The Role of White Matter Disconnection in the Symptoms Relating to the Anarchic Hand Syndrome: A Single Case Study.

The anarchic hand syndrome refers to an inability to control the movements of one's own hand, which acts as if it has a will of its own. The symptoms may differ depending on whether the brain lesion is anterior, posterior, callosal or subcortical, but the relative classifications are not conclusive. This study investigates the role of white matter disconnections in a patient whose symptoms are inconsistent with the mapping of the lesion site. A repeated neuropsychological investigation was associated with a review of the literature on the topic to identify the frequency of various different symptoms relating to this syndrome. Furthermore, an analysis of the neuroimaging regarding structural connectivity allowed us to investigate the grey matter lesions and white matter disconnections. The results indicated that some of the patient's symptoms were associated with structures that, although not directly damaged, were dysfunctional due to a disconnection in their networks. This suggests that the anarchic hand may be considered as a disconnection syndrome involving the integration of multiple antero-posterior, insular and interhemispheric networks. In order to comprehend this rare syndrome better, the clinical and neuroimaging data need to be integrated with the clinical reports available in the literature on this topic.

Role of LCF scale as an outcome prognostic index in patients with traumatic brain injury.

The disabling effects of traumatic brain injuries (TBI) present a significant healthcare concern to developed countries. In order to achieve a reliable prognosis, validated assessment scales are used to monitor the cognitive outcome, like the Level of Cognitive Functioning Scale, or the overall functional outcome, namely the Functional Independence Measure and Glasgow Outcome Scale. The aim of our study was to evaluate the role of Level of Cognitive Functioning Scale (LCF) as an outcome prognostic index in patients with TBI. MATERIALS AND METHODS: Fifty-four patients with TBI with a mean age of 44.9 years (SD 20.915) were enrolled in this retrospective study. Patients were evaluated at admission and at discharge using the Glasgow Outcome Scale, Functional Independence Measure, and Level of Cognitive Functioning Scale. The Glasgow Outcome Scale was also implemented at 6 months after discharge (OUTCOME.GOS), whereas the LCF was used twice a week throughout hospitalization. For our purpose, we named LCF at admission LCFa, whereas permanence in the same LCF value (number of days), LCFaL. RESULTS: Δ.GOS, Δ.FIM (Δ = difference between value at discharge and at admission), and OUTCOME.GOS were significantly affected by age, length of stay, LCFa, and LCFaL. CONCLUSION: The LCF can give a valuable indication to the prognosis of patients with TBI besides monitoring changes in cognitive function. This allows for individual rehabilitation plan, and long-term management strategies could be developed more quickly upon patient's discharge. Consequently, valuable healthcare and social care resources could be assigned correctly.

Anatomical landmarks for tibial nerve motor branches in the management of spastic equinovarus foot after stroke: An ultrasonographic study.

OBJECTIVE: To identify the anatomical landmarks of tibial motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles for selective motor nerve blocks in the management of spastic equinovarus foot. DESIGN: Observational study. PATIENTS: Twenty-five chronic stroke patients with spastic equinovarus foot. METHODS: Motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles were tracked in the affected leg, using ultrasonography, and located in the space (vertical, horizontal and deep) according to the position of the fibular head (proximal/distal) and a virtual line from the middle of the popliteal fossa to the Achilles tendon insertion (medial/lateral). RESULTS: Mean coordinates for the gastrocnemius medialis motor branch were: 1.5 cm (standard deviation (SD) 2.7) vertical (proximal), 1.7 cm (SD 1.3) horizontal (medial), 1.1 cm (SD 0.4) deep; for the gastrocnemius lateralis motor branch: 0.9 cm (SD 2.2) vertical (proximal), 1.8 cm (SD 1.7) horizontal (lateral), 1.0 cm (SD 0.3) deep; for the soleus motor branch: 1.4 cm (SD 1.1) vertical (distal), 1.6 cm (SD 0.7) horizontal (lateral), 2.8 cm (SD 0.7) deep; and for the tibialis posterior motor branch: 4.3 cm (SD 1.5) vertical (distal), 1.9 cm (SD 0.9) horizontal (lateral), 4.2 cm (SD 0.8) deep. CONCLUSION: These findings may help in the identification of tibial motor nerve branches to the gastrocnemii, soleus and tibialis posterior muscles for selective motor nerve blocks in the management of spastic equinovarus foot.

Combined effects of robot­assisted gait training and botulinum toxin type A on spastic equinus foot in patients with chronic stroke: a pilot, single blind, randomized controlled trial.

BACKGROUND: Despite the growing evidence about the use of robotic gait training in neurorehabilitation, there is a scant literature about the combined effects of this innovative technological approach and a first­line treatment for focal spasticity as botulinum toxin type A. In particular, to the best of our knowledge, no previous study evaluated if robotic gait training may enhance the antispastic effect of botulinum toxin type A. AIM: To evaluate the combined effects of robot­assisted gait training and botulinum toxin type A on spastic equinus foot in patients with chronic stroke. DESIGN: Pilot, single blind, randomized controlled trial. SETTING: University hospital. POPULATION: Twenty­two adult outpatients with spastic equinus due to chronic stroke. METHODS: Participants were randomly assigned to two groups: patients allocated to the group 1 received robot­assisted gait training (30 minutes a day for five consecutive days) after AbobotulinumtoxinA injection into the spastic calf muscles as well as patients allocated to the group 2 were only injected with AbobotulinumtoxinA into the same muscles. All patients were evaluated immediately before and one month after injection. The following outcome measures were considered: the modified Ashworth scale, the Tardieu scale and the 6-minute walking test. RESULTS: No difference was found between groups as to the modified Ashworth scale and the Tardieu scale measured at the affected ankle one month after botulinum toxin injection. A significant difference in the 6-minute walking test was noted between groups at the post­treatment evaluation (P=0.045). CONCLUSIONS: Our preliminary findings support the hypothesis that robot­assisted gait training does not enhance the effect of botulinum toxin type A on spastic equinus foot in patients with chronic stroke. CLINICAL REHABILITATION IMPACT: Our observations should be taken into account in daily clinical rehabilitation practice in order to develop effective treatment protocols based on the enhancement of antispastic drugs effect.

Does the Pisa syndrome affect postural control, balance, and gait in patients with Parkinson's disease? An observational cross-sectional study.

INTRODUCTION: An altered sense of verticality, associated with impaired proprioception and somatosensory integration deficits, has been reported in patients with Parkinson's disease (PD) but it has not been characterized in patients with Pisa syndrome (PS). Therefore, we investigated postural control, balance, and gait disturbances in patients with PD and PS, patients with PD but without PS, and aged-matched normal controls. METHODS: This observational cross-sectional study involved patients with PD and PS (n = 10, Hoehn & Yahr score <4), patients with PD but without PS (n = 10), and age-matched healthy controls (n = 10). The primary outcome measure was the velocity of CoP displacement (VEL_MED_AP/ML) assessed by static stabilometry in eyes open (EO) and eyes closed (EC) conditions. The secondary outcomes were other stabilometric parameters, the Sensory Organization Balance Test (SOT), and gait analysis (GA). RESULTS: There were no significant differences in demographic and clinical data and Berg Balance Scale scores between the groups. There was a significant main effect in the VEL_MED_AP/ML between the groups and eye conditions (p = .016). A significant main effect was found in the EO (p = .01) and EC (p = .04) conditions. Post-hoc comparisons showed a significant increase in VEL_CoP in both the EO and EC conditions only in the patients with PD and PS. No significant main effects on SOT and GA were found. CONCLUSION: Patients with PD and PS had more difficulty achieving good postural alignment with gravity and greater velocity of body sway than the other groups. Rehabilitation programs for patients with PD and PS should include spine alignment and dynamic postural training.