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Biomedical subjects

L S Halstead

Publications and source records attributed to L S Halstead.

At least 19 recordsLinked to original sources
PubMed1991

The effects of rectal probe electrostimulation on spinal cord injury spasticity.

Spasticity is a common sequel of spinal cord injury (SCI) with well documented effects on daily activities and increased morbidity. In the course of our fertility studies using rectal probe electrostimulation (RPES) and SCI men to produce ejaculation, we observed that a majority of the men experienced significant improvement in their spasticity for many hours. This paper describes a preliminary effort to quantitate this phenomenon in 14 consecutive subjects treated for anejaculation on 65 occasions in our SCI Fertility Clinic. The effectiveness of RPES on spasticity was evaluated by pre- and post-RPES subject assessment and neurological examinations and follow-up self reports via telephone interviews. Six of the 14 patients (42%) experienced excellent relief following 30 of 33 RPES treatments; 4 (29%) had good to fair relief following 14 of 15 RPES treatments and 4 (29%) had no effect on all 17 RPES trials. The mean duration of relief was 9 hours (3-24). There was no relation between subject age, age of injury, level or completeness of injury or ejaculatory response with relief of spasticity. All men taking medications felt RPES was more effective than drugs in relieving spasms. No untoward effects were reported and 7 (50%) said they would use a home model for daily RPES, if available.

Adolescent↗
PubMed1987

Rectal probe electrostimulation in the treatment of anejaculatory spinal cord injured men.

This paper reviews our experience with rectal probe electroejaculation (RPE) which is part of a larger effort to determine the correlates of successful ejaculation and fertility in SCI men. RPE is performed in the outpatient clinic using specially designed rectal probes. Over the past 18 months, we have attempted RPE on 38 occasions in 12 subjects (eight paraplegics and four quadriplegics) with an age range of 23-38 years and 0.5-18 years since onset of injury. Anterograde ejaculation occurred in nine subjects with improvement in percent motility and total live sperm count on repeated stimulations in five subjects. Significant retrograde ejaculation occurred in one person and sperm acceptable for artificial insemination (AI) was obtained from four subjects. The major side effects were mild dysreflexia (three subjects) and disruption of a normal bowel program (one subject). We conclude that RPE is a safe, relatively brief outpatient procedure and, with repeated stimulations, has a good potential for producing sperm acceptable for AI in selected patients.

Adult↗
PubMed1986

Team care: an analysis of verbal behavior during patient rounds in a rehabilitation hospital.

Patient rounds are an important aspect of multidisciplinary team care. Team perceptions of ideally functioning rounds were compared with the actual communication patterns in rounds in a physical rehabilitation hospital. Perceptions of the patients' needs in the content areas of physical, psychosocial, and support systems were also compared with the actual distribution of content in rounds. Physicians spoke more (41%) and made more authoritative statements (62%) than did staff from any other discipline. The physicians participated far more than was perceived as ideal in all areas but the physical. Patients contributed only 9% of the discussion and less than 1% of authoritative statements. The physical content area was overemphasized (65%) and the psychosocial area was underemphasized (14%) when compared with the perceived needs of the patients. Interpretations of these findings and implications for investigation of the impact of team care are discussed.

Authoritarianism↗
PubMed1986

The innovative rehabilitation team: an experiment in team building.

This article describes an effort by one rehabilitation team to create innovative approaches to team care in a medical rehabilitation hospital. The major arena for implementing change was the weekly patient rounds. We worked to increase patient involvement, developed a rounds coordinator role, used a structured format, and tried to integrate research findings into team decision making. Other innovations included use of a preadmission questionnaire, a discharge check list, and a rounds evaluation questionnaire. The impact of these changes was evaluated using the Group Environment Scale and by analyzing participation in rounds based on verbatim transcripts obtained prior to and 20 months after formation of the Innovative Rehabilitation Team (IRT). The results showed decreased participation by medical personnel during rounds, and increased participation by patients. The rounds coordinator role increased participation rates of staff from all disciplines and the group environment improved within the IRT. These data are compared with similar evaluations made of two other groups, which served as control teams. The problems inherent in making effective, lasting changes in interdisciplinary rehabilitation teams are reviewed, and a plea is made for other teams to explore additional ways to use the collective creativity and resources latent in the team membership.

Decision Making↗
PubMed1985

Late effects of poliomyelitis. Part I: Report of five cases.

We present five case reports to illustrate the late effects of acute paralytic poliomyelitis occurring many years after recovery. We emphasize the importance of ruling out common medical causes for the symptoms and address the question of a "postpolio syndrome." The cause of progressive muscle weakness 30 to 40 years after recovery from poliomyelitis remains unknown.

Acute Disease↗
PubMed1985

New problems in old polio patients: results of a survey of 539 polio survivors.

Presented are the results of a questionnaire survey on new health problems in 539 polio survivors. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from polio to the onset of these problems ranged from 30 to 40 years. Factors at onset of polio most strongly associated with developing these new health problems were: being hospitalized, being over 10 years old, being on a ventilator, and having paralytic involvement of all four limbs. The differential diagnoses of these new problems, implications for treatment and areas for future research are discussed.

Activities of Daily Living↗
PubMed1985

Drug absorption in spinal cord injury.

The absorption characteristics of drugs in spinal cord injury (SCI) were studied using an actively transported drug [riboflavin (RBF)] and a passively absorbed drug [acetaminophen (ACE)]. RBF absorption was studied following oral administration of 150mg RBF as 5'-phosphate flavin mononucleotide in ten clinically complete quadriplegic patients (C1 to C7, two to 15 months post-onset) and six control subjects matched for age, sex, and weight. Urinary excretion was measured under fasting (F) and nonfasting (NF) conditions for time to peak, peak excretion rate, and percent dose recovered. The results showed a significant difference (p less than 0.05) for all parameters between F and NF conditions for both the SCI and able-bodied groups. However, there was no significant difference for the same parameters between the two groups. ACE absorption was studied in five SCI clinically complete quadriplegic patients (C1 to C7, two to 15 months post-onset following the administration of a 650mg tablet. Serum samples were analyzed for ACE content and showed: time of peak, 1.35 +/- 0.6hr; maximum serum level, 6.8 +/- 2.68 micrograms/ml; half-life, 2.89 +/- 1.81hr; absorption lag time, 18.1 +/- 1.8min; area under the serum level-time curve, 21.8 +/- 6.7 micrograms/.hr/ml. When compared to able-bodied population data in the literature, there was a significant increase in the time to peak and lag time, and a decrease in the maximum ACE serum concentration obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetaminophen↗
PubMed1985

Results of a survey of 201 polio survivors.

We present the results of a survey on the late effects of poliomyelitis in 201 persons. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from poliomyelitis to onset of new problems ranged from 30 to 40 years. Factors at onset of polio most strongly associated with development of these late effects of polio were (1) hospitalization (P less than 0.00001), (2) age greater than 10 years (P less than 0.00001), (3) ventilator use (P less than 0.0029), and (4) paralytic involvement of all four limbs (P less than 0.0240). The differential diagnosis of these new problems, implications for treatment, and areas for future research are discussed.

Activities of Daily Living↗
PubMed1979

Spinal cord injury: time out of bed during rehabilitation.

Preliminary experience in applying unobtrusive instrumentation to monitor selected patient activities over extended periods of time has shown this procedure to be both feasible and useful. The target activity studied was time out of bed (TOB) for 36 spinal cord injury patients undergoing comprehensive rehabilitation. Measurements were made with a rest-time monitor (RTM), which provides an objective daily record of how often and for how long a patient is out of bed. During the initial week of mobilization, paraplegic patients (n = 14) were out of bed for an average of 1.7 hours and quadriplegic patients (n = 22) for an average of 1.5 hours. Maximum TOB in each group was 8.7 and 9.2 hours, respectively, which dropped to 7.2 and 7.8 hours at time of discharge. Based on this experience, a standard activity curve has been developed which is used as a reference in assessing the weekly progress of individual patients. Distinctive types of activity patterns are described in relation to clinical and functional outcomes during hospitalization and 12 months after discharge.

Adolescent↗
PubMed1978

A sexual intimacy survey of former nuns and priests.

Men and women who have lived in a celibate religious community experience a unique set of sexual, social, and psychological problems upon resuming a secular life style. In many instances the personality factors and circumstances which led both to a decision to enter and then to leave a celibate religious community are not easily appreciated by the nonreligious professional counselor and do not readily lend themselves to extrapolation from other population groups. This article reports the findings of a preliminary study to identify the sexual experiences and problems of persons who have left religious communities. Data is based on responses to a mailed, anonymous questionnaire by 126 former nuns and priests living in all parts of the country. Information is reported on the following areas: (1) sexual behavior and enjoyment prior to, while living in, and after leaving a religious community; (2) current sexual behavior, satisfaction and problems; (3) sexual counseling experience; and (4) general problems and concerns with integrating sexual intimacy into present life styles. Comparisons are made with similar data published in the literature and data obtained from persons attending Sexual Attitude Reassessment (SAR) Workshops. The findings of this study suggest that persons who have left celibate religious communities have had limited sexual experience in adolescence and early adulthood compared to nonreligious persons. Further, there are special sexual problems and needs in readjusting to a secular life style. Implications for specific counseling are discussed.

Catholicism↗
PubMed1978

Sexual attitudes, behavior and satisfaction for able-bodied and disabled participants attending workshops in human sexuality.

Since 1973, Sexual Attitude Reassessment (SAR) Workshops have been conducted for persons with physical handicaps, health care professionals and interested members of the community. Although reassessment of personal sexual attitudes is the primary objective of the workshops, several closely related objectives have emerged: (1) evaluation of the impact of the experience on changing both sexual attitudes and behaviors; (2) evaluation of the sexual satisfaction and problem areas of participants with particular reference to persons with physical disabilities; and (3) provision of an institute-wide catalyst for initiating programs and services based on newly identified unmet needs. This article presents data from 15 workshops with emphasis on comparing the sexual attitudes, behavior and satisfaction of the able-bodied and the disabled participants. Of the 650 participants, 98 (15%) were disabled and of this group approximately 75% had spinal cord injury. Comparison of pre- and post-workshop responses to sexual attitude scales showed similar and significant changes on four of nine scales for both the able-bodied and disabled groups. Analysis of sexual behavior and satisfaction by physical status revealed that the disabled participants were less active than the able-bodied participants although both groups reported similar percentages of satisfaction (38 and 41% respectively) with their current level of sexual activity. Lack of partners was cited most frequently by both groups as the major reason for dissatisfaction with current sexual status. Implications of these findings are discussed with regard to sexual counseling and areas of further research.

Adult↗
PubMed1978

Activity monitoring in chronic illness: time out of bed for tetraplegics during comprehensive rehabilitation.

Unobtrusive longitudinal monitoring of what patients actually do during comprehensive rehabilitation represents a relatively unexplored but potentially very useful approach to functional evaluation. Recent advances in biomedical technology have created the possibility of supplementing and/or substituting a number of human observations with instrument-based measurements. This paper presents the first data obtained as part of a systematic research effort to explore the feasibility and utility of applying unobtrusive instrumentation to monitor selected patient activities over extended periods of time. The target activity studied was time out of bed for 36 spinal cord injury patients undergoing comprehensive rehabilitation. Measurements were made with a Rest Time Monitor (RTM) which provides a continuous, objective record of when a patient is out of bed, how often and for how long. Based on this experience, a 'standard' activity curve has been developed which is used as a reference in assessing the weekly progress of individual patients. Distinctive types of activity patterns are described in relation to how patients do clinically, and functionally during hospitalization and 12 months after discharge. In addition, data are presented which compare in-hospital activity patterns by level of injury, age and presence or absence of complications. This initial study suggests that longitudinal activity monitoring is a useful tool for clinical assessment and management and may help predict those patients who are most likely to develop pre- and postdischarge complications.

Activities of Daily Living↗
PubMed1977

Metabolic effects of sodium restriction and thiazides in tetraplegic patients.

The metabolic effects of sodium restriction, alone or with thiazide, were studied in 12 healthy subjects, in 24 tetraplegics during the intial 8 months of paralysis (early) and in 16 others during the subsequent period (late). The diuresis caused by both treatments led to more haemoconcentration in early than in late patients. In contrast with the healthy subjects on low sodium, the tetraplegics had a delayed urinary sodium retention and no fall in calciuria. During thiazide, urinary sodium depletion occurred early and the urine calcium fell after 3 days in all tetraplegics. During both treatments, aldosterone and renin increased more in early patients than in the other groups. The clinical implications of inducing dehydration and a sustained stimulation of the renin-angiotensin-aldosterone axis in recently injured tetraplegics with severe orthostatic hypotension are discussed.

Adolescent↗