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Biomedical subjects

E A Hurvitz

Publications and source records attributed to E A Hurvitz.

At least 19 recordsLinked to original sources
PubMed1998

Parental report of pediatric tracheostomy care.

OBJECTIVE: There are little data on the actual care given pediatric tracheostomy patients in their homes. Information on the use of supplies and on techniques and frequency of care is valuable for a better understanding of the needs of this population. DESIGN: Questionnaires were distributed by mail or at clinic visits from May 1995 to June 1996 to a convenience sample of tracheotomized patients at the University of Michigan Pediatric Physical Medicine and Rehabilitation clinic. SETTING: Tertiary care clinic. RESULTS: Clean technique for suctioning was reported by 96.7% of subjects and the rest reported sterile technique. Fifty percent of subjects reported reusing suction catheters. Cleaning solutions used to clean suction catheters for reuse varied. Tracheostomy tube reuse was reported by 55% of subjects. Sixty percent of those who reused tracheostomy tubes had had pneumonia within the previous year, whereas only 25% of those who never reused the tracheostomy tube had pneumonia in the same time period. CONCLUSIONS: Suctioning frequency, suction catheter, and tracheostomy tube reuse and cleaning methods are variables that warrant further investigation of safety and efficacy.

Adolescent↗
PubMed1998

Bowel management in children and adolescents with spinal cord injury.

There is little in the literature regarding bowel management in children and adolescents with spinal cord injuries (SCI). This study was undertaken to examine specific patterns of bowel care, individual levels of satisfaction with bowel management, the incidence of incontinence in this population, and effects on lifestyle because of time commitment and dependence in bowel management. Surveys were sent to all persons (n = 45) under age 19 with a diagnosis of SCI who had received care at our medical center since 1985. Thirty-one subjects (69 percent) returned the surveys. The average age at injury was 8.1 years, with an average follow-up period of 3.9 years. Fifty-five percent were individuals with tetraplegia and 77 percent had a complete injury (ASIA Class A). A bowel management program, including medications or manual manipulation, was required for 81 percent of the subjects; only two were independent in their bowel management. Over half of the subjects performed evening bowel care and over half performed their care daily. Digital stimulation tended to be used more commonly by younger children. Medications, either oral, rectal, or both, were used by 88 percent. Sixty percent of the subjects reported they were completely or very satisfied with their bowel management. About half the subjects had limited freedom because of their bowel programs, which caused some dissatisfaction. Sixty-eight percent reported occasional or frequent interference with school activities because of their bowel programs. No correlation was found between bowel accidents and satisfaction with bowel management, despite the fact that almost 84 percent of the children reported at least rare accidents. Lifestyle limitations, bowel accidents, dependence in bowel management, and subject and family dissatisfaction continue to be significant problems for children and adolescents with SCI.

Adolescent↗
PubMed1997

Quantification of upper extremity function using kinematic analysis.

OBJECTIVE: To illustrate the applicability of motor control analytical techniques to the assessment of upper limb dysfunction in children with ataxia. DESIGN: Descriptive case series. SETTING: The study sample was selected from an outpatient pediatric rehabilitation clinic and testing was performed in a research laboratory. PARTICIPANTS: Four children with upper limb ataxia and seven healthy children were examined. All subjects were recruited on a volunteer basis. Criteria for inclusion (ataxic group) included: (1) age 6 to 15 yrs; (2) ambulatory with assistive devices. MAIN OUTCOME MEASURES: Quantitative measures of elbow kinematics (movement speed and duration) and spatio-temporal "portraits" of elbow movement during unilateral and bilateral forward reaching movements. RESULTS: Movements made by ataxic subjects were characterized by lower peak velocities, prolonged durations, and increased variability compared with normal subjects. In the one subject with unilateral ataxia, interlimb coordination was severely disrupted during the performance of coupled, bilateral arm movements. In addition to changes in specific kinematic values (eg, peak velocity), phase plane and angle-angle displacement curves revealed marked spatio-temporal variability throughout the movement, the magnitude of which was correlated with severity of ataxia. CONCLUSION: The application of the quantitative motor control methods described in this report can provide rehabilitation specialists with a simple yet sensitive means to evaluate treatment and progression of a wide variety of motor disorder conditions. These techniques are particularly well suited to pediatric populations as young as 6 years.

Adolescent↗
PubMed1997

Bladder management in patients with pediatric onset neurogenic bladders.

Our objective was to determine which clean intermittent catheterization (CIC) methods and supplies were used by patients with pediatric onset neurogenic bladders and to relate methodology and materials to reported urinary tract infections. Data were collected via questionnaires distributed by mail and at clinic visits at our university tertiary care outpatient pediatric rehabilitation clinic. Questionnaires were given to 165 patients. Fifty-nine percent were returned (68 patients with myelomeningocele, 27 with pediatric onset spinal cord injury (SCI) and two with other diagnoses). Mean age was 12 years (range 1-27). Fifty-four percent of patients participated in their own CIC. Only two percent used sterile catheterization technique, whereas 98 percent used CIC. A sterile catheter was employed with clean technique by 22 percent. Catheters were reused by 76 percent. Subjects used a wide ranging number of catheters per month, with a median of 5.3. There was no correlation between the number of urinary tract infections (UTIs) per year and the type of catheter used or the use of prophylactic antibiotics. Compared with patients with myelomeningocele, subjects with SCI were significantly more likely to use sterile catheters (p = 0.04), > 10 catheters per month (p = 0.01) and gloves (p < 0.001). Subjects who used gloves or more catheters were more likely to experience UTI. These data suggest that clean reused supplies are not related to an increased likelihood of UTI and should be considered a way to lower costs in these populations.

Adolescent↗
PubMed1996

Home mechanical ventilation of children.

The medical records of 89 ventilator-assisted children followed at the University of Michigan Medical Center from 1978 to 1993 were reviewed. The status of these children was remarkably stable. Parameters of communication, nutrition, education, and mobility changed very little over time, and fewer than half had to be re-admitted. Children aged 9 to 12 years had the most nursing hours; in terms of diagnosis, those with spinal cord injury and bronchopulmonary dysplasia had the most. The younger children had the longest initial hospital stay and the most re-admissions. The authors conclude that appropriate rehabilitation during the initial hospitalization can minimize later changes, instability and rehospitalizations, and that careful follow-up and periodic evaluation can improve the patients' health and function.

Adolescent↗
PubMed1996

Hip, knee, and foot pain during pregnancy and the postpartum period.

BACKGROUND: Although much has been written about low back pain during pregnancy, there are few studies regarding leg, foot, and hip pain. The purpose of this study was to investigate the prevalence and characterize the nature of lower extremity pain in women of child-bearing age and to assess the impact of recent pregnancy on these symptoms. METHODS: In this case-control study, 107 consecutive postpartum women (case subjects) and 91 nulliparous women (controls) completed a questionnaire regarding hip, knee, and foot pain and potentially influencing factors. RESULTS: Postpartum subjects had more symptoms of leg and foot pain than did the controls (56% vs 37%; odds ratio [OR]=2.3; 95% confidence interval [CI], 1.2 to 4.7). A significant majority of pain (82%, P<.05) began during the second and third trimesters. Postpartum subjects also had a significantly higher prevalence of hip pain (38% vs 23%; OR=3.2; 95% CI, 1.4 to 7.0) and foot pain (31% vs 22%; OR=2.2; CI, 1.1 to 4.5). History of previous pain complaints also were found to be risk factors for lower extremity pain during pregnancy for case subjects and in the past year for controls. There was a trend toward older age as a risk factor as well. Multiple pain complaints were more common among case subjects than among controls. CONCLUSIONS: Lower extremity pain is common in women of childbearing age. Pregnant and postpartum women are more likely to develop new lower extremity symptoms than are nulliparous women. The timing of symptom onset in mid- to late pregnancy may suggest that biomechanical factors play a larger role than hormonal influences. Regular exercise appears to be neither protective against nor a risk factor for lower extremity pain during pregnancy.

Adolescent↗
PubMed1995

Home mechanical ventilation in mitochondrial encephalomyopathy syndrome.

Long-term home mechanical ventilation of children has only recently become more practically feasible and ethically acceptable by the medical community. It has been particularly controversial in cases of degenerative myopathies in which quality of life has been questioned. There are no reports in the literature of long-term home mechanical ventilation of a child with mitochondrial encephalomyopathy (MELAS) syndrome despite the many descriptions of possible etiologies of the concomitant respiratory failure. The patient reported here has used home mechanical ventilation for 6 years with few medical complications, no hospitalizations in the past 3 years, and increased function in activities of daily living. Despite the ill-defined nature of the disease and uncertain prognosis, we believe that long-term home mechanical ventilation of children with early onset MELAS syndrome is a viable option for both patients and their families and results in overall improvement in quality of life for the patient.

Child↗
PubMed1995

Peripheral neuropathy: a true risk factor for falls.

BACKGROUND: Several studies have recently linked peripheral nerve dysfunction in the elderly with postural instability and falls. Many causes of peripheral neuropathy (PN) have the potential for associated comorbidities, which could themselves be the true cause of these falls. This study tested the hypothesis that PN is not a cause of falls but just a marker for a comorbidity (e.g., central nervous system dysfunction) that is the true cause of falls in this elderly population. METHODS: Twenty subjects with an electromyographically documented axonal peripheral neuropathy affecting the lower extremities were identified (PN group) and matched by age and sex with 20 subjects with normal lower extremity electrodiagnostic studies (C group). A focused history and physical examination designed to identify factors other than PN which might cause falls was performed, and a history of falls or postural instability over the previous year was obtained. RESULTS: PN was found to be significantly associated with the self-report of falls (11/20, 55% vs 2/20, 10%; odds ratio 17.0, 95% CI = 2.5, > 100) and postural instability (7/9, 77% vs 0/0, 0%; odds ratio 13.0, 95% CI = 1.5, > 100) over the previous year. There was no significant difference between the two groups in total number of other risk factors known to be associated with falls, (23 PN group vs 18 C group). The PN group did take a significantly greater number of medications known to be associated with falls (10 PN group vs 1 C group, p < .01), but the usage pattern among fallers and nonfallers within the PN group suggests that medications were not the primary cause of the falls. The PN subjects who fell demonstrated significantly worse vibratory sense at the ankle and finger (p < .05), and significantly decreased unipedal stance time (3.1 sec vs 9.1 sec, p < .05) than the PN subjects who did not fall. CONCLUSIONS: No associated factors or comorbidities explained the high rate of falls in elderly persons with PN, suggesting that PN is a true risk factor for falls in the elderly. Relatively greater impairment in vibratory sense and ability to maintain unipedal stance may identify those within the PN group who are at a higher risk for falls.

Accidental Falls↗
PubMed1994

Rachitic syndrome after disodium etidronate therapy in an adolescent.

A 12-year-old patient with a severe traumatic brain injury developed heterotopic ossification (HO) with rapidly decreasing range of motion in multiple joints despite intensive passive range of motion exercises and the use of nonsteroidal antiinflammatory drugs (NSAIDs). His alkaline phosphatase was markedly elevated. Etidronate, 20mg/kg/d was used to control the ossification. After 7 months of continual etidronate use, the patient developed periarticular pain with widened growth plates, suggesting a rachitic syndrome. Serum laboratory panel including calcium, phosphorous, alkaline phosphatase, and vitamin D were normal. After 3 months off etidronate, radiological studies showed growth plate calcification, though not before development of bilateral slipped femoral capital epiphyses. Further improvement and resolution of all complications occurred 5 months after discontinuation of etidronate. Rachitic syndromes secondary to didronel use in a clinical setting has not been previously reported. Other possible causes for a rachitic syndromes were not present. Alternate treatments for children with or at risk for HO should be considered.

Brain Injuries↗
PubMed1993

Hyperthermia associated with baclofen withdrawal and increased spasticity.

Rapid baclofen withdrawal is known to cause markedly increased spasticity, but high fever associated with this complication has not been reported. We describe a 13-year-old boy with sensory incomplete C1 quadriplegia two years after injury who was on 200mg of baclofen per day for spasticity. Concerns about adverse side effects prompted tapering of his baclofen. Severely increased spasticity was noted with associated hyperthermia to 107 degrees F after the dosage was gradually decreased. Sepsis work-up was negative, head computed tomography scan was unchanged, and electroencephalogram showed no epileptiform activity. Cooling blankets, intravenous diazepam, and return of baclofen to 160mg per day decreased spasticity and normalized body temperature without recurrence of hyperthermia. Possible fever etiology is the hypermetabolic state associated with the acute return of spasticity.

Adolescent↗
PubMed1992

The relationship between electromyographically documented peripheral neuropathy and falls.

OBJECTIVE: To determine if the presence of an electromyographically demonstrated peripheral polyneuropathy involving the lower extremities is associated with falls. DESIGN: Case control study. SETTING: A University-based referral center. PATIENTS: Twenty-five patients with an axonal peripheral polyneuropathy affecting the lower extremities, demonstrated by electromyography more than 8 and less than 16 months before, and 25 age- and sex-matched controls who had normal electromyographic studies of the lower extremities during the same time period, were identified from a computer record of all electromyography results during the year prior to the study, using diagnostic codes and demographic data. Twenty-eight pairs were identified, 25 of whom completed the study. MAIN OUTCOME MEASURES: Number of falls and resultant injuries during the year before the interview, and number of previously identified risk factors for falling, based on interview. RESULTS: Peripheral neuropathy was found to be significantly associated with falling (14/25, 56% vs 2/25, 8%--odds ratio 23.0, 95% confidence interval 2.5, > 100) and repetitive falling (10/25, 40% vs 1/25, 4%--odds ratio, 95% confidence interval 1.4, > 100). There was a trend toward increased injury requiring medical attention (5/25, 20% vs 0/25, 0%), but it did not reach statistical significance. Previously identified risk factors were not significantly more common in the peripheral neuropathy group. CONCLUSION: An electromyographically identified peripheral neuropathy is strongly associated with and may be a risk factor for falls.

Accidental Falls↗
PubMed1992

Risk factors for heterotopic ossification in children and adolescents with severe traumatic brain injury.

Previous reports on the incidence of heterotopic ossification (HO) in children and adolescents with traumatic brain injury (TBI) have ranged from 3% to 20%. These studies mention HO briefly or address patient cohorts with coma more than three months. We reviewed the medical records of 90 children younger than 19 years old, who were comatose more than 24 hours after TBI. Mean followup was 33.1 months (range = 2 to 128 months). Incidence of HO was 14.4% (n = 13). One to five sites were involved, with hip and knee most frequent, followed by shoulder, elbow, and nonjoint sites. Children with HO were older than 11 years (relative risk [RR] = 18.85, confidence interval [CI] = 3.7, 95.7), had a greater length of coma (RR = 7.22, CI = 1.4, 37.1), and had a greater associated risk for poor functional outcome (RR = 2.89, CI = 1.02, 7.9) compared to those without RO. Multiple limb fractures showed a trend toward association with increased incidence of HO. Other factors, including gender, history of skull fracture, brain CAT scan findings, and presence of spasticity, were not predictive of HO. Eleven children were treated with etidronate, four with nonsteroidal antiinflammatory drugs, and one with surgery. Only three children had residual functional impairments attributed to the presence of HO.

Adolescent↗
PubMed1991

Characteristics of pediatric rehabilitation training offered by physical medicine and rehabilitation residencies.

Pediatric physiatry is a growing subspecialty. A survey was designed to determine the nature of pediatric rehabilitation training in physical medicine and rehabilitation residency programs in the United States. Sixty-five programs (93%) responded. More than three quarters of the programs required three months or more in pediatric rehabilitation, usually in the HO-III or HO-IV year. Forty-two percent of the programs had an even balance of inpatient and outpatient clinical opportunities. Approximately half offered exposure to a separate pediatric rehabilitation ward, and 82% placed residents in a general pediatric rehabilitation clinic. Advanced training has become more widespread in pediatric rehabilitation, with 46% of the residency programs having preceptors with board certification in pediatrics and physiatry or fellowship training, and 42% of the programs responding offering advanced training opportunities in pediatric rehabilitation.

Child↗
PubMed1989

Ultrasound imaging of residual limbs: new use for an old technique.

The use of ultrasound for diagnosing problems in the residual limb of an individual with an amputation has not been documented in the literature. We present a case where this modality was particularly useful in the diagnosis of an extensive abscess in the distal stump. Ultrasound imaging of compromised residual limbs is useful in the diagnosis of stump infections with infected muscle tissue and deep fluid collection. This technique can help shorten the course of intravenous antibiotics by clarifying the need for surgical intervention.

Aged↗
PubMed1988

Orthotic technique for dystonia musculorum deformans.

Tone reducing, inhibitive casting, and orthoses have been effectively used in patients with cerebral palsy and head injury to improve gait patterns and decrease tone. We present a patient with dystonia musculorum deformans who had severe inversion and supination of his left foot with weight bearing. He did poorly with metal double-upright ankle-foot orthoses with lateral T-strap. A tone-reducing ankle-foot orthosis (TRAFO) was successful in decreasing problems with abrasions and allowing him to walk without assistive devices.

Adult↗
PubMed1988

Rigid removable dressing in a case of poor wound healing.

The rigid removable dressing technique for below-knee amputees has many advantages over other conventional systems. There is some reluctance to use this system in the presence of an open lesion. We present a patient with severe wound dehiscence who had success with this system. The advantages of the rigid removable dressing are protection of the stump and better shrinkage, combined with the ability to remove the dressing and look at the wound. This makes the technique ideal for a stump with poor wound healing.

Aged↗