1/8. EMDR: a new treatment for trauma and chronic pain.EMDR (eye movement desensitization and reprocessing) is a new psychological treatment for trauma that is capable of facilitating rapid and permanent reduction in distressing thoughts and feelings (Carlson et al. 1998,Wilson et al. 1995). In addition to reduction of psychological distress, the method leads to more adaptive attitudes and functioning. The utility of the method also appears to extend beyond trauma with positive results reported in the treatment of addictions, phobias, and pain (Henry 1996, Goldstein & Feske 1994, Grant 1986). As a treatment for pain EMDR offers a method of facilitating permanent changes in how pain is experienced somatically and emotionally. knowledge and understanding of the principles underlying EMDR can also provide a guide for more effective interventions by pain specialists.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/8. rehabilitation after the replantation on a 2-year-old girl with both amputated legs.We had an opportunity to perform replantation of both legs on a 2-year-old girl, and our decision to perform replantation rather than amputation surgery was carefully made taking her age, degree of crushing injury, ischaemic time and level of the amputation into consideration. Painstakingly designed rehabilitation treatments were continuously performed on this girl from the early stage after the operation, and the treatments were comprised of four parts; that is, flexion and extension exercise for the ankle in order to prevent it from stiffness or contracture, functional electrical stimulation (FES) in order to prevent muscular atrophy on the lower extremities, muscle strengthening exercise for the lower extremities, and electrical stimulation to regenerate the damaged nerves and to prevent muscular atrophy from occurring. For an objective assessment of the postoperative conditions, total active motion angles of the ankle joint were measured, and also EMG and NCV were conducted at the end of the first month as well as at the end of the 6th month. Total active motion angles of the ankle joint were increased progressively as time went on, from 15 to 60 degrees on the right and from 10 to 45 degrees on the left. NCV did not show any sensation or response from motor nerves, or amplitude decreased considerably 1 month after the operation; however, at the end of the 6th month conditions improved a great deal with both amplitude and latency. And most muscles that did not show any signals on EMG or showed less than normal at the end of the first month after the operation eventually recovered at the end of the 6th month. The patient had no particular difficulties in walking after 6 months or rather she started running in small steps showing her legs functioning superbly. An infant with both of lower extremities amputated is quite a rare case. We believe that the replantation surgery was successful due to the fact that carefully selected preoperative factors were taken into consideration and well designed postoperative rehabilitation program consisted of four parts was carried out continuously.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/8. Repair and reconstruction of severe leg injuries: retrospective review of eighty-five patients.OBJECTIVE: To explore a good way of the reconstruction of severe tibial shaft fractures by using different flaps and external fixators. methods: Eighty-five patients of Type IIIC tibial shaft fractures with average age of 42.5 years were treated in our hospital from 1990 to 2005. Injuries were caused by motorcycle accidents in 66 patients, by machine accidents in 16 patients, and by stone bruise in 3 patients. The management procedures consisted of administration of antibiotics, serial debridment, bone grafting if needed, application of different flaps, such as free thoracoumbilical flaps, fasciocutaneous flaps, saphenous neurocutaneous vascular flaps, sural neurocutaneous vascular flaps and gastrocnemius muscular flaps, and different external fixations, for instance, half-ring fixators, unilateral axial dynamic fixators, AO fixators, Weifang fixators, and Hybrid fixators. The average follow up was 6.3 years. RESULTS: All flaps survived. Eighty-three cases had bone healed. The average bone healing time of different external fixations was 5.5 months in 47 cases with half-ring fixators, 9.2 months in 4 cases treated with unilateral axial dynamic fixators, 8.5 months in 6 cases with AO fixators, 10.7 months in 16 cases with Weifang fixators, and 7.8 months in 10 cases with assembly fixators. Except half-ring fixation, other fixations all needed necessary bone graft. Two cases treated with unilateral axial dynamic fixators had nonunion of bone and developed osteomyelitis. The wounds healed after the removal of the fixators and immobilization by plaster. The last follow up examination showed ankle and knee motion was normal and no pain was noted. CONCLUSIONS: The combination of half-ring external fixators with various flaps provides good results for Type IIIC tibial shaft fractures.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/8. Lengthening of below-the-knee amputation stumps using the ilizarov technique.patients with short, traumatic, below-the-knee amputations (BKAs) frequently function as if they have knee disarticulations. The goal of this study was to evaluate the results in patients who had lengthening of their BKA stumps to improved prosthesis fit and increase ambulation. Three patients with traumatic BKAs, who were left with insufficient stumps for proper prosthesis wear, have had their stumps lengthened by Ilizarov's technique of distraction osteogenesis. The lengthening process produced a moderate degree of pain, and all patients had a temporary decrease in their range of motion. Two patients lost a substantial amount of gained length secondary to early full weight-bearing. Despite these difficulties, the procedure produced longer, more durable stumps in all patients with no final loss of knee range of motion.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
5/8. Orthopedic management of brain-injured adults. Part II.Orthopedic management of the head trauma patient is divided into 3 phases--acute, recovery and stable. The treatment of bone injury is the main thrust in the acute phase. Guidelines were formulated from a retrospective review of 91 head trauma patients including spine and other fractures. The recovery phase consists of prevention and correction of joint deformities due to spasticity. Position, range of motion and splints are the basic methods employed. Indications and techniques for phenol injection to the posterior tibial and musculocutaneous nerves are reviewed. Heterotopic bone formation will be identified in this phase and treated early. In the final phase, one and one-half years postinjury, surgical treatment is employed to improve extremity function. Procedures proven of value in treatment of stroke patients are applicable. Heterotopic bone can also be definitively treated by excisional surgery supplemented by new medical agents.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/8. External fixation in quadriplegia.Extremity fractures frequently occur at the time of spinal cord injury. Fractures immobilized by external fixation devices interfere with patient positioning and predispose to trophic ulcers. The devices also interfere with joint motion. Incorrect application may delay rather than promote fracture union. patients with spinal cord injuries require appropriate fracture management.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/8. Psychiatric aspects of replantation surgery.The surgical literature on replant patients was reviewed and reports of psychiatric complications were noted. Data for this study were obtained from semistructured psychiatric interviews administered to 30 replant patients within a few days of admission. In addition, 24 of the patients received two or more follow-up interviews. Thirty-three percent of the patients showed evidence of preaccident psychopathology; 20% suffered from a substance use disorder. Fifty percent of the patients reported a stressful life event within the year antedating the accident. Sixty percent of the patients were assessed as warranting psychiatric intervention. The presence of preaccident psychopathology, family or marital dysfunction, previous psychiatric history, and a stressful life event were all positively associated with the occurrence of an adverse postoperative emotional reaction. Case material is presented to illustrate specific psychological issues of replantation surgery, such as those concerning body image and the disruption to body integrity. Suggestions for further research are given.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/8. Pain memories in phantom limbs: a case study.Pain experienced in a limb prior to amputation may influence the course of phantom limb pain many months later. Katz and Melzack (1990) found that 42% of their sample reported a 'somatosensory pain memory' which resembled the quality and location of a painful, or non-painful pre-amputation sensation. For many amputees, pain memories are vivid experiences which incorporate both emotional and sensory aspects of the pre-amputation pain (Katz 1992). Katz and Melzack (1990) suggest that sensory input will 'trigger' somatosensory pain memories while the affective component of a pain memory is generated by the intensity, quality and location of the current experience of phantom limb pain. The present case study used a diary design to examine whether 'triggers' could be identified for somatosensory pain memories. Over a 9-month period, the patient reported daily experience of ongoing phantom limb pain, generally confined to the distal part of the limb, and 5 episodes of injury-related phantom limb pain, primarily experienced in the calf of the missing limb. A 'trigger' was identified for each of the episodes of injury-related phantom limb pain, and a significant finding in this study was that two episodes of injury-related phantom limb pain were associated with cognitive and/or emotional, rather than sensory 'triggers'.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |