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Journal of Stroke and Cerebrovascular... Sep 2021The subjective nature of fatigue may contribute to inconsistencies in prevalence rates for post-stroke fatigue. More objective performance fatigue measures may offer a...
OBJECTIVES
The subjective nature of fatigue may contribute to inconsistencies in prevalence rates for post-stroke fatigue. More objective performance fatigue measures may offer a more reliable construct of fatigue. Our goal was to establish test-retest reliability of fatigability in stroke during 6-minute walk (6MW) testing. Relationships between post-stoke fatigability and other constructs were assessed.
MATERIALS AND METHODS
Twenty-three hemiparetic stroke survivors underwent two 6MW tests with portable metabolic monitoring performed at least 48 hours apart. Fatigability was defined as ratio of change in walking speed to distance covered during the 6MW. 6MW oxygen consumption (VO), peak aerobic capacity (VOpeak), walking speed over-ground, dynamic gait index, fatigue, falls efficacy, and BMI were measured.
RESULTS
Fatigability was highly correlated between both 6MW trials (ICC = 0.99, p < 0.001) with no significant difference between trials (0.08, p = 0.48). The strongest correlation was between fatigability and 6MW VO trial 1 and 2 (r = 0.92, p < 0.001 and r = 0.95, p < 0.001, respectively). Moderate-to-strong relationships were observed between fatigability for 6MW and fastest-comfortable walking speed (r = -0.82 and -0.77), self-selected walking speed (r = -7.8 and -0.78), 6MW walking speed (r = -0.80 and 0.80, VOpeak (r = -0.47 and -0.48) (p < 0.001), and DGI (r = -0.70 and -0.68, p < 0.001).
CONCLUSION
This study establishes test-retest reliability for an objective measure of fatigue in stroke-related disability. The strong correlations between fatigability and other functional measures also provides insight into the contributors underlying fatigability in this population.
REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01322607.
Topics: Adult; Aged; Aged, 80 and over; Cardiorespiratory Fitness; Chronic Disease; Cross-Sectional Studies; Exercise Tolerance; Fatigue; Female; Humans; Male; Middle Aged; Oxygen Consumption; Paresis; Predictive Value of Tests; Reproducibility of Results; Stroke; Time Factors; Walk Test; Walking
PubMed: 34242857
DOI: 10.1016/j.jstrokecerebrovasdis.2021.105895 -
Journal of Neurology, Neurosurgery, and... Dec 2020Functional movement disorders (FMD) are proposed to reflect a specific problem with voluntary control of movement, despite normal intent to move and an intact neural...
Functional movement disorders (FMD) are proposed to reflect a specific problem with voluntary control of movement, despite normal intent to move and an intact neural capacity for movement. In many cases, a positive diagnosis of FMD can be established on clinical grounds. However, the diagnosis remains challenging in certain scenarios, and there is a need for predictors of treatment response and long-term prognosis.In this context, we performed a systematic review of biomarkers in FMD. Eighty-six studies met our predefined criteria and were included.We found fairly reliable electroencephalography and electromyography-based diagnostic biomarkers for functional myoclonus and tremor. Promising biomarkers have also been described for functional paresis, gait and balance disorders. In contrast, there is still a lack of diagnostic biomarkers of functional dystonia and tics, where clinical diagnosis is often also more challenging. Importantly, many promising findings focus on pathophysiology and reflect group-level comparisons, but cannot differentiate on an individual basis. Some biomarkers also require access to time-consuming and resource-consuming techniques such as functional MRI.In conclusion, there are important gaps in diagnostic biomarkers in FMD in the areas of most clinical uncertainty. There is also is a lack of treatment response and prognostic biomarkers to aid in the selection of patients who would benefit from rehabilitation and other forms of treatment.
Topics: Biomarkers; Brain; Conversion Disorder; Dystonia; Electroencephalography; Electromyography; Functional Neuroimaging; Gait Disorders, Neurologic; Humans; Magnetic Resonance Imaging; Movement Disorders; Myoclonus; Neuronal Plasticity; Paresis; Positron-Emission Tomography; Reaction Time; Tics; Tremor
PubMed: 33087421
DOI: 10.1136/jnnp-2020-323141 -
Journal of Stroke and Cerebrovascular... Mar 2021The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST)... (Observational Study)
Observational Study
OBJECTIVES
The prognosis of patients with acute ischemic stroke (AIS) essentially depends on both prompt diagnosis and appropriate treatment. Endovascular stroke therapy (EST) proved to be highly efficient in the treatment of emergent large vessel occluding (ELVO) strokes in the anterior circulation. To achieve a timely diagnosis, a robust combination of few and simple signs to identify ELVOs in AIS patients applicable by paramedics in the prehospital triage is worthwhile.
MATERIALS AND METHODS
This retrospective single-center study included 904 AIS patients (324 ELVO, 580 non-ELVO) admitted between 2010 and 2015 in a tertiary stroke center. We re-evaluated two symptoms based on NIHSS items, gaze deviation and hemiparesis of the limbs ("Gaze deviation and Paresis Score, GPS") for the pre-hospital prediction of ELVO.
RESULTS
A positive GPS AIS in patients predicted ELVO with a sensitivity of 0.89, specificity = 0.97, positive predictive value (PPV) = 0.95, negative predictive value (NPV) = 0.94 and diagnostic odds ratio (DOR) = 34.25 (CI: 20.75-56.53). The positive Likelihood-ratio (LR) was 29.67, the negative Likelihood ratio (LR) 0.11. NIHSS of patients with positive GPS (gaze palsy NIHSS ≥ 0, Motor arm NIHSS ≥2 and Motor leg NIHSS ≥2) was markedly higher compared to negative GPS patients (p < 0.001).
CONCLUSIONS
The GPS proved to be similarly accurate in detecting ELVO in the anterior circulation of AIS patients and even more specific than other published clinical scores. Its simplicity and clarity might enable non-neurological medical staff to identify ELVO AIS patients with high certainty in a preclinical setting.
Topics: Aged; Aged, 80 and over; Clinical Decision-Making; Disability Evaluation; Emergency Medical Services; Endovascular Procedures; Female; Fixation, Ocular; Humans; Ischemic Stroke; Male; Middle Aged; Ocular Motility Disorders; Paresis; Predictive Value of Tests; Prognosis; Registries; Reproducibility of Results; Retrospective Studies; Triage
PubMed: 33388631
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105518 -
Parkinsonism & Related Disorders Jan 2020Functional motor disorders are often delineated according to the dominant motor symptom. In a large cohort, we aimed to find if there were differences in demographics,... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Functional motor disorders are often delineated according to the dominant motor symptom. In a large cohort, we aimed to find if there were differences in demographics, mode of onset, pain, fatigue, depression and anxiety and levels of physical functioning, quality of life and social adjustment between patients with different dominant motor symptoms.
METHODS
Baseline data from the Self-Help and Education on the Internet for Functional Motor Disorders Trial was used. Patients were divided into dominant motor symptom groups based on the diagnosis of the referring neurologist. Data on the above topics were collected by means of an online questionnaire and compared between groups using parametric and nonparametric statistics.
RESULTS
In 160 patients a dominant motor symptom could be determined, 31 had tremor, 45 myoclonus, 23 dystonia, 30 paresis, 31 gait disorder. No statistical differences between groups were detected for demographics, mode of onset and severity of pain, fatigue, depression and anxiety. Physical functioning was worse in the gait disorder group (median 20, IQR 25) compared to tremor (50 (55), p = 0.002) and myoclonus (50 (52), p = 0.001). Work and social adjustment was less impaired in the myoclonus group (median 20, IQR 18) compared to gait disorder (median 30, IQR18, p < 0.001) and paresis (28, IQR 10, p = 0.001). Self-report showed large overlap in motor symptoms.
CONCLUSION
No differences were detected between groups of functional motor symptoms, regarding demographics, mode of onset, depression, anxiety, pain and fatigue. The large overlap in symptoms contributes to the hypothesis of shared underlying mechanisms of functional motor disorders.
Topics: Adolescent; Adult; Anxiety; Cohort Studies; Comorbidity; Conversion Disorder; Depression; Dyskinesias; Fatigue; Female; Gait Disorders, Neurologic; Humans; Male; Middle Aged; Movement Disorders; Pain; Paresis; Self Report; Severity of Illness Index; Young Adult
PubMed: 31785442
DOI: 10.1016/j.parkreldis.2019.11.018 -
Journal of Neurologic Physical Therapy... Oct 2021Regarding people with stroke, simple outcome measures in clinical settings capable of representing the actual use of the upper extremity (UE) would be useful to...
BACKGROUND AND PURPOSE
Regarding people with stroke, simple outcome measures in clinical settings capable of representing the actual use of the upper extremity (UE) would be useful to rehabilitation professionals for the purposes of goal setting. This study seeks to describe the relative levels of paretic UE use, investigate the association between manual dexterity and task-related UE use, and to establish the manual dexterity cutoff points that correspond to relative levels of paretic UE use.
METHODS
Forty-six adults with chronic hemiparesis participated in this cross-sectional study. Behavioral mapping was employed to ascertain the actual amount of UE use by the identifying the unimanual and bimanual activities performed in the participants' homes within a 4-hour period. Participants were classified into 4 levels of paretic UE integration into activities considering the data from the behavioral mapping (activity, hand function, and type of grasp). The Box and Block Test (BBT) and the Nine Hole Peg Test (NHPT) were used to evaluate dexterity. The Spearman test was used to evaluate the correlations. In analyzing the receiver operating characteristic curve, we applied the Youden index to determine the cutoff points.
RESULTS
Participants with full/almost full (n = 11), partial (n = 12), and limited (n = 12) integration of the paretic UE into activities and with little/no use (n = 11) were identified. Unimanual and total paretic UE activities were found to have a high correlation with the BBT scores. The boundaries between the integration levels were between full/almost full and partial integration, BBT greater than 30 blocks or NHPT of 41 seconds and less; between partial and limited, BBT greater than 16 blocks; and between limited and little/no use, BBT greater than 3 blocks. Both tests show good accuracy (≥0.81).
DISCUSSION AND CONCLUSIONS
The BBT presents a positive high correlation with paretic UE use at home and was shown to be better able to identify "limited" and "partial" integration of the paretic UE. Both tests can identify when the paretic UE is fully/almost fully integrated into activities at home.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A354).
Topics: Adult; Cross-Sectional Studies; Humans; Independent Living; Paresis; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 34334724
DOI: 10.1097/NPT.0000000000000365 -
Medical Science Monitor : International... Jun 2022BACKGROUND The aim of this study was to evaluate the effects of rehabilitation in terms of changes in the body mass composition in the upper and lower limbs depending on...
BACKGROUND The aim of this study was to evaluate the effects of rehabilitation in terms of changes in the body mass composition in the upper and lower limbs depending on the length of time after stroke and the age of the patient. MATERIAL AND METHODS Eighty-two patients after ischemic stroke were tested 3 times: on admission, after 5 weeks, and 3 months after leaving the hospital (follow-up). During each examination, a segmental analysis of the components of the body mass of the upper limbs and lower limbs was performed, depending on the side of paresis. RESULTS Patients between 7 and 12 months after stroke with right-sided paresis had a reduction of fat (P=0.027) and an increase in muscle tissue in the lower (P=0.030) and upper limbs with paresis (P=0.037), as well as in the healthy upper limb (P=0.034) after rehabilitation. Only in the youngest age group (25-44 years) and in patients with left-sided paresis was there a decrease of adipose tissue in the healthy upper (P=0.012) and paresis limbs (P=0.032) and an increase in the muscle tissue mass in the right upper limb (P=0.010) after rehabilitation. CONCLUSIONS The rehabilitation program had a significant impact on the change in the composition of body mass in upper and lower limbs in people with right-sided paresis, particularly 7 to 12 months after stroke and in the youngest age group (25-44 years). These results may be useful in planning a rehabilitation program for stroke patients to consider the patient's dominant hand and neglect.
Topics: Adult; Humans; Ischemic Stroke; Lower Extremity; Paresis; Stroke; Stroke Rehabilitation
PubMed: 35761761
DOI: 10.12659/MSM.936397 -
The Journal of International Advanced... Nov 2021The aim of this study is to evaluate the incidence of delayed facial nerve paresis after total endoscopic ear surgery. This review also aims to describe the possible... (Review)
Review
The aim of this study is to evaluate the incidence of delayed facial nerve paresis after total endoscopic ear surgery. This review also aims to describe the possible contributing factors and its management. This is a retrospective review of all patients who had undergone total endoscopic ear surgery for all otologic cases that required endoscopic intervention in a single otologic center from 2014 up to 2020. The delayed facial nerve paresis is defined as deterioration of facial nerve function 72 hours after total endoscopic ear surgery. A total of 56 patients were included in the study. Delayed facial nerve paresis following total endoscopic ear surgery was observed in 2 patients (3.4%). Facial weakness sets in on day 6 post operation and another one developed at day 16 after the surgery. Both patients were investigated and only one of them showed a higher titer of Varicella zoster virus antibody while another patient showed no raise of titer. Thus, explanation of postoperative edema or mechanical compression is discussed. The incidence of delayed facial nerve paresis following total endoscopic ear surgery is rare. It can occur probably several days after surgery up to 3 weeks. Our 2 cases revealed that virus reactivation may not be the only factor for delayed facial nerve palsy after surgery. The overall prognosis for incomplete delayed facial nerve paresis is very good as both patients recovered well few days after treatment with steroids.
Topics: Facial Nerve; Facial Paralysis; Humans; Paresis; Postoperative Complications; Retrospective Studies; Tympanoplasty
PubMed: 35177397
DOI: 10.5152/iao.2021.21189 -
Agri : Agri (Algoloji) Dernegi'nin... Jul 2023Herpes zoster (HZ) is a segmental vesicular eruption, pain, and sensorial symptoms. Segmental motor weakness can rarely be seen as a complication of HZ. Here, we present...
Herpes zoster (HZ) is a segmental vesicular eruption, pain, and sensorial symptoms. Segmental motor weakness can rarely be seen as a complication of HZ. Here, we present two cases of motor paresis associated with HZ, case 1 was L2 and L3 segmental motor paresis with femoral neuropathy and case 2 was L5 and S1 segmental motor paresis with sensorial ganglion involvement. In both cases after electrotherapy, exercise program, and medication for pain, there were no motor weakness and pain. Zoster motor paresis is a rare complication that responds to treatment and physicians should be careful about its presence in clinical follow-up.
Topics: Humans; Paresis; Herpes Zoster; Pain; Lower Extremity; Upper Extremity
PubMed: 37493485
DOI: 10.14744/agri.2021.70846 -
Khirurgiia 2022To determine the optimal treatment of patients with complications of esophageal electrochemical burns by batteries.
OBJECTIVE
To determine the optimal treatment of patients with complications of esophageal electrochemical burns by batteries.
MATERIAL AND METHODS
There were 75 children with esophageal electrochemical burns by batteries between 2010 and 2019. All children underwent X-ray of the cervical spine, chest and abdomen, esophagoscopy with removal of the battery, tracheoscopy. Complications occurred in 39 children: TEF - 21, esophageal stenosis - 19, laryngeal paresis - 14, esophageal perforation - 3. Patients with TEF were divided into 2 groups: clinically stable children without respiratory failure and severe illness with respiratory failure including mechanical ventilation. Group I consisted of 6 children, four of them underwent laparoscopic Nissen fundoplication and gastrostomy. Group II consisted of 15 children. In acute period, 3 children underwent laparoscopic fundoplication and gastrostomy, 8 ones - TEF ligation, 4 patients - tracheal repair with esophageal flap and esophageal extirpation. Patients with esophageal stenosis underwent bougienage. Patients with esophageal perforation required therapy. Tracheostomy was necessary for respiratory failure and bilateral laryngeal paresis. Lateralization procedures were performed in patients with negative course of disease.
RESULTS
In the 1st group, spontaneous closure of TEF was found in 3 children after fundoplication and gastrostomy. One child underwent thoracoscopic disconnection of TEF after reduction of fistula. In the 2nd group, fundoplication resulted spontaneous closure of fistula after 2-5 months. In 4 children, recanalization of the fistula or esophageal failure were observed in acute period after TEF ligation.
CONCLUSION
Laparoscopic fundoplication and gastrostomy are optimal for TEF and can result complete or partial spontaneous closure of TEF. If radical procedure is necessary in acute period, tracheal repair with esophageal flap and extirpation of the esophagus with subsequent coloesophagoplasty should be considered.
Topics: Burns; Child; Esophageal Atresia; Esophageal Perforation; Esophageal Stenosis; Humans; Paresis; Respiratory Insufficiency; Tracheoesophageal Fistula
PubMed: 35477201
DOI: 10.17116/hirurgia202204154 -
Canadian Journal of Anaesthesia =... Oct 2022
Topics: Anesthetics, Local; Brachial Plexus Block; Humans; Pain, Postoperative; Paresis; Shoulder
PubMed: 35831737
DOI: 10.1007/s12630-022-02289-y