Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Nov 1991
Review Case ReportsRehabilitation of patients with quadriparesis after treatment of status asthmaticus with neuromuscular blocking agents and high-dose corticosteroids.
Patients with severe status asthmaticus who do not respond to intensive medical therapy are often given neuromuscular blocking agents to facilitate mechanical ventilation. Of 51 consecutive asthmatic patients treated with mechanical ventilation, 27 were treated with neuromuscular blocking agents. Of these 27 patients, all receiving high-dose intravenous steroids, four were noted to develop quadriparesis that was more severe distally. ⋯ They were followed as outpatients until full recovery. Although the exact etiology of the complication is not known, acute steroid myopathy facilitated by the use of neuromuscular blocking agents is a likely cause. Based on the excellent recovery potential of these patients, early rehabilitation in this uncommon complication is strongly urged.
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The Pain Disability Index (PDI) was developed as a self-report measure of general and domain-specific, pain-related disability. This study's purpose was twofold: (1) to assess construct validity of the scale relative to other measures of pain-related disability and psychologic distress and (2) to assess the strength of the PDI, independent of pain intensity, in accounting for behavioral and psychologic aspects of disability. ⋯ Partial correlation controlling for pain intensity demonstrated PDI factor 1 was significantly related to depression, employment status, and medication usage. The finding supports the usefulness of the PDI in providing important information on functional disability beyond what is provided by a simple measure of pain intensity.
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Arch Phys Med Rehabil · Sep 1991
Trigger point of the posterior iliac crest: painful iliolumbar ligament insertion or cutaneous dorsal ramus pain? An anatomic study.
A trigger point is frequently found over the iliac crest at 7 to 8 cm from the midline in low-back-pain syndromes. Previously, this was described as either a painful insertion site of the iliolumbar ligament or pain in the distribution of the cutaneous dorsal ramus of the first or second lumbar nerve. The authors performed 37 dissections, and they report their anatomic findings. ⋯ These rami are superficial and dorsal to the crest, easily accessible to palpation. In two of the 37 dissections performed, some rami were found to be narrowed as they crossed through an osteofibrous orifice over the crest, thus being susceptible to an entrapment neuropathy. The authors conclude that the trigger point sometimes localized over the iliac crest at 7 cm from the midline likely corresponds to elicited pain from a cutaneous dorsal ramus originating from the thoracolumbar junction rather than from the iliac insertion of the iliolumbar ligament.
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Bradycardia followed by cardiac arrest is well documented as a complication of acute injury to the cervical spinal cord. This life-threatening bradycardia is attributed to an imbalance in the autonomic nervous system resulting from dissociation of the parasympathetic from the sympathetic responses during the stage of spinal shock. ⋯ Possible etiologies for the continuation of abnormal bradycardia episodes after the resolution of spinal shock are discussed. Cardiac pacemaker implantation is advocated for patients with high cervical spinal cord injuries and continuing symptomatic bradycardia not responding to medical measures.
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Arch Phys Med Rehabil · May 1991
Case ReportsAcute and chronic hypothermia in a man with spinal cord injury: environmental and pharmacologic causes.
It is well known that people with spinal cord injuries can develop hypothermia when exposed to an unusually cold environment. Hypothermia can also develop during inpatient rehabilitation, particularly as a side effect of certain medications. We present a patient with C4 incomplete spinal cord injury whose core body temperature was chronically subnormal, and who developed acute hypothermia on several occasions during inpatient rehabilitation. ⋯ The serum level of phenytoin became elevated to toxic levels during two episodes of acute hypothermia, but the serum level of carbamazepine did not change appreciably. This case demonstrates that people with spinal cord injuries are at risk for hypothermia, that hypothermia can be induced by nifedipine, and that significant thermal challenges can occur during routine inpatient rehabilitation. In addition, hypothermia appears to affect the metabolism of phenytoin.