Rehabilitation after trauma.
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Biomedical subjects
Publications and source records attributed to A B Ward.
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This study reports on the value of head injury instruction cards as purveyors of information to patients. Patients over 10 years old attending the North Staffordshire Royal Infirmary Accident and Emergency Department with a mild head injury were invited to attend a special brain injury follow-up clinic, where they were asked to complete a questionnaire. Patients failing to attend this clinic were contacted and asked to complete the questionnaire. This revealed that they were no less severely affected by the injury as the attenders. They were asked why they had not attended and a significant number of patients had no recall of being given a head injury instruction card on which the information of the follow-up clinic was given. Memory loss was the most likely cause of this and is more common than is widely appreciated in patients attending accident and emergency departments.
A 23 year old male patient presented with a venous thrombosis in the right calf. This was followed by symptoms, signs and electromyographic findings suggestive of a tarsal tunnel syndrome. Symptoms were briefly relieved by surgical division of the flexor retinaculum. Subsequently, patient developed swelling in the calf and was found to have a malignant ("Triton") tumour of the tibial nerve and required above knee amputation. In the absence of obvious foot or ankle deformity, caution should be exercised in making the diagnosis of tarsal tunnel syndrome.
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Two rugby players with a lone axillary nerve lesion are described. Neither suffered an overt dislocation of the shoulder nor was there any evidence of severe local injury. Recovery in both was complete by 1 year. Possible mechanisms of injury are discussed.
Traditional gynecologic opinion holds that endometriosis is rare in teenagers. However, several reports of this disease in teenagers have appeared over the past four decades, and in one study of a series of endometriosis patients, teenagers accounted for 8.5% of them. With these facts in mind, 43 consecutive laparoscopies were prospectively analyzed in symptomatic teenagers. A 65% incidence of endometriosis was found. The symptoms and physical findings are analyzed. The liberal use of diagnostic laparoscopy in selected symptomatic adolescents is recommended for the early diagnosis and aggressive preventive treatment of this common and potentially crippling illness.
Three cases of fetus papyraceus in twin pregnancy were seen over a 4-month period. They were associated with an antepartum stillbirth and intrauterine growth retardation of the larger twin. Two of the 3 mothers exhibited hypertension. It is concluded, therefore, that the appearance of a fetus papyraceus frequently indicates the presence of a hostile intrauterine environment. We suggest that serial ultrasonic examinations be performed to confirm the diagnosis of fetus papyraceus. In this way, appropriate therapy may be directed toward a better outcome for the second twin.
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Spasticity is a complex problem which can cause profound disability, alone or in combination with weakness, and can give rise to significant difficulties during rehabilitation. This article reviews a current approach to the management of spasticity.