Paradoxical symptomatic cerebral blood flow decreases after combined revascularization surgery for patients with pediatric moyamoya disease: illustrative case

BACKGROUND Transient neurological deficits (TNDs) develop after cerebral revascularization in patients with moyamoya disease (MMD). The authors report a rare pediatric MMD case with extensive decreased cerebral blood flow (CBF) and prolonged TNDs after combined revascularization. OBSERVATIONS A 9-year-old boy presented with transient left upper limb weakness, and MMD was diagnosed. A right-sided combined surgery was performed. Two years after the surgery, frequent but transient facial (right-sided) and upper limb weakness appeared. The left internal carotid artery terminal stenosis had progressed. Therefore, a left combined revascularization was performed. The patient’s motor aphasia and right upper limb weakness persisted for approximately 10 days after surgery. Magnetic resonance angiography showed that the direct bypass was patent, but extensive decreases in left CBF were observed using single photon emission tomography. With adequate fluid therapy and blood pressure control, the neurological symptoms eventually disappeared, and CBF improved. LESSONS The environment of cerebral hemodynamics is heterogeneous after cerebral revascularization for MMD, and the exact mechanism of CBF decreases was not identified. TNDs are significantly associated with the onset of stroke during the early postoperative period. Therefore, appropriate treatment is desired after determining complex cerebral hemodynamics using CBF studies.

An integrated system design interface for operating 8-DoF robotic arm

This study examines the system integration of a game engine with robotics middleware to drive an 8 degree offreedom (DoF) robotic upper limb to generate human-like motion for telerobotic applications. The developed architectureencompasses a pipeline execution design using Blender Game Engine (BGE) including the acquisition of real humanmovements via the Microsoft Kinect V2, interfaced with a modeled virtual arm, and replication of similar arm movements on the physical robotic arm. In particular, this study emphasizes the integration of a human “pilot” with ways to drive such a robotic arm through simulation and later, into a finished system. Additionally, using motion capture technology, a human upper limb action was recorded and applied onto the robot arm using the proposed architecture flow. Also, we showcase the robotic arm’s actions which include reaching, picking, holding, and dropping an object. This paper presentsa simple and intuitive kinematic modeling and 3D simulation process, which is validated using 8-DoF articulated robot to demonstrate methods for animation, and simulation using the designed interface.

Proprioceptive Training with Visual Feedback Improves Upper Limb Function in Stroke Patients: A Pilot Study

Proprioceptive deficit is one of the common sensory impairments following stroke and has a negative impact on motor performance. However, evidence-based training procedures and cost-efficient training setups for patients with poststroke are still limited. We compared the effects of proprioceptive training versus nonspecific sensory stimulation on upper limb proprioception and motor function rehabilitation. In this multicenter, single-blind, randomized controlled trial, 40 participants with poststroke hemiparesis were enrolled from 3 hospitals in China. Participants were assigned randomly to receive proprioceptive training involving passive and active movements with visual feedback (proprioceptive training group [PG]; n = 20 ) or nonspecific sensory stimulation (control group [CG]; n = 20 ) 20 times in four weeks. Each session lasted 30 minutes. A clinical assessor blinded to group assignment evaluated patients before and after the intervention. The primary outcome was the change in the motor subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-M). Secondary outcomes were changes in box and block test (BBT), thumb localization test (TLT), the sensory subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-S), and Barthel Index (BI). The results showed that the mean change scores of FMA-UE were significantly greater in the PG than in the CG ( p = 0.010 for FMA-UE-M, p = 0.033 for FMA-UE-S). The PG group was improved significantly in TLT ( p = 0.010 ) and BBT ( p = 0.027 ), while there was no significant improvement in TLT ( p = 0.083 ) and BBT ( p = 0.107 ) for the CG group. The results showed that proprioceptive training was effective in improving proprioception and motor function of the upper extremity in patients with poststroke. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR2000037808).

A Cadaveric Study of Palmaris Longus Muscle

Background: Aim: To assess the palmaris longus muscle.Methods:40 formalin fixed cadavers of both genders were included. Routine dissection of the upper limb was carried following the Cunnigham’s Manual of Practical Anatomy. During the dissection of the anterior compartment of forearm, the Palmaris longus muscle was identified & carefully dissected.Results:Out of 40 cadavers, 22 were of males and 18 were of females. Morphology of Palmaris longus found to be normal in 18, agenesis in 6, fusiform in 4, hybrid in 6, bifurcated tendon in 5 and fleshy in 1 case. A significant difference was observed (P< 0.05).Conclusions:Surgeon must be aware of the variations of palmaris longus muscle. Morphology of Palmaris longus found to be normal, agenesis, fusiform, hybrid, bifurcated tendon and fleshy.

Detection of Upper Limb Asymmetries in Athletes According to the Stage of the Season—A Longitudinal Study

Sports injuries can affect the performance of athletes. For this reason, functional tests are used for injury assessment and prevention, analyzing physical or physiological imbalances and detecting asymmetries. The main aim of this study was to detect the asymmetries in the upper limbs (right and left arms) in athletes, using the OctoBalance Test (OB), depending on the stage of the season. Two hundred and fifty-two participants (age: 23.33 ± 8.96 years old; height: 178.63 ± 11.12 cm; body mass: 80.28 ± 17.61 kg; body mass index: 24.88 ± 4.58; sports experience: 12.52 ± 6.28 years), practicing different sports (rugby, athletics, football, swimming, handball, triathlon, basketball, hockey, badminton and volleyball), assessed with the OB in medial, superolateral, and inferolateral directions in both arms, in four moments of the season (May 2017, September 2017, February 2018 and May 2018). ANOVA test was used with repeated measures with a p ≤ 0.05, for the analysis of the different studied variances. Significant differences were found (p = 0.021) in the medial direction of the left arm, between the first (May 2017) and fourth stages (May 2018), with values of 71.02 ± 7.15 cm and 65.03 ± 7.66 cm. From the detection of asymmetries, using the OB to measure, in the medial, superolateral and inferolateral directions, mobility and balance can be assessed. In addition, it is possible to observe functional imbalances, as a risk factor for injury, in each of the stages into which the season is divided, which will help in the prevention of injuries and in the individualization of training.