Search PubMed⌕ Search

Biomedical subjects

K T Ragnarsson

Publications and source records attributed to K T Ragnarsson.

At least 19 recordsLinked to original sources
PubMed2002

Quality of life in patients with spinal cord injury--basic issues, assessment, and recommendations.

INTRODUCTION: Spinal cord injury (SCI) often causes severe disabilities. The degree of functional impairment strongly depends on the level and completeness of lesion (tetraplegic, paraplegic). But evaluation of outcomes also needs to consider the broader concept of health-related quality of the life (HRQL) for SCI patients. A multinational group of clinicians and researchers assessed this concept and reviewed the available instruments for measurement of quality of life in this group of patients. TIME POINTS: Phase I is in the acute clinic; phase II during rehabilitation; phase III after discharge home. Annual follow-up investigations should be maintained. The phase of initial care (phase 0) is important for prognosis and should, therefore, be part of the documentation. INSTRUMENTS: Criteria used to evaluate current QoL measures: reliability, validity, responsiveness, availability of translations, application in SCI patients, existing population norms. Several specific instruments or subscales exist for the following domains: physical and psychological functioning, pain, and handicap. Well-known generic measures of HRQL also have been applied to SCI patients, and a disease-specific instrument has been developed (SCIQL-23). A variety of subjective quality of life measures were evaluated as well. GROUP CONSENSUS/GUIDELINE: Prior to discharge from rehabilitation, the group suggested the use of the Functional Independence Measure, the Hospital Anxiety and Depression Scale and a Visual Analogue Scale for pain. Following discharge from the acute clinic, the SF-36, the Craig Handicap Assessment and Reporting Technique, the Quality of Well-being Scale, or the Life Satisfaction questionnaire were proposed. However, the evidence supporting the use of these instruments is sparse.

Disability Evaluation↗
PubMed2001

Herpetic gingivostomatitis in otherwise healthy adolescents and young adults.

The purpose of this study was to review and analyze the records of herpes simplex infections from a specialist Oral Medicine clinic in Iceland, to investigate the clinical impression that the age of patients experiencing initial infection with this virus was higher than expected and that the character of the clinical picture of the disease had changed. Records of patients with herpes infections attending the Oral Medicine clinic covering a 3-year period were examined and the clinical and virological data analyzed. Diagnosis was based on clinical appearance, history, and viral identification with culture or detection of viral DNA by means of the polymerase chain reaction. Records of 60 patients (34 female) were included in the study (mean age, 23.1 years; range, 2 68 years). No patients were known or suspected to be positive for human immunodeficiency virus, none was known to be immunocompromised, and 38 patients (mean age, 16.6 years; 21 female) were diagnosed as having primary herpetic gingivostomatitis. Eighteen patients (mean age, 36.2 years; 11 female) had lesions of recurrent herpes simplex infection present on the oral mucosa. Primary infection with herpes simplex virus was more common in young adults than had been expected. Recurrent infections appeared on the oral mucosal even in otherwise healthy patients, and the clinical course of these infections in this age group sometimes followed a more severe course than that seen in young children.

Adolescent↗
PubMed2000

Pain after spinal cord injury.

Evaluation of pain in a person with SCI should commence with a determination of the neurologic level and the completeness of injury. The pain then can be localized to one of three regions: above level, at level, or below level. The regional pain then should be categorized either as nociceptive or neuropathic and, after this, subdivided into a specific subtype. An evidence based treatment plan can be devised depending on the specific subtype, which may include physical measures, pharmacologic treatments, behavioral interventions, surgery, or an eclectic combination program. The treatment plan usually can provide some relief for any of the subtypes, although complete relief often is not possible.

Humans↗
PubMed1999

Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury--1990-1997.

OBJECTIVES: To describe changes in acute and rehabilitation length of stay (LOS) for persons with traumatic spinal cord injury (SCI), describe predictors of LOS, and explore year-1 anniversary medical and social outcomes. DESIGN: Longitudinal, exploratory study of patients with SCI. SETTING: Eighteen Model Spinal Cord Injury Centers across the United States. SAMPLE: A total of 3,904 persons discharged from the Model Systems between 1990 and 1997 who had follow-up interviews at 1 year postinjury. MAIN OUTCOME MEASURES: Rehabilitation LOS; injury anniversary year-1 presence of pressure ulcers; incidence of rehospitalization; community or institutional residence; and days per week out of residence. RESULTS: Acute rehabilitation LOS declined from 74 days to 60 days. Discharges to nursing homes and rehospitalizations increased between 1990 and 1997. Linear regression showed that lower admission motor Functional Independence Measure (FIM) scores, year of discharge from the Model System, method of bladder management, tetraplegia, race, education, marital status, discharge disposition, and age were related to longer LOS. At first anniversary, logistic regressions revealed that lower discharge motor FIM, injury level, and age were related to the presence of pressure ulcers, rehospitalization, residence, and time spent out of residence. Of those discharged to nursing homes, 44% returned to home by year 1, and these individuals had higher functional status and were younger. DISCUSSION: High functional status is associated with shorter LOS, discharge to the community, and time spent out of residence, indicating efficiency in the system. For 44.4% of individuals one or more of the following outcomes were observed by first year anniversary: rehospitalization; residing in a skilled nursing facility; having pressure ulcers; or infrequently leaving one's residence.

Adult↗
PubMed1999

Physical medicine and rehabilitation at the Mount Sinai medical center during the 20th century.

The Department of Rehabilitation Medicine at the Mount Sinai Medical Center has a long history, beginning in 1910 with the establishment of the Department of Physical Therapy, headed by Heinrich Wolf, M.D. In 1935, William Bierman, M.D., was appointed director. He was, at that time, one of the leading physicians of physical therapy in the United States, and a prolific researcher, writer and clinician. In 1948, the name of the department was changed to the Department of Physical Medicine, reflecting the newly established specialty of the Board of Physical Medicine. In 1959, Lawrence Wisham, M.D., was appointed chairman, and shortly thereafter the name of the department was changed to Physical Medicine and Rehabilitation. Under Dr. Wisham's leadership, services were provided to inpatients on the acute wards of the hospital, and to outpatients. In 1968, the name of the department was changed to Rehabilitation Medicine. In 1986, Kristjan T. Ragnarsson, M.D., became chairman of the department, and shortly thereafter an inpatient rehabilitation medicine service was established and outpatient services expanded. Since that time, rapid growth has occurred within the department, particularly in delivery of clinical services and research. The role of rehabilitation medicine in the delivery of clinical services to people with temporary or permanent disability is now well established, but efficient and effective delivery must be ensured in the current and future healthcare environment.

History, 20th Century↗
PubMed1998

Three women with lupus transverse myelitis: case reports and differential diagnosis.

Although the association between transverse myelitis (TM) and systemic lupus erythematosus (SLE) has been reported previously, it remains a rare clinical condition. Our experience treating three women with lupus TM within a few months is presented. In each patient, spinal cord dysfunction was accompanied by laboratory or clinical evidence of SLE. Further neurologic manifestations, such as optic neuritis, developed in all patients, suggesting other diagnoses, including multiple sclerosis (MS), Devic's syndrome, and lupoid sclerosis. The outcomes for these three women were severe disability, death, and moderate disability, respectively. The severity of outcome did not seem to correlate with the timing or intensity of treatment. Physiatrists should be aware of the potential for neurologic progression in lupus TM, because patients with this condition invariably require rehabilitation.

Adult↗
PubMed1997

Parathyroid hormone suppression in spinal cord injury patients is associated with the degree of neurologic impairment and not the level of injury.

OBJECTIVE: To demonstrate that after spinal cord injury (SCI) suppression of the parathyroid-vitamin D axis is associated with the degree of neurologic impairment and not the level of injury. DESIGN: A retrospective analysis of clinical and biochemical data obtained from hospital records of patients with SCI compared to a control group of patients with traumatic brain injury (TBI). SETTING: The inpatient rehabilitation unit of a tertiary care hospital. SUBJECTS: The medical records of 82 consecutive admissions to the rehabilitation unit with a diagnosis of SCI or TBI were reviewed. Patients with SCI were classified by the American Spinal Injury Association (ASIA) impairment scale and then grouped based on the completeness and level of injury. MAIN OUTCOME MEASURE: Comparisons of serum parathyroid hormone (PTH), 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D (1,25-D) were planned. Multiple comparisons were performed for total and ionized serum calcium levels, serum phosphorus levels, and 24-hour urinary calcium excretion rates to reflect changes in mineral homeostasis. Multiple comparisons were also performed for serum albumin, prolactin, thyroid function tests, and AM cortisol levels, as well as 24-hour urinary urea nitrogen and cortisol excretion rates to reflect metabolic responses to stress. RESULTS: Patients with SCI had significant suppression in PTH (p < .000009) and 1,25-D (p < .02) levels with elevated phosphorus (p < 0.03) and prolactin (p < .03) levels compared to patients with TBI. Also, more patients with SCI were hypoalbuminemic (p < .003) than patients with TBI. Patients with complete SCI (ASIA A) had more suppressed PTH (p < .03) and higher urinary urea nitrogen (p < .05) levels than SCI patients with incomplete injuries (ASIA B-D). Patients with complete, but not incomplete, SCI had lower albumin levels than patients with TBI (p < .05). These differences were not found between patients with tetraplegic and paraplegic SCI. ASIA motor scores did not correlate with any of the measured parameters but when used as a covariate did abolish differences in PTH and 1,25-D among the study groups by ANOVA. CONCLUSION: In patients with SCI, the degree of neurologic impairment, and not the level of injury, is associated with PTH suppression and markers of metabolic stress.

Activities of Daily Living↗
PubMed1997

Management of pain in persons with spinal cord injury.

Pain is a common complaint following spinal cord injury (SCI). While nociceptive pain can often be effectively managed by traditional therapies, neurogenic pain is more refractory to treatment. Several categories of pain are recognized in persons with SCI and an accurate diagnosis will improve the therapeutic response. Nociceptive pain is usually perceived to be above or at the level of the cord lesion and is most commonly related to musculoskeletal pathology. Neurogenic pain is usually felt by the patient at or below the neurological level and may be classified as radicular, segmental or deafferentation central pain, depending on its hypothetical origin and the clinical presentation. Management requires recognition of all factors that may influence pain perception and knowledge of the entire range of therapeutic options.

Afferent Pathways↗
PubMed1996

Regulation of glucose turnover and hormonal responses during electrical cycling in tetraplegic humans.

To examine the importance of blood-borne vs. neural mechanisms for hormonal responses and substrate mobilization during exercise, six spinal cord-injured tetraplegic (C5-T1) males (mean age: 35 yr, range: 24-55 yr) were recruited to perform involuntary, electrically induced cycling [functional electrical stimulation (FES)] to fatigue for 24.6 +/- 2.3 min (mean and SE), and heart rate rose from 67 +/- 7 (rest) to 107 +/- 5 (exercise) beats/min. Voluntary arm cranking in tetraplegics (ARM) and voluntary leg cycling in six matched, long-term immobilized (2-12 mo) males (Vol) served as control experiments. In FES, peripheral glucose uptake increased [12.4 +/- 1.1 (rest) to 19.5 +/- 4.3 (exercise) mumol.min-1.kg-1; P < 0.05], whereas hepatic glucose production did not change from basal values [12.4 +/- 1.4 (rest) vs. 13.0 +/- 3.4 (exercise) mumol.min-1.kg-1]. Accordingly, plasma glucose decreased [from 5.4 +/- 0.3 (rest) to 4.7 +/- 0.3 (exercise) mmol/l; P < 0.05]. Plasma glucose did not change in response to ARM or Vol. Plasma free fatty acids and beta-hydroxybutyrate decreased only in FES experiments (P < 0.05). During FES, increases in growth hormone (GH) and epinephrine and decreases in insulin concentrations were abolished. Although subnormal throughout the exercise period, norepinephrine concentrations increased during FES, and responses of heart rate, adrenocorticotropic hormone, beta-endorphin, renin, lactate, and potassium were marked. In conclusion, during exercise, activity in motor centers and afferent muscle nerves is important for normal responses of GH, catecholamines, insulin, glucose production, and lipolysis. Humoral feedback and spinal or simple autonomic nervous reflex mechanisms are not sufficient. However, such mechanisms are involved in redundant control of heart rate and neuroendocrine activity in exercise.

Adult↗
PubMed1995

Rehabilitation of the geriatric orthopaedic patient.

Older patients who are referred for rehabilitation after undergoing orthopaedic procedures have numerous age-related conditions that may interfere with physical performance and safety. The general rehabilitation goals are to return each patient to the premorbid functional level of mobility and self-care, teach the exercises that are to be performed after hospital discharge, reduce the risk of falls, and ensure that the patient is discharged to a safe environment. Before elective surgery, the elderly orthopaedic patient should be instructed to perform breathing exercises to prevent pulmonary complications and active lower limb exercises to maintain good circulation and joint mobility, and be instructed in functional activities for mobilization in and out of bed. Postoperatively, the interdisciplinary rehabilitation team must facilitate early resumption of active exercises and self-care tasks and discourage prolonged bed rest and dependency on nursing staff and family members. Physical and occupational therapy should be provided to restore mobility and self-care functions. If discharge to home is planned, the home environment should be assessed and modifications recommended to reduce the risk of falls and ensure independent functioning to the extent possible. When the rehabilitation goals have been obtained, the patient should be discharged from the hospital, but additional therapy may be required, either at home or at an outpatient facility.

Accidental Falls↗
PubMed1993

Report on a conference on motor prostheses for workplace mobility of paraplegic patients in North America.

On May 18, 1992 a symposium at Case Western Reserve University in Cleveland, Ohio, USA had the goal of defining the tasks needed to reach clinical utility of investigational neural prosthetic ambulation devices. The characteristics and stage of development of four systems were detailed: the Louiiana State University reciprocating gait orthosis (LSU-RGO) with muscle stimulation; the modular hybrid functional neuromuscular stimulation (FNS) orthosis; the Cleveland VA-Case Western Reserve University (VA-CWRU) implant system; and the Parastep system. Multicenter clinical trials are underway for the Parastep system and are planned to start within the next 2 years for the LSU-RGO with muscle stimulation, the VA-CWRU 8-channel system, and the floor reaction orthosis component of the modular hybrid FNS system. Current investigational systems provide little advantage over the standing wheelchair in some occupations but they do expand social, recreational, and exercise capabilities. Disabled people and some leading rehabilitation physicians are willing to test basic ambulation devices but the regulatory approvals must first be obtained for multicenter clinical trials. Corporate partners are central to the development of devices, their clinical testing, and their subsequent marketing. A key requirement for developing and disseminating motor prostheses is the education of clinicians so that they will participate in trials and be prepared to prescribe the prostheses when they reach the market.

Electric Stimulation↗
PubMed1992

Neuroendocrine changes during functional electrical stimulation.

This study examined the effects of a computerized functional electrical stimulation exercise program on plasma beta-endorphin-like immunoreactivity (BEP-ir), cortisol levels and depression parameters in spinal cord-injured individuals. Nine subjects from 1.2 to 33.5 yr postinjury with both motor and sensory complete lesions between C5 and T12 participated. It was determined that patients who sustained spinal cord-injuries less than 5 yr before this study had lower than normal baseline levels of BEP-ir and flattened circadian rhythms. Patients who sustained their injury greater than 5 yr before this study had higher baseline levels of BEP-ir with some return to normal circadian rhythmicity. Baseline cortisol levels, regardless of time since injury, appeared to be dysregulated. Regular exercise with computerized functional electrical stimulation caused significantly (P less than 0.05) sustained increases in BEP-ir in all patients and improved the regulation of cortisol. Furthermore, the more strenuous the exercise training, greater increases in BEP-ir levels were seen. Last, depression scores improved, which suggests a possible association between subjective mood and BEP-ir levels.

Adult↗
PubMed1991

Rehabilitation in spinal cord disorders. 3. Comprehensive management of spinal cord injury.

This self-directed learning module highlights advances in the management of the person with a spinal cord deficit. Traumatic spinal cord injury is being used as the model, but the principles apply to all patients with spinal cord deficits. This article is part of the chapter on rehabilitation of spinal cord disorders for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. Specifically, this section contains information regarding prehospital care, acute assessment and management, primary rehabilitation by systems, sexuality and psychosocial issues, management of pain and spasticity, functional goals, the role of functional electrical stimulation, and long-term follow-up.

Humans↗
PubMed1991

Rehabilitation in spinal cord disorders. 2. Anatomy, pathogenesis, and research for neurologic recovery.

This self-directed learning module highlights advances in this topic area. It is part of the chapter on rehabilitation in spinal cord disorders in the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This article contains learning objectives on the anatomy of the spine and spinal cord, pathogenesis of spinal cord trauma, mechanisms of spinal fractures and dislocations, causes of nontraumatic spinal cord disorders, and research on neurologic recovery. Advances that are covered in this section include various experimental animal models for producing spinal cord injury and new approaches to limit damage in acute injury and to promote recovery in chronic injury.

Animals↗
PubMed1989

Aerobic training effects of electrically induced lower extremity exercises in spinal cord injured people.

Eleven people with spinal cord injury (SCI) (C4-T6) participated in a program of functional electric stimulation (FES) of their paralyzed leg muscles using the REGYS I system. Individualized protocols consisted of an initial phase of weight lifting, an intermediate phase of ergometer pedalling against 0 Kilopond (kp) alternated with 1/8kp for six two-minute runs separated by two-minute rest periods, and a final phase of 36 sessions of continuous ergometer pedalling against variable resistance. A metabolic analyzer measured exercise stress test parameters before and after each phase while subjects pedalled against incremented resistance. Peak oxygen consumption and total stress test time increased markedly. The respiratory exchange ratio (R=VCO2/VO2) at termination, however, did not differ from unity at any phase, indicating that fatigue (defined as a failure to maintain a pedalling frequency of 35 rpm) occurred when the anaerobic threshold was reached, and that FES exercise can increase the aerobic capacity of persons with SCI. The initial velocity of quadriceps shortening (derived from patellar tendon displacements) also decreased in five of eight subjects tested, suggesting corresponding increases in quadriceps twitch time. Since muscle inactivity converts slow-twitch to fast-twitch fibers, our subjects' increased muscle endurance accompanied by decreased muscle-shortening velocity were compatible with a disproportionate increase in the function of slow-twitch fibers relative to fast-twitch fibers. Although these findings demonstrate that lower extremity FES exercises can safely achieve significant aerobic training effects in patients with SCI, the peak levels of cardiorespiratory performance were similar to those reported for quadriplegic people performing maximal voluntary upper extremity exercises.

Adult↗