An experimental study of reflex variability in selective dorsal rhizotomy

1994 ◽  
Vol 81 (6) ◽  
pp. 885-894 ◽  
Author(s):  
Arnold D. C. Rivera ◽  
Tim Burke ◽  
Steven J. Schiff ◽  
Ira P. Weiss
Keyword(s):  
Measurement Techniques ◽  
Constant Current ◽  
Threshold Estimation ◽  
Selective Dorsal Rhizotomy ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Before And After ◽  
Constant Current Stimulation ◽  
Reflex Threshold

✓ Significant problems regarding the measurement technique currently used to choose nerve roots for sectioning in the selective dorsal rhizotomy procedure have recently been reported. To better understand the source of these problems, a series of six experiments was performed in which the selective rhizotomy technique was applied to cats that were either intact, decerebrate, or spinalized. Measurements were made before and after partial rhizotomy. In decerebrate preparations, large, spontaneous changes in reflex threshold were observed over short periods of time, especially after partial rhizotomy was performed, and threshold changes greater than 1000% could be observed over 10-minute periods. Using constant-current stimulation of the dorsal root at threshold, the response of each ipsilateral leg muscle demonstrated frequent changes, and changes coincided with the variability in threshold estimation. In addition, very low thresholds were measured (0.1 to 0.25 mA) in half (3 of 6) of these experiments, these measurements being well below the currents customarily used for intraoperative decision making. Stimulation at twice threshold was found to consistently increase the pathological quality of the responses observed. Although intact animals never displayed contralateral responses when stimulated at threshold, such contralateral responses could readily be elicited at twice threshold. These laboratory results raise further doubts regarding the reliability of the measurement techniques now widely used for selective dorsal rhizotomy.

Reflex variability in selective dorsal rhizotomy

1993 ◽  
Vol 79 (3) ◽  
pp. 346-353 ◽  
Author(s):  
Ira P. Weiss ◽  
Steven J. Schiff
Keyword(s):  
Spinal Cord ◽  
Dorsal Root ◽  
Selection Method ◽  
Selective Dorsal Rhizotomy ◽  
Content Type ◽  
Reflex Responses ◽  
Dorsal Rhizotomy ◽  
Spatial Facilitation ◽  
Reflex Threshold ◽  
Fine Print

✓ The variability of reflex responses during selective dorsal rhizotomy was studied in eight children between the ages of 3 and 7 years. For a given dorsal root or rootiet, the electrical reflex threshold and response varied considerably when observed over several minutes. Changes in electrode pressure, mechanical dissection of the root, and reflex spatial facilitation were all found to contribute to the variability. Even when electrode pressure was held constant, intrinsic spinal cord reflex variability substantially weakened the predictability of the intraoperative selection method used during this surgery.

Selective dorsal rhizotomy in children with spastic hemiparesis

2010 ◽  
Vol 6 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Allison Oki ◽  
Wende Oberg ◽  
Beth Siebert ◽  
Dutch Plante ◽  
Marion L. Walker ◽  
...  
Keyword(s):  
Stride Length ◽  
The Other ◽  
Assessment Scale ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Spastic Hemiparesis ◽  
Gait Assessment ◽  
Modified Ashworth Scale ◽  
Ashworth Scale

Object Neurological conditions including cerebral palsy, brain injury, and stroke often result in severe spasticity, which can lead to significant deformity and interfere with function. Treatments for spasticity include oral medications, intramuscular botulinum toxin type A injections, orthopedic surgeries, intrathecal baclofen pump implantation, and selective dorsal rhizotomy (SDR). Selective dorsal rhizotomy, which has been well studied in children with spastic diplegia, results in significant reduction in spasticity and improved function in children. To the authors' knowledge, there are no published outcome data for SDR in patients with spastic hemiparesis. The object of this study was to examine the effects of SDR on spastic hemiparesis. Methods A 2-year study was undertaken including all children with spastic hemiparesis who underwent SDR at the authors' institution. The degree of spasticity, as measured by the Modified Ashworth Scale or quality of gait rated using the visual gait assessment scale, the gait parameters, and velocity were compared in patients before and after undergoing SDR. Results Thirteen children (mean age 6 years 7 months) with spastic hemiparesis underwent SDR performed by the same surgeon during a 2-year period. All of the patients had a decrease in tone in the affected lower extremity after the procedure. The mean reduction in tone in 4 muscle groups (hip adductors, knee flexors, knee extensors, and ankle plantar flexors) according to the modified Ashworth scale score was 2.6 ± 1.26 (p < 0.0001). The quality of gait was assessed in 7 patients by using the visual gait assessment scale. This score improved in 6 patients and remained the same in 1. Stride length and gait velocity were measured in 4 children. Velocity increased in 3 patients and decreased in a 3-year-old child. Parents and clinicians reported an improvement in quality of gait after the procedure. Stride length increased bilaterally in 3 patients and increased on one side and decreased on the other in the other patient. Conclusions Selective dorsal rhizotomy showed efficacy in the treatment of spastic hemiparesis in children. All of the patients had decreased tone after SDR as measured by the modified Ashworth scale. The majority of patients had qualitative and quantitative improvements in gait.

scholarly journals A Parasite Biomarker Set for Evaluating Benznidazole Treatment Efficacy in Patients with Chronic Asymptomatic Trypanosoma cruzi Infection

2019 ◽  
Vol 63 (10) ◽  
Author(s):  
Adriana Egui ◽  
M. Carmen Thomas ◽  
Ana Fernández-Villegas ◽  
Elena Pérez-Antón ◽  
Inmaculada Gómez ◽  
...  
Keyword(s):  
T Cells ◽  
Trypanosoma Cruzi ◽  
Chagas Disease ◽  
Parasite Load ◽  
Drastic Reduction ◽  
Content Type ◽  
Short Period ◽  
Before And After ◽  
Cruzi Infection

ABSTRACT One of the current greatest challenges of Chagas disease is the establishment of biomarkers to assess the efficacy of drugs in a short period of time. In this context, the reactivity of sera from 66 adults with chronic indeterminate Chagas disease (IND) for a set of four Trypanosoma cruzi antigens (KMP11, PFR2, HSP70, and 3973d) was analyzed before and after benznidazole treatment. The results showed that the reactivity against these antigens decreased at 9, 24, and 48 months after treatment. Moreover, the 42.4% and 68.75% of IND patients met the established standard criteria of therapeutic efficacy (STEC) at 24 and 48 months posttreatment, respectively. Meeting the STEC implied that there was a continuous decrease in the reactivity of the patient sera against the four antigens after treatment and that there was a substantial decrease in the reactivity for at least two of the antigens. This important decrease in reactivity may be associated with a drastic reduction in the parasite load, but it is not necessarily associated with a parasitological cure. After treatment, a positive PCR result was only obtained in patients who did not meet the STEC. The percentage of granzyme B+/perforin+ CD8+ T cells was significantly higher in patients who met the STEC than in those who did not meet the STEC (35.2% versus 2.2%; P < 0.05). Furthermore, the patients who met the STEC exhibited an increased quality of the multifunctional response of the antigen-specific CD8+ T cells compared with that in the patients who did not meet the STEC.

scholarly journals Quality of work, economic crisis, and temporary employment

2019 ◽  
Vol 41 (1) ◽  
pp. 37-51 ◽  
Author(s):  
Xavier Bartoll ◽  
Raul Ramos
Keyword(s):  
Economic Crisis ◽  
Temporary Employment ◽  
Structural Equations ◽  
Work Quality ◽  
Content Type ◽  
Crisis Period ◽  
Quality Of Work ◽  
Before And After ◽  
Different Dimensions

Purpose The purpose of this paper is to analyse the association between the type of contract (temporary vs permanent) and the quality of work and its different dimensions before and after the economic crisis among Spanish employees. Design/methodology/approach Structural equations techniques are used to analyse the association between the type of contract and the work quality and its different dimensions before and after the crisis. Data are drawn from the 2006/2007 and 2009/2010 waves of the Encuesta de Calidad de Vida en el Trabajo. Findings The results show that in the two considered periods there are no differences in quality of work among male involuntary temporary workers and those with permanent contracts. However, there is an adverse widening gap across all dimensions of work quality for women in involuntary temporary employment during the economic crisis. There is also a shift among men and women in involuntary temporary employment from valuing intrinsic job quality dimension in the pre-crisis period to valuing more the work environment dimension during the crisis period. Research limitations/implications The analysis is limited by the continuity of variables across years and the high proportion of missing values in some variables. The obtained results cannot be interpreted in terms of causality. Originality/value This is the first study to consider whether the deterioration in the Spanish labour market during the crisis has affected the relationship between the type of contract and the different dimensions of the quality of work.

scholarly journals Emotions in leaders’ enactment of professional agency

2019 ◽  
Vol 31 (2) ◽  
pp. 143-165 ◽  
Author(s):  
Päivi Hökkä ◽  
Katja Vähäsantanen ◽  
Susanna Paloniemi ◽  
Sanna Herranen ◽  
Anneli Eteläpelto
Keyword(s):  
Qualitative Content Analysis ◽  
Leadership Coaching ◽  
Content Type ◽  
Current State ◽  
Before And After ◽  
State Of Affairs ◽  
Practical Implications ◽  
A Current

Purpose Although there has been an increase in workplace studies on professional agency, few of these have examined the role of emotions in the enactment of agency at work. To date, professional agency has been mainly conceptualised as a goal-oriented, rational activity aimed at influencing a current state of affairs. Challenged by this, this study aims to elaborate the nature and quality of emotions and how they might be connected to the enactment of professional agency. Design/methodology/approach Data are collected in the context of a leadership coaching programme that aimed to promote the leaders’ professional agency over the course of a year. The participants (11 middle-management leaders working in university and hospital contexts) were interviewed before and after the programme, and the data were analysed using qualitative content analysis. Findings Findings showed that emotions played an important role in the leaders’ enactment of professional agency, as it pertained to their work and to their professional identity. The study suggests that enacting professional agency is by no means a matter of purely rational actions. Practical implications The study suggests that emotional agency can be learned and enhanced through group-based interventions reflecting on and processing one’s own professional roles and work. Originality/value As a theoretical conclusion, the study argues that professional agency should be reconceptualised in such a way as to acknowledge the importance of emotions (one’s own and those of one’s fellow workers) in practising agency within organisational contexts.

scholarly journals Soft Tissue Release and Osteotomies in the Treatment of Patients with Spastic Diplegic Cerebral Palsy

2018 ◽  
Vol 24 (1) ◽  
pp. 80-83
Author(s):  
Ng Bobby Kin-Wah ◽  
Chau Wai-Wang ◽  
Hung Alec Lik-Hang ◽  
Lam Tsz-Ping ◽  
Cheng Jack Chun-Yiu
Keyword(s):  
Cerebral Palsy ◽  
Soft Tissue ◽  
Soft Tissue Release ◽  
Spastic Diplegia ◽  
Single Event ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Surgery Patient ◽  
Before And After ◽  
Mid Term Results

We aim to study the outcome of soft tissue releases by tendon elongations and osteotomies in fixed joint contractures by clinical examination and patient self-reported assessment on 20 patients (14 males and 6 females) with spastic diplegic cerebral palsy treated with single-event multilevel surgery (SEMLS) between 2000 and 2012. A questionnaire was used to collect information on problems encountered before and after surgery and decision on surgery. Comparing patients with Gross Motor Function Classification System class I/II, (N = 8), III (N = 8) and IV/V, patients of classes IV/V showed much slower mean recovery time than I/II group (14.00 vs. 4.38 months, p < 0.01). SEMLS in the treatment of patients with spastic diplegia had good mid-term results in most patients. The patients who had unfavourable outcomes are associated with mental retardation, general or local complications and previous selective dorsal rhizotomy surgery. Patient selection and good rehabilitations preoperation and postoperation provided the most favourable outcomes of SEMLS.

Changes in ankle spasticity and strength following selective dorsal rhizotomy and physical therapy for spastic cerebral palsy

1999 ◽  
Vol 91 (5) ◽  
pp. 727-732 ◽  
Author(s):  
Jack R. Engsberg ◽  
Sandy A. Ross ◽  
Tae Sung Park
Keyword(s):  
Cerebral Palsy ◽  
Physical Therapy ◽  
Spastic Cerebral Palsy ◽  
Control Group ◽  
Selective Dorsal Rhizotomy ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Angle Data ◽  
Work Done ◽  
Fine Print

Object. In this investigation the authors quantified changes in ankle plantarflexor spasticity and strength following selective dorsal rhizotomy (SDR) and intensive physical therapy in patients with cerebral palsy (CP).Methods. Twenty-five patients with cerebral palsy (CP group) and 12 able-bodied volunteers (AB controls) were tested with a dynamometer. For the spasticity measure, the dynamometer was used to measure the resistive torque of the plantarflexors during passive ankle dorsiflexion at five different speeds. Data were processed to yield a single value that simultaneously encompassed the three key elements associated with spasticity: velocity, resistance, and stretch. For the strength test, the dynamometer rotated the ankle from full dorsiflexion to full plantarflexion while a maximum concentric contraction of the plantarflexors was performed. Torque angle data were processed to include the work done by the patient or volunteer on the machine. Plantarflexor spasticity values for the CP group were significantly greater than similar values for the AB control group prior to surgery but not significantly different after surgery. Plantarflexor strength values of the CP group were significantly less than those of the AB control group pre- and postsurgery. Postsurgery strength values did not change relative to presurgery values.Conclusions. The spasticity results of the present investigation agreed with those of previous studies indicating a reduction in spasticity for the CP group. The strength results did not agree with the findings of most previous related literature, which indicated that a decrease in strength should have occurred. The strength results agreed with a previous investigation in which knee flexor strength was objectively examined, indicating that strength did not decrease as a consequence of an SDR. The methods of this investigation could be used to improve SDR patient selection.

Spasticity and strength changes as a function of selective dorsal rhizotomy

1998 ◽  
Vol 88 (6) ◽  
pp. 1020-1026 ◽  
Author(s):  
Jack R. Engsberg ◽  
Kenneth S. Olree ◽  
Sandy A. Ross ◽  
T. S. Park
Keyword(s):  
Knee Extension ◽  
Selective Dorsal Rhizotomy ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Resistive Torque ◽  
Angle Data ◽  
Hamstring Muscles ◽  
Work Done ◽  
Torque Angle ◽  
Fine Print

Object. The goal of this investigation was to quantify changes in hamstring muscle spasticity and strength in children with cerebral palsy (CP) as a function of their having undergone a selective dorsal rhizotomy. Methods. Nineteen children with CP (CP group) and six children with able bodies (AB group) underwent testing with a dynamometer. For the spasticity measure, the dynamometer measured the resistive torque of the hamstring muscles during passive knee extension at four different speeds. Torque—angle data were processed to calculate the work done by the machine to extend the knee for each speed. Linear regression was used to calculate the slope of the line of best fit for the work—velocity data. The slope simultaneously encompassed three key elements associated with spasticity (velocity, resistance, and stretch) and was considered the measure of spasticity. For the strength test, the dynamometer moved the leg from full knee extension to flexion while a maximum concentric contraction of the hamstring muscles was performed. Torque—angle data were processed to calculate the work done on the machine by the child. Hamstring spasticity values for the CP group were significantly greater than similar values for the AB group prior to surgery; however, they were not significantly different after surgery. Hamstring strength values for the CP group remained significantly less than those for the AB group after surgery, but were significantly increased relative to their presurgery values. Conclusions. The results of spasticity testing in the present investigation agreed with those of previous studies, indicating a reduction in spasticity for the CP group. The results of strength testing did not agree with those in the previous literature; a significant increase in strength was observed for the CP group.

Quality of life before and after cosmetic surgery

CNS Spectrums ◽  
2013 ◽  
Vol 19 (4) ◽  
pp. 282-292 ◽  
Author(s):  
Jean-Charles Bensoussan ◽  
Michael A. Bolton ◽  
Sarah Pi ◽  
Allycin L. Powell-Hicks ◽  
Anna Postolova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cosmetic Surgery ◽  
Measurement Techniques ◽  
Future Research ◽  
Before And After ◽  
Related Quality ◽  
Health Related ◽  
Surgery Research ◽  
The Impact

This article reviews the literature regarding the impact of cosmetic surgery on health-related quality of life (QOL). Studies were identified through PubMed/Medline and PsycINFO searches from January 1960 to December 2011. Twenty-eight studies were included in this review, according to specific selection criteria.The procedures and tools employed in cosmetic surgery research studies were remarkably diverse, thus yielding difficulties with data analysis. However, data indicate that individuals undergoing cosmetic surgery began with lower values on aspects of QOL than control subjects, and experienced significant QOL improvement post-procedurally, an effect that appeared to plateau with time.Despite the complexity of measuring QOL in cosmetic surgery patients, most studies showed an improvement in QOL after cosmetic surgery procedures. However, this finding was clouded by measurement precision as well as heterogeneity of procedures and study populations. Future research needs to focus on refining measurement techniques, including developing cosmetic surgery–specific QOL measures.

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