Magnetic and electromagnetic field therapy.

There is increasing interest in the application of magnetic/electromagnetic fields for therapeutic purposes. Magnetotherapy provides non-invasive, safe and easy to apply methods to directly treat the site of injury, the source of pain and inflammation as well as other types of dysfunction. This review summarizes several decades of experience worldwide in studying biological and clinical effects initiated by various magnetic and electromagnetic fields. The physiological basis for tissue repair as well as physical principles of dosimetry and application of magnetic fields are discussed. An analysis of magnetic/electromagnetic stimulation is followed by a discussion of the advantage of magnetic field stimulation compared with electric current stimulation. Finally, the proposed mechanisms of action are discussed.

Respirator use in progressive neuromuscular diseases.

A survey was conducted to acquire information on the current pattern of respiratory device usage for patients with progressive neuromuscular diseases. Questionnaires were sent to 240 directors of Muscular Dystrophy Association (MDA) clinics. Of the 132 respondents, 32 (24%) physicians provide no respiratory support systems, 44 (33%) prescribe such systems routinely, and 56 (42%) provide the devices under specialized circumstances. A wide variety of negative and positive pressure ventilators are employed for patients having diseases such as amyotropic lateral sclerosis, Duchenne muscular dystrophy, spinal muscular atrophy. In the MDA clinics responding, 495 patients were found to be receiving some form of assisted ventilation. Of that number, 214 (43%) have permanent tracheostomies. We conclude that ventilators are being supplied to individuals with progressive neuromuscular disorders throughout the USA. However, there appear to be no standardized patient selection process or established protocol for respirator use in such cases.

Scoliosis management in Duchenne muscular dystrophy: prospective study of modified Jewett hyperextension brace.

The management of scoliosis in Duchenne muscular dystrophy is not standardized. Some centers offer no treatment, some provide customized body jackets or wheelchair inserts, and others recommend early surgical spinal fusion. Spinal orthoses are frequently prescribed at significant cost and inconvenience to the patient, with little evidence as to effectiveness in preventing scoliosis. This paper reports the preliminary findings of 22 patients involved in a study assessing the usefulness of a modified Jewett hyperextension brace. Seven brace wearers and 15 controls were entered into the study. The preliminary results indicate a mean curvature of 23.6 degrees (+/- 12.8 degrees) in the experimental group and 35.7 degrees (+/- 24.8 degrees) in the controls. Over an observation period ranging from two to seven years, the wearers have shown an average curve progression of 8.8 degrees/yr while the control group progressed at 11.2 degrees/yr. This difference is not considered statistically significant. We conclude that wearing the brace minimally slows scoliosis progression, but does not ultimately prevent a significant curve.

Ventilator management in Duchenne muscular dystrophy and postpoliomyelitis syndrome: twelve years' experience.

The ventilator management protocol followed over the last 12 years in 23 patients with Duchenne muscular dystrophy (DMD) and six polio survivors with chronic respiratory failure (CRF) secondary to the late effects of poliomyelitis or postpolio syndrome (PPS) is reviewed. After the onset of respiratory failure, patients with DMD continued to show a classic course of progressive, generalized muscle weakness and a steadily declining vital capacity from an average of 482mL to 336mL. The DMD group required an average increase of 0.95 hours in their daily use of assisted ventilation per year. Their overall average length of survival was increased from 19 years 9 months to 25 years 9 months. Members of the postpolio group, to date, have shown no significant decrease in muscle strength nor have they needed more than nocturnal ventilation. Recommended evaluation and pulmonary follow-up for patients with CRF secondary to neuromuscular disease is outlined. Most of these patients can be managed for a number of years with body ventilators before a tracheotomy is necessary.

DESEMO seats for young children with cerebral palsy.

Twelve children with cerebral palsy ages 18 months to eight years received custom-molded DESEMO seats. All had markedly abnormal motor function manifested in spastic, athetoid, or mixed patterns of movement. None sat independently or were expected to gain such function. Three had minimal head control, and the remaining nine had fair head control. All were inadequately positioned in commercially available seats. The custom-molded DESEMO seat was clinically evaluated with regard to its ability to produce overall relaxation, assist head control, enhance feeding, improve upper extremity function, and prevent deformities. Also assessed were parents' acceptance of the device, cost, cosmesis, convenience, and its capacity to accommodate growth. Seven children utilized the seat as an insert for a motorized wheelchair. The secure positioning provided by this device permitted operation of a standard hand operated joystick control. Two seats were used as floor sitters, allowing the children to participate in peer group activities. Feeding improved dramatically with two children, as evidenced by weight gain and decreased feeding time. Three children with kyphotic spinal deformities showed no improvement or progression of their curves despite the seating device. The positioning device assisted head control for 10 children but failed to enhance head control in the remaining two. The overall cost of the device, including orthotist and physical therapist time, is $640.00 (1985). The average growth potential of the seat is six to nine months.

Ventilator dependency: decision-making, daily functioning and quality of life for patients with Duchenne muscular dystrophy.

Ventilator assistance is offered to patients with Duchenne muscular dystrophy as an option to extend life. This paper discusses the effect of respiratory difficulties and the subsequent quality of life for 17 patients and 14 family members living in the community. Areas covered included decision-making, health, education, vocational and recreational status, community resources and life satisfaction. Activity levels before and after ventilator use were assessed. Despite restrictions in daily life both before and after ventilator use, quality of life was fairly good. Restrictions in daily life were caused by a combination of progression of the disease and the ventilator, and family members were more burdened by the ventilator than were patients. It is concluded that patients and their families should make the decision about accepting or rejecting assisted ventilation.

Ventilator use in progressive neuromuscular disease: impact on patients and their families.

The question of extending the lives of patients with progressive neuromuscular disease by means of ventilator support is controversial. It has been documented that ventilators can prolong the lives of patients with Duchenne muscular dystrophy by between two and 25 years, but few studies have assessed the effects of their use on individual or family functioning, or the quality of survival. A sample of patients with progressive disease and families living in the community was surveyed to assess these effects. Most of the sample were satisfied with their decision to extend life with the ventilator, but they found the experience significantly stressful in the home. Both patients and families believed their health-care team could have met their needs more comprehensively. Recommendations are made for health-care professionals working with patients with late-stage neuromuscular disease who need to use ventilators.