SEARCH · PubMed Health

Results for “QUADRIPLEGIA”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources

PubMed1983

Depression of respiratory function by pneumatic antishock trousers in traumatic quadriplegia.

A case of mild hypoventilation associated with an incompletely inflated pneumatic antishock suit in traumatic quadriplegia is presented. Pulmonary function studies were performed on the same patient 23 days later. Base line studies were performed and then repeated with the antishock suit inflated to 40 and then 100 mm Hg. Measurements were made of tidal volume (Vt), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), forced vital capacity (FVC), forced vital capacity in one second (FEV1), and maximum voluntary ventilation (MVV). With increasing suit pressures, all parameters decreased with the exception of the ERV, which was initially zero. Traumatic quadriplegia must be added to the list of disorders in which caution must be used when considering the use of the abdominal compartment of the pneumatic antishock suit.

Accidents, Traffic↗

PubMed1988

Chiari I malformation with quadriplegia and respiratory disturbance in an infant.

Chiari I malformation consists of variable downward displacement of the cerebellar tonsils. Quadriplegia, respiratory disturbance and pain are common in Chiari I malformation in adults. However, there are no reports of this syndrome in early childhood. We report the case of a 9-month-old girl with Chiari I malformation who had quadriplegia with muscle weakness and who developed respiratory disturbance as an early symptom. The causes of the symptoms of Chiari I malformation are discussed. The use of MRI is proposed as a more useful diagnostic technique than myelography for these patients since MRI is less likely to aggravate the respiratory disturbance.

Age Factors↗

PubMed2003

Proximal femoral resection for subluxation or dislocation of the hip in spastic quadriplegia.

Management of a painful or contracted hip dislocation in individuals with severe spastic quadriplegia is difficult. Clinical and radiographic results of 12 proximal femoral resection-interposition operations performed in seven non-ambulatory persons (five males, two females; mean age 14 years, 8 months; age range 6 years 11 months to 19 years 8 months) with severe spasticity were reviewed to determine if pain relief and restoration of motion were maintained. At a mean follow-up of 7 years 7 months (median 9 years 6 months) all participants maintained a good sitting position and a functional range of motion with improved hygiene. Hip pain was improved in all participants compared with their preoperative status. Proximal femur migration occurred causing slight pain in one person. Heterotopic ossification was observed but was not clinically significant. Complications included traction pin loosening and infection and a late supracondylar femur fracture 3 months after the operation. Proximal femoral resection effectively decreased pain and restored hip motion in those with severe spastic quadriplegia leading to improved sitting and perineal care.

Activities of Daily Living↗

PubMed2005

Sudden quadriplegia after acute cervical disc herniation.

BACKGROUND: Acute neurological deterioration secondary to cervical disc herniation not related to external trauma is very rare, with only six published reports to date. In most cases, acute symptoms were due to progression of disc herniation in the presence of pre-existing spinal canal stenosis. CASE REPORT: A 42-year-old man developed weakness and numbness in his arms and legs immediately following a sneeze. On physical examination he had upper motor neuron signs that progressed over a few hours to a complete C5 quadriplegia. An emergent magnetic resonance imaging study revealed a massive C4/5 disc herniation. He underwent emergency anterior cervical discectomy and fusion. Postoperatively, the patient remained quadriplegic. Eighteen days later, while receiving rehabilitation therapy, he expired secondary to a pulmonary embolus. Autopsy confirmed complete surgical decompression of the spinal cord. CONCLUSIONS: Our case demonstrates that acute quadriplegia secondary to cervical disc herniation may occur without a history of myelopathy or spinal canal stenosis after an event as benign as a sneeze.

Adult↗

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↗

PubMed1994

Two methods of weaning persons with quadriplegia from mechanical ventilators.

Two commonly-used methods of weaning individuals with quadriplegia from mechanical ventilators were compared. The medical records were reviewed of 52 patients who were injured at the C3 or C4 levels, were ventilator dependent following their injury, and were treated at the participating facilities. The study subjects had a total of 82 separate wean attempts: 26 utilized intermittent mandatory ventilation, 34 used progressive ventilator-free breathing (T-piece weaning) and 22 used either a combination of these approaches or a different approach. With an overall weaning success rate of 83%, this study demonstrated that individuals with C3 and C4 quadriplegia are indeed candidates for ventilator weaning. Comparing the two weaning methods, progressive ventilator-free breathing was found to be successful more often than intermittent mandatory ventilation (67.6% compared to 34.6%). In addition, progressive ventilator-free breathing appeared superior in its ability to provide a more functional alternative to individuals unable to wean completely.

Adolescent↗

PubMed1994

The effect of exercise training on pulmonary function in persons with quadriplegia.

The purpose of this study is to determine if measures of pulmonary function are different between endurance trained and nontrained groups of persons with quadriplegia. After minimum criteria were met, 57 subjects with spinal cord injuries ranging from C5-T1 were surveyed to determine type, duration and intensity of exercise training for the previous 6 months. Subjects were assigned to the trained or untrained groups based on the operational definitions of 'trained' vs 'untrained'. A computerized spirometer was used to test forced vital capacity (FVC), forced mid-expiratory flow (FEF25-75%) and maximum voluntary ventilation (MVV) as indicators of respiratory muscle strength, airway patency and respiratory muscle endurance, respectively. Independent t tests and Wilcoxon-Mann-Whitney nonparametric tests revealed no significant differences between the 'trained' and 'untrained' groups for the pulmonary functions. Correlation analysis revealed a moderate relationship (r = 0.498; p < or = 0.0001) between a derived continuous variable called the weighted training equivalent (WTE) and FVC. Regression analysis revealed that WTE and level of injury accounted for approximately 30% of the variance of FVC with WTE contributing 25%. Exercise training may positively affect FVC in persons with quadriplegia.

Adult↗

PubMed2002

Long-term follow-up of pacing of the conditioned diaphragm in quadriplegia.

The authors have previously shown that conditioning of the diaphragm for continuous bilateral pacing is a feasible and effective means of ventilation in patients with complete respiratory paralysis from high cervical (above C3) quadriplegia. The present study reports the long-term results of continuous diaphragmatic pacing. Twelve quadriplegia patients underwent bilateral phrenic nerve pacemaker placement and diaphragm conditioning from 1981 to 1987. Pacing was initiated at 11 Hz and progressively decreased to 7.1 Hz. A pulse train duration of 1.3 seconds for adults and 0.9 seconds for children was used. Long-term follow-up information obtained included pacing status (full-time, part-time, or mechanical ventilation), ventilation parameters, and social circumstances. Of the 12 patients, 6 continued to pace full time (mean 14.8 years); all were living at home. Three patients paced for an average of 1.8 years before stopping; two were institutionalized. One patient who paced full time for 6.5 years before lapsing to part time, lived at home. Two patients were deceased; one paced continuously for 10 years before his demise, the other stopped pacing after 1 year. Patients who stopped full-time pacing did so mainly for reasons of inadequate social or financial support or associated medical problems. All patients demonstrated normal tidal volumes and arterial blood gases while pacing full time. Despite theoretical concerns about long-term nerve damage, no patient lost the ability to pace the phrenic nerve. Threshold currents did not increase over time (original/follow-up: 0.46/0.47 for right, 0.45/0.46 for left), nor did maximal currents (original/follow-up: 1.16/1.14 for right, 1.37/1.26 for left). This follow-up confirms that quadriplegic patients are able to meet long-term, full-time ventilation requirements using phrenic nerve stimulation of the conditioned diaphragm. Careful review of diaphragmatic pacing candidates with respect to associated medical conditions, social support, and motivation is essential for appropriate patient selection and successful long-term results.

Adolescent↗

PubMed1994

Compression syndrome involving the lateral antebrachial cutaneous nerve in high level quadriplegia.

This report describes an etiology for a compression syndrome involving the lateral antebrachial cutaneous nerve (LACN) that is unique to high level quadriplegia. Two cases are presented that involve this syndrome in C5-C6 quadriplegia. Electrodiagnostic techniques and normal values have previously been established for the LACN, but not involving high-level spinal cord injured patients. A series of asymptomatic high-level quadriplegics at various times since their spinal cord injury was studied for appropriate comparison with the symptomatic cases and previously reported normal values. In the cases described, electrodiagnostic evidence of compression was documented and a diagnostic block was performed by injecting a local anesthetic at Olson's point. Once the diagnosis was established, injection with a long-acting local anesthetic and corticosteroid was therapeutic.

Arm↗

PubMed1994

Waist and neck enlargement after quadriplegia.

Changes in waist and neck size in quadriplegic patients after paralysis, noted clinically, were assessed systematically. Twenty quadriplegic men, aged 60 +/- 13 years (mean +/- 1 SD) and 20 neurologically intact men, aged 63 +/- 17 years, selected by absence of weight gain, were questioned about changes in their waist and shirt collar sizes since the onset of paralysis (20 +/- 13 years) or during the previous 20 years for control subjects. Waist size expanded 7.0 +/- 0.3 inches for quadriplegic and 1.7 +/- 1.7 inches for control subjects (p < 0.001). Changes in neck size of 0.7 +/- 1.1 inches for quadriplegic and 0 +/- 0.7 inches for control subjects were found (p < 0.02). We conclude that quadriplegia is often followed by increased waist and neck size. These changes may relate to the impaired breathing mechanisms in quadriplegia.

Abdominal Muscles↗

PubMed1979

Increasing sensory and motor stimulation for the patient with quadriplegia.

The common perception about the individual with quadriplegia (having a lesion at C5 and above) as a fragile, immobile, and medically unstable individual is in direct conflict with the concept of successful rehabilitation. Long hospitalizations, constant medical attention, and profound physical dependence often work against the efforts of those providing rehabilitation to ease the patient's transition back to as normal a life style as possible. This paper describes a successfully executed sensory and motor stimulation program, designed to meet the needs of the sensory-deprived individual with quadriplegia and to deemphasize the perception of both physical and psychological fragility.

Adult↗

PubMed1988

Biofeedback to facilitate unassisted ventilation in individuals with high-level quadriplegia. A case report.

The purpose of this case report is to discuss the effectiveness of electromyographic biofeedback in reeducating and strengthening the accessory breathing muscles in an individual with high-level (C1) complete quadriplegia. Six unassisted breathing sessions were performed with EMG biofeedback intervention. Six unassisted breathing sessions without EMG biofeedback intervention were also performed. In both conditions, the subject's vital capacity and the amount of time of unassisted ventilation were recorded. The study results indicated that EMG biofeedback may be a helpful modality in training accessory breathing muscles to enable an individual with high-level quadriplegia to become independent of mechanical ventilation for varying amounts of time.

Adult↗

PubMed1996

Quadriplegia after lumbar disc surgery. A case report.

STUDY DESIGN: Case report. OBJECTIVE: To report a case of quadriplegia after surgery in the prone position for a herniated lumbar disc. SUMMARY OF BACKGROUND DATA: Ischemia in the vascular territories of the vertebral arteries after back surgery in the prone position is rare. Degenerative changes of the cervical spine or decreased blood flow to the head with mechanical vessel obstruction during extreme neck movements, systemic hypotension, and thromboembolism have mostly been implicated in the pathogenesis. METHODS: The case of a 33-year-old man undergoing surgery for an unilateral single level disc herniation at L4-L5 is presented. Within a few hours after surgery he developed quadriplegia and signs of occipital lobe dysfunction. He underwent magnetic resonance imaging investigation. Therapy included arterial blood pressure control, low molecular dextran, dexamethasone, bladder catheterization, and physiotherapy. RESULTS: Magnetic resonance imaging demonstrated intramedullary ischemic changes in the cervical spinal cord and at the borderline between anterior and posterior circulation. Outcome after 2 years is fair regarding the severe initial deficit-the patient walks alone with a cane and bladder function is under control. He is employed in a sedentary job. CONCLUSIONS: The authors believe that a temporary mechanical occlusion of a vertebral artery led to stasis, formation of thrombi, and subsequent embolism in the vertebrobasilar vascular territory. Extreme head rotation and neck extension is to be avoided in the prone position.

Adult↗

PubMed2003

Quadriplegia in a 10 year-old boy due to multiple cervical neurofibromas.

STUDY DESIGN: A case report of a child with quadriplegia as a result of neurofibromatosis type I who had cervical laminectomy for spinal cord decompression followed by occipitocervical instrumentation is described. OBJECTIVES: To describe the consequences of severe neurofibromatosis type I and an effective surgical technique of occipitocervical instrumentation. SUMMARY OF BACKGROUND DATA: Neurofibromatosis type I is one of the most commonly inherited genetic disorders in the human population. Extensive intraspinal involvement by neurofibromas can cause significant distortion of normal spinal structure as well spinal cord compression. Extensive laminectomy (with subsequent risk of postsurgical kyphosis) is often required for adequate decompression of the spinal cord. METHODS: The clinical and radiographic presentation of a child with severe neurofibromatosis type I resulting in quadriplegia is described. The severe neurologic deficit was caused by compression of the spinal cord by intraspinal neurofibromas. Extensive laminectomy was required to adequately decompress the spinal cord. Occipitocervical fusion from the occiput to C6 was done to stabilize the spine and prevent future kyphosis. RESULTS: Decompression of the spinal cord led to complete neurologic recovery, and instrumentation of the cervical spine was successful in preventing the development of postlaminectomy kyphosis in this pediatric patient. CONCLUSIONS: The reported case emphasizes the need for treating acute neurologic symptoms caused by spinal cord compression in neurofibromatosis type I as well as addressing the future risk of spinal deformity following laminectomy.

Cervical Vertebrae↗

PubMed1987

Spinal cord dysfunction with quadriplegia complicating pneumococcal meningitis.

A case of pneumococcal meningitis complicated by brain-stem herniation and flaccid quadriplegia is described, from which the patient, an 11 year old boy, made a partial recovery. The patient had suffered a head injury with skull fracture some years previously; this was his third episode of meningitis. The aetiology of the quadriplegia has not been fully established, but is presumed to be of vascular nature at spinal cord level, associated with an acute hypotensive episode. Preventative aspects of recurrent bacterial meningitis and brain-stem herniation following lumbar puncture are stressed.

Child↗

PubMed1992

Oxygen cost of resistive-loaded breathing in quadriplegia.

We hypothesized that, in quadriplegia, chest wall distortion would increase the energy cost of ventilation. To assess this, we measured the oxygen cost of breathing (VO2 resp) and changes in chest wall configuration during inspiratory resistive-loaded breathing tasks in five quadriplegic and five normal subjects. Each subject performed three breathing tasks that spanned a range of work rates (Wtot). Configurational changes of the abdomen and upper, lower, and transverse rib cage were assessed with magnetometers. We found that 1) in both groups, VO2resp increased linearly with Wtot over the range of tasks performed, 2) the mean slope of the regression line of VO2resp vs. Wtot was greater for quadriplegic than for normal subjects (3.7 +/- 0.8 vs. 2.0 +/- 0.7 ml O2/J, P less than 0.01), 3) efficiency of breathing (Wtot/VO2resp) was less for quadriplegic than for normal subjects (1.9 +/- 0.6 vs. 3.5 +/- 1.4%, P less than 0.001), 4) during inhalation, upper and lower rib cages behaved similarly in the two groups, but the quadriplegic subjects had a decrease in transverse rib cage and a much greater increase in abdomen than normal subjects, and 5) functional residual capacity decreased in normal but not in quadriplegic subjects during the breathing tasks. We conclude that the lesser efficiency of breathing in quadriplegia may be related to the elastic work of chest wall distortion, shorter mean operational diaphragm length, and possibly differences between normal and quadriplegic subjects in mechanical advantage of available inspiratory muscles.

Adult↗

PubMed1991

Bronchial mucus hypersecretion in acute quadriplegia. Macromolecular yields and glycoconjugate composition.

In acute quadriplegia we have noted that about one in five patients develops unexplained production of markedly excessive and tenacious bronchial mucus. Spontaneous recovery from mucus hypersecretion usually occurs within weeks to months. Mucus samples collected from 12 patients have been found to be abnormal. Macromolecular contents of single aspirates yielded as much as 500 mg. Analytical ultracentrifuge analysis showed the mucus to contain considerable epithelial glycoprotein (GP) of typical buoyant density; its amino acid and carbohydrate compositions were characteristic of the GP from hypersecretory bronchial mucus such as in chronic bronchitis and cystic fibrosis. In five patients studied after recovery from hypersecretion, there tended to be relatively less GP. The mucus samples contained a high density glycoconjugate (GC): this had sugars of GP but also reacted positively with a monoclonal antibody to keratan sulfate. Its amino acid composition was different from that of GP: threonine was lower and glycine was higher than in GP. In mucus from one patient who died, chondroitin sulfate ABC and hyaluronic acid were identified as well. This suggests proteoglycans are involved in the pathophysiology of mucus hypersecretion. The sudden onset and spontaneous recovery of hypersecretion suggests that it is not due to gland hypertrophy. We speculate that in acute quadriplegia it is due to disturbed neuronal control of bronchial mucus gland secretion, perhaps related to initial disappearance and later reappearance of peripheral sympathetic nervous system tone.

Acute Disease↗

PubMed2002

Respiratory sensation and ventilatory mechanics during induced bronchoconstriction in spontaneously breathing low cervical quadriplegia.

Intensity of dyspnea during induced bronchoconstriction in asthma is strongly related to the reduction in inspiratory capacity (IC) as a result of dynamic hyperinflation. To determine the role of rib cage and intercostal muscle afferents in symptom perception during bronchoconstriction, we measured the relationship between dyspnea intensity and IC during induced bronchoconstriction in six subjects with complete C4-C7 quadriplegia who did not require assisted ventilation. Spirometry, lung volumes, breathing pattern, esophageal pressure (Pes), and dyspnea intensity (Borg Scale) were measured during high-dose methacholine bronchoprovocation up to 256 mg/ml or a maximum change (Delta) in FEV(1) of 50%. Contemporaneous control data from subjects with asthma (n = 12) who had completed the same protocol were used for comparison. At maximum response in quadriplegia, FEV(1) decreased by 1.42 +/- 0.18 L (62 +/- 4%predicted) (mean +/- SEM), and IC decreased by 0.89 +/- 0.12 L (30 +/- 4%predicted). Dyspnea at maximum response was rated "moderate" to "severe": Borg 3.6 +/- 0.3. The predominant qualitative respiratory sensations were inspiratory difficulty and unsatisfied inspiration. The best correlate of dyspnea (Borg) was DeltaIC(%predicted) (p < 0.0005), whereas changes in FEV(1), Pes-derived measurements and breathing pattern did not contribute further to the strength of this relationship. Dyspnea intensity, quality, and changes in spirometry and lung volumes at maximum response were similar to those reported previously in asthma. The relationship between dyspnea intensity and DeltaIC(%predicted) was linear and consistent across groups. We conclude that the quality and intensity of dyspnea during methacholine-induced bronchoconstriction and dynamic hyperinflation was not altered by extensive chest wall deafferentation.

Adult↗