Biomedical subjects

R L Waters

Publications and source records attributed to R L Waters.

At least 55 records · Page 3Linked to original sources

PubMed1992

Recovery following complete paraplegia.

Motor and sensory recovery were quantified by serial examinations prospectively performed on 148 persons with paraplegia. Of the 142 patients who remained complete injuries at follow-up, none with an initial neurologic level of injury (NLI) above T9 regained any lower extremity motor function at follow-up. Thirty-eight percent of patients with an initial NLI at or below T9 had some return of lower extremity motor function, primarily in the hip flexors and knee initial NLI at or below T9 had some return of lower extremity motor function, primarily in the hip flexors and knee extensors. Twenty percent of the patients with an initial NLI at or below T12 regained sufficient hip flexor and knee extensor strength to reciprocally ambulate using conventional orthoses and crutches. Unlike motor function, recovery of light touch and sharp-dull discrimination was independent of the initial NLI. Six (4%) of the 148 patients demonstrated "late" conversion (more than 4 months after injury) from complete to incomplete spinal cord injury (SCI) status. Two of the 6 patients with an initial NLI at T12 and subsequent annual NLI at L1 and L2 reciprocally ambulated, and three of the 6 patients regained voluntary bladder/bowel control.

Adolescent↗

PubMed1992

Upper extremity pain in the postrehabilitation spinal cord injured patient.

The purpose of this study was to determine the prevalence of upper extremity (UE) pain in outpatients with chronic spinal cord injury (SCI). A total of 239 SCI outpatients (136 with quadriplegia and 103 with paraplegia) were interviewed for the presence of UE pain at the shoulder, elbow, wrist, and hand. The average age of the subjects at the time of interview was 37.4 years, and the average time since onset was 12.1 years. Subjects who reported pain were referred to SCI clinics to determine the etiology. Fifty-five percent of the patients with quadriplegia reported UE pain, most commonly at the shoulder. Prevalence of reported pain was highest for subjects in the first five years postinjury. Sixty-four percent of patients with paraplegia reported UE pain. Complaints related to carpal tunnel syndrome were the most common, followed by those related to shoulder pain. This study documents the prevalence and nature of UE pain in chronic SCI patients and emphasizes the need for further research to develop strategies for prevention and treatment of pain syndromes.

Activities of Daily Living↗

PubMed1991

Definition of complete spinal cord injury.

Prospective serial neurological examinations were performed on 445 consecutive traumatic spinal cord injury (SCI) patients admitted for rehabilitation on an average of 22.8 +/- 15.6 days after injury. Patients were categorized by both the ASIA and Sacral Sparing (SS) definitions of complete SCI, in order to compare the definitions in terms of consistency and prognostic ability. Recovery during follow-up was determined by sensory scores for light touch, sharp/dull discrimination, proprioception, and the ASIA Motor Index Score. Change in complete status was unidirectional using the SS definition and bidirectional using the ASIA definition. Twelve patients with SS complete injuries on initial examination converted to SS incomplete injuries at follow-up. No patients converted from SS incomplete to SS complete injury. Twenty three patients with ASIA complete injuries upon admission converted to ASIA incomplete status and 6 converted from ASIA incomplete status on admission to ASIA complete status at follow-up. For quadriplegics, the average motor recovery for patients changing complete status according to the ASIA definition was 11.7 +/- 10.3, which was significantly less (p less than .05) than the average recovery using the SS definition (group 1), 17.9 +/- 9.3. For paraplegics, the average motor recovery using the ASIA definition, 8.3 +/- 6.7, did not differ significantly from the value using the SS definition, 6.8 +/- 4.0.

Adolescent↗

PubMed1991

The effects of removal of bullet fragments retained in the spinal canal. A collaborative study by the National Spinal Cord Injury Model Systems.

Serial motor and sensory examinations were conducted on 90 patients with bullet fragments lodged in the spinal canal. Annual follow-up examinations were completed on 66 patients. Despite the fact that approximately 20% of the bullets had perforated the alimentary canal, no cases of infection were noted. Statistical analyses indicated that removal of the bullet fragments made no significant difference with regard to reducing pain or improving the recovery of sensation. However, bullet removal did have an effect on motor recovery, depending on the level at which the lesion occurred. Among those patients with lesions between vertebral levels T12 and L4, there was significantly greater (P less than 0.001) motor recovery in those patients from whom the bullet was removed from than in patients not having bullet removal. Bullet removal from the canal between T1 and T11 had no significant effect on motor recovery.

Adult↗

PubMed1991

Shoulder pain and functional disability in spinal cord injury patients.

Sixty spinal cord injured patients were examined to determine the incidence of nontraumatic shoulder pain and associated functional disability during the first 18 months after spinal cord injury (SCI). Seventy-eight percent of quadriplegics and 35% of paraplegics had pain in the first six months. When reexamined six to 18 months after SCI, 33% of the quadriplegics and 35% of the paraplegics continued to have pain. The functional disability resulting from shoulder pain was not a significant problem for the paraplegics; however, 84% of the quadriplegics having pain had either moderate or severe functional disability during the first six months after SCI, and this impairment persisted in patients with shoulder spasticity at follow-up evaluation between six and 18 months postinjury.

Adolescent↗

PubMed1991

Motor point delineation of the gluteus medius muscle for functional electrical stimulation: an in vivo anatomic study.

The purpose of this study was to delineate the motor point region of the gluteus medius muscle to aid in placing epimysial electrodes for functional electrical stimulation. Seven surgically dissected gluteus medius muscles were studied in five patients. The lateral surface of the muscle was sequentially probed with an electrical stimulator. The motor point region, which responded maximally to an applied electric current, was located on the posterolateral aspect of the muscle, adjacent to the superior margin of the piriformis, 3 cm lateral to the greater sciatic notch; it was rectangular or oval, measuring approximately 3.5 cm by 3.0 cm. The mean threshold current that produced a contraction was 14 mA (range = 2 to 26 mA). The mean minimum current required to produce a maximum contraction was 34 mA (range = 11 to 60 mA). This information provides guidelines for the placement of electrodes for functional electrical stimulation of this deeply situated muscle, and it provides electrical stimulation parameters required for adequate muscle activation.

Adult↗

PubMed1991

Profiles of spinal cord injury and recovery after gunshot injury.

Prospective motor and sensory examinations were conducted on 135 patients with neurologic deficits caused by spinal cord injuries resulting from gunshot wounds. Annual follow-up motor and sensory examinations were conducted for 67 patients. The neurologic data (motor and sensory neurologic levels of injury, zone of injury, and completeness of lesion) were assessed in terms of the vertebral level of injury, region of injury, bullet caliber, direction of bullet entry, and whether the bullet penetrated the spinal canal, completely traversed the spinal canal, or entered and remained lodged in the spinal canal. Seventy-seven of the patients sustained complete lesions and 58 sustained incomplete lesions. Anatomically, 19.3% of the injuries were in the cervical region, 51.8% in the thoracic, and 28.9% in the thoracolumbar. In 93 cases, the neurologic level was at least one level higher than vertebral level of injury. Although twice as many individuals were shot from the back as from the front and from the left as from the right, the point of bullet entry did not appear to be related to the severity of the injury. At the annual follow-up examinations, 66.7% of the patients with complete lesions and 64.0% of the patients with incomplete lesions had no improvement in the neurologic level of injury. Nevertheless, there was a significant (p less than 0.0001) improvement in the American Spinal Injury Association motor index scores one year after injury.

Adolescent↗

PubMed1990

Carpal tunnel syndrome secondary to wrist and finger flexor spasticity.

Ten patients with spastic wrist flexion deformities secondary to traumatic brain injury were evaluated for carpal tunnel syndrome. The angle of wrist flexion deformity averaged 75 degrees (range, 58 to 115 degrees). Nerve conduction studies demonstrated prolonged median motor and/or sensory latencies in all patients. Preoperative wick catheter measurements of carpal tunnel pressures in eight patients averaged 11 mm Hg in the resting position, 21 mm Hg in maximal wrist flexion, and 15 mm Hg in maximal extension. Each patient had carpal tunnel release with simultaneous wrist and finger flexor tendon releases or lengthenings. At surgery nine of the median nerves were constricted at the proximal edge of the transverse carpal ligament. The presence of normal carpal tunnel pressures and impingement of the median nerve at the proximal edge of the transverse carpal ligament indicates that the chronically flexed posture of the wrist resulted in median nerve compression, and this condition may be aggravated by underlying pressure from the spastic finger flexors.

Adolescent↗

PubMed1990

Electromyographic analysis of brachioradialis to flexor pollicis longus tendon transfer in quadriplegia.

Electromyography was done in patients at the C6 level of quadriplegia after transfer of the brachioradialis to the flexor pollicis longus to restore lateral pinch and transfer of the posterior deltoid to the triceps to restore elbow extension. The relationship of the integrated electromyogram to pinch force during a graduated isometric contraction enabled characterization of the motor recruitment pattern. After tendon transfer, the pattern of the electromyographic response for the brachioradialis was the same as in the flexor pollicis longus in normal subjects, and the posterior deltoid after transfer to the triceps fired synergistically with the brachioradialis. These findings indicate reeducation of transferred muscles occurred after surgery and that they functioned as active primary motors.

Adult↗

PubMed1990

Changes in ambulation parameters in spinal cord injury individuals following rehabilitation.

The energy cost and gait parameters of 10 spinal cord injury patients (mean age = 21.7 +/- 2.3 years) were measured at discharge from initial rehabilitation and at 1 year follow-up. At follow-up testing patients walked faster (59.5 m/minute vs 40.4 m/minutes; p less than 0.001), more efficiently (0.26 ml O2/kg.m vs 0.40 ml O2/kg.m; p less than 0.05) had slower heart rates (115 beats/minute vs 133 beats/minute; p less than 0.01), and required decreased axial load on upper extremity assistive devices (18% body weight vs 26% body weight; p less than 0.03). At follow-up testing, those patients with remaining weakness in the lower limbs had greater conditioning effects (increased rate of oxygen consumption and oxygen pulse) than those patients with relatively stronger limbs. These findings indicate that clinicians can expect significant improvements in functional ambulation performance in the first year following initial rehabilitation due to improved strength and conditioning.

Adult↗

PubMed1990

The effect of the halovest and body position on pulmonary function in quadriplegia.

Pulmonary function (vital capacity) was measured in ten quadriplegics and ten normal subjects in the following situations: supine, sitting, supine with a halovest, and sitting with a halovest. When changing from the supine to sitting positions, vital capacity decreased in the quadriplegics and increased in normal subjects. The halovest significantly reduced the vital capacity in normal subjects, but had much less of a detrimental effect in quadriplegics. As a result of this prospective, controlled study, we conclude the following: (a) the compromised state of pulmonary function in quadriplegics is not a contraindication for the use of a halovest, (b) the halovest causes a significant (p less than 0.01) restriction in vital capacity in able bodied subjects, and (c) when tenuous pulmonary function exists in a quadriplegic, pulmonary mechanics are better in the supine position.

Adult↗

PubMed1990

Management of fractures of the humerus in patients who have an injury of the ipsilateral brachial plexus.

Twenty-one adults who had a fracture of the middle of the humeral shaft and an injury of the ipsilateral brachial plexus were followed for an average of twenty-eight months. Only two of these patients showed evidence of neurological improvement. Of the eleven patients who had an associated traumatic injury to the brain, eight were treated non-operatively and three, operatively. The presence of a fracture of the humerus in a flail extremity has been found to delay rehabilitation markedly and to result in prolonged hospitalization. Eleven fractures were treated non-operatively with a brace or cast, and there were five non-unions, two delayed unions, and two malunions. Of the ten fractures that were treated operatively, three that were treated by compression-plating all united. Two fractures were treated by external fixation; one had a delayed union and one, a malunion. In the remaining five patients, who were treated with an intramedullary rod, there were two non-unions, one delayed union, and one malunion.

Adolescent↗

PubMed1989

Surgical management of spastic thumb-in-palm deformity in adults with brain injury.

Spastic thumb-in-palm deformity was surgically treated in 27 adults with brain injury. Procedures included muscle lengthening, recession, or release, arthrodesis of the thumb interphalangeal joint, or Z-plasty of the thumb web space. At mean follow-up of 39 months, 23 of 27 had a satisfactory correction. Unsatisfactory results included two with inadequate correction and two with over-correction. Surgical treatment of this entity requires careful preoperative planning, addressing predominantly those spastic muscles responsible for the deformity.

Adolescent↗

PubMed1989

Gunshot wounds to the spine associated with a perforated viscus.

The cases of 42 patients with low-velocity gunshot wounds to the spine with an associated perforated viscus were reviewed. All viscus perforations occurred prior to the spinal injury. There were a total of 51 perforations, including 14 of the colon, 15 of the small bowel, 15 of the stomach, five of the esophagus, and two of the pharynx. All patients had significant neurologic deficits, with 23 patients suffering a complete neurologic injury. Average clinical follow-up was 18 months (range: 4-64 months). Only three patients developed documented spinal or paraspinal infections. One case of acute meningitis occurred after an isolated stomach perforation, while two other patients developed psoas abscesses after colon injuries. The roles of initial antibiotic therapy and of early bullet removal were evaluated in regard to infection. An extended course of broad spectrum antibiotics combined with bedrest appeared to significantly reduce the risk of spinal or paraspinal infection as compared with a previous study. Early bullet removal did not appear to be a significant factor in the prevention of infection. Prospective studies are needed to accurately delineate the role of initial antibiotic therapy for the prevention of spinal infection in these injuries.

Adolescent↗

PubMed1989

Determinants of gait performance following spinal cord injury.

Measurement of lower extremity muscle strength and the energy expenditure during walking was taken in 36 spinal cord injury patients to assess functional mobility. Patients were categorized according to the type of orthotic prescription (knee-ankle-foot orthosis [KAFO] or ankle-foot orthosis [AFO]) or upper extremity assistive device (cane, crutches, or walker) used during gait. The rates of O2 consumption per minute, O2 cost per meter, heart rate, respiratory quotient, velocity, cadence, and peak axial load exerted by the arms on upper extremity assistive devices were measured. The Ambulatory Motor Index (AMI), derived from the manual muscle grades of both lower limbs, was used as the indicator of the degree of paralysis. The AMI was strongly correlated with the percentage increase in the rate of O2 consumption above normal (p less than .0001), O2 cost per meter (p less than .0001), peak axial load (p less than .0001), velocity (p less than .0001), and cadence (p less than .0001). Differences in these parameters among patient groups categorized according to the type of orthotic prescription (no KAFO, one KAFO, two KAFOs) or upper extremity assistive device (no device, cane or one crutch, two crutches, or walker) were attributable to differences in the AMI. The AMI, therefore, could be used as a reliable clinical indicator of functional mobility after spinal cord injury.

Adult↗

PubMed1989

The effect of the CAT-CAM above-knee prosthesis on functional rehabilitation.

Five, rehabilitated, unilateral above-knee amputees (average age, 34.4 years) using quadrilateral sockets were converted to Contoured Adducted Trochanteric-Controlled Alignment Method (CAT-CAM) sockets to determine the effect on ambulatory function. Patients were evaluated before and after conversion for subjective acceptance, gait deviations, relative femoral shaft inclination, coronal-plane hip abduction torque, and ambulatory metabolic demands. The CAT-CAM socket was subjectively rated superior by four patients. Most gait deviations improved or disappeared. Femoral shaft inclination angles improved an average of 6.5 degrees toward adduction by roentgenographic measurements in four patients. Film records suggest that the compensatory lateral trunk lean, seen in patients with quadrilateral sockets, diminished after conversion. These four patients increased their customary gait velocities, and all showed a reduction in the quantity of oxygen consumed per meter traveled by up to 50%.

Amputation, Surgical↗

PubMed1989

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

The cross-sectional area and the sagittal and transverse diameters of the cervical spinal canal were measured, using high-resolution, thin-section computerized-tomography images, in 100 control subjects and forty-two patients who had a traumatic injury to the spinal cord. No significant differences were found between the control and the spinal cord-injured group with regard to the cross-sectional area of the spinal canal; however, the differences between the two groups were significant with regard to mean sagittal and transverse diameters of the spinal canal. The sagittal diameters of the spinal canal of the control group were significantly larger than those of the spinal cord-injured group. Conversely, the transverse diameters of the spinal canal of the spinal cord-injured group were significantly larger than those of the control group. These findings suggest that certain patients may be predisposed to spinal cord injury, given sufficient trauma. It is not the total volume of space in the spinal canal that is the critical factor; rather, it is the shape. An index of shape is the ratio of the sagittal to the transverse diameter. The difference between the two groups, based on the ratio of sagittal to transverse diameter, was highly significant. Because this measure is a ratio, there is no need to evaluate an individual on the basis of measurements of absolute values.

Adolescent↗

PubMed1988

Energy-speed relationship of walking: standard tables.

The energy expenditure of level walking was measured in 260 normal male and female subjects walking around a 60.5m-circular outdoor track. Subjects were divided into four age groups (children, 6-12 years; teens; young adults, 20-59 years; and senior adults, 60-80 years). Oxygen consumption was measured with a modified Douglas Bag technique during the fourth and fifth minutes of each trial. Standard tables according to age and sex were derived for the average energy expenditure (rate of oxygen uptake, energy cost per meter, and heart rate) and for the gait characteristics (speed, cadence, stride length) at the subjects' customary slow, normal, and fast walking speeds. Statistical analysis was performed to determine the energy-speed relationship for the different age groups to derive normative tables for the rate of oxygen uptake throughout the range of customary walking velocities.

Adolescent↗