Instrumented assessment of muscle overactivity and spasticity with dynamic polyelectromyographic and motion analysis for treatment planning.
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Botulinum Toxins, Type A↗
Biomedical subjects
Nathaniel H Mayer
Publications and source records attributed to Nathaniel H Mayer.
Muscle overactivity and movement dysfunction in the upper motoneuron syndrome.
The upper motoneuron syndrome (UMN) is a collective term that refers to different types of motor behaviors produced by patients who have lesions of the descending corticospinal system. Lesions involving the upper motoneuron, its pathways, and its connections can occur at the level of the cortex, internal capsule, brain stem, or spinal cord. The clinical features of UMN have traditionally been classified as "positive" phenomena, referring to overt behaviors generated by various forms of muscle overactivity, and "negative" phenomena, referring to loss of overt behaviors secondary to impaired muscle activation, impaired control of motor behavior, and impaired motor performance. The clinical impact of UMN on patients is broad and tends to limit functional capacity. The negative and positive signs lead to reduced mobility and limb usage.
Humans↗
Characterization and correlates of medical and rehabilitation charges for traumatic brain injury during acute rehabilitation hospitalization.
OBJECTIVE: To identify factors associated with specific categories of charges during acute inpatient rehabilitation treatment after traumatic brain injury (TBI). DESIGN: Prospective observational study. SETTING: A single Traumatic Brain Injury Model Systems (TBIMS) center. PARTICIPANTS: Eighty-four consecutive TBIMS patients. One exploratory analysis also included all 350 patients with TBI admitted during 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Average daily charges for specific categories of resource use (eg, room and board, rehabilitation therapies, functional labs). RESULTS: Room and board and rehabilitation therapy accounted for almost 90% of average daily charges. There was no linear component of change in average daily charges, but certain categories of charges were significantly higher during the first week than thereafter. Functional status at rehabilitation admission correlated with charges for respiratory, medical, and surgical supplies and with pharmacy and radiology, but not the other categories. Specific medical variables also correlated with specific charge categories. Focused chart reviews of patients with low and high charges in specific categories led to the formulation of additional predictive hypotheses. CONCLUSION: Certain categories of charges correlated with functional scores and acute medical variables that are known before admission to acute inpatient rehabilitation, allowing for better inpatient admission planning under prospective payment. Further research is needed to identify and correlate resource use that is bundled within the room and board category.
Brain Injuries↗
The impact of instrumented gait analysis on surgical planning: treatment of spastic equinovarus deformity of the foot and ankle.
BACKGROUND: Despite the logic behind instrumented gait analysis, its specific contribution to clinical and surgical decision making is not well known. Our purpose in this study was to determine the influence of gait analysis with dynamic electromyography upon surgical planning in patients with upper motor neuron syndrome and gait dysfunction. METHODS: Two surgeons prospectively evaluated 36 consecutive adult patients with a spastic equinovarus deformity of the foot and ankle. After an initial history and physical exam, each surgeon independently formulated a surgical plan. Surgical treatment options for each individual muscle/tendon unit crossing the ankle included lengthening, transfer, release or no surgery. After the initial clinical evaluation and surgical planning, all patients then underwent instrumented gait analysis collecting kinetic, kinematic and poly-EMG data using a standard protocol by a single experienced physiatrist. Each surgeon reviewed the gait studies and patients independently and again formulated a surgical plan. The surgical plans were compared for each surgeon before and after gait study. The agreement between the two surgeon's surgical plans was also compared before and after gait study. Each patient was evaluated for the clinical outcome of surgery. RESULTS: Overall a change was made in 64% of the surgical plans after the gait study. The frequency of changing the surgical plan was not significantly different between the more and less experienced surgeons. The agreement between surgeons increased from 0.34 to 0.76 (p=0.009) after the gait study. The number of surgical procedures planned by each surgeon converged after the gait studies. Correction of the varus deformity was seen in all patients that underwent surgical treatment. CONCLUSION: Instrumented gait analysis alters surgical planning for patients with equinovarus deformity of the foot and ankle and can produce higher agreement between surgeons in surgical planning. CLINICAL RELEVANCE: The equinovarus deformity is due to a variety of deforming forces and a single, best operation does not exist to correct all equinovarus deformities. Rather, a muscle specific approach that identifies the deforming forces will produce the best outcomes when treating the spastic equinovarus deformity.
Ankle↗
Choosing upper limb muscles for focal intervention after traumatic brain injury.
The upper motoneuron syndrome (UMNS) resulting from lesions of corticospinal pathways is an important source of disability after traumatic brain injury (TBI). Classic expressions of motor behavior in UMNS are of 2 kinds: (1) manifestation of muscle underactivity, termed negative signs, and (2) manifestation of a variety of forms of muscle overactivity, termed positive signs. Combinations of negative and positive signs give rise to clinical patterns of movement dysfunction such as the flexed elbow, the clenched fist, and the thumb-in-palm deformity. These clinical patterns can be viewed as reflecting a net balance of muscle forces acting across the joints of a limb. Individual muscles are amenable to a variety of focal interventions such as neurolysis, chemodenervation, or surgery. Since more than one muscle acts across most joints, choices among muscles for focal intervention are many. This article will focus on focal interventions of upper limb muscles of patients with TBI who have UMNS and will explore the theme of choosing upper limb muscles for focal interventions after TBI.
Brain Injuries↗
Long-term neurological complications of traumatic brain injuries.
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Brain Injuries↗
Development of systems of care for persons with traumatic brain injury.
The history of the development of comprehensive systems of care for treatment of survivors of traumatic brain injury is reviewed in relation to publications in The Journal of Head Trauma Rehabilitation (JHTR). This development has drawn from multiple other areas of clinical endeavor and has extended the range of services from an acute inpatient focus to include multisite delivery and lifetime supported living aspects. Widespread implementation of this comprehensive system approach continues to lag because of coordination and financing challenges. The history and details of these developments are comprehensively reflected in the published articles of JHTR over the past 20 years.
Brain Injuries↗