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Topics in Spinal Cord Injury... 2019It is important to develop further understanding regarding the facilitating and constraining factors that influence participation in daily activities, including social... (Comparative Study)
Comparative Study Review
It is important to develop further understanding regarding the facilitating and constraining factors that influence participation in daily activities, including social and human rights issues faced by persons with spinal cord injury (SCI) that affect their opportunities to lead full social lives. To identify, describe, and compare factors that influence participation in daily activities by persons with SCI living in high-income countries (HICs) and in low- and middle-income countries (LMICs). We performed a scoping review of 2,406 articles published between 2001 and 2016 that were identified from electronic databases. From these, 58 remained after checking inclusion and exclusion criteria. Analyses included (a) identifying factors that facilitate and constrain participation in daily activities; (b) categorizing the identified factors as issues related to medical, social, and human rights models; and (c) comparing determinants between LMICs and HICs. The medical model factors pertained to long-term physical health and functional capacities, self-efficacy and adjustment skills, relearning capacities for performing daily activities, and availability of cost-effective adaptive equipment. The social model factors pertained to developing accommodating communities (accessible environments and mutual understanding). The factors of the human rights model pertained to autonomy (empowerment) and development of social justice (application of policies, advocacy, and negotiation). Eight lessons are proposed to enhance health and functional abilities, ensure disability friendly environments, develop social justice, and provide empowerment to enhance participation in daily activities among person with SCI living in LMICs.
Topics: Achievement; Activities of Daily Living; Developing Countries; Disabled Persons; Health Status; Humans; Paralysis; Quality of Life; Self Efficacy; Spinal Cord Injuries
PubMed: 30774289
DOI: 10.1310/sci2501-41 -
Journal of Plastic, Reconstructive &... Mar 2022Functional restoration of upper limb paralysis represents a major reconstructive challenge. Free functional muscle transfer (FFMT) enables reanimation in patients with a... (Review)
Review
BACKGROUND
Functional restoration of upper limb paralysis represents a major reconstructive challenge. Free functional muscle transfer (FFMT) enables reanimation in patients with a lack of local donor tissues or delayed presentation. This systematic review summarises the evidence for FFMT in the reconstruction of upper limb paralysis.
METHODS
A comprehensive search of MEDLINE and EMBASE was performed with a systematic review using methodology adapted from the Cochrane Handbook and the PRISMA statement. Data from included studies were compiled and narratively synthesised. Studies were assessed for risk of bias.
RESULTS
A total of 1155 records were screened, with 39 observational studies of 904 patients included. The most common aetiology was brachial plexus injury (736, 81.4%). Mean time from injury to intervention was 26 months. Restoration of elbow flexion was the commonest reconstructive goal. The most common donor muscle was gracilis (91.5%). Reported outcomes were heterogeneous with patient-reported outcome measures (PROMs) available in only 7 of 39 studies. Nearly half of FFMTs had a post-operative MRC grade of <4 and 18.1% had an MRC <3. Mean flap failure rate was 3.6% (range 0-10.5%). All studies were at high risk of bias.
CONCLUSIONS
FFMT may be an effective surgical intervention for upper limb paralysis; however, the current evidence has significant shortcomings. There is no consensus regarding outcome measures nor is it possible to identify prognostic factors for its effectiveness. This review highlights a need for improved study design with pre-operative assessment, standardisation in outcome reporting, and the use of PROMs to determine the effectiveness of FFMT in upper limb paralysis.
Topics: Brachial Plexus Neuropathies; Elbow; Gracilis Muscle; Humans; Nerve Transfer; Paralysis; Range of Motion, Articular; Recovery of Function; Treatment Outcome
PubMed: 34986998
DOI: 10.1016/j.bjps.2021.09.038 -
The Veterinary Record Apr 2023
Topics: Dogs; Animals; Mannitol; Paralysis; Dog Diseases
PubMed: 37000729
DOI: 10.1002/vetr.2910 -
Facial Plastic Surgery Clinics of North... Feb 2016Temporalis muscle tendon unit (MTU) transfer may be used as a single-stage procedure for dynamic reanimation of the paralyzed face. Principles and biomechanics of muscle... (Review)
Review
Temporalis muscle tendon unit (MTU) transfer may be used as a single-stage procedure for dynamic reanimation of the paralyzed face. Principles and biomechanics of muscle function and tendon transposition are essential in optimizing outcome. Critical steps and pearls for success include minimizing scarring, maintaining glide plains, mobilizing adequate tendon length, insertion of MTU at ideal tension based on intraoperative dynamic tension-excursion relationship, and insertion of tendon as close to the lip margin as possible. Because muscles adapt to tension, load, and task changes by altering their sarcomere arrangement and muscle fiber composition, physiotherapy should be initiated to use the repurposed temporalis MTU for smile restoration.
Topics: Facial Paralysis; Humans; Physical Therapy Modalities; Smiling; Temporal Muscle
PubMed: 26611700
DOI: 10.1016/j.fsc.2015.09.004 -
BMJ Case Reports May 2019Factitious disorder (FD) has diverse presentations but neurological presentation is unusual. In this report, we discuss a case of FD who presented with triparesis, that... (Review)
Review
Factitious disorder (FD) has diverse presentations but neurological presentation is unusual. In this report, we discuss a case of FD who presented with triparesis, that is, weakness of both lower limbs and right upper limb. Diagnosis of FD was made after detailed clinical evaluation, review of past medical records that revealed extensive evaluation to rule out physical illness, and inability to find any associated stressful event or material gain associated with illness. Management was largely supportive and was based on psychotherapy. Identification of FD depends on a high index of suspicion by the physician and the presence of atypical and medically unexplainable signs/symptoms.
Topics: Factitious Disorders; Humans; Male; Paralysis; Physical Therapy Modalities; Psychotherapy; Social Support; Time Factors; Treatment Outcome; Young Adult
PubMed: 31076490
DOI: 10.1136/bcr-2018-226869 -
The Neuroscientist : a Review Journal... Jun 2020Paired associative stimulation (PAS) is a noninvasive neuromodulation method with rare cases of adverse effects for the patients with neurological injuries such as... (Review)
Review
Paired associative stimulation (PAS) is a noninvasive neuromodulation method with rare cases of adverse effects for the patients with neurological injuries such as spinal cord injury (SCI). PAS is based on the principles of associative long-term potentiation and depression where the activation of presynaptic and postsynaptic neurons correlated in time is artificially induced. Statistically significant improvement in motor functions after applying PAS has been reported by several research groups. With further standardization of the technique, PAS could be an effective treatment for functional rehabilitation of SCI patients. In this review, we have summarized the methods and findings of PAS on SCI rehabilitation to facilitate the readers to understand the potentials and limitations of PAS for its future clinical use.
Topics: Animals; Brain; Electric Stimulation Therapy; Evoked Potentials, Motor; Humans; Neuronal Plasticity; Paralysis; Peripheral Nerves; Spinal Cord Injuries; Spinal Cord Stimulation
PubMed: 31889474
DOI: 10.1177/1073858419895461 -
Plastic and Reconstructive Surgery Mar 2021Clinical characteristics and timing associated with nonsurgical recovery of upper extremity function in acute flaccid myelitis are unknown.
BACKGROUND
Clinical characteristics and timing associated with nonsurgical recovery of upper extremity function in acute flaccid myelitis are unknown.
METHODS
A single-institution retrospective case series was analyzed to describe clinical features of acute flaccid myelitis diagnosed between October of 2013 and December of 2016. Patients were consecutively sampled children with a diagnosis of acute flaccid myelitis who were referred to a hand surgeon. Patient factors and initial severity of paralysis were compared with upper extremity muscle strength outcomes using the Medical Research Council scale every 3 months up to 18 months after onset.
RESULTS
Twenty-two patients with acute flaccid myelitis (aged 2 to 16 years) were studied. Proximal upper extremity musculature was more frequently and severely affected, with 56 percent of patients affected bilaterally. Functional recovery of all muscle groups (≥M3) in an individual limb was observed in 43 percent of upper extremities within 3 months. Additional complete limb recovery to greater than or equal to M3 after 3 months was rarely observed. Extraplexal paralysis, including spinal accessory (72 percent), glossopharyngeal/hypoglossal (28 percent), lower extremity (28 percent), facial (22 percent), and phrenic nerves (17 percent), was correlated with greater severity of upper extremity paralysis and decreased spontaneous recovery. There was no correlation between severity of paralysis or recovery and patient characteristics, including age, sex, comorbidities, prodromal symptoms, or time to paralysis.
CONCLUSIONS
Spontaneous functional limb recovery, if present, occurred early, within 3 months of the onset of paralysis. The authors recommend that patients without signs of early recovery warrant consideration for early surgical intervention and referral to a hand surgeon or other specialist in peripheral nerve injury.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Risk, III.
Topics: Adolescent; Central Nervous System Viral Diseases; Child; Child, Preschool; Clinical Decision-Making; Female; Humans; Male; Myelitis; Neuromuscular Diseases; Paralysis; Recovery of Function; Referral and Consultation; Remission, Spontaneous; Retrospective Studies; Time Factors; Upper Extremity
PubMed: 33009334
DOI: 10.1097/PRS.0000000000007583 -
Spinal Cord Series and Cases 2019Urtication and flagellation were used as a last resort in the treatment of paralysis when all other means were exhausted, and very few cases are reported in the... (Review)
Review
Urtication and flagellation were used as a last resort in the treatment of paralysis when all other means were exhausted, and very few cases are reported in the literature. Two cases were identified and reviewed, one of urtication (flogging with nettles) and one of flagellation (beating with rods). In both cases the symptoms were alleviated, but there was insufficient detail to evaluate the therapeutic value of each treatment.
Topics: Animals; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, Ancient; History, Medieval; Humans; Neurology; Paralysis; Urtica dioica; Violence
PubMed: 31632737
DOI: 10.1038/s41394-019-0222-8 -
Spine Dec 2022A prospective multicenter observational study. (Observational Study)
Observational Study
STUDY DESIGN
A prospective multicenter observational study.
OBJECTIVE
The aim was to investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in cervical spine surgery and identify factors associated with positive predictive value when Tc-MEP alerts are occurred.
SUMMARY OF BACKGROUND DATA
The sensitivity and specificity of Tc-MEP for detecting motor paralysis are high; however, false-positives sometimes occur.
MATERIALS AND METHODS
The authors examined Tc-MEP in 2476 cases of cervical spine surgeries and compared patient backgrounds, type of spinal disorders, preoperative motor status, surgical factors, and the types of Tc-MEP alerts. Tc-MEP alerts were defined as an amplitude reduction of more than 70% from the control waveform. Tc-MEP results were classified into two groups: false-positive and true-positive, and items that showed significant differences were extracted by univariate analysis and detected by multivariate analysis.
RESULTS
Overall sensitivity was 66% (segmental paralysis: 33% and lower limb paralysis: 95.8%) and specificity was 91.5%. Tc-MEP outcomes were 33 true-positives and 233 false-positives. Positive predictive value of general spine surgery was significantly higher in cases with a severe motor status than in a nonsevere motor status (19.5% vs . 6.7%, P =0.02), but not different in high-risk spine surgery (20.8% vs . 19.4%). However, rescue rates did not significantly differ regardless of motor status (48% vs . 50%). In a multivariate logistic analysis, a preoperative severe motor status [ P =0.041, odds ratio (OR): 2.46, 95% confidence interval (95% CI): 1.03-5.86] and Tc-MEP alerts during intradural tumor resection ( P <0.001, OR: 7.44, 95% CI: 2.64-20.96) associated with true-positives, while Tc-MEP alerts that could not be identified with surgical maneuvers ( P =0.011, OR: 0.23, 95% CI: 0.073-0.71) were associated with false-positives.
CONCLUSION
The utility of Tc-MEP in patients with a preoperative severe motor status was enhanced, even in those without high-risk spine surgery. Regardless of the motor status, appropriate interventions following Tc-MEP alerts may prevent postoperative paralysis.
Topics: Humans; Prospective Studies; Evoked Potentials, Motor; Spinal Diseases; Cervical Vertebrae; Paralysis; Retrospective Studies; Intraoperative Neurophysiological Monitoring
PubMed: 35943242
DOI: 10.1097/BRS.0000000000004448 -
International Orthopaedics Oct 2022This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic...
PURPOSE
This study aimed to elucidate the severity of neurological deficits in a large series of patients with acute spontaneous spinal epidural haematoma (SSEH) using magnetic resonance imaging (MRI).
METHODS
We included 57 patients treated for acute SSEH at 11 institutions and retrospectively analysed their demographic and MRI data upon admission. We investigated MRI findings, such as the haematoma length and canal occupation ratio (COR). The neurological severity of SSEH was assessed based on the American Spinal Injury Association score on admission.
RESULTS
Of the 57 patients, 35 (61%) presented with severe paralysis. The MRI analysis showed that SSEH was often located in the cervical spine, dorsal to the spinal cord, and spread over more than three vertebrae. No differences in age, sex, and aetiology were found between patients with and without severe paralysis. The hypo-intensity layer encircling the haematoma, intra-haematoma heterogeneity, and increased CORs were observed more frequently in the severe paralysis group. Furthermore, pathological examination of a dissected haematoma from one patient with a hypo-intensity layer revealed a collagen layer around the haematoma, and patients with intra-haematoma heterogeneity were more likely to have a bleeding predisposition.
CONCLUSIONS
In this large series of patients with SSEH, we identified some MRI features associated with severe paralysis, such as the hypo-intensity layer, intra-haematoma heterogeneity, and increased COR. Accordingly, patients with these MRI characteristics should be considered for early surgical intervention.
Topics: Cervical Vertebrae; Hematoma, Epidural, Spinal; Humans; Magnetic Resonance Imaging; Paralysis; Retrospective Studies
PubMed: 35854055
DOI: 10.1007/s00264-022-05513-y