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Biomedical subjects

A J Haig

Publications and source records attributed to A J Haig.

At least 19 recordsLinked to original sources
PubMed1997

Snapping scapula syndrome: three case reports and an analysis of the literature.

The snapping scapula syndrome is an infrequently described source of shoulder discomfort characterized by painful, audible, and/or palpable abnormal scapulothoracic motion. The syndrome may be caused by skeletal or soft-tissue abnormalities that interfere with articulation between the scapula and the rib cage. Often, no obvious source of the snapping can be identified with imaging studies. Three new cases with electrodiagnostic and imaging studies are presented. For the first time a critical analysis and review by diagnoses, gender, age, treatment, and outcome of 89 reported cases is presented. Accurate recognition of the syndrome may lead to prompt and long-term relief of symptoms by conservative or surgical treatment.

Adult↗
PubMed1997

Clinical experience with paraspinal mapping. I: Neurophysiology of the paraspinal muscles in various spinal disorders.

OBJECTIVE: To assess the extent of denervation of the paraspinal muscles in spinal disorders. DESIGN: Nonrandomized prospective trial. SETTING: Electrodiagnostic laboratory of a university spine center and of a private practice in a small community. SUBJECTS: One hundred fourteen consecutive persons referred for electrodiagnosis of spinal or lower extremity disorders. INTERVENTION: The paraspinal mapping (PM) electromyography (EMG) protocol along with codified history, physical examination, extremity EMG, and in 44 cases, radiologic imaging results. MAIN OUTCOME MEASURES: PM scores compared with recently established norms (95% of normal subjects scoring less than < 6), lower extremity (LE) EMG findings, and imaging results. RESULTS: Fifty-eight subjects had normal PM scores; 62 were abnormal. Compared to imaging studies, false positive rate was 8% (1/13). False negative rate (normal PM with definite nerve involvement on imaging) was 33% (6/18), but this decreased to 5% when PM was combined with LE EMG. Four of 4 high lumbar lesions were detected by PM. Of 14 apparent false negatives (13%) compared to LE EMG, 6 had S1 root lesions and 5 had nonspinal lesions. All 7 subjects with isolated S1 radiculopathy had PM scores within normal limits. Occasional polyneuropathies presented with normal PM and abnormal distal findings or with abnormal PM but normal distal findings. No patient with isolated paraspinal findings had evidence of malignancy on follow-up. This report also describes the distribution of denervation in the multifidus, longissimus, and iliocostalis in various disorders. CONCLUSIONS: PM related well to imaging studies and LE EMG. It detects uncommon high lumbar root lesions. S1 may not innervate the paraspinal muscles. There are isolated paraspinal findings in persons without malignancy. The effects of specific muscle denervation on biomechanics, rehabilitation exercise, and prognosis are not known.

Adult↗
PubMed1997

Clinical experience with paraspinal mapping. II: A simplified technique that eliminates three-fourths of needle insertions.

OBJECTIVE: To simplify and minimize the quantified needle examination of the paraspinal muscles (paraspinal mapping [PM]) without compromising sensitivity or specificity. DESIGN: Nonrandomized prospective trial. SETTING: Electrodiagnostic laboratory of a university spine center and of a private practice in a small community. SUBJECTS: One hundred fourteen consecutive persons referred for electrodiagnosis of spinal or lower extremity disorders who had PM data and 35 previously reported asymptomatic volunteers. INTERVENTION: Abbreviated PM protocols were simulated by progressively eliminating data from the 45 needle insertions of the original PM. Simulations involving 35, 15, 13, and 5 insertions resulted in different normal values (95% of asymptomatic volunteers) and different scores in patients. The resulting reclassification of patients as normal or abnormal was compared with the original protocol and with clinical data. MAIN OUTCOME MEASURES: False positive and false negative rates of the simulations compared with the original protocol. RESULTS: Abbreviated protocols involving 30, 15, 13, and 5 needle insertions had normal cutoff scores of less than 5, less than 4, less than 3, and less than 2, respectively, with 2%, 2%, 4%, and 8% false positive rates and 3%, 8%, 13%, and 21% false negative rates compared with the original. In many cases clinical information correlated better with the abbreviated test results than the original PM. CONCLUSIONS: The third protocol compared well with the original PM, and in a limited number of patients with imaging studies demonstrated 92% sensitivity and 92% specificity. By eliminating the iliocostalis, longissimus, and lowest multifidus needle explorations, 73% fewer needle insertions were used. We recommend that this new technique, now called "miniPM," be used in most clinical settings.

Electromyography↗
PubMed1996

Clinical, physiologic, and pathologic evidence for vagus dysfunction in a case of traumatic brain injury.

A trauma victim with locked-in syndrome demonstrated severely decreased bowel sounds, intact response to suppository, and elevated, but unchanging pulse. Absent cardiac response to tracheal suctioning, high gastric residual volumes, and pulmonary edema in response to a urecholine challenge demonstrated dysfunction in the automatic system. Symptoms persisted for 2 1/2 years until death. At autopsy, asymmetric bilateral involvement of the dorsal motor nucleus of the vagus and of the nerve tract in the medulla were demonstrated. In contrast, a control subject with locked-in syndrome caused by a stroke did not demonstrate these phenomena. In trauma patients with delayed gastric emptying, measurement of the heart rate response to deep suctioning may lead to the diagnosis of this vagus dysfunction syndrome.

Adult↗
PubMed1995

Paraspinal mapping. Quantified needle electromyography of the paraspinal muscles in persons without low back pain.

STUDY DESIGN: This was a case series with intervention performed by masked investigators. OBJECTIVES: To determine values for normal subjects on quantified needle electromyography of the paraspinal muscles compared with a previous sample of patients with clear evidence of radiculopathy. SUMMARY OF BACKGROUND DATA: Diagnosis of radicular back pain is difficult, even with modern imaging studies, partly due to the large percentage of imaging abnormalities in asymptomatic persons. Electromyography has been shown to be as sensitive as imaging studies in diagnosing radicular pain. An electromyographic study of the low back has never been done in normal subjects. We have previously anatomically validated and clinically demonstrated a method of quantitative needle electromyography in the paraspinal muscles called paraspinal mapping. METHODS: Thirty-five subjects free of back pain or polyneuropathy were intermixed with volunteers referred for electromyography of radicular back pain. One electrodiagnostician punctured the skin at five predetermined locations and obtained paraspinal mapping scores in one of these. An electromyographer who was masked to the study's nature then performed a complete paraspinal mapping study. A total "sensitivity" score was compared to scores of previously tested patients who had pain complaints and clear evidence for radiculopathy on either radiologic or traditional electromyographic studies. RESULTS: Mean score in normal subjects was 1.11 (SD 1.49). Mean score for abnormal subjects averaged 12.18 (SD 12.03). Differences between examiners were insignificant. CONCLUSIONS: Normal persons have few, if any electromyographic abnormalities in the paraspinal muscles. This is in contrast to computed tomography, magnetic resonance imaging, or myelographic results in normal subjects. Persons with radiculopathy have significantly different scores. Needle electromyographic examination of the paraspinal muscles is useful in distinguishing false-positive radiologic studies.

Adolescent↗
PubMed1995

Outpatient planning for persons with physical disabilities: a randomized prospective trial of physiatrist alone versus a multidisciplinary team.

The purposes of this study were to assess the effect of adding a physiatrist to the usual community management of persons with complex disabilities, and to determine whether there were differences in decision making and patient outcome between evaluations by a physiatrist alone or with a multidisciplinary team in this population. Consecutively referred patients with functional complaints in two of the following areas, mobility, activities of daily living, emotions and cognition, work, or social support, were randomly assigned to a multidisciplinary outpatient team evaluation or physiatrist evaluation in an office setting. Forty persons, 21 team and 19 office, served as subjects. For the entire group, functional assessment scores before and after evaluation were as follows: Barthel index 71.79 versus 76.47 (p < .008) and Frenchay Activities index 9.97 versus 11.32 (p < .05) Wilcoxon Signed Ranks test. Patients quality of life differences were significant (p < .03 or less by Wilcoxon). Most differences between team and physiatrist were not shown to be statistically significant in this small population. Physiatric evaluation, with or without a multidisciplinary team, can improve outpatient functional status and quality of life for persons living in the community with complex disabilities.

Adolescent↗
PubMed1994

Patient-oriented rehabilitation planning in a single visit: first-year review of the Quick Program.

Persons who are geographically remote or do not qualify for inpatient rehabilitation have limited access to an effective multidisciplinary rehabilitation team. We present an innovative evaluation tool called the Quick Program. This multidisciplinary outpatient assessment involves a previsit database, therapy and physiatrist evaluations, a team meeting, and a patient-family meeting in a one-half day visit. Patient demographics and details of recommendations for the first 41 referrals are described. An average of 2.27 referrals per patient were made to resources outside of the core team, suggesting that the team achieved transdisciplinary status. The number of medical interventions recommended to accomplish rehabilitation goals (mean 2.16 per patient) suggests that the physiatrist was an active participant, and that physician input is crucial to success. We conclude that comprehensive rehabilitation planning for patients who have limited access to multidisciplinary rehabilitation team can be accomplished in a single visit.

Adult↗
PubMed1993

Paraspinal mapping: quantified needle electromyography in lumbar radiculopathy.

In the diagnosis of low back pain, the presence of a high percentage of false positive findings on radiologic imaging studies has lead to a more definitive role for electrodiagnosis as a confirmatory test. The paraspinal muscles are a crucial part of the electrodiagnostic examination for radiculopathy. To date, no technique for paraspinal evaluation has been validated. Based on previously documented anatomical techniques, we have designed a method of paraspinal examination termed "paraspinal mapping" (PM). Electromyographic (EMG) needles are placed in five carefully chosen locations and inserted in multiple directions. Individual scores for these insertions are added to determine a total PM sensitivity score. The first 50 studies using PM were compared to peripheral EMG, imaging studies, and pain drawings. Results indicate that the technique is easy to perform. Sensitivity scores relate well with these tests. In this limited and uncontrolled population, PM had higher sensitivity for abnormalities than either peripheral EMG or imaging studies. Because of the anatomical validity of PM, future studies may show it to be useful in localizing the level of radiculopathy independently from peripheral EMG, and to support clinical findings and imaging studies.

Electromyography↗
PubMed1993

Endurance training of trunk extensor muscles.

BACKGROUND AND PURPOSE: The purpose of this study was to assess the effects of an endurance exercise protocol on the isometric holding time of the trunk extensor muscles (mechanical fatigue measure) and on the recorded median frequency (MF) measurements from the surface electromyogram (physiological fatigue measure). SUBJECTS: Twenty-eight healthy female volunteers were selected to participate in the study. METHODS: The subjects were stratified by activity level and then assigned to an exercise or a control group and tested at weeks 0, 3, and 6. Reliability (r) of the measurements, established by testing each subject twice at week 0, was .87. Exercise group subjects trained at home twice daily for 6 weeks, progressing by established protocol. RESULTS: The exercise group subjects increased their isometric holding time by 22% after 6 weeks. The control group showed no significant changes. CONCLUSION AND DISCUSSION: The home program was believed to be effective for increasing isometric endurance of the trunk extensors, measured by holding time. The MF measurements prior to and just after a fatiguing contraction remained stable over time. The change in the slope of the MF with fatigue did not reach statistical significance. This physiologic measure of fatigue did not show commensurate changes with training in this group of subjects. Possible reasons for the results are discussed.

Adult↗
PubMed1992

Long-term survival, prognosis, and life-care planning for 29 patients with chronic locked-in syndrome.

We present a life-table analysis of a cohort of 29 locked-in syndrome (LIS) patients followed for a minimum of five years, and we report on the status of the chronic LIS patient. Twenty-nine LIS patients who remained locked-in for more than one year were identified. Inpatient charts were reviewed for demographic, medical, and functional data. Telephone followup was obtained to examine medical complications after discharge, survival, neurologic recovery, care issues, and permanent disposition. A life-table analysis was performed on survival data. Cerebrovascular disease was the most common cause of LIS. Survival ranged from 2.02 to 18.15 years. Twenty of the 26 patients available for five-year followup survived; hence, five-year survival was 81%. An alternative method of communication and emotional stress for the patient's caregiver was the key issue in patient care. Most patients were cared for in their own homes. Although minimal late neurologic recovery occurs in chronic LIS, survival may, nonetheless, be prolonged with adequate supportive care. Modern computerized technology offers LIS patients the ability to interact with their environment. This information may assist physicians in making ethical and long-term care decisions with the patient rather than for the patient with LIS.

Adult↗
PubMed1991

A technique for needle localization in paraspinal muscles with cadaveric confirmation.

Invasive electromyography (EMG) of the paraspinal muscles is useful in clinical and research settings. No technique for localization of the needle in specific fascicles has been validated. Recent descriptions of the segmented innervation of the multifidus imply that such a technique would add greatly to the EMG determination of root level of a radiculopathy. We have developed a technique for localization which relies on palpation of bony structures and needle insertion at certain angles and depths. The technique was evaluated by injecting latex dye in 199 locations in 13 cadavers. Dissection demonstrated that the technique was accurate in 91 of 112 injections into specific fascicles of the multifidus (originating from different spinous processes), 39 of 43 injections into the longissimus, and 35 of 44 injections into the iliocostalis. Certain types of errors would not have occurred with the aid of EMG in vivo. When these are added to the correct injections, accuracy improves 97%, 93%, and 82%, respectively. The technique described here should be useful for kinesiological studies, biopsies and injections, as well as for the EMG confirmation of a radiculopathy.

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