Factors Contributing to the Severity and Laterality of Pisa Syndrome in Parkinson’s Disease

Objective: Pisa syndrome (PS) is a disabling postural deformity in Parkinson’s disease (PD). We aimed to elucidate clinical factors determining the severity and laterality of PS in PD.Methods: In 54 PD patients with PS, we measured the clinical factors that are previously known to contribute to the occurrence of PS as follows: asymmetry of motor symptoms for the evaluation of asymmetric basal ganglia dysfunction, the degree and direction of subjective visual vertical (SVV) tilt for the misperception of body verticality, the canal paresis for unilateral peripheral vestibulopathy, and the tonic electromyographic (EMG) hyperactivity of paraspinal muscles for dystonia. Multivariable linear and logistic regression analyses were conducted to identify the clinical factors associated with the degree of truncal tilt, for the quantification of the severity of PS, and PS tilting to the less affected side, respectively.Results: The multivariable linear regression analyses revealed that the larger degree of SVV tilt (β = 0.29, SE = 0.10, p = 0.005), right-sided SVV tilt (β = 2.32, SE = 0.82, p = 0.007), and higher Hoehn and Yahr (HY) stage (β = 4.01, SE = 1.29, p = 0.003) significantly increased the severity of PS. In the multivariable logistic regression analyses, greater asymmetry of motor symptoms [odds ratio (OR) = 2.01, 95% CI = 1.34–3.49] was significantly associated with PS tilting to the less affected side, while right-sided SVV tilt (OR = 0.02, 95% CI = 0.001–0.21), unilateral canal paresis (OR = 0.06, 95% CI = 0.003–0.79), and higher HY stage (OR = 0.04, 95% CI = 0.002–0.46) were associated with PS tilting to the more affected side.Conclusion: Misperception of verticality, asymmetric basal ganglia dysfunction, unilateral peripheral vestibulopathy, and motor disability are the clinical factors associated with the severity and laterality of PS in patients with PD.

Soleus H-Reflex Change in Poststroke Spasticity: Modulation due to Body Position

Purpose. This study is aimed at exploring how soleus H-reflex change in poststroke patients with spasticity influenced by body position. Materials and Methods. Twenty-four stroke patients with spastic hemiplegia and twelve age-matched healthy controls were investigated. Maximal Hoffmann-reflex (Hmax) and motor potential (Mmax) were elicited at the popliteal fossa in both prone and standing positions, respectively, and the Hmax/Mmax ratio at each body position was determined. Compare changes in reflex behavior in both spastic and contralateral muscles of stroke survivors in prone and standing positions, and match healthy subjects in the same position. Results. In healthy subjects, Hmax and Hmax/Mmax ratios were significantly decreased in the standing position compared to the prone position (Hmax: p = 0.000 , Hmax/Mmax: p = 0.016 ). However, Hmax/Mmax ratios were increased in standing position on both sides in poststroke patients with spasticity (unaffected side: p = 0.006 , affected side: p = 0.095 ). The Hmax and Hmax/Mmax ratios were significantly more increased on the affected side than unaffected side irrespective of the position. Conclusions. The motor neuron excitability of both sides was not suppressed but instead upregulated in the standing position in subjects with spasticity, which may suggest that there was abnormal regulation of the Ia pathway on both sides.

Nystagmus Parameters of Supine Roll Test Correlates With Prognosis After Repositioning Maneuver in Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo

Background: Positional nystagmus induced by supine roll test is characteristic for diagnosing horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). In this study, we aimed to explore the value of nystagmus parameters in by supine roll test (SRT) as prognostic factors in HC-BPPV.Methods: We retrospectively analyzed the nystagmus parameters of 813 patients diagnosed with HC-BPPV by the SRT model in the SRM-IV system through video nystagmography. Then we used the computer-controlled canalith repositioning procedure (CCRP) mode for treatment. Based on the outcomes, patients were divided into either the cured group or the resistant group. The 1:1 propensity score matching (PSM) was applied to minimize potential selection bias. Then univariable and multivariable analyses were performed to identify the association of nystagmus parameters and the efficacy of CCRP.Results: Among the 813 patients, 99 (12.2%) were classified in the resistant group. The right side of HC-BPPV patients was twice the number of the left side patients (537 vs. 276). PSM is used to pair resistant patients to the cured patients, in which 99 pairs were successfully matched. Results of univariate and multivariate analyses showed that patients in the resistant group have longer latency in the affected side [odds ratio (OR) = 1.231 (1.110–1.366); P < 0.001] and slower slow phase velocity (SPV) in the healthy side [OR = 0.957 (0.917–0.999); P = 0.045].Conclusion: Nystagmus parameters may represent the characteristics of canalith. HC-BPPV patients with a longer latency in the affected side and slower SPV on the healthy side during SRT have a higher risk of HC-BPPV persisting after a single CCRP.

Examining the effects of upper extremity function and arm sling type on balance, gait and fall risk in patients with hemiparesis

Background/aims Previous studies have reported conflicting results on the effects of arm slings on the balance and gait of patients with hemiparesis. These previous studies did not consider the ability to control the upper extremity on the affected side as a factor that could affect the patient's balance or gait when an arm sling was applied. Hence, the aim of this study was to investigate the effect of upper extremity function in the affected side and arm position according to the sling type on balance, gait and fall. Methods A total of 31 stroke patients participated in the study and were assigned to two groups according to upper extremity function (low-score group and high-score group). Under three conditions (no sling, forearm sling and shoulder sling), a fall risk test, postural stability test and limits of stability test were performed and speed, stride duration, step length and total time were measured. Results When the high-score group wore forearm slings, the static and dynamic balance ability decreased and the fall risk increased. When the low-score group wore forearm slings and shoulder slings, the static and dynamic balance ability increased and the fall risk decreased. The high-score group had a shorter gait time when wearing shoulder slings. When the low-score group wore forearm slings, the speed and step length increased and the total time decreased, enhancing the overall gait ability. Conclusions For stroke patients with better upper extremity control ability, shoulder slings are more appropriate. For patients with poor upper extremity control ability, forearm slings are more appropriate. Using the appropriate sling according to the upper extremity function can improve balance and gait ability and fall risk can be reduced.

A Mirror Bilateral Neuro-Rehabilitation Robot System with the sEMG-Based Real-Time Patient Active Participant Assessment

In this paper, a novel mirror visual feedback-based (MVF) bilateral neurorehabilitation system with surface electromyography (sEMG)-based patient active force assessment was proposed for upper limb motor recovery and improvement of limb inter-coordination. A mirror visual feedback-based human–robot interface was designed to facilitate the bilateral isometric force output training task. To achieve patient active participant assessment, an sEMG signals-based elbow joint isometric force estimation method was implemented into the proposed system for real-time affected side force assessment and participation evaluation. To assist the affected side limb efficiently and precisely, a mirror bilateral control framework was presented for bilateral limb coordination. Preliminary experiments were conducted to evaluate the estimation accuracy of force estimation method and force tracking accuracy of system performance. The experimental results show the proposed force estimation method can efficiently calculate the elbow joint force in real-time, and the affected side limb of patients can be assisted to track output force of the non-paretic side limb for better limb coordination by the proposed bilateral rehabilitation system.

Differences in body composition between affected and nonaffected sides in cerebral palsy football athletes: Preliminary findings (Diferencias en la composición corporal entre los lados afectados y no afectados em atletas de fútbol con parálisis cerebral:

To verify the symmetry of body composition distribution in cerebral palsy (CP) football players with hemiparesis, was carried out a cross-sectional study with17 football-7-a-side players with CP and hemiparesis, level I according to the Gross Motion Function Classification System and as class 7 according to the International Federation of CP Football. The body composition was evaluated, on both affected and nonaffected sides, by anthropometry and bioimpedance. As a result, fat free mass weight, limb girths and limb muscular areas were significantly higher on nonaffected side. In addition, fat mass weight, limb skinfolds and lower limb fat areas were significantly lower on nonaffected side, but the arm fat area are similar on both sides. These findings suggested that physical requirements of training and competitions of 7-a-side-football allows the muscular development in the non-affected side, however, they are not enough for the muscular development in the affected side to reach a similar development to the non-affected side. Resumen: Para verificar la simetría de la distribución de la composición corporal en jugadores de fútbol con parálisis cerebral (PC) y hemiparesia, se realizó un estudio transversal con 17 jugadores de fútbol 7 con PC y hemiparesia, nivel I según el Gross Motion Function Classification System, y como clase 7 según la International Federation of CP Football. La composición corporal se evaluó, tanto en el lado afectado como en el no afectado, mediante antropometría y bioimpedancia. Como resultado, el peso de la masa libre de grasa, la circunferencia de las extremidades y las áreas musculares de las extremidades fueron significativamente mayores en el lado no afectado. Además, el peso de la masa grasa, los pliegues cutáneos de las extremidades y las áreas de grasa de las extremidades inferiores fueron significativamente menores en el lado no afectado, pero el área de grasa del brazo es similar en ambos lados. Estos resultados sugirieron que los requisitos físicos del entrenamiento y las competiciones de fútbol 7 permiten el desarrollo muscular en el lado no afectado, sin embargo, no son suficientes para que el desarrollo muscular del lado afectado alcance un desarrollo similar al del lado no afectado.

Disminución de la funcionalidad de miembro superior y bajo nivel de actividad física en supervivientes de cáncer de mama: Un estudio de caso-control (Decreased upper limb function and low level of physical activity following treatment for breast cancer -

El presente estudio tiene como objetivo evaluar la funcionalidad de miembro superior, síntomas de fatiga y nivel de actividad física en mujeres post operatorio de cáncer de mama, grupo PO, en comparación a un grupo control de mujeres sanas. La funcionalidad de la extremidad superior se evaluó mediante el rango de movimiento (ROM) de flexión, abducción y rotación externa del hombro utilizando un inclinómetro digital; fuerza de prensión con un dinamómetro y discapacidad del miembro superior con el cuestionario Disabilities of the arm, shoulder and hand. La fatiga se evaluó con el Inventario Breve de Fatiga y el nivel de actividad física con el Cuestionario Internacional de Actividad Física. Treinta y cuatro mujeres (n=17, grupo PO; n=17, grupo control, GC) fueron evaluadas. El grupo PO presentó menor ROM del hombro y fuerza de prensión (diferencia de rango: 22,9°-22,9°; 5,6kgF, respectivamente) en comparación con el GC; el lado afectado presentó menor ROM del hombro en comparación con el lado no afectado (15°-21°). También hubo una mayor discapacidad en el lado afectado y un menor nivel de actividad física en el grupo PO. No hubo diferencias en la fatiga entre los grupos. Concluimos que el grupo PO presentó menor funcionalidad y un bajo nivel de actividad física en comparación con un grupo control. Abstract. This study aim to compare upper limb functionality, fatigue and physical activity level in women after breast cancer surgery in relation to a control group. Upper limb functionality was evaluated by mean of shoulder range of motion (ROM) of flexion, abduction and external rotation using a digital inclinometer; handgrip strength using a dynamometer and upper limb disability with the Disabilities of the arm, shoulder and hand questionnaire. Fatigue was assessed with the Brief Fatigue Inventory and physical activity level with the International Physical Activity Questionnaire. A thirty-four women (n=17, post-operated breast surgery group, PO; n=17, control group, CG) were recruited. PO group presented a decrease in both shoulder ROM and handgrip strength (range difference: 22.9°-22,9°; 5.6kgF, respectively) compared to CG; the affected side of the PO group presented with less shoulder ROM in comparison to the non-affected side (15°-21°). There was also greater disability on the affected side and a lower physical activity level in the PO group. There were no differences in the fatigue between the groups. We concluded that PO group presented with compromised functionality and low physical activity level compared to a control group.

Interaction of the Left–Right Somatosensory Pathways in Patients With Thalamic Hemorrhage: A Case Report

Neural plasticity compensates for the loss of motor function after stroke. However, whether neural plasticity occurs in the somatosensory pathways after stroke is unknown. We investigated the left–right somatosensory interaction in two hemorrhagic patients using a paired somatosensory evoked potentials (p-SEPs) recorded at CP3 and CP4, which was defined as an amplitude difference between the SEPs of paired median nerve stimulations to both sides and that of single stimulation to the affected side. Patient 1 (61-year-old, left thalamic hemorrhage) has a moderate motor impairment, severe sensory deficit, and complained of pain in the affected right upper limb. Patient 2 (72-year-old, right thalamic hemorrhage) had slight motor and sensory impairments with no complaints of pain. Single SEPs (s-SEPs) were obtained by stimulation of the right and left median nerves, respectively. For paired stimulations, 1 ms after the first stimulation to the non-affected side, followed by a second stimulation to the affected side. In patient 1, a s-SEP with stimulation to the non-affected side and a p-SEP were observed in CP4. However, a s-SEP was not observed in either hemisphere with stimulation to the affected side. On the other hand, in patient 2, a s-SEP in CP3 with stimulation to the non-affected side and in CP4 with stimulation to the affected side were observed; however, a p-SEP was not observed. In addition, to investigate the mechanism by which ipsilateral median nerve stimulation enhances contralateral p-SEP in patient 1, we compared the SEP averaged over the first 250 epochs with the SEP averaged over the second 250 epochs (total number of epochs recorded: 500). The results showed that in the patient 1, when the bilateral median nerve was stimulated continuously, the habituation did not occur and the response was larger than that of the s-SEP with unilateral median nerve stimulation. In the current case report, the damage to the thalamus may cause neuroplasticity in terms of the left–right interaction (e.g., left and right S1). The somatosensory input from the affected side may interfere with the habituation of the contralateral somatosensory system and conversely increase the response.

Muscle volume evaluation using 3DCT for congenital clubfoot

Background In congenital clubfoot, the lower leg is very thin and the calf muscles are hypoplasic. However, there are few studies reporting real muscle volume. Purpose The purpose of this study is to assay the muscle volume in congenital clubfoot using 3DCT and to quantify the degree of the hypoplasia. Material and methods From January 2015 to December 2016, nine consecutive patients, seven male and two female, with unilateral congenital clubfeet were recruited for CT scans. Axial transverse sectional CT scans were acquired from the delineation of the fibular head to the tibial plafond. From the data, we rendered the entire muscle in 3D for muscle volume assay, and further segmented the posterior musculature for comparison between the normal and affected sides. Results The whole muscle volume on the normal side was 291.23 cm3 (181.23–593.49) and that on the affected side was 225.08 cm3 (120.71–429.08), for an affected side to normal side ratio of 0.79 (0.72–0.9), which was significantly smaller ( p < .01). Posterior muscle volume on the normal side was 175.81 cm3 (103.72–376.32) and that on the affected side was 106.52 cm3 (58.3–188.39). The ratio of posterior muscle to whole muscle on the normal side was 0.62 (0.46–0.75), and that on the affected side was 0.48 (0.4–0.55), such that the affected side was significantly smaller ( p < .01) Conclusion This study contributes quantitative data supporting the longstanding observations that the posterior calf muscles are significantly smaller on the affected side compared to the normal side in congenital clubfoot, and further underscores the importance of the extending the excursion of these muscles.