Archives of physical medicine and rehabilitation
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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%).
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Arch Phys Med Rehabil · Aug 1993
Comparative StudyAttitudes of medical students and health-care professionals toward people with disabilities.
This study used the Attitude Towards Disabled Persons Scale (ATDP) to investigate differences in attitudes toward individuals with physical disabilities among first-year and fourth-year medical students and health-care professionals. Of 851 questionnaires sent out, 310 were returned, and 297 were used in the final analyses. The fourth-year medical students had significantly more positive attitudes toward people with physical disabilities when compared to the first-year medical students. ⋯ Across the sample, females, compared to males, and whites, compared to Asians, were found to hold significantly more positive attitudes toward people with physical disabilities. Contact with people with physical disabilities did not have to be on an equal-status basis to have a positive effect on attitudes toward people with physical disabilities. The need for health and educational disciplines to further the movement towards integration of people with physical disabilities was emphasized, and suggestions for future research were offered.
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Arch Phys Med Rehabil · Jul 1993
Comparative StudyPediatric traumatic brain injury: acute and rehabilitation costs.
Pediatric traumatic brain injury constitutes an enormous public health problem, but little is known about the economic costs of such injury. Using charges as a proxy for cost, we prospectively collected data on initial hospital charges and professional fees for emergency department services, acute inpatient care, and acute inpatient rehabilitation for 96 patients with mild, moderate, and severe traumatic brain injuries. We also examined the relationship between these costs and injury severity and etiology. ⋯ Using Glasgow Coma Scale criteria, median cost of mild, moderate, and severe traumatic brain injuries were $598, $12,022, and $53,332, respectively. Injury etiology added modestly but significantly to the prediction of cost over and above that predicted by injury severity alone. Rehabilitation costs accounted for 37% of the total for all children, but 45% of those with the most severe injuries.
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Arch Phys Med Rehabil · Jul 1993
Comparative StudySacral transcutaneous oxygen tension levels in the spinal cord injured: risk factors for pressure ulcers?
Evidence is mounting that susceptibility to pressure ulcers in the spinal cord injured is due to the interactive effects of prolonged immobilization and injury-related autonomic dysfunction associated with reduced tissue perfusion. To determine whether tissue oxygenation at the sacrum is reduced in spinal cord injury, we compared transcutaneous oxygen tension (PtcO2) levels in 21 subjects with spinal cord injury and 11 able-bodied controls lying prone and supine on egg-crate mattresses. Spinal cord injured subjects above and below the median supine PtcO2 value were also compared in terms of the presence or absence of pressure ulcers. ⋯ In contrast, those of the spinal cord injured fell rapidly by 18mmHg and stabilized after 15 minutes at a level 27mmHg below that of the controls. Five of the 10 (50%) spinal cord injured subjects with PtcO2 levels below the median supine PtcO2 level had a pressure ulcer compared to one among the 11 (9%) spinal cord injured subjects with PtcO2 levels above the median (p = .055, by Fisher's exact test). These results suggest the need for further studies on the role of reduced tissue oxygenation in the etiology of pressure ulcers.
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Arch Phys Med Rehabil · Jul 1993
Electrical stimulation of the sacral dermatomes in spinal cord injury: effect on rectal manometry and bowel emptying.
The impairment in defecation function that comes as a result of spinal cord injury may have a significant negative impact upon quality of life. Electrical stimulation (ES) of the somatic nervous system has been used to elicit autonomic reflexes in animals, before and after spinal cord transection. To determine whether ES might be used to promote bowel emptying, seven persons with recent spinal cord injury (SCI) and seven control subjects were studied. ⋯ No significant change was noted in the time required for SCI patients to initiate a bowel movement, or in the time required to complete bowel emptying. Electrical stimulation of the sacral dermatomes can result in a change in the bowel activity of the recto-sigmoid colon. To date, no clinical effect on bowel emptying has been demonstrated.