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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Important symptoms of compartment syndrome would include pain, which is an early sign and often disproportionate to the injury sustained. It can be elicited with passive stretching of the muscle in the compartment that is affected. Patients may also complain of a tightness or pressure in the affected limb, which is another early indication of developing pathology. Paraesthesia is another early sign and may be in the distribution of the nerve if it travels through the affected compartment. Objective signs, which are often late, include pallor suggesting vascular insufficiency, and pulselessness, although this would need to be confirmed on doppler ultrasound. Paralysis is one of the latest signs, suggesting loss of motor function in the limb. It can be difficult to interpret as the mechanism of injury may prevent movement, however in disease pathology, prolonged nerve or muscle injury can result in permanent damage.
Extraordinary dreams
Published in Josie Malinowski, The Psychology of Dreaming, 2020
To some extent, the answer might be that prevention is better than cure since there is currently very little scientific research that’s been conducted into treatments for sleep paralysis. However, we know quite a lot about risk factors, so one way to avoid sleep paralysis is to reduce the risk factors as much as possible. That means maintaining a regular sleep schedule, avoiding caffeine and alcohol close to bedtime, using tools to reduce stress and anxiety before sleep, and so forth. Some inventive individuals have even gone so far as to stuff a tennis ball in the back of their pyjamas to try and prevent their sleeping selves from rolling onto their back.
Parasomnias
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Cataplexy is a flaccid paralysis of the large skeletal muscles which represents an intrusion of the atonia of REM sleep into wakefulness. Most often the paralysis is partial and manifested only by a transient weakness in the arms, legs, or neck. In some instances however, postural atonia is more complete and the patient falls dramatically to the ground. The attacks have a sudden onset often triggered by strong emotion such as laughter, excitement, or anger. Cataplexy is invariably symptomatic of narcolepsy of which it is occasionally the presenting complaint.
Effect of neurocognitive rehabilitation on upper limb function in community-dwelling chronic stroke patients: A pilot study
Published in Physiotherapy Theory and Practice, 2022
Nakagawa Kotaro, Hideki Nakano, Shinya Iki, Tomoya Ishigaki, Takuya Kawaguchi
Eight community-dwelling chronic stroke patients participated in this study. The inclusion criteria were as follows: age ≥18; onset of a stroke ≥6 months prior to the study; and diagnosis of hemorrhagic and ischemic or hemorrhagic stroke. We excluded patients with Mini-Mental State Examination scores <24 points or severe higher brain dysfunction that might affect the results, including aphasia, apraxia, agnosia, dysmnesia, aprosexia, executive function disorder, social behavior disorder, central post-stroke pain, and those who declined to participate in this study. We defined paralysis as the total lack of ability to perform movements of the limbs or body, as a result of the interrupted flow of nerve signals to muscles (Muszkieta et al., 2010). The patients’ Brunnstrom stages (Brunnstrom, 1966) were as follows: upper limb, stage 2, n = 1; stage 3, n = 1; stage 4, n = 2; stage 5, n = 4; hand, stage 2, n = 2; stage 4, n = 1; and stage 5, n = 5. Interestingly, Brunnstrom’s six recovery stages are as follows: stage 1, flaccidity; stage 2, synergies developing (minimal voluntary movements); stage 3, voluntary synergistic movement; stage 4, some movements deviating from synergy; stage 5, independence from the basic synergies; and stage 6, isolated joint movements (Chen et al., 2000). In this study, we confirmed that our patients presented with motor paralysis based on the physician’s diagnosis.
The Hua-Shan rehabilitation program after contralateral seventh cervical nerve transfer for spastic arm paralysis
Published in Disability and Rehabilitation, 2022
Jie Li, Ying Ying, Fan Su, Liwen Chen, Jingrui Yang, Jie Jia, Xiaofeng Jia, Wendong Xu
Central paralysis, induced by lesions to brain center, is a general term for conditions marked by unilateral motor and sensory disability. The injury to the motor region will lead to the weakness and the loss of fine control over hands. Meanwhile, spasticity will occur owing to the interruption of the inhibitory activity of upper motor neurons. These factors limit the patients to regain the motor function, which are also the difficulties in treatments of central paralysis. Meanwhile, stroke, a disease characterized by high morbidity, high mortality and high disability rate, is an important cause to brain injury and brings the society great economical burdens [1,2]. Epidemiologic studies suggested that the mortality of stroke has been reduced, while the disability rate has been gradually increased and now it has ranked top among all the diseases [1]. About half of the stroke survivors turned into sever disability and lost their activity of daily life (ADL) [1,2]. In China, the incidence of stroke is gradually increasing by 8.7% annually, which has been a leading cause to death and disability [1]. After the stroke, it is reported that 30–60% of patients cannot use their paralyzed arm [3], highlighting the importance of promoting arm function. Great efforts have been made in this field, while difficulties have also been met.
Minimally invasive endoscopic treatment of chronic otitis media with facial nerve palsy- A case report and literature review
Published in Acta Oto-Laryngologica Case Reports, 2021
Facial nerve paralysis is one of the uncommon but important complications of chronic otitis media (COM). Its prevalence was reported to be 1%–2.3% in the pre-antibiotic era which has gradually decreased with the introduction of antibiotics; nevertheless, it is still seen in developing nations [1]. If left untreated or not managed on time, the paralysis can cause permanent physical deformity. Facial paralysis impairs facial movement, which results in unappealing deformation of expressions such as smiling. Thus, facial paralysis markedly affects a person’s quality of life, social life and can lead to serious psychological damage [2]. Early surgical eradication is the most viable way to overcome paralysis [3]. Surgical interventions include microscopic mastoidectomy via postaural approach, canal wall down or up technique, along with facial nerve decompression [1]. Recently endoscope has been introduced in the field of otology that has changed the management of the surgery. Most otologists are accepting endoscopic ear surgery mainly because of the minimally invasive approach [4]. Most articles on endoscopic facial nerve decompression were published for traumatic facial nerve palsy. We did not find any articles on endoscopic facial nerve decompression for chronic otitis media. Here we present the first case report on the total transcanal endoscopic management of a non-cholesteatomatous COM with facial nerve palsy.