Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Nov 1992
Case ReportsHeterotopic ossification in children with burns: two case reports.
Heterotopic ossification is the formation of ectopic bone in soft tissue, and has been reported as a rare complication in pediatric burn patients. At our hospital, two 86% body surface area burn patients developed heterotopic ossification in the shoulder, elbows, distal femur, proximal tibia, fibula, and ribs approximately four months after the burn injury. These two rare and unusual cases are presented documenting the clinical involvement, radiological studies, laboratory data, as well as treatment of their heterotopic ossification. Discussion will focus on the incidence, diagnosis, pathophysiology, and treatment of heterotopic ossification in burn patients and how this information relates to the specific diagnosis and management of the complication of heterotopic ossification in the burn child.
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Arch Phys Med Rehabil · Nov 1992
Functional electrical stimulation leg cycle ergometer exercise: training effects on cardiorespiratory responses of spinal cord injured subjects at rest and during submaximal exercise.
This study investigated the cardiorespiratory (CR) responses at rest and during submaximal (0-W) functional electrical stimulation (FES)-induced leg cycle ergometer (LCE) exercise prior to and following a progressive intensity FES-LCEa exercise training program in spinal cord injured (SCI) subjects. Seven quadriplegics and six paraplegics participated in FES-LCE training three sessions per week for approximately 12 weeks (36 sessions). Monitored CR responses, including oxygen uptake (VO2), pulmonary ventilation (VE), respiratory exchange ratio (RER), arteriovenous O2 difference (a-vO2), blood pressure (BP), heart rate (HR), stroke volume (SV), total peripheral resistance (TPR), and cardiac output (Q), were determined before and after training. ⋯ These results suggest that FES-LCE training improves peripheral muscular and central cardiovascular fitness in SCI subjects. Posttraining HR and BP may also be more stable in quadriplegics and alleviate hypotension. This therapeutic exercise may ultimately lead to improved rehabilitation outcome and reduced stress during activities of daily living, and possibly reduce the risks for secondary CR disabilities.
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Arch Phys Med Rehabil · Jun 1992
Spontaneous coping strategies to manage acute pain and anxiety during electrodiagnostic studies.
Electrodiagnostic studies produce both anxiety and pain, which can prevent adequate examination and limit the usefulness of test results. This study examined the spontaneous coping strategies used to manage the pain and anxiety experienced during electrodiagnostic testing. Fifty patients (26 women and 24 men) evaluated in our electrodiagnostic laboratory were administered visual analogue scale (VAS) pain and anxiety measures and the Spielberger State-Trait Anxiety Inventory (STAI) before the procedure. ⋯ Physicians' ratings of pain and anxiety were highly correlated with patients' self-reports. This study suggests that ineffective coping strategies may enhance the pain and anxiety experienced during electromyography. Alternatively, teaching subjects active self-control skills and increasing patients' self-efficacy beliefs may help manage this situation-specific acute anxiety and, possibly, the associated pain.
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Arch Phys Med Rehabil · May 1992
Long-term survival, prognosis, and life-care planning for 29 patients with chronic locked-in syndrome.
We present a life-table analysis of a cohort of 29 locked-in syndrome (LIS) patients followed for a minimum of five years, and we report on the status of the chronic LIS patient. Twenty-nine LIS patients who remained locked-in for more than one year were identified. Inpatient charts were reviewed for demographic, medical, and functional data. ⋯ Although minimal late neurologic recovery occurs in chronic LIS, survival may, nonetheless, be prolonged with adequate supportive care. Modern computerized technology offers LIS patients the ability to interact with their environment. This information may assist physicians in making ethical and long-term care decisions with the patient rather than for the patient with LIS.
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Arch Phys Med Rehabil · May 1992
Physiologic effects of electrical stimulation leg cycle exercise training in spinal cord injured persons.
The purpose of this study was to assess the physiologic training effects of functional electrical stimulation leg cycle ergometer (FES-LCE) exercise in persons with spinal cord injury (SCI) who were previously untrained in this activity. Ten persons with quadriplegia (C5 to C7) and eight with paraplegia (T4 to T11) performed FES-LCE training on an ERGYS I ergometer 10 to 30 minutes per day, 2 or 3 days per week for 12 to 16 weeks (36 total sessions). Training session power output (PO) ranged from 0.0W (no external resistance) to 30.6W. ⋯ There were no significant changes in peak stroke volume (+6%), mean arterial pressure ([MAP], - 5%), or arteriovenous oxygen difference ([a-vO2diff], + 10%) during posttraining FES-LCE tests. In addition, no significant differences were noted for the peak level of any monitored variable during ACE posttests after FES-LCE training. The rise in total vascular conductance, implied by the significant decrease in posttraining TPR during FES-LCE tests, denotes that a peripheral circulatory adaptation developed in the persons with SCI during FES-LCE exercise training.(ABSTRACT TRUNCATED AT 250 WORDS)