Body schema and body image disturbances in individuals with multiple sclerosis

This chapter argues that the concepts of body schema and body image can deepen our understanding of individuals with multiple sclerosis (MS) and can advance our conception of the physiotherapeutic process. Experiences of agency and body ownership are closely connected to body schema and body image and relate directly to the self-experiences of individuals with MS. The chapter argues that the concept of self-pattern provides a way to integrate these different factors. Sensorimotor disturbances in persons with MS compromise body schema and can disrupt various elements of their self-pattern, including pre-reflective experiential, reflective, extended, and intersubjective factors. On this view, movement analysis, handling skills, and clinical reasoning within physiotherapy can be recontextualized. Specificity is particularly important in this context, as sensorimotor functions are cornerstones of intentionality and an individual’s perceptions of affordances in daily life and are not merely neurophysiological processes, as conceived in traditional views on physiotherapy.

Attention-Demanding Cognitive Tasks Worsen Postural Control in Patients With Cervical Dystonia: A Case-Control Study

Background: Patients with cervical dystonia (CD) show impaired postural control, balance, and gait, likely due to abnormal head postures and sensorimotor disturbances. However, until now no study has investigated whether attention-demanding activity worsens postural control and balance in CD patients.Objective: To investigate whether patients with CD show cognitive-motor interference (CMI), a specific kind of dual-task interference that occurs during the simultaneous execution of a cognitive and motor task. This information may be useful to determine whether performing activities of daily living worsens postural control and balance in CD patients.Methods: We performed a pilot case-control study. Twenty-two patients affected by CD and 19 healthy controls were enrolled in order to test CMI. Each subject was evaluated during the execution of a cognitive task while postural stability was assessed through a stabilometric platform.Results: CD patients showed impaired postural control compared to healthy controls, with instability increasing with increasing cognitive task complexity. No relationships were found between stabilometric parameters and clinical characteristics of CD.Conclusions: Our hypothesis is that CMI in CD patients derives from deranged network connectivity when activated simultaneously during the performance of two tasks that interfere with each other and “compete” for the same resources within the cognitive system.

FEATURES OF SENSORIMOTOR DISTURBANCES IN DIFFERENT PERIODS AFTER ISCHEMIC STROKE

The aim of the study was to investigate the clinical and neurophysiological features of sensorimotor disturbances in patients at different time periods after ischemic stroke. Methods. The study involved 133 patients with ischemic stroke in the right and left cerebral hemispheres in the late recovery (58) and residual (75) periods. There were 35 controls. Were performed transcranial magnetic stimulation, evoked abdominal reflexes and somatosensory evoked potentials. Results. It was shown that functional recovery processes are continuing with varying degrees of severity in patients and in a year after stroke. Conclusions. Persistence and severity of sensorimotor disturbances, as well as compensatory opportunities, defined afferent component of poststroke deficit, which implies an additional impact in this area to expand the possibilities of neurorehabilitation in patients after stroke.

Cervical Osteomyelitis with Thoracic Myelitis and Meningitis in a Diabetic Patient

A 45-year-old man with a history of untreated diabetes mellitus had a persisting fever, back pain, and diarrhea. The primary care physician diagnosed the patient with the flu and gastroenteritis. The patient developed paraplegia for two weeks and was admitted to another hospital. The physician in this hospital suspected infectious meningitis and myelitis, and administered piperacillin and steroids without cerebrospinal fluid (CSF) examination. On referral to our hospital, he presented a high fever and complete paraplegia. The lumbar puncture revealed a yellowish CSF, polynucleosis, and hypoglycorrhachia. Bacteria were not detected on Gram's staining and were not confirmed by CSF culture. Magnetic resonance imaging (MRI) showed no thoracolumbar lesion and suggested a cervical epidural abscess without any spinal cord compression. He was diagnosed as having osteomyelitis with meningitis and thoracic myelitis. The infection subsided with broadspectrum antibiotics. After two weeks, bilateral sensorimotor disturbances of the upper extremities appeared. MRI findings showed the epidural abscess compressing the cervical spinal cord. We performed debridement of the epidural abscess. The infection was clinically controlled by using another antibiotic. One month after the infection subsided, a 360° reconstruction was performed. In this case, the misdiagnosis and the absence of CSF examination and culture to detect the pathogenic bacteria at an earlier stage in the patient's disease course might have led to the exacerbation of the pathology.

Addressing neuropsychiatric disturbances during rehabilitation after traumatic brain injury: current and future methods

Cognitive, emotional, behavioral, and sensorimotor disturbances are the principal clinical manifestations of traumatic brain injury (TBI) throughout the early postinjury period. These post-traumatic neuropsychiatric disturbances present substantial challenges to patients, their families, and clinicians providing their rehabilitative care, the optimal approaches to which remain incompletely developed. In this article, a neuropsychiatrically informed, neurobiologically anchored approach to understanding and meeting challenges is described. The foundation for that approach is laid, with a review of clinical case definitions of TBI and clarification of their intended referents. The differential diagnosis of event-related neuropsychiatric disturbances is considered next, after which the clinical and neurobiological heterogeneity within the diagnostic category of TBI are discussed. The clinical manifestations of biomechanical force-induced brain dysfunction are described as a state of post-traumatic encephalopathy (PTE) comprising several phenomenologically distinct stages. PTE is then used as a framework for understanding and clinically evaluating the neuropsychiatric sequelae of TBI encountered commonly during the early post-injury rehabilitation period, and for considering the types and timings of neurorehabilitative interventions. Finally, directions for future research that may address productively the challenges to TBI rehabilitation presented by neuropsychiatric disturbances are considered.