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Evaluation of the Spine in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Ashish Dagar, Sarvdeep Singh Dhatt, Deepak Neradi, Vijay G Goni
Inspection starts as soon as the patient enters the room and should be done from the front, side, and back. Notice the patient’s attitude, gait, how he/she carries their head, whether he/she requires support with the hands to the neck or head to avoid pain. A child with a painful inflammatory lesion in the spine will walk with caution to avoid any jerks with the trunk held stiff and a broad base formed by the lower limbs. He/she may stand with his/her hands kept on the knees to bypass weight transmission across the dorsolumbar spine. A child with paraparesis will modify his/her gait according to the type of paresis. In spastic paresis, the child may walk with scissoring (adductor spasm) or circumduction gait with the loss of normal rhythmic movements of the gait cycle. A patient with flaccid paresis may walk with assistance to clear ground. A high-stepping gait will be present in case of weakness of ankle dorsiflexion. Observe fine movements of the hands, such as unbuttoning of the shirt while the patient gets ready for examination.
Methods of Analysis
Published in Andrei I. Holodny, Functional Neuroimaging, 2019
It is important to note that giving the patient proper instructions prior to imaging and emphasizing the direct benefit from the fMRI procedure are most important in minimizing head motion. In patients with paresis, different paradigms could be used to minimize artifacts while keeping functional information intact. Examples include passive movement or sensory stimulation rather than applying voluntary movement tasks. For patients with aphasia, a covert task using a block paradigm (during which the patient does not vocalize his/her response, but instead responds silently) can be ideal.
Sub-atmospheric decompression illness
Published in Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol, Handbook of Aviation and Space Medicine, 2019
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol
Sub-atmospheric DCI includes: Decompression sickness (DCS): DCS first recognised in divers/compressed air workers in 1850s as ‘caisson disease’.Compressed air and sub-atmospheric DCS have different features.Arterial gas embolism (AGE): May arise from pulmonary barotrauma or venous gas emboli through patent foramen ovale or pulmonary shunts.May lead to cerebral arterial gas embolism (CAGE) where occlusion of cerebral vessels may produce ischaemia. CAGE more likely during breath hold in decompression.Symptoms of unilateral paresis, facial weakness, dysphasia or focal neurological symptoms.Requires urgent recompression therapy (short delay to move to centre of excellence acceptable).
The effects of lower extremity deep sensory impairments on walking capability in patients with incomplete cervical spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2022
Tomoki Naka, Tetsuo Hayashi, Atsushi Sugyo, Ryouichi Watanabe, Fumihiro Towatari, Takeshi Maeda
Recovery of the ability to walk after a spinal cord injury is among the most important issues in rehabilitation and is one of the primary factors that influences societal reintegration of these patients.1 Despite differences in functionality after spinal cord injury, patients with paresis are expected to recover.2 Numerous studies have investigated motor function and walking capability. According to studies by Scivoletto et al. and Hayashi et al.,3,4 differences in motor function and functional walking recovery rates differ between young patients and those over 50 years of age, with age thought to exert a considerable influence on neurological functional recovery. Previous studies have reported that starting walking training early following an injury and increasing the duration of the walking training,5–7 improved the results of indicators such as the lower extremity motor score (LEMS), Walking Index for Spinal Cord Injury II (WISCI), and 10 m walk test (10MWT). Moreover, in more fundamental research that compared non-exercising and exercising groups with a varied exercise start date relative to injury, the efficacy of early-stage exercise has been indicated.8 However, with respect to the relationship between sensory impairment and walking capability, while one can find evidence indicating that sensory impairment influences walking speed in patients with stroke,9 no reports have focused on the relationship between sensory impairment and walking capability in patients with spinal cord injury.
Early clinical predictors of post stroke spasticity
Published in Topics in Stroke Rehabilitation, 2021
Stefanie Glaess-Leistner, Song Jin Ri, Heinrich J Audebert, Jörg Wissel
We also found that paresis could be highly predictive for PSS occurrence, given that it was observed in 100% of patients developing PSS in the first three months following stroke. However, 36% of patients without PSS also had paresis of limbs contralateral to the cerebral lesion. Therefore, the existence of paresis can be just only a precondition of PSS, but not a predictor. Actually, in other study 42.6% of patients with initial paresis due to stroke showed PSS in 6 months and they suggested that severe paresis at onset would be a strong predictor of PSS.8 In our study, topical distribution, paresis extent and severity, thereby, severe affected function status from paresis were also crucial factors given that the more severe the paresis and dysfunction in clinical assessments, the higher the proportion of patients that suffer from PSS. Overall, the extent of functional impairment was shown to be a significant predictor of PSS. A high NIHSS score as expression of damaged neurological functions, in addition to low Barthel Index and high Rankin Scale score as the expression of functional limitation and impairment in everyday functions, in addition to a low MMSE score as the expression of reduced cognitive ability, was all associated with PSS occurring in the later post-stroke period. Severe stroke status is associated with their affected life quality i. e. low Barthel Index and with functional impairment i. e. high score for modified Rankin scale and these were often associated with the development of PSS.8,10,18
The insidious impact of under-diagnosed proximal weakness induced by statins
Published in Expert Review of Neurotherapeutics, 2021
To a neurologist, the term myopathy implies the exam finding of proximal weakness. Indeed, limb-girdle and axial weakness are the sine quo non for any diagnosis of myopathy. The National Lipid Association agreed, defining a statin-induced myopathy as associated with proximal paresis [6]. Remarkably, however, there are few reports and no statin RCTs in which conventional manual muscle testing (MMT) for proximal weakness was included in evaluations of participants with or without SAMS. Thus, the incidence of proximal weakness induced by the drug class with or without myalgia may be under-appreciated. Reviews of adverse responses to statins instead conclude that muscle symptoms are primarily myalgias and patients rarely develop clinically significant proximal weakness [7]. Our experience and studies in which strength testing was included suggest that the incidence may exceed 10%. In addition, the axial and limb-girdle paresis often causes insidious disability, particularly in users with neurological diseases and especially stroke.