Failure to Compensate: Patients With Nerve Injury Use Their Injured Dominant Hand,Even When Their Nondominant Is More Dexterous

ObjectiveTo identify how individuals respond to unilateral upper extremity peripheral nerve injury via compensation (increased use of the nondominant hand). We hypothesized that injury to the dominant hand would have a greater effect on hand use (left vs right choices). We also hypothesized that compensation would not depend on current (postinjury) nondominant hand performance because many patients undergo rehabilitation that is not designed to alter hand use.DesignObservational survey, single-arm.SettingsAcademic research institution and referral center.ParticipantsA total of 48 adults (N=48) with unilateral upper extremity peripheral nerve injury. Another 14 declined participation. Referred sample, including all eligible patients from 16 months at 1 nerve injury clinic and 1 hand therapy clinic.InterventionsNot applicable.Main Outcome MeasuresHand use (% of actions with each hand) via Block Building Task. Dexterity via Jebsen-Taylor Hand Function.ResultsParticipants preferred their dominant hand regardless of whether it was injured: hand usage (dominant/nondominant) did not differ from typical adults, regardless of injured side (P>.07), even though most participants (77%) were more dexterous with their uninjured nondominant hand (mean asymmetry index, ?0.16±0.25). The Block Building Task was sensitive to hand dominance (P=2 × 10^?4) and moderately correlated with Motor Activity Log amount scores (r²=0.33, P<.0001). Compensation was associated only with dominant hand dexterity (P=3.9 × 10^?3), not on nondominant hand dexterity, rehabilitation, or other patient and/or injury factors (P>.1).ConclusionsPatients with peripheral nerve injury with dominant hand injury do not compensate with their unaffected nondominant hand, even if it is more dexterous. For the subset of patients unlikely to recover function with the injured hand, they could benefit from rehabilitation that encourages compensation with the nondominant hand.     

Hip Displacement in Cerebral Palsy: The Role of Surveillance

IntroductionHip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment.Hip surveillance programmesSeveral population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients’ age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement.ConclusionDespite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.     

手部多发掌骨骨折术后的功能康复指导疗效评价

目的探讨手部多发掌骨骨折患者术后进行功能康复指导的临床疗效。方法 92例手部多发掌骨骨折患者依据是否早期行康复治疗分成康复组(50例)与普通组(42例)。普通组采取常规治疗,康复组在普通组治疗基础上进行功能康复指导。对比两组治疗效果及并发症发生情况。结果康复组治疗总有效率为92.0%高于普通组的76.2%,差异有统计学意义(P<0.05)。康复组并发症发生率为8.0%低于普通组的23.8%,差异有统计学意义(P<0.05)。结论手部多发掌骨骨折患者术后尽早进行康复锻炼,可有效减少并发症发生,可最大程度的恢复手部功能,对提升患者生活质量,恢复正常生活作用显著,建议临床应用。     

舒巴坦治疗老年心力衰竭患者肺部感染的临床效果及不良反应发生率分析

目的本研究分析舒巴坦治疗老年心力衰竭患者肺部感染的临床效果及不良反应发生情况,为临床治疗提供参考。方法160例老年心力衰竭肺部感染患者为研究对象,分为两组:对照组(n=80)患者在常规治疗的基础上采用头孢曲松钠治疗,观察组(n=80)患者在常规治疗的基础上采用头孢哌酮钠舒巴坦治疗。分析两组患者的细菌清除率、治疗前后心功能和肺功能的改善及不良反应的发生情况。结果观察组患者在细菌清除率明显高于对照组患者的细菌清除率(对照组vs观察组=84.35%vs 87.92%,χ²=5.654,P<0.05);两组患者治疗后心功参数LVEDD、LVESD、LVEF和肺功参数用力呼气容积和用力肺活量均得到显著的改善(P<0.05),且与对照组相比,观察组患者的上述指标改善显著(P<0.05);两组研究对象的不良反应包括凝血功能障碍、肝功能障碍、轻度皮疹和呕吐。结论舒巴坦治疗老年心力衰竭患者肺部感染安全性高,且临床疗效值得认可,可在临床推广应用。     

自然腔道取出标本手术对直肠癌患者术后康复及免疫功能的影响分析

目的:探讨经自然腔道取出标本手术(NOSES)对直肠癌患者术后康复及免疫功能的影响。方法:回顾性分析2015年2月—2016年12月收治的98例直肠癌患者的临床资料,其中49例接受NOSES直肠癌根治术(观察组),49例采用传统腹腔镜直肠癌根治术(对照组),分析两组患者的相关临床指标以及手术前后应激因子与免疫功能指标的变化。结果:观察组患者术后排气时间短于对照组(2.62 d vs. 3.31 d,P0.05);手术时间、术中出血量、淋巴结清扫数目与对照组无统计学差异(均P0.05)。两组患者术前E-选择素、内皮素(ET)、可溶性血管细胞黏附分子1(sVCAM-1)、基质金属蛋白酶9(MMP-9)、免疫球蛋白水平均无统计学差异(均P0.05),观察组患者术后E-选择素、ET、sVCAM-1、MMP-9水平明显低于对照组,而免疫球蛋白水平明显高于对照组(均P0.05)。观察组患者并发症发生率低于对照组(8.16%vs. 18.37%),但差异无统计学意义(P0.05)。结论:NOSES直肠癌根治术可达到与传统手术相同的肿瘤学根治目的,且可减少应激因子的表达,对机体免疫功能影响较小,安全性高,患者恢复快。     

Community exercise programing and its potential influence on quality of life and functional reach for individuals with spinal cord injury*

Context/Objective: After an individual with a Spinal Cord Injury (SCI) participates in the initial rehabilitation process, they often experience limited access to physical therapy services and other fitness activities. The purpose of this study was to examine previously collected data for changes in quality of life (QoL) and functional reach in individuals with SCI following an 8-week community exercise program.

Design: Secondary analysis of previously collected data.

Setting: Community-based exercise program.

Participants: Twenty-two participants with an average of 9 years post-SCI, both complete and incomplete injuries, and injury levels ranging from C2 to L5.

Interventions: Participants completed an 8-week program, once per week for 4 hours that included a four-station circuit of resistance training, aerobic exercise, trunk stability, and education.

Outcome Measures: Physical function was measured using the modified Functional Reach Test (mFRT). QoL was measured with the Life Satisfaction Questionnaire-9 (LiSAT-9).

Results: The mFRT improved by 2 inches (±7.04) P?<?0.001 and QoL improved as well, P?<?0.001.

Conclusion: The findings of this study are consistent with the hypothesis that a supervised post-rehabilitation community exercise program, like Spinal Mobility, may positively impact the QoL and functional reach in individuals with SCI.     

麻醉深度对开颅手术患者术后早期认知功能的影响

目的探讨麻醉深度对开颅手术患者术后早期认知功能的影响。方法选择2018年6月—2019年6月在北票市中心医院接受开颅手术的患者90例,随机分为浅麻醉组和深麻醉组各45例。比较两组手术前后不同时间点平均动脉压和心率变化情况。以简易智能量表评价并比较两组手术前后不同时间点的认知功能。结果两组手术前后不同时间点平均动脉压和心率差异无统计学意义(P>0.05)。两组术后第1天和第3天简易智能量表评分差异有统计学意义(P<005),术后第7天简易智能量表评分差异无统计学意义(P>0.05)。结论对于行开颅手术的患者,在保证安全的前提下进一步增加麻醉深度,并不会影响血流动力学的稳定性,而且有利于患者术后早期认知功能的恢复。