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No. 311 Systemic Vasculitis Accompanied by Syringomyelia: A Case Report
S154
myelomeningocele. Design: Single group open non-randomized trial. Setting: Gait analysis laboratory. Participants: 3 subjects with myelomeningocele specifically with L3-L4 damage without gender exclusion aged 4 to 10. Interventions: Gait analysis was performed using three dimensional motion capture system. A therapeutic kinesiology taping technique was used in this protocol and the strips were located specifically to enhance gluteus medius muscle activity through a Y-strip and inhibit the activity of the adductor muscles of the hip through an I-strip in order to improve muscular balance. Electromyography (EMG) data was collected as well; sensors were located into the iliopsoas muscle, adductor muscles of the hip, gluteus medius muscle, and gluteus maximus muscle. The gait analysis was performed with and without kinesiology tape and the results were compared and discussed. Main Outcome Measures: Kinematic data and EMG data. A three dimensional movement capture system was used in order to acquire the movement data and process the kinematics and electromyography variables. An EMG system was used to collect the electromyography data through eight wireless sensors. Level of Evidence: Level 2. Results: Gait analysis reports were acquired, and kinematics of the pelvic movement were compared among the three subjects with and without kinesiology tape. The kinematics variables studied were pelvic tilt, pelvic obliquity, and pelvic rotation of both legs for all the subjects. EMG graphs were also compared. Conclusions: The actual study does not show significant evidence of an immediate improvement in gait after kinesiology tape is applied in children with myelomeningocele based on the comparison of the kinematics and EMG variables. However it is important to note that this study was performed on only three subjects. A larger study needs to be performed with more patients.
PRESENTATIONS
No. 312 Can Spinal Cord Injury Patients Show a Worsening in ASIA Impairment Scale Classification Despite Actually Having Neurological Improvement? The Limitation of ASIA Impairment Scale Classification. Ibrahim Gundogdu, MD1; Erhan Arif Ozturk, MD1; Koray Aydemir, MD2; Fatma Aytul Cakci, MD1. (1Ministry of Health, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey); (2Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Ankara, Turkey). Disclosure: None. Objective: To demonstrate the possible problems with ASIA impairment scale (AIS) classification in spinal cord injury (SCI) cases involving presumed motor and sensory changes and to clarify the possible causes of the inverse relationship between the motor/sensory changes and AIS conversion in certain conditions. Borderline AIS grades are most problematic when determining AIS classification. Design: The analysis of SCI case examples for the probable AIS grade changes in the event of recovery. Setting: Tertiary care education and research hospital. Participants: SCI patients. Main Outcome Measures: Neurological examination (motor/sensory) findings and AIS grades. Results: We encountered the same unique problem of deteriorating AIS grades within the critical zones of conversion when presumed neurological improvement took place and vice versa. Conclusions: This is the first report which analyzes the structure and definitions in the AIS standards for possible causes of the inverse relationship between the motor/sensory changes and AIS conversion. When recovery occurs without observing any motor or sensory changes while taking only the AIS into account, it would be possible to make an incorrect conclusion. This is most likely an indication of a limitation of the AIS. To enlighten this paradox the large amount of data in SCI databases should be reanalyzed. Reprinted with permission.
No. 311 Systemic Vasculitis Accompanied by Syringomyelia: A Case Report. Koray Aydemir; Volkan Yilmaz, MD; Ayca Uran; Mehmet Ali Taskaynatan (Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation Ankara, Turkey).
No. 313 Recuperacion Neurologica Y Funcional De Pacientes Con Lesion Medular Por Tumoración Intrarraquidea. Aída Barrera Oritz; Dra. Del Refugio Pacheco Gallegos; Saúl Renán León Hernández; Ramiro Pérez Zavala.
Disclosure: None. Setting: Tertiary care university hospital. Patient: A 26-year-old male with upper extremity weakness. Case Description: A 26-year-old patient was admitted to our department with complaints of upper extremity weakness for two months. There was no history of trauma and family history wasn’t contributory. He stated that intestinal resection was performed and he was diagnosed with empyema. On physical examination the patient was mobile in short distances. Muscle strength were as follows; left C4 myotome was 4/5, bilateral C5 myotomes were 3/5, bilateral C6 and C7 myotomes were 2/5, bilateral C8-T1 myotomes were 1/5. Bilateral wasting of thenar and hypothenar eminences and dorsal interossei were inspected. Assessment/ Results: Cervical magnetic resonance imaging showed syrinx cavitation between C5 and C7 levels. Electromyography indicated lower motor neuron affection (C4-T1). Computed tomography findings revealed cavitating lesions in the right lung. Cyclophosphamide and prednisolone were prescribed as medical treatment. Neurorehabilitation process is started. A remarkable motor and functional recovery is obtained in a short term. Discussion: Systemic vasculitis is a clinical condition which is generally characterized by the inflammation of small and medium sized vessels. The disease may affect multi organ systems and may be accompanied by various disorders. If central nerve system (CNS) involvement is suspected, proper radiological assessments should be performed for confirmation of the diagnosis. Conclusion: Clinicians should take into account vasculitis associated syringomyelia in differential diagnosis of upper extremity weakness problems in vasculitic patients. Reprinted with permission.
Objetivo: Determinar los factores asociados a recuperación neurológica y funcional de pacientes con LMT. Material y métodos: Estudio de cohorte histórica de pacientes de un instituto nacional de salud con diagnóstico de LMT de enero del 2000 a diciembre 2010. Variables: escala de la American Spinal Cord Injury Association (ASIA) y la medida de independencia funcional (FIM). Se aplicó estadística descriptiva univariante los análisis bivariantes incluyeron chi cuadrada o test exacto de fisher rangos de Wilcoxon u de Mann Whitney y análisis de varianza de un factor para comparar tres o mas promedios de una variable con distribución normal. La normalidad de las distribuciones se contrastó con la prueba de Kolmogorov-Smirnov. Para el análisis multivariado se aplicó regresión logística con el método de wald hacia atrás. Intervenciones: No aplicable. Resultados: 68 expedientes 52% femenino edad promedio de 4616 años. Inicio de rehabilitación promedio 8.6 meses. Intradural extramedular (44.1%) meningioma (26.5%) torácico (77.9%). El ASIA posterior al tratamiento presentó un cambio significativo (p ¼ 0.0001) asociado a manejo hospitalario tratamiento quirúrgico en el instituto y presencia de úlceras. El cambio de FIM inicial y final con diferencia significativa (p¼ 0.0001) estuvo asociado a manejo hospitalario tipo de tumor tratamiento quirúrgico y cirugía en el instituto. La regresión logística binaria seleccionó como factores pronósticos al manejo hospitalario tiempo de inicio de la rehabilitación y tiempo que el paciente permanece en rehabilitación. Conclusiones: Las LMT afectan a poblaciones en edades productivas. Los factores asociados a mejor recuperación son manejo hospitalario tiempo de inicio y de seguimiento en rehabilitación. Nivel De Evidencia: 2.
myelomeningocele. Design: Single group open non-randomized trial. Setting: Gait analysis laboratory. Participants: 3 subjects with myelomeningocele specifically with L3-L4 damage without gender exclusion aged 4 to 10. Interventions: Gait analysis was performed using three dimensional motion capture system. A therapeutic kinesiology taping technique was used in this protocol and the strips were located specifically to enhance gluteus medius muscle activity through a Y-strip and inhibit the activity of the adductor muscles of the hip through an I-strip in order to improve muscular balance. Electromyography (EMG) data was collected as well; sensors were located into the iliopsoas muscle, adductor muscles of the hip, gluteus medius muscle, and gluteus maximus muscle. The gait analysis was performed with and without kinesiology tape and the results were compared and discussed. Main Outcome Measures: Kinematic data and EMG data. A three dimensional movement capture system was used in order to acquire the movement data and process the kinematics and electromyography variables. An EMG system was used to collect the electromyography data through eight wireless sensors. Level of Evidence: Level 2. Results: Gait analysis reports were acquired, and kinematics of the pelvic movement were compared among the three subjects with and without kinesiology tape. The kinematics variables studied were pelvic tilt, pelvic obliquity, and pelvic rotation of both legs for all the subjects. EMG graphs were also compared. Conclusions: The actual study does not show significant evidence of an immediate improvement in gait after kinesiology tape is applied in children with myelomeningocele based on the comparison of the kinematics and EMG variables. However it is important to note that this study was performed on only three subjects. A larger study needs to be performed with more patients.
PRESENTATIONS
No. 312 Can Spinal Cord Injury Patients Show a Worsening in ASIA Impairment Scale Classification Despite Actually Having Neurological Improvement? The Limitation of ASIA Impairment Scale Classification. Ibrahim Gundogdu, MD1; Erhan Arif Ozturk, MD1; Koray Aydemir, MD2; Fatma Aytul Cakci, MD1. (1Ministry of Health, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey); (2Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Ankara, Turkey). Disclosure: None. Objective: To demonstrate the possible problems with ASIA impairment scale (AIS) classification in spinal cord injury (SCI) cases involving presumed motor and sensory changes and to clarify the possible causes of the inverse relationship between the motor/sensory changes and AIS conversion in certain conditions. Borderline AIS grades are most problematic when determining AIS classification. Design: The analysis of SCI case examples for the probable AIS grade changes in the event of recovery. Setting: Tertiary care education and research hospital. Participants: SCI patients. Main Outcome Measures: Neurological examination (motor/sensory) findings and AIS grades. Results: We encountered the same unique problem of deteriorating AIS grades within the critical zones of conversion when presumed neurological improvement took place and vice versa. Conclusions: This is the first report which analyzes the structure and definitions in the AIS standards for possible causes of the inverse relationship between the motor/sensory changes and AIS conversion. When recovery occurs without observing any motor or sensory changes while taking only the AIS into account, it would be possible to make an incorrect conclusion. This is most likely an indication of a limitation of the AIS. To enlighten this paradox the large amount of data in SCI databases should be reanalyzed. Reprinted with permission.
No. 311 Systemic Vasculitis Accompanied by Syringomyelia: A Case Report. Koray Aydemir; Volkan Yilmaz, MD; Ayca Uran; Mehmet Ali Taskaynatan (Gulhane Military Medical Academy, Department of Physical Medicine and Rehabilitation Ankara, Turkey).
No. 313 Recuperacion Neurologica Y Funcional De Pacientes Con Lesion Medular Por Tumoración Intrarraquidea. Aída Barrera Oritz; Dra. Del Refugio Pacheco Gallegos; Saúl Renán León Hernández; Ramiro Pérez Zavala.
Disclosure: None. Setting: Tertiary care university hospital. Patient: A 26-year-old male with upper extremity weakness. Case Description: A 26-year-old patient was admitted to our department with complaints of upper extremity weakness for two months. There was no history of trauma and family history wasn’t contributory. He stated that intestinal resection was performed and he was diagnosed with empyema. On physical examination the patient was mobile in short distances. Muscle strength were as follows; left C4 myotome was 4/5, bilateral C5 myotomes were 3/5, bilateral C6 and C7 myotomes were 2/5, bilateral C8-T1 myotomes were 1/5. Bilateral wasting of thenar and hypothenar eminences and dorsal interossei were inspected. Assessment/ Results: Cervical magnetic resonance imaging showed syrinx cavitation between C5 and C7 levels. Electromyography indicated lower motor neuron affection (C4-T1). Computed tomography findings revealed cavitating lesions in the right lung. Cyclophosphamide and prednisolone were prescribed as medical treatment. Neurorehabilitation process is started. A remarkable motor and functional recovery is obtained in a short term. Discussion: Systemic vasculitis is a clinical condition which is generally characterized by the inflammation of small and medium sized vessels. The disease may affect multi organ systems and may be accompanied by various disorders. If central nerve system (CNS) involvement is suspected, proper radiological assessments should be performed for confirmation of the diagnosis. Conclusion: Clinicians should take into account vasculitis associated syringomyelia in differential diagnosis of upper extremity weakness problems in vasculitic patients. Reprinted with permission.
Objetivo: Determinar los factores asociados a recuperación neurológica y funcional de pacientes con LMT. Material y métodos: Estudio de cohorte histórica de pacientes de un instituto nacional de salud con diagnóstico de LMT de enero del 2000 a diciembre 2010. Variables: escala de la American Spinal Cord Injury Association (ASIA) y la medida de independencia funcional (FIM). Se aplicó estadística descriptiva univariante los análisis bivariantes incluyeron chi cuadrada o test exacto de fisher rangos de Wilcoxon u de Mann Whitney y análisis de varianza de un factor para comparar tres o mas promedios de una variable con distribución normal. La normalidad de las distribuciones se contrastó con la prueba de Kolmogorov-Smirnov. Para el análisis multivariado se aplicó regresión logística con el método de wald hacia atrás. Intervenciones: No aplicable. Resultados: 68 expedientes 52% femenino edad promedio de 4616 años. Inicio de rehabilitación promedio 8.6 meses. Intradural extramedular (44.1%) meningioma (26.5%) torácico (77.9%). El ASIA posterior al tratamiento presentó un cambio significativo (p ¼ 0.0001) asociado a manejo hospitalario tratamiento quirúrgico en el instituto y presencia de úlceras. El cambio de FIM inicial y final con diferencia significativa (p¼ 0.0001) estuvo asociado a manejo hospitalario tipo de tumor tratamiento quirúrgico y cirugía en el instituto. La regresión logística binaria seleccionó como factores pronósticos al manejo hospitalario tiempo de inicio de la rehabilitación y tiempo que el paciente permanece en rehabilitación. Conclusiones: Las LMT afectan a poblaciones en edades productivas. Los factores asociados a mejor recuperación son manejo hospitalario tiempo de inicio y de seguimiento en rehabilitación. Nivel De Evidencia: 2.