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1
Thapa, Shreejana, Pritam Gurung, Janam Shrestha, Samir Acharya, Pravesh Rajbhandhari, and Basant Pant. "A Case of Dorsal Spine Rhabdomyosarcoma in a 2 years old Child." Annapurna Journal of Health Sciences 2, no. 2 (August 8, 2022): 56–59. http://dx.doi.org/10.52910/ajhs.87.
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Rhabdomyosarcoma is highly aggressive malignant form of mesenchymal tumor arising from skeletal muscle cells rhabdomyoblast, that have failed to fully differenciate. It is most commonly seen in the children before 12 year of age. Primary spinal rhabdomyosarcoma is very rare. A 2 year old girl presented with mass over right upper back and inability to move lower limb. Patient underwent dorsal laminectomy and excision of the mass. Histology and molecular pathology helps in definite diagnosis and further need of chemotherapy or radiotherapy.
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Kušljugić, Ademir, Suada Kapidžić-Duraković, Zijada Kudumović, and Amela Čičkušić. "Chronic Low Back Pain in Individuals with Lower-limb Amputation." Bosnian Journal of Basic Medical Sciences 6, no. 2 (May 20, 2006): 67–70. http://dx.doi.org/10.17305/bjbms.2006.3177.
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Low back pain (LBP) is a common condition in individuals which experienced psychology and physical trauma. LBP is usually found in persons with lower-limb amputation (LLA), as the most common sign of somatisation or inappropriately made prostheses. Our goal was to investigate cases of chronic pain syndrome in persons with LLA and to determine factors, which influence their functional inability due to LBP. Pain after LLA has been studied. 37 persons, including 26 war veterans (70.2 %) and 11 (29.8 %) civilians with LLA due to an illness, were examined. All participants gave their informed consent and filled Oswestry index of disability due to chronic LBP, divided into 10 sections with 6 questions each, with marks in the range 0-5. The average age of 37 analyzed participants with LLA was 46.2+-10.92 years. 30 participants (81.1 %) were married, 4 (10.8 %) were single and 3 (8.1 %) were widows. 27 (73.0 %) participants had below the knee amputation, 5 (13.5 %) had above the knee amputation and 5 (13.5 %) had foot amputation. 33 (89.6 %) participants experienced chronic LBP in the last 2-10 years and 4 (10.8 %) did not have pains. According to Oswestry index for chronic pain higher level of social functionality was found in civilian amputees than in war veterans (p<0.05). Married civilian amputees have higher level of disability during seating (p<0.01), sleeping (p<0.01) and traveling (p<0.05). Higher level of social disorder among civilian amputees is due to the fact that they belong to older group of participants which usually have social integration at the lower degree. More serious problems during seating, traveling and sleeping among this group are probably due to co morbidity. Chronic LBP was found among 89.6 % of the participants. Higher level of social disorder, problems during seating, traveling and sleeping were identified in the civilian amputees and the married participants.
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Sen, Anuradha, and Omeshwar Singh. "POUR after spinal anesthesia in lower limb orthopaedic surgeries-a prospective study." International Journal of Research in Medical Sciences 6, no. 3 (February 22, 2018): 981. http://dx.doi.org/10.18203/2320-6012.ijrms20180626.
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Background: Postoperative urinary retention (POUR) is a common problem with overall rates looking at the entire surgical population quoted between 4% and 6%. POUR has been defined as the inability to void in the presence of a full bladder.Methods: This was a prospective, single-centre, observational study conducted between June 2015 to December 2016 at a tertiary care centre of Northern India. The study group enrolled 186 patients undergoing various lower limb surgeries under spinal anesthesia.Results: In the present study, out of 186 patients, 101 patients were male and 85 patients were female. Most of the patients were in the 41-60 years age group (78) followed by 72 patients were in the >61 years age group. 21 patients (11.29%) suffered with post operative urine retention (POUR) in whom catheterization was required, the incidence of POUR in joint replacement surgeries was 20.96% (13/62). In the present study incidence of POUR was more in males (12 patients) as compared to females (9 patients). POUR was more common in the elderly age group.Conclusions: By carefully identifying patients at risk, adopting appropriate anesthetic techniques and perioperative care principles and accurately monitoring bladder volume by ultrasound, POUR may be prevented and the associated morbidity minimized. Hence it becomes imperative to evaluate the true incidence and consequences of POUR in large prospective clinical studies. Spontaneous micturition should remain a criterion for discharge after spinal anaesthesia.
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Umberger, Brian R. "Stance and swing phase costs in human walking." Journal of The Royal Society Interface 7, no. 50 (March 31, 2010): 1329–40. http://dx.doi.org/10.1098/rsif.2010.0084.
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Leg swing in human walking has historically been viewed as a passive motion with little metabolic cost. Recent estimates of leg swing costs are equivocal, covering a range from 10 to 33 per cent of the net cost of walking. There has also been a debate as to whether the periods of double-limb support during the stance phase dominate the cost of walking. Part of this uncertainty is because of our inability to measure metabolic energy consumption in individual muscles during locomotion. Therefore, the purpose of this study was to investigate the metabolic cost of walking using a modelling approach that allowed instantaneous energy consumption rates in individual muscles to be estimated over the full gait cycle. At a typical walking speed and stride rate, leg swing represented 29 per cent of the total muscular cost. During the stance phase, the double-limb and single-limb support periods accounted for 27 and 44 per cent of the total cost, respectively. Performing step-to-step transitions, which encompasses more than just the double-support periods, represented 37 per cent of the total cost of walking. Increasing stride rate at a constant speed led to greater double-limb support costs, lower swing phase costs and no change in single-limb support costs. Together, these results provide unique insight as to how metabolic energy is expended over the human gait cycle.
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Pua, Uei, and Daniel ES Wong. "Angioplasty in Critical Limb Ischaemia: One-year Limb Salvage Results." Annals of the Academy of Medicine, Singapore 37, no. 3 (March 15, 2008): 224–29. http://dx.doi.org/10.47102/annals-acadmedsg.v37n3p224.
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Introduction: Lower extremity amputation prevention (LEAP) is an ongoing programme in our institution aimed at limb salvage in patients with critical limb ischaemia (CLI). Patients in the LEAP programme with reconstructible anatomy on initial Doppler imaging received either bypass surgery or percutaneous transluminal balloon angioplasty (PTA). We describe the 1-year limb salvage rates in 46 consecutive patients with CLI who received PTA in 2005. Clinical Picture: A total of 46 patients, 28 women and 18 men, between the ages of 40 and 91 years old (mean age, 70.8) received PTA in 2005. The most common presenting symptom was rest pain (n = 23), followed by pre-existing gangrene (n = 20), non-healing ulcer (n = 17) and cellulitis (n = 8). The majority of the patients (57%) had 3 to 4 risk factors. Diabetes mellitus (91%) and hypertension (80%) were the 2 most common risk factors. The patients were kept under surveillance for periods ranging from 12 to 21 months with a mean of 13.3 months, both clinically and with haemodynamic measurements [ankle-brachial index (ABI), toe pressure (TP) and digital-brachial index (DBI)]. Treatment: The aim of PTA is to achieve straight-line flow from the abdominal aorta down to either a patent dorsalis pedis or plantar arch with limb salvage as the ultimate goal. The patterns of the treated segments were as follows: aorto-iliac occlusions (n = 3), pure infrapopliteal disease (n = 5), femoropopliteal disease with at least 1 good infrapopliteal run-off vessel (n = 16) and combined femoropopliteal and infrapopliteal disease (n = 25). Technical success was achieved in 89% of patients (41 out of 46 patients). The most common cause of technical failure is the inability to cross long chronic total occlusions. Outcome: Paired T test was performed and showed statistically significant improvement in haemodynamic markers within the technically successful group. This included increase in the mean ABI from 0.62 (pre-angioplasty) to 0.91 (Day 1 post-angioplasty), an increase of 0.29 [95% confidence interval (95% CI), 0.1953 to 0.3875; P <0.001]. One year post-angioplasty, the mean ABI was 0.84, an increase of 0.22 (95% CI 0.1512 to 0.3121; P <0.001). There was also significant increase in the mean DBI of 0.17 from 0.23 to 0.41 (pre-angioplasty versus Day 1 post angioplasty – 95% CI of 0.1006 to 0.2433; P <0.001). In addition, significant increase in the mean TP of 28.2 mmHg from 36.8 to 63.2 mmHg (pre-angioplasty versus Day 1 post angioplasty – 95% CI, 18.493 to 37.939; P <0.001) was also noted. Of the 23 patients who presented with rest pain, total abolishment of symptoms was achieved in 21 patients (91%). Healing of pre-existing gangrene was attained in 15 patients (66%). Five patients subsequently received minor amputation for pre-existing gangrene. Clinical improvement in all the patients who presented with non-healing ulcers (n = 17) and cellulitis (n = 8) was attained. More importantly, all healed ulcers remained healed throughout the study period. The limb salvage rates were 93% at 1 month, 87% at 3 months, 82% at 6 months and 78% at 1 year. Conclusion: Angioplasty is a safe and effective limb salvage method in patients with CLI and has a high 1-year limb salvage rate. Key words: Angioplasty, Arterial occlusive diseases, Balloon, Lower extremity, Treatment outcome
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Moltó, Iván Nacher, Juan Pardo Albiach, Juan José Amer-Cuenca, Eva Segura-Ortí, Willig Gabriel, and Javier Martínez-Gramage. "Wearable Sensors Detect Differences between the Sexes in Lower Limb Electromyographic Activity and Pelvis 3D Kinematics during Running." Sensors 20, no. 22 (November 12, 2020): 6478. http://dx.doi.org/10.3390/s20226478.
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Each year, 50% of runners suffer from injuries. Consequently, more studies are being published about running biomechanics; these studies identify factors that can help prevent injuries. Scientific evidence suggests that recreational runners should use personalized biomechanical training plans, not only to improve their performance, but also to prevent injuries caused by the inability of amateur athletes to tolerate increased loads, and/or because of poor form. This study provides an overview of the different normative patterns of lower limb muscle activation and articular ranges of the pelvis during running, at self-selected speeds, in men and women. Methods: 38 healthy runners aged 18 to 49 years were included in this work. We examined eight muscles by applying two wearable superficial electromyography sensors and an inertial sensor for three-dimensional (3D) pelvis kinematics. Results: the largest differences were obtained for gluteus maximus activation in the first double float phase (p = 0.013) and second stance phase (p = 0.003), as well as in the gluteus medius in the second stance phase (p = 0.028). In both cases, the activation distribution was more homogeneous in men and presented significantly lower values than those obtained for women. In addition, there was a significantly higher percentage of total vastus medialis activation in women throughout the running cycle with the median (25th–75th percentile) for women being 12.50% (9.25–14) and 10% (9–12) for men. Women also had a greater range of pelvis rotation during running at self-selected speeds (p = 0.011). Conclusions: understanding the differences between men and women, in terms of muscle activation and pelvic kinematic values, could be especially useful to allow health professionals detect athletes who may be at risk of injury.
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Meloni, Marco, Valentina Izzo, Valerio Da Ros, Daniele Morosetti, Matteo Stefanini, Enrico Brocco, Laura Giurato, Roberto Gandini, and Luigi Uccioli. "Characteristics and Outcome for Persons with Diabetic Foot Ulcer and No-Option Critical Limb Ischemia." Journal of Clinical Medicine 9, no. 11 (November 21, 2020): 3745. http://dx.doi.org/10.3390/jcm9113745.
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The study aimed to evaluate clinical and vascular characteristics, as well as outcomes, for diabetic persons with foot ulceration and no-option critical limb ischemia (CLI). The study group included a sample of patients admitted to our diabetic foot unit because of a new diabetic foot ulcer and CLI. All subjects were managed using a limb salvage protocol which includes lower-limb revascularization. According to whether or not the revascularization procedure was a success, patients were respectively divided into two groups: successfully treated CLI patients (ST-CLI) and no-option CLI patients (NO-CLI). Failed revascularization was considered in the case of technical recanalization failure of occluded vessels (inability to overcome the obstruction) and/or absence of arterial flow to the foot. Limb salvage, major amputation, and death after 1 year of follow-up were evaluated and compared between the two groups. Overall, 239 patients were included, 74.9% belonging to ST-CLI and 25.1% to NO-CLI. NO-CLI patients reported more cases of ischemic heart disease (80 vs. 62.1, p = 0.008), heart failure (63.3 vs. 32.4%, p < 0.0001), and end-stage renal disease (ESRD) (60 vs. 25.7%) than ST-CLI patients. In addition, more vessels were affected in the NO-CLI group (5.2 ± 1.6 vs. 4 ± 1.5, p < 0.0001), and there was more involvement of tibio-peroneal trunk (50 vs. 30.2%, p = 0.006), anterior tibial (93.3 vs. 82.7, p = 0.03), posterior tibial (93.3 vs. 73.7%, p = 0.0005), peroneal (70 vs. 48%, p = 0.002), and below-the-ankle arteries (73.3 vs. 39.1%, p < 0.0001) than ST-CLI. The 1 year outcomes for the whole population were 69.9% limb salvage, 10.9% major amputation, and 19.2% death. The outcomes for NO-CLI and ST-CLI were, respectively, as follows: limb salvage (13.8 vs. 73.4%, p < 0.0001), amputation (30 vs. 4.5%, p = 0.0001), and mortality (50 vs. 8.9%, p < 0.0001). NO-CLI patients showed a more severe pattern of peripheral arterial disease (PAD) with distal arterial lesions and worse outcomes than ST-CLI.
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George, Jerry, Sibi Joseph, Mongezi Tau, Lourdes de Fatima Ibanez Valdes, Thozama Dubula, and Humberto Foyaca-Sibat. "Case Report: Thalamomesencephalic stroke in a patient with HIV." F1000Research 9 (March 30, 2021): 1250. http://dx.doi.org/10.12688/f1000research.26722.3.
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We present a 41-year-old HIV-positive female patient complaining of complete right palpebral ptosis, diplopia, and inability to balance herself. On examination, the right eye was able to move laterally and downwards. The motor exam showed left hemiparesis (4/5) on upper and lower limbs, bilateral Babinski sign with left hemiataxia without the sensory disorder. CT scan and magnetic resonance imaging angiography demonstrated an ischemic infarct on the right paramedian branch of the posterior cerebral artery territory. This patient did not present clinical manifestations of the thalamic lesion. To our knowledge, this is the first reported case of a young patient presenting a unilateral thalamomesencephalic ischemic stroke secondary to HIV vasculitis with bilateral Babinski signs and without thalamic signs in the medical literature.
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George, Jerry, Sibi Joseph, Mongezi Tau, Lourdes de Fatima Ibanez Valdes, Thozama Dubula, and Humberto Foyaca-Sibat. "Case Report: Thalamomesencephalic stroke in a patient with HIV." F1000Research 9 (December 1, 2020): 1250. http://dx.doi.org/10.12688/f1000research.26722.2.
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We present a 41-year-old HIV-positive female patient complaining of complete right palpebral ptosis, diplopia, and inability to balance herself. On examination, the right eye was able to move laterally and downwards. The motor exam showed left hemiparesis (4/5) on upper and lower limbs, bilateral Babinski sign with left hemiataxia without the sensory disorder. CT scan and magnetic resonance imaging angiography demonstrated an ischemic infarct on the right paramedian branch of the posterior cerebral artery territory. This patient did not present clinical manifestations of the thalamic lesion. To our knowledge, this is the first reported case of a young patient presenting a unilateral thalamomesencephalic ischemic stroke secondary to HIV vasculitis with bilateral Babinski signs and without thalamic signs in the medical literature.
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Khan, Iffat Islam, Md Mahbubul Islam, Redoy Ranjan, Mohammad Tariqul Islam, and Asit Baran Adhikary. "A 60-year-old male presented with left-sided weakness and difficulty in speech." Bangabandhu Sheikh Mujib Medical University Journal 14, no. 1 (January 7, 2021): 7–12. http://dx.doi.org/10.3329/bsmmuj.v14i1.50517.
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This article has no abstract. The first 100 words appear below:
A 60-year-old male presented with weakness of the left side of the body followed by a sudden fall on the ground while working in the field, with difficulty in speech for 03 months. Weakness was sudden in onset which involved left upper and lower limbs with the inability to move the left side of the body and difficulty in walking. The patient also noticed that there was a deviation of the face towards the right side associated with dribbling of food with difficulty in speech but can follow the command with difficulty. There was also urinary incontinence for the same duration, but the bowel movement was normal.
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Sasikumar, Shilpa, and Vipin S G. "AYURVEDIC MANAGEMENT OF PAKSHAGHATA (ISCHAEMIC STROKE): CASE REPORT." Journal of Biological & Scientific Opinion 9, no. 3 (August 24, 2021): 29–33. http://dx.doi.org/10.7897/2321-6328.093144.
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Stroke occurs when there is interrupted blood supply to a part of brain or when the blood supply is reduced, leads to brain cell damage. Stroke is mainly of two types: ischemic and haemorrhagic stroke. Ischemic type of stroke is the most common type. The prevalence of stroke is approximately 250 per 1 lakh person and 9.95 percent of total death. The present case reported to the Sri Jayendra Saraswathi Ayurveda college and hospital, Nazarathpettai, Chennai, Tamilnadu with the complaints of inability to move left hand and left leg with the history of stroke 6 months back, also had slurred speech. This patient’s condition improved very well by internal medicines and panchakarma procedures. At the end of the treatment the patient’s upper and lower limbs range of movements and functions improved. There was also considerable recovery in the mobility, mode, energy and language ability. Recovery was promising and worth documenting.
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Leard, Teresa, and Carrie Barrett. "Successful Management of Severe Unilateral Lower Extremity Lymphedema in an Outpatient Setting." Physical Therapy 95, no. 9 (September 1, 2015): 1295–306. http://dx.doi.org/10.2522/ptj.20140358.
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Background and Purpose Non–cancer-related lymphedema is frequently unrecognized until it has advanced and, therefore, presents substantial management challenges. Treatment for lymphedema reflects cancer research and not the distinct complexities of non–cancer-related lymphedema. This case report describes an outpatient intervention for a patient with non–cancer-related unilateral lower extremity lymphedema. Case Description The patient was a 42-year-old woman who was morbidly obese and had left lower extremity chronic stage III lymphedema. Massive disfiguring lymphedema of her lower leg caused chronic wounds, pain, difficulty ambulating, and the inability to lift her leg in transfers. The patient received complete decongestive therapy (CDT) in an outpatient setting. Outcomes The volume of the patient's leg decreased more than 66%, so that her massive lower leg was transformed to nearly the same size as her unaffected limb. Proper compression management restored independent transfers and pain-free ambulation. Discussion Delayed diagnosis and treatment of non–cancer-related lymphedema result in increased severity and impaired mobility, making this a unique, complex condition requiring modifications to CDT in the outpatient setting. This case report demonstrates successful outpatient treatment of a patient with severe unilateral lower extremity lymphedema associated with large wounds and impaired mobility using CDT that was modified to accommodate her complex medical status, transportation barriers, and health insurance availability. Following 23 weeks of physical therapist interventions, the patient's affected lower extremity was the same size as the unaffected lower extremity, and she was independent in ambulation and stair climbing.
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George, Jerry, Sibi Joseph, Mongezi Tau, Lourdes de Fatima Ibanez Valdes, Thozama Dubula, and Humberto Foyaca-Sibat. "Case Report: Thalamomesencephalic stroke due to vasculitis in a patient with HIV." F1000Research 9 (October 16, 2020): 1250. http://dx.doi.org/10.12688/f1000research.26722.1.
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We present a 41-year-old HIV-positive female patient complaining of complete right palpebral ptosis, diplopia, and inability to balance herself. On examination, the right eye was able to move laterally and downwards. The motor exam showed left hemiparesis (4/5) on upper and lower limbs, bilateral Babinski sign with left hemiataxia without the sensory disorder. A computed tomography (CT) angiogram confirmed a diffuse vasculitis with parenchymal changes in the right thalamus and midbrain. CT scan and magnetic resonance imaging angiography demonstrated an ischemic infarct on the right paramedian branch of the posterior cerebral artery territory. This patient did not present clinical manifestations of the thalamic lesion. To our knowledge, this is the first reported case of a young patient presenting a unilateral thalamomesencephalic ischemic stroke secondary to HIV vasculitis with bilateral Babinski signs and without thalamic signs in the medical literature.
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Houlind, M. B., H. Rømer, W. Schmelling, T. Palsson, and K. K. Petersen. "Identification of pre-operative of risk factors associated with persistent post-operative pain by self-reporting tools in lower limb amputee patients – A feasibility study." Scandinavian Journal of Pain 16, no. 1 (July 1, 2017): 174. http://dx.doi.org/10.1016/j.sjpain.2017.04.030.
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AbstractAimsThe incidence of persistent post-operative pain (PPP) is 30–85% in lower limb amputee (LLA) patients and identification of preoperative risk factors are warranted. Preoperative levels of anxiety, depression, pain catastrophizing, neuropathic pain and severe preoperative pain have previously been linked with PPP but such screening tools are not used in the clinical hospital setting. The aim of this study was to assess feasibility of using questionnaires for anxiety, depression, pain catastrophizing, neuropathic pain and preoperative pain levels in a clinical preoperative setting.MethodsPatients scheduled for non-traumatic amputation of the lower leg or femur were recruited from three Danish hospitals. Exclusion criteria were surgery 4-weeks prior to LLA, same leg re-amputation, or inability to participate. Pre-operative values of anxiety, depression and catastrophizing were assessed using the Hospital Anxiety (A) and Depression(D) Scale (HADS) (cutoff: 8) and Pain Catastrophizing Scale (PCS) (cutoff =32). Neuropathic pain was assessed preoperatively using Pain-Detect-Questionnaire (PD-Q) (cutoff: 19). The maximum preoperative pain intensity was assessed using the Numeric Rating Scale (NRS; 0: no pain and 10: worst imaginable pain). Scores are presented as median values with interquartile range (Q1–Q3).ResultsEight of 18 patients (5 females) completed this pilot study: median age 71 (range 56–83), 6 femur and two lower leg amputees. Nine of ten excluded patients were unable to complete the questionnaires and one patient was operated acutely. Median pre-operative HADS-D and -A scores were 7 (3–9, 50% ≥ cutoff) and 4 (1–8, 25% ≥ cutoff), pre-operative PCS score was 24 (18–28, 13% ≥ cutoff), pre-operative PD-Q score was 16 (8–22, 50% ≥ cutoff) and NRS score was 9.5 (8–10).ConclusionsThis study indicates that it is possible to implement preoperative questionnaires in a clinical setting. However, more than 50% of the patients are unable to complete the questionnaires.
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Padanilam, Simon J., Steven R. Dayton, Ryan Jarema, Michael J. Boctor, and Vehniah K. Tjong. "Return to Sport After ACL Reconstruction: Strength and Functionality Testing." Video Journal of Sports Medicine 1, no. 5 (September 2021): 263502542110405. http://dx.doi.org/10.1177/26350254211040510.
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Background: Functionality testing following anterior cruciate ligament (ACL) reconstruction can benefit clinicians and patients in determining readiness for return to sport. While a component of a multifactorial decision, inability to perform well on these tests predicts increased risk of reinjury. As of 2013, only 41% of orthopaedic surgeons report using strength or functionality testing in evaluating patients for return to sport (RTS). Indications: In the intermediate to late stages of their rehabilitation program, patients may undergo these tests to determine readiness and safety to return to sport. Technique Description: The tests described in this video include the single and triple hop for distance, triple crossover hop, single and double vertical leg jump tasks, drop jump landing task, and isokinetic and isometric strength testing. Results: Clinicians who incorporate these tests into patient rehabilitation programs may reduce patient risk of ACL reinjury by 75% to 84%. The limb symmetry index (LSI) is a reliable calculated measure for these tests, with a strong reliability for the hop tests. The limb symmetry index can be calculated for each test and represents the ratio of measured performance of the involved, or post-ACL reconstruction, leg when compared against the uninvolved leg. The commonly used limb symmetry index threshold for passing each hop test is 90%. Patients who score 90% or greater on each of these tests are less likely to experience knee reinjury. Discussion/Conclusion: The ability of knee strength and functionality tests in determining RTS following ACL reconstruction has been highlighted as a tool in potentially reducing risk of knee reinjury. Other isometric and isokinetic testing can be used in addition to the described functionality tests but may not be possible in certain practices due to equipment and funding limitations. Usage of these strength and functionality tests, in conjunction with clinician evaluation, may lead to more optimal outcomes for patients and lower rates of reinjury. Psychological assessment may aid in evaluating patient readiness for return to sport. Importantly, further sport-specific testing is still recommended and will optimize patient outcomes.
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Mesin, Luca, Paola Porcu, Debora Russu, Gabriele Farina, Luigi Borzì, Wei Zhang, Yuzhu Guo, and Gabriella Olmo. "A Multi-Modal Analysis of the Freezing of Gait Phenomenon in Parkinson’s Disease." Sensors 22, no. 7 (March 29, 2022): 2613. http://dx.doi.org/10.3390/s22072613.
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Background: Freezing of Gait (FOG) is one of the most disabling motor complications of Parkinson’s disease, and consists of an episodic inability to move forward, despite the intention to walk. FOG increases the risk of falls and reduces the quality of life of patients and their caregivers. The phenomenon is difficult to appreciate during outpatients visits; hence, its automatic recognition is of great clinical importance. Many types of sensors and different locations on the body have been proposed. However, the advantages of a multi-sensor configuration with respect to a single-sensor one are not clear, whereas this latter would be advisable for use in a non-supervised environment. Methods: In this study, we used a multi-modal dataset and machine learning algorithms to perform different classifications between FOG and non-FOG periods. Moreover, we explored the relevance of features in the time and frequency domains extracted from inertial sensors, electroencephalogram and skin conductance. We developed both a subject-independent and a subject-dependent algorithm, considering different sensor subsets. Results: The subject-independent and subject-dependent algorithms yielded accuracies of 85% and 88% in the leave-one-subject-out and leave-one-task-out test, respectively. Results suggest that the inertial sensors positioned on the lower limb are generally the most significant in recognizing FOG. Moreover, the performance impairment experienced when using a single tibial accelerometer instead of the optimal multi-modal configuration is limited to 2–3%. Conclusions: The achieved results disclose the possibility of getting a good FOG recognition using a minimally invasive set-up made of a single inertial sensor. This is very significant in the perspective of implementing a long-term monitoring of patients in their homes, during activities of daily living.
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Felgueiras, Helena P. "Emerging Antimicrobial and Immunomodulatory Fiber-Based Scaffolding Systems for Treating Diabetic Foot Ulcers." Pharmaceutics 15, no. 1 (January 11, 2023): 258. http://dx.doi.org/10.3390/pharmaceutics15010258.
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Diabetic foot ulcers (DFUs) are one of the main complications of diabetes and are characterized by their complexity and severity, which are frequently aggravated by overexpressed inflammatory factors and polymicrobial infections. Most dressing systems offer a passive action in the treatment of DFUs, being frequently combined with antibiotic or immunomodulatory therapies. However, in many instances due to these combined therapies' inability to properly fight microbial presence, and provide a suitable, breathable and moist environment that is also capable of protecting the site from secondary microbial invasions or further harm, aggravation of the wound state is unavoidable and lower limb amputations are necessary. Considering these limitations and knowing of the urgent demand for new and more effective therapeutic systems for DFU care that will guarantee the quality of life for patients, research in this field has boomed in the last few years. In this review, the emerging innovations in DFU dressing systems via fiber-based scaffolds modified with bioactive compounds have been compiled; data focused on the innovations introduced in the last five years (2017–2022). A generalized overview of the classifications and constraints associated with DFUs healing and the bioactive agents, both antimicrobial and immunomodulatory, that can contribute actively to surpass such issues, has also been provided.
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Fernando, Malindu E., Robert G. Crowther, Peter A. Lazzarini, Kunwarjit S. Sangla, Scott Wearing, Petra Buttner, and Jonathan Golledge. "Gait in People With Nonhealing Diabetes-Related Plantar Ulcers." Physical Therapy 99, no. 12 (August 14, 2019): 1602–15. http://dx.doi.org/10.1093/ptj/pzz119.
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Abstract Background Abnormalities in gait have been associated with high plantar pressures and diabetes-related plantar foot ulcers. Whether these are a transient response to the ulcer or are representative of long-term lower limb biomechanical abnormalities is currently unknown. Objective The aim of this study was to examine whether 12 gait parameters identified as being associated with nonhealing diabetes-related plantar foot ulcers at baseline remained associated during a 6-month follow-up period. Design This was a longitudinal observational case-control study. Methods Gait assessments were performed at entry and twice during follow-up over a 6-month period in 12 participants with nonhealing diabetes-related plantar foot ulcers (case participants) and 62 people with diabetes and no history of foot ulcers (control participants) using a standardized protocol. Linear mixed-effects random-intercept models were used to identify gait parameters that consistently differed between case participants and control participants at all assessments after adjustment for age, sex, body mass index, presence of peripheral neuropathy, and follow-up time. Standardized mean differences (SMD) were used to measure effect sizes. Results Five of the 12 gait parameters were significantly different between case participants and control participants at all 3 time points. Case participants had a more abducted foot progression angle (SMD = 0.37), a higher pelvic obliquity at toe-off (SMD = −0.46), a greater minimum pelvic obliquity (SMD = −0.52), a lower walking speed (SMD = −0.46), and a smaller step length (SMD = −0.46) than control participants. Limitations The limitations included a small sample size, the observational nature of the study, and the inability to evaluate the impact of gait on wound healing. Conclusions This study identified abnormal gait parameters consistently associated with nonhealing diabetes-related plantar foot ulcers. Further research is needed to test the clinical importance of these gait characteristics.
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Banerjee, Ela. "Skin Deep: A Rare Case of Thyrotoxic Periodic Paralysis in an African American Patient." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A954. http://dx.doi.org/10.1210/jendso/bvab048.1949.
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Abstract Background: Thyrotoxic Periodic Paralysis (PP) is a rare form of hypokalemic PP that occurs in association with hyperthyroidism, especially Grave’s disease. This disease is frequently seen in males and is particularly prevalent among Asians with an incidence rate of 2%. In non-Asian populations, the incidence among those with hyperthyroidism is even lower at 0.1 - 0.2% and therefore significantly rare in African populations. Inability to recognize this emergency in the non-Asian population can therefore result in potentially fatal outcomes. Case Presentation: A 27 year old African American male with a history of Grave’s disease presented to the emergency department (ED) with the inability to move his muscles. Patient was initially diagnosed with Grave’s disease in 2017 when he was found to have suppressed TSH with elevated TSI and started on methimazole 40mg daily. The patient ran out of methimazole about 2 weeks prior to presentation and woke up on the day of admission with extreme muscle weakness. At the outside hospital, he was found to have potassium of 1.5mEq/L,TSH of < 0.1uL/ml and Free T4 of 3.4 ng/dL. He was given 1000 mg Propylthiouracil, stress dose hydrocortisone, propranolol and potassium replacement and then transferred to our ED for Endocrine evaluation. On assessment, he complained of nausea, vomiting, full body muscle weakness, tingling in his extremities and irritability. He denied any recent illnesses. On physical exam, Temperature 97.4 F, Respiration 18, Pulse 84, BP 157/72, O2 saturation 99%. His thyroid gland was enlarged however non-tender and without bruit. He had normal respiratory and cardiac exam. He was lying flat in bed and unable to raise his limbs against gravity and also unable to hold up his limbs when raised. He lacked his patellar and ankle jerk reflexes bilaterally. He was otherwise alert and oriented x 3. On labs, TSH was 0.004 uL/ml, Total T3 was 294 ng/dL, Free T4 of 3.01 ng/dL, Potassium was 2.1 mEq/L. His potassium was cautiously replaced and improved to 4.7 mEq/L later in the day, at which time, the patient was able move and sit up in bed. He was restarted on Methimazole 40mg daily for his thyroid disease and arranged for outpatient follow up. Discussion: Thyrotoxic PP is seen in a male-to-female ratio ranging from 17:1 to 70:1 and occurs at an average age of 20-40 years. Thyrotoxic PP is especially rare in the non-Asian population at an incidence rate of 0.1 - 0.2%. Nevertheless, in setting of ever-growing diversity due to immigration and inter-race relationships, it is difficult to predict one’s genetics based on the color of their skin. It is possible that our African American patient may have an Asian ancestor unbeknownst to him. Therefore, we must keep a broad differential regardless of one’s race so as to not miss timely diagnosis of medical emergencies which can result in reduced muscle strength, flaccid paralysis, respiratory failure, cardiac arrhythmias and eventual death.
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Garrigues-Ramón, Marta, Mariano Julián, Cristóbal Zaragoza, and Carlos Barrios. "Inability of Laplace's law to estimate sub-bandage pressures after applying a compressive bandage: a clinical study." Journal of Wound Care 30, no. 4 (April 2, 2021): 276–82. http://dx.doi.org/10.12968/jowc.2021.30.4.276.
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Objective: The aim of the current study was to compare pressures exerted on the lower limb by a high compression bandage as recorded by sub-bandage sensors and those estimated by Laplace's law. The correlation between pressures obtained in each anatomical zone and the corresponding limb perimeters were explored. Method: For the measurement of sub-bandage pressures, four anatomical zones in the lower right limb were determined. Pressures were recorded by nine pneumatic sensors and a PicoPress transducer. A two-layer compression bandage system (UrgoK2, Urgo Group, France) was used for the dressing. Pressures were registered in supine position. Sensor pressures were compared with those estimated by a modified Laplace's equation. Results: A total of 47 female volunteers were recruited (mean age: 21.9±2.3 years) to the study. In the four anatomical segments studied, pressures obtained by the sensors were lower than would be expected by applying Laplace's law (p<0.05). The biggest difference between the two methods was found at the supramalleolar level (42.1% lower by sensors compared with Laplace's equation). The correlation coefficient between pressure recorded by the sensors and that calculated at the perimeters was very weak, ranging from 0.5233 to 0.9634. Conclusion: Laplace's law, used to predict the sub-bandage pressure after applying a compressive bandage in the lower limb, was not useful, providing significantly higher pressures than those obtained by pneumatic sensors. Laplace's law underestimates the variable musculoskeletal components at the different segments of lower limb that act as compression damping forces.
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Cao, Fu Cheng, and Hong Wu Qin. "Force Control Based on Model Predictive for Lower Limb Rehabilitation Training." Applied Mechanics and Materials 738-739 (March 2015): 991–94. http://dx.doi.org/10.4028/www.scientific.net/amm.738-739.991.
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Human as a varying dynamic system, the control strategies of human-robot interacts differ significantly from that of conventional industrial robot. Considered the patient-centered exercise regimens, a force control method based predict is presented to control a lower limb rehabilitation robot. The control law is introduced that optimises the the maintained force level and limits excessive forceto injury the subject's lower extremity joints. Simulation results show that the robot could guide thelower limb of subjects to move under predefined model of the external force.
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Gray, Cori, and Craig Stern. "Recommendations for the Treatment of Parkinson's Disease." Journal of Contemporary Pharmacy Practice 65, no. 2 (June 1, 2018): 41–45. http://dx.doi.org/10.37901/jcphp16-00031.
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Parkinson's disease is a progressive disorder of the nervous system characterized by trembling or shaking of a limb, rigidity or stiffness of limbs, an inability to move, and impaired balance and coordination. Most symptoms begin to occur when neurons that produce dopamine in the substantia nigra of our brain die or become impaired. Dopamine is a chemical messenger that sends signals to our brain to produce smooth muscle movements. Without the neurons that create dopamine, our brain becomes unable to produce these muscle movements. Another pathological feature is the appearance of intracytoplasmic inclusions (Lewy bodies) in the remaining, intact nigral neurons.
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Chien, Sharon, Chang Y. Chung, Sujatha Sukumaran, Nicholas Osborne, Susan Lee, Charlene Ellsworth, James G. McNally, and Richard A. Firtel. "The Dictyostelium LIM Domain-containing Protein LIM2 Is Essential for Proper Chemotaxis and Morphogenesis." Molecular Biology of the Cell 11, no. 4 (April 2000): 1275–91. http://dx.doi.org/10.1091/mbc.11.4.1275.
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We have identified limB, a gene encoding a novel LIM domain-containing protein, LIM2, in a screen for genes required for morphogenesis. limB null cells aggregate, although poorly, but they are unable to undergo morphogenesis, and the aggregates arrest at the mound stage. limB null cells exhibit an aberrant actin cytoskeleton and have numerous F-actin–enriched microspikes. The cells exhibit poor adhesion to a substratum and do not form tight cell–cell agglomerates in suspension. Furthermore, limB null cells are unable to properly polarize in chemoattractant gradients and move very poorly. Expression of limB from a prestalk-specific but not a prespore-specific promoter complements the morphogenetic defects of thelimB null strain, suggesting that thelimB null cell developmental defect results from an inability to properly sort prestalk cells. LIM2 protein is enriched in the cortex of wild-type cells, although it does not colocalize with the actin cytoskeleton. Our analysis indicates that LIM2 is a new regulatory protein that functions to control rearrangements of the actin cytoskeleton and is required for cell motility and chemotaxis. Our findings may be generally applicable to understanding pathways that control cell movement and morphogenesis in all multicellular organisms. Structure function studies on the LIM domains are presented.
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Choi, Eun Pyeong, Seong Ju Yang, A. Hyun Jung, Hye Su Na, Yeong Ok Kim, and Ki Hun Cho. "Changes in Lower Limb Muscle Activation and Degree of Weight Support according to Types of Cane-Supported Gait in Hemiparetic Stroke Patients." BioMed Research International 2020 (September 23, 2020): 1–8. http://dx.doi.org/10.1155/2020/9127610.
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This study was aimed at investigating the changes in the degree of weight support loaded on the cane and paretic-side lower limb muscle activation according to the types of cane and cane-supported gait using a weight-support feedback cane (WSFC). Eleven hemiparetic stroke patients were recruited from a local rehabilitation hospital. WSFC can measure the degree of weight support loaded on the cane during cane-supported walking in units of kg, through a force sensor installed inside the handle. This study measured the degree of weight support loaded on the cane and lower limb muscle activation under four conditions: two-point and three-point gait with mono and quadripod canes. In the two-point gait with mono and quadripod canes, subjects were asked to move the WSFC and paretic-side foot forward at the same time and then move the nonparetic-side foot. In the three-point gait with mono and quadripod canes, subjects were asked to first move the WSFC forward, then the paretic-side foot, and finally the nonparetic-side foot. The degree of weight support loaded on the cane was significantly higher in the three-point gait with WSFC than in the two-point gait with WSFC for both mono (P=.047) and quadripod canes (P=.002). Additionally, the paretic-side lower limb muscle activation during the stance phase was significantly higher in the two-point gait with WSFC than in the three-point gait with WSFC for both mono (P=.008~.044) and quadripod canes (P=.008~.026). Our results suggest that applying the three-point gait with high cane dependence in the early stages of training for stability and subsequently applying the two-point gait for the enhancement of lower limb muscle activation and training of normal gait pattern could be effective.
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Błażkiewicz, Michalina, Ida Wiszomirska, Katarzyna Kaczmarczyk, Grażyna Brzuszkiewicz-Kuźmicka, and Andrzej Wit. "Lower limb loading during knee up in step aerobics: a pilot study." Biomedical Human Kinetics 8, no. 1 (November 3, 2016): 124–30. http://dx.doi.org/10.1515/bhk-2016-0018.
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SummaryStudy aim: Step aerobics is a form of aerobic power distinguished from other types of aerobic exercise by its use of an elevated platform. The purpose of this study was to examine how the aerobic exercise “knee up” affects kinematic and kinetic parameters and, above all, the length of the muscle contractions. Material and methods: The study analysed ten female fitness instructors with at least six years of experience. The task consisted in the knee up move performed using a 15 cm step and music with the beat frequency of 148 BPM. Kinematic and kinetic parameters were recorded using the Vicon system synchronized with two Kistler force plates. OpenSim software was used for calculation of the length of involved muscles. Results: Ranges in angles and torques suggest that the location that is the most prone to injuries and overtraining is the knee joint, followed by the hip and ankle joints. Greater values of the vertical component of ground reaction forces were observed during stepping down, which suggests greater load to the joints. The greatest work in the move analysed in this study was performed by the sartorius muscle and the tensor fasciae latae muscle. Conclusions: Despite the benefits that have been demonstrated when step classes are structured correctly and adapted to the participants, further research is needed concerning biomechanical load, exercise prescription, and injury prevention.
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Hébert-Losier, Kim. "Clinical Implications of Hand Position and Lower Limb Length Measurement Method on Y-Balance Test Scores and Interpretations." Journal of Athletic Training 52, no. 10 (October 1, 2017): 910–17. http://dx.doi.org/10.4085/1062-6050-52.8.02.
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Context: The Lower Quarter Y-Balance Test (LQ-YBT) was developed to provide an effective and efficient screen for injury risk in sports. Earlier protocol recommendations for the LQ-YBT involved the athlete placing the hands on the hips and the clinician normalizing scores to lower limb length measured from the anterior-superior iliac spine to the lateral malleolus. The updated LQ-YBT protocol recommends the athlete's hands be free moving and the clinician measure lower limb length to the medial malleolus. Objective: To investigate the effect of hand position and lower limb length measurement method on LQ-YBT scores and their interpretation. Design: Cross-sectional study. Setting: National Sports Institute of Malaysia. Patients or Other Participants: A total of 46 volunteers, consisting of 23 men (age = 25.7 ± 4.6 years, height = 1.70 ± 0.05 m, mass = 69.3 ± 9.2 kg) and 23 women (age = 23.5 ± 2.5 years, height = 1.59 ± 0.07 m, mass = 55.7 ± 10.6 kg). Intervention(s): Participants performed the LQ-YBT with hands on hips and hands free to move on both lower limbs. Main Outcome Measure(s): In a single-legged stance, participants reached with the contralateral limb in each of the anterior, posteromedial, and posterolateral directions 3 times. Maximal reach distances in each direction were normalized to lower limb length measured from the anterior-superior iliac spine to the lateral and medial malleoli. Composite scores (average of the 3 normalized reach distances) and anterior-reach differences (in raw units) were extracted and used to identify participants at risk for injury (ie, anterior-reach difference ≥4 cm or composite score ≤94%). Data were analyzed using paired t tests, Fisher exact tests, and magnitude-based inferences (effect size [ES], ±90% confidence limits [CLs]). Results: Differences between hand positions in normalized anterior-reach distances were trivial (t91 = −2.075, P = .041; ES = 0.12, 90% CL = ±0.10). In contrast, reach distances were greater when the hands moved freely for the normalized posteromedial (t91 = −6.404, P < .001; ES = 0.42, 90% CL = ±0.11), posterolateral (t91 = −6.052, P < .001; ES = 0.58, 90% CL = ±0.16), and composite (t91 = −7.296, P < .001; ES = 0.47, 90% CL = ±0.11) scores. A similar proportion of the cohort was classified as at risk with the hands on the hips (35% [n = 16]) and the hands free to move (43% [n = 20]; P = .52). However, the participants classified as at risk with the hands on the hips were not all categorized as at risk with the hands free to move and vice versa. The lower limb length measurement method exerted trivial effects on LQ-YBT outcomes. Conclusions: Hand position exerted nontrivial effects on LQ-YBT outcomes and interpretation, whereas the lower limb length measurement method had trivial effects.
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Dan, Yongping, Yifei Ge, Aihui Wang, and Zhuo Li. "Human-Gait-Based Tracking Control for Lower Limb Exoskeleton Robot." Journal of Robotics and Mechatronics 34, no. 3 (June 20, 2022): 615–21. http://dx.doi.org/10.20965/jrm.2022.p0615.
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Research shows that it is practical for the normal human movement mechanism to assist the patients with stroke in robot-assisted gait rehabilitation. In passive training, the effect of rehabilitation training for patients can be improved by imitating normal human walking. To make the lower limb exoskeleton robot (LLER) move like a normal human, a tracking control scheme based on human gait data is proposed in this paper. The real human gait data is obtained from healthy subjects using a three-dimensional motion capture platform (3DMCP). Furthermore, the normal human motion characteristics are adopted to enhance the scientificity and effectiveness of assistant rehabilitation training using LLER. An adaptive radial basis function network (ARBFN) controller based on feed-forward control is presented to improve the trajectory tracking accuracy and tracking performance of the control system, where the ARBFN controller is deployed to predict the uncertain model parameters. The feed-forward controller based on the tracking errors is used to compensate for the input torque of LLER. The effectiveness of the presented control scheme is confirmed by simulation results based on experimental data.
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Sribalaji, C. A., S. Abhishek, S. P. Harisubramanyabalaji, and Anjan Kumar Dash. "Design and Development of Assistive Leg for Lower Limb Rehabilitation." Advanced Materials Research 984-985 (July 2014): 1235–44. http://dx.doi.org/10.4028/www.scientific.net/amr.984-985.1235.
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The main objective of this paper is to design and develop an assistive leg for the paralyzed patients, which supports them, by changing their paralyzed gait pattern to normal gait pattern. The normal gait pattern is achieved by reflex action. Two angle measurement sensors are mounted in the normal leg and two servo motors are mounted in the paralytic leg-at the hip and ankle. The principle is that as the person takes a step in his normal leg, the sensors detect the amount of leg movement and sent the data to microcontroller. Then the servo motors in the paralytic leg are actuated based on the commands from the microcontroller depending on the type of gait suitable for the person. It is observed in such patients that they follow three kinds of gait. Depending on the amount of normal leg movement the gait pattern is decided and the servo motors rotate to move the paralytic leg. During all these, the person still takes the help from the walking aid.
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Ruby, FA, S. Ahsan, Q. Hassan, M. Chandy, and A. Parvin. "A case report of spinal intramedullary lipoma." Pulse 7, no. 1 (May 7, 2015): 50–52. http://dx.doi.org/10.3329/pulse.v7i1.23251.
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3 months old boy presented with inablility to move upper limb and cries on touching the upper limb from 1 week of age. On examination reflexes were absent in upper limb but hyper reflexia was found in lower limb. Cervical and brain MRI revealed expansion of the cervical spinal canal with smoothly marginated mass within the cervical cord which is hyperintense in T1WI, T2WI and completely loses its signal intensity in FS and gradient weighted sequences. There was no diffusion restriction and appears mostly intramedullary. MRI features were consistent with intramedullary lipoma in cervical spinal cord.Pulse Vol.7 January-December 2014 p.50-52
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Carruthers, Celeste K. "The Qualifications and Classroom Performance of Teachers Moving to Charter Schools." Education Finance and Policy 7, no. 3 (July 2012): 233–68. http://dx.doi.org/10.1162/edfp_a_00067.
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Do charter schools draw good teachers from traditional, mainstream public schools? Using a thirteen-year panel of North Carolina public schoolteachers, I find that less qualified and less effective teachers move to charter schools, particularly if they move to urban schools, low-performing schools, or schools with higher shares of nonwhite students. It is unclear whether these findings reflect lower demand for teachers’ credentials and value added or resource constraints unique to charter schools, but the inability to recruit teachers who are at least as effective as those in traditional public schools will likely hinder charter student achievement.
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Frechette, Mikaela L., Libak Abou, Laura A. Rice, and Jacob J. Sosnoff. "Relationship Between Lower Limb Function and Fall Prevalence in Ambulatory Adults With Spinal Cord Injury: A Systematic Review." Topics in Spinal Cord Injury Rehabilitation 28, no. 2 (March 1, 2022): 153–75. http://dx.doi.org/10.46292/sci21-00026.
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Background Falls are common, detrimental events among ambulatory individuals with spinal cord injury (SCI). Following SCI, changes to lower limb function are probable and likely to impact an individual’s fall risk, yet no comprehensive review has been completed on the topic. Objectives This study systematically reviewed data on the relationship between lower limb function and fall prevalence in ambulatory individuals with SCI. Methods A literature search was conducted in PubMed, Web of Science, Scopus, and CINAHL. Two independent reviewers screened abstracts/titles and then full articles. Study details, participants’ characteristics, lower limb function assessed, and fall-related data were extracted from the studies. A qualitative analysis of the relationship between lower limb function and fall prevalence was performed. The risk of bias was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Results The search yielded 1553 articles. Eight prospective, two retrospective, and three cross-sectional studies met the eligibility criteria. These studies ranged from low to high risk of bias. Overall, the qualitative analysis provided little evidence to support the relationship between lower limb function recorded by clinical measures and fall prevalence. Conclusion This review highlights the inconsistent relationship between lower limb function and falls prevalence in ambulatory adults with SCI. Greater uniformity in methodology and consistent categorization of fallers and nonfallers among researchers is necessary to move the field forward. Investigating additional factors such as behavior traits, assistive device use, and environmental risk factors may be appropriate in understanding fall prevalence in this population.
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Yanagisawa, Takufumi, Ryohei Fukuma, Ben Seymour, Masataka Tanaka, Koichi Hosomi, Okito Yamashita, Haruhiko Kishima, Yukiyasu Kamitani, and Youichi Saitoh. "BCI training to move a virtual hand reduces phantom limb pain." Neurology 95, no. 4 (July 16, 2020): e417-e426. http://dx.doi.org/10.1212/wnl.0000000000009858.
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ObjectiveTo determine whether training with a brain–computer interface (BCI) to control an image of a phantom hand, which moves based on cortical currents estimated from magnetoencephalographic signals, reduces phantom limb pain.MethodsTwelve patients with chronic phantom limb pain of the upper limb due to amputation or brachial plexus root avulsion participated in a randomized single-blinded crossover trial. Patients were trained to move the virtual hand image controlled by the BCI with a real decoder, which was constructed to classify intact hand movements from motor cortical currents, by moving their phantom hands for 3 days (“real training”). Pain was evaluated using a visual analogue scale (VAS) before and after training, and at follow-up for an additional 16 days. As a control, patients engaged in the training with the same hand image controlled by randomly changing values (“random training”). The 2 trainings were randomly assigned to the patients. This trial is registered at UMIN-CTR (UMIN000013608).ResultsVAS at day 4 was significantly reduced from the baseline after real training (mean [SD], 45.3 [24.2]–30.9 [20.6], 1/100 mm; p = 0.009 < 0.025), but not after random training (p = 0.047 > 0.025). Compared to VAS at day 1, VAS at days 4 and 8 was significantly reduced by 32% and 36%, respectively, after real training and was significantly lower than VAS after random training (p < 0.01).ConclusionThree-day training to move the hand images controlled by BCI significantly reduced pain for 1 week.Classification of evidenceThis study provides Class III evidence that BCI reduces phantom limb pain.
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Goo, Anthony, Curt A. Laubscher, Ryan J. Farris, and Jerzy T. Sawicki. "Design and Evaluation of a Pediatric Lower-Limb Exoskeleton Joint Actuator." Actuators 9, no. 4 (December 11, 2020): 138. http://dx.doi.org/10.3390/act9040138.
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Lower-limb exoskeletons have undergone significant developments for aiding in the ambulation of adults with gait impairment. However, advancements in exoskeletons for the pediatric population have comparatively been lacking. This paper presents a newly developed joint actuator designed to drive the hip and knee joints of a pediatric lower-limb exoskeleton. The performance requirements associated with the actuators were determined based on a target audience of children ages 6–11 years old. The developed actuators incorporate a hybrid belt-chain transmission driven by a frameless brushless DC motor. One actuator underwent benchtop testing to evaluate its performance with respect to their torque production, bandwidth properties, backdrivability in terms of inertia and friction characteristics, speed capabilities, and operational noise levels. As a preliminary validation, a set of actuators were placed in a prototype orthosis to move a pediatric test dummy in gait tracking via state-feedback control. The results showed that the newly developed actuators meet the design specifications and are suitable for use in the pediatric exoskeleton being developed.
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Grzebień, Anna, Mariusz Chabowski, Maciej Malinowski, Izabella Uchmanowicz, Magdalena Milan, and Dariusz Janczak. "Analysis of selected factors determining quality of life in patients after lower limb amputation- a review article." Polish Journal of Surgery 89, no. 2 (April 30, 2017): 57–61. http://dx.doi.org/10.5604/01.3001.0009.8980.
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The amputation of the lower limb is a crippling procedure, which impairs both physical and mental aspect of the patient’s life and therefore, it is important to provide these patients with comprehensive health care. Patients and their families must change their lives and reorganize them, which is undoubtedly associated with a decrease in the quality of life. The aim of this study was to analyze various determinants of quality of life in patients after lower limb amputation and their impact on the physical, mental and social aspect of life. Based on the available literature, this paper discusses certain factors determining quality of life, including the presence of phantom pain and stump pain, the way patients move, independence in daily activity, occupational activity, and access to rehabilitation. Analysis of the impact of particular factors on quality of life in people after lower limb amputation may contribute to the improvement and introduction of new paradigms regarding care provided for amputees.
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Calle-Siguencia, John, Mauro Callejas-Cuervo, and Sebastián García-Reino. "Integration of Inertial Sensors in a Lower Limb Robotic Exoskeleton." Sensors 22, no. 12 (June 16, 2022): 4559. http://dx.doi.org/10.3390/s22124559.
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Motion assistance exoskeletons are designed to support the joint movement of people who perform repetitive tasks that cause damage to their health. To guarantee motion accompaniment, the integration between sensors and actuators should ensure a near-zero delay between the signal acquisition and the actuator response. This study presents the integration of a platform based on Imocap-GIS inertial sensors, with a motion assistance exoskeleton that generates joint movement by means of Maxon motors and Harmonic drive reducers, where a near zero-lag is required for the gait accompaniment to be correct. The Imocap-GIS sensors acquire positional data from the user’s lower limbs and send the information through the UDP protocol to the CompactRio system, which constitutes a high-performance controller. These data are processed by the card and subsequently a control signal is sent to the motors that move the exoskeleton joints. Simulations of the proposed controller performance were conducted. The experimental results show that the motion accompaniment exhibits a delay of between 20 and 30 ms, and consequently, it may be stated that the integration between the exoskeleton and the sensors achieves a high efficiency. In this work, the integration between inertial sensors and an exoskeleton prototype has been proposed, where it is evident that the integration met the initial objective. In addition, the integration between the exoskeleton and IMOCAP is among the highest efficiency ranges of similar systems that are currently being developed, and the response lag that was obtained could be improved by means of the incorporation of complementary systems.
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Rezende, Ricardo Barros Martins, Jefferson Lessa Soares de Macedo, Simone Corrêa Rosa, and Fernando Soares Galli. "Epidemiological profile and treatment of substance losses by trauma to the lower limbs." Revista do Colégio Brasileiro de Cirurgiões 44, no. 5 (October 2017): 444–51. http://dx.doi.org/10.1590/0100-69912017005004.
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ABSTRACT Objectives: to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. Methods: we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. Results: 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. Conclusion: the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.
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Hou, Shihao, Bizhen Lian, Wenhao Li, and Hong Tang. "A Basketball Training Posture Monitoring Algorithm Based on Machine Learning and Artificial Intelligence." Mobile Information Systems 2022 (August 12, 2022): 1–10. http://dx.doi.org/10.1155/2022/2264659.
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To increase the widespread attention of human gesture recognition technology, this paper proposes a basketball pose recognition method based on unit action division. Initially, the human gesture recognition algorithm is introduced for the verification of various effects and gestures of basketball players by monitoring various actions of basketball and to obtain the data of limbs using different detectors for different basketball movements. A large amount of data collection work was carried out for the experiment, and the corresponding experimental scenarios were described in the experimental design for testing. The methods for data processing and data division presented in this work are used to process the collected data. A feature vector set that describes a particular action is acquired and used as a sample set. The sample set is then delivered to the classifier. The classifier is implemented here based on the already-existing Weka platform, and performance evaluation and analysis of various classifiers are implemented. The results show that the differential limb function category has a better recognition effect on BP. The average accuracy of upper limb function was 92.19%, the average recall rate was 92.19%, and the accuracy of lower limb was much higher. The average accuracy of the four algorithms was within the range of 96.99% to 99.19% for lower limb movements and 84.89% to 92.19% for upper limb movements. The BP prosthetic network is used to create separate classifiers, ensuring that each basketball move was more than 95% accurate and that the average accuracy per basketball move was much more accurate. As a result, the accuracy level reached up to 98.85%. The validity of the basketball gesture recognition method recognized by the authors is sufficient and reasonable.
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MASUDA, Taiki, Toshinari TANAKA, Ryunosuke SAWAHASHI, Jonah KOMATSU, Manabu OKUI, Rie NISHIHAMA, and Taro NAKAMURA. "Development of a wearable lower limb force feedback device that can move freely in VR space." Proceedings of JSME annual Conference on Robotics and Mechatronics (Robomec) 2022 (2022): 2P2—D04. http://dx.doi.org/10.1299/jsmermd.2022.2p2-d04.
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Li, Tianhua, Shuhong Yang, Fang Hu, Qian Geng, Qing Lu, and Junqin Ding. "Effects of ankle pump exercise frequency on venous hemodynamics of the lower limb." Clinical Hemorheology and Microcirculation 76, no. 1 (October 15, 2020): 111–20. http://dx.doi.org/10.3233/ch-200860.
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PURPOSE: The purpose of this study was (1) to compare the effects of ankle pump exercise(APE) frequency on hemodynamics of the common femoral vein(CFV) and (2) to analyse the relationship between APE duration and lower limb fatigue. METHODS: Twenty-seven males and thirty-three females performed APE. Among them, there were thirty participants with non-lower limb fracture (N-LLF) and thirty participants with lower limb fracture (LLF).The colour doppler ultrasound was used to record the time-averaged mean velocity (TAMV) of common femoral venous flow when the participants at rest and move at different frequencies of 6 times/min, 10 times/min, 30 times/min, 60 times/min. The ratings of perceived exertion (RPE) was used to assess the lower limb fatigue of the participants when performing APE at the frequency of 60 times/min after 1 min, 2 mins, 3 mins, 4 mins and 5 mins. RESULTS: With the increase of frequency, TAMV increased significantly in both the participants with N-LLF and LLF (p < 0.01). The TAMV were 19.82±3.86, 33.78±8.76, 37.06±8.67, 43.82±10.40, 52.18±10.53, respectively in the participants with N-LLF and 16.98±3.01, 22.20±4.96, 24.01±5.78, 29.20±7.05, 35.75±9.28, respectively in the injured limb of patients with LLF when at rest and moving at the frequency of 6 times/min, 10 times/min, 30 times/min, 60 times/min. There was a positive correlation (p < 0.01) between lower limb fatigue and exercise duration.When the RPE was 16 points (the corresponding fatigue degree is “tired”), the exercise duration of the participants with N-LLF was 3 mins and that of the injured limb of patients with LLF was 2 mins. CONCLUSIONS: Both fast and slow-frequency APE can promote venous blood return in the lower limb. Despite of the equivalent APE duration, fast-frequency APE can promote venous blood return more effectively. When the frequency of APE was 60 times/min, participants with N-LLF can exercise for 3 mins, and the injured limb of patients with LLF can exercise for 2 mins.
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Bastian, A. J., K. M. Zackowski, and W. T. Thach. "Cerebellar Ataxia: Torque Deficiency or Torque Mismatch Between Joints?" Journal of Neurophysiology 83, no. 5 (May 1, 2000): 3019–30. http://dx.doi.org/10.1152/jn.2000.83.5.3019.
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Prior work has shown that cerebellar subjects have difficulty adjusting for interaction torques that occur during multi-jointed movements. The purpose of this study was to determine whether this deficit is due to a general inability to generate sufficient levels of phasic torque inability or due to an inability to generate muscle torques that predict and compensate for interaction torques. A second purpose was to determine whether reducing the number of moving joints by external mechanical fixation could improve cerebellar subjects' targeted limb movements. We studied control and cerebellar subjects making elbow flexion movements to touch a target under two conditions: 1) a shoulder free condition, which required only elbow flexion, although the shoulder joint was unconstrained and 2) a shoulder fixed condition, where the shoulder joint was mechanically stabilized so it could not move. We measured joint positions of the arm in the sagittal plane and electromyograms (EMGs) of shoulder and elbow muscles. Elbow and shoulder torques were estimated using inverse dynamics equations. In the shoulder free condition, cerebellar subjects made greater endpoint errors (primarily overshoots) than did controls. Cerebellar subjects' overshoot errors were largely due to unwanted flexion at the shoulder. The excessive shoulder flexion resulted from a torque mismatch, where larger shoulder muscle torques were produced at higher rates than would be appropriate for a given elbow movement. In the shoulder fixed condition, endpoint errors of cerebellar subjects and controls were comparable. The improved accuracy of cerebellar subjects was accompanied by reduced shoulder flexor muscle activity. Most of the correct cerebellar trials in the shoulder fixed condition were movements made using only muscles that flex the elbow. Our findings suggest that cerebellar subjects' poor shoulder control is due to an inability to generate muscle torques that predict and compensate for interaction torques, and not due to a general inability to generate sufficient levels of phasic torque. In addition, reducing the number of muscles to be controlled improved cerebellar ataxia.
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Liu, J. H., B. Li, Q. Ning, M. Zhou, Y. X. Li, M. C. Liu, and K. Xu. "Mechanical design of a passive lower-limb exoskeleton for load-carrying assistance." Journal of Physics: Conference Series 2213, no. 1 (March 1, 2022): 012035. http://dx.doi.org/10.1088/1742-6596/2213/1/012035.
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Abstract This paper presents a passive exoskeleton with 17 degrees-of-freedom (DOF) for load-carrying, which includes two 3DOFs ankle joint, two 2DOFs hip joint, two 1DOF knee joint, one 1DOF backpack, and two redundant DOFs at the thigh and shank, respectively, to improve the compatibility of human-machine locomotion. The modular backpack was designed to facilitate carrying of different loads. A horn-shaped spatial mechanism was designed to connect the hip joint and the backpack, and transfer the payload to the ground. A tension spring was adopted to absorb the gravitational potential energy of the load when walking, and fix the horn-shaped spatial mechanism at both sides. The segmented brace at the thigh and the shank were designed to adjust different legs. In order to improve the force transmission performance, we cancelled the extension DOF of the hip joint, and moved the rotation axis of the knee joint backward. The knee joint assistance mechanism was designed to allow the knee joint move freely when the flexion angle did not exceed 60°. However, when the knee bends over 60°, the knee joint presses the torsion spring to store energy. After then, it releases energy to assist knee extending. The Cooper-Harper scale tests demonstrated that the exoskeleton had excellent static support effect and movement flexibility, which verified the rationality of the exoskeleton design.
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Hunt, William, Mintu Nath, Sarah Bowrey, Lesley Colvin, and Jonathan P. Thompson. "Effect of a continuous perineural levobupivacaine infusion on pain after major lower limb amputation: a randomised double-blind placebo-controlled trial." BMJ Open 13, no. 2 (February 2023): e060349. http://dx.doi.org/10.1136/bmjopen-2021-060349.
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ObjectivesRandomised controlled trial of the effect of a perineural infusion of levobupivacaine on moderate/severe phantom limb pain 6 months after major lower limb amputation.SettingSingle-centre, UK university hospital.ParticipantsNinety patients undergoing above-knee and below-knee amputation for chronic limb threatening ischaemia under general anaesthesia. Exclusion criteria were patients having surgery under neuraxial anaesthesia; inability to operate a patient-controlled analgesia device or complete a Visual Analogue Scale; amputation for trauma or malignancy; or contraindication to levobupivacaine.InterventionsEither levobupivacaine 0.125% or saline 0.9% (10 mL bolus, infusion of 8 mL/hour for 96 hours) via a sciatic or posterior tibial nerve sheath catheter placed under direct vision during surgery.Primary and secondary outcome measuresThe primary outcome measure was the presence of phantom limb pain, residual limb pain and phantom limb sensations up to 6 months after amputation. Secondary outcome measures included early postoperative pain and morphine requirements after surgery.ResultsData from 81 participants were analysed; 6-month follow-up data were available for 62 patients. Pain and morphine requirements varied widely before and after amputation in both groups. The incidences of moderate/severe phantom limb pain, residual limb pain and phantom limb sensations were low from 6 weeks with no significant differences between groups in phantom limb pain at rest (OR 0.56, 95% CI 0.14 to 2.14, p=0.394) or movement (OR 0.58, 95% CI 0.15 to 2.21, p=0.425) at 6 months. Early postoperative pain scores were low in both groups with no between-group differences in residual limb pain or phantom limb sensations (rest or movement) at any time point. High postoperative morphine consumption was associated with worsening phantom limb pain both at rest (−17.51, 95% CI −24.29 to −10.74; p<0.001) and on movement (−18.54, 95% CI −25.58 to −11.49; p<0.001). The incidence of adverse effects related to the study was low in both groups: postoperative nausea, vomiting and sedation scores were similar, and there were no features of local anaesthetic toxicity.ConclusionsLong-term phantom limb pain, residual limb pain and phantom limb sensations were not reduced significantly by perineural infusion of levobupivacaine, although the study was underpowered to show significant differences in the primary outcome. The incidence of phantom limb pain was lower than previously reported, possibly attributable to frequent assessment and early intervention to identify and treat postoperative pain when it occurred. There were large variations in postoperative pain scores, high requirements for analgesics before and after surgery and some problems maintaining recruitment and long -term follow-up. Knowledge of these potential problems should inform future research in this group of patients. Further work should investigate the association between perioperative morphine requirements and late phantom limb pain.Trial registration numbersEudraCT 2007-000619-27;ISRCTN68691928.
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Dsouza, Ajay Prashanth, Sachin Tandon, Munire Gundogan, and Abdalla Ali Abdalla. "Adding Value to the Magnetic Resonance Examination in a Case of Brachial Plexus Birth Palsy." Journal of Clinical Imaging Science 8 (August 24, 2018): 38. http://dx.doi.org/10.4103/jcis.jcis_26_18.
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We report a case of brachial plexus birth palsy in an infant with the inability to move the left upper limb since birth. There was neither history of birth trauma nor any complications during delivery. Magnetic resonance imaging (MRI) of brachial plexus showed postganglionic injury with musculoskeletal abnormalities. The child underwent surgical repair of the plexus and is on physical rehabilitation. In this case report, we discuss the utility of a single MRI examination with an elaborate discussion on various MRI signs of brachial plexus injury including secondary musculoskeletal manifestations. The case reiterates the significance of two-in-one approach while imaging these cases with MRI. Apart from reporting the damage to the brachial plexus, the radiologist should actively search for glenohumeral dysplasia. Awareness of classification and assessment of glenohumeral dysplasia should be routinely included as an integral part of imaging report as it adds incremental value to the overall patient management and functional outcome.
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Suslyaev, V. G., K. K. Scherbina, L. M. Smirnova, A. V. Sokurov, and T. V. Ermolenko. "Medical technology of early recovery of the ability to move independently after amputation of the lower limb." Bulletin of the Russian Military Medical Academy 21, no. 2 (December 15, 2019): 101–9. http://dx.doi.org/10.17816/brmma25928.
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Results of early restoration of the ability to independent movement after amputation of the lower extremities as possibilities of prevention of development of the complications connected with a hypodynamia for reduction of terms of medical rehabilitation and restoration of quality of life are presented. Preparation for prosthetics was carried out with the application of modern methods of medical physical culture according to four motor activity levels. For prevention of development of contractures of joints, decrease in the puffiness of tissues of a stump will be applied techniques of medical physical culture, orthopedic laying, elastic bandaging of a stump of a shin and hip, carrying compression elastic and polymeric (silicone) covers. For improvement of lympho-venous outflow, reduction of puffiness of soft fabrics and of a phantom pain syndrome elastic glue bandaging (a therapeutic adhesive tapes) of a stump is shown. Non-drug treatment of phantom pain syndrome is especially relevant at contraindications, intolerance the patient of medicines. Among non-drug techniques of simplification of a phantom pain, syndrome use various techniques of reflexotherapy (acupuncture, an akupressura, etc.), to an empatotekhnik, a mirror therapy, phantom-impulsive gymnastics. Holding sessions of a mirror-therapy was followed with phantom-impulsive gymnastics by the standard technique. For prevention of formation of a flexion contracture of a knee joint after below-knee amputation used universal adjustable elastic orthosis for the knee made of polyurethane foam in the form of the rolled design with the fixing tapes is offered. Besides of, the technique of training moving by artificial limb helps the truncated extremity with the regulated reception sleeve or the made reception sleeve which is put on a stump from the water hardened plastic bandage is improved. The value of the offered technique consists in the imitation of end-bearing on a stump in the adjustable socket with the put-on reception sleeve and to training in use before fitting and walking with an artificial limb. This medical technology of early restoration of moving ability after amputation of a shin or a hip with the application of new designs of adjustable reception sleeves from thermoplastic materials in the form of a adjustable socket row with modular connection for assembly of artificial limbs of the lower extremities by express methods provides essential positive social and economic effect. The technical documentation set on new designs of artificial limbs of a shin and hip is developed for early primary prosthetics. The offered medical technology of early primary prosthetics is introduced at 27 state and five non-state prosthetic and orthopedic enterprises of the Russian Federation and also the prosthetic and orthopedic enterprises of Dushanbe (Republic of Tajikistan), Tashkent (Republic of Uzbekistan).
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Philip, Swetha Sara, Sunithi Elizabeth Mani, and Gordon N. Dutton. "Pediatric Balint’s Syndrome Variant: A Possible Diagnosis in Children." Case Reports in Ophthalmological Medicine 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/3806056.
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Balint’s syndrome is well described in adults, but not in children. It is caused by bilateral posterior parietal lobe damage and comprises a triad of simultanagnosia (inability to simultaneously see more than a small number of items), optic ataxia (impaired visual guidance of movement of the limbs and body), and apraxia of gaze (inability to volitionally direct gaze despite the requisite motor substrate) often associated with homonymous lower visual field loss. We, here, describe five children (four males, one female; mean age 7.4 years, [range 4−11 years]; birth weight ≤ 2.5 kg; four were born ≤ 36 weeks of gestational age and one at 40 weeks) who presented to the Cerebral Visual Impairment Clinic at a tertiary care center in South India with clinical features remarkably consistent with the above description. In all children neuroimaging showed bilateral parietooccipital gliosis with regional white matter volume loss and focal callosal thinning, consistent with perinatal hypoxic ischemic encephalopathy and possible neonatal hypoglycemia.
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Tokutake, Katsuhiro, Masaru Takeuchi, Shigeru Kurimoto, Sota Saeki, Yuta Asami, Keiko Onaka, Masaomi Saeki, Tadayoshi Aoyama, Yasuhisa Hasegawa, and Hitoshi Hirata. "A Therapeutic Strategy for Lower Motor Neuron Disease and Injury Integrating Neural Stem Cell Transplantation and Functional Electrical Stimulation in a Rat Model." International Journal of Molecular Sciences 23, no. 15 (August 6, 2022): 8760. http://dx.doi.org/10.3390/ijms23158760.
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Promising treatments for upper motor neuron disease are emerging in which motor function is restored by brain–computer interfaces and functional electrical stimulation. At present, such technologies and procedures are not applicable to lower motor neuron disease. We propose a novel therapeutic strategy for lower motor neuron disease and injury integrating neural stem cell transplantation with our new functional electrical stimulation control system. In a rat sciatic nerve transection model, we transplanted embryonic spinal neural stem cells into the distal stump of the peripheral nerve to reinnervate denervated muscle, and subsequently demonstrated that highly responsive limb movement similar to that of a healthy limb could be attained with a wirelessly powered two-channel neurostimulator that we developed. This unique technology, which can reinnervate and precisely move previously denervated muscles that were unresponsive to electrical stimulation, contributes to improving the condition of patients suffering from intractable diseases of paralysis and traumatic injury.
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Kumar, Naveen, Deepanjali Surendran, Bheemanathi Hanuman Srinivas, and Chanaveerappa Bammigatti. "Primary Sjogren’s syndrome: a great masquerader." BMJ Case Reports 12, no. 12 (December 2019): e231802. http://dx.doi.org/10.1136/bcr-2019-231802.
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A 41-year-old woman presented with paresthesia and inability to walk for 7 days. She had history of fatigue, polyarthralgia and difficulty in swallowing food for the last 1 year. She became edentulous over the last 5 years and wore dentures for the same. She appeared pale, emaciated and had oral thrush. She had areflexic quadriparesis with weakness more in lower limbs compared with upper limbs. With the initial diagnosis of Guillian-Barre syndrome, she was given five cycles of plasmapheresis following which there was a significant improvement in power. Sjogren’s syndrome was suspected based on edentulous state in a middle-aged woman with multisystem involvement. Evaluation with Schirmer’s test, parotid scintigraphy and labial minor salivary gland biopsy confirmed the diagnosis. She was treated with steroids following which a dramatic improvement in haemoglobin and total leucocyte count was noted. We report a varied presentation of primary Sjogren’s syndrome.
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S, Manasa, Rajashekhar CV, and Khader Abdul. "A SUCCESSIVE CLINICAL STORY ON GUILLAIN-BARRE SYNDROME UNDER THE LIGHT OF AYURVEDA: A CASE STUDY." International Journal of Research in Ayurveda and Pharmacy 13, no. 5 (October 15, 2022): 5–11. http://dx.doi.org/10.7897/2277-4343.1305113.
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Guillain-Barre syndrome (GBS) is a group of autoimmune syndromes comprising the disease's demyelinating and acute axonal degenerating forms. It is also an acute-onset, monophasic, immune-mediated polyneuropathy that often follows an antecedent infection. Here is an interesting case study where a 16-year-old girl with her parents reported to the outpatient department with the chief complaint of inability to walk without support, weakness in bilateral calf muscles, weakness in bilateral upper limbs and lower limbs and tingling sensation, pulling type of pain in the right ankle joint and also the heaviness of bilateral lower limbs, more in the morning. By examination, her sensory and motor systems showed impairment; one was hypotonic, proprioception was affected, and her gait was a high steppage gait. Her assessment was done by using Hughes GBS Disability Scale- 3/6. The patient’s nerve conduction study revealed severe motor and sensory axonal neuropathy in the upper and lower limbs. By seeing the nature of the disease and the patient's symptoms, we correlated with sarvanga vata according to our classics. Treatments were koshta shodhana (gut cleansing), abhyanga (massage of the whole body with medicated oil), Shastikashali panda sweda (Rubbing of medicated rice poultice over the body), basti (transrectal administration of medicines) and oral medicaments. Panchakarma treatments were for 30 days, followed by oral medications for the next 140 days. The intervention period of 154 days showed complete recovery of all the motor and sensory deficits; however, follow-up of the patient was maintained for 269 days, looking into the sustainability of the outcomes.
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Burleigh, A. L., F. B. Horak, and F. Malouin. "Modification of postural responses and step initiation: evidence for goal-directed postural interactions." Journal of Neurophysiology 72, no. 6 (December 1, 1994): 2892–902. http://dx.doi.org/10.1152/jn.1994.72.6.2892.
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1. In this study, the interaction between anticipatory postural adjustments for step initiation and automatic postural responses to an external perturbation were investigated by having subjects initiate a voluntary forward step while perturbed by a backward surface translation, which caused forward sway of the body. The postural adjustments for step initiation act to move the body center of mass (COM) forward, whereas the automatic postural responses act to move the COM backward to restore stance equilibrium. Because the postural behaviors are in opposition, we asked whether a temporal hierarchy exists in which automatic postural responses are executed to restore equilibrium and followed by stereotypic postural adjustments for step initiation, or whether the interaction between these two postural behaviors is more dynamic. 2. Lower extremity electromyographs (EMGs), ground reaction forces, and kinematics were recorded from 10 subjects during three conditions: to quantify the anticipatory postural adjustments for step initiation, subjects stepped forward as soon as they felt a proprioceptive cue; to quantify the automatic postural responses to perturbation, subjects maintained stance equilibrium in response to a backward surface translation under both feet; and to quantify the interaction between the postural adjustments for the voluntary step and the automatic responses to the perturbation, subjects were exposed to a backward surface translation and instructed to step forward as soon as they felt the platform begin to move. 3. The anticipatory adjustments for step initiation included tibialis activation [stance limb = 163 +/- 28 (SE) ms; swing limb = 173 +/- 33 ms] and soleus inhibition resulting in center of foot pressure (COP) moving backward and lateral toward the swing limb to propel the COM forward over the stance limb. Subsequently, activation of the swing limb gastrocnemius resulted in heel-off. In contrast, the automatic postural adjustments for maintenance of stance equilibrium during a backward surface translation included activation of soleus and gastrocnemius (104 +/- 23 ms and 115 +/- 14 ms, respectively) resulting in a symmetrical forward displacement of the COP that moved the COM back to its original position with respect to the feet. 4. When a forward step was initiated in response to the translation, the automatic postural responses were reduced in amplitude bilaterally in soleus and in the stance limb gastrocnemius. When present the postural response occurred at the same latency when the goal was to initiate a step as when the goal was to maintain standing.(ABSTRACT TRUNCATED AT 400 WORDS)
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Padhy, Susanta Kumar, Prabhat Sapkota, and Aditya Somani. "Triparesis: an unusual presentation of factitious disorder." BMJ Case Reports 12, no. 5 (May 2019): e226869. http://dx.doi.org/10.1136/bcr-2018-226869.
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Factitious disorder (FD) has diverse presentations but neurological presentation is unusual. In this report, we discuss a case of FD who presented with triparesis, that is, weakness of both lower limbs and right upper limb. Diagnosis of FD was made after detailed clinical evaluation, review of past medical records that revealed extensive evaluation to rule out physical illness, and inability to find any associated stressful event or material gain associated with illness. Management was largely supportive and was based on psychotherapy. Identification of FD depends on a high index of suspicion by the physician and the presence of atypical and medically unexplainable signs/symptoms.