Biomedical subjects

Thomas E Strax

Publications and source records attributed to Thomas E Strax.

6 recordsLinked to original sources

PubMed2006

Severe Dysphagia after botulinum toxin B injection to the lower limbs and lumbar paraspinal muscles.

We report a case of severe dysphagia in a 29-yr-old woman with cerebral palsy after she was injected with botulinum toxin B to her lower limbs and lumbar paraspinal muscles. Four days after the treatment, she developed difficulty swallowing, more severe for solid foods than for liquids, accompanied by dry mouth, blurred vision, and voice hoarseness. Fifteen days after the injection, with worsening of her dysphagia, she was hospitalized. A laryngoscopic evaluation revealed bilateral vocal cord paresis, and a modified barium swallow test demonstrated delayed oral initiation, upper airway penetration, and no reflexive cough. In the following days, she improved spontaneously and was discharged 12 days later when she re-acquired the ability to swallow solid foods. Her symptoms resolved completely only 75 days after the injection. Although dysphagia is a common side effect of botulinum injection in the neck, to our knowledge, this is the first reported case of severe dysphagia after injection in a distant anatomic site.

Adult↗

PubMed2005

A novel back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises for patients with chronic low back pain: the Japanese experience in the general setting.

STUDY DESIGN: A prospective cohort study. OBJECTIVES: To introduce a novel back school for the treatment of patients with chronic low back pain (CLBP), and to report its clinical results. SUMMARY OF BACKGROUND DATA: Although back school is one of the treatment methods for patients with CLBP, its efficacy and appropriate style remain controversial. No studies have been published regarding the combined program of back school with a multidisciplinary team approach. METHODS: A total of 182 patients with CLBP (74 men and 108 women; average age, 43.8 years) participated in this study. All patients were enrolled in the back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises. The following outcome measures were evaluated at the baseline, and 6 and 12 months after the enrollment: the level of pain evaluated with a Visual Analog Scale (VAS), flexibility of trunk and hamstrings (finger-floor distance, straight leg raising), trunk muscle strength and endurance, frequency of therapeutic exercises, and self-reported patient satisfaction. RESULTS: An averaged VAS score was 6.2 before enrollment in the program and 2.8 at follow-up. The pain improved in 141 patients (80.8%), did not change in 27 (15.4%), and was aggravated in 7 (3.8%). There was statistically significant improvement of finger-floor distance, trunk muscle strength, and endurance in the patients whose pain was relieved after enrollment in the program (P < 0.05). The compliance with the exercise program was significantly correlated with the clinical results (P < 0.05). CONCLUSIONS: We developed a novel back school using a multidisciplinary team approach, featuring quantitative functional evaluation and therapeutic exercises. The current study demonstrated that our program could provide a satisfactory result for the treatment of patients with CLBP. The quantitative functional evaluation was a worthwhile outcome measure when evaluating the efficacy of the treatment program. Teaching body mechanics and performing the therapeutic exercises through the multidisciplinary team approach are essential to managing CLBP in a general setting.

Adult↗

PubMed2005

Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option.

We report 2 cases of complex regional pain syndrome (CRPS) involving the lower extremity; in both, a sphenopalatine ganglion (SPG) block was performed as part of a pain management program. In the first case, a woman in her late twenties presented with CRPS in the left lower extremity that was inadequately controlled with typical oral medications. Sympathetic block of the extremity did not provide significant pain relief. However, a noninvasive sphenopalatine block with 4% tetracaine resulted in a 50% reduction in pain level. The patient was shown how to self-administer the sphenopalatine block and was provided with exercises and therapy to help improve her functional status. The second case involved a woman in her mid forties with CRPS in the right lower extremity that was partially controlled with oral medications. The patient experienced a 50% reduction in pain level when SPG block with 4% tetracaine was given. Further study is needed to determine the effects of SPG blocks on symptoms related to chronic regional pain syndrome.

Adult↗

PubMed2004

Quantitative evaluation of long sitting in paraplegic patients with spinal cord injury.

OBJECTIVES: To evaluate the characteristics of long sitting (ie, sitting with legs extended) in patients with spinal cord injury (SCI) and to compare these results with able-bodied control subjects. DESIGN: A kinematic study using a video camera and forceplate with a strain-gauge type load cell. SETTING: A referral center for patients with SCI in Japan. PARTICIPANTS: Twenty-four subjects, including 11 able-bodied, matched control subjects and 13 SCI patients with complete paraplegia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sitting posture in the sagittal plane as well as the movement pattern and distance of the center of pressure (COP). RESULTS: Patients with SCI kept their pelvis tilted posteriorly and the lumbar spine was less lordotic during long sitting. The changing COP pattern during long sitting differed in able-bodied subjects as compared patients with SCI. During long sitting with arms outstretched over the thighs, COP movement in the subjects with SCI was significantly greater than that in the able-bodied subjects. When the arms were outstretched over the thighs, the COP shifted anteriorly in the able-bodied subjects and posteriorly in the patients with SCI. CONCLUSIONS: Long sitting in the paraplegic patients with SCI was unstable compared with the able-bodied subjects. The COP distribution pattern differed significantly between the 2 groups. The support and function of the upper extremities may influence balance during long sitting in the patients with SCI. The method of seating evaluation using a video camera and gravicorder was easy to use and appeared to provide an objective measurement of dynamic seating function in the patients with SCI.

Activities of Daily Living↗

PubMed2004

Musculoskeletal injection skills competency in physical medicine and rehabilitation residents: a method for development and assessment.

An educational module was developed in attempt to satisfy two main objectives: to develop and implement a methodology for instruction of generally encountered injection techniques in the practice of physical medicine and rehabilitation and to implement an objective assessment format to measure attainment of these skills. Guidelines for this module were developed in consideration of Accreditation Council for Graduate Medical Education (ACGME) physical medicine and rehabilitation residency program requirements and ACGME Outcome Project. Eleven physical medicine and rehabilitation residents participated in a 1-day didactic/laboratory workshop covering injection education and techniques, followed by a supervised 2-wk practice session. Knowledge acquisition and skill attainment were measured via before and after multiple-choice written examination and simulated patient encounters utilizing anatomic models. An increase in knowledge was observed on the multiple-choice examination from pretest to posttest (pretest, 59.3%; posttest, 90.6%). Before instruction, 0 of 11 residents were able to perform any of the injection techniques (14 injection techniques and one sterile technique). At completion of the module, 7 of 11 residents (64%) competently performed 15 of 15 techniques (100%), 3 of 11 (26%) competently performed 14 of 15 techniques (93%), and 1 of 11 (9%) competently performed 11 of 15 techniques (73%). Participation in this module resulted in substantial acquisition of knowledge and skills regarding musculoskeletal injections for physical medicine and rehabilitation residents. This workshop provided a framework for the definition of baseline competency in this clinical skill area.

Attitude of Health Personnel↗

PubMed2003

Consumer, advocate, provider: a paradox requiring a new identity paradigm.

The best measure of a society is how well it cares for its weakest members. Over the past 60 years, I have had to merge the roles of consumer, advocate, and provider into a new identity paradigm. This address shares my experiences-the best and the worst of what I have seen. On reflection, I offer the following words of advice to both persons who have disabilities and those who are able-bodied: "if there is no wind, row!"

Persons with Disabilities↗