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PubMed1990

Electromyographic analysis of brachioradialis to flexor pollicis longus tendon transfer in quadriplegia.

Electromyography was done in patients at the C6 level of quadriplegia after transfer of the brachioradialis to the flexor pollicis longus to restore lateral pinch and transfer of the posterior deltoid to the triceps to restore elbow extension. The relationship of the integrated electromyogram to pinch force during a graduated isometric contraction enabled characterization of the motor recruitment pattern. After tendon transfer, the pattern of the electromyographic response for the brachioradialis was the same as in the flexor pollicis longus in normal subjects, and the posterior deltoid after transfer to the triceps fired synergistically with the brachioradialis. These findings indicate reeducation of transferred muscles occurred after surgery and that they functioned as active primary motors.

Adult↗

PubMed1995

Monozygotic twin patients with congenital ichthyosis, microcephalus, spastic quadriplegia, myoclonus, and EEG abnormalities.

A pair of monozygotic twins manifested widespread ichthyosis on the trunk and extremities, mainly on the extensor surface of the lower legs. Both patients had severe developmental retardation, microcephalus, spastic quadriplegia, myoclonus, and hearing impairment. Cranial computed tomography and magnetic resonance imaging revealed diffuse cortical atrophy. Electroencephalography documented diffuse slow wave dysrhythmia and marked epileptic discharges, namely bilateral occipital dominant, and low-voltage multifocal spikes which appeared asynchronously as a burst, mainly during sleep. Skin biopsy revealed hyperkeratosis with parakeratosis. Granular cell layer was not thickened and diminished. Papillomatosis was absent. Electron microscopy did not reveal any distinctive abnormalities. Sjögren-Larsson syndrome and other known ichthyosis syndromes were excluded because of the difference in localization of skin lesions, skin manifestations, lack of papillomatosis, the nature and severity of neurologic symptoms and marked electroencephalographic abnormalities.

Diseases in Twins↗

PubMed2005

A case of hearing loss and quadriplegia after a pontine hemorrhage.

We herein describe the case of a 50-year-old female who developed a pontine hemorrhage with consciousness disturbance and quadriplegia. Her respiratory condition was so bad that she needed to be intubated and put on artificial respiration. After her consciousness and respiratory condition gradually recovered, we noticed that she had developed a bilateral hearing loss. The auditory brain stem response test revealed only I waves on both sides, thus suggesting that her hearing loss had been caused by an injury to the hearing-conducting pathway including the cochlear nuclei. In this case, the hematoma extended from the lower to the upper part of pons and, furthermore, it was also located broadly in the dorsal part of the pons. As a result, the cochlear nuclei and corpus trapezoideum appeared to have been destroyed by the hematoma. However, since most cases with a brain stem hemorrhage showing bilateral hearing loss tend to be in a severe condition, this condition is often easy to overlook. We should therefore carefully evaluate patients' reaction to hearing stimulation to avoid overlooking any hearing loss in such patients.

Evoked Potentials, Auditory, Brain Stem↗

PubMed1986

Paraplegia and quadriplegia: special considerations during pregnancy and labor and delivery.

Patients with spinal cord injury resulting in paraplegia or quadriplegia increasingly desire to bear children. Management by a health care team attentive to the special problems that may complicate pregnancy offers the best chance for a successful pregnancy outcome. Life-threatening autonomic hyperreflexia may occur in patients with lesions above the T5-6 level. Precautions should be taken to avoid an unsupervised delivery. Vaginal delivery is appropriate unless there is an obstetric indication for cesarean section. Surveillance for urinary tract infection, anemia, and skin ulcers is advisable.

Autonomic Nervous System↗

PubMed2003

Late quadriplegia after adult coarctation repair.

Quadriplegia developed suddenly 1 month after coarctation repair in a 53-year-old human. Cervical cord ischemia caused by thrombosis in an enlarged anterior spinal artery collateral was diagnosed on magnetic resonance scan and spinal angiography. After urgent cord decompression and anticoagulation there was neurologic improvement over a period of several months. Urgent investigation of neurologic abnormalities occurring late after coarctation repair may enable intervention to avert permanent neurologic sequelae.

Angiography↗

PubMed1995

Effect of body training position on outcomes of an aerobic training study on individuals with quadriplegia.

The use of the supine training position to enhance aerobic training was evaluated in a 10-week upper-body exercise study. Fourteen subjects with quadriplegia (QD) were matched on initial peak power output (PO) values and then randomly assigned to either a supine (SUP, n = 7) or sitting (SIT, n = 7) training group. Peak VO2 and PO were measured pretraining and posttraining in both the supine and sitting positions. There were significant (p < .01) increases in peak VO2 (720 to 780 mL.min-1) and PO (29.3 to 33.3W) with training. Although the SIT group exhibited a small training effect size (0.1), while the SUP group exhibited a moderate effect size (0.6), the interaction between time and training group failed to reach significance (p = .07) because of a large injury level-related variation in VO2. The training effect achieved by the SUP group generalized to the sitting position, as their peak VO2 increased 80mL.min-1 in the sitting position. Endurance improved (p < .0001) in all subjects, with time to exhaustion increasing from 52min to 135min over the 10 weeks of training. The sum of 4 skinfolds decreased (p < .05) from 67.5 to 61.0mm. The lack of change in stroke volume at rest and at 50% of peak PO suggests that an inotropic adaptation of the heart, commonly observed in subjects without SCI, did not occur in this population. However, a 4.7bpm increase (p < .01) in resting heart rate (HR) and a near significant increase (p = .07) in peak HR from pretraining to posttraining suggests a training-induced chronotropic adaptation of the heart. Although improvements in aerobic capacity can be achieved by training in either supine or sitting positions, the training effect size was larger in the supine position. Improvements in SV were not observed in either training position; this may be because of low absolute workloads were used. Central cardiovascular adaptation may occur in subjects with QD but changes are reflected as chronotropic and not inotropic adaptations.

Adolescent↗

PubMed1995

Transient traumatic quadriplegia in a 29-year-old man without predisposing anatomic lesion.

A 29-year-old man presented 45 minutes after sustaining a blow to the right side of his head when his motorcycle slid on gravel and flipped on the side of the road. After walking away from the accident, the patient noted burning pain in his neck. Shortly thereafter, complete quadriplegia with a sensory level at C4 developed. The patient was given a high dose of methylprednisolone and transferred to a tertiary care center. En route, neurological testing demonstrated rapid improvement, and on arrival, all abnormal motor and sensory findings had completely resolved. Radiographic examination and magnetic resonance imaging of the entire spine showed no abnormality. Torg's ratio was > 1 at vertebral level C3 through C6. There was no evidence of developmental stenosis, congenital fusion, cervical instability, or intervertebral disk protrusion.

Accidents, Traffic↗

PubMed1992

Quadriplegia after chiropractic manipulation in an infant with congenital torticollis caused by a spinal cord astrocytoma.

An infant with congenital torticollis underwent chiropractic manipulation, and within a few hours had respiratory insufficiency, seizures, and quadriplegia. A holocord astrocytoma, with extensive acute necrosis believed to be a result of the neck manipulation, was found and resected. We believe that every child with torticollis, regardless of age, should undergo neurologic and radiologic evaluation before any form of physical treatment is instituted.

Astrocytoma↗

PubMed1992

Decrease in gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula.

The gastric emptying times associated with three whey-based formulas were significantly shorter than that associated with a casein-based formula in nine gastrostomy-fed patients with spastic quadriplegia (p less than 0.001). Patients fed whey-based formulas had significantly fewer episodes of emesis than when they were fed casein-based formula (p less than 0.001). We conclude that whey-based formulas reduce the frequency of emesis by improving the rate of gastric emptying.

Adolescent↗

PubMed1987

Effect of triceps function on the brachioradialis transfer in quadriplegia.

Fifteen patients with traumatic quadriplegia who had transfer of the brachioradialis to the flexor pollicis longus were evaluated to determine the influence of triceps function on pinch strength. Pinch was measured with the elbow free and with the elbow locked at 90 degrees in an orthosis that served as an external means of blocking elbow flexion in those patients with impaired triceps strength. Those patients having two foot-pounds or less elbow extension torque had an average pinch of 1.20 kg without elbow immobilization. With the elbow immobilized, pinch strength increased 153%, averaging 3.04 pounds. Those patients having more than two foot-pounds elbow extension torque had an average pinch of 4.08 pounds with the elbow free and pinch strength was not improved by immobilization in the orthosis. The absence of triceps function significantly decreases the effectiveness of the brachioradialis when used to motor a tendon transfer. Surgical procedures, such as posterior deltoid to triceps transfer, which provide active elbow extension can be expected to significantly increase the pinch strength supplied through the brachioradialis transfer in patients without voluntary elbow extension.

Arm↗

PubMed2001

[Quadriplegia secondary to potassium depletion].

Muscle paralysis due to potassium depletion are unusual. We report the case of a patient who developed quadriplegia and language disorders due to potassium depletion, following large intestinal resection. Potassium supplementation was given intravenously at a rate of 0.25 mmol.kg-1.h-1 during the first 48 h. This allowed complete total and rapid recovery from the paralysis.

Electroencephalography↗

PubMed1989

[Hypokalemic quadriplegia and coma in renal tubular acidosis].

A case is reported of an acute episode of severe hypokalaemia (K+ = 1.1 mmol.l-1) associated with hyperchloraemic acidosis and simultaneous high urine pH (pH = 7) in a 24 year old woman with type I distal tubular acidosis and nephrocalcinosis. The flaccid paralysis involved the trunk, neck, facial and pharyngeal muscles. She was in areflexic quadriplegia, coma and respiratory failure requiring endotracheal intubation and positive pressure ventilation. There were no cardiac disturbances, presumably because of the chronic potassium depletion, the patient's youth and healthy myocardium. Despite the usually recommended maximal potassium infusion rate (0.25 mmol.kg-1.h-1), there was a transient worsening of her neuromuscular status. Only 12 h later, the first movements were noticed. In order to prevent such a deterioration, a more rapid potassium infusion could have been used. However, in our case, the occurrence of hypokalaemic extrasystoles was reduced and the patient was still intubated and ventilated. It was therefore decided not to run the risk of myocardial inexcitability carried out with supramaximal infusion rates and to keep the usual protocol. Besides, several pitfalls have to be avoided during the treatment of the numerous metabolic disorders coexisting with severe hypokalaemia, such as metabolic acidosis and hyperglycaemia.

Acidosis, Renal Tubular↗

PubMed1986

Arteriovenous shunting in quadriplegia.

Arterio-venous shunting has been demonstrated in the limbs of ten subjects with traumatic quadriplegia, as shown by increased venous oxygen concentration and a Doppler sonogram pattern indicative of continuous forward flow. This phenomenon is similar to that seen in the diabetic neuropathic foot, suggesting that autonomic dysfunction is a major factor in the development of foot ulceration in the quadriplegic and in the diabetic.

Foot↗

PubMed1986

The Quadriplegia Index of Function (QIF): sensitivity and reliability demonstrated in a study of thirty quadriplegic patients.

The Quadriplegia Index of Function (QIF) was originally developed by the authors in 1980 because the popular Barthel Index was deemed too insensitive to document the small but significant functional gains made by quadriplegics (tetraplegics) during medical rehabilitation. The QIF has now been tested on a group of 30 complete quadriplegic patients at admission to and discharge from inpatient medical rehabilitation. Resultant scores were compared to those simultaneously obtained by the Barthel Index and the Kenny Self-Care Evaluation. The QIF was found to be more sensitive (46 per cent improvement as opposed to 30 per cent by the Kenny Self Care Evaluation and 20 per cent by the Barthel Index). The QIF was also tested for reliability. Ratings by three different nurses, working independently, were found to be significantly positively correlated for all sub-scores (p less than .001). We conclude that the QIF provides a useful option in choosing a functional assessment instrument for use with quadriplegic patients.

Activities of Daily Living↗

PubMed1989

'Duplicate limbs' sensation in acute traumatic quadriplegia.

A 64-year-old man sustained acute quadriplegia due to a traffic accident, while in the midst of a petit mal seizure. After recovery from the initial medical complications he developed a duplicate limb phenomenon. The patient felt that another pair of upper and lower limbs had grown from his body, parallel to the paralysed limbs. To the best of our knowledge this duplicate phenomenon in all limbs has not been described before in a traumatic quadriplegic patient. It is our impression that this phenomenon is a rare example of preoccupation with the paralytic limbs, of sensory deprivation with a (possible) unusual drug reaction.

Humans↗

PubMed1991

Myotonic dystrophy and traumatic quadriplegia: case report.

A thirty-year-old man with traumatic quadriplegia, was also found to have weakness above the level of the injury. He had facial weakness, difficulty in swallowing, and recurrent respiratory problems. A diagnosis of myotonic dystrophy was supported by examination of his sister. The problems of diagnosis, and the implications of the diagnosis on the management of the patient with myotonic dystrophy and a spinal injury are discussed.

Adult↗

PubMed1999

Development of a short-form Quadriplegia Index of Function scale.

OBJECTIVE: To develop a short-form version of the Quadriplegia Index of Function (QIF) that would be more practical to use than the original version. DESIGN: Cross-sectional data collected at 6 months post spinal cord injury. SETTING: Regional Spinal Cord Injury Center. PATIENTS: Consecutive sample of 95 patients with tetraplegia, non-ambulatory at 6 months, admitted to a regional SCI center between December 1987 and August 1992. METHODS: A short-form QIF was developed by using regression analysis to determine the best six items that would predict the sum of the 37 items selected from seven mobility and self-care categories of the original scale. This short-form QIF was evaluated for internal consistency and discriminant validity. Validity of the short-form QIF was assessed by correlation with motor scores and using analysis of variance by motor levels and motor score groupings. RESULTS: Regression analysis identified the following items as best predictors of the 37-item QIF score: (1) wash/dry hair, (2) turn supine to side in bed, (3) put on lower body clothing, (4) open carton/jar (feeding), (5) transfer from bed to chair, and (6) lock wheelchair. These items explained 99% of the variance in total scores. Short-form QIF scores (simple sum of the six best items) ranged from 0 to 24, with a median score of seven, interquartile range 0-16. Item response patterns were largely dichotomous. Item-total correlations ranged from 0.60 to 0.80; Cronbach's alpha was 0.89. Spearman correlation coefficient between upper extremity motor score and short-form QIF was 0.82. Analysis of variance indicated that the motor score groupings and motor levels accounted for 63 and 54% of the variance in short-form QIF scores, respectively. Post hoc analyses indicated that motor levels from C5 to T1 had different mean QIF scores, except for C7 versus C8. There may be ceiling effects for individuals with low level injuries. CONCLUSION: There is significant redundancy in the QIF. Six items, selected from five categories, yield results comparable to the 37-item QIF. The short-form QIF must next be assessed for sensitivity to change. A brief disability measure would improve data quality and completeness, and may permit ongoing collection of observational rather than self-report data.

Activities of Daily Living↗

PubMed2000

Flaccid quadriplegia from tonsillar herniation in pneumococcal meningitis.

A young woman with fulminant pyogenic meningitis became quadriplegic, areflexic and flaccid due to herniation of the cerebellar tonsils and compression of the upper cervical cord. This state of spinal shock was associated with absent F-waves. Intracranial pressure was greatly elevated and there was an uncertain relationship of tonsillar descent to a preceding lumbar puncture. Partial recovery occurred over 2 years. Tonsillar herniation can cause flaccid quadriplegia that may be mistaken for critical illness polyneuropathy. This case demonstrates cervicomedullary infarction from compression, a mechanism that is more likely than the sometimes proposed infectious vasculitis of the upper cord.

Adult↗