The percutaneous needle tenotomy in the treatment of tendon contractures in brain damaged patients: Pilot study

ObjectiveAssessment of the feasibility and efficacy of percutaneous needle tenotomy in patients with neuro-orthopedic disorders secondary to impairment of the central nervous system.Material and methodFourteen patients were followed in the Physical medicine and rehabilitation Department from September 2014 to March 2015. The average age was 58.7years (29–86 y). The origin of neuro-orthopedic disorder was stroke (n=7), parkinsonism (n=2), head trauma (n=2), cerebral palsy (n=1), Little's disease (n=1) and Alzheimer's disease (n=1). The indication of percutaneous needle tenotomy was selected during a medical-surgical consultation. Twenty-one goals were identified: hygiene (n=6), pain (n=4), sitting (n=3), standing (n=4), transfers (n=1), walking (n=2), grasping (n=1). A total of 31sites were covered: the finger flexors (n=9), the semitendinosus, biceps femoris and tensor fascia lata (n=7), the Achilles tendon (n=5), the biceps and brachioradialis (N=3), the wrist flexors (n=2), flexor digitorum longus (7claw toes) and hip adductors (n=1). In 10 patients the treatment involved several sites. Tenotomy was performed with a 18Gneedle (1,2×40mm), under local or regional anesthesia. A plaster cast was associated with hamstring tenotomy if the objective was functional. A cast was always associated with Achilles tendon, elbow flexor and wrist flexor tenotomy. The Goal Attainment Scale (GAS) was used to assess the effectiveness of treatment.ResultsThe targets were achieved in all cases (GAS≥0). No side effects were noted.DiscussionPercutaneous needle tenotomy is a technique which can be used as treatment of some neuro-orthopedic disorders in brain-damaged patients. Percutaneous tenotomy of the Achilles’ tendon has already been described by Minkowitz. Our study shows the feasibility and effectiveness of needle tenotomy, sometimes multi-site, performed in this type of patient

Beyond stroke: Impact of the lesion side on the recovery of between-hands coordination

ObjectiveOne-fit-all post-stroke rehabilitation has limited plausibility. Better understanding the effects of the lesion location on the recovery process may help to develop new tailored therapeutic strategies to individuals. The purpose of this study was to assess the natural evolution of bimanual coordination over standard rehabilitation according to the lesion side, aiming to identify a potential responder-profile for bimanual-oriented therapy.Material/patientsTwelve hemiparetic, moderately impaired patients were included within 30 days after a first unilateral stroke. The kinematic and clinical assessments were performed once a week for 6 weeks and at 3 months after inclusion. The patients performed a reach-to-grasp task in unimanual condition followed by a synchronous bimanual condition. The clinical evaluation included the Fugl-Meyer Assessment, Box and Block Test, 9-Hole Peg Test and Barthel Index.ResultsThe clinical scores indicated no difference in motor function between left- (LHD) and right-hemispheric damaged (RHD) patients over time. Interestingly, the LHD patients produced smoother bimanual reaching movements than the RHD patients while we found no effect of the lesion side on reaching kinematics of the paretic UL in unimanual condition. These inter-group differences disappeared after 5 weeks of standard therapy, likely indicating a time lag in motor recovery.DiscussionBecause the RHD patients were less prematurely coordinated again during bimanual movements than the LHD patients, they may benefit differently from a bimanual rehabilitation, and especially from the simultaneous involvement of the ipsilesional UL. It becomes necessary to investigate to what extent this difference due to lesion side may be integrated into the design of rehabilitation protocols

Isokinetic muscle strengthening after acquired cerebral damage: A literature review

AbstractObjectiveIsokinetic strengthening is a rehabilitation technique rarely used in stroke patients. However, the potential benefits of force and endurance training in this population are strongly suspected.MethodThis literature review synthesizes the results of clinical trials on this topic. The research was conducted on PubMed, using “Stroke”, “rehabilitation”, “isokinetic”, “upper limb” and “training” as keywords.ResultsSeventeen studies focusing on the use of isokinetics in assessment or rehabilitation (six studies) following stroke were reviewed. For the lower limb, muscle strength and walking ability improved after isokinetic rehabilitation programs. For the upper limb, the only two studies found in the literature suggest improvement in the strength of the trained muscles, of grip force, of the Fugl-Meyer motor score and of global functional capacities. This review does not reveal any consensus on the protocols to be implemented: type of muscle contraction, velocities….ConclusionWhile isokinetic strengthening has not proven its efficiency in rehabilitation of the upper limb following stroke, its interest with regard to rehabilitation of the lower limbs has been recognized. Randomized controlled trials in this field are necessary to confirm its efficiency, especially concerning upper arm rehabilitation

Excludability: A laboratory study on forced ranking in team production

Exclusion has long been employed as a common disciplinary measure against defectors, both at work and in social life. In this paper, we study the effect of excludability - exclusion of the lowest contributor - on contributions in three different team production settings. We demonstrate theoretically and experimentally that excludability increases contributions. Excludability is particularly effective in production settings where the average or maximum effort determines team production. In these settings, we observe almost immediate convergence to full contribution. In settings where the minimum effort determines team production, excludability leads to a large increase in contributions only if the value of the excluded individual's contribution to the public good is redistributed among the included individuals

Size-dependent spinodal and miscibility gaps for intercalation in nano-particles

Using a recently-proposed mathematical model for intercalation dynamics in phase-separating materials [Singh, Ceder, Bazant, Electrochimica Acta 53, 7599 (2008)], we show that the spinodal and miscibility gaps generally shrink as the host particle size decreases to the nano-scale. Our work is motivated by recent experiments on the high-rate Li-ion battery material LiFePO4; this serves as the basis for our examples, but our analysis and conclusions apply to any intercalation material. We describe two general mechanisms for the suppression of phase separation in nano-particles: (i) a classical bulk effect, predicted by the Cahn-Hilliard equation, in which the diffuse phase boundary becomes confined by the particle geometry; and (ii) a novel surface effect, predicted by chemical-potential-dependent reaction kinetics, in which insertion/extraction reactions stabilize composition gradients near surfaces in equilibrium with the local environment. Composition-dependent surface energy and (especially) elastic strain can contribute to these effects but are not required to predict decreased spinodal and miscibility gaps at the nano-scale