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Biomedical subjects

W H Eisma

Publications and source records attributed to W H Eisma.

At least 55 records · Page 3Linked to original sources
PubMed1998

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part I. Impairments and perceived disability.

The aim of this retrospective and long-term follow-up study was to identify impairments resulting from reflex sympathetic dystrophy (RSD) of the upper extremity and to analyze the relationship between impairment and disability in RSD patients. The study group consisted of a referred sample of 65 RSD patients, with clinical signs in the upper extremity. RSD developed after fractures of the wrist or hand in 29 patients or after a carpal tunnel release in 9 patients. The mean interval between the RSD diagnosis and our evaluation was 5.5 (3-9) years (SD = 0.8). The main outcome measurements were the impairments assessed by standard physical examination. ADL and pain were quantified with a visual analogue scale (VAS). Pain was evaluated immediately before and after the physical examination and the perceived pain was determined in the week before the examination. Significant differences in impairments were found between the affected and the unaffected sides (p < 0.05). According to the AMA-guides, the impairments did not lead to disabilities. Significant correlations were found between VAS-ADL and VAS-pain in the last week prior to evaluation and full fist grip-strength. Pain seems to be the most disabling effect.

Activities of Daily Living↗
PubMed1998

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part II. Social life events, general health and changes in occupation.

The aim of this retrospective long-term follow-up study was to describe the psychosocial aspects, such as social life events (SLE), around the causative event of reflex sympathetic dystrophy (RSD) and the psychological history of 65 patients, 3-9 years after RSD of the upper extremity. General health and long-term changes in occupation were assessed by means of a general health questionnaire (RAND-36) and a structured interview, respectively. SLE, with a life-change unit rate more than 35, was present in 32 patients. A psychological (or psychiatric) history was found in 22 patients. In total, 60% of the patients had a SLE and/or a psychological history. The pain scores of the RAND-36 among RSD patients differed significantly from those of the control group. 17 patients changed occupation after RSD. Nearly 30% of the patients had to stop work for more than one year. The results show a high coincidence between RSD and associated psychosocial disorders and this may play a role in intensifying and prolonging the symptomatology of RSD.

Adolescent↗
PubMed1997

External and internal hemipelvectomy for sarcomas of the pelvic girdle: consequences of limb-salvage treatment.

The outcome of different limb-saving treatment modalities for pelvic girdle sarcoma is controversial. The oncological and functional results after 11 external and 10 internal hemipelvectomies and the consequences of limb-salvage treatment were studied in 21 consecutive patients with primary bone (19 patients) or soft tissue sarcoma (two patients) of the pelvic girdle. Following external hemipelvectomy, 10 patients (91%) died after a median follow-up of 1.6 years (range: 0.3-7.1). Isolated local recurrences occurred in three patients (27%), with concomitant distant failure in one (9%), while isolated distant failure occurred in six patients (55%). The rate of flap necrosis and wound infection following external hemipelvectomy were both 25%. Following internal hemipelvectomy, nine patients (90%) were alive without evidence of disease after a median follow-up of 6.6 years (range: 2.3-16.0). Concomitant local and distant failures were found in one patient (10%). Reconstruction-related complications necessitated revisional procedures in five of seven patients (72%), leading to external hemipelvectomy in one. Patients with a locally advanced pelvic girdle sarcoma who are unable to undergo an internal hemipelvectomy have a worse prognosis than patients who undergo an internal hemipelvectomy. An internal hemipelvectomy is not attended by an increased risk of local failure, but is by long-term local complications, requiring extensive surgical procedures.

Adolescent↗
PubMed1997

Shoulder fusion for paralyzed upper limb.

Fusion of the shoulder joint after a brachial plexus injury is a well known procedure in cases of flail shoulder in combination with normal motor and sensory function in the band. However, in combination with modern orthoses to stabilize the elbow, fusion of the shoulder in cases of a totally flaccid and afunctional arm might be more beneficial. In a retrospective study the impact of shoulder fusion on daily abilities in a population with a completely flaccid arm caused by a brachial plexus injury was investigated. Compared with a similar population, consisting of 16 patients with an afunctional unstable shoulder, all 12 patients who underwent shoulder fusion proved to perform at a higher functional level. Shoulder fusion in combination with an elbow stabilizing orthosis for a completely flaccid upper limb is a beneficial procedure that leads to less disability and results in a better quality of life.

Brachial Plexus↗
PubMed1997

Pediatric polytrauma: short-term and long-term outcomes.

OBJECTIVE: To assess the short-term and long-term outcomes of pediatric polytrauma patients and to analyze the extent to which short-term outcomes can predict long-term outcomes. MATERIALS AND METHODS: All pediatric polytrauma patients (Injury Severity Score of > or = 16, < or = 15 years of age) who were treated at a Level I trauma center between 1985 and 1989 and who were 18 years or older at follow-up (1996) were included. Short-term outcomes were quantified using the Glasgow Outcome Scale. The Functional Independence Measure, the RAND-36, and questions on social outcome were used to assess long-term outcomes. MEASUREMENTS AND MAIN RESULTS: Fifty-nine of 74 patients survived (80%). At 1 year after injury, 22% were disabled, mainly due to severe brain injuries, and 32% had changed school. After 9 years of follow-up, the degree of physical disablement was low (12%). Cognitive impairments were found in 42% of the patients. Only 10% were in receipt of disablement allowances; 76% were employed or attended school. The quality of life enjoyed by the patients (RAND-36) did not differ from that enjoyed by a healthy reference population. The Glasgow Outcome Scale (from 6 weeks onward) was a good predictor of long-term disablement. CONCLUSIONS: Although the short-term impact of injuries is extensive, the long-term outcomes are satisfactory. Severe injuries sustained during childhood do not lead to a diminished quality of life during adulthood.

Adolescent↗
PubMed1997

Energy storage and release of prosthetic feet. Part 1: Biomechanical analysis related to user benefits.

The energy storing and releasing behaviour of 2 energy storing feet (ESF) and 2 conventional prosthetic feet (CF) were compared (ESF: Otto Bock Dynamic Pro and Hanger Quantum; CF: Otto Bock Multi Axial and Otto Bock Lager). Ten trans-tibial amputees were selected. The study was designed as a double-blind, randomised trial. For gait analysis a VICON motion analysis system was used with 2 AMTI force platforms. A special measuring device was used for measuring energy storage and release of the foot during a simulated step. The impulses of the anteroposterior component of the ground force showed small, statistically non-significant differences (deceleration phase: 22.7-23.4 Ns; acceleration phase: 17.0-18.4 Ns). The power storage and release phases as well as the net results also showed small differences (maximum difference in net result is 0.03 J kg-1). It was estimated that these differences lead to a maximum saving of 3% of metabolic energy during walking. It was considered unlikely that the subjects would notice this difference. It was concluded that during walking differences in mechanical energy expenditure of this magnitude are probably not of clinical relevance. Ankle power, as an indicator for energy storage and release gave different results to the energy storage and release as measured with the special test device, especially during landing response. In the biomechanical model (based on inverse dynamics) used in the gait analysis the deformation of the material is not taken into consideration and hence this method of gait analysis is probably not suitable for calculation of shock absorption.

Adult↗
PubMed1997

Energy storage and release of prosthetic feet. Part 2: Subjective ratings of 2 energy storing and 2 conventional feet, user choice of foot and deciding factor.

This paper is the second part of a study on biomechanical and functional properties of prosthetic feet. The first part dealt with a biomechanical analysis related to user benefits. This part deals with subjective ratings and deciding factors for trans-tibial amputees using 2 energy storing feet (ESF) and 2 conventional feet (CF). The Otto Bock Dynamic Pro and Hanger Quantum feet were used as ESF and the Otto Bock Multi Axial and Otto Bock Lager feet were used as CF. Ten trans-tibial amputees, active walkers, without stump problems, were selected (mean age: 49 years old). The study was designed as a double-blind, randomised trial and for each foot there was a habituation period of 2 weeks. Two questionnaires were designed. (A) concerned information about the preference of the subjects and (B) concerned the order of importance of difference aspects concerning a prosthesis. Results indicated that no clear preference for either the ESF or the CF existed and that the individual preference is not related to age. The items 'ability to walk fast' and 'no fatigue during walking', score statistically significantly worse for the CF2. With the small contrast between the ESF and CF, in relation to energy storing capacities, the subjects cannot distinguish between the ESF and CF. The 'absence of stump pain' and 'stability while walking' are ranked as most important aspects concerning a prosthesis. The perception of stability is likely to be related to the level and kind of activities the subject performs.

Adult↗
PubMed1997

Epidemiology of lower limb amputees in the north of The Netherlands: aetiology, discharge destination and prosthetic use.

The aim of this study was to give a retrospective review of all lower limb amputations performed in the 3 northern provinces of the Netherlands in 1991-1992. Assembled data were compared with the existing information in the National Medical Register (NMR) over the same period. With the participation of all regional hospitals, 473 lower limb amputations from transpelvic to transmetatarsal level were identified. Of the amputations 94% were performed for vascular pathology, 3% for trauma, and 3% for oncologic reasons. After surgery a prosthesis was provided to 48% of the amputees. The actual number of performed amputations exceeds the number of amputations registered by the NMR by 9%. Incidence rates of lower limb amputations in the Netherlands are 18-20/100,000 over the last 12 years. These numbers are lower than in other areas and no sharp decrease in frequency compared with other countries in Western Europe.

Adolescent↗
PubMed1996

Gait analysis of transfemoral amputee patients using prostheses with two different knee joints.

OBJECTIVE: To evaluate the gait of transfemoral amputee patients using a prosthesis with a 4-bar linkage knee joint with either a mechanical swing phase control (Otto Bock 3R20) or a pneumatic swing phase control (Tehlin knee). DESIGN: Randomized cross-over trial. SETTING: Rehabilitation Department of a university hospital in The Netherlands. PATIENTS: Twenty-eight subjects with unilateral transfemoral amputation for reasons other than chronic vascular disease; ages between 16 and 65 years and familiar with the use of the Otto Bock 3R20 knee. SELECTION PROCEDURE: a consecutive sample. INTERVENTION: The Otto Bock 3R20 was used by the subjects before they entered the study. The patients changed to the Tehlin knee at random either after 1 or 2 assessments with the Otto Bock 3R20. MAIN OUTCOME MEASURES: Temporal and kinematic variables in gait analysis (speed recordings were taken before and after the equipment for the measurements of the other parameters was placed on the patients). Subjective scores for comfortable and fast ambulation were obtained by means of 2 questionnaires. Questionnaire A consisted of multiple choice questions (maximum score: 5) and questions using an 8-point rating scale (maximum score: 7). In questionnaire B, the patient was asked to compare the present prosthesis with the previous one. RESULTS: Fast walking speed in gait analysis was higher with the Tehlin knee than with the 3R20 (without equipment 95% confidence interval (CI) .02-.09 m/sec, with equipment CI .04-.11), while comfortable walking speed was not higher with the Tehlin knee (without equipment CI -.20-.20 m/sec, with equipment CI .00-.05). Symmetry of walking as regards swing phase duration was closer to 100% with the Tehlin knee than with the 3R20 (comf. walking CI 4% to 19%, fast walking CI 7% to 17%). Knee joint range of motion during swing phase was smaller with the Tehlin knee than with the 3R20 (comf. walking CI 1.8 degrees-8.7 degrees, fast walking CI 2.0 degrees-9.5 degrees). Knee flexion duration during swing phase was shorter for the Tehlin knee than for the 3R20 at fast walking speed (CI 6-46msec), while knee flexion duration from and to 10 degrees flexion was shorter for the Tehlin knee at comfortable speed (CI 18-67msec) and fast speed (CI 20-64msec). In questionnaire A the amputees reported the Tehlin knee to be better for fast walking (part A1 CI .01-.52, part A2 CI .13-.98) and in questionnaire B for both comfortable and fast walking.

Adolescent↗
PubMed1996

Rehabilitation of patients with spinal cord lesions in The Netherlands: an epidemiological study.

Very little is known about the occurrence of spinal cord lesions and results of the rehabilitation of patients with such lesions in the Netherlands. This study was conducted to describe the process of rehabilitation in the Dutch situation, to assess the incidence of spinal cord lesions in a regional rehabilitation centre and to characterise differences between traumatic and non-traumatic spinal cord lesions regarding age, level and extent of lesion. In this study 293 patients were included who were admitted to the rehabilitation centre between 1982 and 1993. Sixty-six per cent of this group came from the university hospital. The mean length of stay in the rehabilitation centre was 154 days. After completing the rehabilitation programme 94% of patients went home. Sixteen new SCI patients per million per year were admitted to the rehabilitation centre. Of our group 52% had a non-traumatic lesion, which concerned older patients with more incomplete lesions. In our opinion close collaboration between the university hospital and the rehabilitation centre is needed for optimal rehabilitation. Attention to independent living programmes and appropriate housing facilities can shorten the length of stay and increase the number of discharges of patients to their own environment. For patients with non-traumatic spinal cord lesions special programmes should be made available.

Adult↗
PubMed1996

Major trauma in young and old: what is the difference?

OBJECTIVE: To evaluate the differences in mortality and long-term outcome between young and elderly patients with multiple injuries. DESIGN: Retrospective and descriptive. MATERIALS AND METHODS: Over a 5-year period (from January 1985 to January 1990) all the consecutive young (20 to 29 years, n = 167) and elderly (> or = 60 years, n = 121) patients with an Abbreviated Injury Scale score/Injury Severity Score of > or = 16 treated at the University Hospital Groningen (the Netherlands) were reviewed. Age, sex, mechanisms of injury, Abbreviated Injury Scale score, Injury Severity Score, mortality, duration of artificial ventilation, hospitalization, and intensive care treatment and discharge destination were analyzed. Long-term outcome was determined using the Glasgow Outcome Scale. MEASUREMENTS AND MAIN RESULTS: Motorized vehicles were the leading cause of injury in both groups. Mortality in the young was lower than in the elderly (19.6% versus 38.8%); all elderly with an Injury Severity Score of > or = 50 died. Nearly all deaths in young and elderly were caused by severe brain injuries (83.8% versus 74.4%). Deaths related to multiple organ failure were not observed in the young and were rare in the elderly. The surviving young and elderly could be discharged home in equal percentages and their functional outcome 2 years after injury did not differ essentially. CONCLUSION: We did not find any valid argument to treat severely injured elderly patients any differently from their younger counterparts, which implies that the increased trauma care cost is also justified for severely injured elderly.

Adult↗
PubMed1996

Clinical rehabilitation of the amputee: a retrospective study.

The aim of this study was to determine the rehabilitation outcome of lower limb amputee patients after clinical rehabilitation. Altogether 183 amputee patients admitted for clinical rehabilitation in the years 1987-1991 were reviewed by retrospective analysis of medical record data. Three groups of amputee patients were identified by reason for amputation. The vascular group: (N = 132), mean age 67 years, mean admission time 119 days, 85% prosthetic fitting. The oncology group (N = 15), mean age 55 years, mean admission time 77 days, 60% prosthetic fitting. The traumatic amputee group: (N = 14), mean age 41 years, mean stay 134 days and 100% prosthetic fitting. Some 22 patients were bilateral amputees and were assessed separately. The most important reasons for not fitting a prosthesis were oncological metastases, stump and wound healing problems. After rehabilitation 86% of all patients could be discharged home. These results are more favourable than those seen in previous studies.

Adolescent↗
PubMed1995

Bilateral split hand/foot malformation and inv(7)(p22q21.3).

A boy with typical tetramelic split hands and feet is described. In addition, there was a large arteriovenous malformation of the right arm. Chromosome studies showed a pericentric inversion of chromosome 7: 46,XY,inv(7)(p22q21.3). Inspection of the extremities and chromosome studies in the parents were normal. This case confirms the suggested localisation of a locus, important for early limb differentiation, on the long arm of chromosome 7, most probably in the chromosomal region 7q21.2-7q21.3. Previously reported cases are reviewed briefly.

Child, Preschool↗
PubMed1995

Energy cost during ambulation in transfemoral amputees: a knee joint with a mechanical swing phase control vs a knee joint with a pneumatic swing phase control.

The aim of the study was (i) to evaluate the preference of transfemoral amputees for a 4-bar linked knee joint with either a mechanical swing phase control or a pneumatic swing phase control, and (ii) to compare the energy expenditure in transfemoral amputees using a prosthesis with a mechanical swing phase control with that of the same amputees using a prosthesis with a pneumatic swing phase control. The study included 28 unilateral transfemoral amputees amputated for reasons other than chronic vascular disease. All patients had a prosthesis with a knee joint with mechanical swing phase control (the Otto Bock 3R20) before entering the study. The amputees changed their knee joint to one with pneumatic swing phase control (the Tehlin knee joint) at random either after the first or second assessment. The amputees were asked for their preference at the second and third assessments. The energy expenditure while walking at speeds of 2 and 3 km/h was measured at each assessment. After having tried both knee joints, 19 patients preferred the Tehlin knee, 6 patients preferred the Otto Bock 3R20, and 3 patients had no preference. The energy expenditure measurement showed that walking with the Tehlin knee required more energy than walking with Otto Bock 3R20. Because of the limited number of patients included in the study and the fact that a double-blind design was impossible to achieve, conclusions should be drawn with caution.

Adolescent↗
PubMed1994

Amputation and reflex sympathetic dystrophy.

Reflex sympathetic dystrophy is a chronic pain syndrome characterized by chronic burning pain, restricted range of motion, oedema and vasolability. Patients are difficult to treat and the prognosis is very often poor. This report emphasizes that an amputation in case of a reflex sympathetic dystrophy is mostly due to a too late recognition of this syndrome. In the international literature little is written about an amputation as a therapy for reflex sympathetic dystrophy. It is only mentioned as a therapy in the end stages of this syndrome. Sometimes a rejected amputation, as in this case report, can have a relatively good result. An early recognition of this pain syndrome produces the best possible outcome.

Adult↗
PubMed1994

The gait of unilateral transfemoral amputees.

The aim of this study was to describe the gait of persons with a unilateral transfemoral amputation by means of a questionnaire, gait analysis and measurement of energy expenditure, and to find correlations among the variables studied. The study included 29 transfemoral amputees amputated for other reasons than a chronic vascular disease. The patients were assessed using the following methods: 1) A questionnaire rating the walking distance and walking difficulty in different circumstances. 2) Gait analysis measuring temporal variables and goniometry of hips and knees. 3) Measurement of energy expenditure during sitting and walking. Scores on the questionnaire showed a correlation with socket design, a negative correlation with age and energy expenditure, and a positive correlation with fast speed. The gait of transfemoral amputees was asymmetrical as far as temporal variables were concerned, and for most amputees also for the range of motion of hip and knee. The walking speed of the amputees was lower than that of non-amputees and showed a positive correlation with hip extension-flexion range of motion and a negative correlation with age and stride time. The energy expenditure of the amputees during ambulation was higher than that of non-amputees, and seemed to correlate with residual limb length and the hip abduction-adduction range of motion.

Adolescent↗