Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Mar 1994
Comparative StudyComparison of indices of traumatic brain injury severity as predictors of neurobehavioral outcome in children.
This study examined the ability of early measures of traumatic brain injury (TBI) severity to predict neurobehavioral and functional skill outcomes shortly after injury and at 1 year postinjury. Ninety-eight children aged 6 to 15 years with TBI were consecutively identified on presentation to two regional medical centers. Ten measures of TBI severity were subsequently administered: initial Glasgow Coma Scale (motor, eye, verbal, and total GCS), duration of loss of consciousness, Abbreviated Injury Scale Head score, GCS motor score at 3 days postinjury, days to reach a total GCS score of 15, days to reach a GCS motor score of six, and duration of posttraumatic amnesia (days to reach a 75% performance on the Children's Orientation and Amnesia Test [COAT]). ⋯ The GCS verbal and motor scores were better predictors of outcome than the GCS eye score. However, consideration of individual GCS subscores did not improve upon prediction of outcome versus the GCS total score. These results provide strong validation for the use of duration of posttraumatic amnesia, measured by the COAT, as a measure of TBI severity and a significant indicator of neurobehavioral and functional outcome in children.
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Arch Phys Med Rehabil · Mar 1994
Case ReportsOccult radiographic fractures of the chest wall identified by nuclear scan imaging: report of seven cases.
Between 1985 and 1990 the enactment of state mandatory seat belt laws has reduced the risk of death from auto accident by at least 40% and the risk of moderate to severe injury by 45%. Although head and facial trauma has also been significantly reduced, there has not been a decrease in injuries to other parts of the body. ⋯ Nuclear scan imaging subsequently revealed that all seven had a healing fracture of either the sternum or ribs. In each instance, direct trauma to the sternum and ribs anteriorly by the chest strap itself and/or laterally displaced bending forces transmitted to the postero lateral rib margins was sufficient to produce x-ray occult fractures.
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Arch Phys Med Rehabil · Jan 1994
Randomized Controlled Trial Multicenter Study Clinical TrialIntrathecal baclofen for treatment of intractable spinal spasticity.
This study assessed the safety and efficacy of intrathecal baclofen in the treatment of intractable spasticity caused by spinal cord injury or multiple sclerosis. Twenty-three patients with severe chronic spasticity underwent bolus test dosing with 50, 75, or 100 micrograms of intrathecal baclofen administered by lumbar puncture. All patients were either refractory to oral baclofen at a dose of 120 mg/d or side effects were unacceptable at a lower dose. ⋯ There has been one pump malfunction and four catheter malfunctions; few serious medication and postoperative complications have occurred. There was one death caused by underlying disease, one patient voluntarily withdrew, and three patients developed tolerance to the extent that optimal control of spasticity tone could not be maintained. Although intrathecal baclofen is safe and effective in the majority of patients, three patients required > 1,000 micrograms/d with increasingly higher doses over time and exhibited a poor response.
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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.