News Update: It has almost been one year since last issue of Neuro-Connect.  How has we progressed?

 



¡P       NSG (Neurology Specialty Group) is now the name which replaces the former NSIG.  The Chinese title remains unchanged. Members are welcomed to send your suggestions, queries, comments to the NSG to the following address: nsig@hongkongpa.com.hk

 

¡P       The NSG Executive Committee ¡V Two NSG friends have joined the Ex-com. since October 2001.  They are Ms. Ellen Ip from Prince of Wales Hospital and Mr. Jack Ling from Princess Margaret Hospital.  We welcome their participation in progressing the NSG¡¦s activities and mission.  Thank you to Ms. Candy Leung who stepped down from the Ex-com. service.  Her dedicated work for us is very much appreciated.

 

¡P       The HKPA Carnival on November 4, 2001 (Sunday) at Telford Plaza was an exciting experience.  The booth of NSG was on "Prevention of stroke".  The interesting game created by physiotherapy colleagues of the Hong Kong Sanatorium attracted hundreds of participants from the young to the old.

 

¡P      ¡¥Conductive Education for the Elderly¡¦ ¡V a Clinical Sharing series on December 21, 2001 was attended by 35 physiotherapists.  Participants had benefited much from the very informative sharing and stimulating discussion from Ms. Clare Cheng and Consa Leung.

 

¡P      Two Lectures - ¡¥Update on Surgical Management of Parkinson's Disease¡¦ by Professor Wai Sun Poon on January 18, 2002, and ¡¥Advance in Stroke Management and Investigation¡¦ by Dr. Lawrence K.S. Wong on July 10, 2002 were both well-attended by enthusiastic therapists (60 and 100 attendances respectively).  A number of thought-provoking questions pertaining to rehabilitation were discussed.

 

¡P      The Basic Bobath Course (full name: Evaluation and Treatment of Hemiplegic Patients ¡V Bobath Concept) has the first two weeks completed in April 2002.  The last week will run between September 30 to October 4, 2002, followed by the five-day Advanced Course.  Mrs. Patty Shelly and Ms. Heather Bright are the two Tutors from IBITAH, with Ms. Marianne Lawton (Canada) and Rosanna Chau (Hong Kong) assisting as Bobath Tutor  Candidates.  Well done, Rosanna ¡V we are with you!

 

 

Postural Symmetry Across the Mid-line Vertical after Stroke ¡V is it a matter of perception or strength?

 

Stephanie Au-Yeung, Assistant Professor, The Hong Kong Polytechnic University

 

In the assessment of posture after stroke, we always pay attention to the differences between both sides of the body.  We are interested in symmetrical alignment of the body segments across the midline vertical, e.g., leveled shoulder and pelvic girdles, symmetrical weight-bearing on both feet in a standing posture or on both buttocks in sitting.  In fact, symmetry might be perceived as an expression of ¡§balance¡¨ of the body system¡¦s activities.  What underlies postural symmetry across the midline vertical when a person with stroke assumes an erect posture?  To grasp a better idea for the answer, we have to understand factors governing the body¡¦s vertical, apart from noting just the right and the left side of the body, or the ipsi- and contra-lateral side to the brain lesion.

 

The innervation to the trunk and girdle muscles is bilateral.  It has been shown that weakness of the limbs did not relate to the body¡¦s orientation with respect to gravity during sitting1.  Pérennou and coworkers1 showed in their study that the severity of neglect, and perhaps hemianaesthesia, led to biased postural vertical in sitting in 19 of 22 people with recent stroke less than three months after onset.  Vision has minimal effect on the orientation of body uprightness in a group of non-pushers after stroke2.  The organs which provide the graviceptive information of the body in space with respect to gravity account for the body¡¦s orientation to the vertical ¡V the somatosensory afferents, including the cutaneous afferents, the proprioceptors and the golgi-tendon organs, the otoliths and the semi-circular canals3,4. On the other hand, the right cerebral hemisphere has a role in spatial information processing and therefore plays a part in postural performance5.  A study on 16 patients with stroke within six months after onset demonstrated a significant asymmetrical loading at the buttock-seat interface when the patients assumed erect sitting without support at their feet6.  The deviant from symmetry with loading preferred on the side of the brain lesion was found more severe in patients with right brain lesion (n=9) (Mann-Whitney U test , Z=-2.28, p=0.02)6.

 

In the treatment of postural asymmetry, or improving the person¡¦s posture with biased postural deficits, we would need to examine the integrity of the sensory pathways.  We should also note the possible problems in sensorimotor integration resulted from lesion in the parietal lobe.  What treatment would benefit patients with the postural problems?  The author would suggest adopting clinical reasoning in deducing the factors underlying the problems, and take reference to updated reports on motor control and rehabilitation management would enrich the scope and validity of our therapy (refer to the list of recommended reading).

 

 Reference:

1.     Pérennou DA, Amblard B, Leblond C, Pélissier J. Biased postural vertical in humans with hemispheric lesions.  Neuroscience Letter 1998; 252:75-78.

2.     Pérennou DA, Amblard B, Laassel EM, Benaim C, Herisson C, Pélissier J.  Understanding the pusher behavior of some stroke patients with spatial deficits: a pilot study.  Archives in Physical Medicine and Rehabilitation 2002; 83:570-575.

3.     Clark B, Graybiel A.  Perception of the postural vertical in normals and subjects with labyrinthine defects.  Journal of Experimental Psychology 1963; 65:490-494.

4.     Bronstein AM.  The interaction of otolith and proprioceptive information in the perception of verticality.  The effects of labyrinthine and CNS disease.  Annals in New York Academy of Science 1999; 871:324-333.

5.     Ghez, C.  Voluntary movement. In: E.R. Kandel, J.H. Schwartz, T.M. Jessell (eds) Principles of Neural Science 3rd ed. Connecticuti: Appleton & Lange, 1991, pp. 622-624.

6.     Au-Yeung SYS.  Posture in erect sitting of hemiplegic subjects.  MPhil. Thesis, The Hong Kong Polytechnic University 1997.

 

Recommended reading:

¡P       Frassinetti F, Rossi M, Ladavas E.  Passive limb movements improve visual neglect.  Neuropsychologia 2001; 39:725-733.

¡P       Pérennou DA, Amblard B, Leblond C, Pélissier J. Biased postural vertical in humans with hemispheric lesions.  Neuroscience Letter 1998; 252:75-78.

 

 

Gait Disturbances in Parkinson¡¦s Disease

 

Margaret Mak, Assistant Professor, The Hong Kong Polytechnic University

 

Walking disability is one of the major problems encountered by patients with Parkinson¡¦s disease (PD). Physiotherapy has been used to improving this function. Despite long history, the evidence supporting the efficacy of conventional physical therapy for gait management in PD is not strong. On the other hand, evidence mounts demonstrating the usefulness of various sensory cues for patients with PD, including auditory and visual cues, attentional strategies and instructional sets. This trend reflects rehabilitation programmes that takes into account the neurological mechanisms that undelie the motor dysfunction of PD. A recently published article by Rubinstein and coworkers1 provides the most recent and comprehensive review on conventional and evidence-based innovative physiotherapy management.  You may find the information useful so that you could try these methods in the clinical settings.

  

1.  Rubinstein TC, Giladi N, Hausdorff  JM. The power of cueing to circumvent dopamine deficits: A review of physical therapy treatment of gait disturbances in Parkinson's disease. Movement Disorders; 2002: DOI 10.1002/mds.10259 (electronic version).

 

Risk factors to late-onset Alzheimer's Disease

 

Apart from the genetic factor ¡¥apolipoprotein E-e4¡¦ as a known risk to Alzheimer¡¦s Disease, latest report from a Finish group mentioned that combined high blood pressure and high cholestoral make a person eight times more susceptible to develop the disease.  (Resource: Kivipelto et al.: CNS Drugs 2002; 16(7):435-44; Reuter¡¦s News: International Conference on Alzheimer's Disease and Related Disorder, July 2002)

 

Maximizing brain health and Staving off Alzheimer's Disease

 

Mental aerobics and healthy brain diet may be preventive measures against sequelae of brain ageing  (Aug 2002, Science-Reuters; Small: BMJ 2002; 324:1502-1505; Cotman and Berchtold: Trends in Neuroscience 2002; 25:295-301).  With knowledge of neuroanatomy and neurophysiology, physiotherapists could design aerobic programmes for brain workouts!

 

Prepared by Stephanie Au-Yeung