RESUMO
STUDY DESIGN: Case report. OBJECTIVES: To describe a case of suprascapular nerve entrapment (SNE) in a patient with a spinal cord injury (SCI) as a cause of shoulder pain. SETTING: Physical Medicine and Rehabilitation Institute, Nancy, France. REPORT: Six months after the occurrence of acute paraplegia T9 ASIA, a 45-year-old man complained of pain in the posterior and lateral areas of the left shoulder. A clinical assessment found an atrophy of the infraspinatus muscle and a muscular weakness during external shoulder rotation. SNE was suggested as a cause of pain and confirmed by nerve conduction recording. Magnetic resonance imaging excluded any compressive cyst. SNE at the spinoglenoid notch, related to upper limb overuse, was suggested. A gluco-corticoid injection in the proximity of the suprascapular nerve eliminated the pain in a few hours. Two months after the injection, the pain had not reappeared, the infraspinatus muscle atrophy was resolved, and supraspinal nerve conduction was normalized. CONCLUSION: Shoulder pain is common in individuals with paraplegia, but this is the first time that SNE has been reported as a cause of pain. This micro-traumatic pathology, well known in athletes, is probably under-diagnosed in patients with SCI who overuse their upper limbs for wheelchair propulsion and body transfers.
Assuntos
Transtornos Traumáticos Cumulativos/fisiopatologia , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Transtornos Traumáticos Cumulativos/tratamento farmacológico , Transtornos Traumáticos Cumulativos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/tratamento farmacológico , Dor de Ombro/etiologia , Traumatismos da Medula Espinal/patologiaRESUMO
OBJECTIVES: Retrospective analysis of the efficiency of a protocol for care of chronic vegetative states (CVS) and minimally conscious state (MCS) in Lorraine. MATERIAL AND METHOD: Two indicators are used: protocol activity (number of patients hospitalized between 1988 and 2006, number of admissions per year, of requests per year, origin of requests, waiting time) and the epidemiological data (age, sex ratio, etiology, length of stay, geographic origin, number of deaths, number of hospital discharges). The number of CVS and MCS and patients having progressed towards arousal is specified as well as the technical procedures (orthopedic surgery, number of tracheotomies). RESULTS: Forty-seven patients (30 males and 17 females) were hospitalized in a 12-bed unit. The number of admissions per year was 2.4, and the annual number of requests varied between five and 15. Hospitalization times ranged from six to 18 months. The average length of hospitalization was 41 months. Eighty-eight percent of the cases were residents of Lorraine. The etiology was traumatic (53%), vascular (38% including 12% anoxia), miscellaneous (9%). Fifteen percent rate of return to arousal (average time period: 28.41 months, traumatic etiology) with hospital discharge in four cases. CONCLUSION: The protocol is managed as part of a local scheme and enables an appropriate response to a specific clinical profile by providing up-to-date multidiscipline follow-up care and a rapid solution should intercurrent events occur (signs of arousal, orthopedic deterioration, change of environment). Typical limitations are geographical remoteness and difficulties with family support care.
Assuntos
Protocolos Clínicos , Assistência de Longa Duração , Estado Vegetativo Persistente/terapia , Atividades Cotidianas , Adulto , Nível de Alerta , Dano Encefálico Crônico/reabilitação , Feminino , França/epidemiologia , Humanos , Transtornos da Linguagem/etiologia , Transtornos da Linguagem/reabilitação , Expectativa de Vida , Assistência de Longa Duração/métodos , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Equipe de Assistência ao Paciente , Estado Vegetativo Persistente/diagnóstico , Estado Vegetativo Persistente/epidemiologia , Estado Vegetativo Persistente/reabilitação , Autonomia Pessoal , Recuperação de Função Fisiológica , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: Relationships between the vestibular system and the body schema have been suggested but never demonstrated in amputees. We studied the effects of vestibular stimulation on body representation in amputees focusing on the phantom limb phenomenon. METHOD: Prospective study in 31 amputated subjects of one or several limbs before the age of 16 years. The amputees underwent a caloric vestibular stimulation test, ipsilateral (n = 31) and contralateral (n = 8) to the side of amputation. Amputees were asked to report their perceptions spontaneously and to answer open questions. Four types of perceptions were analyzed: normal phantom, deformed phantom, painful phantom, and no phantom, before, during, and after the vestibular stimulation test. Data were compared between the two groups for pre- and post-test perceptions (chi2 test). RESULTS: Vestibular caloric stimulation provoked temporary perception of a normal phantom limb in 16 of 17 amputees who previously did not experience phantoms. For 12 of 12 amputees who currently experienced deformed or painful phantom limbs, caloric stimulation led to temporary replacement of the abnormal phantom with a non-painful normal phantom. CONCLUSIONS: The phenomena observed: 1) throw light on assumed mechanisms controlling construction of static and dynamic engrams used to produce the body schema; 2) complete the neuromatrix theory proposed to explain the phantom limb phenomenon; and 3) suggest that the vestibular system triggers the procedure of reconstruction of the global body schema.
Assuntos
Amputados , Testes Calóricos/efeitos adversos , Membro Fantasma/etiologia , Testes de Função Vestibular , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Membro Fantasma/diagnóstico , Estudos Prospectivos , Fatores de TempoRESUMO
OBJECTIVE: To estimate the benefit brought by an early surgery management of pelvis region pressure ulcers compared to medical processing in a population of subjects spinal cord disabled. MATERIAL AND METHOD: The studied population consist of 53 patients (62 pressure ulcers) divided into two groups: the group 1 includes 30 patients (34 pressure ulcers) presenting pressure ulcers stage III or IV (NPUAP scale) with early surgery management, included consecutively during a period of 2 years; the group 2 includes 23 patients (28 escarres) included in a retrospective way, with medical processing by the same team of care. The criteria of judgment are the delay of healing and the delay of delivery of the station sat in the armchair. RESULTS: In the group 1, the average delay of healing is of 42 days and the average delay of delivery for the armchair of 39 days. In the group 2 healing can be obtained only in 13 cases and in an average delay of 180 days. Differences are significant (p < 0.05). DISCUSSION - CONCLUSION: The originality of this study results in the comparison of two processing within two groups of patients having close demographic characteristics. It clearly shows the interest of the early surgery of the pelvic pressure ulcers comparing to medical processing and illustrates the requirement for a close cooperation between teams specialized in plastic surgery and teams specialized physical medicine.
Assuntos
Cicatriz/prevenção & controle , Úlcera por Pressão/cirurgia , Traumatismos da Medula Espinal/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pelve , Procedimentos Cirúrgicos Operatórios/métodos , Fatores de TempoRESUMO
Phantom limbs in amputees, or body illusion in hemiplegics, have been the subject of wide ranging descriptions. The detected abnormalities involve morphological, postural and/or kinetic features. The aim of this prospective study carried out in 25 amputees and 10 adult paraplegics was to describe the typology of these perceptions. Data were collected from free and semi-directive investigations before and after caloric vestibular stimulation. Amputees and paraplegics perceived normal, deformed and painful body phantom segments, reffered perceptions and "normal limbs" which took on the request posture considering the general body position (illusion of body normality). This perception corresponds to an image of the body, such as it should be and not such as it is. In amputees, the limb follows the movements of the prothesis. These perceptions conform quite well reality so that the loss of the paralyzed limb is not perceived as a missing limb. This illusion of body normality should be distinguished from the normal phantom limb, characterized by a stronger perception of the lost limb compared with the other. In both amputees and paraplegics, vestibular stimulation can generate or modify phantoms limbs or body illusion and can abolish painful phantom limbs. The neuromatrix, which rebuilds body representations, could get its information from reorganized cortical areas (instantaneous body image), autobiographical engrams (painful phantoms limbs), or innate engrams (identity body schema) that, via congruence mechanisms, could be identified as a somatic reference, particularly for motor programming. This interpretation is compatible with current knowledge and suggests how amputees can easily use a prothesis.