Quadriplegic Patients Research Articles

The reliability of lung function tests in a quadriplegic patient

10. Andrade J, Batista M, Evora P, Tavares JR, Buffolo E, Ribeire EE, et al. Methylene blue administration in the treatment of the vasoplegic syndrome after cardiac surgery. Rev Bras Circ Cardiovasc. 1996;11:207-14. 11. Leyh RG, Kofidis T, Struber M, Fischer S, Knobloch K, Wachsmann B, et al. Methylene blue: the drug of choice for catecholamine-refractory vasoplegia after cardiopulmonary bypass? J Thorac Cardiovasc Surg. 2003;125:1426-31. 12. Levin RL, Degrange MA, Bruno GF, Del Mazo CD, Taborda DJ, Griotti JJ, et al. Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery. Ann Thorac Surg. 2004;77:496-9. 13. Stanford SC, StanfordBJ,Gillman PK.Risk of severe serotonin toxicity following co-administration of methylene blue and serotonin reuptake inhibitors: an update on a case report of post-operative delirium. J Psychopharmacol. 2010;24:1433-8. 14. Gillman PK. CNS toxicity involving methylene blue: the exemplar for understanding and predicting drug interactions that precipitate serotonin toxicity. J Psychopharmacol. 2011;25:429-36. 15. Sternbach H. The serotonin syndrome. Am J Psychiatry. 1991;148:705-13.

Inhibition of the motor command during motor imagery: a MEG study with a quadriplegic patient

Inhibition of the motor command during motor imagery: a MEG study with a quadriplegic patient

Pes planovalgus deformity surgical correction in ambulatory children with cerebral palsy

Planovalgus foot deformity is common in diplegic and quadriplegic patients. Surgery is the definitive treatment to restore the alignment of the talus, calcaneus, and navicular bones. We aimed, in the current study, to compare the effectiveness of subtalar fusion and calcaneal lengthening, and to assess the recurrence in ambulatory children with cerebral palsy. This is a retrospective study of 78 patients (138 feet diagnosed with planovalgus deformity) who underwent surgical correction using subtalar fusion or calcaneal lengthening. Range of motion, radiographic indices, kinematic, and pedobarographic data were used to examine the deformity and the outcome of surgery. A repeated measures analysis of variance (ANOVA) was used to test the study hypothesis. Most of the patients were diplegic (87.2%) and the mean age at surgery was 11.9±2.9years (range from 4.7 to 18.3years), with a mean follow-up of 5±4.4years (range from 1 to 15.4years). Sixty-three feet were treated with calcaneal lengthening, while 75 were treated with subtalar fusion. The feet treated with subtalar fusion were more severe preoperatively. However, both surgery groups showed improvement postoperatively. Among 12 cases of recurrence, medial column fusion was the main surgery performed to correct the deformity. Surgery is effective in the treatment of planovalgus deformity in ambulatory children with cerebral palsy. Severe and rigid planovalgus feet can be treated effectively with subtalar fusion. Feet with milder deformity show good results, with calcaneal lengthening. Surgery provides good correction in young patients, but there is a higher recurrence rate.

Retrograde Intubation Using a Frova Intubating Introducer in a Patient with a Tracheostomy

To the Editor The Frova intubating introducer with an angled flexible tip and rigid internal stylet was designed for difficult orotracheal intubations. Here we report the novel use of the Frova intubating introducer for retrograde intubation via a caudally directed tracheostomy tract in a patient in whom antegrade intubation had been unsuccessful. A 59-year-old male quadriplegic patient with a tracheostomy was diagnosed with tracheoesophageal fistula and admitted to the operating room for fistulectomy. The patient had undergone cervical spine surgery after a car accident 9 years ago and presented with severely wasted neck and limbs, a large tongue, and a <1-cm mouth opening. For the fistulectomy, oronasotracheal intubation was needed because the tracheoesophageal fistula was just 1 cm above the tracheostomy site. We attempted nasal fiberoptic bronchoscope-guided intubation under light sedation, but the narrowness of the oral cavity and a large amount of secretions made it difficult to pass the fiberoptic bronchoscope beyond the tongue base. We therefore decided to try retrograde intubation through the tracheostomy opening. We attempted to insert a Cook airway exchange catheter (Cook Critical Care, Letchworth, Hertfordshire, UK) ordinarily used as a “guidewire” for retrograde intubation, via the tracheostomy tract several times, but the tip failed to advance cephalad. Alternatively, we inserted a Frova intubating introducer (Cook Critical Care) with a rigid internal stylet into the tracheostomy tract, and after advancing the angled tip 5 cm in the cephalad direction, the stylet was removed. We kept advancing the Frova intubating introducer into the pharyngeal space. The distal tip emerged from the left nostril, and then retrograde intubation was successfully conducted by using the introducer as a guide. Insertion of a flexible guide for retrograde intubation via a tracheostomy with a caudal orientation of the internal tracheal lumen results in advancement of the guide further into the trachea rather than cephalad through the larynx. In our case, because the Cook airway exchange catheter, initially used as a guide, was flexible and did not have an angled tip, it could not be advanced in the cephalad direction via the caudally directed tracheostomy tract, causing our initial attempt at retrograde intubation to fail (Fig. 1). However, the Frova intubating introducer is made of more rigid polyethylene and has a length of 65 cm, an outside diameter of 4.7 mm, a tip portion of approximately 2 cm with a flexible angle of 65°, and an internal stylet that can be inserted for rigidity up to the distal 5 cm.1 These features account for why we were able to advance the Frova intubating introducer in the cephalad direction via a caudally oriented tracheostomy tract (Fig. 2). Retrograde intubation using an intubating introducer via a tracheostomy is not a recommended technique and could result in creation of a false passage, vocal cord injury, retropharyngeal hematoma, and tissue damage.2 Because our patient had maintained a tracheostomy for over 8 years, the risk of a false passage was relatively low.Figure 1: The Cook airway exchange catheter was unable to be advanced in the cephalad direction via a caudally oriented tracheostomy tract with a hyperacute angle.Figure 2: A, The Frova intubating introducer with an angled flexible tip and rigid internal stylet. B, (a) The angled tip of the Frova intubating introducer is inserted in the cephalad direction. (b) The Frova intubating introducer is advanced while carefully applying lever-like force in the caudal direction. C, The Frova intubating introducer is successfully advanced in the cephalad direction with a retraction movement while removing the internal stylet at the same time.PATIENT CONSENT STATEMENT Published with the written consent of the patient's family and the approval of the Institutional Review Board (ref. 4–2011-0554) of Yonsei University Health System. Shin Hyung Kim, MD Yong Seon Choi, MD, PhD Young Jun Oh, MD, PhD Department of Anesthesiology and Pain Medicine Anesthesia and Pain Research Institute Yonsei University College of Medicine Seoul, Korea [email protected] ACKNOWLEDGMENTS The authors are grateful to Dong-Su Jang, Research Assistant, for his help with the figures in the article.

Diffusion tensor imaging demonstrated radiologic differences between diplegic and quadriplegic cerebral palsy

Little information is available on the use of imaging for the classification of cerebral palsy patients. The present study examined the radiological differences between quadriplegic cerebral palsy patients (QCP), diplegic cerebral palsy patients (DCP) and normal control subjects (NC) by performing diffusion tensor imaging (DTI) of the corticospinal tract (CST) of upper and lower extremities. Twenty-three cerebral palsy patients (11 QCP, 12 DCP) and 12 NC were enrolled. DTI were scanned using a 1.5T and the CST images were analyzed using FMRIB software. We measured the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the CST. Compared to DCP and NC, QCP had decreased mean FA and increased mean ADC values of the CSTs of upper and lower extremities. The mean FA values of the lower extremities in DCP were significantly decreased, compared to NC; however this was not observed for the mean FA value of the upper extremities. The DTI results of the CST in QCP and DCP significantly corresponded with their typical clinical manifestation. DTI may thus be a very powerful modality to assess the state of CST in cerebral palsy patients.

GuardIVa: a novel antimicrobial haemostatic IV dressing: Part 2

This article is the second of a two-part series on GuardIVa®, a novel antimicrobial haemostatic IV dressing from HemCon Medical Technologies. In Part 1 ( Donnellan et al, 2011 ), the ability of GuardIVa Antimicrobial Haemostatic IV Dressing to significantly suppress skin flora re-growth was demonstrated in a clinical study conducted with healthy human volunteers. In addition, the antimicrobial and haemostatic efficacy of the dressing and its effects on wound healing were presented following a number of independently conducted in-vitro and in-vivo tests. In Part 2, the dressing was assessed for use as part of dressing change kits for patients with temporary short-term catheters in the intensive care unit (ICU) of a major US hospital. The use of GuardIVa Antimicrobial Haemostatic IV Dressing by a wound care nurse on a high level functioning quadriplegic patient presenting with redness, fluid and bleeding at the access site of a percutaneous medical device was also assessed. The positive outcomes from these experiences demonstrate that the GuardIVa dressings may be used as an effective component of catheter site regimens implemented by health professionals in a range of medical applications in diverse facilities.

Spinal Fusion for Scoliosis in Rett Syndrome With an Emphasis on Early Postoperative Complications

Retrospective case-control study. To examine the postoperative complications of posterior spinal fusion in a population of patients with Rett syndrome (RS). Scoliosis is a common feature of RS, a progressive neurologic disorder affecting almost exclusively females. Despite this, there is little published information regarding the surgical treatment of scoliosis in this disorder. Sixteen consecutive female patients with RS treated by posterior spinal fusion and unit rod instrumentation for progressive scoliosis between 1995 and 2003 were evaluated. Only patients with a minimum of 2-year follow-up were included. Preoperative medical conditions and postoperative complications were recorded. As a control group, we randomly selected 32 spastic quadriplegic patients who underwent the identical procedure during the same time period, selected from our database and matched according to age, level of neurologic impairment, and medical complexity. There was a high rate of early medical complications in the RS patients, with 28 major and 37 minor complications. Only 1 patient did not have a major medical complication, and every patient had at least 1 minor gastrointestinal and/or respiratory complication. Major respiratory complications occurred in 10 patients (63%) and comprised 61% of all major complications. Major gastrointestinal complications occurred in 6 patients (37%) and comprised 21% of all major complications. Other major complications included disseminated intravascular coagulopathy (1 patient), subacute bacterial endocarditis (1 patient), sacral decubiti requiring surgical debridement (2 patients), and extensive bilateral heterotopic ossification of the hips (1 patient). There were no cases of instrumentation failure, pseudarthrosis, deep infection, or need for rod revision. Postoperative complication scores were similar to those in patients with spastic quadriplegic pattern cerebral palsy. Spinal fusion for scoliosis in RS can give a satisfactory technical result, but a high rate of early postoperative medical problems should be anticipated.

Obturator Nerve Block Using Ultrasound-guided Intraneural Alcohol Injection in Patient with Hip Adductor Spasticity

Objective: To investigate the effects of obturator nerve blocks with ultrasound guided intraneural alcohol injection. Method: Nine quadriplegic patients suffering hip adductor spasticity were included in this study. The obturator nerve was identified at just below inguinal ligament area on anteromedial surface of upper leg at supine position. An 23 G needle was inserted into anterior branch of obturator nerve under real time ultrasonography. The 50% alcohol solution was injected 3∼5 ml at a time within the epineurium of the anterior branch of obturator nerve until the expanding nerve was visualized. We examed modified Ashworth scale (MAS) of hip adductor and passive range of movement of hip abduction at supine position at study entry, 1, 4, and 12 weeks after ultrasound guided intraneural injection. Results: There were statistically significant improvement was seen in MAS of hip adductors and hip abduction angle at 1, 4, and 12 weeks after ultrasound guided intraneural injection, compared with parameters measured at previous injection (p<0.05). Conclusion: Ultrasound guided intraneural alcohol injection into anterior branch of obturator nerve for treatment of hip adductor spasticity in patients with quadriplegia is an effective and safe procedure for relieving localized spasticity of the hip adductors. (Brain & NeuroRehabilitation 2012; 5: 82-86)

Kinematic patterns of modified grasp (tenodesis) in C6 quadriplegic patients

Kinematic patterns of modified grasp (tenodesis) in C6 quadriplegic patients

Implanted phrenic nerve stimulation in quadriplegic patients wih high cervical lesions

Implanted phrenic nerve stimulation in quadriplegic patients wih high cervical lesions

The Therapeutic Value of Adversity

The Therapeutic Value of Adversity

Wavelet Energy based Neural Fuzzy Model for Automatic Motor Imagery Classification

ABSTRACT Brain-computer interface (BCI) is a communication system by which a person can send messages without any use of peripheral nerves and muscles. BCI systems might help to restore abilities to patients who have lost sensory or motor function because of the damaged region, such as amyotrophic lateral sclerosis (ALS), spinal cord injury, brainstem stroke, or quadriplegic patients. Brain computer interfacing can be effectively implemented by analyzing EEG signals generated in the brain. This paper presents a method for accurately classifying EEG signals generated by imagery left and right hand movements. Firstly, wavelet transform and energy of the decomposed signal is used to obtain the final feature vector matrix. Secondly, the feature data is classified using ANFIS. . The Mutual Information value calculated is 1.2942 bit. The classification accuracy achieved 93.5% in the course of testing on the data from subject. Support Vector Machine is also used to compare the performance with ANFIS. includes the wavelet transfo

Gateway to the Brain

A brain-implanted microelectrode array can provide reliable signals for almost 3 years, allowing a quadriplegic patient to move and click a cursor by thought alone.

P11.6 Instrumental drainage techniques for spastic quadriplegic patients with chronic pulmonary infections

P11.6 Instrumental drainage techniques for spastic quadriplegic patients with chronic pulmonary infections

Somatosensory Evoked Potentials in Children With Bilateral Spastic Cerebral Palsy

Alterations were monitored of somatosensory evoked potentials in children with bilateral spastic cerebral palsy and these findings correlated with relevant clinical and laboratory parameters. Fifty-one children with bilateral spastic cerebral palsy (31 boys, 20 girls; age range 24-168 months) participated in the study. Abnormal somatosensory evoked potentials latencies were recorded in 23 of 34 (67.6%) cortical recordings of the median nerve and in 38 of 51 (74.5%) cortical recordings of the tibial nerve. Abnormal tibial nerve somatosensory evoked potentials were strongly correlated with abnormal electroencephalogram (P=0.014), while impaired median nerve recordings were correlated with abnormal visual evoked potentials (P = 0.02) and a history of perinatal or neonatal infection (P=0.016). Furthermore, perinatal/neonatal infection adversely effected the recordings in both tibial and medial nerves in quadriplegic patients (P=0.023). Sensory impairment is strongly related with abnormal visual evoked potentials, abnormal electroencephalogram, and a history of perinatal or neonatal infection.

Neurogenic heterotopic ossification of the hands in a patient with spinal cord injury: a case report

The study was designed as a case report. The objective of this study was to report an unusual case of bilateral neurogenic heterotopic ossification of the hands in a patient with spinal cord injury. Physical Medicine and Rehabilitation department in Sale, Morocco. A 47-year-old male patient with C5 quadriparesis was admitted in our department for rehabilitation. He had severe spasticity, characterized by extensors predominance in the upper extremities, and an aspect of pudgy fingers at the proximal phalanges in both hands. A plain radiograph of hands demonstrated ossification parallel to the proximal phalanx of the third and fourth digits on the right and of the second and third digits on the left. Serum alkaline phosphatase rate was increased. The diagnosis of heterotopic ossification of hands was retained. Neurogenic heterotopic ossification of hands can occur in quadriplegic patients. Finger extensors spasticity might help toward its development.

A Review of Medicolegal Malpractice Suits Involving Cervical Spine

Utilizing Verdict Search (East Islip, New York), a medicolegal research service for civil and criminal court cases, 78 cervical spine surgical malpractice suits were identified (10-year period). Factors leading to cervical spine surgical litigation may represent an untapped source of risks/complications associated with these operations. Data with fewer adverse events are submitted to and/or published in spine journals, as they are discoverable in a court of law. Cervical spine surgery in 68 patients included 48 anterior operations (1 to 4 level anterior diskectomy/fusions, 1-level corpectomy/fusion). Twenty patients had posterior surgery (7 fusions, 13 laminectomies with/without fusions). Two patients had other operations/procedures, whereas 8 had no surgery. Four major questions were asked; (1) What were the operations/neurologic deficits that led to the suits?, (2) Who was sued?, (3) What purported and/or alleged "malpractice" events prompted the suits?, and (4) What were the outcomes of these suits? Postoperative neurologic deficits that led to suits included quadriplegia in 41 patients (21 anterior, 20 posterior operations). Other injuries/lesser postoperative deficits were observed in 15 patients, whereas 22 had pain alone. Malpractice suits involved 63 spine surgeons, whereas 15 did not. The 3 most common malpractice events prompting cervical suits, and typical for most surgery-related suits, included negligent surgery, lack of informed consent, and failure to diagnose/treat; the fourth unanticipated factor was failure to brace. Outcomes for these suits included 30 defense verdicts (10 quadriplegic patients), 22 plaintiffs' verdicts (average payout $4.0 million dollars), and 26 settlements (average $2.4 million dollars). Data gleaned from medicolegal suits may provide additional information regarding the morbidity associated with cervical surgery. These data may lessen patients' expectations, and limit spine surgeons' liability. In the future, consideration may be given to tort reform, or a No-Fault malpractice system.

Tratamento da subluxação e luxação do quadril na paralisia cerebral em pacientes tetraparéticos espásticos, nível motor V, através datenotomia de adutores e psoas

Objective: To assess if adductor and psoas release is effective in prevent hip displacement in quadriplegic Cerebral Palsy pacients, Gross motor V. Methods: A retrospective study with 26 patients who had psoas and adductor release was analyzed. Reimers Index before and after surgery was analysed. We divided the patients into two groups: surgery made in patients above five yars and after five years of age. Results: With a follow up of seven years, most of the patients of both groups had Reimers Index controlled by the surgery proposed. Conclusion: Adductor and psoas release was effective in controlled hip displacement in quadriplegic Cerebral Palsy patients, Gross Motor V. The age at the time of the surgery does not influence in the result.Reimers Index up to 70% and asymmetric hip not had good results.

Anterior decompression, fusion and plating in cervical spine injury: Early experience in Abuja, Nigeria

Background:We present a review of the results of the current surgical management of acute cervical spine injuries in the Federal Capital Territory, Abuja, Nigeria. This is the first detailed retrospective study on the surgical management of patients with cervical spine injuries from Nigeria.Methods:The medical reports of patients with traumatic cervical spine and spinal cord injuries undergoing surgery from 1 August 2009 till 30 August 2010 were reviewed. Management and early results of outcome were ascertained and detailed consecutively in a prospective Microsoft Office Access® database (Microsoft Group of Companies). Frankel grading was used for pre- and immediate post-operative evaluation (within 48 hours). The Barthel index (BI) was used to classify patients as dependent or independent at follow-up.Results:Twenty consecutive patients presented with acute cervical spine and spinal cord injuries since August 2009. Twenty anterior cervical spine decompression and fixation with an iliac graft and an anterior cervical plate (ACDF) were performed in 18 patients. All operations were performed with general anaesthesia using standard techniques but without a microscope or a high speed drill. Of the 18 patients who were operated, 4 patients died within a short period following surgical intervention. Seven patients have made a full recovery and seven remain fully dependent. Only two of the dependent quadriplegic patients have become reintegrated back into the society.Conclusion:The management of spinal cord injuries in Abuja is evolving. The operations were performed adequately with much limited complement of equipment. Poor intensive care therapy is a major challenge and improvements in this area of care will likely lead to better patient outcomes.

La stimulation phrénique implantée

The implanted phrenic nerve stimulation is a technique restoring the spontaneous breathing in patients with a failing respiratory command, which leads to a dependency on mechanical ventilation. This technique may particularly involve quadriplegic patients with a high-level spinal cord injury and patients with congenital central hypoventilation syndrome. The electrophysiological diaphragm investigations allow a better patient selection, assessing in one hand a definite problem with central respiratory command and on the other hand the integrity of phrenic nerves. To date, two different phrenic stimulation techniques are available in France: the quadripolar intra-thoracic stimulation and the bipolar intra-diaphragmatic stimulation. Both techniques allow patients to be weaned off their mechanical ventilator, improving dramatically their quality of life. In fact, one of the systems (phrenic intra-diaphragmatic stimulation) was granted reimbursement in France in 2009 and is now on the social security list of reimbursed products. In the future, the phrenic intra-diaphragmatic stimulation may find its place in the intensive care unit with temporal use following surgeries leading to specific respiratory complications as well as diaphragmatic atrophy induced by prolonged mechanical ventilation.