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Mathematical Biosciences and... Jan 2022Rehabilitation engineering is playing a more vital role in the field of healthcare for humanity. It is providing many assistive devices to diplegia patients (The...
Rehabilitation engineering is playing a more vital role in the field of healthcare for humanity. It is providing many assistive devices to diplegia patients (The patients whose conditions are weak in terms of muscle mobility on both sides of the body and their paralyzing effects are high either in the arms or in the legs). Therefore, in order to rehabilitate such types of patients, an intelligent healthcare system is proposed in this research. The electric sticks and chairs are also a type of this system which was used previously to facilitate the diplegia patients. It is worth noting that a voice recognition system along with wireless control feature has been integrated intelligently in the proposed healthcare system in order to replace the common and conventional assistive tools for diplegia patients. These features will make the proposed system more user friendly, convenient and comfortable. The voice recognition system has been used for movements of system in any desired direction along with the ultrasonic sensor and light detecting technology. These sensors detect the obstacles and low light environment intelligently during the movement of the wheelchair and then take the necessary actions accordingly.
Topics: Delivery of Health Care; Humans; Movement; Muscle Weakness; Paralysis; Self-Help Devices; Wheelchairs; Wireless Technology
PubMed: 34902999
DOI: 10.3934/mbe.2022022 -
Multimedia Manual of Cardiothoracic... Mar 2022Diaphragm paralysis is a rare complication in pediatric heart surgery (0.28%-5.6%, depending on the procedure). When unilateral paralysis happens in adults, it is rarely...
Diaphragm paralysis is a rare complication in pediatric heart surgery (0.28%-5.6%, depending on the procedure). When unilateral paralysis happens in adults, it is rarely symptomatic. However, it can cause respiratory distress syndrome when it happens in newborn or young children. The clinical diagnosis comes with a failure to wean from ventilation. The chest X-ray shows the ascension of the concerned hemidiaphragm. The goal of the surgical treatment is to pull down the paralyzed diaphragm and to increase the ventilating capacity. The classical surgical approach is a posterior-lateral thoracotomy in the 5th intercostal space of the concerned paralyzed hemidiaphragm. This approach has several drawbacks such as requiring drainage, reopening the chest after heart surgery, the high level of pain, and the cosmetic side effects. The subcostal approach is a good alternative because it is less time- consuming, it does not require any drainage, and it is less painful. This video-tutorial describes the abdominal approach and provides its advantages compared to a thoracotomy.
Topics: Adult; Cardiac Surgical Procedures; Child; Child, Preschool; Diaphragm; Humans; Infant, Newborn; Paralysis; Respiratory Paralysis; Thoracotomy
PubMed: 35616979
DOI: 10.1510/mmcts.2022.008 -
European Annals of Otorhinolaryngology,... Feb 2018There is a growing need for evaluation tools allowing the quantification of the outcome after voice surgeries. Since the end of the 1990s, multiple unfruitful attempts... (Review)
Review
There is a growing need for evaluation tools allowing the quantification of the outcome after voice surgeries. Since the end of the 1990s, multiple unfruitful attempts have been made to reach a consensus, including the Dejonckere protocol for the European Laryngological Society in 2001. This suggested to perform objective and quantifiable measures in the following domains: perception, acoustic, aerodynamic, self-evaluation by the patient and videolaryngostroboscopy. But in a PubMed search with the keywords "Voice Assessment" and "Voice Outcome" since 2001 retrieving 452 articles, only 33 of them were using methods taking into account the first four dimensions proposed by Dejonckere. To elaborate a new and simpler protocol, we chose to focus on unilateral vocal fold paralyses (UVFP), which represents a homogeneous disease in terms of physiology. This protocol was elaborated on the basis of a review of the literature and of the database and experience of the IFOS panel members. In summary, our group recommends the use and implementation of the ELS "basic protocol" with some minor modifications. Voice audio recordings are an indispensable prerequisite, and may even have medico-legal implications. We recommend the systematic use of the Voice Handicap Index (VHI). Perceptual analysis must be performed by using Hirano's GRB scale and voice breathiness has to be prioritized. Currently, acoustic analysis remains optional given the lack of data to support clinical usefulness. Aerodynamic studies should include at a minimum an evaluation of the Maximum Phonation Time, calculated in seconds following multiple trials in order to obtain a recording representing the patient's best possible glottis closure.
Topics: Clinical Protocols; Female; Humans; Male; Patient Outcome Assessment; Vocal Cord Paralysis; Voice Quality
PubMed: 29398504
DOI: 10.1016/j.anorl.2017.12.007 -
Head & Neck Dec 2020Laryngeal dysfunction after thyroid and parathyroid surgery requires early recognition and a standardized approach for patients that present with voice, swallowing, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Laryngeal dysfunction after thyroid and parathyroid surgery requires early recognition and a standardized approach for patients that present with voice, swallowing, and breathing issues. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to define the terms "immediate vocal fold paralysis" and "partial neural dysfunction" and to provide clinical consensus statements based on review of the literature, integrated with expert opinion of the group.
METHODS
A multidisciplinary expert panel constructed the manuscript and recommendations for laryngeal dysfunction after thyroid and parathyroid surgery. A meta-analysis was performed using the literature and published guidelines. Consensus was achieved using polling and a modified Delphi approach.
RESULTS
Twenty-two panelists achieved consensus on five statements regarding the role of early identification and standardization of evaluation for patients with "immediate vocal fold paralysis" and "partial neural dysfunction" after thyroid and parathyroid surgery.
CONCLUSION
After endorsement by the AHNS Endocrine Section and Quality of Care Committee, it received final approval from the AHNS Council.
Topics: Humans; Larynx; Parathyroidectomy; Recurrent Laryngeal Nerve; Thyroid Gland; Thyroidectomy; Vocal Cord Paralysis
PubMed: 32954575
DOI: 10.1002/hed.26472 -
Journal of Vascular Surgery Nov 2016Delayed paralysis is an unpredictable problem for patients undergoing complex repair of the thoracic/thoracoabdominal aorta. These experiments were designed to determine...
OBJECTIVE
Delayed paralysis is an unpredictable problem for patients undergoing complex repair of the thoracic/thoracoabdominal aorta. These experiments were designed to determine whether ethyl pyruvate (EP), a potent anti-inflammatory and antioxidant agent, might ameliorate delayed paralysis following thoracic aortic ischemia reperfusion (TAR).
METHODS
C57BL6 mice were subjected to 5 minutes of thoracic aortic ischemia followed by reperfusion for up to 48 hours. Mice received either 300 mg/kg EP or lactated ringers (LR) at 30 minutes before ischemia and 3 hours after reperfusion. Neurologic function was assessed using an established rodent scale. Spinal cord tissue was analyzed for markers of inflammation (keratinocyte chemoattractant [KC], interleukin-6 [IL-6]), microglial activation (ionized calcium-binding adapter molecule-1 [Iba-1]), and apoptosis (Bcl-2, Bax, and terminal deoxynucleotidyl transferase dUTP nick end labeling [TUNEL] staining) at 24 and 48 hours after TAR. Nissl body stained motor neurons were counted in the anterior horns sections from L1-L5 segments.
RESULTS
Ninety-three percent of the LR mice developed dense delayed paralysis between 40 and 48 hours after TAR, whereas only 39% of EP mice developed delayed paralysis (P < .01). Bcl-2 expression was higher (P < .05) and Iba-1 expression was lower (P < .05) in the EP group only at 24 hours reperfusion. At 48 hours, the number of motor neurons was higher (P < .01) and the number and TUNEL-positive cells was lower (P < .001) in the EP-treated mice. EP decreased the expression of KC (P < .01) and IL-6 (P < .001) at 48 hours after TAR.
CONCLUSIONS
The protection provided by EP against delayed paralysis correlated with preservation of motor neurons, higher expression of antiapoptotic molecules, decreased microglial cell activation, and decreased spinal cord inflammation. EP may be a treatment for humans at risk for delayed paralysis.
Topics: Animals; Anti-Inflammatory Agents; Aorta, Thoracic; Apoptosis; Apoptosis Regulatory Proteins; Constriction; Disease Models, Animal; Inflammation; Inflammation Mediators; Male; Mice, Inbred C57BL; Neuroprotective Agents; Paralysis; Pyruvates; Regional Blood Flow; Reperfusion Injury; Signal Transduction; Spinal Cord; Spinal Cord Ischemia; Time Factors
PubMed: 27776698
DOI: 10.1016/j.jvs.2015.06.214 -
Acta Neurologica Taiwanica Sep 2017Acute neuromuscular weakness related to hypokalemia is a readily treatable disorder associated with diverse aetiologies. In this study we aim to report clinical pattern...
OBJECTIVE
Acute neuromuscular weakness related to hypokalemia is a readily treatable disorder associated with diverse aetiologies. In this study we aim to report clinical pattern and biochemical features to identify the different aetiologies of the hypokalemic neuromuscular weakness.
METHODS
Retrospective reviews of the medical record were analysed. Evaluation included demography, clinical features, investigations performed to ascertain the aetiologies. All the patients were categorised in to 3 groups; Idiopathic hypokalemic paralysis (IHP), dengue associated hypokalemic paralysis (DHP) and secondary group (SG) which included renal tubular acidosis (RTA- 1 and 2), thyrotoxic periodic paralysis (TPP) and Gitelman's syndrome (GS).
RESULTS
Forty patients were analysed and the mean age was 31.78 (range, 14-60) years and 35 (87.5%) were male.The underlying aetiologies comprised of IHP in 20, DHP in 12, RTA-2 in 4, RTA-1 in 2, TPP, GS in one each. Weakness on Medical Research Council (MRC) grade was 2.6±1.19 (range 0-4). Comparison of various clinical and laboratory parameters revealed that more patient in IHP and SG had recurrent attack (p=0.001). DHP group had low platelet (p=0.001), high creatine phosphokinase (CPK) (p=0.01) and serum glutamic oxaloacetic transaminase (SGOT) (p=0.008). SG had significantly lower serum potassium (p=0.04) and more time to improve (p=0.02). Recovery time correlated negatively with serum potassium (r=-0.44, p=0.004) and grade of weakness (r= 0.42,p=0.007).
CONCLUSION
In half of the patients, secondary causes were identified. After IHP, the DHP emerged as second common cause in post monsoon season. SG had significantly lower serum potassium, recurrent attack and more time to improve.
Topics: Acute Disease; Adolescent; Adult; Female; Humans; Hypokalemia; Male; Middle Aged; Neuromuscular Diseases; Paralysis; Potassium; Retrospective Studies; Young Adult
PubMed: 29468618
DOI: No ID Found -
The Journal of Physiology Apr 2023Fatigue is a common feature of paralysed skeletal muscle, hindering performance when subjected to functional electrical stimulation (ES) for movement. We asked whether...
Fatigue is a common feature of paralysed skeletal muscle, hindering performance when subjected to functional electrical stimulation (ES) for movement. We asked whether (1) 20 Hz ES for 5% of each day (2.5 s on and 2.5 s off for 3 h) increases tibialis anterior and medial gastrocnemius muscle and motor unit (MU) endurance after paralysis by hemisection and deafferentation (HSDA), and (2) muscle length or loading affects their isometric contractile properties. The daily 5% ES increased muscle endurance, largely independent of muscle length or loading, but to a lesser extent than the daily 50% ES (2.5 s on and 2.5 s off for 24 h). The former was effective in counteracting the decline and slowing of muscle force promoted by the 50% ES. The altered muscle properties were confirmed at the MU level in final experiments once the properties had plateaued. Fast-fatigable MUs were converted to fatigue-intermediate and -resistant MUs that finally comprised ∼80% as compared to ∼10% of the total MU number in the daily 5% ES and the control normal groups, respectively. We conclude that the daily 5% ES regimen counteracts the fatigue of paralysed muscle without compromising contractile force, and thereby, is effective in conditioning muscle for effective movement. KEY POINTS: We asked whether 20 Hz electrical stimulation (ES) for 5% of each day (2.5 s on and 2.5 s off for 3 h; 5% ES) preserves medial gastrocnemius and tibialis anterior muscle and MU isometric contractile forces and increases their endurance after paralysis. Daily 5% ES promoted increased muscle endurance irrespective of the muscle length or loading but to a lesser extent than daily 50% ES (20 Hz ES 2.5 s on and 2.5 s off for 24 h). 5% ES was effective in counteracting decline and slowing of muscle force that resulted from 50% ES. Motor units (MUs) were converted from fast fatigable to fatigue intermediate and resistant MUs, comprising ∼80% as compared to ∼10% in the control normal groups. We conclude that the 5% ES regimen counteracts the fatigue of paralysed muscle without compromising contractile force, and thereby is effective in conditioning the muscle for effective movement.
Topics: Humans; Motor Neurons; Muscle, Skeletal; Muscle Contraction; Spinal Cord Injuries; Paralysis; Electric Stimulation; Muscle Fatigue
PubMed: 36815721
DOI: 10.1113/JP283972 -
Anesthesiology Jul 2017Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that... (Review)
Review
Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5-C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.
Topics: Anesthesia, Conduction; Humans; Paralysis; Phrenic Nerve; Shoulder
PubMed: 28514241
DOI: 10.1097/ALN.0000000000001668 -
PloS One 2014C5 palsy is a serious but poorly understood complication after posterior cervical decompression that could lead to muscle weakness, brachialgia and numbness of the upper... (Review)
Review
BACKGROUND
C5 palsy is a serious but poorly understood complication after posterior cervical decompression that could lead to muscle weakness, brachialgia and numbness of the upper limbs. The incidence of C5 palsy varies greatly between studies. The risk factors are inconclusive and even conflicting.
OBJECT
To perform a systematic review on the incidence and risk factors of C5 palsy after posterior cervical decompression.
MATERIALS AND METHODS
Four databases, PubMed, Embase, Web of Science and Cochrane CENTRAL, were searched to identify eligible studies. Either a fixed- or a random-effects model was used to calculate the pooled odd ratio (RR) or standardized mean difference (SMD) with its 95% confidence interval (95%CI).
RESULTS
Of the 589 pre-recruited studies, 25 were included in this study for systematic review. The pooled incidence of C5 palsy after posterior decompression was 5.8% (95%CI: 4.4-7.2%). The incidence after open-door laminoplasty, double-door laminoplasty and laminectomy was 4.5%, 3.1% and 11.3%, respectively. The significant risk factors of C5 palsy were OPLL (OR, 2.188; 95%CI, 1.307-3.665), narrower intervertebral foramen (SMD, -0.972; 95%CI, -1.398 to -0.545), laminectomy (vs. open-door laminoplasty, OR, 2.988; 95%CI, 1.298-6.876), excessive spinal cord drift (SMD, 1.289, 95%CI, 0,197-2.381) and male gender (OR, 1.54; 95%CI, 1.036-2.301).
CONCLUSIONS
The results of this systematic review suggest that patients with excessive spinal cord drift, preexisting intervertebral foramenal stenosis, OPLL, laminectomy and male gender are at high risk for postoperative C5 palsy, and risk-reduction options should be considered for such patients.
Topics: Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Decompression, Surgical; Female; Humans; Incidence; Laminectomy; Male; Middle Aged; Paralysis; Postoperative Complications; Risk Factors; Sex Factors; Spinal Nerve Roots
PubMed: 25162509
DOI: 10.1371/journal.pone.0101933 -
JAMA Facial Plastic Surgery May 2017Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL).
IMPORTANCE
Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL).
OBJECTIVE
To measure the association between depression, QOL, and facial paralysis in patients seeking treatment at a facial plastic surgery clinic.
DESIGN, SETTING, PARTICIPANTS
Data were prospectively collected for patients with all-cause facial paralysis and control patients initially presenting to a facial plastic surgery clinic from 2013 to 2015. The control group included a heterogeneous patient population presenting to facial plastic surgery clinic for evaluation. Patients who had prior facial reanimation surgery or missing demographic and psychometric data were excluded from analysis.
MAIN OUTCOMES AND MEASURES
Demographics, facial paralysis etiology, facial paralysis severity (graded on the House-Brackmann scale), Beck depression inventory, and QOL scores in both groups were examined. Potential confounders, including self-reported attractiveness and mood, were collected and analyzed. Self-reported scores were measured using a 0 to 100 visual analog scale.
RESULTS
There was a total of 263 patients (mean age, 48.8 years; 66.9% were female) were analyzed. There were 175 control patients and 88 patients with facial paralysis. Sex distributions were not significantly different between the facial paralysis and control groups. Patients with facial paralysis had significantly higher depression, lower self-reported attractiveness, lower mood, and lower QOL scores. Overall, 37 patients with facial paralysis (42.1%) screened positive for depression, with the greatest likelihood in patients with House-Brackmann grade 3 or greater (odds ratio, 10.8; 95% CI, 5.13-22.75) compared with 13 control patients (8.1%) (P < .001). In multivariate regression, facial paralysis and female sex were significantly associated with higher depression scores (constant, 2.08 [95% CI, 0.77-3.39]; facial paralysis effect, 5.98 [95% CI, 4.38-7.58]; female effect, 1.95 [95% CI, 0.65-3.25]). Facial paralysis was associated with lower QOL scores (constant, 81.62 [95% CI, 78.98-84.25]; facial paralysis effect, -16.06 [95% CI, -20.50 to -11.62]).
CONCLUSIONS AND RELEVANCE
For treatment-seeking patients, facial paralysis was significantly associated with increased depression and worse QOL scores. In addition, female sex was significantly associated with increased depression scores. Moreover, patients with a greater severity of facial paralysis were more likely to screen positive for depression. Clinicians initially evaluating patients should consider the psychological impact of facial paralysis to optimize care.
LEVEL OF EVIDENCE
2.
Topics: Depression; Facial Paralysis; Female; Humans; Male; Middle Aged; Prospective Studies; Psychiatric Status Rating Scales; Psychometrics; Quality of Life; Risk Factors; Severity of Illness Index
PubMed: 27930763
DOI: 10.1001/jamafacial.2016.1462