Gait in drug naïve patients with de novo Parkinson's disease--altered but symmetric

BACKGROUND

Motor symptoms in Parkinson's disease (PD) are typically asymmetrical. Early stage of PD is characterised with a predominantly unilateral appearance of tremor, rigidity and bradykinesia, with or without axial involvement. Also, studies have demonstrated gait asymmetry in de novo drug naïve PD patients. Aim of this study was to investigate gait pattern, gait symmetry and gait variability in early phases of PD.

METHODS

The gait was measured in 40 de novo, drug naïve PD patients and 43 healthy control subjects (HC) while performing a simple walking task. Calculated parameters were cycle time (CT), stride length (SL) and swing time (ST), and their coefficients of variation (CV).

RESULTS

Considering gait parameters, PD patients and HC differed in terms of all parameters, except for the CV of CT. Analysis of gait symmetry, comparison between the gait patterns of the left and the right leg in PD patients revealed no difference for any of the assessed parameters. The majority of the gait parameters did not differ between left and right legs of HC.

CONCLUSIONS

It can be concluded that even gait was already altered in de novo drug naive PD patients, gait symmetry remained preserved. The SL was the most prominent parameter of altered gait in initial stages of PD patients, while the ST heralded postural asymmetry.

Vitamin D and parathyroid hormone in relation to bone mineral density in postmenopausal women

BACKGROUND/AIM

Despite vitamin D insufficiency being widely reported, in Serbia the epidemiological data lack information regarding vitamin D status in the sera of postmenopausal women. The aim of this study was to establish the prevalence of inadequate serum 25-hydroxyvitamin D [25(OH)D] concentrations in postmenopausal Serbian women with seasonal variations of 25(OH)D, in relation to parathyroid hormone (PTH) and bone mineral density (BMD).

METHODS

A total of 95 postmenopausal women, mean age 65.1 +/- 9.08 years, were examined. Measurements of 25(OH)D and PTH were performed both in the winter and the summer period, using electrochemiluminiscence immunoassays. BMD (g/cm2) was measured by the dual-energy x-Ray absortimetry (DXA) method on the spine and hip areas.

RESULTS

A decreased value of vitamin D (< 75 nmol/L) in 88.4% of postmenopausal women and an elevated level of PTH (> 65 pg/mL) in 25.3% of the cases were found. Elevated PTH varied individually, but was mostly increased if 25(OH)D was equal or lower than 37.6 nmol/L. 25(OH)D insufficiency was found in winter in 94.5% and in summer in 80% of the cases (p < 0.01). The mean of the PTH was higher (p < 0.05) in winter than in summer. A significant negative correlation between 25(OH)D and PTH (p < 0.001) was proved. Correlation between 25(OH)D and PTH with BMD at lumbar spine was established in the whole group, but at the femoral neck in women aged over 65 years (p < 0.05).

CONCLUSION

Our results showed a high prevalence of vitamin D insufficiency (88.4%) among postmenopausal women. The levels of 25(OH)D and PTH changed significantly according to the season.

Is pre-fracture functional status better than cognitive level in predicting short-term outcome of elderly hip fracture patients?

INTRODUCTION

The aim of the study was to determine to what extent severe cognitive impairment impacts short-term rehabilitation outcomes of elderly patients with proximal hip fracture.

MATERIAL AND METHODS

A total of 337 community-dwelling elderly patients with acute hip fracture were observed during a 12-month period at a major teaching hospital in Serbia. Cognitive status was assessed at admission with the Short Portable Mental Status Questionnaire (SPMSQ). Outcome after 4 months was analysed with respect to presence of severe cognitive impairment, defined as an SPMSQ score of < 3. Outcome assessment included presence of postoperative complications, absolute motor Functional Independence Measure (FIM) gain, Activities of Daily Living index (ADL), Instrumental Activities of Daily Living score (IADL), and walking ability.

RESULTS

An SPMSQ score of < 3 was observed in 36 patients (10.7%) with acute hip fracture. Patients with an SPMSQ score of < 3 achieved worse short-term outcomes regarding all observed variables. However, cognitive status was found to be an independent predictor only with respect to mortality at 4 months (odds ratio (OR) = 0.969, 95% confidence interval (CI) = 0.947-0.992, p = 0.009). In contrast, pre-fracture motor FIM independently predicted mortality (OR = 2.982, 95% CI = 1.271-7.000, p = 0.012), and preserved walking ability at 4 months follow-up (OR = 0.945, 95% CI = 0.912-0.980, p = 0.002). Correspondingly, pre-fracture ADL was an independent predictor of absolute motor FIM gain at 4 months follow-up (OR = 0.175, 95% CI = 0.405-11.426, p = 0.035).

CONCLUSIONS

Failure to consider functional status prior to fracture might overestimate the impact of cognitive status on functional outcome of hip fracture patients.

Evaluation of comparative results of rehabilitation of patients with acromioclavicular dislocation of the third degree treated by surgical techniques by Phemister and Vukov

INTRODUCTION

In terms of access to treatment of acromioclavicular joint injuries, there are many controversies, especially after the appearance of works that promote "neglecting of injury".

GOAL

The aim of this paper is to give a comparative analysis of the results of rehabilitation of patients after acute injury of the acromioclavicular joint of the third degree, treated by two surgical techniques: by Phemister and Vukov.

MATERIAL AND METHODS

In this study, we investigated a total of 60 operated patients: 30 patients were operated by Phemister techniq-ue, and 30 by Vukov technique.

RESULTS

Postoperative follow-up lasted for one year. Between these two groups, the time when the rehabilitation process began is significantly different p < 0.01. With technique by Vukov, the rehabilitation begins on the first postoperative day and with technique by Phemister it begins later (after 7 weeks outpatient). With technique by Phemister, rehabilitation lasted on average 60 days, and with technique by Vukov on average 40 days. The duration of recovery is also significantly different p < 0.01, with technique by Vukov the duration time is shorter, and therefore the process of rehabilitation in days--is shorter than with the other technique. Both techniques gave good stability of the lateral end of clavicle. The difference was not statistically significant p > 0.05, which means that both techniques can be applied depending on the indication and the experience of the surgeon.

Homeostatic modulation of stimulation-dependent plasticity in human motor cortex

Since recently, it is possible, using noninvasive cortical stimulation, such as the protocol of paired associative stimulation (PAS), to induce the plastic changes in the motor cortex, in humans that mimic Hebb's model of learning. Application of TMS conjugated with peripheral electrical stimulation at strictly coherent temporal manner lead to convergence of inputs in the sensory-motor cortex, with the consequent synaptic potentiation or weakening, if applied repetitively. However, when optimal interstimulus interval (ISI) for induction of LTP-like effects is applied as a single pair, Motor evoked potential (MEP) amplitude inhibition is observed, the paradigm known as short-latency afferent inhibition (SLAI). Aiming to resolve this paradox, PAS protocols were applied, with 200 repetitions of TMS pulses paired with median nerve electrical stimulation, at ISI equal to individual latencies of evoked response of somatosensory cortex (N(20)) (PAS(LTP)), and at ISI of N(20) shortened for 5 msec (PAS(LTD)) - protocols that mimic LTP-like changes in the human motor cortex. MEP amplitudes before, during and after interventions were measured as an indicator based on output signals originating from the motor system. Post-intervention MEP amplitudes following the TMS protocols of PAS(LTP) and PAS(LTD) were facilitated and depressed, respectively, contrary to MEP amplitudes during intervention. During PAS(LTP) MEP amplitudes were significantly decreased in case of PAS(LTP), while in the case of PAS(LTD) an upward trend was observed. In conclusions, a possible explanation for the seemingly paradoxical effect of PAS can be found in the mechanism of homeostatic modulation of plasticity. Those findings indicate the existence of complex relationships in the development of plasticity induced by stimulation, depending on the level of the previous motor cortex excitability.

Shoulder hemiarthroplasty rehabilitation with fractures

Fractures of the upper end of the humerus are relatively common. They are predominant in the female population (85%), age over 50 years, where the force that leads to fractures in 90% of cases is moderate. Multifragmentary (three-part and four-part) fracture of the upper end of humerus, treated nonoperatively, often leaves behind a significant disability.

MATERIALS AND METHODS

Between October 2003-2010, the rehabilitation of 34 patients with shoulder hemiarthroplasty was carried out.

RESULTS

The achieved results are accompanied by a precise evaluation of Constant-score, after sixth month of operation. By scoring system, it estimates the pain, the mobility of the shoulder joint, the functional evaluation of the hand and grip strength. In 25 patients (73.5%) the Constant-score was >90 points. In 7 patients (20.6%) was 80-89, and in 2 patients (5.9%) the value of Constsant-score was < 60 points.

CONCLUSION

The maximum possible restitution of shoulder function in patients with shoulder hemiarthroplasty is-provided by: well conducted operation--early started, adequate kinesiotherapeutic protocol, implemented long enough--a good motivation of patients for the treatment.

The quality of life of patients after a lumbar microdiscectomy: a four-year monitoring study

INTRODUCTION/AIM

Health-conditioned quality of patients' life is equally a result of their subjective perception of the disease and their objective condition. The aim of this paper is to evaluate the quality of life of surgically treated lumbar radiculopathy patients by using a generic and a lumbar disease-specific questionnaire.

METHODOLOGY

50 patients were evaluated (average age: 44.9 years; 52 male and 48 female). Two questionnaires were used for this purpose: the SF36 generic questionnaire, measuring eight quality of life domains divided into two sub-domains (overall physical and overall mental health), and the NASS LBP lumbar disease-specific questionnaire measuring four domains (pain and disability, motor and sensory neurogenic symptoms, expectations from the treatment and satisfaction with it). The results of the physical domain (SF36-PHYS) are low at the beginning of monitoring (25.7); they increase over the following 6 months (46.4) and drop insignificantly after 4 years (45.9). The mental health value (40.4) remained unchanged as compared to that of the general population. Values of the physical functioning domain reach that of the general population (80.0) after 6 months. Neurogenic symptoms domain results (NASS LBP-NS) do not correlate with other scales and domains. The conclusion is that the quality of life of patients after a lumbar microdiscectomy deteriorates significantly from a physical point of view immediately after it. It normalizes over the following 6 months, though a certain degree of physical damage still remains. Mental health alteration is not specific for lumbar radiculopathy. The neurogenic symptoms domain is the least improved dimension of their quality of life: it is very specific and to be evaluated with a special test set.