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P183 Usefulness of robotics for improving and monitoring upper limb motor recovery in stroke patients
Abstracts of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131 Method: 23 Patients with myotomal muscle weakness due to cervical disk herniation included in the study. Diagnosis of cervical disk herniation and root compression were confirmed with magnetic resonance imaging. All patients were treated non-operatively. Clinical examination and the electrophysiologic investigation including nerve conduction studies, needle EMG of extremity and paraspinal muscles wase done at the beginning and every 4 months within first year and every year following two years of follow-up period. 23 patients completed 24 months and 19 patients completed 36 months of follow-up period. Results: At first examination 15 patients had sensory loss, and 9 patients had diminished reflexes in addition to myotomal muscle weakness. Triceps was the most common site of myotomal muscle weakness. In 16 patients, only reduced recruitment of motor units was found without positive sharp waves and fibrillation potentials on the first needle EMG examination. Abnormal spontaneous activity was found only in 7 patients. In 12 patients needle EMG findings were normal at the second EMG examination. In 13 patients muscle strength became normal within 4 months and in 17 patients within the first year. In 4 patients the muscle strength remained same as before. Only two patients had clinically observed muscle atrophy at the end of study period. Conclusion: The functional outcome of patient with myotomal muscle weakness due to cervical disk herniation is good. Most of myotomal muscle weakness represents neuropraxic lesion at the compressed root segment. Moreover probability of reinnervation is high possibly due to multilevel innervation of muscles.
P182 Long-term follow up of patients with myotomal muscle weakness due to cervical disc herniation Cengiz Bahadir, Burcu Önal, Feride Ocak, Vildan Yaman, Semra Bozkurt Haydarpa¸sa Training and Research Hospital Physical Medicine and Rehabilitation Clinic, Istanbul, Turkey Purpose: Root compression frequently causes pain, loss or diminished reflexes, sensory disturbances and muscle weakness. Patients with myotomal muscle weakness caused by cervical disk herniations are frequently treated operatively. In this study, long term outcomes of the nonoperatively treated patient with myotomal muscle weakness were investigated. Method: 23 Patients with myotomal muscle weakness due to cervical disk herniation included in the study. Diagnosis of cervical disk herniation and root compression were confirmed with magnetic resonance imaging. All patients were treated non-operatively. Clinical examination and the electrophysiologic investigation including nerve conduction studies, needle EMG of extremity and paraspinal muscles wase done at the beginning and every 4 months within first year and every year following two years of follow-up period. 23 patients completed 24 months and 19 patients completed 36 months of follow-up period. Results: At first examination 15 patients had sensory loss, and 9 patients had diminished reflexes in addition to myotomal muscle weakness. Triceps was the most common site of myotomal muscle weakness. In 16 patients, only reduced recruitment of motor units was found without positive sharp waves and fibrillation potentials on the first needle EMG examination. Abnormal spontaneous activity was found only in 7 patients. In 12 patients needle EMG findings were normal at the second EMG examination. In 13 patients muscle strength became normal within 4 months and in 17 patients within the first year. In 4 patients the muscle strength remained same as before. Only two patients had clinically observed muscle atrophy at the end of study period. Conclusion: The functional outcome of patient with myotomal muscle weakness due to cervical disk herniation is good. Most of myotomal muscle weakness represents neuropraxic lesion at the compressed root segment. Moreover probability of reinnervation is high possibly due to multilevel innervation of muscles.
S117
P183 Usefulness of robotics for improving and monitoring upper limb motor recovery in stroke patients Fabrizio Pisano 1 , Carmen Delconte 1 , Danilo Pianca 1 , Maria Antonietta Tommasi 1 , Alessandra Mazzone 2 , Giuseppe Minuco 2 , Roberto Colombo 2 1 Neurology, Fondazione Maugeri, IRCCS, Veruno (ITALY); 2 Bioengineering, Fondazione Maugeri, IRCCS, Veruno (ITALY) Purpose: Recently new sensory-motor techniques based on the use of robot devices have been applied in neurorehabilitation of brain damaged patients. We evaluated effectiveness of a robotic system for improving upper limb motor control in a group of stroke patients Method: Eighteen subjects, with the presence of 10/20° voluntary movement at elbow and shoulder, were enrolled: 9 patients (R group, 53±12.6 y.o.) were treated 45 min daily with the robot device plus 45 min daily with traditional physical therapy; the other 9 subjects (CT group, 62.8±11 y.o.) underwent 45 min traditional physical therapy twice a day. Each patient performed the following clinical evaluations: MRC scale, Fugl-Meyer (FM), Motor Power Score (MPS), Range of Motion (RoM). Moreover we identified new robot measured evaluation metrics: 1) an active movement index (quantifying the patient’s ability to execute the assigned motor task without robot assistance), 2) the mean velocity, 3) movement accuracy index (measuring the distance of the executed path from the theoretic one), 4) movement efficiency (obtained by computing the path length of the trajectory traveled by the patient in order to reach the target). Results: Student’s unpaired t-test was used to compare the results between R group and CT group. R group showed greater improvement in MPS (p<0.002) and FM (p<0.01) compared with the CT. Also MRC was significantly increased, even if slightly (p<0.05), in comparison with CT group. Improvements were particularly recorded for movements of shoulder abduction and flexion and elbow extension Conclusion: Robot aided therapy can improve motor recovery of the hemiparetic upper limb, thanks to enhanced motor learning after intensive repetitive, goal-directed forward-reaching movement. Besides these techniques, can also provide objective parameters for monitoring the rate of improvement of motor performance.
P184 Anterior tarsal tunnel syndrome Figen Tokucoglu 2 , Yaprak Secil 2 , Candan Aksit 3 Ataturk Egitim ve Arastirma Hastanesi, 2nd Neurology Clinic; 2 Izmir Ataturk Egitim ve Arastirma Hastanesi, 1st Neurology Clinic; 3 Izmir Esrefpasa Belediye Hastanesi, Izmir, Turkey
1 Izmir
Anterior tarsal tunnel syndrome is a rare entrapment neuropathy involving the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle and foot. The syndrome is characterized by pain, weakness, and sensory changes of the foot and ankle. This clinical picture may be a clinically underrecognized entity, thus making a missed diagnosis and delayed treatment likely. We would like to present a case whose way of living caused the development pathological condition. A fifty seven years old male patient without significant medical history complained pain and numbness of the left foot. Clinical examination disclosed minor weakness of the dorsal flexion of the toes without any objective sensory findings. Pathological electrophysiological findings are prolonged distal latency of deep peroneal nerve (7.10ms), low action potential amplitude (0.2 mV), acute denervation potentials with reduced interference pattern. Other nerve conduction studies including right upper and both lower limbs were in normal limits. The dimensions of the tarsal tunnel are reported to be 21.7±4.3 × 55.0±9.0 × 12.6±2.1 mm. In this small area deep peroneal nerve may be exposured compression by tight shoes, ostophytes, aberrant muscles or blood vessels. In our case external compression was produced by sitting on the ankles during the worshipping according to islamic ways which presented itself with calloussed skin over the anterior surface of the ankles. Therapeutical measures include consevative ways to reduce or remove the external compression along the anterior aspect of the foot and ankle. If con-
P182 Long-term follow up of patients with myotomal muscle weakness due to cervical disc herniation Cengiz Bahadir, Burcu Önal, Feride Ocak, Vildan Yaman, Semra Bozkurt Haydarpa¸sa Training and Research Hospital Physical Medicine and Rehabilitation Clinic, Istanbul, Turkey Purpose: Root compression frequently causes pain, loss or diminished reflexes, sensory disturbances and muscle weakness. Patients with myotomal muscle weakness caused by cervical disk herniations are frequently treated operatively. In this study, long term outcomes of the nonoperatively treated patient with myotomal muscle weakness were investigated. Method: 23 Patients with myotomal muscle weakness due to cervical disk herniation included in the study. Diagnosis of cervical disk herniation and root compression were confirmed with magnetic resonance imaging. All patients were treated non-operatively. Clinical examination and the electrophysiologic investigation including nerve conduction studies, needle EMG of extremity and paraspinal muscles wase done at the beginning and every 4 months within first year and every year following two years of follow-up period. 23 patients completed 24 months and 19 patients completed 36 months of follow-up period. Results: At first examination 15 patients had sensory loss, and 9 patients had diminished reflexes in addition to myotomal muscle weakness. Triceps was the most common site of myotomal muscle weakness. In 16 patients, only reduced recruitment of motor units was found without positive sharp waves and fibrillation potentials on the first needle EMG examination. Abnormal spontaneous activity was found only in 7 patients. In 12 patients needle EMG findings were normal at the second EMG examination. In 13 patients muscle strength became normal within 4 months and in 17 patients within the first year. In 4 patients the muscle strength remained same as before. Only two patients had clinically observed muscle atrophy at the end of study period. Conclusion: The functional outcome of patient with myotomal muscle weakness due to cervical disk herniation is good. Most of myotomal muscle weakness represents neuropraxic lesion at the compressed root segment. Moreover probability of reinnervation is high possibly due to multilevel innervation of muscles.
S117
P183 Usefulness of robotics for improving and monitoring upper limb motor recovery in stroke patients Fabrizio Pisano 1 , Carmen Delconte 1 , Danilo Pianca 1 , Maria Antonietta Tommasi 1 , Alessandra Mazzone 2 , Giuseppe Minuco 2 , Roberto Colombo 2 1 Neurology, Fondazione Maugeri, IRCCS, Veruno (ITALY); 2 Bioengineering, Fondazione Maugeri, IRCCS, Veruno (ITALY) Purpose: Recently new sensory-motor techniques based on the use of robot devices have been applied in neurorehabilitation of brain damaged patients. We evaluated effectiveness of a robotic system for improving upper limb motor control in a group of stroke patients Method: Eighteen subjects, with the presence of 10/20° voluntary movement at elbow and shoulder, were enrolled: 9 patients (R group, 53±12.6 y.o.) were treated 45 min daily with the robot device plus 45 min daily with traditional physical therapy; the other 9 subjects (CT group, 62.8±11 y.o.) underwent 45 min traditional physical therapy twice a day. Each patient performed the following clinical evaluations: MRC scale, Fugl-Meyer (FM), Motor Power Score (MPS), Range of Motion (RoM). Moreover we identified new robot measured evaluation metrics: 1) an active movement index (quantifying the patient’s ability to execute the assigned motor task without robot assistance), 2) the mean velocity, 3) movement accuracy index (measuring the distance of the executed path from the theoretic one), 4) movement efficiency (obtained by computing the path length of the trajectory traveled by the patient in order to reach the target). Results: Student’s unpaired t-test was used to compare the results between R group and CT group. R group showed greater improvement in MPS (p<0.002) and FM (p<0.01) compared with the CT. Also MRC was significantly increased, even if slightly (p<0.05), in comparison with CT group. Improvements were particularly recorded for movements of shoulder abduction and flexion and elbow extension Conclusion: Robot aided therapy can improve motor recovery of the hemiparetic upper limb, thanks to enhanced motor learning after intensive repetitive, goal-directed forward-reaching movement. Besides these techniques, can also provide objective parameters for monitoring the rate of improvement of motor performance.
P184 Anterior tarsal tunnel syndrome Figen Tokucoglu 2 , Yaprak Secil 2 , Candan Aksit 3 Ataturk Egitim ve Arastirma Hastanesi, 2nd Neurology Clinic; 2 Izmir Ataturk Egitim ve Arastirma Hastanesi, 1st Neurology Clinic; 3 Izmir Esrefpasa Belediye Hastanesi, Izmir, Turkey
1 Izmir
Anterior tarsal tunnel syndrome is a rare entrapment neuropathy involving the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle and foot. The syndrome is characterized by pain, weakness, and sensory changes of the foot and ankle. This clinical picture may be a clinically underrecognized entity, thus making a missed diagnosis and delayed treatment likely. We would like to present a case whose way of living caused the development pathological condition. A fifty seven years old male patient without significant medical history complained pain and numbness of the left foot. Clinical examination disclosed minor weakness of the dorsal flexion of the toes without any objective sensory findings. Pathological electrophysiological findings are prolonged distal latency of deep peroneal nerve (7.10ms), low action potential amplitude (0.2 mV), acute denervation potentials with reduced interference pattern. Other nerve conduction studies including right upper and both lower limbs were in normal limits. The dimensions of the tarsal tunnel are reported to be 21.7±4.3 × 55.0±9.0 × 12.6±2.1 mm. In this small area deep peroneal nerve may be exposured compression by tight shoes, ostophytes, aberrant muscles or blood vessels. In our case external compression was produced by sitting on the ankles during the worshipping according to islamic ways which presented itself with calloussed skin over the anterior surface of the ankles. Therapeutical measures include consevative ways to reduce or remove the external compression along the anterior aspect of the foot and ankle. If con-