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Die Anaesthesiologie Jan 2024
Topics: Humans; Paresis; Psychophysiologic Disorders; Postoperative Period
PubMed: 37993726
DOI: 10.1007/s00101-023-01357-2 -
Folia Medica Jun 2023Acute hemiparesis is an emergency of various etiologies and possible fatal outcome.
Acute hemiparesis is an emergency of various etiologies and possible fatal outcome.
Topics: Humans; Paresis; Stroke
PubMed: 38351818
DOI: 10.3897/folmed.65.e81368 -
No Shinkei Geka. Neurological Surgery Mar 2021A woman in her 60s was admitted to our hospital because of sudden-onset right hemiparesis, paresthesia, and neck pain. At first, a head CT scan was performed to rule out...
A woman in her 60s was admitted to our hospital because of sudden-onset right hemiparesis, paresthesia, and neck pain. At first, a head CT scan was performed to rule out stroke, which did not detect any abnormalities. Subsequently, a neck CT scan was performed, which revealed a mild high-density structure compressing the dural sac within the cervical spinal canal. She was suspected to have a spinal hematoma. A MRI scan revealed a spindle-shaped structure with a heterogeneous high signal on T2-weighted and a mild high signal on T1-weighted sagittal images, which led to the diagnosis of a spontaneous spinal epidural hematoma. The patient was treated with conservative therapy upon which her symptoms improved. She was discharged seven days after admission. Spontaneous cervical spinal epidural hematoma often causes neck pain followed by unilateral spinal cord compression symptoms(such as hemiparesis and paresthesia)and can be misdiagnosed as a stroke. In cases of hemiparesis with sudden-onset neck pain, cervical lesions should be considered in the differential diagnoses in addition to stroke.
Topics: Female; Hematoma, Epidural, Cranial; Hematoma, Epidural, Spinal; Humans; Magnetic Resonance Imaging; Neck; Paresis; Spinal Cord Compression
PubMed: 33762457
DOI: 10.11477/mf.1436204398 -
Neurorehabilitation and Neural Repair Nov 2019People with hemiparesis after stroke appear to recover 70% to 80% of the difference between their baseline and the maximum upper extremity Fugl-Meyer (UEFM) score, a...
People with hemiparesis after stroke appear to recover 70% to 80% of the difference between their baseline and the maximum upper extremity Fugl-Meyer (UEFM) score, a phenomenon called proportional recovery (PR). Two recent commentaries explained that PR should be expected because of mathematical coupling between the baseline and change score. Here we ask, If mathematical coupling encourages PR, why do a fraction of stroke patients (the "nonfitters") exhibit PR? At the neuroanatomical level of analysis, this question was answered by Byblow et al-nonfitters lack corticospinal tract (CST) integrity at baseline-but here we address the mathematical and behavioral causes. We first derive a new interpretation of the slope of PR: It is the average probability of scoring across remaining scale items at follow-up. PR therefore breaks when enough test items are discretely more difficult for a patient at follow-up, flattening the slope of recovery. For the UEFM, we show that nonfitters are most unlikely to recover the ability to score on the test items related to wrist/hand dexterity, shoulder flexion without bending the elbow, and finger-to-nose movement, supporting the finding that nonfitters lack CST integrity. However, we also show that a subset of nonfitters respond better to robotic movement training in the chronic phase of stroke. These persons are just able to move the arm out of the flexion synergy and pick up small blocks, both markers of CST integrity. Nonfitters therefore raise interesting questions about CST function and the basis for response to intensive movement training.
Topics: Humans; Models, Neurological; Models, Statistical; Outcome Assessment, Health Care; Paresis; Stroke; Stroke Rehabilitation
PubMed: 31416391
DOI: 10.1177/1545968319868718 -
Veterinary Journal (London, England :... Oct 2016Bovine spastic paresis (BSP) is a sporadic, progressive neuromuscular disease that is thought to affect all breeds of cattle. The disease manifests as a unilateral or... (Review)
Review
Bovine spastic paresis (BSP) is a sporadic, progressive neuromuscular disease that is thought to affect all breeds of cattle. The disease manifests as a unilateral or bilateral hyperextension of the hind limb due to increased muscle tone or permanent spasm of mainly the gastrocnemius and/or the quadriceps muscle. Clinical signs only appear in rising, standing and moving animals, which is an important diagnostic feature. Although several medical treatments have been described, surgical procedures such as neurectomy or tenectomy are generally indicated. Even though complete recovery can be achieved, BSP-affected animals should not be used for breeding, since BSP is commonly considered a hereditary disease. The condition therefore negatively affects animal welfare, economics and breeding. When first described in 1922, BSP was already assumed to be heritable, and this assumption has been perpetuated by subsequent authors who have only discussed its possible modes of inheritance, which included monogenetic and polygenetic modes and gene-environment interactions. Besides some clinical aspects and the consideration of the tarsal joint angle as a BSP-correlated trait, this review mainly focuses on the assumed genetic aspects of BSP. Evaluation of the published literature demonstrates that to date, irrevocable proof for the assumed heritability of BSP is still missing. The assumption of heredity is further contradicted by known allele frequencies and incidences of proven hereditary diseases in cattle, such as arachnomelia or bovine spinal muscular atrophy. Consequently, future research is needed to determine the cause of spastic paresis. Procedures that will help test the null-hypothesis ('BSP is not hereditary') and possible modes of inheritance are discussed in this review.
Topics: Animals; Cattle; Cattle Diseases; Genetic Background; Hindlimb; Muscle Spasticity; Muscle, Skeletal; Paresis
PubMed: 27687928
DOI: 10.1016/j.tvjl.2016.07.001 -
Annals of Physical and Rehabilitation... Jun 2015The ability to rise from a chair to reach a standing position is impaired after stroke. This paper aims to review for the first time the factors that impact the ability... (Review)
Review
BACKGROUND AND PURPOSE
The ability to rise from a chair to reach a standing position is impaired after stroke. This paper aims to review for the first time the factors that impact the ability to rise from a chair and identify recommendations for post-stroke rehabilitation.
METHODS
In order to analyse relevant scientific publications (French and English), the search terms "stroke", "rehabilitation" and "sit-to-stand" (STS and its variations) were used. The initial literature search identified 122 titles and abstracts for full review and 46 were retained because both the junior and senior researchers agreed that they were aligned with the objectives of this review.
RESULTS AND CONCLUSION
During STS, most individuals with hemiparesis able to stand independently presented several changes such as lateral deviation of the trunk towards the unaffected side (ipsilesional side), asymmetrical weight bearing (WB) and asymmetry of knee moment forces. Interestingly, the WB asymmetry was observed even before seat-off, when subjects with hemiparesis still had their thighs in contact with the chair suggesting a planned strategy. Among other interesting results, the time to execute the STS was longer than in controls and influenced by the sensorimotor deficits. A greater risk of falling was observed with a need for more time to stabilize the body during STS and especially during the extension phase. Some rehabilitation interventions may be effective in improving STS duration, WB symmetry and the ability to stand independently with repeated practice (mentally or physically) of STS tasks. However, more research is essential to further investigate effects of specific training protocols and pursue better understanding of this complex and demanding task, particularly for stroke patients who need assistance during this transfer.
Topics: Humans; Knee; Movement; Paresis; Posture; Stroke; Stroke Rehabilitation; Task Performance and Analysis; Thigh; Weight-Bearing
PubMed: 26004813
DOI: 10.1016/j.rehab.2015.04.007 -
Neurology Aug 2021To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke. (Clinical Trial)
Clinical Trial Observational Study
OBJECTIVE
To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke.
METHOD
In this prospective longitudinal study, 89 patients with first-ever stroke with arm paresis were assessed at 3 weeks and 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), and unimanual motor impairment was assessed with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA items (FMA-SAFE; range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC).
RESULTS
Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time point ( > 0.88, < 0.001), and recovery trajectories were similar. In patients with moderate to severe initial FMA, FMA-SAFE score was the strongest predictor of Ad-AHA outcome ( = 0.81) and degree of recovery ( = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome ( = 0.05). Repeated analyses without FMA-SAFE score identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL >5.5 cm strongly predicted low to minimal FMA/Ad-AHA recovery (≤10 and 20 points respectively, specificity = 0.91). FC explained some additional variance to FMA-SAFE score only in unimanual recovery.
CONCLUSION
Although recovery of bimanual activity depends on the extent of corticospinal tract injury and initial sensory and cognitive impairments, FMA-SAFE score captures most of the variance explained by these mechanisms. FMA-SAFE score, a straightforward clinical measure, strongly predicts bimanual recovery.
CLINICALTRIALSGOV IDENTIFIER
NCT02878304.
CLASSIFICATION OF EVIDENCE
This study provides Class I evidence that the FMA-SAFE score predicts bimanual recovery after stroke.
Topics: Adult; Aged; Cognitive Dysfunction; Connectome; Female; Hand; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Male; Middle Aged; Outcome Assessment, Health Care; Paresis; Prognosis; Psychomotor Performance; Recovery of Function; Severity of Illness Index; Stroke
PubMed: 34400568
DOI: 10.1212/WNL.0000000000012366 -
Journal of Neurophysiology Apr 2022Most patients with stroke experience motor deficits, usually referred to collectively as hemiparesis. Although hemiparesis is one of the most common and clinically...
Most patients with stroke experience motor deficits, usually referred to collectively as hemiparesis. Although hemiparesis is one of the most common and clinically recognizable motor abnormalities, it remains undercharacterized in terms of its behavioral subcomponents and their interactions. Hemiparesis comprises both negative and positive motor signs. Negative signs consist of weakness and loss of motor control (dexterity), whereas positive signs consist of spasticity, abnormal resting posture, and intrusive movement synergies (abnormal muscle co-activations during voluntary movement). How positive and negative signs interact, and whether a common mechanism generates them, remains poorly understood. Here, we used a planar, arm-supported reaching task to assess poststroke arm dexterity loss, which we compared with the Fugl-Meyer stroke scale; a measure primarily reflecting abnormal synergies. We examined 53 patients with hemiparesis after a first-time ischemic stroke. Reaching kinematics were markedly more impaired in patients with subacute (<3 mo) compared to chronic (>6 mo) stroke even for similar Fugl-Meyer scores. This suggests a dissociation between abnormal synergies (reflected in the Fugl-Meyer scale) and loss of dexterity, which in turn suggests different underlying mechanisms. Moreover, dynamometry suggested that Fugl-Meyer scores capture weakness as well as abnormal synergies, in line with these two deficits sharing a neural substrate. These findings have two important implications: First, clinical studies that test for efficacy of rehabilitation interventions should specify which component of hemiparesis they are targeting and how they propose to measure it. Metrics used widely for this purpose may not always be chosen appropriately. For example, as we show here, the Fugl-Meyer score may capture some hemiparesis components (abnormal synergies and weakness) but not others (loss of dexterity). Second, there may be an opportunity to design rehabilitation interventions to address specific subcomponents of hemiparesis. Motor impairment is common after stroke and comprises reduced dexterity, weakness, and abnormal muscle synergies. Here we report that, when matched on an established synergy and weakness scale (Fugl-Meyer), patients with subacute stroke have worse reaching dexterity than chronic ones. This result suggests that the components of hemiparesis are dissociable and have separable mechanisms and, thus, may require distinct assessments and treatments.
Topics: Biomechanical Phenomena; Humans; Muscle Spasticity; Paresis; Recovery of Function; Stroke; Stroke Rehabilitation
PubMed: 35108107
DOI: 10.1152/jn.00447.2021 -
Clinical Biomechanics (Bristol, Avon) Dec 2015People with floppy ankle muscles paresis use ankle foot orthoses to improve their walking ability. Ankle foot orthoses also limit ankle range of motion thereby... (Review)
Review
BACKGROUND
People with floppy ankle muscles paresis use ankle foot orthoses to improve their walking ability. Ankle foot orthoses also limit ankle range of motion thereby introducing additional problems. Insight in effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles aids in clinical decision making and may improve adherence.
METHODS
Studies published before October 27th, 2014, were searched in Pubmed, Embase, Cinahl, and Cochrane Library. Studies evaluating effects of ankle foot orthoses on body functions and/or activities in people with floppy paretic ankle muscles were included. Studies solely focusing on people with spastic paretic ankle muscles were excluded. Study quality was assessed using a custom-made scale. Body functions and activities were defined according to the International Classification of Functioning, Disability and Health.
FINDINGS
Twenty-four studies were included, evaluating 394 participants. Participants were grouped according to paresis type (i) dorsiflexor paresis, (ii) plantar flexor paresis, (iii) both dorsiflexor and plantar flexor paresis. Dorsal, circular, and elastic ankle foot orthoses increased dorsiflexion during swing (by 4-6°, group i). Physical comfort with dorsal ankle foot orthoses was lower than that with circular ankle foot orthoses (groups i and iii). Dorsal ankle foot orthoses increased push-off moment (by 0.2-0.5 Nm/kg), increased walking efficiency, and decreased ankle range of motion (by 12-30°, groups ii and iii).
INTERPRETATION
People with dorsiflexor paresis benefit more from circular and elastic ankle foot orthoses while people with plantar flexor paresis (and dorsiflexor paresis) benefit more from dorsal ankle foot orthoses.
Topics: Ankle Joint; Foot; Foot Orthoses; Humans; Paresis; Range of Motion, Articular; Walking
PubMed: 26586583
DOI: 10.1016/j.clinbiomech.2015.09.013 -
Journal of the American Veterinary... Feb 2019
Topics: Animals; Cat Diseases; Cats; Electrocardiography; Extremities; Male; Paresis
PubMed: 30714864
DOI: 10.2460/javma.254.4.470