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Cureus Apr 2024A 59-year-old male patient came to the outpatient department with complaints of left-sided hemicranial headache with drooping of the left upper eyelid (UL) for three...
A 59-year-old male patient came to the outpatient department with complaints of left-sided hemicranial headache with drooping of the left upper eyelid (UL) for three days associated with difficulty in swallowing and deviation of the tongue. The patient had a history of vigorous coughing for the past 15 days for which he did not take any medications. He was thoroughly evaluated in the outpatient department and diagnosed with Horner's syndrome. Acute Horner's syndrome with pain is nearly a hallmark of carotid dissection, and MRI of the brain and orbit was thus advised. On MRI, a hyperdense area was noted around the left internal carotid artery for which he was advised magnetic resonance angiography, which revealed internal carotid artery dissection (ICAD) of the left side. The patient was diagnosed with left-sided Horner's syndrome following left ICAD with involvement of the left hypoglossal nerve. He was started on antiplatelets and anticoagulants and closely followed up. Early diagnosis and prompt treatment were lifesaving for this patient.
PubMed: 38756256
DOI: 10.7759/cureus.58367 -
Biosensors & Bioelectronics Sep 2024Milk fever is a metabolic disorder that predominantly affects dairy animals during the periparturient period and within four weeks of calving. Milk fever is primarily...
Milk fever is a metabolic disorder that predominantly affects dairy animals during the periparturient period and within four weeks of calving. Milk fever is primarily attributed to a decrease in the animal's serum Ca levels. Clinical milk fever occurs when Ca concentration drops below 1.5 mM (6 mg/dL). Without prompt intervention, clinical milk fever leads to noticeable physical symptoms and health complications including coma and fatality. Subclinical milk fever is characterized by Ca levels between 1.5 and 2.12 mM (6-8.48 mg/dL). Approximately 50% of multiparous dairy cows suffer from subclinical milk fever during the transition to lactation. The economic impact of milk fever, both direct and indirect, is substantial, posing challenges for farmers. To address this issue, we developed a low-cost electrochemical sensor that can measure bovine serum calcium levels on-site, providing an opportunity for early detection of subclinical and clinical milk fever and early intervention. This calcium sensor is a scalable solid contact ion sensing platform that incorporates a polymeric calcium-selective membrane and ionic liquid-based reference membrane into laser-induced graphene (LIG) electrodes. Our sensing platform demonstrates a sensitivity close to the theoretical Nernstian value (29.6 mV/dec) with a limit of detection of 15.6 μM and selectivity against the species in bovine serum. Moreover, our sensor can detect Ca in bovine serum with 91% recovery.
Topics: Animals; Cattle; Biosensing Techniques; Female; Electrochemical Techniques; Calcium; Dairying; Parturient Paresis; Equipment Design; Graphite; Limit of Detection; Cattle Diseases
PubMed: 38749287
DOI: 10.1016/j.bios.2024.116321 -
Journal of Neurophysiology Jul 2024The flexion synergy and extension synergy are a representative consequence of a stroke and appear in the upper extremity and the lower extremity. Since the ipsilesional...
The flexion synergy and extension synergy are a representative consequence of a stroke and appear in the upper extremity and the lower extremity. Since the ipsilesional corticospinal tract (CST) is the most influential neural pathway for both extremities in motor execution, damage by a stroke to this tract could lead to similar motor pathological features (e.g., abnormal synergies) in both extremities. However, less attention has been paid to the interlimb correlations in the flexion synergy and extension synergy across different recovery phases of a stroke. We used results of the Fugl-Meyer assessment (FMA) to characterize those correlations in a total of 512 participants with hemiparesis after stroke from the acute phase to 1 year. The FMA provides indirect indicators of the degrees of the flexion synergy and extension synergy after stroke. We found that, generally, strong interlimb correlations ( > 0.65 with all values < 0.0001) between the flexion synergy and extension synergy appeared in the acute-to-subacute phase (<90 days). However, the correlations of the lower-extremity extension synergy with the upper-extremity flexion synergy and extension synergy decreased (down to = 0.38) 360 days after stroke ( < 0.05). These results suggest that the preferential use of alternative neural pathways after damage by a stroke to the CST enhances the interlimb correlations between the flexion synergy and extension synergy. At the same time, the results imply that the recovery of CST integrity or/and the fragmentation (remodeling) of the alternative neural substrates in the chronic phase may contribute to diversity in neural pathways in motor execution, eventually leading to reduced interlimb correlations. For the first time, this article addresses the asynchronous relationships in the strengths of flexion and extension synergy expressions between the paretic upper extremity and lower extremity across various phases of stroke.
Topics: Humans; Male; Stroke; Female; Upper Extremity; Middle Aged; Aged; Paresis; Lower Extremity; Pyramidal Tracts; Adult
PubMed: 38748436
DOI: 10.1152/jn.00102.2024 -
Journal of Neuroengineering and... May 2024Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted... (Randomized Controlled Trial)
Randomized Controlled Trial
Effects of robot-assisted gait training using the Welwalk on gait independence for individuals with hemiparetic stroke: an assessor-blinded, multicenter randomized controlled trial.
BACKGROUND
Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000.
METHODS
An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score.
RESULTS
A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914-18.995], p = 0.065, HR 4.443 [95%CI 0.973-20.279], p = 0.054, respectively).
CONCLUSIONS
The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction.
TRIAL REGISTRATION
This study was registered with the Japan Registry of Clinical Trials ( https://jrct.niph.go.jp ; jRCT 042180078) on March 3, 2019.
Topics: Humans; Male; Stroke Rehabilitation; Female; Aged; Robotics; Middle Aged; Gait Disorders, Neurologic; Paresis; Stroke; Gait; Exercise Therapy; Single-Blind Method; Physical Therapy Modalities; Treatment Outcome
PubMed: 38745235
DOI: 10.1186/s12984-024-01370-5 -
Clinical Biomechanics (Bristol, Avon) May 2024Reduced ankle quasi-joint stiffness affects propulsion in the paretic side of patients with hemiparesis, contributing to gait asymmetry. We investigated whether the use...
Effects of ankle-foot orthosis with dorsiflexion resistance on the quasi-joint stiffness of the ankle joint and spatial asymmetry during gait in patients with hemiparesis.
BACKGROUND
Reduced ankle quasi-joint stiffness affects propulsion in the paretic side of patients with hemiparesis, contributing to gait asymmetry. We investigated whether the use of an ankle-foot orthosis with dorsiflexion resistance to compensate for reduced stiffness would increase quasi-joint stiffness and spatiotemporal symmetry in patients with hemiparesis.
METHODS
Seventeen patients walked along a 7-m walkway in both ankle-foot orthosis with dorsiflexion resistance and control (i.e., ankle-foot orthosis) conditions. Dorsiflexion resistance by spring and cam was set to increase linearly from zero-degree ankle dorsiflexion. Gait data were analyzed using a three-dimensional motion analysis system.
FINDINGS
Ankle-foot orthosis with dorsiflexion resistance significantly increased the quasi-joint stiffness in the early and middle stance phase (P = 0.028 and 0.040). Furthermore, although ankle power generation in the ankle-foot orthosis with dorsiflexion resistance condition was significantly lower than in the control condition (P = 0.003), step length symmetry significantly increased in the ankle-foot orthosis with dorsiflexion resistance condition (P = 0.016). There was no significant difference in swing time ratio between conditions.
INTERPRETATION
Applying dorsiflexion resistance in the paretic stance phase increased quasi-joint stiffness but did not lead to an increase in ankle power generation. On the other hand, applying dorsiflexion resistance also resulted in a more symmetrical step length, even though the ankle joint power generation on the paretic side did not increase as expected. Future research should explore whether modifying the magnitude and timing of dorsiflexion resistance, considering the biomechanical characteristics of each patients' ankle joint during gait, enhances ankle joint power generation.
Topics: Humans; Ankle Joint; Paresis; Male; Female; Middle Aged; Foot Orthoses; Gait; Aged; Gait Disorders, Neurologic; Range of Motion, Articular; Biomechanical Phenomena; Adult
PubMed: 38744222
DOI: 10.1016/j.clinbiomech.2024.106263 -
Neurocase Dec 2023We examined effects of a visual search task (VST) in virtual reality (VR) with a moving background on spatial cognition and standing balance in left hemiparetic strokes....
We examined effects of a visual search task (VST) in virtual reality (VR) with a moving background on spatial cognition and standing balance in left hemiparetic strokes. The VST with background deviation was allocated to Case A. In Case B, the VST without the deviation was performed. As a results, in Case A, the reaction time of VST was shortened in the paretic space and ability of weight-shift to the paretic side was improved. In conclusion, the VST in the VR with a spatial manipulation may improve spatial cognition and standing balance in left hemiparetic strokes.
Topics: Humans; Virtual Reality; Postural Balance; Male; Stroke; Paresis; Middle Aged; Aged; Female; Space Perception; Visual Perception; Cognition; Stroke Rehabilitation; Reaction Time
PubMed: 38736186
DOI: 10.1080/13554794.2024.2346980 -
Journal of Cranio-maxillo-facial... Apr 2024Electromyographic evaluation is a reliable tool for confirming facial palsy and assessing its severity. It allows differentiating facial paresis and paralysis, and...
Is pre-operative electromyography a reliable tool in differentiating acute and chronic facial palsy? A preliminary evaluation in patients treated with triple innervation facial reanimation.
Electromyographic evaluation is a reliable tool for confirming facial palsy and assessing its severity. It allows differentiating facial paresis and paralysis, and further distinguishes acute palsies, still showing muscle fibrillations, from chronic cases. This article aims to show that EMG fibrillations might represent a better criterion to differentiate acute and chronic palsies than the standard 18-24 months' cut-off usually employed for classification and treatment purposes. We performed a cohort study using the eFACE tool for comparing triple innervation facial reanimation results in patients with EMG fibrillation treated <12 months, 12-18 months, and >18 months from paralysis onset. Patients showed a statistically significant post-operative improvement in all eFACE items, both in the whole sample and in the three groups. Only the deviation from the optimal score for the gentle eye closure item in group 2 didn't reach statistical significance (p = 0.173). The post-operative results were comparable in the three groups, as the Kruskal-Wallis test showed a difference only for the platysmal synkinesis item scores, which were significantly lower in group 3 (p = 0.025).
PubMed: 38734508
DOI: 10.1016/j.jcms.2024.04.001 -
Archives of Physical Medicine and... May 2024To assess the effectiveness of alternating hot-cold water immersion (AHCWI) in patients with acute stroke.
OBJECTIVE
To assess the effectiveness of alternating hot-cold water immersion (AHCWI) in patients with acute stroke.
DESIGN
A single-blind pilot randomized controlled trial.
SETTING
Department of Rehabilitation Medicine of a medical center.
PARTICIPANTS
Early stroke survivors (N=24) with moderate-to-severe arm paresis.
INTERVENTIONS
In addition to conventional rehabilitation, eligible patients were randomly assigned to an AHCWI group (n=12, for AHCWI) or a control group (n=12, for upper limb [UL] cycling exercises) 5 times per week for 6 weeks.
MAIN OUTCOME MEASURES
The Fugl-Meyer Assessment motor-UL (FMA-UL) score, Motricity Index-UL (MI-UL) score, modified Motor Assessment Scale (MMAS; including its UL sections, MMAS-UL) score, Berg Balance Scale score, Barthel Index (BI), and modified Ashworth Scale score were assessed by the same uninvolved physical therapist at baseline and after 4 and 6 weeks of intervention.
RESULTS
Compared with the control group, the AHCWI group performed better, with significant group effects (P<.05), and exhibited significant improvements in FMA-UL, MI-UL, and MMAS-UL scores at 4 and 6 weeks (P<.05). Although the remaining outcomes were not significantly different, they favored the AHCWI group. Notably, a significant difference was observed in the BI at 4 weeks (P=.032). Significant changes in the muscle tone or adverse effects were not observed in either group after the intervention.
CONCLUSIONS
AHCWI with stroke rehabilitation is feasible and may facilitate motor function recovery of the paretic UL after a stroke.
PubMed: 38734047
DOI: 10.1016/j.apmr.2024.05.008 -
Sensors (Basel, Switzerland) Apr 2024Thanks to medical advances, life expectancy is increasing. With it comes an increased incidence of diseases, of which age is a risk factor. Stroke is among these...
Thanks to medical advances, life expectancy is increasing. With it comes an increased incidence of diseases, of which age is a risk factor. Stroke is among these diseases, and is one of the causes of long-term disability. The opportunity to treat these patients is via rehabilitation. A promising new technology that can enhance rehabilitation is virtual reality (VR). However, this technology is not widely used by elderly patients, and, moreover, the elderly often do not use modern technology at all. It therefore becomes a legitimate question whether elderly people will be able to use virtual reality in rehabilitation. This article presents a rehabilitation application dedicated to patients with upper limb paresis and unilateral spatial neglect (USN). The application was tested on a group of 60 individuals including 30 post-stroke patients with an average age of 72.83 years. The results of the conducted study include a self-assessment by the patients, the physiotherapist's evaluation, as well as the patients' performance of the exercise in VR. The study showed that elderly post-stroke patients are able to use virtual reality applications, but the ability to correctly and fully perform an exercise in VR depends on several factors. One of them is the ability to make logical contact ( = 0.0001 < 0.05). However, the study presented here shows that the ability to use VR applications does not depend on age but on mental and physical condition, which gives hope that virtual reality applications can be used in post-stroke rehabilitation among patients of all ages.
Topics: Humans; Stroke Rehabilitation; Aged; Virtual Reality; Male; Female; Stroke; Aged, 80 and over; Middle Aged; Paresis
PubMed: 38732851
DOI: 10.3390/s24092745 -
Radiation Research May 2024Carbon-ion irradiation is increasingly used at the skull base and spine near the radiation-sensitive spinal cord. To better characterize the in vivo radiation response...
Carbon-ion irradiation is increasingly used at the skull base and spine near the radiation-sensitive spinal cord. To better characterize the in vivo radiation response of the cervical spinal cord, radiogenic changes in the high-dose area were measured in rats using magnetic resonance imaging (MRI) diffusion measurements in comparison to conventional photon irradiations. In this longitudinal MRI study, we examined the gray matter (GM) of the cervical spinal cord in 16 female Sprague-Dawley rats after high-dose photon (n = 8) or carbon-ion (12C) irradiation (n = 8) and in 6 sham-exposed rats until myelopathy occurred. The differences in the diffusion pattern of the GM of the cervical spinal cord were examined until the endpoint of the study, occurrence of paresis grade II of both forelimbs was reached. In both radiation techniques, the same order of the occurrence of MR-morphological pathologies was observed - from edema formation to a blood spinal cord barrier (BSCB) disruption to paresis grade II of both forelimbs. However, carbon-ion irradiation showed a significant increase of the mean apparent diffusion coefficient (ADC; P = 0.031) with development of a BSCB disruption in the GM. Animals with paresis grade II as a late radiation response had a highly significant increase in mean ADC (P = 0.0001) after carbon-ion irradiation. At this time, a tendency was observed for higher mean ADC values in the GM after 12C irradiation as compared to photon irradiation (P = 0.059). These findings demonstrated that carbon-ion irradiation leads to greater structural damage to the GM of the rat cervical spinal cord than photon irradiation due to its higher linear energy transfer (LET) value.
PubMed: 38724886
DOI: 10.1667/RADE-23-00151.1