Quadriplegic Patients Research Articles

A Comparison of Two Different Breathing Exercises for Quadriplegic Patients

Department of Physical Therapy Maryland Institute for Emergency Medical Services Systems (MIEMSS) Baltimore, MD

Transfer activities of quadriplegic patients

Transfer activities of quadriplegic patients

Randomized, double-blind comparative study of intravenous ciprofloxacin versus ceftazidime in the treatment of serious infections

We compared intravenously administered ciprofloxacin with ceftazidime in a randomized double-blind study. Patients received ciprofloxacin 200 mg intravenously every 12 hours or ceftazidime 2 g intravenously every eight hours, with placebo infusions to maintain blinding. Therapy with metronidazole was added for suspected or documented intra-abdominal infection. Thirty-two of the 57 ciprofloxacin-treated patients were evaluable for determination of efficacy and had 41 bacterial isolates from 34 sites. Thirty-six of the 56 ceftazidime patients were evaluable for determination of efficacy and had 41 bacterial isolates from 38 sites. Seven of 35 bacteremic patients had no identifiable primary focus. The most commonly isolated pathogens were Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella pneumoniae. Cure rates and bacteriologic eradication rates were comparable. Nine patients did not improve. Patients with treatment failures in the ciprofloxacin group included a quadriplegic patient with relapse of urinary tract infection with bacteremia ( K. pneumoniae). Another patient with bacteremia ( Pseudomonas aeruginosa), pneumonia ( Proteus vulgaris), and urinary tract infection ( P. vulgaris, Providencia sp.) died on the first treatment day. The third patient ( S. aureus and Streptococcus pneumoniae pneumonia) had a new aspiration pneumonia develop on the third day; the pneumococcus also persisted. Undrained S. pneumoniae empyema caused the fourth ciprofloxacin treatment failure, and the fifth patient had a relapse of S. aureus pneumonia with bacteremia. One ceftazidime-treated patient died of pneumococcal pneumonia on the first day. Another had persistent Staphylococcus epidermidis and Listeria bacteremia despite 48 hours of treatment. Two other patients had pneumonia ( S. aureus and P. aeruginosa, respectively) and completed full courses of ceftazidime therapy without improvement. Five patients had pneumococcal bacteremia; four patients were cured: one of two patients in the ciprofloxacin group and three of three patients in the ceftazidime group. Significant increases in the number of platelets (four patients with ciprofloxacin treatment, one patient with ceftazidime treatment) and declines in the number of platelets (one patient with ciprofloxacin treatment, one patient with ceftazidime treatment) were observed. Intravenously administered ciprofloxacin is comparable with ceftazidime and is a safe and effective antibiotic for the treatment of patients with serious infections, including bacteremia.

Origins of Cerebral Palsy

Analyses were undertaken to determine the causes of cerebral palsy in a prospective study of 43,437 full-term children. Presumed causes were found for about 71% of the 34 quadriplegic and 40% of the 116 nonquadriplegic patients with cerebral palsy. Risk estimates based on predictive models, adjusted for multiple factors, suggest that 53% of the quadriplegic patients with cerebral palsy could be attributed to congenital disorders, 14% to birth asphyxia, and 8% to other identified disorders. Thirty-five percent of the nonquadriplegic patients with cerebral palsy could be attributed to congenital disorders and 6% to other disorders. In the victims of cerebral palsy, characteristic consequences of birth asphyxia were more often the result of nonasphyxial disorders. These included meconium in the amniotic fluid, low 10-minute Apgar scores, neonatal apnea spells, seizures, persisting neurologic abnormalities, and slow head growth after birth.

Functional electrical stimulation and lower extremity bracing for ambulation exercise of the spinal cord injured individual: a medically prescribed system.

The purpose of this study was to determine whether commercially available electrical muscle stimulators could provide functional ambulation exercise for the spinal cord injured individual. Commercially available electrical muscle stimulators were used for functional electrical stimulation and interfaced with reciprocating gait orthoses so that a new system has been developed. Advantages of the system include commercially available subsystems and subsystems for applications such as gait training. The system involves six electrical stimulation units worn on a belt; controlled by remote switches; and interfacing to electrodes placed over the quadriceps femoris, hamstring, and gluteal muscle groups of each leg. Four electrical stimulation units (for quadriceps femoris muscle stimulation) function primarily for stand-up and sit-down activities. Two other units (for stimulation of the hip extensor muscles) function primarily for ambulation. The system is described for use with a C7-level quadriplegic individual. The patient successfully performed over 20 repetitions of stand-up and sit down exercises with the system. An average walking distance of about 0.8 km was routinely traversed at velocities ranging from 1.2 to 2.0 km per hour. It was concluded that muscle fatigue, rather than battery power, was the functionally limiting factor for the quadriplegic patient. A recommendation is that application of the system for walking exercise should be preceded by a physical conditioning program of functional electrical stimulation. Specific medical criteria should be satisfied prior to formally prescribing the system for an individual. Finally, the steps involved in the writing of the walking system prescription are outlined.

Spinal cord injury and health locus of control beliefs.

Individual beliefs about control over their health were assessed in 53 patients with spinal cord injury. Patients who believed they exercised control over their health were less depressed than patients who were fatalistic. A significant number of patients were found to be higher in their internal attributions of health control (N = 31) than those who believed in chance (N = 5) and those who believed medical personnel were in control of their health (N = 11). The results are integrated with a past study of depression following spinal cord injury and locus of control beliefs.

Functional neuromuscular stimulation system using an implantable hydroxyapatite connector and a microprocessor-based portable stimulator

For developing functional neuromuscular stimulation (FNS) orthoses, percutaneous implants made of sintered hydroxyapatite (HAp) and a microprocessor-based portable stimulator were devised, and related basic studies were carried out. First, a button-shaped HAp was percutaneously implanted up to 23 months in the skin of dogs, and 30 months in human subjects. The HAp was closely contacted with the skin tissue. Then, button-shaped HAp electrical connectors were percutaneously implanted in the skin of rabbits. Sufficient contractions of the calf muscle were elicited by electrical stimuli delivered to intramuscular electrodes through the connector. These results indicated that the HAp electrical connector could be clinically utilized as an implantable skin interface for FNS. The microprocessor-based stimulator capable of processing control command signals and delivering 16-channels of electrical stimuli was developed. Usefulness of the stimulator was demonstrated by applying it to flexor and extensor muscles of the thumb in a C5 quadriplegic patient.

Flexed Neck Posture Due to Cervical Posttraumatic Syringomyelia

A flexed neck posture, especially with prolonged sitting, developed in three quadriplegic patients as a manifestation of posttraumatic syringomyelia (PTS). This posture developed at 1, 6, and 20 years after spinal cord injury. All patients complained of increasing weakness of the neck with several hours of sitting, and all required analgesics for aching neck pain. Neck weakness preceded an ascent of the level of sensory or motor deficit in two patients, and followed it in one. Current muscle testing failed to demonstrate weakness of neck extension in any patients, but electromography revealed chronic denervation and reinervation of cervical paraspinal muscles in each patient. Magnetic resonance imaging revealed a syrinx extending from the site of injury to the medulla oblongata in each case. We conclude that a flexed neck posture can represent: (1) a loss of stamina in denervated head support musculature, (2) either a precursor or successor to the conventional signs of PTS, and (3) high cervical syringomyelia.

The clinical features of spasms in patients with a cervical cord injury

A study concerning subjective symptoms of spasms which occur during 24 hours was carried out in 13 quadriplegic patients. All had spasms. Tonic and clonic spasms occurred involving their limbs and trunk. Extensor spasms occurred more often in the lower limbs than in the upper limbs. The duration of spasms was 8 seconds on average and the frequency was 15 times on average per day. The spasms which were severe tended to last longer in duration and were more frequent in occurrence. No spasms occurred without a trigger. The activities in daily living were interfered with by spasms in most patients. Most of these activities also triggered spasms.

Vascular Spasm During Heparin-Dihydroergotamine Prophylaxis in a Quadriplegic Patient: Case History

Lower extremity ischemia occurred in a quadriplegic patient following dihy droergotamine-heparin prophylaxis. Ergotamine should be used with caution in paralyzed patients.

Artificial ventilation by means of electrical activation of the intercostal/accessory muscles alone in anesthetized dogs.

We have previously shown that large inspired volumes can be achieved in phrenicotomized animals by intercostal/accessory muscle activation via spinal cord stimulation. In the present study, we evaluated the utility of this technique to provide complete ventilatory support for prolonged time periods (6 to 8 h, selected arbitrarily). In 10 deeply anesthetized dogs, a single electrode was introduced onto the epidural surface of the spinal cord and positioned at the T2-T3 spinal level. Bilateral phrenicotomy was performed in all animals to prevent possible diaphragm activation. The spinal cord was rhythmically stimulated approximately 13 times/min with trains of 15- to 20-Hz impulses of sufficient amplitude to achieve inspired volumes of 13 to 15 ml/kg and pressure-time index (product of duty cycle and delta P/Pmax) of less than 0.15 with each contraction. Level of alveolar ventilation was monitored by end-tidal PCO2 and intermittent arterial blood gas measurements. Mean inspired volume and minute ventilation were 236 +/- 7.84 (SE) ml and 3.12 +/- 0.13 (SE) L/min, respectively, and not significantly different between the first and sixth hours of continuous stimulation. Mean duty cycle (Ti/Ttot) was 0.26 +/- 0.01. Mean airway pressure (delta P) during prolonged electrical stimulation under conditions of airway occlusion was 8.05 +/- 0.61 (SE) cm H2O. Mean ratio of delta P/Pmax was 0.47 +/- 0.03 (SE) cm H2O; mean pressure-time index was 0.12 +/- 0.01 (SE). There was no evidence of system fatigue, as evidenced by the lack of any significant shift in the pressure frequency curve over a 6-h time period.(ABSTRACT TRUNCATED AT 250 WORDS)

Decharges EEG localisees continues pendant le sommeil chez l'enfant

Continuous generalized spike-and-wave complexes occurring during slow-sleep were first observed in some children by Patry et al. (1971). A general review of the reported cases was made by Tassinari et al. (1984). We have observed a new clinical-EEGraphic picture. Spikes and spike-and-wave complexes localized to one hemisphere were recorded during at least 85% non-REM sleep both in 3 quadriplegic and in 3 hemiplegic mentally retarded children, aged from 2 years and 10 months to 11 years (mean age: 5 years and 2 months). Cyclic organization of sleep was almost normal. Wake EEG showed an epileptic focus. Brain CT showed midline defect and brain atrophy in quadriplegic patients, and a wide temporal-parietal porencephalic cyst in hemiplegic patients. This EEGraphic pattern was associated with a more pronounced mental impairment: neuropsychological improvement was observed in 2 cases, when continuous sleep discharges disappeared. As aforesaid, this picture seems to be related either to hemispheric or to midline brain defects. In our cases, sleep phase organization could be examined, while continuous generalized discharges occurring during sleep do not allow such a study.

Surgical Reconstruction in Tetraplegia

The authors reviewed their 10 years of combined experience in the surgical reconstruction of the upper extremities in 170 quadriplegic patients from two spinal cord treatment centers. The authors' current recommendations regarding patient selection are presented, refinements in previously published surgical techniques are defined, and the principles of postoperative care are discussed.

Institutional screening for the fragile X syndrome.

Cytogenetic screening of mentally retarded patients for the fragile X (fra[X]) chromosome is helpful in identifying individuals who could benefit from genetic counseling and treatment. Previous studies have demonstrated a prevalence of the fra(X) syndrome as high as 6% in institutionalized retarded males. The physical and behavioral predictors of positive findings from cytogenetic testing have not been clarified, since many features of the fra(X) syndrome are found in other retarded populations. We performed physical and cytogenetic examinations on 440 patients at the Wheat Ridge (Colo) Regional Center. Twenty-eight (6.3%) demonstrated abnormal karyotypes. Seventeen of these were autosomal abnormalities or sex chromosome aneuploidies and 11 demonstrated the fra(X) chromosome (seven males, four females). In males, the physical features that were predictive of the fra(X) syndrome included the combination of ear lengths of 7.0 cm or greater, macroorchidism of 30 mL or greater, and the presence of hand calluses or lesions secondary to hand biting. The fra(X) chromosome was not seen in spastic quadriplegic patients. All seven males with the fra(X) syndrome were detected among the 141 ambulatory males who resided in the highest functioning units at this institution.

Hyponatraemia in quadriplegic patients

1. Studies were performed in five hyponatraemic (plasma sodium 129 +/- 1.6 mmol/l; plasma osmolality 268 +/- 3.0 mosmol/kg) quadriplegic patients in order to elucidate its aetiology. Five age- and sex-matched healthy subjects served as controls. 2. Daily urine volumes were high (4454 +/- 624 ml) in the quadriplegic patients secondary to habitually increased fluid intake. 3. All quadriplegic patients had suppressed plasma arginine vasopressin levels (less than 0.8 pmol/l) and were able to form dilute urine after a water load (20 ml/kg). However, free water clearance and the ability to excrete the water load were frequently impaired, and these defects were associated with reductions in both osmolar clearance and delivery of filtrate to the distal diluting sites of the nephron. 4. During hypertonic saline (5%, w/v, NaCl) infusion, plasma arginine vasopressin rose progressively before plasma osmolality reached the normal range, consistent with a resetting of the osmostat. 5. We conclude that hyponatraemia in quadriplegic patients is related to an intrarenal defect in water excretion and resetting of the osmostat coupled with increased fluid intake.

Cervical spinal cord injury--a public catastrophe.

Cervical spine cord injuries continue to be a major cause of death and disability for trauma victims. Motor vehicle trauma results in 500 to 650 quadriplegic patients per year. Most of the patients are cared for at Level I trauma centers which may not have a dedicated rehabilitation facility. Long-term rehabilitation, nursing care, and financial support remain difficult areas in the overall management of these injuries. Seventy-one cervical spine fracture patients were admitted to this medical center over a 2-year period. Twenty-two patients had a neurologic injury, 15 quadriplegic patients, and seven with incomplete deficits. Vehicular trauma was the etiology in 14 injuries; gunshot wounds in five; falls in three. Twelve of these 22 patients had associated injuries, including chest and abdominal trauma. Prolonged stays in the intensive care unit were common (avg. = 13.5 days). Bronchoscopy (8/22 patients) and aggressive pulmonary care were constantly needed. Six patients died in the intensive care unit. The average hospital stay of the survivors was 45 days. Three of the 16 surviving patients were ventilator dependent at the time of discharge. Ten patients were discharged to a rehabilitation center, one to a nursing home, and five went home (one on a ventilator). The total hospital charges were $1,250,000. No financial resources were available for five of the 16 surviving patients. Four patients had resources which covered less than 50% of the total charges. Average hospital charges for survivors were $50,370. Maximum reimbursement using all outlier days under DRG 5 would be $12,385. The financial support of initial hospitalization, rehabilitation, and nursing care for these quadriplegic patients is a serious national health care issue.

Rubber band as external assist device to provide simple grip for quadriplegic patients.

The rubber band as an external assist device provides an effective grip for the hand of high spinal cord injury quadriplegic patients. This technique can also be useful for preoperative patients who are undergoing physical and occupational therapy or to assess patients' needs for surgery. The rubber band as an adaptive device is preferred because of its availability, low visibility, and ease of application. We attempt to provide a more standardized method of the rubber band technique and to popularize it.

Rehabilitation outcomes in complete C5 quadriplegia.

Establishment of rehabilitation goals for spinal cord injury patients generally has been based on the degree of residual motor function. Despite extensive clinical experience with spinal cord injury rehabilitation, there have been no reports of the ability of C5 quadriplegic patients to perform self-care and mobility skills before and after rehabilitation. This study was designed to examine the rehabilitation outcomes of 63 patients with C5 complete quadriplegia, who completed an interdisciplinary inpatient rehabilitation program, using the 100-point modified Barthel Index as a means of rating functional status. There were statistically significant increases in the mean modified Barthel index scores from 7.1 on admission to 28.9 on discharge for the entire group of patients. The self-care subscore increased significantly from 6.5 on admission to 20.0 on discharge and the mobility subscore increased significantly from 0.5 on admission to 8.9 on discharge. Ability to perform self-care and mobility subscore tasks is described. This study documented significant improvements in function during comprehensive rehabilitation among patients with C5 spinal cord injury.

Occupational Therapy Management of Tendon Transfers in Persons with Spinal Cord Injury Quadriplegia

Upper extremity surgical reconstruction can play an important role In helping the spinal cord injured quadriplegic patient achieve maximum independence in a variety of activities of daily living. The transfer of the brachioradialis to the extensor carpi radialis brevis, the brachioradialis to the flexor pollicis longus, and the posterior deltoid to the triceps each provide opportunities for functional improvement in this patient group. The occupational therapist's understanding of functional potentials and problems unique to spinal cord injury provides a realistic perspective to the team on potential benefits of each surgery. The occupational therapist also plays a critical role in identifying appropriate surgical candidates, in establishing treatment goals with the patient, and in administering a carefully planned post-operative treatment program.

電気的神経筋刺激による麻痺上肢の機能再建

A respiration-controlled functional electrical stimulation (FES) system was developed to restore motor function of the upper extremities in the patient with high spinal cord injury. Stimulation data for controlling the hand, wrist and elbow were obtained from the analysis of EMGs measured during upper extremity motion in normal subjects and were stored in the memory of the system as data files. Each data file was divided into subfile 1 for controlling hand and wrist motion and subfile 2 for elbow motion. After subfile 1 or 2 was selected, giving expiration to respiration sensor 1 (S1) and expiration and inspiration to sensor 2 (S2) provided hand opening and grasp or elbow extension and flexion, respectively. This strategy achieved well-coordinated and reliable movement of the paralyzed upper extremities; a C_4 quadriplegic patient could voluntarily control her upper extremity for activities of daily living (ADL) such as drinking canned tea.