Prognostic value of triple phase bone scanning for reflex sympathetic dystrophy in hemiplegia.

Twenty-two patients with cerebral vascular accident (CVA), clinically confirmed by head computed tomography, were observed for symptoms of the reflex sympathetic dystrophy syndrome (RSDS). All patients received triple phase bone scans; 16 scans were positive for RSDS. Patients with negative scans had no symptoms of RSDS. Five patients with positive scans had RSDS symptoms at the time of bone scanning. Seven of 11 patients with positive scans but no symptoms of RSDS at the time of bone scan developed symptoms of RSDS within six months. We found a significant relationship between positive bone scans and the subsequent development of RSDS (p < 0.01). Considering only those patients who were asymptomatic for RSDS at the time of bone scanning, we found bone scanning to be a good predictor for the future development of clinical RSDS. We found the correlation between positive bone scans and the subsequent development of clinical RSDS in previously asymptomatic individuals to be statistically significant (p < 0.05). We conclude that bone scans may be a good predictor of patients at risk for developing clinical RSDS after CVA.

Methods of gait evaluation.

On overview is given of the range of methods for gait evaluation, describing briefly their individual potential and limitations. Included are a brief historical section, as well as the most recent, and highly sophisticated, systems; future research and development needs, not least with regard to practical feasibility, are pointed out.

Low-back pain in pregnancy.

Two hundred women were interviewed within 24-36 hours after giving birth. The patients were not examined. It was found that 56% of the patients suffered from low-back pain during pregnancy. The percentage of Caucasians was statistically higher in the back pain group. The percentage of Hispanics was statistically higher in the no pain group. Among the variables that were compared in both groups were the age, the weight gained by the mothers during pregnancy, the baby's weight, the number of previous pregnancies, number of prior children. None of the variables reached a statistically significant level. The pain group complained of pain the low-back area, which radiated in 45.5% of cases to the lower extremities. In about one-third of the patients the pain increased as the day wore on, whereas in another one-third the pain increased during the night and disturbed sleep. Standing, sitting, forward bending, lifting, and walking tended to increase the pain. Most of the patients started suffering from back pain between the fifth and seventh months of pregnancy. Several theories to explain the occurrence of backache during pregnancy are discussed.

Acquired amputation and prostheses before the sixteenth century.

Amputation has been practiced at least since 43,000 B.C.E. for ritualistic, punitive, curative, or vocational reasons. Fitting with prostheses has been done since at least 1,500 B.C.E. Anesthetics were used, but which ones is not known. Analgesics such as salicylates in plants, narcotics such as cocaine and opium, and soporifics such as alcohol and peyote were common. Amputation was done with knives, axes, and saws. Control of bleeding was by ligature, cautery, bandaging pressure, and plant and animal products. Suture was with cotton or human hair, acacia and other thorns, ant jaws, and sinew, with or without a drain. Prostheses were made of fiber, wood, bone, and metals, often lined with rags.

Carpal tunnel syndrome: median nerve stress test.

The purpose of this study was to determine the effect of wrist position on distal sensory and motor latencies of the median nerve. An orthosis was devised to maintain the wrist either in extension or in flexion while measuring these latencies. Fourteen patients with presumptive carpal tunnel syndrome (CTS) and 12 control subjects were evaluated following extension or flexion of the wrist for 5 and 10 minutes. Results showed an increase in distal latencies for both groups; the highest increment was found among CTS patients following 5 minutes of wrist flexion. Since it is not uncommon for patients to present with classical CTS symptoms but without electrodiagnostic findings in support of such diagnosis, it is suggested that such patients be reevaluated after 5 minutes of wrist flexion (median nerve stress) test.

Hemicorporectomy for functional rehabilitation.

Hemicorporectomy is usually performed as a last resort for life-threatening diseases. A case is reported in which this deforming traumatic procedure was performed in a 66-year-old man for functional and rehabilitation reasons rather than life-saving indications. The indications for the procedure, the patient's decision-making, the preoperative preparation of the patient, both physically and psychologically, the preparation of the family and the rehabilitation procedures are summarized.

EMG feedback therapy: review of treatment of 114 patients.

Advances in the understanding of the relationship of proprioceptive (kinesthetic) feedback to motor physiology have prompted the study of therapeutic effects of audiovisual displays of EMG activity. Patients with various manifestations of disturbed neuromotor control were studied prospectively for three years. This group included 114 patients with hemiparesis, torticollis, dystonia, and spinal cord or peripheral nerve injury. Initially, all but one of these patients had some residual volitional motor activity, which was insufficient for adequate function, and all patients had had conventional therapy with little or no functional recovery. Prior to EMG feedback therapy, the duration of illness was from three months to 35 years. The shaping of a patient's motor responses usually occurred gradually, often over an 8 to 12 week period. This modification was accomplished by feeding processed audio-visual signals back to the patient. These signals were proportional to the degree of activity of the muscles responsible for the defective function. The concept of microvolt-second, as a unit of muscle activity, is introduced and defined. Patterned movements, which were previously defective were observed to improve to varying degrees. Following the initial course of treatment, reinforcement was required by some patients. The mechanisms of improvement after EMG feeback therapy are not well understood; however, some hypotheses are presented. The results of this study indicate that EMG feedback therapy may induce significant functional recovery in patients with disturbed neuromotor control.