Effect of Annoying Sounds on Postural Control.

Objectives: This study aimed to explore the impact of irritating sounds on the postural control of healthy adults, considering both linear and nonlinear parameters, subjective assessments, and gender differences. Methods: Thirty-four young participants (17 females, 17 males) completed three 30 s bipedal standing stability tests on a balance platform: one with visual control (EO), another without visual control (EC), and a third without visual control but accompanied by irritating sounds (ECS). Additionally, participants filled out a questionnaire evaluating their sound sensitivity. Linear and nonlinear parameters from each balance test were considered for statistical analysis. Results: The findings reveal significant gender-based variations in sensitivity to sound, with women exhibiting higher sensitivity. No statistically significant differences in postural control were observed between males and females, except for a notable increase in irregularity (SampEn values) in the anterior-posterior direction for females in the ECS trial. Correlation analyses revealed a moderate and statistically significant correlation between SampEn values in the AP direction and SE scores. Conclusions: This study highlights the intricate relationship between sensory stimuli, attention, and the body's ability to maintain balance. The presence of irritating sounds led to increased irregularity in postural control, particularly in the absence of visual control.

Myofascial and Movement Tests after Anterior Cruciate Ligament Reconstruction.

Functional evaluation after anterior cruciate ligament reconstruction is one of the key points involved in decision making about the return of patients to full and unrestricted physical activity. The objective of the present study was to verify whether myofascial chain NEURAC® and Functional Movement Screen (FMS™) tests can be used to detect functional differences between the operated and the non-operated extremity in patients after anterior cruciate ligament reconstruction. A total of 83 young and physically active recreational athletes (mean age: 26.9 ± 9.7 years) who underwent primary single-bundle anterior cruciate ligament reconstruction using an autogenous semitendinosus-gracilis tendon graft were evaluated between the 3rd and the 4th month after surgery. Subjects received a similar, standardised rehabilitation programme. Two experienced raters, blinded to the objective of this study, were involved in functional outcome data collection using myofascial NEURAC® and Functional Movement Screen tests. Only two of the NEURAC® tests showed significant differences in the results between the operated and the non-operated extremity: the supine bridging (mean 2.92 vs. 3.51 points, p < 0.001) and prone bridging (mean 2.76 vs. 3.67 points, p < 0.001) tests. Additionally, the summary score of all NEURAC® tests significantly differed between extremities (mean 12.08 for the operated vs. 13.67 points for the non-operated extremity, p < 0.001). Myofascial tests (supine and prone bridging) in comparison with a battery of Functional Movement Screen tests seem to be more effective in detecting functional differences between the operated and the non-operated extremity at the early stage of recovery after anterior cruciate ligament reconstruction.

The Influence of Unilateral Subthalamic Deep Brain Stimulation on the Quality of Life of Patients with Parkinson's Disease.

AIM: To assess the health-related quality of life (HRQoL) with the Parkinson"s Disease Questionnaire 39 (PDQ-39) after unilateral subthalamic deep brain stimulation (STN DBS) and to identify correlations between the changes in UPDRS (Unified Parkinson"s Disease Rating Scale) scores and separate PDQ-39 QoL dimensions and PDQ summary index (SI) score at short-term follow-up (FU1) and long-term follow-up (FU2). MATERIAL AND METHODS: We evaluated 33 patients with PD after unilateral STN DBS. All patients were assessed at baseline and at FU1 and at FU2. HRQoL levels were determined by applying PDQ-39 and PD progression was evaluated by parts I-IV of the UPDRS. RESULTS: All dimensions of PDQ-39 as well as PDQ-39 SI score were highly significantly improved at FU1. The same improvements were mostly visible at FU2 except for psychosocial functioning. The PDQ-39 SI score was reduced by 40 % (p < 0.01) at FU1 and by 25 % (p < 0.01) at FU2. A significant reduction between the UPDRS baseline scores and the UPDRS follow-up scores was noticed for medication off and on conditions under unilateral STN DBS. Interestingly, we did not find strong positive correlations between the improvements of the UPDRS scores and individual PDQ-39 dimensions as well as PDQ-39 SI score. CONCLUSION: Improvements in PDQ-39 dimensions and PDQ-39 SI score are maintained at FU1 and except for the aspects of psychosocial functioning at FU2. Different correlations between the improvements of separate UPDRS scores on PDQ-39 dimensions require future studies in larger study groups.

Large Hemorrhagic Cerebral Venous Infarction due to Deep Brain Stimulation Leads Placement. Report of 2 Cases.

The true incidence of hemorrhagic venous infarctions in deep brain stimulation (DBS) procedures is very difficult to determine. These hemorrhagic venous complications are very rare and often grouped as all hemorrhagic complications. We report the clinical cases of 2 patients with Parkinson's disease (PD) who received unilateral globus pallidus DBS and developed hemorrhagic venous infarctions. In these 2 patients a small injury to a dural outflow venous structure or a superficial brain vein resulted in hemorrhagic venous infarctions. We present the management of these rare complication with detailed radiologic follow-up. The first patient made a full recovery but the second patient deceased 5 months after DBS surgery due to aspiration pneumonia. We stress that careful planning of a stereotactic trajectory reduces significantly hemorrhagic complications in DBS surgery but not fully exclude some side effects like venous hemorrhagic infarctions which may result in prolong hospitalization or death.

Age-related changes in shock absorption capacity of the human spinal column.

BACKGROUND: The spinal column possesses shock absorption properties, mainly provided by the intervertebral discs. However, with the process of senescence, all structures of the spine, including the discs, undergo degenerative changes. It may lead to alteration of the mechanical properties of the spinal motion segment and diminished capacity for vibration attenuation. OBJECTIVE: The objective of this study was to investigate the age-related changes in shock absorption properties of the spine. PATIENTS AND METHODS: A total of 112 individuals divided into three groups according to age (third, fifth, and seventh decades of life) were enrolled in this study. The transmissibility of vibrations through the spine was measured in a standing position on a vibration platform by accelerometers mounted at the levels of S2 and C0. Registered signals were described using four parameters: VMS (variability), peak-to-peak amplitude (PPA), and spectral activity in two bands F2 (0.7-5 Hz) and F20 (15-25 Hz). RESULTS: In all age groups, signals registered at C0 were characterized by significantly lower values of VMS, PPA, and F20, when compared to level S2. Simultaneously, the parameter F20 significantly differed among all age groups when C0 vibrations were analyzed: 2.43±1.93, 5.02±3.61, and 10.84±5.12 for the third, fifth, and seventh decades of life, respectively. CONCLUSION: The human spinal column provides vibration attenuation; however, this property gradually declines with the aging process.

Long-term clinical outcome of bilateral pallidal stimulation for intractable craniocervical dystonia (Meige syndrome). Report of 6 patients.

BACKGROUND: The aim of the present study was to report the short-term as well long-term results of bilateral pallidal stimulation in 6 consecutive patients for severe debilitating craniocervical dystonia (Meige syndrome) using Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). METHODS: We evaluated 6 consecutive patients with the diagnosis of intractable long-standing craniocervical dystonia. The formal objective assessment included the motor and disability BFMDRS scores. The BFMDRS assessment was performed before and after it roughly annually up to 60months when bilateral pallidal stimulation was switched on and compared to baseline BFMDRS scores. We present short-term (3months postoperatively) follow-up as well long-term (from 6 to 60months) results. Baseline BFMDRS scores and subsequent follow-up BFMDRS scores were compared with the use of a Wilcoxon signed-rank test for matched pairs. A two-tailed probability level of 5% (p<0.05) was considered significant. RESULTS: Bilateral GPi DBS improved the BFMDRS total movement score by 65% at short-term follow-up and by 53% at long-term follow-up when compared to baseline scores. Subscores for eyes at short-term follow-up were reduced by 78%, for mouth by 58%, and for speech/swallowing by 49%. This improvements for individual subscores were maintained at long-term follow-up and were as follows for eyes by 67%, mouth by 50% and speech/swallowing by 39%. The BFMDRS disability score was reduced by 48% at short-term follow-up and by 55% at long-term follow-up when compared to baseline scores. CONCLUSION: Our results showed that bilateral GPi DBS in craniocervical dystonia is effective and safe. Phasic dystonic movements like blepharospasm or oromandibular dystonia responded very fast and favorable to pallidal stimulation reducing disabilities.

Effect of Drop Foot on Spatiotemporal, Kinematic, and Kinetic Parameters during Gait.

Background. The complexity of the structure and function of a living body can be affected by disorders and can cause various dysfunctions. Objective. The aim of this study was to determine compensatory mechanisms in subjects with drop foot during gait. Methods. The study evaluated 10 subjects with drop foot (DF) whose results were compared to a group of 10 healthy controls (C). Spatiotemporal, kinematic, and kinetic parameters during the gait cycle were collected using Vicon system synchronized with Kistler platforms. Results. Spatiotemporal, kinematic, and kinetic parameters were significantly different between the analysed groups. In the DF group, the subjects walked almost 47% slower and performed 60% less steps per minute compared to the C group. The main problem in the DF group was insufficient ankle dorsiflexion in the 0-10% of the gait cycle. Mean values in the groups during the first 10% of the gait cycle were as follows: DF (-10.42 ± 5.7°) and C (-2.37 ± 1.47°), which affected the substantial differences in the values of muscle torque: DF (0.2 ± 0.1 Nm/kg) and C (-0.26 ± 0.06 Nm/kg). Conclusions. Comparative analysis for joint angles and torques demonstrated that the mechanism of compensation is the most noticeable in the knee joint and less in the hip joint.

Dual Anchor Internal Pulse Generator Technique May Lower Risk of Twiddler's Syndrome: A Case Series and Literature Review.

BACKGROUND: Twiddler's syndrome (TS) is described as a spontaneous rotation or intentional external manipulation of implanted internal pulse generator (IPG) for neurological or cardiac disorders. There have been identified some predisposing factors of the development of TS such as: loose subcutaneous tissue, older age of individuals undergoing deep brain stimulation (DBS) procedures, creation of too large pockets for IPG. Apart from these factors, the construction of IPG itself may predispose to the development of TS. OBJECTIVE: To report the clinical course of three patients with TS. Moreover, the purpose of this study is to present the change in fixation technique of IPG that can prevent the occurrence of TS in patients after DBS procedure. METHODS: A prospectively collected database of all hardware related complications for patients operated on for various movement disorders was analyzed. In a total number of 347 DBS systems implanted since 1999 we have identified three patients diagnosed with TS. All three patients with TS in our series were implanted with the IPG harboring a single anchoring hole. This complication has never occurred in patients with the IPG harboring two anchoring holes in our center. RESULTS: All three patients underwent revision surgery. During reoperations all connection cables were replaced and IPG sutured with one additional silk stich through the plastic housing to immobilize it properly in subcutaneous pocket. There were no recurrences of TS in our patients. CONCLUSIONS: Our case series suggests that a predisposing factor of TS may also be the construction of IPG itself (a single anchoring hole intended for fixation), which naturally represents less fixation of the IPG to the fascia or muscle in the subcutaneous pocket. In this preliminary report we present suggestions to lower the risk of TS, including using dual anchor capable IPGs, reducing pocket volume and using nonabsorbable suture.

Mechanisms of compensation in the gait of patients with drop foot.

BACKGROUND: Drop foot is a complex syndrome, with multiple interactions between joints and muscles. Abnormalities in movement patterns can be measured using motion capture techniques, but identifying compensation mechanisms remains challenging. METHODS: In order to identify compensatory mechanisms in patients with drop foot, this study evaluated a sample of 15 such patients using a computerized gait analysis system, as compared to a group of 15 healthy subjects. FINDINGS: Four classes of parameters were distinguished, falling in differing intervals of percentage differences between the groups in the study. The first class comprised two kinematic parameters for which the values of percentage differences in the control group were more than 100% greater than for the patient group. The second class comprised two kinetic parameters falling in the interval of 100-49%. In the third class, in the 49-20% interval the main differences were observed for spatiotemporal parameters, whereas in the 20-4% interval the differences were distributed similarly for kinematic, kinetic and spatiotemporal parameters. INTERPRETATION: These differences in gait pattern between the groups may be related to both primary motor deficits and secondary compensatory mechanisms. Generally, we conclude that drop foot affects the patients' overall kinematic and kinetic gait parameters, with compensation seen as a chain originating from a change of movement within the ankle joint.

Unilateral Subthalamic Nucleus Stimulation in the Treatment of Asymmetric Parkinson"s Disease with Early Motor Complications.

AIM: The aim of this study was to assess the results of unilateral subthalamic nucleus (STN) stimulation for the treatment of Parkinson"s disease (PD) with marked asymmetry of parkinsonian motor symptoms and early motor complications. MATERIAL AND METHODS: The clinical series consisted of 32 consecutive PD patients, in whom unilateral STN stimulation was performed. All patients were assessed according to the Unified Parkinson"s Disease Rating Scale (UPDRS), and Hoehn and Yahr staging. The patients were assessed preoperatively, and at 12, and 24 months after unilateral STN stimulation. 22 patients were followed for 2 years. RESULTS: Medication off/stimulation on total UPDRS motor scores were improved by 29% when compared to the baseline medication off motor scores. The contralateral motor scores improved by 49%, whereas the axial motor scores by 18% in medication off/stimulation on condition. The duration and severity of levodopa induced dyskinesia were reduced respectively by 73% and by 77%. The daily levodopa dose was decreased by only 10%. CONCLUSION: Unilateral STN stimulation is a safe and effective procedure for selected patients with marked asymmetry Parkinson"s disease motor symptoms and early motor complications.

Use of the TIMP in Assessment of Motor Development of Infants With Down Syndrome.

PURPOSE: Infants with Down syndrome (DS) who are admitted to rehabilitation centers are several weeks old, and the tests that they undergo are often not specific enough to highlight the main developmental disorders in the first postnatal trimester. The aim of this study was to assess the possibility of using the Test of Infant Motor Performance (TIMP) to examine motor development of children with DS. METHODS: Using the TIMP, 141 infants, including 64 infants with DS, with a mean age of 9.4 weeks, were examined. The control group represented 77 infants without developmental disorders, with a mean age of 10.0 weeks. RESULTS: The results show that children with DS achieve lower TIMP scores in comparison with children without developmental disorders. CONCLUSIONS: The TIMP is a sensitive measure of delayed motor development in infants with DS and can be used to confirm the need for therapy.

Twiddler syndrome in a patient with tremor dominant Parkinson's disease. A case report and literature review.

Twiddler syndrome is described as a spontaneous rotation or intentional external manipulation of implanted cardiac or occasionally deep brain stimulation (DBS) devices. We report this hardware related complication in a patient with tremor dominant Parkinson's disease (PD), who underwent unilateral subthalamic nucleus (STN) DBS and subsequently developed twiddler syndrome. The clinical course of twiddler syndrome in this patient is described. Some surgical nuances which may prevent its occurrence are suggested. Our case report indicates that twiddler syndrome occurs in DBS patients. Impedance check of DBS hardware, plain chest X-ray, or palpation for a knobbly extension lead through the skin above the IPG allows the correct diagnosis and subsequently a prompt surgical revision. Our subsequent literature review revealed only 10 patients with twiddler syndrome in DBS patient population worldwide. This number may suggest that this syndrome may be unrecognized or underreported, given the number of patients with movement disorders implanted with DBS hardware worldwide.

Relationships between kinesiotherapy methods used in rehabilitation and the course of lost function recovery following surgical treatment of cranio-cerebral trauma.

INTRODUCTION AND AIM: This paper aims to outline the relationships between kinesiotherapy methods used in rehabilitation and the recovery of the patient's ability to perform activities of daily living (ADLs), improvement of functional condition, regression of pareses and improvement of conscious state following surgical treatment of traumatic subdural haematomas. MATERIALS AND METHODS: The study was conducted on 84 patients treated surgically for traumatic subdural haematomas, divided into two groups. The key differentiating factor was the kinesiotherapy method used in rehabilitation. Patients were assessed using the International Scale of Muscle Weakness (ISMW), Barthel Index and modified Rankin Scale, while their conscious state was assessed using the Glasgow Coma Scale. RESULTS: A significant improvement of the assessed features was observed in all patients. However, patients treated with proprioceptive neuromuscular facilitation (PNF) and elements of the Bobath concept regained lost function significantly faster than patients treated with traditional kinesiotherapy. No significant differences were observed in the course of improvement of conscious state between the two groups. CONCLUSIONS: Treatment using functional elements may significantly accelerate the return of the ability to perform ADLs, improvement in functional condition and regression of pareses in comparison with traditional kinesiotherapy.