摘要:

Falls are a major cause of decreased mobility and disability in the elderly. Multiple factors are believed to contribute to falling. Among these, gait abnormalities have drawn attention as a possible risk factor. Although previous studies have revealed few differences in gait parameters compared with similar aged controls, it was hypothesized that because of intrinsic differences in balance and motor control, we would observe differences in joint kinetics. In this study, 15 subjects (mean age, 77 ± 9 yr), who had at least 2 mo of repeated falls from an unclear cause, were evaluated in a gait laboratory and were compared with a control group of 15 subjects (mean age, 75 ± 5 yr) with no history of falls. Analysis of data demonstrated a significantly greater peak torque in the falls group for the following: hip flexion, hip adduction, knee extension, knee varum, ankle dorsiflexion, and ankle eversion (P< 0.003 in each comparison). Also, ankle plantarflexion torque was significantly decreased in the falls group (P= 0.001). Joint powers showed different absorption at the knee and ankle in the falls group. The discovery of these kinetic differences may provide further insight into the mechanism of falls in the elderly and, more importantly, lead to identifiable markers to detect those who may be susceptible to falls.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The objective of this study was to determine whether the continuous intrathecal delivery of baclofen will control spastic hypertonia associated with long-standing hemiplegia from acquired brain injury. Six hemiparetic patients (average age, 50 (range, 42-66) yr) with more than 6 mo of disabling lower limb spastic hypertonia on one side caused by either a unilateral traumatic brain injury or a stroke were recruited in a consecutive manner. The setting was a tertiary care outpatient and inpatient rehabilitation center directly attached to a university hospital. Patients were screened via a randomized, double-blind, placebo-controlled, crossover design to receive either an intrathecally administered bolus injection of normal saline or 50 μg of baclofen. Data for Ashworth rigidity scores, spasm scores, and deep tendon reflex scores were collected on the affected upper limb and lower limb side. Those who dropped an average of two points on their affected lower limb side Ashworth scores were then offered computer-controlled pump implantation for continuous intrathecal administration of baclofen. Differences over time were assessed via descriptive statistics and Wilcoxon's signed-rank test. After 3 mo of treatment, the average lower limb Ashworth score on the affected side decreased from 3.7 ± 1.0 to 1.9 ± 0.6 standard deviation (SD) (P< 0.0001), the reflex score from 1.8 ± 1.3 to 0.5 ± 0.8 SD (P= 0.0208), and the spasm score from 1.3 ± 1.2 to 0.8 ± 1.3 SD (P> 0.05). The average upper limb Ashworth score on the affected side decreased from 3.4 ± 0.9 to 2.1 ± 0.9 SD (P= 0.0002), the reflex score from 2.3 ± 0.5 to 1.7 ± 0.5 SD (P> 0.050, and the spasm score from 0.8 ± 1.3 to 0 ± 0 SD (P> 0.05). The average intrathecally administered dose of baclofen that was required to attain these effects was 205.3 μg, which was continuously infused for 24 h. Continuous intrathecal infusion of baclofen is capable of maintaining a reduction in the dystonia on the hemiparetic side without significantly affecting motor strength on the normal side.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Heterotopic ossification, or the appearance of ectopic bone in para-articular soft tissues after surgery, immobilization, or trauma, complicates the surgical and physiatric management of injured joints. The chief symptoms of heterotopic ossification are joint and muscle pain and a compromised range of motion. Current therapies for prevention or treatment of heterotopic ossification include surgery, physical therapy, radiation therapy, and medical management. Unlike heterotopic ossification of the hip, heterotopic ossification of the elbow has not been extensively investigated, leaving its optimal management ill-defined. To remedy this deficiency, we review risk factors, clinical anatomy, physical findings, proposed mechanisms, and current practice for treatment and prevention of heterotopic ossification. We then consider and draw conclusions from four cases of elbow injury treated at our institutions (three complicated by heterotopic ossification) in which treatment included surgery, radiation therapy, physical therapy, and medical therapy. We summarize our institutional practices and conclude with a call for a randomized clinical trial to better define optimal management of heterotopic ossification of the elbow.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

A 24-yr-old, completely (T8) paraplegic male patient presenting with severe spasticity had a drug administration device implanted in April 1991 for continuous intrathecal administration of baclofen. After a period of remarkable improvement in both the spasticity level and his quality of life, the patient experienced several short-lasting episodes of increased spasticity, with severe spasms. Among the possible causes of these deleterious episodes were microcrystalluria, obstipation, a decubitus ulcer, a foreign body in the buttocks, drug tolerance to baclofen, electromagnetic interference, and erroneous filling and programing of the pump. The catheter was the most common source of intrathecal baclofen withdrawal symptoms and had to be changed four times in 5 yr. Intrathecal baclofen administered through an implantable drug administration device is a highly effective but complex and expensive procedure that requires careful patient selection and close monitoring by highly qualified and well-trained health professional. Withdrawal symptoms may be related to noncompliance on the part of the patient, erroneous filling or programing of the pump, depletion of the battery, random component failure, concomitant illness, drug tolerance, or advancement of the disease itself. When failure of the device is suspected, substitution with oral baclofen is recommended until a full work-up is performed to determine the defect.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Gait analysis can be a powerful tool for rehabilitation research and clinical practice. However, there has been little coordinated effort to set goals for the application of gait analysis in rehabilitation. Therefore, a priority setting process was engaged to obtain the opinions of a diverse pool of experts related to human motion analysis. The primary goal of this process was to develop priorities for future research, development, and standardization in gait analysis. A multistep approach was used that included expert testimony, group discussions, individually developed priorities, and a ranking process. Several important priorities emerged from this activity. The highest priority was assigned to research on the efficacy, outcomes, and cost-effectiveness of gait analysis.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Examination of the supinator muscle of the forearm may be useful in suspected lesions of the 5th and 6th cervical nerve roots, the upper trunk of the brachial plexus, or the radial nerve. It is critical in localizing the level of involvement in a patient with possible posterior interosseous nerve injury. The traditional techniques in the electrodiagnostic examination of this muscle have approached the muscle from the volar aspect, just radial to the insertion of the biceps tendon, medial to the brachioradialis, through the extensor carpi radialis longus/brevis, between the radial wrist extensors and extensor digitorum communis, or through the extensor digitorum communis. These approaches have the inherent risk of piercing vessels and/or nerves. After reviewing the pertinent anatomy in standard textbooks, magnetic resonance imaging, and a cadaver, we developed a more dorsal approach in the examination of the supinator. Examination of 20 patients by staff, fellows, and residents at our institution resulted in consistent, accurate needle placement, with no complications. We describe a more dorsal approach in the examination of the supinator muscle in the forearm.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID