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Meiling JB, Boon AJ, Niu Z, Howe BM, Hoskote SS, Spinner RJ, Klein CJ. Parsonage-Turner Syndrome and Hereditary Brachial Plexus Neuropathy. Mayo Clin Proc 2024; 99:124-140. [PMID: 38176820 DOI: 10.1016/j.mayocp.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/10/2023] [Accepted: 06/23/2023] [Indexed: 01/06/2024]
Abstract
Parsonage-Turner syndrome and hereditary brachial plexus neuropathy (HBPN) present with indistinguishable attacks of rapid-onset severe shoulder and arm pain, disabling weakness, and early muscle atrophy. Their combined incidence ranges from 3 to 100 in 100,000 persons per year. Dominant mutations of SEPT9 are the only known mutations responsible for HBPN. Parsonage and Turner termed the disorder "brachial neuralgic amyotrophy," highlighting neuropathic pain and muscle atrophy. Modern electrodiagnostic and imaging testing assists the diagnosis in distinction from mimicking disorders. Shoulder and upper limb nerves outside the brachial plexus are commonly affected including the phrenic nerve where diaphragm ultrasound improves diagnosis. Magnetic resonance imaging can show multifocal T2 nerve and muscle hyperintensities with nerve hourglass swellings and constrictions identifiable also by ultrasound. An inflammatory immune component is suggested by nerve biopsies and associated infectious, immunization, trauma, surgery, and childbirth triggers. High-dose pulsed steroids assist initial pain control; however, weakness and subsequent pain are not clearly responsive to steroids and instead benefit from time, physical therapy, and non-narcotic pain medications. Recurrent attacks in HBPN are common and prophylactic steroids or intravenous immunoglobulin may reduce surgical- or childbirth-induced attacks. Rehabilitation focusing on restoring functional scapular mechanics, energy conservation, contracture prevention, and pain management are critical. Lifetime residual pain and weakness are rare with most making dramatic functional recovery. Tendon transfers can be used when recovery does not occur after 18 months. Early neurolysis and nerve grafts are controversial. This review provides an update including new diagnostic tools, new associations, and new interventions crossing multiple medical disciplines.
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Affiliation(s)
- James B Meiling
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Andrea J Boon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA; Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Zhiyv Niu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Sumedh S Hoskote
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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2
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Solaja O, Baergen AK, Head LK, Wolff GK, Boyd KU. Clinical Outcomes of Upper Extremity Nerve Transfers in Neuralgic Amyotrophy. Plast Reconstr Surg 2023; 152:1072e-1075e. [PMID: 37036330 DOI: 10.1097/prs.0000000000010519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
SUMMARY Neuralgic amyotrophy (NA) is a disease affecting peripheral nerves. Treatment has historically been conservative, as the natural course of the disease was thought to be self-limiting. Recent work has demonstrated that as many as two-thirds of people with NA have persistent pain, fatigue, or weakness. At the authors' center, supercharged end-to-side (SETS) nerve transfers are commonly performed in patients with NA to optimize motor recovery while allowing for native axonal regrowth. The authors describe the technique and clinical outcomes of patients with NA affecting the anterior interosseous nerve (AIN) who were treated with SETS nerve transfer from extensor carpi radialis brevis to AIN. Ten patients (90% male; mean age, 51.3 ± 9.7 years) underwent extensor carpi radialis brevis-to-AIN transfer at a mean period of 6.4 ± 1.4 months after onset of symptoms. Mean postoperative follow-up duration was 14.8 ± 3.2 months. Before surgery, all patients demonstrated clinically significant weakness in the flexor pollicis longus (FPL), flexor digitorum profundus muscle to the index finger (FDP2), or both. FPL strength improved from a median Medical Research Council (MRC) grade of 1.5 to 4 ( P = 0.011) and FDP2 strength improved from a median MRC grade of 1 to 5 ( P = 0.016). A postoperative MRC grade of 4 or greater was achieved in nine of 10 (90%) FPL and 10 of 10 (100%) FDP muscles. This is the first report of SETS nerve transfer for the treatment of NA. The outcomes of this work suggest that SETS nerve transfers may be an option to optimize motor outcomes in patients with NA. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Ogi Solaja
- From the Divisions of Plastic and Reconstructive Surgery
| | | | - Linden K Head
- From the Divisions of Plastic and Reconstructive Surgery
| | - Gerald K Wolff
- Physical Medicine and Rehabilitation, University of Ottawa
| | - Kirsty U Boyd
- From the Divisions of Plastic and Reconstructive Surgery
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3
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Janssen RMJ, Lustenhouwer R, Cup EHC, van Alfen N, Ijspeert J, Helmich RC, Cameron IGM, Geurts ACH, van Engelen BGM, Graff MJL, Groothuis JT. Effectiveness of an outpatient rehabilitation programme in patients with neuralgic amyotrophy and scapular dyskinesia: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2023; 94:474-481. [PMID: 36697215 DOI: 10.1136/jnnp-2022-330296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is an acute inflammation of nerves within the brachial plexus territory leading to severe pain and multifocal paresis resulting in >60% of patients having residual complaints and functional limitations correlated with scapular dyskinesia. Our primary aim was to compare the effects of multidisciplinary rehabilitation (MR), focused on motor relearning to improve scapular dyskinesia and self-management strategies for reducing pain and fatigue, with usual care (UC) on shoulder, arm and hand functional capability in patients with NA. METHODS In a non-blinded randomised controlled trial (RCT), patients with NA (aged≥18 years, scapular dyskinesia, >8 weeks after onset) were randomised to either an MR or an UC group. MR consisted of a diagnostic multidisciplinary consultation and eight sessions of physical and occupational therapy. Primary outcome was functional capability of the shoulder, arm and hand assessed with the Shoulder Rating Questionnaire-Dutch Language Version (SRQ-DLV). RESULTS We included 47 patients with NA; due to drop-out, there were 22 participants in MR and 15 in UC for primary analysis. The mean group difference adjusted for sex, age and SRQ-DLV baseline score was 8.60 (95%CI: 0.26 to 16.94, p=0.044). The proportion attaining a minimal clinically relevant SRQ-DLV improvement (≥12) was larger for the MR group (59%) than the UC group (33%) with a number needed to treat of 4. CONCLUSION This RCT shows that an MR programme focused on motor relearning to improve scapular dyskinesia, combined with self-management strategies for reducing pain and fatigue, shows more beneficial effects on shoulder, arm and hand functional capability than UC in patients with NA. TRIAL REGISTRATION NUMBER NCT03441347.
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Affiliation(s)
- Renske M J Janssen
- Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renee Lustenhouwer
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Functional Genomics, Faculty of Science, Center for Neurogenomics and Cognitive Research, Vrije Universiteit, Amsterdam, The Netherlands
| | - Edith H C Cup
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Nens van Alfen
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Jos Ijspeert
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Rick C Helmich
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ian G M Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Maud J L Graff
- Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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4
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Naum R, Gwathmey KG. Autoimmune polyneuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:587-608. [PMID: 37562888 DOI: 10.1016/b978-0-323-98818-6.00004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The autoimmune peripheral neuropathies with prominent motor manifestations are a diverse collection of unusual peripheral neuropathies that are appreciated in vast clinical settings. This chapter highlights the most common immune-mediated, motor predominant neuropathies excluding acute, and chronic inflammatory demyelinating polyradiculoneuropathy (AIDP and CIDP, respectively). Other acquired demyelinating neuropathies such as distal CIDP and multifocal motor neuropathy will be covered. Additionally, the radiculoplexus neuropathies, resulting from microvasculitis-induced injury to nerve roots, plexuses, and nerves, including diabetic and nondiabetic lumbosacral radiculoplexus neuropathy and neuralgic amyotrophy (i.e., Parsonage-Turner syndrome), will be included. Finally, the motor predominant peripheral neuropathies encountered in association with rheumatological disease, particularly Sjögren's syndrome and rheumatoid arthritis, are covered. Early recognition of these distinct motor predominant autoimmune neuropathies and initiation of immunomodulatory and immunosuppressant treatment likely result in improved outcomes.
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Affiliation(s)
- Ryan Naum
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - Kelly Graham Gwathmey
- Neuromuscular Division, Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States.
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Lustenhouwer R, Cameron IG, van Alfen N, Toni I, Geurts AC, van Engelen BG, Groothuis JT, Helmich RC. Cerebral Adaptation Associated with Peripheral Nerve Recovery in Neuralgic Amyotrophy: A Randomized Controlled Trial. Neurorehabil Neural Repair 2023; 37:3-15. [PMID: 36575812 PMCID: PMC9896536 DOI: 10.1177/15459683221145149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a common peripheral nerve disorder caused by auto-immune inflammation of nerves in the brachial plexus territory, characterized by acute pain and weakness of the shoulder muscles, followed by motor impairment. Recent work has confirmed that NA patients with residual motor dysfunction have abnormal cerebral sensorimotor representations of their affected upper extremity. OBJECTIVE To determine whether abnormal cerebral sensorimotor representations associated with NA can be altered by specialized, multidisciplinary outpatient rehabilitation focused on relearning motor control. METHODS 27 NA patients with residual lateralized symptoms in the right upper extremity participated in a randomized controlled trial, comparing 17 weeks of multidisciplinary rehabilitation (n = 16) to usual care (n = 11). We used task-based functional MRI and a hand laterality judgment task, which involves motor imagery and is sensitive to altered cerebral sensorimotor representations of the upper extremity. RESULTS Change in task performance and related brain activity did not differ significantly between the multidisciplinary rehabilitation and usual care groups, whereas the multidisciplinary rehabilitation group showed significantly greater clinical improvement on the Shoulder Rating Questionnaire. Both groups, however, showed a significant improvement in task performance from baseline to follow-up, and significantly increased activity in visuomotor occipito-parietal brain areas, both specific to their affected upper extremity. CONCLUSIONS Abnormal cerebral sensorimotor representations of the upper extremity after peripheral nerve damage in NA can recover toward normality. As adaptations occurred in visuomotor brain areas, multidisciplinary rehabilitation after peripheral nerve damage may be further optimized by applying visuomotor strategies. This study is registered at ClinicalTrials.gov (NCT03441347).
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Affiliation(s)
- Renee Lustenhouwer
- Department of Rehabilitation, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands,Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands
| | - Ian G.M. Cameron
- Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands,Faculty of Electrical Engineering,
Mathematics and Computer Science, University of Twente, Enschede, The
Netherlands
| | - Nens van Alfen
- Department of Neurology, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
| | - Ivan Toni
- Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands
| | - Alexander C.H. Geurts
- Department of Rehabilitation, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
| | - Baziel G.M. van Engelen
- Department of Neurology, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands,Jan T. Groothuis, Radboud university
medical center, Department of Rehabilitation, P.O. Box 9101, Nijmegen, 6500 HB,
The Netherlands.
| | - Rick C. Helmich
- Donders Centre for Cognitive
Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud
University, Nijmegen, the Netherlands,Department of Neurology, Radboud
university medical center, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, the Netherlands
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Omura KM, Augusto de Araujo Costa Folha O, Moreira PS, da Silva Bittencourt E, Seabra AD, Cardoso MM. Energy conservation, minimum steps, and adaptations when needed: A scoping review. Hong Kong J Occup Ther 2022; 35:125-136. [PMCID: PMC9716468 DOI: 10.1177/15691861221137223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background/objective Although many therapeutic approaches use energy conservation, only a few effectively report the steps involved. Thus, it is intended to identify energy conservation practices to be organized in flexible and adaptable stages. Methods A scoping review was carried out, whose search strategies were applied in seven databases (CINAHL, Cochrane Library, Portal BVS, PsycINFO, PubMed, Scopus, and Web of Science) following guidelines by Arksey and O’Malley on the Rayyan software. Searches were carried out from January 2010 to December 2020. Inclusion of refered publications with different study designs, participation of adults with or by demands of energy conservation, joint protection, and control of fatigue and/or pain. Exclusion of productions without an occupational therapist or involving merely pharmacological or surgical therapeutic strategies. Results 653 articles were identified, after the selection and eligibility steps, 30 articles were full review, 18 articles were included and 635 excluded. Energy conservation studies have been increasingly focusing on neurological and systemic diseases, especially regarding symptoms of fatigue and pain. The findings were arranged in six strategies whose interventions are essentially based on guidelines and setting goals for patients, client-centered approach. Merely supervised interventions are less frequent. The number of sessions is closed, but the duration of treatment is not yet. Conclusions The signs of pain and fatigue are confirmed as indicators of energy conservation strategies, this delivery can be condensed from planning and organization, priorities, activity analysis, balance between activity and rest, outsourcing of tasks and physical/environmental adaptation. Trial Registration, OSF https://osf.io/rsyq4.
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Affiliation(s)
| | | | | | | | | | - Marcelo Marques Cardoso
- Marcelo Marques Cardoso, Faculty of Physiotherapy and Occupational Therapy, Universidade Federal do Pará, Instituto de Ciências da Saúde – Faculdade de Fisioterapia e Terapia Ocupacional (UFPA, ICS – FFTO), Rua Augusto Corrêa, 01 – Guamá, CEP 66075-110. Belém, Pará – Brasil.
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7
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IJspeert J, Lustenhouwer R, Janssen RM, Han JJ, Hatch MN, Cameron I, Helmich RC, van Engelen B, van der Wees P, Geurts ACH, van Alfen N, Groothuis JT. Reachable workspace analysis is a potential measurement for impairment of the upper extremity in neuralgic amyotrophy. Muscle Nerve 2022; 66:282-288. [PMID: 35665519 PMCID: PMC9544162 DOI: 10.1002/mus.27651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS Neuralgic amyotrophy (NA) is a multifocal neuropathy involving the nerves of the upper extremity, limiting functional capability and reducing range of motion. The reachable workspace (RWS) is a computerized three-dimensinal analysis system that evaluates the relative surface area (RSA) of an individual's arm reachability and has shown utility in several neuromuscular disorders. The aims of this study were to examine the ability of the RWS to quantitatively detect limitations in upper extremity active range of motion in patients with NA, and correlate these with other upper extremity functional outcome measures. METHODS Forty-seven patients with NA and 25 healthy age- and sex-matched controls were measured with the RWS. Study participants' RSAs were correlated with scores on the Shoulder Rating Questionnaire (SRQ), the Disabilities of Arm Shoulder and Hand (DASH) questionnaire, and upper extremity strength measurements using hand-held dynamometry. RESULTS Patients with NA showed significantly lower values in the affected arm for all quadrants (except for the ipsilateral lower quadrant) and total RSA compared with controls (P < 0.001). We found moderate correlations between the reachable workspace, the DASH questionnaire result (r = -0.415), and serratus anterior muscle strength (r = 0.414). DISCUSSION RWS is able to detect limitations in active range of motion of the affected arm in patients with NA, and is moderately correlated with upper extremity functional measures. RWS can demonstrate impairment of the affected upper extremity in NA and it has potential as a clinical outcome measure.
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Affiliation(s)
- Jos IJspeert
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, GA, 6525, The Netherlands
| | - Renee Lustenhouwer
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, GA, 6525, The Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Renske M Janssen
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jay J Han
- Department of Physical Medicine & Rehabilitation, University of California Irvine School of Medicine, Irvine, California
| | - Maya N Hatch
- Department of Physical Medicine & Rehabilitation, University of California Irvine School of Medicine, Irvine, California
| | - Ian Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Rick C Helmich
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip van der Wees
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, GA, 6525, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, GA, 6525, The Netherlands
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8
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Novak P, Cunder K, Petrovič O, Oblak T, Dular K, Zupanc A, Prosič Z, Majdič N. Rehabilitation of COVID-19 patients with respiratory failure and critical illness disease in Slovenia: an observational study. Int J Rehabil Res 2022; 45:65-71. [PMID: 35044993 PMCID: PMC8828317 DOI: 10.1097/mrr.0000000000000513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/12/2021] [Indexed: 12/04/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection often causes pneumonia and respiratory failure that may lead to postintensive care syndrome, including critical illness neuropathy (CIN) and critical illness myopathy (CIM). The data on the rehabilitation outcomes of post-novel coronavirus disease (COVID) patients with CIN and CIM following respiratory failure and mechanical ventilation are still limited. To address this, we enrolled in our prospective observational study a sample of 50 consecutive COVID-19 patients admitted to our facility between 2 November 2020 and 3 May 2021 with electrophysiologically confirmed or clinically suspected diagnosis of CIN/CIM. The functional abilities were assessed at admission and discharge with the Functional Independence Measure (FIM), The Canadian Occupational Performance Measure, 10-metre walk test, 6-min walk test and the de Morton Mobility Index. The gain in motor FIM and the length of stay were used as an index of rehabilitation efficiency. Nutritional status was also assessed using anthropometric measurements and bioelectrical Impedance analysis. Psychologic evaluation was performed at admission only. At admission, functional limitations and severe malnutrition were present in all patients with psychologic problems in about one third. At discharge (42 ± 16 days later), clinically important and statistically significant improvements were found in all outcome measures, which was also noted by the patients. The gain in motor FIM was larger with the longer length of stay up to 2 months and plateaued thereafter. We conclude that post-COVID-19 patients who develop CIN/CIM following respiratory failure can improve functional and nutritional status during inpatient rehabilitation.
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Affiliation(s)
- Primož Novak
- University Rehabilitation Institute
- Medical Faculty, University of Ljubljana, Republic of Slovenia
| | - Katarina Cunder
- University Rehabilitation Institute
- Medical Faculty, University of Ljubljana, Republic of Slovenia
| | | | | | | | | | | | - Neža Majdič
- University Rehabilitation Institute
- Medical Faculty, University of Ljubljana, Republic of Slovenia
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Lustenhouwer R, Cameron IGM, Wolfs E, van Alfen N, Toni I, Geurts ACH, van Engelen BGM, Groothuis JT, Helmich RC. OUP accepted manuscript. Brain Commun 2022; 4:fcac034. [PMID: 35233524 PMCID: PMC8882006 DOI: 10.1093/braincomms/fcac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/03/2021] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
Abstract
Neuralgic amyotrophy is a common peripheral nerve disorder caused by autoimmune inflammation of the brachial plexus, clinically characterized by acute pain and weakness of the shoulder muscles, followed by motor impairment. Despite recovery of the peripheral nerves, patients often have residual motor dysfunction of the upper extremity, leading to persistent pain related to altered biomechanics of the shoulder region. Building on clinical signs that suggest a role for cerebral mechanisms in these residual complaints, here we show and characterize cerebral alterations following neuralgic amyotrophy. Neuralgic amyotrophy patients often develop alternative motor strategies, which suggests that (mal)adaptations may occur in somatomotor and/or visuomotor brain areas. Here, we tested where changes in cerebral sensorimotor representations occur in neuralgic amyotrophy, while controlling for altered motor execution due to peripheral neuropathy. We additionally explore the relation between potential cerebral alterations in neuralgic amyotrophy and clinical symptoms. During functional MRI scanning, 39 neuralgic amyotrophy patients with persistent, lateralized symptoms in the right upper extremity and 23 matched healthy participants solved a hand laterality judgement task that can activate sensorimotor representations of the upper extremity, across somatomotor and visuomotor brain areas. Behavioural and cerebral responses confirmed the involvement of embodied, sensorimotor processes across groups. Compared with healthy participants, neuralgic amyotrophy patients were slower in hand laterality judgement and had decreased cerebral activity specific to their affected limb in two higher-order visual brain regions: the right extrastriate cortex and the parieto-occipital sulcus. Exploratory analyses revealed that across patients, extrastriate activity specific to the affected limb decreased as persistent pain increased, and affected limb-related parieto-occipital activity decreased as imagery performance of the affected limb became slower. These findings suggest that maladaptive cerebral plasticity in visuomotor areas involved in sensorimotor integration plays a role in residual motor dysfunction and subsequent persistent pain in neuralgic amyotrophy. Rehabilitation interventions that apply visuomotor strategies to improve sensorimotor integration may help to treat neuralgic amyotrophy patients.
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Affiliation(s)
- Renee Lustenhouwer
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Ian G. M. Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Donders Centre for Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO BOX 217, 7500 AE Enschede, The Netherlands
| | - Elze Wolfs
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Baziel G. M. van Engelen
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Rick C. Helmich
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Correspondence to: Rick Helmich Department of Neurology, Radboud University Medical Center PO Box 9101, 6500 HB Nijmegen, The Netherlands E-mail:
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Abstract
PURPOSE OF REVIEW This review focuses on the current insights and developments in neuralgic amyotrophy (NA), an auto-immune multifocal peripheral nervous system disorder that leaves many patients permanently impaired if not recognized and treated properly. RECENT FINDINGS NA is not as rare as previously thought. The phenotype is broad, and recent nerve imaging developments suggest that NA is the most common cause of acute anterior or posterior interosseous nerve palsy. Phrenic nerve involvement occurs in 8% of all NA patients, often with debilitating consequences. Acute phase treatment of NA with steroids or i.v. immunoglobulin may benefit patients. Long-term consequences are the rule, and persisting symptoms are mainly caused by a combination of decreased endurance in the affected nerves and an altered posture and movement pattern, not by the axonal damage itself. Patients benefit from specific rehabilitation treatment. For nerves that do not recover, surgery may be an option. SUMMARY NA is not uncommon, and has a long-term impact on patients' well-being. Early immunomodulating treatment, and identifying phrenic neuropathy or complete nerve paralysis is important for optimal recovery. For persistent symptoms a specific treatment strategy aiming at regaining an energy balance and well-coordinated scapular movement are paramount.
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11
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Pepin ME, Chan D. Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy. Physiother Theory Pract 2020; 38:1078-1089. [PMID: 32892675 DOI: 10.1080/09593985.2020.1815260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE AND PURPOSE Shoulder symptoms are often encountered in physical therapy and a myriad of etiologies can cause these symptoms, either locally or remotely. The purpose of this case report is to describe the physical therapist's differential diagnostic process for a patient with acute and severe onset of shoulder pain. Case Description: The patient was a 37-year-old female with sudden onset of right shoulder pain that awakened her at night. Pain was associated with decreased range of motion and shoulder weakness. Faced with an uncertain diagnosis, the physical therapist followed a systematic approach to clinical decision-making. Outcomes: Neuralgic amyotrophy was the primary diagnostic hypothesis but other causes of shoulder pain could not be ruled out. Conclusion: The clinical decision-making process helped the physical therapist narrow down the differential diagnosis list and make a decision to send the patient for further testing. Magnetic resonance imaging and electromyogram confirmed the diagnosis of neuralgic amyotrophy.
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Affiliation(s)
- Marie-Eve Pepin
- Physical Therapy Program, Wayne State University, Detroit, MI, USA
| | - Derek Chan
- Center for Athletic Medicine, Henry Ford Health Care System, Detroit, MI, USA
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12
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Lustenhouwer R, Cameron IGM, van Alfen N, Oorsprong TD, Toni I, van Engelen BGM, Groothuis JT, Helmich RC. Altered sensorimotor representations after recovery from peripheral nerve damage in neuralgic amyotrophy. Cortex 2020; 127:180-190. [PMID: 32203744 DOI: 10.1016/j.cortex.2020.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/15/2019] [Accepted: 02/06/2020] [Indexed: 12/19/2022]
Abstract
Neuralgic amyotrophy is a common peripheral nerve disorder caused by acute autoimmune inflammation of the brachial plexus. Subsequent weakness of the stabilizing shoulder muscles leads to compensatory strategies and abnormal motor control of the shoulder. Despite recovery of peripheral nerves and muscle strength over time, motor dysfunction often persists. Suboptimal motor recovery has been linked to maladaptive changes in the central motor system in several nervous system disorders. We therefore hypothesized that neuralgic amyotrophy patients with persistent motor dysfunction may have altered cerebral sensorimotor representations of the affected upper limb. To test this hypothesis, 21 neuralgic amyotrophy patients (mean age 45 ± 12 years, 5 female) with persistent lateralized symptoms in the right upper limb and 20 age- and sex-matched healthy controls, all right-handed, performed a hand laterality judgement task in a cross-sectional comparison. Previous evidence has shown that to solve this task, subjects rely on sensorimotor representations of their own upper limb, using a first-person imagery perspective without actual motor execution. This enabled us to investigate altered central sensorimotor representations while controlling for altered motor output and altered somatosensory afference. We found that neuralgic amyotrophy patients were specifically less accurate for laterality judgments of their affected right limb, as compared to healthy controls. There were no significant group differences in reaction times. Both groups used a first-person imagery perspective, as evidenced by changes in reaction times as a function of participants' own arm posture. We conclude that cerebral sensorimotor representations of the affected upper limb are altered in neuralgic amyotrophy patients. This suggests that maladaptive central neuroplasticity may occur in response to peripheral nerve damage, thereby contributing to motor dysfunction. Therapies focused on altering cerebral sensorimotor representations may help to treat peripheral nerve disorders such as neuralgic amyotrophy.
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Affiliation(s)
- Renee Lustenhouwer
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Ian G M Cameron
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Nens van Alfen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Neurology, Nijmegen, the Netherlands.
| | - Talitha D Oorsprong
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Ivan Toni
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands.
| | - Baziel G M van Engelen
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Neurology, Nijmegen, the Netherlands.
| | - Jan T Groothuis
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Rehabilitation, Nijmegen, the Netherlands.
| | - Rick C Helmich
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, the Netherlands; Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Medical Neuroscience, Department of Neurology, Nijmegen, the Netherlands.
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13
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Alfen N. Trapped or twisted? Teasing out anterior interosseous neuropathy. Muscle Nerve 2020; 61:268-270. [DOI: 10.1002/mus.26811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Nens Alfen
- Department of Neurology and Clinical Neurophysiology 920, Donders Institute for Brain, Cognition and BehaviorRadboud University Medical Center Nijmegen The Netherlands
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14
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IJspeert J, Kerstens HCJW, Janssen RMJ, Geurts ACH, van Alfen N, Groothuis JT. Validity and reliability of serratus anterior hand held dynamometry. BMC Musculoskelet Disord 2019; 20:360. [PMID: 31391035 PMCID: PMC6686461 DOI: 10.1186/s12891-019-2741-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/25/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Strength testing of the serratus anterior muscle with hand held dynamometry (HDD) in supine subjects has low reproducibility, and is influenced by compensatory activity of other muscles like the pectoralis major and upper trapezius. Previously, two manual maximum voluntary isometric contraction tests of the serratus anterior muscle were reported that recruited optimal surface electromyography (sEMG) activity in a sitting position. We adapted three manual muscle tests to make them suitable for HHD and investigated their validity and reliability. METHODS Twenty-one healthy adults were examined by two assessors in one supine and two seated positions. Each test was repeated twice. Construct validity was determined by evaluating force production (assessed with HHD) in relation to sEMG of the serratus anterior, upper trapezius and pectoralis major muscles, comparing the three test positions. Intra- and interrater reliability were determined by calculating intra-class correlation coefficients (ICC) smallest detectable change (SDC) and standard error of measurement (SEM). RESULTS Serratus anterior muscle sEMG activity was most isolated in a seated position with the humerus in 90° anteflexion in the scapular plane. This resulted in the lowest measured force levels in this position with a mean force of 296 N (SEM 15.8 N). Intrarater reliability yielded an ICC of 0.658 (95% CI 0.325; 0.846) and an interrater reliability of 0.277 (95% CI -0.089;0.605). SDC was 127 Newton, SEM 45.8 Newton. CONCLUSION The results indicate that validity for strength testing of the serratus anterior muscle is optimal with subjects in a seated position and the shoulder flexed at 90° in the scapular plane. Intrarater reliability is moderate and interrater reliability of this procedure is poor. However the high SDC values make it difficult to use the measurement in repeated measurements.
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Affiliation(s)
- Jos IJspeert
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hans C. J. W. Kerstens
- Department of paramedical studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Renske M. J. Janssen
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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15
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Lustenhouwer R, van Alfen N, Cameron IGM, Toni I, Geurts ACH, Helmich RC, van Engelen BGM, Groothuis JT. NA-CONTROL: a study protocol for a randomised controlled trial to compare specific outpatient rehabilitation that targets cerebral mechanisms through relearning motor control and uses self-management strategies to improve functional capability of the upper extremity, to usual care in patients with neuralgic amyotrophy. Trials 2019; 20:482. [PMID: 31391076 PMCID: PMC6686223 DOI: 10.1186/s13063-019-3556-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background Neuralgic amyotrophy (NA) is a distinct peripheral neurological disorder of the brachial plexus with a yearly incidence of 1/1000, which is characterised by acute severe upper extremity pain. Weakness of the stabilising shoulder muscles in the acute phase leads to compensatory strategies and abnormal motor control of the shoulder - scapular dyskinesia. Despite peripheral nerve recovery, scapular dyskinesia often persists, leading to debilitating residual complaints including pain and fatigue. Evidence suggests that persistent scapular dyskinesia in NA may result from maladaptive cerebral neuroplasticity, altering motor planning. Currently there is no proven effective causative treatment for the residual symptoms in NA. Moreover, the role of cerebral mechanisms in persistent scapular dyskinesia remains unclear. Methods NA-CONTROL is a single-centre, randomised controlled trial comparing specific rehabilitation to usual care in NA. The rehabilitation programme combines relearning of motor control, targeting cerebral mechanisms, with self-management strategies. Fifty patients will be included. Patients are recruited through the Radboud university medical center Nijmegen, the Netherlands. Patients with a (suspected) diagnosis of NA, with lateralized symptoms and scapular dyskinesia in the right upper extremity, who are 18 years or older and not in the acute phase can be included. The primary outcome is the Shoulder Rating Questionnaire score, which measures functional capability of the upper extremity. Secondary clinical outcomes include measures of pain, fatigue, participation, reachable workspace, muscle strength and quality of life. In addition, motor planning is assessed with first-person motor imagery and functional magnetic resonance imaging. In a sub-study the patients are compared to 25 healthy participants, to determine the involvement of cerebral mechanisms. This will enable interpretation of cerebral changes associated with the rehabilitation programme and functional impairments in NA. Discussion NA-CONTROL is the first randomised trial to investigate the effect of specific rehabilitation on residual complaints in NA. It also is the first study into the cerebral mechanisms that might underlie persistent scapular dyskinesia in NA. It thus may aid the further development of mechanism-based interventions for disturbed motor control in NA and in other peripheral neurological disorders. Trial registration ClinicalTrials.gov, NCT03441347. Registered on 20 February 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3556-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Renee Lustenhouwer
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Ian G M Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Ivan Toni
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Rick C Helmich
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.,Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
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16
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Janssen RMJ, Satink T, Ijspeert J, van Alfen N, Groothuis JT, Packer TL, Cup EHC. Reflections of patients and therapists on a multidisciplinary rehabilitation programme for persons with brachial plexus injuries. Disabil Rehabil 2018; 41:1427-1434. [PMID: 29385821 DOI: 10.1080/09638288.2018.1430175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE There is lack of knowledge, evidence, and guidelines for rehabilitation interventions for persons with neuralgic amyotrophy (NA) or brachial plexus pathology. A first pilot study, evaluating the effect of an integrated rehabilitation programme, showed improvements in activity and participation levels. AIM To gain insight, from the perspective of patients and therapists, into the critical ingredients of the programme, that contributed to improvements in activity and participation. MATERIALS AND METHODS A qualitative study using semi-structured interviews with eight patients and five therapists (three occupational therapists and two physical therapists). Participants were asked to identify and describe factors regarding the rehabilitation that they perceived as positive and aspects of the programme that could be improved. Data were analysed using a constant comparative approach. RESULTS Patients reported (1) Time to diagnose: "Finally I'm in the right place;" (2) Awareness: "They gave me a mirror;" (3) Partnership: "There was real contact with the therapists; we made decisions together;" (4) Close collaboration: "Overlapping scopes of practice; doing the same from a different perspective;" and finally (5) Self-management: "Now I can do it myself." Therapists reported (1) "Patients knowledge and understanding is critical to success;" (2) "Activate problem solving and decision making;" (3) "Personalize your therapy; it's more than just giving exercises and information;" (4) "Constant consultation within the team; consistency in messages and approach;" and (5)" Ultimately the patient is in charge." CONCLUSIONS The critical ingredients, correspond well with each other and include a person-centred approach, education, support in problem solving and decision making and an integrated team approach. These ingredients provided the patients with confidence to take responsibility to manage their everyday lives, the ultimate goal of the programme. Implications for rehabilitation Both patients and therapists believe that the ability to self-manage and take control should be the outcome of high quality integrated rehabilitation programmes for patients with neuralgic amyotrophy and/or other brachial plexus injuries. A person-centred, collaborative, and integrated team approach, among all members of the team, are critical components of care delivery in personalised interventions. Critical programme ingredients are knowledge and education of both the patient and therapists; partnership between patient-therapist and within the team; patient activation and self-reflection; and personalised care. Patients recommend more options for personalisation of the intensity and duration of rehabilitation, the possibility to consult a psychologist and peer support within a group setting.
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Affiliation(s)
- Renske M J Janssen
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Ton Satink
- b Department of Occupational Therapy , HAN University of Applied Sciences , Nijmegen , The Netherlands
| | - Jos Ijspeert
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Nens van Alfen
- c Department of Neurology and Clinical Neurophysiology , Donders Center for Medical Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Jan T Groothuis
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tanya L Packer
- d School of Occupational Therapy , Dalhousie University , Halifax , Canada
| | - Edith H C Cup
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
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17
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Zhang S, Zhang LQ, Wright M, Gater DR. Challenging Diagnosis and Inpatient Rehabilitation of Acute Bilateral Neuralgic Amyotrophy Possibly Attributed to Lyme Disease: A Case Report. PM R 2017; 10:770-774. [PMID: 29277293 DOI: 10.1016/j.pmrj.2017.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 11/22/2017] [Accepted: 11/29/2017] [Indexed: 11/25/2022]
Abstract
Neuralgic amyotrophy (NA) is a neurologic syndrome of unknown etiology primarily affecting the brachial plexus. We are reporting an unusual case of acute bilateral NA that was possibly secondary to Lyme disease. The patient demonstrated significant functional gains and was discharged home after 2 weeks of inpatient rehabilitation, supporting the role of inpatient rehabilitation in acute NA. In this report, we discuss the diagnosis, electrodiagnostic progression, pain management, goals for inpatient rehabilitation, and overall prognosis of NA. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Shangming Zhang
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Rehabilitation Hospital, Penn State Hershey Medical Center, Hershey, PA 17033.,Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH.,Department of Physical Medicine and Rehabilitation, Penn State Hershey Rehabilitation Hospital, Penn State Hershey Medical Center, Hershey, PA
| | - Lucy Q Zhang
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Rehabilitation Hospital, Penn State Hershey Medical Center, Hershey, PA 17033.,Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH.,Department of Physical Medicine and Rehabilitation, Penn State Hershey Rehabilitation Hospital, Penn State Hershey Medical Center, Hershey, PA
| | - Megan Wright
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Rehabilitation Hospital, Penn State Hershey Medical Center, Hershey, PA 17033.,Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH.,Department of Physical Medicine and Rehabilitation, Penn State Hershey Rehabilitation Hospital, Penn State Hershey Medical Center, Hershey, PA
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Rehabilitation Hospital, Penn State Hershey Medical Center, Hershey, PA 17033.,Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH.,Department of Physical Medicine and Rehabilitation, Penn State Hershey Rehabilitation Hospital, Penn State Hershey Medical Center, Hershey, PA
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18
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Yang SY, Lin CY, Lee YC, Chang JH. The Canadian occupational performance measure for patients with stroke: a systematic review. J Phys Ther Sci 2017; 29:548-555. [PMID: 28356652 PMCID: PMC5361031 DOI: 10.1589/jpts.29.548] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/01/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated whether the Canadian Occupational Performance Measure is a suitable outcome measure for assessing patients with stroke in research and clinical settings. [Subjects and Methods] The study included into two parts: (1) an investigation of the reliability and validity of the Canadian Occupational Performance Measure for patients with stroke and (2) an exploration of Canadian Occupational Performance Measure results in randomized controlled trials of patients with stroke. For this review, the study searched the MEDLINE, PubMed, and CINAHL Plus with Full Text databases for articles published before September 2015. [Results] Finally, three eligible articles were collected in part 1, and ten randomized controlled trials studies were collected in part 2. The findings of part 1 revealed that the Canadian Occupational Performance Measure had efficient test-retest reliability, however, the Canadian Occupational Performance Measure revealed weak associations with other assessment tools such as Barthel Index used for patients with stroke. Six of the randomized controlled trials studies used the Canadian Occupational Performance Measure as a primary outcome and two as a secondary outcome, while the other two as a goal-setting instrument. [Conclusion] This review indicates that the Canadian Occupational Performance Measure is appropriate for clinicians, including physiotherapists, in assessing outcome for patients with stroke. The Canadian Occupational Performance Measure can assist patients in identifying their outcome performance and provide therapists with directions on interventions.
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Affiliation(s)
- Shang-Yu Yang
- Department of Occupational Therapy, Shu Zen Junior College
of Medicine and Management, Taiwan
- Institute of Allied Health Science, College of Medicine,
National Cheng Kung University: No.1 University Road, Tainan City 701, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health
and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and
Health Science, Asia University, Taiwan
| | - Jer-Hao Chang
- Institute of Allied Health Science, College of Medicine,
National Cheng Kung University: No.1 University Road, Tainan City 701, Taiwan
- Department of Occupational Therapy, College of Medicine,
National Cheng Kung University, Taiwan
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19
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Finsterer J, Zarrouk-Mahjoub S. Treatment of muscle weakness in neuromuscular disorders. Expert Rev Neurother 2016; 16:1383-1395. [PMID: 27376189 DOI: 10.1080/14737175.2016.1206471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Weakness is one of the predominant clinical manifestations of neuromuscular disorders (NMDs), which strongly influences daily life, prognosis, and outcome of affected patients. One of the major therapeutic goals in NMD-patients is to completely resolve muscle weakness. Various treatment options are available and include physical therapy, electrotherapy, diet, drugs, avoidance or withdrawal of muscle-toxic and weakness-inducing agents, detoxification, stem-cell-therapy, plasma-exchange, respiratory therapy, or surgery. Most accessible to treatment is weakness from immune-mediated neuropathies, immune-mediated transmission-disorders, and idiopathic immune myopathies. Areas covered: This manuscript aims to summarize and discuss recent findings and future perspectives concerning the treatment of muscle weakness in NMDs. Data were obtained by a literature search in databases such as PubMed and Current-Contents. Expert commentary: Weakness is most easily treatable in acquired NMDs and in hereditary myopathies and neuropathies beneficial treatment options are also available. Research needs to be encouraged and intensified to further expand the spectrum of treatment options for weakness.
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20
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Van Eijk JJJ, Groothuis JT, Van Alfen N. Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment. Muscle Nerve 2016; 53:337-50. [PMID: 26662794 DOI: 10.1002/mus.25008] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 12/21/2022]
Abstract
In this review we provide a current overview of the clinical features, pathophysiology, epidemiology, and diagnostic and therapeutic strategies in neuralgic amyotrophy (NA). The disorder has several phenotypic variations, with a classic form in 70% of the patients. It is not rare, with an incidence of 1 per 1,000 individuals, but it is still often missed. Recurrences are common, yet the proposed multifactorial etiology, which includes genetic, biomechanical, and immunologic factors, limits our capacity to predict or prevent them. NA is a clinical diagnosis, and ancillary studies serve to exclude infectious or malignant causes or to assess a differential diagnosis. If patients are seen early and are still in pain, a short trial of high-dose oral corticosteroids is advised, and adequate analgesia may require opioids and non-steroidal anti-inflammatory drugs. Persistent complaints are common, and a multidisciplinary rehabilitation approach focusing on scapular coordination, energy distribution strategies, and self-management is indicated.
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Affiliation(s)
- Jeroen J J Van Eijk
- Department of Neurology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.,Department of Neurology and Clinical Neurophysiology, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Center, P.O. Box 9101, 6500, HB Nijmegen, The Netherlands
| | - Nens Van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Incidence of neuralgic amyotrophy (Parsonage Turner syndrome) in a primary care setting--a prospective cohort study. PLoS One 2015; 10:e0128361. [PMID: 26016482 PMCID: PMC4445915 DOI: 10.1371/journal.pone.0128361] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/26/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Neuralgic amyotrophy is considered a rare peripheral nervous system disorder but in practice seems grossly under recognized, which negatively affects care for these patients. In this study we prospectively counted the one-year incidence rate of classic neuralgic amyotrophy in a primary care setting. METHODS In a prospective cohort study during the year 2012 we registered all new cases of neck, shoulder or arm complaints from two large primary care centers serving a population of 14,118. Prior to study, general practitioners received a short training on how to diagnose classic neuralgic amyotrophy. Neuralgic amyotrophy was defined according to published criteria irrespective of family history. Only patients with a classic phenotype were counted as definite cases. After inclusion, patients with suspected neuralgic amyotrophy who had not yet seen a neurologist were offered neurologic evaluation for diagnostic confirmation. RESULTS Of the 492 patients identified with new onset neck, shoulder or arm complaints, 34 were suspected of having neuralgic amyotrophy. After neurologic evaluation the diagnosis was confirmed in 14 patients. This amounts to a one-year incidence rate for classic neuralgic amyotrophy of 1 per 1000. CONCLUSIONS Our findings suggest that neuralgic amyotrophy is 30-50 times more common than previously thought. Unawareness of the disorder and its clinical presentation seems the most likely explanation for this difference. An incidence rate of 1 per 1000 and the long-term sequelae many patients suffer warrant more vigilance in diagnosing the disorder, to pave the way for timely treatment and prevent complications.
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