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Biomedical subjects

A S Burns

Publications and source records attributed to A S Burns.

9 recordsLinked to original sources
PubMed2004

Spinal shock revisited: a four-phase model.

Spinal shock has been of interest to clinicians for over two centuries. Advances in our understanding of both the neurophysiology of the spinal cord and neuroplasticity following spinal cord injury have provided us with additional insight into the phenomena of spinal shock. In this review, we provide a historical background followed by a description of a novel four-phase model for understanding and describing spinal shock. Clinical implications of the model are discussed as well.

Animals↗
PubMed2001

The management of neurogenic bladder and sexual dysfunction after spinal cord injury.

STUDY DESIGN: Review article. OBJECTIVES: To review the medical literature and comprehensively discuss the management of bladder and sexual dysfunction after spinal cord injury. SUMMARY OF BACKGROUND DATA: The physiologic alterations that accompany spinal cord injury can lead to significant bladder and sexual dysfunction. Fertility in men is also diminished. Without appropriate intervention, the above conditions can lead to significant morbidity and mortality. METHODS: Structured review of published reports obtained through a MED-LINE search and texts. RESULTS/CONCLUSION: With appropriate surveillance and management, morbidity and mortality from neurogenic bladder dysfunction can be successfully prevented. Current treatment interventions also facilitate the restoration of sexual function and fertility after spinal cord injury.

Female↗
PubMed2001

Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management.

STUDY DESIGN: Review article. OBJECTIVES: To review the medical literature and provide a framework for predicting neurorecovery and functional outcomes after spinal cord injury based on injury severity. SUMMARY OF BACKGROUND DATA: The ability to accurately predict the magnitude of neurorecovery and expected functional outcomes after spinal cord injury is of great importance. This information is needed to justify medical and rehabilitation interventions to third party payers as well as to begin the process of planning for postdischarge care. Over the past several decades, significant progress has been made in accurately predicting neurorecovery and its impact on functional outcomes. METHODS: Structured review of published reports obtained through MED-LINE search and texts. RESULTS/CONCLUSION: Within 72 hours to 1 month after a spinal cord injury, it is possible to predict with reasonable accuracy the magnitude of expected recovery based on physical examination. The impact of motor level on long-term functional outcomes is also clear and has remained relatively unchanged for several decades. Functional outcomes are likely to improve in upcoming years as novel interventions, such as drugs and functional neuromuscular stimulation, are developed with the goals of limiting secondary injury and restoring neurologic function. New training methods, such as body weight support, that use activity-dependent neuroplasticity will also have a more prominent role.

Humans↗
PubMed2001

Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia.

STUDY DESIGN: Retrospective analysis. OBJECTIVES: To evaluate the efficacy of intrathecal baclofen (ITB) for upper extremity spastic hypertonia in tetraplegia of spinal origin. SETTING: University of Alabama at Birmingham hospital. METHODS: The medical records of 14 individuals with tetraplegia of spinal origin who underwent intrathecal baclofen pump placement were reviewed. The effects of intrathecal baclofen on spasm frequency, deep tendon reflexes, and tone (Ashworth scale) were assessed for the upper and lower extremities for a 1-year follow-up period. RESULTS: There were statistically significant declines in upper extremity spasm scores (1.8 points, P=0.012), reflex scores (1.4 points, P<0.0001) and Ashworth scores (0.6 points, P<0.0001) for the 1-year follow-up period. For the lower extremities, all decreases were significant (P<0.0001). There was also a statistically significant (P<0.0001) increase in intrathecal baclofen dosage requirements during the 1-year follow-up period to maintain the reductions in spasm frequency, reflexes and tone. CONCLUSIONS: Intrathecal baclofen is a safe and effective intervention for treating upper extremity hypertonia of spinal origin. In addition, the level of intrathecal catheter placement is felt to be of importance.

Adult↗
PubMed2001

Deep water running: an effective non-weightbearing exercise for the maintenance of land-based running performance.

Deep water running (DWR) has become a well-recognized from of cardiovascular conditioning for injured athletes and has been used successfully to maintain running performance. DWR provides for decreased stress and weightbearing to injured tissue and joints, allows for maintenance of cardiovascular fitness and a training effect, and offers greater specificity of exercise in relation to running. During a 22-month period, 181 active duty Army soldiers, placed on temporary profiles for injuries that precluded them from their regular weightbearing physical fitness activities, participated in a DWR program. Injuries to the back, knee, and ankle were the most common reasons for referral to the program. This article reviews the physiological characteristics of DWR, specifics of DWR program design, DWR mechanics, and the advantages of DWR over other aerobic forms of exercise to maintain land running performance in military personnel on temporary non-weightbearing profiles.

Adolescent↗
PubMed2001

Gynecologic and reproductive issues in women with spinal cord injury.

As the treatment of SCI and its secondary medical complications improves, women with SCI are becoming increasingly successful in re-integrating themselves into society. Part of this re-integration involves the resumption of active sexual lives and motherhood. Clinicians who care for patients with SCIs play an important role in facilitating the resumption of these roles. With appropriate follow-up and care, women with SCI should be expected to maintain good gynecologic health and deliver healthy children with minimal complications.

Contraception↗
PubMed1998

Is subcortical disease associated with a poor response to antidepressants? Neurological, neuropsychological and neuroradiological findings in late-life depression.

BACKGROUND: Late-life depression is associated with increased subcortical white matter hyperintensities. There is some evidence that they are associated with a poorer response to acute treatment. Neurological signs and neuropsychological dysfunction are further evidence of abnormalities in the brain, but they have not been studied in relation to therapy resistance. METHODS: A prospective study of 24 normal controls and 75 consecutive elderly (aged 65 to 85) patients with DSM-III-R major depression entered a naturalistic study of treatment. Assessment of response to monotherapy and then lithium augmentation or ECT created three outcome groups. Investigations included magnetic resonance brain imaging, neuropsychological and neurological examination. RESULTS: Response to monotherapy within 12 weeks was shown by 42.7%, a further 37.3% responded to lithium augmentation or ECT within 24 weeks and 20% had responded poorly to all treatments at 24 weeks. Subcortical hyperintensities were significantly increased in the more resistant patients. These included confluent deep white matter, multiple (> 5) basal ganglia lesions and pontine reticular formation lesions. Most of the neuropsychological impairment was restricted to the resistant groups and was of a subcortico-frontal type. Extrapyramidal, frontal and pyramidal neurological signs characterized the resistant groups. The combination of extrapyramidal signs, pyramidal tract signs and impairment of motor hand sequencing strongly predicted resistance to 12 weeks of antidepressant monotherapy with 89% sensitivity and 95% specificity. CONCLUSION: In late-life depression a poor response to antidepressant monotherapy can be expected in those patients with a frontal lobe syndrome, extrapyramidal signs or if MRI T2-weighted lesions are present in both the basal ganglia and the pontine reticular formation.

Aged↗
PubMedDate not supplied

Importance of gadolinium enhancement when using MRI to evaluate spinal cord pathology.

Since its introduction, magnetic resonance imaging has become an indispensable diagnostic tool for the physiatrist evaluating potential spinal cord pathology. Despite ongoing advances in MRI technology and subsequent improved sensitivity, significant pathology can still be missed. In this article, we review the clinical role of contrast enhancement in visualizing many forms of spinal cord pathology.

Abscess↗