Upper Extremity Neuropathies in Patients with Spinal Cord Injuries

Abstract

We present a cross-sectional study designed to screen and evaluate 19 male patients with acute or chronic spinal cord injury for the presence of carpal tunnel syndrome (CTS) and radial neuropathies (RNP) in order to establish the prevalence of CTS and RNP, to compare characteristics of persons with spinal cord injury who do not have these neuropathies, to evaluate the effects of their activities and to define the causation of these neuropathies in order to prevent their occurrence during and after the rehabilitation process. Patients admitted to the Spinal Cord Injury Service with acute and chronic spinal injury (below C3) were included in the study. The level of activity was determined with the Functional Independence Measure (FIM) Score. Patients underwent neurological examination. Neurophysiological studies were done in all cases to determine the presence, nature and duration of CTS and RNP. As longevity of the spinal cord injured population is increasing, heightened awareness of the prevalence of CTS and RNP are necessary to develop strategies to prevent and manage these neuropathies which may adversely affect the patient’s quality of life.

Of 19 patients studied, three had clinical CTS, confirmed by neurophysiological testing. Of the remaining patients, 11 had no neuropathies and five had non-CTS neuropathies. No RNP was found, but one patient in the non-CTS group had symptomatic left ulnar neuropathy also confirmed by neurophysiological exam. (J Spinal Cord Med; 18:95–97)     

The effect of delay in rehabilitation on outcome of severe traumatic brain injury

Background

Expeditious care within minutes of severe injury improves outcome and is the driving force for development of trauma care systems. Transition from hospital care to rehabilitation is an important step in recovery after trauma-related injury. We hypothesize that delay in the transition from acute care to rehabilitation adversely affects outcome and diminishes recovery after traumatic brain injury (TBI).

Methods

After institutional review board approval, the trauma registry of our regional level I pediatric trauma center was queried for all children with severe blunt TBI (initial Glasgow Coma Scale score ≤8) that required inpatient rehabilitation. Records were stratified as severe TBI (Glasgow Coma Scale [GCS] scores 3, 4, 5) and moderate TBI (GSC scores 6, 7, 8). Intensity of acute care was defined by need for mechanical ventilation and length of intensive care unit stay. Outcome was defined by functional independence measurement (FIM) scores at time of transfer to inpatient rehabilitation. Linear regression was used to compare time in days between discharge from intensive care and admission to inpatient rehabilitation (delay) to rehabilitation efficiency (RE), defined as the ratio of FIM score improvement to length of stay for inpatient rehabilitation. Functional improvement was determined by analysis of FIM score improvement (ΔFIM) between initiation and completion of inpatient rehabilitation.

Results

Between January 2000 and December 2006, 60 children (38 males, mean age, 11.2 years; 22 females, mean age, 10.6 years) with blunt TBI and an initial GCS score of 8 or lower required resuscitation, comprehensive critical care, and inpatient rehabilitation. Mean length of stay in the intensive care unit was 11.1 ± 7.4 days. Fifty-two children required an average of 9.4 ± 6.8 ventilator days. Delay ranged between 0 and 24 days (mean, 4.1 days) and was significantly correlated with RE and ΔFIM (correlation coefficient = −0.346, P = .0068). For children with the highest potential for salvage (GCS scores 6, 7, 8), RE correlation increased to −0.457 (P = .011), whereas those with most severe injury (GCS scores 3, 4, 5) demonstrated a weaker correlation that was not significant. For children with most severe injury (GCS scores 3,4,5), the correlation of ΔFIM was significant (−0.38; P = .035); however, RE was not.

Conclusions

These data demonstrate the price of delay of comprehensive rehabilitation, especially for the most vulnerable TBI children with best potential for salvage. The “golden hour,” which has become the mantra for continued refinement of systems of emergency and trauma care, must progress without interruption to the “golden day,” during which comprehensive critical care seamlessly transitions to timely and aggressive rehabilitation to effect the greatest functional recovery.     

脊髓损伤患者62例前瞻性临床研究

目的:通过前瞻性研究设计,对影响脊髓损伤患者功能恢复的各种影响因素进行初步分析.方法:设计前瞻性队列研究方案,在不干涉临床治疗方案前提下,采集2006年12月至2007年12月收治的脊髓损伤患者资料,纳入标准定为:急性脊髓损伤(受伤时间在1周以内),男女不限,年龄限定在18～65岁,根据临床查体结合MRI或CT检查证实为美国脊髓损伤协会(ASIA)分级标准(2000年修订)的A级(完全性脊髓损伤,损伤平面下不存在任何运动和感觉功能)或者B级(不完全性脊髓损伤,损伤平面下不存在运动功能,但存在感觉功能).所有入选病例均获随访,并分别在受伤入院当时及第1次评估后1、3、6个月采用ASIA分级标准、功能独立性评测(FIM)评价脊髓损伤及恢复情况,分析影响脊髓损伤患者功能恢复的因素.结果:共入选62例患者,男性60例,女性2例;年龄18～41岁,平均24岁;A级损伤29例,B级损伤33例.A级损伤中,手术减压患者(手术组)和非手术减压患者(非手术组)的感觉、运动ASIA评分及FIM评分比值在术后各时间点上的差异无统计学意义(P>0.05),B级损伤中,手术组和非手术组在手术前后感觉、运动ASIA评分、FIM评分的比值在各个时间点上差异均具有统计学意义(P<0.05).在手术组患者中,减压手术在伤后8 h以内(≤8 h)进行者,术前和术后感觉、运动ASIA评分、FIM评分比值与在伤后8 h以外(>8 h)进行者相比差异具有统计学意义(P<0.05).结论:对于A级损伤,手术减压时间点的选择对损伤的脊髓功能恢复影响差别不大,考虑到护理的方便和维持脊柱稳定性的要求,可以选择减压内固定手术;对于B级损伤,应该尽早进行减压手术以最大程度地恢复损伤脊髓的功能.     

APACHEⅡ评分及FIM评分法在危重病人护理中的应用研究

目的探讨APACHEⅡ评分法（第二代急性生理学和慢性健康状况评分）及FIM（功能独立性测定）在制定危重病人护理措施中的应用效果。方法将120例危重病人随机分为观察组（60例）和对照组（60例）。观察组每天进行APACHEⅡ及人院和出院时FIM评分,并根据评分结果进行护理人员配置和实施护理对策对照组按护理级别及疾病种类实施常规护理。比较两组危重病人住院时间、医疗费用的差异及住院期间并发症发生率护士对护理资源配置的满意度和患者家属对护理工作的满意度。结果观察组住院时间、医疗费用、并发症发生率均显著低于对照组（均P值〈0．05）：患者对护理工作的满意度以及护士对护理资源配置的满意度均显著高于对照组（P值〈0．05,雅〈0．01）。结论APACHEⅡ及FIM评分的应用可指导护理人力的合理调配,有利于护士对疾病严重程度评估,并提高对病情预后的预见性,实施相应的护理措施,提高护理质量及患者满意度。     

Preoperative supraphysiological testosterone in older men undergoing knee replacement surgery

OBJECTIVES: Older patients undergoing knee replacement surgery can recover more slowly than younger patients and require extended rehabilitation. Because administration of supraphysiological testosterone (T) dramatically increases strength, we hypothesized that preoperative T therapy would improve functional recovery and reduce hospital stay in older men undergoing knee replacement surgery. DESIGN: Double-blinded, placebo-controlled pilot trial. SETTING: A Veterans Affairs orthopedics clinic and inpatient postoperative unit. PARTICIPANTS: Twenty-five men, mean age 70, undergoing elective knee replacement. INTERVENTION: Preoperative, supraphysiological T administration (600 mg T enanthate intramuscularly weekly for 4 weeks) or sesame oil placebo. MEASUREMENTS: Length of hospital stay and functional ability by Functional Independence Measure (FIM) score. RESULTS: Mean length of hospital stay +/- standard deviation was nonsignificantly reduced in the T group (5.9 +/- 2.4 days vs 6.8 +/- 2.5 days; P =.15). At postoperative Day 3, there was a significant improvement in ability to stand (mean FIM score 5.2 +/- 1.0 vs 4.0 +/- 1.1; P =.04) and trends towards improvements in walking and stair climbing in the T group. There were no complications attributable to T therapy. CONCLUSIONS: In older men undergoing knee replacement surgery, preoperative supraphysiological T administration may confer some clinical benefit. Future studies using longer courses of preoperative T administration in larger numbers of older men undergoing knee replacement surgery are warranted.     

高压交变电磁场对脑卒中康复的临床观察

Now，rehabilitationofcerebrovasculardiseasesreceivesmoreattention．Physicaltherapyandexercisetherapyarewidelyusedforrehabilitationofstroke．Wetreated１２６strokepatientsbyusinghigh－voltagealternativeelectromagneticfield，andobtainsatisfyingtherapeuticeffect．１Subjectandmethod１．１Subject１２６patientsconsistingwithdiagnosticcriteriaes－tablishedinNationalCerebrovasculardiseasesMeetingwerere－cruited犤１犦．Thesepatientsincluded５７menand６９women，age：４８～７２years，meanage：（５８．４…     

针刺治疗脑梗死37例临床评价

目的选用国际公认的临床评价方法,观察针刺治疗不同时期脑梗死的疗效。方法对37例脑梗死患者进行针刺治疗,采用NIHSS、FIM和BI评分,对临床疗效进行综合评价。结果针刺治疗脑梗死有显著疗效,治疗后患者NIHSS、FIM和BI亦有显著改善。结论针刺治疗脑梗死应按照WHO残疾分类原则进行评定,以统一和标准的方法来描述疾病与健康的状况,以利于疗效认定和多中心的比较研究。     

A Factor Analysis of Functional Independence and Functional Assessment Measure Scores Among Focal and Diffuse Brain Injury Patients: The Importance of Bifactor Models

Objective

To explore the factor structure of the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM) among focal and diffuse acquired brain injury patients.

Effect of early and intensive rehabilitation in acute stroke patients: retrospective pre-/post-comparison in Japanese hospital

Purpose: There is little high-quality or large-scale clinical research focusing on the effect of early and intensive rehabilitation in Eastern countries. This study aimed to determine whether an early and intensive rehabilitation program in a Japanese hospital affects functional outcomes of acute stroke patients.

Methods: In total, 1588 stroke patients were investigated. A maintained database of all hospitalized acute stroke patients admitted to our facility over two consecutive 2-year periods was reviewed. We relaunched of a new rehabilitation program to be earlier and more intensive at the midpoint of this two periods. The functional outcomes of the patients in the first 2-year period and the subsequent 2-year period were compared.

Results: The total time of rehabilitation exercises per day was significantly increased from the first period to the second period. The number of patients who started rehabilitation within 24?h after admission was significantly increased in the patients admitted during the second period compared with those admitted during the first period. The Functional Independence Measure (FIM) efficiency was significantly higher in the patients admitted during the second period than in those admitted during the first period.

Conclusions: An early and intensive rehabilitation program in a Japanese hospital affects functional outcomes of acute stroke patients.

• Implications for Rehabilitation

• Early and intensive rehabilitation for the stroke patients is an effective means of improving FIM score.

• Early and intensive rehabilitation affects the improvement of FIM efficiency without increasing adverse events.

     

基于肌骨超声评价电针对手部肌腱修复术后粘连的效果

目的:利用肌骨超声评估及总主动关节活动度(TAM)、功能独立性评定(FIM)观察电针的应用对手部肌腱损伤修复术后的临床效果。方法:收集符合标准的手部肌腱损伤修复术后患者40例,并随机分为电针组和对照组各20例。两组患者均需接受康复宣教、物理因子治疗、支具配戴等综合治疗,而电针组在此基础上增加电针治疗。在治疗前,治疗后4周和8周分别使用肌骨超声评估肌腱粘连程度,并评估患者TAM和FIM。结果:治疗4周后,2组患者重度粘连所占比例显著低于治疗前(P<0.05),TAM、FIM评分均显著高于治疗前(P<0.05)。治疗后电针组患者重度粘连所占比例低于对照组,TAM高于对照组(P<0.05),但两组患者治疗后FIM评分差异并无显著性意义(P>0.05)。治疗8周后,电针组患者重度粘连所占比例,TAM均显著优于组内治疗后4周及对照组治疗后8周(P<0.05),但电针组FIM评分较组内治疗后4周及对照组治疗后8周不具有显著性差异(P>0.05)。结论:电针治疗对手部肌腱修复术后的粘连是积极有效的,治疗后患者受损手部的运动功能得到了极大的提升。