Biomedical subjects

W P Waring

Publications and source records attributed to W P Waring.

14 recordsLinked to original sources

PubMed1996

Pattern of denervation in clinically uninvolved limbs in patients with prior poliomyelitis.

In most cases of poliomyelitis, motor neuron death is extensive. In mild cases primarily involving one limb, the pattern of neuron death has not been fully determined. Nine mildly affected patients were studied systematically for electrophysiologic evidence of denervation by sampling one muscle in each limb. Fiber density was found to be increased in all but one muscle. Needle electromyography and turns and amplitude plots of the interference pattern were abnormal in all muscles in weak limbs and the majority of muscles in unaffected limbs. Turns: amplitude ratios were lower in muscles in weak limbs and greater in muscles in unaffected limbs in a pattern suggesting a horizontal gradation of motor neuron death across the spinal cord. This may be attributed to axonal transport of the virus. The horizontal pattern of sub clinical involvement in mild cases of poliomyelitis was compared and found to be similar to reported patterns of progression of limb weakness in amyotrophic lateral sclerosis type motor neuron disease.

Adult↗

PubMed1992

Correlation of creatine kinase and gait measurement in the postpolio population: a corrected version.

Measurements of stride length, gait speed, and distance walked during seven days were obtained from 15 postpolio and eight control subjects. Pedometers were used to measure distance walked. Measurements of stride length and speed were performed three times, and there was a high correlation between tests (R = .852-.969). The pedometers failed to record accurately in some postpolio subjects, and these subjects were dropped from analysis when ambulation distance was used as a variable. There were significant differences between the postpolio subjects and controls with respect to gait speed (47.7 +/- 14.0 vs 74.9 +/- 15.9 m/min, p less than 0.0005), stride length (55.3 +/- 11.7 vs 69.8 +/- 8.6 cm, p = .006), and average kilometers walked per day for seven days (1.97 +/- 1.3 vs 3.89 +/- 1.7, p = .016). The postpolio subjects had their serum creatine kinase (CK) levels measured at the end of the study. Forty percent of subjects had a level above the normal limits of our laboratory. There was a significantly positive correlation between CK levels and the distance walked during the previous 24 hours (R = .75, p = .012). The findings of this study illustrate the impact of gait abnormalities on the ambulatory abilities of the postpolio population. The correlation of CK with ambulation supports the association of exercise as a source of elevated CK levels in the postpolio population.

Adult↗

PubMed1992

Correlation of creatine kinase and gait measurement in the postpolio population.

Measurements of stride length, gait speed, and distance walked during seven days were obtained from 15 postpolio and eight control subjects. Pedometers were used to measure distance walked. Measurements of stride length and speed were performed three times, and there was a high correlation between tests (R = .852-.969). The pedometers failed to record accurately in some postpolio subjects, and these subjects were dropped from analysis when ambulation distance was used as a variable. There were significant differences between the postpolio subjects and controls with respect to gait speed (47.7 +/- 14.0 vs 74.9 +/- 15.9m/min, p less than 0.0005), stride length (55.3 +/- 11.7 vs 69.8 +/- 8.6cm, p = .006), and average kilometers walked per day for seven days (1.97 +/- 1.3 vs 3.89 +/- 1.7, p = .016). The postpolio subjects had their serum creatine kinase (CK) levels measured at the end of the study. Forty percent of subjects had a level above the normal limits of our laboratory. There was a significantly positive correlation between CK levels and the distance walked during the previous 24 hours (R = .75, p = .012). The findings of this study illustrate the impact of gait abnormalities on the ambulatory abilities of the postpolio population. The correlation of CK with ambulation supports the association of exercise as a source of elevated CK levels in the postpolio population.

Creatine Kinase↗

PubMed1991

Acute spinal cord injuries and the incidence of clinically occurring thromboembolic disease.

A detailed analysis was undertaken to study the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and death during the initial hospitalisation after traumatic spinal cord injury (SCI). The National Spinal Cord Injury Statistical Center supplied data on 1419 subjects with acute injuries hospitalised between October 1, 1986 and June 9, 1989. The incidence of PE was 4.6% (4.3% for paraplegia and 4.8% for quadriplegia) and 14.5% for DVT (15.9% for paraplegia and 12.5% for quadriplegia). Fifty two patients (3.7%) died during their initial hospitalisation. Age, gender, and quadriplegia were not statistically significantly correlated with the development of DVT, while motor complete lesion was a better predictor of DVT than a complete lesion. The highest incidence of DVT was 22.9% in patients with motor complete paraplegia, while the lowest incidence was 9.3% in patients with motor incomplete quadriplegia. The only significant predictor for PE was age. Mortality was associated with increased age, PE, quadriplegia, and complete lesions. The highest incidence of death was 14.0% in patients greater than or equal to 40 years of age with quadriplegia and the lowest incidence of death was 0.37% in patients less than 40 years of age with paraplegia. This study emphasises the need for careful analysis and detailed stratification when designing or interpreting SCI research with DVT, PE, and mortality. Completeness of lesion, age, and category of impairment, whether quadriplegia or paraplegia, are appropriate strata to select.

Acute Disease↗

PubMed1991

Shoulder pain in acute traumatic quadriplegia.

Fifty two patients with traumatic quadriplegia admitted to a spinal cord injury program within 6 months of injury were studied retrospectively. Seventy five per cent had shoulder pain documented in their medical records during initial rehabilitation, and 60% had shoulder pain for 2 weeks or more. When shoulder pain was documented it was bilateral in 61% of the cases. Age greater than 50 years, decreased shoulder range of motion, and not receiving shoulder exercise during the first 2 weeks after injury were positive risk factors associated with the onset of shoulder pain. At discharge 42% of the patients with shoulder pain were pain-free, 35% were noted to have improvement of their pain, and 23% had the same or worse shoulder pain. Study results demonstrate the high incidence of shoulder pain during initial rehabilitation of patients with traumatic quadriplegia and the importance of starting shoulder exercises during early acute care.

Accidents, Traffic↗

PubMed1991

The interobserver reliability of the revised American Spinal Injury Association standards for neurological classification of spinal injury patients.

To test the interobserver reliability of clinicians using the American Spinal Injury Association's 1989 revised "Standards for Neurological Classification of Spinal Injury Patients," two quizzes were given to 15 house officers and physician faculty members of a department of Physical Medicine and Rehabilitation. The first quiz consisted of five spinal cord injury cases of varying degrees of complexity. The participants were asked to classify each case with respect to sensory level, motor level, zone of injury and Frankel classification by using the original standards. Two months later, after a brief explanation of the significant changes in the revised standards, the same group was given five slightly different cases to classify. With the use of the 1989 revision of the standards, the percent correct improved for Frankel grade (65-81%), motor level (59-85%), sensory level (71-93%) and zone of injury (31-89%). Many of the same type of errors were repeated in both quizzes, i.e., T-12 and L-1 sensory level distinction and the classification of thoracic motor levels. We conclude that the interobserver reliability for the revised ASIA standards, although improved, continues to be less than optimal. We recommend that changes clarifying sensory levels near the inguinal ligament and motor level classification with very incomplete injuries be made in the standards. In addition, training methods should be developed to improve the interobserver reliability of the standards when they are used by clinicians and researchers.

Humans↗

PubMed1991

Evaluation, treatment, and follow-up results of post polio patients with dysphagia.

Twenty consecutive patients were evaluated for reports of dysphagia from post-polio clinics. Only half the patients reported a history of swallowing problems at the time of their acute poliomyelitis. Each patient received a videofluorographic evaluation of the oral and pharyngeal phases of swallowing, and then was provided with recommendations to improve swallowing skills. A follow-up questionnaire was sent to all patients. The respondents had an average interval of 12 months since the initial evaluation. Of the 18 patients responding to the questionnaire, 14 (77%) reported regular use of the swallowing suggestions. Comparison of pre-evaluation results to followup of the 18 respondents yielded a statistically significant decline in the frequency of choking (p = 0.0156) and food sticking in the throat (p = 0.0195). We conclude that a dysphagia program can result in significant improvement of the swallowing symptoms reported with the post-polio population.

Adult↗

PubMed1991

Neurologically normal patients with suspected postpoliomyelitis syndrome: electromyographic assessment of past denervation.

Patients with neurologic signs consistent with previous poliomyelitis have been shown to have electrodiagnostic evidence of widespread denervation, often in clinically normal muscles thought to have been uninvolved by poliomyelitis. Eight percent of patients seen in our postpoliomyelitis clinic had no abnormalities on neurologic examination or with conventional electrodiagnostic studies to corroborate history of poliomyelitis. Seventeen patients were studied, subtle electrodiagnostic evidence of denervation was sought. Measurements of fiber density and analysis of turns and amplitude showed no abnormalities in nine patients. Five patients had borderline elevated fiber density. Analysis of turns and amplitude showed mild neurogenic changes in two patients and borderline changes in three patients. These findings were disparate, with isolated abnormalities in individual muscles. It was concluded that (1) there is a group of patients whose histories of poliomyelitis are uncertain, and (2) the lack of clear evidence for previous denervation after extensive electrodiagnostic testing is a valid means for excluding the diagnosis of postpoliomyelitis syndrome.

Adult↗

PubMed1990

Epidemiology of spasticity following traumatic spinal cord injury.

Two epidemiologic studies of spasticity at discharge and first annual follow-up in patients with traumatic spinal cord injury (SCI) are reported. Study 1 analyzed occurrence of spasticity and its severity for 96 subjects at one SCI center, with 67% of subjects developing spasticity by discharge and 37% receiving antispasticity medication. By follow-up, these figures were 78% and 49%, respectively. Incidence of spasticity was higher among cervical and upper thoracic than lower thoracic and lumbosacral levels of injury groups (p less than 0.001). Study 2 analyzed presence of spasticity severe enough to have warranted treatment on 466 subjects at 13 collaborating SCI centers, where 26% of subjects received treatment by discharge and 46% by follow-up. Probability of spasticity treatment was significantly related (p less than 0.05) to days from injury to discharge and level of injury group, whereas age, gender, and Frankel grade were not related. Among only cervical and upper thoracic subjects, Frankel grade was significantly related (p less than 0.01), with grades A (27%) and D (29%) being less frequently treated than grades B (50%) and C (52%). Importance of controlling the above significantly related factors is emphasized for future studies of methods to reduce incidence or severity of spasticity.

Adult↗

PubMed1989

Clinical management of carpal tunnel syndrome in patients with long-term sequelae of poliomyelitis.

Thirty-three patients with long-term sequelae of poliomyelitis with a diagnosis of carpal tunnel syndrome established by either abnormal nerve conduction studies or previous carpal tunnel surgery were surveyed. There was no significant long-term resolution of symptoms in the patients who had surgery (n = 9) or were currently using wrist orthoses (n = 11) compared with patients without such treatment (n = 13). In patients who used a single cane or those who used crutches (N = 10), there was a direct correlation between the hand holding the cane or crutch and the hand in which carpal tunnel syndrome developed. The chronic use of cane and crutch predisposes these patients to development of carpal tunnel syndrome, and caution should be used when considering wrist surgery.

Canes↗

PubMed1989

Serum creatine kinase in the post-polio population.

Elevated creatine kinase (CK) levels may be noted in neuromuscular patients as a result of muscle damage and necrosis. We measured the serum CK levels of 62 post-polio patients with chronic neurologic disease (Neuro) and 13 post-polio patients with no evidence of neurologic compromise (Control). Patient groups were comparable for age, gender and years since onset of poliomyelitis. The Neuro group had substantially increased CK levels compared with the Control group, 211 +/- 19.0 IU v 114 +/- 26.2 IU (mean +/- 1 SE; P less than 0.05). Of the Neuro group, 40% had abnormally elevated CK values, compared with 8% of the Control group. Within the Neuro group, there was a robust correlation between elevated CK values and self-reports of strenuous work and level of community ambulation (P less than 0.05). These findings support the hypothesis that chronic muscle overuse may be a contributing factor to the advanced senescence reported by post-polio patients with neuromuscular compromise.

Creatine Kinase↗

PubMed1989

Influence of appropriate lower extremity orthotic management on ambulation, pain, and fatigue in a postpolio population.

A major functional problem for the postpolio patient is the loss of ambulation ability. A retrospective study of lower extremity orthotic management for ambulation was made of 104 subjects with histories of paralytic poliomyelitis who received treatment and evaluation in a postpolio clinic. Thirty-six patients (35%) had a remote history of a surgical arthrodesis of the ankle. Fifty-six subjects (54%) reported using lower extremity orthoses after the onset of their polio. At initial postpolio clinic evaluation 19 subjects (18%) were using lower extremity orthoses, and all of these patients had a remote history of orthotic use. After clinical evaluation, a new lower extremity orthosis was recommended for 37 subjects (36%). Nine of these patients had never used orthotic devices. New orthoses for a previously braced limb or an additional orthosis for a previously unbraced limb were prescribed more frequently in previously braced patients (28 of 56 vs 9 of 48, p less than 0.02). Seventy-two percent of subjects with ankle fusion required new orthoses; 19% of those without fusion required one (p less than 0.001). A questionnaire returned by 81 subjects (78%) indicated that appropriate orthotic prescription significantly improved the ability to walk, increased perceived walking safety, and reduced knee and overall pain (p = 0.04 to 0.008).

Adult↗

PubMed1988

Patterns of referral to a university hospital consultation service: failure to accurately predict need for physiatric services.

The purpose of this study was to determine the predictive value of screening the narrative sections of the consultation request form to determine the need for physiatric intervention rather than PT intervention alone. We conducted a review of 107 requests for consultation from various acute care services at our hospital. After reviewing the referring physician's narrative summaries, we determined that 36% of 107 patients would require physiatric evaluation, and that the remaining patients could be "passed through" to PT for treatment. After evaluation of the medical records and examination of the patients, 54% of patients required physiatric assessment and only 45% could be "passed through" to PT. The hypothesis that this narrative information would be an adequate predictor of need for physiatric consultation was rejected at the p less than 0.005 level (chi 2 = 18.63; df = 1). In addition, the referring service indicated whether it wished PT or physiatry to evaluate the patient on the consultation form. The hypothesis that screening for the need for physiatric intervention by the indicated preference of the referral was rejected at the p less than 0.0005 level (chi 2 = 20.45; df = 1). We concluded that we could not reliably predict when patients required physiatric or only PT intervention based on the consultation request narrative. Ongoing physiatric involvement on a consultative basis, educational conferences, and other forms of education for house staff and attending physicians may serve to improve understanding of physiatric services and physiatric utilization.

Health Services Needs and Demand↗

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Female↗