- Email: [email protected]
Walking effect of a dynamic response rehabilitation gait orthosis in patients with neurological disorders
ABSTRACTS
368
Carotid
Stenosis
in a M u l t i e t h n i c
Population
M Wang, S Lavine, R Mimran, S G i a n n o t t a (Los Angeles, C a l i f o r n i a
Sagittal sinus(SSS) thrombosis secondary to known hypercoagulable states successfully treated with direct thrombolysis
M Wasay, S Kojan, Z Siddieo W Sweatt, A Haq, H Unwin, R G-reenlee
Background: Selective catheterization, of the dural venous sinuses with urokinase Backaround Carotid stenosis is an important treatable cause of stroke. Several population-based studies have demonstrated ethnic differences in carotid atheroscleroals. This study was performed at a large multiethnic hospital to elucidate these differences. Methods 1,006 carotid uifrasounds performed by the radiology department over a 4-year pedod were reviewed. Patients were classified as Caucasian (n=151), Hispanic {n=515), Black (n=173), or Asian (n=167) by self-declaration and birthplace. Degree of carotid stenosis was defined as normal, mild (139%), moderate (40-59%), severe (60-79%), critical (80-99%), and total 000%). Results 20.5% of Caucasian patients had greater than 60% stenosis as compared to 10.1% of Hispanics, 8.7% of Blacks, and 10.7% of Asians, There were no significant differences in age or gender representatiow~ between races, and the indications for ordering carotid duplex also did not vary significantly by race. Conclusions These results indicate that significant differences in operative revels of carotid stenosis exist between races. This suggests that the importance of different etiologies of stroke may vary between ethnic groups,
Walking Effect of a Dynamic Response Rehabilitation Gait Orthosis in Patients with Neurological Disorders
S.Willner [MalmO, Sweden] background: The primary goal in the traditional Ankle Foot Orthosis (AFO) for management of drop foot is to stabilize the foot and prevent it from dragging. The stance and swing of the foot are rigid and the gait will be improved only to a limited range. A more dynamic gait orthosis has therefore been developed with improved gait and lengthening of the walking capacity. Methods:. A new design and composite materials are used to obtain patient acceptance and compliance because of its lightweight and tbirmess. Equally important, to improve the toe-off of the forefoot, normalize the length of the steps and as a consequence of these, lengthen the walking capacity. Results: Gait analysis has shown an improved stride length, walking velocity, but particularly a normalization of the single support. In a study consisting of 23 patients with drop foot caused by different neurological disorders, walking capacity was compared with the patients wearing the new Dynamic Response Gait Orthosis (ToeOFF). a conventional AFO, and no outer support--in the same patients. In 23 patients, a comparative study between the use of ToeOFF and no support showed a tenfold improved walking capacity mad m 17 cases a twofold improvement between ToeOFF and conventional AFO. Conclusion: A new Dynamic Response Gait Orthosis has been devetoped thin offers improved walking capacity and patient acceptance.
infusion has been shown m be effective and safe. The safety and efficacy of direct tlu'ombotysis in patients with hypercoagulablestates is not well established. We report our experience in these patients. Methods: We retrospectively reviewed 18 patients with SSS thrombosis that were treated with direct thrombolysis at our institution, The etiologic favor was found to be a hypercoagnlable state in five patients (lupus anticoagulant [2 patients], homoeystmuria [2 patients] and Paroxysmal nocturnal hemoglobiartria (PNH) [1 patient]). Results: Subjects were 4 men and 1 woman. Age range was 23 - 48. Past medical histories included PNH (l patient) and SSS thrombosis (1 patient). Presenting symptoms were headache (5 patients), blurred vision (2 patients), diplopia (1 patient) and facial numbness (2 patients).Nenrological exam showed papinedema(4 patients), brisk reflexes (3 patients) and bilateral sixth nerve palsy (l patient). Further studies revealed evidence of bomocystinuria (2 patients ) and lupus anticoagulant (2 patients). MRI showed SSS tl'aombosis in five patients and transverse sinus (TS) thrombosis in four patients. Angiogramshowed SSS, TS and sigmoid sinus thrombosis (1 patient), SSS and TS thrombosis (3 patients) and SSS thrombosis (! patient). All patients received 250,000 units bofus urokinase via selective cathetrizatiun to SSS and continuous infusion at rate of 80,000 - 100,000 units/hr for 1 day (2 patients), 2 days (1 patient) and 3 days (2 patients). Repeat angiogram showed patency of SSS in all patients. One patient (PNH) developed groin and rel~operitunea| hematomas requiring blood transfusion. One patient with lupus anticoagulant had recurrence of SSS thrombosis after one month with subtherapentic anticoagulatiun. Patient was thrombolysed again for 1 day without complications and discharged home. Conclusion:Direct thrombolysis is effective and safe in patients with SSS thrombosis secondary to homocystinuria, lupus anticoagulant and PNH.
TPA- EVERYDAY NEUROLOGY PRACTICE
E. Wirkowski, M. Gottesman, C. Mazer, G. Brod S. Manzella & D. Doxey (Mineola~ NY)
Backamund: Assessment of practicality to establish acute stmketPA pathways and number of candidates for tPA treatment in t a r tia~mre hospital not participating in NINDS trial. Method: Data anatys|s and one year phone carl follow up of patients that presented to the ER between September 1996 and December 1997 within 3 hours of onset of CVA. ~ : 45 patients reached the ER within 3 hours. 14 received tPA, 31 were rejected. Two groups were compared: tPA (group A, N=14) and no tPA ( group B, N=18), both NIHSS=14 and same age. Five patients from group A and 6 from group B had hemorrhagic conversion on head CT. The length of stay: group A and B were 12.9 and 18.9 days respectively, Hospital mortality: Group A- 3, group B- 5 patients. 81% of patients in group A and only 61% in group B were discha~ed home or to Rehab. One year follow-up revealed higher mortality and dependence in group B. Conclusions: Establishment of tPA stroke treatment is pessibie in t er tiarCyare hospital. Amount of patients that receive tPA treatment is limited mainly by time, Amount of hemorrhagic conversion was similar in both groups. Our findings were in agreement with NINDS stroke study.
368
Carotid
Stenosis
in a M u l t i e t h n i c
Population
M Wang, S Lavine, R Mimran, S G i a n n o t t a (Los Angeles, C a l i f o r n i a
Sagittal sinus(SSS) thrombosis secondary to known hypercoagulable states successfully treated with direct thrombolysis
M Wasay, S Kojan, Z Siddieo W Sweatt, A Haq, H Unwin, R G-reenlee
Background: Selective catheterization, of the dural venous sinuses with urokinase Backaround Carotid stenosis is an important treatable cause of stroke. Several population-based studies have demonstrated ethnic differences in carotid atheroscleroals. This study was performed at a large multiethnic hospital to elucidate these differences. Methods 1,006 carotid uifrasounds performed by the radiology department over a 4-year pedod were reviewed. Patients were classified as Caucasian (n=151), Hispanic {n=515), Black (n=173), or Asian (n=167) by self-declaration and birthplace. Degree of carotid stenosis was defined as normal, mild (139%), moderate (40-59%), severe (60-79%), critical (80-99%), and total 000%). Results 20.5% of Caucasian patients had greater than 60% stenosis as compared to 10.1% of Hispanics, 8.7% of Blacks, and 10.7% of Asians, There were no significant differences in age or gender representatiow~ between races, and the indications for ordering carotid duplex also did not vary significantly by race. Conclusions These results indicate that significant differences in operative revels of carotid stenosis exist between races. This suggests that the importance of different etiologies of stroke may vary between ethnic groups,
Walking Effect of a Dynamic Response Rehabilitation Gait Orthosis in Patients with Neurological Disorders
S.Willner [MalmO, Sweden] background: The primary goal in the traditional Ankle Foot Orthosis (AFO) for management of drop foot is to stabilize the foot and prevent it from dragging. The stance and swing of the foot are rigid and the gait will be improved only to a limited range. A more dynamic gait orthosis has therefore been developed with improved gait and lengthening of the walking capacity. Methods:. A new design and composite materials are used to obtain patient acceptance and compliance because of its lightweight and tbirmess. Equally important, to improve the toe-off of the forefoot, normalize the length of the steps and as a consequence of these, lengthen the walking capacity. Results: Gait analysis has shown an improved stride length, walking velocity, but particularly a normalization of the single support. In a study consisting of 23 patients with drop foot caused by different neurological disorders, walking capacity was compared with the patients wearing the new Dynamic Response Gait Orthosis (ToeOFF). a conventional AFO, and no outer support--in the same patients. In 23 patients, a comparative study between the use of ToeOFF and no support showed a tenfold improved walking capacity mad m 17 cases a twofold improvement between ToeOFF and conventional AFO. Conclusion: A new Dynamic Response Gait Orthosis has been devetoped thin offers improved walking capacity and patient acceptance.
infusion has been shown m be effective and safe. The safety and efficacy of direct tlu'ombotysis in patients with hypercoagulablestates is not well established. We report our experience in these patients. Methods: We retrospectively reviewed 18 patients with SSS thrombosis that were treated with direct thrombolysis at our institution, The etiologic favor was found to be a hypercoagnlable state in five patients (lupus anticoagulant [2 patients], homoeystmuria [2 patients] and Paroxysmal nocturnal hemoglobiartria (PNH) [1 patient]). Results: Subjects were 4 men and 1 woman. Age range was 23 - 48. Past medical histories included PNH (l patient) and SSS thrombosis (1 patient). Presenting symptoms were headache (5 patients), blurred vision (2 patients), diplopia (1 patient) and facial numbness (2 patients).Nenrological exam showed papinedema(4 patients), brisk reflexes (3 patients) and bilateral sixth nerve palsy (l patient). Further studies revealed evidence of bomocystinuria (2 patients ) and lupus anticoagulant (2 patients). MRI showed SSS tl'aombosis in five patients and transverse sinus (TS) thrombosis in four patients. Angiogramshowed SSS, TS and sigmoid sinus thrombosis (1 patient), SSS and TS thrombosis (3 patients) and SSS thrombosis (! patient). All patients received 250,000 units bofus urokinase via selective cathetrizatiun to SSS and continuous infusion at rate of 80,000 - 100,000 units/hr for 1 day (2 patients), 2 days (1 patient) and 3 days (2 patients). Repeat angiogram showed patency of SSS in all patients. One patient (PNH) developed groin and rel~operitunea| hematomas requiring blood transfusion. One patient with lupus anticoagulant had recurrence of SSS thrombosis after one month with subtherapentic anticoagulatiun. Patient was thrombolysed again for 1 day without complications and discharged home. Conclusion:Direct thrombolysis is effective and safe in patients with SSS thrombosis secondary to homocystinuria, lupus anticoagulant and PNH.
TPA- EVERYDAY NEUROLOGY PRACTICE
E. Wirkowski, M. Gottesman, C. Mazer, G. Brod S. Manzella & D. Doxey (Mineola~ NY)
Backamund: Assessment of practicality to establish acute stmketPA pathways and number of candidates for tPA treatment in t a r tia~mre hospital not participating in NINDS trial. Method: Data anatys|s and one year phone carl follow up of patients that presented to the ER between September 1996 and December 1997 within 3 hours of onset of CVA. ~ : 45 patients reached the ER within 3 hours. 14 received tPA, 31 were rejected. Two groups were compared: tPA (group A, N=14) and no tPA ( group B, N=18), both NIHSS=14 and same age. Five patients from group A and 6 from group B had hemorrhagic conversion on head CT. The length of stay: group A and B were 12.9 and 18.9 days respectively, Hospital mortality: Group A- 3, group B- 5 patients. 81% of patients in group A and only 61% in group B were discha~ed home or to Rehab. One year follow-up revealed higher mortality and dependence in group B. Conclusions: Establishment of tPA stroke treatment is pessibie in t er tiarCyare hospital. Amount of patients that receive tPA treatment is limited mainly by time, Amount of hemorrhagic conversion was similar in both groups. Our findings were in agreement with NINDS stroke study.