Biomedical subjects

J L Gooch

Publications and source records attributed to J L Gooch.

24 records · Page 2Linked to original sources

PubMed1993

Sports medicine. 3. Lower extremity injuries.

This self-directed learning module highlights new advances in sports-related injuries of the lower extremity. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains sections on injuries of the hip and thigh, knee and leg, and ankle and foot. The most common injuries are primarily addressed, while less common injuries are more briefly discussed. New advances that are covered in this section include closed kinetic chain strengthening exercises and recent advances in rehabilitation after anterior cruciate ligament reconstruction.

Achilles Tendon↗

PubMed1993

Sports medicine. 4. Spine and head injuries.

This self-directed learning module highlights important aspects of athletic spine and head injuries. It is part of the chapter on sports medicine in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article covers the presentation, pathomechanics, and classification of common and important cervical and lumbar injuries. Sports participation criteria for children with spine deformities are discussed. In addition, a description of the degrees of concussion, the general guidelines for return to play after a sports-related head injury, and postconcussion sequelae are reviewed.

Athletic Injuries↗

PubMed1991

Prolonged paralysis after treatment with neuromuscular junction blocking agents.

OBJECTIVES: Previous reports have described prolonged paralysis after treatment with neuromuscular junction blocking agents in critically ill patients. The purpose of this study was to further describe a group of patients who developed prolonged weakness after treatment with these agents. DESIGN: Clinical information, electrodiagnostic and muscle pathology results are described in this group of patients. Clinical information includes diagnoses, dosage of neuromuscular junction blocker, other medications affecting the neuromuscular system, and neuromuscular examination and clinical course. SETTING: All patients were seen in the ICUs of three local hospitals. PATIENTS: Included were critically ill patients with a variety of diagnoses, all of whom developed severe weakness after discontinuation of neuromuscular junction blocking agents. INTERVENTIONS: Electrodiagnostic studies and muscle biopsies were performed on several of the patients. MEASUREMENTS AND MAIN RESULTS: All patients had pronounced weakness without sensory loss. Electrodiagnostic and muscle pathology findings were consistent with failed neuromuscular transmission. Although many patients had disorders or were taking medications that can injure the neuromuscular system, no disorder or medication was common to all. Recovery of strength often took several months and most patients were slow to wean from mechanical ventilator support. CONCLUSIONS: Although alternative explanations cannot be excluded with certainty, the use of neuromuscular junction blocking agents may lead to neurogenic atrophy and care must be taken when using them.

Biopsy↗

PubMed1990

Motor unit spike counts before and after maximal voluntary contraction.

Motor unit spike counts in the biceps brachii muscle were evaluated using a monopolar needle electrode during maintenance of antigravity posture with the elbow flexed to 45 degrees before and after maximal voluntary contraction (MVC). After MVC, the number of motor unit spikes/second needed to maintain this posture was about 50% less than prior to MVC. Surface rectified integrated EMG activity declined in parallel to the decline in spike counts. To determine whether different muscles were compensating for the reduction in spike counts, synergistic muscles were examined simultaneously. Similar reductions were noted. In one deafferented subject, EMG activity increased rather than decreased after MVC . Fatigue decreases the contraction-relaxation rate of muscle fibers, which lowers fusion frequency. Thus, lower rates of motor unit activation can result in the maintenance of constant force. A feedback system from muscle to CNS likely senses this slowing and leads to the spike count reduction.

Elbow Joint↗

PubMed1990

Sensory nerve evoked responses in spinal cord injury.

Previous studies have documented the presence of fibrillations, positive waves, and decreased motor evoked response amplitudes in spinal cord injury (SCI) subjects. The purpose of this study was to further evaluate sensory nerve status in this population. Twenty-eight subjects with SCI for at least five months and evidence of spasticity were included. Sural sensory and tibial motor evoked response amplitudes were measured. The mean sural sensory amplitude was 8.0 +/- 5.9 microV (normal = 15.0 +/- 5.3 microV). The mean tibial motor amplitude was 5.1 +/- 4.3 mV (normal = 11.7 +/- 3.8 mV). In six subjects with significantly reduced sural sensory amplitudes, more extensive electrodiagnostic testing was performed. These studies showed diffusely decreased lower extremity sensory and motor evoked response amplitudes and diffuse positive waves and fibrillations in no particular distribution. Thus, subjects with SCI may have sensory as well as motor nerve abnormalities. An intact connection between the second order and primary sensory neuron may be necessary for maintenance of axonal integrity of the primary neuron.

Adolescent↗

PubMedDate not supplied

Intraoperative monitoring in selective dorsal rhizotomy.

The method used in the intraoperative portion of the selective dorsal rhizotomy procedure for the selection of abnormal circuits within the central nervous system of children with spasticity due to cerebral palsy is described. The decision to transect dorsal rootlets is made on the basis of electrophysiological, behavioral and medical criteria. In 100 cases the average number of rootlets transected was 64%. Of the total stimulated, 23.3% exhibited normal electrophysiological and behavioral responses. Decision making regarding the preservation or transection of the remaining 12.7% of the segments is described. This information is presented in an effort to increase understanding of this particular portion of the procedure and to encourage standardization of the procedure between centers in the future.

Child↗