ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A 17-item questionnaire was designed to assess the relative importance of various factors to physical medicine and rehabilitation (PM&R) training directors when ranking PM&R resident applicants during the National Resident Match. The questionnaire was sent to all PM&R residency training directors. The recipients were asked to grade most selection factors based on a numerical scale: 1, unimportant; 2, some importance; 3, important; 4, very important; 5, critical. The specific factors addressed in the questionnaire were: academic criteria, letters of recommendation, individual applicant characteristics and aspects of the interview process. Twelve yes-or-no questions were also designed to determine the weight that residency training directors place on certain academic criteria.A response rate of 88% (66/75) was obtained. The most important academic criteria were grades in a PM&R clerkship in their facility (4.1 ± 0.8), followed by grades in a PM&R clerkship in another facility (3.6 ± 0.9). The most important letters of recommendation were from a PM&R faculty member in the respondent's department (4.0 ± 0.8), followed by the dean's letter (3.7 ± 1.0) and the PM&R chairman's letter (3.7 ± 1.0). The three most important applicant characteristics evaluated during the interview were compatibility with the program (4.4 ± 0.8), the ability to articulate thoughts (4.2 ± 0.8) and the ability to work with the team (4.2 ± 0.8). Most program directors used multiple criteria to complete their rank list, but the most important were based upon the interview (4.5 ± 0.9), letters of recommendation (3.7 ± 0.9), medical school transcript (3.6 ± 0.8) and the dean's letter (3.6 ± 1.1). Knowledge of the specialty, personal statements and research interest were the least important candidate criteria. The majority of respondents believed that clinical and preclinical honor grades were more important than honor status on the United States Medical Licensing Examination steps 1 and 2.

ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The objective of this study was to clarify the significance of the association of the patient wrist ratio and a median abnormality at the carpal tunnel. The average wrist ratio and median nerve latencies were determined in 665 patients with symptoms involving at least one hand or forearm. The mean average wrist ratio of the 419 women (0.690) exceeded that of the 246 men (0.672), differing significantly (mean difference 0.018; 95% confidence interval, 0.012 to 0.024; P<0.0001). The mean average wrist ratio of the 236 women (0.704) with a median abnormality exceeded that of the 183 women (0.672) without a median latency abnormality (difference 0.032; 95% confidence interval, 0.026 to 0.038; P<0.0001); the mean average wrist ratio of the 166 men (0.681) with a median abnormality exceeded that of the 80 men (0.655) without a median latency abnormality (difference 0.026; 95% confidence interval, 0.016 to 0.035; P<0.0001). Regression analyses revealed an increasing average wrist ratio to correlate positively with a slowing of the dominant hand median nerve motor and sensory latencies, with the best latency correlation being the median minus the ulnar palm-to-wrist latency difference in the women (r=0.394, P<0.0001) and in the men (r=0.329, P<0.0001). A median abnormality was found in 79% of the women and in 86.9% of the men with an average wrist ratio of 0.7 or greater; women had 73.8% of the average wrist ratios of 0.7 or greater. The patient wrist ratio (and related factors) seems a vital yet confounding variable relative to much of the previous epidemiologic investigation of the carpal tunnel syndrome, and may be a key element in explanation of the greater prevalence of a median neuropathy at the carpal tunnel in women and the tendency of a bilateral occurrence of the condition.

ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To better understand the epidemiology of accidents affecting wheelchair users, we evaluated 2,066 nonfatal wheelchair-related accidents reported, between 1986 and 1990, to the National Electronic Injury Surveillance System (NEISS) Division of the United States Consumer Product Safety Commission. The NEISS used data from representative emergency departments across the United States during this period. An extrapolation from this sample and from those of 1991 and 1992 provided an average national estimate of 36,559 wheelchair-related accidents per year that are serious enough to cause the injured person to seek attention at an emergency department; there was a significant (P=0.007) upward trend over time. Elderly women were the most likely to sustain an injury. Of the people injured, 7.6% were not wheelchair users themselves. The most common causes of accidents were related to falls and tips in 73.2% of incidents, associated secondary causes (e.g., a ramp) in 41.4% and transfers in 16.9%. The most frequently reported location for the falls was at home (50.8%). The majority of resulting injuries were contusions and abrasions (32.8%), lacerations (28.0%), fractures (20.2%) and sprains and strains (10.3%). Hospitalization was required in 12% of cases. The results of this analysis have implications for rehabilitation professionals, regulatory bodies and wheelchair manufacturers.

ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Nerve conduction studies are commonly performed in elderly individuals. No complete set of reference data for the distal lower limb nerves exists for this population, making it difficult to accurately interpret electrodiagnostic findings. The purpose of this study was to provide reliable reference data by comprehensively examining conduction characteristics in routinely tested peripheral nerves of the lower limb in a healthy elderly population. Conduction studies of the tibial, deep peroneal, sural and medial dorsal cutaneous nerves were performed in one lower limb of 122 healthy elderly individuals between the ages of 60 and 89 years. Peak amplitudes of the sural sensory action potential and the tibial compound muscle action potential correlated significantly with both age and leg length. All other parameters did not show significant correlation with age. Conduction velocities and distal latencies slowed significantly with increasing leg length except for tibial distal latency.

ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This study examined whether experiences of handicap influence levels of depression and distress among persons with spinal cord injury (SCI) during the years after initial discharge from rehabilitation. SCI outpatients (163), who had received inpatient treatment at one of two rehabilitation centers in Michigan and who were between 2 to 7 years since injury, participated in the study. Measures of depression, of psychological distress and of handicap were collected during 2 consecutive years utilizing the Zung Self-Rating Scale, the Brief Symptom Inventory and the Craig Handicap Assessment and Reporting Technique (CHART) in conjunction with the Perceived Handicap Questionnaire (PHQ), respectively. According to the study's findings, depressed/distressed SCI subjects reported spending more hours in bed (P<0.01), fewer days out of the house (P<0.03) and receiving more paid personal care assistance (P<0.02) than did other subjects. They also expended more for general medical expenses (P<0.001) and reported less access to readily available transportation (P<0.003). CHART total scores, reflecting a simple objective measure of handicap as described by Whiteneck et al. (Whiteneck GG, Charlifue SW, Gerhart KA, Overholser JD, Richardson GN:Guide for Use of the CHART: Craig Handicap Assessment and Reporting Technique. Craig Hospital, CO, 1988) were significantly associated with both distress and depression as measured during the second year of data collection. Other significant predictors of depression and distress included subjects' self-perceived handicap (measured by the PHQ), gender, marital status and age. Together both measures of handicap were among the strongest predictors of depression and distress after discharge by SCI subjects who were on average 4.5 years post-injury.

ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Degenerative bone and joint diseases that commonly accompany spinal cord injury (SCI) may be exacerbated by physical activity of the lower extremities. To determine if orthopaedic stress imposed by electrically stimulated cycling exercise is associated with osteonecrosis or osteoarthrosis in persons with chronic SCI, ten quadriplegics and paraplegics who had each undergone electrical stimulation cycle ergometry exercise two or three times weekly for longer than 1.5 years underwent magnetic resonance examinations of the femoral heads and the dominant knee. Three of the ten subjects had no evidence of meniscal or bone marrow pathologies, osteochondritis dessicans, avascular necrosis, joint effusion or accumulation or soft tissue tears. The magnetic resonance scans of six subjects were noted to have very mild effusion, slight meniscal degeneration and minimal chondromalacia patellae. Consistent patterns of bone or joint pathology were not discernible among these scans, and the positive findings did not represent threatening clinical states. The scans of one subject showed heterogenous regions of bone infarct characteristic of osteochondritis and avascular necrosis, observations that were atypical of all other subjects. No injuries consistent with the biomechanics of cycling exercise were observed in any subject. Despite the high sensitivity of magnetic resonance imaging in detecting bone and joint deterioration, significant bone and joint findings represented only 14 of 150 observations, less than previously reported in sedentary subjects with SCI. This study suggests that electrical stimulation cycle ergometry does not foster bone or joint deterioration in individuals with chronic SCI.

ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The tarsal tunnel syndrome (TTS) is an entrapment of the posterior tibial nerve at the ankle, which, like carpal tunnel syndrome, improves with surgery but needs an instrumental diagnosis to exclude other diseases. This study was performed to evaluate the diagnostic value of nerve conduction tests proposed for the diagnosis of TTS. Of the 13 patients who were investigated 12 had secondary unilateral and 1 idiopathic bilateral TTS. One or more neurophysiologic parameters were abnormal in all cases. The diagnostic value of each neurophysiologic parameter was calculated by comparing conduction on the affected side with conduction on the healthy side of each patient with TTS. The accuracies of the sensory nerve action potential and mixed nerve action potential, both after stimulation of the plantar nerves, were almost the same, with sensory nerve action potentials more sensitive and less specific and mixed nerve action potentials less sensitive and more specific. Because from the clinical point of view we must be more afraid of false-positive results, the mixed nerve action potential is recommended for presurgical diagnosis of TTS. Coexistence of mixed nerve and sensory nerve action potential abnormalities, especially if asymmetric, are highly indicative of TTS.

ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A study was made of 301 terminal cancer patients who received physical therapy in the hospice facility during a period of 61/2 years. Of 239 patients with activities of daily living disturbance, the average transfer and locomotion score on the Barthel mobility index (maximum score 47) was 12.4 before beginning the physical therapy program. Later, after activities of daily living exercises, at their maximum level these patients reached an average score of 19.9. Response to a questionnaire was obtained from 169 families of deceased patients; 149 patients (88%) had indicated a desire for ambulation or mobility by wheelchair; 166 patients (98%) were satisfied with the hospice care; 132 patients (78%) were satisfied with the rehabilitation in the terminal stage; 107 patients (63%) considered the terminal rehabilitation procedures to be effective. The more fully patients discussed the physical therapy program with the therapist, the more effective and more satisfactory the rehabilitation was judged to be. Families actively participating in the rehabilitation assessed it as more effective, more satisfactory to the patients and more useful in overall patient care than those who did not participate at all. This study shows that rehabilitation can make an important contribution to the care of the terminal cancer patient.

ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Six ventilator-assisted individuals (VAIs) with spinal muscular atrophy (SMA) are described. All six survived by using intermittent positive pressure ventilation via an indwelling tracheostomy for a mean of 11.7 ± 17.7 yr despite frequent episodes of mucus plugging and pneumonia. Four of the VAIs also received all nutrition via indwelling gastrostomy tubes because of severe bulbar muscle weakness. Four VAIs used tracheostomy intermittent positive pressure ventilation with their tracheostomy cuffs deflated and could communicate verbally. Five of the six VAIs remained institutionalized from the onset of ventilatory use. Two SMA VAIs survived for 15 and 4 yr, respectively, despite need for ventilatory support since early infancy. All four SMA VAIs who could communicate remained socially active and one, gainfully employed. We conclude that for patients with advanced SMA markedly prolonged survival is possible with ventilatory assistance despite severe respiratory and bulbar muscle dysfunction.

ISSN:0894-9115    

出版商:OVID    

年代:1994

数据来源: OVID