F. Wuyts

Randomized controlled trial of truncal exercises early after stroke to improve balance and mobility.

Background. Sitting balance and the ability to perform selective truncal movements are important predictors of functional outcome after stroke. However, few clinical trials have evaluated the effect of truncal exercises. Objective. The authors assessed the effect of additional truncal exercises on truncal function, standing balance, and mobility. Methods. An assessor-blinded randomized controlled trial was carried out at a stroke rehabilitation hospital. A total of 33 participants (mean 35 days post onset) were randomly assigned to an experimental group (n = 18) or a control group (n = 15). In addition to conventional therapy, the experimental group received 16 hours of truncal exercises. The control group received 16 hours of sham treatment. Truncal function was evaluated by the Trunk Impairment Scale (TIS) and standing balance and mobility by the Tinetti Test. The Romberg with eyes open and eyes closed, Four Test Balance Scale (FTBS), Berg Balance Scale (BBS), Rivermead Motor Assessment Battery (RMAB), Functional Ambulation Categories, and Dynamic Gait Index (DGI) were performed to elucidate the findings of the primary outcome measures. Results. A treatment effect was found for the experimental group on the TIS (P < .001), Tinetti Test (P < .001), FTBS (P = .014), BBS (P = .007), RMAB (P < .001), and DGI (P = .006). Conclusions. In addition to conventional therapy, truncal exercises have a beneficial effect on truncal function, standing balance, and mobility in people after stroke.

Histomorphometric Study of the Normal Middle Ear Mucosa: Preliminary Results Supporting the Gas-Exchange Function in the Postero-Superior Part of the Middle Ear Cleft

This study concerns the distance between the centre of gravity of blood vessels and the basement membrane of the middle ear cleft mucosa. The measurements were performed perpendicular to the long axis of the cross-section of the vessels, and revealed a significant difference between two regions of the middle ear cleft. At the level of the postero-superior part (epitympanum, aditus ad antrum, mastoid antrum and highest part of the mastoid air cells system), the distance between the blood vessels and the basement membrane of the mucosa was statistically shorter than in the antero-inferior part of the middle ear cleft. This indicates a privileged function of gaseous exchange of the postero-superior part of the middle ear cleft and may divide the middle ear cleft into different functional parts.

Influence of sensory loss on the perception of verticality in stroke patients

Purpose: The aim of this study was to investigate the relationship between somatosensory loss and perception of verticality in stroke patients suffering single-hemisphere lesions. Method: Somatosensory loss was measured using the Rivermead Assessment for Somatosensory Performance (RASP). Perception of verticality was assessed with the Subjective Visual Vertical (SVV) and the Subjective Postural Vertical (SPV) tests. Absolute Values of SVV and SPV were used to analyze the amount of deviation in relation to somatosensory loss. Results: Thirty-two patients were included in the study (mean age = 45.91 SD = 31.88 years). Analysis showed that somatosensory loss was related to results of the SVV (r = −0.552, p = 0.001, Pearson Rank) and the SPV (r = −0.661, p < 0.001, Spearman Ï). Furthermore, results showed that both joint-related (SVV: r = −0.411, p = 0.019, Pearson Rank; SPV: r = −0.597, p = 0.001, Spearman Ï) and skin-related (SVV: r = −0.595, p < 0.001, Pearson Rank; SPV: r = −0.663, p < 0.001, Spearman Ï) somatosensory information is related to verticality perception. Conclusions: This study provides evidence that perception of verticality is related to somatosensory loss, which means that somatosensory loss will lead to a larger amount of deviation of SVV and SPV in relation to the gravitational vector. Furthermore, it is interesting to note that both SVV and SPV are influenced by somatosensory loss. Implications for Rehabilitation Somatosensory information is related to both visual and postural aspects of verticality perception. Both joint- and cutaneous-related modalities of sensory information are related to perception of verticality. Sensory training could be important in the recovery of verticality perception.

INFLUENCE OF SURGICAL BLADDER REDUCTION ON URODYNAMIC PARAMETERS: THREE TECHNIQUES INVESTIGATED IN A RAT MODEL

PURPOSE Bladder wall wrapping and invagination have been used for the surgical treatment of the underactive detrusor and improvement of bladder emptying has been described. In a rat model we investigated the evolution in time of urodynamic parameters after 3 techniques of surgical bladder reduction. MATERIAL AND METHODS Female Wistar rats underwent at random, a bladder reduction with vertical wrapping, the horizontal variant or invagination of the wall. Cystometry was performed before and 30 minutes after surgery, and after 1, 5 and 10 weeks. Sham operated animals had cystometries performed at day 1 and after 1, 5 and 10 weeks. At week 10 contraction of four differently orientated detrusor strips was examined in vitro. A histological study was done. RESULTS Contraction pressure was not improved in vivo after 10 weeks follow-up. Capacity, despite an early significant reduction, became slightly higher than presurgery in both wrapping groups and even significantly higher in the invagination group. In each group residual volume almost doubled. In vitro some strips containing operated parts did contract more strongly than controls but not significantly. Strips which contain operated parts showed slightly increased fibrosis in the invagination and the vertical wrapping group and a huge amount of fibrosis in the horizontal wrapping group. CONCLUSIONS This experiment indicated that the rationales behind the techniques of surgical bladder reduction are not correct. The partial successes in men may be explained by the original intrinsic deficiencies of the detrusor which prevent a secondary bladder enlargement as reaction to the volume reduction.

Respiratory sinus arrhythmia on the ESA-short-arm human centrifuge

In this article, we investigated the hypothesis that the effects of hypergravity on respiratory sinus arrhythmia (RSA) can mimic the effects observed after spaceflight cardiovascular deconditioning. Artificial gravity along the head-to-feet axis on a short-arm centrifuge induces gravity gradients. This physiological condition of significantly higher g at the feet than at the heart level is specific and likely induces blood sequestration in the lower limbs. After spaceflight, astronauts are in a condition of cardiovascular deconditioning, where blood pooling in the lower part of the body and autonomic adaptation are factors contributing to orthostatic intolerance and changes in heart-rate variability (HRV). ECG and respiration were recorded during imposed and controlled breathing (ICB) protocols, which were repeated at different levels of artificial gravity as well as during supine and standing control conditions, and the changes were analyzed.

Short- and Long-Term Outcomes of Uvulopalatopharyngoplasty in Nonapneic Snorers and Obstructive Sleep Apnea Patients

Objectives: The aim of this study was to investigate the short- and long-term effects of uvulopalatopharyngoplasty (UPPP) on the major outcome parameters in nonapneic snorers and obstructive sleep apnea (OSA) patients. In addition, we investigated which factors affect the long-term subjective benefit perceived by the patient. Methods: A questionnaire on snoring, daytime sleepiness, habits and subjective benefit was mailed to 48 patients treated by UPPP because of nonapneic snoring or OSA. The results of this long-term (28 months) follow-up were compared with pre- and postoperative scores for snoring and daytime sleepiness. Each patient had undergone a polysomnography before and 3.5 months after UPPP (short-term follow-up). Results: Thirty-nine patients (27 nonapneic snorers and 12 OSA patients) returned the questionnaire and were eligible for statistical analysis. A significant improvement in snoring and daytime sleepiness was documented both in short- and long-term outcomes for nonapneic snorers as well as OSA patients without a significant improvement of polysomnography variables. Smoking after surgery was found to adversely affect subjective benefit. Conclusions: UPPP results in long-term improvement of clinical symptoms. This improvement is not necessarily accompanied by a decrease in respiratory disturbance index or an amelioration of sleep quality. Persistent smoking decreases the subjective benefit of surgery.

Voice Recognition from Spectrograms: A Wavelet Based Approach

The performance of a pattern recognition technique is usually determined by the ability of extracting useful features from the available data so as to effectively characterize and discriminate between patterns. We describe a novel method for feature extraction from speech signals. For this purpose, we generate spectrograms, which are time-frequency representations of the original signal. We show that, by considering this spectrogram as a textured image, a wavelet transform can be applied to generate useful features for recognizing the speech signal. This method is used for the classification of voice dysphonia. Its performance is compared with another technique taken from the literature. A recognition accuracy of 98% is achieved for the classification between normal an dysphonic voices.

Evaluatie en behandeling van patiënten met benigne paroxysmale positionele vertigo

Veel patienten consulteren een arts wegens duizeligheid en/of een verminderde posturale controle. Duizeligheid is een niet-specifieke klacht en kan het gevolg zijn van sterk uiteenlopende aandoeningen van verschillende organen. Met andere woorden, de differentiele diagnose is breed en dient niet alleen rekening te houden met otologische en neurologische factoren, maar ook met factoren gerelateerd aan bijvoorbeeld interne geneeskunde.

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Präsident: Prof. U. Koch, Hamburg Referatthema: Erkrankungen der Speicheldrüsen Hauptvorträge/Rundtischgespräche: Plastisch-rekonstruktive Verfahren im Kopfund Halsbereich; Der Laser in der Hals-NasenOhren-Heilkunde; Immunologische und molekularbiologische Grundlagenforschung; Wandel von Therapieverfahren durch moderne audiologische und neurootologische Diagnostik; Diagnostik und Therapie funktioneller Störungen im Kopfund Halsbereich. Anmeldungen von Vorträgen oder Postern und Videos: Bitte bis 1. Dezember 2000 (Eingangsstempel) auf einem Originalvordruck an: Geschäftsstelle der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopfund Hals-Chirurgie Hittorfstrasse 7 D–53129 Bonn (Deutschland)

Accuracy of computer navigation in ENT surgery: the influence of the matching strategy

OBJECTIVE To measure the effect of 4 different matching strategies on the accuracy of computer navigation on the face and within the nose and rhinopharynx. DESIGN Survey. SETTING Laboratory study. SUBJECTS Six human cadavers studied within 24 hours of death. INTERVENTIONS A commercially available navigation system with infrared optical tracking was used for computer navigation on the face and within the nose of the subjects after matching with external fiducials or with 3 different configurations of anatomical landmarks. Navigation errors were measured and correlated to matching strategies and compared through statistical analysis. RESULTS Matching with external fiducials on the face results in smaller navigation error than matching with anatomical landmarks. The configuration of matching strategies with anatomical landmarks also significantly determines the accuracy of computer navigation, especially when different locations of accuracy measurement are considered. CONCLUSION Statistically significant findings have shown that the choice of a matching strategy is a major factor in the accuracy of computer navigation for ear, nose, throat surgery. Arch Otolaryngol Head Neck Surg. 2000;126:1462-1466