ABSTRACT
Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients' impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.
Subject(s)
Nervous System Diseases/rehabilitation , Activities of Daily Living , Cognition/physiology , Critical Care , Depression/diagnosis , Depression/etiology , Depression/psychology , Disability Evaluation , Humans , Independent Living , Mobility Limitation , Nervous System Diseases/complications , Nervous System Diseases/psychology , Neurologic Examination , Neuropsychological Tests , Posture/physiology , Prognosis , Respiratory Function Tests , Thromboembolism/complicationsABSTRACT
INTRODUCTION: Traumatic cauda equina syndromes due to projectile wounds often have a poor prognosis. We report on an unusual ballistic cauda equina traumatism with a good functional outcome. CLINICAL CASE: A 44-year-old man was admitted to emergency room for an incomplete cauda equina syndrome after trying to kill himself by means of a pneumatic nail gun. The nail had gone right through the third lumbar vertebra. Because of the stability of the fracture, orthopaedic surgery was not indicated. Neurological recovery was progressive. At 6 months, there was still a partial L5-S1 motor deficit on the left side but the patient could walk without crutches, and within an unlimited walking distance. DISCUSSION: Initial imaging displayed a projectile trajectory focused on the spinal canal on level L3, which could have been considered as bad prognosis. The positive analytic and functional outcome correlates with the limited neurological tissue damage, probably explained by the ballistic properties of the projectile. CONCLUSION: Apart from the influence of a possible surgical act, the neurological and functional prognosis of a traumatic cauda equina syndrome caused by a projectile also depends on its physical characteristics.
Subject(s)
Lumbar Vertebrae/injuries , Polyradiculopathy/etiology , Polyradiculopathy/rehabilitation , Wounds, Gunshot/complications , Adult , Electromyography , Forensic Ballistics , Fractures, Bone/diagnosis , Fractures, Bone/etiology , Fractures, Bone/rehabilitation , Humans , Magnetic Resonance Imaging , Male , Polyradiculopathy/diagnosis , Polyradiculopathy/epidemiology , Prognosis , Rare Diseases , Recovery of Function , Suicide, Attempted , Tomography, X-Ray Computed , Treatment Outcome , WalkingABSTRACT
BACKGROUND: Weakness and somatosensory deficits have long been known to be involved in the postural instability of subjects with stroke. Recently, it has been shown that impaired representations of the orientation of the longitudinal axis of the body (LBA, egocentric reference) and of verticality (allocentric reference) may also play a role. The objective of the present study was to determine whether these two references were independently linked to postural asymmetry in standing stroke patients. METHODS: Twenty-two subjects were tested after a first hemispheric stroke (13 +/- 7.5 weeks). The LBA perception was investigated in the supine position by adjusting the orientation of a luminous rod in the frontal plane to correspond to the subjective LBA. The subjective visual vertical (SVV) was assessed by adjusting the orientation of a luminous line in the frontal plane to correspond to the SVV in upright patients. Weight distribution was measured in the standing position for about 2 minutes and 45 seconds by two separate force platforms under the feet. RESULTS: LBA and SVV were strongly associated (r = 0.7; p < 0.001). The estimate of the LBA was a better predictor (r = -0.52: p < 0.02) of weight bearing asymmetry than was SVV (r = -0.41; p = 0.074) when adjusted for motor weakness and hypoesthesia. CONCLUSION: Contralesional rotation of the longitudinal axis of the body could lead to unequal distribution of loading on the feet. This novel interpretation of weight bearing asymmetry underlines the complexity of control of the erect stance following stroke and brings new perspectives for rehabilitation programs.
Subject(s)
Movement Disorders/physiopathology , Orientation/physiology , Perceptual Disorders/physiopathology , Postural Balance/physiology , Space Perception/physiology , Stroke/complications , Adult , Aged , Aged, 80 and over , Brain/blood supply , Brain/pathology , Brain/physiopathology , Female , Humans , Leg/physiopathology , Male , Middle Aged , Movement Disorders/diagnosis , Movement Disorders/etiology , Muscle, Skeletal/innervation , Muscle, Skeletal/physiopathology , Perceptual Disorders/diagnosis , Perceptual Disorders/etiology , Proprioception/physiology , Rotation/adverse effects , Somatosensory Disorders/diagnosis , Somatosensory Disorders/etiology , Somatosensory Disorders/physiopathology , Vision Disorders/diagnosis , Vision Disorders/etiology , Vision Disorders/physiopathology , Weight-Bearing/physiologyABSTRACT
INTRODUCTION: In the recent literature we can find many articles dealing with upper extremity rehabilitation in stroke patients. New techniques, still under evaluation, are becoming the practical applications for the concept of post-stroke brain plasticity. METHODS: This literature review focuses on controlled randomized studies, reviews and meta-analyses published in the English language from 2004 to 2008. The research was conducted in MEDLINE with the following keywords: "upper limb", "stroke", "rehabilitation". RESULTS: We reviewed 66 studies. The main therapeutic strategies are: activation of the ipsilesional motor cortex, inhibition of the contralesional motor cortex and modulation of the sensory afferents. Keeping a cortical representation of the upper limb distal extremity could prevent the learned non-use phenomenon. The modulation of sensory afferents is then proposed: distal cutaneous electrostimulation, anesthesia of the healthy limb, mirror therapy, virtual reality. Intensifying the rehabilitation care means increasing the total hours of rehabilitation dedicated to the paretic limb (proprioceptive stimulation and repetitive movements). This specific rehabilitation is facilitated by robot-aided therapy in the active-assisted mode, neuromuscular electrostimulation and bilateral task training. Intensifying the rehabilitation training program significantly improves the arm function outcome when performed during subacute stroke rehabilitation (< six months). Ipsilesional neurostimulation as well as mental practice optimize the effect of repetitive gestures for slight motor impairments. Contralesional neurostimulation or anesthesia of the healthy hand both improve the paretic hand's dexterity via a decrease of the transcallosal inhibition. This pathophysiological mechanism could also explain the positive impact of constraint-induced movement therapy (CI therapy) in an environmental setting for chronic stroke patients. CONCLUSION: To ensure a positive functional outcome, stroke rehabilitation programs are based on task-oriented repetitive training. This literature review shows that exercising the hemiparetic hand and wrist is essential in all stages of a stroke rehabilitation program. New data stemming from neurosciences suggest that ipsilesional corticospinal excitability should be a priority.
Subject(s)
Arm/physiopathology , Stroke Rehabilitation , Stroke/physiopathology , Humans , Meta-Analysis as Topic , Physical Therapy Modalities , Randomized Controlled Trials as Topic , Recovery of FunctionABSTRACT
Neurological complications of cosmopolitan parasitosis are rare. We report a case of a cerebral and systemic vasculitis secondary to a visceral larva migrans syndrome associated with a Toxocara canis and Fasciola hepatica co-infestation.
