Comparative Assessment of Two Robot-Assisted Therapies for the Upper Extremity in People With Chronic Stroke

OBJECTIVE

We investigated the effects on motor and daily function of robot-assisted therapies in people with chronic stroke using the Bi-Manu-Track (BMT) and InMotion 3.0 (IMT) compared with control treatment (CT).

METHOD

In this comparative efficacy trial, 30 participants were randomized to receive BMT, IMT, or CT. Outcome measures included the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), and Medical Research Council (MRC) scale.

RESULTS

The IMT group improved more in FMA and proximal MAS scores than the BMT group (both ps < .01) and the CT group (p < .01 and p = .03, respectively). The IMT and BMT groups showed clinically relevant improvements after treatment on the MRC rather than the MAL.

CONCLUSION

The results indicate that the IMT might improve motor function. The IMT and BMT groups showed similar benefits for muscle power but limited improvements in self-perceived use of the affected arm.

Construction of a tissue engineered intervertebral disc with high biological activity using an allogeneic intervertebral disc supplemented with transfected nucleus pulposus cells expressing exogenous dopamine beta-hydroxylase

This study addressed the in vitro construction and biological activity of tissue engineered intervertebral discs with exogenous human dopamine beta-hydroxylase (DBH) nucleus pulposus cells. pSNAV2.0-DBH expression plasmids were utilized to enhance the survival rates of intervertebral disc tissue cells. Various concentrations of transfected nucleus pulposus cells were injected into the discs, and DBH mRNA expression was determined using polymerase chain reaction amplification. Polysaccharide content and total collagen protein content in the engineered disc nucleus pulposus tissue were determined. The visible fluorescence intensities of the 1 x 10(5) and 1 x 10(6) groups vs the 1 x 10(4) group were significantly increased (P < 0.05); no significant difference was observed between the 1 x 10(5) and 1 x 10(6) groups (P > 0.05) at 7 days after injection. DBH mRNA expression could be detected in the all but the EGFP control group at 14 days culture. No significant difference was observed in the protein content between the 1 x 10(4) and the control groups at various times, while the protein content was significantly higher in the 1 x 10(5) vs the control and the 1 x 10(4) groups at 7-, 14-, and 21-day cultures. These results demonstrate that a tissue engineered intervertebral disc with high biological activity can be constructed by utilizing allogeneic intervertebral discs stored in liquid nitrogen and a 1 x 10(5) transfected nucleus pulposus cell complex with in vitro culture for 14 days. This model can be used in animal experiments to study the biological activity of the engineered discs.

Relative and absolute reliabilities of the myotonometric measurements of hemiparetic arms in patients with stroke

OBJECTIVE

To investigate the relative and absolute reliabilities of the myotonometer.

DESIGN

Psychometric study.

SETTING

Three medical centers.

PARTICIPANTS

Patients with stroke (N=61).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Muscle tone, elasticity, and stiffness of relaxed affected deltoid, triceps brachii, biceps brachii, extensor digitorum, flexor carpi radialis, and flexor carpi ulnaris were measured twice, 30 minutes apart, using the myotonometer. Intraclass correlation coefficient, a relative reliability index, was calculated for 3 muscular properties and for each muscle to examine the degree of consistency and agreement between the 2 test sessions. Absolute reliability indices, including the SEM, smallest real difference, and Bland-Altman limits of agreement, were used to quantify measurement errors and check systematic biases of the 2 test sessions.

RESULTS

The intraclass correlation coefficients were .83 to .95 for muscle tone, elasticity, and stiffness of all muscle groups. The SEM and the smallest real difference of muscle tone, elasticity, and stiffness of the biceps were the smallest among the 6 muscles tested. The Bland-Altman analyses showed no systematic bias between most of the repeated measurements. Compared with other muscles, biceps had narrower limits-of-agreement ranges, indicating that the myotonometric measurements of the biceps had higher stability and less variation over time.

CONCLUSIONS

The myotonometer reliably measures muscular properties, with good relative and absolute reliabilities. These findings are useful for clinicians and researchers to assess muscle properties reliably and determine whether a real change has occurred in groups and on individual levels of patients with stroke.

The challenge of diagnosing psoas abscess

Diagnosing psoas abscess in patients with low back pain might be hampered by their atypical symptoms. We describe a case in which a 39-year-old retired provost marshal presented to our emergency facility with acute onset of low back pain following an episode of lumbar strain during a flight. His initial computed tomography of lumbar spine and abdominal sonography were inconclusive. Two weeks later, he was admitted to our rehabilitation unit for similar symptoms. One day later, leukocytosis and elevated c-reactive protein following rising body temperature were found. Fever of unknown origin (FUO) was impressed after series of laboratory studies. However, an inflammatory gallium scan performed 2 weeks later due to persistent fever revealed active infection in the L4 vertebra and soft tissue of the L5 paraspinal region. MRI was then performed and demonstrated abnormal enhancement at the bodies of the L2 and L3 vertebrae, prevertebral soft tissue and bilateral psoas muscles. A CT-guided percutaneous aspiration of 10 cc yellowish pus was attained, which yielded no pathogens. His symptoms subsided 1 week after being given appropriate antibiotics. This case showed the importance of nuclear scanning and MRI in patients with low back pain and FUO. It also suggests that repeated imaging study and/or other modality should be considered when the initial imaging result is not compatible with the clinical presentation of psoas abscess, which was initially missed by image studies.