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Biomedical subjects

K R Bell

Publications and source records attributed to K R Bell.

12 recordsLinked to original sources
PubMed2001

Sleep apnea in adults with traumatic brain injury: a preliminary investigation.

OBJECTIVE: To determine the occurrence and nature of sleep-related breathing disorders in adults with traumatic brain injury (TBI). DESIGN: Prospective, observational, consecutive sample enrollment of subjects admitted for rehabilitation after TBI. SETTING: Inpatient rehabilitation and subacute rehabilitation units of a tertiary care university medical system. PARTICIPANTS: Subjects (n = 28) included adults with TBI and a Rancho Los Amigos Scale level of 3 or greater who were less than 3 months postinjury and admitted for comprehensive inpatient rehabilitation. INTERVENTIONS: Overnight sleep study using portable 6-channel monitoring system. MAIN OUTCOME MEASURE: Respiratory disturbance index (RDI), which is the number of apneic and hypopneic episodes per hour of sleep. RESULTS: Evidence of sleep apnea was found in 10 of 28 (36%) subjects as measured by a RDI level of 5 or greater and in 3 of 28 (11%) subjects as measured by a RDI level of 10 or greater. This rate of sleep apnea is significantly (p =.002) higher than would be predicted based on population norms. No correlation was found between the occurrence of significant sleep apnea and measures of TBI severity or other demographic variables. Sleep-related breathing disorders were primarily central though obstructive apneas were also noted. CONCLUSION: In this preliminary investigation, sleep-related breathing disorders as defined by a respiratory disturbance index of 5 or greater appears to be common in adult subjects with TBI.

Adult↗
PubMed2001

Women and traumatic brain injury.

Women with TBI have been inadequately studied in relation to most aspects of pathophysiology, recovery, health and behavioral issues, and community integration. This is not entirely surprising in light of the preponderance of men with TBI but also reflects the traditional tendency of medical researchers to concentrate their efforts on men. Although most of the residual effects of TBI are gender-neutral, women may present some unique problems in relation to pain and endocrine issues, reproduction, and sexual functioning In addition, a woman's roles as wife, mother, and daughter are likely to result in a different constellation of family dynamics when TBI is introduced. Attention to enrollment of women in research studies and the increasing number of multi-institutional studies of TBI may provide enlightenment on these issues in the future.

Behavioral Symptoms↗
PubMed1999

Medical management of posttraumatic headaches: pharmacological and physical treatment.

Posttraumatic headache can be a very difficult syndrome to manage, especially if chronic. As with most other types of headache, medications are the primary treatment modality, although there is very limited evidence-based data to support any given approach. A number of physical interventions also are available to be used in conjunction with medication, particularly for headaches with a musculoskeletal component. This article will review the general principles of pharmacological treatment for headache and the physical approach to treatment of headaches and head and facial pain. The major categories of medications commonly used for treatment of many varieties of headache will be discussed. In addition, the problems encountered in diagnosing and treating chronic daily headache and analgesic rebound headache are addressed. The approach to treatment of such syndromes as myofascial pain, cervico-zygapophyseal joint pain, neuritic pain, and craniocervical somatic pain are outlined.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1997

Primary adrenal insufficiency following traumatic brain injury: a case report and review of the literature.

Primary adrenal insufficiency (PAI) is a relatively rare but serious condition that can lead to signs and symptoms ranging from mild generalized weakness and fatigue to fulminant shock and death. We present the case of a previously healthy 31-year-old man who developed PAI while undergoing rehabilitation after a severe traumatic brain injury (TBI). The patient suffered a TBI with comminuted skull fractures, bifrontal confusions, and bilateral epidural hematomas in a jet-ski accident. Acute hospitalization was prolonged by several medical complications, and the patient was admitted for subacute rehabilitation 1 month after his injury with cognitive deficits, persistent agitation, confusion, generalized weakness, and poor endurance for therapy. His weakness, fatigue, and orthostasis did not improve with attempts at gradual remobilization. The patient also had persistent anorexia, nausea, and hyponatremia despite various treatment regimens. Endocrinology workup showed normal anterior pituitary function but an abnormal response to adrenocorticotropic hormone (ACTH) stimulation, leading to the diagnosis of PAI. The patient was treated with prednisone and fludrocortisone, which resulted in improvement in clinical symptoms followed by rapid gains in all functional areas. No previous descriptions of PAI following head injury were found in the medical literature. It is important for physiatrists to be aware of this entity because symptoms of adrenal insufficiency can be similar to those commonly seen with TBI alone. PAI may also be confused with other endocrine disorders more frequently seen after TBI such as the syndrome of inappropriate antidiuretic hormone secretion. Recognition and appropriate management of adrenal insufficiency can lead to significant clinical and functional gains.

Adrenal Insufficiency↗
PubMed1997

Cervical osteomyelitis following tonsillectomy.

We present a case of fatal cervical osteomyelitis following an elective tonsillectomy in a previously fit young man. Following induction of general anaesthesia, and prior to surgery, the patient received bilateral glossopharyngeal nerve blocks with 0.5% bupivacaine and adrenaline 1:200,000. The initial recovery was uneventful but persistent throat and neck pain developed at home which was diagnosed as a throat infection and possible hyperextension injury of the neck. It is impossible to say how much the dissection of chronically infected tonsils or the infiltration of local anaesthetic into or near a potentially infected area contributed to the development of cervical osteomyelitis. The absence of any other symptoms and signs, a normal blood count and cervical spine X-ray, and the rarity of cervical osteomyelitis, all contributed to a delay in diagnosis.

Adult↗
PubMed1997

The effect of glossopharyngeal nerve block on pain after elective adult tonsillectomy and uvulopalatoplasty.

This controlled, randomised, double-blind study compared whether glossopharyngeal nerve block and intravenous morphine administered peri-operatively, decreased pain following elective adult tonsillectomy and uvulopalatoplasty more than morphine alone. Sixteen of 30 patients undergoing uvulopalatoplasty and 38 of 78 patients having tonsillectomy received bilateral glossopharyngeal nerve blocks, using bupivacaine 0.5% and adrenaline 1:200,000, or no intervention. There were no differences in postoperative analgesic consumption between the two groups. Visual analogue pain scores measured during swallowing in the recovery room and on the ward postoperatively were significantly less overall in uvulopalatoplasty patients who had received a block (p = 0.004). This difference was not found for tonsillectomy. We found no significant differences between groups, in pain scores recorded during the first 5 days at home. We conclude that glossopharyngeal block does not improve analgesia following tonsillectomy although there is short-lived benefit following uvulopalatoplasty.

Adult↗
PubMed1996

Subacute brain injury rehabilitation: an opportunity for medical education and training.

Changes in the delivery of health care have resulted in new sites for rehabilitation of patients with severe brain injury (BI). Adjustments in the training of resident physicians in physical medicine and rehabilitation are likely to ensue. We utilized Likert scales and open-ended questions to survey residents who were assigned over a 2(1/2)-year period to a subacute BI rehabilitation unit (SRU). Residents were surveyed about their desire to participate in a SRU training site, and the usefulness of such a rotation, and compared the rotation to traditional settings in which patients with similar diagnoses were treated. The results indicated that significant positive changes in residents' attitudes towards this type of training site occurred (p = 0.01). The rotation was felt to be useful (p = 0.008) despite initial misgivings. Positive educational aspects were exposure to the unique problems of patients with severe BI (e.g. spasticity and agitation) and a sense of independence and competence in leadership roles. Problematic aspects included the management of medically unstable patients without supportive resources, and a lack of nurses trained in rehabilitation principles. Training of residents in the rehabilitation management of patients with severe BI can be perceived as a valuable educational experience by trainees.

Attitude of Health Personnel↗
PubMed1995

Community re-entry of long-term institutionalized brain-injured persons.

Although evidence exists for delayed recovery after traumatic brain injury, patients who do not receive rehabilitation early after their injuries often remain permanently in long-term care facilities. Case reports of five severely brain-injured persons who were discharged into long-term nursing care facilities for at least 1 year before initial rehabilitation admission are discussed. After prescreening for evidence of functional improvement, these patients were admitted to a rehabilitation unit with the goal of community discharge. Functional improvement was evaluated using the Functional Independence Measure (FIM) and additional categories of function. Community discharge was successfully achieved in all five patients, who demonstrated particular improvement in bathing, transfers, memory, bowel management, problem solving and independence during waking hours. Further efforts should be made to identify patients in long-term care facilities who might benefit from rehabilitation services, and to identify those factors which contribute to successful community discharge.

Activities of Daily Living↗
PubMed1994

Features of targeted arm movement after unilateral excisions that included the supplementary motor area in humans.

The strategies used to make rapid targeted flexion movements at the elbow were assessed for the right and left arms of ten neurologically normal subjects and seven patients who had unilateral cortical resections that included all or part of one supplementary motor area (SMA). Visual targets were displaced either a constant distance (fixed step task) or a variable distance (variable step task). The reaction time (RT) for SMA patients as a group did not differ significantly from normal, although for some patients, RT exceeded the normal range bilaterally. Total movement time (TMT) was longer than normal for the SMA group, and again, increased TMTs tended to occur bilaterally. Both groups of subjects used a combination of duration and velocity scaling to adjust movement amplitude. In normal subjects, however, velocity scaling predominated, whereas in SMA patients, duration scaling was increased bilaterally. Our data indicate that the initiation of rapid elbow movement to a target presented visually is not consistently delayed after lesions that include part of the SMA, but the movement speed and strategy used to adjust movement amplitude may be changed bilaterally.

Adult↗
PubMed1987

Effect of cooling on H- and T-reflexes in normal subjects.

The local application of cold has been used to decrease spasticity and facilitate neuromuscular function, but previous attempts to identify its effect on the stretch reflex have not been entirely successful. We examined the effects of cold on the Hoffmann (H) reflex and on the tendon tap (T) reflex in 16 subjects. A series of H/M recruitment curves and T-reflexes were recorded via surface EMG electrodes before and during cooling of the triceps surae. Skin and intramuscular temperatures were recorded with average decreases of 18.4C and 12.1C, respectively. Peak-to-peak amplitude of the M, H, and T compound action potentials (CAPs) was measured. In all cases, the amplitude of the maximal M-wave decreased (p less than 0.001) in response to cooling. These changes in the recording of CAPs should be considered when cooling experiments result in alterations in H or T waveforms. When using the M-wave as a covariant in our analysis, there were no significant changes in the H-reflex amplitude; the height of CAPs elicited by T decreased (p = 0.025). Our findings do not support earlier claims that simple cooling facilitates the excitatory alpha motoneuron pool as measured by the H-reflex; we do confirm that muscle spindle activity, as measured by the T-reflex, is decreased by muscle cooling.

Adult↗
PubMedDate not supplied

Deep venous thrombosis in the spastic upper limb.

Deep venous thrombosis (DVT) of the upper extremity (UE) is an uncommon diagnosis, whereas DVT of the lower extremity is a well-known cause of morbidity and mortality in the rehabilitation patient. Patients with UE DVT secondary to venous stasis, vessel wall abnormalities, hypercoagulability, venous instrumentation and cancer have been previously reported in the literature. To our knowledge no case of DVT in a spastic upper extremity has been noted. A case report of a patient with UE DVT in a spastic extremity secondary to traumatic brain injury is presented, with a discussion of the aetiology, diagnosis and management of this disorder.

Adult↗