The triad of left hemiplegia, hemihypesthesia, and homonymous hemianopsia: implications for rehabilitation.

Patients with carotid cerebrovascular disorder can be categorized as having either right hemiplegia with various degrees of aphasia, left hemiplegia with hemihypesthesia, or homonymous hemianopsia, or the triad of left hemiplegia, hemihypesthesia and homonymous hemianopsia. The purpose of this study was to compare the functional performance of patients with each type of carotid cerebrovascular disorder before and 1 year after comprehensive rehabilitation aimed at improving communication and/or functional skills. Performance was measured using both the Barthel Index and Williams Drawing Test. On average, patients with the triad of neurologic deficits started and finished with poorer functional performance than the other patients. However, the average gain in functional scores over time was similar for all groups.

Technique to improve chronic motor deficit after stroke.

The unaffected upper extremity of chronic stroke patients was restrained in a sling during waking hours for 14 days; on ten of those days, these patients were given six hours of practice in using the impaired upper extremity. An attention-comparison group received several procedures designed to focus attention on use of the impaired upper extremity. The restraint subjects improved on each of the laboratory measures of motor function used--in most cases markedly. Extensive improvement, from a multi-year plateau of greatly impaired motor function, was also noted for the restraint group in the life situation and these gains were maintained during a two-year period of follow-up. For the comparison group only one measure showed small to moderate improvement, and this was lost during the follow-up period; there was essentially no overlap between the individuals of the two groups. Thus, prolonged restraint of an unaffected upper extremity and practice of functional movements with the impaired limb proved to be an effective means of restoring substantial motor function in stroke patients with chronic motor impairment identified by the inclusion criteria of this project.

Intermittent catheterisation: follow-up studies [proceedings].

One hundred twenty-six male spinal cord injury patients whose acute bladder management included indwelling urethral catheters were converted to an intermittent catheterisation programme and most of them subsequently achieved a catheter-free state. A higher prevalence of pyelocaliectasis was observed in these patients compared to previous reports of similar changes in patients upon whom intermittent catheterisation was initiated immediately after injury. Right side predominance of pyelocaliectasis was demonstrated but requires further study. The extent of neurological deficit (complete or incomplete lesions) does not appear to influence the development of pyelocaliectasis. These findings support our contention that intensive urological follow-up is necessary for all spinal cord injury patients even though a catheter-free state has been achieved through use of intermittent catheterisation.

Insensible weight loss in patients with spinal cord transection.

Insensible weightlosses (IWL) were determined in each of 24 patients with physiologically complete spinal cord transection. The patients were placed on a bed balance with an accuracy of +/- 5 g in an environmental chamber maintained at 24 degrees C. dry bulb and 17 degrees C. wet bulb temperature. Bihourly weight changes, corrected for food and fluid ingestion, were determined for a total of 24 hours. Tetraplegics have significantly lower (P less than 0.05) IWL than paraplegics. The IWL of paraplegics are in the range of IWL of normal persons reported in the literature. We conclude that a lower allowance for IWL should be for tetraplegics than for paraplegics or persons with intact spinal cords.