Changes In Ambulatory Status Research Articles

Ambulation in Patients with Myelomeningocele: A 12-Year Follow-up

Factors determining change in ambulatory status were studied over a 12-year observation time in 60 ambulating patients with myelomeningocele. There were 26 female and 34 male subjects with a median age of 22 years (range, 12-54). We used the method of Lindseth to define the neurologic level of the lesion and classified walking ability according to the criteria of Hoffer. The prevalence of spasticity and spine and lower-limb deformities was assessed. Orthopedic and neurosurgical interventions and other medical events were registered, as well as occurrence of pressure sores, musculoskeletal pain, and use of orthoses. There were 19 patients with downward transitions in ambulatory level during the follow-up time. Factors explaining deterioration in these 19 patients included deterioration of the neurologic level of lesion, spasticity, knee and hip flexion contractures, low-back pain, lack of motivation, as well as those of major medical events like stroke, recurrent septicemia, lower limb edema, and invasive surgical interventions.

Orthopedic Procedures After Rhizotomy

The goal of selective dorsal rhizotomy (SDR) is to reduce surgically abnormal excitatory impulses to the lower extremities and thus to decrease spasticity in patients with cerebral palsy. One hundred thirty-one patients underwent SDR from 1986 to 1994 and were retrospectively reviewed for changes in tone, requirements for orthopedic intervention, and changes in ambulatory status. One hundred twelve patients had adequate follow-up. Postrhizotomy tone was decreased in all of the 112 patients, as measured by the Ashworth scale. No statistically significant change in ambulatory status was found. A total of 71 (65%) of 112 patients required orthopedic intervention for continued contractures and deformity. Of those judged "hypotonic" by the physiatrist postoperatively, 37% required subtalar stabilization for severe planovalgus. Hip subluxation was noted and treated (by femoral or pelvic osteotomy or both) in 27 (25%) of 112. Despite appropriately completed SDR, parents must understand the importance of periodic long-term follow-up and the possible, if not likely, need for additional surgery to alleviate contractures and stabilize subluxation of joints.

Expectations and outcomes after hip fracture among the elderly.

Hip fractures among the elderly are a common occurrence, with high social and personal costs. Sequelae not infrequently include loss of independent functioning, permanent disability, and death. This prospective study of a cohort of eighty recently diagnosed "hardy" hip fracture patients examines initial rehabilitation expectations using a combination of methods. The study addresses the relationship between initial expectations and changes in ambulatory status from prefracture to three months post-fracture. The importance of previous experience with illness is also explored. Participants who had positive expectations for recovery and those who had greater previous experience were likely to have less negative change in ambulation from prefracture to three months, and better overall ambulation at three months. The findings suggest a relationship between patient expectations for recovery and actual recovery of ambulation, and support the heretofore "clinical impression" that cognition and affect influence the course of rehabilitation after hip fracture.

Supracondylar Fracture of the Femur Following Prosthetic Knee Arthroplasty

Sixty-one supracondylar fractures above prosthetic knee replacements in 58 patients were reviewed with a mean follow-up time of 3.7 years (range, 9 months to ten years). The mean interim between arthroplasty and fracture was 2.9 years (range, intraoperative to ten years). Twenty-seven cases demonstrated notching of the anterior femoral cortex. Seventeen patients suffered from a severe neurologic disorder. Group A consisted of 30 patients with 31 fractures treated by open reduction and internal fixation or revision arthroplasty. Follow-up study revealed 25 unions, three malunions, one nonunion, and two above-knee amputations for deep sepsis. Four of 31 patients had increased pain levels or change in ambulatory status postoperatively. Group B consisted of 30 fractures in 28 patients treated by casting alone or traction followed by cast bracing. Follow-up examination showed 17 unions, seven malunions, and six nonunions. Fifteen of the 30 patients had increased pain levels or change in ambulatory status after treatment. Casting produced significant decreases in motion in both groups. The results indicate that this fracture is associated with anterior notching of the femoral cortex and preexisting neurologic disorders. Patients with a supracondylar fracture following prosthetic knee arthroplasty are best managed by secure internal fixation and early motion.