Condet

Mohamad E. Allaf, MD

• Vice Chairman and Professor of Urology, Oncology, and Biomedical Engineering Director of Minimally Invasive and Robotic Surgery
• Department of Urology Brady Urological Institute
• Johns Hopkins University
• School of Medicine Baltimore, Maryland

https://www.hopkinsmedicine.org/profiles/details/mohamad-allaf

Wearable lowerlimb exoskeletons for gait rehabilitation are still in their early stages of devel opment and randomized control trials are needed to demonstrate their clinical efficacy antibiotics for uti duration cheap linezolid 600 mg line. Keywords: Wearable exoskeleton antibiotics for uti in 3 year old 600 mg linezolid amex, Lowerlimb broken dog's tail treatment order linezolid 600 mg visa, Neuromuscular impairment antibiotics for cat acne linezolid 600 mg generic, Gait rehabilitation, Spinal cord injury, Stroke Background Gait disorders affect approximately 60% of patients with neuromuscular disorders [1] and generally have a high impact on their quality of life [2]. Moreover, immobility and loss of independence for performing basic activities *Correspondence: antonio. Therefore, walking recovery is one of the main rehabilitation goals for patients with neuromuscular impairments [8, 9]. J NeuroEngineering Rehabil (2021) 18:22 Page 2 of 21 Robotic gait rehabilitation appeared 25 years ago as an alternative to conventional manual gait training. The use of gait rehabilitation robots began in 1994 [12] with the development of Lokomat [13]. Since then, different rehabilitation robots have been developed and can be classified into grounded exoskeletons. In addition, there have been recent developments towards "soft exoskeletons" or "exosuits" which use soft actuation systems and/or structures to assist the walking function [22­25]. Despite these developments, to date the optimal type of rehabilitation robot for a specific user and neuromuscular impairment still remains unclear [26]. Wearable exoskeletons are emerging as revolutionary devices for gait rehabilitation due to both the active participation required from the user, which promotes physical activity [27], and the possibility of being used as an assistive device in the community. The number of studies on wearable exoskeletons during the past 10 years has seen a rapid increase, following the general tendency now towards rehabilitation robots [28]. There have been several reviews surveying the field of wearable exoskeletons for gait rehabilitation. Some of these reviews have focused on reviewing the technological aspects of exoskeletons from a general perspective [29, 30], while others have focused on specific aspects such as the control strategies [31] or the design of specific joints [32]. This review provides a comprehensive overview on wearable lower-limb powered exoskeletons for over ground training, without body weight support, that are intended for use with people who have gait disorders due to neuromuscular impairments. In comparison with other reviews, we analyse a wide range of aspects of wearable exoskeletons, from their technology to their clinical evidence, for different types of pathologies. This systematic review was carried out to address the following questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation? After removing duplicates, 777 publications were screened first by their title and secondly by their abstract. The identification, screening and eligibility check of the studies were all done by the same author. In case of uncertainty during the screening or the classification process, a decision was reached in agreement with the three authors of the manuscript. Selected studies were published between 2009 and 2019, focusing this literature study on the last 11 years. Inclusion and exclusion criteria We only included studies written in English, which provided relevant clinical information aimed at studying the effects of exoskeleton devices on gait rehabilitation. To be included in the analysis, each article had to meet the following three conditions: (1) studies had to use a wearable and powered lower-limb exoskeleton, (2) report overground outcome measures, and (3) participants had to have a neuromuscular impairment. Note that we considered as wearable exoskeletons those that present a rigid external structure and therefore, soft exoskeletons or exosuits were not included in the present survey. Studies that used body weight support or a treadmill were excluded with the purpose of focusing only on studies that solely investigated the effect of wearable RodrнguezFernбndez et al. The 87 studies were grouped in three categories according to the pathology treated in the study: Spinal Cord injury (n = 54), stroke (n = 22) and other pathologies (n = 11; poliomyelitis: 3, cerebral palsy: 3, multiple sclerosis: 2, brain tumor surgery: 1, spinocerebellar degeneration: 1, and traumatic brain injury: 1) exoskeleton technology. Note that for the analysis, only data from patients who used the robotic devices were included, i. Approach the information of each study was classified according to technical aspects of the exoskeleton and clinical aspects. The technical aspects included: (1) exoskeleton design and structure, (2) control methods, and (3) type of actuators. The clinical aspects included: (4) patient demographics, (5) patient impairments, (6) training protocol, (7) outcome measures, (8) the walking aids used during training, and (9) the training environment. This classification was used to analyse the technical and clinical aspects of the 87 studies. Bani, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran), Kawasaki2017 (Image courtesy of Ohata Koji, Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Japan), Yeung2017 (Reproduced from [49]), and Boes2017 (Reproduced from [50]). Note that Vanderbilt Exoskeleton and Kinesis are the former prototypes from the current commercial version of Indego and H2, respectively the classification of primary and secondary outcome measures were grouped using the five categories proposed by Contreras-Vidal et al.

The oculomotor nerve emerges from a groove on the medial side of the crus cerebri and passes forward in the lateral wall of the cavernous sinus antibiotics examples trusted 600 mg linezolid. Internal Structure of the Midbrain the midbrain comprises two lateral halves antibiotic resistance literature review cheap 600mg linezolid fast delivery, called the cerebral peduncles; each of these is divided into an anterior part bacteria that causes tuberculosis best 600mg linezolid, the crus cerebri infection quizlet cheap 600 mg linezolid free shipping, and a posterior part, the tegmentum, by a pigmented band of gray matter, the substantia nigra. The narrow cavity of the Internal Structure of the Midbrain 211 Tuber cinereum Mammillary body Posterior perforated substance Interpeduncular fossa Pons Optic nerve Optic chiasma Optic tract Crus cerebri of midbrain Oculomotor nerve Trochlear nerve Motor root of trigeminal nerve Sensory root of trigeminal nerve Cerebellum Medulla oblongata A Corona radiata Pulvinar of thalamus Corona radiata Lateral geniculate body Superior brachium Superior colliculus Medial geniculate body Inferior brachium Inferior colliculus Superior cerebellar peduncle Middle cerebellar peduncle Optic tract Optic chiasma Optic nerve Crus cerebri of midbrain Oculomotor nerve Trochlear nerve Pons Trigeminal nerve Lentiform nucleus Medulla oblongata Cerebellum B Figure 5-23 the midbrain. The tectum is the part of the midbrain posterior to the cerebral aqueduct; it has four small surface swellings referred to previously; these are the two superior and two inferior colliculi. The cerebral aqueduct is lined by ependyma and is surrounded by the central gray matter. On transverse sections of the midbrain,the interpeduncular fossa can be seen to separate the crura cerebri, whereas the tegmentum is continuous across the median plane (Fig. Transverse Section of the Midbrain at the Level of the Inferior Colliculi the inferior colliculus, consisting of a large nucleus of gray matter, lies beneath the corresponding surface elevation and forms part of the auditory pathway. The pathway then continues through the inferior brachium to the medial geniculate body. Note that the cerebral peduncles are subdivided by the substantia nigra into the tegmentum and the crus cerebri. The trochlear nucleus is situated in the central gray matter close to the median plane just posterior to the medial longitudinal fasciculus. The emerging fibers of the trochlear nucleus pass laterally and posteriorly around the central gray matter and leave the midbrain just below the inferior colliculi. The fibers of the trochlear nerve now decussate completely in the superior medullary velum. The mesencephalic nuclei of the trigeminal nerve are lateral to the cerebral aqueduct. The decussation of the superior cerebellar peduncles occupies the central part of the tegmentum anterior to the cerebral aqueduct. The reticular formation is smaller than that of the pons and is situated lateral to the decussation. The medial lemniscus ascends posterior to the substantia nigra; the spinal and trigeminal lemnisci are situated lateral to the medial lemniscus. The nucleus is composed of medium-size multipolar neurons that possess inclusion granules of melanin pigment within their cytoplasm. The substantia nigra is concerned with muscle tone and is connected to the cerebral cortex, spinal cord, hypothalamus, and basal nuclei. The crus cerebri contains important descending tracts and is separated from the tegmentum by the substantia nigra. The corticospinal and corticonuclear fibers occupy the middle two-thirds of the crus. The frontopontine fibers occupy the medial part of the crus,and the temporopontine fibers occupy the lateral part of the crus. These descending tracts connect the cerebral cortex to the anterior gray column cells of the spinal cord, the cranial nerve nuclei, the pons, and the cerebellum (Table 5-4). Transverse Section of the Midbrain at the Level of the Superior Colliculi the superior colliculus. It receives afferent fibers from the optic nerve,the Internal Structure of the Midbrain 213 Trochlear nerve Inferior colliculus Cerebral aqueduct containing cerebrospinal fluid Central gray matter Mesencephalic nucleus of trigeminal nerve Lateral lemniscus Nucleus of trochlear nerve Trigeminal lemniscus Spinal lemniscus Medial lemniscus Crus cerebri Temporopontine fibers Medial longitudinal fasciculus Region of reticular formation Corticospinal and corticonuclear fibers Decussation of superior cerebellar peduncles Tectum Tegmentum Substantia nigra Interpeduncular fossa A Frontopontine fibers Superior colliculus Cerebral aqueduct Central gray matter Trigeminal lemniscus Spinal lemniscus Mesencephalic nucleus of trigeminal nerve Nucleus of oculomotor nerve Medial longitudinal fasciculus Reticular formation Red nucleus Medial lemniscus Temporopontine fibers Corticospinal and corticonuclear fibers Substantia nigra Decussation of rubrospinal tracts Oculomotor nerve Frontopontine fibers B Figure 5-25 Transverse sections of the midbrain. Note that trochlear nerves completely decussate within the superior medullary velum. Cerebral cortex Third ventricle Stria medullaris thalami Internal capsule Habenula Lentiform nucleus Caudate nucleus Striae terminalis Thalamus Pineal Superior colliculus Inferior colliculus Pulvinar of thalamus Trochlear nerve Superior cerebellar peduncle Sulcus limitans Middle cerebellar peduncle Facial colliculus Floor of fourth ventricle Cuneate tubercle Entrance into cerebral aqueduct Medial eminence Median sulcus Striae medullares Vestibular area Hypoglossal triangle Vagal triangle Entrance into central canal Gracile tubercle Posterior median sulcus Central canal Figure 5-26 Posterior view of the brainstem showing the two superior and the two inferior colliculi of the tectum. Inferior colliculus Mesencephalic nucleus of trigeminal nerve Lateral lemniscus Cerebral aqueduct Central gray matter Nucleus of trochlear nerve Medial longitudinal fasciculus Reticular formation Medial lemniscus Temporopontine fibers Fibers of superior cerebellar peduncle Decussation of superior cerebellar peduncles Substantia nigra Corticospinal and corticonuclear fibers Interpeduncular fossa Frontopontine fibers Figure 5-27 Photomicrograph of a transverse section of the midbrain at the level of the inferior colliculus. The efferent fibers form the tectospinal and tectobulbar tracts, which are probably responsible for the reflex movements of the eyes, head, and neck in response to visual stimuli.

Of these infection 7 weeks after birth 600 mg linezolid visa, tumors are the most frequent antibiotics for genital acne cheap linezolid 600mg online, including hypothalamic tumors and the more frequent tumors of the pituitary (see Chapter 12) antibiotics in milk order linezolid 600 mg online. Disturbances of the medial aspects of the hypothalamus (the ventromedial nucleus) may lead to severe behavioral disorders virus que esta en santo domingo purchase linezolid 600 mg with amex, because these nuclei have important connections with the frontal cortex and the amygdaloid complex. Each half is a relatively large (about 4 cm in length), ovoid, gray mass that sits partially within the hollow made by the internal capsule and helps form the lateral walls of the third ventricle. The word thalamus means "bridal chamber," a name that reflects the deep, hidden, and secure location of the thalamus within the two hemispheres. On dissection of the brain, the relatively well-defined thalamus is easily visible because of its grayish color, signaling the presence of many nerve endings. For example, many pathways that carry information from the brainstem to the cortex relay their information through the thalamic nuclei before reaching the cortex. Thus, the thalamus plays a central role in processing most information that reaches the cortex. The thalamic nuclei are relatively well-defined geographic areas that can be divided into groups, based on their geographic location within the thalamus and their specific function. In addition to receiving ascending input, all thalamic nuclei receive descending input from the cerebral hemispheres, principally from the cortical regions to which they project. As such, the thalamus plays a key role in providing a complex "relay station" for all sensory systems, except for olfaction, that project to the cerebral hemispheres. The thalamus and the hypothalamus together make up an important part of the activities of the limbic system (see later in this chapter for a more detailed description). Function-As the gateway to the cortex, the thalamus serves as the major pathway for primary sensory and motor impulses to and from the cerebral hemispheres. Thalamus Switching station for sensory information; also involved in memory Amygdala Involved in memory, emotion, and aggression Hippocampus Involved in learning, memory, and emotion Medulla Controls vital functions such as breathing and heart rate Cerebellum Controls coordinated movement; also involved in language and thinking Spinal cord Transmits signals between brain and rest of body Figure 5. Other neuronal fibers that do not pass through the thalamus are those that are involved in arousal. The thalamus is analogous to the concept of a large, busy, commuter train station. It makes preliminary classifications, integrates information, and "sends" it on to the cortex for further processing. Specifically, each half of the thalamus sends information to , and receives information from, the cerebral hemisphere on the same (ipsilateral) side of the brain. In this fashion, the descending projections serve as a two-way system between each cortical region and the corresponding thalamic nuclei. The nuclei of the thalamus can be divided into two groups by their structure, connections, and function. The first group includes nonspecific nuclei, which are located primarily toward the median portion of the thalamus. These nuclei project widely to other brain structures, including other thalamic areas, and to the cortex, particularly its frontal regions. They receive input from the spinal cord and the reticular formation and appear to play a role in monitoring the overall excitability of neurons in the cortex and the thalamus. The second group of thalamic nuclei is referred to as specific nuclei, which are involved in sensory and motor processing (Figure 5. Reproduced by permission of the McGraw-Hill Companies; b: reproduced with permission from original drawings by Frank H. This list of thalamic nuclei provides only an overview of the neuropsychological function, because the connections of the thalamus are extremely complicated and an understanding of them all lies beyond the scope of this text. Lesions, particularly vascular accidents, and to some extent tumors, have been most often associated with the thalamic syndrome, marked deficits in gross areas of sensory or motor function. For example, lesions of the left thalamus have been implicated with depressed scores on cognitive-verbal tasks (Vilkki & Laitinen, 1974; Zillmer, Fowler, Waechtler, Harris, & Khan, 1992). Lesions of the right thalamus have been associated with defects in spatial ability (Bundick, Zillmer, Ives, & Beadle-Linsay, 1995; Jurko & Andy, 1973), facial recognition (Vilkki & Laitinen, 1974), and the perception of music (Roeser & Daly, 1974). Consequently, many sequelae of thalamic injury are those you might expect from the interruption of essential relay elements in pathways to and from the cerebral hemispheres. In some thalamic lesions, the symptoms are short lived, indicating that alternative pathways are quickly formed. On visual inspection, the cerebellum is a spectacular brain structure because of its clearly defined morphology and symmetry (Figure 5. The cerebellar cortex is heavily infolded, and the numerous parallel sulci give it a layered appearance.

Multifocal myoclonus antibiotics jaw pain discount 600 mg linezolid, in a patient who is stuporous or in coma triple antibiotic ointment buy discount linezolid 600 mg on line, is indicative of severe metabolic disturbance antibiotics for feline acne order 600 mg linezolid with mastercard. However virus your current security settings discount linezolid 600mg without prescription, it may be seen in some waking patients with neurodegenerative disorders. Ventilatory patterns, with the exception of psychogenic hyperventilation, are normal. In some patients with psychogenic coma, the eyes deviate toward the ground when the patient is placed on his or her side. Most patients with metabolic brain disease have diffusely abnormal motor signs including tremor, myoclonus, and, especially, bilateral asterixis. The patient with gross structural disease, on the other hand, generally has abnormal focal motor signs and if asterixis is present, it is unilateral. Finally, metabolic and structural brain diseases are distinguished from each other by a combination of signs and their evolution. Most conscious patients with metabolic brain disease are confused and many are disoriented, especially for time. Their abstract thinking is defective; they cannot concentrate well and cannot easily retain new information. Early during the illness, the outstretched dorsiflexed hands show irregular tremulousness and, frequently, asterixis. Posthyperventilation apnea may be elicited and there may be hypoventilation or hyperventilation, depending on the specific metabolic illness. By contrast, awake patients with psychogenic illness, if they will cooperate, are not disoriented and can retain new information. The orderly rostral-caudal deterioration that is characteristic of supratentorial mass lesions does not occur in metabolic brain disease, nor is the anatomic defect regionally restricted as it is with subtentorial damage. Neurons and glial cells undergo many chemical processes in fulfilling their specialized functions. The nerve cells must continuously maintain their membrane potentials, synthesize and store transmitters, manufacture axoplasm, and replace their always decaying structural components (Figure 5­2). In addition, they may aid neuronal function by supplying substrate (lactate)51 (although the degree, if any, to which neurons metabolize lactate in vivo is controversial53). Astrocytes also participate in controlling blood flow52 and in maintaining the blood-brain barrier. Awake or asleep, the brain metabolizes at one of the highest rates of any organ in the body. However, although the overall metabolism of the brain is relatively constant, different areas of the brain metabolize at different rates, depending on how active an area is. These considerations are central to an understanding of many of the metabolic encephalopathies, and the following paragraphs discuss them in some detail. Overall flow in gray matter, for example, is normally three to four times higher than in white matter. Lactate, once released by astrocytes, can be taken up by neurons and serves them as an adequate energy substrate. A functional magnetic resonance imaging scan of the normal individual flexing and extending his fingers. Blood flow increases to a greater degree than oxygen consumption in the motor areas, leading to an increase in oxyhemoglobin. The paramagnetic oxyhemoglobin causes an increased blood oxygen level-dependent signal in the motor cortex bilaterally. The increase in glucose metabolism over oxygen metabolism results in increased lactate production, possibly the substrate for the increased demand of neurons58 (Figure 5­4). Important among these are adenosine, nitric oxide, dopamine, acetylcholine, vasoactive intestinal polypeptide, and arachidonic acid metabolites. Examples of such reactive hyperemia or ``uncoupling' of flow and metabolism occur in areas of traumatic or postischemic tissue injury, as well as in regions of inflammation or in the regions surrounding certain brain tumors. So far, the nature of the local stimulus to such pathologic vasodilation also has eluded investigators. The effects of the process, however, can act to increase the bulk of the involved tissue and thereby accentuate the pathologic effects of compartmental swelling in the brain, as discussed in Chapter 2.

Neglect virus 68 florida cheap linezolid 600mg without prescription, as can be imagined antibiotic resistance case study purchase linezolid 600 mg line, is notoriously difficult to treat in the beginning stages antimicrobial essential oil order linezolid 600 mg with visa. Therapists may use various methods such as forcing attention to the left side via gradual movement of objects to the left antimicrobial silver purchase linezolid 600 mg mastercard, or even through the use of prism glasses. These methods do meet with some success, but often do not generalize to daily life. The first issue is understanding the asymmetric presentation of neglect between the two hemispheres. Any theory of neglect must explain why the overwhelming majority of cases show left-sided neglect, and why right-sided neglect is so rare. If neglect is thought of as a network problem rather than as a dysfunction of an individual system, it is easier to make sense of the variety of lesion sites that may produce neglect. Research has established that the right hemisphere is more specialized for global spatial processing, whereas the left hemisphere has a propensity for decoding specific spatial features. Because the right hemisphere, and particularly the right parietal lobe, plays a role in understanding the gestalt or totality of space, disruptions there are more likely to upset global spatial awareness. Also, the right hemisphere plays a larger role in arousal and attentional levels, which are prime factors in many explanatory models of neglect. However, each of these problems can occur in isolation without the patient losing consciousness of the left side of space. Interestingly, it appears that patients may shift their "spatial axis" to the right so that midline is pulled or repositioned within the right side of space relative to the body (Mattingly, 1996). Marcel Kinsbourne (1993) has postulated that this strong rightward orientation is less a function of right hemisphere dysfunction per se than a release of inhibition that lets the left hemisphere assert dominance in the presence of a now weakened right hemisphere. Perhaps some of the prime areas damaged, rendering the right hemisphere spatially ineffective, are locations within the right parietal lobe having to do with personal spatial frames of reference. Body position with respect to space is always egocentric, although people may have multiple frames with respect to bodies, heads, or position in relation to environment. Animal studies support the contention that there are distinct neuronal centers for these spatial frames within the right parietal cortex (for example, see Anderson, Snyder, Li, & Stricanne, 1993). Do these findings explain why the midline shift in neglect is nearly always to the right? Bradshaw and Mattingly (1995) suggest that each hemisphere plays a specific role in spatial body position processing. According to this view, damage to the left parietal lobe produces no corresponding leftward shift because the spatial concerns of the left hemisphere are more feature oriented and language focused, resulting in a "no specialized spatial position" sense within the left parietal lobes. If right neglect does occur, they suggest, together with other investigators (such as Ogden, 1985), that the focus of the left hemisphere lesion would be anterior to the parietal lobes. Unfortunately, partly because of the rarity of occurrence, no research has explained the mechanisms of right-sided neglect. Understanding neglect is not only a problem of dominance and asymmetry, it is also an issue of conceptualizing the problem as a higher order network processing phenomenon. That unilateral neglect can occur with other nonparietal foci of damage is partial testament to this claim. We mentioned earlier that the region of the right inferior parietal lobe is the area most commonly damaged in cases of left unilateral neglect. As in other disorders discussed throughout this book, however, absence of function associated with a lesion does not necessarily imply that the lesioned area "contains" the function. Just as the hippocampus does not "contain" or store memory but is one of the most crucial links in memory processing and consolidation, the right inferior parietal lobe does not in itself contain "body mindfulness" but may be a crucial link. Neuroanatomically, left unilateral neglect also occurs with damage to a variety of subcortical structures, most notably the thalamus (see Bradshaw & Mattingly, 1995). It is reasonable to speculate that neglect results from a disconnection in higher order processing that involves the coordination of many second-order systems, such as visual processing, attention, memory, and possibly other systems. They are beyond the scope of this overview, and excellent reviews exist elsewhere (for example, see Bradshaw & Mattingly, 1995). Most models describe the process of body and hemispace cognition as including visual-perceptual processes, attention, and motor action. He identifies three major functional areas that must interact for the body­space system to work normally. The parietal lobes control perceptual processing, the premotor and prefrontal cortices mediate exploratory-motor behavior, and the cingulate gyrus directs motivation.

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References

• Gussenhoven MJ, Ravensbergen J, et al. Renal dysfunction after angiography; a risk factor analysis in patients with peripheral vascular disease. J Cardiovasc Surg (Torino) 1991; 32:81.
• Johnson TM 2nd, Kincade JE, Bernard SL, et al: Self-care practices used by older men and women to manage urinary incontinence: results from the national follow-up survey on self-care and aging, J Am Geriatr Soc 48:894n902, 2000.
• Altman DG. Practical Statistics for Medical Research. Chapman & Hall, 1991, p. 456.
• Christman BW, McPherson CD, Newman JH, et al. An imbalance between the excretion of thromboxane and prostacyclin metabolites in pulmonary hypertension. N Engl J Med 1992;327(2):70-5.
• Goldhirsch A, Winer EP, Coates AS, et al. Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013.
• Silver CM, Motamed M, Carlotti E. Arthroplasty of the temporomandibular joint with the use of a vitallium condyle prosthesis: report of three cases. J Oral Surg 1977;35:909-914.
• Wassmund M. Frakturen und Lurationen des Gesichtsschadels. Leipzig Meusser Verlag: 1927.