Reliability and Validity of the Upper Limb Physician's Rating Scale in Children with Cerebral Palsy

PURPOSE: The Upper Limb Physician's Rating Scale (ULPRS) is a tool that assesses movement quality of the upper limbs. It is used as an outcome measure after botulinum toxin type A injection in children with cerebral palsy (CP). This study aimed to investigate the reliability and validity of the ULPRS in children with spastic CP. MATERIALS AND METHODS: Thirty children with spastic CP (M:F=17:13) aged 5 to 13 years old were recruited. The ULPRS was scored based on recorded videotapes by four physicians on two separate occasions. The Melbourne Assessment of Unilateral Upper Limb Function (MUUL) was scored by an occupational therapist. Intraclass correlation coefficients (ICCs), 95% confidence intervals and weighted kappa statistics were calculated for the scores of ULPRS to obtain interrater and intrarater reliability. The relationship between ULPRS and MUUL was assessed using Pearson correlation coefficients. RESULTS: The ICCs for the total ULPRS scores were 0.94 between raters and 0.99 to 1.00 within raters. The weighted kappa statistics for subitem scores for the ULPRS ranged from 0.67 to 1.00 within raters and from 0.46 to 0.86 between raters. The relationship between ULPRS and MUUL was strong (Pearson correlation coefficient=0.751; p<0.05). CONCLUSION: The results demonstrated the high reliability of the total ULPRS score within and between raters. A significant concurrent validity between ULPRS and MUUL also supports the clinical utility of the ULPRS as an outcome measure of spastic upper limb in children with CP.

Comparison of quality of life, satisfaction with surgery and shoulder-arm morbidity in breast cancer survivors submitted to breast-conserving therapy or mastectomy followed by immediate breast reconstruction

OBJECTIVES: This study was designed to compare the prevalence of shoulder-arm morbidity, patient satisfaction with surgery and the quality of life of women submitted to breast-conserving therapy or modified radical mastectomy and immediate breast reconstruction . METHODS: This study was a cross-sectional study of women who underwent breast-conserving therapy (n=44) or modified radical mastectomy and immediate breast reconstruction (n=26). Quality of life was evaluated with the SF-36 Health Survey Questionnaire. RESULTS: No differences were found in the prevalence of lymphedema. The movements that were most commonly affected by these procedures were abduction, flexion and external rotation. When the two groups were compared, however, we only found a statistically significant difference for the prevalence of restricted internal rotation, which occurred in 32 percent of women in the breast-conserving therapy group and 12 percent of those in the modified radical mastectomy and immediate breast reconstruction group (OR: 7.23; p=0.03 following adjustment for potential confounding factors). No difference in quality of life or satisfaction with surgery was found between the two groups. CONCLUSIONS: These data suggest that the type of surgery did not affect the occurrence of lymphedema. Breast-conserving therapy, however, increased the risk of shoulder movement limitation. No differences were found between the two surgical techniques with respect to quality of life or satisfaction with surgery.

Benign monomelic amyotrophy with proximal upper limb involvement: case report

Monomelic amyotrophy (MA) is a rare condition in which neurogenic amyotrophy is restricted to an upper or lower limb. Usually sporadic, it usually has an insidious onset with a mean evolution of 2 to 4 years following first clinical manifestations, which is, in turned, followed by stabilization. We report a case of 20-years-old man who presented slowly progressive amyotrophy associated with proximal paresis of the right upper limb, which was followed by clinical stabilization 4 years later. Eletroneuromyography revealed denervation along with myofasciculations in various muscle groups of the right upper limb. We call atention to this rare location of MA, as well as describe some theories concerning its pathophysiology .

A amiotrofia monomélica é condição rara em que a amiotrofia neurogênica é restrita somente a um membro superior ou inferior. Usualmente esporádica, possui um início insidioso e evolução lenta de 2-4 anos após as primeiras manifestações, seguida por estabilização. Relatamos o caso de um homem que aos 20 anos apresentou lentamente amiotrofia e paresia proximal no membro superior direito, estabilizando-se em quatro anos. A eletroneuromiografia identificou a presença de desnervação e fasciculações em diversos músculos proximais do membro superior direito. Chamamos a atenção para esta rara localização desta entidade, assim como descrevemos algumas das hipóteses da fisiopatologia.

Effects of Educational Program of Manual Lymph Massage on the Arm Functioning and the Quality of Life in Breast Cancer Patients / 간호학회지

PURPOSE: The purpose of this study was to determine the effect of EPMLM(educational program of manual lymph massage) on the arm functioning and QOL(quality of life) in breast cancer patients with lymphedema. METHOD: Subjects in the experimental group(n=20) participated in EPMLM for 6 weeks from June to July, 2005. The EPMLM consisted of training of lymph massage for 2 weeks and encourage and support of self-care using lymph massage for 4 weeks. The arm functioning assessed at pre-treatment, 2weeks, and 6weeks using Arm functioning questionnaire. The QOL assessed at pre-treatment and 6 weeks using SF-36. The outcome data of experimental group was compared with control group(n=20). The collected data was analyzed by using SPSS 10.0 statistical program. RESULT: The arm functioning of experimental group was increased from 2 weeks after(W=.224, p=.011) and statistically differenced with control group at 2 weeks(Z=-2.241, p=.024) and 6 weeks(Z=-2.453, p=.013). Physical function of QOL domain increased in experimental group(Z=-1.162, p=.050), also statistically differenced with control group(Z=-2.182, p= .030) at 6weeks. CONCLUSION: The results suggest that the educational program of manual lymph massage can improve arm functioning and physical function of QOL domain in breast cancer patients with lymphedema.

Our experience with interamuscular injections of botulinum toxin A for the treatment of upper limb flexors spasticity after stroke

Focal spasticity can be a major drawback in the rehabilitation of stroke patients. Previous studies suggest a beneficial effect of Botulinum toxin A[Botox A] for relief of spasticity. To evaluate the therapeutic effects of intramuscular injections of Botox A [Btx A] on spasticity of the upper limb. D e s i g n: An open-label non-controlled trial for a duration of 16 weeks was design to determine the e fficacy and safety of intramuscular Btx A injections in the treatment of 56 patients with spastic hemiparesis after stroke. The patients were assessed at baseline, 2, 4, 12 and 16 weeks after treatment by several outcome measures - modified Ashworth scale, motricity index arm score, limb position at rest, semi-quantitative o rdinal scale for severity of pain, patient's global response to Btx A t reatment, Barthel index of activities of daily living, difficulties encountered during thre e upper limb motor tasks. Significant reduction of muscle tone, spasticity related pain and improvement in the three selected functional tasks [cleaning the palm of the affected hand, cutting the fingernails of the affected hand, putting the affected arm into the sleeve] were observed one week after Btx A injections and were sustained throughout the 16 weeks follow-up period. Botox A is effective and safe adjunctive treatment to on-going rehabilitation for patients with post - stroke localized moderate-to-severe spasticity refractory to physical and medical treatments

Dermolipectomias braquiais ampliadas ao antebraço e tronco: indicações, resultados / Enlarged brachial dermolipectomies to the upper arm and trunk: indications, technique and result

O tratamento de braços obesos ou flácidos tem sido feito, há décadas, através de ressecções de segmento fusiforme de pele, precedidos ou não por lipoaspiração. Após o advento da lipoaspiração essa técnica tem sido empregada no membro superior beneficiando, entretanto, pequeno número de pacientes que não apresentam flacidez. Poucos trabalhos científicos têm sido apresentados e publicados sobre o tema e poucas variações acrescidas às técnicas básicas. Tais fatos devem-se, principalmente, à baixa incidência desse tipo de cirurgia entre as intervenções estéticas. Os autores apresentam sua experiência em dermolipectomias braquiais e na ampliação dessa cirurgia em caso de flacidez importante de antebraço, axila e tronco. Demonstram modificações técnicas e apresentam resultados.

Treatment of obese or flaccid arms is peformed, for decades, by simple resection of eliptical segment of skin, sometimes with previous liposuction. A few scientific papers have been presented or published about this theme. By other side, few variations were added to the basic techniques. This fact is done, mainly to the low incidence of brachial dermolipectomy among aesthetic surgeries. Authors present their experience in this kind of surgery and the extension of resection to the forearm and to the thorax in patients with large flaccidity. They present technique modifications and discuss results.

Clinical & genetic analysis of four patients with distal upper limb spinal muscular atrophy.

BACKGROUND & OBJECTIVES: Distal upper limb spinal muscular atrophy (SMA) is an uncommon segmental variant of SMA. The condition is usually sporadic, affects males more often than females, and manifests late in the second decade of life, remaining confined to the upper limbs. We examined four patients with this form of SMA in order to determine if they carried homozygous deletion mutations in the survival motor neuron (SMN) or neuronal apoptosis inhibitory protein (NAIP) genes that underlie proximal SMA. METHODS: The four patients with distal upper limb SMA were analysed clinically, electrophysiologically and biochemically. Genomic DNA from each of the patients was analysed by restriction enzyme digestion of polymerase chain reaction (PCR) amplification products, as well single stranded conformation polymorphism (SSCP), to detect deletion events of selected exons of the SMN and NAIP genes. RESULTS: The clinical phenotype of the four patients, together with the biochemical and electrophysiological studies, confirmed a diagnosis of distal upper limb SMA. The molecular studies excluded homozygous deletion mutations in these patients as causative of their phenotype. INTERPRETATION & CONCLUSION: The genetic component underlying distal upper limb SMA appears not to involve mutations that are common in proximal SMA patients. It is possible that genes other than SMN and NAIP may be involved, while somatic mosaicism of SMN gene mutations could be implicated in the segmental nature of distal upper limb SMA.

Tremor ortostático primário: relato de quatro casos / Primary orthostatic tremor: report of 4 cases

Relatamos quatro casos de tremor ortostático primário. O motivo do relato está na raridade da doença e no seu diagnóstico diferencial com outros tremores, muitas vezes confuso. Nossos casos foram estudados eletrofisiologicamente e a frequência dos tremores variou entre 15 e 20 Hz. Existem diferenças clínicas, eletrofisiológicas e terapêuticas entre o tremor ortostático primário e outros tremores de membros inferiores, de acordo com a literatura e com as características de nossos quatro casos.

Sporotrichosis: survey and clinical aspects from Botucatu School of Medicine, state of Säo Paulo - Brazil

FUNDAMENTO - Esporotricose é micose subcutânea de maior ocorrência em regiöes subtropicais e temperadas, com características distintas segundo o país ou regiäoestudada. OBJETIVO - Estudar a casuística de esporotricose do Departamento de Dermatologia da Faculdade de Medicina de Botucatú - UNESP, diagnosticada entre 1976 e 1995. MÉTODOS - Realizou-se estudo transversal sendo utilizados dados primários, obtidos segundo protocolo específico, incluindo dados de anamnese, exame clínico-dermatológico e de seguimento dos pacientes. RESULTADOS - Foram observados 53 casos de esporotricose entre 1976-1995 correspondendo a 0,18 porcento dos casos dermatológicos em primeira consulta no mesmo período; 73,6 porcento dos casos foram do sexo masculino, 56,6 porcento acima de quarenta anos e 54,7 porcento trabalhadores rurais. As lesöes específicas foram mais frequentes nos membros superiores (61,3 porcento) e inferiores (21,0 porcento). A forma linfangítica (50,9 porcento) e a cutânea localizada (41,5 porcento) apresentaram incidência similar. Nos casos da forma localizada da doença, as lesöes ulceradas (46,6 porcento), infiltrativas (26,6 porcento) e vegetante ou verucosa (23,0 porcento foram as mais observadas. CONCLUSÖES - Devem ser salientadas neste estudo: a alta freqüência de lesöoes nos membros superiores, a distribuiçäo pós-contato com gato doméstico infectado pelo sporothix schenckii.

Síndrome de Paget-Schroetter: informe de un caso / Paget-Schroetter: a case report

La trombosis espontánea o de esfuerzo de la vena subclavia es una enfermedad rara, sólo comprende 2 por ciento de todos los casos de trombosis venosa. El síndrome, sin embargo, es posible que se deba a una compresión en la salida torácica y que ocurra generalmente después de un esfuerzo extremo que afecta a la extremidad superior, con los brazos en abducción y rotación externa. Clínicamente el paciente tiene dolor en el hombro seguido de edema de la extremidad superior. El tratamiento es anticoagulación con heparina, más terapia trombolítoica con estreptoquinasa. Los pacientes en quienes la trombosis es consecuencia de compresión de la salida torácica necesitan resección temprana de la primera costilla dorsal para eviatar la recidiva. Se informa el caso de un soldado joven que después de ejercicio intenso tuvo dolor y edema del miembro superior derecho; la flebofrafía demostró trombosis de la vena sublclavia y se le hizo resedcción de la primera costilla para evitar la recidiva.