Background and purpose:This study aimed to investigate to what extent upper limb (UL) motor impairment, trunk compensation, and activity performance are related to self-perception of UL activity performance in subacute stroke.
Methods:This was a prospective observational study. Twenty-four adults with subacute stroke (age: 65.4 � 10.8 years) underwent clinical and kinematic assessments at baseline (33.9 � 5.2 days after stroke onset) and 4 weeks after the baseline. The clinical assessment included the UL Fugl-Meyer motor assessment (FMA), Simple Test for Evaluating hand Function (STEF), and the performance and satisfaction scores of the Canadian Occupational Performance Measure (COPM).The kinematic measurement was performed using a motion capture system during a standardized reach-to-grasp task. Endpoint performance variables and trunk displacement were calculated as kinematic outcomes. An inpatient rehabilitation program of 3 h/day was provided every day for 4 weeks between the two measurement points. The relationships between COPM scores and clinical/kinematic outcomes were examined by multiple regression analysis. Significance levels of p < 0.05 were used.
Results:The results of the multiple regression analysis showed that the changes in STEF (β = 0.520, p = 0.005) and trunk compensation (β = −0.398, p = 0.024) were moderately related to the change in the COPM satisfaction (R 2 adj = 0.426, p = 0.001), while the change in UL FMA was not.Discussion: The changes in activity performance and trunk compensation were related to improved self-perception of UL activity performance. Therapeutic management for activity performance and trunk compensation may be important for improving self-perception of UL activity performance after stroke.
Background:
Vertebral artery (VA) to middle cerebral artery (MCA) bypass is a rarely selected technique because a complex expanded dissection is required, and often, a better donor artery than VA exists. A good indication for VA-MCA bypass is the treatment of head-and-neck malignancies with the sacrifice of the internal carotid artery (ICA) or for carotid artery rupture.
Methods:
A 23-year-old man with epipharyngeal carcinoma, treated by ligating the carotid artery with a VAMCA bypass before chemoradiotherapy, was reported. Radiographic findings showed that the bone of the carotid canal was dissolved, and the right ICA was engulfed by the tumor. As epipharyngeal carcinoma is hypersensitive to radiation, in cases where the tumor rapidly disappears, ICA may dangle in the pharynx and rupture may occur. In addition, to irradiate sufficiently, the ICA may become an obstacle. Hence, we decided to perform carotid ligation with a VA-MCA bypass before radiation and chemotherapy for the primary lesion. We selected the V3 portion of the VA as the donor on the ipsilateral side, as it can supply high-flow cerebral blood flow, which is not influenced by carcinoma and less influenced by irradiation for the epipharynx.
Results:
The VA-MCA bypass was completed without complications followed by endovascular occlusion of the ICA. Induction chemotherapy was initiated for the patient 2 weeks after surgery. The patient achieved a complete response following chemoradiotherapy.
Conclusion:
ICA ligation with VA-MCA high-flow bypass earlier than chemoradiotherapy is useful for epipharyngeal carcinoma as it prevents carotid artery rupture and allows radical intervention.
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