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At least 433 records · Page 24Linked to original sources
PubMed2001

Percutaneous, intramuscular neuromuscular electrical stimulation for the treatment of shoulder subluxation and pain in chronic hemiplegia: a case report.

This case report describes the first survivor with chronic stroke who was treated with percutaneous, intramuscular neuromuscular electrical stimulation (NMES) for shoulder subluxation and pain. The patient developed shoulder subluxation and pain within 2 mo of his stroke. After discharge from acute inpatient rehabilitation, he developed shoulder and hand pain, which was treated with subacromial bursa steroid injection and ibuprofen with eventual resolution. The patient remained clinically stable until approximately 15 mo after his stroke-when he developed severe shoulder pain associated with shoulder abduction, external rotation, and downward traction. The patient could not tolerate transcutaneous NMES because of the pain of stimulation. At approximately 17 mo post-stroke, the patient's posterior deltoid, middle deltoid, and supraspinatus muscles were percutaneously implanted with intramuscular electrodes. After 6 wk of percutaneous, intramuscular NMES treatment, marked improvements in shoulder subluxation and pain, and modest improvements in activities of daily living and motor function were noted. One year after the onset of treatment, the patient remained pain free, but subluxation had recurred. However, the patient was able to volitionally reduce the subluxation by abducting his shoulder. The patient remained pain free for up to 40 mo after the initiation of percutaneous, intramuscular NMES treatment. This case report demonstrates the feasibility of using percutaneous, intramuscular NMES for treating shoulder subluxation and pain in hemiplegia.

Electric Stimulation Therapy↗
PubMed2001

Intramuscular electromyographically controlled neuromuscular electrical stimulation for ankle dorsiflexion recovery in chronic hemiplegia.

We report three cases of survivors of chronic stroke treated with active repetitive movement training of the paretic ankle dorsiflexors mediated by intramuscular electromyographically controlled neuromuscular electrical stimulation (NMES). These case reports demonstrate the feasibility of using intramuscular electromyographically controlled NMES for facilitating ankle dorsiflexion recovery among survivors chronic stroke with moderate hemiplegia. Relevant issues for clinical implementation and future investigations are reviewed.

Ankle↗
PubMedDate not supplied

The use of dynamic EMG in predicting the outcome of split posterior tibial tendon transfers in spastic hemiplegia.

The purpose of this study was to assess the outcome of split posterior tibial tendon transfers in patients with spastic cerebral palsy to determine whether the use of preoperative dynamic electromyography was predictive of surgical success. The study is a consecutive case series of 25 children with spastic hemiplegia who underwent unilateral split posterior tibial tendon transfers for varus foot deformities. Three patients were considered failures because of residual varus, which required further surgery. An additional 5 patients had mild residual varus. Preoperative dynamic electromyographic data were evaluated to determine the etiology of postoperative undercorrection. Undercorrection seems to be related to unrecognized anterior tibial muscle overactivity and advanced age at surgery. Overcorrection did not occur. Dropfoot was noted postoperatively in 52% of patients and was related to early cessation of anterior tibial muscle activity in swing. Split posterior tibial tendon transfer is a successful surgery on those patients with increased posterior tibial muscle activity. Undercorrection can be avoided by assessing the activity of the anterior tibial muscle before surgery. These results are expected to assist in surgical decision making for the equinovarus foot in cerebral palsy.

Adolescent↗
PubMed2006

Conversion disorder presenting as hemiplegia and hemianesthesia with loss of neurologic reflexes: a case report.

Conversion disorders can present with a variety of sensorimotor signs and symptoms. We present the case of a young woman who presented with sudden onset hemiplegia and hemianesthesia including unilateral loss of deep tendon reflexes, Babinski reflex, and loss of rectal tone with bladder incontinence. The loss of rectal tone, loss of deep tendon reflexes, and a flaccid Babinski reflex are unusual signs in conversion disorders. A thorough medical workup including x-rays, CT scans, and magnetic resonance imaging revealed no organic causes for the neurologic deficits. Before the onset of symptoms, the patient was emotionally upset during an argument, which may have provided the psychologic stressor necessary for a conversion disorder. The young woman gradually regained full neurologic function over the next 14 hours. Conversion disorders should be considered when the neurologic findings do not correspond to known anatomic or physiologic pathways, although a thorough medical investigation must be performed to search for organic causes.

Adult↗
PubMed1999

The effect of wrist angle on electrically evoked hand opening in patients with spastic hemiplegia.

This paper studied the effect of wrist angle on the amount of hand opening achieved by electrical stimulation in people with spastic hemiplegia. With their forearm in pronation, subjects were asked to relax while their affected wrist was passively moved in steps of about 15 degrees from full flexion into extension. Trains of stimuli were applied to the long finger extensor muscles through surface electrodes on the forearm. At each wrist position stimulation was turned on for a few seconds until hand opening equilibrated. Wrist angle and fingertip positions were recorded using a three-dimensional (3-D) motion analysis system. Maximal displacements between thumbtip and each fingertip occurred when the wrist was fully flexed. As the wrist was extended, hand aperture achieved by electrical stimulation progressively declined, reaching zero at 40 degrees of wrist extension. We conclude that electrical stimulation can significantly increase the grasp aperture of the hemiplegic hand, but this is strongly dependent on wrist posture and accompanying voluntary effort.

Adolescent↗
PubMed1996

Congenital scalp defect, distal limb reduction anomalies, right spastic hemiplegia and hypoplasia of the left arteria cerebri media. Further evidence that interruption of early embryonic blood supply may result in Adams-Oliver (plus) syndrome.

In this report we describe a male patient with the interesting combination of a large congenital scalp defect, distal limb reduction anomalies, right spastic hemiplegia and hypoplasia of the left arteria cerebri media. Follow-up data from birth up to the age of 18 years revealed positive evolution with low to normal intelligence. The findings in the present patient, i.e. an Adams-Oliver syndrome associated with a severe neurological deficit, are best explained as resulting from interruption of the early embryonic blood supply.

Abnormalities, Multiple↗
PubMed2006

Brainstem dysfunction in alternating hemiplegia of childhood: a neurophysiological study.

Six patients with alternating hemiplegia of childhood (AHC) underwent motor evoked potentials (MEPs), somatosensory evoked potentials (SEPs) and blink reflex recording. No SEP abnormality was found. As for MEP recording, central conduction time did not differ between patients studied during either interictal or ictal phase, and normal subjects, suggesting that the pyramidal system function is spared. In blink reflex recording, the latencies of both the ipsilateral (iR2) and contralateral (cR2) R2 components were significantly longer (P<0.01) in patients during the interictal phase than in normal subjects. Moreover, the iR2 and cR2 areas were significantly reduced (P<0.01) in patients during the interictal phase, compared with normal subjects. During the ictal phase, the ipsilateral R2 latency was significantly decreased after stimulation of the hemiplegic side, compared with the interictal phase (P<0.05). The blink reflex abnormalities suggest a brainstem dysfunction, which may be linked to the pathophysiological mechanisms of the disease.

Adolescent↗
PubMed1992

Peripheral and central mechanisms of hindfoot equinus in childhood hemiplegia.

A detailed clinical examination of 24 hemiplegic children at a mean age of 9.9 years showed that nine had an obligate toe-strike when walking at a self-selected speed and this was maintained throughout stance. None of the 24 children had a fixed equinus. No association could be found between this pattern of gait equinus and lower-limb atrophy, reduced ankle-joint range, muscle extensibilite, power of dorsiflexors and plantarflexors or actual muscle imbalance at the ankle joint. Gait equinus was independent of reduced compliance of the calf muscles, of a clinical diagnosis of tonic spasticity, of fine-motor dexterity of the toes, and of the side of the hemiplegia. Gait equinus cannot be explained merely in terms of a central paralytic foot-drop. A developmental model of equinus is advanced.

Ankle Joint↗
PubMed1996

Do incomplete ascertainment and recruitment matter? - a study in childhood hemiplegia.

London children with hemiplegia were ascertained from multiple sources . The effectiveness of ascertainment varied markedly between different sectors of London, and many families did not respond to a written appeal to participate in the research (though most did respond to a personal appeal). Subjects from areas with high and low ascertainment rates had very similar demographic, medical, cognitive and behavioral variables, and so did easy- and hard-to-recruit subjects. The characteristics of the sample as a whole closely resembled those of previous epidemiological samples of hemiplegic children. It would be rash to assume that incomplete ascertainment and recruitment are innocuous, even though they did not make this sample unrepresentative.

Adolescent↗
PubMed1996

IQ and its predictors in childhood hemiplegia.

In a population-based sample of 149 children with hemiplegia, IQ was highly correlated with a simple-to-calculate index of neurological severity. Performance IQ was an average of 13 points lower then verbal IQ-a difference that seemed to reflect specific visuospatial difficulties rather than an effect of the motor disability itself. Side of lesion was not significantly related to either IQ or verbal-performance discrepancy. Neurological factors and social class had additive effects on IQ, suggesting that neurological damage neither amplified nor obliterated the impact of ordinary psychosocial and genetic factors on IQ.

Age of Onset↗
PubMedDate not supplied

Infarction after surgery for focal epilepsy: manipulation hemiplegia revisited.

The success of surgery for seizure focus resection depends on postoperative reduction or disappearance in number of seizures, improvement in psychosocial functioning, and low morbidity and mortality. Permanent neurologic sequelae are most often not discussed in this context. Deficits more than a superior quadrantanopsia are not expected after temporal lobectomy. Four cases of ischemic stroke after seizure focus resection, each distant from the site of tissue removal, are reported. These are the first such radiologically documented reports of "manipulation hemiplegia." The permanent neurologic deficits are not attributed to resected tissue or edema.

Adolescent↗
PubMed1975

Effect of dantrolene sodium on spasticity associated with hemiplegia.

The effects of dantrolene sodium (Dantrium) were studied in 23 patients with hemiplegic spasticity, 13 of whom were younger than 50, and 10 older than 50. The dosage of dantrolene ranged from 100 mg per day initially to 600 mg per day maximally. The drug was most effective in reducing or abolishing clonus and somewhat less efficacious in decreasing the resistance to stretch and the tendon reflexes. Functionally, gait was improved and the patients found it easier to take care of their personal needs. In general, motor performance was improved. The observation that patients in the 50+ age group responded less well remains unexplained. Dantrolene sodium is a valuable tool in the management of spasticity due to hemiplegia.

Adult↗
PubMed2006

A comparison of laryngoplasty and modified partial arytenoidectomy as treatments for laryngeal hemiplegia in exercising horses.

OBJECTIVE: To compare upper airway mechanics, arterial blood gases, and tracheal contamination in horses with induced left laryngeal hemiplegia (recurrent laryngeal neuropathy [RLN]) treated by laryngoplasty/vocal cordectomy (LPVC) or modified partial arytenoidectomy (MPA). STUDY DESIGN: Repeated measures under the following conditions: Control, RLN, LPVC, and MPA. ANIMALS: Six horses. METHODS: Two trials were conducted under all conditions at 80% and 100% of maximal heart rate (HR(max)). In Trial 1, arterial blood gases, tracheal and pharyngeal pressures, and laryngeal videoendoscopy were recorded. In Trial 2, upper airway pressure and airflow were determined. Tracheobronchial aspirates were performed after exercise to quantify airway contamination. RESULTS: Compared with control, RLN significantly increased inspiratory impedance and worsened exercise-induced hypoxemia. At 80% HR(max), LPVC restored most variables to control values. At 100% HR(max), LPVC improved all variables, but did not restore minute volume, arterial pH, and PaCO(2). At 80% HR(max), MPA restored all variables except bicarbonate to control values. At 100% HR(max), MPA improved all variables, but did not statistically restore minute ventilation or bicarbonate level. Only minor differences were noted between LPVC and MPA. Both resulted in equivalent tracheal contamination. CONCLUSIONS: Airway mechanics and arterial blood gas values were not restored to normal after either LPVC or MPA in horses exercising at HR(max). This does not affect ventilation at sub-maximal exercise, but has clinical implications at HR(max). Both procedures diminish normal laryngeal protective mechanisms. CLINICAL RELEVANCE: At sub-maximal exercise intensities both LPVC and MPA restore airway ventilation to normal. At maximal exercise the superiority of LPVC over MPA is slight.

Animals↗
PubMed1996

Horner's syndrome and ipsilateral laryngeal hemiplegia in three cats.

Horner's syndrome is described in three cats associated with wounds to the ventrolateral neck. In each case, ipsilateral laryngeal hemiplegia was observed on laryngoscopy. This finding provided strong evidence to support a diagnosis of second order Horner's syndrome due to disruption of the cervical sympathetic trunk, as motor fibres innervating laryngeal abductors also traverse the neck; both as descending fibres within the contiguous cervical vagus and as ascending fibres within the recurrent laryngeal nerve. Notably, the ability to vocalise was unimpaired in all cases and, in two cats, neck wounds were not apparent until the neck had been clipped and closely examined. These findings indicate that assessment of laryngeal function is of value when localising the site of the neural defect responsible for selected cases of second order Horner's syndrome.

Adrenergic Fibers↗
PubMed1983

Assessment of the efficacy of an abductor muscle prosthesis for treatment of laryngeal hemiplegia in horses.

Four variations of abductor muscle prosthesis for treating laryngeal hemiplegia were evaluated in 153 horses by questionnaire, and in the 100 Thoroughbred racehorses in this group survival analysis was used to compare their racing performances and earnings with those of 400 control horses. The questionnaire indicated that the technique which included a ventriculectomy and 2 prostheses was regarded as being the most successful (P less than 0.01) and resulted in the least residual stertor (P less than 0.001). Survival analysis showed that there was no significant difference between the treated group of horses and the control horses (P greater than 0.05).

Animals↗
PubMed1997

Cardiorespiratory responses to exercise in horses with different grades of idiopathic laryngeal hemiplegia.

The relationship between different grades of laryngeal function, as assessed by endoscopy at rest, and the measurements of indices of gas exchange and exercise capacity was assessed during a standardised treadmill exercise test in 149 horses. Horses with abnormalities other than idiopathic laryngeal hemiplegia (ILH) were excluded from the study and laryngeal function was graded according to an established system. There were no significant differences in age, weight, maximum oxygen uptake, maximum carbon dioxide production, maximum respiratory exchange ratio, maximum oxygen pulse and run time between the grades. Blood lactate concentration at 10 m/s was greater (P < 0.01) in horses with grade 5 laryngeal function than other grades. Minimum PaO2 (P < 0.001) and SaO2 (P < 0.01) were lower and maximum PaCO2 (P < 0.001), higher in horses with grades 4 and 5 laryngeal function than other grades. Horses with grade 4 function had a lower minimum CaO2 (P < 0.01) than horses with other grades. Minimum PAO2 decreased from grades 1 and 2 to grades 4 and 5 (P < 0.05). The minimum alveolar ventilation was lower (P < 0.05) in horses with grades 4 and 5 laryngeal function compared to other grades. The results of this study indicate that endoscopic assessment of laryngeal function at rest, using a simple grading system, provides an indication of dynamic changes in ventilation and the effects on blood gases during exercise. From the data, we suggest that horses that have some movement of the left arytenoid cartilage but are unable to achieve full abduction have similar ventilatory effects and blood gas responses during maximal exercise to those with complete paralysis. Some horses with grade 3 laryngeal function had blood gas results similar to those of horses with grades 4 and 5 laryngeal function, indicating that discrepancies may occur between the resting assessment and laryngeal function during strenuous exercise.

Animals↗
PubMed1976

Sparing effect of hemiplegia on tophaceous gout.

The sparing effect of hemiplegia on the development of tophaceous gout is described. The useless upper limb had no tophaceous deposits and the partially paralysed lower limb had only limited urate deposits. Disuse was presumably the major contributor to the limited deposition of urates on the paralysed side.

Gout↗
PubMed2005

A diagnostic test of unawareness of bilateral motor task abilities in anosognosia for hemiplegia.

Anosognosia for hemiplegia (AHP) is conventionally defined/diagnosed by generic questions about awareness of limb plegia. However, unawareness of inability to perform tasks requiring bilateral use of limbs is more widespread and outlasts generic unawareness of plegia. Some patients consistently overestimate bilateral task ability. Our aim was to assess how well specific questions about bilateral task ability predict whether patients consistently overestimate their abilities. Six statistical indices were calculated to rank the questions for predictiveness of consistency of overestimation of bilateral task ability. Overall, bimanual questions are better predictors than bipedal questions of consistent overestimation. Three bimanual and two bipedal questions had both sensitivity and specificity above 80%. On the basis of accuracy and discriminability, one bimanual and one bipedal question that performed maximally could be used for a quick bedside heuristic index. For a more thorough diagnostic, especially for research, five bimanual and two bipedal questions were good predictors, and should be used. For both purposes, such tests should be given in combination with conventional generic questions assessing awareness of limb plegia, since the two kinds of question reflect different kinds of unawareness of motor incapacity.

Agnosia↗