1/83. Using seat contour measurements during seating evaluations of individuals with SCI.Measuring the shape of the buttock-cushion interface has been used successfully in research to study tissue loading and as a means to fabricate custom contoured cushions. Seat contours are also able to provide useful clinical information on the weight-bearing surface of the cushion, which can be used to address posture. This article offers specific case studies that demonstrate how the analysis of seat contours can be used to identify pelvic tilt, pelvic obliquity, and areas of high loading. Seat contour measurements complement other clinical measures, such as seat interface pressures and general postural assessments, to form a more complete picture of the buttock-cushion interface. They have become useful in the clinical management of various pressure and posture problems experienced by individuals with spinal cord injury and other wheelchair users.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/83. Treating stage IV pressure ulcers with negative pressure therapy: a case report.Decubitus ulcers remain a significant healthcare concern today, especially in the elderly and immobile population. Following the observation of three Stage IV decubitus ulcers refractory to standard medical and surgical therapy for 10 months, a new vacuum-assisted closure device (V.A.C.) was initiated to speed wound healing. The V.A.C. was initiated in August 1996. The three Stage IV ulcers were located on the patient's right ischium, left ischium, and sacrum. On initiation, they measured 7 1/2 cm x 2 1/2 cm x 2 1/2 cm, 8 cm x 3 1/2 cm x 2 1/2 cm, and 3 1/2 cm x 2 cm x 2 cm respectively. The treatment consisted of insertion of sterile sponge into the wound bed connected to the negative pressure device by suction hose. The device operated at a negative pressure of 125 mm Hg with a 5-minute-on 2-minute-off-cycle. Dressing changes were performed every 48 hours during the treatment period. Successful closure of the sacral ulcer occurred in October 1996. The ischial ulcers were small enough to be taken off V.A.C. therapy in early November 1996. While we are encouraged by the results of this study, further additional clinical studies are warranted.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
3/83. Flaccid quadriplegia from tonsillar herniation in pneumococcal meningitis.A young woman with fulminant pyogenic meningitis became quadriplegic, areflexic and flaccid due to herniation of the cerebellar tonsils and compression of the upper cervical cord. This state of spinal shock was associated with absent F-waves. intracranial pressure was greatly elevated and there was an uncertain relationship of tonsillar descent to a preceding lumbar puncture. Partial recovery occurred over 2 years. Tonsillar herniation can cause flaccid quadriplegia that may be mistaken for critical illness polyneuropathy. This case demonstrates cervicomedullary infarction from compression, a mechanism that is more likely than the sometimes proposed infectious vasculitis of the upper cord.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/83. Xanthogranulomatous funiculitis and epididymo-orchitis in a tetraplegic patient.STUDY DESIGN: A case report of xanthogranulomatous funiculitis and epididymo-orchitis. Xanthogranulomatous inflammation is an uncommon, non-neoplastic process characterised by destruction of tissue, which is replaced by a striking cellular infiltrate of lipid-laden macrophages. CASE REPORT: A 21-year male sustained complete tetraplegia at C-6 level, after a fall in 1998. The neuropathic bladder was managed with an indwelling urethral catheter. He had many unsuccessful trials of micturition. Sixteen months after the cervical injury, he noticed swelling of the left side of the scrotum following removal of a blocked catheter. He was prescribed antibacterial therapy. Four weeks later, physical examination revealed a hard and irregular swelling encompassing the testis, epididymis and spermatic cord. The clinical diagnosis was epididymo-orchitis progressing to pyocele. Through a scrotal incision, the swollen testis, epididymis and diseased segment of the spermatic cord were removed en masse. Histopathology showed extensive areas of necrosis, with xanthogranulomatous inflammation in the spermatic cord and to a lesser extent in the testis/epididymis. CONCLUSION: Repeated episodes of high-pressure urinary reflux along the vas deferens during dyssynergic voiding, and subsequent interstitial extravasation of urine together with chronic, low-grade, suppurative infection possibly led to development of xanthogranulomatous inflammation in the testis and the epididymis. Since tissue destruction is a feature of xanthogranulomatous inflammation, the definite and curative treatment is either complete (or, where applicable, partial) excision of the affected organ in most of the cases.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/83. Diverticulosis in an unused colon.It has been suggested that diverticulosis is the result of uncoordinated muscle activity of the colon in response to normal physiologic stimuli such as eating, emotions and the urge to defecate. This results in spasm of the longitudinal muscle with the heaping up of circular muscle bundles, creating interhaustral folds along the colonic wall adjacent to the mesentery. Narrowing of the lumen and shortening of the colon results which is enhanced by a low residue diet and prevented by a bulky diet. Segmentation results when muscular contraction approximates these interhaustral folds. Higher intraluminal pressure is produced in the areas of segmentation which enhances the development of diverticulosis in the bowel between interhaustral folds where there is a thinning of the circular muscles and where vessels pierce the colonic wall. The case presented herein supports these hypothesis in that the patient has experienced the extreme in a low residue diet for 50 years.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/83. Improvement of sleep apnea in a patient with cerebral palsy.Intrathecal baclofen (ITB) can reduce spasticity in adults and children with cerebral palsy. Benefits of ITB therapy include improved Ashworth scores, activities of daily living, and mobility. The impact of ITB therapy on sleep apnea in patients with cerebral palsy has not been reported. This case report describes a 29-yr-old female with mixed spastic athetoid quadriparetic cerebral palsy with dystonia, gross motor function IV, who had sleep apnea, requiring nightly continuous positive airway pressure. She received ITB with the goal to improve her wheelchair positioning and decrease her excessive movements. After the initiation of the ITB, reduction of her spasticity and dystonia was noted, as well as improvement of her sleep apnea. This case suggests that ITB therapy may improve respiratory function through reduction of respiratory muscle spasticity.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/83. Metabolic and cardiopulmonary responses to acute progressive resistive exercise in a person with C4 spinal cord injury.STUDY DESIGN: Single-subject (female, 38 years of age) case. OBJECTIVES: To describe metabolic and cardiopulmonary responses to progressive resistive exercise in an individual with C4 asia A tetraplegia, and to review the relationship between level of spinal cord injury (SCI) and exercise responses. SETTING: Large, urban mid-western city rehabilitation hospital in united states of America. methods: Bilateral shoulder elevation/depression (shoulder shrug) exercise with two different resistances (0.7 kg/shoulder, 1.4 kg/shoulder) at two different frequencies (20 min., 40 min.), for 2 min per bout, deployed in a discontinuous protocol. RESULTS: Compared to rest heart rate (HR), exercise HR increased the greatest (13 bpm) for the 1.4 kg resistance at 40 min. and the least (6 bpm) during the 0.7 kg at 20 min. blood pressure (BP) response was lower than resting BP for all four exercise conditions with the lowest (74/56 mmHg) at 1.4 kg at 40 min. oxygen uptake was highest (4.6 ml.kg(-1) min(-1)) during 1.4 kg at 20 min and V(E) was greatest (18.2 L/min) during 1.4 kg at 40 min. Rate of perceived exertion (RPE) was the highest (17) during the 1.4 kg at 40 min. CONCLUSIONS: Progressive resistance exercise provoked intense perceived physical effort, but only small metabolic and cardiopulmonary increases in a person with C4 SCI. exercise recommended at a 'somewhat hard' intensity should avoid significant hypotension and still impressively increase oxygen uptake and ventilation compared to rest. An inverse relation between level of injury and aerobic responses may extend rostrally to the C4 level.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/83. Refractory heterotopic ossification with complications.BACKGROUND: Heterotopic ossification (HO) following spinal cord injury can lead to various complications, including venous thrombosis, autonomic dysreflexia, and pressure ulcers. We report refractory, complicated HO in a 19-year-old man with C8 incomplete tetraplegia. He first presented at 9 weeks postinjury with fever and swelling of his right leg. Ultrasound indicated a deep venous thrombosis (DVT). Persistent symptoms prompted triple-phase bone scan and magnetic resonance imaging (MRI), which revealed HO compressing the right external iliac vein and no evidence of DVT. The HO was complicated by hypercoagulability. CLINICAL COURSE: The HO was refractory to oral indomethacin and etidronate; therefore, intravenous etidronate was instituted, resulting in only a transient decrease in alkaline phosphatase. Local irradiation of the right hip did not decrease the activity of HO. The patient was discharged on oral etidronate, indomethacin, and warfarin. This complicated case raises issues regarding early diagnosis and aggressive treatment of HO, as well as treatment of associated hypercoagulability.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/83. Electrical stimulation of abdominal muscles for control of blood pressure and augmentation of cough in a C3/4 level tetraplegic.OBJECTIVES: Evaluation of a FES (Functional Electrical Stimulation) device for the relief of postural hypertension and augmentation of cough in a C3 ventilator-dependent tetraplegic. STUDY DESIGN: A single case study. SETTING: A supra regional spinal unit in the UK. METHOD: A dual channel stimulator was designed that allowed selection and initiation of two predetermined stimulation intensities using a chin controlled joystick. Two sets of 70 mm diameter electrodes were placed either side of the abdomen. Approximately 80 mA, 300 micros, 40 Hz was required for assisted cough while about 40 mA was required for maintenance of blood pressure. After eating, the lower level stimulus is self-administered every 3 to 5 min gradually increasing the time between groups of burst to once every hour after 90 min. RESULTS: Following eating, a blood pressure of 60/45 mmHg was recorded. After five 1 s bursts of stimulation in quick repetition, this was increased to 133/92 mmHg. After 2 min blood pressure had fallen to 124/86 mmHg and to 93/66 after a further 4 min. The electrical stimulation was then repeated, returning the blood pressure to the previous higher level. Measurement of peak expiratory flow showed an increase from 275 l/min for an unassisted cough to 425 l/min when using the device. CONCLUSION: The device is used every day. The user is now independent in coughing function and no longer requires suction or manual assistance. maintenance of blood pressure has significantly improved his quality of life.- - - - - - - - - - ranking = 4.5keywords = pressure (Clic here for more details about this article) |
10/83. lower extremity compartment syndrome in an adolescent with spinal cord injury.OBJECTIVE: Describe the unusual complication of lower extremity compartment syndrome occurring in an adolescent with spinal cord injury (SCI). methods: Case presentation. RESULTS: A 17-year-old male with C5 asia A complete SCI developed a compartment syndrome of his lower leg on the ninth day postinjury. Presenting signs included an equinus deformity of the foot, blackened induration over the anterior tibia, circumferential erythematous markings over the calf, large urticarial lesions over the knee, and calf swelling. The presumed etiology of the compartment syndrome was excessive pressure from elastic wraps, which were placed over gradient elastic stockings. Pressures were 51 mmHg in the superficial posterior, 50 mmHg in the deep posterior, 33 mmHg in the anterior, and 34 mmHg in the peroneal compartments. The patient also developed rhabdomyolysis with myoglobinuria. In addition to supportive care, the patient underwent a dual incision fasciotomy for compartment release. CONCLUSIONS: The development of lower extremity compartment syndrome was probably a result of excessive pressure applied by elastic wraps. Elastic wraps should be used with caution in individuals with SCI.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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