ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

To explore the possible mechanisms of phantom limb discomfort after amputation, three amputees with phantom limb pain were studied. This study examined the change of regional cerebral blood flow using technetium-99m hexamethylpropyleneamine oxime-single photon emission computerized tomography, which was arranged at the time of severe phantom limb discomfort and after the discomfort subsided or was completely relieved. Nine representative transverse slices parallel to the orbitomeatal line were selected for quantification. The cortical ribbon (2-cm thickness) was equally subdivided into 12 symmetrical pairs of sector regions of interest in each slice. The irregularly shaped regions of interest were drawn manually around the right thalamus and basal ganglion and then mirrored to the left thalamus and basal ganglion. The contralateral to ipsilateral ratio of regional cerebral blood flow for each area was calculated. The intensity of phantom limb pain was evaluated on a 0 to 10 visual analog scale. In Cases 1 and 2, the contralateral to ipsilateral regional cerebral blood flow ratios of multiple areas of the frontal, temporal, or parietal lobes were increased at the time of more severe phantom limb pain, and the ratios were normalized or even decreased when the phantom limb pain subsided. In Case 3, increased contralateral to ipsilateral regional cerebral blood flow ratios were also found over the frontal, temporal, and parietal lobe. However, most of the increased regional cerebral blood flow ratios of regions of interest in the first study persisted in the follow-up study. Also, the regional cerebral blood flow ratios of greater number of regions of interest of the same gyrus and new gyrus were increased. There was no significant right-left difference of regional cerebral blood flow over bilateral thalami and basal ganglia in all three cases. The results suggested that phantom limb pain might be associated with cortical activation involving the frontal, temporal, or parietal cortex, and it may imply the possibility of the existence of an ascending polysynaptic pathway that conveys the uncomfortable phantom limb sensation to the cerebral cortex. These findings may also indicate that reorganization of the cortical blood flow occurs in amputees. However, it is still difficult to conclude that the changes in regional cerebral blood flow were attributable directly to pain. With no comparison group of amputees and because of the small number of cases, it is hard to generalize about cerebrocortical involvement in phantom pain, and it is possible that the findings represent a normal phenomenon seen after amputation. Another possibility is that the findings represent increased arousal caused by pain rather than an intrinsic pain pathway. Further study is worthwhile.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study was designed to examine the scale quality of our newly developed short behavior scale and to identify its role in predicting the functional outcome of stroke patients. The short behavior scale consists of six items that assess cognitive function related to the daily behavioral status of a patient in activities of daily living and exercise. It can be scored quickly through observation of a patient's behavior. We assessed 190 stroke inpatients, who had a mean age of 61 years. The mean days and length of stay from onset were 47.3 and 138.2, respectively. We examined internal consistency with the Cronbach's alpha coefficient. Interrater reliability was tested by having two examiners evaluate 30 patients independently. We studied how the short behavior scale correlated with the admission Functional Independence Measure, Mini-Mental State Examination scores, and speech and visuospatial functions. We also studied how the short behavior scale contributed to the prediction of discharge Functional Independence Measure raw scores with stepwise multiple regression analysis. In another group of 116 patients, we cross-validated our predictive equation. The Cronbach's alpha coefficient was 0.88. The intraclass correlation coefficient was 0.84 for total score. The short behavior scale correlated significantly with cognitive Functional Independence Measure scores and Mini-Mental State Examination scores. We could explain 70.8% of the variance of discharge Functional Independence Measure scores from the Short Behavior Scale, days from onset to admission, age, speech scores, and admission Functional Independence Measure scores. Stability of the predictive equation was shown in cross-validation to a second sample of 116 patients. In conclusion, our newly developed short behavior scale proved reasonable and would be useful to enhance the precision of outcome prediction in stroke rehabilitation.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Research in animals shows that the levels of neuropathic pain expression is genetically associated with a characteristic response profile to sensory stimuli. The aim of the present investigation was to examine if pressure algometry can identify a specific pain sensitivity profile in patients with complex regional pain syndrome, Type I (reflex sympathetic dystrophy), and to distinguish complex regional pain syndromes from other chronic pain dysfunction syndromes. Pressure pain threshold and pain tolerance measured at the sternum in 17 patients with complex regional pain syndrome, Type I (reflex sympathetic dystrophy), were compared with values obtained in 13 patients suffering from other chronic pain dysfunction syndromes and in a control group of 24 pain-free volunteers. The pressure algometer consisted of a force displacement transducer with a 0.25 cm2tip connected to a recorder. The rate of force application was 1 kg/0.25 cm2/s. The difference between threshold and tolerance was defined as the pain sensitivity range. Young patients with complex regional pain syndrome (<40 yr) demonstrated a significantly higher mean pain sensitivity range compared with young subjects who had chronic pain or who were pain-free. Mean threshold and tolerance values were significantly lower in patients with complex regional pain syndrome (2.7 ± 1.0 kg (mean ± standard deviation) and 5.4 ± 2.0 kg, respectively) and in patients suffering from other chronic pain syndromes (2.6 ± 1.1 and 4.6 ± 1.7 kg) than in healthy subjects (5.4 ± 2.3 and 8.4 ± 2.6 kg). Women in the chronic pain group exhibited a significantly lower pressure pain threshold than all other subgroups. Regardless of group, women exhibited lower pressure pain tolerance than men. In conclusion, the study contained herein shows a specific pain sensitivity profile to experimental stimuli behavior in young patients with complex regional pain syndrome expressed by a large pressure pain sensitivity range, at a location away from the painful area. However, one single pressure pain measurement over the sternum is insufficient for differentiation of patients with complex regional pain syndrome from those with chronic pain because of intersubject variation.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The objective of the study contained herein was to evaluate the clinical use of the Berg Balance Scale in a heterogeneous acute inpatient rehabilitation population and to assess the relationship between balance scores at admission and rehabilitation outcomes, including functional gain and length of stay. This was a prospective study of 45 patients with diagnoses including stroke (n= 15), traumatic brain injury (n= 19), and other impairments (n= 11) who were admitted for acute inpatient rehabilitation. Functional ability was evaluated with the Functional Independence Measure (FIM™) instrument, and balance was measured using the 14-item Berg Balance Scale. These measures were assessed both at admission to and discharge from inpatient rehabilitation. Correlation and multiple regression analyses were used to determine the relationship between balance and functional ability scores at admission and rehabilitation outcomes at discharge, including length of stay, functional gain, and efficiency. Analyses of variance comparing impairment groups indicated that patients with traumatic brain injury were younger than the stroke and other groups, but there were no group differences on FIM or balance scores at admission or discharge. There were no significant group differences for any of the outcome measures. When the impairment groups were collapsed into a single heterogeneous group, multiple regression analyses demonstrated that the sitting unsupported item score at admission accounted for 27% of the variation in length of stay, once demographic influences were controlled. The FIM efficiency score was predicted best by the total Berg Balance Scale score, with 22% of the variance accounted for. In contrast, balance scores did not provide predictive information about the FIM gain score beyond that already provided by the FIM-Total score at admission, which accounted for 10% of the variance once demographics were controlled. Balance scores collected at admission to inpatient rehabilitation, in whole and in part, were shown to account for moderate amounts of variation in length of stay and the FIM efficiency score. For several of the rehabilitation outcomes, balance scores at admission accounted for more variation than scores on the FIM instrument. These findings suggest that routine assessment of balance at admission to inpatient rehabilitation may enhance the ability to predict rehabilitation outcomes beyond that provided by assessment of functional status alone.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Pressure ulcers are a prevalent and potentially serious medical problem encountered in both the medical and rehabilitation settings. Because the progress of rehabilitation is often interrupted by the presence of pressure ulcers, the efficient care of these wounds is of great interest to the rehabilitation team. Patients in two acute care facilities with Stage III or IV pressure ulcers were identified and consented to participate in the study contained herein. All wounds were mechanically débrided of necrotic tissue, and then the patients were randomly assigned to the conservative treatment group (A;n= 18) or the conservative treatment plus whirlpool group (B;n= 24). Conservative treatment included measures to maximize pressure relief and wound care with wet-to-wet dressings using normal saline. The dressings were changed twice daily and when they became soiled. Whirlpool was administered for 20 min per day in Group B patients. Only those patients whose ulcers were followed-up for 2 or more wk were included in the study. Ulcers were then measured by a physician who was blinded as to the treatment groups. Ulcer dimension changes over time were compared between groups. The results indicate that the conservative treatment plus whirlpool group improved at a significantly faster rate than did the conservative treatment only group (P< 0.05).

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

In this study of the median nerve, serial bipolar and referential recordings from the thenar eminence show that the median premotor potential actually consists of two distinct negative waves, an early (N-I) and a late premotor potential (N-II). Anesthetic block of the palmar cutaneous branch of the median nerve eliminated the early premotor potential in all subjects. This suggests that the early premotor potential (N-I) is the sensory nerve action potential of the palmar cutaneous branch of the median nerve. Local anesthesia of the palmar cutaneous branch of the median nerve also defined its area of innervation as circumscribed in our subjects. No normative data concerning the sensory nerve action potential of the palmar cutaneous branch of the median nerve is currently available, because previous studies apparently recorded the late premotor potential. The late premotor potential (N-II) is a negative far field potential seen only on referential recordings. It seems unlikely that the late premotor potential (N-II) can be completely explained as a junctional potential from the thumb as some have proposed. This study demonstrates a positive far field potential (P-I) at the palm-thumb junction, having a latency inconsistent with that of the late premotor potential. The late premotor potential can also be recorded with the reference electrode at an electrically neutral site, questioning previous explanations for its generator. A second traveling wave (N-III) was recorded distal to the area of the palmar cutaneous branch of the median nerve innervation continuing into the thumb. N-III is most likely the median digital sensory nerve action potential.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A retrospective chart review was performed to assess the effects of acute care hospital-based rehabilitation in patients with multiple limb trauma on functional status and length of stay and to determine whether the distribution of limbs involved has any effect on these variables. Admission and discharge motor Function Independence Measure scores and length of stay were compared for all patients and the injury subgroups. Significant functional gains were made between admission motor Functional Independence Measure (45.4 ± 11.9) and discharge motor Functional Independence Measure (74.1 ± 11.6;P< 0.05) for the group as a whole and across subgroups, with no significant differences between the subgroups. For all patients, the rehabilitation length of stay was 27.7 ± 23.0, with again no difference noted between the subgroups. Individuals with functional deficits attributable to multiple limb trauma benefit significantly from comprehensive intensive acute inpatient rehabilitation. The distribution of limbs involved has little effect on functional outcome or length of stay.

ISSN:0894-9115    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A survey was conducted to evaluate the physiatric research fellowship training. A 22-item questionnaire was sent to the 42 identified physiatrists who had completed at least a 1-yr research fellowship. Twenty-nine of these individuals (69%) responded. The physiatrists, all of whom have completed their research fellowships, uniformly cited competent faculty research mentors as being critical, even if they were not in the same department. Having protected research time as well as a research didactic program and journal club were highly rated issues. The trainees preferred a 2-yr fellowship that also stressed initiation of their own research, grant writing and management experience, and first authorship on research papers. We conclude that the majority of the research fellows agree on what are important issues with respect to their training.

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