Acute hypokalemic myopathy in alcoholism. A clinical entity.

Two cases of an acute myopathy without muscle pain, tenderness, or swelling are described in alcoholic patients. Both were associated with severe hypokalemia and were largely reversible with potassium repletion. Hypokalemia may be the cause of some cases of acute myopathy in alcoholism, particularly those in which muscle cramps are absent.

Pain characteristics and their management in persons with AIDS.

Discussion of pain problems in persons with AIDS has been limited in medical and nursing literature, yet pain is a major source of suffering and concern for patients. Common pain characteristics are described in 100 persons with CDC-defined AIDS, using the 1987 definition. The two most frequently cited types of pain for both drugs users and nondrug users with AIDS were abdominal pain and neuropathic pain. Drug users experienced pain due to esophagitis and headaches more frequently than nondrug users, while nondrug users experienced Kaposi's sarcoma-related pain more often. Treatment responses were individualized, with drug users requiring more frequent use of opiates. General treatment strategies are suggested with special emphasis on the unique needs of PWAs.

Dickens and disability.

The novels of Charles Dickens include many vivid portraits of individuals with physical disabilities or deformities, and these conditions are often used symbolically to highlight some of the author's recurring themes. Disabled children are depicted as innocent victims, while their older counterparts are most often viewed as corrupt victimizers whose physical deformities are outward manifestations of their inner depravity. Punishment for moral failings in non-disabled characters frequently takes the form of paralysis and/or aphasia resulting from a cerebrovascular accident. In this context the wheelchair becomes a potent metaphor of imprisonment as a form of retributive justice.

Physical disability among physicians: an analysis of 259 cases.

This article presents data on 259 physicians and medical students with a wide range of physical disabilities and specialty training. Three out of four were in active medical practice despite their disability, most often in the specialties of internal medicine, family practice, or psychiatry. Neurological disorders accounted for over half the sample, with spinal cord injury, multiple sclerosis, stroke, and post-polio weakness being the most commonly encountered diagnoses. These data indicate that physically disabled physicians are more numerous than the previous literature would suggest that they are capable of practising in many professional specialties.

The physically disabled physician.

This article reviews the available literature on physically disabled physicians and discusses the attitudinal, environmental, and political barriers they may encounter. Information on 215 physicians and 92 medical students with a wide range of disabilities was analyzed. Currently available personal and technological resources are outlined and special issues pertaining to medical education are highlighted. Greater awareness and acceptance by medical peers are essential for professional success.

Rehabilitation of the blind stroke patient.

Over a two-year period 220 consecutive stroke admissions to a rehabilitation medicine inpatient service were reviewed. There were nine admissions (4.1%) involving seven separate patients who were also legally blind. The characteristics, outcomes, and special problems of these patients are reviewed. Despite their advanced age and double disability almost all became ambulatory and a majority of them were able to be discharged to their homes. Visual loss was often the primary limiting factor in functional outcome. A striking finding was the lack of perceptual problems in those right brain damaged patients with the greatest degree of visual impairment.

Electrotherapy for acceleration of wound healing: low intensity direct current.

Accelerated wound healing has been an observed effect of low intensity direct current (LIDC) in the range of 200 microA to 800 microA, but present electrotherapeutic equipment has been less than optimal in providing this range of stimulation. A small and portable LIDC stimulator was specially constructed and used in a study of the effects of LIDC on wound healing rates among inpatients here. Thirty patients with indolent ulcers located either below the knee or in the sacral area were randomly assigned to the LIDC protocol or to more conventional wound therapy. The patients in each treatment group were matched by age, diagnosis, wound size, and wound etiology. Comparison revealed 1.5 to 2.5 times faster healing in those receiving LIDC, which was statistically significant. The wounds treated with LIDC required less debridement and the healed scars were more resilient. Additionally, no wound infections occurred and patients reported less discomfort at the wound site. Low intensity direct current appears to be a convenient, reproducible, and effective method for improved healing of chronic open wounds and warrants more widespread use in the clinical setting.

Statistical methods in rehabilitation research.

Of 128 articles in Volume 63 (1982) of the Archives of Physical Medicine and Rehabilitation 48 (37.5%) utilized some form of statistical methodology. The most commonly encountered methods were: mean (with or without standard deviation or standard error); analysis of variance (ANOVA); t-tests; simple correlation/linear regression; and chi-square analysis. A critical review of the analytic statistics used in 40 of these articles revealed that only 23 (57.5%) were considered satisfactory in descriptive and methodologic terms. The most frequently encountered deficiencies were: inadequate description of methods; misuse of t-tests; absence of appropriately complex statistical analysis. A greater understanding of and familiarity with biostatistics is essential for all readers of the Archives to allow critical evaluation of the rehabilitation literature.

Predictors of stroke outcome.

Findings from several studies of stroke victims indicate that consistent negative predictors of outcome are significant perceptual or cognitive dysfunction, prior stroke, delay in initiating rehabilitation therapy, the presence of nystagmus, and poor motivation. Factors associated with a good prognosis after rehabilitation include early return of voluntary movements, bladder control, high intelligence and feeding skills.

Reflex sympathetic dystrophy in quadriplegia: case report.

A patient with quadriplegia developed severe localized unilateral hand pain associated with clinical evidence of abnormal sympathetic hand activity. Diagnosis revealed reflex sympathetic dystrophy (RSD), which was resolved with conservative management. The association of RSD with spinal cord injury has been reported only rarely. Since few speculations about this condition have been made, we suggest that unexplained painful syndromes in the extremities of patients with spinal cord injury be carefully evaluated to rule out the possibility of RSD.

Reversible electroencephalogram changes associated with administration of baclofen in a quadriplegic patient: case report.

We present the case of a spastic quadriplegic who developed mental symptoms which resolved when his Baclofen was discontinued. Of interest was the presence of EEG abnormalities similar to those described in cats receiving this drug. These abnormalities, previously unreported in humans, resolved upon discontinuing Baclofen therapy.

Use of alternative therapies by rehabilitation outpatients.

OBJECTIVE: To document the prevalence and patterns of use of alternative medical therapies as well as their perceived effectiveness by patients in a rehabilitation medicine outpatient practice. DESIGN: Cross-sectional survey by written questionnaire. SETTING: An urban rehabilitation medicine outpatient referral office. PATIENTS: A random sample of 103 patients referred for rehabilitation outpatient care, while waiting for their appointment, were given a questionnaire addressing their use of alternative therapies. MAIN OUTCOME MEASURES: Use of alternative therapies and their perceived effectiveness. RESULTS: One or more alternative medical therapies had been used by 29.1% of subjects in the past 12 months for their presenting problem. The most common therapies were massage, chiropractic, vitamin and mineral supplementation, and acupuncture. Musculoskeletal pain syndromes involving the spine and extremities were the most common problems for which patients sought both physiatric and alternative care. Of the patients who used alternative treatments 53% reported some degree of efficacy. CONCLUSIONS: A significant proportion of rehabilitation medicine patients use and frequently perceive a benefit from alternative therapies, particularly massage, chiropractic, vitamin and mineral supplementation, and acupuncture. Incorporating alternative therapies into physiatric practice is a desirable future direction for the specialty.

Use of a motorized wheelchair in conjunction with a guide dog for the legally blind and physically disabled.

There is limited literature concerning use of wheelchairs by patients with combined visual impairment and neuromuscular diseases. This case report describes the use of a motorized wheelchair and guide dog by a legally blind patient with severe visual loss due to oculocutaneous albinism. He had concomitant decreased functional mobility from degenerative joint disease of both knees, which limited his ambulation capability. After careful consideration of risks and a successful trial of its use in the corridors of our institution, as well as successfully traveling with it outdoors, he was given a motorized wheelchair. He has continued to use it safely and successfully along with his guide dog. Combined visual and neuromuscular diseases will be encountered with increasing frequency because of the aging population, and it is therefore important for physiatrists to be able to provide assistive devices for such individuals. Vision loss is not an absolute contraindication to motorized wheelchair use.

Physical disability among American medical students.

The present survey aimed to assess the prevalence and nature of physical disabilities among medical school graduates and to investigate the academic performance of these new physicians with disabilities. A questionnaire was sent to the deans of student affairs of each of the then existing 128 United States and Puerto Rican medical schools, addressing the profiles of students with physical disabilities in the 1987 through 1990 graduating classes. Seventy-seven (60%) United States and Puerto Rican medical schools responded to the questionnaire, of which 67 were able to complete it. A total of 67 students with physical disabilities (40 males and 27 females) were reported. Three of the 67 students were excluded from the study because their conditions did not match our definition of physical disability. The remaining 64 students (38 males and 26 females), ranging from 0 to 10 per school, comprised 0.19% of the 33,138 students who graduated from the 67 medical schools during these 4 academic yr. The disabilities represented by the 64 students encompassed a wide spectrum of etiologies, including neurologic (39%), musculoskeletal (20%), medical-surgical (13%), visual (13%), and auditory (9%) problems. The majority of students with disabilities had above average (36%) to average (48%) academic standings. The actual prevalence of medical students with disabilities might be higher than reported because of the underreporting of the less noticeable types of disabilities.

Ulnar nerve compression by heterotopic ossification in a head-injured patient.

Although heterotopic ossification (HO) at the elbow is a frequent occurrence following head injury, nerve compression by heterotopic bone is quite rare. We report the case of a 22-year-old woman with head injury and well-documented HO at the left elbow who developed signs and symptoms of an ulnar neuropathy four months after her original injury. Electrodiagnostic studies confirmed the presence of a severe ulnar nerve lesion at the level of the elbow. Anterior transposition of the left ulnar nerve showed the nerve to have been compressed by heterotopic bone.