Síndrome de la mano inútil con astereognosia secundaria a un astrocitoma cervical / Useless hand syndrome with astereognosis secondary to a cervical astrocytoma

Resumen El presente caso es un ejemplo del síndrome de la mano inútil de Oppenheim secundario a un astrocitoma cervical alto. La pérdida sensorial propioceptiva y discriminativa suspendida con conservación de la termoalgesia y el tacto crudo en ambas extremidades superiores es secundaria al daño a la entrada de la raíz dorsal y al núcleo cuneiforme. La torpeza y las dificultades para una prensión precisa con la mano se deben al daño del núcleo proprioespinal en las astas dorsales a nivel C3-C4. Este núcleo integra influencias excitadoras descendentes del tracto corticoespinal e interneuronas inhibitorias controladas por los sistemas descendentes y las aferencias de las extremidades anteriores. Probablemente la pérdida de las aferentes cervicales propioceptivas inhibitorias sea la culpable de las dificultades para agarrar con las manos.

The present case is an example of the useless hand syndrome of Oppenheim secondary to a high cervical astrocytoma. The suspended proprioceptive and discriminative sensory loss with conservation of thermoalgesia and crude touch in both upper extremities is secondary to damage to dorsal root entry and cuneate nucleus. The clumsiness and difficulties in precise grasping with the hand are due to damage of the propriospinal nucleus in the dorsal horns at C3-C4 level. This nucleus integrates descending excitatory influences from corticospinal tract and inhibitory interneurons controlled by descending systems and the forelimb afferents. Probably the loss of the inhibitory proprioceptive cervical afferents is the culprit of the difficulties in grasping by the hands.

Evaluation of oral stereognosis in completely edentulous patients with palatal tori / Evaluación de la estereognosia oral en pacientes completamente edéntulos con toros palatinos

Background: The corollary is not investigated in the completely edentulous patients with palatal tori. Objective: The aim of this study was to assess the oral stereognostic ability in completely edentulous patients with palatal tori. Material and Methods: Thirty-four completely edentulous patients aged 50 to 89 years were allocated to Group 1 (without palatal tori, n=18) and Group 2 (with palatal tori, n=16). The oral stereognostic test was conducted using 6 intraoral test pieces (circle/square/rectangle/triangle/plus/toroid) that were fabricated to standard dimensions using the light cure acrylic resin. Each test piece was placed in the patient's mouth and was asked to manipulate the test piece between the tongue and the palate. The patients identified the shapes by matching them on a shape chart. Each correct identification was assigned a score of 1. The response time taken to identify each shape was recorded. Statistical computation was done using a chi - square test and Mann-Whitney U test. Results: Significant difference was observed in the overall scoring percentages between the 2 groups (p<0.05). Group 2 had lower oral stereognostic scores compared to group 1 (p<0.05). There was no statistically significant difference in the mean response time for identifying the shapes among the groups, however group 2 patients had longer response time. Conclusion: Oral stereognostic ability of the completely edentulous patients with torus palatinus was lower when compared to completely edentulous patients without tori.

Antecedentes: el corolario no se investiga en los pacientes completamente desdentados con toros palatinos. Objetivo:El objetivo de este estudio fue evaluar la capacidad estereognóstica oral en pacientes completamente edéntulos con toros palatinos. Material y Métodos: Treinta y cuatro pacientes completamente edéntulos de 50 a 89 años fueron asignados al Grupo 1 (sin toros palatinos, n = 18) y al Grupo 2 (con toros palatinos, n = 16). La prueba estereognóstica oral se realizó utilizando 6 piezas de prueba intraorales (círculo / cuadrado / rectángulo / triángulo / cruz / aro) que se fabricaron a dimensiones estándar utilizando la resina acrílica fotopolimerizable. Cada pieza de prueba se colocó en la boca del paciente y se le pidió que manipulara la pieza de prueba entre la lengua y el paladar. Los pacientes identificaron las formas haciéndolas coincidir en un gráfico de formas. A cada identificación correcta se le asignó una puntuación de 1. Se registró el tiempo de respuesta necesario para identificar cada forma. El cálculo estadístico se realizó mediante la prueba de chi-cuadrado y la prueba U de Mann-Whitney. Resultados: Se observó una diferencia significativa en los porcentajes de puntuación generales entre los 2 grupos (p<0,05). El grupo 2 tuvo puntuaciones estereognósticas orales más bajas en comparación con el grupo 1 (p<0,05). No hubo diferencia estadísticamente significativa en el tiempo medio de respuesta para identificar las formas entre los grupos, sin embargo, los pacientes del grupo 2 tuvieron un tiempo de respuesta más largo.Conclusión: La capacidad estereognóstica oral de los pacientes completamente edéntulos con torus palatino fue menor en comparación con los pacientes completamente edéntulos sin torus.

Development of a new haptic perception instrument: a pilot study / Desenvolvimento de um novo instrumento de avaliação da percepção háptica: um estudo piloto

ABSTRACT Objective Hand sensory tests do not consider distinct physiological receptors, nor detect normal range variations concerning developmental or pathological changes. We developed an instrument with a set of tests with timing and scoring for assessing haptic perception, which is the interaction between sensory and motor systems, in surfaces exploration, by moving hands. Method Firstly, group meetings were set for test/manual conception and materials testing. The test/manual were submitted to 30 reviewers in 3 stages (10 reviewers on each stage). Results The Hand Haptic Perception Instrument (HHPI) evaluates hand sensorimotor performance on six domains: depression, elevation, texture, compressibility, weight (barognosis) and form perception. Each domain requires specific materials. Score ranges from 0 to 57, being 0 the worst rating. Conclusion This methodological process allowed the development of six domains and instructions to assess haptic perception. This version of HHPI is a pilot model. Further studies will determine reliability and normality ranges.

RESUMO Objetivo Testes de sensibilidade manual não consideram receptores fisiológicos distintos, tampouco variações do desenvolvimento normal ou patológico. Desenvolvemos um instrumento, com pontuação e tempo de desempenho, para avaliar percepção háptica, que é a interação sensório-motora na exploração de superfícies, pelo movimento das mãos. Método Reuniões de grupo foram estabelecidas para desenvolver os testes/ manual e testar materiais. O instrumento e seu manual foram submetidos a 30 revisores, em 3 estágios (com 10 revisores em cada estágio). Resultados O instrumento de avaliação da percepção háptica manual (IAPHM) avalia o desempenho sensório-motor da mão em seis domínios: depressão, elevação, textura, compressibilidade, peso (barognosia) e percepção de forma. Cada domínio requer materiais específicos. A pontuação vai de 0 a 57, sendo 0 a pior pontuação. Conclusão Esse método permitiu o desenvolvimento do instrumento para avaliar percepção háptica. Essa versão do IAPHM é um modelo piloto. Estudos futuros determinarão confiabilidade e variações de normalidade.

Efectividad de terapia restrictiva combinada con terapia ocupacional y física en la función motora de extremidad superior en niños con parálisis cerebral tipo hemiparesia / Effectiveness of restrictive therapy combined with occupational and physical therapy on upper extremity motor function in children with cerebral palsy hemiparesis

Introduction: restrictive therapy is effective to enhance affected upper limb use, however combined therapy application protocols and use of instruments to evaluate results, vary. Objective: to evaluate changes in motor function of the affected upper extremity, following the application of restrictive therapy combined with occupational and physical therapy, in 7 to 13 year old children with cerebral palsy (CP) hemiparesis. Methods and patients: a cohort study of nine children, mean age 10 +/- 2.3 years, without affected upper limb function treatment in the previous ≥ 6 months. The intervention consisted of restriction of the undamaged limb for two months, 20 therapy sessions twice a week, and a home work program. Shriner’s Hospital upper extremity evaluation protocol (SHUEE) and a stereognosis test were applied prior to, and at 1 and 3 months post intervention. Results: median values for dynamic posture analysis and grasp-release, increase significantly when all three evaluations are considered, and at discharge and follow-up, as compared to baseline levels. Spontaneous functional use increases median value with respect to baseline, without statistical significance. At treatment finalization, stereognosis median reaches 100 percent, achieving an optimal performance maintained at follow-up. Conclusion: restrictive therapy combined with occupational and physical therapy is effective to achieve changes in motor function of affected upper limbs in children with CP hemiparesis, as evaluated with SHUEE.

Introducción: la terapia restrictiva es efectiva para potenciar uso de extremidad superior (EESS) comprometida, pero los protocolos de aplicación en forma combinada y uso de instrumentos para evaluar resultados, son variados. Objetivo: evaluar cambios en función motora de EESS comprometida, por aplicación de terapia restrictiva en combinación con terapia ocupacional y física, en niños de 7 a 13 años, portadores de parálisis cerebral (PC) tipo hemiparesia. Pacientes y métodos: estudio de cohorte de 9 niños, edad promedio 10 +/- 2,3 años, sin tratamiento que estimule función de EESS comprometida en un período previo ≥ 6 meses. La intervención consistió en restricción de mano indemne por 2 meses, 20 sesiones de terapia dos veces por semana, y protocolo para trabajo en el hogar. Se aplicó evaluación de EESS del Hospital de Niños de Shriners (SHUEE) y test deestereognosia, las que fueron efectuadas antes, a un mes y tres meses posteriores a la intervención. Resultados: los valores de la mediana del análisis postural dinámico y agarre-liberación, aumentan en forma significativa al considerar las tres evaluaciones en su conjunto y, al alta y seguimiento respecto de medición basal. El porcentaje de uso funcional espontáneo, aumenta el valor de la mediana respecto del valor inicial, sin significancia estadística. Al finalizar la intervención, la mediana de estereognosia es de 100 por ciento, logrando óptimo desempeño mantenido al seguimiento. Conclusión: la terapia restrictiva combinada con terapia ocupacional y física, es efectiva para lograr cambios en función motora de EESS comprometida en niños con PC tipo hemiparesia, evaluado con SHUEE.

A study to evaluate the effect of oral stereognosis in acceptance of fixed prosthesis.

Aims: The aim of the study was to evaluate and compare the oral stereognostic ability and satisfaction for fixed prosthesis in human being. Materials and Methods: The present study was carried out on 40 subjects, the purpose being to investigate the relation of oral perception to diagnostic and therapeutic procedures. Two types of cast metal crowns-one had morphology closely resembling original tooth and other one confirmed to ideal contours were constructed on endodontically treated posterior tooth. One cast metal crown was randomly selected from two cast metal crown and fitted on prepared tooth. Oral stereognostic score of subject was determined by correct response to questionnaire based on the recognition ability of subjects. Patient satisfaction level was checked by psychometric parameter Likert scale. Same procedure was repeated with other type of cast metal crown. Results: Data obtained were compared by paired and unpaired two sample t-test. Oral stereognostic score and satisfaction score were found to be higher for cast metal crown with morphology resembling to original tooth due to recognition and discriminatory ability of subjects and recall-memory. Oral stereognostic level was found to be higher in younger than older subjects. The level of satisfaction was found to be higher in older subjects than younger subjects. Conclusion: It was concluded that acceptance of fixed prosthesis is not only based on dentist's routine procedure of treatment and patient's judgment about oral health, function, and esthetics, but also depends upon patient's oral perception and discriminatory skill for external morphology of fixed prosthesis.

Relation between oral stereognosis and masticatory efficiency in complete denture wearers: an in vivo study

Aim: The purpose of the present study was to evaluate the possible association between the oral stereognostic ability and masticatory efficiency at the time of denture insertion and after 6 months in complete denture wearers. Methods: Sixty edentulous patients were selected. The study was conducted in two parts. First, on the day of denture fit-in oral stereognostic ability test was conducted,followed by masticatory efficiency was carried out. The patients were recalled for check up after 6months and the same test was performed again. Data were tabulated and analyzed statistically by paired t-test and Pearson’s correlation coefficient. Results: There was weak correlation between oral stereognosis and masticatory efficiency. Many opinions have been presented in the literature in the past regarding oral stereognosis. The issue whether oral stereognosis also helps inpatients’ adaptation towards complete denture prosthesis is still ambiguous. No consensus has been reached. This study is further an attempt to understand the basic physiology of oral stereognosis and whether there is any possible relation between oral stereognosis and masticatory efficiency.Conclusions: Within the limitation of this study, it can be concluded that oral stereognostic ability improves with time, which might be due to adaptation to the denture. As adaptation towardsdenture improves masticatory efficiency improves as well. This study showed that there might bea weak association between oral stereognosis and masticatory efficiency.

Oral stereognostic ability in hypodontia patients

Hypodontia is congenital absence of one or more, but not all, of the normal complement of teeth. It is one of the most frequent alterations of human dentition. Hypodontia either alone or association with craniofacial developmental disorders can pose speech and masticatory dysfunctions along with aesthetic and functional problems. Oral Stereognostic ability can be used to diagnose and predict the prognosis of different treatment modalities in hypodontia patients. To compare oral Stereognostic ability in hypodontia patients with those having normal dentition. Case Control study, conducted in the Department of Prosthodontics, de'Montmorency College of Dentistry/ Punjab Dental Hospital, Lahore, Pakistan. Forty hypodontia subjects were selected. Forty dental students of third and final year with normal dentition were selected as controls. Oral Stereognostic ability scores were calculated using specific test samples for both groups. This study showed that oral Stereognostic ability scores were reduced in hypodontia subjects with a significant p value<0.001. It confirms that hypodontia subjects had some difficulty in perceiving the intra oral objects. Oral Stereognostic ability was impaired in hypodontia subjects; correction at early age might improve the case

The influence of gender and bruxism on human minimum interdental threshold ability

OBJECTIVE: To evaluate the influence of gender and bruxism on the ability to discriminate minimum interdental threshold. MATERIAL AND METHODS: One hundred and fifteen individuals, representing both genders, bruxers and non-bruxers, with a mean age of 23.64 years, were selected for this study. For group allocation, every individual was subjected to a specific physical examination to detect bruxism (performed by three different examiners). Evaluation of the ability to discriminate minimum interdental threshold was performed using industrialized 0.010 mm-, 0.024 mm-, 0.030 mm-, 0.050 mm-, 0.080 mm- and 0.094 mm-thick aluminum foils that were placed between upper and lower premolars. Data were analyzed statistically by multiple linear regression analysis at 5% significance level. RESULTS: Neither gender nor bruxism influenced the ability to discriminate minimum interdental threshold (p>0.05). CONCLUSIONS: Gender and the presence of bruxism do not play a role in the minimum interdental threshold.

Desempenho de meninos e meninas em prova de estereognosia / Performance of boys and girls in a stereognosia task

O primeiro relato de preocupação com a diferença entre homens e mulheres aconteceu no final do século XVIII, por médicos, durante a Revolução Francesa; porém, os grandes avanços nessa área de pesquisa aconteceram na década de 1990. Desde então, estudos vêm sendo desenvolvidos, e a literatura apresenta não somente diferenças neuroanatômicas entre os sexos como também diferenças no desempenho de algumas habilidades específicas, como a lateralidade, construção da habilidade motora, atividades visoespaciais, tácteis entre outras. No entanto, é extremamente escassa a pesquisa na área da estereognosia. Neste trabalho, 53 crianças destras (28 do sexo feminino e 25 do sexo masculino) com idade entre oito e nove anos foram avaliadas durante a execução de uma tarefa específica que testa a estereognosia. A correlação dos dados foi realizada por análise de variância para medidas repetidas. Observou-se que tanto os meninos quanto as meninas acertaram mais com a mão direita do que com a mão esquerda, e que a ordem de início da tarefa influiu no seu desempenho quando foi realizada pela segunda vez. Não foi observada diferença entre meninos e meninas na prova utilizada.

The first report on differences between men and women was published by doctors and had place at the end of the 18th century during the French Revolution, but wide advances on this kind of research occurred in the 1990’s. Many studies have been developed since then, and the literature has referred neuroanatomical differences between genders as well as differences in specific abilities such as laterality, motor ability, visospatial and tactile abilities among others. However, studies on stereognosia have been rare. In this study, 53 right-handed children (28 females and 25 males) aged 8 to 9 years old were observed as to the performance of a specific stereognosia task. By using analysis of variance for repeated measures, it was found out that boys and girls did it better with the right hand, and the hand used to start the initial task influenced on the performance of the following part of the task. There was not any statistical difference between boys and girls in the stereognosia task used in this study.