PM & R : the journal of injury, function, and rehabilitation
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Case Reports
Neuromuscular ultrasound application to the electrodiagnostic evaluation of quadrilateral space syndrome.
Quadrilateral space syndrome (QSS) is a rare neurovascular compression syndrome that results from the compression of the axillary nerve and posterior circumflex humeral artery in the quadrilateral space. Electromyography often is used to evaluate for the presence of neuropathic changes in the deltoid and teres minor in cases of suspected QSS. ⋯ In cases in which patients are overweight or have significant teres minor atrophy, localization of the muscle through conventional methods may be extremely difficult. We present a case of an overweight man with posterior shoulder pain who was diagnosed with QSS via the use of a combination of ultrasound and electromyography.
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Devastating paralysis, autonomic dysfunction, and abnormal cardiovascular control present significant hemodynamic challenges to individuals with spinal cord injury (SCI), especially during exercise. In general, resting arterial pressure after SCI is lower than with able-bodied individuals and is commonly associated with persistent orthostatic intolerance along with transient episodes of life-threatening hypertension, known as "autonomic dysreflexia." During exercise, the loss of central and reflexive cardiovascular control attenuates maximal heart rate and impairs blood pressure regulation and blood redistribution, which ultimately reduces venous return, stroke volume, and cardiac output. ⋯ Athletes with SCI also have been documented to self-induce autonomic dysreflexia before competition with a view of increasing blood pressure and improving their performance, a technique known as "boosting." For health safety reasons, boosting is officially banned by the International Paralympics Committee. This article addresses the complex issue of how the autonomic nervous system affects sports performance in athletes with SCI, with a specific focus on the potential debilitating effects of deranged cardiovascular control.
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Observational Study
Pain location and functioning in persons with spinal cord injury.
The influence of pain location and extent on functioning in persons with spinal cord injury (SCI) and chronic pain is not well understood. ⋯ The findings support the importance of assessing pain intensity at specific locations as a part of a thorough evaluation of chronic pain, as well as the importance of addressing pain at multiple sites, when managing pain in persons with an SCI.
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Multicenter Study
Mirror visual feedback for phantom pain: international experience on modalities and adverse effects discussed by an expert panel: a delphi study.
Mirror visual feedback (mirror therapy) is practiced worldwide in very different ways to alleviate phantom pain; no study has compared these variations yet or researched the associated risk and harm. ⋯ Analysis of the results suggests that the different treatment plans suit different patients and practitioners. Matching these could enhance effectiveness and compliance. Knowledge about adverse effects needs to inform treatment decisions. These findings triggered the development of a mirror visual feedback gateway to guide patients to the treatment plan for their needs, and to collect data from the practitioners to enhance neuroscientific understanding and inform practice.
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To describe and compare the plantar pressures, temporal foot roll-over, and ground reaction forces (GRFs) between both limbs of subjects with unilateral transfemoral amputation and with those of able-bodied participants during walking. We also verify the relevance of a force plate and a pressure plate to discriminate changes in gait parameters of subjects with limb loss. ⋯ The plantar pressures, temporal foot roll-over, and GRFs in subjects with unilateral transfemoral amputation showed an asymmetric gait pattern, and different values were observed in both of their lower limbs as compared with those of able-bodied subjects during walking. The force plate and pressure plate were able to determine differences between participants in gait pattern, suggesting that both plantar pressure and GRF analyses are useful tools for gait assessment in individuals with unilateral transfemoral amputation. Because of the convenience of pressure plates, their use in the clinical context for prosthetic management appears relevant to guide the rehabilitation of subjects with lower limb amputation.