American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Mar 1999
Clinical presentations, medical complications, and functional outcomes of individuals with gunshot wound-induced spinal cord injury.
Gunshot wounds are currently the second leading cause of spinal cord injury in the United States, and coexisting injuries or complications accompanying penetrating wounds often increase patient morbidity. A review of 217 traumatic spinal cord injury rehabilitation admissions to a tertiary care hospital during a 5-yr period revealed 49 individuals (23%) with gunshot wound-induced spinal cord injury. A single bullet entry site was seen in 54%, whereas 17% had greater than 3 sites of entry. ⋯ Injury characteristics revealed significantly (P < 0.01) more paraplegia and complete spinal cord injury within the gunshot wound-induced spinal cord injury group. Gunshot wound-induced spinal cord injury and nonviolent traumatic spinal cord injury groups had similar lengths of stay, Functional Independence Measure scores, and discharge to home rates. This article adds to the growing body of literature examining clinical, medical, and functional outcome characteristics of individuals with spinal cord injury secondary to violence-related cause.
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Am J Phys Med Rehabil · Jan 1999
Normal values for sensory thresholds in the cervical dermatomes: a critical note on the use of Semmes-Weinstein monofilaments.
In many healthy subjects, sensory thresholds for touch using Semmes-Weinstein monofilaments appear to be higher than the 2.83 filament, which some authors have suggested as a screening instrument. The currently proposed normal values, the interpretation of results, as well as the calibration of the filaments are questioned. A normative study of 20 normal subjects using Semmes-Weinstein monofilaments was undertaken at a pain clinic in a university hospital. ⋯ Individual results have to be related to the mean of the subject to determine abnormality. Calibration of the monofilaments is important. When these terms are met, testing with Semmes-Weinstein monofilaments is an easy, reliable, and relatively inexpensive method of quantitative sensory testing and can be a useful tool in the process of rehabilitation.
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Am J Phys Med Rehabil · Nov 1998
Randomized Controlled Trial Comparative Study Clinical TrialComparison of phenol block and botulinus toxin type A in the treatment of spastic foot after stroke: a randomized, double-blind trial.
Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage of reducing harmful spasticity in one area, while preserving useful spasticity in another area. This randomized, double-blind study is the first trial that was designed to find out whether botulinus toxin Type A and phenol relieves the signs and symptoms of ankle plantar flexor and foot invertor spasticity after stroke and if either of these methods offers any advantages and disadvantages over the other. Twenty patients who were included in this preliminary study were randomly assigned to receive a single treatment of 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. ⋯ The decrease in clonus duration that was detected by electromyography was significant in both groups at all visits, but the decrease in the group that received botulinus toxin Type A was significantly better at Weeks 2 and 4 (P < 0.05). It is concluded that both motor point injections with botulinus toxin Type A and tibial nerve blockade with phenol are effective in plantar flexor spasticity, but the changes were more significant in the group that received botulinus toxin Type A at Weeks 2 and 4, whereas there was not a significant difference between the two groups at Weeks 8 and 12. Future research should explore the long-term effect of these two treatment modalities.
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Am J Phys Med Rehabil · Nov 1998
Randomized Controlled Trial Comparative Study Clinical TrialComparison of discomfort associated with surface and percutaneous intramuscular electrical stimulation for persons with chronic hemiplegia.
Neuromuscular stimulation may facilitate motor recovery after stroke or brain injury, reduce shoulder pain associated with hemiplegia, and reduce cerebral spasticity. However, the discomfort of surface neuromuscular stimulation significantly limits the clinical implementation of this modality for persons with hemiplegia. The study contained herein tests the hypothesis that stroke and brain injury survivors with chronic hemiplegia (>6 mo) and intact sensation tolerate percutaneous intramuscular stimulation better than surface stimulation. ⋯ Percutaneous stimulation was associated with significantly lower discomfort as reflected by the visual analog scale (0.74 v 3.3; 95% confidence interval of difference, -3.84, -1.28). The McGill Pain Questionnaire produced similar results with percutaneous stimulation associated with a significantly fewer number of words chosen to describe the discomfort (0.87 v 3.30; 95% confidence interval of difference, -3.50, -1.30) and significantly lower Pain Rating Index (1.47 v 6.27; 95% confidence interval of difference, -7.77, -1.83). Data suggest that percutaneous intramuscular stimulation is significantly better tolerated than surface stimulation and that percutaneous stimulation may enhance patient compliance with neuromuscular stimulation treatments.