American journal of physical medicine & rehabilitation
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Containment of health care costs is a pressing national issue. In this study, we examined physician knowledge of rehabilitation hospital costs by quantifying their awareness of hospital charges. All physicians at a free-standing rehabilitation hospital were surveyed. ⋯ Physicians' confidence in their knowledge of these fees was quite low. They indicated that they were guessing 80 to 90% of the time, had an idea of the cost for 10 to 20% of the items, and were confident in their knowledge for less than 1% of the items. There were no significant correlations between accuracy of the charge estimates and ordering frequency, actual charge of the item, or experience level of the physicians.
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Am J Phys Med Rehabil · Nov 1996
Anatomy of the iliolumbar ligament: a review of its anatomy and a magnetic resonance study.
Data of the postmortem studies of the iliolumbar ligament are controversial because of the number, complexity, and variability of the structures present in the lumbosacral region. The objective of this work was to study the anatomy of the iliolumbar ligament to resolve some clinical problems: (1) do anatomic bases exist that can explain the lumbar painful syndrome termed "iliolumbar syndrome?" (2) do iliolumbar ligament varieties exist that can influence lumbosacral joint stability? Magnetic resonance was used to analyze the anatomic structure of the iliolumbar ligament of live human beings. Thirty iliolumbar ligaments of 15 volunteers were analyzed with magnetic resonance. ⋯ This posterior band is thinner than the anterior, with a smaller insertional base on the iliac crest, which explains its lesser resistance to torsional overloading and also explains the frequency of this painful syndrome. It is probable that the spatial disposition of the iliolumbar ligament influences its antitorsional role. Further anatomic and biomechanic studies are needed.
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The Glasgow Coma Scale (GCS) is routinely used in the acute care setting after traumatic brain injury (TBI) to guide decisions in triage, based on its ability to predict morbidity and mortality. Although the GCS has been previously demonstrated to predict mortality, efficacy in prediction of functional outcome has not been established. The purpose of this study was to assess the value of the acute GCS in predicting functional outcome in survivors of TBI. ⋯ Correlation analysis revealed only modest, but statistically significant, relationships between initial and lowest GCS scores and outcome variables. Initial and lowest GCS score comparison with outcome demonstrated the following correlation coefficients: admission DRS, -0.25 and -0.28; discharge DRS, -0.24 and -0.24; admission LCFS, 0.31 and 0.33; discharge LCFS, 0.27 and 0.25; admission FIM-COG, 0.36 and 0.37; discharge FIM-COG, 0.23 and 0.23; admission FIM-M, 0.31 and 0.31; discharge FIM-M, 0.25 and 0.21. The GCS as a single variable may have limited value as a predictor of functional outcome.
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Am J Phys Med Rehabil · Mar 1996
Randomized Controlled Trial Clinical TrialEffect of mexiletine on spinal cord injury dysesthetic pain.
Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat. Subarachnoid lidocaine has been used in selected patients with some success. Mexiletine, an analog of lidocaine that acts at Na+/K+ channels in the peripheral nerve, has been found effective in persons with diabetic dysesthetic neuropathy. ⋯ The Wilcoxon's signed-rank test and paired t test were used for statistical analysis. Results showed no significant effect of mexiletine on SCI dysesthetic pain scales or Barthel index. In conclusion, in this trial, mexiletine did not appear to decrease spinal cord injury-related dysesthetic pain.
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Am J Phys Med Rehabil · Sep 1995
Case ReportsNeurologic recovery and functional improvement after vecuronium-induced quadriparesis.
Vecuronium bromide (Norcuron, Organon, Inc., West Orange, NJ) is a common neuromuscular blocking agent used to facilitate mechanical ventilation. Cases have been reported in which prolonged use of vecuronium resulted in severe motor neuropathy, with or without myopathy. However, the time course of recovery, the functional prognosis, and the use of inpatient rehabilitation is not well-established. ⋯ Significant improvement was noted during an average of 3 to 4 wk in a comprehensive inpatient rehabilitation program, documented by the improvement in total motor Functional Independence Measure scores for patient 1 (from 15 to 71) and for patient 2 (from 65 to 84). In addition, the distal compound motor amplitudes showed a 4-fold increase for the ulnar, a 7-fold increase for the median, an 11-fold increase for the peroneal, and a 3-fold increase for the tibial nerves on follow-up nerve conduction studies correlating with neurologic recovery. In summary, even when patients present with quadriparesis, the recovery after vecuronium toxicity appears to be favorable.