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Biomedical subjects

J A DeLisa

Publications and source records attributed to J A DeLisa.

At least 73 records · Page 4Linked to original sources
PubMed1984

Rehabilitation medicine within the Veterans Administration: report of a survey.

The health care delivery system of the Veterans Administration (VA) represents the largest single group of physicians practicing physical medicine and rehabilitation. The long-term needs of the aged, often disabled, and poor veterans of America's wars suggest that rehabilitation should be a high priority within the VA system. Yet, Max Cleland, former VA Administrator, and a VA Task Force on Rehabilitation have indicated that operational performance falls short of promises and that programs are fragmented and uncoordinated, with minimal research production. The results are reported of a 17-page questionnaire sent to the 273 full- and part-time physicians in Rehabilitation Medicine Services (RMS) in an attempt to determine the state of rehabilitation medicine in clinical practice, teaching, education, publishing and research.

Hospitals, Veterans↗
PubMed1984

Electrodiagnostic values through the thoracic outlet using C8 root needle studies, F-waves, and cervical somatosensory evoked potentials.

Mid-humerus cadaver determinations of ulnar F-wave, C7 spinal somatosensory evoked potential (SEP), and modified C8 root stimulation (RS) were performed bilaterally on 20 normal subjects to standardize technique and obtain normal values for the segment from mid-humerus to cervical spine. Our cadaver study shows that the best position for upper extremity measurement of mid-humerus-cervical spine distance is at 60 degrees of shoulder abduction, 45 degrees of internal rotation, and at the distance of 35cm, measured by caliper. Using this position and distance the following normal values were obtained: 1) Mid-humerus F-wave minimal, maximal, and mean latencies, and minimal nerve conduction velocity (NCV) were 21.8 +/- 1.2msec, 22.3 +/- 1.2msec, 22.3 +/- 1.1msec, and 59.7 +/- 2.4m/sec, respectively. Latency difference between minimal and maximal F-wave was 1.4 +/- 0.4msec. 2) Cervical spine SEP was 5.1 +/- 0.4msec, with left to right difference of less than 0.9msec. 3) C8 RS and mid-humerus ulnar nerve (UN) pick-up latency and NCV were 4.9 +/- 0.2msec and 71.4 +/- 2.2m/sec, whereas C8 root pick-up and mid-humerus UN stimulation latency and NCV were 5.2 +/- 0.4msec and 66.9 +/- 5.2m/sec, respectively. To evaluate proximal nerve conductivity through the thoracic outlet, the sequential use of the three modified techniques for 35cm mid-humerus-cervical spine distance is recommended.

Adult↗
PubMed1983

Assessing the driving potential of cerebral vascular accident patients.

In this report, literature pertaining to training the post-cerebral vascular accident (CVA) driving candidate is reviewed; a driver training program is described, with special emphasis on evaluating the CVA candidate; the role of the occupational therapist as a disabled driver training instructor is outlined; information and suggestions for comprehensive evaluation and training of right- and left-CVA driving candidates are presented; and data comparing driver's training outcomes for right- and left-CVA candidates are provided. Retrospective data of left- and right-CVA driver performance are compared.

Automobile Driver Examination↗
PubMed1983

Nerve conduction studies in upper extremities: skin temperature corrections.

The relationship of skin to near nerve (NN) temperature and to nerve conduction velocity (NCV) and distal latency (DL) was studied in 34 normal adult subjects before and after cooling both upper extremities. Median and ulnar motor and sensory NCV, DL, and NN temperature were determined at ambient temperature (mean X skin temp = 33 C) and after cooling, at approximately 26, 28, and 30 C of forearm skin temperature. Skin temperatures on the volar side of the forearm, wrist, palm, and fingers and NN temperature at the forearm, midpalm, and thenar or hypothenar eminence were compared with respective NCV and DL. Results showed a significant linear correlation between skin temperature and NN temperature at corresponding sites (r2 range, 0.4-0.84; p less than 0.005). Furthermore, both skin and NN temperatures correlated significantly with respective NCV and DL. Midline wrist skin temperature showed the best correlation to NCV and DL. Median motor and sensory NCV were altered 1.5 and 1.4m/sec/C degree and their DL 0.2 msec/C degree of wrist skin temperature change, respectively. Ulnar motor and sensory NCV were changed 2.1 and 1.6m/sec/C degree respectively, and 0.2 msec/C degree wrist temperature for motor and sensory DL. Average ambient skin temperature at the wrist (33 C) was used as a standard skin temperature in the temperature correction formula: NCV or DL(temp corrected) = CF(Tst degree - Tm degree) + obtained NCV or DL, where Tst = 33 C for wrist, Tm = the measured skin temperature, and CF = correction factor of tested nerve. Use of temperature correction formula for NCV and DL is suggested in patients with changed wrist skin temperature outside 29.6-36.4C temperature range.

Adult↗
PubMed1983

Voluntary anterior dislocation of the shoulder: case study.

Anterior shoulder dislocation can be willfully produced by a subject through abnormal unbalanced muscle contraction at the shoulder joint. It may be associated with pathologic lesions at the shoulder. Treatment consists of vigorous shoulder strengthening exercises and/or surgery to increase anterior stability at the joint. For any treatment approach to be successful the subject must avoid dislocation of the shoulder. A psychologic component frequently associated with this condition is its use as a mechanism for attention, sympathy or defense--a factor that has a significant negative effect on response to treatment.

Adult↗
PubMed1982

Managing spasticity.

Spasticity, a common symptom of upper motor neuron lesions, may actually aid the patient and should be treated only if it interferes with function, comfort or nursing care. Stretching exercises and elimination of nociceptive stimuli are the first steps in management. If problems persist, medication should be considered. Tenotomies are useful. Motor-point blocks and peripheral nerve blocks are temporary aids, while neurectomies usually provide permanent relief. More drastic neurosurgical procedures are reserved for uncontrolled, incapacitating cases.

Adult↗
PubMed1981

Carpal tunnel syndrome in chronic renal dialysis patients.

Pain, dysesthesias, sensory changes, and weakness in hands of uremic patients receiving renal dialysis are usually attributed to peripheral neuropathy or vascular steal syndrome. Our experience suggested superimposed carpal tunnel syndrome (CTS) as an additional etiology. This premise was studied by using electromyography and standardized electrodiagnostic techniques to measure median and ulnar conduction velocities and distal motor and sensory latencies. Of 48 patients tested, 15 (31%) had symptomatic CTS, confirmed by electrodiagnosis. Seven of these patients had bilateral CTS. Twelve patients subsequently had surgical flexor retinaculum release, resulting in relief of symptoms. Thirty-seven of the 48 patients tested, including all 15 with CTS, had peripheral neuropathy. Of the patients with peripheral neuropathy, and who were on dialysis longer than 5 years, 57% also had CTS. Slowing of ulnar nerve conduction velocity across the elbow was found in 11 arms, including 3 with CTS. The high incidence of CTS in this renal dialysis population appears to be related to nerve compression secondary to a thickened transverse carpal ligament. Increasing time on dialysis was related to an increased incidence of CTS. However, the presence of forearm access (AV fistula or cannula) was not crucial to the development of CTS. CTS is treatable and should be considered in the differential diagnosis of hand and arm symptoms in chronic dialysis patients.

Arteriovenous Shunt, Surgical↗
PubMed1981

Severe femoral neuropathy with "hanging leg" syndrome.

Severe femoral neuropathy with a partial sciatic nerve injury is an unusual clinical finding in the absence of penetrating trauma, pelvic fracture, hemorrhage, mass lesion, or peripheral neuropathy. This report documents the occurrence of this condition and discusses its recognition despite lack of detectable radiologic or routine laboratory abnormalities. A careful history and clinical electrodiagnosis are the most important factors in establishing the nature of the mechanism of injury, anatomic location, diagnosis, and prognosis. Review of these factors suggests that the injury is related to nerve stretching or compression with prolonged maintenance of a "hanging leg" position on the affected side.

Electromyography↗
PubMed1981

Peroneal nerve conduction velocity: the importance of temperature correction.

The relationship between skin surface temperature, near nerve temperature and nerve conduction velocity (NCV) of the peroneal nerve was studied in normal and diabetic subjects to determine a peroneal NCV-treatment correction factor and to investigate whether temperature correction of NCV reduces its variability. Twenty normal subjects (age 21 to 72 years, mean 44, SD 17) were tested for peroneal NCV, skin and near nerve temperatures bilaterally at ambient temperature (mean 26.6C). Tests were repeated after cooling the lower extremity to a skin temperature of 26C, and at skin temperatures of 28 and 29C as the legs were allowed to gradually warm. An additional 20 normal and 20 diabetic subjects were tested weekly at ambient temperature for peroneal NCV and skin temperature, measured at 15cm above the lateral malleolus. The results showed a linear relationship between skin temperature, near nerve temperature and peroneal NCV (p less than 0.001). Peroneal NCV was altered 2.0 meters per second per degree (C) change in skin and near nerve temperature (p less than 0.001). When using our formula, peroneal motor NCV corrected = 2.0 [32 - skin temp(C)] + NCV (m/sec), for correction of peroneal NCV to a standard skin temperature of 32C, it was found that temperature corrected NCV were less variable (p less than 0.05) than noncorrected NCV in the same diabetic subjects. These results indicate that temperature corrected NCV should be calculated routinely during clinical NCV examinations of patients with peripheral neuropathies.

Adult↗
PubMed1981

Distal sensory latency measurement of the superficial radial nerve in normal adult subjects.

The antidromic distal sensory latency of the superficial radial nerve was studied using 2 methods: (I) Recording from a major branch of a nerve as it crosses the extensor pollicis longus tendon, using segments of 10, 12, and 14cm; (II) Recording from the thumb, using segments of 14, 16, and 18cm. The mean latency, to the peak of the negative response, using method I, was 3.1 +/- 0.4 msec (+/- 2SD) and for method 2 was 3.5 +/- 0.6 msec (+/- 2SD), both for the 14cm segment. The amplitude by method I was significantly larger than by method II, making it easier to record. The hand should be warmed if the latency value is outside the normal range and the skin temperature is less than 31C.

Adult↗
PubMed1980

Head and neck cancer, a rehabilitation approach.

Survival from head and neck cancer is not uncommon. However, treatment is often radical and may compromise the patient's appearance, function, and quality of life. The most common modalities of treatment, employed either singly or in combination, are chemotherapy, radiation, and surgery. Each treatment modality involves unique complications and compromises, many of which are amenable to rehabilitation techniques. A role of the occupational therapist on a cancer rehabilitation team is described and an overview of the therapeutic procedures for the evaluation and treatment of common problems recognized in these patients is presented. The material is derived both from clinical experience of the rehabilitation team and from a literature review employed in developing the rehabilitation program.

Antineoplastic Agents↗
PubMed1980

Motor nerve latencies through the tarsal tunnel in normal adult subjects: standard determinations corrected for temperature and distance.

A standardized method of obtaining distal motor latencies of the medial and lateral plantar nerves over fixed distances with temperature correction in 37 normal subjects is presented. The posterior tibial nerve was supramaximally stimulated 6, 8, 10, 12 and 14cm proximal to the active electrode over the motor point of the abductor hallucis. These same stimulation points were then used when recording from the abductor digiti minimi. Distance was measured with both flexible tape and calipers. Surface skin temperature was recorded at 3 different skin sites on the foot. Distal motor latency for the medial plantar nerve using a flexible tape with no temperature correction for an 8cm segment was 3.4 +/- SD 0.5msec and 3.8 +/- 0.5msec for a 10cm segment. With the same 8cm stimulation point, a flexible tape, but no temperature correction, the lateral plantar nerve distal motor latencies were 3.6 +/- SD 0.5; for the 10cm point, they were 3.9 +/- SD 0.5. Nontemperature corrected data for 6, 12, and 14cm segments using both calipers and flexible tape are presented, as are the data from 8 and 10cm segments of both the medial and lateral plantar nerves with temperature correction between 28 and 32C. These standard vales allow more accurate assessment of the tarsal tunnel syndrome (TTS). A case of bilateral tarsal tunnel is included. It is noted that early changes in TTS may not be relfected in prolonged latency measurements, and that the emg may be a more sensitive indicator of the process. Both latencies and emgs are used for the diagnosis.

Adult↗
PubMed1979

Action myoclonus following acute cerebral anoxia.

Action myoclonus secondary to posthypoxic encephalopathy is being seen increasingly with improved resuscitation techniques. A case report describes 5 specific physical and occupational therapeutic techniques for achieving independence in ambulation, transfers and self-care: (1) analysis and segmentation of complex motions into small steps; (2) controlled progression of training; (3) voluntary cessation of abnormal activity (pacing); (4) progressive densensitization to external stimuli; and (5) quantification of progress. Literature review suggests that posthypoxic action myoclonus is secondary to a loss of inhibitory synapses in the brainstem reticular formation due to low serotonin levels. The proposed therapeutic effect of clonazepam, the drug used in this patient, is decreased serotinin degredation. L-5-hydroxytryptamine, an investigative drug, is also therapeutic, for it stimulates increased serotonin production.

Acute Disease↗
PubMed1979

Amyotrophic lateral sclerosis: comprehensive management.

The cause of amyotrophic lateral sclerosis remains unknown, and no curative treatment is available. From a rehabilitation perspective, however, comprehensive management and symptomatic treatment can minimize complications, increase function and improve the patient's quality of life. Quinine, diazepam (Valium) and phenytoin (Dilantin) may relieve muscle cramps, and orthoses may permit greater participation in daily activities. Problems with respiration and swallowing may require surgical procedures and the use of feeding tubes. Decisions regarding surgical intervention must be made in the context of the patient's overall status.

Activities of Daily Living↗
PubMed1979

Musculocutaneous nerve palsy: an isolated complication of surgery.

Isolated paralysis of the musculocutaneous nerve, as reported in the literature, is an extremely rare phenomenon. It is our purpose to document the occurrence of one case as a complication of abdominal surgery. Possible mechanisms suggest why the musculocutaneous nerve may be vulnerable to injury during surgical procedures that incorporate certain methods of patient positioning. The particular pattern of nerve damage reflected in this case report may be helpful in further elucidating the other, more common, diffuse postoperative brachial plexus palsies.

Adult↗
PubMed1979

Exercise effect on creatine phosphokinase elevation in motor neuron disease.

Creatine phosphokinase (CPK) is usually elevated in inflammatory and degenerative muscle disease but is usually reported as normal in neuropathic diseases. A review of the literature indicates, however, that it is elevated in 50 to 75% of patients who have motor neuron diseases, and that these elevations are usually 5 to 6 times normal. The effect of bedrest and moderate exercise on serial CPK values in a patient with motor neuron disease is assessed. Bedrest for 24 hours decreased his CPK to 0.58 of the baseline value; 5 hours following moderate exercise it increased to 1.71 of the basal value. This phenomenon appears to be a response to exercise stimuli rather than to the disease process itself. CPK values up O 1000 IU/L are compatible with the diagnosis of amyotrophic lateral sclerosis (ALS). In patients whose CPK values seem atypical, it is best to have them rest 48 hours before repeating the test.

Amyotrophic Lateral Sclerosis↗