1/42. Virtual reality in paraplegia: a VR-enhanced orthopaedic appliance for walking and rehabilitation.spinal cord injuries (SCIs) have a profound physical, social and emotional cost to patients and their families. Obviously SCIs severely disrupt normal patterns of interaction with the environment. Firstly, the opportunities for active interaction are inevitably diminished due to motor or sensory impairment. Moreover, such problems may increase as the time since injury lengthens and the patient becomes more withdrawn and isolated in all spheres of activity. However, advances in Information technology are providing new opportunities for rehabilitation technology. These advances are helping people to overcome the physical limitations affecting their mobility or their ability to hear, see or speak. In this chapter an overview is given of the design issues of a VR-enhanced orthopaedic appliance to be used in SCI rehabilitation. The basis for this approach is that physical therapy and motivation are crucial for maintaining flexibility and muscle strength and for reorganizing the nervous system after SCIs. First some design considerations are described and an outline of aims which the tool should pursue given. Finally, the design issues are described focusing both on the development of a test-bed rehabilitation device and on the description of a preliminary study detailing the use of the device with a long-term SCI patient.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/42. Pediatric spinal cord injuries: a case presentation.spinal cord injuries (SCIs) in the pediatric population present a unique challenge to the caregiver in that both the physical injury and the growth and development issues need to be addressed simultaneously. Different types of injuries are anticipated than those seen in adults because of the developmental phases of the pediatric spinal cord. This article will review the differences between the pediatric and adult spinal cords, growth and development, and the types of injuries incurred by this population, followed by a case presentation.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
3/42. naloxone infusion and drainage of cerebrospinal fluid as adjuncts to postoperative care after repair of thoracoabdominal aneurysms.The mechanisms that produce paraplegia in patients after TAA repair are complex and involve alterations in regional blood flow to the spinal cord, CSF dynamics, and reperfusion. Although neither the minimal level of blood flow nor the maximal spinal cord pressure that can be tolerated by the spinal cord is known, adjuncts such as CSF drainage and naloxone infusions may allow longer durations of aortic cross-clamping before irreversible ischemia occurs. Because paraplegia is multifactorial and none of the recommended adjuncts alone provides complete protection of the spinal cord, a combination of treatments may be necessary to reduce the prevalence of neurological complications after thoracoabdominal aortic reconstruction. critical care nurses thus must be acquainted with the advanced monitoring techniques and the pathophysiology behind these new treatment modalities. Advanced assessment skills are also essential to recognize the potential neurological complications that may occur in these patients. Care of patients with TAA is a challenge. critical care nurses must use multidimensional skills in the areas of hemodynamic monitoring, physical assessment, and psychological counseling to effectively manage postoperative care of these patients.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
4/42. superior mesenteric artery syndrome in traumatic paraplegia: a case report and literature review.superior mesenteric artery syndrome (SMAS) is a relatively rare condition thought to be caused by the functional obstruction of the third part of the duodenum as it passes between the superior mesenteric artery and the aorta. The following case report describes a patient who developed SMAS in the setting of traumatic paraplegia. The patient began to exhibit symptoms consistent with SMAS (epigastric pain, postprandial epigastric fullness, nausea, emesis) shortly after his injury and during home therapies. On admission to an inpatient rehabilitation hospital, the patient's symptoms persisted and prevented participation in any therapies. When radiographic studies demonstrated the existence of SMAS, conservative and surgical management were discussed with the patient and the family. The patient was managed conservatively with positional changes during feeding and the administration of metoclopramide (10mg orally, three times a day) before meals and before sleep. The patient was able to meet or exceed all short-term physical and occupational therapy goals with one episode of postprandial nausea noted. The patient returned home 21 days after admission to the rehabilitation hospital with home therapies. The patient was able to perform transfer skills and most self-care tasks.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
5/42. paraplegia diagnosed by a new physical sign.Clinical diagnosis is a process of logical deduction from the data gathered by history and physical examination. When organic causes of an illness have been ruled out, a diagnosis of "functional disorder" or "conversion reaction" is considered. Cost of care of such patients can be enormous, especially when a large number of investigations are done to find an organic illness, which does not really exist. In such cases, a positive and early diagnosis of a conversion reaction can save needless tests and much distress to the patient. This report describes a case of paraplegia that was investigated for years before a diagnosis of conversion reaction was firmly made, based on a novel observation. We believe that we describe here a new physical sign, which can be used to diagnose "hysterical paraplegia."- - - - - - - - - - ranking = 2.599316070826keywords = physical examination, physical (Clic here for more details about this article) |
6/42. Acute paraplegia in a patient with spinal tophi: a case report.A 28-year-old man with a 5-year history of gouty arthritis suffered from an acute episode of lower back pain. He visited a rehabilitative clinic and received physical therapy following his examination. Weakness and numbness of both lower legs developed rapidly after physical therapy. He was sent to our hospital with complete paralysis of both lower limbs and complete sensory loss below the umbilicus 3 hours after the physical therapy. No peripheral tophi were found. myelography showed an extrinsic compression of the dura sac at T10. Emergency decompressive laminectomy of T9 to T11 was performed. During the surgery, caseous material was found deposited in the ligamentum flavum and the left T9 to T10 facet joint, with indentation of the dura sac. The pathologic diagnosis was spinal tophi. After surgery, the patient's neurologic function recovered rapidly. It was suspected that inappropriate physical therapy might have aggravated acute inflammation of spinal gout and resulted in a rapid deterioration of neurologic function. Though gout is a chronic medical disease, an acute attack of spinal gout may be disastrous and requires emergency neurosurgical intervention.- - - - - - - - - - ranking = 1.3333333333333keywords = physical (Clic here for more details about this article) |
7/42. Necrotizing perineal fasciitis in two paraplegic nursing-home residents: CT imaging findings.Necrotizing fasciitis is a severe infection of the superficial fascia. Early recognition and aggressive management are essential to the treatment of this highly morbid disease. The clinical and physical findings are often the initial clues leading to the correct diagnosis. Computed tomography can play a crucial role in delineating the anatomy, evaluating for the extent of the infection, and for eventual complications. Before the advent of cross-sectional imaging, the majority of suspected patients underwent extensive surgical debridement procedures with resultant morbidity and mortality. We present two cases in which computed tomography played a major role in determining the need for emergent surgery and conservative management.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
8/42. The biopsychosocial model and spinal cord injury.OBJECTIVE: To highlight the importance of taking the psychological, social and biological aspects into consideration when dealing with somatic complaints of spinal cord injured patients. SETTING: Supra-regional Spinal Injury Unit in the UK. STUDY DESIGN: Case study series. MATERIAL AND methods: The somatic complaints of four patients with spinal cord injury were assessed and their relationship to psychological and social issues were correlated. Two patients suffered unexplained pain, another excessive spasm uncontrolled with intrathecal baclofen pump and the fourth with several pressure sores, constipation and other physical problems. The impact of psychosocial issues on the somatic complaints were analysed. RESULTS: In all four patients the resolution of their psychosocial issues resulted in significant gains vis-a-vis their somatic complaints. CONCLUSION: Psychological and social issues of spinal injury patients could have a serious impact on the resolution of somatic complaints. It is important to take these into consideration in their treatment.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
9/42. New-onset neurologic deficits after general anesthesia for MRI.Two patients with spine disease were unable to tolerate supine placement for magnetic resonance imaging (MRI) because of severe back pain. General anesthesia was administered to enable the patients to undergo MRI. Both patients awakened from anesthesia with new-onset paraplegia and underwent emergency decompressive laminectomy. Acute paraplegia after anesthesia occurs infrequently and is most commonly associated with mechanical injury, vascular compromise, or anesthetic technique. The physical limitations of the MRI environment make it difficult to position some patients in a manner that accommodates their pathophysiology and may place certain patients at risk of neurologic compromise. For this subset of patients, the necessity of MRI with general anesthesia should be reassessed and alternative imaging methods considered.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
10/42. Hysterical paralysis: a report of three cases and a review of the literature.STUDY DESIGN: Three cases of hysterical paralysis are reported and the literature is reviewed. OBJECTIVE: To report and discuss three cases of psychogenic paraplegia in order to increase the awareness and assist in the diagnosis and treatment of this uncommon disorder. SUMMARY OF BACKGROUND DATA: Hysterical paralysis, a form of conversion disorder, is an uncommon psychogenic, nonorganic loss of motor function precipitated by a traumatic event. The prevalence of conversion disorder in the general population reportedly is between 5 and 22 per 100,000 persons. The pursuit of a diagnosis for the hysterical paraplegic patient necessarily consumes valuable resources and time. If early recognition can be facilitated, these resources may be conserved. methods: The medical records for three healthy young women who presented to the authors' service reporting complete loss of lower extremity function were reviewed retrospectively along with the related laboratory, electrodiagnostic, and imaging studies. Two of the women were involved in motor vehicle accidents. One had a history of a previous hysterical seizure. Inconsistencies in physical examination and studies were noted. RESULTS: All three patients had normal laboratory, electrodiagnostic, and imaging studies. Discrepancies included complete loss of motor control and sensation in the lower extremities in the face of normal deep tendon reflexes as well as incontinence of bowel and bladder despite intact rectal tone. The patients spontaneously recovered and ambulated out of the hospital without assistance after their normal test results and physical examination inconsistencies were presented to them. CONCLUSIONS: Hysterical paraplegia is a type of conversion disorder. It is a diagnosis of exclusion that typically presents as mono-, hemi-, para-, or quadriplegia. The pursuit of a diagnosis for the hysterical paraplegic patient necessarily consumes valuable resources and time. The typical patient is a female from a low socioeconomic background with limited education. The DSM-IV-TR criteria must be met to fulfill the diagnosis of conversion disorder. Electrodiagnostic and imaging studies can aid in the diagnosis. Treatment revolves around explaining the normal diagnostic results to the patients and guiding them to appropriate psychiatric and physiotherapy. Rapid recovery should be expected, but can take up to 6 months.- - - - - - - - - - ranking = 1.8652988083187keywords = physical examination, physical (Clic here for more details about this article) |
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