ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage of reducing harmful spasticity in one area, while preserving useful spasticity in another area. This randomized, double-blind study is the first trial that was designed to find out whether botulinus toxin Type A and phenol relieves the signs and symptoms of ankle plantar flexor and foot invertor spasticity after stroke and if either of these methods offers any advantages and disadvantages over the other. Twenty patients who were included in this preliminary study were randomly assigned to receive a single treatment of 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. A combination of subjective and objective measures were used to assess functional change at baseline and at Weeks 2, 4, 8, and 12. At follow-up, significant improvement (P< 0.05) in the Ashworth score for dorsiflexion was observed in both groups. The change in the Ashworth score for eversion was significant in the group that received botulinus toxin Type A (P< 0.05) but not in the group that received phenol (P> 0.05). When those variables were compared between the two groups, the change in the Ashworth score at Weeks 2 and 4 was significantly better in the group that received botulinus toxin Type A (P< 0.05) but there was not a significant difference between the two groups at Weeks 8 and 12 (P> 0.05). The decrease in clonus duration that was detected by electromyography was significant in both groups at all visits, but the decrease in the group that received botulinus toxin Type A was significantly better at Weeks 2 and 4 (P< 0.05). It is concluded that both motor point injections with botulinus toxin Type A and tibial nerve blockade with phenol are effective in plantar flexor spasticity, but the changes were more significant in the group that received botulinus toxin Type A at Weeks 2 and 4, whereas there was not a significant difference between the two groups at Weeks 8 and 12. Future research should explore the long-term effect of these two treatment modalities.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Neuromuscular stimulation may facilitate motor recovery after stroke or brain injury, reduce shoulder pain associated with hemiplegia, and reduce cerebral spasticity. However, the discomfort of surface neuromuscular stimulation significantly limits the clinical implementation of this modality for persons with hemiplegia. The study contained herein tests the hypothesis that stroke and brain injury survivors with chronic hemiplegia (>6 mo) and intact sensation tolerate percutaneous intramuscular stimulation better than surface stimulation. Four stroke and two traumatic brain injury survivors participated in the study contained within this article. Each subject received three pairs of percutaneous and surface stimulations of the paretic finger extensors. The order of the type of stimulation within each pair was randomly assigned. The stimulation parameters for each type of stimulation were normalized to produce the same torque at the metacarpophalangeal joint. Subjects rated their perceived level of discomfort using a 10-cm visual analog scale and the McGill Pain Questionnaire. A blinded evaluator administered the pain measures. Percutaneous stimulation was associated with significantly lower discomfort as reflected by the visual analog scale (0.74v3.3; 95% confidence interval of difference, −3.84, −1.28). The McGill Pain Questionnaire produced similar results with percutaneous stimulation associated with a significantly fewer number of words chosen to describe the discomfort (0.87v3.30; 95% confidence interval of difference, −3.50, −1.30) and significantly lower Pain Rating Index (1.47v6.27; 95% confidence interval of difference, −7.77, −1.83). Data suggest that percutaneous intramuscular stimulation is significantly better tolerated than surface stimulation and that percutaneous stimulation may enhance patient compliance with neuromuscular stimulation treatments.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The purpose of this study was to stimulate the laryngeal cough reflex using a nebulized, mild chemical irritant and to record an associated laryngeal evoked potential from the internal branch of the superior laryngeal nerve. The laryngeal evoked potential was obtained on ten normal subjects from the right internal branch of the superior laryngeal nerve. The electrodiagnostic setup included an active electrode placed just below the hyoid bone with a 4-cm separation and distal reference. A ground electrode was placed between the active and reference electrodes. The receptors and internal branch of the superior laryngeal nerve were stimulated by inhalation of a nebulized 20% solution of tartaric acid and normal saline. The time line was triggered by a pneumatic switch on initial inspiration of the nebulized tartaric acid. The electrodiagnostic settings were set at a sweep speed of 1 ms/division, a gain of 10 to 20 μV/division, and 20 to 2,000 filters. There were 132 variables recorded from the internal branch of the superior laryngeal nerve of the ten subjects. The mean peak distal latency was 1.66 ± 0.42 ms with a 1.6 median, 1.6 mode, and 0.17 variance. The duration was 0.41 ms, and amplitude was 5.19 ± 2.91 μV. In conclusion, the laryngeal evoked potential, the afferent component of the involuntary cough reflex, can be recorded from the internal branch of the superior laryngeal nerve after inhalation of tartaric acid-induced cough.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Spinal cord injury leads to a pronounced reduction of cardiovascular, pulmonary, and metabolic ability. Physical activity, up to and including high-performance sports, has obtained importance in the course of rehabilitation and the postclinical phase. Thirteen elite female wheelchair basketball players from the German National Basketball Team and 10 female sedentary spinal cord-injured persons were examined in the study. Heart volume was measured by an echocardiography. All subjects underwent a graded exercise test on a wheelchair ergometer. Additionally, heart rate, lactate, and player points were measured during a competitive basketball game in wheelchair basketball players. Cardiac dimensions were larger for spinal cord-injured wheelchair basketball players (620.3 ml; 9.6 ml · kg−1) in comparison with spinal cord-injured persons (477.4 ml; 8.2 ml · kg−1) but did not exceed the heart volume of untrained nonhandicapped persons. In contrast, athletes with amputations or those having had poliomyelitis reached training-induced cardiac hypertrophy in relation to body mass (713.7 ml; 13.2 ml · kg−1), as observed in nonhandicapped athletes. During graded wheelchair ergometry, wheelchair basketball players showed a higher maximal work rate (59.9v45.5 W), maximal oxygen consumption (33.7v18.3 ml · min−1· kg−1), and maximal lactate (9.1v5.47 mmol · l−1) without a difference in maximal heart rate and workload at AT4than did spinal cord-injured persons. The average heart rate during the wheelchair basketball game was 151 · min−1, and the lactate concentration was 1.92 mmol · l−1. Female athletes with a less severe handicap and higher maximal oxygen consumption during the graded exercise test reached a higher game level in the evaluation. During the competitive basketball game, high cardiovascular stress was observed, indicating a fast aerobic metabolism; the anaerobic lactic acid capacity played a subordinate role. Wheelchair basketball is an effective and suitable sport to enhance physical performance and to induce positive physiological adaptations.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The high lumbar disc refers to a disc herniation involving the upper lumbar discs (L2-4). Radiculopathy caused by an upper lumbar disc is occasionally difficult to diagnose secondary to ambiguous presenting symptoms. Once accurately diagnosed, the treatment program is straight-forward but specific for the high nerve root pathology. A series of three cases of high lumbar radiculopathies managed with an aggressive conservative approach are presented. This case series will review the diagnostic and treatment strategies that are useful in the identification and management of a high lumbar radiculopathy. Various pitfalls in the management of these cases are reviewed, all of which may worsen the patient's clinical situation. A high index of suspicion is necessary to elucidate this entity.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This case report describes abnormalities in bilateral rectus capitis posterior minor muscles in one individual with persistent head and neck pain. These findings are muscle atrophy, fatty infiltration on magnetic resonance imaging, and electromyographic abnormalities compatible with denervated muscle. The objective of the study contained herein was to determine if fatty infiltration on magnetic resonance imaging of the rectus capitis posterior minor muscle is the result of disuse or denervation. Electromyography and magnetic resonance imaging data were collected from normal and atrophied muscles. Electromyography and magnetic resonance imaging abnormalities compatible with denervation atrophy were detected. Although we cannot rule out aging or other unknown causes, we suspect that denervation is caused by nerve damage from trauma to the C1dorsal ramus as a consequence of entrapment within the rectus capitis posterior major muscle.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The clinical events leading up to the sudden death of a dysphagic stroke patient with dementia is described. A 63-yr-old man sustained right thalamic and mid-brain infarctions. On the inpatient stroke rehabilitation ward, he exhibited significant impulsivity and dementia, the latter felt to be premorbid. The patient frequently coughed, and modified barium swallow testing showed dysphagia, with aspiration occurring only when consuming greater than teaspoon amounts of liquid. He subsequently died at home while eating a meal. Autopsy showed an intact large cheese ball (bocconcini) occluding the airway. Sudden death in the impulsive stroke patient secondary to airway occlusion by a food bolus has not previously been reported, although such patients seem to be at greater risk. New eating-related interventions are warranted for dysphagic patients who exhibit impulsivity. It is proposed that food particle size be limited to 1 cm2and that such patients be closely monitored while eating.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID