ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We have analyzed the history of institutional fractures in 153 men, age 48 to 96, 86% white, who had resided in this VA nursing home for an average of 6.3 years as of August 1984. At that time, we reviewed their medical charts to record the numbers and sites of fractures which had been diagnosed during the preceding 1 to 5 years of nursing home residence, the duration of this period depending on the duration of institutionalization. Fractures during the period of nursing home residence under review had occurred in 24 of the 153 men; 6 residents had experienced two or more fractures. Fracture rates during institutionalization in hip, spine, and wrist were 2,564, 366, and 549/100,000 patient years, respectively. The incidence at all sites was 5,861/100,000 patient years. These rates were 5 to 11 times higher than the figures previously reported in the age-matched general population of white men in the United States, England, or Finland. The nursing home men who had experienced fractures at any site were significantly (nondirectional P<0.02) older than those who had not experienced any fracture. The hip fracture group, however, did not differ significantly (P>0.05) in age from the no fracture group.

ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The cold pressor test elicits an emotional/motivational pain experience from the immersion of a limb in cold water. It has been widely used to evaluate (experimental and chronic) pain. However, normative models for quantification and comparison for pain tolerance have not previously been established. This study developed a normative mathematical model for pain tolerance using the cold pressor test with over 600 subjects. Norms for age, sex, and ethnic group were calculated. In addition, chronic pain patients were compared with painfree patients to determine normative differences in response. The results indicate that at any given age Anglo-Saxon males have the longest tolerance time followed by non-Anglo-Saxon males, Anglo-Saxon females, and finally non- Anglo-Saxon females. There is a consistent decrease in tolerance time as the male age increases and minimal change in tolerance time as the female age increases. Chronic pain patients exhibited the same type of pain response pattern as healthy volunteers when corrected for age, sex, and ethnocultural subgroup.

ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Among the protean complications of diabetes mellitus are contractures of the joints and periarticular soft tissue. These complications have not been well described in the literature. This syndrome of “limited joint mobility,” has been reported as occurring in young, insulin-dependent diabetics, with primary involvement of the small joints of the hands. In older diabetics, similar changes have been described with additional contractures developing in the large joints of the upper extremities. This report presents clinical findings occurring in five older diabetics with primary contractures of the shoulder. Theoretical considerations are also discussed regarding the neurophysiology of this entity as well as the current treatment options.

ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The purpose of this study was to determine the frequency and severity of peripheral nerve lesions occurring in patients with traumatic brain injury. A prospective study of 132 patients was conducted. Patients fulfilling research criteria (flaccidity, areflexia, abnormal motor patterns) underwent neurodiagnostic examination. Fifteen electromyograph/NCV studies were performed, yielding positive findings in 13 patients (10%); 3 patients were found to have preventable lesions. Many patients had permanent impairment or attendant complications from the peripheral nerve injury that adversely affected eventual recovery.

ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A period of significant agitation affects up to 30% of patients after traumatic brain injury. The severity and persistence of this agitation may be such as to require pharmacologic methods as part of the treatment plan. To define which subgroup of patients develop severe agitation warranting intervention and to utilize the information to predict therapeutic responsiveness to tricyclic antidepressants (TCA), we examined cortisol dynamics in 35 traumatically braininjured (TBI) patients 2-10 months post-TBI. Fasting hypercortisolemia (cortisol>20 Mg/dl) and/or an absent diurnal variation (1600:0800 cortisol>0.5) was noted in more than 70% of TBI subjects. These abnormalities in cortisol dynamics were not predictive of severe agitation (x2=0, df=1, P=0.99 for hypercortisolemia; x2=0.163, df=1, P=0.7 for absent diurnal variation) and did not differ significantly between TCA responders and nonresponders. The cortisol response to dexamethasone suppression was abnormal (postdexamethasone cortisol value at 0800 and 1600 >5 Mg/dl) in 34 of 35 subjects and was also not predictive of the presence of agitation. The 0800 cortisol was lower in TCA nonresponders in comparison with TCA responders (8.3 ± 5 ν 17.2 ± 9). In summary, severe TBI warranting inpatient rehabilitation results in hypothalamic- pituitary-adrenal dysfunction. The extent of these abnormalities renders the assessment of cortisol secretion of limited value in making clinical judgments concerning the development of post-traumatic agitation or the management of that agitation by tricyclic therapy.

ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The psychosocial needs of newly disabled 50- to 85-year-old individuals are often neglected in rehabilitation. The Rehabilitation Hospital of the Medical College of Ohio has addressed these needs with the establishment of an over 50 support group. Topics chosen by the group focused on common fears and concerns. The group has been valuable in offering opportunities for peer reinforcement, problem solving, and ventilation of feelings in a safe and supportive setting which had not before existed.

ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A predictable pattern in research efforts is seen in 28 academic centers in physical medicine and rehabilitation. They consist of at least one technician and one small research room (220 square feet), with an additional small room (280 square feet), and 1/4 technician for every MD or PhD in the department (r=0.72). Persons who are not active researchers with external funding must first define the research question in order to develop fundable research proposals. Clinical research is a process that starts from the clinical situation, leads to formulation and answering of the question, and eventually results in integration back into clinical practice. There are many reasons for posing a clinical research question and each results in a different type of question. Asking the right question is the most important part of research, as how the problem is stated determines what data is to be collected, the analysis to be done, and what kind of conclusions can be drawn. A strong research study addresses questions that are clearly spelled out and leads to conclusions that are within the limits of the experimental design and the availability, reliability, and validity of the data. Complex design and analysis do not make a study better if the question itself is not well formulated. It is not as important to know how to answer the question as it is to know how to ask the question. If the initial question is incomplete or incorrect, the rest of the research is at best irrelevant. If the type of question (descriptive, normative, or cause and effect) and the desired use of the research (generalized or not) are identified for each potential research question, one can begin to decide which questions are feasible to answer, given available resources. The resources available that must be considered in selecting the question include time, cost, staff expertise, facilities, and potential subjects. The research format includes not only the questions, but also the methods employed to answer those questions, a data collection plan, and an analysis plan. Posing these in advance, in addition to being good research, substantially reduces costs by decreasing unnecessary data collection and analysis and decreasing the time necessary to complete the project. Exercises and readings are provided to assist development of the entire research format.

ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The prevalence of various manifestations of spasticity from questionnaire responses and from clinical examination of chronic spinal cord injured patients is reported. Extensor spasms, flexor withdrawal spasms, and clonus were reported by most subjects. Those with incomplete lesions reported more interference with activities, more pain, and less functional usefulness, than did those with complete lesions. Extensor spasms were reported to interfere more with transfers, whereas flexor withdrawal spasms were reported to be more frequent at night and to interfere more with sleep. Increased muscle tone was observed more often in extensor than in flexor muscles. Those with incomplete lesions had more hypertonus and more limited passive joint movements than did those with complete lesions. Flexor withdrawal reactions and extensor spasms were also more pronounced in those with incomplete lesions, particularly those with Frankel grade C lesions.

ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Primary fibromyalgia syndrome, a myofascial disorder, is characterized by diffuse pain and tender points. Effective long term rehabilitation interventions for this disorder have not been demonstrated. The current rehabilitation interventions of fibromyalgia are evaluated and the psychologic consequences are summarized.

ISSN:0894-9115    

出版商:OVID    

年代:1989

数据来源: OVID