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Archives of Physical Medicine and... Mar 2015First, to evaluate the clinical effectiveness of a virtual reality (VR)-based telerehabilitation program in the balance recovery of individuals with hemiparesis after... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
First, to evaluate the clinical effectiveness of a virtual reality (VR)-based telerehabilitation program in the balance recovery of individuals with hemiparesis after stroke in comparison with an in-clinic program; second, to compare the subjective experiences; and third, to contrast the costs of both programs.
DESIGN
Single-blind, randomized, controlled trial.
SETTING
Neurorehabilitation unit.
PARTICIPANTS
Chronic outpatients with stroke (N=30) with residual hemiparesis.
INTERVENTIONS
Twenty 45-minute training sessions with the telerehabilitation system, conducted 3 times a week, in the clinic or in the home.
MAIN OUTCOME MEASURES
First, Berg Balance Scale for balance assessment. The Performance-Oriented Mobility Assessment balance and gait subscales, and the Brunel Balance Assessment were secondary outcome measures. Clinical assessments were conducted at baseline, 8 weeks (posttreatment), and 12 weeks (follow-up). Second, the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences. Third, cost (in dollars).
RESULTS
Significant improvement in both groups (in-clinic group [control] and a home-based telerehabilitation group) from the initial to the final assessment in the Berg Balance Scale (ηp(2)=.68; P=.001), in the balance (ηp(2)=.24; P=.006) and gait (ηp(2)=.57, P=.001) subscales of the Tinetti Performance-Oriented Mobility Assessment, and in the Brunel Balance Assessment (control: χ(2)=15.0; P=.002; experimental: χ(2)=21.9; P=.001). No significant differences were found between the groups in any balance scale or in the feedback questionnaires. With regard to subjective experiences, both groups considered the VR system similarly usable and motivating. The in-clinic intervention resulted in more expenses than did the telerehabilitation intervention ($654.72 per person).
CONCLUSIONS
First, VR-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in the same way as do in-clinic interventions, both complemented with a conventional therapy program; second, the usability of and motivation to use the 2 interventions can be similar; and third, telerehabilitation interventions can involve savings that vary depending on each scenario.
Topics: Adult; Aged; Cost-Benefit Analysis; Disability Evaluation; Female; Humans; Male; Middle Aged; Paresis; Physical Therapy Modalities; Postural Balance; Single-Blind Method; Stroke; Stroke Rehabilitation; Treatment Outcome; User-Computer Interface
PubMed: 25448245
DOI: 10.1016/j.apmr.2014.10.019 -
Archives of Physical Medicine and... Nov 2014To investigate the effectiveness of mirror therapy (MT) combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the effectiveness of mirror therapy (MT) combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb after stroke.
DESIGN
Randomized, controlled, assessor-blinded study.
SETTING
Inpatient stroke rehabilitation center of a tertiary care teaching hospital.
PARTICIPANTS
Patients with first-time ischemic or hemorrhagic stroke (N=20), confined to the territory of the middle cerebral artery, occurring <6 months before the commencement of the study.
INTERVENTION
The MT and control group participants underwent a patient-specific multidisciplinary rehabilitation program including conventional occupational therapy, physical therapy, and speech therapy for 5 d/wk, 6 h/d, over 3 weeks. The participants in the MT group received 1 hour of MT in addition to the conventional stroke rehabilitation.
MAIN OUTCOME MEASURES
The Upper Extremity Fugl-Meyer Assessment for motor recovery, Brunnstrom stages of motor recovery for the arm and hand, Box and Block Test for gross manual hand dexterity, and modified Ashworth scale to assess the spasticity.
RESULTS
After 3 weeks of MT, mean change scores were significantly greater in the MT group than in the control group for the Fugl-Meyer Assessment (P=.008), Brunnstrom stages of motor recovery for the arm (P=.003) and hand (P=.003), and the Box and Block Test (P=.022). No significant difference was found between the groups for modified Ashworth scale (P=.647).
CONCLUSIONS
MT when combined with bilateral arm training and graded activities was effective in improving motor performance of the paretic upper limb after stroke compared with conventional therapy without MT.
Topics: Adult; Aged; Feedback, Sensory; Female; Humans; Male; Middle Aged; Occupational Therapy; Paresis; Physical Therapy Modalities; Pilot Projects; Psychomotor Performance; Recovery of Function; Single-Blind Method; Stroke; Stroke Rehabilitation; Upper Extremity; Young Adult
PubMed: 25064777
DOI: 10.1016/j.apmr.2014.06.020 -
The Veterinary Record Jun 2018Bovine spastic syndrome (BSS) was described for the first time in 1941. The disease occurs in various-maybe even all-cattle breeds and is a chronic-progressive... (Review)
Review
Bovine spastic syndrome (BSS) was described for the first time in 1941. The disease occurs in various-maybe even all-cattle breeds and is a chronic-progressive neuromuscular disorder that commonly affects cattle of at least three years of age. Typical clinical signs of the disease are clonic-tonic cramps of the hindlimbs that occur in attacks. Since BSS does not recover, affected animals can only be treated symptomatically by improving welfare conditions and management factors, or with physical therapy or drugs. Although still not irrevocably proven, BSS is assumed to be a hereditary disease. Therefore, affected animals should be excluded from breeding, which negatively affects economics and breeding. Besides epidemiology, clinical signs, aetiopathogenesis, diagnosis and treatment, this review discusses genetic aspects and differences to the similar disease bovine spastic paresis. Furthermore, this review also picks up the discussion on possible parallels between human multiple sclerosis and BSS as a further interesting aspect, which might be of great interest for future research.
Topics: Animals; Cattle; Cattle Diseases; Humans; Multiple Sclerosis; Muscle Spasticity; Paresis; Syndrome
PubMed: 29678888
DOI: 10.1136/vr.104814 -
International Ophthalmology Oct 2022To describe etiology, clinical characteristics, radiological features and management of isolated inferior oblique pareses.
PURPOSE
To describe etiology, clinical characteristics, radiological features and management of isolated inferior oblique pareses.
METHODS
A diagnosis of inferior oblique paresis was made after a thorough strabismus examination and neuroimaging. The patients were managed surgically with adjustable strabismus surgery, or conservatively. Surgical success was defined as average horizontal deviation within ≤ 10 prism diopters [PD] post-operatively and for vertical deviation, it was ≤ 5 PD, at last follow-up.
RESULTS
Seven cases were congenital, 6 cases were bilateral, with esotropia in 6 cases; 'A' pattern in 7 cases and hypotropia in 3 cases. The mean preoperative horizontal deviation was 52.5 PD, and the mean postoperative horizontal deviation was 2.37 PD (p = 0.028). The pre-operative vertical deviation was 18 PD and post-operative vertical deviation was 5 PD. MRI showed reduced IO muscle size; average area being 11.27 mm in the affected eyes, with normal sized inferior recti (average: 24.63 mm) and medial recti muscles (average: 30.08 mm). Surgical success was seen in all six cases. Average follow-up was 265 days. The Parks' three step test was not valid, except for one acquired unilateral case.
CONCLUSION
Isolated pareses of inferior oblique muscle exhibit defective elevation in adduction of the affected eye, 'A' pattern and fundus intorsion, and is confirmed by neuroimaging. These can be successfully managed surgically to correct the deviation.
Topics: Fundus Oculi; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Orbital Diseases; Paresis; Retrospective Studies; Strabismus; Treatment Outcome; Vision, Binocular
PubMed: 35583684
DOI: 10.1007/s10792-022-02316-3 -
Annals of Physical and Rehabilitation... Nov 2019This paper revisits the taxonomy of the neurophysiological consequences of a persistent impairment of motor command execution in the classic environment of sensorimotor... (Review)
Review
This paper revisits the taxonomy of the neurophysiological consequences of a persistent impairment of motor command execution in the classic environment of sensorimotor restriction and muscle hypo-mobilization in short position. Around each joint, the syndrome involves 2 disorders, muscular and neurologic. The muscular disorder is promoted by muscle hypo-mobilization in short position in the context of paresis, in the hours and days after paresis onset: this genetically mediated, evolving myopathy, is called spastic myopathy. The clinician may suspect it by feeling extensibility loss in a resting muscle, although long after the actual onset of the disease. The neurologic disorder, promoted by sensorimotor restriction in the context of paresis and by the muscle disorder itself, comprises 4 main components, mostly affecting antagonists to desired movements: the first is spastic dystonia, an unwanted, involuntary muscle activation at rest, in the absence of stretch or voluntary effort; spastic dystonia superimposes on spastic myopathy to cause visible, gradually increasing body deformities; the second is spastic cocontraction, an unwanted, involuntary antagonist muscle activation during voluntary effort directed to the agonist, aggravated by antagonist stretch; it is primarily due to misdirection of the supraspinal descending drive and contributes to reducing movement amplitude; and the third is spasticity, one form of hyperreflexia, defined by an enhancement of the velocity-dependent responses to phasic stretch, detected and measured at rest (another form of hyperreflexia is "nociceptive spasms", following flexor reflex afferent stimulation, particularly after spinal cord lesions). The 3 main forms of overactivity, spastic dystonia, spastic cocontraction and spasticity, share the same motor neuron hyperexcitability as a contributing factor, all being predominant in the muscles that are more affected by spastic myopathy. The fourth component of the neurologic disorder affects the agonist: it is stretch-sensitive paresis, which is a decreased access of the central command to the agonist, aggravated by antagonist stretch. Improved understanding of the pathophysiology of deforming spastic paresis should help clinicians select meaningful assessments and refined treatments, including the utmost need to preserve muscle tissue integrity as soon as paresis sets in.
Topics: Humans; Motor Neurons; Muscle Contraction; Muscle Spasticity; Muscle, Skeletal; Paresis
PubMed: 30500361
DOI: 10.1016/j.rehab.2018.10.004 -
Langenbeck's Archives of Surgery Dec 2023Hemithyroidectomies are mainly performed for two indications, either therapeutically to relieve compression symptoms or diagnostically for suspicious nodule(s). In case... (Observational Study)
Observational Study
PURPOSE
Hemithyroidectomies are mainly performed for two indications, either therapeutically to relieve compression symptoms or diagnostically for suspicious nodule(s). In case of the latter, one could consider the approach to be rather extensive since the majority of patients have no symptoms and will have benign disease. The aim of this study is to investigate the complication rates of diagnostic hemithyroidectomy and to compare it with the complication rates of compressive symptoms hemithyroidectomy.
METHODS
Data from patients who had undergone hemithyroidectomy either for compression symptoms or for excluding malignancy were extracted from a well-established Scandinavian quality register (SQRTPA). The following complications were analyzed: bleedings, wound infections, and paresis of the recurrent laryngeal nerve (RLN). Risk factors for these complications were examined by univariable and multivariable logistic regression.
RESULTS
A total of 9677 patients were included, 3871 (40%) underwent surgery to exclude malignancy and 5806 (60%) due to compression symptoms. In the multivariable analysis, the totally excised thyroid weight was an independent risk factor for bleeding. Permanent (6-12 months after the operation) RLN paresis were less common in the excluding malignancy group (p = 0.03).
CONCLUSION
A range of factors interfere and contribute to bleeding, wound infections, and RLN paresis after hemithyroidectomy. In this observational study based on a Scandinavian quality register, the indication "excluding malignancy" for hemithyroidectomy is associated with less permanent RLN paresis than the indication "compression symptoms." Thus, patients undergoing diagnostic hemithyroidectomy can be reassured that this procedure is a safe surgical procedure and does not entail an unjustified risk.
Topics: Humans; Thyroidectomy; Thyroid Neoplasms; Paresis; Wound Infection; Retrospective Studies
PubMed: 38062331
DOI: 10.1007/s00423-023-03168-w -
Veterinary Journal (London, England :... Nov 2014The aetiology, pathogenesis, diagnosis and treatment of bovine spastic paresis of the gastrocnemius muscle (BSP-G) have been investigated for several decades, but much... (Review)
Review
The aetiology, pathogenesis, diagnosis and treatment of bovine spastic paresis of the gastrocnemius muscle (BSP-G) have been investigated for several decades, but much remains to be elucidated. In some breeds, the proportion of atypical presentations of BSP involving the quadriceps muscle (BSP-Q) and/or several other muscles (mixed presentation, BSP-M) appears to be increasing. Differentiation between BSP-G, -Q and -M is challenging and existing surgical treatments are usually ineffective in cattle affected by one of the atypical forms of the disease. This paper reviews the current knowledge on BSP and addresses several areas where understanding of the disease is incomplete.
Topics: Animals; Cattle; Cattle Diseases; Muscle Spasticity; Paresis
PubMed: 25201252
DOI: 10.1016/j.tvjl.2014.07.015 -
Journal of Pediatric Rehabilitation... 2017
Topics: Child; Humans; Neuronal Plasticity; Paresis; Physical Therapy Modalities; Treatment Outcome
PubMed: 28339413
DOI: 10.3233/PRM-170413 -
Trends in Neurosciences Aug 2022Despite advances in understanding of corticospinal motor control and stroke pathophysiology, current rehabilitation therapies for poststroke upper limb paresis have... (Review)
Review
Despite advances in understanding of corticospinal motor control and stroke pathophysiology, current rehabilitation therapies for poststroke upper limb paresis have limited efficacy at the level of impairment. To address this problem, we make the conceptual case for a new treatment approach. We first summarize current understanding of motor control deficits in the arm and hand after stroke and their shared physiological mechanisms with spinal cord injury (SCI). We then review studies of spinal cord stimulation (SCS) for recovery of locomotion after SCI, which provide convincing evidence for enhancement of residual corticospinal function. By extrapolation, we argue for using cervical SCS to restore upper limb motor control after stroke.
Topics: Arm; Cervical Cord; Humans; Motor Cortex; Paresis; Recovery of Function; Spinal Cord; Spinal Cord Injuries; Stroke
PubMed: 35659414
DOI: 10.1016/j.tins.2022.05.002 -
The Medical Journal of Australia Aug 2022
Topics: Emergency Medical Services; Hospitals; Humans; Paresis; Stroke
PubMed: 35820662
DOI: 10.5694/mja2.51654