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PubMed2003

Pericardial patch closure of an atrial septal defect using endoscopic robotic technology.

Significant progress has been made over the last several years in the area of minimally invasive cardiac surgery with beneficial clinical results and increased patient satisfaction. With the addition of robotic technology to the cardiac operating room come improvements in technical manual dexterity and decreased surgical trauma. This paper reports an endoscopic pericardial patch closure of an ostium secundum atrial septal defect (ASD) using a combination of the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) and the PORT ACCESS System (CardioVations, Sommerville, NJ, USA) for full cardiopulmonary bypass (CPB). CPB, aortic occlusion, and cardioplegia delivery were accomplished via peripheral cannulation with the PORT ACCESS System. Two robotic arms, one endoscopic camera, and one working incision were placed through ports in the thorax. The ASD was closed with a gluteraldehyde fixed pericardial patch using both running and interrupted suture. CPB and aortic occlusion times were 160 and 93 min, respectively. The patient was discharged on the second postoperative day and returned to normal lifestyle shortly thereafter. The benefits of peripheral access CPB and robotic technology to patients who do not want a median sternotomy provide an alternative method to traditional surgical intervention.

Adult↗

PubMed2000

Ulnar nerve lesions: functional outcome after five years.

OBJECTIVE: To analyse perceived impairments, disability, job restrictions and job changes in subjects with a neurapraxia and neurotmesis of the ulnar nerve five years after trauma. DESIGN: Retrospective, descriptive follow-up study. SETTING: Department of Rehabilitation of a University Hospital. SUBJECTS: Sixteen subjects with a neurotmesis (NT-group) and 20 subjects with a neurapraxia (NP-group) were compared by means of a structured interview assessing perceived impairments and change in job and a questionnaire assessing disabilities (Groningen Activity Restriction Scale: GARS). RESULTS: The NP-group perceived significantly more pain, loss of strength and sensation, loss of dexterity and perceived more job-related restrictions than the NT-group. The NP-group had significantly higher scores on the GARS. There was a moderate correlation between the visual analogue score of the pain and the GARS in the NP- and NT-groups. No significant difference was found between the groups with respect to job changes. CONCLUSIONS: This study shows that subjects with a neurapraxia of the ulnar nerve perceive more impairments and disabilities compared with those subjects with a neurotmesis.

Adult↗

PubMed2002

Development and validation of two new sensory tests of the hand for patients with stroke.

OBJECTIVE: To establish validity and reliability of two new sensory tests evaluating moving (MTP) and sustained (STP) touch-pressure and their relationship to hand function for patients with stroke. The STP had four components in which a light or heavy ball was applied passively or held actively. PARTICIPANTS: Twenty-eight participants with hemiparesis (1-109 months) from rehabilitation hospitals or outpatient programmes. DESIGN: Content validity was established. Then reliability and concurrent and construct validity were determined. Sensation was compared with hand functional ability using the Modified Moberg recognition task, the Box and Block test and one task of the TEMPA test. RESULTS: Reliability: Both types of reliability were significant for MTP (ICC = 0.92) and all components of STP (ICC = 0.62 to 0.92). Concurrent validity: MTP and STP correlated significantly (r = -0.39 to -0.83) with the Semmes-Weinstein Monofilament test used as a 'gold standard' comparison. Construct validity: MTP was significantly related to Moberg (r = 0.49). Three of four components of STP correlated with TEMPA (r = 0.49-0.53) and Moberg (0.45-0.71). Only STP (heavy ball) correlated with Box and Block (0.42-0.48). Of the four components of STP, only the passive STP (light ball) was not related to hand function. CONCLUSION: The new sensory tests of moving, and three components of sustained touch-pressure were reliable. The passive STP (light ball) was discarded. All but this test were relevant to the two functional roles of sensation: exploration for MTP and dexterity during holding for STP.

Adult↗

PubMed2004

Evaluation of the Modified Jebsen Test of Hand Function and the University of Maryland Arm Questionnaire for Stroke.

OBJECTIVE: To examine the concurrent validity and test-retest reliability of the Modified Jebsen Test of Hand Function (MJT) and the University of Maryland Arm Questionnaire for Stroke (UMAQS). DESIGN: Individuals with acquired neurological disorders were retested within an average of 9.6 days after the first assessment. SETTING: Individuals were recruited from two specialist rehabilitation units, members of the Multiple Sclerosis Society and Headway Group. SUBJECTS: Twenty-six individuals with acquired neurological disorders; stroke (12), MS (7), head injury (4), tumour (3) with moderate to high functioning upper limbs were recruited for this study. MAIN OUTCOME MEASURES: Arm function was assessed using the MJT, the UMAQS, the Nine Hole Peg Test (NHPT) and grip strength, calculating the ratio between affected and unaffected arm. RESULTS: The MJT showed good concurrent validity. Pearson's correlation with the NHPT was 0.86 and 0.88, on T1 and T2 respectively. The UMAQS showed no significant correlation with grip strength, the NHPT and the MJT. Test-retest reliability of the MJT was high with a correlation of 0.95, and 95% limits of agreement of 0.02 +/- 0.14. Correlations over time of the dominant hand/nondominant hand of the UMAQS were 0.72 and 0.83, with limits of agreement of -2.92 +/- 13.28 and 1.73 +/- 11.53. CONCLUSIONS: The present study supports the use of the MJT as a measure of gross functional dexterity. More information is needed to evaluate the UMAQS.

Arm↗

PubMed2004

The impact of physical therapy on functional outcomes after stroke: what's the evidence?

OBJECTIVE: To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke. METHODS: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnline were searched for controlled studies. Physical therapy was divided into 10 intervention categories, which were analysed separately. If statistical pooling (weighted summary effect sizes) was not possible due to lack of comparability between interventions, patient characteristics and measures of outcome, a best-research synthesis was performed. This best-research synthesis was based on methodological quality (PEDro score). RESULTS: In total, 151 studies were included in this systematic review; 123 were randomized controlled trials (RCTs) and 28 controlled clinical trials (CCTs). Methodological quality of all RCTs had a median of 5 points on the 10-point PEDro scale (range 2-8 points). Based on high-quality RCTs strong evidence was found in favour of task-oriented exercise training to restore balance and gait, and for strengthening the lower paretic limb. Summary effect sizes (SES) for functional outcomes ranged from 0.13 (95% Cl 0.03-0.23) for effects of high intensity of exercise training to 0.92 (95% Cl 0.54-1.29) for improving symmetry when moving from sitting to standing. Strong evidence was also found for therapies that were focused on functional training of the upper limb such as constraint-induced movement therapy (SES 0.46; 95% Cl 0.07-0.91), treadmill training with or without body weight support, respectively 0.70 (95% Cl 0.29-1.10) and 1.09 (95% Cl 0.56-1.61), aerobics (SES 0.39; 95% Cl 0.05-0.74), external auditory rhythms during gait (SES 0.91; 95% Cl 0.40-1.42) and neuromuscular stimulation for glenohumeral subluxation (SES 1.41; 95% Cl 0.76-2.06). No or insufficient evidence in terms of functional outcome was found for: traditional neurological treatment approaches; exercises for the upper limb; biofeedback; functional and neuromuscular electrical stimulation aimed at improving dexterity or gait performance; orthotics and assistive devices; and physical therapy interventions for reducing hemiplegic shoulder pain and hand oedema. CONCLUSIONS: This review showed small to large effect sizes for task-oriented exercise training, in particular when applied intensively and early after stroke onset. In almost all high-quality RCTs, effects were mainly restricted to tasks directly trained in the exercise programme.

Biofeedback, Psychology↗

PubMed2005

Effectiveness of unilateral and symmetrical bilateral task training for arm during the subacute phase after stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of an arm training programme combining repetition of unilateral and symmetrical bilateral tasks for people in the subacute phase after stroke. DESIGN: Randomized controlled trial. SETTING: Inpatient functional rehabilitation unit. SUBJECTS: Forty-one people who had had a stroke, in the subacute phase, receiving conventional arm occupational and physical therapy, were randomized to an experimental group (n=20) and a control group (n=21). INTERVENTIONS: In addition to the usual arm therapy in the rehabilitation unit, the experimental group received an arm therapy programme (15-20 45-min sessions) based on repetition of unilateral and symmetrical bilateral tasks. The control group received additional usual arm therapy of a similar duration and frequency to the experimental treatment. MAIN MEASURES: The effect of the programme was judged on the basis of: (1) arm impairments (motor function, grip strength, gross and fine manual dexterity and motor co-ordination), (2) arm disabilities in tasks related to daily activities, and (3) functional independence in activities of daily living (ADL) and instrumental ADL (IADL). RESULTS: Although both experimental and control groups of participants improved similarly during the study period, the statistical analyses did not show any difference between the groups at the end of the treatment for the different dependent variables evaluated: (1) arm impairments: p = 0.43-0.79; (2) arm disabilities: p = 0.16-0.90; and (3) functional independence: p = 0.63 and 0.90. CONCLUSIONS: An arm training programme based on repetition of unilateral and symmetrical bilateral practice did not reduce impairment and disabilities nor improve functional outcomes in the subacute phase after stroke more than the usual therapy.

Activities of Daily Living↗

PubMedDate not supplied

The effectiveness of hand exercises for persons with rheumatoid arthritis: a systematic review.

A systematic review was conducted to evaluate the efficacy of hand exercises for persons with rheumatoid arthritis. The databases Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, PEDro, and Cochrane were used to search for articles on exercise and hand and rheumatoid arthritis (and their synonyms). Any articles that evaluated the effects of exercise on the hand were included in the review and evaluated for quality on a form specifically developed for the reviews in this issue. Only nine studies evaluated the effect of hand exercise or a program that included hand exercise. Quality scores ranged from 21 to 39 out of a possible 48. Few studies used psychometrically sound measures or reported on changes to everyday function. Although some significant results were obtained, they may have been due to multiple outcome measures, lack of blinding, and within-group rather than between-group comparisons. Impairment and dexterity were frequent outcomes, but measurement of self-report function was lacking. Long-term exercise may increase strength, but results on range of motion are inconsistent across studies, subjects, and joints. There is a need for randomized controlled trials with goal-specific exercise, measurement of outcomes appropriate to the goals, adequate sample size, and comparison with an appropriate control condition.

Arthritis, Rheumatoid↗

PubMed2006

Health status measurements at diagnosis as predictors of survival among adults with brain tumors.

PURPOSE: The intent of this study was to determine whether baseline measures of functional capacity and performance could be used to predict survival in adults following the diagnosis of brain tumors. PATIENTS AND METHODS: Comprehensive health status and health-related quality of life (HRQL) were measured using the Health Utilities Index (HUI; McMaster University, Hamilton, Canada) system by a self-assessment questionnaire in a survey of 100 consecutive patients. The Karnofsky Performance Score (KPS) and Folstein's Mini-Mental State Examination (MMSE) scores were measured by a physician blinded to the HUI results. The patients were observed for up to 5 years to recorded dates of death. RESULTS: An HUI questionnaire was completed for 93% of the patients and 69% died within 5 years of assessment. The HUI revealed a burden of morbidity and complexity of disability that far exceeded that reported for the general population. KPS and MMSE correlated strongly with each other (r = 0.52; P < .001). A decrease of 0.1 units in HUI Mark 2 (HUI2) self-care single-attribute utility score was associated with an increased hazard of death of 30% (P = .023) for patients with low-grade tumors (n=25). For patients with high-grade tumors (n=56), a 10 unit decrease in the KPS, a 5 unit decrease in MMSE, and a 0.1 decrease in HUI Mark 3 (HUI3) speech and dexterity single-attribute scores were associated with an increased hazard of death of 20% (P = .022), 26% (P = .015), 36% (P = .021), and 18% (P = .035), respectively. CONCLUSION: Scores derived from the measurement of HRQL following diagnosis can predict survival in adults with brain tumors.

Adult↗

PubMed1999

Long-term cognitive effects of Lyme disease in children.

Most studies of adults infected with Lyme disease (LD) have found adverse cognitive effects from the disease. In contrast, the only controlled study investigating cognitive effects of LD in a pediatric population found no effects after a 2-year follow-up. However, it was questioned whether the negative effects might take longer than 2 years to emerge. Therefore, this investigation reports a 4-year follow-up of the original sample. Twenty-five children with strictly defined LD were compared with 17 sibling control children. A neuropsychological battery was utilized, including assessment of the cognitive areas of IQ, information processing speed, fine-motor dexterity, novel problem solving and executive functioning, short-term and intermediate memory, and acquisition of new learning. In addition, parents' subjective ratings were obtained on the disease's impact on their child's participation in everyday activities. No between-group differences were found for 17 of the 18 neuropsychological test measures, nor were there differences in parents' subjective ratings. Therefore, in contrast with studies of adults with LD, the results of long-term follow-up of the pediatric population continue to strongly support the finding that children treated appropriately for LD have an excellent prognosis for normal cognitive functioning.

Adolescent↗

PubMed1999

A neuropsychological comparison of demented and nondemented patients with Parkinson's disease.

The strength and sensitivity of neuropsychological test findings in patients with Parkinson's disease (PD) was reviewed using meta-analytic principles to provide a basis of comparison of deficits in nondemented and demented patients with PD. The review revealed significant relationships among duration of disease, physical disability, and cognitive impairment in nondemented patients, and qualitative and quantitative differences in the pattern of neuropsychological test impairments between nondemented and demented patients with PD. The disparate profiles of neuropsychological impairment in nondemented and demented patients may indeed reflect disease progression in keeping with the significant clinical correlations in nondemented patients. That is, as the duration of the disease endures, it appears that performance on tasks of delayed recall deteriorates first, followed by performance on measures of manual dexterity, cognitive flexibility, and abstraction.

Adult↗

PubMed2002

Dose-related neurocognitive effects of marijuana use.

BACKGROUND: Although about 7 million people in the US population use marijuana at least weekly, there is a paucity of scientific data on persistent neurocognitive effects of marijuana use. OBJECTIVE: To determine if neurocognitive deficits persist in 28-day abstinent heavy marijuana users and if these deficits are dose-related to the number of marijuana joints smoked per week. METHODS: A battery of neurocognitive tests was given to 28-day abstinent heavy marijuana abusers. RESULTS: As joints smoked per week increased, performance decreased on tests measuring memory, executive functioning, psychomotor speed, and manual dexterity. When dividing the group into light, middle, and heavy user groups, the heavy group performed significantly below the light group on 5 of 35 measures and the size of the effect ranged from 3.00 to 4.20 SD units. Duration of use had little effect on neurocognitive performance. CONCLUSIONS: Very heavy use of marijuana is associated with persistent decrements in neurocognitive performance even after 28 days of abstinence. It is unclear if these decrements will resolve with continued abstinence or become progressively worse with continued heavy marijuana use.

Adolescent↗

PubMed2004

Effects of a 6-month exercise program on patients with multiple sclerosis: a randomized study.

OBJECTIVE: To improve walking and other aspects of physical function with a progressive 6-month exercise program in patients with multiple sclerosis (MS). METHODS: MS patients with mild to moderate disability (Expanded Disability Status Scale scores 1.0 to 5.5) were randomly assigned to an exercise or control group. The intervention consisted of strength and aerobic training initiated during 3-week inpatient rehabilitation and continued for 23 weeks at home. The groups were evaluated at baseline and at 6 months. The primary outcome was walking speed, measured by 7.62 m and 500 m walk tests. Secondary outcomes included lower extremity strength, upper extremity endurance and dexterity, peak oxygen uptake, and static balance. An intention-to-treat analysis was used. RESULTS: Ninety-one (96%) of the 95 patients entering the study completed it. Change between groups was significant in the 7.62 m (p = 0.04) and 500 m walk tests (p = 0.01). In the 7.62 m walk test, 22% of the exercising patients showed clinically meaningful improvements. The exercise group also showed increased upper extremity endurance as compared to controls. No other noteworthy exercise-induced changes were observed. Exercise adherence varied considerably among the exercisers. CONCLUSIONS: Walking speed improved in this randomized study. The results confirm that exercise is safe for multiple sclerosis patients and should be recommended for those with mild to moderate disability.

Adult↗

PubMed1977

Juvenile dystonic lipidosis: an unusual form of neurovisceral storage disease.

An unusual neurovisceral lipid storage disorder in two unrelated juvenile patients manifested itself by dystonia and involuntary movements, with facial grimacing, dysarthria, gait difficulty, and impaired manual dexterity. Supranuclear paresis of vertical gaze and splenomegaly were present. Absent were seizures, major intellectual deterioration, spasticity, or blindness. Histiocytes showed lysosomal storage of various phospholipids, cholesterol, neutral lipids, and autofluorescent material. Appendiceal neurons showed only an increse of phospholipids by histochemistry. Neuronal deposits differed ultrastructurally from these in histiocytes. Leukocyte sphingomyelinase activity was normal. The nosology of this disease and its relationship to so-called juvenile types of Niemann-Pick disease is discussed. The primary metabolic defect in these patients remains unknown.

Adolescent↗

PubMed1991

Idazoxan treatment in progressive supranuclear palsy.

To confirm the preliminary report that increases in norepinephrine neurotransmission improve motor performance, we administered the investigational drug idazoxan (IDA) to nine patients with progressive supranuclear palsy (PSP) according to a double-blind crossover protocol. There were seven women and two men, whose mean age was 70 years and mean duration of illness 4 years. All had an advanced parkinsonian syndrome, supranuclear ocular motor palsies, and poor responses to dopaminergic drugs. During administration of 40 mg tid of IDA, the total score and the motor subscale score of the United Parkinson's Disease Rating Scale significantly decreased. Features that improved most included mobility, balance, gait, and measures of digital dexterity. There were no significant changes in any measure during placebo administration. Corticobulbar manifestations and eye movements were not significantly improved during treatment. Side effects of IDA included transient hypertension, tachycardia, action tremor, flushing, and sweating, but none was so severe that any patient withdrew from the study. Among the few attempted treatments of PSP, IDA is the first medication shown in a double-blind study to improve aspects of motor function.

Adrenergic alpha-Antagonists↗

PubMed1996

Primary progressive apraxia in Pick's disease: a clinicopathologic study.

A 62-year-old right-handed man gradually experienced increasing difficulty with speech and manual dexterity. He had apraxia of speech, buccofacial apraxia, and complex limb apraxia as well as terminal dementia. At autopsy, focal cortical atrophy, neuronal loss, and neuropil rarefaction in the second and third cortical layers were most prominent in the left opercular, lower precentral, superior parietal, and left temporal pole. Numerous Pick bodies were diffusely present in the temporal and posterior frontal lobes and, to a lesser degree, in the superior parietal lobule. This report demonstrates an association between the distribution of Pick's pathology and several apraxic impairments.

Apraxias↗

PubMed1998

Assessment of motor function after stereotactic pallidotomy.

Despite a paucity of controlled data, stereotactic pallidotomy is increasingly used for the treatment of advanced Parkinson's disease (PD). To study the efficacy of the procedure on the cardinal PD features of rigidity, tremor, bradykinesia, and postural instability, we blindly rated randomized videos of 34 patients recorded in the "off' state immediately before and 3 months after unilateral stereotactic lesioning of the globus pallidus internus. Total "off' time Unified Parkinson's Disease Rating Scale motor scores improved 13.6% from 28.9 +/- 7.5 to 25.0 +/- 7.0 (p < 0.001). Particularly robust improvement was seen in contralateral tremor, gait, and arising from a chair (p < 0.001). Significant improvement was also seen in ipsilateral tremor, contralateral and some ipsilateral dexterity measures, and body bradykinesia. Most other features tended toward improvement but did not reach statistical significance. We conclude that pallidotomy is a safe and effective treatment of parkinsonian symptoms, many of which improve bilaterally.

Adult↗

PubMed1999

Neurobehavioral function and tibial and chelatable lead levels in 543 former organolead workers.

OBJECTIVE: To evaluate the associations between tibial lead, dimercaptosuccinic acid (DMSA)-chelatable lead, and neurobehavioral function in former organolead manufacturing workers with past exposure to organic and inorganic lead. METHODS: Data were collected from 543 subjects with a mean age of 58 years and an average of 17.8 years since last lead exposure. Years since last exposure to lead was used to estimate tibial lead levels in the year of last occupational lead exposure, termed "peak tibial lead." Current tibial lead levels, measured by x-ray fluorescence, were extrapolated back using a clearance half-time of lead in tibia of 27 years, assuming first-order clearance from tibia. RESULTS: Peak tibial lead levels ranged from -2.2 to 105.9 microg Pb/g bone mineral, and DMSA-chelatable lead levels were between 1.2 and 136 microg. After adjustment for confounding variables, peak tibial lead was a significant negative predictor of performance on the Wechsler Adult Intelligence Scale-Revised vocabulary subtest (p = 0.02), serial digit learning test (p = 0.04), Rey Auditory-Verbal Learning Test (immediate recall and recognition, p = 0.03 for each), Trail Making Test B (p = 0.03), finger tapping (dominant hand [p = 0.02] and nondominant hand [p < 0.01]), Purdue pegboard (dominant hand, nondominant hand, both hands, and assembly, p < 0.01 for each), and Stroop Test (p < 0.01). Moreover, with one exception, average neurobehavioral test scores were poorer at higher peak tibial lead levels. DMSA-chelatable lead was only significantly associated with choice reaction time (p = 0.01). CONCLUSION: Peak tibial lead was consistently associated with poorer neurobehavioral test scores, particularly in the domains of manual dexterity, executive ability, verbal intelligence, and verbal memory.

Adult↗

PubMed2000

Past adult lead exposure is associated with longitudinal decline in cognitive function.

OBJECTIVE: To determine whether adults with past exposure to neurotoxicants have progressive declines in cognitive function years after exposure has ceased, and whether tibia lead is a predictor of the magnitude of change. METHODS: A total of 535 former organolead manufacturing workers with a mean age of 55.6 years, a mean duration of 16 years since last occupational lead exposure, and low blood lead levels at the first study visit and 118 controls were evaluated with neurobehavioral tests two to four times over 4 years. "Peak" tibia lead levels, estimated from current levels measured by X-ray fluorescence, were used to predict changes in cognitive function over time. RESULTS: In former lead workers, peak tibia lead ranged from -2.2 to 98.7 microg Pb/g bone mineral. Compared to controls, former lead workers performed worse over time for three tests of visuo-constructive ability and verbal memory and learning (p < 0.05). In former lead workers, peak tibia lead predicted declines for six tests of verbal memory and learning, visual memory, executive ability, and manual dexterity (p < 0.05 for four tests and < 0.10 for two additional tests). On average, for these six tests, an increase of 15.7 microg/g of peak tibia lead was equivalent in its effects on annual test decline to 5 more years of age at baseline. CONCLUSIONS: These are the first data to suggest that cognitive function can progressively decline due to past occupational exposures to a neurotoxicant.

Adult↗