Physical therapy in the rehabilitation of patients with aerobic infections of the extremities

OBJECTIVE: To evaluate how infection of extremity after war wound influenced the possibilities and immediate effects of a physical therapy. METHODS: The retrospective clinical investigation comparing two groups: group A (n = 86) with infection, group B (n = 87) without infection. Main indicators for possibilities of the physical therapy were the numbers and types of physical procedures used. For the estimation of immediate effects of physical therapy the muscle power and the range of motion were used. RESULTS: The number of daily physical procedures in the group with infection, compared to the group without infection, was significantly lesser ((A: 2.87 +/- 1.73; B: 4.02 +/- 1.73; p < 0.001). The patients with infection were significantly less frequently submitted to thermotherapy, hydrotherapy, interferent current and electrostimulation. Patients with infection, compared to patients without infection, had significantly poorer improvement of amplitude of analyzed movements at the end of treatment (A: 6.66 +/- 7.28 degrees; B: 16.66 +/- 14.79 degrees; p < 0.001). CONCLUSION: The infection of the extremities limited the possibilities and reduced the immediate effects of physical therapy.     

Patient selection for an upper extremity neuroprosthesis in tetraplegic individuals

One hundred and twenty persons with new onset traumatic tetraplegia consecutively admitted to our rehabilitation service were screened for consideration for use of an upper extremity neuroprosthesis. Strict inclusion criteria allowed only for participation of patients with ASIA impairment scale A, B or C injuries at the C5 or C6 level. One hundred and six persons were excluded from participation for the following reasons: five patients died, 27 had central cord syndrome, two had Brown-Sequard syndrome, 12 were injured at too high a level, 42 were injured at too low a level, two were excluded on the basis of motor incompleteness alone, four were excessively denervated, two had limited range of motion, one had overriding medical complications, seven had psychosocial issues making participation impractical, and two elected tendon transfer surgery. In total, 14 patients (representing 11.7% of all tetraplegic individuals and 50% of the C5 or C6 ASIA Impairment Scale A, B or C patients) were found to be candidates for the neuroprosthesis. Given the prevalence of tetraplegia, approximately 12,200 Americans would be candidates for the FES neuroprosthetic hand grasp system under the current research protocols. With both the expansion of current protocols to other diagnostic categories and further research and development, application of this neuroprosthesis to a considerable number of previously excluded subjects will likely be possible.     

Tri-state myoelectric control of bilateral upper extremity neuroprostheses for tetraplegic individuals

For the purpose of bimanual control of tetraplegic hands that have useful movement restored by a neuroprosthetic device, the use of myoelectric signals from bilateral sternoclei-domastoid muscles is proposed. Three state control has been proposed where each sternocleidomastoid controls its ipsilateral hand. Demonstration was made with spinal-cord-injured and nonspinal-cord-injured subjects providing three levels of activation that can be repeatably made with each of these muscles. The agonist and antagonist sternocleidomastoids during this command control were differentiated so that the desired hand will respond to a command. Neither normal head movements nor head position within its comfortable range of motion were shown to interfere with the proposed command. The provision of feedback was shown as important to provide robustness in the operation for the users selection of the right or left hand. The performance of spinal cord injured and noninjured persons using this controller was quantitatively measured through the completion of precision tracking tasks by the manipulation of on-screen virtual hands. All subjects were able to operate the controller with a degree of skill acceptable for completion of functional tasks with bilateral stimulated hand grasps. The sensitivity of the subjects performance to variation in controller parameters was also measured.     

Precision of dual energy x-ray absorptiometry in the upper extremities

Dual energy x-ray absorptiometry (DEXA) has been shown to be a precise method for measuring bone mineral density (BMD) and content (BMC) in lumbar spine and proximal femur, but it has not been widely used in other skeletal sites. The in vivo day-to-day precision of DEXA (Norland XR-26) for seven anatomic sites in the upper extremities was evaluated by twice measuring both the right and left sides in ten subjects. For consistently defined regions-of-interest, the following precision values (coefficient of variation) were obtained for BMD and BMC: 0.8% and 1.0% (proximal humerus); 0.5% and 0.5% (humeral shaft); 0.7% and 0.5% (radial shaft); 1.3% and 1.1% (ulnar shaft); 0.7% and 1.0% (distal radius); 0.7% and 1.2% (distal ulna); 0.4% and 0.6% (hand). The initially observed relative side-to-side differences did not change significantly in the repeated measurements. Our results indicate that DEXA is a precise method for assessment of BMD and BMC also in the upper extremities.     

Effect of smoking on vascular resistance in the upper extremities

311 first-degree relatives of 78 consecutive patients with gastric carcinoma and 386 first-degree relative of control probands computer matched from a large Finnish population were studied by means of biopsies from antrum and the fundus and by functional and immunological methods. Both the A and B type of Strickland the McKay as well as the AB types of Pitchumoni and Glass were discernable in the present series and often accumulated in the same families. Particularly the A type associated with high serum gastrin values and parietal cell antibodies revealed a family accumulation. In general members of the same family tended to behave similarly with regard to morhology, function and immunology of the antro-fundal mucosa. The 386 computer matched controls from the general population were treated by means of mathematical methods derived from stochastic theory. It appeared that on a family level there was clearly discernable a line representin families with predominance of fundal gastritis (A type?) which significantly deviated from the main population. However, no such behavior was found as to the families with predominantly antral gastritis (B type?) which behaved like the population at large.     

Surgical rehabilitation of deafness

The critical effects of pH on the electronic absorption and fluorescence characteristics of the siderophore, pyochelin, are investigated. A single anionic species is shown to be sufficient to explain the data obtained under alkaline conditions. In acidic solutions, several competing ground- and excited-state equilibria are present, which lead to fluorescence emissions from both the protonated form of pyochelin and its phenolate ion. From the spectroscopic data we are also able to show that pyochelin interacts with zinc ions in the ground state via its anionic form, thereby confirming that this siderophore does not bind Fe(III) ions uniquely.     

The rehabilitation of the wounded with combat injuries to the extremities

In the article necessity of organization of system of rehabilitation of the wounds in the limbs is emphasized, its main rules, components, problems and methods are opened. Due to early specialized surgical care in combination to modern conservative grant terms of stationary treatment are much reduced, in 2 times quantity of good remote results is increased, in 3 times number of bad outcomes, in 1.5 time--number of retired, on 15.2%--physical inability are reduced. Ways of further perfection of system of complex rehabilitation treatment are planned.     

Risk factors for deep venous thrombosis of the upper extremities

BACKGROUND: Hypercoagulable states and triggering factors (surgery, trauma, immobilization, pregnancy, and use of oral contraceptives) are associated with an increased risk for deep venous thrombosis of the lower extremities. In contrast, risk factors for deep venous thrombosis of the upper extremities have not been identified. OBJECTIVE: To evaluate the prevalence of hypercoagulable states and triggering factors in patients with primary deep venous thrombosis of the upper extremities. DESIGN: Frequency-matched case-control study. SETTING: Hemophilia and thrombosis center at a university hospital. PATIENTS: 36 patients who had primary deep venous thrombosis of the upper extremities, 121 patients who had primary deep venous thrombosis of the lower extremities, and 108 healthy controls. Patients who had deep venous thrombosis of the lower extremities and study controls were frequency-matched by age, sex, geographic origin, and social status with patients who had deep venous thrombosis of the upper extremities. MEASUREMENTS: Resistance to activated protein C was evaluated by a clotting method based on the activated partial thromboplastin time. If test results were abnormal or borderline, DNA analysis for substitution in coagulation factor V gene was done. Antithrombin, protein C, protein S, antiphospholipid antibodies, and total plasma homocysteine levels were also measured. RESULTS: Prevalences of abnormalities of the natural anticoagulant system (9%) and hyperhomocysteinemia (6%) in patients who had deep venous thrombosis of the upper extremities were similar to prevalences of both factors in controls (6% and 7%, respectively) but lower than in patients who had deep venous thrombosis of the lower extremities (31% and 14%, respectively). Antiphospholipid antibodies were found only in patients who had venous thrombosis of the lower extremities (7%). The overall prevalence of hypercoagulable states in patients who had thrombosis of the upper extremities (15%) was similar to that in controls (12%) but was significantly lower than that in patients who had thrombosis of the lower extremities (56%). A recent history of strenuous exercise of muscles in the affected extremity was the most frequent triggering factor for patients who had deep venous thrombosis in the upper extremities (33%). CONCLUSIONS: This preliminary study indicates that the prevalence of hypercoagulable states is low in patients who have primary deep venous thrombosis of the upper extremities.     

Surgical rehabilitation of stomal disease

The Authors report their experience in the surgical rehabilitation of patients with complicated ileo- or colostomy. Mechanical and psychosocial implications as well as different rehabilitative methods are discussed. The results of a surgical protocol in the treatment of stomal diseases observed in 63 patients are herein reported. In 14 patients the surgical treatment was performed in general anaesthesia, while in 49 local anaesthesia was used. The latter was better tolerated by the patients. In conclusion, surgery should play a major role in this rehabilitation protocol, either in terms of prevention or definitive treatment.     

Variations in the intraoral electromotive force in the electrotherapy of the upper extremities]

We tested the intraoral microwaves under applied electrotherapy in cephalic neuralgia. The tests have been undertaken on 40 patients divided in 4 groups, according to the nature of the metallic components of the prosthetic appliances. There have been withdrawn practical conclusions regarding fixed prosthesis and the use of electrotherapy in the cephalic neuralgia.     

Bioconverter for upper extremity rehabilitation

The bioconverter is a simple instrument which uses the output of the Basmajian-Emory myotrainer to activate electrical devices, such as radios, television, etc. It can be used to assist in training by providing an acceptable and/or pleasurable stimulus (such as a radio) as muscle activation improves. The myotrainer contains adjustable sensitivity circuits, and the bioconverter has a pre-set holding circuit of 2, 4, or 6 seconds duration. A case of a deaf and blind patient is presented where the bioconverter is used to activate other sensory (skin) stimuli rather than audio-visual ones. The bioconverter can also be used in relaxation training. In this mode of operation the controlled equipment is on when no EMG is present and is turned off when too high an EMG level exists.     

Study on the inflation pressure of air tourniquets in surgery of the upper extremities

52 patients were studied under two different inflation pressure so as to find out the proper inflation pressure in the upper extremity operation. Analyzing the hemostasis effect and EMG of the upper extremity under different inflation pressre, it suggested that when the air tourniquet is used in the upper extremity operation the traditionally used pressure (33.3-40.0 kPa) of the air tourniquet should be changed according to the patient's condition. Usually good hemotasis effect could be obtained under the pressure of 4.0-6.6 kPa, which is more than the systolic pressure of the brachial artery.     

Age-associated loss of power and strength in the upper extremities in women and men

Cross-sectional and longitudinal age-associated reductions in power and isometric strength are described for the upper extremities. Over a 25-year period, repeated measures were taken approximately every 2 years from men and women in the Baltimore Longitudinal Study of Aging (BLSA). The longitudinal measures covered an average 9.6 years, range 1-25 years for men and an average 4.6 years, range 1-8 years for women. Strength and power declined beginning by age 40 in both women and men. Thereafter, power declined about 10% more than strength in men, while no significant differences were found in women. Age had a statistically independent influence on strength and power measures after adjusting for gender, height, weight, caloric expenditure, and muscle mass. Twenty-five-year longitudinal analyses in men confirmed the declines observed cross-sectionally, while no changes were observed in women over the 4-5 years of longitudinal data available. Further longitudinal studies are needed to understand the relationships between strength and power losses with age in women. The differences between power and strength changes with age in men argue for the importance of factors other than strength affecting power.     

Blood flow and venous distensibility in the upper and lower extremities of newborn infants

The electrocapacitance plethysmograph was utilized to measure peripheral blood flow and venous distensibility in 17 newborn infants and 20 adults. Measurements were made in the upper and lower extremities in each subject under identical environmental conditions. Blood flow in the forearm and calf were found to be significantly higher in infants than adults. In infants there were no significant differences in the blood flow between the upper and lower extremities. In contrast, in the adults, the blood flow was significantly higher in the upper than in the lower extremities. Similarly, venous distensibility was observed to be higher in infants than in adults. While no significant differences were observed in the venous distensibility between the upper and lower extremities in infants, the venous distensibility was found to be higher in the forearm than in the leg in adults.     

Musculocutaneous neurectomy for spastic elbow flexion in non-functional upper extremities in adults

The charts of twenty-nine patients who had undergone thirty musculocutaneous neurectomies for acquired spasticity of the elbow in a non-functional upper extremity were reviewed. The most common causes of the spasticity were cerebrovascular accident (59 per cent) and head injury (24 per cent). The aims of the operation were to increase the patient's capacity for self-care and to improve ambulation, personal hygiene, and appearance. Patients who had 30-degree flexion contractures preoperatively did not require a cast postoperatively; those who had 30 to 75-degree flexion contractures preoperatively required a cast postoperatively; and patients who had flexion contractures of more than 75 degrees preoperatively required a concomitant release of soft tissue in the elbow and application of a cast postoperatively. One patient who was operated on to improve appearance had no active elbow flexion postoperatively and was regarded as having a poor result. Musculocutaneous neurectomy is a safe, reliable procedure for treating the spastic elbow in the non-functional upper extremity.