ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Alcohol and drug use have been shown to contribute to the onset of traumatic spinal cord injury and to be a marker for later onset substance abuse issues. Admission toxicology (drug and alcohol) screens were collected from 87 consecutive rehabilitation medicine patients with a diagnosis of acute traumatic spinal cord injury. Forty-six patients (53%) presented with positive screens (44% alcohol only, 30% drug only, 26% both). Seventy-five percent of those with positive alcohol screens met state criteria for alcohol intoxication (blood alcohol level, ≥0.08 mg/dl). Compared with individuals with negative screens, those with positive screens were significantly (P< 0.05) younger and unmarried. Compared with nonviolence-related spinal cord injury, patients with violence-related spinal cord injury (gunshot wound and assault) were significantly (P< 0.01) more likely to have positive admission toxicology screens (76%v41%), drug screens (62%v14%), and intoxication screens (72%v34%). Rehabilitation outcome comparisons between those with positive and negative screens revealed similar length of stay, admission and discharge Functional Independence Measure (FIM™) scores, FIM change scores, and FIM efficiency scores. This study has important implications with regard to substance abuse issues and their impact on traumatic spinal cord injury outcome, which may assist in better targeting prevention.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The aim of this study is to compare sensory nerve conduction with somatosensory evoked potentials of the lateral femoral cutaneous nerve to determine which is the most reliable electrodiagnostic method to assess meralgia paresthetica. Thirty patients with unilateral clinically defined meralgia paresthetica and 30 controls were studied with both methods. The main outcome measures were sensory action potential side-to-side amplitude ratio, somatosensory evoked potentials side-to-side latency difference, and side-to-side amplitude ratio. Sensory nerve conduction was abnormal in all patients: only four participants had abnormal somatosensory evoked potentials with double derivation (Fz/Cz and Ci/Cc) recording, and eight participants had abnormal findings with Fz/Cz derivation. Overall, this study demonstrates that sensory nerve conduction is the more reliable method for meralgia paresthetica electrodiagnosis. In fact, only very serious nerve damage regularly induces abnormal somatosensory evoked potentials, which is not recommended for routine electrodiagnostic study of meralgia paresthetica.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Bone mineral density is reduced in stroke patients on the hemiplegic and contralateral sides, reflecting a degree of paralysis and vitamin D deficiency. Because the deficiency of vitamin K, a factor essential for site-specific carboxylation of bone Gla protein, is also associated with reduced bone mineral density, an additional contribution of vitamin K to bone changes was assessed in 168 elderly patients with long-standing post-stroke hemiplegia and hypovitaminosis D. Sera were analyzed to relate vitamin K1concentrations to bone-related biochemical indexes and bone mineral density measured by radiodensitometry of the second metacarpal. Bone mineral density was lower on both sides in patients than in the 56 controls (P< 0.02). Serum vitamin K1concentrations, which correlated positively with bone Gla protein concentrations (P< 0.0001), were lower in patients (0.48 ± 0.47 nmol/L) than controls (1.33 ± 0.49;P< 0.0001). Serum bone Gla protein and 25-hydroxyvitamin D concentrations were lower in patients than controls (P< 0.0001), whereas ionized Ca concentrations were higher in patients (1.277 ± 0.041 mmol/L) than controls (1.210 ± 0.049;P< 0.0001), correlating with the Barthel index. Multivariate linear regression identified vitamin K1, bone Gla protein, 25-hydroxyvitamin D, ionized calcium, and the Barthel index as independent bone mineral density determinants on the hemiplegic side and 25-hydroxyvitamin D, calcium, and the Barthel index on the intact side. Immobilization and vitamin K deficiency had stronger osteopenic effects on the hemiplegic side than contralaterally.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Despite recommendations that rehabilitation programs adopt family/patient satisfaction as an outcome measure, few studies have addressed satisfaction with services for children with head injury. This report describes our use of the Measure of Processes of Care (MPOC) to document the perceptions of care of parents whose children were hospitalized with a head injury and to compare parental perceptions of care with those of the service providers (n= 16). The MPOC is a self-administered questionnaire consisting of 56 items, each of which is included in one of five care-giving scales: (1) enabling and partnership; (2) providing general information; (3) providing specific information about the child; (4) coordinated and comprehensive care; (5) respectful and supportive care. The MPOC was mailed to parents of children with a head injury who were consecutively admitted to a pediatric trauma center during a 5-mo period. The results, based on the responses of 73 parents (response rate, 59.3%), revealed that the needs of these parents are being met to varying degrees. Mean scores for the five scales ranged from 4.6 to 6.4 and from 5.9 to 6.6 for parents and providers, respectively. Significant differences between the groups were found for two scales: providing general and specific information. Because of the low percentage of valid responses for three of the five scales, the MPOC appears to be an inappropriate tool for use with parents of children with mild head injury (89%) in the acute care setting. The MPOC, however, is applicable for parents of children who are more severely injured (e.g., average hospital stay, 9 days) and is informative for rehabilitation service providers.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The quality of life and the exercise endurance of patients with chronic obstructive pulmonary disease are impaired. The aim of our study was to determine the impact of a 3-wk intensive inpatient rehabilitation program on the quality of life of patients with chronic obstructive pulmonary disease and to examine the correlation between quality-of-life measures and physiologic measures throughout rehabilitation. Thirty-two patients with chronic obstructive pulmonary disease (20 men, 12 women) were evaluated by spirometry and maximal exercise testing for exercise endurance and by the French version of the Nottingham Health Profile for quality of life. Rehabilitation components were individualized exercise at ventilatory threshold (4 hr/day), health education, and physical therapy and relaxation for 3 wk. Our results showed an improvement in the quality of life (especially in physical mobility, energy, and social isolation) and exercise endurance (increase of 14% of maximal power and symptom-limited oxygen uptake). In contrast, no significant correlations were found between the quality of life and physiologic parameters (gas exchange, cardiovascular and lung function parameters) throughout rehabilitation. Changes in the quality of life seem to be independent of the physiologic results during the course of a short and intensive inpatient rehabilitation program. Quality of life should, therefore, be more systematically evaluated to determine the psychosocial benefits, which, although subjective, are important for encouraging patients' compliance with rehabilitation programs.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Seven children with spastic diplegic cerebral palsy and 14 age- and gender-matched nondisabled children participated in the present study for an investigation and comparison of their static standing balance under altered sensory environments. The type of visual input (full, occluded, or sway referenced vision) and the type of somatosensory input (fixed or compliant foot support) were varied factorially to give six sensory environments. Each participant was tested barefooted for 30 s under all six conditions. A force platform collected the ground reaction force, from which standing balance was calculated as the sway area of the center of pressure. The results showed that when somatosensory information was reliable (fixed foot support), there was no significant difference in stance stability between the children with spastic diplegic cerebral palsy and their matched controls, and both types of children were equally affected by the type of visual input. However, when somatosensory information was unreliable (compliant foot support), the difference in stance stability between the children with spastic diplegic cerebral palsy and their matched controls was significantly greater when the visual input was deprived (occluded) or unreliable (sway referenced) than when it was reliable. These results suggest that the children with spastic diplegic cerebral palsy may have difficulties in resolving intersensory conflicts for maintenance of standing balance, or the demands of motor control in sensory conflict conditions outweigh the motor ability of children with spastic diplegic cerebral palsy.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This preliminary study was designed to investigate the effects of botulinus toxin Type A and phenol treatments on electrophysiologic tests evaluating spinal afferent and efferent motor pathways involved in spasticity. The questions posed were whether different types of mechanisms act on reducing spasticity with these different treatment modalities and whether the tests are correlated with clinical recovery. Twenty patients with lower limb spasticity secondary to stroke were randomly assigned to receive 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. The amplitudes of the Achilles tendon response, M response, H reflex response, and maximum H:M ratio and Achilles tendon response to H response ratio were recorded from the soleus muscle at baseline and at Weeks 2, 4, and 12. The most obvious change was a reduction in the amplitude of the tendon response in the group that received botulinus toxin Type A, and it was a reduction in the M response amplitude in the group that received phenol. The decrease in the tendon response amplitude and tendon response to H ratio in the group that received botulinus toxin Type A and the decrease in the M response amplitude in the phenol group were found to be well correlated with clinical recovery as assessed by the Ashworth scale. The findings suggested that botulinus toxin Type A injection decreases spasticity primarily by affecting the fusimotor system and muscle spindle, and the involvement of the α-motor fibers within the tibial nerve is the most likely factor contributing to the reduction of spasticity after phenol blockade. The therapeutic effectiveness of these agents could be assessed and followed up by the changes in electrophysiologic responses matching their mechanisms of action. The findings should be supported by further electrophysiologic techniques.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID