1/7. Multidisciplinary management of the airway in a trauma-induced brain injury patient.laryngomalacia occurs in some brain injury patients secondary to global muscle hypotonia. Surgical therapies for epiglottis prolapse have centered around removal or reshaping of the epiglottis. This approach has brought mixed success and frequent complications. We present a case that demonstrates successful nonsurgical treatment of a 33-year-old male brain injury patient with moderate obstructive sleep apnea that is believed to be a consequence of post-brain injury nocturnal epiglottis prolapse. The presence of a tracheostomy performed at the time of emergency surgery had become an emotional and physical barrier to our patient's recovery. The tracheostomy could only be reversed if the obstructive sleep apnea disorder could be managed in an alternative fashion. A titratable mandibular repositioning appliance was prescribed and its effectiveness was demonstrated with nasolaryngoscopy and polysomnography. After initially fitting the oral appliance, a period of accommodation and gradual protrusive adjustments was allowed. Subsequent confirmation polysomnography demonstrated improvement, but not suitable resolution, of disordered breathing events. However, an additional 1.25-mm protrusive titration of the oral appliance during the course of the confirmation polysomnogram led to therapeutic success. The patient's tracheostomy was subsequently reversed with significant quality of life benefits.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/7. Congenital indifference to pain and deletion of chromosome 10q-: new association.We describe a case of a de novo terminal deletion of the long arm of chromosome 10 with the novel feature of congenital indifference to pain in a 2-year 10-month-old boy. Relative indifference to pain defined by a lack of emotional response to pain has not been described previously in association with the terminal deletion of the long arm of chromosome 10.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/7. Familial dysautonomia manifesting as neonatal nemaline myopathy.An infant presented with congenital hypotonia, poor sucking, apathy, and areflexia. Muscle biopsy at two months of age revealed numerous nemaline rods, suggesting congenital nemaline myopathy. During the ensuing months, familial dysautonomia was suggested by recurrent pulmonary infections, dysphagia, alacrima, hyperhydrosis, emotional lability, and unexplained episodes of hyperthermia and breath-holding spells. The diagnosis was confirmed by positive intradermal histamine and ocular mecholyl tests. The finding of nemaline rods adds a new facet to the recognized polymorphic presentation of familial dysautonomia.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/7. rotator cuff tearing and inferior subluxation of the humeral head: report of two cases.We encountered two patients with atraumatic rotator cuff tears who exhibited inferior subluxation of the humeral head. In both patients shoulder motion was limited by pain. Repair of the rotator cuff tear relieved the pain and restored glenohumeral joint motion. Although the cause of this unusual complication of rotator cuff damage remains unclear, the inferior subluxation was associated with reflex muscle hypotonia, which would have reduced the pressure in the subacromial space and thus would have decreased the pain caused by the cuff lesion. No similar case seems to have been documented in the literature.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
5/7. stroke and its manifestations in the foot. A case report.CVA is a very common problem that can lead to lower extremity complications. Impairment in gait pattern occurs often due to spasticity and less frequently due to prolonged flaccidity. This problem is manifested by equinus, varus, equinovarus, and toe flexion deformities. Therefore, prevention or elimination of spasticity must be achieved. Various modalities have been used, both conservative and surgical. Nonsurgical interventions include range of motion and strengthening exercises, pharmacologic agents, local anesthetic and phenol motor point blocks, and the use of orthoses. Surgical intervention should be considered after conservative treatment has failed. The goal of treatment is to reduce the deforming force as a result of spasticity and to allow for almost normal function to be achieved. This includes tendon transfers, tendon lengthenings, tenotomies, and arthrodeses of small toe joints. Preoperatively, the extent and progression of spasticity must be determined because this may affect the rate of recurrence of the deformity following surgical correction. The combination of arthrodeses of the interphalangeal joints and flexor tendon release is the best option in the presence of a spastic deformity. arthrodesis provides for stability at the joint, whereas a flexor release eliminates the deforming force. Failure to address the plantar-flexor force of the long flexors can lead to instability at the fusion site. This may in turn lead to nonunion and recurrence of flexion contracture as shown in the case report in this article.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/7. Effects of continuous passive motion on the edematous hands of two persons with flaccid hemiplegia.OBJECTIVES. This study evaluated the effect of the use of a continuous passive motion device for the edematous hands of two persons with flaccid hemiplegia. METHOD. The subjects were both 1 month post-cerebrovascular accident with left-sided hemiplegia. Each subject's routine therapy program was maintained throughout this ABA design study. During the first week, baseline data were gathered, during the second week the intervention was provided (2 hr of continuous passive motion device use), and during the third week data were gathered with treatment withdrawn. edema was measured with a hand volumeter and finger circumference. RESULTS. The continuous passive motion device had an effect in reducing edema in the hands of the two subjects. CONCLUSION. The continuous passive motion device is a readily available tool that could enhance the treatment of edematous hands of persons with flaccid hemiplegia by offering a contribution to already established treatment protocols. Further research is needed, however, to establish guidelines for use.- - - - - - - - - - ranking = 8keywords = motion (Clic here for more details about this article) |
7/7. The natural course of myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine.The natural course of ossification of the posterior longitudinal ligament, particularly the relationship between the onset of myelopathy and factors associated with its aggravation, was studied in 207 patients during an average period of 10 years 3 months. Myelopathic signs were already present in 37 (18%) patients at the time of the initial examination. Fourteen of these 37 patients showed aggravation of symptoms during the observation period. Myelopathy appeared during the observation period in 33 (16%) of the 207 patients. One hundred thirty-seven (66%) patients were free of myelopathy. Some patients had no myelopathic signs, despite severe spinal stenosis, because of the ossification. In these patients, the range of motion of the cervical spine was severely limited, indicating that dynamic factors are important in the development of myelopathy. In treating this disease, it is necessary to take into consideration the natural course of the disease and to identify the involvement not only of static factors, such as compression caused by ossification, but also of dynamic factors.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |