Nadia Mohd Mustafah

Postural Control and Gait Performance in the Diabetic Peripheral Neuropathy: A Systematic Review

Purpose. The aim of this paper is to review the published studies on the characteristics of impairments in the postural control and gait performance in diabetic peripheral neuropathy (DPN). Methods. A review was performed by obtaining publication of all papers reporting on the postural control and gait performance in DPN from Google Scholar, Ovid, SAGE, Springerlink, Science Direct (SD), EBSCO Discovery Service, and Web of Science databases. The keywords used for searching were “postural control,” “balance,” “gait performance,” “diabetes mellitus,” and “diabetic peripheral neuropathy.” Results. Total of 4,337 studies were hit in the search. 1,524 studies were screened on their titles and citations. Then, 79 studies were screened on their abstract. Only 38 studies were eligible to be selected: 17 studies on postural control and 21 studies on the gait performance. Most previous researches were found to have strong evidence of postural control impairments and noticeable gait deficits in DPN. Deterioration of somatosensory, visual, and vestibular systems with the pathologic condition of diabetes on cognitive impairment causes further instability of postural and gait performance in DPN. Conclusions. Postural instability and gait imbalance in DPN may contribute to high risk of fall incidence, especially in the geriatric population. Thus, further works are crucial to highlight this fact in the hospital based and community adults.

Incomplete paraplegia caused by extramedullary hematopoiesis in a patient with thalassemia intermedia

Introduction:Extramedullary hematopoiesis (EMH) is the production of blood cell precursors outside the bone marrow that occur in various hematological diseases. In patients with thalassemia intermedia, ineffective erythropoiesis drives compensatory EMH in the liver, pancreas, pleura, spleen, ribs and spine.Case Presentation:We describe a patient with thalassemia intermedia who presented with acute neurological symptoms caused by paraspinal EMH, which responded well to combination therapy of steroid, hypertransfusion, laminectomy and excision of pseudotumor and hydroxyurea therapy to boost the formation of fetal haemoglobin.Discussion:Prompt recognition of EMH based on clinical presentation and typical radiological findings should be made. Early treatment is recommended to prevent irreversible damage to the spinal cord.

Prosthetic restoration in patient with incomplete spinal cord injury

We describe a case of 55-years-old man with a known T11 AIS C since 1985. The muscle strength of his left leg is better than the right leg and he is an active community ambulator. He walks using his right knee ankle foot orthosis without a knee lock. However, on April 2012 he had undergone a left transtibial amputation secondary to infected diabetic foot ulcer. He only had his first contact with rehabilitation team 2 months after the amputation and started on gait retraining since. Given the fact that he is a K3 level as he used to climb Batu Caves which is known to have 272 steps and he plans to continue this activity for his religious purposes, we prescribed him with prosthesis – patella tendon bearing socket, pin and lock suspension, silicone liner and energy storing foot. In conclusion, a community ambulator in dual disabilities, that is, spinal cord injury and amputee is hardly encountered due to multiple confounding factors. However, the right prosthetic prescription in patient with good prognosticating factors to ambulate will determine successful rehabilitation.

Analysis of kinematic gait parameters in chronic stroke survivors

This paper presents the gait pattern classification between stroke survivors and normal subjects. This present investigation is competent to reveal the characteristics of postural control, gait pattern among stroke survivors. These findings also are capable in giving the effective guidelines for developing appropriate strategies for safe standing and walking to reduce fall incidence. Furthermore, this results also can be used to monitor stroke patients, in the aspects of theirs rehabilitation progress from time to time. 18 subjects has been recruited (nine stroke subjects and nine normal subjects) with range of age between 40 to 65 years old. Additionally, all subjects must be able to walk freely without any cane or mechanical aid during walking. In this study, Vicon® Nexus Plug-in-Gait is used to compute the kinematic gait parameters. Movements in anatomical planes is used as a reference during walking. This paper focus on the sagittal plane only. From the results, it is found that there is a significant difference in the maximum angle of knee between stroke and normal subjects. As a conclusion, the significant value which is 0.003 only can be observed from the maximum knee angle between both groups. The results of this study may be varies due to several aspects such as physical body structure and also age.

An unexpected delivery: pregnancy experience of a paraplegic lady

Introduction:Spinal cord injury (SCI) has increased over the years, and so has the survival. Women with SCI remain fertile and have equal chance of pregnancy.Case presentation:We described a case of a 29-year-old lady with traumatic spinal cord injury (SCI) resultant with paraplegia in 2008, who conceived naturally 2 years after the injury. She only had her antenatal check-up at a low-risk antenatal center throughout her pregnancy and was not referred to specialized obstetric care. She did not appreciate active labor, and unexpectedly had a precipituous labor and gave birth in the bathroom.Discussion:Pregnancy is relatively safe in women with spinal cord injury (SCI). However, disability-related issues can be exaggerated during pregnancy, delivery and post-partum periods. Thus, understanding common issues related to pregnancy in this population is important. Specialized obstetric care with rehabilitation input throughout antenatal and postnatal care is crucial for a good overall outcome of a pregnant woman with SCI.

The Effect of Diabetic Peripheral Neuropathy on Ground Reaction Forces during Straight Walking in Stroke Survivors

Purpose. The aim of this present study was to investigate the ground reaction forces (GRFs) alterations in stroke survivors with diabetic peripheral neuropathy (DPN). Methods. Ten stroke survivors with DPN, 10 stroke survivors without DPN, and 10 healthy controls with matched body weight between groups participated in this case-control cross-sectional study. Three-dimensional GRFs (anterior-posterior, medial-lateral, and vertical) were collected at a comfortable walking speed using the Nexus Vicon motion analysis system and force plate. The Kruskal–Wallis test was used to analyze GRFs parameters. Results. We found significant alterations of medial-lateral forces of the nonparetic side and vertical forces of the paretic side in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. In addition, there were smaller braking and lower propulsion peak in anterior-posterior forces, smaller magnitude of medial-lateral forces, and lower first and second peak of vertical forces in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. Conclusion. The study findings identified that GRFs were affected in stroke survivors with DPN on both the paretic and the nonparetic sides. Further investigations are warranted to explore the impact of DPN on the kinematics and muscle activity related to the gait performance in stroke survivors with DPN.

Analysis of kinematic gait parameters in stroke with diabetic peripheral neuropathy (DPN)

This paper presents the gait pattern of hip, knee, and ankle angles for stroke subjects diagnosed with diabetic peripheral neuropathy (DPN), compared with stroke subjects. The aim of this study is to reveal the gait characteristics of kinematic parameters including hip, knee and ankle angles for stroke with DPN subjects. The findings of this study may help clinician such as medical doctors and physiotherapists to monitor and improve their muscles performances in rehabilitation program. 29 subjects consists of 9 stroke with DPN patients, 10 stroke and 10 control subjects were participated in this study. All subjects need to confirm that they do not have any extra diseases that could results in the supplementary effect on the body balance, before signing the consent form. They are instructed to walk with their comfortable speed within 5 metres walkaway without using any aid or device. In this study, Vicon® Nexus Plug-in-Gait is used to compute the kinematic gait parameters. The raw data is pre-processed using Vicon software to obtain the kinematic data from the walking trials. This paper focus on the sagittal plane only. From the results obtained, it can be found that there are four significant different at average knee (0.034°), maximum hip (0.004°) and knee (0.000°), and minimum ankle (0.025°) between the groups.