Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Jun 1993
Pastoral needs and support within an inpatient rehabilitation unit.
Because patients reported concerns regarding the adequacy of pastoral service delivery during their inpatient rehabilitation hospitalization, a study was performed to ascertain the patient's pastoral needs and the extent of pastoral services provided. After discharge from the inpatient rehabilitation hospital, patients were surveyed as to their perceived religious and spiritual needs, as well as to the extent of religious, spiritual, and pastoral services provided during their inpatient stay. The majority of responders (74%) reported their religious and spiritual beliefs were important. ⋯ There is a clear need to establish a mechanism to identifying the religious and spiritual needs of each individual patient. These needs must be considered with both sensitivity and compassion by all members of the rehabilitation staff. The rehabilitation facility must also develop a mechanism to identify pastoral care resources available within the hospital and local community, and to assure that the patient's needs are addressed.
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This self-directed learning module highlights important aspects of athletic spine and head injuries. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. ⋯ Sports participation criteria for children with spine deformities are discussed. In addition, a description of the degrees of concussion, the general guidelines for return to play after a sports-related head injury, and postconcussion sequelae are reviewed.
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Deep pressure pain threshold (PPT) and pressure pain tolerance (PPtol) were measured by pressure algometry at the mastoid processes, external malleoli, and sternum in 24 healthy volunteers. The algometer consisted of a force displacement transducer with a 0.25 cm2 pressure tip linked to a recorder. The rate of force application was approximately 1kg/sec/0.25cm2. ⋯ On repeat examination, comparison between the mean values at each site showed no statistical differences in any instance. Pressure algometry, as used in this study in healthy subjects, proved a reliable technique for the estimation of deep PPT and PPtol values. It may possibly serve for screening the response to experimental pain in various groups of pain patients.
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Arch Phys Med Rehabil · Feb 1993
Airway secretion clearance by mechanical exsufflation for post-poliomyelitis ventilator-assisted individuals.
Pulmonary complications from impaired airway secretion clearance mechanisms are major causes of morbidity and mortality for post-poliomyelitis individuals. The purpose of this study was to review the long-term use of manually assisted coughing and mechanical insufflation-exsufflation (MI-E) by post-poliomyelitis ventilator-assisted individuals (PVAIs) and to compare the peak cough expiratory flows (PCEF) created during unassisted and assisted coughing. Twenty-four PVAIs who have used noninvasive methods of ventilatory support for an average of 27 years, relied on methods of manually assisted coughing and/or MI-E without complications during intercurrent respiratory tract infections (RTIs). ⋯ The PCEF were as follows: unassisted, 1.78 +/- 1.16L/sec; following a maximum assisted insufflation, 3.75 +/- 0.73L/sec; with manual assistance by abdominal compression following a maximum assisted insufflation, 4.64 +/- 1.42L/sec; and with MI-E, 6.97 +/- 0.89L/sec. We conclude that manually assisted coughing and MI-E are effective and safe methods of airway secretion clearance for PVAIs with impaired expiratory muscle function who would otherwise be managed by endotracheal suctioning. Severely decreased maximum insufflation capacity but not vital capacity indicate need for a tracheostomy.
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Arch Phys Med Rehabil · Jan 1993
Comparative StudyConventional and acupuncture-like transcutaneous electrical nerve stimulation excite similar afferent fibers.
The purpose of our study was to determine whether similar or different peripheral afferent fiber(s) is(are) activated by "conventional" transcutaneous electrical nerve stimulation (TENS) applied at low intensity-high frequency, as opposed to "acupuncture-like" TENS administered at high intensity-low frequency. The electrical stimulation was delivered to the median nerve at the wrist of 17 healthy subjects. For conventional TENS, single pulses were applied at an intensity of 3 X T (sensory threshold). ⋯ The results showed that the mean conduction velocities of the afferent fibers excited by conventional TENS, single pulse, and short-train acupuncture-like TENS ranged from 50.3 to 65.4, 50.0 to 63.5, and 41.3 to 54.8m/s, respectively. Thus, conventional and acupuncture-like TENS activated similar fiber types, predominantly in the A alpha beta range. Our findings suggested that the effects of these two types of TENS may be mediated by the activation of similar peripheral afferent fibers.