Athletes with disabilities.

Sports participation by persons with disabilities has increased dramatically over the past fifty years. Athletes with spinal injury, amputees, and those with developmental disabilities are at risk for certain injuries because of their specific injury impairments. There are also general medical problems that can arise in association with these physical conditions. Providing sporting event coverage and appropriate treatment for the disabled athlete requires knowledge of these impairment-specific injuries and risks. Physiatrists can provide essential leadership and and support to disabled sports programs.

Palmar cutaneous nerve recording and clarification of median premotor potential generators.

In this study of the median nerve, serial bipolar and referential recordings from the thenar eminence show that the median premotor potential actually consists of two distinct negative waves, an early (N-I) and a late premotor potential (N-II). Anesthetic block of the palmar cutaneous branch of the median nerve eliminated the early premotor potential in all subjects. This suggests that the early premotor potential (N-I) is the sensory nerve action potential of the palmar cutaneous branch of the median nerve. Local anesthesia of the palmar cutaneous branch of the median nerve also defined its area of innervation as circumscribed in our subjects. No normative data concerning the sensory nerve action potential of the palmar cutaneous branch of the median nerve is currently available, because previous studies apparently recorded the late premotor potential. The late premotor potential (N-II) is a negative far field potential seen only on referential recordings. It seems unlikely that the late premotor potential (N-II) can be completely explained as a junctional potential from the thumb as some have proposed. This study demonstrates a positive far field potential (P-I) at the palm-thumb junction, having a latency inconsistent with that of the late premotor potential. The late premotor potential can also be recorded with the reference electrode at an electrically neutral site, questioning previous explanations for its generator. A second traveling wave (N-III) was recorded distal to the area of the palmar cutaneous branch of the median nerve innervation continuing into the thumb. N-III is most likely the median digital sensory nerve action potential.

Persisting impairment following Rocky Mountain Spotted Fever: a case report.

A patient initially presented in the emergency room with fever, confusion, and a petechial rash. Rocky Mountain Spotted Fever (RMSF) was diagnosed and appropriate treatment was initiated. He subsequently became obtunded and required mechanical ventilation and temporary cardiac pacing. Four weeks later, he presented to our rehabilitation unit with ataxia, hyperreflexia and upper motor neuron signs, dysesthesias, sensorimotor axonopathy demonstrated by electrodiagnostic studies, and a global decrement in cognitive capability. Although he significantly improved in functional mobility and self-care, he exhibited little improvement in his cognitive impairment at 6-month follow-up. An understanding of the natural history of, and long-term impairments associated with, RMSF will be helpful to physiatrists in developing rehabilitation care plans and in assisting such patients with community re-entry.

Do health maintenance organizations work for Medicare?

Since 1985, the Health Care Financing Administration (HCFA) has encouraged health maintenance organizations (HMOs) to provide Medicare coverage to enrolled beneficiaries for fixed prepaid premiums. Our evaluation shows that the risk program achieves some of its goals while not fulfilling others. We find that HMOs provide care of comparable quality to that delivered by free-for-service (FFS) providers using fewer health care resources. Enrollees experience substantially reduced out-of-pocket costs and greater coverage. However, because the capitation system does not account for the better health of those who enroll, the program does not save money for Medicare.