ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The prevalence of upper limb nerve injuries has been reported to be as high as 73% in individuals who rely on manual wheelchairs for mobility. Many authors hypothesize that the repetitive trauma to carpal canal structures caused by propelling a wheelchair is the reason for this high prevalence. The purpose of this study was to determine the prevalence of nerve conduction abnormalities in a group of elite wheelchair racers whose wrists are exposed to additional propulsion-related trauma during training and competition. We performed bilateral upper limb nerve conduction studies on each athlete (n= 12). The racers pushed their chairs an average of 56 miles a week for training purposes. Fifty percent of the athletes (n= 6) had evidence of median mononeuropathy by nerve conduction. Of these 6 racers, 5 had evidence of mononeuropathy bilaterally, making a total of 11 positive hands of the 23 tested. Twenty-five percent of the athletes had evidence of ulnar mononeuropathy at the wrist, and 25% had evidence of ulnar mononeuropathy at the elbow. Seventeen percent of athletes had evidence of radial nerve injury. Years with a disability accounted for a significant amount of the variance in the mean median sensory amplitude (R2= 0.511;P= 0.020) and the mean ulnar palmar amplitude (R2= 0.605;P= 0.008). Variables not correlated with nerve conduction studies include age, hours per day in a wheelchair not spent training, years competing, and number of miles pushed in training. Despite the amount of time spent training, these wheelchair athletes have a similar or lower prevalence of median mononeuropathy then reported in the general wheelchair-using population.

ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Differences in functional prognosis for patients with hemorrhagic and nonhemorrhagic strokes are unclear. The purpose of this study is to compare the functional outcome of hemorrhagic and nonhemorrhagic stroke patients after inpatient stroke rehabilitation. By retrospective review, 25 hemorrhagic stroke patients were matched with 25 nonhemorrhagic stroke patients on the basis of age and onset to admission interval. Discharge Functional Independence Measure (FIM), FIM gain, FIM efficiency, length of stay (LOS), and discharge disposition were compared. Admission FIM, gender, and comorbidities were similar between the two groups. There were no differences in discharge FIM, FIM gain, and discharge to home rates between groups. However, the hemorrhagic group had a significantly shorter LOS (31.7v37.6 days;P= 0.05) with higher FIM-total efficiency (0.84v0.60;P= 0.02). The FIM-motor scale accounted for most of the gains in efficiency (0.71v0.53;P= 0.05) with no significant difference in FIM-cognition efficiency between groups. Post hoc analysis revealed that onset to admission interval was a strong predictor of LOS (r= 0.62;P< 0.0001). Hemorrhagic stroke patients appear to exhibit functional gains somewhat faster than nonhemorrhagic counterparts. Confirmation of these preliminary findings must await future studies.

ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The present survey aimed to assess the prevalence and nature of physical disabilities among medical school graduates and to investigate the academic performance of these new physicians with disabilities. A questionnaire was sent to the deans of student affairs of each of the then existing 128 United States and Puerto Rican medical schools, addressing the profiles of students with physical disabilities in the 1987 through 1990 graduating classes. Seventy-seven (60%) United States and Puerto Rican medical schools responded to the questionnaire, of which 67 were able to complete it. A total of 67 students with physical disabilities (40 males and 27 females) were reported. Three of the 67 students were excluded from the study because their conditions did not match our definition of physical disability. The remaining 64 students (38 males and 26 females), ranging from 0 to 10 per school, comprised 0.19% of the 33,138 students who graduated from the 67 medical schools during these 4 academic yr. The disabilities represented by the 64 students encompassed a wide spectrum of etiologies, including neurologic (39%), musculoskeletal (20%), medical-surgical (13%), visual (13%), and auditory (9%) problems. The majority of students with disabilities had above average (36%) to average (48%) academic standings. The actual prevalence of medical students with disabilities might be higher than reported because of the underreporting of the less noticeable types of disabilities.

ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Comparison of latencies of the H reflex from side-to-side is considered a valid indicator of pathology, but amplitudes are too variable to allow similar comparison. Three pairs of electrodes were placed circumferentially and longitudinally along the calf to record the H reflex in three axes simultaneously. An H reflex with the greatest amplitude was produced by incrementally increasing submaximal stimulation to the tibial nerve. Three-dimensional vector graphs were constructed at three levels in each calf in ten normal individuals. Best fit curve Procrustes statistical analysis showed an average of 82.2 to 90.6% agreement of 3-D shape left-to-right with greater agreement at distal levels. Standard deviation ranged from 11.3% proximally to 8.2% distally. This represents much closer agreement than established norms for amplitude, which can vary from two to four times side-to-side. Three-dimensional vector analysis holds promise to further understanding of peripheral and central electrophysiologic phenomena.

ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Weakening of the trunk muscles is thought to be one disadvantage of prolonged lumbar orthotic use. This study examines weakness of the trunk flexor and extensor muscles in patients who are wearing lumbar orthotics for extended periods. Strength of the trunk flexor and trunk extensor muscles was tested in 24 individuals, using the Kinetic computer. Both concentric and eccentric forces were recorded. Four groups of patients were studied. Group 1 (n= 6) consisted of patients with low back pain who had used a lumbar orthotic for a prolonged period of time. Group 2 (n= 6) consisted of hospital employees with no history of low back pain, who wore lumbar orthotics prophylactically, for back protection. Group 1C (n= 6) consisted of healthy controls, with no history of either back pain or lumbar orthotic use, who were individually age- and gender-matched to each patient in Group 1. Group 2C (n= 6) consisted of healthy controls matched in the same fashion to each patient in Group 2. After consultation with a statistician, statistical analysis was performed using the Wilcoxon's test. Nonparametric statistics were chosen because of the lack of evidence of a normal distribution of the parameters being studied. This analysis revealed significant weakness in concentric flexion (P= 0.0464), concentric extension (P= 0.0277), and eccentric extension (P= 0.0464) in Group 1 compared with matched controls in Group 1C. The only significant weakness compared with controls in Group 2 was in eccentric flexion (P= 0.0277). Trends were toward weakness in the orthotic users for the other motions studied, with aPvalue of less than 0.1 for eccentric extension. Prolonged use of lumbar orthotics may be associated with trunk muscle weakness in the population studied. Prescribers should continue to limit duration of use when possible and to consider strengthening exercises when prolonged use is anticipated.

ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The Walkabout® is a new hip-knee-ankle-foot orthotic (HKAFO) system with a medial single hip joint (MSH-KAFO) invented by S. McKay in 1992. Compared with other HKAFO systems, the hip joint part is compact and removable, so it has distinguishable, real merits: ease in donning and doffing the device, compatibility with a wheelchair, and cosmesis. We clinically tested five patients, paraplegic because of spinal cord injury, using the MSH-KAFO system. All were males, aged 26-36 yr old. Their functional levels were L-1 (2 cases), T-10 (2 cases), and T-5 (1 case). All patients could stand stably without crutches and walk in parallel bars immediately the first time they wore the braces. After a few hours of crutch-walking exercises, all could walk independently with Lofstrand crutches. Their walking velocities ranged from 10 to 37.5 (mean, 19.9) m/min at the follow-up points (mean, 7.1 mo). With four cases, we measured oxygen uptake for predictions of energy consumption. At comfortable walking, predicted energy consumptions were from 1.31 to 3.89 (mean, 2.75) METs. Compared with the data in literature, these seemed to be at the same level with normal walking and lower than the KAFOs walking level. Our results suggest that MSH-KAFO is a very convenient standing and walking device for paraplegics and is compatible with wheelchair use.

ISSN:0894-9115    

出版商:OVID    

年代:1996

数据来源: OVID