ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Gunshot wounds are currently the second leading cause of spinal cord injury in the United States, and coexisting injuries or complications accompanying penetrating wounds often increase patient morbidity. A review of 217 traumatic spinal cord injury rehabilitation admissions to a tertiary care hospital during a 5-yr period revealed 49 individuals (23%) with gunshot wound-induced spinal cord injury. A single bullet entry site was seen in 54%, whereas 17% had greater than 3 sites of entry. Common (>25%) sites of bullet entry included the back, abdomen, neck, and chest. Common gunshot wound-related medical complications included pain (54%), infections (40%), pneumothorax (24%), nonspinal fractures (22%), colonic perforation (17%), cerebrospinal fluid leak (10%), and retroperitoneal hematoma (10%). When compared with nonviolence-related traumatic spinal cord injury (motor vehicle accidents and falls), patients with gunshot wound-induced spinal cord injury were significantly more frequently (P< 0.01) younger, non-Caucasian, unmarried, and unemployed. Injury characteristics revealed significantly (P< 0.01) more paraplegia and complete spinal cord injury within the gunshot wound-induced spinal cord injury group. Gunshot wound-induced spinal cord injury and nonviolent traumatic spinal cord injury groups had similar lengths of stay, Functional Independence Measure scores, and discharge to home rates. This article adds to the growing body of literature examining clinical, medical, and functional outcome characteristics of individuals with spinal cord injury secondary to violence-related cause.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Manual vibratory massage is part of the preventive physiotherapeutic activities performed in intensive care units. The vibratory massage can be performed manually or as electrovibratory massage. The manual massage is a fast rhythmical vibration performed by the arm and shoulder muscles of the masseur and transferred to the patient's thorax by the hand. The hand of the masseur has to achieve a tremor with a frequency of 8 to 11 tremors/s. The aim of the pilot study was to examine the influence of manual vibratory massage on the pulmonary function of postoperative patients who were receiving mechanical ventilation, with special interest being focused on pulmonary ventilation and perfusion and cerebral blood flow velocity. Manual vibratory massage was performed postoperatively in the intensive care unit on eight patients: three patients had undergone heart transplantation, three had undergone lung transplantation, and two had undergone coronary artery bypass grafting (mean age, 53.6 ± 8 yr). With the aid of continuous monitoring, we examined the changes of the respiration parameters and the cerebral blood flow velocity (measured by transcranial Doppler sonography). The vibratory massage was performed with a frequency of 8 to 10 vibrations/s for 15 min, 7.5 min on each side of the thorax, starting from the lower costal arch and progressing to the upper thoracic aperture. For 10 min before, during, and 10 min after the massage, the parameters of peripheral oxygen saturation, central venous pressure, mean arterial pressure, heart rate, lung resistance and compliance, tidal volume, respiration rate, and cerebral blood flow velocity were recorded at 2-min intervals. Moreover, before and after vibratory massage, arterial blood gases were determined. In four of the eight patients, it was possible to determine pulmonary arterial pressure, pulmonary capillary wedge pressure, as well as pulmonary vascular resistance. During the vibratory massage, we could prove a significant increase of the mean tidal volume by 30% (P= 0.008). The percutaneous oxygen saturation significantly increased also, from 92 to 93.6% (P= 0.002). Central venous pressure significantly decreased by 11% (P= 0.04), and pulmonary vessel resistance was reduced by 18.3% (P= 0.001). The pulmonary resistance decreased from 10.5 to 9.2 H2O/l/s (P< 0.05) by the end of the observation period. Cerebral blood flow velocity showed no significant change. Vibratory massage seems to improve pulmonary mechanism and perfusion, thus, reducing ventilation perfusion mismatch and increasing oxygen saturation.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Rehabilitation patients who will undergo noncardiac surgery or strenuous rehabilitation programs often cannot exercise to greater than 85% of predicted maximal heart rate as required for valid treadmill testing. Because many patients have known or suspected coronary artery disease, greatly increasing their risk for a cardiac event, dipyridamole thallium scans are usually performed, despite a cost of approximately $1400, patient radiation exposure, and the need for a gamma camera. Instead, arm-leg cycle stress testing can be continued to an appropriately high heart rate, is done in the physician's office with an electrocardiograph machine and a blood pressure cuff, and costs $250. This study describes nine patients who had both dipyridamole thallium scans and arm-leg cycle ergometry. Four awaited peripheral vascular surgery, one needed bilateral knee replacements, one was an amputee, and three had claudication. Six had documented and three had suspected coronary disease.RESULTS:In eight of nine patients, the electrocardiograms during both dipyridamole thallium imaging and ergometry were in agreement as to the presence or absence of ischemia (kappa statistic, 0.7273;P= 0.0117). In seven of nine patients, thallium images and ergometry agreed (78% concurrence). To achieve 90% agreement between dipyridamole thallium scans and cycle results, however, 68 patients would have to be studied.CONCLUSION:In this preliminary study, arm-leg ergometry was feasible in all patients and seemed cost-effective and useful for detecting myocardial ischemia. Clinically, if the ergometry were inconclusive, dipyridamole thallium scans could be performed subsequently to obtain the needed information.

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:

To assess the efficacy of electrical acupuncture in the rehabilitation of patients with hemiplegia in stroke, we randomized 128 patients within 2 wk of stroke onset to receive either comprehensive rehabilitation plus electrical acupuncture (n= 59) or comprehensive rehabilitation only (n= 59). Electrical acupuncture was administered by electrical stimulation of acupuncture points through adhesive surface electrodes five times per week. Neurological status (Brunnstrom's stage) and the Chinese version of the Functional Independence Measure were assessed before treatment and at discharge. Patients treated with electrical acupuncture had a shorter duration of hospital stay for rehabilitation and better neurological and functional outcomes than the control group had, with a significant difference in scores for self-care and locomotion (P= 0.02). This result did not postulate the previous study that acupuncture therapy for stroke patients should depend on needle manual and "de qi" response. We suggest that electrical acupuncture through adhesive surface electrodes in conjunction with current optimal rehabilitation programs is a convenient and effective therapy for stroke patients.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The objective of this study was to identify the most important clinical variables determining gait speed in persons with stroke. Sixteen chronic stroke subjects (mean age, 47.9 (±15.6) yr; mean time post-stroke, 43.9 (±36.5) mo) able to walk independently without a brace participated in the study. The impairments in motor function, sensation of the paretic lower limb, and balance were evaluated with the Fugl-Meyer Assessment. A spasticity index was used to assess the muscle tone of the plantarflexors. The maximal strengths in plantarflexion and hip flexion were measured with a Biodex dynamometric system. Cinematography and foot-contact data collected on the paretic side were used to determine the comfortable and maximal gait speeds. The level of association between gait speeds and the clinical variables were first examined with Pearson's correlation coefficients and, then, with multiple linear regression analyses using the stepwise method. Results revealed that the motor function of the lower limb, balance, and hip flexion strength were significantly related to comfortable and maximal gait speeds (0.5 <r< 0.88;P< 0.05). For the comfortable gait speed, the regression analysis selected only the hip flexor strength as a significant variable (R2= 0.69). For maximal gait speed, the variables retained were hip flexor strength, sensation at the lower limb, and plantarflexor strength (R2= 0.85). The present results suggest that strength and sensation at the lower limb are important factors to consider in determining the gait capacity of chronic stroke subjects.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Most manual wheelchair users with hemiplegia use both the unaffected arm and leg to propel their wheelchairs. The objective of this study was to compare the wheelchair propulsion of subjects using the hemiplegic pattern (one arm and one leg) with subjects using two hands. In a case-controlled study in a kinesiologic laboratory, nine wheelchair users who used the hemiplegic pattern were compared with nine matched controls who used the two-handed pattern. Participants were tested for propelling and stopping the wheelchair, forward and backward, on a level surface and on a 5° incline. Video recording was used to assess deviation from the midline, foot slippage, the number of propulsive cycles, and the propelling velocity. Also, on the 5° incline, we noted the need for support when unlocking the wheel locks, instances of grabbing the side rail, or rollback between propulsions. The participants using the hemiplegic pattern when propelling up the incline deviated more to the hemiparetic side (P< 0.05), used more propulsive cycles per unit of distance (P< 0.01), were slower (P< 0.001), and used the side rail more often (P< 0.05). When propelling forward on level ground, the participants using the hemiplegic pattern were slower (P< 0.005). When stopping after moving backward down the incline, they were more likely to deviate to the unaffected side (P< 0.01). In conclusion, wheelchair users who use the hemiplegic pattern experience more difficulties than those using two hands, some of which may be amenable to improvements in wheelchair prescription and training.

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 purpose of this study was to examine whether patients with visual field defects resulting from cerebral injury are handicapped in their driving ability, because visual field loss as assessed in standard perimetry is often the basis for withdrawal of a person's driving license. Driving performance was tested on a driving simulator to obtain standardized results and for safety reasons. The visual field was assessed both with standard automated perimetry and computer-based, high-resolution, qualitative perimetry. We investigated nine patients with purely cerebral field defects (mostly homonymous binocular defects) who had no further neuropsychological or ophthalmological deficits. Their performance (driving speed, reaction time, and driving error rate) was compared with that of a control group of ten subjects. We found no differences in any of the tested parameters between the visually impaired subjects and the normal participants. This suggests that individuals with visual field defects, including those who suffer from homonymous hemianopia, may perform as adequately as normal individuals in realistic driving scenarios. The perimetrically assessed visual field may, thus, be of limited value for the prediction of driving safety, and we conclude that patients who have field defects should not summarily be denied a driving license.

ISSN:0894-9115    

出版商:OVID    

年代:1999

数据来源: OVID