RESUMEN
The role of neurolytic agents in the treatment of tone disorders is not new. Exploration of their use, however, has been limited, and few studies address use in select populations. In practice use of phenol and alcohol blocks requires considerable experience and skill. This article will focus on mechanism of action, rationale for use, technique of administration, and potential side-effects.
Asunto(s)
Etanol/uso terapéutico , Espasticidad Muscular/tratamiento farmacológico , Bloqueo Nervioso , Fenoles/uso terapéutico , Animales , Humanos , Bloqueo Nervioso/métodos , Fenoles/efectos adversos , Tortícolis/tratamiento farmacológicoRESUMEN
OBJECTIVE: To predict successful prosthetic ambulation for patients immediately transferred to an inpatient rehabilitation facility after amputation surgery. METHODS: Seventy-five individuals with lower-limb amputation were studied at a tertiary acute care and rehabilitation facility. Successful prosthetic ambulation, defined as the ability to ambulate with a prosthesis at least 45 m, was measured in addition to other key demographic and medical factors. RESULTS: Sixty-eight percent were successful prosthetic ambulators at rehabilitation discharge. The absence of residual-limb contracture and a longer length of stay during rehabilitation showed a significant relationship to successful prosthetic ambulation with regression analysis. Younger age was modestly correlated to outcome. There were no significant differences when comparing success of the early rehabilitation program with surgical level or etiology of amputation. For successful prosthetic users, mean wear time at rehabilitation discharge was 5.7 hours with a mean distance walked of 67 m. Of those who failed this approach, 70% were related to a failure of wound healing. CONCLUSIONS: In this cohort, 68% of patients who were selected for a trial of early prosthetic rehabilitation ambulated using a prosthesis at rehabilitation discharge. This approach appears to be more effective for younger patients without contractures who are medically stable to participate in the rehabilitation process.
Asunto(s)
Amputación Quirúrgica/rehabilitación , Miembros Artificiales , Locomoción/fisiología , Adulto , Anciano , Distribución de Chi-Cuadrado , Estudios de Cohortes , Femenino , Humanos , Pierna , Masculino , Persona de Mediana Edad , Modalidades de Fisioterapia , Valor Predictivo de las Pruebas , Probabilidad , Pronóstico , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del TratamientoRESUMEN
Shoulder pain and rotator cuff tears are highly prevalent in individuals with paraplegia (PP). The purpose of this study was to use magnetic resonance imaging (MRI), plain radiographs, questionnaires, and physical examination to gain insight into the prevalence of shoulder disorders in individuals with PP. A total of 28 individuals with PP was recruited (mean age=35; mean year from injury=11.5). Each subject completed a questionnaire designed to identify arm pain, had a standard physical examination focusing on the shoulder, and underwent imaging studies (radiographic and MRI). Nine of the thirty-two subjects (36 percent) experienced shoulder pain in the month prior to testing. The MRI studies documented only one rotator cuff tear. Five subjects showed osteolysis of the distal clavicle by plain radiographic study. In two subjects this was seen bilaterally. Although no relationship was seen between pain and imaging abnormalities, stepwise linear regressions found a statistically significant positive relationship between imaging abnormalities and body mass index (BMI) (radiographic: beta= 0.56, p<0.01; MRI: beta=0.52, p<0.01). This study found a low prevalence of rotator cuff tears and a high prevalence of distal clavicle osteolysis in a sample of relatively young individuals with PP. Although there was only one tear identified by MRI, a number of subclinical abnormalities were seen and found to correlate with BMI.
Asunto(s)
Imagen por Resonancia Magnética , Paraplejía/rehabilitación , Lesiones del Hombro , Dolor de Hombro/diagnóstico , Silla de Ruedas/efectos adversos , Adolescente , Adulto , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Paraplejía/diagnóstico , Prevalencia , Probabilidad , Pronóstico , Radiografía/métodos , Factores de Riesgo , Sensibilidad y Especificidad , Hombro/diagnóstico por imagen , Hombro/patología , Dolor de Hombro/epidemiología , Dolor de Hombro/etiologíaRESUMEN
Laryngeal electromyography is a crucial diagnostic test in laryngology. Laryngeal electromyography is important for the diagnosis of vocal fold paresis and cricoarytenoid joint pathology (e.g., arytenoid dislocation). In addition, laryngeal electromyography offers prognostic information regarding potential vocal fold paralysis recovery, which can improve the management strategies for vocal fold paralysis.
Asunto(s)
Trastornos de Deglución/diagnóstico , Trastornos de Deglución/fisiopatología , Músculos Laríngeos/fisiopatología , Laringismo/diagnóstico , Laringismo/fisiopatología , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatología , Electromiografía/métodos , Humanos , Pronóstico , Factores de TiempoRESUMEN
CONTEXT: Inpatient rehabilitation after elective hip and knee arthroplasty is often necessary for patients who cannot function at home soon after surgery, but how soon after surgery inpatient rehabilitation can be initiated has not been studied. OBJECTIVE: To test the hypothesis that high-risk patients undergoing elective hip and knee arthroplasty would incur less total cost and experience more rapid functional improvement if inpatient rehabilitation began on postoperative day 3 rather than day 7, without adverse consequences to the patients. DESIGN: Randomized controlled trial conducted from 1994 to 1996. SETTING: Tertiary care center. PARTICIPANTS: A total of 86 patients undergoing elective hip or knee arthroplasty and who met the following criteria for being high risk: 70 years of age or older and living alone, 70 years of age or older with 2 or more comorbid conditions, or any age with 3 or more comorbid conditions. Of the 86 patients, 71 completed the study. INTERVENTIONS: Random assignment to begin inpatient rehabilitation on postoperative day 3 vs postoperative day 7. MAIN OUTCOME MEASURES: Total length of stay and cost from orthopedic and rehabilitation hospital admissions, functional performance in hospitals using a subset of the functional independence measure, and 4-month follow-up assessment using the RAND 36-item health survey I and the functional status index. RESULTS: Patients who completed the study and began inpatient rehabilitation on postoperative day 3 exhibited shorter mean (+/-SD) total length of stay (11.7+/-2.3 days vs 14.5+/-1.9, P<.001), lower mean (+/-SD) total cost ($25891+/-$3648 vs $27762+/-$3626, P<.03), more rapid attainment of short-term functional milestones between days 6 and 10 (36.2+/-14.4 m ambulated vs 21.4+/-13.3 m, P<.001; 4.8+/-0.8 mean transfer functional independence measure score vs 4.3+/-0.7, P<.01), and equivalent functional outcome at 4-month follow-up. CONCLUSION: These data showed that high-risk individuals were able to tolerate early intensive rehabilitation, and this intervention yielded faster attainment of short-term functional milestones in fewer days using less total cost.
Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Pacientes Internos , Tiempo de Internación/estadística & datos numéricos , Anciano , Análisis de Varianza , Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Rodilla/economía , Comorbilidad , Costos y Análisis de Costo , Ambulación Precoz/economía , Procedimientos Quirúrgicos Electivos/economía , Procedimientos Quirúrgicos Electivos/rehabilitación , Femenino , Indicadores de Salud , Hospitales Universitarios/economía , Hospitales Universitarios/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Modelos Lineales , Masculino , Terapia Ocupacional/economía , Pennsylvania , Modalidades de Fisioterapia/economía , Factores de TiempoRESUMEN
OBJECTIVE: To determine the inter-rater reliability of function and strength measurements in patients undergoing elective hip and knee arthroplasty in an acute care setting. METHOD: Forty-four patients underwent either total hip or knee arthroplasty. Patients were rated by 4 occupational therapists and 7 physical therapists on their performance of 5 functional tasks: lower extremity dressing, toilet transfer, supine-to-sit transfer, sit-to-stand transfer, and ambulation to 100 feet. Strength measurements of the quadriceps femoris muscle were measured quantitatively with a Microfet hand-held dynamometer. Data were analyzed to determine the interrater reliability using the Kappa statistic (K) for the functional tasks and the intra-class correlation coefficient (ICC) for the strength measurements. RESULTS: A high level of inter-rater reliability was achieved for lower extremity dressing, toilet transfer, supine-to-sit transfer, sit-to-stand transfer, and ambulation to 100 feet, as evidenced by K values between 0.75 and 0.99. Reliability was also excellent for quantitative strength measurements using the dynamometer, with an ICC of 0.94. CONCLUSION: This study demonstrated excellent interrater reliability with measurements of function and strength post-operatively after elective hip and knee arthroplasty. The practical implication is that by using a standardized measurement tool in the acute care setting, the treatment team can more reliably assess patients' progress, which may aid clinical decision making.
Asunto(s)
Actividades Cotidianas , Artritis/cirugía , Prótesis de Cadera/rehabilitación , Prótesis de la Rodilla/rehabilitación , Terapia Ocupacional/métodos , Modalidades de Fisioterapia/métodos , Enfermedad Aguda , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
Vecuronium bromide (Norcuron, Organon, Inc., West Orange, NJ) is a common neuromuscular blocking agent used to facilitate mechanical ventilation. Cases have been reported in which prolonged use of vecuronium resulted in severe motor neuropathy, with or without myopathy. However, the time course of recovery, the functional prognosis, and the use of inpatient rehabilitation is not well-established. We are reporting the functional recovery of two cases with the diagnosis of severe vecuronium motor neuropathy and/or myopathy. The patients presented with pneumonia and meningococcemia, respectively, and received vecuronium during ventilatory support, which lead to quadriparesis. In one patient, vecuronium toxicity occurred while neuromuscular junction monitoring was in place. Significant improvement was noted during an average of 3 to 4 wk in a comprehensive inpatient rehabilitation program, documented by the improvement in total motor Functional Independence Measure scores for patient 1 (from 15 to 71) and for patient 2 (from 65 to 84). In addition, the distal compound motor amplitudes showed a 4-fold increase for the ulnar, a 7-fold increase for the median, an 11-fold increase for the peroneal, and a 3-fold increase for the tibial nerves on follow-up nerve conduction studies correlating with neurologic recovery. In summary, even when patients present with quadriparesis, the recovery after vecuronium toxicity appears to be favorable.
Asunto(s)
Fármacos Neuromusculares no Despolarizantes/efectos adversos , Cuadriplejía/inducido químicamente , Cuadriplejía/rehabilitación , Bromuro de Vecuronio/efectos adversos , Actividades Cotidianas , Adulto , Femenino , Humanos , Persona de Mediana Edad , Conducción Nerviosa/efectos de los fármacosRESUMEN
The objective of this prospective study was to determine if differences exist between individuals who require an inpatient rehabilitation program after elective hip and knee arthroplasty from those patients who can be discharged directly home. Multiple variables consisting of baseline demographics, social status, insurance status, medical history, pain level, quantitative strength, range of motion, and functional ability were examined. The primary outcome measure was the discharge destination from the orthopedic service and consisted of either a discharge to home or a discharge to an inpatient rehabilitation unit. Of the 162 patients followed, 65 (40%) were discharged to an inpatient rehabilitation unit, whereas 97 were discharged to home. The patients discharged to inpatient rehabilitation tended to live alone, were significantly older (mean difference = 6.3 yr), and had increased comorbid conditions (p < 0.001 for all variables). Patients discharged to a rehabilitation unit reported significantly greater pain levels than those discharged to home (P < 0.001). The attainment of a supervision level of function demonstrated greater differences between groups than the attainment of independent function for all functional measures. A logistic regression model was developed that predicted 76% of the discharges to rehabilitation by the third physical therapy session postsurgery. In conclusion, predictive markers do exist that differentiate individuals who require further inpatient therapy services after joint replacement surgery.
Asunto(s)
Procedimientos Quirúrgicos Electivos , Prótesis de Cadera/rehabilitación , Prótesis de la Rodilla/rehabilitación , Alta del Paciente , Anciano , Comorbilidad , Femenino , Articulación de la Cadera/fisiopatología , Humanos , Articulación de la Rodilla/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
Musculoskeletal abnormalities have rarely been reported after major organ transplantation. We recorded five cases of elbow complications after orthotopic liver and bilateral lung transplantation. Three patients (four elbows) developed heterotopic ossification at the elbow, leading to decreased range of motion, pain and difficulty performing self-feeding and perineal hygiene. Two patients (three elbows) had electrodiagnostic evidence of ulnar mononeuropathy at the elbow, whereas one patient had bilateral median mononeuropathies caused by compression at the level of the ligament of Struthers. Surgical resection of ectopic bone with postoperative radiation was required in two patients (two elbows), and nerve decompression was used in three patients (four elbows). Common factors noted in all patients with either heterotopic ossification or ulnar mononeuropathy at the elbow included prolonged encephalopathy and the use of wrist restraints with the presentation of symptoms occurring weeks after surgery. In the patient with bilateral median nerve entrapment, symptoms occurred immediately after surgery suggesting perioperative limb compression. Elbow complications after organ transplantation should be recognized to minimize long-term disability through preventive measures and appropriate treatment.
Asunto(s)
Codo , Trasplante de Hígado , Trasplante de Pulmón , Nervio Mediano , Osificación Heterotópica/etiología , Complicaciones Posoperatorias , Nervio Cubital , Adulto , Anciano , Codo/diagnóstico por imagen , Codo/inervación , Femenino , Humanos , Masculino , Osificación Heterotópica/diagnóstico por imagen , Osificación Heterotópica/prevención & control , Osificación Heterotópica/terapia , Enfermedades del Sistema Nervioso Periférico/diagnóstico por imagen , Enfermedades del Sistema Nervioso Periférico/etiología , Enfermedades del Sistema Nervioso Periférico/prevención & control , Enfermedades del Sistema Nervioso Periférico/terapia , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/terapia , Radiografía , Rango del Movimiento ArticularRESUMEN
The objective of this study was to evaluate the presence of progressive postpoliomyelitis muscle weakness (PPMW) in affected individuals 20 to 40 years after the initial polio infection. Over a three-year period, the isometric and isokinetic strength of the quadriceps femoris muscle was studied in seven symptomatic patients with previous poliomyelitis (mean = 38.3 years from infection) to determine if quadriceps strength decreased during the three years. Each patient had a quadriceps affected by polio on one side and a clinically nonaffected quadriceps on the contralateral limb. The maximal isometric force and the peak isokinetic force of the affected quadriceps (AQ) and nonaffected quadriceps (NQ) muscles were tested on a computerized isokinetic dynamometer machine at six-month intervals. Isometric force increased significantly, by 29% per year (p less than .02) in the AQ and by 14% per year (p less than .05) in the NQ. Paired analysis to determine the change in strength between the affected and nonaffected muscles for the isometric data showed a mean nonsignificant increase in the AQ of 14% per year (p = .01). The change in peak isokinetic force demonstrated a significant increase in the AQ of 35% per year (p less than .05); whereas, the NQ peak isokinetic force increased 15% per year which was not statistically significant. Paired analysis to determine the change in strength between the affected and nonaffected muscles for the isokinetic data showed a nonsignificant relative increase in the AQ of 20% per year (p less than .06).(ABSTRACT TRUNCATED AT 250 WORDS)