Sonographic soft tissue arthritic changes associated with post-stroke hemiplegic knee pain : utility of musculoskeletal ultrasound in a resource-limited setting

Purpose: Post-stroke arthritic changes that may compromise rehabilitation have been described in the upper and lower limbs. We aimed at evaluating the soft tissue arthritic changes associated with pain in hemiplegic knees of stroke patients in our environment. Material and methods: Hemiplegic and non-hemiplegic knees of 48 stroke patients as well as both knees of 26 apparently healthy controls were evaluated with a 7.5-12 MHz linear ultrasound probe. History of knee pain, and sociodemographic, laboratory, and clinical data were recorded for all study participants. Muscle tone and power as well as functional ambulatory category (FAC) were graded for the stroke patients. Data was analysed using SPSS version 20. Results: Pain was reported more often in hemiplegic than non-hemiplegic knees (n = 16 vs. n = 6, p = 0.021). The frequencies of soft tissue arthritic changes found, which included reduced lateral and medial femoral cartilage thickness, suprapatellar effusion, and irregular cartilage-bone margin, were similar between hemiplegic and non-hemiplegic knees (p > 0.05). Suprapatellar effusion and reduced lateral femoral cartilage thickness were more prevalent in the hemiplegic knees compared to the healthy control knees (p < 0.05). Stroke patients with pes anserinus tendinosis had greater risk of hemiplegic knee pain (HKP) when compared to stroke patients without this lesion (OR = 10; 95% CI: 1.7-61). FAC, muscle tone, and power showed no association with HKP. Conclusions: Soft tissue arthritic changes associated with knee pain are comparable between hemiplegic and non-hemiplegic knees of stroke patients. The risk of knee pain in stroke is higher in the presence of pes anserinus tendinosis

A Simulation Study of Functional Electrical Stimulation for An Upper Limb Rehabilitation Robot using Iterative Learning Control (ILC) and Linear models

A proportional iterative learning control (P-ILC) for linear models of an existing hybrid stroke rehabilitation scheme is implemented for elbow extension/flexion during a rehabilitative task. Owing to transient error growth problem of P-ILC, a learning derivative constraint controller was included to ensure that the controlled system does not exceed a predefined velocity limit at every trial. To achieve this, linear transfer function models of the robot end-effector interaction with a stroke subject (plant) and muscle response to stimulation controllers were developed. A straight-line point-point trajectory of 0 - 0.3 m range served as the reference task space trajectory for the plant, feedforward, and feedback stimulation controllers. At each trial, a SAT-based bounded error derivative ILC algorithm served as the learning constraint controller. Three control configurations were developed and simulated. The system performance was evaluated using the root means square error (RMSE) and normalized RMSE. At different ILC gains over 16 iterations, a displacement error of 0.0060 m was obtained when control configurations were combined.Comment: 15 pages, 16 Figure

New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Devic's neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person.</p> <p>Case presentation</p> <p>We report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermitte's sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier.</p> <p>Conclusion</p> <p>Neuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders.</p

Super-Refractory Status Epilepticus: An Atypical Presentation and Case-Based Review

Super-refractory status epilepticus is known to typically arise either from a distinct underlying cause or, in patients with no history of epilepsy, from no overt cause. It has recently presented in an unclear pattern, and thus there are various challenges in its management in resourcepoor settings. This case report presents a recent experience and lessons learned from a case of super–refractory status epilepticus preceded by atypical features in a 50-year-old Nigerian woman, and briefly reviews the current concepts in management of this epilepsy, especially in the context of resource-poor settings. Super-refractory status epilepticus can present with a confusing clinical picture. A good outcome in the management of this difficult problem is highly dependent on accurate diagnosis and prompt treatment. In view of the difficulties resource–poor countries have in accessing the resources and facilities required for optimal care of patients with super–refractory status, any future treatment protocols should allow for the provision of readily available therapy options in such settings