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Biomedical subjects

A J Haig

Publications and source records attributed to A J Haig.

46 records · Page 3Linked to original sources
PubMed1990

Aggressive early medical management by a specialist in physical medicine and rehabilitation: effect on lost time due to injuries in hospital employees.

Musculoskeletal injuries to hospital workers are both common and costly. Little advice has been written on how to decrease losses after injury. In a tertiary care hospital with 2700 employees a specialist in physical medicine and rehabilitation evaluated injured employees who were out of work for more than 2 days. Physician management emphasized increasing patient investment in the problem, early assessment of delayed recovery, and effective communication with the employer. There were 61 injuries averaging 6.7 days off per injury. In a previous year, 52 injuries averaged 11.8 days. Employees out for more than 2 days with back pain and seen by the physiatrist (52%) averaged 11 days off per injury whereas others averaged 14.9 days. In this hospital, early management by a specialist resulted in a substantial decrease in time off because of injury.

Absenteeism↗
PubMed1990

Recovery from vegetative state of six months' duration associated with Sinemet (levodopa/carbidopa).

Certain pharmacologic interventions may improve outcome for brain injury in animals and humans. Medications affecting the dopaminergic pathway appear to be important. We present the case of a 24-year-old man with traumatic brain injury who remained unresponsive to commands and unchanged for six months despite periodic aggressive therapy. Within days of beginning Sinemet (levodopa/carbidopa), the patient became conversant and responsive. The reported low likelihood of spontaneous recovery of cognition in patients who are vegetative for six months suggests that Sinemet was responsible for this patient's recovery. In this case, the relatively small risk of side effects from Sinemet was greatly outweighed by the change in functional outcome.

Activities of Daily Living↗
PubMed1987

Mortality and complications of the locked-in syndrome.

The locked-in syndrome is a severe disability consisting of quadriplegia and anarthria with preserved consciousness. No large series of cases have been reported and very few cases of long-term survival have been described. We present a follow-up of 27 patients "locked-in" for more than one year. Twenty-four were still alive up to 12.5 years after onset, with a mean survival of 4.9 years. Significant recovery was noted in only a few patients. Seventeen patients lived at home at the time of study. Eight were never hospitalized after the initial event. Gastrostomy and tracheostomy tubes and indwelling catheters were eventually removed from many patients. Electronic devices were used by ten patients to facilitate communication. We conclude that rehabilitation and medical care must be planned carefully, given the length of survival shown in this group.

Adult↗
PubMedDate not supplied

Describing paraspinal EMG findings: inadequacy of the single 0-4+ score.

OBJECTIVE: Clinical electrodiagnostic textbooks instruct that lumbar radiculopathies typically have paraspinal abnormalities and that these abnormalities should be recorded using a single 0-4+ scale. Recent work demonstrates that that the innervation of the paraspinal muscles is segmental, not homogenous, and that asymptomatic persons may have reproducible ("1+") positive waves or fibrillation potentials. DESIGN: To assess current use of the 0-4+ scale, a retrospective study of EMG scores in persons diagnosed with radiculopathy at a university laboratory was performed. No specific paraspinal EMG technique was used. Included were 117 consecutive, qualified S-1 radiculopathies and 33 L-5 radiculopathies. RESULTS: When radiculopathy was defined by "more than one limb muscle abnormal," paraspinal scores were recorded as 0 to 1+ in 83% of L-5 and 63% of S-1 cases (chi2, L-5 vs. S-1, not significant). For more severe radiculopathies (at least one limb muscle with a "2+" score), 0-1+ paraspinal scores were recorded in 76% of L-5 and 57% of S-1 cases (chi2, not significant). A total of 82% of S-1 radiculopathies with no overlapping L-5 innervation had 0-1+ scores. CONCLUSIONS: These data demonstrate the common use of equivocal paraspinal scores in patients whom electromyographers believe have radiculopathies. Standardized exploration techniques and a more detailed scoring system for the paraspinal muscles may eliminate this discrepancy.

Action Potentials↗
PubMedDate not supplied

Paraspinal electromyography in high lumbar and thoracic lesions.

OBJECTIVE: To use needle electromyography in the paraspinal muscles to localize the root level of a radiculopathy. DESIGN: We collected nine cases of clinically proven, isolated high lumbar or thoracic disk herniations of patients who underwent MiniPM. Four were from a prospective study of 114 persons with low back pain (MiniPM had 100% sensitivity to magnetic resonance imaging-documented high disks). RESULTS: In the most medial "S" column, mean MiniPM scores were 0.7 for the level above the radiologically documented lesion; 3.1 at the lesion; and 1.6, 1.6, and 1.1 at the three spinous processes below the lesion. Similar numbers were obtained in the "M" column (slightly lateral), with no significant differences between S and M. Differences were significant between and at the level of the lesion for S (P < 0.06) and M (P < 0.01), and between the lesion level and three levels below for the M column (P < 0.01). CONCLUSIONS: These findings suggest that paraspinal electromyography has a higher than previously reported sensitivity for high lumbar lesions. Electromyography using MiniPM can localize some radiculopathies. The individual cases suggest that, consistent with the anatomy of the caudi equina, thoracic lesions and lateral lumbar lesions denervate only at one level, but more central lumbar lesions also denervate distally innervated paraspinal muscles.

Adult↗
PubMedDate not supplied

Diagnoses and treatment options in occupational low-back pain.

Job modification is often effective for prevention of LBP, but employee selection is generally risky, unreliable, and (increasingly) illegal. For acute care, excellent results are obtained with a simple, well-organized protocol. A trial of additional interventions is usually not productive. In rehabilitation, the challenge is to choose interventions at the most cost-effective time and identify local programs which have proven effectiveness. Case-closure issues such as medical end-result, impairment rating, and permanent job restrictions continue to be poorly supported by scientific literature. They are often best resolved by consensus of the patient, physician, and employer. We look forward to more reliable predictors of long-term outcome. An old adage says, "If there are dozens of treatments for a disease, probably none of them is effective." In recent years we have advanced from dozens of equally acceptable treatments to a few well-documented ones, as outlined in the Quebec study. Such an approach is very effective in changing the course of back pain. However, there are still many unproven treatments in common use. Perhaps some will prove useful. In adding interventions to a simple, effective protocol, one must be aware of the true risks and benefits.

Humans↗