UNILATERAL UPPER LIMB LYMPATIC OBSTRUCTION AND SEVERE LYMPHOEDEMA IN A PATIENT ON LONG-TERM SIROLIMUS

Background and objectives: Complex limb wounds with multiple tissue involvement are commonly due to high energy trauma. Tissue damage is a dynamic entity and the exact extent of the injury is rarely instantly perceptible. Hence, reconstruction frequently involves a multi-stage procedure concluding with tissue replacement. Materials and Methods: A retrospective study was conducted between 2006 and 2018 and included 179 patients with contaminated multi-tissue injuries treated with hyperbaric oxygen therapy, negative pressure therapy, physiotherapy and drug treatment associated with multiple surgical time in a multistep approach, focusing on pain levels and wound closure rates. Results: Despite the long-term response to traumatic events, a combined approach of delayed surgical reconstructive time in mangled upper limb yielded satisfactory functional outcomes. Conclusions: The complex upper limb wound with deep tissue exposure may be treated with a multi-stage procedure alternatively to immediate reconstruction. The integrated technique enables the preservation of existing healthy tissue and concurrent radical debridement, reducing the risk of infection, as well as avoiding the loss of free flaps and dehiscence due to incorrect wound estimation.

Download Full-text

Does a Multicomponent Exercise Program Improve Physical Fitness in Older Adults? Findings From a 5-Year Longitudinal Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2020-0070 ◽

2021 ◽

pp. 1-8

Author(s):

Andréa Kruger Gonçalves ◽

Eliane Mattana Griebler ◽

Wagner Albo da Silva ◽

Débora Pastoriza Sant´Helena ◽

Priscilla Cardoso da Silva ◽

...

Keyword(s):

Older Adults ◽

Physical Fitness ◽

Cardiorespiratory Fitness ◽

Upper Limb ◽

Exercise Program ◽

Potential Benefits ◽

Multicomponent Program ◽

Post Hoc

The objective was to assess the physical fitness of older adults participating in a 5-year multicomponent exercise program. The sample consisted of 138 older adults aged 60–93 years (70.4 ± 7.8 years) evaluated with the Senior Fitness Test (muscle strength, flexibility, balance, and cardiorespiratory fitness). The multicomponent program was carried out between the months of March and November of each year. Data were analyzed using generalized estimating equations (factor year: Year 1, Year 2, Year 3, Year 4, and Year 5; factor time: pretest and posttest) with Bonferroni’s post hoc test. Participation in the multicomponent exercise program for 5 years (baseline pretest Year 1 and follow-up Year 5) improved lower and upper limb strength, lower limb flexibility, and balance and cardiorespiratory fitness, while upper limb flexibility was maintained. Year-by-year analysis revealed variable patterns for each fitness parameter. The results of this study show the potential benefits of implementing a long-term community-based exercise program.

Download Full-text

Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽

10.1136/bmjopen-2017-016566 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016566

Author(s):

Eline C C van Lieshout ◽

Johanna M A Visser-Meily ◽

Sebastiaan F W Neggers ◽

H Bart van der Worp ◽

Rick M Dijkhuizen

Keyword(s):

Motor Cortex ◽

Upper Limb ◽

Brain Stimulation ◽

Primary Outcome ◽

Primary Motor Cortex ◽

Repetitive Transcranial Magnetic Stimulation ◽

Stroke Patients ◽

Post Stroke ◽

Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

Download Full-text

Technology for monitoring everyday prosthesis use: a systematic review

10.31224/osf.io/ea2np ◽

2020 ◽

Author(s):

Alix Chadwell ◽

Laura Diment ◽

Encarna Micó Amigo ◽

Dafne Zuleima Morgado Ramirez ◽

Alexander Dickinson ◽

...

Keyword(s):

Upper Limb ◽

Lower Limb ◽

Battery Life ◽

Activity Levels ◽

Everyday Activity ◽

Prosthetic Devices ◽

Clinical Scores ◽

Standard Clinical Practice ◽

The Cost

BackgroundUnderstanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring.MethodsA systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis-users during daily-living.Results60 lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm.ConclusionsActivity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user’s requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users.

Download Full-text

Correction: Use of Autologous Human mesenchymal Stromal Cell/Fibrin Clot Constructs in Upper Limb Non-Unions: Long-Term Assessment

PLoS ONE ◽

10.1371/annotation/e4403abb-b80e-43c5-be74-1bdb2c899d1c ◽

2013 ◽

Vol 8 (11) ◽

Cited By ~ 5

Author(s):

Stefano Giannotti ◽

Luisa Trombi ◽

Vanna Bottai ◽

Marco Ghilardi ◽

Delfo D'Alessandro ◽

...

Keyword(s):

Upper Limb ◽

Mesenchymal Stromal Cell ◽

Stromal Cell ◽

Fibrin Clot

Download Full-text

Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: One-Year Follow-up

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320924361 ◽

2020 ◽

Vol 34 (7) ◽

pp. 609-615

Author(s):

Jesse Dawson ◽

Navzer D. Engineer ◽

Cecília N. Prudente ◽

David Pierce ◽

Gerard Francisco ◽

...

Keyword(s):

Ischemic Stroke ◽

Vagus Nerve ◽

Upper Limb ◽

Nerve Stimulation ◽

Vagus Nerve Stimulation ◽

Exercise Program ◽

Home Exercise ◽

Home Exercise Program

Background. Vagus nerve stimulation (VNS) paired with rehabilitation may improve upper-limb impairment and function after ischemic stroke. Objective. To report 1-year safety, feasibility, adherence, and outcome data from a home exercise program paired with VNS using long-term follow-up data from a randomized double-blind study of rehabilitation therapy paired with Active VNS (n = 8) or Control VNS (n = 9). Methods. All people were implanted with a VNS device and underwent 6 weeks in clinic therapy with Control or Active VNS followed by home exercises through day 90. Thereafter, participants and investigators were unblinded. The Control VNS group then received 6 weeks in-clinic Active VNS (Cross-VNS group). All participants then performed an individualized home exercise program with self-administered Active VNS. Data from this phase are reported here. Outcome measures were Fugl-Meyer Assessment—Upper Extremity (FMA-UE), Wolf Motor Function Test (Functional and Time), Box and Block Test, Nine-Hole Peg Test, Stroke Impact Scale, and Motor Activity Log. Results. There were no VNS treatment–related serious adverse events during the long-term therapy. Two participants discontinued prior to receiving the full crossover VNS. On average, participants performed 200 ± 63 home therapy sessions, representing device use on 57.4% of home exercise days available for each participant. Pooled analysis revealed that 1 year after randomization, the FMA-UE score increased by 9.2 points (95% CI = 4.7 to 13.7; P = .001; n = 15). Other functional measures were also improved at 1 year. Conclusions. VNS combined with rehabilitation is feasible, with good long-term adherence, and may improve arm function after ischemic stroke.

Download Full-text

Long‐Term Follow‐Up after Finger and Upper‐Limb Replantation: Clinical, Angiologic, and Lymphographic Studies

Journal of Reconstructive Microsurgery ◽

10.1055/s-2007-1000156 ◽

1998 ◽

Vol 14 (02) ◽

pp. 131-136 ◽

Cited By ~ 16

Author(s):

Claudia Meuli-Simmen ◽

Marco Canova ◽

Alfred Bollinger ◽

Viktor Meyer

Keyword(s):

Upper Limb ◽

Long Term Follow Up

Download Full-text

Reconstruction

10.1093/med/9780198757689.003.0007 ◽

2018 ◽

Author(s):

S. Raja Sabapathay ◽

Roderick Dunn

Keyword(s):

Upper Limb ◽

Soft Tissues ◽

Wound Care ◽

Thumb Reconstruction ◽

Limb Reconstruction ◽

Surgical Incisions ◽

Wound Excision ◽

Upper Limb Reconstruction ◽

Primary Healing

The principles of upper limb reconstruction are to perform careful wound excision, fix the skeleton, reconstruct vessels, nerves, tendons, and bone as required (either immediate or delayed), and to obtain primary healing of the soft tissues with healthy vascularized tissue. This enables early movement—ideally, supervised by hand therapists—and generally results in a good outcome. In particular, delayed healing and immobility can lead to long-term morbidity. We provide a general overview of the principles of surgical incisions in the hand, wound care, and suturing, and discuss the use of skin grafts and flaps in the upper limb. We describe reconstruction of the different areas of the upper limb, along with detailed sections on digital and thumb reconstruction.

Download Full-text

086 Clinical, investigational and treatment factors do not determine prognosis of patients with inflammatory neuropathies

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.74 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A27.3-A28

Author(s):

Mahima Kapoor ◽

Aisling Carr ◽

Michael P Lunn ◽

Mary M Reilly

Keyword(s):

Upper Limb ◽

Remission Rate ◽

Ivig Treatment ◽

Retrospective Data ◽

Significant Difference ◽

Recent Treatment ◽

Successful Group ◽

Inflammatory Neuropathies ◽

Measure Disease Activity

IntroductionIdentifying patients who need long-term immunoglobulin (IVIg) treatment in patient with inflammatory neuropathies is essential as recent treatment trials show a remission rate of up to 40%.AimsCompare retrospective data on clinical, investigational and treatment factors in patients who have ceased IVIg with patients who have failed a cessation trial.Methods15 patients who successfully suspended IVIg infusions were compared with 15 in whom decreasing or stopping IVIg was unsuccessful.Results30 patients (12 with CIDP and 3 with MMN in both groups) were diagnosed 39.5 months from onset of symptoms in the successful group vs. 40.7 months in the unsuccessful group (p=0.953). There was a significant difference in the summed upper limb sensory amplitudes on electrophysiology prior to starting IVIg between the patients with CIDP (17.4 mV vs. 9.8mV p=0.007). There was no difference in the average doses between the groups. A successful cessation trial was attempted at a mean of 60.5 months post starting treatment, compared with 60 months in the unsuccessful patients.ConclusionThere is a need for objective biomarker to measure disease activity because other than one neurophysiology marker, other factors did not help predict a successful cessation trial of IVIg.

Download Full-text