ABSTRACT
Rehabilitation of the elderly patient with a neurologic disease consists primarily of the coordinated actions of an interdisciplinary team of physicians. Key aspects of this process are remediation to reduce neurologic impairments, prevention of secondary complications and comorbidities, compensation to offset and adapt to residual disabilities, and maintenance of function over the long term.
Subject(s)
Brain Diseases/rehabilitation , Health Services for the Aged/economics , Aged , Aged, 80 and over , Hospitalization , Humans , Patient Care Team , Quality of LifeABSTRACT
Ideomotor apraxia, disordered movement execution to command, commonly follows left-hemisphere damage, implying left-hemisphere dominance for certain kinds of movements. To delineate this dominance we used different command modalities to elicit meaningful movements and tested imitation of nonsense movements. Twenty-seven patients with unilateral hemispheric stroke and 10 age-matched controls were evaluated. Patients with left-hemisphere damage performed both meaningful and nonsense movements poorer than the other study groups; thus, the meaningfulness of the movements is irrelevant for the left-hemisphere motor dominance. The performance varied, however, with the command modality and movement type. Based on this and earlier studies we posit that the left-hemisphere motor dominance is determined by the artificiality of the test situation (it concerns movements performed to command and out of the natural context) and increased spatial and temporal complexity of the demanded movements. No association between the lesion locus within the left hemisphere and the severity of the ideomotor apraxia was found.
Subject(s)
Apraxias/physiopathology , Brain Damage, Chronic/physiopathology , Dominance, Cerebral/physiology , Kinesthesis/physiology , Motor Skills/physiology , Psychomotor Performance/physiology , Aged , Aged, 80 and over , Aphasia/diagnosis , Aphasia/physiopathology , Apraxias/diagnosis , Attention/physiology , Brain Damage, Chronic/diagnosis , Cerebral Infarction/diagnosis , Cerebral Infarction/physiopathology , Female , Functional Laterality/physiology , Humans , Male , Middle Aged , Neuropsychological TestsABSTRACT
Spasticity is a disorder of excess muscle tone associated with CNS disease. We hypothesized that botulinum toxin, a neuromuscular blocking agent, would reduce tone in spastic muscles after stroke. This randomized, double-blind, placebo-controlled, multicenter clinical trial evaluated the safety and efficacy of botulinum toxin type A (BTXA) in the treatment of chronic upper limb spasticity after stroke. Thirty-nine patients received IM injections of a total dose of either 75, 150, or 300 units of BTXA or placebo into the biceps, flexor carpi radialis, and flexor carpi ulnaris muscles. At baseline, patients demonstrated a mean wrist flexor tone of 2.9 and elbow flexor tone of 2.6 on the Ashworth Scale (0 to 4). Treatment with the 300-unit BTXA dose resulted in a statistically and clinically significant mean decrease in wrist flexor tone of 1.2 (p = 0.028), 1.1 (p = 0.044), and 1.2 (p = 0.026) points and elbow flexor tone of 1.2 (p = 0.024), 1.2 (p = 0.028), and 1.1 (p = 0.199) at weeks 2, 4, and 6 postinjection. In the placebo group, tone reduction at the wrist was 0.3, 0.2, and 0.0 and at the elbow was 0.3, 0.3, and 0.6 at weeks 2, 4, and 6 postinjection. BTXA groups reported significant improvement on the physician and patient Global Assessment of Response to Treatment at weeks 4 and 6 postinjection. There were no serious adverse effects. In this 3-month study, BTXA safely reduced upper extremity muscle tone in patients with chronic spasticity after stroke.
Subject(s)
Anti-Dyskinesia Agents/therapeutic use , Botulinum Toxins/therapeutic use , Muscle Spasticity/drug therapy , Adult , Aged , Anti-Dyskinesia Agents/adverse effects , Arm , Bias , Botulinum Toxins/adverse effects , Double-Blind Method , Elbow Joint/physiopathology , Female , Humans , Male , Middle Aged , Movement , Muscle Spasticity/physiopathology , Muscle, Skeletal/physiopathology , Patient Selection , Placebos , Time Factors , Wrist Joint/physiopathologyABSTRACT
Recognition of non-verbal environmental sounds was investigated in 52 subjects with unilateral cerebro-vascular accidents and 18 age-matched normal controls. Impaired performance was most consistently found following cortical damage of homologous areas in either the left or the right hemisphere. Lesions involved the superior temporal gyrus (including the planum temporale), the inferior parietal lobe and the parietal operculum; this area appears to constitute the human auditory cortical processing area. We found different error patterns dependent upon the side of the lesion: patients with right hemisphere damage failed to discriminate between acoustically related sounds, patients with left hemisphere lesions tended to confuse semantically related sound sources. The impairment following right hemisphere damage was specific for non-verbal environmental sounds while left hemisphere damage was associated with disturbed semantic capabilities in multiple modalities.
Subject(s)
Auditory Perception , Cerebrovascular Disorders/physiopathology , Sound , Aged , Cerebrovascular Disorders/complications , Female , Functional Laterality , Humans , Male , Middle AgedABSTRACT
The bioluminescent reaction of adenosine 5'-triphosphate (ATP) with luciferin and luciferase has been used in conjunction with a sensitive photometer (Lab-Line's ATP photometer) to detect significant bacteriuria in urine. This rapid method of screening urine specimens for bacteriuria was evaluated by using 348 urine specimens submitted to the clinical microbiology laboratory at the University of Minnesota Hospitals for routine culture using the calibrated loop-streak plate method. There was 89.4% agreement between the culture method and the ATP assay, with 7.0% false positive and 27.0% false negative results from the ATP assay using 10(5) organisms/ml of urine or greater as positive for significant bacteriuria and less than 10(5) organisms/ml as negative for significant bacteriuria.
