Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Quadriplegia”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1993

Assessing selfcare status in quadriplegia: comparison of the quadriplegia index of function (QIF) and the functional independence measure (FIM).

The purpose of this study was to compare the quadriplegia index of function (QIF) to the functional independence measure (FIM) in assessing the daily performance of selfcare activities by individuals with cervical spinal cord injury. This study evaluated feeding, grooming and bathing activities in 22 C4-C7, Frankel A-D spinal cord injury patients between 3 and 12 months postinjury. The manual muscle test (MMT) was performed on 17 of these subjects during the same window of time as the QIF and the FIM. An upper extremity motor score (UEMS) was derived from the MMT. In order to relate motor power to functional ability, the UEMS was used as a measure of neurological function to test the hypothesis that the QIF scores are more highly correlated to motor power than are the FIM scores for this population. Spearman coefficients were calculated to correlate the QIF, the FIM and the UEMS. For the bathing and grooming categories, both the QIF and the FIM showed significant and similar correlations to the UEMS. For the feeding category, however, the QIF had a significantly better correlation to the UEMS than did the FIM (Rho = 0.90 vs 0.53, p < 0.01). Use of the QIF feeding scale may allow the detection of changes in function as individuals recover that the FIM scale would miss. Further evaluation of the remaining selfcare and mobility scales is needed. Modification of the FIM with more sensitive portions of the QIF would improve the discriminative ability of outcome studies and program evaluations.

Adolescent↗
PubMed1998

A comparison of two functional tests in quadriplegia: the quadriplegia index of function and the functional independence measure.

Individuals with spinal cord injury are evaluated according to a set of guidelines based on motor, sensory, and functional tests. The resulting scores are used to quantify the extent of neurological injury and functional loss. The purpose of the present study was to compare certain scoring systems using the same group of patients. Twenty-nine subjects with cervical spine cord injury were evaluated by the same examiner using three scales: (1) The American Spinal Cord Injury Association (ASIA) (2) The Quadriplegia Index of Function (QIF) (3) The Functional Independence Measure (FIM) Assessments were made both at admission to, and discharge from, the rehabilitation center. Positive change in motor score is widely used as an indicator of recovery after spinal cord injury. We assessed the relationship of the two functional tests, the FIM and the QIF, to ASIA scores and found strong correlations in both cases. The feeding and dressing categories of QIF showed an even stronger correlation to ASIA motor scores, though the statistical significance was the same for corresponding categories of FIM and QIF. The percent of recovery on ASIA motor scores was significantly correlated only to gain in QIF scores, not FIM. FIM lacks the category of bed activities. Some additions to the FIM may be useful, especially in the feeding and dressing categories, and a category of bed activities could be included as well, in order to improve sensitivity.

Activities of Daily Living↗
PubMedDate not supplied

Increased energy needs in patients with quadriplegia and pressure ulcers.

Health individuals with quadriplegia generally have a reduced metabolic rate. However, individuals with quadriplegia who develop pressure ulcers may have an elevated metabolic rate. In this study, energy expenditure in 16 individuals with quadriplegia and pressure ulcers (PU-QUAD) was compared to the energy expenditure in 16 individuals with quadriplegia but no pressure ulcers (NPU-QUAD) and 16 healthy non-spinal cord injured subjects (controls). Resting energy expenditure (REE) was measured by indirect calorimetry. Both measured REE (t(30) = 2.38, p = 0.24) and percent predicted REE (t(30) = 3.23, p = .003) were significantly higher in subjects with quadriplegia and pressure ulcers compared with subjects with quadriplegia but no pressure ulcers. On average, REE in the PU-QUAD subjects was nearly equal to the absolute energy expenditure of healthy non-spinal cord injured controls. To ensure optimal care of patients with quadriplegia and pressure ulcers, quantification of energy expenditure with provision of adequate caloric intake is recommended.

Adult↗
PubMed1995

Effect of provocative maneuvers on heart rate variability in subjects with quadriplegia.

This study investigated heart rate variability (HRV) in individuals with quadriplegia who have disruption of autonomic control of the heart. Seven male subjects with neurological complete quadriplegia and seven with incomplete quadriplegia were studied at rest and during provocation. HRV was measured by power spectral analysis using a fast Fourier transform. Two spectral components were generated: 1) the high-frequency (HF) peak, a reflection of parasympathetic activity, and 2) the low-frequency (LF) peak, primarily sympathetic activity with some parasympathetic input. Results of the provocative maneuvers were grouped into one composite variable. Significant differences in the LF spectral component were found between the groups with complete and incomplete lesions in the supine position and after provocation (LF supine: P = 0.01; LF provocation: P = 0.002). After provocation, significant differences were demonstrated in the HF spectral component between these groups (P = 0.005). In contrast to previous findings, a LF component in subjects with complete quadriplegia was observed; this LF component decreased after provocation, suggesting the parasympathetic component withdrew during stressful maneuvers. There also appeared to be general downregulation of parasympathetic activity to the heart in subjects with complete quadriplegia. The presence of an increased LF spectral component during provocation in those with incomplete lesions implies sympathetic stimulation of the heart and may be used as a marker of sympathetic activity in individuals with quadriplegia.

Cold Temperature↗
PubMed1986

Changes in lung volume and rib cage configuration with abdominal binding in quadriplegia.

Previous studies suggest that abdominal binding may affect the interaction of the rib cage and the diaphragm over the tidal range of breathing in quadriplegia. To determine whether abdominal binding influences rib cage motion over the entire range of inspiratory capacity, we used spirometry and the helium-dilution technique to measure functional residual capacity (FRC), inspiratory capacity, and total lung capacity (TLC) in eight quadriplegic and five normal subjects in supine, tilted (37 degrees), and seated positions. Combined data in all three positions indicated that, with abdominal binding, FRC and TLC decreased in normal subjects [delta FRC = -0.33 + 0.151 (SD) P less than 0.01); delta TLC = -0.16 + 0.121, P less than 0.05]. In quadriplegia there was also a reduction in FRC with binding (delta FRC = -0.32 + 0.101, P less than 0.001). However, TLC increased in quadriplegia (delta TLC = 0.07 + 0.061, P less than 0.025). In an additional six quadriplegic and five normal subjects, we used magnetometers to define the influences of abdominal binding on rib cage dimensions and TLC. In quadriplegia, rib cage dimensions were increased at TLC with abdominal binding, whereas there was no change in normals. Our data suggest that this inspiratory effect of abdominal binding on augmenting rib cage volume in quadriplegia is greater than the effect of impeding diaphragm descent, and thus abdominal binding produces a net increase in TLC in quadriplegia.

Abdomen↗
PubMed1995

Pulmonary function and posture in traumatic quadriplegia.

OBJECTIVE: To determine optimum posture for pulmonary function in traumatic quadriplegia. DESIGN: Lung function with changes in posture of normal healthy volunteers was compared with that of traumatic quadriplegic patients. MATERIALS AND METHODS: Functional residual capacity (FRC), Forced vital capacity (FVC), and arterial blood gases in room air were compared in 16 male patients aged 18 to 32 years, 8 of whom (group I) sustained traumatic quadriplegia (C6 to C7) at least 1 year previously, and 8 of whom (group II) were healthy volunteers. MEASUREMENTS: FRC, FVC and blood gases were measured after 15 minutes in the following random positions: 20 degrees head down, horizontal, 35 degrees head up, 60 degrees head up, and 90 degrees head up. MAIN RESULTS: FRC was lower in all positions in group I but there was a similar directional change in FRC with posture in both groups. The greatest increase in FRC occurred in group I between the 35-degree head up and the 60-degree head up positions. Group I, in contrast to group II, decreased FVC from the 35-degree head up to the 60-degree head up position. There were no significant changes in PO2 with position in group II, but quadriplegic patients showed PO2 improvement from the head down to the horizontal and 60-degree head up positions. CONCLUSIONS: In traumatic quadriplegia, maximum oxygenation and patency of alveoli (FRC) are achieved in the 60- to 90-degree head up positions. In contrast to normal subjects, no changes in FRC and FVC occurred between the horizontal and 35-degree head up positions in quadriplegia. The optimum position in these patients for physiotherapy (deep breathing and coughing, as reflected by maximum FVC) is the horizontal or 35-degree head up position. These differences in lung volumes and oxygenation with posture may be important in optimizing respiratory care in traumatic quadriplegia.

Adult↗
PubMed1994

Immune responses to nervous system decentralization and exercise in quadriplegia.

Interactions among the nervous, neuroendocrine, and immune systems render host defenses highly sensitive to autonomic over- or understimulation. Persons with quadriplegia experience decentralization of directly innervated immune tissues and neuroendocrine axis dysregulation, immobilization deconditioning, heightened exposure to immune suppressing xerobiologicals, and psychic and nonpsychic stressors differing from those of nondisabled cohorts. When compared with matched nondisabled controls, young survivors of quadriplegia have reduced CD4:CD8 ratios, suppressed proliferative responses to mitogen challenge, reduced number and cytotoxicity of CD3-CD56+ (NK) cells, and elevation of the soluble IL-2 receptor. Deviations from control values are typically observed in persons with injuries higher than sympathetic outflow, suggesting a cause related to autonomic dysfunction. Cycling exercise performed by persons with quadriplegia using computer-sequenced electrically stimulated contraction of the quadriceps, hamstring, and gluteus muscle groups fails to provoke an archetypical leukocytosis, but transitionally elevates NK cell number and cytotoxicity lasting one-half hour after exercise. These findings show that the immune system of persons with quadriplegia is selectively responsive to exercise challenge. As opportunistic infections of the urinary tract, lungs, and skin are major causes of morbidity in survivors of quadriplegia, these observations may identify a treatment through which their host defenses can be fortified.

Autonomic Nervous System↗
PubMed1994

[Hypoxic encephalopathy with quadriplegia and cortical blindness].

We report a 63-year-old woman with quadriplegia and cortical blindness due to hypoxic encephalopathy. She was hospitalized with a fever of 40 degrees C. After injection of an antipyretic drug, she suddenly entered a state of shock. Artificial breathing was induced, but she did not regain consciousness. She was admitted to this hospital in a state of coma. One month later, she regained consciousness, and her quadriplegia and decreased visual acuity became apparent. Neurological examination revealed cortical blindness (initially with Anton sign), geotropic ocular deviation, forced weeping, flaccid quadriplegia, and bilateral pyramidal tract signs (generalized hyperreflexia, positive bilateral Babinski sign). Magnetic resonance imaging of the brain, on a T2 weighted image, showed high-intensity areas in the bilateral precentral gyri and bilateral calcarine cortex. In this case, artificial breathing was induced immediately after shock, and respiratory arrest occurred for a very short time, suggesting that the cause of this hypoxia may be due to mild hyproperfusion. Among previously reported cases, there are 5 cases with relative selective lesions in the bilateral precentral gyri and bilateral calcarine cortex. Findings in all cases were by autopsy, revealing oligemic hypoxia. The onsets of these cases were cardiogenic or peripheral shock from cardiac arrest or arrhythmia, etc., during surgery. Two cases died in a coma state. The other 3 cases regained consciousness with quadriplegia. Among these 3 cases, the case reported by Murayama had quadriplegia and cortical blindness, as in this case.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaphylaxis↗
PubMed1992

Ventilatory and P0.1 response to hypercapnia in quadriplegia.

Unlike individuals with comparable degrees of respiratory muscle weakness from other causes, quadriplegic patients have a blunted ventilatory and P0.1 response to hypercapnia. This suggests that the diminished response in quadriplegia is due, in part, to an alteration in respiratory drive. We measured the hypercapnic response in 9 subjects with chronic quadriplegia (Q) and 8 normal controls (N). Ventilatory muscle strength, maximum voluntary ventilation (MVV), and lung volumes were measured in all subjects. The ventilatory response (HCVR) in Q was significantly less than in N (0.73 +/- 0.37 vs 2.95 +/- 0.4 L.min-1.mmHg-1; P less than 0.001), even when normalized for indices of respiratory muscle performance (e.g., vital capacity, MVV). There was no significant change in the HCVR in Q after the administration of naloxone. We also serially studied 2 subjects with acute quadriplegia, and found that despite progressive improvement in respiratory muscle performance, there was no accompanying increase in the response to hypercapnia. These data suggest that muscle weakness alone cannot explain the blunted hypercapnic response in quadriplegia, and are consistent with the hypothesis that these subjects have a reduced ventilatory drive.

Adult↗
PubMed2001

Spasticity management in the child with spastic quadriplegia.

In children with spastic quadriplegia, also described as 'whole body involvement', spasticity can interfere with motor function, contributes to the development of deformities and adversely impacts on care, positioning, and comfort. In this population, spasticity interventions address goals such as improving comfort, reducing pain, easing the burden of carers, slowing the progression of musculoskeletal deformities and perhaps improving function. Children with severe diplegia are distinguished from those with quadriplegia by their ability to ambulate, as well as by a greater emphasis being placed on functional motor goals even though similar treatment modalities are often employed to manage spasticity. The many treatment options currently available include, but are not limited to, botulinum toxin type A, phenol neurolysis, oral medications, intrathecal baclofen, selective dorsal rhizotomy, and orthopaedic surgery. The integration of these treatment modalities can help to optimize the overall care and function for a child with spastic quadriplegia or severe diplegia. However, the development of a management programme is complex and needs to take into account many factors, including age, weight and nutritional status, rate of progression of musculoskeletal deformities, developmental potential, comorbid conditions, current functional status and prognosis, and family and patient treatment goals. Children with marked spasticity are likely to benefit from a combination of interventions, rather than a single treatment modality. Because of these complexities, management should be planned and coordinated by a multidisciplinary team of medical and allied health professionals which recognizes the central role of the family in all decisions. Once the special characteristics of the child with spastic quadriplegia and the various treatment options are understood, outcomes can be maximized.

Child↗
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↗
PubMed1985

Heart rate response to facial immersion and apnea in quadriplegia.

Profound bradycardia is a common complication in the early posttraumatic period following cervical spinal cord damage. It is thought to be due to temporary inactivity of the sympathetic nervous system after separation from supraspinal control, coupled with unopposed parasympathetic dominance because of vagus nerve sparing. Hypoxia, underventilation, and tracheal suctioning appear to intensify the bradycardia. This study examined the effect of vagal stimulation using facial immersion and apnea on heart rate in patients with quadriplegia. Ten patients with quadriplegia (eight males and two females, mean age 25, age range 16-37) and ten healthy controls (eight males and two females, mean age 25, age range 15-37) underwent facial immersion during ECG monitoring. The patients with quadriplegia were studied at a mean of 9.4 months after injury (range, 4-26 months); cord level of injury ranged from C5 to C8; seven of the ten had had heart rates of less than 50 beats/min in the early period after injury and five of the ten had received treatment for this. No change in heart rate was seen in the quadriplegic group during facial immersion (delta = 1.5 +/- 2.7 beats/min, mean +/- SE), but a significant drop in heart rate was seen in the control group (delta = -12.2 +/- 3.7 beats/min, mean +/- SE; p less than 0.01). No significant decreases were seen in either group during apnea alone. Patients with chronic quadriplegia appear to have less sensitivity than controls to the vagal-stimulating maneuver of facial immersion and apnea.

Adolescent↗
PubMed2006

Pyogenic cervical spondylitis with quadriplegia as a complication of severe burns: Report of a case.

We report a case of cervical pyogenic spondylitis complicated by epidural abscess with quadriplegia during treatment of severe burns. The patient was a 49-year-old man with 3rd-degree burns to 20% of his body, involving the lower extremities. We performed escharectomy of the 3rd-degree necrosis on days 7 and 16, followed by the first skin graft on day 23. Pseudomonas aeruginosa was detected in the postoperative graft wound culture. On day 23 after the skin graft, he became febrile and began to experience cervical pain and muscle weakness of the extremities. By day 24, quadriplegia had developed. A cervical vertebral magnetic resonance imaging (MRI) scan showed pyogenic spondylitis with an epidural abscess, which was causing the quadriplegia. We treated the patient by performing curettage of the pyogenic lesion and anterior fixation of the cervical vertebral bodies. The fact that P. aeruginosa was detected in the pyogenic focus culture indicated that burn wound sepsis was responsible for the infection. This case reinforces that acting on a strong suspicion helps to establish a diagnosis and initiate appropriate treatment early.

Burns↗
PubMed1995

Pregnancy and its outcome in quadriplegia due to Pott's spine.

Pregnancy with quadriplegia is a problem sometimes encountered in obstetric practice. The etiology of quadriplegia in the developed world is mainly spinal cord tumor or accident, while in the developing countries the main cause is tuberculosis of the spine. We report the management of two pregnant patients with quadriplegia due to tuberculosis of the cervical spine. Worsening of the neurological condition necessitated early surgical intervention, and termination of pregnancy was advised in both patients. Literature on the subject makes frequent reference to the life-threatening complication of autonomic hyperreflexia encountered during pregnancy and delivery. It is characterized by sweating, headache, severe hypertension leading to unconsciousness and convulsions. These complications, surprisingly, were absent in both of our patients.

Adult↗
PubMed1985

Localization of sensory levels in traumatic quadriplegia by segmental somatosensory evoked potentials.

We studied the usefulness of cortical somatosensory evoked potentials (SEPs) elicited by segmental sensory stimulation in traumatic quadriplegia. By stimulating sensory branches of musculocutaneous (C5, C6), median (C7, C8), and ulnar nerves (C8), we studied 10 chronic traumatic quadriplegics and compared them with age-matched controls. In all traumatic quadriplegics tested, the SEP abnormalities provided a direct linear relationship with clinical localization of posterior column sensory levels. Our findings suggest that segmental SEPs can enhance the clinical assessment of posterior column sensory levels in chronic traumatic quadriplegia. Further studies may find this technique useful in acute quadriplegia, particularly during surgical monitoring.

Adult↗
PubMed2005

Acute quadriplegia complicating critical illness polyneuropathy in a patient with infective endocarditis: a case report.

A 75-year-old woman with infective endocarditis developed critical illness polyneuropathy (CIP) with quadriplegia after cardiac surgery. The quadriplegia resolved gradually after aggressive treatment of the underlying infection and with rehabilitation. However, a MEDLINE search of the English-language literature failed to yield results matching quadriplegia and infective endocarditis. CIP is a complication of septic syndrome and sepsis. This complication has been largely unrecognized in intensive care units owing to difficulties in performing a clinical examination or electrophysiologic studies. Difficulty in weaning from the ventilator is an important early manifestation of CIP. Electroneuromyography (ENMG) should be routinely performed to establish the diagnosis. We suggest that any septic patients with unexplained muscle weakness, paralysis, or difficulty in weaning from the ventilator should be evaluated for CIP.

Acute Disease↗
PubMed2003

Treatment and prognosis of patients with paraplegia or quadriplegia because of metastatic spinal cord compression in prostate cancer.

Metastatic spinal cord compression (MSCC) is a serious complication of metastatic prostate cancer (PCa). This study retrospectively evaluated patients who presented with paraplegia or quadriplegia because of MSCC of PCa. Of 847 patients with PCa who were treated between 1989 and 1998, 26 (3.1%) demonstrated paraplegia or quadriplegia because of MSCC. Characteristics, treatment efficacy, and prognosis of these patients were analyzed. In total, 15 cases became paraplegic despite androgen ablation therapy (Group I). Average time to paraplegia from initial hormonal treatment was 34 months. Out of nine cases who underwent radiation therapy (RT) to spinal lesions with/without chemotherapy, one patient became ambulatory. However, this patient subsequently had recurrent compression. Two cases had remission of paralysis. Two cases underwent laminectomy plus RT and in one case paralysis improved. MSCC was the first indication of PCa in 11 cases (Group II). Two cases underwent laminectomy plus hormone therapy and nine cases underwent hormone therapy alone. Four patients became ambulatory and two cases showed improved motor capacity. Average interval from paraplegia to death was 7.4 months in Group I and 27.1 months in Group II. However, there was no statistical difference in these two groups on disease-specific survival from the start of initial treatment. It is difficult to recover the ability to walk if paraplegia or quadriplegia occurs in PCa patients although decompression surgery plus hormone therapy seemed to impair the prognosis. Stage M1 patients with paraplegia had survival rates as good as stage M1 patients without paralysis. This should encourage an aggressive treatment approach. However, for patients with hormone-independent disease there seems to be no effective treatment and prognosis is poor.

Adenocarcinoma↗