ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Inclusion body myositis is a rare and slowly progressive myositis associated with cytoplasmic inclusions and fibrillar nuclear material. These histopathologic findings are of unknown significance. The clinical presentation of IBM has marked similarities to that of chronic polymyositis with proximal greater than distal weakness and muscle wasting more pronounced in the lower than upper extremities. In contrast to polymyositis, however, relatively few individuals report neck flexor weakness or dysphagia. Corticosteroid treatment is usually ineffective. The clinical, histopathologic and electrophysiologic findings in a patient with IBM are presented. Of particular interest in this report is the detailed motor unit recruitment frequency data. A number of previous IBM reports fail to mention specific electrophysiologic data or present evidence suggestive of a possible combined neuropathic and myopathic disease. Recruitment intervals of 150 ms or greater in combination with decreased motor unit duration and amplitudes in the involved muscles imply a myopathic pathophysiology. These findings are discussed in relation to electrophysiologic data from previously reported cases.

ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Therapeutic trials often attempt to “blind” patient and investigator to the true nature of treatments received, reducing the influences of conscious or subconscious prejudices. In drug trials, this is accomplished with placebo tablets, but blinding in trials of physical treatments is more problematic. This issue arose in a clinical trial of transcutaneous electrical nerve stimulation (TENS) for patients with chronic low back pain. Several study design features were incorporated to promote blinding: use of sham TENS units visually identical with real units, exclusion of potential subjects with previous TENS experience, avoidance of a crossover design and use of identical visit frequency, instructions and modifications in electrode placement. Subjects were asked not to discuss treatments with the clinicians who performed outcome assessments. Both patients and clinicians were asked to guess actual treatment assignments at the trial's end. Every patient in the true TENS group believed the unit was functioning properly, but the degree of certainty varied. In the sham TENS group, 84% also believed they had functioning units, but their certainty was significantly less than in the active treatment group. Differences in patient perceptions did not affect compliance, as the two groups had similar dropout rates, appointment compliance, days of TENS use and daily duration of TENS use. Clinicians guessed treatments correctly 61% of the time (as opposed to 50% expected by chance), again suggesting partial success in blinding. These efforts at blinding may partly explain the negative trial results for TENS efficacy. We conclude that complete blinding is difficult to achieve because of sensory difference in treatment and unintended communication between patient and examiner. Nonetheless, trials of physical treatments can achieve partial blinding with the techniques described here, and the success of blinding can be assessed with simple questions at study completion.

ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The Health Care Financing Administration's decision to adopt a prospective based payment system has caused many institutions to implement new policies and practices. A recent area of interest for many hospitals has been the creation of diagnosis-related group (DRG) exempt units to maximize reimbursement practices. We analyzed changes which occurred when an eight bed acute care stroke unit (SU) was converted to a DRG exempt eight bed rehabilitation unit (RU). The time period involved was 1 1/2 months before and 1 1/2 months after the transition occurred. Analysis of data from the pre- and posttransition periods revealed that: (1) length of stay increased significantly from 11.7 to 15.3 days (P<0.001); (2) functional independence measure (FIM) score improvement was significantly greater (P<0.05) for RU patients (0.84/day) than for SU patients (0.39/day); (3) disposition to home v other facilities increased significantly from 50 to 81% (P<0.05); (4) the overall occupancy increased from 94 to 100% and all beds were filled with rehabilitation patients; (5) the proportion of patients with Medicare as their primary insurer was comparable before (64%) and after (67%) unit conversion; (6) gross income from rehabilitation patients increased by 43%. Indirect savings via reduction of acute hospital length of stay for Medicare patients increased total income from operation of this unit. We conclude that patients on the RU stayed longer, had greater daily improvements in functional status, and were more likely to be discharged to home. This appears to be due to a more efficient use of rehabilitation beds and a concomitant overall improvement in reimbursement to the hospital. We believe that these changes are a result of the RU gaining exemption from the prospective payment system and the comprehensive interdisciplinary nature of care provided to patients in such units.

ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Recognition of cardiac problems and their impact on the treatment of dysvascular amputees is important during rehabilitation because the energy demands and cardiac work loads of functional activities are substantially greater when performed by persons with amputation than when performed by control subjects. For this reason, monitoring the cardiovascular response to therapeutic exercise might be expected to enhance the medical and rehabilitative management of dysvascular amputees. In the present study, 31 amputees with peripheral vascular disease underwent continuous noninvasive dynamic cardiovascular monitoring during an initial physical therapy session. The sample had a mean age of 65 yr. There were 20 females. Twenty patients had unilateral below knee amputation. Fifty-two percent had a preamputation history of cardiac disease and six experienced major cardiovascular complications during rehabilitation. After a mean acute hospitalization of 20 days and a mean rehabilitation stay of 36 days, 11 patients were walking independently and 25 were discharged to home. During the monitored physical therapy session, patients achieved a mean maximum heart rate of 113 beats/min, mean maximum blood pressure of 159/81, mean maximum rate-pressure product of 14,546, and mean percent of agepredicted maximal heart rate of 73%. Seventeen (55%) patients demonstrated abnormalities during the monitored session, four of whom had no prior history of heart disease. These changes consisted predominantly of ST-T segment abnormalities, but also included exercise-induced arrhythmias and decreases in blood pressure. Patients with a history of heart disease demonstrated significantly more abnormalities during the monitored session than did those without a history of heart disease. The positive predictive value of the combination of the heart disease history and results of the cardiac monitoring procedure was greater than the positive predictive value of either factor alone. The cardiovascular monitoring procedure provided useful information in a convenient and noninvasive manner, and it can be adapted for use in a variety of clinical settings.

ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

This paper describes the functional outcomes and lengths of stay of 184 patients discharged from comprehensive rehabilitation with complete thoracic traumatic spinal cord injuries. The 100-point modified Barthel Index (MBI) was used to assess functional abilities. There were statistically significant improvements in the mean total MBI score for the entire sample from 35.2 at rehabilitation admission to 71.0 at discharge. The mean lengths of stay were 46 days in acute care and 84 days in the rehabilitation facility. There were 79 patients with lesions between Tl and T6 (“high paraplegics”) and 105 patients with lesions between T7 and T12 (“low paraplegics”). There were no significant differences in the mean MBI scores, self-care subscores, mobility subscores, acute lengths of stay or rehabilitation lengths of stay between high and low paraplegic patients. However, low paraplegic patients were more likely to walk than were the high paraplegic patients. Surgical stabilization was performed on 36% of the sample; total MBI scores were similar for surgically stabilized and nonsurgically stabilized patients. High and low thoracic paraplegic patients achieved significant functional gains during rehabilitation. These functional gains occurred in a setting which provided for the vocational, psychosocial and recreational needs of the individual, and which fostered independence, community participation and a return to a healthy and active lifestyle.

ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Electronic filtering of the recorded signal is a significant aspect of all electrodiagnostic testing, but the filter type and frequency band are infrequently reported. Although the effects of different high- and low-frequency filters have been hypothesized, they have been the subject of little study under actual clinical conditions. This investigation showed clinically and statistically (p<0.01) significant alterations in both motor and sensory nerve evoked responses produced by modification of filter settings within the range routinely used for recording. As the low-frequency filter was varied from 3 to 20 Hz; large differences were seen in amplitude, area and duration of the compound muscle action potential. When the high-frequency filter was changed from 10 to 2 kHz, the mean amplitude of the sensory nerve action potential decreased by 12% and the mean latency was increased 0.1 ms. We conclude that filter parameters must remain constant when determining normal values and when performing serial studies on any patient. Filter settings should be reported as part of all electrodiagnostic reports and scientific manuscripts.

ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

In this study we investigated motor response times of stroke patients at admission to a rehabilitation hospital and again after 6 wk of hospitalization. A prospective comparative study was carried out on 164 stroke patients; 48 hospitalized patients served as controls. Mean motor response times to visual stimuli presented in the left and right visual fields and to centrally presented stimuli were studied. The principle finding was that stroke patients improved significantly in their response times from initial to final evaluation. While at initial assessment they performed significantly more slowly than controls, by final assessment the response times of the two groups did not differ. Visual hemineglect influenced change in response time differentially depending on side of lesion: right hemisphere lesion patients with neglect improved, whereas left hemisphere lesion patients with neglect actually deteriorated. The presence of depression influenced right hemisphere lesion patients' response times and change in response times but it did not have any influence for left hemisphere lesion patients. The findings that response time generally improved during rehabilitation has important implications for the treatment of individuals with brain injury. It will be important to identify therapeutic practices which will be effective in the remediation of response time for all patients. Ultimately the goal of intervening in slow response time is to improve performance of functional activities which are influenced by an individual's ability to respond to visual stimuli.

ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The roles and responsibilities of the principal investigator of a research project are described to allow the young researcher to make an intelligent decision regarding which role to take in a research project. Guidelines are given about which tasks may be delegated and how to do this. These tasks include formulation of the question, project design, obtaining funding, project startup and ongoing management, data analysis and publication. Particular attention is paid to design/analysis and publication, since these determine authorship on biomedical research articles.

ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0894-9115    

出版商:OVID    

年代:1990

数据来源: OVID