Ultrasonographic diagnosis of heterotopic ossification mimicking deep vein thrombosis.
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Adult↗
Biomedical subjects
J R Parziale
Publications and source records attributed to J R Parziale.
Standard v lightweight wheelchair propulsion in spinal cord injured patients.
Twenty-six male SCI subjects (six quadriplegics, eight "high paraplegics," and 12 "low paraplegics") propelled both standard and lightweight wheelchairs at a "sprint pace" (Sp) for 400 feet, and at a "duration pace" (Du) for four continuous minutes. Pulse, blood pressure and respirations were measured before and after each trial, and V was calculated. Appropriate training and rest periods were given; order of wheelchair testing was randomized. A questionnaire was later administered. Variations in pulse, systolic blood pressure, and respirations were significant between myelopathic levels (P less than 0.01), but were not affected by the type of wheelchair used. Quadriplegic V was less (P less than 0.01) than that of either paraplegic group for Sp and Du trials; for Sp, lightweight wheelchair V is faster (P less than 0.01) than standard wheelchair V for all groups.
Adult↗
The evolution of an acute care hospital unit to a DRG-exempt rehabilitation unit. A preliminary communication.
The Health Care Financing Administration's decision to adopt a prospective based payment system has caused many institutions to implement new policies and practices. A recent area of interest for many hospitals has been the creation of diagnosis-related group (DRG) exempt units to maximize reimbursement practices. We analyzed changes which occurred when an eight bed acute care stroke unit (SU) was converted to a DRG exempt eight bed rehabilitation unit (RU). The time period involved was 1 1/2 months before and 1 1/2 months after the transition occurred. Analysis of data from the pre- and posttransition periods revealed that: (1) length of stay increased significantly from 11.7 to 15.3 days (P less than 0.001); (2) functional independence measure (FIM) score improvement was significantly greater (P less than 0.05) for RU patients (0.84/day) than for SU patients (0.39/day); (3) disposition to home v other facilities increased significantly from 50 to 81% (P less than 0.05); (4) the overall occupancy increased from 94 to 100% and all beds were filled with rehabilitation patients; (5) the proportion of patients with Medicare as their primary insurer was comparable before (64%) and after (67%) unit conversion; (6) gross income from rehabilitation patients increased by 43%. Indirect savings via reduction of acute hospital length of stay for Medicare patients increased total income from operation of this unit. We conclude that patients on the RU stayed longer, had greater daily improvements in functional status, and were more likely to be discharged to home. This appears to be due to a more efficient use of rehabilitation beds and a concomitant overall improvement in reimbursement to the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)
Bed Conversion↗
Correlation of chronic low-back pain behavior and muscle function examination of the flexion-relaxation response.
The relationship between videotape ratings of pain behavior and the flexion-relaxation phenomenon was evaluated in a sample of 39 chronic low-back pain patients. The results showed that guarded movement explained approximately 27% of the variability in the flexion-relaxation phenomenon, adjusting for pain intensity rating. There were no significant differences in sex observed. It is recommended that clinicians pay close attention to qualitative aspects of patient behavior to improve the sensitivity of the physical examination in detecting bona fide impairment.
Adult↗
The mechanical performance of ambulation using spring-loaded axillary crutches. A preliminary report.
Crutches with the extension post replaced by a spring-loaded post were compared with standard axillary crutches with respect to stresses developed during the stance phase of locomotion. Seven subjects were tested using both standard and spring-loaded crutches. The crutches were fitted with strain gauges; crutch length and grip location were adjusted for each subject using accepted standards. Subjects ambulated using a three-point "swing-through" gait pattern while strain gauge data were recorded. Spring-loaded axillary crutches had 22% smaller shock waves upon initial contact and 24% smaller peak stresses (P less than 0.05). Subjects reported improved endurance and comfort with the spring-loaded crutch. Although larger trials will be necessary, these initial results show promise in reduction of impact-loading of the upper extremity of patients using axillary crutches.
Crutches↗
Diagnostic peripheral nerve block resulting in compartment syndrome. Case report.
A hemiplegic patient with severe upper extremity spasticity 2 years after a cerebrovascular accident received a diagnostic median nerve block below the elbow with bupivacaine. He had been placed on Coumadin as prophylaxis for cerebrovascular arteriosclerotic disease, and prothrombin time was kept at twice the control value. Less than 48 hours after the procedure, a compartment syndrome developed in the volar forearm. Compartment syndrome has not previously been reported as a complication resulting from a nerve block procedure. We conclude that (1) compartment syndrome may develop after a peripheral nerve block procedure for spasticity, (2) prophylactic anticoagulation may increase the risk for hemorrhagic events resulting from percutaneous injection and (3) early recognition is essential and appropriate decompressive fasciotomy may be indicated if a compartment syndrome develops after a nerve block procedure.
Bupivacaine↗
Functional considerations in partial foot amputations.
Recent developments in both surgical techniques and prosthetic management have improved the prognosis for foot amputations between the transmetatarsal and Syme's levels. Retention of active ankle motion is often permitted by partial foot amputations. Vocational and avocational requirements for active, voluntary ankle motions should be considered preoperatively in selected patients. Three case reports are used to illustrate this concept. Appropriate surgical techniques and prosthetic devices may improve the quality of life for some individuals requiring distal lower extremity amputations.
Amputation, Surgical↗