1/67. 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 Moreover, such problems may increase as the time since injury lengthens and the patient becomes more withdrawn and isolated in all spheres of activity.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) |
2/67. 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) |
3/67. Outcome of functional electrical stimulation in the rehabilitation of a child with C-5 tetraplegia.hand function was provided for a six-year-old child with C-5 American spinal injuries association (asia) classification-A tetraplegia through a percutaneous intramuscular (i.m.) functional electrical stimulation (FES) system. In conjunction with implantation of 10 percutaneous i.m. electrodes for provision of grasp and release of her right hand, reconstructive surgery was performed to provide upper extremity positioning to optimize hand use. The subject participated in FES training over a nine-week period for approximately five hours weekly, with an additional five hours each week dedicated to exercise and conditioning of her arm muscles. Physical and functional assessments included range of motion (ROM), manual muscle testing (MMT), activities of daily living (ADL) abilities and the Canadian Occupational Performance Measure (COPM), used to evaluate the effect of stimulated hand function and surgical reconstruction on functional ability. These were conducted prior to FES and surgery and repeated after rehabilitation training. With rehabilitation and training, the child was able to control her FES system. Physical assessments revealed increased strength of both shoulders and more useful range of arm movement. Functional assessments show that the FES system enabled her to perform age-appropriate ADL that previously were achievable only with physical assistance. Her overall level of independence in ADL ability increased, as did self-rated levels of satisfaction and performance on chosen activities. Positive gains demonstrated here suggest the need for further studies of FES systems in young children with SCI.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
4/67. The gastric emptying scan as a tool for surgical management of severe bowel dysfunction in spinal cord injury: 2 case reports.We describe 2 patients with spinal cord injury (SCI) for whom the gastric emptying scan (GES) was crucial for determining the correct surgical approach in the therapeutic management of gastrointestinal complaints. Two men, ages 45 and 51 years, were admitted to a university hospital for delayed gastric complications from SCI. Both SCIs were traumatic, and the interval since injury was 18 months for the younger man and 6 months for the older man. Both men lacked voluntary motor and sensory function below the cord level of the lesion and had quadriplegia. Using GES, we measured motility (the cutoff for normal in this laboratory is 37%) and the time at which half the gastric contents were emptied (normal values are 45 /- 8 min). Both patients had abnormal motility: residuals at 1 hour were above 50%. Half the gastric contents were emptied at 75 and 90 minutes, respectively. The therapeutic value of the GES was demonstrated for both patients, in combination with the history, physical examination, and abdominal radiographic studies. The first patient underwent ileostomy, and the second required a gastrostomy tube and a jejunostomy tube in addition to metoclopramide. The GES is a valuable diagnostic tool with an important role in the surgical management of patients with SCI.- - - - - - - - - - ranking = 0.60969577298257keywords = physical, physical examination (Clic here for more details about this article) |
5/67. 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 = 0.60969577298257keywords = physical, physical examination (Clic here for more details about this article) |
6/67. 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 = 0.33333333333333keywords = physical (Clic here for more details about this article) |
7/67. Determining impairment following spinal cord injury.Determining the level of impairment and disability of an individual with SCI is reasonably straightforward. An impairment rating may be determined by either analyzing the impact of the SCI on various bodily systems or by considering the injury as a more global diagnostic category. Functional abilities based on level of neurologic preservation are well recognized. Although secondary medical complications, which may affect both impairment and disability, can arise at any time after SCI, neurologic and functional abilities are overwhelmingly stabilized by 12 months postinjury. A comprehensive history and physical examination should allow even the inexperienced examiner to obtain a valid determination of impairment after SCI. Although a more functionally oriented and perhaps interdisciplinary evaluation is needed to assess disability, it is also fairly straightforward. On the other hand, an evaluation of handicap is a more challenging undertaking, requiring a more detailed knowledge of the field of vocational rehabilitation.- - - - - - - - - - ranking = 0.60969577298257keywords = physical, physical examination (Clic here for more details about this article) |
8/67. Crohn's disease in a patient with acute spinal cord injury: a case report of diagnostic challenges in the rehabilitation setting.Diagnosis of the abdominal emergency in tetraplegic and high paraplegic patients remains challenging. Classic peritoneal signs, such as a rigid abdomen, rebounding, guarding, and Murphy's sign may be absent, whereas subtle physical, laboratory, or radiologic abnormalities may be the only evidence for an acute abdomen. Our report describes the course of a 70-year-old man with C5 American Spinal Injury association class A tetraplegia who developed a perforated cecum secondary to Crohn's disease. We review the visceral and somatic sensory pathways for abdominal pain with emphasis on the challenges in assessing the acute abdomen in a patient with spinal cord injury (SCI). Recommendations for the assessment of the acute abdomen in an individual with SCI will be provided. This is the first reported case of Crohn's disease in an individual with an acute SCI. It shows the importance of maintaining high clinical suspicion for unexpected intraabdominal processes that may lead to significant morbidity and mortality if left undiagnosed.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
9/67. Perinephric abscesses in the neurologically impaired.STUDY DESIGN: Retrospective chart review. OBJECTIVES: To document the occurrence and management of large perinephric abscesses in neurologically impaired patients at high risk for this infectious complication. SETTING: US veterans Affairs hospital. methods: The records, radiographs, operative findings and outcomes of all patients who presented with perinephric abscesses evident on physical exam within the last 5 years were reviewed. RESULTS: Four patients presented with large perinephric abscesses evident on physical examination. All had severe neurologic impairment with high sensory levels; three had spinal cord injuries, one had advanced multiple sclerosis. All had neurogenic bladders and recurrent urinary tract infections. The diagnosis was made through a combination of history, physical examination and computed tomography (CT) examination. All were found to have upper tract obstruction. All were managed with immediate abscess drainage and three had elective nephrectomy once the infection had resolved. No patients died of their perinephric abscess. CONCLUSIONS: These four cases illustrate that although advances in antibiotics, imaging and percutaneous management have improved the speed of diagnosis and reduced the mortality in patients with perinephric abscesses, the neurologically impaired population continues to remain at significant risk for the development and the delayed diagnosis of these morbid renal infections.- - - - - - - - - - ranking = 1.5527248792985keywords = physical, physical examination (Clic here for more details about this article) |
10/67. 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) |
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