Relationship between patients' perceptions of postsurgical sequelae and altered sensations after bilateral sagittal split osteotomy.
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PURPOSE: Following orthognathic surgery, patients use qualitatively different words to describe altered sensation on their face. These words indicate normal, hypoesthetic, paresthetic, or dysesthetic sensations and so reflect the intrusiveness of the altered sensation. The objective of this study was to examine the relationship between the intrusiveness of the altered sensation and the extent to which it and the associated impairment in facial function were perceived to be a problem in the lives of the patients. PATIENTS AND METHODS: One hundred forty-six patients who had a mandibular osteotomy with or without a maxillary procedure were included. Word choice data were obtained during patients' assessment of spontaneous and evoked facial sensations before surgery and at 1 week, 1, 3, and 6 months after surgery and the difficulty or problem levels associated with the altered sensation itself (PAS) and facial functions or oral behaviors in every day life (PAF) were obtained from validated questionnaires. Stratified-by-subject repeated measures Mantel Haenszel correlation statistics were calculated to assess the associations between the intrusiveness of the altered sensation and the problem levels associated with the altered sensation and with the facial functions. RESULTS: On average, the perception of the difficulty with each of the PAS and PAF items decreased from 1 week to 6 months after surgery (all P values < .0001). Patients reported more difficulty in every day life related to the effect of the altered sensations than they did related to the effect on facial functions. The correlations of the intrusiveness of the altered sensation and problems with altered sensations (PAS) were stronger overall and at each visit than the correlations with problems of altered facial function (PAF). Although the correlation coefficients tended to increase in value from 1 week to 6 months postsurgery for the PAF items, the increase was proportionately greater for the PAS items. CONCLUSIONS: The difficulties in everyday life perceived by patients following orthognathic surgery caused by altered sensations and, to a lesser extent, altered facial function are positively related to the type of altered sensation experienced. The extent of the difficulty follows the intrusiveness level: patients whose sensations are uncomfortable or painful report the most difficulty followed by those who experience nonpainful sensations that are not normally present (ie, positive symptoms), then those who experience only a simple loss in sensation (ie, negative symptoms). Subjective difficulty with altered sensation reflects, in part, its qualitative nature; whereas subjective difficulty with function may reflect the extent of loss in sensory innervation. (+info)
Shortening osteotomy for the treatment of spinal neuroarthropathy following spinal cord injury. A case report and literature review.
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The development of Charcot's arthropathy of the spine secondary to spinal cord injury is rare and reports in the literature concerning it's surgical management are limited. Arthrodesis is the recommended treatment for painful and unstable neuropathic joints. Traditionally this involves extensive debridement of the affected joint with anterior and posterior instrumented fusion and autograft to bridge the defect. This paper reviews the reported surgical management of post-traumatic spinal neuroarthropathy in the recent literature and presents a case where sound fusion was achieved by a shortening osteotomy and end-to-end apposition of the fresh bleeding bony surfaces of the adjacent vertebral bodies. The patient reported marked improvement of symptoms post-operatively without any complications of surgery. CT scan at 13 months confirmed successful bony union. Clinical follow up was completed to 3 years. This technique eliminated the need for anterior surgery and extensive autograft thus reducing surgical morbidity. (+info)
Sensorimotor impairments and reaching performance in subjects with poststroke hemiparesis during the first few months of recovery.
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BACKGROUND AND PURPOSE: Little is known about the relationship between upper-extremity (UE) sensorimotor impairment and reaching performance during the first few months after stroke. The purpose of this study was to examine: (1) how measures of UE sensorimotor impairment are related to the speed, accuracy, and efficiency of reaching in subjects with hemiparesis during the subacute phase after stroke and (2) how impairments measured during the acute phase after stroke may predict the variance in reaching performance a few months later. SUBJECTS AND METHODS: Upper-extremity sensorimotor impairments and reaching performance were evaluated in 39 subjects with hemiparesis at 2 time points: during the acute phase (8.7+/-3.6 [X+/-SD] days) and the subacute phase (108.7+/-16.5 days) after stroke. Ten subjects who were healthy (control subjects) were evaluated once. Regression analyses were used to determine which impairments were the best predictors of variance in reaching performance in the subacute phase after stroke. RESULTS: Only a small amount of variance (<30%) in reaching performance was explained at the subacute time point, using either acute or subacute impairments as predictor variables. Of the impairments measured, UE strength deficits were the strongest, most consistent predictors of the variance in reaching performance during the first 3 months after stroke. DISCUSSION AND CONCLUSION: Surprisingly, the detailed clinical assessment of UE sensorimotor impairment, measured at the acute or subacute phase after stroke, did not explain much of the variance in reaching performance during the subacute phase after stroke. The findings that UE strength deficits (ie, decreased active range of motion and isometric force production) were the most common predictors of the variance in reaching performance during the first 3 months after stroke are consistent with the current viewpoint that impaired volitional muscle activation, clinically apparent as UE weakness, is a prominent contributing factor to UE dysfunction after stroke. (+info)
Visceral and somatic hypersensitivity in a subset of rats following TNBS-induced colitis.
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BACKGROUND: Chronic abdominal pain is one of the most common gastrointestinal symptoms experienced by patients. Visceral hypersensitivity has been shown to be a biological marker in many patients with chronic visceral pain. We have previously shown that IBS patients with visceral hypersensitivity also have evidence of thermal hyperalgesia of the hand/foot. OBJECTIVE: The objective of the current study was to develop an animal model of chronic visceral and somatic hypersensitivity in rats treated with intracolonic trinitrobenzene sulfonic acid. DESIGN: Male Sprague-Dawley rats (200-250g) were treated with either 20mg/rat trinitrobenzene sulfonic acid (TNBS, Sigma Chemical Co.) in 50% ethanol (n=75), an equivalent volume of 50% ethanol (n=20) or an equivalent volume of saline (n=20). The agents were delivered with a 24-gauge catheter inserted into the lumen of the colon. Mechanical and thermal behavioral tests were performed using an automated von Frey and Hargreaves device to evaluate somatic hyperalgesia. Colonic distension was performed using an automated distension device to evaluate visceral pain thresholds. All animals were tested 16weeks after TNBS treatment following complete resolution of the colitis. RESULTS: At 16weeks, 24% of the treated rats (18/75 rats) still exhibited evidence of visceral as well as somatic hypersensitivity compared to saline- and ethanol-treated rats. CONCLUSION: Transient colonic inflammation leads to chronic visceral and somatic hypersensitivity in a subset of rats. These findings are similar to the subset of patients who develop chronic gastrointestinal symptoms following enteric infection. (+info)
A portable tactile sensory diagnostic device.
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Current methods for applying multi-site vibratory stimuli to the skin typically involve the use of two separate vibrotactile stimulators, which can lead to difficulty with positioning of stimuli and in ensuring that stimuli are delivered perfectly in phase at the same amplitude and frequency. Previously, we reported a two-point stimulator (TPS) that was developed in order to solve the problem of delivering two-point stimuli to the skin at variable distances between the sites of stimulation. Because of the success of the TPS, we designed and fabricated a new stimulator with four significant improvements over our original device. First, the device is portable, lightweight and can be used in a variety of non-laboratory settings. Second, the device consists of two independently controlled stimulators which allow delivery of stimuli simultaneously to two distinct skin sites with different amplitude, frequency and/or phase. Third, the device automatically detects the skin surface and thus allows for much better automated control of stimulus delivery. Fourth, the device is designed for rapid manufacture and, therefore, can be made readily available to other research (non-laboratory) settings. To demonstrate the device, a modified Bekesy tracking method was used to evaluate the simultaneous amplitude discrimination capacity of 20 subjects. (+info)
Vestibular signal processing in a subject with somatosensory deafferentation: the case of sitting posture.
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BACKGROUND: The vestibular system of the inner ear provides information about head translation/rotation in space and about the orientation of the head with respect to the gravitoinertial vector. It also largely contributes to the control of posture through vestibulospinal pathways. Testing an individual severely deprived of somatosensory information below the nose, we investigated if equilibrium can be maintained while seated on the sole basis of this information. RESULTS: Although she was unstable, the deafferented subject (DS) was able to remain seated with the eyes closed in the absence of feet, arm and back supports. However, with the head unconsciously rotated towards the left or right shoulder, the DS's instability markedly increased. Small electrical stimulations of the vestibular apparatus produced large body tilts in the DS contrary to control subjects who did not show clear postural responses to the stimulations. CONCLUSION: The results of the present experiment show that in the lack of vision and somatosensory information, vestibular signal processing allows the maintenance of an active sitting posture (i.e. without back or side rests). When head orientation changes with respect to the trunk, in the absence of vision, the lack of cervical information prevents the transformation of the head-centered vestibular information into a trunk-centered frame of reference of body motion. For the normal subjects, this latter frame of reference enables proper postural adjustments through vestibular signal processing, irrespectively of the orientation of the head with respect to the trunk. (+info)
Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children.
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Following recent advances in the analysis of centre-of-pressure (COP) recordings, we examined the structure of COP trajectories in ten children (nine in the analyses) with cerebral palsy (CP) and nine typically developing (TD) children while standing quietly with eyes open (EO) and eyes closed (EC) and with concurrent visual COP feedback (FB). In particular, we quantified COP trajectories in terms of both the amount and regularity of sway. We hypothesised that: (1) compared to TD children, CP children exhibit a greater amount of sway and more regular sway and (2) concurrent visual feedback (creating an external functional context for postural control, inducing a more external focus of attention) decreases both the amount of sway and sway regularity in TD and CP children alike, while closing the eyes has opposite effects. The data were largely in agreement with both hypotheses. Compared to TD children, the amount of sway tended to be larger in CP children, while sway was more regular. Furthermore, the presence of concurrent visual feedback resulted in less regular sway compared to the EO and EC conditions. This effect was less pronounced in the CP group where posturograms were most regular in the EO condition rather than in the EC condition, as in the control group. Nonetheless, we concluded that CP children might benefit from therapies involving postural tasks with an external functional context for postural control. (+info)
Postural sway reduction in aging men and women: relation to brain structure, cognitive status, and stabilizing factors.
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Postural stability becomes compromised with advancing age, but the neural mechanisms contributing to instability have not been fully explicated. Accordingly, this quantitative physiological and MRI study of sex differences across the adult age range examined the association between components of postural control and the integrity of brain structure and function under different conditions of sensory input and stance stabilization manipulation. The groups comprised 28 healthy men (age 30-73 years) and 38 healthy women (age 34-74 years), who completed balance platform testing, cognitive assessment, and structural MRI. The results supported the hypothesis that excessive postural sway would be greater in older than younger healthy individuals when standing without sensory or stance aids, and that introduction of such aids would reduce sway in both principal directions (anterior-posterior and medial-lateral) and in both the open-loop and closed-loop components of postural control even in older individuals. Sway reduction with stance stabilization, that is, standing with feet apart, was greater in men than women, probably because older men were less stable than women when standing with their feet together. Greater sway was related to evidence for greater brain structural involutional changes, indexed as ventricular and sulcal enlargement and white matter hyperintensity burden. In women, poorer cognitive test performance related to less sway reduction with the use of sensory aids. Thus, aging men and women were shown to have diminished postural control, associated with cognitive and brain structural involution, in unstable stance conditions and with diminished sensory input. (+info)