes of usual rehabilitation plus 15 minutes of the intervention proposed. The usual-care arm received 60 minutes of usual rehabilitation. Balance impairment (Mini BESTest) was assessed at the baseline and at 4 weeks. Differences between groups were analysed using Mann-Whitney U test. RESULTS: The agreement for the intervention designed was reached after 2 rounds. Participants in pilot study were 69 (SD = 9.7) years, 21.4% females. Post-treatment, median improvements in Mini BESTest were 20 (SD = 8) and 11 (SD = 10) points, P < .01 for intervention and control group respectively. CONCLUSION: A multidimensional approach of balance impairments in poststroke patients through the validated exercise programme proposed, may improve balance deficits.


Assuntos
Terapia por Exercício , Equilíbrio Postural , Transtornos das Sensações/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Acidentes por Quedas/prevenção & controle , Idoso , Técnica Delfos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Recuperação de Função Fisiológica , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
15.
Med Clin (Barc) ; 153(7): 284-289, 2019 10 11.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31253478

RESUMO

Delirium, despite its high incidence, serious consequences and potential reversibility, remains an underdiagnosed syndrome. In patients with dementia, the healthcare professional may find significant difficulties in differentiating whether the patient presents cognitive alterations and behavioural disorders characteristic of dementia or, on the contrary, is faced with a delirium superimposed on dementia (DSD). In view of this difficulty, many tools have been proposed in recent years to improve the diagnosis of DSD in these highly complex patients. The aim of these tools is to be easy and quick to apply, and although focusing on assessing cognitive aspects such as attention or level of consciousness, some of them have also incorporated the assessment of other more novel aspects, such as the ability to respond to external stimuli (Arousal) or the degree of mobility.


Assuntos
Delírio/diagnóstico , Demência/complicações , Técnicas de Diagnóstico Neurológico , Idoso , Atenção , Estado de Consciência , Delírio/complicações , Demência/diagnóstico , Diagnóstico Diferencial , Técnicas de Diagnóstico Neurológico/normas , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Transtornos Motores/diagnóstico , Equilíbrio Postural , Transtornos das Sensações/diagnóstico , Sensibilidade e Especificidade
16.
J Vasc Interv Radiol ; 30(11): 1832-1839, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31235411

RESUMO

PURPOSE: To evaluate hand sensibility after transradial access (TRA) in patients with and without radial artery occlusion (RAO). MATERIALS AND METHODS: In this study, 71 patients with and without RAO after TRA for a coronary intervention were studied (79% male, mean age 65 y ± 9). Sensibility testing of both hands was performed with the Semmes-Weinstein monofilaments test. The primary endpoint was abnormal sensibility, defined as diminished sensibility in at least 1 radial nerve-supplied dermatome. The contralateral hand served as control. The influence of TRA, RAO, and clinical characteristics on hand sensibility was evaluated. RESULTS: In patients with RAO, more abnormal sensibility was observed on the RAO side compared with the control hand (72% vs 17%, P < .01). In patients without RAO, more abnormal sensibility was observed in the TRA hand compared with the control hand (43% vs 10%, P < .01). When analyzing all hands separately, TRA, RAO, and diabetes were independent predictors for abnormal hand sensibility in a multivariate model (odds ratio 3.8, 95% confidence interval 1.4-9.8, P < .01; odds ratio 3.0, 95% confidence interval 1.1-8.5, P = .03; odds ratio 3.5, 95% confidence interval 1.4-8.6, P < .01). CONCLUSIONS: TRA and RAO are associated with diminished hand sensibility.


Assuntos
Arteriopatias Oclusivas/complicações , Cateterismo Periférico/efeitos adversos , Mãos/irrigação sanguínea , Mãos/inervação , Artéria Radial/fisiopatologia , Transtornos das Sensações/etiologia , Limiar Sensorial , Grau de Desobstrução Vascular , Idoso , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Artéria Radial/diagnóstico por imagem , Fatores de Risco , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Resultado do Tratamento
17.
Med Hypotheses ; 128: 17-20, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31203902

RESUMO

HYPOTHESIS: Lack of otoconia or otoconial loss may be the major reason for increasing imbalance with age, posttraumatic dizziness and residual dizziness as well as other so far unexplained imbalance affecting probably millions of people. BACKGROUND: It is written in every textbook that we need sensation of gravity for stable gait and stance, especially on two legs. Lack of otoconia is known to cause lifelong balance problems in animals. Loss of otoconia is happening in aging humans, like shown by increasing incidence of benign paroxysmal positional vertigo (BPPV) and in histological sections. While hundreds of papers have been published on BPPV, increasing imbalance with age and increasing falls, none has ever described the loss of otoconia as a major reason for this imbalance. Maybe this is due to the problems to proof this hypothesis in an individual patient. We will explain why otoconial loss may cause dizziness, postural and locomotor instability in patients with no other identifiable cause or in addition to other causes. Several reasons can cause otoconial loss and lead to the described symptoms. We will describe the symptoms and the tests which could in combination support the diagnosis. CONCLUSION: Our hypothesis argues for the new diagnosis in many patients with so far undiagnosed or incorrectly or incompletely diagnosed dizziness or imbalance.


Assuntos
Membrana dos Otólitos/fisiopatologia , Equilíbrio Postural , Transtornos das Sensações/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Vertigem Posicional Paroxística Benigna/diagnóstico , Tontura/diagnóstico , Tontura/fisiopatologia , Marcha , Humanos , Pessoa de Meia-Idade , Modelos Biológicos , Prevalência , Canais Semicirculares/fisiopatologia , Transtornos das Sensações/fisiopatologia , Vertigem/diagnóstico , Vertigem/fisiopatologia , Adulto Jovem
18.
BMJ Open ; 9(5): e027720, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31154310

RESUMO

INTRODUCTION: As adults age, their senses tend to decline and a large portion of those most affected by sensory decline reside in long-term care. At present, the creation of a sense-sensitive environment in long-term care is a difficult task as there is minimal evidence or tools available to guide this process. The 5Senses screening tool was developed to measure the sense-sensitivity of a particular environment, with a focus on long-term care. The purpose of this paper is to describe a study protocol to assess the psychometric properties of the newly developed 5Senses screening tool. METHODS AND ANALYSIS: We will conduct a psychometric evaluation of the 5Senses screening tool in long-term care based on the Standards for Educational and Psychological Testing Framework. In phase I, we will seek input from international content experts (n=20) to assess the content validity of all sections of the tool. In phase II, we will invite auditors (n=3-9), residents (n=3-9) and staff (n=3-9) to partake in think-aloud sessions to assess response process validity. In phase III, we will conduct field testing of the revised 5Senses screening tool with auditors (n=100), residents (n=100) and staff (n=100) to evaluate additional measures including acceptability, inter-rater reliability, internal structure validity and internal consistency reliability, where possible. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Ottawa Research Ethics Board. Findings will be disseminated through a peer-reviewed manuscript, through a dedicated website, through presentations in long-term care communities and through presentations at research conferences.


Assuntos
Avaliação Geriátrica/métodos , Programas de Rastreamento/instrumentação , Transtornos das Sensações/diagnóstico , Idoso , Envelhecimento/fisiologia , Humanos , Assistência de Longa Duração , Psicometria/normas , Estudos de Validação como Assunto
19.
J Clin Exp Neuropsychol ; 41(8): 814-831, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31156064

RESUMO

Objective: The purpose of this study was to characterize post-chemotherapy sensory, memory, and attention abilities in childhood survivors of acute lymphoblastic leukemia (ALL) to better understand how treatment affects cognitive functioning. Methods: Eight ALL survivors and eight age-matched, healthy children between the ages of 5-11 years participated in the study. Among the ALL survivors, a median of 63 days (range 22-267 days) elapsed between completion of chemotherapy and this assessment. Sounds were presented in an oddball paradigm while recording the electroencephalogram in separate conditions of passive listening and active task performance. To assess different domains of cognition, we measured event-related brain potentials (ERPs) reflecting sensory processing (P1 component), working memory (mismatch negativity [MMN] component), attentional orienting (P3a), and target detection (P3b component) in response to the sounds. We also measured sound discrimination and response speed performance. Results: Relative to control subjects, ALL survivors had poorer performance on auditory tasks, as well as decreased amplitude of the P1, MMN, P3a, and P3b components. ALL survivors also did not exhibit the amplitude gain typically observed in the sensory P1 component when attending to the sound input compared to when passively listening. Conclusions: Atypical responses were observed in brain processes associated with sensory discrimination, auditory working memory, and attentional control in pediatric ALL survivors indicating deficiencies in all cognitive domains compared to age-matched controls. Significance: ERPs differentiated aspects of cognitive functioning, which may provide a useful tool for assessing recovery and risk of post-chemotherapy cognitive deficiencies in young children. The decreased MMN amplitude in ALL survivors may indicate (N-methyl D-aspartate) NMDA dysfunction induced by methotrexate, and thus provides a potential therapeutic target for chemotherapy-associated cognitive impairments.


Assuntos
Antineoplásicos/efeitos adversos , Encéfalo/efeitos dos fármacos , Sobreviventes de Câncer/psicologia , Transtornos Cognitivos/induzido quimicamente , Potenciais Evocados/efeitos dos fármacos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Transtornos das Sensações/induzido quimicamente , Adolescente , Adulto , Antineoplásicos/uso terapêutico , Atenção/efeitos dos fármacos , Atenção/fisiologia , Encéfalo/fisiopatologia , Criança , Pré-Escolar , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Eletroencefalografia/efeitos dos fármacos , Feminino , Seguimentos , Humanos , Masculino , Memória de Curto Prazo/efeitos dos fármacos , Memória de Curto Prazo/fisiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/fisiopatologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/psicologia , Tempo de Reação/efeitos dos fármacos , Tempo de Reação/fisiologia , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Transtornos das Sensações/psicologia
20.
Hum Mutat ; 40(10): 1826-1840, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31116475

RESUMO

Mutations in genes encoding aminoacyl-tRNA synthetases have been reported in several neurological disorders. KARS is a dual localized lysyl-tRNA synthetase and its cytosolic isoform belongs to the multiple aminoacyl-tRNA synthetase complex (MSC). Biallelic mutations in the KARS gene were described in a wide phenotypic spectrum ranging from nonsyndromic deafness to complex impairments. Here, we report on a patient with severe neurological and neurosensory disease investigated by whole-exome sequencing and found to carry biallelic mutations c.683C>T (p.Pro228Leu) and c.871T>G (p.Phe291Val), the second one being novel, in the KARS gene. The patient presented with an atypical clinical presentation with an optic neuropathy not previously reported. At the cellular level, we show that cytoplasmic KARS was expressed at a lower level in patient cells and displayed decreased interaction with MSC. In vitro, these two KARS variants have a decreased aminoacylation activity compared with wild-type KARS, the p.Pro228Leu being the most affected. Our data suggest that dysfunction of cytoplasmic KARS resulted in a decreased level of translation of the nuclear-encoded lysine-rich proteins belonging to the respiratory chain complex, thus impairing mitochondria functions.


Assuntos
Aminoacil-tRNA Sintetases/genética , Lisina-tRNA Ligase/genética , Mutação , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/genética , Doenças do Nervo Óptico/complicações , Transtornos das Sensações/complicações , Transtornos das Sensações/genética , Alelos , Sequência de Aminoácidos , Aminoacil-tRNA Sintetases/química , Aminoacil-tRNA Sintetases/metabolismo , Complexo I de Transporte de Elétrons/genética , Complexo I de Transporte de Elétrons/metabolismo , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Fibroblastos/metabolismo , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Lisina-tRNA Ligase/química , Lisina-tRNA Ligase/metabolismo , Imagem por Ressonância Magnética , Modelos Moleculares , Doenças do Sistema Nervoso/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Linhagem , Ligação Proteica , Conformação Proteica , Transtornos das Sensações/diagnóstico , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismo
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