Study Design: Case Report and literature review.
Methods: Retrospective review of medical records.
Results: The patient was treated non-operatively for the neck rotation and MO of his longus coli muscle and had gradual improvement of symptoms.
Conclusions: To our knowledge, this is the first report of symptomatic MO of the longus coli following traumatic cervical spine fracture in an adult. Treatment with supportive measures appears to achieve satisfactory outcome. 相似文献
Design: Cross-sectional; semi-structured interviews.
Setting: Spinal Cord Injury (SCI) Centers in the Veterans Health Administration.
Participants: Twenty-six SCI/D healthcare providers.
Interventions: None.
Outcome Measures: Perceived advantages and disadvantages of PHR portals.
Results: The complex situations of individuals with SCI/D shaped provider perspectives of PHR portals and their potential role in practice. Perceived advantages of PHR portal use in SCI/D care included the ability to coordinate information and care, monitor and respond to outpatient requests, support patient self-management activities, and provide reliable health information to patients. Perceived disadvantages of PHR portal use in SCI/D care included concerns about the quality of patient-generated health data, other potential liabilities for providers and workload burden, and the ability of individuals with SCI/D to understand clinical information accessed through a portal.
Conclusion: Our study highlights advantages and disadvantages that should be considered when promoting engagement of SCI/D healthcare providers in use of PHR portals, and portal features that may have the most utility in SCI/D care. 相似文献
Design: Cross-sectional study.
Setting: Swiss Spinal Cord Injury Community Survey 2012.
Participants: Individuals aged 16 or older with chronic SCI living in Switzerland.
Interventions: Not applicable.
Outcome measures: The availability of ten HAs (self-report) was analyzed by sex, age, living situation, indoor mobility, SCI severity, SCI etiology and time since SCI. The unmet need (self-report of not having a HA but needing it) of HAs was analyzed by financial hardship.
Results: Among the 482 study participants (mean age 55.2 years, standard deviation 15.0 years, 71.6% males), 85.1% had at least one HA. The most frequent HA was a wheelchair accessible shower (62.7%). Availability of HAs markedly varied with indoor mobility (e.g. 38.4% of participants using a wheelchair had a stair lift compared to 17.4% of those walking) and with SCI severity (e.g. 54.8% of those with complete paraplegia had a wheelchair accessible kitchen worktop compared to 26.0% of those with incomplete paraplegia). Unmet need was highest for adjustable kitchen worktops (78.7% of those with a need) and adjustable kitchen cabinets (75.7%) and lowest for wheelchair accessible showers (9.4%) and grab bars next to the toilet (8.5%). No significant differences in unmet need were found when stratifying for financial hardship.
Conclusion: Availability of HAs is dependent on indoor mobility and SCI severity. There is a considerable degree of unmet need for selected HAs, which couldn't be explained by financial hardship. 相似文献
Methods: The authors analyzed retrospectively 31 patients who underwent free radial forearm flap reconstruction between November 2009 and May 2013. Donor site complications were compared with data from patients treated before introdutction of the algorithm. Within the group were compared patients in which the flap was harvested suprafascial with those in which the flap was harvested as subfascial.
Results: Before application of the algorithm, there was a 23.3% complication rate at the RFF donor site, in our experience. After introduction of the algorithm, complication rate has dropped to 3.2%, consisting in a partial skin graft necrosis treated by local wound-care and healed without further intervention.
Conclusions: Application of the algorithm described has led to a significant reduction in RFF donor site complication rates. This demonstrates that if flap donor sites are analyzed and tailor treated in the same way as primary defects are, instead of being given secondary importance and just grafted, outcomes improve. 相似文献
Design: Neural stem cells (NSCs) were grown under different culture conditions.
Setting: The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Outcome Measures: The study consisted of four groups: NSCs cultured under control conditions (group 1) or with the addition of BMSC-CM (group 2);(BMP-4) (group 3) or both (group 4).The expression of glial fibrillary acidic protein (GFAP) was detected by immunocytochemical staining and Western blotting.
Results: The expression of GFAP was higher in Group3 and lower in Group 2 compared to that in Group 1. The expression of GFAP in Group 4 was intermediate between that of Group 2 and Group 3.
Conclusions: These results suggest that BMSC-CM can decrease the generation of astrocytes and that the inhibition of the (BMP-4) /Smad1/5/8 signaling pathway may be the underlying mechanism. This phenomenon may be mediated by increasing the expression of Smad6. 相似文献
Objective: To evaluate the characteristics associated with improving two or more functional levels and therefore classifying as a substantial responder after an inpatient rehabilitation facility stay in post-resection chordoma patients.
Setting: Acute inpatient rehabilitation facility in the United States.
Methods: A total of 40 patients were admitted to an inpatient rehabilitation facility from 2010–2015 after chordoma resection. Demographics, tumor management information, lengths of stay and functional independence measures on admission and discharge were collected. Substantial responders were identified as individuals who improved two or more functional levels based on total FIM score change. Logistic regression was used to analyze the available data for association of quantitative and categorical variables with being a substantial responder.
Results: The categorical variables analyzed in this study (sex, readmission to an acute hospital, Charlson Comorbidity Index, tumor level, nerve sacrifice, recurrent tumor and metatases) were not associated with being a substantial responder. The quantitative variables age and length of stay at the inpatient rehabilitation facility were individually associated with being a substantial responder, while length of stay at the acute hospital was not.
Conclusions: Patients who were younger were more likely to be classified as substantial responders. Patients with longer lengths of stay at the inpatient rehabilitation facility were also more likely to be classified as substantial responders. 相似文献
Objective: This study aims to investigate the process of breaking bad news from the perspective of spinal cord injury survivors.
Design: A cross sectional, qualitative study.
Setting: Community.
Participants: Fourteen spinal cord injury survivors.
Interventions: Subjects participated in a semi-structured interview about ‘when’, ‘where’ ‘by whom’ and ‘how’ they received and ‘would’ prefer to receive bad news.
Outcome measures: Answers to ‘how’ questions were coded according to SPIKES protocol (Setting, Perception, Invitation, Knowledge, Empathizing, Summary).
Results: Eight participants (57%) reported that they received bad news from a physician, mostly during rehabilitation. All would prefer to be informed by a physician and majority preferred to be gradually informed during rehabilitation. Half were not satisfied with the content of information. Only half felt that his/her physiatrist understood his/her emotional distress. Majority of participants who received bad news from physicians reported that the setting was private and their family members accompanied them.
Conclusion: Most spinal cord injury survivors were unsatisfied with knowledge and emotional support provided by rehabilitation physicians. Participants would prefer to receive bad news by a senior physiatrist in a planned meeting during rehabilitation. 相似文献
Design: Case-series analysis of the individual identity trajectories of eight individuals.
Setting: Subacute rehabilitation facility, Victoria, Australia.
Participants: Eight individuals with an SCI; 7 males and 1 female.
Intervention: Six-week therapeutic songwriting intervention facilitated by a music therapist to promote identity rehabilitation.
Outcome Measures: Identity, subjective well-being and distress, emotional state.
Results: Three participants demonstrated positive trajectories and a further three showed negative trajectories; remaining participants were ambiguous in their response. Injury severity differentiated those with positive trajectories from those with negative trajectories, with greater injury severity apparent for those showing negative trends. Self-concept also improved more in those with positive trajectories. Core demographic variables did not however meaningfully predict the direction of change in core identity or wellbeing indices.
Conclusion: Identity-focused songwriting holds promise as a means of promoting healthy identity reintegration. Further research on benefits for those with less severe spinal injuries is warranted. 相似文献
Methods: Medline and Embase database were searched for the words ‘pilonidal, sinus, Limberg, flap’. Non-English articles and those not-related to our scope of search were omitted. We included a retrospective study of patients underwent LF in our district hospital. Data including length of hospital stay, post-operative complications and recurrence were collected.
Results: Literature review revealed 68 studies (22 case series, 35 comparative studies, nine RCTs and two meta-analyses). Recurrence rate was 0–7.4% in case series. Recurrence rate in comparative studies was 0–8.3%, compared to 4–37.7% for primary closure and 0–11% for Karydakis flap. RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap. About 26 patients included in the cohort study (16 male, average age 27 years). Six patients presented with recurrent disease. Post-operative length of hospital stay was four to seven days. Post-operative complication rate was 11.5% – [two partial wound dehiscence, one wound infection]. Recurrence rate was 7.7%. Average follow-up was 18 months.
Conclusions: Limberg flap presents a safe and effective method that can be offered for patients with primary or recurrent PSD. 相似文献
Study design: Case series observational study.
Setting: Gait and Motion Analysis Laboratory at the National Research Center Rehabilitation Technical Aids.
Methods: Electromyography and motion data from two subjects with complete spinal cord injury at T10 and T8 walking with un-powered exoskeletons were collected simultaneously.
Outcome measures: Surface electromyography of trunk muscles and motion data including joint angle and center of mass (COM).
Results: Compared to T10 subject, T8 subject activated trunk muscles in higher levels walking with all tested un-powered exoskeletons and had greater pelvic obliquity walking with reciprocating gait orthosis (RGO) and energy-stored exoskeleton (ES-EXO). ES-EXO can redistribute muscle forces, recruit trunk muscles evenly, increase walking speed and improve COM trajectory in frontal plane.
Conclusion: This study revealed differences in kinematics and muscle activities in walking with three un-powered exoskeletons between two patients with different neurological injured levels. ES-EXO had advantages over conventional un-powered exoskeletons on recruiting muscles evenly and improving walking speed, step length and COM trajectory. 相似文献
Design: This is a prospective cohort study. Sixteen potential predictive variables were studied. Univariate regression analyses were first performed to determine the strength of association of each variable independently with the total Spinal Cord Independence Measure (SCIM) score. Significant ones were then included in a General linear model in order to determine the most relevant predictive factors among them. Analyses were carried out separately for tetraplegia and paraplegia.
Setting: A single specialized Level I trauma center.
Participants: One hundred fifty-nine patients hospitalized for an acute traumatic SCI between January 2010 and February 2015.
Interventions: Not applicable.
Main outcome measure: The SCIM (version 3) functional score.
Results: Motor-complete SCI (AIS-A,B) was the main predictive factor associated with decreased total SCIM score in tetraplegia and paraplegia. Longer acute care length of stay and the occurrence of acute medical complications (either pneumonia, urinary tract infections or pressure ulcers) were predictors of decreased functional outcome following tetraplegia, while increased body mass index and higher trauma severity were predictive of decreased functional outcome following paraplegia.
Conclusions: This study supports previous work while adding information regarding the importance of optimizing acute care hospitalization as it may influence chronic functional status following traumatic SCI. 相似文献
Design: Randomized clinical trial.
Setting: A tertiary rehabilitation center.
Participants: Patients with SCI who were referred to Brain and Spinal Cord Injury Research Center.
Intervention: The nutrition education program consisted of 5 education sessions during a period of 7 months.
Outcome measures: Body weight and serum concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measure at the beginning of the trial and after 7 months. Two-way repeated measure analysis of variance (ANOVA) was used.
Results: Total of 57 patients (27 in control group and 30 in education group) participated. Nutrition education program showed no significant effect on the levels of TC, TG, LDL-C and HDL-C (P: 0.224, 0.172, 0.107 and 0.081, respectively). No significant changes in weight and waist circumflex have been observed as well (P: 0.970 and 0.361, respectively).
Conclusion: Our findings do not support a significant influence of nutrition education program on weight and lipid profile. It seems that the nutrition education program alone is not adequately effective to have beneficial influence on weight and lipid profile.
Clinical trial registration No.: IRCT201406215968N3 相似文献
Design: Community-based secondary data analyses.
Setting: Shanghai, China.
Methods: We analyzed gender, age at injury, complications, disturbances of function, treatment, etiology, and severity of injury of SCI individuals that enrolled in “halfway houses”, government-supported community co-op centers. Bivariate statistical analyses were conducted to examine the factors associated with complete and traumatic SCI.
Results: We analyzed 808 SCI individuals who participated in halfway houses in Shanghai during 2009–2015. The male-to-female ratio was 2.1:1. The proportion of middle or elder age groups at injury (age 46 to 60 and age 61 or over) showed a rising trend from 1970 to 2015. The leading causes of SCIs in Shanghai were traumatic injuries (58%), followed by disease (29.5%). The proportion of traumatic injuries decreased over time, while the proportion of non-traumatic injuries rose significantly. A majority of traumatic injury individuals were aged between 16–45.
Conclusion: The middle or elder age groups at injury among SCI individuals increased continuously from 1970 to 2015. The principal causes of injury in Shanghai were traumatic injuries and disease-related injuries. Men had a higher prevalence of traumatic SCI in Shanghai. Preventive measures should focus on male and middle-aged adults. As a fast-aging society in Shanghai, more effective prevention, medical care, and rehabilitation schemes should be implemented for aging SCI individuals. 相似文献
Case report A 76-year-old male patient presented in December 2013 with a suspicious malignant lesion of the pancreatic tail on the MRI. He was also complaining of a painful mass in the right para-rectal area. An exploratory laparoscopy performed in December 2013 revealed microscopic whitish peritoneal implants in the left hypochondrium and a massive metastasis involving a mesh prosthesis placed é years before in the right para-rectal area. The pathology report of biopsies of the mesh confirmed a metastasis compatible with a pancreatic tumor.
Discussion Possible modes of metastasis and limited published data to date on mesh prosthesis metastasis are presented. This situation can be assimilated to port-site metastasis after laparoscopy.
Conclusion A mesh prosthesis metastasis after laparoscopic hernia repair is very rare. 相似文献
Design: Pre-test/post-test.
Participants/methods: Eighty-nine persons with SCI participated voluntarily in a no-cost, twice weekly physical therapy group exercise class over 3 months. Forty-five persons completed pre- and post-participation interviews on exercise frequency and intensity, perceived health, pain, mood, sleep, and television watching habits.
Results: Mean participant age of the respondents was 43.82 years. 49% had AIS C or D injuries, 24% had AIS A,B paraplegia, 9% had AIS A,B C1-C4 and 18% had AIS A,B C5–C8. 75.6% of participants were male and 84.4% had a traumatic etiology as the cause of their SCI. There was a significant improvement in days of strenuous and moderate exercise as well as health state. There was an average decrease in pain scores, depression scores, number of hours spent watching television, and days/week of mild exercise.
Conclusion: Participation in structured, small group exercise as a component of a wellness program after SCI shows promise for improving regular exercise participation and health state, but benefits may also occur across other areas of health and function including mood, pain, and hours spent watching television. Further follow-up is needed to determine whether improvements can be maintained after program completion and across all neurological levels. 相似文献
Objective: To identify, categorize and rank predictors of mFIM score for patients with SCI following inpatient rehabilitation, both at the time of discharge and at one-year follow-up.
Methods: Data sources included CINAHL, PubMed, ERIC, Google Scholar, and Medline for literature published from February 2000 to February 2015. Quality and risk of bias of included studies was assessed using the Risk of Bias Assessment Instrument for Prognostic Factor Studies (QUIPS). Significant predictors of mFIM score were categorized using the domains of the International Classification of Function and Disability model ICF and ranked based on how frequently they were significant predictors of mFIM score.
Results: Twenty-seven predictors of mFIM score spanning the ICF domains were identified among seven studies. At discharge, variables in the Body Structure and Function domain were the most consistent predictors of mFIM score. At one-year follow-up, variables in the Activity and Participation domain were the most consistent predictors of mFIM score. Contextual factors were the least frequent predictors at both discharge and one-year follow-up.
Conclusion: This systematic-review assists clinicians setting realistic goals that maximize functional independence at the time of discharge and after reintegrating to society. 相似文献
Design: Cross-sectional multicenter study.
Setting: Dutch community.
Participants: Persons dependent on wheelchairs (N?=?282) with traumatic or non-traumatic SCI for ≥10 years and age at injury of 18–35 years.
Interventions: Not applicable.
Outcome measures: The International Lower Urinary Tract Function Basic SCI Data Set and the Short-Form Qualiveen (SF-Qualiveen).
Results: Median time since injury was 22.0 years (IQR: 16.8–30.3). Clean intermittent catheterization (CIC) was most commonly used (42.6%). Longer time since injury was associated with fewer continent urinary diversions and more transurethral catheter use. Transurethral catheter use and continent urinary diversions were more prevalent among women. Participants with tetraplegia were more likely to use reflex voiding or a suprapubic catheter, and participants with paraplegia were more likely to use CIC. Transurethral catheter users reported the highest impact of NLUTD on quality of life (SF-Qualiveen score: 1.9; SD?=?0.8). Participants with a continent urinary diversion reported the lowest impact (SF-Qualiveen score: 0.9; SD?=?0.6). Higher age and indwelling catheter use versus CIC were associated with a higher impact of NLUTD on QoL.
Conclusions: CIC is the most common bladder-emptying method in Dutch people with long-term SCI. Clinicians should be aware of the impact of NLUTD on QoL, especially for those using an indwelling catheter. 相似文献
Design: Retrospective chart review.
Setting: Inpatient and outpatient acute rehabilitation facility.
Participants: Thirty-four subjects.
Interventions: We reviewed patients’ medical records to ascertain the presence of symptomatic autonomic dysreflexia (AD) prior to and after implantation of an intrathecal baclofen (ITB) pump for spasticity in spinal cord injury patients. We recorded risk factors for autonomic dysreflexia including kidney and bladder stones, heterotopic ossification (HO), and ischial / sacral pressure ulcers.
Outcome Measures: Presence of autonomic dysreflexia pre and post-intrathecal baclofen pump placement, presence of risk factors associated with autonomic dysreflexia including (1) kidney or bladder stones, (2) heterotopic ossification, and (3) pressure ulcers.
Results: Of the 34 subjects, 25 (73.5%) experienced AD prior to ITB pump placement and only 2 (5.9%) after placement. Four subjects (11.8%) had kidney or bladder stones, of which, all had AD prior to placement and none had AD afterwards. Twenty-six subjects (76.5%) had pressure ulcers, of which, all experienced AD prior to placement and only one (0.02%) afterwards. Six patients (17.6%) had HO, of which 5 (83%) had AD prior to placement and none afterwards. Additionally, three patients (8.8%) had at least 2 of the above risk factors, of which, all had AD prior to ITB placement and none afterwards.
Conclusion: This study showed a significant reduction of symptomatic episodes of autonomic dysreflexia after spinal cord injury, even in those with additional risk factors for development of autonomic dysreflexia. 相似文献
Patients and methods: We present a case of a 73-year–old patient with Parkinson’s disease with complaints of severe epigastric pain, emesis and an increased lipase.
Results:
Diagnosis of an organo-axial gastric volvulus was made. Treatment consisted of reduction of the volvulus by decompression via nasogastric tube. The underlying cause was a para-esophageal hernia that was repaired by Nissen-fundoplication later on.
Conclusions: We describe symptomatology, diagnostic and therapeutic options of gastric volvulus. 相似文献