Biomedical subjects

Ralph M Buschbacher

Publications and source records attributed to Ralph M Buschbacher.

24 records · Page 2Linked to original sources

PubMed2004

Pressure ulcer prevention.

The purpose of this collective review is to outline the predisposing factors in the development of pressure ulcers and to identify a pressure ulcer prevention program. The most frequent sites for pressure ulcers are areas of skin overlying bony prominences. There are four critical factors contributing to the development of pressure ulcers: pressure, shearing forces, friction, and moisture. Pressure is now viewed as the single most important etiologic factor in pressure ulcer formation. Prolonged immobilization, sensory deficit, circulatory disturbances, and poor nutrition have been identified as important risk factors in the development of pressure ulcer formation. Among the clinical assessment scales available, only two, the Braden Scale and Norton Scale, have been tested extensively for reliability and/or validity. The most commonly used risk assessment tools for pressure ulcer formation are computerized pressure monitoring and measurement of laser Doppler skin blood flow. Pressure ulcers can predispose the patient to a variety of complications that include bacteremia, osteomyelitis, squamous cell carcinoma, and sinus tracts. The three components of pressure ulcer prevention that must be considered in any patient include management of incontinence, nutritional support, and pressure relief. The pressure relief program must be individualized for non-weight-bearing individuals as well as those that can bear weight. For those that can not bear weight and passively stand, the RENAISSANCE Mattress Replacement System is recommended for the immobile patient who lies supine on the bed, the stretcher, or operating room table. This alternating pressure system is unique because it has three separate cells that are not interconnected. It is specifically designed so that deflation of each individual cell will reach a ZERO PRESSURE during each alternating pressure cycle. The superiority of this system has been documented by comprehensive clinical studies in which this system has been compared to the standard hospital bed as well as to two other commercially available pressure relief mattresses. The most recent advance in pressure ulcer prevention is the development of the ALTERN8* seating system. This seating system provides regular periods of pressure relief and stimulation of blood flow to skin areas while users are seated. By offering the combination of pressure relief therapy and an increase in blood flow, the ALTERN8* reportedly creates an optimum pressure ulcer healing environment. Foam is the most commonly used material for pressure reduction and pressure ulcer prevention and treatment for the mobile individual. For those immobilized individuals who can achieve a passive standing position, a powered wheelchair that allows the individual to achieve a passive standing position is recommended. The beneficial effects of passive standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased blander pressure, enhanced orthostatic circulatory regulation, reduction in muscular tone, decrease in upper extremity muscle stress, and enhanced functional status in general. In the absence of these dynamic alternating pressure seating systems and mattresses, there are enormous medicolegal implications to the healthcare facility. Because there is not sufficient staff to provide pressure relief to rotate the patient every 2 hours in a hospital setting, with the exception of the intensive care unit, the immobile patient is prone to develop pressure ulcers. The cost of caring for these preventable pressure ulcers may now be as high as 60,000 dollars per patient. The occupational physical strain sustained by nursing personnel in rotating their patients has led to occupational back pain in nurses, a major source of morbidity in the healthcare environment.

Aged↗

PubMed2004

Strategies to reduce hyperthermia in ambulatory multiple sclerosis patients.

Approximately 400,000 Americans have multiple sclerosis. Worldwide, multiple sclerosis affects 2.5 million individuals. Multiple sclerosis affects two to three times as many women as men. The adverse effects of hyperthermia in patients with multiple sclerosis have been known since 1890. While most patients with multiple sclerosis experience reversible worsening of their neurologic deficits, some patients experience irreversible neurologic deficits. In fact, heat-induced fatalities have been encountered in multiple sclerosis patients subjected to hyperthermia. Hyperthermia can be caused through sun exposure, exercise, and infection. During the last 50 years, numerous strategies have evolved to reduce hyperthermia in individuals with multiple sclerosis, such as photoprotective clothing, sunglasses, sunscreens, hydrotherapy, and prevention of urinary tract infections. Hydrotherapy has become an essential component of rehabilitation for multiple sclerosis patients in hospitals throughout the world. On the basis of this positive hospital experience, hydrotherapy has been expanded through the use of compact aquatic exercise pools at home along with personal cooling devices that promote local and systemic hypothermia in multiple sclerosis patients. The Multiple Sclerosis Association of America and NASA have played leadership roles in developing and recommending technology that will prevent hyperthermia in multiple sclerosis patients and should be consulted for new technological advances that will benefit the multiple sclerosis patient. In addition, products recommended for photoprotection by The Skin Cancer Foundation may also be helpful to the multiple sclerosis patient's defense against hyperthermia. Infections in the urinary tract, especially detrusor-external sphincter dyssynergia, are initially managed conservatively with intermittent self-catheterization and pharmacologic therapy. In those cases, refractory to conservative therapy, transurethral external sphincterotomy followed by condom catheter drainage is recommended. However, if external urethral sphincterotomy fails to reduce residual urine and detrusor pressure, urinary diversion or bladder reconstruction may be necessary.

Body Temperature↗

PubMed2004

The Sit & Stand chair. A revolutionary advance in adaptive seating systems.

A major factor governing independence for the elderly and persons with disabilities is the ability to stand from a chair. Factors such as pain, reduced joint range of motion, stiffness, and muscle weakness frequently limit the ability to stand. Sit-to-stand position is even further reduced in patients whose hands and shoulders are afflicted with rheumatoid arthritis. When achieving a sit-to-stand position in the elderly and persons with disabilities, there is considerable risk of the individual falling and sustaining bone fracture. The purposes of this scientific report are to achieve the following goals: (1) to provide a narrative discussion of the senior author's contributions to furniture manufacturing as well as his successful patent application for the SIT & STAND chair, (2) to describe the steps involved in the development of the SIT & STAND prototype, and (3) to examine the performance of the SIT & STAND chair in assisting the elderly or persons with disabilities in achieving a sit-to-stand position. The invention of the SIT & STAND chair by the senior author, Michael Galumbeck, was a culmination of his lifelong interest in adaptive seating systems. His electrically operated chair has the unique ability to assist the occupant to achieve safely a sit-to-stand position. The rear portion of his chair remains in a fixed position to support the buttocks of the user during mechanical lift. The front portion of the seat folds down incrementally as the chair rises to allow the feet of the user to be positioned in a more posterior position firmly on the floor. Using its actuator, the height that the chair rises will vary with the length of the legs of the occupant. Using the drawing program Solid Works (Solid Works, Concord, Massachusetts), drawings of the chair were made. To visualize the operation and performance of the chair, separate drawings were made in the lateral position. The prototype of the SIT & STAND chair was manufactured with an electric actuator that allows elevation of the back portion of the seat. The design of this chair ensured that there were no pinch points that could endanger the user or assistant. Its framework ensured that it was stable and did not tip over. After the prototype chair is manufactured, it is being sent to Underwriters Laboratory Inc. (Los Angeles, California) for review and certification. The performance of the SIT & STAND chair was determined in a clinical study involving seven elderly or disabled individuals who complained of difficulty in rising from a chair from a seated position. During each performance evaluation, a mechanical chest and shoulder harness attached to an overhead sling encircled the individual to ensure that he/she would not fall. In the first part of the evaluation, these individuals were asked to achieve a standing position after being seated in the SIT & STAND chair without the use of the actuator. Three individuals were unable to achieve a standing position, while four achieved this standing position with considerable difficulty and potential instability. When these participants used the SIT & STAND chair with the use of the electrical actuator, all individuals achieved a standing position without difficulty or instability. All individuals expressed disappointment that the SIT & STAND chair was not commercially available for them to purchase and use in their homes. Because the SIT & STAND chair allows the individual to achieve a standing position without assistance, the SIT & STAND chair has other potential benefits not evaluated in this study. The beneficial effects of standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased bladder pressure, enhanced circulatory regulation, reduction in muscular tone, decrease in upper extremity muscle stress, and participation in activities of daily living. Another irrefutable benefit of the SIT & STAND chair is that the chair eliminates the need for physical assistance from family members or health care personnel, preventing the development of disabling back injuries in personal care assistants. In addition, the SIT & STAND chair entirely removes the risk of pain or harm to the individual, which sometimes occurs with manual assist to stand, such as dislocation or fracture of frail shoulders with the under-axilla lift. Realizing the medical benefits of the SIT & STAND chair, Aetna completed a clinical policy bulletin that states that the seat lift mechanism is a medically necessary durable medical product. On the basis of this extensive product and performance evaluation, we recommend the SIT & STAND chair for the elderly as well as persons with disability to safely achieve a sit-to-stand position.

Activities of Daily Living↗

PubMed2003

Reference values for peroneal nerve motor conduction to the tibialis anterior and for peroneal vs. tibial latencies.

OBJECTIVE: To generate a large normative database for the peroneal study to the tibialis anterior and to analyze differences between the peroneal latency to the extensor digitorum brevis and the tibial latency to the abductor hallucis. DESIGN: A total of 244 asymptomatic subjects without risk factors for neuropathy were tested for latency, amplitude, area, duration, and nerve conduction velocity to the tibialis anterior. For the peroneal/tibial analysis, 221 subjects were included. Temperature control was used, and demographic characteristics were recorded. RESULTS: Latency to the tibialis anterior increased and nerve conduction velocity decreased with increasing height. Amplitudes, area, and nerve conduction velocity were lower in older persons. The upper limits of normal (97th percentile) were 4.9 msec (latency) and 15.0 msec (duration). The lower limits of normal (3rd percentile) were 1.7 mV (amplitude), 6.8 microV/sec (area), and 43 m/sec (nerve conduction velocity). The upper limits of normal side-to-side difference was 1.2 msec (latency), 6.3 msec (duration), 50% (amplitude), 47% (area), and 20% (nerve conduction velocity). The upper limits of normal drop from below- to above-fibular-head stimulation was 36% (amplitude) and 43% (area). For the peroneal/tibial comparison, the upper limits of normal latency increase of peroneal over tibial was 1.8 msec and tibial over peroneal was 1.5 msec. CONCLUSION: A large normative database was collected. Upper and lower limits of normal were calculated, and side-to-side differences were analyzed. For the peroneal/tibial comparison, an upper limits of normal difference was described.

Adult↗

PubMed2003

An introduction to electromyography: an invited review.

Electromyography is a complex diagnostic test that is useful in diagnosing many neuromuscular and musculoskeletal conditions. Physiatrists and neurologists become familiar with this test during their training, while other physicians have minimal or no exposure, outside of perhaps some basic physiology lectures. A review of the anatomy, physiology, and physics upon which electrodiagnostic testing is based and of the various techniques used during a study provides the necessary foundation for understanding and using study results. A discussion of the conditions for which electrodiagnostic testing is useful, including carpal tunnel syndrome, radiculopathy, peripheral neuropathy, and disorders of the neuromuscular junction, is included both to review these disorders and to encourage appropriate referral for electrodiagnostic study.

Electromyography↗

PubMed2003

Sural and saphenous 14-cm antidromic sensory nerve conduction studies.

OBJECTIVE: To create a large database of normal values for the sural and saphenous nerve conduction studies and to compare the results for the two nerves. DESIGN: Using a 14-cm antidromic technique, data were collected for onset latency, peak latency, onset-to-peak amplitude, peak-to-peak amplitude, area, duration, side-to-side variability, and between-nerve variability. A total of 230 subjects were included in the study. RESULTS: For the sural nerve, the upper limits of normal, defined as the 97th percentile of observed values, for onset latency, peak latency, and duration were 3.6, 4.5, and 2.1 msec, respectively. The comparable values for the saphenous nerve were 3.8, 4.4, and 1.9 msec, respectively. The lower limits of normal (third percentile) for sural onset-to-peak amplitude and peak-to-peak amplitude were 4 and 4 microV. The comparable values for the saphenous study were 2 and 1 microV. The upper limit of normal difference in onset latency between the two nerves was: saphenous 0.7 msec longer than sural or sural 0.3 msec longer than saphenous. The corresponding values for peak latency were: 0.6 and 0.5 msec. CONCLUSION: Normal ranges are presented for a large database of subjects for the sural and saphenous nerve conduction studies.

Adult↗