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At least 109 records · Page 6Linked to original sources

PubMed1984

Ventilatory support by pacing of the conditioned diaphragm in quadriplegia.

We provided full-time ventilatory support in five patients with respiratory paralysis accompanying quadriplegia by continuous electrical pacing of both hemidiaphragms simultaneously for 11 to 33 months through the application to the phrenic nerves of a low-frequency stimulus. The strength and endurance of the diaphragm muscle increased with pacing. Biopsy specimens taken from two patients who had uninterrupted stimulation for 6 and 16 weeks showed changes suggestive of the development of fatigue-resistant muscle fibers. When we compared these results with those of our earlier experience with intermittent unilateral stimulation of the diaphragm in 17 patients with respiratory paralysis, we found that continuous bilateral pacing using low-frequency stimulation appeared to be superior because of more efficient ventilation of both lungs, fewer total coulombs required to effect the same ventilation, and absence of myopathic changes in the diaphragm muscle. For patients with respiratory paralysis and intact phrenic nerves, continuous simultaneous pacing of both hemidiaphragms with low-frequency stimulation and a slow respiratory rate is a satisfactory method of providing full-time ventilatory support.

Adolescent↗

PubMed1985

Enhancement of two motor functions of the lower extremity in a child with spastic quadriplegia.

This single-subject experimental design examined the immediate effects of four neurodevelopmental treatment (NDT) activities on two dependent variables: dorsiflexor muscle activity during an equilibrium response and frequency of heel contact during movement to a standing position. The subject was a 2.5-year-old boy with spastic quadriplegia. During the seven days of Baseline 1 Phase, the nine days of Treatment Phase, and the seven days of Baseline 2 Phase, dorsiflexor muscle activity was examined using an EMG instrument with surface electrodes. Frequency of heel contact was recorded as the number of times in seven trials that the child came to a standing position with his heel contacting the floor. Conditions were identical across all three phases except that four NDT activities were introduced during the Treatment Phase and were withdrawn during the Baseline 2 Phase. The results demonstrated that these NDT activities increased dorsiflexor muscle activity during a posterior equilibrium reaction and increased the frequency of heel contact when the child came to a standing position. This study contributes to the growing body of literature in NDT.

Biofeedback, Psychology↗

PubMed1988

Effect of arm ergometry training on wheelchair propulsion endurance of individuals with quadriplegia.

Arm cycle ergometry has been shown to be an effective mode of cardiopulmonary training for individuals with spinal cord injuries. Arm cycle ergometry training results in an increased maximal oxygen uptake, exercise-induced bradycardia, and increased physical work capacity. Whether improvements in cardiopulmonary function parallel improvements in functional endurance, however, is unknown. In addition, no readily available tool to evaluate improvements in functional endurance has been identified. The purpose of this investigation was to determine the effects of arm cycle ergometry training on the wheelchair propulsion endurance of individuals with spinal cord injuries. Eight adult men with quadriplegia were evaluated before and after eight weeks of arm cycle ergometry training. A modified Cooper's 12-minute run-walk test, a sustained wheelchair propulsion task, was used to document improvements in functional endurance. Submaximal exercise heart rate, physical work capacity, and maximal oxygen uptake were used to document improvements in cardiopulmonary function. The results demonstrate that improvements in cardiopulmonary function parallel increases in wheelchair propulsion endurance. A sustained 12-minute wheelchair propulsion task is shown to be a readily available tool in the evaluation of functional endurance of individuals with spinal cord injuries. The improvements in wheelchair propulsion endurance should assist the individual in completing activities of school, work, recreation, and daily living.

Activities of Daily Living↗

PubMed1988

Rehabilitation outcomes in complete C5 quadriplegia.

Establishment of rehabilitation goals for spinal cord injury patients generally has been based on the degree of residual motor function. Despite extensive clinical experience with spinal cord injury rehabilitation, there have been no reports of the ability of C5 quadriplegic patients to perform self-care and mobility skills before and after rehabilitation. This study was designed to examine the rehabilitation outcomes of 63 patients with C5 complete quadriplegia, who completed an interdisciplinary inpatient rehabilitation program, using the 100-point modified Barthel Index as a means of rating functional status. There were statistically significant increases in the mean modified Barthel index scores from 7.1 on admission to 28.9 on discharge for the entire group of patients. The self-care subscore increased significantly from 6.5 on admission to 20.0 on discharge and the mobility subscore increased significantly from 0.5 on admission to 8.9 on discharge. Ability to perform self-care and mobility subscore tasks is described. This study documented significant improvements in function during comprehensive rehabilitation among patients with C5 spinal cord injury.

Activities of Daily Living↗

PubMed1993

Drug-induced dystonia in a patient with C4 quadriplegia. Case report.

Prochlorperazine, a piperazine phenothiazine, is a commonly used anti-emetic that blocks dopamine receptors in the central nervous system. Prochlorperazine causes various extrapyramidal syndromes, with the incidence in the inpatient population estimated to be 0.5 to 0.8%. These side effects are typically manifested by motor dysfunction and easily observed on physical examination. We report the case of an 18-year-old male with C4 complete quadriplegia who developed an acute dystonic reaction isolated to the tongue during short-term treatment with prochlorperazine. This case demonstrates the importance of maintaining a high level of suspicion in the spinal cord population, considering that many key physical findings may be absent below the level of function.

Adolescent↗

PubMed1995

Candida mediastinitis and septic shock following occult esophageal perforation in a patient with posttraumatic quadriplegia.

Unexplained septic shock was ultimately shown to be caused by Candida mediastinitis after perforation of the cervical esophagus by a dislodged cervical methylmethacrylate construct in a 25-year-old patient with traumatic quadriplegia. Communication between the prevertebral abscess and pleural space further led to the formation of a esophageal-pleural-cervical fistula. Despite antibiotics, surgical removal of the construct, and drainage of the esophagus and mediastinum, the patient died from refractory shock and respiratory failure.

Adult↗

PubMed1996

Direct injury to the cervical spine of a child by a lap-shoulder belt resulting in quadriplegia: case report.

Most pediatric cervical spine injuries from seat-belt restraints result from hyperflexion of the neck without direct injury to the spine from the restraining device. We report what we believe to be the first case of direct injury to the cervical spine by the shoulder component of a lap-shoulder seat belt. This resulted in quadriplegia. The mechanism of injury and recommendations to obviate such injuries are discussed.

Accidents, Traffic↗

PubMed1997

Stingers, transient quadriplegia, and cervical spinal stenosis: return to play criteria.

This article focuses on sports related spinal cord and nerve injuries, ranging from mild "stinger" syndrome to complete quadriplegia. Particular emphasis is placed on recommendations for return to competition after such injuries. Cervical spinal cord symptoms after a spine injury from contact sports require a more precise work up to detect cervical spinal stenosis than radiographic bone measurements alone can provide. Imaging technology such as MRI, contrast positive CT, and myelography more accurately identify true spinal stenosis and allow for safer return to play decisions.

Athletic Injuries↗

PubMed1983

The posterior interspinous fusion in the treatment of quadriplegia.

The purpose of this report is to describe our experience with the posterior interspinous fusion in the treatment of spinal injury with quadriplegia. The charts and roentgenograms of 22 patients treated with this operation by the senior author (RW) from July 1978 to June 1981 were reviewed retrospectively. Follow-up averaged 19.5 months. All injured spines had significant posterior ligamentous damage. There were 14 fracture-subluxations, two unilateral facet dislocations, and six bilateral facet dislocations. The specific operative indications included six unacceptable closed reductions, nine failures of three-month trials in a halo vest, and seven cases of predominantly ligamentous injury. All fusions were solid by the third postoperative month. There were no non-unions. There was horizontal translational deformity (2.0 and 3.0 mm, respectively) within the fusion in two cases. In one case, there was an 18 degrees kyphosis within the fusion. Flexible kyphosis adjacent to the fusion, which averaged 16 degrees, was seen in five cases. The overall rate of neurologic recovery for this group was 32%. No patient lost function. Eliminating those patients who were complete quadriplegics preoperatively, the neurologic recovery rate was 77%. In comparison with the other treatments for cervical instability, posterior interspinous fusion is seen to be safe and effective.

Adolescent↗

PubMed2000

Neonatal infectious spondylitis of the cervical spine presenting with quadriplegia: a case report.

STUDY DESIGN: A case report.- OBJECTIVE: To highlight the evaluation and treatment of neonatal infectious spondylitis of the cervical spine. SUMMARY OF BACKGROUND DATA: Most authors advise intravenous antibiotics as first-choice treatment. The place of aspiration or operative drainage is debated, as is the position and duration of immobilization. METHODS: A 3-week-old neonate was presented with intermittent quadriplegia. RESULTS: Additional investigation demonstrated an osteolytic process in the body of C3 with a large epidural abscess compressing the spinal cord. Because an infectious spondylitis of C3 was suspected, aspiration of the abscess was performed, and antibiotic therapy was started. The patient improved to neurologically normal within 3 weeks and remains asymptomatic throughout a follow-up period of 7 years. CONCLUSIONS: Neonatal infectious spondylitis should be diagnosed early and treated promptly; otherwise, it may have devastating consequences.

Abscess↗

PubMed2003

An unusual case of CV junction tuberculosis presenting with quadriplegia.

STUDY DESIGN: Isolated tubercular involvement of craniovertebral junction in a human immunodeficiency virus-positive patient causing paraplegia and sudden death with radiologic features is presented. OBJECTIVES: Isolated involvement of craniovertebral junction by tuberculosis causing quadriparesis is a rare entity. The role of imaging features is presented in diagnosis of craniovertebral junction tuberculosis, which is a treatable disease. Early detection of this entity with prompt treatment can prevent a fatal outcome. SUMMARY OF BACKGROUND DATA: Tuberculosis of the cervical spine is a rare and potentially dangerous manifestation of extrapulmonary tuberculosis. The incidence is probably less than 1% of all cases of spinal tuberculosis. However, in the developing countries this constitutes an increasingly important cause of craniovertebral junction instability and cervicomedullary compression. Most of the patients present with pain in the neck and local tenderness. Neurologic deficits of varying degrees have been reported in 24-40% of cases of craniovertebral junction tuberculosis. Quadriplegia followed by sudden death is exceptional (as seen in our case). The incidence of craniovertebral junction tuberculosis in immunocompromised patients is not known. Dramatic recovery is possible if craniovertebral junction tuberculosis is detected early in its course. Prompt medical and surgical treatment may avert a potential catastrophic event in such cases. Imaging methods such as computed tomography and magnetic resonance imaging are diagnostic of this condition and aid in the detection and prompt treatment of the same. METHOD: Frontal radiograph of the cervical spine and chest, and lateral view of cervical spine followed by plain and contrast enhanced computed tomography scan of the cervical spine was performed to detect the lesion. RESULT: These radiographic features were correlated with the clinical findings. The computed tomography findings of bone destruction, prevertebral and extradural peripherally enhancing soft tissue and infiltrating opacities in the lung apexes were consistent with tuberculosis. CONCLUSIONS: The computed tomography findings described in this report are very specific for tuberculosis of the craniovertebral junction. Clinical and radiologic correlation could help in making the early diagnosis and prompt treatment possible.

Adult↗

PubMedDate not supplied

Goniometric reliability for a child with spastic quadriplegia.

Intrarater and interrater reliabilities were assessed for upper-extremity goniometric measurements of a 5-year-old girl with severe spastic quadriplegia. Percentage agreement was the method used to evaluate goniometric reliability of three motions bilaterally: shoulder flexion, shoulder abduction, and elbow extension. Intrarater reliability for each of the two raters was higher than interrater reliability. The mean differences and the range of differences between raters for each of the six motions measured also were recorded. There was wide variability in measurements both within and between raters. These results suggest that a difference of +/- 10-15 degrees in range of motion over time does not justify conclusions of either significant improvement or significant regression in a child with severe spastic cerebral palsy.

Cerebral Palsy↗

PubMed1986

Assessing sexual functions of the adult with traumatic quadriplegia.

The individual who sustains a spinal cord injury resulting in traumatic quadriplegia experiences a drastic alteration in his lifestyle from both physiological and psychological perspectives. The effects of spinal cord injury on a patient's sexuality will be explored according to Carrera's rule for optimum sexual functioning: all systems go, a positive self-image, and nurturing environment.

Adult↗

PubMed1977

Agenesis of the corpus callosum, infantile spasms, spastic quadriplegia, microcephaly and severe mental retardation in three siblings.

A sibship consisting of three siblings, one male and two females with unrelated parents, showed a clinical syndrome including: infantile spasms with hypsarrhythmia, microcephaly, severe mental retardation and spastic quadriplegia. The pneumoencephalogram performed in two sibs showed agenesis of the corpus callosum and aqueductal stenosis with tri-ventricular dilatation. The disorder did not show a progressive course with deterioration of mental and neurologic functions. No biochemical or cytogenetic defect could be identified. Complement fixation for cytomegalovirus was negative. This syndrome complex is probably inherited as an autosomal recessive trait. The clinical and the genetic aspects of the syndrome are discussed.

Abnormalities, Multiple↗

PubMed2006

Cerebrovascular accident with quadriplegia following postpartum eclampsia.

A 26-year-old woman (para 1 + 0) was managed at the National Hospital, Abuja, Nigeria for postpartum eclampsia with quadriplegia following referral from a peripheral hospital with a history of a solitary tonic/clonic seizure and unconsciousness. Her antenatal period had been uneventful until she presented with labour pains, where examination revealed an elevated blood pressure. She fitted once after delivery and remained unconscious for more than 12 h, hence the referral. The patient was managed in the intensive care unit (ICU), where she was found to be quadriplegic. She received mechanical ventilation for 21 days as part of her management in the ICU. Despite multidisciplinary care, she remained quadriplegic until a doctors' strike precluded further in-patient management. This rare complication of eclampsia is discussed, together with the patient's management.

Adult↗

PubMed1989

Recognition memory as a method of assessing intelligence of an infant with quadriplegia.

The authors demonstrate a test of visual cognitive abilities (Fagan Test of Infant Intelligence) in the assessment and management of a ventilator-dependent infant with quadriplegia. Assessment of visual recognition memory indicated that the infant's cognitive development progressed normally, despite severe physical limitations and a prolonged stay in hospital. The results suggested that the infant would benefit from age-appropriate auditory, visual and social stimulation and a specialized program of rehabilitation. The test may be particularly useful in assessing the intellectual abilities of infants whose motor dysfunction precludes effective response to traditional tests of sensorimotor intelligence.

Aging↗

PubMed1993

Spastic quadriplegia in Western Australia: a genetic epidemiological study. I: Case population and perinatal risk factors.

In a case-control study of all cerebral palsy cases with moderate and severe spastic quadriplegia born between 1976 and 1985, males comprised three-quarters of the cases and tended to have more severe motor impairment than females. The majority of cases had multiple and severe disabilities, and 27 per cent had died by the time of data collection. There was an excess of low-birthweight and preterm births compared with all live births in WA. An intrapartum cause was considered possible in 18 of the 74 children; however, half of these had evidence of compromise before labour.

Australia↗

PubMed1993

Spastic quadriplegia in Western Australia. II: Pedigrees and family patterns of birthweight and gestational age.

Pedigrees were obtained for all 74 index children and for three controls for each case. Recurrence of similar spastic quadriplegic phenotypes occurred in two families. A karyotype of 46,XY,dup(13)(q14q34), resulting in a partial trisomy 13, was found in another case. Rates of miscarriages and stillbirths plus neonatal deaths were higher among siblings of index cases than in siblings of birth-year controls, but were similar to siblings of birthweight controls. Average birthweights and gestational ages were lower in index cases than in birth-year controls. Children with spastic quadriplegia had significantly lower birthweights and gestational ages than their siblings. However, they also tended to come from families with a pattern of low birthweight and preterm delivery. The differences between families remained after controlling for factors affecting birthweight.

Australia↗