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Biomedical subjects

P S Tepperman

Publications and source records attributed to P S Tepperman.

15 recordsLinked to original sources
PubMed1989

Primary care after spinal cord injury. What every physician should know.

Primary care physicians can help patients with spinal cord injury return to the community by accepting them into their practice. The transition from physiatrist to primary care physician after formal rehabilitation is a cooperative effort. Knowing how to treat the common skin, pulmonary, cardiovascular, autonomic, neuromotor, and musculoskeletal complications of spinal cord injury is essential. Just as important is the willingness to address problems of sexual dysfunction and psychosocial issues. If so prepared, primary care physicians can provide excellent care to patients with spinal cord injury and thereby assume an important role in the long-term rehabilitation of these patients.

Follow-Up Studies↗
PubMed1986

Stroke rehabilitation. A problem-oriented approach.

Optimal rehabilitation of stroke disability depends on a detailed analysis of neurologic impairments, associated medical conditions, psychosocial status, activities of daily living, and environmental barriers. Such analysis will permit design of the most appropriate management program, aimed at minimizing disability, maximizing function, and returning the stroke patient to a gratifying existence in spite of residual impairment and disability.

Activities of Daily Living↗
PubMed1986

Arthritis rehabilitation. A multifaceted process.

Rehabilitation of the patient with arthritis is a multifaceted process that should always involve patient, family, and a wide variety of healthcare professionals and community organizations. The optimal goal is to improve the patient's functional performance. Success depends on correct identification of functionally limiting problems.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1986

Cervical and lumbopelvic traction. To stretch or not to stretch.

Cervical traction and lumbopelvic traction are commonly prescribed for relief of neck pain and low back pain, respectively. Scientific validation of efficacy is scant, but considerable empirical benefit has been observed. In the absence of contraindications and with appropriate application, cervical and lumbopelvic traction may be used to provide symptomatic relief of neck and low back pain.

Back Pain↗
PubMed1986

Effect of ankle position on isometric quadriceps strengthening.

A prospective study of 20 normal subjects was undertaken to determine the effect of three ankle positions (active dorsiflexion, active plantar flexion, natural or rest position) on comfort and facilitation of quadriceps contraction in isometric strengthening in a supine position with the hip and knee fully extended. Surface EMG activity was found to be greatest for the vastus lateralis followed by the vastus medialis and least for the rectus femoris. Equal facilitation was apparent with either active ankle dorsiflexion or plantar flexion. Both were superior to the natural (rest) position. In situations where isometric quadriceps exercises are required, the authors recommend either active ankle dorsiflexion or plantar flexion to facilitate quadriceps strengthening. The choice between the two positions should be based on patient comfort.

Adult↗
PubMed1985

Assessment of hand blood flow: a modified technique.

A blood flow artifact has been identified with the conventional bolus-injection technique in radionuclide studies of hand disorders. The artifact, consisting of increased blood flow on the injected side, was demonstrated in 22 of 25 subjects. Using a modified injection technique to allow time for local blood flow to return to the basal state, the artifact could be eliminated in 19 of 23 additional subjects. Use of this simple protocol should help avoid misinterpretation of blood flow asymmetry in the assessment of hand disorders.

Adult↗
PubMed1984

Reflex sympathetic dystrophy in hemiplegia.

Eighty-five consecutive post-CVA hemiplegic patients were assessed prospectively for radionuclide and clinical features of reflex sympathetic dystrophy (RSD). Scintigraphy, a safe and relatively noninvasive procedure, has proved to be more sensitive than clinical evaluation for early diagnosis of RSD. RSD was found to be more prevalent in the post-CVA hemiplegic patient than previously reported. Twenty-one patients (25%) exhibited radionuclide evidence of RSD based on delayed scan criteria of increased uptake in the hemiplegic wrist, metacarpal-phalangeal (MCP) and interphalangeal (IP) joints. Two patterns of soft tissue blood flow were observed. Eight scan-positive RSD patients presented a low flow pattern identical to the non-RSD hemiplegic patients while the remaining thirteen exhibited a high flow pattern. Neither demographic characteristics, co-morbid conditions, etiology of CVA, nor site of lesion had any bearing on RSD development. There was no clinical or radionuclide evidence of bilateral involvement commonly described in other heterogeneous RSD populations. Clinical diagnosis was difficult, as various features of the syndrome were often present for other reasons and the presentation was frequently incomplete. MCP tenderness to compression proved to be the most valuable clinical sign of RSD, with a predictive value, sensitivity, and specificity rates of 100%, 85.7%, and 100% respectively.

Age Factors↗
PubMed1984

Three-phase bone studies in hemiplegia with reflex sympathetic dystrophy and the effect of disuse.

Eighty-five patients with cerebral vascular accidents were assessed with three-phase bone scintigraphy of the hands and with whole-body delayed bone imaging. Nine patients (10%) had normal three-phase bone images. Fifty-five patients (65%) showed decreased blood flow and blood-pool images of the hands and wrists with normal delayed bone scintigrams, indicating the effect of paralysis or disuse. Twenty-one patients (25%) had diffuse increased uptake with periarticular accentuation, felt to be bone-scintigraphic evidence of reflex sympathetic dystrophy of the hands and wrists; in two patients this occurred before its clinical appearance. Thirteen of the 21 reflex sympathetic dystrophy syndromes (RDS)-involved limbs (62%) had increased blood flow, whereas 8 (38%) had decreased flow. Gross limb blood flow appears to be related to the degree of muscle activity, but flow may be altered by the presence of sympathetic changes. A possible dissociation between whole-limb flow and bone blood flow in paralyzed limbs involved with RDS is discussed. The elbow was involved in only one case, and a true "shoulder-hand" distribution was seen in only 11 of 21 cases (52%). Five patients (6%) had leg involvement on whole-body imaging. Traumatic synovitis of the wrist, and trauma to subluxed shoulders, could be recognized on the delayed study.

Adult↗
PubMed1983

Therapeutic heat and cold. A practitioner's guide.

Application of heat generally increases metabolic activity, with resulting increase in circulation and exacerbation of inflammation, while cold in most cases has the opposite effect. Choice of treatment method in a given case is based on many factors, including the physical properties (ie, depth of penetration and method of energy delivery) of the modality under consideration and knowledge of the contraindications. A thorough understanding of the physiologic bases for use of thermotherapy and cryotherapy as well as of the various methods for delivery of therapeutic heat and cold will allow the physician to make optimal use of the modalities available.

Acute Disease↗
PubMed1981

Cervical spine disease and dysphagia. Four new cases and a review of the literature.

Four cases of dysphagia associated with disease of the cervical spine have been presented. One of the patients had cervical spondylosis with osteophyte formation while the other three had Forestier's disease or ankylosing hyperostosis. Symptoms of dysphagia dominated the clinical picture and led to their referral for further management. Two patients underwent surgical procedures and one died in the postoperative period. Two patients were managed conservatively, one with antibiotics, and both did reasonably well. The literature of 40 cases published in the last 54 years has been reviewed. We suggest that dysphagia due to cervical spine disease while an uncommon complication of these bony growths, is by no means rare. The dysphagia may be due to bony protuberances into the hypopharynx or into the esophagus and may be accompanied by soft tissue inflammation. Although most patients have been treated surgically, there may be a role for anti-inflammatory or antibiotic therapy in the first instance as surgery is often morbid and sometimes fatal.

Aged↗
PubMed1980

Motor speech disorders: a clinical approach.

Disorders of motor speech may result from impairments in basic motor control systems similar to those causing motor disturbances of the trunk and extremities. Dysarthria and dyspraxia are two distinct disorders of motor speech which differ in both pathologic localization and clinical presentation. These motor speech disorders must be clearly differentiated from other linguistic disorders which result from brain damage. A clear understanding of the relationship among basic neuroanatomy, neurophysiology, neuropathology, and functional clinical assessment will provide the clinician with valuable diagnostic information. This should lead to early referral to the speech pathologist for appropriate management.

Basal Ganglia Diseases↗
PubMed1977

Pressure sores. Prevention and step-up management.

The tissue changes that produce pressure sores may be described as occurring in five stages: blanching hyperemia, nonblanching hyperemia, blister and eschar formation, clean ulcer, and infected ulcer. Tissue breakdown is a direct response to external pressure, friction, or shearing force. Prevention of pressure sores comes down to identifying intrinsic and extrinsic risk factors and taking all possible steps to circumvent them. A "step-up" approach to management takes its name from the components surface agents, thermal agents, exposure, ultraviolet light, and pressure redistribution.

Humans↗