The aim of this study was to compare the effects of bilateral arm training with auditory cueing ( BATRAC) versus control intervention on motor performance of the upper extremity (UE) and to explore the central neurophysiological mechanism underlying this effect in moderately impaired chronic stroke patients. DesignThis was a randomized-controlled clinical trial. Materials and MethodsOverall, 76 chronic stroke patients (mean age = 50.2 ± 6.2 years), 6-67 months after the onset of the fi rst stroke were enrolled. They received either BATRAC (with both UE trained simultaneously in symmetric and asymmetric patterns) or control intervention (unilateral therapeutic exercises for the paretic UE). Each session lasted for 1 h, scheduled as three sessions/week (on an alternate day) for 8 successive weeks. Outcome measures included the Fugl-Meyer motor performance test for the UE (FMUE) and percutaneous transcranial magnetic stimulation to elicit motor-evoked potential (MEP) in paretic abductor pollicis brevis muscle. ResultsGroup comparisons indicated a signifi cantly better improvement in the MEP parameters (transcranial magnetic stimulation threshold, central motor conduction time, and MEP amplitude) in the BATRAC group. The FMUE scores increased in both groups, but there was no signifi cant difference between groups in the FMUE scores. ConclusionThese fi ndings recommend the use of BATRAC in chronic stroke patients not only to improve motor performance but also to induce central neurophysiological effects.
Introduction: Limb amputation significantly impacts the patient physical, emotional, and social life. Multiple etiological factors may lead to limb amputation. Unfortunately, there is limited data about amputation in Saudi Arabia. Since Sultan Bin Abdulaziz Humanitarian City (SBAHC) is a tertiary centre receiving such patients, we collected data from ten years to look at the etiology, characteristics, and clinical impact of amputations in the Kingdom. Methods: A retrospective study of 1409 amputee patients data at SBAHC collected over ten years included demographic variables, etiology, site, level, and type of amputation. We also collected Functional independent measurement (FIM) scores for 618 patients. Result: Males constitute the majority of amputees (75.7%) and the average age in males was higher in males compared to females (45 vs 36 years respectively, p<0.001). Vascular diseases (42.3%) and Trauma (36.8%) were the leading cause of amputation in this cohort. Diabetes mellitus was the most frequent comorbidity (40.5%), followed by hypertension (26.2%). Trans-tibial amputations were the most typical (22.6%), followed by trans-femoral amputation (14.1%). Traumatic trans-femoral amputation was more prevalent among young adults than traumatic trans-tibial amputation. Trauma-related amputation cases were highest in the age group of 21-30 years (69.2%), while vascular-related amputations were highest in the age group of 70 and above years (89.5%). FIM scores improved significantly in locomotion (33.6%) followed by transfer (30.6%) and self-care (16.4%) at six-month post-discharge compared to admission (all p-values<0.01). Conclusion: Vascular pathology arising due to chronic diseases is the primary risk factor that may lead to amputation and warrant primary and secondary prevention programs. Seatbelt enforcement can significantly decrease amputation related to Road Traffic Accidents, which has been the second most familiar cause of amputation.
Background Interleukin-1β (IL-1β) and other inflammatory mediators plays a pivotal role in driving the pathways associated with osteoarthritis (OA) pathogenesis and promotes cartilage degradation [1]. Glucosamine sulphate (GS) possesses anti-inflammatory efficacies against OA in animals and humans and is suggested to delay damage of cartilage and long-term progression of OA as a disease modifying anti-OA drug through its chondroprtective effect [2]. Despite the increased use of GS in the treatment of OA, the mechanisms accounting for its in vivo antiarthritic activity are still unclear. Objectives to identify the effect of α-D GS on serum level of IL-1β in patients with symptomatic primary knee OA. Methods Sixty patients (mean age=52.2±8.6 years), fulfilling the American College of Rheumatology criteria of idiopathic knee OA, were randomized to receive either 1500 mg α-D GS and 1200 mg Ibuprofen (group I), or only 1200 mg Ibuprofen (group II) daily for 12 weeks. Patients were followed up by Visual Analogue knee pain Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) functional index and quantitative detection of IL-1 β serum levels. Reference serum level of IL-1 β was determined in 20 matched healthy volunteers. Results Group I showed significant progressive improvement in pain VAS and total WOMAC scale, pain, stiffness and function subscales during the follow up visits compared to group II. At baseline, both groups had significantly higher IL-1β serum level than control group. On follow up group I showed significant progressive reduction in IL-1β serum level with a final level that was significantly lower than group II and was not significantly higher than control group. In group II the reductions in IL-1β serum level did not reach level of statistical significance and the final level persisted significantly higher than that of control group. Conclusions adding α-D GS to treatment of primary symptomatic knee OA could relieve symptoms, improve function and affect some of the disease mechanisms. References Attur M, Belitskaya-Lévy I, Oh C, et al. Increased IL-1 beta gene expression in peripheral blood leukocytes is associated with increased pain and predicts risk for progression of symptomatic knee osteoarthritis. Arthritis Rheum 2011; 63: 1908-17. Rovati L C, Girolami F, Persiani S. Crystalline glucosamine sulfate in the management of knee osteoarthritis: efficacy, safety, and pharmacokinetic properties. Ther Adv Musculoskelet Dis 2012; 4: 167- 80. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1118
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