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The Journal of Hand Surgery... Dec 2022There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review...
There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review of the effectiveness of nerve transfer for radial nerve palsy. Electronic literature research of PubMed, Cochrane, Scopus and Lilacs database was conducted in June 2021 using the terms 'Distal nerve transfer' AND 'Radial nerve injury' 'Radial nerve palsy' OR 'Radial nerve paresis' OR 'Median nerve transfer' OR 'wrist extensor' OR 'finger extension' OR 'thumb extension' OR 'wrist motion'. The data extracted included the study details, demographic data, procedure performed and final functional outcome according to the muscle research council scale. A total of 92.59% and 56.52% had satisfactory outcome following distal nerve transfer of median nerve to restore wrist and finger extension respectively. No significant correlation was found between time to injury duration and satisfactory outcomes. Outcomes of nerve transfers are comparable to tendon transfers. Multi-centric studies are needed to compare the results amongst various surgical procedures described. Level III (Therapeutic).
Topics: Humans; Wrist; Nerve Transfer; Fingers; Wrist Joint; Radial Neuropathy; Paralysis
PubMed: 36550081
DOI: 10.1142/S2424835522500953 -
International Journal of Oral and... May 2023The aim of this systematic review was to determine the most prevalent complications resulting from total temporomandibular joint (TMJ) replacement. An electronic search... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review was to determine the most prevalent complications resulting from total temporomandibular joint (TMJ) replacement. An electronic search was performed using the Embase, LILACS, MEDLINE (via PubMed), SciELO, Scopus, and Web of Science databases up to June 2022. Prospective and retrospective clinical studies on patients who underwent TMJ replacement were included. Two reviewers performed the study selection, data extraction, and individual risk of bias assessment using the Joanna Briggs Institute Critical Appraisal Tools. The pooled prevalence of each complication was calculated through a proportion meta-analysis using the random-effects model. Twenty-eight studies met the eligibility criteria and were included in the review. All of the eligible studies had a low risk of bias. The results of the meta-analysis revealed that the most prevalent complication was paresis or paralysis of the facial nerve branches (7.8%; 95% confidence interval (CI) 2.6-15.1%, I = 94.5%), followed by sensory alterations (1.8%; 95% CI 0.6-4.9%, I = 88.8%), heterotopic bone formation (1.0%; 95% CI 0.1-2.5%, I = 75.8%), and infection (0.7%; 95% CI 0.1-1.6%, I = 22.7%). In conclusion, TMJ replacement has a low prevalence of complications, and most of them can be managed successfully.
Topics: Humans; Temporomandibular Joint Disorders; Prospective Studies; Retrospective Studies; Temporomandibular Joint; Joint Prosthesis
PubMed: 36494246
DOI: 10.1016/j.ijom.2022.10.009 -
Brain Circulation 2022Cerebral cavernous malformations (CMs) are slow-flow vascular lesions that affect up to 0.5% of the pediatric population. These lesions are at risk for hemorrhage,... (Review)
Review
Cerebral cavernous malformations (CMs) are slow-flow vascular lesions that affect up to 0.5% of the pediatric population. These lesions are at risk for hemorrhage, causing seizures, and leading to neurological deficits. Here, we conduct a literature review and then present a report of a supratentorial CM in a 2-year-old patient with no significant past medical history who presented at our institution with 1 month of eye twitching. We performed a literature search of five databases of all articles published before 2020. Our inclusion criteria included cohort and case series of children with mean age under 12 years. Our search yielded 497 unique articles, of which 16 met our inclusion criteria. In our pooled literature analysis, a total of 558 children were included, 8.3% of which had a positive family history and 15.9% had multiple CMs. About 46.1% of the children had seizures, and 88.4% of those who underwent surgery had a total resection. About 85.1% of those with epilepsy were Engel Class 1 postsurgery. Over a mean follow-up of 4.1 years, 3.4% of patients had additional neurological deficits, including paresis and speech deficits. Our analysis of published literature shows surgical intervention should be considered first-line therapy for patients who are symptomatic from CM, present with seizure, and have surgically accessible lesions. Additional work is needed on outcomes and long-term effects of minimally invasive treatments, including radiosurgery and laser ablation, in pediatric populations.
PubMed: 36267435
DOI: 10.4103/bc.bc_26_22 -
JPMA. the Journal of the Pakistan... Jul 2022To explore the current scientific evidence on the effects of task-oriented rehabilitation programme of upper extremity post-stroke.
OBJECTIVE
To explore the current scientific evidence on the effects of task-oriented rehabilitation programme of upper extremity post-stroke.
METHODS
The systematic review comprised studies from 2012 to August 2020 which were both Hand-searched and explored on Cochrane, PubMed, PEDro and MEDLINE databases with authentic search techniques using population-intervention-control-outcomes format and Boolean operator. Randomised controlled trials on the use of task-oriented training for the improvement of upper extremity functional outcomes in subjects with stroke were shortlisted and reviewed. The risk bias tool was used to evaluate the biasness in the studies and the PEDro scale was used to evaluate the methodological quality of the studies.
RESULTS
Of the 28 articles assessed, 16(%) were included for detailed review. All studies varied significantly with PEDro scores between 6 and 10. There were 12(75%) high-quality studies and 4(25%) fell in fair category. All the studies showed significant results in the improvement of upper extremity after stroke through task-oriented training rehabilitation (p<0.05).
CONCLUSIONS
Evidence supports the beneficial effects of task-oriented rehabilitation for the improvement of upper extremity functions post-stroke.
Topics: Hand; Humans; Recovery of Function; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 36156569
DOI: 10.47391/JPMA.3864 -
Medicina (Kaunas, Lithuania) Sep 2022Besides corticosteroids, clinicians found that vestibular rehabilitation therapy (VRT) has a potential effect on vestibular neuritis (VN) improvement. This study aimed... (Meta-Analysis)
Meta-Analysis Review
Besides corticosteroids, clinicians found that vestibular rehabilitation therapy (VRT) has a potential effect on vestibular neuritis (VN) improvement. This study aimed to investigate the efficacy of both corticosteroid therapy (CT) compared to VRT, and each group compared to their combination (CT vs. (CT+VRT) and VRT vs. (CT + VRT). : Systematic searches were performed in PubMed, CINAHL, and Scopus for randomized controlled trials (RCTs) reporting the administration of at least CT and VRT for VN. The outcome of interest was VN's subjective and objective improvement parameters. Four RCTs involving a total of 182 patients with VN were eligible for systematic review and meta-analysis. The weighted mean difference (WMD) of canal paresis (objective parameter) in the CT group is significantly lower than in the VRT group after a 1 month follow-up (8.31; 95% CI: 0.29, -16.32; = 0.04; fixed effect). Meanwhile, the WMD of Dizziness Handicap Inventory (DHI) (subjective parameter) in the VRT group is significantly lower than in the CT group after a 1 month follow-up (-3.95; 95% CI: -7.69, -0.21; = 0.04; fixed effect). Similarly, the WMD of DHI in the combination group (CT+VRT) is significantly lower than in the CT group after a 3 month follow-up (3.15; 95% CI: 1.50, 4.80; = 0.0002; fixed effect). However, there is no significant difference in all outcomes after 12 months of follow-ups in all groups (CT vs. VRT, CT vs. combination, and VRT vs. combination). : This study indicates that CT enhances the earlier canal paresis improvement, as the objective parameter, while VRT gives the earlier DHI score improvement, as the subjective parameter. However, their long-term efficacy does not appear to be different. VRT has to be offered as the primary option for patients with VN, and corticosteroids can be added to provide better recovery in the absence of its contraindication. However, whether to choose VRT, CT, or its combination should be tailored to the patient's condition. Future studies are still needed to revisit this issue, due to the small number of trials in this field. (PROSPERO ID: CRD42021220615).
Topics: Adrenal Cortex Hormones; Humans; Paresis; Randomized Controlled Trials as Topic; Vertigo; Vestibular Neuronitis
PubMed: 36143898
DOI: 10.3390/medicina58091221 -
Advances in Clinical and Experimental... Dec 2022The assessment of motor function is vital in post-stroke rehabilitation protocols, and it is imperative to obtain an objective and quantitative measurement of motor... (Meta-Analysis)
Meta-Analysis
Accuracy of machine learning algorithms for the assessment of upper-limb motor impairments in patients with post-stroke hemiparesis: A systematic review and meta-analysis.
BACKGROUND
The assessment of motor function is vital in post-stroke rehabilitation protocols, and it is imperative to obtain an objective and quantitative measurement of motor function. There are some innovative machine learning algorithms that can be applied in order to automate the assessment of upper extremity motor function.
OBJECTIVES
To perform a systematic review and meta-analysis of the efficacy of machine learning algorithms for assessing upper limb motor function in post-stroke patients and compare these algorithms to clinical assessment.
MATERIAL AND METHODS
The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. The review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The search was performed using 6 electronic databases. The meta-analysis was performed with the data from the correlation coefficients using a random model.
RESULTS
The initial search yielded 1626 records, but only 8 studies fully met the eligibility criteria. The studies reported strong and very strong correlations between the algorithms tested and clinical assessment. The meta-analysis revealed a lack of homogeneity (I2 = 85.29%, Q = 48.15), which is attributable to the heterogeneity of the included studies.
CONCLUSION
Automated systems using machine learning algorithms could support therapists in assessing upper extremity motor function in post-stroke patients. However, to draw more robust conclusions, methodological designs that minimize the risk of bias and increase the quality of the methodology of future studies are required.
Topics: Humans; Motor Disorders; Stroke; Upper Extremity; Stroke Rehabilitation; Paresis
PubMed: 36047897
DOI: 10.17219/acem/152596 -
German Medical Science : GMS E-journal 2022Neuromuscular electrical stimulation (NMES) has been used as a treatment option in the therapy of dysphagia for several years. In a previous review of the literature, it... (Review)
Review
BACKGROUND
Neuromuscular electrical stimulation (NMES) has been used as a treatment option in the therapy of dysphagia for several years. In a previous review of the literature, it was concluded that NMES might be a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. However, due to different stimulation protocols, electrode positioning and various underlying pathological conditions, it was difficult to compare the studies which were identified and it was concluded that more empirical data is needed to fully understand the benefits provided by NMES. The purpose of this systematic review is, therefore, to evaluate recent studies regarding a potential effectiveness of transcutaneous NMES applied to the anterior neck as a treatment for dysphagia considering these different aspects.
METHOD
For this systematic review, a selective literature research in PubMed has been carried out on 5 May 2021 using the terms and screened for inclusion criteria by two reviewers in Rayyan. The search resulted in 62 hits.
RESULTS
Studies were excluded due to their publication language; because they did not meet inclusion criteria; because the topical focus was a different one; or because they did not qualify as level 2 studies. Eighteen studies were identified with varying patient groups, stimulation protocols, electrode placement and therapy settings. However, 16 studies have reported of beneficial outcomes in relation with NMES.
DISCUSSION
The purpose of this systematic review was to evaluate the most recent studies regarding a potential effectiveness of NMES as a treatment for oropharyngeal dysphagia considering different aspects. It could generally be concluded that there is a considerable amount of level 2 studies which suggest that NMES is an effective treatment option, especially when combined with TDT for patients with dysphagia after stroke and patients with Parkinson's disease, or with different kinds of brain injuries. Further research is still necessary in order to clarify which stimulation protocols, parameters and therapy settings are most beneficial for certain patient groups and degrees of impairment.
Topics: Deglutition Disorders; Electric Stimulation; Electric Stimulation Therapy; Humans; Stroke; Stroke Rehabilitation; Treatment Outcome
PubMed: 35875244
DOI: 10.3205/000310 -
Journal of Rehabilitation Medicine Oct 2022Rehabilitation is important in the first months after a stroke for recovery of functional ability, but it is also challenging, since distinct recovery trajectories are...
BACKGROUND
Rehabilitation is important in the first months after a stroke for recovery of functional ability, but it is also challenging, since distinct recovery trajectories are seen. Therefore, studying the early changes in muscle characteristics over time (e.g. muscle strength, muscle mass and muscle volume), which are known to be associated with functional abilities, may deepen our understanding of underlying recovery mechanisms of stroke survivors.
OBJECTIVE
This systematic review aims to describe the longitudinal changes in skeletal muscles, including muscle strength, muscle mass and muscle volume, during the first 3 months post-stroke.
METHODS
Electronic searches were conducted in Medline, Scopus and CENTRAL. Longitudinal cohort studies or controlled interventional trials that report data about patients in the first 3 months after stroke were identified. Skeletal muscle characteristics should be measured at least twice within 3 months post-stroke by objective, quantitative assessment methods (e.g. dynamometry, ultrasound, computed tomography). Effect sizes were calculated as Hedges' g using standardized mean differences.
RESULTS
A total of 38 studies (1,097 subjects) were found eligible. Results revealed an mean increase on the paretic side for upper and lower limb muscle strength (small to moderate effect sizes), whereas muscle thickness decreased (moderate to large effect sizes). Similar, but smaller, effects were found on the non-paretic side. There were insufficient data available to draw conclusions about lean muscle mass and muscle cross-sectional area. No studies aimed at investigating distinct trajectories of the muscle changes.
CONCLUSION
Muscle strength and thickness changes during the first 3 months after stroke in both the paretic and non-paretic side. Future studies should aim to understand "how" the stroke-induced muscle strength changes are achieved. Exploring existing data from longitudinal studies, by using cluster analyses, such as pattern recognition, could add to the current knowledge-base.
Topics: Humans; Longitudinal Studies; Muscle, Skeletal; Muscular Diseases; Paresis; Stroke; Stroke Rehabilitation
PubMed: 35848335
DOI: 10.2340/jrm.v54.573 -
World Neurosurgery Sep 2022Supplementary motor area syndrome (SMAS) may occur after frontal tumor surgery, with variable presentation and outcomes. We reviewed the literature on postoperative SMAS... (Review)
Review
BACKGROUND
Supplementary motor area syndrome (SMAS) may occur after frontal tumor surgery, with variable presentation and outcomes. We reviewed the literature on postoperative SMAS after brain tumor resection.
METHODS
PubMed, Web of Science, Scopus, and Cochrane were searched following the PRISMA guidelines to include studies reporting SMAS after brain tumor resection.
RESULTS
We included 31 studies encompassing 236 patients. Most tumors were gliomas (94.5%), frequently of low grade (61.4%). Most lesions were located on the left hemisphere (64.4%), involving the supplementary motor area (61.4%) and the cingulate gyrus (20.8%). Tractography and functional magnetic resonance imaging evaluation were completed in 45 (19.1%) and 26 (11%) patients. Gross total resection was achieved in 46.3% patients and complete SMA resection in 69.4%. A total of 215 procedures (91.1%) used intraoperative neuromonitoring mostly consisting of direct cortical/subcortical stimulation (56.4%), motor (33.9%), and somatosensory (25.4%) evoked potentials. Postoperative SMAS symptoms occurred within 24 hours after surgery, characterized by motor deficits (97%), including paresis (68.6%) and hemiplegia (16.1%), and speech disorders (53%), including hesitancy (24.2%) and mutism (22%). Average SMAS duration was 45 days (range, 1-365 days), with total resolution occurring in 188 patients (79.7%) and partial improvement in 46 (19.5%). Forty-eight patients (20.3%) had persisting symptoms, mostly speech hesitancy (60.4%) and fine motor disorders (45.8%).
CONCLUSIONS
Postoperative SMAS may occur within the first 24 hours after mesial frontal tumor surgery. Preoperative mapping and intraoperative neuromonitoring may assist resection and predict outcomes. Neuroplasticity and interhemispheric connectivity play a major role in resolution.
Topics: Brain Mapping; Brain Neoplasms; Glioma; Humans; Magnetic Resonance Imaging; Motor Cortex; Neurosurgical Procedures; Syndrome
PubMed: 35752423
DOI: 10.1016/j.wneu.2022.06.080 -
BMC Neurology Jun 2022Upper limb (UL) paresis is one of the most common stroke consequences and significantly restricts patients in everyday life. Instruments objectively measuring direct arm...
BACKGROUND
Upper limb (UL) paresis is one of the most common stroke consequences and significantly restricts patients in everyday life. Instruments objectively measuring direct arm use in stroke patients are lacking, but might be helpful to understand patients' impairment. Aiming to examine whether accelerometry is a suitable objective measure for everyday UL use in stroke patients, we conducted a systematic review on the association between accelerometer-derived measurements and clinical scales.
METHODS
Articles were systematically searched in PubMed, Scopus, Cochrane Library, PeDro and LIVIVO through December 12, 2021, screened for inclusion by AH, and subsequently independently screened by CK and MK. Disagreements were discussed until consensus. We included English and German peer-reviewed articles dealing with the validity of accelerometers as a measurement of UL use in stroke patients and eligible systematic reviews. Studies exclusively using accelerometry as an outcome parameter, book contributions, conference abstracts and case studies were excluded. Data extraction was conducted by AH and confirmed by CK focussing on study type, objective, accelerometer device, sample size, stroke status, assessments conducted, measurement method, wearing time and key results. We analysed all eligible articles regarding the correlation between accelerometry and other clinical assessments and the validity in accordance with the type of accelerometer.
RESULTS
Excluding duplicates, the initial search yielded 477 records. In the 34 eligible studies accelerometers was used with a predominance of tri-axial accelerometery (n = 12) and only few with two-axial application (n = 4). Regarding measures to examine association to accelerometer data different clinical scales were applied depending on the setting, the degree of impairment and/or the status of stroke. Cut-off values to determine correlations varied largely; most significant correlations are reported for the MAL [Range 0.31- 0.84] and the ARAT [Range 0.15-0.79].
CONCLUSIONS
Accelerometers can provide reliable data about daily arm use frequency but do not supply information about the movements´ quality and restrictions on everyday activities of stroke patients. Depending on the context, it is advisable to use both, accelerometry and other clinical measures. According to the literature there is currently no accelerometer device most suitable to measure UL activity. High correlations indicate that multi-dimensional accelerometers should be preferred.
Topics: Accelerometry; Activities of Daily Living; Humans; Paresis; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 35705906
DOI: 10.1186/s12883-022-02743-w