Physiotherapy Handbooks: 1. Exercises for the face, neck and upper limbs; 2. Exercises for the upper and lower trunk; 3. Exercises for the lower limb

✓ Although selective functional posterior rhizotomy (SFPR) is an established procedure for the treatment of spasticity, the electrophysiological criteria used to define which posterior rootlets should be cut have not been standardized. The purpose of this study was to determine the validity of the intraoperative electrophysiological criteria used to select posterior rootlets for sectioning in SFPR. Intraoperative stimulation of posterior lumbosacral nerve roots and rootlets, using a 50-Hz stimulus at threshold intensity, was performed in five nonspastic children (controls) undergoing laminectomy for spinal cord untethering and in 32 spastic patients undergoing SFPR. Electromyographic responses were recorded in the upper and lower limbs, the neck, and the face. The pattern of sustained responses was assessed in detail in 17 additional patients who had previously undergone SFPR and in the five controls. Sustained responses with ipsilateral lower limb extrasegmental spread occurred in both spastic patients and the control group. Contralateral lower limb spread and suprasegmental spread to the upper limbs, neck, and face were found only in spastic children. Sustained responses with an incremental pattern were restricted to the spastic population and correlated well with the extent of contralateral and suprasegmental spread, whereas decremental patterns were not associated with contralateral spread. It is concluded that contralateral and suprasegmental spread into the upper limbs, neck, and face, and incremental responses are probably valid criteria of abnormality.

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A rare case of Sweet syndrome secondary to melioidosis

BMC Dermatology ◽

10.1186/s12895-019-0096-2 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Sahathevan Vithoosan ◽

Balendran Thanushah ◽

Paramarajan Piranavan ◽

Dayal Gamlaksha ◽

Harindra Karunatilake ◽

...

Keyword(s):

Inflammatory Markers ◽

Burkholderia Pseudomallei ◽

Skin Lesions ◽

Upper Limbs ◽

Cutaneous Manifestations ◽

Sweet Syndrome ◽

Emerging Infection ◽

Oral Ulcers ◽

First Case ◽

The Face

Abstract Background Melioidosis is an emerging infection in South Asia caused by Burkholderia pseudomallei with various clinical presentations that include pneumonia, bacteraemia, arthritis, and deep-seated abscesses. Various cutaneous manifestations have been described in association with melioidosis. However Sweet Syndrome secondary to melioidosis has not been reported in the literature. Herein we describe the first case of Sweet syndrome secondary to melioidosis. Case presentation A 53-year-old previously healthy Sri Lankan female presented with high-grade fever, painful oral ulcers, odynophagia and multiple bilateral cervical lymphadenopathies for 1 month. She also had a loss of appetite and weight. She had oral ulcers and bilateral blepharitis. Dermatological examination revealed multiple tender papules with a mamillated appearance and targetoid lesions with a yellowish centre over the face, upper trunk and upper limbs. She also had multiple tender subcutaneous nodules over the extensor aspect of upper limbs. Her inflammatory markers were significantly elevated. Aspirate from a submental lymph node abscess revealed the growth of Burkholderia pseudomallei. Melioidosis antibody titer was > 10,240. The histology of the skin lesions of the face and left forearm showed a prominent neutrophilic infiltrate in the dermis and the morphological features were in favour of Sweet syndrome with panniculitis. She was started on intravenous meropenem 2 g daily and showed rapid clinical improvement with the disappearance of skin lesions as well as a reduction in inflammatory markers. Conclusion Sweet syndrome is an uncommon inflammatory disorder known to be associated with upper respiratory tract and gastrointestinal infections, malignancies and the use of certain drugs. Melioidosis is an emerging infection with various cutaneous manifestations. This is the first case of melioidosis causing the secondary sweet syndrome. It emphasizes the importance of considering melioidosis as a potential aetiology in patients with Sweet syndrome.

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Light sheet microscopy-based 3-dimensional histopathology of the lymphatic vasculature in Emberger syndrome

Phlebologie ◽

10.1055/a-1191-8380 ◽

2020 ◽

Vol 49 (04) ◽

pp. 242-248

Author(s):

René Hägerling

Keyword(s):

Lower Limb ◽

Lymphatic Vessels ◽

Light Sheet ◽

Lower Limbs ◽

Vascular Pathology ◽

Histopathological Analysis ◽

Upper Limbs ◽

3 Dimensional ◽

Light Sheet Microscopy ◽

Lymphatic Vasculature

Abstract Introduction Lymphovascular diseases represent a heterogenous group of inherited and sporadic disorders and refer to a range of possible underlying pathologies and pathogenesis.Emberger Syndrome, an inherited form of lymphedema, is characterized by bilateral lower limb lymphedema, however, upper limbs do not show any signs of swelling.To identify disease-associated histopathological alterations in patients with Emberger Syndrome and to elucidate potential histological differences between the lymphatic vasculature of upper and lower limbs, a detailed knowledge on the 3-dimensional tissue and vessel architecture is essential. However, the current gold standard in 2-dimensional histology provides only very limited spatial information. Material and methods To elucidate the underlying vascular pathology in Emberger Syndrome on the cellular level, we applied the 3-dimensional visualization and analysis approach VIPAR (volume information-based histopathological analysis by 3D reconstruction and data extraction) to entire wholemount immunofluorescence-stained human tissue samples. VIPAR is a light sheet microscopy-based imaging technique, which allows 3-dimensional reconstruction of entire tissue biopsies followed by automated and semi-automated analysis of vascular parameters in 3-dimensional space. Results Using VIPAR we could show that in Emberger Syndrome the dermal lymphatic vasculature is intact and non-disrupted.However, lower limbs showed an hypoplastic lymphatic vasculature with absence of lymphatic valves in pre-collecting and collecting vessels. In contrast to the lower limbs, the lymphatic vasculature of the upper limbs showed no morphological alterations of lymphatic vessels and lymphatic valves compared to healthy controls. Discussion Based on the 3-dimensional histopathological analysis we were able to perform a detailed phenotyping of lymphatic vessels in the upper and lower limb in Emberger Syndrome and to identify the underlying vascular pathology. In addition, we could show vascular alteration between the upper and lower limbs indicating a vascular heterogeneity of dermal lymph vessels causing the lower limb lymphedema.

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Cross-Sectional Survey of Musculoskeletal Disorders in Workers Practicing Traditional Methods of Underground Coal Mining

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072566 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2566

Author(s):

Madiha Ijaz ◽

Sajid Rashid Ahmad ◽

Muhammad M. Akram ◽

Steven M. Thygerson ◽

Falaq Ali Nadeem ◽

...

Keyword(s):

Coal Mining ◽

Upper Limb ◽

Lower Limb ◽

Lower Limbs ◽

Underground Mines ◽

Upper Limbs ◽

Underground Coal Mining ◽

Cross Sectional Survey ◽

Cross Sectional ◽

R Programming

Background: In subcontinental underground mines, coal mining is carried out manually and requires many laborers to practice traditional means of coal excavation. Each task of this occupation disturbs workers’ musculoskeletal order. In order to propose and practice possible ergonomic interventions, it is necessary to know what tasks (drilling and blasting, coal cutting, dumping, transporting, timbering and supporting, loading and unloading) cause disorder in either upper limbs, lower limbs, or both. Methods: To this end, R-programming, version R 3.1.2 and SPSS, software 20, were used to calculate data obtained by studying 260 workers (working at different tasks of coal mining) from 20 mines of four districts of Punjab, Pakistan. In addition, a Standard Nordic Musculoskeletal Questionnaire (SNMQ) and Rapid Upper Limb Assessment (RULA) sheet were used to collect data and to analyze postures respectively. Results: In multi regression models, significance of the five tasks for upper and lower limb disorder is 0.00, which means that task based prevalence of upper and lower limb disorders are common in underground coal mines. The results of the multiple bar chart showed that 96 coal cutters got upper limb disorders and 82 got lower limb disorders. The task of timbering and supporting was shown to be dangerous for the lower limbs and relatively less dangerous for the upper limbs, with 25 workers reporting pain in their lower limbs, and 19 workers reporting pain in their upper limbs. Documented on the RULA sheet, all tasks got the maximum possible score (7), meaning that each of these tasks pose a threat to the posture of 100% of workers. The majority of participants (182) fell in the age group of 26 to 35 years. Of those workers, 131 reported pain in the lower limbs and slight discomfort (128) in the upper limbs. The significance value of age was 0.00 for upper limb disorder and was 0.012 for lower limb disorder. Frequency graphs show age in direct proportion to severity of pain while in inverse proportion with number of repetitions performed per min. Conclusions: All findings infer that each task of underground coal mining inflicts different levels of disorder in a workers’ musculoskeletal structure of the upper and lower limbs. It highlighted the need for urgent intervention in postural aspects of each task.

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1674. Orthopedic Complications of Congenital Zika Syndrome in Brazil

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1538 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S613-S613

Author(s):

Nilson Nogueira Mendes Neto ◽

Igor T Queiroz ◽

Jessika T da S. Maia ◽

Marcelo Zacarkim ◽

A Desiree Labeaud ◽

...

Keyword(s):

Lower Limb ◽

Upper Limbs ◽

Rehabilitation Center ◽

Congenital Vertical Talus ◽

Clinical Presentations ◽

Congenital Zika Syndrome ◽

History Of ◽

Vertical Talus ◽

Social Profiles

Abstract Background Congenital Zika Syndrome (CZS) has a broad spectrum of clinical presentations that are still being described. This cohort study aimed to describe the orthopedic complications in children with microcephaly (MCP) related to Zika virus (ZIKV). Methods We evaluated 36 children with CZS up to 17 months of age followed at a pediatric rehabilitation center in the northeast of Brazil. Cohort enrollment occurred with children born between January 2015 and May 2016. We assessed their social profiles and orthopedic findings. Results Of the 36 cases, 25 were male. All of them lived in rural area. 25 had at least one congenital orthopedic alteration. Hip subluxation was the most common problem detected (n = 15); other lower limb abnormalities included knee subluxation (n = 7), clubfoot (n = 7); congenital vertical talus (n = 4); plano-valgus foot (n = 5). In relation to the upper limbs, 11 children presented with some shoulder and/or elbow abnormality and 16 had some alteration in the hand and/or on the wrist. Conclusion Orthopedic problems appear to be common in children with CZS and should be a focus of larger clinical studies. An initial orthopedic assessment may provide a better quality of life by helping children avoid further complications/deformities. Our results emphasize the orthopedic problems associated with CZS and the need to better describe many complications in the natural history of this infection. Disclosures All authors: No reported disclosures.

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Preference in Girls' Lower Limb Tasks

Asian Journal of Physical Education & Recreation ◽

10.24112/ajper.121309 ◽

2006 ◽

Vol 12 (1) ◽

pp. 39-47

Author(s):

Karen P. NONIS ◽

Dawne LARKIN ◽

Helen E. PARKER

Keyword(s):

Data Analysis ◽

Individual Differences ◽

Lower Limb ◽

Repeated Measures ◽

English Abstract ◽

Age Group ◽

Upper Limbs ◽

Within Subjects ◽

Environmental Demands ◽

And Task

LANGUAGE NOTE | Document text in English; abstract also in Chinese.The research on laterality indicates that children become increasingly right preferent with age but these relate mainly to data on the upper limbs while lower limb preference is limited. This study investigated the direction of six lower limb preference tasks which included: kicking (stationary and moving ball); pick-up; step-up; balance and hopping. Fifty-one girls in the age group of 3, 4, 5 and 6 years were tested over four sessions at four monthly intervals and classified as right, left or mixed preferent after performing on two successive trials. This study hypothesized that girls would become increasingly right preferent with age and that lower limb preference would differ for each task. Data analysis used a three-way ANOVA repeated measures procedure with Age (4 levels) as the between subjects factor and Session (4 sessions) and Task (6 tasks) as the within subjects factors (N = 51). The ANOVA results showed two task groupings indicating that lower limb preference is task dependent. The authors proposed the interaction of individual differences, changing task and environmental demands influence the expression of lower limb preference.偏向的研究顯示孩童随著年齡的增長會逐漸向右邊偏向，但這些卻主要是針對上肢的研究資料，而對下肢偏向的資料卻有限。本報吿探討六種下肢偏向的動作方向測試，其中包括：踢腿(定點和滾球)、拾起、踩踏、平衡和定點彈跳。五十一位三至六歲的女童參與四次測試，每次測試相隔四個月。在連續兩次嘗試後，將她們分類為向右偏向、向左偏向和綜合偏向。這項研究假設女童隨著年齡的增長，會逐漸有向右邊的偏向，對下肢的偏向會隨著動作的不同而有所改變。報告的資料分析使用了三項ANOVA反復測量規程，以年齡(4個數值)作為物件之間的因素，測試(4次測試)和動作(6個動作)作為物件之內的因素(N = 51)。ANOVA的結果呈現兩種動作類，顯示對於下肢的偏向是取決於動作的。作者提出看法，認為各個不同孩童的互動、動作和環境的轉換都對下肢偏向起著影響。

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Interlimb neural interactions in corticospinal and spinal reflex circuits during preparation and execution of isometric elbow flexion

Journal of Neurophysiology ◽

10.1152/jn.00705.2019 ◽

2020 ◽

Vol 124 (3) ◽

pp. 652-667

Author(s):

Atsushi Sasaki ◽

Naotsugu Kaneko ◽

Yohei Masugi ◽

Matija Milosevic ◽

Kimitaka Nakazawa

Keyword(s):

Lower Limb ◽

Elbow Flexion ◽

Motor Preparation ◽

Lower Limbs ◽

Spinal Reflex ◽

Upper Limbs ◽

Limb Muscle ◽

Motor Execution ◽

Lower Limb Muscles ◽

Neural Interactions

We found that upper limb muscle contractions facilitated corticospinal circuits controlling lower limb muscles even during motor preparation, whereas motor execution of the task was required to facilitate spinal circuits. We also found that facilitation did not depend on whether contralateral or ipsilateral hands were contracted or if they were contracted bilaterally. Overall, these findings suggest that training of unaffected upper limbs may be useful to enhance facilitation of affected lower limbs in paraplegic individuals.

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Lichen Planus Pigmentosus-like Reaction to Guasha

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475416659857 ◽

2016 ◽

Vol 20 (6) ◽

pp. 586-588 ◽

Cited By ~ 2

Author(s):

Gang Yang ◽

Cheng Tan

Keyword(s):

Hepatitis C ◽

Lichen Planus ◽

Sun Exposure ◽

Mustard Oil ◽

Upper Limbs ◽

Hepatitis C Infection ◽

Hair Dyes ◽

The Face

Background and Objective: Lichen planus pigmentosus (LPP) is an uncommon variant of lichen planus (LP) that manifests as macular hyperpigmentation involving chiefly the face and upper limbs. Although its etiology has not been fully elucidated, a relationship with hepatitis C infection, restrictive underwear, localized friction, and sun exposure have been proposed. Rarely, exposure to mustard oil, amla oil, henna, or hair dyes has been reported. Conclusion: We herein describe an LPP-like reaction to Guasha.

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Inter-Limb Coordination Variability in Ice Climbers of Different Skill Level

Baltic Journal of Sport and Health Sciences ◽

10.33607/bjshs.v1i80.342 ◽

2018 ◽

Vol 1 (80) ◽

Author(s):

Ludovic Seifert ◽

Leo Wattebled ◽

Maxime L’Hermette ◽

Romain Herault

Keyword(s):

Lower Limb ◽

Skill Level ◽

Lower Limbs ◽

Upper Limbs ◽

Environmental Constraint ◽

Research Results ◽

Grade 5 ◽

Limb Coordination ◽

Left And Right ◽

Mode Of Coordination

Research background and hypothesis. Ice climbers determine their own ascent paths by creating holes with their crampons and ice tools. The coupling of upper and lower limbs thus emerges from the icefall environment without prescriptions for one mode of coordination. Research aim. The aim of this study was to analyse the upper / lower limb coordination of ice climbers of different skill level and to explore how the environmental constraint (ice fall shape) is used by the climbers to adapt their motor behaviour.Research methods. Six elite ice climbers and ﬁ ve beginners climbed a 30m icefall, respectively in grade 5 / 5+ and grade 4. Frontal camera videotaped the ﬁ rst 15m of the ascent, then the left and right ice tools and the left and right crampons were digitalised in order to analyse the upper limbs coupling, the lower limbs coupling and the upper / lower limb coordination. Research results. The results indicated that in-phase mode of upper / lower limb coordination was the main attractor for both groups. However, elite climbers showed greater variability in their behaviour, exploring larger range of upper and lower angles (particularly vertical and crossed positions) and types of movement (ice tool swinging and ice hole hooking). Discussion and conclusions. It was concluded that holes in ice fall, and more globally ice fall shape, were affordances that induced variable upper / lower limb coordination in elite climbers, whereas beginners used a basic and stable motor organization in order to maintain body equilibrium.Keywords: upper / lower limb coordination, environmental constrains, types of movement.

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Exuberant clinical presentation of probable Malassezia folliculitis in a young nonimmunosuppressed patient

Anais Brasileiros de Dermatologia ◽

10.1590/s0365-05962012000300016 ◽

2012 ◽

Vol 87 (3) ◽

pp. 459-462 ◽

Cited By ~ 2

Author(s):

Silvio Alencar Marques ◽

Sabrina Bortoletto Gomes da Silva ◽

Rosangela Maria Pires de Camargo ◽

Hamilton Ometto Stolf ◽

Mariangela Esther Alencar Marques

Keyword(s):

Clinical Presentation ◽

Specific Treatment ◽

Inflammatory Disorder ◽

Upper Limbs ◽

Malassezia Folliculitis ◽

Treatment Support ◽

The Face ◽

Immunosuppressed Patients

Malassezia folliculitis is an inflammatory disorder observed in both immunocompetent and immunosuppressed patients. The authors describe an unusual and exuberant presumed case affecting the face, trunk and upper limbs of a 12-year-old nonimmunosuppressed patient. Although the agent was not identified by culture, the clinical and histopathological aspects plus the response to specific treatment support the diagnosis of Malassezia folliculitis. The only possible predisponent cause observed on the patient was greasy skin. Repetitive cultures were negative. Treatment with itraconazol promoted apparent cure, however, the patient relapsed twelve months later.

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