scholarly journals Successful Application of an Insole with a Metatarsal Inhibition Bar and Deep Heel Cup for Improving Gait Dysfunction in a Patient with Poor Coordination with Disrupted Corticoreticular Tracts: A Case Report

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 320
Author(s):  
Su Min Son ◽  
Jung Won Lee ◽  
Min Cheol Chang
Keyword(s):  
Diffusion Tensor ◽  
Brain Magnetic Resonance Imaging ◽  
Gait Pattern ◽  
Medial Lemniscus ◽  
Motor Weakness ◽  
Coordination Problems ◽  
Custom Made ◽  
Gait Dysfunction ◽  
Hip Flexion ◽  
Toe Walking

We report the successful management of gait dysfunction in a patient with coordination problems using an insole with a metatarsal inhibition bar (MIB) and a deep heel cup. Furthermore, we investigated the state of the neural tracts via diffusion tensor tractography (DTT). A 23-month-old boy with gait dysfunction presented with toe walking with a wide base and decreased hip flexion. Motor weakness or spasticity was not observed. Conventional brain magnetic resonance imaging did not reveal any abnormal findings, but DTT revealed disrupted bilateral corticoreticulospinal tracts (CRTs). No abnormalities were observed in the corticospinal tract or the medial lemniscus. We applied a custom-made insole with an MIB and a deep heel cup. Immediately after application, the patient’s gait pattern stabilized significantly and was nearly normalized. Our therapeutic experience indicates that the application of an insole with an MIB and deep heel cups could be beneficial for patients with coordination problems and gait dysfunction. Our DTT results showed that CRTs could be the causative brain pathology for gait dysfunction in patients with coordination problems.

scholarly journals Improvement of Gait Dysfunction after Applying a Hinged Ankle–Foot Orthosis in a Hemiplegic Cerebral Palsy Patient with Disrupted Medial Lemniscus: A Case Report

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 81
Author(s):  
Su Min Son ◽  
Min Cheol Chang
Keyword(s):  
Knee Flexion ◽  
Diffusion Tensor ◽  
Therapeutic Option ◽  
Gait Pattern ◽  
Ankle Dorsiflexion ◽  
Medial Lemniscus ◽  
Abnormal Gait ◽  
Hemiplegic Cerebral Palsy ◽  
Genu Recurvatum ◽  
Magnetic Resonance Imaging Mri

We describe the successful application of hinged ankle−foot orthoses (AFOs) in a cerebral palsied (CP) patient with gait instability due to a disrupted medial lemniscus (ML). The patient was a 27-month-old male CP child with gait instability who presented with reduced knee flexion and ankle dorsiflexion, with severe genu recurvatum on his right lower extremity during gait. The patient had no motor weakness or spasticity. Conventional magnetic resonance imaging (MRI) revealed no definite abnormal lesion. However, diffusion tensor tractography (DTT) showed disruption of the left ML, consistent with right hemiplegic symptoms. The integrity of the major motor-related neural tracts, including the corticospinal and corticoreticulospinal tracts, was preserved. We considered that the patient’s abnormal gait pattern was related to the disrupted ML state. We applied hinged AFOs, which immediately resulted in a significantly stabilized gait. The angles of knee flexion and ankle dorsiflexion increased. Our findings indicate that the application of hinged AFOs could be a useful therapeutic option for CP patients with gait instability related to ML disruption. In addition, we showed that DTT is a useful tool for identifying the causative brain pathology in CP patients, especially when conventional brain MRIs show no specific lesion.

Changes in the corticospinal tract after wearing prosthesis in bilateral transtibial amputation

2017 ◽  
Vol 41 (5) ◽  
pp. 507-511
Author(s):  
Sang Yoon Lee ◽  
Si Hyun Kang ◽  
Don-Kyu Kim ◽  
Kyung Mook Seo ◽  
Hee Joon Ro ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Diffusion Tensor Imaging ◽  
Magnetic Resonance ◽  
Primary Motor Cortex ◽  
Corticospinal Tract ◽  
Diffusion Tensor ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Transtibial Amputation

Background:After amputation, the brain is known to be reorganized especially in the primary motor cortex. We report a case to show changes in the corticospinal tract in a patient with serial bilateral transtibial amputations using diffusion tensor imaging.Case Description and Methods:A 78-year-old man had a transtibial amputation on his left side in 2008 and he underwent a right transtibial amputation in 2011. An initial brain magnetic resonance imaging with a diffusion tensor imaging was performed before starting rehabilitation on his right transtibial prosthesis, and a follow-up magnetic resonance imaging with diffusion tensor imaging was performed 2 years after this.Findings and Outcomes:In the initial diffusion tensor imaging, the number of fiber lines in his right corticospinal tract was larger than that in his left corticospinal tract. At follow-up diffusion tensor imaging, there was no definite difference in the number of fiber lines between both corticospinal tracts.Conclusion:We found that side-to-side corticospinal tract differences were equalized after using bilateral prostheses.Clinical relevanceThis case report suggests that diffusion tensor imaging tractography could be a useful method to understand corticomotor reorganization after using prosthesis in transtibial amputation.

Abstract 14258: Modulation of Kynurenine Pathway to Prevent Brain Injury After Cardiac Arrest and Cardiopulmonary Resuscitation in Mice

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Aurora Magliocca ◽  
Carlo Perego ◽  
Francesca Motta ◽  
Giulia Merigo ◽  
Francesca M Fumagalli ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Diffusion Tensor ◽  
Neuroprotective Effect ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Kynurenine Pathway ◽  
Baseline Heart Rate ◽  
Brain White Matter ◽  
Fluoro Jade B

Introduction: Kynurenine pathway (KP) is emerging as one of the potential components affecting cardiac arrest (CA) outcomes. The aim of this study is to evaluate the effects of KP inhibition through genetic deletion of the rate-limiting enzyme of the KP, indoleamine-2,3-dyoxygenase (IDO) on survival and neurological outcome after CA. Methods and Results: Sixteen adult male wild-type (WT) and IDO-deleted (IDO -/- ) mice were subjected to 8 min untreated CA followed by resuscitation. At baseline heart rate and mean arterial pressure (MAP) did not differ among groups. At the time of return of spontaneous circulation, 30 and 60 min later, MAP was higher in the IDO -/- group compared to the WT one (p=0.0005). IDO -/- mice showed higher survival compared to WT at 7 days after CA (68.5% in IDO -/- vs 37.5% in WT; log rank p=0.036). Neurological function was higher in IDO -/- than in WT mice during the 7 days following CA (p=0.0124). IDO -/- mice also showed an improved locomotor function compared to WT mice (p=0.037). Brain magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) sequences showed a reduction in fractional anisotropy in the external capsule of the corpus callosum in WT mice compared to IDO -/- mice at 7 days after resuscitation (p=0.015). We then treated additional IDO -/- mice with L-kyn 15 min before CA, to revert the IDO -/- phenotype. Brain MRI with diffusion-weighted imaging (DWI) sequences and histological analysis were performed 24h after CA in WT, IDO -/- , and IDO -/- +L-Kyn mice. Brain MRI revealed restriction of water diffusivity 24h after CA in WT mice. IDO-deletion reduced water diffusion abnormalities while the beneficial effect was reverted in the L-kyn group (p=0.01). Degenerating neurons in the frontal cortex, represented as Fluoro-Jade B positive cells, were more numerous in WT compared to IDO -/- mice; L-kyn halted this IDO deletion-induced reduction in degenerating cells (p=0.05). Conclusion: KP inhibition improves survival and neurological outcome after CA. The neuroprotective effect of IDO-deletion was associated with preservation of brain white matter microintegrity and with reduction of cerebral cytotoxic edema. Reversal of these beneficial effects by L-kyn administration in IDO -/- mice further confirm the KP role in CA outcome.

scholarly journals Effect of a nonsurgical treatment program on the gait pattern of idiopathic toe walking: a case report

2016 ◽  
pp. 139 ◽  
Author(s):  
Andrzej Szopa ◽  
Małgorzata Domagalska-Szopa ◽  
Weronika Gallert-Kopyto ◽  
Wojciech Kiebzak ◽  
Ryszard Plinta
Keyword(s):  
Case Report ◽  
Treatment Program ◽  
Gait Pattern ◽  
Nonsurgical Treatment ◽  
Idiopathic Toe Walking ◽  
Toe Walking

scholarly journals A Dual-Learning Paradigm Simultaneously Improves Multiple Features of Gait Post-Stroke

2018 ◽  
Vol 32 (9) ◽  
pp. 810-820 ◽  
Author(s):  
Kendra M. Cherry-Allen ◽  
Matthew A. Statton ◽  
Pablo A. Celnik ◽  
Amy J. Bastian
Keyword(s):  
Knee Flexion ◽  
Joint Angle ◽  
Step Length ◽  
Learning Task ◽  
Gait Pattern ◽  
Learning Paradigm ◽  
Post Stroke ◽  
Learning Conditions ◽  
Hip Flexion ◽  
Gait Impairments

Background. Gait impairments after stroke arise from dysfunction of one or several features of the walking pattern. Traditional rehabilitation practice focuses on improving one component at a time, which may leave certain features unaddressed or prolong rehabilitation time. Recent work shows that neurologically intact adults can learn multiple movement components simultaneously. Objective. To determine whether a dual-learning paradigm, incorporating 2 distinct motor tasks, can simultaneously improve 2 impaired components of the gait pattern in people posttroke. Methods. Twelve individuals with stroke participated. Participants completed 2 sessions during which they received visual feedback reflecting paretic knee flexion during walking. During the learning phase of the experiment, an unseen offset was applied to this feedback, promoting increased paretic knee flexion. During the first session, this task was performed while walking on a split-belt treadmill intended to improve step length asymmetry. During the second session, it was performed during tied-belt walking. Results. The dual-learning task simultaneously increased paretic knee flexion and decreased step length asymmetry in the majority of people post-stroke. Split-belt treadmill walking did not significantly interfere with joint-angle learning: participants had similar rates and magnitudes of joint-angle learning during both single and dual-learning conditions. Participants also had significant changes in the amount of paretic hip flexion in both single and dual-learning conditions. Conclusions. People with stroke can perform a dual-learning paradigm and change 2 clinically relevant gait impairments in a single session. Long-term studies are needed to determine if this strategy can be used to efficiently and permanently alter multiple gait impairments.

INFLUENCE OF CUSTOMIZED FOOT ORTHOTICS ON GAIT BALANCE FOR PELVIC ASYMMETRY PATIENTS

2019 ◽  
Vol 19 (05) ◽  
pp. 1950039
Author(s):  
JI-YONG JUNG ◽  
JUNG-JA KIM
Keyword(s):  
Pressure Distribution ◽  
Plantar Pressure ◽  
Gait Pattern ◽  
Biomechanical Stress ◽  
Lower Extremity Muscle ◽  
Plantar Pressure Distribution ◽  
Human Movements ◽  
Custom Made ◽  
Postural Imbalance ◽  
Electromyography Signals

Gait is one of the most common and important factor of human movements in daily life. Pelvis is closely connected with the gait due to it allows maintain stable posture by supporting the spine and lower extremities against the gravity. Therefore, pelvic asymmetry, which is caused by biomechanical stress and muscle imbalance, has been associated with postural imbalance and abnormal walking pattern. The purpose of this study was to manufacture customized foot orthotics for improving gait balance and evaluate the effectiveness of customized foot orthotics during walking by measuring lower extremity muscle activity and plantar pressure distribution. All subjects with pelvic asymmetry were asked to walk on a treadmill under three conditions: walking without foot orthotics, walking with customized foot orthotics and walking with non-customized foot orthotics. Root mean square (RMS) value of the electromyography signals, force and peak pressure of the plantar pressure distribution was analyzed based on the gait cycle. The results showed that excessive tension of the muscles and high pressure of the foot that was induced by pelvic asymmetry were more reduced when walking with custom-made foot orthotics than walking without foot orthotics and walking with non-customized foot orthotics. This paper suggest that custom-made orthotics for patients with pelvic asymmetry could be helpful to relieve the excessive loading of the foot and maintain balanced gait pattern.

scholarly journals Microstructural integrity of corticospinal and medial lemniscus tracts: insights from diffusion tensor tractography of right-hand amputees

2019 ◽  
Vol 122 (1) ◽  
pp. 316-324 ◽  
Author(s):  
Huiling Peng ◽  
Carmen M. Cirstea ◽  
Christina L. Kaufman ◽  
Scott H. Frey
Keyword(s):  
White Matter ◽  
Upper Limb ◽  
Structural Integrity ◽  
Diffusion Tensor ◽  
Medial Lemniscus ◽  
Residual Limb ◽  
Healthy Control ◽  
Continued Use ◽  
Microstructural Integrity ◽  
Activity Dependent

Reductions in sensory and motor activity following unilateral upper limb amputation during adulthood are associated with widespread, activity-dependent reorganization of the gray matter and white matter through the central nervous system. Likewise, in cases of congenital limb absence there is evidence that limited afferent or efferent activity affects the structural integrity of white matter pathways serving the affected side. Evidence that the structural integrity of mature sensory and motor tracts controlling the lost upper limb exhibits similar activity dependence is, however, sparse and inconsistent. Here we used diffusion tensor tractography to test whether amputation of the dominant right hand during adulthood ( n = 16) alters the microstructural integrity of the major sensory (medial lemniscus, ML) and motor (corticospinal tract, CST) pathways controlling missing hand function. Consistent with prior findings, healthy control subjects ( n = 27) exhibited higher fractional anisotropy (FA), an index of white matter microstructural integrity, within dominant left CST and nondominant right ML. Critically, in contrast to what might be expected if the microstructural organization of these tracts is activity dependent, these asymmetries persisted in amputees. Moreover, we failed to detect any differences in dominant left ML or CST between healthy control subjects and amputees. Our results are consistent with these white matter tracts being robust to changes in activity once mature or that continued use of the residual limb (in a compensatory fashion or with prosthesis) provides stimulation sufficient to maintain tract integrity. NEW & NOTEWORTHY We report that unilateral hand amputation in adults has no significant effects on the structure of major sensory or motor pathways contralateral to the amputation. Our results are consistent with the organization of these white matter tracts being robust to changes in activity once mature or that continued use of the residual limb (with or without a prosthesis) provides stimulation sufficient to maintain tract integrity.

scholarly journals Central Pain Due to Injury of the Spinothalamic Tract Misdiagnosed as Complex Regional Pain Syndrome: A Case Report

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 145 ◽  
Author(s):  
Jang ◽  
Kwon ◽  
Lee
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Memory Impairment ◽  
Whiplash Injury ◽  
Diffusion Tensor ◽  
Pain Syndrome ◽  
University Hospital ◽  
Central Pain ◽  
Spinothalamic Tract ◽  
Motor Weakness ◽  
The Right

Objectives: We report on a patient with whiplash injury who had central pain, due to injury of the spinothalamic tract (STT), but who was misdiagnosed as complex regional pain syndrome (CRPS). Case description: While a minivan in which a 43-year-old female was seated in the passenger seat was stopped for a signal, a truck collided with the minivan from behind, and the minivan then repeatedly collided with trucks in front and behind the minivan. Her head repeatedly struck the minivan seat resulting in whiplash injuries. After onset, she felt pain in both legs with mild motor weakness in all four extremities and memory impairment. Eight years after onset, she was diagnosed at a university hospital as CRPS type 1 with the clinical features of hyperalgesia and mild edema and motor weakness of both legs. She visited another university hospital nine years after onset and complained of pain in the right arm and both legs, constant tingling and burning pain along with allodynia and hyperalgesia. She also showed mild weakness in the four extremities, mild edema of both legs, and memory impairment. On diffusion tensor tractography (DTT), the left spinothalamic tract (STT) showed marked narrowing, and the right STT revealed mild narrowing and partial tearing. In addition, partial tears were observed in both corticospinal tracts and the right corticoreticulospinal tract. Discontinuations were observed in the left corticoreticulospinal tract and the left fornical crus. Conclusion: Injury of the STT was demonstrated on DTT in a patient with central pain following whiplash injury. Previously, the patient was misdiagnosed as CRPS.

Human Connectome-Based Tractographic Atlas of the Brainstem Connections and Surgical Approaches

Neurosurgery ◽  
2016 ◽  
Vol 79 (3) ◽  
pp. 437-455 ◽  
Author(s):  
Antonio Meola ◽  
Fang-Cheng Yeh ◽  
Wendy Fellows-Mayle ◽  
Jared Weed ◽  
Juan C. Fernandez-Miranda
Keyword(s):  
Spatial Resolution ◽  
Diffusion Mri ◽  
Diffusion Tensor ◽  
Population Based ◽  
Medial Longitudinal Fasciculus ◽  
Surgical Approaches ◽  
Medial Lemniscus ◽  
Spinothalamic Tract ◽  
Rubrospinal Tract ◽  
Human Connectome Project

Abstract BACKGROUND The brainstem is one of the most challenging areas for the neurosurgeon because of the limited space between gray matter nuclei and white matter pathways. Diffusion tensor imaging-based tractography has been used to study the brainstem structure, but the angular and spatial resolution could be improved further with advanced diffusion magnetic resonance imaging (MRI). OBJECTIVE To construct a high-angular/spatial resolution, wide-population-based, comprehensive tractography atlas that presents an anatomical review of the surgical approaches to the brainstem. METHODS We applied advanced diffusion MRI fiber tractography to a population-based atlas constructed with data from a total of 488 subjects from the Human Connectome Project-488. Five formalin-fixed brains were studied for surgical landmarks. Luxol Fast Blue-stained histological sections were used to validate the results of tractography RESULTS We acquired the tractography of the major brainstem pathways and validated them with histological analysis. The pathways included the cerebellar peduncles, corticospinal tract, corticopontine tracts, medial lemniscus, lateral lemniscus, spinothalamic tract, rubrospinal tract, central tegmental tract, medial longitudinal fasciculus, and dorsal longitudinal fasciculus. Then, the reconstructed 3-dimensional brainstem structure was sectioned at the level of classic surgical approaches, namely supracollicular, infracollicular, lateral mesencephalic, perioculomotor, peritrigeminal, anterolateral (to the medulla), and retro-olivary approaches. CONCLUSION The advanced diffusion MRI fiber tracking is a powerful tool to explore the brainstem neuroanatomy and to achieve a better understanding of surgical approaches.

A Low Power Wireless Data Acquisition Device to Monitor Gait Patterns for Children With Toe Walking During Daily Activities

2011 ◽  
Vol 5 (2) ◽  
Author(s):  
Edmond H. M. Lou ◽  
Emma K. Brunton ◽  
Fraaz Kamal ◽  
Andreas Renggli ◽  
Kyle Kemp ◽  
...  
Keyword(s):  
Data Acquisition ◽  
Gait Pattern ◽  
Daily Activities ◽  
Wireless Data ◽  
Normal Gait ◽  
Walking Pattern ◽  
Wireless Data Acquisition ◽  
Idiopathic Toe Walking ◽  
Clinical Gait Analysis ◽  
Toe Walking

Clinical gait analysis is the accepted “gold standard” for evaluating an individual’s walking pattern. However, in certain conditions such as idiopathic toe walking (ITW), the degree of voluntary control that a subject may elicit upon their walking pattern in a gait laboratory may not truly reflect their gait during daily activities. Therefore, a battery-powered, wireless data acquisition system was developed to record daily walking patterns to assist in the assessment of treatment outcomes in this patient population. The device was developed to be small (30×50×12 mm3), light-weight (15 g), easy to install, reliable, and consumed little power. It could be mounted across the laces of the shoe, while forces and walking activities were recorded to investigate the percentage of toe walking during the assessment. Laboratory tests were performed and preliminary clinical trials at a gait laboratory were done on six normal gait walkers. These volunteers also try to walk on their toes to simulate the toe walking at the gait laboratory. The system was able to track the gait pattern and determine the percentage of toe walking relative to normal gait. Three boys and one girl were diagnosed with ITW then participated into this study. A total of 4 sets thirty-three 10 min data sessions (5.5 h) were collected outside the laboratory. The results showed that the test subjects walked on their toes 70±4% of the total walking time, which was higher than that they performed 64±5% at the gait laboratory. This preliminary study shows promising results that the system should be able to use for clinical assessment and evaluation of children with ITW.

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