Major Upper Limb Replantation: An Account of Patient Tenacity.
Ontology highlight
ABSTRACT:
SUBMITTER: Parashar A
PROVIDER: S-EPMC7489713 | biostudies-literature | 2020 Aug
REPOSITORIES: biostudies-literature
Publications
Major Upper Limb Replantation: An Account of Patient Tenacity.
Parashar Atul A Sharma Raman R Kaladagi Raghavendra R Nair Suraj S Shetty Harshavardhan H
Plastic and reconstructive surgery. Global open 20200814 8
Supplemental Digital Content is available in the text. ...[more]
Similar Datasets
Project description:PurposeEven though replantation of limb mutilation is increasing, postoperative wound infection can result in increasing the financial and psychological burden of patients. Here, we sought to explore the distribution of pathogens and identify risk factors for postoperative wound infection to help early identification and managements of high-risk patients.MethodsAdult inpatients with severed traumatic major limb mutilation who underwent replantation from Suzhou Ruixing Medical Group between November 09, 2014, and September 6, 2022 were included in this retrospective study. Demographic, and clinical characteristics, treatments, and outcomes were collected. Data were used to analyze risk factors for postoperative wound infection.ResultsAmong the 249 patients, 185 (74.3%) were males, the median age was 47.0 years old. Postoperative wound infection in 74 (29.7%) patients, of whom 51 (20.5%) had infection with multi-drug resistant bacteria. Ischemia time (OR 1.31, 95% CI 1.13-1.53, P = 0.001), wound contamination (OR 6.01, 95% CI 2.38-15.19, P <0.001), and stress hyperglycemia (OR 23.37, 95% CI 2.30-236.93, P = 0.008) were independent risk factors, while the albumin level after surgery (OR 0.94, 95% CI 0.89-0.99, P = 0.031) was significant associated with the decrease of postoperative wound infection. Ischemia time (OR 1.21, 95% CI 1.05-1.40, P = 0.010), wound contamination (OR 8.63, 95% CI 2.91-25.57, P <0.001), and MESS (OR 1.32, 95% CI 1.02-1.71, P = 0.037 were independent risk factors for multi-drug resistant bacteria infection.ConclusionsPost-replantation wound infection was common in patients with severe traumatic major limb mutilation, and most were multi-drug resistant bacteria. Ischemia time and wound contamination were associated with the increase of postoperative wound infection, including caused by multi-drug resistant. Positive correction of hypoproteinemia and control of stress hyperglycemia may be beneficial.
| S-EPMC10984543 | biostudies-literature
Project description:BACKGROUND:Breast cancer is the most common cancer in women worldwide. Major breast cancer surgery especially with axillary lymph node dissection (ALND), is associated with upper limb functional decline. Majority of studies are conducted in Western population and may not be applicable to Asians. This pilot study aims to evaluate whether major breast surgery results in upper limb functional impairment in a cohort of Asian women with breast cancer. METHODS:This is a prospective cohort study of 41 patients who underwent 44 major breast surgeries from April 2018 to August 2019. Main inclusion criteria were patients over 21?years of age undergoing major breast surgery for breast cancer. Major breast surgery was defined as wide local excision (WLE) or mastectomy. Main exclusion criteria were patients with pre-existing neurological or rheumatological co-morbidities affecting upper limb function or previous trauma with resulting deformities to the upper limbs. Patients underwent early rehabilitation from post-operative day 1. Shoulder flexion and abduction active range of motion (AROM) and QuickDASH disability score were assessed 1?week before surgery, post-operative week 2 and week 6. Baseline demographics and peri-operative data were also collected. RESULTS:Median age was 62.5?years. There were 16 (36.4%) wide local excisions and 28 (63.6%) simple mastectomies. Two (4.5%) cases had neoadjuvant chemotherapy. Fifteen (34.1%) cases had ALND. At post-operative week 6, shoulder flexion was comparable to baseline (p?=?0.775), while abduction improved from baseline (p?=?0.016). However, QuickDASH disability score was significantly worse at post-operative week 6 compared to baseline (median score 2.5 vs 0, p?=?0.027). Subgroup analysis of patients with ALND demonstrated significantly worse QuickDASH disability score at post-operative week 6 (p?=?0.010) but not for patients with only sentinel lymph node biopsy (p?=?0.396). CONCLUSION:This pilot study in an Asian cohort found that patients were able to regain AROM of shoulder after major breast surgery at post-operative week 6 but had a worse QuickDASH disability score, especially in the subgroup with ALND. Aggressive and early rehabilitation should be encouraged. However, a longer follow-up is required to evaluate long term functional outcomes.
| S-EPMC7236525 | biostudies-literature
Project description:IntroductionA comprehensive study to assess quality and outcomes of care for Veterans with upper limb amputation is needed. This paper presents methods and summary findings from a national survey of Veterans with upper limb amputation.MethodsAfter completion of a pilot study to develop and refine methods, computer-assisted telephone interviews were conducted with 808 Veterans with upper limb amputation (response rate = 47.7%; cooperation rate = 63.3%).ResultsRespondents were 776 unilateral and 32 bilateral amputees, 97.5% male, mean age 63.3 (sd 14.1). Prostheses were used by 60% unilateral and 91% bilateral, the majority used body powered devices. Prostheses were used ≥8 hours/day by 52% unilateral and 76% bilateral. Prosthetic training was received by 71% unilateral and 59% bilateral. Mean prosthetic satisfaction was 3.9 (sd 0.6) and 3.8 (sd 0.7) as measured by TAPES; and 25.0 (sd 5.1) and 25.7 (sd 4.5) as measured by OPUS CSD for unilateral and bilateral respectively. Mean perceived disability (measured by QuickDASH) scores were 49.5 (sd 20.7) for unilateral and 34.7 (sd 22.0) for bilateral. VR-12 PCS scores were below population norms. The majority reported contralateral limb pain, musculoskeletal conditions, back and neck pain. Phantom limb pain was reported in 83.4% of unilateral and 68.8% of bilateral, and residual limb pain in 65.1% of unilateral and 68.8% of bilateral. Most, (81.8% unilateral, 84.4% bilateral) had been to a Veterans Affairs medical center (VA) for amputation care, while 57% of unilateral and 81.3% of bilateral had been to a VA amputation clinic.Discussion/conclusionVeterans with upper limb amputation have moderately impaired physical functioning. Prosthesis use rates were lower than previously reported. Although satisfied with their prostheses, nearly half used them ≤8 hours/day. Rates of musculoskeletal problems, phantom and residual limb pain were higher than previously reported. A substantial proportion never received prosthetic training, or VA amputation care.
| S-EPMC6417699 | biostudies-literature
Project description:Background:Multiple Sclerosis (MS) clinical trials increasingly focus on progressive and advanced MS, with upper limb function (ULF) as a key outcome. Within clinical trials, Patient Reported Outcomes (PROs) quantify clinical variables and establish meaningfulness of changes. Scientific standards and regulatory criteria (from Food and Drug Administration [FDA]) require PROs be "fit-for-purpose": well-defined and reliable measures of specific concepts in defined contexts. Objective:To identify, from literature, existing PROs measuring ULF and determine which satisfy scientific and regulatory clinical trials requirements. Method:We screened PubMed/Web of Science using multiple relevant terms. Abstracts and full texts were screened using suitability criteria. PRO development papers were evaluated using recently expanded Consensus Standards for Measurement Instruments (COSMIN) criteria for content development. Results:We identified 3619 articles; 485 used 24 different ULF PROs. No PRO satisfied scientific and regulatory requirements as a well-defined measure of a clearly defined construct in a specific clinical context. Conclusions:Existing ULF PROs don't meet fit-for-purpose criteria. MS clinical trials require new measures with greater emphasis on patient engagement to derive theoretical frameworks, concepts of interest, and contexts of use followed by systematic literature searches, expert input, and qualitative research to support item generation. Until then, trials will miss aspects of meaningful within-patient change and thereby misrepresent (likely underestimating) treatment effects.
| S-EPMC7125352 | biostudies-literature
Project description:An alien limb is a debilitating disorder of volitional control. The core feature of alien limb is the performance of simple or complex semi-purposeful movements which the patient reports to be unintentional or unwanted, or occasionally in opposition to their intentions. Theories of the mechanism of alien limb phenomena have emphasised the role of disinhibition in the brain, and exaggerated action 'affordances'. However, despite advances in cognitive neuroscience research and a large public and media interest, there has been no unifying computational and anatomical account of the cause of alien limb movements. Here, we extend Bayesian brain principles to propose that alien limb is a disorder of 'predictive processing' in hierarchical sensorimotor brain networks. Specifically, we suggest that alien limb results from predictions about action outcomes that are afforded unduly high precision. The principal mechanism for this abnormally high precision is an impairment in the relay of input from medial regions, predominantly the supplementary motor area (SMA), which modulate the precision of lateral brain regions encoding the predicted action outcomes. We discuss potential implications of this model for future research and treatment of alien limb.
| S-EPMC7212084 | biostudies-literature
Project description:Brachial hemiparesis is one of the most frequent sequelae of stroke, leading to important functional disability given the role of the upper limb in executing activities of daily living (ADL). The Stroke Upper Limb Capacity Scale (SULCS) is a stroke-specific assessment instrument that evaluates functional capacity of the upper limb based on the execution of 10 tasks. The objective of this study is the transcultural adaptation and psychometric validation of the Portuguese version of the SULCS.A Portuguese version of the SULCS was developed, using the process of forward-backward translation, after authorisation from the author of the original scale. Then, a multicentre study was conducted in Portuguese stroke patients (n = 122) to validate the psychometric properties of the instrument. The relationship between sociodemographic and clinical characteristics was used to test construct validity. The relationship between SULCS scores and other instruments was used to test criterion validity.Semantic and linguistic adaptation of the SULCS was executed without substantial issues and allowed the development of a Portuguese version. The application of this instrument suggested the existence of celling effect (19.7% of participants with maximum score). Reliability was demonstrated through the intraclass correlation coefficient of 0.98. As for construct validity, SULCS was sensible to muscle tonus and aphasia. SULCS classification impacted the scores of the Motor Evaluation Scale for Upper Extremity in Stroke (MESUPES) and the Stroke Impact Scale (SIS).The present version of SULCS shows valid and reliable cultural adaptation, with good reliability and stability.
| S-EPMC5543451 | biostudies-other
Project description:A potential contributor to impaired motor imagery in amputees is an alteration of the body schema as a result of the presence of a phantom limb. However, the nature of the relationship between motor imagery and phantom experiences remains unknown. In this study, the influence of phantom limb perception on motor imagery was investigated using a hand mental rotation task by means of behavioral and electrophysiological measures. Compared with healthy controls, significantly prolonged response time for both the intact and missing hand were observed specifically in amputees who perceived a phantom limb during the task but not in amputees without phantom limb perception. Event-related desynchronization of EEG in the beta band (beta-ERD) in central and parietal areas showed an angular disparity specifically in amputees with phantom limb perception, with its source localized in the right inferior parietal lobule. The response time as well as the beta-ERD values were significantly positively correlated with phantom vividness. Our results suggest that phantom limb perception during the task is an important interferential factor for motor imagery after amputation and the interference might be related to a change of the body representation resulting from an unnatural posture of the phantom limb.
| S-EPMC4754632 | biostudies-other
Project description:Robotic therapy can improve upper limb function in hemiparesis. Excitatory transcranial direct current stimulation (tDCS) can prime brain motor circuits before therapy.We tested safety and efficacy of tDCS plus robotic therapy in an adult with unilateral spastic cerebral palsy (USCP).In each of 36 sessions, anodal tDCS (2 mA, 20 min) was applied over the motor map of the affected hand. Immediately after tDCS, the participant completed robotic therapy, using the shoulder, elbow, and wrist (MIT Manus). The participant sat in a padded chair with affected arm abducted, forearm supported, and hand grasping the robot handle. The participant controlled the robot arm with his affected arm to move a cursor from the center of a circle to each of eight targets (960 movements). Motor function was tested before, after, and six months after therapy with the Wolf Motor Function Test (WMFT) and Fugl-Meyer (FM).Reaching accuracy on the robot task improved significantly after therapy. The WMFT and FM improved clinically meaningful amounts after therapy. The motor map of the affected hand expanded after therapy. Improvements were maintained six months after therapy.Combined tDCS and robotics safely improved upper limb function in an adult with USCP.
| S-EPMC5546204 | biostudies-other
Project description:BackgroundUpper limb kinematic assessments provide quantifiable information on qualitative movement behavior and limitations after stroke. A comprehensive characterization of spatiotemporal kinematics of stroke subjects during upper limb daily living activities is lacking. Herein, kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases.MethodChronic stroke subjects with upper limb movement impairments and healthy subjects performed a set of daily living activities including gesture and grasp movements. Kinematic measures of trunk displacement, shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension, movement time, hand peak velocity, number of velocity peaks (NVP), and spectral arc length (SPARC) were extracted for the whole movement as well as the subphases of reaching distally and proximally. The effects of the factors gesture versus grasp movements, and the impairment level on the kinematics of the whole task were tested. Similarities considering the metrics expressions and relations were investigated for the subphases of reaching proximally and distally between tasks and subgroups.ResultsData of 26 stroke and 5 healthy subjects were included. Gesture and grasp movements were differently expressed across subjects. Gestures were performed with larger shoulder motions besides higher peak velocity. Grasp movements were expressed by larger trunk, forearm, and wrist motions. Trunk displacement, movement time, and NVP increased and shoulder flexion/extension decreased significantly with increased impairment level. Across tasks, phases of reaching distally were comparable in terms of trunk displacement, shoulder motions and peak velocity, while reaching proximally showed comparable expressions in trunk motions. Consistent metric relations during reaching distally were found between shoulder flexion/extension, elbow flexion/extension, peak velocity, and between movement time, NVP, and SPARC. Reaching proximally revealed reproducible correlations between forearm pronation/supination and wrist flexion/extension, movement time and NVP.ConclusionSpatiotemporal differences between gestures versus grasp movements and between different impairment levels were confirmed. The consistencies of metric expressions during movement subphases across tasks can be useful for linking kinematic assessment standards and daily living measures in future research and performing task and study comparisons.Trial registrationClinicalTrials.gov Identifier NCT03135093. Registered 26 April 2017, https://clinicaltrials.gov/ct2/show/NCT03135093 .
| S-EPMC8753836 | biostudies-literature
Project description:Whole-body vibration and upper limb vibration (ULV) continue to gain popularity as exercise intervention for rehabilitation and sports applications. However, the fatiguing effects of indirect vibration stimulation are not yet fully understood. We investigated the effects of ULV stimulation superimposed on fatiguing isometric contractions using a purpose developed upper limb stimulation device. Thirteen healthy volunteers were exposed to both ULV superimposed to fatiguing isometric contractions (V) and isometric contractions alone Control (C). Both Vibration (V) and Control (C) exercises were performed at 80% of the maximum voluntary contractions. The stimulation used was 30 Hz frequency of 0.4 mm amplitude. Surface-electromyographic (EMG) activity of the Biceps Brachii, Triceps Brachii and Flexor Carpi Radialis were measured. EMG amplitude (EMGrms) and mean frequency (MEF) were computed to quantify muscle activity and fatigue levels. All muscles displayed significantly higher reduction in MEFs and a corresponding significant increase in EMGrms with the V than the Control, during fatiguing contractions (p < 0.05). Post vibration, all muscles showed higher levels of MEFs after recovery compared to the control. Our results show that near-maximal isometric fatiguing contractions superimposed on vibration stimulation lead to a higher rate of fatigue development compared to the isometric contraction alone in the upper limb muscles. Results also show higher manifestation of mechanical fatigue post treatment with vibration compared to the control. Vibration superimposed on isometric contraction not only seems to alter the neuromuscular function during fatiguing efforts by inducing higher neuromuscular load but also post vibration treatment.
| S-EPMC6837201 | biostudies-literature