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Biomedical subjects

R L Braddom

Publications and source records attributed to R L Braddom.

At least 19 recordsLinked to original sources
PubMed1998

Perils and pointers in the evaluation and management of back pain.

This article examines the current treatment of low back pain in light of the recent Agency for Health Care Practice and Research (AHCPR) guidelines on the acute management of low back pain (the AHCPR is an agency of the federal government). The article describes the most important history questions, the most helpful physical signs, and the most practical examination techniques. Considerable emphasis is placed on ruling out the "red flag" diagnoses that require immediate treatment. The article agrees with the AHCPR that if the red flags of cancer, infection, fracture, and neurologic deficit are ruled out, most of the remaining causes of acute back pain are largely self-healing over 4-8 weeks. Emphasis is placed on using the history and physical examination rather than expensive studies to rule out the red flag cases, so that cost-effective management of low back pain is possible. The author also reviews the ten top causes of low back pain and their evaluation and treatment.

Back Pain↗
PubMed1997

Controlling the spread of vancomycin-resistant enterococci with a rehabilitation cohort unit.

Enterococci are common to the human gastrointestinal tract. Recently there has been an emergence of vancomycin-resistant enterococci (VRE); infection requires strict contact isolation. Patients with VRE infections are at higher risk for morbidity and mortality. As a result of the high prevalence of VRE, it was recommended that a cohort unit be established to control its spread within our metropolitan community hospital. We report the development of a rehabilitation VRE cohort unit. We present case studies of five patients who developed nosocomial colonization and one with an infection with VRE; all were treated on the rehabilitation cohort unit. Protocols for VRE isolation and procedures for decontamination in the cohort unit were developed. If a cohort unit is necessary, it is feasible to conduct a rehabilitation program in a cohort unit with strict adherence to contact isolation.

Adult↗
PubMed1997

Persisting impairment following Rocky Mountain Spotted Fever: a case report.

A patient initially presented in the emergency room with fever, confusion, and a petechial rash. Rocky Mountain Spotted Fever (RMSF) was diagnosed and appropriate treatment was initiated. He subsequently became obtunded and required mechanical ventilation and temporary cardiac pacing. Four weeks later, he presented to our rehabilitation unit with ataxia, hyperreflexia and upper motor neuron signs, dysesthesias, sensorimotor axonopathy demonstrated by electrodiagnostic studies, and a global decrement in cognitive capability. Although he significantly improved in functional mobility and self-care, he exhibited little improvement in his cognitive impairment at 6-month follow-up. An understanding of the natural history of, and long-term impairments associated with, RMSF will be helpful to physiatrists in developing rehabilitation care plans and in assisting such patients with community re-entry.

Activities of Daily Living↗
PubMed1994

H reflex latency in the healthy elderly.

The purpose of this study was to evaluate prospectively and analyze the relationship of tibial nerve H reflex latency to age, sex, leg length, and skin temperature in a large healthy elderly population. The H reflex was recorded bilaterally in 92% of 103 carefully screened individuals aged 60-88 years. The mean H reflex latency was 30.8 (SD = 2.6) and 30.7 (SD = 2.6) ms for right and left legs, respectively. A high correlation (r = 0.55, P < 0.05) was present between H reflex latency and leg length. No significant correlation existed for H reflex latency and age. The upper normal limit for the difference between right and left H reflex latencies was 1.8 ms. This limit is greater than that reported in the literature for younger individuals due to a larger standard deviation. These findings suggest that aging increases the between-leg variability of H reflex latency in individuals. This greater difference must be taken into account when using side-to-side H reflex latency comparison to detect unilateral pathology in the elderly.

Aged↗
PubMed1994

Median and ulnar nerve conduction studies: normative data for young adults.

Temperature control and standardized technique, along with consideration of age, height, finger circumference, and instrumentation is imperative for appropriate interpretation of electrodiagnostic studies. Normative data must be based on these factors in adequate numbers of healthy subjects. This study provides comprehensive normative electrodiagnostic data for the median and ulnar nerves. Forty-four subjects participated in this study. The median motor studies showed a motor distal latency (DL) of 3.2 (0.4)msec, and distal amplitude (DAMP) of 12.1 (3.8)mV and sensory studies showed a DL of 2.5 (0.2)msec, and DAMP of 31.4 (8.7) microV for the men and 52.4 (14.3)microV for the women. The ulnar motor studies showed a motor DL of 2.6 (0.3)msec, and DAMP of 12.6 (2.3)mV and sensory studies showed a DL of 2.4 (0.2)msec, and DAMP of 27.0 (7.8)microV for the men and 52.9 (13.9)microV for the women. Sidedness and handedness did not affect the nerve conduction parameters of this study. Aging changes for these nerves were minimal but more apparent for the median nerve. The most noticeable change with aging was the decrease in amplitude of the sensory nerve action potential.

Action Potentials↗
PubMed1994

Gender and arm length: influence on nerve conduction parameters in the upper limb.

Median, ulnar, and radial nerve conduction studies (NCS) were performed in 44 subjects. Student's t-test was used to compare nerve conduction velocities (NCV), distal latencies (DL), and distal amplitudes (DAMP) for the two sexes. Only the sensory DAMPs showed statistical significance (p < .001) for gender. Women had greater mean median (52.4 microV vs 31.4 microV), ulnar (52.9 microV vs 27.0 microV), and radial (46.1 microV vs 20.1 microV) sensory DAMPs. Stepwise linear regression analysis of NCVs, DLs, and DAMPs on gender and arm length showed statistical significance only for the median (R2 = .46, p < .001), ulnar (R2 = .59, p < .001), and radial sensory DAMPs (R2 = .29, p < .001) for gender. Arm length did not account for any additional variability. Gender showed an effect on the distal sensory DAMPs obtained by antidromic technique in this study. In contrast to the reported effect of leg length and height on lower limb studies, arm length did not affect upper limb studies.

Adult↗
PubMed1994

Standardized nerve conduction studies in the lower limb of the healthy elderly.

Nerve conduction studies are commonly performed in elderly individuals. No complete set of reference data for the distal lower limb nerves exists for this population, making it difficult to accurately interpret electrodiagnostic findings. The purpose of this study was to provide reliable reference data by comprehensively examining conduction characteristics in routinely tested peripheral nerves of the lower limb in a healthy elderly population. Conduction studies of the tibial, deep peroneal, sural and medial dorsal cutaneous nerves were performed in one lower limb of 122 healthy elderly individuals between the ages of 60 and 89 years. Peak amplitudes of the sural sensory action potential and the tibial compound muscle action potential correlated significantly with both age and leg length. All other parameters did not show significant correlation with age. Conduction velocities and distal latencies slowed significantly with increasing leg length except for tibial distal latency.

Aged↗
PubMed1992

Standardized nerve conduction studies in the upper limb of the healthy elderly.

Nerve conduction studies are increasingly being performed on elderly individuals; however, no standardized data for the elderly population exists to provide an accurate interpretation of electrodiagnostic findings. The purpose of this study was to provide standardized data in the healthy elderly for the nerves of the upper limb that are routinely chosen for study by electromyographers. Nerve conduction studies were performed prospectively in one upper limb of 155 carefully screened healthy elderly individuals between the ages of 60 and 95 years. Upper limb temperature was controlled to limit the influence of temperature on the measured conduction parameters. Standard nerve conduction techniques using constant measured distances were applied to evaluate the median, ulnar and radial nerves. A normative electrodiagnostic database for elderly individuals was established in this study. The mean nerve conduction parameters of this healthy elderly population compared favorably with existing literature values for younger populations. However, age had a statistically significant but low strength effect on all ulnar nerve conduction velocities and distal latencies as well as the distal sensory amplitudes of all three nerves. Gender had a greater effect than age on these parameters as well as on median sensory distal latency. Other median motor and sensory conduction parameters along with radial sensory distal latency were not significantly related to age or gender based on two-way analysis of variance.

Aged↗
PubMed1991

Autonomic dysreflexia. A survey of current treatment.

Autonomic dysreflexia (AD) is a syndrome that often occurs in patients with spinal cord injuries above T-6 and can have life-threatening results if not properly managed. The hypertension associated with AD can cause a great deal of morbidity and mortality, requiring quick and effective blood pressure reduction. Both pharmacologic and nonpharmacologic methods are used to prevent or alleviate the symptoms associated with an acute episode of AD. We found that current literature is lacking in controlled, prospective, randomized studies comparing the efficacy of various medications used in the treatment of AD. We conducted a nationwide survey to determine the consensus among clinicians concerning the management of AD. The survey was designed to determine the current clinical status of AD, to assess methods of treatment being used and to summarize and give a rationale for the drugs most commonly prescribed. Finally, a suggestion for a wallet-sized card briefly outlining effective treatments of AD in an emergency situation is included. Results indicate that most clinicians feel that after nonpharmacologic measures have failed, antihypertensive medication is useful in controlling the symptoms of AD while the inciting cause is being found and treated. Agents used most frequently include, but are not limited to, nifedipine, phenoxybenzamine, prazosin, mecamylamine and nitrates.

Autonomic Nervous System Diseases↗
PubMed1989

The use of a tissue expander to enlarge a graft for surgical treatment of a pressure ulcer in a quadriplegic. Case report.

This case reports the use of a tissue expander to facilitate the surgical closure of a decubitus ulcer in a spinal cord injured quadriplegic. The patient is a 42-year-old man with chronic nonhealing of a right ischial pressure ulcer. It had required a flap rotation and partial ischiectomy in the remote past that had been problem-free for many years. The patient subsequently required the placement of a new flap, but insufficient tissue was available to close the wound with the hip in 90 degrees of flexion. Closing the wound with the hip in extension merely led to breakdown when the hip was put in the 90 degrees of flexion required for the sitting position. The problem was solved by using a tissue expander to increase the available soft tissue. A tissue expander was inserted and gradually expanded over a period of weeks by injecting it with fluid. It was then removed, and the expanded tissue that had grown over it allowed closure of the wound without tension on the tissues with the hip in flexion. The patient subsequently returned to the sitting position and his work as a computer programmer. Tissue expanders are commonly used in breast reconstruction, but have found many other uses in plastic surgery over the last decade. It is felt that tissue expansion techniques should not be the primary surgery treatment of decubitus ulcers, but can be used in difficult cases like this one to provide additional tissue.

Adult↗
PubMed1986

A Delphi survey of traits of effective physiatric leaders.

A Delphi study of 14 physiatric leaders, 10 men and 4 women, ages 30 to 65, to determine their most important leadership characteristics, asked them to list the characteristics they considered most important for effective leadership. Responses were collated and any trait mentioned by at least three was put into a second survey, in which they were asked to rank the traits. A third survey gave them the results of the second, and asked for a final ranking. Fourteen traits made the final survey, in which the ten most important (in descending order of importance) were Organizational Skill, Commitment, Vision/Purpose, Communication Ability, Ability to Delegate, Sense of Ethics, Decisiveness, Knowledgeable, Flexibility/Adaptability and Analytical/Problem Solving Skill.

Adult↗
PubMed1985

Familial carpal tunnel syndrome in three generations of a black family.

This is a report of familial carpal tunnel syndrome (CTS) occurring in seven members of three generations of a black family. Two of the cases had associated flexor tendonitis with trigger finger symptoms. Twenty members of four generations had nerve conduction studies. The age of those affected by CTS ranged from 29 to 67 years of age. Two subjects to date required bilateral CTS surgical releases. The familial CTS appears to have an autosomal dominant pattern of CTS inheritance with high penetrance. This is believed to be the first report of familial CTS in a black family.

Adolescent↗
PubMed1978

Musculocutaneous nerve injury after heavy exercise.

Three cases of musculocutaneous nerve injury distal to its innervation of the coracobrachialis muscle are reported. The syndrome typically features painless weakness of the biceps brachii and brachialis muscles, sensory loss in the distal volar forearm, a history of recent vigorous upper extremity resistive exercise, and resolution of the problem on resting the affected extremity. In all three reported cases the dominant arm was involved. The condition should not be confused with C-5 or C-6 radiculopathy, brachial plexopathy, or rupture of the biceps brachii muscle belly or tendon.

Adult↗