Hemiplegia affects a significant portion of the human population. It is a condition that causes motor impairment and severely reduces the patient’s quality of life. This paper presents an automatic ...system for identifying the hemiplegia type (right or left part of the body is affected). The proposed system utilizes the data taken from patients and healthy subjects using the accelerometer sensor from the RehaGait mobile gait analysis system. The collected data undergo a pre-processing procedure followed by a feature extraction stage. The extracted features are then sent to a neural network trained by the Levenberg-Marquardt backpropagation (LM-BP) algorithm. The experimental part of this research involved creating a custom-created dataset containing entries taken from ten healthy and twenty non-healthy subjects. The data were taken from seven different sensors placed in specific areas of the subjects’ bodies. These sensors can capture a three-dimensional (3D) signal using the accelerometer, magnetometer, and gyroscope device types. The proposed system used the signals taken from the accelerometers, which were split into 2-sec windows. The proposed system achieved a classification accuracy of 95.12% and was compared with fourteen commonly used machine learning approaches.
Hemiplegia is a condition caused by brain injury and affects a significant percentage of the population. The effect of patients suffering from this condition is a varying degree of weakness, ...spasticity, and motor impairment to the left or right side of the body. This paper proposes an automatic feature selection and construction method based on grammatical evolution (GE) for radial basis function (RBF) networks that can classify the hemiplegia type between patients and healthy individuals. The proposed algorithm is tested in a dataset containing entries from the accelerometer sensors of the RehaGait mobile gait analysis system, which are placed in various patients’ body parts. The collected data were split into 2-second windows and underwent a manual pre-processing and feature extraction stage. Then, the extracted data are presented as input to the proposed GE-based method to create new, more efficient features, which are then introduced as input to an RBF network. The paper’s experimental part involved testing the proposed method with four classification methods: RBF network, multi-layer perceptron (MLP) trained with the Broyden–Fletcher–Goldfarb–Shanno (BFGS) training algorithm, support vector machine (SVM), and a GE-based parallel tool for data classification (GenClass). The test results revealed that the proposed solution had the highest classification accuracy (90.07%) compared to the other four methods.
Background
To evaluate the associations between magnetic resonance imaging (MRI) findings and pain, disability and quality of life before surgery and up to 5 years after lumbar microdiscectomy.
...Materials and methods
Sixty-one patients who underwent one-level lumbar microdiscectomy by the same surgeon participated in this analytic, observational, prospective study. Lumbar spine MRI was performed preoperatively and 5 years postoperatively. Pain, disability and quality of life were measured with VAS, ODI, Roland Morris and SF-36 pre- and up to 5 years postoperatively. Subsequently associations between radiological findings and clinical outcomes were recorded.
Results
Before surgery patients with disc extrusion or sequestration, with increased thecal sac compression (
d
> 2/3), with Modic changes (MC) 2 and 3 on the operated level and Pfirrmann grades IV and V on the operated and both adjacent discs presented the worst preoperative clinical outcomes. MC preoperatively were not related with postoperative results, in contrast with the type of disc herniation and thecal sac compression. Preoperative Pfirrmann grade IV and V on the operated and both adjacent discs and postoperative MC 2 and 3 on the operated level were related to poor clinical outcomes 36–60 months post-discectomy.
Conclusions
Extrusion or sequestration of the operated disc, increased compression of thecal sac, MC 2 and 3 on the operated level and Pfirrmann grades IV and V on the operated and adjacent discs were associated with the worst clinical outcomes. Nerve root impingement, facet joint arthritis, perineural fibrosis and disc granulation tissue had no effect on clinical scores.
ABSTRACT
Various techniques and courses of treatment have been researched, proposed, and implemented to evaluate and treat poststroke dysphagia (PSD) which is one of the main medical conditions ...affecting not only elderly people, as previously assumed, but also in recent years younger populations as well. The effectiveness of therapeutic methods depends mainly on the expertise of an interdisciplinary team of therapists, as well as on the timely application of the treatment. The present review discusses the therapeutic benefits of repetitive transcranial magnetic stimulation (rTMS) in patients suffering from PSD regardless of the location of the lesion. The use of rTMS directly manipulates cortical brain stimulation to restore neuroplasticity in the affected brain areas. This review presents a synopsis of the available literature on the patient along with a discussion on the effectiveness of rTMS as a safe and easy to use promising technique in the rehabilitation of dysphagic patients. Although the results from the studies so far have been largely positive in that direction, the question still remains whether larger scale and longitudinal studies will be able to corroborate the aspiring future of rTMS. Therefore, research questions to advance further investigation on the application and future of this technique are much in need.
Mobile-bearing knee designs represent an alternative to conventional fixed-bearing implants in total knee arthroplasty. The purpose of this study was to determine the clinical results of a ...mobile-bearing knee implant.
From 1990 to 1998, 326 primary consecutive mobile-bearing total knee prostheses were implanted in 260 patients who had a mean age and standard deviation of 66.7 ± 6.9 years. Femoral and tibial components were cemented in all knees, and the patella was resurfaced in 199 knees (61%). Patients were evaluated with the use of the Knee Society clinical rating system and radiographic examinations. Complications were noted, and survivorship of the prostheses was determined.
The mean follow-up period was 156 ± 27.3 months, with maximum follow-up at eighteen years. The mean Knee Society knee score improved from 32.4 ± 21.2 preoperatively to 92.6 ± 10.0 at the time of the last follow-up (p = 0.00), and the mean Knee Society functional score improved from 39.3 ± 18.7 preoperatively to 66.7 ± 18.6 at the time of the last follow-up (p = 0.00). Mean knee flexion improved from 92.3° ± 14.5° preoperatively to 112.1° ± 13.4° at the time of the last follow-up (p = 0.00). There were twenty-four (7.4%) knees that required revision. In eighteen (5.5%) knees, worn out or broken polyethylene was found and a polyethylene-only exchange was done. Six knees (1.8%) were fully revised. The survival rate was 0.96 (95% confidence interval, 0.93 to 0.98) at ten years and 0.87 (95% confidence interval, 0.79 to 0.93) at eighteen years.
A fully congruent, mobile-bearing total knee prosthesis had excellent survivorship during the ten to eighteen-year follow-up interval.
A survey on thromboprophylaxis in spinal surgery and trauma was conducted among spine trauma surgeons.
Neurosurgeons and orthopedic surgeons from the Spinal Trauma Study Group were surveyed in an ...attempt to understand current practices in the perioperative administration of thromboprophylaxis in spinal surgery.
Although much research has been invested in the prevention of thromboembolic events following surgical procedures, there have been few investigations specific to spinal surgery, especially in the context of trauma.
A total of 47 spine surgeons were provided with a 24-question survey pertaining to deep vein thrombosis prophylaxis in spine surgical patients. There was 100% response to the survey, and 46 of the 47 physicians (98%) responded to the case scenarios.
Institutional protocols for deep vein thrombosis prophylaxis existed for 42 (89%) of the respondents; however, only 27 (57%) indicated that these protocols included spinal cord injury (SCI) patients. Before surgery, no prophylaxis or mechanical prophylactic measures for SCI and non-SCI spinal fracture patients were routinely used by 36 (77%) and 40 (85%) respondents, respectively. After surgery, pharmacologic prophylaxis was prescribed by 42 (91%) and 28 (62%) surgeons for SCI and non-SCI spinal fracture patients, respectively. There was a statistically significant tendency to use more intensive prophylactic measures for patients with SCI (x2, 10.86; P < 0.01) as well as a statistically significant longer duration of proposed thromboprophylaxis (x2, 24.62; P < 0.001). Postoperative pharmacologic thromboprophylaxis for elective anterior thoracolumbar spine surgery was reported by 23 (51%) of the respondents, whereas only 18 (40%) used pharmacological prophylaxis in elective posterior thoracolumbar spine cases. Spine complications from low-molecular weight heparin were reported by 22 (47%) surgeons, including fatal pulmonary embolism by 19 (40%) surgeons.
A basis for a consensus protocol on thromboprophylaxis in spinal trauma was attempted. No more than mechanical prophylaxis was recommended before surgery for non-SCI patients or after surgery for elective cervical spine cases. Chemical prophylaxis was commonly used after surgery in patients with SCI and in patients with elective anterior thoracolumbar surgery.
A radiographic review of 78 consecutive patients with degenerative rotatory lumbar scoliosis.
To assess the correlation between rotary olisthesis and neural canal dimensions using radiographic ...indexes and to establish a gradation system of lateral rotatory olisthesis.
Degenerative scoliosis is a three-dimensional deformity often associated with spinal stenosis, although the association is not well defined.
A total of 78 consecutive patients (average age, 69 years) with de novo degenerative scoliosis (79% lumbar, 21% thoracolumbar; average curve, 25 degrees) were studied with plain radiographs and MRI at presentation. Radiographic measurements included lateral translation, anteroposterior olisthesis, Cobb angle, and intervertebral rotation (Nash-Moe grade difference). Computerized measurements of MRI included dural sac cross-sectional area and anteroposterior diameter, minimum subarticular height, and foramen cross-sectional area bilaterally (convexity and concavity). Measurements were conducted twice on each lumbar level (total, 312) and the average was recorded.
Lateral translation 5 mm or less (Grade I) was associated with Nash-Moe change 0 (23%) or I (77%), lateral translation 6-10 mm (Grade II) was coupled with Nash-Moe change 0 (20%) or I (80%) and lateral deviation more than 11 mm (Grade III) was associated with I (76%) or II (24%) Nash-Moe change. Maximum intervertebral rotation tended to be at either L2-L3 (48%) or L3-L4 (39%). Increased lateral translation was associated with increased intervertebral rotation (r = 0.37, P < 0.001). Increased anteroposterior olisthesis was associated with decreased anteroposterior diameter (r = -0.18, P < 0.001) and cross-sectional area (r = -0.11, P < 0.05) of the dural sac. Larger segmental Cobb angles were associated with greater foraminal cross-sectional area in the convexity (r = 0.12, P < 0.05). In the concavity, there was no significant correlation (P > 0.05) between indexes of rotary olisthesis and foraminal area or subarticular height. Cross-sectional foraminal area and subarticular height were significantly larger in the convexity than in the concavity of the scoliotic levels.
In degenerative scoliotic curves, lateral translation is associated with rotation. Increased rotary olisthesis does not lead to decreased dural sac area. Anteroposterior olisthesis is inversely correlated to the dural sac anteroposterior diameter and cross-sectional area. With increased segmental Cobb angle, foraminal cross-sectional area enlarges in the convexity and does not decrease in the concavity. Presence of intervertebral rotation alone does not appear to be associated with reduced neural canal dimensions. Ligamentum flavum hypertrophy, posterior disc bulging, and bony overgrowth are more likely to contribute to stenosis irrespective of scoliosis.
Abstract
Introduction
The Ohkuma questionnaire is a validated screening tool originally used to detect dysphagia among patients hospitalized in Japanese nursing facilities.
Objective
The purpose of ...this study is to evaluate the reliability and validity of the adapted Greek version of the Ohkuma questionnaire.
Methods
Following the steps for cross-cultural adaptation, we delivered the validated Ohkuma questionnaire to 70 patients (53 men, 17 women) who were either suffering from dysphagia or not. All of them completed the questionnaire a second time within a month. For all of them, we performed a bedside and VFSS study of dysphagia and asked participants to undergo a second VFSS screening, with the exception of nine individuals. Statistical analysis included measurement of internal consistency with Cronbach's α coefficient, reliability with Cohen's Kappa, Pearson's correlation coefficient and construct validity with categorical components, and One-Way Anova test.
Results
According to Cronbach's α coefficient (0.976) for total score, there was high internal consistency for the Ohkuma Dysphagia questionnaire. Test-retest reliability (Cohen's Kappa) ranged from 0.586 to 1.00, exhibiting acceptable stability. We also estimated the Pearson's correlation coefficient for the test-retest total score, which reached high levels (0.952;
p
= 0.000). The One-Way Anova test in the two measurement times showed statistically significant correlation in both measurements (
p
= 0.02 and
p
= 0.016).
Conclusion
The adapted Greek version of the questionnaire is valid and reliable and can be used for the screening of dysphagia in the Greek-speaking patients.
Abstract Background context Although there are several studies evaluating the necessity and efficacy of thromboprophylaxis after spinal trauma with or without spinal cord injury (SCI), to date there ...is no established standard of practice pertaining to this specific patient population with regards to venous thromboembolism (VTE) prophylaxis. Purpose To reach a consensus opinion in the administration of thromboprophylaxis in both preoperative and postoperative care in the settings of spinal trauma and SCI. Study design A live survey on thromboprophylaxis after spinal surgery in the setting of trauma was conducted at a meeting among spine trauma surgeons. Methods Twenty-five spine surgeons (Neurosurgeons and Orthopedic surgeons), all members of the Spine Trauma Study Group, participated in a live survey in which they attempted to reach consensus pertaining to the management of deep vein thrombosis prophylaxis in patients with spine fractures (with and without a concomitant SCI). The consensus survey consisted of a 10-item questionnaire. Chi-square test was used for group comparisons in questionnaire responses. Results Complete agreement was reached for the need of postoperative pharmacologic thromboprophylaxis in cervical spine injuries with SCI and anterior thoracolumbar procedures with or without SCI. Postoperative pharmacologic thromboprophylaxis after cervical spine injuries without SCI was agreed not to be needed. In cases of delayed surgery for patients with SCI, pharmacologic thromboprophylaxis was recommended to be started as soon as possible in the presurgical period. The optimal duration of pharmacologic VTE prophylaxis was determined to be 3 months. Only 53% agreement was noted for the withholding of preoperative chemical prophylaxis in cervical or thoracolumbar spinal injuries with SCI (and 68% without SCI). Only 80% of the surgeons agreed that postoperative pharmacologic thromboprophylaxis is needed after posterior thoracolumbar procedures in patients with or without SCI. The use of vena cava filter after SCI was not universally recommended. Conclusions Postoperative pharmacologic thromboprophylaxis was opined to be unnecessary in patients with cervical spine injuries without SCI, however, it is recommended for cervical spine trauma with SCI or anterior thoracolumbar procedures irrespective of SCI. Pharmacologic thromboprophylaxis was recommended to start preoperatively as soon as possible in SCI cases or in cases with surgical delay. Pharmacologic prophylaxis was recommended to be administered for at least 3 months postinjury. Although these recommendations met complete consensus by this group, individual patient factors should also be considered in determining optimal thromboprophylaxis in this patient population. Future research recommendations on thromboprophylaxis in spinal trauma are proposed.
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