[Preventive approach to stroke from the viewpoint of a rehabilitation institution in Israel].
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Cerebrovascular Disorders↗
Biomedical subjects
P Solzi
Publications and source records attributed to P Solzi.
Symptomatic postprandial hypotension in high paraplegia. Case report.
Symptomatic postprandial decrease in blood pressure has been described in patients with various autonomic disorders, but not in patients with spinal injuries. Presented herein is a 31 year old female patient with traumatic complete paraplegia under the T3 level, in whom postprandial hypotension (PPH) was observed. The PPH was preceded by an increase in insulin level and was followed by an acceleration of heart rate. Oral caffeine prevented the hypotension and alleviated the symptoms. It is suggested that the PPH might be manifested as a result of damage to an upper thoracic spinal baroreflex. Clinical investigation of PPH is recommended for patients with high paraplegia.
Adult↗
Is the appearance of periarticular new bone formation related to local neurological disability?
The present work examined the relationship between the appearance of periarticular new bone formation (PNBF) and the presence of local sensorimotor disability, and the relationship between PNBF and the severity of the motor disability. The study population consisted of 18 patients with spinal cord lesions and 18 patients with traumatic brain injury. The confinement of PNBF below the level of neurological deficit in patients with spinal cord lesions, and mainly to paralysed or paretic limbs in brain injured patients, indicates a possible causal relationship between the presence of sensorimotor disability and PNBF. On the other hand, the high incidence of bilateral PNBF in patients with incomplete spinal lesions and the appearance of PNBF in some nonplegic and even paretic limbs in the brain injured patients, demonstrates the lack of connection between the severity of the motor deficit and the risk of PNBF. It is suggested that local factors which are related to sensorimotor disability are probably involved in PNBF induction, but additional elements may also play a role in the induction of PNBF and in its propagation.
Adolescent↗
Acute stroke patients: long-term effects of rehabilitation and maintenance of gains.
The efficacy of rehabilitation programs to facilitate recovery after acute stroke remains controversial. To further evaluate this issue, the records of 139 "middle-band" stroke survivors were reviewed retrospectively at admission to, discharge from, and one-year follow-up from inpatient rehabilitation. Patients were divided into two groups (out-patient [O/P] or no O/P) based on their involvement in physical and occupational therapy services. A repeated measures ANOVA indicated that both groups made clinically and statistically significant improvements in all functional indices between stroke onset, discharge from inpatient rehabilitation, and follow-up: O/P therapy: mobility F(1,46) = 1651, p less than .0001; self-care F(1,47) = 1062, p less than .0001; total F (1,47) = 1093, p less than .0001; no O/P therapy: mobility F(91,88) = 5643, p less than .0001; self-care F(1,88) = 5722, p less than .0001; total F(1,88) = 6733, p less than .0001. Pairwise comparisons for all functional indices revealed that all statistically significant changes in function in the no O/P therapy group occurred between stroke onset and discharge: self-care (p less than .0001), mobility (p less than .0001), and total (p less than .0001). Pairwise comparisons of all indices in the O/P therapy group revealed that all differences between stroke onset and discharge functional scores were at the p less than .0001 level, and score differences between discharge from inpatient rehabilitation and follow-up were as follows: self-care (p less than .05), mobility (p less than .001), and total (p less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Polysomnography in locked-in syndrome.
Sleep patterns were evaluated in a case of 'locked-in' syndrome. This patient had an ischemic infarction involving the ventral portion of the upper half of the pons bilaterally, with a posteromedial extension into the tegmentum. Reticular structures, notably the median raphe nuclei, supposed to play a major regulatory role in sleep, were most probably involved. Unexpectedly, repeated polysomnographic studies revealed sleep patterns with only minor abnormalities.
Electroencephalography↗
Stuttering as a manifestation of right-hemispheric subcortical stroke.
A right-handed man developed stuttering, without aphasia, as a result of a circumscribed subcortical infarction in the right hemisphere. He never stuttered before and has no family history of stuttering. Damage to callosal pathways coordinating the activity of both hemispheres during speech is proposed as a possible explanation for the stuttering.
Aged↗
Postural stability in stroke patients: vectorial expression of asymmetry, sway activity and relative sequence of reactive forces.
Bilateral force measurements on the supporting limbs in postural sway while standing still were made to evaluate post-cerebral-vascular accident (CVA) patients during rehabilitation. Normal subjects of the same age group were tested as controls. From the force tracings obtained, three oscillation frequencies were identified, with orders of magnitudes of 7, 1 and 0.1 Hz, respectively, of which the middle frequency, i.e. that corresponding to 1 Hz, was selected for subsequent processing and analysis. These included the determination of relative sequence of the force vectors on both feet and evaluation of timings and amplitudes of the waveforms. Weight-bearing imbalance was defined in the vertical direction to express the difference between the average forces supported by each of the legs. In the horizontal plane, two parameters were defined: sway total activity (SA), to represent the vector summation of the absolute values of the horizontal force components acting on both legs; and asymmetry (ASYM) to express the difference in activities between the two legs. The results presented disclose the reactive force patterns acting on each of the legs of post-CVA hemiplegic individuals, in comparison with normal individuals. Although these forces were shown to act synchronously on both legs, they appeared to be asymmetrical in nature, with a typical vectorial pattern for every individual, which generally differed from that of normal subjects. Sway activity was found to be significantly higher in hemiplegics compared with the normal controls.
Adult↗
Mutism associated with buccofacial apraxia and bihemispheric lesions.
Mutism following brain trauma is quite common, is usually transient, and recovery of speech is essentially the rule. Lasting total absence of speech without aphasia is highly unusual. Three such patients, two of traumatic and one due to vascular origin showing buccofacial apraxia (BFA) and computerized tomography (CT) evidence of bilateral frontal lesions are reported. It is suggested that complete lasting mutism associated with BFA is a result of bihemispheric lesions affecting mainly the opercular part of the inferior frontal gyrus and immediate adjacent regions.
Adult↗
Eye-sighting preference of normal and hemiplegic children and adults.
Monocular eye-sighting preference was examined in 32 children with hemiplegia, 51 adult-onset hemiplegic patients and 57 normal children and adults. Eye preference was compared with ear preference on dichotic listening for 25 of the hemiplegic children. No independent association could be detected between eye preference and ear preference. In both the children and adults with hemiplegia the preferred eye tended to be on the same side as the damaged hemisphere. Among the adults, this tendency was more pronounced with more extensive lesions, as manifested by aphasia and/or hemianopia. These findings are interpreted as indicating that eye-sighting preference is unrelated to unitary hemispheric dominance, and that, unlike dominance for hearing and speech, it is not irreversible after a critical period of development. A simpler explanation than incomplete hemispheric dominance is offered for the weakly positive association between mixed laterality and cerebral dysfunction.
Adult↗
Blink reflex in stroke: follow-up and correlation with function and CT parameters.
Blink reflex (BR) was examined serially in patients 1, 2 and 3 months after unilateral hemispheric cerebrovascular accident and compared with functional state and CT findings of lesion extent and location. BR R2 components were depressed and correlated with lesion size. Initial walking ability was correlated with latency and amplitude of both direct and consensual R2 elicited by stimulation of the paretic side. No correlation was found between BR and arm function or the final ambulatory ability. A model suggesting a close association between BR projection-facilitating fibers and those mediating facial movements is presented.
Blinking↗
Teaching PM&R in Israel.
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Clinical Clerkship↗
The threshold-of-interference test: a new test of interhemispheric suppression in brain injury.
A new procedural version of the Willeford competing sentences test (Willeford. Audiol Hear Educ 1976;2:12-20) is introduced here for use with brain damaged patients. The threshold-of-interference test seeks the minimal level of the competing sentences at which the patient can no longer repeat the message at the test ear. Findings are reported for normal controls and for brain damaged adults, with clinical data and computerized axial tomography scan evidence. The threshold-of-interference test appears to be efficient, quick in administration, and particularly useful in exposing auditory processing anomalies, especially in right hemisphere damage.
Aged↗
Urinary continence after stroke: association with cystometric profile and computerised tomography findings.
Repeated cystometry was performed in 17 patients after a cerebrovascular accident. Cranial computerised tomography (CT) was performed in all patients. In this series, urinary continence showed a significant correlation both with cystometric bladder tone and with the CT brain findings. The most favourable prognostic factors for urinary continence were a non-hypertonic bladder and absence of extensive brain lesions.
Adult↗
Interhemispheric suppression: a test of central auditory function.
Two groups of brain damaged adults, those with cerebrocranial injury (CCI) and victims of cerebrovascular accident (CVA) were tested with the competing sentences test of Willeford (In: Central Auditory Dysfunction. New York: Grune and Stratton, 1977: Chap 2). The main purpose was the exposure of functional disorders of communication in such patients who test within normal or near-normal limits on routine audiological testing and also on tests for aphasia. Of 142 serially admitted CCI patients, 43%, many with diffuse lesions, gave abnormal responses, mostly at the left ear, with 19 of them showing total extinction at that ear. On two sound field competing message tests the CCI patients were significantly poorer than normal controls. CVA patients with confirmed right hemisphere lesions tended strongly toward left ear suppression, while left hemisphere damaged patients often showed bilateral drop in scores. It is clear that brain damaged patients can have central dysfunction of auditory processing despite normal findings on routine audiological tests and tests for aphasia. The implications for activities of daily living and for habilitation are discussed.
Adult↗
Evaluation of Tinel's and Phalen's signs in diagnosis of the carpal tunnel syndrome.
In 80 upper extremities clinically suspected of carpal tunnel syndrome, electromyography (EMG) was performed and the Phalen and Tinel signs were sought. These two signs showed relatively low sensitivity (60-67%) and specificity (59-77%) despite a statistically significant association with the EMG findings. These two signs are not reliable as clinical criteria for carpal tunnel syndrome.
Adult↗
Temporal changes in electrophysiological, clinical and radiological parameters in the hemiplegic's shoulder.
The relationship between electrophysiological, clinical and radiological parameters in the shoulder of hemiplegic patients was examined in a group of 24 subjects. Measurements and observations were made about the fourth month after CVA and again some eight months later. Total follow-up period extended to a maximum of 28 months. Electrophysiological tests included concentric needle EMG and conduction tests. In the shoulder X-ray four stages were described: normal, V-shaped space, initial subluxation and advanced subluxation. The presence of pain, reflex sympathetic dystrophy, atrophy and return of movement were registered. The most striking findings, consistent with lower motor neuron lesion, were those of parallel changes in axillary nerve latencies (obtained through stimulation from Erb's point) and shoulder X-ray stage. Age and time lapse between examinations turned out to be significantly related to such changes: younger patients did better and changes were registered even after one year from the first examination. An anatomical explanation linking the axillary nerve with humeral head disposition on the hemiplegic side is offered.
Cerebrovascular Disorders↗
Criteria for referral of CVA patients for rehabilitation.
A multi-stage follow-up project is in progress at the Loewenstein Rehabilitation Hospital. In the first stage, a group of 153 patients was examined while in the acute phase of CVA (1 to 5 days from stroke), and again 6 months later, by a physician, a physiotherapist and an occupational therapist. Medical, demographical and functional profiles were determined. The most severe cases were admitted for rehabilitation and those with apparently good functioning ability were discharged to their homes. Six months later, the group referred for rehabilitation remained at a very low functional level (35% of them were still at the rehabilitation hospital); on the other hand, those sent home were lacking in general function (37%), in spite of their good ADL and hand performance. Most strikingly, 72% were not engaged in any meaningful activity. Age proved to be a strongly limiting factor. A more selective criterion for referral is required, while allowing patients with medium-grade cognitive and locomotor disturbances the chance of admission to rehabilitation.
Activities of Daily Living↗
Age and aphasic syndromes.
275 patients with CVA and 62 with CCI were examined within one month of the event and again, after 4-6 months. Previous reports have indicated that the average age of patients with Wernicke's aphasia is significantly higher than that of Broca's aphasia. Our findings after the second examination, support these reports. First month examinations, however, showed only a weak trend, lacking statistical significance. Our findings did not show more fluent aphasia in older patients than in younger ones. There is minimal literature on the positive relationship between age and auditory comprehension in aphasia. We found this to be the most highly correlated relationship. Our studies emphasize the importance of changes during the early post-event period in comparing aphasic syndromes in older versus younger patients, since there is a clear shift in the age/syndrome relationship in that period. Age differences in such changes can affect prognosis for rehabilitation.
Adult↗