ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A survey of all residents and residency program directors in Physical Medicine and Rehabilitation (PM&R) was done to assess perspectives of residents and directors regarding research training, resources, mentorship, and encouragement available to residents. A response rate of 55% was obtained from 1188 resident mailings, and 83% of 77 program directors responded. A number of discrepancies in perceptions of residentsvprogram directors were identified. In general, residents perceived that they had less research support and training than directors felt their departments were offering. Only 24% of residents felt that they got adequate training in statistics, 40% for research design, and 26% for writing research papers. The corresponding numbers for residency program directors were 47%, 73%, and 61%. There were similar discrepancies in the perception of the quality of research training. On a 1 to 5 scale, residents registered a mean score of 2.8 (SD 1.0) to the question of how qualified their faculty was to teach principles of research. Program directors' mean response was 3.2 (SD 1.0). Residents were also often not aware of resources available for research in their departments. Only 19% of residents knew of access to a research coordinator/grant writer, 36% for statistical support, and 67% for library assistance. The corresponding numbers for program directors were 31 %, 69%, and 97%. Additional results of the survey are summarized, and suggestions for further study to improve the resident research training experience are given.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The value of vibrometry in the evaluation of carpal tunnel syndrome is controversial. Several investigators have suggested that vibrometry screening with multiple frequencies would improve the correlation and increase the sensitivity when screening for carpal tunnel syndrome. One hundred sixty-nine industrial workers from two manufacturing plants in southern Michigan were screened for median nerve impairment using both vibrometry (seven frequencies, 8–500 Hz) and electrophysiologic testing in each hand. The vibratory threshold at each frequency, as well as composite measures-Jetzer index and negative sums, were compared with electrophysiologic measures of amplitude and latency. The individual frequencies and the Jetzer index correlated with median sensory latency, but the relationships were weak (r= 0.22 to 0.32). Only at the lower frequencies (8, 16, and 32 Hz) did the vibratory threshold correlate with sensory amplitude; correlation ranged from 0.187 to 0.303. Vibration threshold sensation is most closely related to axonal loss or conduction block, but the earliest finding in carpal tunnel syndrome is that of demyelination; thus we would not expect an abnormal vibratory threshold with mild carpal tunnel syndrome. These results support this interpretation and suggest that vibratory screening for early carpal tunnel syndrome is not effective.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The purpose of this study was to investigate disability in persons after traumatic brain injury (TBI) by using combinations of functional assessment item, subscale, domain, and full-scale scores to predict (1) the need for assistance in performance of specific physical care tasks measured in minutes of help per day provided by another person in the home and (2) the subject's level of satisfaction with life in general. This study also sought to account for the amount of supervision that persons with TBI may require beyond that needed for physical care tasks. The Functional Independence Measure (FIM) contributed to prediction of subjects' physical care needs. A single-point change in total FIM score was equivalent to an average of about 5 min of help from another person per day. Satisfaction with life in general was predicted mainly by the depression subscale of the Brief Symptom Inventory. However, this latter prediction was only true when subjects who required constant supervision were removed from analysis. Thus, the amount of supervision required by persons with TBI is an important variable to study in this population. Three categories of supervision were identified: constant (all of the time), periodic (daily or weekly), or not at all. The need for supervision and physical assistance from another person and a subject's satisfaction with life in general are important standards by which functional assessment instruments may be compared to reflect, in pragmatic terms, the impact of disability on the lives of individuals and on human and economic resources of the community.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The medical records of 156 patients with acute traumatic Spinal Cord Injury (SCI), admitted for inpatient SCI rehabilitation during the period from January 1, 1990 through December 31, 1992, were retrospectively reviewed. Seventy-one patients with acute traumatic SCI were identified at risk for thermoregulatory dysfunction (50 patients with cervical SCI and 21 with upper thoracic level SCI). A total of 713 days were documented in which febrile events occurred in 60 of 71 patients during the study period. Over 39% of these fevers measured 101°F (38.3°C) or greater. There were 71 days of documented febrile episodes occurring in 17 patients for which an etiology could not be determined. Fifteen of these individuals had fewer than five such febrile days each during their entire rehabilitation hospitalization.Study results indicate that in a population of patients with acute traumatic SCI at risk for thermoregulatory dysfunction, the occurrence of fever is quite high. Fever not attributable to infectious or inflammatory etiologies is uncommon. Fever attributable to thermoregulatory dysfunction in this setting should be considered only after other etiologies have been carefully excluded.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To evaluate the efficacy of therapeutic exercises in the prevention of bone loss, 146 untrained healthy postmenopausal women were prospectively controlled for (mean ± SD) 3.0 ± 1.3 yr. Eighty-two subjects aged (mean ± SD) 61.5 ± 6.1 yr participated in an exercise program (group 1) and sixty-four aged (mean ± SD) 59.1 ± 7.4 yr served as controls (group 2). Periodically during the study period, we measured women's bone density at two forearm sites and recorded their physical activities. Because bone loss differed insignificantly between the groups, group 1 was retrospectively subdivided into group 1a (regular exercise) and group 1b (nonregular exercise). The results showed that only 39 women (48 percent) of group 1 (group 1a) performed the exercise program regularly for the prescribed time. Regression slopes of forearm bone density (distal and proximal scans)vtime were significantly less negative (P< 0.05) in group 1a (distal, −0.3 percent and proximal, −0.7 percent per year) than in group 1b (distal, −1.8 percent and proximal −1.6 percent per year) or group 2 (distal, −1.7 percent and proximal, −1.9 percent per year). We conclude that in untrained elderly women, poor compliance with regular physical activities is a main factor, explaining the lack of response to exercise treatment in prevention of osteoporosis.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Four special tests to assess benign and minor median nerve lesion at the wrist (MLW) were evaluated in 40 controls and three groups of 25 carpal tunnel syndrome with different degrees of orthodromic sensory conduction velocity (OSCV) slowing. The motor tests were the median-ulnar distal latency difference of the thenar muscles and the second lumbrical-interossei distal latency difference. They were abnormal in only 20% and 4% of patients, respectively, in group 1 (OSCV > 45 m/s), in 56% and 60% in group 2 (45 m/s > OSCV > 40 m/s), and were both abnormal in 96% of patients in group 3 (OSCV < 40 m/s). The two sensory tests were the medianulnar orthodromic sensory latency difference of the fourth digit and the centimetric technique; they were abnormal in 80% and 96% (group 1) and in 96 and 100%, respectively (group 2). All things considered, only the sensory tests showed a satisfactory efficacy to assess benign and minor MLW, because the motor tests reached a positivity of 96% only in group 3.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

OBJECTIVE: To identify and quantify the anatomic sites of foot lesions resulting in amputation among patients suffering from peripheral arterial disease with and without diabetes mellitus. DESIGN: A retrospective study. SETTING: Department of Orthopaedic Rehabilitation. PATIENTS: A total of 212 recent lower limb amputees with diabetes mellitus (158) or peripheral arterial disease only (54) admitted for prosthetic rehabilitation. RESULTS: In 62.2% of all amputees the site of lesion that led to amputation was located in the digits. A lesion under the metatarsal heads was reported in 8.0%, along the mid-foot and heel in 8.5%, on the dorsum of the foot in 3.3%, around the ankle joint and lower leg in 5.7%. Finally, 12.3% reported multiple lesions or were unable to recall the exact anatomic location. CONCLUSIONS: Most foot lesions resulting in amputation are located around the digits. These high-risk sites, therefore, need the patient's and the health care team's special attention. The patient should be trained in self foot examination and meticulous daily care, whereas the role of the health care team is in foot evaluation and provision of protective foot wear.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

There now is extensive literature on the survival and function of replanted digits but little on the function of the hand as a whole after this procedure, as opposed to amputations. In our review of the literature, we found almost nothing on the patient's perspective of the outcome from these procedures. This study was a preliminary attempt to study the outcome of these procedures from the patient's viewpoint. There were nine replantations and ten amputations of digits in the final study groups, based on medical record screening and patient questionnaires. Multivariate analysis, Hotelling T2, was used to test significant differences between the variables in the two groups. Significant differences were found in the two groups. The replantations had longer lengths of treatment and therapy, were off work longer (34.4 wk of therapy and 40 wk off work), and rated their function poorer compared with amputations. The patients with digit amputations had 7.2 wk of therapy and lost 6.8 wk of work. Ninety percent of the amputees rated their function as good or excellent, in contrast to 44.4% of the replantation patients. These findings are supported by existing literature that suggests that single-digit replants do not help with function of the whole hand, which is the therapeutic aim.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

At a certain position of trunk flexion, there is a sudden onset of electrical silence in back muscles. This is called “flexion-relaxation (F-R) phenomenon.” The goals of this study were (1) to evaluate the relationship between flexion angle and activity of back muscles during flexion movement and (2) to determine what the difference is between healthy subjects and patients with chronic low back pain (CLBP). Twenty-five healthy subjects (13 males and 12 females; average age, 28.3 yr) and 20 patients with CLBP (12 males and 8 females; average age, 34.1 yr) volunteered for this study. The subjects were asked to flex forward maximally from the erect position and to maintain full flexion, followed by returning to the initial upright position. Flexion angle of trunk and hip was measured during the examination. Electromyographic activity of erector spinae was also monitored simultaneously. F-R phenomenon was observed in all healthy subjects before reaching the maximum flexion. Electrical silence continued even after extending the trunk began. In contrast, no patients with CLBP demonstrated F-R phenomenon. A significant difference in muscular activities of erector spinae between the groups was obtained when returning to the erect position from the maximum flexion. Moreover, time lag between trunk and hip movement was much greater in patients than in healthy subjects. This study demonstrated that neuromuscular coordination between trunk and hip could be abnormal in patients with CLBP.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID