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1.
Background
Atrial fibrillation (AF) is the most commonly encountered dysrhythmia in the emergency department, and its prevalence is increasing. A substantial proportion of these patients have recent-onset AF (<48 h). The poor prognosis associated with AF is being increasingly recognized, and there is some evidence for better outcomes in younger patients with recent-onset AF when sinus rhythm is restored. Flecainide is recommended in the latest international guidelines for cardioversion of recent-onset AF, but its safety and efficacy relative to other recommended agents are unclear.Objective
Our aim was to clarify the Level 1 evidence for the use of i.v. flecainide in acute AF.Methods
We performed a systematic review and meta-analysis of the literature. Medline, Ovid, Embase, and Cochrane Central databases were searched for relevant studies. Only randomized controlled trials (RCTs) of i.v. flecainide for acute conversion of recent-onset AF were selected for meta-analysis.Results
Four hundred and three studies were screened, of which 11 RCTs were eligible for meta-analysis. Flecainide had high efficacy for cardioversion within 2 h (number needed to treat [NNT] = 1.8). Efficacy was superior to propafenone, amiodarone, procainamide, ibutilide, and sotalol (NNT = 4.3). There was no statistically significant difference in pro-dysrhythmia compared to these anti-dysrhythmics or placebo.Conclusions
Intravenous flecainide cardioversion could be a safe and effective option for emergency physicians to restore sinus rhythm in selected patients with acute AF. 相似文献2.
Amanda Faith Casey Roy Rasmussen Sasho J. Mackenzie Jillian Glenn 《Archives of physical medicine and rehabilitation》2010,91(7):1064-1069
Casey AF, Rasmussen R, Mackenzie SJ, Glenn J. Dual-energy x-ray absorptiometry to measure the influence of a 16-week community-based swim training program on body fat in children and adolescents with intellectual disabilities.
Objective
To use dual-energy x-ray absorptiometry (DXA) to measure the effects of a 16-week community-based swim training program on percent body fat in children and adolescents with intellectual disability (ID).Design
Convenience sample.Setting
University sport complex and exercise science laboratory.Participants
Children and adolescents (n=8; mean age ± SD, 13.1 ± 3.4y), 2 girls and 6 boys with ID, of varying fat levels (11%-35%).Intervention
A swim training program lasting for the duration of 16 weeks with three 1-hour sessions held at a 25-m pool each week.Main Outcome Measure
Assessing percent body fat at pretest and posttest through the use of DXA.Results
After the 16-week exercise training program, we observed a 1.2% median increase in body fat percentage with a range from -0.3% to 4.5%. Wilcoxon matched-pairs signed-ranks tests suggest that these results are statistically significant (P=.039; exact).Conclusions
Exercise training alone proved ineffectual in reducing percent body fat in 8 children and adolescents with ID. Further research should consider implementing a combined diet and exercise program. To gauge the effectiveness of intervention programs, valid methods and complex measurement tools such as DXA should be used to assess changes in percent body fat in such a heterogeneous population. 相似文献3.
Astrid M. Horstman Karin H. Gerrits Marijke J. Beltman Peter A. Koppe Thomas W. Janssen Arnold de Haan 《Archives of physical medicine and rehabilitation》2010,91(1):123-128
Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen, TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke.
Objective
To characterize muscle properties of paretic lower-limb (PL) and nonparetic lower-limb (NL) knee extensors in patients with subacute stroke.Design
Case-control study.Setting
Rehabilitation center research laboratory.Participants
Patients with subacute stroke (n=14) and able-bodied age-matched control subjects (n=12).Interventions
Not applicable.Main Outcome Measures
Half relaxation times (HRTs) and maximal rates of torque development (MRTDs) were assessed as indicators of contractile speed using both voluntary and electrically evoked contractions. Moreover, changes in torque were measured during a fatigue protocol (35 electrically evoked intermittent contractions; 1.5s on, 2s off) and recovery.Results
No differences among groups were found for normalized MRTDs during electrically evoked contractions (P=.117). However, during voluntary contractions both PLs (53% of control, P=.022) and NL (71% of control, P<.001) had significantly lower MRTD compared with control. Both PL (134% of control, P=.001) and NL (123% of control, P=.032) had significantly higher HRTs than control, indicating muscle slowing in patients with subacute stroke. PLs fatigued more and faster than control (P=.011) and both PL and NL recovered slower (P<.001).Conclusions
The changes in HRTs and fatigue suggest adaptations in muscle properties toward slower, more fatigable muscle shortly after stroke. The inability to make use of contractile speed because of impaired neural activation seems the most limiting factor during the initial phase of torque development in PL. Thus, besides strengthening, muscle endurance and speed should also be addressed during rehabilitation. 相似文献4.
Bell DR, Padua DA, Clark MA. Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement.
Objective
To determine differences in strength and range of motion (ROM) between participants who exhibit medial knee displacement (MKD) during a squat that is corrected by a heel lift and those who do not.Design
Case control.Setting
Sports medicine research laboratory.Participants
Thirty-seven healthy subjects (control, 19; MKD, 18) with no lower-extremity injury in the past 6 months volunteered to participate.Interventions
Not applicable.Main Outcome Measures
Peak force was measured in newtons using a hand-held dynamometer and passive ROM was measured in degrees with a goniometer. Separate multivariate analyses of variance were used to determine differences in strength and ROM between groups. Post hoc testing was used to elucidate differences between groups.Results
The MKD group had the following: greater hip external rotation strength (P=.03), increased hip extension strength (P=.01), less plantarflexion strength (P=.007), and increased hip external rotation ROM (P=.008).Conclusions
The MKD group exhibited tight and weak ankle musculature. Interventions focusing on improving strength and ROM of the ankle may improve kinematics during a squat. 相似文献5.
Sze PC Cheung WH Lam PS Lo HS Leung KS Chan T 《Archives of physical medicine and rehabilitation》2008,89(7):1329-1334
Sze P-C, Cheung W-H, Lam P-S, Lo HS-D, Leung K-S, Chan T. The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program.
Objective
To investigate the efficacy of a falls prevention clinic and a community step-down program in reducing the number of falls among community-dwelling elderly at high risk of fall.Design
Prospective cohort.Setting
Community.Participants
Community-dwelling elderly (N=200) were screened for risk of fall; 60 were identified as being at high risk and were referred to the intervention program.Intervention
Twelve sessions of a once-a-week falls prevention clinic, including fall evaluation, balance training, home hazard management program, and medical referrals, were provided in the first 3 months. The community step-down program, including falls prevention education, a weekly exercise class, and 2 home visitations, was provided in the following 9 months.Main Outcome Measures
Fall rate, injurious fall, and its associated medical consultation were recorded during the intervention period and the year before intervention. Balance tests included the Berg Balance Scale (BBS), Sensory Organization Test, and limits of stability test; fear of falling, as evaluated using the Activities-specific Balance Confidence (ABC) scale, was measured at baseline and after the training in the falls prevention clinic.Results
Significant reductions in fall rate (74%), injurious falls (43%), and fall-associated medical consultation (47%) were noted. Significant improvement in balance scores (BBS, P<.001; endpoint excursion in limits of stability test, P=.004) and fear of falling (ABC scale, P=.001) was shown.Conclusions
The programs in the falls prevention clinic were effective in reducing the number of falls and injurious falls. The community step-down programs were crucial in maintaining the intervention effects of the falls prevention clinic. 相似文献6.
7.
Brian C. Clark Todd M. Manini Richard L. Hoffman David W. Russ 《Archives of physical medicine and rehabilitation》2009,90(1):178-180
Clark BC, Manini TM, Hoffman RL, Russ DW. Restoration of voluntary muscle strength after 3 weeks of cast immobilization is suppressed in women compared with men.
Objective
To investigate sex-related differences in the loss and recovery of voluntary muscle strength after immobilization.Design
Longitudinal, repeated measures.Setting
Research laboratory.Participants
Healthy men (n=5) and healthy women (n=5).Intervention
Three weeks of forearm immobilization.Main Outcome Measures
Voluntary wrist flexion muscle strength was assessed at baseline and weekly during the immobilization protocol and 1 week after cast removal. Central activation was assessed before and after immobilization and after 1 week of recovery to determine what percentage of the muscle could be activated voluntarily.Results
Men and women lost voluntary strength at a similar rate during immobilization. However, after 1 week of recovery voluntary strength had returned to within 1% of baseline in the men, but remained approximately 30% less than baseline in the women (P=0.03). Both sexes displayed reduced central activation after immobilization (P=0.02), but the decrease was similar in both sexes (P=0.82).Conclusions
These findings suggest sex-dependent adaptations to and recovery from limb immobilization, with voluntary strength recovering slower in women. As such, sex-specific rehabilitation protocols may be warranted, with women requiring additional or more intensive rehabilitation programs after periods of disuse. Future work is needed to determine the extent and mechanisms of these differences. 相似文献8.
James S. Krause Karla S. Reed John J. McArdle 《Archives of physical medicine and rehabilitation》2010,91(8):1218-1224
Krause JS, Reed KS, McArdle JJ. Factor structure and predictive validity of somatic and nonsomatic symptoms from the Patient Health Questionnaire-9: a longitudinal study after spinal cord injury.
Objective
To investigate the factor structure and predictive validity of somatic and nonsomatic depressive symptoms over the first 2.5 years after spinal cord injury (SCI) using the Patient Health Questionnaire-9 (PHQ-9).Design
Somatic and nonsomatic symptoms were assessed at baseline during inpatient hospitalization (average of 50 days after onset) and during 2 follow-ups (average of 498 and 874 days after onset).Setting
Data were collected at a specialty hospital in the Southeastern United States and analyzed at a medical university. We performed time-lag regression between inpatient baseline and follow-up somatic and nonsomatic latent factors of the PHQ-9.Participants
Adults with traumatic SCI (N=584) entered the study during inpatient rehabilitation.Interventions
Not applicable.Main Outcome Measure
PHQ-9, a 9-item measure of depressive symptoms.Results
The inpatient baseline nonsomatic latent factor was significantly predictive of the nonsomatic (r=.40; P=.000) and somatic latent factors at the second follow-up (r=.29; P=.006), whereas the somatic factor at inpatient baseline did not significantly predict either factor. In contrast, when regressing latent factors between the 2 follow-ups, the nonsomatic factor predicted only the nonsomatic factor (r=.66; P=.002), and the somatic factor predicted only future somatic symptoms (r=.66; P=.000). In addition, the factor structure was not stable over time. Item analysis verified the instability of somatic items between inpatient baseline and follow-up and also indicated that self-harm at inpatient baseline was highly predictive of future self-harm.Conclusions
Nonsomatic symptoms are better predictors of future depressive symptoms when first assessed during inpatient rehabilitation, whereas somatic symptoms become stable predictors only after inpatient rehabilitation. Self-harm (suicidal ideation) is the most stable symptom over time. Clinicians should routinely assess for suicidal ideation and use nonsomatic symptoms when performing assessments during inpatient rehabilitation. 相似文献9.
Jungyoup Lee Kyuseok Kim Christopher C. Lee Yeoun Woo Nam Jin Hee Lee Joong Eui Rhee Adam J. Singer Kyung Su Kim Youngsun Ro 《The American journal of emergency medicine》2011,29(8):849-854
Objectives
Diltiazem is one of the most commonly used medications to control the rapid ventricular response in atrial fibrillation (AF). The recommended starting dose is an intravenous bolus of 0.25 mg/kg over 2 minutes. To avoid hypotension, we have empirically used a lower dose of diltiazem. We compared the efficacy and safety of different doses of diltiazem in rapid AF.Methods
A retrospective chart review was undertaken in patients who presented to the emergency department with rapid AF. Patients were divided into 3 groups according to diltiazem dosage: low dose (≤0.2 mg/kg), standard dose (>0.2 and ≤0.3 mg/kg), and high dose (>0.3 mg/kg). We compared the rates of therapeutic response (adequate rate control) and complications (such as hypotension). Multivariate regression analysis was used to determine the effect of diltiazem dose on the occurrence of complications.Results
A total of 180 patients were included in the analysis. There were no significant differences in the rates of therapeutic response for the low-, standard-, and high-dose groups (70.5%, 77.1%, and 77.8%; P = .605). The rates of hypotension in the low-, standard-, and high-dose groups were 18%, 34.9%, and 41.7%, respectively. After adjusting confounding variables, the rate of hypotension was significantly lower in the low-dose group in comparison with the standard-dose group (adjusted odds ratio, 0.39; 95% confidence interval, 0.16-0.94).Conclusions
Low-dose diltiazem might be as effective as the standard dose in controlling rapid AF and reduce the risk of hypotension. 相似文献10.
11.
Spinal Epidural Abscess: A 5-Year Case-Controlled Review of Neurologic Outcomes After Rehabilitation
David W. Koo Andrea F. Townson Marcel F. Dvorak Charles G. Fisher 《Archives of physical medicine and rehabilitation》2009,90(3):512-516
Koo DW, Townson AF, Dvorak MF, Fisher CG. Spinal epidural abscess: a 5-year case-controlled review of neurologic outcomes after rehabilitation.
Objective
To describe the neurologic outcomes of 29 spinal epidural abscess (SEA) patients after rehabilitation compared with a case-controlled traumatic spinal cord injury (TSCI) cohort.Design
Five-year retrospective chart review.Setting
University-affiliated surgical spine unit and inpatient rehabilitation program.Participants
Patients (n=29; 19 men, 10 women) requiring inpatient rehabilitation after SEA and TSCI case controls (n=29) matched by level of injury, American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor score (AMS), sex, and age.Main Outcome Measure
The primary outcome was a change in AMS from acute admission to discharge from inpatient rehabilitation.Results
Despite having lower admission motor scores, there was a significant trend toward greater neurologic recovery in the SEA group (P=.047). In contrast to what is known regarding recovery from complete TSCI, this study shows potential for dramatic recovery in SEA subjects presenting with AIS grade A deficit with a 73% conversion rate to incomplete status; out of 11 SEA subjects with initial AIS grade A, 2 improved to AIS grade B, 1 to AIS grade C, and 5 to AIS grade D.Conclusions
This study shows the potential for a significant improvement in neurologic deficits related to SEA. Based on the results of our study, it is clearly inappropriate to generalize recovery patterns seen in the TSCI patient population to SEA-associated myelopathy because the latter appears to have more favorable outcomes. 相似文献12.
13.
Epidemiology and patient outcome after medical emergency team calls triggered by atrial fibrillation
Introduction
Atrial fibrillation (AF) in hospitalized patients may lead to activation of the medical emergency team (MET). We sought to assess the baseline characteristics and outcomes of the patients presenting AF as a cause of MET call activation.Methods
Using a prospectively constructed MET database, we retrospectively reviewed all patients with AF as a trigger for MET activation between August 2005 and April 2010. Demographics, principal diagnostic and outcome of these patients were compared with those of a control group of patients matched for age, sex and ward of origin, randomly selected from the database.Results
We studied 5431 MET calls of which 557 (10.3%), in 458 patients were triggered by AF. Mean age for AF patients was 74.8 years, 230 (50.2%) were female and 271 (59.1%) were in a surgical ward. 92 (20.1%) AF patients died in hospital compared with 131 (28.6%) in the control group. Among the 336 patients without limitations of medical therapy (LOMT), 46 (13.7%) died in hospital. In total, 46 (13.7%) patients were transferred to a higher level care ward while 290 (86.3%) remained on the ward. Only 2 (4.3%) of these patients died compared with 44 (15.2%) among those who remained in the general ward (p = 0.03).Conclusions
In our hospital, AF triggers one tenth of MET activations and mortality associated with it is high even when issues of LOMT are excluded. The decreased mortality among patients admitted to a higher level ward suggests that some of these deaths may be avoidable. 相似文献14.
Martin W. Stenekes Jan H. Geertzen Jean-Philippe A. Nicolai Bauke M. De Jong Theo Mulder 《Archives of physical medicine and rehabilitation》2009,90(4):553-15
Stenekes MW, Geertzen JH, Nicolai J-P, De Jong BM, Mulder T. Effects of motor imagery on hand function during immobilization after flexor tendon repair.
Objective
To determine whether motor imagery during the immobilization period after flexor tendon injury results in a faster recovery of central mechanisms of hand function.Design
Randomized controlled trial.Setting
Tertiary referral hospital.Participants
Patients (N=28) after surgical flexor tendon repair were assigned to either an intervention group or a control group.Intervention
Kinesthetic motor imagery of finger flexion movements during the postoperative dynamic splinting period.Main Outcome Measures
The central aspects of hand function were measured with a preparation time test of finger flexion in which subjects pressed buttons as fast as possible following a visual stimulus. Additionally, the following hand function modalities were recorded: Michigan Hand Questionnaire, visual analog scale for hand function, kinematic analysis of drawing, active total motion, and strength.Results
After the immobilization period, the motor imagery group demonstrated significantly less increase of preparation time than the control group (P=.024). There was no significant influence of motor imagery on the other tested hand function (P>.05). All tests except kinematic analysis (P=.570) showed a significant improvement across time after the splinting period (P≤.001).Conclusions
Motor imagery significantly improves central aspects of hand function, namely movement preparation time, while other modalities of hand function appear to be unaffected. 相似文献15.
Cheryl Soo Robyn L. Tate Vanessa Aird Jeanine Allaous Stuart Browne Belinda Carr Carissa Coulston Louise Diffley Joseph Gurka Jill Hummell 《Archives of physical medicine and rehabilitation》2010,91(6):905-912
So C, Tate RL, Aird V, Allaous J, Browne S, Carr B, Coulston C, Diffley L, Gurka J, Hummell J. Validity and responsiveness of the Care and Needs Scale for assessing support needs after traumatic brain injury.
Objective
To investigate the validity and responsiveness of the Care and Needs Scale (CANS), which was designed to assess support needs of people with traumatic brain injury (TBI).Design
Two samples of community clients (n=38, n=30) were recruited to examine concurrent, convergent/divergent, and discriminant validity. The ability of the CANS to detect change over a 6-month period from the time of inpatient rehabilitation discharge (predictive validity and responsiveness) was investigated in a third sample of 40 rehabilitation inpatients.Setting
Two Brain Injury Rehabilitation Units in Sydney, Australia.Participants
People (N=108) aged between 16 and 70 years admitted for rehabilitation after TBI.Interventions
Not applicable.Main Outcome Measures
The CANS, Supervision Rating Scale, FIM, Sydney Psychosocial Reintegration Scale, and Disability Rating Scale.Results
Evidence for concurrent validity was shown with fair to moderate correlation coefficients between the CANS and measures of supervision, functional independence, and psychosocial functioning (absolute value, rs=.43-.68; P<.01). Support for convergent and divergent validity was provided by correlation coefficients that were higher for measures tapping similar constructs (absolute value, rs=46; P<.01) but lower for measures of dissimilar constructs (absolute value, rs=.07-.26; not significant). In addition, the CANS discriminated between levels of injury severity, functional independence, and overall functioning (P<.01). In terms of predictive validity and responsiveness, CANS scores at inpatient rehabilitation discharge predicted the participant's functioning 6 months later.Conclusions
These results show the CANS is a valid and responsive tool and, together with its previously shown reliability, is suitable for routine application in clinical and research practice. 相似文献16.
Outpatient rehabilitation in patients with coronary artery and peripheral arterial occlusive disease
Jeger RV Rickenbacher P Pfisterer ME Hoffmann A 《Archives of physical medicine and rehabilitation》2008,89(4):618-621
Jeger RV, Rickenbacher P, Pfisterer ME, Hoffmann A. Outpatient rehabilitation in patients with coronary artery and peripheral arterial occlusive disease.
Objective
To assess participation rates and outcome in outpatient cardiac rehabilitation (OCR) of patients with peripheral arterial occlusive disease (PAOD).Design
Prospective cohort study.Setting
Referral center, ambulatory care.Participants
All patients undergoing OCR at 2 university hospitals in Switzerland from March 1999 to August 2005.Intervention
OCR during 3 months.Main Outcome Measures
Primary endpoints were workload during bicycle stress test and quality of life (QOL), both at the end of OCR. Secondary endpoints were complications during OCR and termination of OCR.Results
Of 1508 patients, 99 (7%) had PAOD (27 with Fontaine stage I, 69 with stage II, 3 with stage III). Patients with PAOD were older, had more cardiovascular risk factors, and were more likely to have undergone cardiac bypass grafting than those without PAOD. PAOD patients at OCR entry achieved a lower exercise workload than non-PAOD patients (PAOD patients, 105±31W and 69%±17% of target vs non-PAOD patients, 125±38W and 79%±19%; P<.001) but both groups achieved similar gains in exercise capacity at the end of OCR (PAOD patients, 126±44W and 82%±25% vs non-PAOD patients, 153±48W and 98%±24%; P<.001). For both groups, QOL was similar at baseline and follow-up, and improved equally in most dimensions. OCR was discontinued more often in patients with PAOD than in those without (18% vs 10%, P=.018). Cardiac and noncardiac complication rates were similar.Conclusions
Patients with PAOD undergoing OCR have a similar benefit but higher dropout rates than other patients. Thus, PAOD patients should be encouraged to participate in OCR, possibly by creating specifically tailored concepts. 相似文献17.
Liu J Drutz C Kumar R McVicar L Weinberger R Brooks D Salbach NM 《Archives of physical medicine and rehabilitation》2008,89(9):1686-1692
Liu J, Drutz C, Kumar R, McVicar L, Weinberger R, Brooks D, Salbach NM. Use of the six-minute walk test poststroke: is there a practice effect?
Objectives
To determine whether a practice effect occurs across 2 trials of the six-minute walk test (6MWT) among community-dwelling people within 1 year poststroke and to identify characteristics distinguishing people who show a practice effect from those who do not.Design
Secondary analysis of scores on 2 trials of the 6MWT administered approximately 30 minutes apart at baseline in a randomized controlled trial.Setting
General community.Participants
People (N=91) living in the community with a residual walking deficit within the first year of a first or recurrent stroke.Interventions
Not applicable.Main Outcome Measure
Distance walked on the 6MWT.Results
Mean 6MWT scores ± SD for trials 1 and 2 were 196±119m and 197±126m, respectively (n=83). The mean difference in 6MWT performance across trials was 0±35m (95% confidence interval [CI], -7 to 8m). The Pearson correlation coefficient between 6MWT distances was .96 (P<.001), and the intraclass correlation coefficient was .98 (95% CI, .97-.99). The Bland-Altman plot showed no clear pattern. Participants whose improvement was equal to or greater than the minimal detectable change of 29m between trials (14%) did not significantly differ from those in the rest of the study sample; however, they tended to be younger (P=.05) and more likely to have a mild or moderate gait deficit (P=.06).Conclusions
Findings do not support a practice effect across 2 trials of the 6MWT in individuals within 1 year poststroke. Thus, a practice walk does not appear necessary. Further research is recommended to evaluate the influence of young age, acute stroke, and mild-to-moderate gait deficit on practice effects. 相似文献18.
Bouwsema H van der Sluis CK Bongers RM 《Archives of physical medicine and rehabilitation》2008,89(9):1759-1764
Bouwsema H, van der Sluis CK, Bongers RM. The role of order of practice in learning to handle an upper-limb prosthesis.
Objective
To determine which order of presentation of practice tasks had the highest effect on using an upper-limb prosthetic simulator.Design
A cohort analytic study.Setting
University laboratory.Participants
Healthy, able-bodied participants (N=72) randomly assigned to 1 of 8 groups, each composed of 9 men and 9 women.Interventions
Participants (n=36) used a myoelectric simulator, and participants (n=36) used a body-powered simulator. On day 1, participants performed 3 tasks in the acquisition phase. On day 2, participants performed a retention test and a transfer test. For each simulator, there were 4 groups of participants: group 1 practiced random and was tested random, group 2 practiced random and was tested blocked, group 3 practiced blocked and was tested random, and group 4 practiced blocked and was tested blocked.Main Outcome Measures
Initiation time, the time from the starting signal until the beginning of the movement, and movement time, the time from the beginning until the end of the movement.Results
Movement times got faster during acquisition (P<.001). The blocked group had faster movement times (P=.009), and learning in this group extended over the complete acquisition phase (P<.001). However, this advantage disappeared in the retention and transfer tests. Compared with a myoelectric simulator, movements with the body-powered simulator were faster in acquisition (P=.004) and transfer test (P=.034).Conclusions
Performance in daily life with a prosthesis is indifferent to the structure in which the training is set up. However, practicing in a blocked fashion leads to faster performance; in novice trainees, it might be suggested to practice part of the training tasks in blocks. 相似文献19.
Bradley G. Impink Michael L. Boninger Heather Walker Jennifer L. Collinger Christian Niyonkuru 《Archives of physical medicine and rehabilitation》2009,90(9):1489-1494
Impink BG, Boninger ML, Walker H, Collinger JL, Niyonkuru C. Ultrasonographic median nerve changes after a wheelchair sporting event.
Objectives
To investigate the acute median nerve response to intense wheelchair propulsion by using ultrasonography and to examine the relationship between carpal tunnel syndrome (CTS) signs and symptoms and the acute median nerve response.Design
Case series.Setting
Research room at the National Veterans Wheelchair Games.Participants
Manual wheelchair users (N=28) competing in wheelchair basketball.Intervention
Ultrasound images collected before and after a wheelchair basketball game.Main Outcome Measures
Median nerve cross-sectional area, flattening ratio, and swelling ratio and changes in these after activity. Comparison of median nerve characteristics and patient characteristics between participants with and without positive physical examination findings and with and without symptoms of CTS.Results
Significant changes in median nerve ultrasound characteristics were noted after activity. The group as a whole showed a significant decrease in cross-sectional area at the radius of 4.05% (P=.023). Participants with positive physical examinations showed significantly different (P=.029) and opposite changes in swelling ratio compared with the normal group. Subjects with CTS symptoms had a significantly (P=.022) greater duration of wheelchair use (17.1y) compared with the asymptomatic participants (9y).Conclusions
Manual wheelchair propulsion induces acute changes in median nerve characteristics that can be visualized by using ultrasound. Studying the acute median nerve response may be useful for optimizing various interventions, such as wheelchair set up or propulsion training, to decrease both acute and chronic median nerve damage and the likelihood of developing CTS. 相似文献20.
Mark A. Slater Anne L. Weickgenant Melanie A. Greenberg Dennis R. Wahlgren Rebecca A. Williams Christian Carter Thomas L. Patterson Igor Grant Steven R. Garfin John S. Webster J. Hampton Atkinson 《Archives of physical medicine and rehabilitation》2009,90(4):545-552
Slater MA, Weickgenant AL, Greenberg MA, Wahlgren DR, Williams RA, Carter C, Patterson TL, Grant I, Garfin SR, Webster JS, Atkinson JH. Preventing progression to chronicity in first onset, subacute low back pain: an exploratory study.