Hemiparesis with multiple periventricular enhancing lesions on cranial CT

Summary A 23-year-old woman had progressive right hemiparesis followed by spontaneous clinical remission. The clinical profile and multifocal contrast-enhancing CT lesions in the periventricular region of the cerebrum favored the diagnosis of an acute demyelinating process. Serial examinations showed resolution of CT abnormalities. Right internal carotid angiography showed prominent deep draining medullary veins with fleck-like stains. The angiographic appearances might reflect vascular involvement in the demyelinating process.

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Zusammenfassung Eine 23jährige Frau mit progressiver Evolution einer rechten Hemiparese, gefolgt von spontaner klinischer Remission, wurde vorgeführt. Das klinische Profil sowie mehrfokale kontraststeigernde CT-Läsionen in der periventrikulären Region des Cerebrums begünstigten einen akuten Entmyelisierungsprozeß. Reihenmäßige CT-Untersuchungen zeigten eine Resolution der CT-Abnormitäten. Die rechte interne Karotid-Angiographie ergab eine prominente Sichtbarmachung der tiefabführenden medullären Venen mit teilchenförmigen Flecken. Die angiographischen Ergebnisse deuten vielleicht auf eine vaskuläre Beteiligung am Entmyelisierungsprozeß.

     

Fast repetitive force changes in hemiparetic and cerebellar patients

Summary A method for the continuous registration of rapid isometric force changes was investigated in 24 healthy control persons, 10 hemiparetic patients and 10 cerebellar patients. Though the selection of both patient groups involved comparable deficits with respect to the number of force changes attained, the analysis of the underlying force-velocity patterns revealed considerable differences in the performance of hemiparetic and cerebellar patients. Hemiparetic patients showed gross deficits in both the force increasing and decreasing phases. In contrast to this, most cerebellar patients were able to release force as fast as normal controls, while marked slowness was only found for the force increasing phases.This work has been supported by the Deutsche Forschungsgemeinschaft (Ma 1031/1-1)     

Traumatic Atlantoaxial Dislocation with Type II Odontoid Fractures: A Case Report

BackgroundOdontoid fracture frequently ensues after a cervical trauma, and most commonly at the junction between the dens and the body (type II odontoid fracture).Case PresentationThis report is focused on a 24-years-old male patient with right-sided hemiparesis, resulting from traumatic atlantoaxial dislocation with type II odontoid fracture. Cervical CT-scanning showed a spondylolisthesis of the C1-C2 complex with type II odontoid fracture, and the injury was treated using posterior reduction and internal stabilization. Therefore, hemiparesis was reduced, and during the follow-up period, our patients were disease-free.ConclusionEarly diagnosis and the appropriate management of atlantoaxial trauma is a possible approach towards preventing severe neurological deficits.     

Shoulder arthroplasty in patients with ipsilateral hemiparesis: a safe and durable procedure? A case series

HypothesisShoulder arthroplasty is a safe and durable procedure that provides pain relief, improved range of motion (ROM), and minimal complications for shoulder pain and dysfunction in patients with ipsilateral hemiparesis.MethodsThis is a retrospective review of all adult patients who underwent primary reverse total shoulder arthroplasty (RSA) or total shoulder arthroplasty (TSA) in the hemiparetic upper extremity at a single quaternary care academic medical center from 1988 to 2019. Patients were excluded if their neurologic insult was secondary to a spinal-cord injury, cerebral palsy, or inflammatory arthritis, if they underwent a hemiarthroplasty, if they exhibited mild hemiparesis (Medical Research Council Scale of ≥4), or if they had less than 30 days of radiographic follow-up. The primary clinical outcome was revision surgery for any reason. The secondary clinical outcomes included pain using the visual analog scale, ROM via active-assisted manual muscle testing (AAROM), and postoperative complications. The primary radiographic outcome was implant lucency using a standard scale.ResultsA total of 5 shoulders in 5 patients were included, 4 RSAs and 1 TSA with a mean clinical follow-up of 6.2 years (range: 1.42-14.2 years) and mean radiographic follow-up of 3.7 years (range: 31 days-13.5 years). No patient underwent revision surgery. The mean visual analog scale score significantly improved from 7.6 to 1.4 at the last follow-up (P = .005). The mean forward elevation AAROM improved from 27° preoperatively to 88° at the last follow-up (P = .015). There was no significant difference in external rotation at the last follow-up (P = .105). One patient had asymptomatic grade 1 glenoid component lucency with superior subluxation of the humerus after undergoing TSA at a final follow-up of 4.5 years. No other complications were reported.ConclusionShoulder arthroplasty is a durable procedure that provides pain relief, improved AAROM, and minimal complications in patients with ipsilateral hemiparesis. The increase in active-assisted forward elevation ROM can improve caregiver ease with hygiene and dressing. Patients in this study who underwent RSA did not have subsequent glenohumeral dislocation. Larger numbers of patients would be required for adequate power analysis regarding instability in this cohort of patients who may be at risk; our small series did not identify any instability events.Level of evidenceLevel IV; Treatment Study     

Performance of elbow tracking under constant torque disturbance in normotonic stroke patients and normal subjects

Objective. In this study, the influences of externally imposed constant torque on the voluntary elbow movements of stroke and normal subjects were investigated quantitatively.

Background. Muscle weakness, spasticity and incoordination are the major factors that interfere with stroke patient’s limb functions. Imposing external torque disturbance may worsen the motor performance. This experiment was designed to investigate the effects of small constant external torque on the performance of voluntary elbow movements.

Methods. Tracking of a ramp-and-hold angle trajectory in the direction of extension was used as the main task for performance assessment. Each subject repeated the same tracking movement six times in each of three loading conditions: no, assistive or resistive loading. Five normal and six stroke subjects were recruited for this study. We used parameters extracted from movement trajectory and processed electromyograms as the performance indicators.

Results. For normal subjects, there was no difference in the tracking performance in the three loading conditions. For stroke patients, the affected side had inferior performance to the healthy side in the free loading condition and the difference diminished in assistive and resistive loading conditions as the performance of the affected side improved. Integrated electromyograms of biceps or triceps did not show significant changes in different loading conditions.

Conclusions. Small externally imposed constant torque, either resistive or assistive, may improve motor performance of affected elbows in stroke patients.

Relevance. Most of the currently available prostheses are passive devices, aiming at providing better support and improving stability. The results of the current study imply that an active prosthetic device that applies a small constant torque to the hemiparetic elbow can improve its motor performance in stroke patients. The direction of external torque is to assist the weaker side of the antagonistic muscle pair.     

Quantification of reflex activity in stroke survivors during an imposed multi-joint leg extension movement

The goal of this study was to compare short- and long-latency reflex responses in eight major lower-extremity muscle groups following an imposed multi-joint leg movement between a group of 14 chronic (>1 year) stroke survivors and 10 healthy age-matched controls, and to investigate the influence of joint velocities and muscle excitation levels on these reflex responses in each respective group. Subjects were seated with their foot anchored to a sliding footplate that could extend their leg. Prior to the leg being moved, subjects were instructed to pre-activate hip and knee flexors and extensors. Feedback of joint torque was used to help subjects activate muscles over a range of excitation levels. Following pre-activation, the subject’s leg was passively extended so the knee or hip joint rotated at one of three different speeds (30, 60, and 120°/s). In general, it was found that the magnitude of stroke survivors’ reflex response was greater compared to controls’ in certain biarticular muscles, notably the gastrocnemius and medial hamstring, and the uniarticular adductor longus, and that the long-latency reflex component (between 40 and 150 ms post-movement) accounted for most of the observed differences. Furthermore, while reflex response amplitudes increased in both groups with increasing movement speed, the rate of increase was significantly larger in stroke subjects than in controls. Clinically, these findings may help explain why stroke survivors walk slowly since it is under these conditions that reflex responses better emulate those of their able-bodied counterparts.     

A single session of open kinetic chain movements emphasizing speed improves speed of movement and modifies postural control in stroke

Little attention has been given to training speed of movement, even though functional activities require quick submaximal contractions. Closed kinetic chain (CKC) exercises are considered more functional; however, the best method for training speed is not known. A single bout of open kinetic chain (OKC) exercises emphasizing speed was performed to determine whether movement velocity and muscle activation would improve in a single session and whether the improvements transfer to a physiological balance task. Eleven participants <1 year post-stroke performed an arm raise task before and after a single session of fast OKC exercises. Surface electromyography (EMG) from soleus (SOL), tibialis anterior (TA), biceps femoris (BF) and rectus femoris (RF) muscles, peak velocity and average power were recorded during the OKC exercises. EMG from SOL, TA, BF and RF and center of pressure (COP) velocity were measured during arm raise task. At the end of the OKC exercises, velocity, power and TA, BF and RF EMG area increased. The arm acceleration and BF EMG area increased significantly during the arm raise. The improvements observed at the end of the OKC exercises transferred to the arm raise task. The improvements in balance were comparable to those previously seen after CKC exercises.     

Reliability of treadmill exercise testing in older patients with chronic hemiparetic stroke

OBJECTIVE: To assess the test-retest reliability of cardiopulmonary measurements during peak effort and submaximal treadmill walking tests in older patients with gait-impaired chronic hemiparetic stroke. DESIGN: Nonrandomized test-retest. SETTING: Hospital geriatric research stress testing laboratory. PARTICIPANTS: Fifty-three subjects (44 men, 9 women; mean age, 65+/-8y) with chronic hemiparetic gait after remote (>6mo) ischemic stroke. Patients had mild to moderate chronic hemiparetic gait deficits, making handrail support necessary during treadmill walking. INTERVENTIONS: Peak effort and submaximal effort treadmill walking tests were conducted and then repeated on a separate day at least a week later.Main outcome measures Reliability coefficients (r) were calculated for heart rate, systolic blood pressure (SBP), oxygen consumption (Vo(2) [L/min]), Vo(2) (mL.kg(-1).min(-1)), respiratory exchange ratio (RER), rate-pressure product (RPP), and oxygen pulse during peak effort testing. The reliability coefficients for all but SBP and RPP data were calculated from the submaximal tests. RESULTS: Heart rate (r=.87), Vo(2)peak (L/min) (r=.92), Vo(2)peak (mL.kg(-1).min(-1)) (r=.92), and oxygen pulse (r=93) were highly reliable parameters during maximal testing in this population. Submaximal testing produced highly reliable results for V.o(2) (L/min) (r=.89) and oxygen pulse (r=.85). All cardiopulmonary measures except RER had a reliability coefficient greater than.80 during submaximal testing in this population. CONCLUSION: Our study provides the first evidence that peak effort treadmill testing provides highly reliable oxygen consumption measures in chronic hemiparetic stroke patients using minimal handrail support. The submaximal tests were at or near the threshold level of reliability for the 2 most important measures of V.o(2) (L/min) and V.o(2) (mL.kg(-1).min(-1)) (r=.89, r=.84, respectively), with the remaining measures falling above.70.     

Corticomuscular coherence in the acute and subacute phase after stroke

Objective

Stroke is one of the leading causes of physical disability due to damage of the motor cortex or the corticospinal tract. In the present study we set out to investigate the role of adaptations in the corticospinal pathway for motor recovery during the subacute phase after stroke.

Effects of kinesiotaping combined with the motor relearning method on upper limb motor function in adults with hemiparesis after stroke

IntroductionKinesio Taping (KT) is being widely used in neurorehabilitation as an adjuvant technique due to its therapeutic effects. The objective of this study was to determine the effects of Kinesio Taping combined with the motor relearning method on upper limb motor function in adult patients with post-stroke hemiparesis.MethodsA quasi-experimental study with pre-test and post-test in a sample of 10 adult patients with post-stroke hemiparesis, randomly assigned in two groups: experimental (n: 5) who received 12 sessions of Kinesio Taping combined with the motor relearning method and a control group (n: 5) who only received 12 sessions of the motor relearning method. Motor function was assessed through the selective movement pattern scale for adult patients with upper motor neuron injury before and after each intervention.Resultsstatistically significant differences (p < 0.05) were found when comparing the means of upper limb movement patterns of the experimental group.Conclusionsthe use of Kinesio Taping combined with the motor relearning method was encouraging for upper limb motor function in patients with spastic hemiparesis.