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Biomedical subjects

M Dijkers

Publications and source records attributed to M Dijkers.

12 recordsLinked to original sources
PubMed1995

Hip joint center location from palpable bony landmarks--a cadaver study.

An anatomical anthropometric study of adult human cadaveric pelves was performed to investigate the relationship between hip joint center (HJC) and selected aspects of pelvic geometry. Sixty-five pelves (35 female and 30 male) were examined. Measurements of pelvic geometry and HJC (center of bony acetabular rim) were taken from bony landmarks of de-fleshed pelves. Correlation analysis revealed that HJC cannot be accurately located as a function of pelvic width alone, but requires estimation as a function of pelvic height and depth as well. HJC was optimally located relative to the respective ASIS: 14% of pelvic width medial (mean error 0.58 cm), 34% of pelvic depth posterior (mean error 0.30 cm), and 79% of pelvic height inferior (mean error 0.35 cm). No significant differences were found between males and females in HJC estimation.

Aged↗
PubMed1991

Spinal cord injury surveillance in the United States: an overview.

In the United States, injuries are the leading cause of premature lost years of life, surpassing cancer and heart disease combined. Public health surveillance of injuries such as spinal cord injury (SCI) has recently begun to evolve, following decades of experience with similar methods for infectious and chronic disease conditions. In 1985, the Federal Government's Centers for Disease Control began to promote the development of surveillance systems for sentinel injuries at both the state and national level. Many states have developed, or are in the process of developing, statewide registries for SCI. The rationale behind the establishment of these registries is 4-fold: (1) to identify SCI persons in order to facilitate and coordinate provision of health and other services; (2) to gather accurate data for injury prevention efforts and planning for needed services; (3) to evaluate services provided, and (4) to document outcome and cost-effectiveness of care systems. The purpose, content and scope of these registries are reviewed in detail.

Data Collection↗
PubMed1991

The value of serial leg measurements for monitoring deep vein thrombosis in spinal cord injury.

Deep vein thrombosis (DVT) is a common complication of spinal cord injury (SCI). Many specialized SCI nursing units use serial leg measurements to establish clinical diagnosis of DVT, in spite of extensive studies showing that clinical signs and symptoms of DVT have a specificity and sensitivity hardly better than chance. For 30 patients who spent 920 days in an SCI intensive care unit, we collected daily serial calf and thigh measurements and the results of radiofibrinogen uptake test (RFUT) performed about every third day. Three criteria for clinical diagnosis of DVT found in the literature were used: an increase from baseline, an increase from the previous day or a right-left difference of a specific minimal size. The cut-off points for minimal size used were also those suggested by the literature: over .5 inch, over 1 cm, or 1.2 cm and over for women, 1.5 cm and over for men. We found such changes or differences correlated weakly or not at all with RFUT results, and symptomatic increases or differences occurred very frequently. Major factors presumably underlying the variability of measurements and their lack of sensitivity and specificity are: premorbid leg asymmetry; atrophy of the legs after SCI; true changes in circumference due to factors other than DVT; and lack of measurement reliability. It was concluded taking serial leg measurements is of no value in the SCI population. For those reluctant to abandon tradition, suggestions are provided for improving the quality of measurements and related decision making. Further research is needed.

Adolescent↗
PubMed1990

Differences between rehabilitation disciplines in views of depression in spinal cord injury patients.

Reports based on clinical impressions have suggested that depression after spinal cord injury (SCI) is a near-universal phenomenon; however, studies using objective methods and strict criteria have not confirmed this. The aim of this study was to explore the experiences and opinions of rehabilitation clinicians with the depressed mood in their SCI patients. A questionnaire was completed by 149 staff members of various disciplines working in four specialised SCI rehabilitation centres. We found that the disciplines vary in the symptomatology they observe (nurses most, physicians and mental health professionals least), and that these differences to some degree correspond to variations in the estimate of the frequency and intensity of depression in the average patient. The amount of staff experience was found not to be a factor. The implications of these findings for theories of staff expectations regarding patient mood states and the functioning of the clinical team are discussed.

Adult↗
PubMed1989

A controlled study of neuropsychological deficits in acute spinal cord injury patients.

According to a number of studies, between 40% and 60% of acute traumatic spinal cord injury (SCI) patients demonstrate cognitive dysfunction resulting from various forms of cerebral damage, including concurrent or premorbid closed head injury, chronic alcohol or substance abuse, and other causes. However, applicability of findings from these reports has been limited due to the use of inadequate neuropsychological testing techniques and the lack of control data. In a collaborative investigation, 81 acute SCI patients and 61 non-injured control subjects between 18 and 55 years of age completed a comprehensive motor-free neuropsychological test battery, including: Halstead Category Test (HCT), Vocabulary Subtest (VOCAB) of the Wechsler Adult Intelligence Scale - Revised; Mental Control (MC) Subtest, and Initial and Recall trials of Logical Memory (LM) and Paired Associates (PA) Subtests of the Wechsler Memory Scale; and the 8 trials of the Rey Auditory Verbal Learning Test (RAVLT). Percentages of retained information on the LM and PA were also calculated. Impairment levels for each test were defined as values which exceeded two standard deviations (one-tailed) from the control mean. Based on this definition, the prevalence of neuropsychological abnormality on each test ranged between 10% and 40%. Mean performance levels of patients were significantly more impaired than those of control subjects for all tests except for the Interference trial of the RAVLT and for the percentages of retained information on the LM and PA subtests. Comparison of test results of SCI patients with those of control subjects demonstrates that poor attention span and limited initial learning ability are frequent problems among SCI patients. Other common neuropsychological deficits among these patients include poor concentration ability, impaired memory function, and altered problem solving ability. These deficits may interfere with rehabilitation following SCI.

Adolescent↗
PubMed1988

Closed head injury in acute traumatic spinal cord injury: incidence and risk factors.

Investigators estimate that 15% to 50% of all patients with spinal cord injury (SCI) also incur a closed head injury (CHI), but studies have been hampered by design flaws, including retrospective assessment and inconsistent definition of CHI. We conducted a prospective study of combined CHI and SCI among 82 SCI patients consecutively admitted at two hospitals within 24 hours of injury. The purpose of the study was to determine the incidence and duration of loss of consciousness and posttraumatic amnesia (PTA), and to establish the risk factors for combined CHI and SCI. The overall incidence of CHI as defined by the presence of PTA of any duration was 49%. There was a significantly increased risk of CHI for patients involved in traffic accidents (risk ratio = 3.7; 95% confidence interval 1.8 to 7.2). There was no increased risk associated with level of injury (quadriplegic vs paraplegic; risk ratio = 1.2; 95% confidence interval = 0.8 to 1.8). All SCI patients, regardless of level of injury, deserve systematic evaluations for CHI in their acute care evaluations.

Adult↗
PubMed1988

Galveston Orientation and Amnesia Test: its utility in the determination of closed head injury in acute spinal cord injury patients.

The incidence of closed head injury (CHI) associated with acute spinal cord injury (SCI) has been estimated at 40% to 50%. Closed head injury can be defined as the presence of loss of consciousness (LOC) and/or posttraumatic amnesia (PTA). Consequently, one of the difficulties in establishing a diagnosis of CHI is determining the existence of PTA in those patients without documented LOC. Previous work described the inconsistent evaluation of PTA in the SCI population. This study was conducted to evaluate the utility of the Galveston Orientation and Amnesia Test (GOAT) in establishing the diagnosis of CHI in a series of acute traumatic SCI patients. The GOAT was administered serially for three to five days to 34 patients admitted to our hospital. When information derived from the GOAT was added to that derived from review of medical records alone, the observed incidence of PTA (and by implication CHI) increased significantly (McNemar statistic = 6.4; p = 0.01). The GOAT is a quick, simple, and reproducible evaluation of spheres of orientation, which is extremely helpful in diagnosis of PTA in this population. This instrument should be used to evaluate patients at high risk for head injury. Although abnormalities in the GOAT evaluation may also be attributable to factors other than CHI (eg, hypoxia, medication effects), such findings provide evidence suggestive of CHI. This will help determine which patients require a more detailed neuropsychologic assessment.

Adult↗
PubMedDate not supplied

Traumatic brain injury registries in the United States: an overview.

In the United States, injuries account for more death and disability in the one to 44 year age group than all communicable diseases and other conditions combined. Concerns about this, about the cost of acute and rehabilitation care after injury, and about quality of life for survivors are mounting, as epitomized by Federal Government initiatives. Public health surveillance of injuries such as traumatic brain injury has recently begun to evolve, following decades of experience with similar methods for infectious and chronic disease conditions. In 1985, the Centers for Disease Control began to promote the development of surveillance systems for 'sentinel injuries' at both the state and national level. Many states have developed, or are in the process of developing, statewide registries for traumatic brain injury. The rationale behind the establishment of these registries is fourfold: 1) to identify injured persons in order to facilitate and coordinate their rehabilitation and other needed services; 2) to gather data for injury prevention and control; 3) to gather data for health care planning; and 4) to evaluate services provided to injured persons. Purpose, content, and scope of these registries are presented in detail.

Brain Injuries↗