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Pain Research & Management 2018The objectives of this study were to assess the interexaminer agreement between one "reference" (gold standard) and each of two examiners, using the DC/TMD examination...
OBJECTIVES
The objectives of this study were to assess the interexaminer agreement between one "reference" (gold standard) and each of two examiners, using the DC/TMD examination method, Axis I and to evaluate whether a recalibration changed reliability values.
METHODS
Participants (4 healthy and 12 TMD patients) in 2013 underwent a clinical examination according to DC/TMDs, Axis I. In 2014, additionally 16 participants (4 healthy and 12 TMD patients) were recruited. Two trainee examiners (one more experienced) and one "reference examiner" (gold standard) at both sessions assessed the participants. Calibration preparation (2013): The clinical protocol was sent to the trainee examiners with a request that its verbal commands should be learned by heart. An eight-hour-course was provided on the day preceding the examination session day. Recalibration preparation (2014): The same examiners in advance to this year's examination session were also asked to recapture the protocol's instructions (verbal commands to be learned by heart) and go through the information from the 2013 course and encouraged to contact by e-mail in case of unclear subjects. At a meeting prior to the examination session, they were also given the opportunities to ask questions. The interexaminer agreements in 2013 and 2014 between the "reference" and each examiner were analysed using Bland-Altman plots, intraclass correlation coefficient, Cohen's kappa, and consistency values.
RESULTS
For the majority of the gathered data, no clear change of agreement between 2013 and 2014 could be observed, and only one muscle zone in 2014 could show any clear difference in agreement between the examiners.
CONCLUSIONS
No clear and consistent difference in the level of agreement between the two examiners could be observed, although one was more experienced than the other. Likewise, for most components of the DC/TMD tool, recalibration of examiners did not change the reliability findings.
Topics: Female; Headache; Humans; Longitudinal Studies; Male; Observer Variation; Pain; Paresis; Physical Examination; Range of Motion, Articular; Reproducibility of Results; Temporomandibular Joint Disorders; Time Factors
PubMed: 30356427
DOI: 10.1155/2018/7474608 -
Developmental Medicine and Child... Aug 2015Acute hemiparesis in children is a common clinical syndrome presenting to a variety of care settings. The recognition and the differential diagnosis is challenging,... (Review)
Review
Acute hemiparesis in children is a common clinical syndrome presenting to a variety of care settings. The recognition and the differential diagnosis is challenging, particularly in young children. Arterial ischaemic stroke (AIS) is the primary diagnosis to be considered as this requires emergency investigations and management; however, there are several conditions collectively described as 'stroke mimics' that need consideration. Accurate diagnosis is essential for appropriate management. Clinical data combined with neuroimaging are important for accurate diagnosis and management. This review and the accompanying illustrative case vignettes suggest a practical approach to differential diagnosis and management of children presenting with acute hemiparesis.
Topics: Child; Humans; Paresis
PubMed: 25832616
DOI: 10.1111/dmcn.12750 -
The American Journal of Occupational... 2018Our objective was to determine the effect of loss of body sensation on activity participation in stroke survivors.
OBJECTIVE
Our objective was to determine the effect of loss of body sensation on activity participation in stroke survivors.
METHOD
Participants (N = 268) were assessed at hospital admission for somatosensory and motor impairment using the National Institutes of Health Stroke Scale. Participation was assessed using the Activity Card Sort (ACS) in the postacute phase. Between-group differences in activity participation were analyzed for participants with and without somatosensory impairment and with or without paresis.
RESULTS
Somatosensory impairment was experienced in 33.6% of the sample and paresis in 42.9%. ACS profiles were obtained at a median of 222 days poststroke. Somatosensory loss alone (z = 1.96, p = .048) and paresis in upper and lower limbs without sensory loss (z = 4.62, p < .001) influenced activity participation.
CONCLUSION
Somatosensory impairment is associated with reduced activity participation; however, paresis of upper and lower limbs can mask the contribution of sensory loss.
Topics: Activities of Daily Living; Aged; Cohort Studies; Female; Humans; Leisure Activities; Lower Extremity; Male; Middle Aged; Paresis; Social Participation; Somatosensory Disorders; Stroke; Survivors; Upper Extremity
PubMed: 29689179
DOI: 10.5014/ajot.2018.025114 -
The Israel Medical Association Journal... Dec 2015
Topics: Carotid Artery Injuries; Humans; Ischemia; Leg; Male; Middle Aged; Occupational Diseases; Paresis
PubMed: 26897987
DOI: No ID Found -
Die Anaesthesiologie Jan 2024
Topics: Humans; Paresis; Psychophysiologic Disorders; Postoperative Period
PubMed: 37993726
DOI: 10.1007/s00101-023-01357-2 -
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 -
Journal of Medical Case Reports Feb 2019In the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome,...
BACKGROUND
In the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome, which is characterized by one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy (1.5 + 7 + 7 + 5 = 20.5) in a patient with ischemic stroke.
CASE PRESENTATION
A 45-year-old Asian Hindu woman presented with vomiting and imbalance of 1 day's duration. She had left-sided ataxic hemiparesis with one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy. Magnetic resonance imaging of her brain revealed acute non-hemorrhagic infarct in the right posterolateral aspect of pons and medulla, with normal brain vessels angiography. We described her disorder as twenty-and-a-half syndrome. She was put on antiplatelet therapy.
CONCLUSIONS
Twenty-and-a-half syndrome is reported for the first time. It is due to posterior circulation stroke; in our case, it was due to lacunar infarcts in the pons and medulla, manifesting as one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy.
Topics: Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Atorvastatin; Brain; Brain Ischemia; Cranial Nerve Diseases; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Magnetic Resonance Imaging; Middle Aged; Paresis; Physical Therapy Modalities; Platelet Aggregation Inhibitors; Ramipril; Stroke; Syndrome
PubMed: 30764883
DOI: 10.1186/s13256-019-1980-4 -
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 -
The Journal of Thoracic and... Nov 2017
Topics: Child; Diaphragm; Humans; Infant; Paresis; Respiration Disorders
PubMed: 28823800
DOI: 10.1016/j.jtcvs.2017.07.026 -
Internal Medicine (Tokyo, Japan) Oct 2022The most common neurological symptom of spontaneous intracranial hypotension (SIH) is abducens nerve paresis, and the precise pathophysiology is unclear. The accepted...
The most common neurological symptom of spontaneous intracranial hypotension (SIH) is abducens nerve paresis, and the precise pathophysiology is unclear. The accepted explanation is traction on the cranial nerves caused by the downward displacement of the cranial content. We herein report magnetic resonance imaging of SIH that can explain the mechanism underlying abducens nerve paresis. The cavernous sinuses were particularly thickened compared with the surrounding dura. This phenomenon can be explained by venous swelling, which can occur after leakage of cerebrospinal fluid in a closed cavity. This swelling pushes the abducens nerve up, which then causes abducens nerve paresis.
Topics: Abducens Nerve; Abducens Nerve Diseases; Cavernous Sinus; Edema; Humans; Intracranial Hypotension; Magnetic Resonance Imaging; Paresis
PubMed: 35342130
DOI: 10.2169/internalmedicine.8488-21