Gait Characteristics in Youth With Transverse Myelitis

Physical therapy intervention improves pain, mobility, and strength in a patient with transverse myelitis seropositive to Chikungunya: Case report

INTRODUCTION

Chikungunya Fever is an arbovirus transmitted by Aedes aegypti or Aedes albopictus mosquitoes. Neurological manifestations associated with arboviruses such as Dengue and Zika Virus were reported between 2017 and 2019.

AIM

To describe the impact of physical therapy management on pain, mobility, and strength for a patient with transverse myelitis seropositive to Chikungunya.

METHODS

A 29-year-old patient with transverse myelitis due to Chikungunya virus infection was subjected to physiotherapeutic evaluation and intervention for the management of pain, mobility, and lower limb strength. Pain intensity, tactile sensitivity for light touch and pain, and thermal sensitivity were assessed by the Numeric Pain Rating Scale (NPRS), aesthesiometer and pin-prick stimulator, and hot/cold test tubes, respectively. Functional mobility and lower limbs strength were assessed by the Timed Up and Go (TUG) test and the 30-s Chair-Stand test (30 CST), respectively. The physiotherapeutic protocol included kinesiotherapy, Transcutaneous Electrical Nerve Stimulation, and Functional Electrical Stimulation.

RESULTS

After 20 sessions of a multimodal physical therapy intervention, all joints tested by NPRS showed pain reduction: lumbar spine (57.15%), hip and ankles (100%), right knee (28.58%), and left knee (33.34%).There was an improvement in performing the TUG test at "getting up" and "sitting down" phases (decrease of 30% and 23%, respectively), while the number of repetitions in the 30 TFC increased by 75%, in addition, there was an improvement in performance in the tests, with more autonomy and independence.

CONCLUSION

At the end of the physiotherapeutic intervention, pain, mobility, and strength of the lower limbs were improved.

Influence of ganglioside combined with methylprednisolone sodium succinate on efficacy and neurological function in patients with acute myelitis

BACKGROUND

Acute myelitis (AM) can lead to sudden sensory, motor and autonomic nervous dysfunction, which negatively affects their daily activities and quality of life, so it is necessary to explore optimization from a therapeutic perspective to curb the progression of the disease.

AIM

To investigate the effect of ganglioside (GM) combined with methylprednisolone sodium succinate (MPSS) on the curative effect and neurological function of patients with AM.

METHODS

First, we selected 108 AM patients visited between September 2019 and September 2022 and grouped them based on treatment modality, with 52 patients receiving gamma globulin (GG) + MPSS and 56 patients receiving GM + MPSS, assigned to the control group (Con) and observation group (Obs), respectively. The therapeutic effect, neurological function (sensory and motor function scores), adverse events (AEs), recovery (time to sphincter function recovery, time to limb muscle strength recovery above grade 2, and time to ambulation), inflammatory factors (IFs) [interleukin (IL)-6, C-reactive protein (CRP), and tumor necrosis factor (TNF)-α] and other data of the two groups were collected for evaluation and comparison.

RESULTS

The Obs had: (1) A significantly higher response rate of treatment than the Con; (2) Higher scores of sensory and motor functions after treatment that were higher than the baseline (before treatment) and higher than the Con levels; (3) Lower incidence rates of skin rash, gastrointestinal discomfort, dyslipidemia, osteoporosis and other AEs; (4) Faster posttreatment recovery of sphincter function, limb muscle strength and ambulation; and (5) Markedly lower posttreatment IL-6, CRP and TNF-α levels than the baseline and the Con levels.

CONCLUSION

From the above, it can be seen that GM + MPSS is highly effective in treating AM, with a favorable safety profile comparable to that of GG + MPSS. It can significantly improve patients’ neurological function, speed up their recovery and inhibit serum IFs.

Derivation of the Gait Deviation Index for Spinal Cord Injury

The Gait Deviation Index (GDI) is a dimensionless multivariate measure of overall gait pathology represented as a single score that indicates the gait deviation from a normal gait average. It is calculated using kinematic data recorded during a three-dimensional gait analysis and an orthonormal vectorial basis with 15 gait features that was originally obtained using singular value decomposition and feature analysis on a dataset of children with cerebral palsy. Ever since, it has been used as an outcome measure to study gait in several conditions, including spinal cord injury (SCI). Nevertheless, the validity of implementing the GDI in a population with SCI has not been studied yet. We investigate the application of these mathematical methods to derive a similar metric but with a dataset of adults with SCI (SCI-GDI). The new SCI-GDI is compared with the original GDI to evaluate their differences and assess the need for a specific GDI for SCI and with the WISCI II to evaluate its sensibility. Our findings show that a 21-feature basis is necessary to account for most of the variance in gait patterns in the SCI population and to provide high-quality reconstructions of the gait curves included in the dataset and in foreign data. Furthermore, using only the first 15 features of our SCI basis, the fidelity of the reconstructions obtained in our population is higher than that when using the basis of the original GDI. The results showed that the SCI-GDI discriminates most levels of the WISCI II scale, except for levels 12 and 18. Statistically significant differences were found between both indexes within each WISCI II level except for 12, 20, and the control group (p < 0.05). In all levels, the average GDI value was greater than the average SCI-GDI value, but the difference between both indexes is larger in data with greater impairment and it reduces progressively toward a normal gait pattern. In conclusion, the implementation of the original GDI in SCI may lead to overestimation of gait function, and our new SCI-GDI is more sensitive to larger gait impairment than the GDI. Further validation of the SCI-GDI with other scales validated in SCI is needed.

Application of the Gait Deviation Index to Study Gait Impairment in Adult Population With Spinal Cord Injury: Comparison With the Walking Index for Spinal Cord Injury Levels

The Gait Deviation Index (GDI) is a multivariate measure of overall gait pathology based on 15 gait features derived from three-dimensional (3D) kinematic data. GDI aims at providing a comprehensive, easy to interpret, and clinically meaningful metric of overall gait function. It has been used as an outcome measure to study gait in several conditions: cerebral palsy (CP), post-stroke hemiparetic gait, Duchenne muscular dystrophy, and Parkinson’s disease, among others. Nevertheless, its use in population with Spinal Cord Injury (SCI) has not been studied yet. The aim of the present study was to investigate the applicability of the GDI to SCI through the assessment of the relationship of the GDI with the Walking Index for Spinal Cord Injury (WISCI) II. 3D gait kinematics of 34 patients with incomplete SCI (iSCI) was obtained. Besides, 3D gait kinematics of a sample of 50 healthy volunteers (HV) was also gathered with Codamotion motion capture system. A total of 302 (iSCI) and 446 (HV) strides were collected. GDI was calculated for each stride and grouped for each WISCI II level. HV data were analyzed as an additional set. Normal distribution for each group was assessed with Kolmogorov-Smirnov tests. Afterward, ANOVA tests were performed between each pair of WISCI II levels to identify differences among groups (p < 0.05). The results showed that the GDI was normally distributed across all WISCI II levels in both iSCI and HV groups. Furthermore, our results showed an increasing relationship between the GDI values and WISCI II levels in subjects with iSCI, but only discriminative in WISCI II levels 13, 19, and 20. The index successfully distinguished HV group from all the individuals with iSCI. Findings of this study indicated that the GDI is not an appropriate multivariate walking metric to represent the deviation of gait pattern in adult population with iSCI from a normal gait profile when it is compared with the levels of walking impairment described by the WISCI II. Future work should aim at defining and validating an overall gait index derived from 3D kinematic gait variables appropriate for SCI, additionally taking into account other walking ability outcome measures.