Efficacy and Safety of Short-Term Use of COX-2 Inhibitors in Patients After an Acute Stroke With Musculoskeletal Pain.

Efficacy and safety of short-term use of COX-2 inhibitors in patients after an acute stroke with musculoskeletal pain.

Ann Indian Acad Neurol. 2013 Jan; 16(1): 47-52
Rabadi MH, Rabadi FM, Hallford G, Aston CE

Musculoskeletal pain commonly occurs in the elderly, many of whom are also prone to suffer from strokes. We studied whether short-term use (? 4 weeks) of cyclooxygenase-2 (COX-2) inhibitors for musculoskeletal pain in stroke patients helped them to participate in their therapies and was safe and efficacious.Three hundred and three patients admitted consecutively with first ischemic stroke were studied. Two cohorts were defined, based on whether patients with acute stroke had sufficient musculoskeletal pain that warranted oral COX-2 inhibitors (COX-2 group) or not (case-matched controls). Primary efficacy measures were change in Fugl-Meyer (F-M) pain score and change in total functional independence measure (TFIM) scores on discharge from hospital. Safety was judged by the incidence of vascular episodes during the study period.From the original 303 patients, 64 patients in the COX-2 group were matched with 64 patients in the non-COX-2 group. The groups were matched for age (±5 years), gender, and admission TFIM score (± 5 points). Baseline characteristics between the 2 groups were similar. The primary and secondary outcome measures were similar between the 2 groups, except for ambulation endurance, which favored the non-COX-2 group (P < 0.03). Greater change in the pain score (less pain) was found in the COX-2 group; this effect was strongest in patients who were independent prior to their stroke (on post hoc analysis). There were too few adverse events in either group of any significance.The short-term use of COX-2 inhibitors reduced musculoskeletal pain in acute stroke patients, improved functional motor outcome, and were found to be safe. HubMed – rehab


Urodynamic profile of patients with neurogenic bladder following non-traumatic myelopathies.

Ann Indian Acad Neurol. 2013 Jan; 16(1): 42-6
Gupta A, Taly AB

To observe the urodynamic profile of the patients following non-traumatic myelopathies (NTMs) with neurogenic bladder.Neurological rehabilitation department of university tertiary research hospital.Seventy-nine patients (44 men) with monophasic NTM, with the age range 8-65 years (31.0 ± 16.0 years), were admitted for inpatients’ rehabilitation. Length of stay in rehabilitation ranged from 6 to 120 days (32.0 ± 24.8 days). Fifty-six patients (70.9%) had spinal lesion above D10, 17 had lesion between D10 and L2 (21.5%), and 6 (7.6%) had cauda equina syndrome. All patients had neurogenic bladder with urinary complaints. Urodynamic study (UDS) was performed in all patients.UDS showed 71.4% patients (40/56) had neurogenic detrusor overactivity (NDO) with or without sphincter dyssynergy (DSD) with lesion above D10; only 52.9% patients (9/17) had NDO with or without DSD detrusor with lesion between D10 and L2; and majority (5/6 patients) had underactive detrusor in the cauda equina group. Bladder management was based on the UDS findings. No significant correlation was found (P > 0.05) between detrusor behavior and the level, severity (ASIA Impairment Scale) of spinal injury, or gender using chi-square test.Neurogenic bladder following NTM was observed in all patients. UDS suggested predominantly NDO in lesions above D10 and mixed pattern in between D10 and L2 lesions. No significant correlation was found between detrusor behavior and the level or severity of NTM in the study. HubMed – rehab


Symptomatic lobar intracerebral haemorrhage preceded by transient focal neurological episodes.

BMJ Case Rep. 2013; 2013:
Hurford R, Charidimou A, Werring D

We report the case of a symptomatic intracerebral haemorrhage (ICH) in an elderly woman, secondary to cerebral amyloid angiopathy (CAA), and present the relevant imaging. A few months before, our patient experienced multiple, stereotyped, brief episodes of spreading paraesthesias, which were considered to be transient ischaemic attacks (TIAs) and treated with antithrombotic agents. In this case report, we explore CAA, a highly prevalent but under-recognised form of small vessel cerebrovascular disease and common cause of ICH. We then briefly discuss the clinical significance of transient focal neurological episodes in the context of CAA, as potential warning signs of future ICH. An important clinical message is that misdiagnosis of CAA-related focal neurological symptoms as TIAs (and prescribing antithrombotic drugs) could lead to potentially avoidable ICH. We also provide the current evidence base for the acute and secondary prevention treatment of patients with lobar ICH attributed to CAA, and discuss the prognosis. HubMed – rehab


Arm movements can increase leg muscle activity during sub-maximal recumbent stepping in neurologically intact individuals.

J Appl Physiol. 2013 May 9;
Kam DD, Rijken H, Manintveld T, Nienhuis B, Dietz V, Duysens J

Facilitation of leg muscle activity by active arm movements during locomotor tasks could be beneficial during gait rehabilitation after spinal cord injury. The present study explored the effects of arm movements on leg muscle activity during sub-maximal recumbent stepping. Healthy subjects exercised on a recumbent stepping machine both with and without arm movements. Activity of five leg muscles was recorded and compared for stepping with and without arm movements. To determine which arm movements are optimal for leg muscle facilitation, subjects were instructed to step with 1) mechanically coupled vs. decoupled arm and leg movements, 2) synchronous (SYNC) vs. asynchronous (ASYNC) arm movements and 3) at 50 vs. 70 revolutions per minute (RPM). Leg muscle activity was increased by active arm movements in all muscles, except the vastus lateralis (VL) muscle. Activity of other extensors (soleus (SO), medial gastrocnemius (MG) and biceps femoris (BF)) was primarily increased during the extension phase whereas activity of flexors (tibialis anterior (TA)) was also increased during the flexion phase. Facilitation was more or less consistent for both frequencies and for SYNC and ASYNC movements. For coupled arm movements facilitation tended to be diminished or absent. The observed facilitation in the present study is probably of neuromuscular rather than of biomechanical origin, since the arms are probably hardly involved in postural control or weight-bearing during recumbent stepping. Further studies in patients should explore the possibility to integrate neuromuscular facilitation in rehabilitation programs. HubMed – rehab



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