ABSTRACT
Analgesic drugs are used more often than nondrug therapies for the treatment of pain in older patients. Despite the risk of adverse reactions, analgesics can be used safely for chronic pain in older patients when physicians prescribe with care. Nonopoid analgesics include acetaminophen, aspirin, NSAIDs, and COX-2 inhibitors. Opoid analgesics may be useful, but they should be continued only if side effects can be controlled and the patient demonstrates improved function. Adjuvant medications include antidepressants, anticonvulsants, neuroleptics, and oral membrane stabilizers. Benzodiazepines may be harmful in older patients, and muscle relaxants tend to be overused. Topical agents may be useful for certain neuropathic pain conditions.
Subject(s)
Analgesics/adverse effects , Analgesics/therapeutic use , Drug Prescriptions , Pain/drug therapy , Patient Selection , Activities of Daily Living , Age Factors , Aged , Analgesics/classification , Anticonvulsants/therapeutic use , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Chemotherapy, Adjuvant , Chronic Disease , Humans , Pain/classification , Pain/physiopathology , Risk Factors , Safety , Substance-Related Disorders/etiology , Substance-Related Disorders/prevention & controlSubject(s)
Complex Regional Pain Syndromes/therapy , Acute Disease , Association , Chronic Disease , Complex Regional Pain Syndromes/physiopathology , Complex Regional Pain Syndromes/psychology , Counseling , Disease Progression , Humans , Information Services , Nerve Block , Physical Therapy Modalities/methods , Self-Help GroupsABSTRACT
The purpose of this project was to develop instrumentation and protocols in which electrical stimulation is used to induce exercise in paralyzed quadriceps muscles strength and endurance evaluation and conditioning. A computer-controlled electrical stimulation system, using surface electrodes, automatically regulates the bouts of leg extension exercise. Load weights attached just above the ankles can be progressively increased over a number of training sessions in such a manner that a measure of the fitness of the legs can be obtained. With three exercise sessions per week for 9 weeks, the strength and endurance of the quadriceps muscles of two paraplegic and four quadriplegic subjects were gradually and safely increased. During exercise at a means load weight of 5.4 kg, means heart rate did not rise above rest, whereas systolic blood pressure increased about 20 mm Hg, and skin temperature above the active muscles increased about 1.75 degrees C. Such exercise conditioning appears to be safe and may provide important health benefits, including improved fitness of the muscles and bones, better circulation in the paralyzed limbs, and enhanced self-image. Conditioned electrically stimulated paralyzed leg muscles may be used for locomotion in conjunction with special vehicles.
Subject(s)
Electric Stimulation/instrumentation , Exercise Therapy/instrumentation , Paraplegia/rehabilitation , Quadriplegia/rehabilitation , Adult , Blood Pressure , Female , Heart Rate , Humans , Male , Muscle Contraction , Skin Temperature , Spinal Cord Injuries/rehabilitation , WheelchairsABSTRACT
Functional electrical stimulation has been used to restore some degree of controllable movement to paralyzed muscle. The purpose of this study was to demonstrate the feasibility of using electrically stimulated paralyzed leg muscles to propel a wheelchair-type vehicle. For this, a conventional manual wheelchair was modified by the addition of a drive system which permits forward propulsion by reciprocating movements of the legs. A battery-powered electrical stimulator using surface electrodes over the quadriceps muscles controls locomotive characteristics. This vehicle has been successfully operated by paraplegic and quadriplegic test subjects. Advantages of using paralyzed leg muscles for locomotion may include improvement in locomotive capability, circulation in the lower extremities, cardiovascular and respiratory fitness, strength and size of the exercised muscles and bones, and self-image.
Subject(s)
Locomotion , Paraplegia/rehabilitation , Quadriplegia/rehabilitation , Wheelchairs , Electric Stimulation/instrumentation , Humans , Muscle ContractionSubject(s)
Burns/rehabilitation , Cicatrix/surgery , Disabled Persons , Accidents, Occupational , Adolescent , Adult , Burns/surgery , Burns/therapy , Child , Child, Preschool , Disability Evaluation , Female , Gasoline , Hand Injuries/surgery , Hand Injuries/therapy , Humans , Infant , Male , Middle Aged , Pressure , Skin TransplantationABSTRACT
One hundred thirteen medical schools which offered full degree programs were identified and surveyed by questionnaires to obtain information which identified the existence, characteristics and involvement of physical medicine or rehabilitation medicine programs. The survey also attempted to identify specific changes which have occurred in undergraduate medical education in rehabilitation medicine since the Commission of Education and Rehabilitation Medicine survey of 1963-64. The results suggest that growth of the programs has not followed the expansion in the number of medical schools nor in the number of students enrolled. The programs have however, improved their administrative standing and involvement in medical schools. The impact on the undergraduate medical student is not satisfactory as judged by elective enrollment and recruiting of residents. Lack of funding was found to be one of the major obstacles to curriculum development, along with a marked shortage of academic physiatrists. The impact of the changes in undergraduate medical school curricula on rehabilitation medicine has produced considerable conjoint teaching in conjunction with a large number of basic science and clinical departments.