Measurement of brake response time after right anterior cruciate ligament reconstruction.

Recommendations on safe driving after anterior cruciate ligament (ACL) reconstruction have been largely intuitive. This study evaluated 12 male patients who underwent ACL reconstruction with subsequent outpatient rehabilitation and compared them with 10 subjects who had no knee dysfunction. The following clinical measures were assessed every 2 weeks for 10 weeks: brake response time (BRT), 6-meter walk time (6MWT), knee range of motion (ROM), pain (visual analog scale), and joint effusion. Statistical testing was completed using analysis of covariance with repeated measures. The results from treatment group were compared with norms from the AAA Traffic Safety and Engineering Department. BRT showed significant differences over 10 weeks (P =.043) in the study group. There were no significant differences between the study and control group based on condition (ACL reconstruction v control) (P =.586). Pain and effusion were found to have no significant interaction effect on BRT. The treatment group's BRT increased from the 25th percentile (AAA normals) to the 87th percentile after 10 weeks of rehabilitation. Although treatment group BRT was equal to AAA normal population BRT at week 4, the large improvement from week 2 to week 4 meant that learning effects could not be ruled out until week 6. Significant differences were found for 6MWT between week 2 and all other weeks (P <.0001). The results suggest brake reaction time matches control times at 4 to 6 weeks. Thus, BRT might be used to establish return to driving criteria (in part) after ACL reconstruction if other driving impediments do not exist.

Measurement of brake response time after right anterior cruciate ligament reconstruction.

OBJECTIVE: Recommendations on safe driving after anterior cruciate ligament (ACL) reconstruction have been largely intuitive. We studied brake response time in patients who participated in outpatient rehabilitation after right ACL reconstruction. DESIGN: Prospective, repeated measures design comparing 14 patients post-ACL reconstruction with 21 subjects with normal knees. INTERVENTIONS AND MAIN OUTCOME MEASURES: The following measures were assessed every 2 weeks for 10 weeks: brake response time, 6-meter walk time, knee range of motion, pain, and joint effusion. Statistical testing used analysis of covariance with repeated measures. Significant variables were analyzed separately and post hoc tests conducted using the least squares differences method. Both groups were compared with published norms from the American Automobile Association. RESULTS: No significant gender differences across main effects were detected. Brake response times for men improved significantly after week 6 (p < .05) and week 10 (p < .01). Brake response times for women in the ACL treatment group matched controls at 6 weeks. Six-meter walk times for control subjects were faster than those for the ACL group preoperatively (2.6 sec vs 5.5 sec), but equalized by week 6. CONCLUSIONS: After right ACL reconstruction, brake reaction times of rehabilitated men and women matched those of established controls after 4 to 6 weeks. Measuring brake response times during rehabilitation may ensure that individual patients return to driving in a safe and timely manner.

Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest.

OBJECTIVE: To examine the utility of somatosensory evoked potential (SEP) peaks and CSF creatine kinase BB isoenzyme activity (CKBB) in predicting nonawakening from coma due to cardiac arrest. BACKGROUND: Accurate predictors of neurologic outcome in patients comatose after cardiac arrest are needed to improve medical decision making. METHODS: A total of 72 comatose patients had bilateral median SEPs, and of these, 52 had CSF and CKBB. Awakening was defined as following commands or having comprehensible speech. Both short (N1) and long (N3) latency SEP peaks were analyzed. Nonparametric analyses were used. RESULTS: For patients who had both tests, CKBB > or = 205 U/L predicted nonawakening with a sensitivity of 49% and a specificity of 100%. Bilateral absence of the N1 peak predicted nonawakening with a sensitivity of 53% and a specificity of 100%. Using CKBB > or = 205 U/L, bilaterally absent SEP N1 peaks, or both predicted nonawakening with a sensitivity of 69% and a specificity of 100%. Using CKBB > or = 205 U/L, bilaterally absent N1 peaks, bilateral N3 > or = 176 msec or absent, or some combination predicted nonawakening with a sensitivity of 78% and a specificity of 100%. CONCLUSION: The combination of an absent N1 peak and elevated CKBB performs better than either alone in predicting nonawakening after cardiac arrest. Prolonged or absent N3 latency may increase sensitivity. These results should be interpreted with caution given the small number of patients and the possibility of a self-fulfilling prophecy.

Musculoskeletal rehabilitation and sports medicine. 1. Head and spine injuries.

This self-directed learning module focuses on head, neck, and spine injuries that are frequent occurrences in sporting activity. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The physiatrist must be able to recognize not only the cause of the acute injury but also the functional consequences of the impairment. This article will discuss some of the more common head, neck, and spine injuries in patients engaged in sports activity and will suggest typical management options for these patients.

Management of focal dystonia of the extensor hallucis longus muscle with botulinum toxin injection: a case report.

Recently botulinum toxin has been used with increasing frequency as a safe and effective treatment for many previously refractory conditions associated with excessive muscle activity. The indications for use of botulinum toxin injection continue to expand. This report describes the case of an 83-year-old woman with a history of diabetes mellitus and lumbar spinal stenosis who developed a severe focal dystonia of the left great toe, such that the toe maintained the extended position. Functionally, the resultant deformity prevented the patient from wearing shoes. In addition, the patient had significant pain in the left great toe. Under needle electromyographic localization, 50 units of botulinum toxin were injected into the left extensor hallucis longus muscle. Two weeks after the injection the patient was symptom free and could place her left foot into a shoe. Seven months later, she remained symptom free. This case illustrates that localized injection of botulinum toxin to a specific lower limb muscle can effectively result in decreased muscle activity and functional improvement.

Management of traumatic optic neuropathy with coexistent spinal cord injury: a case report.

Traumatic optic neuropathy (TON) causes blindness of varied severity and occurs infrequently as a complication of closed head injury. A case is presented of TON that occurred in a patient who suffered complete T4 paraplegia from a motorcycle accident but in whom no severe head injury took place. In this case, high-dose intravenous methylprednisolone was begun for the spinal cord injury and repeated 24 hours later for the TON. Vision improved from near total blindness to 20/400 in the left eye (OS) and 20/130 in the right eye (OD). Two weeks later, however, the patient's vision suddenly worsened. Magnetic resonance imaging (MRI) using fat suppression confirmed a lesion along the optic nerve consistent with TON. A third course of methylprednisolone again led to improved vision. The steroids were then tapered orally over 2 weeks and the patient had no further relapses. Moderate to severely impaired vision of 20/ 400 OS and 20/130 OD continues to interfere with the patient's function and spinal cord rehabilitation program. It was concluded that a steroid taper was important in maintaining initial visual gains in this case. Awareness of TON and careful attention to the patient's clinical course can minimize deficit and maximize functional outcomes.

[Nervous system diseases in men and women]. / Bolezni nervnoi sistemy u muzhchin i zhenshchin.

The authors have collected data from special literature on neurological diseases and grouped them by sex prevalence. Such factors as hereditary, metabolic-endocrine, immunological, emotional, social have great implications in sex distribution of neurological disorders. It is stated that this problem needs further investigation, new methodological approaches which could appear promising in studying pathogenesis of numerous diseases and help in designing effective treatments.