Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Sep 1993
Comparative StudyUndetected musculoskeletal trauma in children with traumatic brain injury or spinal cord injury.
A prospective study of 82 traumatically injured patients was conducted to determine the frequency with which skeletal trauma was undetected at acute care facilities. The clinical significance of each instance of undetected trauma on the patient's rehabilitation programs was assessed. Between May 1987 and October 1988, all trauma patients who sustained a spinal cord injury (SCI) or a severe traumatic brain injury (TBI) had total body bone scans (Tc-99mMDP) prior to beginning rehabilitation. ⋯ Additionally, heterotopic ossification was detected in 14 children, of which only two sites were previously known. In three children with TBI, the area of heterotopic ossification impeded functional range of motion. Based upon this data we conclude that a total body bone scan is useful in the child with TBI for the detection of undiagnosed skeletal or soft tissue trauma and heterotopic ossification not recognized during acute care.
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Arch Phys Med Rehabil · Sep 1993
Case ReportsProlonged paralysis after neuromuscular junction blockade: case reports and electrodiagnostic findings.
Previous reports have described prolonged paralysis after treatment with neuromuscular junction (NMJ) blocking agents in critically ill patients. The purpose of this study was to describe the clinical and electrodiagnostic findings in 12 such patients. All patients developed prolonged and often profound weakness with no sensory loss after discontinuation of NMJ blockers. ⋯ Repetitive nerve stimulation demonstrated no decrement or increment in most patients, with a decrement to 3 Hz stimulation in one patient. Needle examination showed frequent fibrillation potentials and normal or low amplitude, short duration, polyphasic motor units. Physicians prescribing NMJ blockers in critically ill patients should be made aware of this potential complication and of the other agents (ie, corticosteroids) that may exacerbate the problem.
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Aspiration pneumonia developed within 1 year in 29 of 60 stroke patients referred for videofluoroscopic evaluation of poststroke dysphagia and drawn from a total population of 304 acute stroke patients. The presence of vallecular pooling, piriform pooling, or bolus penetration to or through the true vocal cords on videofluoroscopy did not correlate with the development of aspiration pneumonia. Kinematic pharyngeal transit times did show a significant correlation with the development of aspiration pneumonia (time of first movement, p = .038; time of arrival of bolus at valleculae, p = .0008; time of return of epiglottis to resting position, p = .0001). Those patients with total kinematic pharyngeal transit times (Em) of less than 2.00 sec were at little or no risk for aspiration pneumonia (0%), those with 2.01 to 5.00sec at moderate risk (38.5%), and those with more than 5.00sec were at marked risk (90%).