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Biomedical subjects

R L Waters

Publications and source records attributed to R L Waters.

At least 37 records · Page 2Linked to original sources
PubMed1996

Effect of surgery on motor recovery following traumatic spinal cord injury.

The influence of spine surgery on motor recovery between 1 month and 1 year was assessed prospectively in a group of 269 patients following traumatic spinal cord injury (SCI) using the classification system originally developed by the American Spinal Injury Association. The Allen classification was used to categorize cervical vertebral pathology and the Denis system was used for injuries to the thoracic and lumbar spine. Gunshot injuries were classified based upon the bullet trajectory and location relative to the spinal canal. Individuals undergoing surgery were divided into various subgroups depending on the type of surgery performed: anterior decompression with or without spine fusion and instrumentation, posterior decompression/laminectomy with or without spine fusion and instrumentation and spine fusion with instrumentation. Motor score recovery between 1 month and 1 year after injury was highly dependent (P < or = 0.001) on the level and completeness of injury averaging 0.7 +/- 2.7 for complete paraplegics, 7.8 +/- 4.8 for complete tetraplegics, 11.8 +/- 8.3, for incomplete paraplegics and 22.2 +/- 10.9 for incomplete tetraplegics. Motor recovery did not significantly differ between patients categorized in various surgical subgroups or between those having surgery and those treated non-operatively. Additionally, although the sample size was small, motor recovery among tetraplegic individuals did not depend on whether unilateral and bilateral facet dislocations were reduced and in patients with incomplete lesions, those with reductions actually had a poorer outcome than those who were left in a dislocated position.

Accidents, Traffic↗
PubMed1996

Brachioradialis transfer for wrist extension in tetraplegic patients who have fifth-cervical-level neurological function.

The brachioradialis tendon was transferred to the extensor carpi radialis longus and brevis tendons to restore active extension of the wrist in nine patients who had traumatic tetraplegia. The classification of neurological function was the fifth cervical level for all patients. The average time from the injury to the operation was six years (range, one to twenty years), and the average duration of follow-up was ten years (range, two to fifteen years). The evaluation of the patient included a determination of the preoperative and postoperative ranges of motion of the wrist, manual muscle-testing of the strength of the brachioradialis and the wrist extensors, a functional assessment of the ability to perform activities of daily living (eating, grooming, dressing, personal hygiene, and desktop activities [writing, typing, using a telephone, and so on]), and an assessment of functional independence. In addition, the result of the operation was evaluated subjectively by the patient. No patient had active extension of the wrist against gravity preoperatively. The strength of the wrist extensors improved postoperatively to a grade of good in six patients and to a grade of fair-plus in three. Function of the hand improved markedly in seven patients, and no patient had a loss of function. The patients had improvement in the ability to pick up objects, to feed and groom themselves, to tend to personal hygiene, to write and type, and to use a telephone.

Activities of Daily Living↗
PubMed1996

The effect of a flexion contracture of the elbow on the ability to transfer in patients who have quadriplegia at the sixth cervical level.

We studied six patients (twelve upper extremities) who had quadriplegia at the sixth cervical level. Our purpose was to evaluate how the loss of terminal extension of the elbow adversely affected the ability of the patient to perform transfers with a sliding board and so-called depression raises (lifting of the body with use of the extended upper extremities to reduce the pressure on the ischial tuberosities). Function of the triceps muscle was considered to be absent in eight upper extremities and present in four. A flexion contracture of the elbow was simulated with use of a specially fabricated, hinged elbow brace. Terminal extension was progressively limited, in 5-degree increments, until the patient was no longer able to perform the transfer or the depression raise. The mean flexion contracture at which the patient could not perform the transfer or the depression raise was approximately 25 degrees when function of the triceps was absent and approximately 50 degrees when function of the triceps was intact. The results of this study emphasize the importance of maintaining the full range of motion of the elbow in a patient who has high-level quadriplegia. In a patient who has quadriplegia at the sixth cervical level who otherwise would be independent with regard to transfer skills and mobility in bed, a flexion contracture of the elbow of approximately 25 degrees or more can result in the loss of a functional level and render the patient as dependent as one who has quadriplegia at the fifth cervical level.

Activities of Daily Living↗
PubMed1995

Injury pattern effect on motor recovery after traumatic spinal cord injury.

OBJECTIVE: To determine whether type of fracture or gunshot injury correlated with extent of motor impairment at 1 month and/or with the amount of motor recovery between 1 month and 1 year. DESIGN: Prospective neurological examinations were performed longitudinally after the recommendations of the American Spinal Injury Association (ASIA). Fractures were classified by the Allen system (cervical spine) or the Denis system (thoracic and lumbar spine). Gunshot injuries were classified based on trajectory and bullet location. SETTING: Subjects were examined at a community medical center. PATIENTS: There were 278 patients with traumatic spinal cord injury who were admitted between 1985 and 1990. MAIN OUTCOME MEASURES: The ASIA motor score was the primary outcome measure. RESULTS: There were no significant differences in motor recovery based on type of injury (penetrating vs nonpenetrating), type of fracture, or bullet location. CONCLUSIONS: Injuries severely disruptive of the spinal canal were more likely to result in complete SCI. Flexion-rotation injuries in the thoracic and lumbar spine, bilateral facet dislocations in the cervical spine, and gunshot wounds in which the bullet passed through the canal were more likely to be complete. Incomplete injuries were more common among patients with preexisting cervical spondylosis who had fallen and patients with gunshot wounds in which the bullet did not penetrate the spinal canal. The primary determinant of motor recovery was completeness of injury at 1 month.

Adult↗
PubMed1995

Motor recovery following spinal cord injury caused by stab wounds: a multicenter study.

A prospective multicenter study was conducted by centers participating in the National Model Spinal Cord Injury System program to examine neurological deficit and recovery patterns following spinal cord injury (SCI) resulting from stab wounds. Thirty two patients were evaluated. Sixty three percent presented with motor incomplete lesions on initial examination. In addition, four of seven who initially presented with motor complete paraplegia were motor incomplete at follow-up. Furthermore, 50% of those with motor incomplete lesions had asymmetrical motor patterns indicative of a Brown-Séquard Syndrome. Although the percentage of patients sustaining an incomplete SCI injury following a stab injury to the spine is higher than the percentage of incomplete lesions associated with other etiologies, the amount of motor recovery when controlling for level and completeness of injury is no greater than previously reported for other etiologies.

Adult↗
PubMed1995

Gunshot wounds to the spine.

Gunshot wounds to the spine are becoming more prevalent, especially in urban areas. Neurologic injury can occur even if the projectile does not penetrate the spinal canal. Initial treatment should consist of stabilizing the patient's medical condition followed by a careful neurologic examination. Spinal stability can be determined from plain radiographs and CT scan, with the overwhelming majority of injuries being stable. Retained bullets rarely cause problems of delayed infection, late neurologic decline, or lead toxicity, eliminating the need for prophylactic bullet removal; however, in the thoracolumbar spine, removal of bullet fragments lodged within the spinal canal has been shown to significantly improve neurologic recovery.

Algorithms↗
PubMed1995

Rehabilitation of the patient with a spinal cord injury.

An overview of the individual with spinal cord injury caused by gunshot wounds is presented. In addition to the demographics of the group of patients, the cost estimates of care are discussed. The authors' experience in monitoring neurologic recovery and rehabilitation expectations and outcomes are also reported.

Cost of Illness↗
PubMed1994

Motor and sensory recovery following incomplete tetraplegia.

Fifty individuals with incomplete tetraplegia due to trauma underwent serial prospective examinations to quantify motor and sensory recovery. None of 5 patients who were motor complete with the presence of sacral (S4-S5) sharp/dull touch sensation unilaterally recovered any lower extremity motor function. However, in 8 motor complete subjects having bilateral sacral sharp/dull sensation present, the mean lower extremity motor score increased to 12.1 +/- 7.8 at 1 year. In 3 of the 8 cases, functional (> or = 3/5) recovery was seen in some muscles at 1 year. Though mean upper and lower extremity ASIA Motor Scores increased significantly (p < .001) between 1 month and 1 year for the entire sample, the annualized rate of motor recovery rapidly declined in the first 6 months and then subsequently approached plateau. Eighty-seven percent (20 of 23) of patients having a lower extremity motor score > or = 10 at 1 month were community ambulators using crutches and orthoses at 1 year follow-up.

Adolescent↗
PubMed1994

Rerouting of the biceps brachii for paralytic supination contracture of the forearm in tetraplegia due to trauma.

Six tetraplegic patients (eight forearms) who had a supination contracture were evaluated after lengthening and rerouting of the biceps brachii. Preoperatively, the mean range of supination and pronation of the forearm was 85 and 14 degrees, respectively. Pronation increased a mean of 75 degrees without affecting the strength of flexion or the flexion-extension arc of motion of the elbow. The forearms that had a satisfactory result had a mean active range of supination of 69 degrees, while those that had a poor result had no active supination. The mean duration of follow-up was twenty-seven months (range, twelve to seventy-two months). The result was considered satisfactory for six limbs and unsatisfactory for two. Functional gains were made in the patients' ability to feed and groom themselves, in their ability to tend to personal hygiene, and in writing and typing skills when the dominant extremity was treated. The results were less predictable for the non-dominant extremity. The maximum gain in the range of motion occurred at three months and the maximum functional gain, by six months.

Activities of Daily Living↗
PubMed1994

Comparison of computerized tomography parameters of the thoracolumbar spine in normal control subjects and spinal cord injured patients.

The cross-sectional area and the sagittal and transverse diameters of the spinal canal at the thoracolumbar junction were measured using high resolution thin-section computerized tomography images in 15 control subjects and 28 patients with traumatic injury to the spinal cord at the thoracolumbar junction. No significant difference between the control and study groups was found with regard to any of the three measures taken. With the exception of the sagittal canal diameter for the first lumbar vertebra, all the mean values were higher for the spinal cord injured group. The ratio of the sagittal to transverse diameter was larger for the control group; however, this difference also was not significant. These findings suggest no significant differences in the dimensions and shape of the canal at the thoracolumbar region between the spinal cord injured and control groups. In contrast to the cervical spinal canal, there appears to be no correlation between the spinal cord injury and the dimensions of the thoracolumbar spinal canal.

Adult↗
PubMed1994

Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association.

Assessment of strength using motor scores derived from the standards of the American Spinal Injury Association (ASIA) was compared with assessment using motor scores based on biomechanical aspects of walking in the prediction of ambulatory performance. Measurements of strength, gait performance, and the energy expenditure were performed in 36 spinal cord injured patients. The ASIA scoring system compared favorably with the biomechanical scoring system. The ASIA score strongly correlated with the percent increase in the rate of O2 consumption above normal (p < .0005), O2 cost per meter (p < .0006), peak axial load exerted by the arms on crutches (p < .0001), velocity (p < .0001), and cadence (p < .0001). Patients with lower extremity ASIA scores < or = 20 were limited ambulators with slower average velocities at higher heart rates, greater energy expenditure, and greater peak axial load exerted on assistive devices than patients with lower extremity ASIA scores > or = 30 who were community ambulators. We conclude the ASIA motor score is a simple clinical measure that strongly correlates with walking ability.

Adult↗
PubMed1994

The relationship of the interosseous membrane to the axis of rotation of the forearm.

Fresh anatomic specimen forearms were studied using a mechanical device, the axis finder, to locate the axis of rotation. The relationship of the axis to the membrane was demonstrated directly using a small jig. The axis of rotation of the forearm is constant and independent of elbow flexion or extension. It runs from the center of the radial head to the center of the distal ulna. All fibers of the interosseous membrane cross the axis of rotation near their distal insertion into bone. This relationship of the ligaments to the axis of rotation is similar to those of the ankle, knee, and thumb joints. The membrane does not limit forearm rotation and can provide little stability if the bony ring is disrupted.

Forearm↗
PubMed1994

Motor and sensory recovery following incomplete paraplegia.

Fifty-four individuals admitted for rehabilitation with a diagnosis of incomplete paraplegia due to trauma underwent serial prospective examinations to quantify motor and sensory recovery. Motor and sensory scoring guidelines recommended by the American Spinal Injury Association were used to assess changes. Lower extremity motor scores (LEMS) differed significantly (p < .03) between groups of patients partitioned by category of initial neurologic level of injury (NLI) with the following averages at 1 month after injury: 6.8 +/- 11.3 above T12, 15.0 +/- 8.2 at T12 and 18.3 +/- 11.4 below T12. However, the amount of motor recovery was independent of the NLI with the differences between the NLI groups remaining essentially constant from 1 month to 2 years. While the LEMS increased significantly (p < .001) an average of 11.9 +/- 8.7 points between 1 month and 1 year, the annualized rate of motor recovery rapidly declined in the first 6 months and then subsequently plateaued. All patients having a 1-month LEMS greater than 10 points (28 cases) with hip flexion or knee extension strength > or = 2/5 were able to ambulate in the community with a reciprocal gait pattern using crutches and orthoses at 1-year follow-up.

Adolescent↗
PubMed1993

Recovery following ischemic myelopathy.

Motor and sensory recovery were determined in five patients with ischemic myelopathy associated with traumatic laceration or surgical manipulation of the thoracic aorta. The neurologic level of injury was between T-2 and T-10. All patients had an anterior spinal artery pattern of incomplete spinal cord injury consisting of relatively greater loss of motor function than sensation and preservation of sacral sensation. None of the three patients with zero lower extremity motor function at 30 regained any motor function at 1 year. Two patients with partial motor function 1 month after infarction had further motor recovery at 1 year. One of these two individuals was able to ambulate independently with a reciprocal gait using orthoses.

Adolescent↗
PubMed1993

Motor and sensory recovery following complete tetraplegia.

Sixty-one individuals admitted for rehabilitation with a diagnosis of complete tetraplegia due to traumatic spinal cord injury underwent prospective examinations for motor and sensory recovery. The amount of motor, light touch and sharp/dull (pin prick) sensory recovery was independent of the initial neurologic level of injury between C4 and C8. In the interval between one month and one year following injury, the American Spinal Injury Association Motor Score increased an average of 8.6 +/- 4.7. However, the rate of motor recovery rapidly declined in the first six months and then approached plateau. Ninety-seven percent of muscles with Grade 1/5 ("Trace") or 2/5 ("Poor") strength one month after injury recovered to > or = 3/5 ("Fair") strength by the time of first annual follow-up. Muscles with 0/5 strength one month after injury and located one neurological level below the most caudal level having motor function regained > or = 3/5 strength in only 27 percent of cases at one year follow-up and at two levels below in only 1% of cases.

Adolescent↗
PubMed1993

Gait performance after spinal cord injury.

Physiologic and mechanical gait parameters were measured in 36 spinal cord injury (SCI) patients to quantify gait impairment. Average age of the 30 males and six females was 29.0 +/- 10.1 years. Patients were tested at the time of discharge from initial rehabilitation (mean, 0.5 +/- 0.7 years postinjury). Compared with able-bodied subjects tested in the same laboratory, the SCI patients walked 52% slower (41.1 m/minute versus 79.8 m/minute, respectively), the rate of oxygen consumption was 23% higher (14.9 ml/kg.minute versus 12.1 ml/kg.minute), and the oxygen cost per meter was 240% higher (0.52 ml/kg.m versus 0.15 ml/kg.m). Peak axial load on upper extremity walking aids averaged 21.7% of body weight, and the ambulatory motor index (AMI), derived from lower limb strength grades, was 52% of normal strength. The AMI closely correlated with the peak axial load and the percent increase in the oxygen rate above normal. Differences in the AMI among patients accounted for changes in physiologic parameters; therefore, the AMI can be used as a clinical predictor of functional mobility. Annual follow-up studies were performed on ten of the 36 patients. Compared with the initial testing, these patients walked faster (59.9 m/minute versus 40.4 m/minute), more efficiently (0.26 ml/kg.m versus 0.40 ml/kg.m), with slower heart rates (115 beats/minute versus 133 beats/minute), and the peak axial load was less (18% of body weight versus 26% of body weight).

Adult↗
PubMed1992

Emergency cervical-spine immobilization.

STUDY OBJECTIVE: To determine the effectiveness of a cervical-spine immobilization using a rigid cervical extrication collar and an Ammerman halo orthosis with and without spine boards. DESIGN: A mixed model multivariate design with one within factor (device type) and one between factor (spine board application). SETTING: Radiology suite. TYPE OF PARTICIPANTS: Twenty normal men with a mean age of 29.6. INTERVENTIONS: Unrestrained cervical motion was compared with motion in a cervical extrication collar and an Ammerman halo orthosis with and without a spine board. MEASUREMENTS: Photographic measurement of head and neck motion during maximal flexion-extension, lateral bending, and rotation. Radiologic measurement of maximal intervertebral flexion-extension. MAIN RESULTS: Both cervical extrication collar and Ammerman halo orthosis significantly reduced motion in all planes (P less than .001) with the Ammerman halo orthosis reducing these motions significantly more (P less than .001). With the use of a spine board these motions were restricted even more (P less than .001). The Ammerman halo orthosis with a spine board provided the greatest immobilization, equivalent to that provided by an halo-vest. CONCLUSION: A rigid cervical collar and a spine board provide significantly better immobilization than the collar alone. Further immobilization is provided by an Ammerman halo orthosis.

Adult↗