Prone positioning is crucial in the respiratory management of patients with acute respiratory distress syndrome (ARDS) and reduces mortality. However, this may be complicated by compression-related peripheral nerve injury. We report the case of a male in his 80s with obesity admitted to the intensive care unit (ICU) with COVID-19 pneumonia who developed brachial plexus disorder in the right upper extremity and musculocutaneous neuropathy in the left. The patient’s cough, dyspnea, and fatigue did not improve; therefore, he was intubated and placed in the prone position for one week. The patient complained of bilateral upper limb weakness on regaining consciousness. We diagnosed left musculocutaneous nerve palsy and right brachial plexus palsy based on physical findings and needle electromyography (EMG). Physical therapy was initiated, including joint range-of-motion exercises focused on preventing contractures in the extremities and active assistive exercises. Motor impairment improved, and the patient was discharged from the rehabilitation center.
Cortical stimulation patterns in patients with Parkinson’s disease (PD) are asymmetric and get altered over time. This study examined cortical neurophysiological markers for PD and identified neurophysiological markers for lateralization in PD. We used transcranial magnetic stimulation (TMS) to study corticospinal and intracortical excitability in 21 patients with idiopathic PD. We used the Movement Disorder Society Unified Parkinson’s Disease Rating Scale for examination during on and off periods and evaluated inhibitory and facilitatory process markers using TMS, including resting motor thresholds (RMT), active motor thresholds, and motor evoked potential amplitude. The RMT in the more affected cortex was significantly shorter than in the less affected cortex, and was strongly correlated with improved motor function following medication. Patients in the tremor group exhibited significantly lower RMT compared to those in the akinetic-rigid group. Cortical electrophysiological laterality observed in patients with PD may be a useful marker for guiding treatment and identifying underlying compensatory mechanisms.
The present report highlights a case of successful treatment of an 11-year-old male patient who presented with an atlanto-occipital dislocation and multiple fractures of the forearm, pelvis, and lower leg because of a fall. The patient experienced dysarthria and paralysis of the tongue, which became completely immobile and could not be moved from side to side, impeding speech. The patient also experienced dysphagia due to the inability to propel food toward the pharynx and chewing attempts resulted in scattering of food residue throughout the oral cavity. The lack of tongue mobility led to saliva accumulation, forcing the patient to swallow frequently, which was possible as larynx movement was unaffected. The other cranial and motor sensory nerves appeared normal. Our diagnostic examinations confirmed the presence of isolated bilateral paralysis of the hypoglossal nerve secondary to traction at the base of the skull. The patient was still unable to protrude his tongue and tongue gradually atrophied two weeks after admission. Electromyography revealed denervation of the tongue and minimal active contraction of the single motor units. Immobilization therapy and rehabilitation therapy were initiated to improve tongue movement, but this was unsuccessful and one month after the accident, the patient's tongue was still atrophied. The patient was placed on a soft food diet and experienced no difficulty in swallowing either saliva or food three months after admission. Tongue mobility was deemed normal. Electromyography six months after the initial episode revealed normal motor unit potentials during contractions. We postulate that compression and stretching of the bilateral hypoglossal nerves against the greater horn of the hyoid bone was a probable cause of the hypoglossal palsy. The use of immobilization and rehabilitation therapy likely supported the recovery of functionality and resulted in a good prognosis.
Intensive training can at least partially improve finger movement dysfunction observed after stroke or any neurodegenerative disease. Wearable equipment can significantly improve patients' quality of life. However, long-term use of conventional training gloves containing metal can injure joints. In this study, we investigated the safety and efficacy of a novel, metal-free, wearable strength-building device. [Participants and Methods] We enrolled 20 healthy participants in whom we measured grip and pinch strength before and while the equipment was worn. Additionally, we investigated the adverse effects and discomfort experienced while participants wore the equipment.[Results] The grip strength was reduced by approximately 20% while participants wore the equipment. We did not observe any serious adverse events. [Conclusion] The knitting equipment described in this study resists movements associated with gripping the hand and acts on all fingers, and may be useful for rehabilitation to improve finger function during routine activities.
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