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At least 37 records · Page 2Linked to original sources

PubMed2000

Biomechanical analysis of a weight-relief maneuver in C5 and C6 quadriplegia.

OBJECTIVE: To determine the kinematics and kinetics of performing a weight-relief maneuver in persons with C5 and C6 quadriplegia. STUDY DESIGN: A three-dimensional kinematic and kinetic analysis was performed on the upward phase of a weight-relief maneuver with the use of a motion analysis system, two force platforms, and an instrumented seat. Electromyography (EMG) data were collected from the upper pectoralis, anterior deltoid, latissimus dorsi, and biceps brachii muscles of the right upper limb. SETTING: Biomechanics laboratory. SUBJECTS: Seven persons with C5 and C6 quadriplegia (ASIA A and B) with "flickers" (grade 1/5) or less in wrist flexor and triceps brachii muscles. MAIN OUTCOME MEASURES: Angular displacements and associated moments of the shoulder, elbow, and wrist, kinematic variables describing the position and displacement of the trunk and upper limbs, and EMG data. RESULTS: Subjects lifted from a forward flexed posture with their arms adducted against their trunks. During the course of lifting, they flexed their shoulders and wrists and extended their elbows. They generated peak mean (+/- SE) shoulder and elbow flexor moments of .65 (+/-.04) and .41 (+/-.06) N x m x kg(-1), respectively. Shoulder adductor moments increased over the course of the lift. The median (and interquartile range) mean EMG activity in the upper pectoralis and the anterior deltoid muscles were 63% (35%-76%) and 44% (36%-49%) of EMG obtained during maximal voluntary contractions, respectively. CONCLUSION: Persons with quadriplegia with paralysis of the triceps brachii muscles lift themselves by generating active shoulder flexor and adductor moments. They also rely on wrist flexor moments that are generated by the stretch of the wrist flexor muscles.

Adult↗

PubMed1996

Design and development of a pressure relief seating apparatus for individuals with quadriplegia.

Persons with spinal cord injury above C7 lack the ability to extend their elbows and grip with their hands. Consequently, when seated, they are unable to press down to shift their weight to relieve pressure on the ischial tuberosities. This can ultimately cause serious pressure sores to develop on the buttocks. Those with adequate insurance coverage can eliminate this problem with an electric power recliner wheelchair. With the touch of a button, the backrest will fold down to a laying position, thus relieving the pressure on the ischial tuberosity. Unfortunately, not all individuals with quadriplegia possess this type of coverage. Therefore, the problem requires an alternate design that will utilize mechanical rather than electrical power to produce a cost-effective solution. The purpose of this project was thus to design and build an affordable apparatus adaptable to wheelchairs that allows individuals with quadriplegia to shift their weight from one side to the other thus relieving the pressure on the ischial tuberosities. A pneumatic system that utilizes two inflatable air bladders was employed. One cushion is placed under each buttock and inflated separately to tilt the user from one side to the other. The inflated cushion elevates one side of the buttock, which relieves the pressure from the other side. The power required to operate the system is generated using repetitions of elbow flexion. The system was evaluated on an individual with C6 quadriplegia. The subject demonstrated independent pressure relief without intrusion on cosmesis or independence.

Cost-Benefit Analysis↗

PubMed2005

Acute quadriplegia following closed traction reduction of a cervical facet dislocation in the setting of ossification of the posterior longitudinal ligament: case report.

STUDY DESIGN: A case report of acute quadriplegia resulting from closed traction reduction of traumatic bilateral cervical facet dislocation in a 54-year-old male with concomitant ossification of the posterior longitudinal ligament (OPLL). OBJECTIVES: To report an unusual presentation of a spinal cord injury, examine the approach to reversal of the injury, and review the treatment and management controversies of acute cervical facet dislocations in specific patient subgroups. SUMMARY OF BACKGROUND DATA: The treatment of acute cervical facet dislocations is an area of ongoing controversy, especially regarding the question of the necessity of advanced imaging studies before closed traction reduction of the dislocated cervical spine. The safety of an immediate closed, traction reduction of the cervical spine in awake, alert, cooperative, and appropriately select patients has been reported in several studies. To date, there have been no permanent neurologic deficits resulting from awake, closed reduction reported in the literature. A case of temporary, acute quadriplegia with complete neurologic recovery following successful closed traction reduction of a bilateral cervical facet dislocation in the setting of OPLL is presented. METHODS: The clinical neurologic examination, radiographic, and advanced imaging studies before and after closed, traction reduction of a cervical facet dislocation are evaluated and discussed. A review of the literature regarding the treatment of acute cervical facet dislocations is presented. RESULTS: Radiographs showed approximately 50% subluxation of the fifth on the sixth cervical vertebrae, along with computerized tomography revealing extensive discontinuous OPLL. The cervical facet dislocation was successfully reduced with an awake, closed traction reduction, before magnetic resonance imaging (MRI) evaluation. The patient subsequently had acute quadriplegia develop, with the ensuing MRI study illustrating severe spinal stenosis at the C5, C6 level as a result of OPLL or a large extruded disc herniation. Following an immediate anterior decompression and a posterior stabilization procedure, the patient regained full motor and sensory function. CONCLUSIONS: This case report highlights the advantages and shows some safety concerns regarding immediate, closed traction reduction of cervical facet dislocation with real-time neural monitoring in an awake, alert, oriented, and appropriately select patient before MRI studies in the setting of preexisting central stenosis from OPLL.

Acute Disease↗

PubMed2006

Epidural varix at the cervicothoracic junction: unusual cause of quadriplegia: a case report.

STUDY DESIGN: A case report describing an unusual incident of quadriplegia in a young adult male caused by an epidural varix at the cervicothoracic junction. OBJECTIVE: To report an unusual case of quadriplegia caused by an epidural varix at the cervicothoracic junction. SUMMARY OF BACKGROUND DATA: Epidural varices are dilated tortuous elongated veins inside the central canal. In degenerative spinal stenosis, these varices are a result of venous stagnation and contribute to the pathogenesis of radicular pain. In the absence of stenosis, primary varicosities develop as a result of dynamic obstruction to venous outflow during spinal movements. A primary epidural varix can produce neurologic deficit similar to a space occupying lesion within the spinal canal. The myeloradiculopathy is of a slow progressive nature. MATERIAL AND METHODS: A young man presented with an acute onset flaccid quadriplegia in the absence of significant trauma. Magnetic resonance imaging revealed an extradural space occupying lesion at the cervicothoracic junction that was diagnosed as an isolated epidural varix during surgery. RESULTS: No neurologic recovery occurred. Postoperative magnetic resonance imaging revealed a syrinx in the cervicothoracic cord. CONCLUSION: In the absence of other precipitating factors, the cord injury was attributed to the epidural varix. A temporary impedance to the venous outflow with the increase in the venous pressure has been hypothesized as the mechanism of cord injury.

Adult↗

PubMed1995

Cost analysis of continuous intrathecal baclofen versus selective functional posterior rhizotomy in the treatment of spastic quadriplegia associated with cerebral palsy.

The purpose of the study was to analyze the relative cost of selective functional posterior rhizotomy (SFPR) and continuous intrathecal baclofen in the treatment of children with severe spastic quadriplegia related to cerebral palsy. No attempt was made to analyze the efficacy of the two types of treatment. Nine children with spastic quadriplegia secondary to cerebral palsy in whom continuous intrathecal baclofen was attempted were matched as closely as possible with a group of 10 patients with spastic quadriplegia out of a total of 100 children who had undergone SFPR in the same time period. Clinical care flow charts were created to identify the various points of contact with members of the health care team, so that cost points could be identified and costs calculated. The cost per patient up to 1 year a after treatment CDN$ 64,163.10 for patients with implanted pumps for continuous intrathecal baclofen versus CDN$ 16,913.54 for SFPR. When adjustments were made to exclude costs and savings associated with research protocols, the average for the baclofen group decreased to approximately CDN$ 63,000, with minimal change for the SFPR group. The higher cost per patient on baclofen was related to the cost associated with screening patients who did not go on to have implantation of a continuous infusion pump, and to additional hospitalization for complications in the baclofen group. It is cautioned that this cost analysis was based on the experience at British Columbia's Children's Hospital, and the results may not be generalizable to other institutions or to other patient populations.

Adolescent↗

PubMedDate not supplied

National football head and neck injury registry: report on cervical quadriplegia, 1971 to 1975.

Data on cervical spine injuries resulting from participation in football have been compiled by a national registry established in 1975. Information has been collected retrospectively by defined criteria since 1971. Efforts have been made to establish the mechanism of injury responsible in the majority of instances on the basis of epidemiologic evidence and recognized biomechanical principles. During the 5-year period, 77 deaths resulted from severe neck injuries. During this period, 1,275,000 players were exposed. Ninety-nine cervical fracture-dislocations resulting in permanent quadriplegia and 259 cervical fractures-dislocations occurred. There may be a "trend" towards an increase in permanent quadriplegia resulting from serious cervical spine injuries sustained while playing football. Apparently, the cause can be attributed to the helmet-face mask that has encouraged the use of the head as the primary point of contact in blocking, tackling, and head butting. The figures clearly identify defensive backs, linebackers, or specialty team members making tackles by using the head as the initial point of contact, as the individuals at greatest risk to sustain cervical spine injuries resulting in permanent quadriplegia.

Athletic Injuries↗

PubMedDate not supplied

Factors related to quadriplegia in football and the implications for intervention strategies.

Axial compressive loading, the principal cause of spinal cord quadriplegia in American football, is produced when a player is forcibly struck on the crown of the helmet. This impact subjects the small cervical vertebrae to a large compressive force that often produces stress that exceeds the failure limit of the spine. Several factors influence the outcome in axial collisions, including the available kinetic energy, the displacement needed to dissipate the energy, and the end conditions of the collision (i.e., the position of the head). Effective intervention of this catastrophic injury requires the melding of information from the fields of biomechanics and epidemiology. From a biomechanical perspective, neck loading should be kept at a level that is below the failure limit of the cervical spine. The epidemiologic rate at which these injuries develop among football players suggests that cervical quadriplegia is rare. Thus, protective devices intended to lower the forces on the cervical spine may not succeed in dramatically reducing the incidence of this injury. Because this injury is rare, it is important to consider that introducing new protective equipment, intended for intervention of one problem (i.e., cervical quadriplegia), may lead to other injuries.

Biomechanical Phenomena↗

PubMedDate not supplied

Acute pure motor quadriplegia: is it dengue myositis?

BACKGROUND AND AIM: In view of paucity of comprehensive evaluation about dengue infection producing quadriplegia, we report the clinical, laboratory and neurophysiological studies in these patients. SUBJECTS AND METHODS: Seven out of 16 patients with dengue infection presented with quadriplegia and they were subjected to a detailed clinical history and examination. Diagnosis of dengue was based on characteristic clinical and positive serum IgM ELISA. Blood counts, serum chemistry, CSF analysis and nerve conduction and electromyographic (EMG) studies were performed in all. Outcome was defined at the end of 1 month into complete, partial and poor on the basis of activities of daily living RESULTS: The age of the patients ranged between 9 and 42 years and 2 were females. Fever was present in all and myalgia in 5 patients. Weakness developed within 3-5 days of illness, which was severe in 4 and moderate in 3 patients. Hypotonia and hyporeflexia were present in 5 patients. Nerve conduction and EMG studies were normal in all except one whose EMG was myopathic. Serum CPK and SGPT were raised in all and serum bilirubin in 3 patients. All the patients had coagulopathy and 6 had thrombocytopenia. Muscle biopsy in 1 patient was suggestive of myositis. Six patients improved completely and one had poor recovery who needed ventilatory support. CONCLUSION: Dengue virus infection may result in acute pure motor quadriplegia due to myositis. In an endemic area it should be considered in the differential diagnosis of acute flaccid paralysis.

Adolescent↗

PubMed1992

The role of allergen immunotherapy in the respiratory complications of quadriplegia.

Patients with traumatic quadriplegia have frequent respiratory complications. These complications may be exacerbated by the presence of common and previously well-tolerated allergic disease. Quadriplegic patients are limited in their ability to cope with upper and lower respiratory allergies by a reduced vital capacity and impairment of maneuvers needed to keep the upper and lower respiratory tracts clear. This report describes two patients with traumatic quadriplegia who were treated with allergen immunotherapy. After immunotherapy, both patients had negligible long-term postinjury respiratory complications and an improved quality of life. Allergen immunotherapy should be considered early in the management of allergic patients with traumatic quadriplegia.

Adult↗

PubMed1986

Congenital cervical stenosis presenting as transient quadriplegia in athletes. Report of two cases.

The cases of two patients in whom complete but transient quadriplegia developed after an injury that was incurred while playing football are presented. Both patients were found to have a congenitally narrow cervical vertebral canal. Critical stenosis resulting in the transient quadriplegia occurred after a presumed injury to a cervical disc. In our opinion, a myelogram should be made for patients with a history of transient quadriplegia, numbness, or a burning sensation down the back or the lower extremities, even if other radiographic studies are interpreted as negative. Patients who have stenosis of the cervical spine should be advised to discontinue participation in contact sports.

Adult↗

PubMed1985

[A case of quadriplegia with respiratory paralysis surviving as a candidate for rehabilitation].

A case of a 20-year-old woman who survived respiratory quadriplegic state and then became to be a candidate for rehabilitation is reported. The patient was injured in an automobile accident and immediately developed cardiopulmonary arrest, quadriplegia and maximum mydriasis bilaterally. She was transferred to our hospital six minutes after the accident. Immediate and appropriate resuscitation could bring restoration of only cardiac contractions without spontaneous breathing and minimal movement of extremities. Skull and cervical spine x-rays showed anterior atlanto-axial dislocation with a fracture of dens in addition to a linear skull fracture in the right temporoparietal region. Traction by Glisson's method was applied initially three and a half hours after the accident under controlled ventilation with a respirator. Five days after the onset, her consciousness became clear and she displayed an onionskin pattern of anesthesia with sensory preservation around her mouth and nose. Subsequently quadriplegia gradually improved from the lower extremities to the upper, however the proximal muscles of the upper extremities remained to be involved for a long period of time. The authors speculated that such a peculiar pattern of paralysis was due to the injury of the rostral part of the pyramidal decussation and to the acute central cord injury at the C2 level of the spinal cord. Halo-vest immobilization technique was applied and active postural drainage was done as the treatment of the respiratory quadriplegia. She could wean off the respirator four months after the onset and became independent in her active daily living six months after the accident.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Early diagnosis of spastic diplegia, spastic hemiplegia, and quadriplegia.

A retrospective study examined early neurodevelopmental behaviors of children with spastic diplegia, spastic hemiplegia, and quadriplegia (spastic, athetoid, or mixed) who had been followed up longitudinally in a high-risk infant follow-up clinic. Compared with peers with normal outcomes, children with all three types of cerebral palsy had significantly lower scores on the Bayley Mental Scale at 4 months of age; children with hemiplegia and quadriplegia also scored significantly lower on the Bayley Motor Scale. On the Movement Assessment of Infants at 4 months of age, the children with hemiplegia and quadriplegia showed significantly higher risk scores than the nonhandicapped group. The Movement Assessment of Infants was more than three times as sensitive as the Bayley Motor Scale in detecting motor abnormalities in 4-month-old infants with diplegia and more than twice as sensitive in detecting early abnormalities of hemiplegia. At 1 year of age, however, the Bayley Motor Scale was extremely sensitive in picking up motor deficits in children with all three types of cerebral palsy.

Cerebral Palsy↗

PubMedDate not supplied

Applying the Roy Adaptation Model to the care of clients with quadriplegia.

The Roy Adaptation Model has provided a framework for nursing practice, education, and research for more than 20 years. This article focuses on the model's contribution to nursing practice. Adaptation, the goal of the model, serves as an effective guide for planning care for the client with quadriplegia. A case study is used to show the effectiveness of using the nursing process within the guidelines of the Roy Adaptation Model to promote adaptation in a client with quadriplegia who is coping with living in a long-term care facility.

Adaptation, Psychological↗

PubMed1991

Effect of work rate increment on peak oxygen uptake during wheelchair ergometry in men with quadriplegia.

The purpose of this study was to determine the effect of work rate increment on peak oxygen uptake (VO2 peak) during wheelchair ergometry (WCE) in men with quadriplegia due to cervical spinal cord injuries (CSCI). Twenty-two non-ambulatory subjects (aged 20-38 years) with CSCI were divided into two groups based on wheelchair sports classification (n = 12 for IA group and n = 10 for IB/IC group). Subjects underwent three different, continuous graded exercise tests (spaced at least 1 week apart) on an electronically braked wheelchair ergometer. Following a 3-min warmup, the work rate was increased 2, 4, or 6 W.min-1 for the IA group and 4, 6, or 8 W.min-1 for the IB/IC group. Ventilation and gas exchange were measured breath-by-breath with a computerized system. Repeated-measures ANOVA showed no significant difference among the three protocols for VO2 peak in the IA group (P greater than 0.05). The mean (SD) VO2 peak values (ml.kg-1.min-1) were 9.3 (2.4), 9.4 (3.2), and 8.4 (2.6) for the 2, 4, and 6 W.min-1 protocols, respectively. In contrast, the IB/IC group showed a significant difference among the protocols for VO2 peak (P less than 0.05). The mean (SD) VO2 peak values (ml.kg-1,min-1) were 15.1 (4.0), 14.1 (4.4), and 12.7 (4.0) for the 4, 6, and 8 W.min-1 protocols, respectively. Post hoc analysis revealed a difference between the 4 and 8 W.min-1 protocols. Our results suggest that graded exercise testing of men with quadriplegia due to CSCI, using WCE, should employ work rate increments between 2 and 6 W.min-1 and that work rate increments of 8 W.min-1 or greater will result in an underestimate of VO2 peak.

Adult↗

PubMed2005

Current thinking: return to play and transient quadriplegia.

Athletes that participate in contact and collision sports assume risk of serious injury each time they take the field. For those athletes that have sustained an episode of transient quadriplegia, the decision of whether to return to competition can be a difficult one. Some athletes, realizing how close they may have come to permanent injury, may decide that further participation is not in their best interest. Others may be somewhat undecided, and some may want to return at all costs. As the treating physician, the goal is to identify those athletes who after a single episode of transient quadriplegia are at increased risk for further injury and consequently should discontinue participation in contact sports. Factors that may contribute to that determination include mechanism of injury, prior history of neurologic symptoms or injury, and anatomic features that may predispose to further injury such as disc herniation, fracture, or cervical stenosis.

Adolescent↗

PubMed1993

Tomographic thallium-201 myocardial perfusion imaging after intravenous dipyridamole in asymptomatic subjects with quadriplegia.

Cardiovascular disease is the leading cause of mortality in those with a spinal cord injury (SCI). As a consequence of changes in body composition and level of activity, individuals with a SCI tend to have a high prevalence of multiple risk factors for coronary artery disease (CAD). In this report, we have demonstrated the usefulness of tomographic thallium-201 myocardial perfusion imaging after intravenous dipyridamole in six clinically asymptomatic subjects with quadriplegia. The average age of the subjects was 47 +/- 2 years, and they had a duration of injury of 15 +/- 2 years. On average, the individuals had five risk factors for CAD. After intravenous administration of dipyridamole and mild upper extremity exercise, the subjects reported no adverse symptoms and had no electrocardiographic evidence suggestive of ischemia. By contrast, three of the six subjects had reversible defects noted on thallium scintigraphy, and one additional subject had a fixed defect that was suggestive of infarction. The remaining two subjects had abnormal scans with fixed defects of the inferioposterior region, which may be ascribed to diaphragmatic attenuation, perhaps a result of partial diaphragmatic paralysis. Thus, dipyridamole thallium myocardial imaging is a safe and effective noninvasive method for the detection of myocardial ischemia or infarction in individuals with quadriplegia who are at increased risk for CAD.

Adult↗

PubMed1994

Disorders of carbohydrate and lipid metabolism in veterans with paraplegia or quadriplegia: a model of premature aging.

One hundred veterans with paralysis due to spinal cord injury (SCI), equally divided between those with paraplegia and quadriplegia, and 50 able-bodied veteran controls underwent a 75-g oral glucose tolerance test (OGTT). In subjects with SCI, 22% were diabetic by criteria established by the World Health Organization (WHO), whereas only 6% of the control group were diabetic. Eighty-two percent of the controls had normal (NL) oral glucose tolerance, compared with 38% of those with quadriplegia and 50% of those with paraplegia. Subjects with diabetes mellitus (DM) were older in both the SCI and control groups, but those with SCI developed carbohydrate disorders at younger ages than did the control group. SCI subjects had significantly higher mean glucose and insulin values at several points during the OGTT when compared with controls, suggesting an accentuated state of insulin resistance in those with SCI. Mean fasting plasma glucose (FPG) values for both SCI and control groups were significantly higher in subjects with DM compared with those with NL glucose tolerance. When the FPG value was compared between SCI or control subjects with abnormalities in glucose tolerance, the subgroups with SCI and NL or impaired glucose tolerance (IGT) had significantly lower FPG levels than the respective control subgroups, suggestive of decreased hepatic glucose output in SCI.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Composition↗

PubMed2004

Transient quadriplegia and return-to-play criteria.

There will always be an inherent risk to participation in contact sports. Appropriate education of coaches, players, and parents is important. Recurrence rate is high in the athlete who has experienced transient quadriplegia or any neck injury. The athlete and his family should be made aware of this risk. Counseling is even more important, both from a medical and legal standpoint, in the patient with underlying spinal stenosis, found either incidentally or following an episode of transient quadriplegia. In these situations, consideration of consultation with a neurologist or neurosurgeon is prudent.

Athletic Injuries↗