Author: easystandleader

Posted on by — Leave a comment

Pressure sore prevention for the wheelchair-bound spinal injury patient.

date: 12/18/1980
author: Ferguson-Pell MW, Wilkie IC, Reswick JB, Barbenel JC.
publication: Paraplegia. 1980 Feb;18(1):42-51.
pubmed_ID: 7375126

The concept of a wheelchair cushion fitting clinic for the prevention of pressure sores is reviewed in the light of recent estimates of the cost of pressure sores in the U.K. A method for measuring the pressure beneath the ischial tuberosities is discussed and techniques for measuring a patient’s habitual exercise frequency and seated posture are described. Results from the records of 600 spinal injury patients including Rancho Los Amigos Hospital are reported and used to demonstrate the importance of low pressure beneath the ischial tuberosities as an indicator of wheelchair cushion suitability.

Posted on by — Leave a comment

Pressure ulcers in veterans with spinal cord injury: a retrospective study.

date: 10/01/2003
author: Garber SL, Rintala DH.
publication: J Rehabil Res Dev. 2003 Sep-Oct;40(5):433-41.
pubmed_ID: 15080228

Pressure ulcers are a major complication of spinal cord injury (SCI) and have a significant effect on general health and quality of life. The objectives of this retrospective chart review were to determine prevalence, duration, and severity of pressure ulcers in veterans with SCI and to identify predictors of (1) outcome in terms of healing without surgery, not healing, or referral for surgery; (2) number of visits veterans made to the SCI outpatient clinic or received from home care services for pressure ulcer treatment; and (3) number of hospital admissions and days hospitalized for pressure ulcer treatment. From a sampling frame of 553 veterans on the Houston Veterans Affairs Medical Center SCI roster, 215 (39%) were reported to have visited the clinic or received home care for pressure ulcers (ICD-9 code 707.0 = decubitus, any site) during the 3 years studied (1997, 1998, and 1999). From this sample, 102 veterans met the inclusion criteria for further analyses, 56% of whom had paraplegia. The duration of ulcers varied greatly from 1 week to the entire 3-year time-frame. Overall, Stage IV pressure ulcers were the most prevalent as the worst ulcer documented. Number and severity of ulcers predicted outcome and healthcare utilization. This study illustrates the magnitude of the pressure ulcer problem among veterans with SCI living in the community. Reducing the prevalence of pressure ulcers among veterans with SCI will have a significant impact on the Department of Veterans Affairs’ financial and social resources. Innovative approaches are needed to reduce pressure ulcer risk in veterans with SCI.

Posted on by — Leave a comment

Lower extremity functional neuromuscular stimulation in cases of spinal cord injury.

date: 07/15/1984
author: Cybulski GR, Penn RD, Jaeger RJ.
publication: Neurosurgery. 1984 Jul;15(1):132-46.
pubmed_ID: 6382044
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/6382044
Functional neuromuscular stimulation (FNS) provides a mechanism for the activation of muscles paralyzed by injury to the spinal cord. Although this technique was first used to treat patients with spinal cord injury over 20 years ago, only recent advances in electronics and biomechanics have made it a promising aid for the rehabilitation of these patients. Thus far, restoration of palmar prehension and lateral prehension in quadriplegics and of standing and biped gait in paraplegics has been achieved under carefully controlled laboratory conditions. This article reviews the current status of FNS and its potential as a practical tool to aid spinal cord-injured patients. Neurosurgeons who care for these patients might be expected to be involved in the future use of FNS if implantable systems are developed and tested.

Posted on by — Leave a comment

Estimating the user population of a simple electrical stimulation system for standing.

date: 10/01/1990
author: Jaeger RJ, Yarkony GM, Roth EJ, Lovell L.
publication: Paraplegia. 1990 Oct;28(8):505-11
pubmed_ID: 2263407
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/2263407
Many laboratory demonstrations have been reported on standing or walking with the aid of electrical stimulation. These demonstrations have typically been in small numbers of selected spinal cord injured individuals. The extent to which this technology might ultimately be applicable to the spinal cord injured population at large is not presently known. This study reports estimates of the size of the potential user population of a specific surface electrical stimulation device and protocol. The medical records were reviewed of 192 patients with traumatic thoracic, lumbar, or sacral spinal cord injury resulting in paraplegia. Based on the inclusionary criteria, between 20 and 48 patients (10.4% and 25%) of this sample population could be considered eligible for this surface stimulation protocol. As approximately 45% of the USA population of spinal cord injured individuals have paraplegia, the results suggest that between 4.7% and 11.25% of all spinal cord injured persons in the USA might be potential users of this particular electrical stimulation technology.

Posted on by — Leave a comment

Functional neuromuscular stimulation for standing after spinal cord injury.

date: 03/01/1900
author: Yarkony GM, Jaeger RJ, Roth E, Kralj AR, Quintern J.
publication: Arch Phys Med Rehabil. 1990 Mar;71(3):201-6.
pubmed_ID: 2317138
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/2317138
A study was undertaken to determine if functional neuromuscular stimulation could be used to obtain standing in patients with traumatic spinal cord injury. Twenty-five subjects were selected during the study, and standing was accomplished in 21 using bilateral quadriceps stimulation with the hips in hyperextension. Four subjects elected not to continue participation to the point of standing. Stimulation parameters were 0 to 120V pulse amplitude, frequency 13Hz or 20Hz, and pulse width of 0.4msec. Confirmation of standing with support of 95% of the body weight by the legs was verified by quantitative measurements with a dual-scale force platform or a biomechanics force platform. Subjects initially selected had injury levels between C7 and T11 and ranged in age from 22 to 47 years, with duration of injury from one to 13 years. The subjects had complete lesions, with no active motor function below the last normal level, and absent sensation or partial sparing of sensation with vague perception of pinprick, but no position sense. Six subjects stood at home and 15 stood only in the laboratory. This five-year experience indicates that paraplegic individuals may obtain standing with functional neuromuscular stimulation.

Posted on by — Leave a comment

Long-term followup of renal function after spinal cord injury.

date: 09/01/1985
author: Kuhlemeier KV, Lloyd LK, Stover SL.
publication: J Urol. 1985 Sep;134(3):510-3.
pubmed_ID: 4032551

Effective renal plasma flow was measured in acute spinal cord injury patients for up to 10 years after injury to determine the extent of renal deterioration in these patients and to identify the factors associated with a loss of renal function. The over-all mean decrease in effective renal plasma flow for all patients as a whole was 4.5 ml. per year. Factors associated with a statistically significant reduction in effective renal plasma flow included age, gender, renal calculi, quadriplegia, and a history of chills and fever. Other factors examined but not found to be statistically significant included years since injury, presence of severe decubiti, bladder calculi, bacteriuria and extent of injury. This study suggests that renal function usually can be preserved in spinal cord injury patients if the treatable risk factors are managed properly.

Posted on by — Leave a comment

Cardiorespiratory fitness and muscular strength of wheelchair users.

date: 12/15/1981
author: Davis GM, Kofsky PR, Kelsey JC, Shephard RJ.
publication: Can Med Assoc J. 1981 Dec 15;125(12):1317-23.
pubmed_ID: 6459841

The classification of lower-limb disabilities is commonly based on the site of the spinal cord lesion or the amount of functional muscle. Another important variable in assessing wheelchair users is their ability to carry out the activities of daily living. The cardiorespiratory fitness of those with lower-limb disabilities is usually assessed with arm-ergometry and wheelchair tests, each of which has some advantages. Muscle strength and endurance are also important aspects of the disabled person’s ability to function. Fitness is often poor in the disabled, and normal wheelchair use does not seem to prove an adequate training stimulus. Exercise with an arm ergometer and with pulleys and participation in vigorous wheelchair sports can improve physical condition. Participation in exercise programs should be based on the results of a fitness assessment and on the level of the spinal cord lesion in those with paraplegia. Progression in such programs should be gradual to ensure that the exerciser does not become discouraged and drop out of classes before fitness is increased. Data on wheelchair athletes suggest that, with persistence, many individuals in wheelchairs can adjust relatively well to their disabilities.

Posted on by — Leave a comment

Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury.

date: 11/01/2001
author: Faghri PD, Yount JP, Pesce WJ, Seetharama S, Votto JJ.
publication: Arch Phys Med Rehabil. 2001 Nov;82(11):1587-95
pubmed_ID: 11689980
Outside_URL: http://www.ncbi.nlm.nih.gov/pubmed/11689980
OBJECTIVE: To evaluate the effects of functional electric stimulation (FES) of lower limb muscles during 30 minutes of upright standing on the central and peripheral hemodynamic response in persons with spinal cord injury (SCI). DESIGN: A repeated-measure design. Subjects were used as their own control and underwent 2 testing protocols of FES-augmented standing (active standing) and non-FES standing (passive standing). SETTING: Rehabilitation hospital. PARTICIPANTS: Fourteen individuals with SCI (7 with tetraplegia, 7 with paraplegia). INTERVENTIONS: During active standing, FES was administered to 4 muscle groups of each leg in an overlapping fashion to produce a pumping mechanism during standing. During passive standing, subjects stood for 30 minutes using a standing frame with no FES intervention. MAIN OUTCOME MEASURES: Central hemodynamic responses of stroke volume, cardiac output, heart rate, arterial blood pressure, total peripheral resistance (TPR), and rate pressure product (RPP) were evaluated by impedance cardiography. All measurements were performed during supine and sitting positions before and after standing, and during 30 minutes of upright standing. RESULTS: Comparisons between the groups with paraplegia and tetraplegia showed a significant increase in heart rate in the paraplegics after 30 minutes of active standing. During active standing, paraplegics’ heart rate increased by 18.2% (p = .015); during passive standing, it increased by 6% (p = .041). TPR in the tetraplegics significantly (p = .003) increased by 54% when compared with the paraplegics during passive standing. Overall, the tetraplegic group had a significantly lower systolic blood pressure (p = .013) and mean arterial pressure (p = .048) than the paraplegics during passive standing. These differences were not detected during active standing. When data were pooled from both groups and the overall groups response to active and passive standing were compared, the results showed that cardiac output, stroke volume, and blood pressure significantly decreased (p < .05) during 30 minutes of passive standing, whereas TPR significantly increased (p < .05). All of the hemodynamic variables were maintained during 30 minutes of active standing, and there were increases in RPP and heart rate after 30 minutes of active standing. CONCLUSION: FES of the lower extremity could be used by persons with SCI as an adjunct during standing to prevent orthostatic hypotension and circulatory hypokinesis. This effect may be more beneficial to those with tetraplegia who have a compromised autonomic nervous system and may not be able to adjust their hemodynamics to the change in position. Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Posted on by — Leave a comment

Cardiovascular responses to upright and supine exercise in humans after 6 weeks of head-down tilt (-6 degrees)

date: 11/01/2000
author: Sundblad P, Spaak J, Linnarsson D.
publication: Eur J Appl Physiol. 2000 Nov;83(4 -5):303-9.
pubmed_ID: 11138568

Seven healthy men performed steady-state dynamic leg exercise at 50 W in supine and upright postures, before (control) and repeatedly after 42 days of strict head-down tilt (HDT) (-6 degrees) bedrest. Steady-state heart rate (fc), mean arterial blood pressure, cardiac output (Qc), and stroke volume (SV) were recorded. The following data changed significantly from control values. The fc was elevated in both postures at least until 12 days, but not at 32 days after bedrest. Immediately after HDT, SV and Qc were decreased by 25 (SEM 3)% and 19 (SEM 3)% in supine, and by 33 (SEM 5)% and 20 (SEM 3)% in upright postures, respectively. Within 2 days there was a partial recovery of SV in the upright but not in the supine posture. The SV and Qc during supine exercise remained significantly decreased for at least a month. Submaximal oxygen uptake did not change after HDT. We concluded that the cardiovascular response to exercise after prolonged bedrest was impaired for so long that it suggested that structural cardiac changes had developed during the HDT period.