Thigh hematoma in the active and aging person with spinal cord injury.
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Activities of Daily Living↗
Biomedical subjects
S A Stiens
Publications and source records attributed to S A Stiens.
Rehabilitation intervention for patients with upper extremity dysfunction: challenges of outcome evaluation.
Upper extremity (UE) dysfunction attributed to overuse is an increasingly prevalent problem managed with interdisciplinary rehabilitation. Outcome evaluation of these programs is limited by a number of factors. First, patients with UE dysfunction include a wide variety of pathophysiologic processes and diagnoses that are associated with multiple secondary impairments, disabilities, and handicaps that limit personal performance. Second, the particular experience of disablement and expectations each person brings to the rehabilitation process necessitates an individualized program with unique goals. Successful outcome measurement of the rehabilitation process must take into account the achievement of individual goals as well as objective scalar quantification of impairments, disabilities, and handicaps that are comparable between groups. Understanding of the relationships between UE impairments and given functional outcomes will come from controlled, dosed treatment studies in "pure" diagnostic patient groups. Outcomes research applied to UE rehabilitation as it is currently practiced should include individually devised patient assessments of accomplishment and satisfaction in addition to long-term quantitative reassessment of the person under all domains of disablement and work performance.
Arm Injuries↗
Reduction in bowel program duration with polyethylene glycol based bisacodyl suppositories.
UNLABELLED: The neurogenic bowel caused by spinal cord injury frequently requires a bowel program (BP) with stimulant suppositories for effective defecation. OBJECTIVE: The effectiveness of bowel programs initiated by hydrogenated vegetable oil based bisacodyl (HVB) suppositories was compared with that of polyethylene glycol based bisacodyl suppositories (PGB). DESIGN: Single subject, randomized treatment. SETTING: Outpatient. SUBJECT: Chronic T2 complete spinal cord injury (SCI). INTERVENTION: The suppository for the every third-day BP was randomized to PGB or HVB. The times in minutes of the following BP events were recorded: suppository insertion, first flatus, begin stool flow, end stool flow, and transfer off toilet. OUTCOME MEASURES: BP event times were used to derive BP intervals: suppository insertion to first flatus = Time to Flatus, first flatus until begin stool flow = Flatus to Stool Flow, begin stool flow until end stool flow = Defecation Period, end stool flow until the transfer off the toilet = Wait Until Transfer, and suppository insertion until transfer off the toilet = Total BP Time. The number of digital stimulations required and the amount of stool results were recorded. RESULTS: The data included two groups of BPs: HVB (N = 13) and PGB (N = 13). Wilcoxon's rank sum tests were used to compare mean times for each of the BP intervals: Time to Flatus (HVB 37 minutes, PGB 10 minutes, p < .0001), Flatus to Stool Flow (HVB 6.0 minutes, PGB 5.9 minutes, p = .9578), and the Defecation Period (HVB 31, PGB 21, p = .0043).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Racial disparities in severity of cerebrovascular events.
BACKGROUND AND PURPOSE: This study was conducted to determine if blacks hospitalized for cerebrovascular events had more severe cerebrovascular events than whites similarly hospitalized. METHODS: Data from the Maryland Health Services Cost Review Commission were used to determine incidence of coma, death rates, age at death of those who died, and length of stay for acute hemorrhagic and occlusive stroke in hospitalized blacks and whites after adjusting for sex and, if appropriate, age. RESULTS: With a single exception (number of patients with hemorrhagic stroke who died during short-term hospitalization), all indices indicated that blacks incurred more severe cerebrovascular events than whites (P < .05 or less). CONCLUSIONS: Maryland state data from hospitalized patients indicate that blacks had more severe strokes than whites.
Age Factors↗
Pressure ulcer incidence on a spinal cord injury unit.
Because of the high risk for pressure ulcers among hospitalized, spinal cord injured patients, one quality improvement measure is to monitor incidence of pressure ulcers. A retrospective chart review of each patient who developed an ulcer during an 18-month period revealed patient characteristics associated with pressure ulcer risk. Of 468 inpatient admissions, 35 patients developed 81 pressure ulcers. Patient variables associated with an incidence rate of 7.5% were an admission diagnosis of pressure ulcer, surgical repair of pressure ulcers, length of stay, new spinal cord injury, longstanding injury (> 10 years), and the use of condom catheters.
Adult↗
Chief residency in PM&R. A balance of education and administration.
The role of the Physical Medicine and Rehabilitation (PM&R) chief resident (CR) in physiatry residency education programs is the subject of annual deliberation in many academic centers. A national survey of PM&R programs was conducted to determine CR number, selection method, responsibilities, duration of service, and postresidency destiny. The questionnaire generated a response rate of 86% with 90% of programs reporting 1-3 CRs per year. A range of 1-11 CRs were selected annually per program. The most common methods of CR selection were faculty vote (45%), combined resident-faculty vote (22%), and other (33%). The prevalence of administrative responsibilities included orienting new residents (97%), formulating call schedules (92%), dispute mediation (88%), medical student-residency interviews (87%), rotation schedule configuration (64%), faculty meeting participation (61 %), social event promotion (59%), and elective and externship schedule development (31 %). Educational duties included teaching and organizing didactics (87%), organizing pharmaceutical and rehabilitation equipment inservices (77%), arranging didactics (77%), board review coordination (72%), arranging grand round speakers (66%), core curriculum lectures (61%), and facilitating resident research (37%). CR career goals included group practice (48%), academic faculty (29%), solo practice (5%), and fellowship (18%). Overall, PM&R CRs maintain considerable involvement in the educational aspects of residency training, although their clinical and administrative duties predominate. Although the PM&R CRs contribute significantly to the academic growth and development of their respective training programs, only a modest percentage (47%) of CRs choose to remain in academic physiatry via an attending (29%) or fellowship (18%) position.
Academic Medical Centers↗
A clinical rehabilitation course for college undergraduates provides an introduction to biopsychosocial interventions that minimize disablement.
A two-credits per semester clinical medicine course was established in the Department of Physical Medicine and Rehabilitation (PM&R) in cooperation with the Johns Hopkins University undergraduate Human Biology faculty to present the variety of inpatient consultation personnel, units, patient diagnostic groups, and functional problems. College students spend 4 hr weekly on the PM&R consultation service as team members under resident supervision. The curriculum emphasizes student understanding of the roles of rehabilitation team members. Objectives include demonstration of working knowledge of the Biopsychosocial Model, the World Health Organization Model of disablement and interdisciplinary rehabilitation intervention. The course includes simulations of physical impairments, demonstrations of adaptive equipment, interactive chart reviews, readings, and audio lectures. A retrospective sequential review was made of the last 100 physical medicine and rehabilitation consultations with student attendance. The results confirm student exposure to many ward settings (surgery, 30%; neurology/neurosurgery, 28%; medicine, 24%; intensive care, 15%; oncology, 2%; and psychiatry, 1%), patient complexity (averaging 10 problems), and multiple ICD-9 diagnosis categories (circulatory, 36%; neurologic, 22%; musculoskeletal, 17%; neoplasms, 10%; injury, 5%; endocrine, 4%; infections, 3%; and others, 3%). The rehabilitation consultation service is particularly effective as an introduction to hospital-based medical practice due to the diagnostic variety of the patients, the functional approach of rehabilitation, and student exposure to multiple hospital settings. The Biopsychosocial Model of medical practice is demonstrated through multiple interdisciplinary perspectives of needs and interventions for patients with obvious functional deficits. This process develops a rudimentary understanding of the effect of illness on the person and the variety of medically effective therapeutic modalities.
Adult↗