ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The ongoing changes in health care seek to create an affordable, accessible, and high-quality health care delivery system for all Americans. In response to this, Physical Medicine and Rehabilitation (PM&R) is re-examining its role in the provision of health care to the disabled, particularly the severely affected. We surveyed 100 physiatrists and 100 PM&R residents across the country regarding their opinions on the competence, qualifications, and desire of physiatrists to provide primary care for the disabled. Fifty-five physiatrists and 51 residents responded (55% overall). Thirty-nine percent of all respondents agreed that PM&R should be designated as a primary care specialty, and 53% believed that physiatrists should provide primary care to the severely disabled (e.g., spinal cord and head injury). Overall, 53% felt that physiatrists are competent in general medical care, but 38% are convinced that the current 4-yr PM&R residency training sufficiently prepares physiatrists to assume the role of a primary care provider. Of the patient populations considered, the respondents thought that physiatrists should manage the care of spinal cord injury (60%) and head injury (51%), but only 40% were willing to assume primary care responsibilities.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Postoperative assessment of amputation wound healing remains largely subjective in nature, being based on the physician's clinical judgement. These considerations significantly impact on the rehabilitation course, as premature prosthetic fitting may result in wound breakdown. Alternatively, delayed healing may result in prolonged hospital length of stay. Few attempts have been made to correlate objective parameters of limb perfusion with amputation wound healing or prosthetic fitting outcome during the rehabilitation phase of treatment. A pilot study was conducted, in which the transcutaneous oxygen monitor, a noninvasive device measuring transcutaneous partial pressure of oxygen (tcpO2), was applied to the stumps of 11 consecutive above-or below-knee amputees admitted for rehabilitation after amputation. All patients were tested within 1 wk of admission and 45 days of amputation. The treatment team was blinded as to the test results. A direct correlation was observed between wound healing outcome and tcpO2results (Fisher's exact test [FET],P=0.03), and no patient with a tcpO2of <15 mm Hg healed during their rehabilitation stay (FET,P= 0.006). TcpO2of <15 mm Hg was significantly correlated with prolonged length of stay (Point Biserial Correlation Coefficient [rpbi],=-0.835;P=0.01), delayed prosthetic fitting (rpbi=0.742;p=0.01), and poorer wound healing at admission (rpbi= 0.932;P=0.001). Postoperative tcpO2measurement may have use in objectively identifying patients at greater risk of delayed wound healing and prosthetic fitting, although further study is warranted.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Although Transcutaneous Electrical Nerve Stimulation (TENS) has become a popular modality in pain management over the past 20 yr, there is still debate over its mechanisms of action and the precise relevance of stimulation parameters to its hypoalgesic effects. Thus, confusion still surrounds the selection of optimal stimulation parameters. Two separate studies (total n=88) were carried out to investigate the effect of four combinations of TENS pulse durations (50 (µ.s & 200 µ.s) and frequencies (4 Hz and 110 Hz) on nerve conduction in the human superficial radial nerve and on Mechanical Pain Threshold (MPT) within the associated sensory distribution of the nerve over the dorsum of the hand. Results showed that application of one combination of TENS parameters (110 Hz, 200 µ,s) directly over the course of the nerve produced a significant increase in both peripheral nerve conduction latency (P< 0.05; analysis of variance (ANOVA)) and MPT (P< 0.01). In addition, there was a high correlation (r=0.9) between shifts in MPT and negative peak latency for the groups treated with this combination of TENS parameters. The results of this study thus illustrate that combinations of TENS parameters are important to the peripheral neurophysiological effects of this modality and, further, its associated hypoalgesic effects, at least on the model of pain used here.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Two experiments using transcranial magnetic stimulation (TMS) were undertaken to investigate facilitatory effects of thinking about a specific movement without voluntary discharges on motor-evoked potentials (MEP). First, surface electromyographic (EMG) responses from the abductor pollicis brevis were recorded with maximal stimulator output in the three conditions: the muscle being at rest, contracting with 10% of maximal muscle activity, and with the subject “only thinking” about thumb abduction (nine subjects). Median value of MEP amplitudes during “only thinking” was twice that at rest (P=0.008) and one-half that during voluntary contraction (P= 0.008). Second, needle EMG responses from the first dorsal interosseus were compared at rest, during thinking about index finger abduction, and during TMS at threshold intensity. Four normal subjects were tested with stimulation of each cerebral hemisphere for a total of eight tests. The number of detectable MEP responses of 20 stimuli to one hemisphere was counted for each condition of rest or thinking. The mean MEP response rate during thinking (58%) was higher than that at rest (12%) (P< 0.005). These results demonstrate that thinking about a specific movement has facilitatory effects on MEP and that the degree of facilitation in thinking is smaller than in voluntary contraction.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Although numerous studies have examined the prevalence of depression after stroke and its relationship to functional outcome, minimal research attention has been focused on depression in the acute inpatient rehabilitation setting. Fifty-one consecutive admissions to a geriatric rehabilitation unit were screened for depression using the Geriatric Depression Scale at both admission and discharge. Depressedvnondepressed patients were compared on the following variables: age, length of stay (days), admission Functional Independence Measure (FIM) score, discharge FIM score, change in FIM score, Mini-Mental State Exam score, and discharge to nursing homevhome. Depression was prevalent in 29.4% at admission. Depression at admission was not associated with any significant differences in the above variables, but patients classified as depressed at discharge had lower FIM scores at both admission and discharge. Clinical implications and recommendations for future research are discussed.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The purpose of this study is to investigate the Fugl-Meyer Motor Impairment Scale and physical disability as measured by the Functional Independence Measure (FIM) as predictors of physical independence after stroke inpatient rehabilitation. Forty-eight patients admitted to a rehabilitation hospital within 6 wk of their first unifocal stroke were prospectively studied. Upper and lower extremity Fugl-Meyer scores were obtained near rehabilitation admission. FIMs were obtained on admission and discharge. Discharge FIM self-care was predicted best by admission FIM total (rs=0.75;P< 0.0001), although admission FIM self-care, other FIM components, and upper- and lower-extremity Fugl-Meyer scores were also good predictors. Discharge FIM mobility and locomotion correlated well with their admission counterparts (rs=0.54 and 0.45;P<.001 and <.01, respectively) but were even more strongly related to admission Fugl-Meyer scores (rs=0.63 and 0.74, respectively;P<0.0001). As expected, cognitive and psychosocial components of the FIM at discharge correlated poorly with admission Fugl-Meyer. These data confirm the strong motor impairment basis for the physical disability subdimensions of the FIM and suggest that dependency in physical activities of daily living after stroke is primarily determined by degree of motor impairment.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Journal clubs can play an integral part in graduate medical education. They promote critical thinking, dissemination of information, and research and impact clinical practice. Little has been written, however, about how to organize a journal club or improve its efficacy. Although numerous articles discuss how journal clubs can be used to evaluate medical literature, only a few have examined what physicians are actually doing. We surveyed all accredited PM&R program chief residents to ascertain the prevalence, format, and efficacy of PM&R residency journal clubs. All programs that responded (89%) reported having a journal club, with most stating its purpose was to disseminate information from the current literature. Review of classic articles and specialty topics (e.g., electromyography, sports medicine) was fairly uncommon. Eighty-four percent of journal clubs were department-sponsored, and most met monthly for 1 hr during the workday. Typically, four or more articles were presented under the guidance of the chief or other resident. Impacting clinical practice and teaching critical analysis were other important goals of the journal clubs, yet most (76%) lacked an organized method for critical review. This, in addition to poor faculty attendance, was a chief concern of those surveyed. Surprisingly, journal club participation was not felt to significantly alter the amount of reading residents did. Although most felt their journal clubs were successful, improving faculty participation, strengthening critical analysis skills, identifying and incorporating classic articles, improving clinical relevance, and providing a mechanism for feedback may further improve journal club efficacy and participant satisfaction.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Conversion disorder can sometimes simulate Guillain-Barre Syndrome (GBS). This often involves the mimicry of organic symptoms similar to those experienced by a relative or acquaintance. The patient with the conversion unconsciously adopts these symptoms to convert their psychologic stress to a physical phenomenon. This case is of 15-yr-old girl who had a documented case of GBS and who subsequently had recurrent episodes of a conversion disorder that simulated her original GBS presentation. The methods for diagnostically separating recurrent GBS from conversion reaction are noted.

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1995

数据来源: OVID