ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Facial nerve paralysis is the most common mononeuropathy and idiopathic facial paralysis (Bell's palsy) the most common seventh nerve disease electromyographers may be asked to evaluate. The electrophysiologic method of choice to assess the facial nerve is side-to-side evoked amplitude comparison with the affected side expressed as a percentage of the nonaffected side. This examination should be performed on days 3, 5, 7, 9,11 and 13 after onset of paralysis. If the percentage of surviving axons falls below 10% within the first 14 days, an incomplete recovery is suggested. Electromyography may assist in prognosticating a functional return, determining neural conduction across the site of injury and following reinervation in the recovery period. The persistence or early return of an absent R1 component of the blink reflex may qualitatively suggest a satisfactory functional outcome in facial paralysis. Supramaximally exciting the facial nerve at the stylomastoid foramen and comparing the clinical response on the affected and nonaffected side, maximum stimulation test, can also predict eventual seventh nerve return. Observing a minimal twitch, utilizing the nerve excitability test or measuring the facial nerve latency have yielded poor correlations with functional return and are of limited usefulness in the prognostication of acute facial palsies. Trigeminal somatosensory evoked potentials can be employed to evaluate the status of the trigeminal nerve as approximately 50% of patients with Bell's palsy also have lesions involving the fifth nerve. Side-to-side amplitude comparison and electromyography are the two most valuable electrophysiologic methods of assessing facial nerve functioning.

ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This review is concerned with the epidemiology of lower limb amputations, frequency and results of limbsaving procedures and the contemporary management of dysvascular amputees. National data showed no decline in the number and rates of amputations from 1981-1985, but the frequency of bypass surgery increased indicating that the problem of peripheral arterial occlusive disease is far from being resolved. Femoral/popliteal bypasses are performed twice as often as aorto/ileac procedures but failure rates are high. Based on observations of 238 amputees we noted that femoral/popliteal bypasses had the highest failure rate, particularly when performed as a last limbsaving effort. A laudable trend of preserving the knee was noted but poor stump conditions were the most important factors influencing the length of hospital stay (average 51 days). The amputee rehabilitation process is discussed along with a description of contemporary prosthetic technology. The cost effectiveness of state of the art devices for the older dysvascular amputee is questioned. The cost of amputation and rehabilitation is enormous, especially when preceded by unsuccessful arterial reconstruction. The loss of a leg is, of course, a major disaster for every individual and therefore limbsaving efforts and amputation techniques must be refined and the rehabilitation effort optimized.

ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Twenty patients admitted to hospital with congestive heart failure were evaluated for severe concomitant lumbosacral and leg pain. In each instance the discomfort was worse at night and progressively decreased with a resolution of the pulmonary edema. Neurologic and electromyographic examinations in all but four patients were normal with reflexes, strength and straight leg raising testing normal. An absent Achilles reflex was recognized in two, a diminished knee jerk reflex in one and in a third, weakness in the extensor hallucis longus. Lumbar spinal stenosis was identified in all of the patients with a concomitant degenerative spondylolisthesis present in nine instances and in an additional two a spondylolisthesis with interruption of the neural arch. It is theorized that diminished right heart compliance can induce a sufficient increase in venous volume and pressure within the paravertebral plexus of Batson to acutely exacerbate a chronic lumbar spinal stenosis. In support of this hypothesis, the multiple factors involved in the pathomechanics and physiology of lumbar radiculopathy, spinal stenosis and the role of the paravertebral plexus of veins are examined. Specifically, their response to altered volume and pressure gradients tending to induce venous “creep” as well to alterations in posture and diurnal cycles are reviewed.

ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We present a case history of a patient with definite multiple sclerosis who developed an abrupt onset of unilateral diaphragmatic paralysis, minor increase in lower extremity spastidty and complaint of marked neck stiffness. Her vital capacity during this episode was 600 mL and she was in impending respiratory failure. The diaphragmatic paralysis was demonstrated by radiographic plain films and fluoroscopy. Phrenic nerve stimulation was performed during fluoroscopy and the evoked motor response from the diaphragm recorded. There was a normal amplitude diaphragmatic twitch observed with an evoked motor response latency of 1 ms and amplitude of 300 juV. After high dose intravenous steroids, her neck stiffness and spasticity improved, her vital capacity improved to 1500 mL and her diaphragm regained its normal position and movement confirmed by followup radiographic plain films and fluoroscopy. We postulate the presence of a demyelinating plaque in the brainstem fibers descending to the phrenic nucleus as the etiology of the diaphragmatic paralysis. We are unaware of any other case reports of unilateral “upper motor neuron” phrenic nerve paralysis secondary to multiple sclerosis.

ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Averaged F-wave conduction velocities (a-FWCV) of peroneal nerve were measured on 38 healthy volunteers and 22 patients with clinical and electromyographic evidence of unilateral L5or L5+ S1radiculopathy. The peroneal nerve was stimulated supramaximally at the fibular head and the compound muscle action potential was recorded from the extensor digitorum brevis muscle. Averaged tracings from 32 consecutive stimuli were obtained. The averaged Fwave latency (Fp) and M-wave latency (Mp) were measured from the stimulating artifact to the peak of the waves. The distance (D) between the stimulating point and the T12spinous process was measured. The value of a-FWCV was calculated as 2D/(Fp-Mp — 1) m/second. In normal subjects, the average value of a-FWCV was 56 ± 4, and there was no significant difference between males and females, nor between the right and left sides. The differences among the tests administered at different times on the same subject were also statistically insignificant. Of the 22 patients, 17 had subnormal value of a-FWCV if the lower normal limits were defined as mean minus 2.5 SD (i.e., 46 m/second) calculated from the normal control value. However, only one of them had subnormal value of FWCV calculated by the conventional method (without averaging technique). All the patients with two root (L5+ S1) involvement had subnormal a-FWCV. It is concluded that the a-FWCV is a more sensitive measure than the conventional FWCV in the assessment of L5radiculopathy.

ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A survey of physiatrists' views of conducting research yielded 550 usable returns, a response rate of 44%. Respondents were virtually unanimous in indicating that research is important for the continuing development of physical medicine and rehabilitation. However, 58% reported devoting no time to research, and only 2% were spending more than 25% time in research. The two most frequently cited barriers to greater research involvement were a lack of funding and insufficient equipment, facilities and assisting personnel. The most preferred means of supplementing research skills were collaboration or consultation with other rehabilitation professionals conducting research.

ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fifteen children with bilateral lower limb disability were fit alternately with plastic/metal (PM) and leather/metal (LM) knee-ankle-foot orthoses. Fit was maintained by periodic growth adjustments. Gait, activities of daily living, and subjective reactions were gathered for each orthosis type. Despite previous anecdotal reports and expert opinion to the contrary, no overall differences were found between the two types of orthoses. Several specific differences were revealed, however; most children preferred the PM orthoses, saying they were lighter and more easily donned and doffed; the PM orthoses also controlled hip and knee sagittal motion and foot valgus/varus during gait more effectively. Individual biomechanical, neuromuscular and psychologic attributes of the disabled child must be carefully matched with the technical attributes of each orthotic option to effect an optimal prescription.

ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Injuries to the anorectum have been described as having resulted from therapeutic enema use. We report three cases occurring in patients with premorbid perianal pathology. All extended hospitalization although each was managed nonoperatively. These accidents can be prevented by pre-enema rectal examination and attention to perianal anatomy and patient complaints of discomfort during the procedure.

ISSN:0894-9115    

出版商:OVID    

年代:1988

数据来源: OVID