Objectives: To demonstrate reduction in detrusor overactivity using surface electrical stimulation of posterior tibial nerve (PTN) or dorsal penile nerve (DPN) in patients with spinal cord injury (SCI). Design: Patients with SCI with symptoms of urinary urgency/leaks, with cystometrogram (CMG) proven detrusor overactivity were recruited in this study. Ten persons with observable F-wave from tibial nerve were included in the PTN group. Five persons who had F-wave absent but preserved bulbocavernosus reflex were included in the DPN group. Stimulation was given at 20 Hz, 10-40 mA for 20 minutes/session/day for 14 consecutive days. Detrusor overactivity was recorded using CMG on days 1 and 15. Settings: Rehabilitation Institute, Department of Physical Medicine and Rehabilitation, Christian Medical College and Hospital, Vellore, TN, India. Participants: Patients with SCI. Interventions: Surface stimulation of peripheral nerves for reduction of detrusor overactivity. Outcome measures: Qualitative analysis using voiding diary data and quantitative analysis using CMG data comparing pre-and post-intervention. Results: P value obtained from voiding chart was 0.021 for PTN and 0.062 for DPN. P value obtained from CMG data was not significant in both groups. In one subject, treatment was extended to 4 weeks and further improvement in voiding diary was seen. Conclusions: In this pilot study of 15 patients, voiding chart data showed statistically significant improvement following PTN stimulation and trend of improvement following DPN stimulation. However, the CMG data were not statistically significant in this sample population. Further studies with larger, appropriately powered sample size would be helpful to demonstrate the associations of symptoms with CMG data.
Study Design
Case report.
Objective
To describe an unusual case of deep diving followed by spinal cord injury due to decompression sickness (DCS).
Setting
Princess Royal Spinal Injuries Centre, Sheffield Teaching Hospitals NHS Foundation Trust, England.
Method
Description and observation of management and outcomes, of spinal decompression sickness (DCS).
Results
The patient's symptoms and signs developed after she surfaced after a deep sea diving event. She was managed and treated in a tertiary level care hospital. MRI performed within 24 hours, showed signs of increased signal intensity in the cervical and thoracolumbar regions. She was treated with hyperbaric oxygen which improved her pain symptoms but there was no immediate resolution in motor sensory deficits. Repeat MRI done after a week showed resolution if hyperintensity in the cervical region but not in the thoracolumbar region. Patient progressed to have significant neurological recovery in the next 6 months. She became ambulant with unilateral ankle foot orthotic and a pair of crutches, she continued to have bladder incontinence at 1 year follow-up interval.
Conclusion
Central nervous involvement is not uncommon in decompression sickness in divers. Early diagnosis and proper management can reduce acute symptoms and prevent further complications of permanent neurological disability. Primary prevention by education and adhering to standard diving guidelines is needed to reduce mortality and morbidity in decompression sickness.
Objective: To compare the energy expenditure and gait parameters of bilateral transtibial prostheses user with and without sleeve suspension. Materials and methods: Five (4 male, 1 female) bilateral transtibial, patellar tendon bearing supracondylar (PTB-SC) prostheses users, 2 years postamputation, having good residual limbs and muscle power, were recruited in the study. Instrumented gait analysis, physiological cost index (PCI), timed up and go test (TUG), cadence and subjective feedback questionnaire were recorded on day 1 (without sleeve suspension) and day 15 (with sleeve suspension). Sleeve suspension was added with the prostheses on day 1. Adequate gait training for two weeks was provided to the participants. Wilcoxon signed-rank test was performed in SPSS 25.0 to compare the data recorded on days 1 and 15. p value less than 0.05 was considered as significant.
Results:The p values of various gait parameters walking speed, percentage of stance, swing, single limb support and normalized stride length, cadence and TUG test were found to be not significant while p value of step width and physiological cost index was considered significant. All the five subjects have reported comfort in ambulation after wearing sleeve suspension.
Conclusion:The study reports the effect of PTB-SC sleeve suspension in improving gait parameters and energy expenditure in five bilateral below knee amputee. Statistically significant improvement was reported in the cost of energy consumption and step width, suggesting that good prosthetic fitment is essential. However, the change in other gait parameters such as walking speed, percentage of stance, swing, single limb support, and stride length remained within normative data range. There is a need to conduct the study in a larger cohort with bilateral amputation where the essential component in prosthesis fitment, like sleeve suspension, can be varied, which in turn can give better stability and comfort resulting in improvement in walking efficiency.
Background
Electrodiagnostic test is considered as the gold standard for diagnosis of carpal tunnel syndrome (CTS). Ultrasonography provides a simple non-invasive means of visualising peripheral nerve pathology.
Objective
The objective of the study was to assess the role of ultrasonography in CTS and its correlation with the present day gold standard of nerve conduction studies (NCS).
Materials and Methods
A prospective cohort size of 100 subjects was calculated based on a hypothesized sensitivity of 90% and a confidence interval of 85-95%. All 100 subjects, 64 controls and 36 patients underwent nerve conduction studies and USG. Transverse images of the median nerve were obtained at three levels: proximal to the carpal tunnel inlet, at the carpal tunnel inlet and at the carpal tunnel outlet. The flattening ratio was also assessed at the tunnel inlet and outlet. Statistical analysis was done to corelate the ultrasound findings at each level with nerve conduction studies and calculation of the positive and negative predictive values. The cut offs of the cross-sectional areas of the median nerve at the three anatomical levels on ultrasonography were taken at the best sensitivity and specificity according to the ROC curve.
Results
We found that at any one anatomical level, the sensitivity of ultrasound to detect carpal tunnel syndrome by increase in the cross-sectional area of median nerve as compared to the nerve conduction studies is 90%.
Conclusions
At 45% specificity, ultrasonography could be used as a non-invasive and easily available screening tool in carpal tunnel syndrome. Also, the best level to look for nerve compression is at the level of the carpal tunnel inlet.
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