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Biomedical subjects

J A DeLisa

Publications and source records attributed to J A DeLisa.

At least 55 records · Page 3Linked to original sources
PubMed1990

Needle electrode insertion into tibialis posterior. A new approach.

The tibialis posterior can be a valuable muscle in the electrodiagnostic evaluation of the sacral plexus, lumbosacral roots, lower extremity neuropathies and tibial nerve lesions. It may be under utilized, however, because it is generally considered to be inaccessible to needle examination. The purpose of this study was to compare the widely recommended posterior approach to this muscle to an anterior approach that we define. In six cadaver legs, the safe access to this muscle via the anterior approach was 16.8 +/- 5 mm by contrast to 9.5 +/- 2 mm by the posterior approach. We conclude that the anterior approach to needle electromyography of the tibialis posterior muscle is easier, safer and deserves more widespread practice.

Cadaver↗
PubMed1990

Deep peroneal sensory nerve. Standardization in nerve conduction study.

Ankle or foot pain may be due to various clinical conditions. Injury or entrapment of the deep peroneal sensory nerve is part of the differential diagnosis; however, no technique studying the deep peroneal sensory conduction velocity has been described. We describe a technique that is simple and reproducible with averaging. We electrophysiologically studied the deep peroneal sensory nerve in 40 neurologically healthy adult subjects. The latency to onset of the sensory action potential was 2.9 +/- 0.4 ms (range = 2.1-3.6 ms). The latency to the peak of the sensory action potential was 3.6 +/- 0.4 ms (range = 2.7-4.2 ms). The conduction velocity was 42 +/- 5 m/s (range = 33-53 m/s). The amplitude was 3.4 +/- 1.2 microV (range = 1.6-6.6 microV). We conclude that the deep peroneal sensory nerve is readily accessible for electrophysiologic evaluation. It may be of value in diagnosing deep peroneal nerve pathology.

Action Potentials↗
PubMed1990

Research in physical medicine and rehabilitation. XI. Research training: setting the stage for lifelong learning.

This is the summary article in our research series. We have attempted to provide useful information for persons at all levels of research training, from the student to the clinician with a collaborative but not active role, to the new clinical researcher, to the experienced faculty member. But there is much more to be learned than can be presented in a short series of articles. From this series, you should be able to make a reasoned choice about what role in research you would like to take, and seek to maintain or upgrade your research skills to accomplish that. The previous articles, exercises and references presented will guide you in independent study. The focus of this article is to help you choose an environment in which you can continue to learn and develop. Although the "ideal" place as described here may never exist, no institution is totally devoid of research possibilities and you can use this article to help seek or develop local resources you may not have considered. By extracting questions and clues from people around you, you stimulate them to "think research" even if a formal program is absent; at the least, you can ally yourself with a nearby institution which has researchers in other clinical specialties or areas of basic science. Each organization is obviously different, having different strengths and resources. It is up to each chairperson to decide what proportion of limited resources should be invested in research. Once this decision is made, it is the initiative of the individual faculty members that will make a productive department.

Education, Medical, Continuing↗
PubMed1989

Evoked potential assessment: utility in prognosis of chronic head injury.

Brainstem auditory evoked potentials (BAEP) and somatosensory evoked potentials (SSEP) were performed on 29 patients an average of 12.4 months after traumatic brain injury (TBI). The study purpose was to predict long-term outcome in chronic TBI patients by using multimodality evoked potentials (MEP), the Rancho Los Amigos Scale (RLAS), and other clinical parameters. Neither the BAEP nor SSEP correlated significantly with the cognitive level on the RLAS at the MEP study approximately one year after TBI (RLAS1). Only 11.7% of RLAS1 could be predicted by the combined study of BAEP and SSEP. BAEP and SSEP obtained about one year after TBI jointly had a 15% predictive power of the long-term follow-up RLAS score obtained 18 months after performance of the MEP (RLAS2). Stepwise regression analysis showed that the best predictive indicator of the status of long-term outcome was RLAS1 which alone can predict 60% of long-term outcome. The predictive value of combinations of RLAS1 and age improved prediction of long-term outcome to 66.8%, and the combination of RLAS1, age, and SSEP further increased the value to 72%. Perhaps the MEPs were relatively insensitive in reflecting the patient's adaptation to fixed neuronal damage since patients can perform higher cognitive function by adaptation through behavioral modification and cognitive retraining despite little structural improvement. This adaptation would result in a discrepancy between MEP and RLAS scores in the late chronic phase.

Adolescent↗
PubMed1988

Electrodiagnosis and recovery of function.

The study of electrodiagnosis with respect to recovery of function is in its infancy. There is a need for better understanding of the mechanisms of recovery and for better techniques to monitor recovery. This paper reviews the potential uses and limitations of current electrodiagnostic tests to predict and monitor neuromuscular recovery. It illustrates the use of these techniques in patients with spinal cord injury.

Adult↗
PubMed1987

Diagnostic ultrasound: its value in acute urinary tract infection in spinal cord injury.

Two cases of acute urinary tract infection in patients with spinal cord injury highlight the complications of calculus and perinephric abscess. Rather than waiting the customary 48 hours to assess response to antibiotics before evaluation for secondary complications, diagnostic ultrasound is advocated upon diagnosis of pyelonephritis. The potential benefits of early imaging seem to far outweigh the negligible risk and expense.

Abscess↗
PubMed1987

Compound nerve action potentials from the median and ulnar nerves.

The compound nerve action potentials from mixed motor/sensory (MNAP) and sensory (SNAP) nerve stimulation in the median and ulnar nerves were recorded in both arms of 20 able-bodied subjects. Intranerve and internerve peak-to-peak amplitudes were compared. An SNAP/MNAP amplitude ratio greater than 0.25 exceeded the mean by 2SD. The fastest, intermediate, and slowest conduction velocities were calculated from chosen points on the biphasic waveform. An intermediate MNAP conduction velocity for the median and ulnar nerves of less than 49.5m/sec exceeded more than 2SD below the mean. Likewise, an intermediate SNAP conduction velocity of less than 45.5m/sec exceeded 2SD below the mean. Median MNAP latency across the carpal tunnel was 1.0 +/- 0.3 and ulnar MNAP conduction velocity across the elbow was 59.7 +/- 3.8m/sec. This technique may supplement traditional electrodiagnostic studies in evaluating upper extremity neuropathies.

Action Potentials↗
PubMed1986

Evaluation of continuing medical education: making a difference.

This article is the fifth in a series of continuing health professional education and it focuses on the evaluation of continuing medical education (CME). Evaluation is the final step in the overall instructional design cycle in that it measures the effectiveness of CME. This article presents a decision-making flow chart which illustrates a means of determining what kind of an evaluation is appropriate for a given educational activity. The major types of evaluations are formative and summative, each having cognitive, psychomotor and affective categories. The evaluation data sources should be triangulated and may be either objective or subjective. There should be clear linkage between the course goals/objectives, the evaluation measures and the results of the evaluation. This will improve the CME process and make it more cost effective.

Cost-Benefit Analysis↗
PubMed1986

Cauda equina injury: late motor recovery.

A 21-year-old man was left with complete paraplegia and lower extremity sensory loss after a gunshot wound to the 4th lumbar vertebral body. Within three weeks of the injury he noted slight recovery of proximal left leg movements. With further motor recovery and rehabilitation, he was discharged ambulatory at nine months postinjury. The patient described late motor recovery developing 13 to 16 years after injury, particularly in right knee extensors and bilateral ankle plantar flexors, simultaneous with an aggressive home exercise program. Serial manual muscle tests revealed increased strength in hip flexors, knee flexors and extensors, and ankle plantar flexors. The patient progressed from ambulating with bilateral knee-ankle orthoses and forearm crutches to bilateral ankle-foot orthoses and a point cane. His original injury was a combination of neurapraxia, which recovered by resolution of conduction block in several weeks to months; axonotmesis, which recovered by axon regeneration over several years; and neurotmesis, which did not recover. The muscle strengthening achieved 14 years after cauda equina injury may represent strengthening of muscle fibers reiinervated after the initial nine-month rehabilitation program. Clinical implications for rehabilitation are discussed including the possible need for a therapeutic trial of muscle strengthening.

Adult↗
PubMed1985

Pressure ulcers. What to do if preventive management fails.

Tissue breakdown is a direct response to external pressure, friction, or shear. The key to management of pressure ulcers is prevention. With good nursing care, as well as education of medical personnel, the patient, and family members, such lesions should rarely occur. The axioms of treatment are to remove all pressure, debride necrotic tissue, keep the ulcer clean, and prevent further injury. There is only empirical evidence attesting to the effectiveness of the various dressings and physical and topical agents used in treatment. Most pressure ulcers can be classified as grade I or II and healed by conservative measures; however, the process can be very time-consuming. Surgery is warranted for some grade III and all grade IV and V pressure ulcers and for potential complications, such as fistulas.

Aging↗
PubMed1985

Optokinetic nystagmus and upper extremity dressing independence after stroke.

Right hemisphere brain-damaged stroke patients demonstrate a variety of neurologic deficits which seem to impair their ability to regain self-care independence. Visual perceptual and visual search disorders have been implicated with persistent functional deficits. The objective of this study was to measure the extent to which defects of optokinetic nystagmus (OKN), an ocular movement reflex, may be associated with inability to regain independent function. Eighteen right hemisphere brain-damaged stroke patients suffering similar sensory-motor deficits were followed up from admission as they underwent self-care training in a comprehensive stroke rehabilitation center. Ten subjects demonstrated unilateral absence of OKN and eight subjects demonstrated bilaterally intact responses upon admission. Upper extremity (UE) dressing independence was used as an indicator of functional skill level at admission, during treatment, and at discharge. Subjects with unilateral loss of OKN were significantly less independent at admission and at discharge when compared to subjects with intact OKN. Although both groups of patients made statistically significant gains in UE dressing, those with defective OKN had a 40% greater inpatient length of stay and were more likely to be discharged to a nursing home or needed care by a significant other after rehabilitation.

Activities of Daily Living↗
PubMed1985

Results of carpal tunnel release in renal hemodialysis patients.

Forty-eight renal hemodialysis patients were evaluated clinically and electrodiagnostically for carpal tunnel syndrome (CTS). The incidence (32%) was significantly higher than that previously reported by other authors. All patients with CTS also had peripheral neuropathy by electrodiagnostic criteria. CTS was found four times as often in patients who had dialyzed longer than five years compared to those who had dialyzed less than five years. Patients with CTS were more likely to have an active or inactive access in the involved forearm than were patients without CTS. In patients with CTS treated by transverse carpal ligament release, 87.5% obtained relief from pain and numbness. Because of the high incidence of CTS in the chronic hemodialysis population, electrodiagnostic screening is recommended in these patients. Patients with clinical and electrodiagnostic signs of CTS will benefit from transverse carpal ligament release.

Adult↗
PubMed1985

Multiple sclerosis: Part I. Common physical disabilities and rehabilitation.

Rehabilitation of the multiple sclerosis patient must be individualized because of the varied manifestations and fluctuating course of the disease. The activity schedule must be modified to compensate for muscle weakness and fatigability. Spasticity and the preventable complication of joint contractures may be treated with joint ranging, medications, motor-point blocks and surgical intervention. Mobility problems, such as foot drop, may be improved with an ankle-foot orthosis, but ultimately a patient may require a wheelchair. Measures to prevent pressure sores include position change, pressure release, incontinence management and special equipment.

Adult↗
PubMed1985

Multiple sclerosis: Part II. Common functional problems and rehabilitation.

Cognitive impairments, often unrecognized in multiple sclerosis, include memory loss, new learning problems, denial and depression. Spasticity and incoordination of the oropharyngeal and respiratory muscles create functional problems with speech and swallowing. Genitourinary problems include sexual dysfunction and neurogenic bladder. Specific measures can be used to alleviate these problems.

Cognition Disorders↗
PubMed1984

Pyridoxine metabolism in carpal tunnel syndrome with and without peripheral neuropathy.

The role of insufficient pyridoxine as an etiologic factor in the development of carpal tunnel syndrome (CTS) has been reported and has led to the empirical use of pyridoxine to treat CTS. Previous studies have not employed standardized electrodiagnostic criteria to objectively determine the presence of CTS or to rule out peripheral neuropathy (PN). The present study categorized subjects with symptoms suggestive of CTS into four groups by standardized electrodiagnostic criteria: (1) CTS, (2) PN, (3) CTS and PN, (4) normal. At least seven subjects were in each group. Erythrocyte glutamine oxaloacetic acid transaminase (EGOT) activity with and without in vitro enhancement with pyridoxal phosphate was used as a means of identifying subjects with and without pyridoxine metabolic abnormalities. A significant difference in pyridoxine metabolic activity (PMA) was found between groups by both chi square (p less than 0.05) and analysis of variance (p less than 0.05). Further evaluation showed that this difference was associated with the presence or absence of PN (p less than 0.05). There was no difference in PMA when groups were separated on the basis of CTS. Results showed that a PMA abnormality was a factor highly correlated with the presence of PN but not CTS. This finding suggested that the positive response reported previously in subjects with CTS taking supplemental pyridoxine may actually be related to an unrecognized PN, which was compounding the symptomatology.

Aspartate Aminotransferases↗