scholarly journals Hand Passive Mobilization Performed with Robotic Assistance: Acute Effects on Upper Limb Perfusion and Spasticity in Stroke Survivors

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Massimiliano Gobbo ◽  
Paolo Gaffurini ◽  
Laura Vacchi ◽  
Sara Lazzarini ◽  
Jorge Villafane ◽  
...  
Keyword(s):  
Upper Limb ◽  
Near Infrared ◽  
Muscle Tone ◽  
Joint Stiffness ◽  
Tissue Perfusion ◽  
Robotic Assistance ◽  
Acute Effects ◽  
Clinical Trial Registration ◽  
Registration Number ◽  
Passive Mobilization

This single arm pre-post study aimed at evaluating the acute effects induced by a single session of robot-assisted passive hand mobilization on local perfusion and upper limb (UL) function in poststroke hemiparetic participants. Twenty-three patients with subacute or chronic stroke received 20 min passive mobilization of the paretic hand with robotic assistance. Near-infrared spectroscopy (NIRS) was used to detect changes in forearm tissue perfusion. Muscle tone of the paretic UL was assessed by the Modified Ashworth Scale (MAS). Symptoms concerning UL heaviness, joint stiffness, and pain were evaluated as secondary outcomes by self-reporting. Significant (p=0.014) improvements were found in forearm perfusion when all fingers were mobilized simultaneously. After the intervention, MAS scores decreased globally, being the changes statistically significant for the wrist (from 1.6±1.0 to 1.1±1.0; p=0.001) and fingers (from 1.2±1.1 to 0.7±0.9; p=0.004). Subjects reported decreased UL heaviness and stiffness after treatment, especially for the hand, as well as diminished pain when present. This study supports novel evidence that hand robotic assistance promotes local UL circulation changes, may help in the management of spasticity, and acutely alleviates reported symptoms of heaviness, stiffness, and pain in subjects with poststroke hemiparesis. This opens new scenarios for the implications in everyday clinical practice. Clinical Trial Registration Number is NCT03243123.

scholarly journals Upper Limb Sensory Evaluations in Women With Breast Cancer Related Lymphedema Receiving Complex Decongestive Physiotherapy: An Ultrasonographic Study

2021 ◽  
Author(s):  
Emine Baran ◽  
Levent Özçakar ◽  
Serap Özgül ◽  
Sercan Aksoy ◽  
Türkan Akbayrak
Keyword(s):  
Breast Cancer ◽  
Upper Limb ◽  
Phase 1 ◽  
Subcutaneous Fat ◽  
Pressure Pain Threshold ◽  
Clinical Trial Registration ◽  
Tactile Localization ◽  
Complex Decongestive Physiotherapy ◽  
Registration Number ◽  
Breast Cancer Related Lymphedema

Abstract Purpose: The aim of this study was to investigate if/how the presence of lymphedema affected the sensation of the upper limb, and to assess whether complex decongestive physiotherapy (CDP) had a favorable impact on the sensory testings.Methods: A total of 27 patients with unilateral stage 2 breast cancer related lymphedema (BCRL) were included in the study. Bilateral ultrasonographic (epidermis, dermis, and subcutaneous fat thicknesses) and circumferential measurements were peformed at 10 cm distal to the elbow crease. Semmes-Weinstein monofilament (SWM), static and moving two-point discrimination, pressure pain threshold (PPT) and tactile localization tests were also applied at the same site. After their initial evaluation, all patients underwent CDP phase 1 program (five times a week, for three weeks). All the evaluations were repeated at the end of their treatment as well.Results: Before CDP, affected sides had significantly higher values than the unaffected sides in terms of SWM (p<0.001), static (p=0.002) and moving two-point discrimination (p=0.011), PPT (p=0.001), and tactile localization (p<0.001) values. After CDP, SWM (p=0.002), static (p=0.009) and moving two-point discrimination (p=0.024), PPT (p=0.014) and tactile localization (p<0.001) values decreased significantly on the affected sides.Conclusion: BCRL seem to reduce light touch, static and moving two-point discrimination, PPT and tactile localization sensations whereas CDP seems to improve these sensory perceptions in women with BCRL. Of note, ultrasonographic measurements also appear to be promising for prompt and convenient follow up in the management of these patients. Clinical Trial Registration Number: NCT04296929Date of registration: March 5, 2020

scholarly journals Effectiveness of Botulinum Toxin on Pain in Stroke Patients Suffering from Upper Limb Spastic Dystonia

Toxins ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 39
Author(s):  
Carlo Trompetto ◽  
Lucio Marinelli ◽  
Laura Mori ◽  
Luca Puce ◽  
Chiara Avanti ◽  
...  
Keyword(s):  
Upper Limb ◽  
Rating Scale ◽  
Muscle Tone ◽  
Numeric Rating Scale ◽  
Stroke Patients ◽  
Muscle Stretching ◽  
Passive Mobilization ◽  
Pain At Rest ◽  
Incobotulinumtoxin A ◽  
Numeric Rating

This observational study aimed at investigating pain in stroke patients with upper limb spastic dystonia. Forty-one consecutive patients were enrolled. A 0–10 numeric rating scale was used to evaluate pain at rest and during muscle tone assessment. Patients were asked to indicate the most painful joint at passive mobilization (shoulder, elbow, wrist-fingers). The DN4 questionnaire was administered to disclose neuropathic pain. All patients were assessed just before and 1 month after incobotulinumtoxin-A treatment. Pain was present in 22 patients, worsened or triggered by passive muscle stretching. DN4 scored < 4 in 20 patients. The most painful joints were wrist–fingers in 12 patients, elbow in 5 patients and shoulder in the remaining 5 patients. Both elbow and wrist–fingers pain correlated with muscle tone. BoNT-A treatment reduced pain in all the joints, including the shoulder. We discussed that nociceptive pain is present in a vast proportion of patients with upper limb spastic dystonia. BoNT-A treatment reduced both spastic dystonia and pain in all the joints but the shoulder, where the effect on pain could be mediated by the reduction of pathological postures involving the other joints.

Near-infrared fluorescence imaging with indocyanine green for quantification of changes in tissue perfusion following revascularization

Vascular ◽  
2021 ◽  
pp. 170853812110328
Author(s):  
Pim Van den Hoven ◽  
Floris S Weller ◽  
Merel Van De Bent ◽  
Lauren N Goncalves ◽  
Melissa Ruig ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Imaging ◽  
Fluorescence Intensity ◽  
Near Infrared ◽  
Tissue Perfusion ◽  
Control Group ◽  
Maximum Slope ◽  
Nir Fluorescence ◽  
Significant Difference ◽  
Revascularization Procedures

Objectives Current diagnostic modalities for patients with peripheral artery disease (PAD) mainly focus on the macrovascular level. For assessment of tissue perfusion, near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) seems promising. In this prospective cohort study, ICG NIR fluorescence imaging was performed pre- and post-revascularization to assess changes in foot perfusion. Methods ICG NIR fluorescence imaging was performed in 36 patients with PAD pre- and post-intervention. After intravenous bolus injection of 0.1 mg/kg ICG, the camera registered the NIR fluorescence intensity over time on the dorsum of the feet for 15 min using the Quest Spectrum Platform®. Time-intensity curves were plotted for three regions of interest (ROI): (1) the dorsum of the foot, (2) the forefoot, and (3) the hallux. Time-intensity curves were normalized for maximum fluorescence intensity. Extracted parameters were the maximum slope, area under the curve (AUC) for the ingress, and the AUC for the egress. The non-treated contralateral leg was used as a control group. Results Successful revascularization was performed in 32 patients. There was a significant increase for the maximum slope and AUC egress in all three ROIs. The most significant difference was seen for the maximum slope in ROI 3 (3.7%/s to 6.6%/s, p < 0.001). In the control group, no significant differences were seen for the maximum slope and AUC egress in all ROIs. Conclusions This study shows the potential of ICG NIR fluorescence imaging in assessing the effect of revascularization procedures on foot perfusion. Future studies should focus on the use of this technique in predicting favorable outcome of revascularization procedures.

scholarly journals NIRS Measurement of Peripheral Fractional Oxygen Extraction (FOE) after Cardiopulmonary Bypass

2002 ◽  
Vol 16 (3-4) ◽  
pp. 191-197 ◽  
Author(s):  
Charles William Yoxall ◽  
Kusum Menon ◽  
Andrew John Macnab ◽  
Roy Everett Gagnon ◽  
Jacques Gerard LeBlanc
Keyword(s):  
Cardiopulmonary Bypass ◽  
Near Infrared ◽  
Tissue Perfusion ◽  
Venous Occlusion ◽  
Repeated Measurements ◽  
Oxygen Extraction ◽  
Critically Ill Children ◽  
Large Teaching Hospital ◽  
Pulmonary Artery Catheters ◽  
Oxyhaemoglobin Saturation

Objectives:To compare peripheral fractional oxygen extraction (FOE), as measured by near infrared spectroscopy (NIRS), with conventional indicators of tissue perfusion in haemodynamically stable and unstable children after cardiopulmonary bypass.Design:Observational study.Setting:Paediatric Intensive Care Unit of a large teaching hospital.Patients:17 children immediately after cardiopulmonary bypass. Male : female = 9 : 8, median age 7 months (range, newborn to 16 years).Methods:On admission, children were classified as “stable” or “unstable” based on the haemodynamic support they needed. Peripheral venous oxyhaemoglobin saturation (SvO2) was measured non-invasively using NIRS with venous occlusion. FOE was calculated from SvO2and arterial saturation measured by pulse oximetry. Repeated measurements of peripheral SvO2were made for up to 8 hours. In 5 children who had pulmonary artery catheters, simultaneous mixed SvO2measurements were recorded.Results:Median FOE was 7.9% higher in the unstable group than in the stable group (p= 0.013). Peripheral SvO2and mixed SvO2were correlated (R2= 0.65,p< 0.0001).Conclusions:Peripheral FOE is higher in unstable children. Changes in peripheral SvO2are related to changes in mixed SvO2. These measurements may provide useful information about haemodynamic status in critically ill children. Further evaluation of the technique is warranted.

Impact of depression and stress on placental DNA methylation in ethnically diverse pregnant women

Epigenomics ◽  
2021 ◽  
Author(s):  
Markos Tesfaye ◽  
Suvo Chatterjee ◽  
Xuehuo Zeng ◽  
Paule Joseph ◽  
Fasil Tekola-Ayele
Keyword(s):  
Dna Methylation ◽  
Fetal Brain ◽  
Ethnically Diverse ◽  
Antenatal Depression ◽  
Epigenetic Changes ◽  
Clinical Trial Registration ◽  
False Discovery ◽  
Genome Wide ◽  
Neuropsychiatric Diseases ◽  
Registration Number

Aim: To investigate the association between placental genome-wide methylation at birth and antenatal depression and stress during pregnancy. Methods: We examined the association between placental genome-wide DNA methylation (n = 301) and maternal depression and stress assessed at six gestation periods during pregnancy. Correlation between DNA methylation at the significantly associated CpGs and expression of nearby genes in the placenta was tested. Results: Depression and stress were associated with methylation of 16 CpGs and two CpGs, respectively, at a 5% false discovery rate. Methylation levels at two of the CpGs associated with depression were significantly associated with expression of ADAM23 and CTDP1, genes implicated in neurodevelopment and neuropsychiatric diseases. Conclusion: Placental epigenetic changes linked to antenatal depression suggest potential fetal brain programming. Clinical trial registration number: NCT00912132 (ClinicalTrials.gov)

scholarly journals MRI and Dose Selection in a Phase II Trial of Baricitinib with Conventional Synthetic Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis

2019 ◽  
Vol 46 (8) ◽  
pp. 887-895 ◽  
Author(s):  
Charles Peterfy ◽  
Julie DiCarlo ◽  
Paul Emery ◽  
Mark C. Genovese ◽  
Edward C. Keystone ◽  
...  
Keyword(s):  
Bone Erosion ◽  
Joint Damage ◽  
Phase Iii ◽  
Cartilage Loss ◽  
Dose Selection ◽  
Mri Findings ◽  
Clinical Trial Registration ◽  
Treatment Groups ◽  
Link Type ◽  
Registration Number

Objective.Magnetic resonance imaging (MRI) was used in a phase IIb study of baricitinib in patients with RA to support dose selection for the phase III program.Methods.Three hundred one patients with active RA who were taking stable methotrexate were randomized 2:1:1:1:1 to placebo or once-daily baricitinib (1, 2, 4, or 8 mg) for up to 24 weeks. One hundred fifty-four patients with definitive radiographic erosion had MRI of the hand/wrist at baseline and at weeks 12 and 24. Two expert radiologists, blinded to treatment and visit order, scored images for synovitis, osteitis, bone erosion, and cartilage loss. Combined inflammation (osteitis + 3× synovitis score) and total joint damage (erosion + 2.5× cartilage loss score) scores were calculated. Treatment groups were compared using ANCOVA adjusting for baseline scores.Results.Mean changes from baseline to Week 12 for synovitis were −0.10, −1.50, and −1.60 for patients treated with placebo, baricitinib 4 mg, and baricitinib 8 mg, respectively (p = 0.003 vs placebo for baricitinib 4 and 8 mg). Mean changes for osteitis were 0.00, −3.20, and −2.10 (p = 0.001 vs placebo for baricitinib 4 mg and p = 0.037 for 8 mg), respectively. Mean changes for bone erosion were 0.90, 0.10, and 0.40 (p = 0.089 for 4 mg and p = 0.275 for 8 mg), respectively, in these treatment groups.Conclusion.MRI findings in this subgroup of patients suggest suppression of synovitis, osteitis, and combined inflammation by baricitinib 4 and 8 mg. This corroborates previously demonstrated clinical efficacy of baricitinib and increases confidence that baricitinib 4 mg could reduce the radiographic progression in phase III studies. [Clinical trial registration number (www.ClinicalTrials.gov): NCT01185353]

scholarly journals Powered Upper Limb Orthosis Actuation System Based on Pneumatic Artificial Muscles

2018 ◽  
Vol 48 (1) ◽  
pp. 23-36 ◽  
Author(s):  
Dimitar Chakarov ◽  
Ivanka Veneva ◽  
Mihail Tsveov ◽  
Pavel Venev
Keyword(s):  
Upper Limb ◽  
Joint Stiffness ◽  
Artificial Muscles ◽  
Joint Motion ◽  
Robot Interaction ◽  
Pneumatic Actuators ◽  
Joint Torques ◽  
Actuation System ◽  
Pneumatic Muscles ◽  
Pneumatic Artificial Muscles

AbstractThe actuation system of a powered upper limb orthosis is studied in the work. To create natural safety in the mutual “man-robot” interaction, an actuation system based on pneumatic artificial muscles (PAM) is selected. Experimentally obtained force/contraction diagrams for bundles, consisting of different number of muscles are shown in the paper. The pooling force and the stiffness of the pneumatic actuators is assessed as a function of the number of muscles in the bundle and the supply pressure. Joint motion and torque is achieved by antagonistic actions through pulleys, driven by bundles of pneumatic muscles. Joint stiffness and joint torques are determined on condition of a power balance, as a function of the joint position, pressure, number of muscles and muscles

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