This is an Online E Log Book to discuss our patient's de-identified health data shared after taking his signed informed consent. Here we discuss our patient's problems through series of inputs from available global online community experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.
PPM 1 - OPD right now
45M with gradually progressive severe hyper extension of neck and right upper limb posturing. Retrocollis with upper limb dystonia! @PPM4 can we help with an engineering solution the patient himself has discovered? @PPM3 its likely to be more like an orthotic support for his neck. He has already failed botulinum injections locally as well as baclofen, trihexiphenydyl, tetrabenazine, lorazepam.
PPM 1 -
PPM 1 - Thanks!
PPM 4 - AI attempted -
PPM 4 - AI attempted -
Here is a transcription of the handwriting:
---
*17/1/25*
*Sir, *
This patient has features of neurogenic claudication *(?)* vascular confusion. Also, find lower limb vasculopathy *via CT Angio.*
Would it be possible to measure the lumbar canal diameter & let us know?
---
*12/1/25*
*Sir, *
This patient has features of neurogenic claudication. Although vascular surgeon also found lower limb vasculopathy in CT angiogram, would it be possible to measure lumbar canal diameter & let us know?
(Signature)
17/1/25
PPM 4 - AI read your original handwriting on top.. maybe you don't need manual help transcribing your handwriting anymore?
PPM 1 - Wow!
This is really going to be very useful although AI still probably didn't read mine correctly although it did read the PG's handwriting correctly (because the PG's was also human readable)! As for hand writers like me I guess we just need to stop writing altogether and use typing interfaces to communicate largely.
PPM 4 - or voice!
But I think if you can give me say 100-200 of your handwriting paragraph samples and corresponding correct text, AI could be trained to recognize your handwriting well. Do you have such a dataset where you have your handwriting and then you have the PG transcribed version?
PPM 1 - Great idea!
Yes we could do that only I will then need to have to write more and that too may make my hand writing change!
PPM 1 - Took a look at this now!
It needs a head support at the back!
Maybe something similar to this 👇
Would be more appropriate although it may need to be further tailored after initial trial @PPM4 @PPM5
I guess an Orthotics engineer could do all these? @PPM3 but again that won't happen till NMC makes their presence a minimum standard requirement.
PPM 4 - From the patient's use of that towel, it seemed like the head also needed support. Here only the neck gets support.
One way to prototype tbis quickly is to get a long strip of velcro and use it as a harness. Cut it into multiple parts, and interlock them.
Eg
You can get this for 200 rs
https://www.amazon.in/Velcro-Roll-Double-Sided-Self-Gripping-Multi-Purpose/dp/B0BR7SKV5N?gQT=1
PPM 4 -
Claude did well, OpenAI was poor.
--
This appears to be a medical prescription or treatment notes. I will transcribe the visible content:
OSM
("ALCOHOL/SM")
& ARC
WITHDRAWAL
1) T. LEVIPIL 500mg 50/OD
2) T. BENFOTIAMINE 200mg
80/BD
→ x2 weeks
3) T. BACLOFEN XL 20mg
10/HS
→ x2 weeks
4) Review to By OPD
5) Review after 2 weeks
6) T. NAPROXEN 250mg 85/SOS
Date: 17/1/25 12:30PM
c/o M/S HEADACHE
(POSTERIOR)
ADMISSION
T. FENOFENADINE 120mg 1-×-×
x2 days
T. ULTRACET
½-½-½-½ x2 days
[There appears to be a doctor's stamp and signature at the bottom]
PPM 1 - Yes this is quite good 👏👏
We need an engineering brain to do it here onsite!
Can you guide the patient at his home on phone? @PA may be able to set up a group call?
@PPM6 @SE 👆
PPM 1 - Interesting PET scan of this same patient @PA showing reduced uptake in the left basal ganglia hinting at the disease localisation there.
PPM 4 - Could attempt that on a gmeet call.. I'll try to get some velcro strap to demo it on video.
PPM 1 - That would be great. Let's see if that patient reverts back soon.
PPM 3 - Stereotactic Neurosurgeon may give appropriate advice🙏🏻.
Better continue this improvised item.
PPM 1 - Yes but it keeps slipping down. I guess an Orthotic engineer could engineer something more stable?
I'm thinking something like a rigid head support at the back of the head but if a velcro harness can do that in a stable way as @PPM4 suggested that would also be good.
Yes while the PET has been used as a tool to localize the muscles with most glucose uptake to facilitate botulinum injection https://www.e-arm.org/m/journal/view.php?number=196, in this particular patient it appears to be suggestive of a hitherto unreported correlation with basal ganglia uptake and causality for the dystonia.
PPM 3 - Yes, it can be made, but it may not be comfortable.
PPM 1 - He would only need it during walking.
PPM 3 - Milwaukee brace available ready to fit kit.
PPM 1 - Good idea. Will try that. We showed him some images of similar braces. He said he had already tried it but didn't work although I'll specifically look up Milwaukee.
PPM 3 - Yes, no brace will be comfortable. It will comfort the orthotist only😌
PPM 1 - He looked very peculiar walking with that hyper extension posture looking into the sky and when he sat and leaned his head comfortably against the wall that's when I felt that a simple head support would go miles to relieve him of that painful posture and both your and @PPM4's idea of building on the patient's cloth driven support is perhaps the right way forward.
PPM 3 - How long he sits leaning? Clinic or home anywhere...
PPM 4 - Would a simple long ruler/pipe strapped to his back and extending to head work? That would mimic the wall support that you mentioned.
PPM 3 - Spare the occipital protuberance. Old typ dental chair headrest is acceptable for long duration.
PPM 1 - Yes it may.
Yes or an old time saloon chair is what I had in mind.
PPM 4 - Right.. headrest when sitting, but what about when walking? Pipe, velcro harness... Anything else that can help?
PPM 3 - Milwaukee is for walking.
PPM 4 - Milwaukee Brace Kit. 👇
PPM 3 - It holds the neck. There is another plastic brace.
PPM 4 - 👍
PPM 1 - Modified Milwaukee that might be more appropriate for this particular patient?👇
https://m.indiamart.com/proddetail/rebuilt-milwaukee-brace-20807185630.html
PPM 4 - 👌
PPM 3 - Minerva
PPM 1 - 👍
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