Magnetic stimulation: C-8 root standardization based on arm length and arm position.

Normal values for C-8 root distal latencies (DL) by magnetic stimulation (Magstim) have been reported; however, the methods of standardization have failed to consider the variables of arm length and arm position. Consequently, an artificial widening of the "normal" range occurs due to a false elevation of the standard deviation. In this study, Magstim of the C-8 nerve root was performed on 30 normal volunteers. Gender, hand temperature, age, arm length, and DL with the arm resting at the patient's side and fully abducted were recorded. DL was 13.3 +/- 1.1 ms with a side-to-side variation of 0.3 +/- 0.3 ms. The difference in DL between the arm at rest and in full abduction was 0.2 +/- 0.3 ms. Data analysis also demonstrated a direct correlation between arm length and DL. Utilizing this information a formula has been derived to more accurately describe the normal distribution of the C-8 root DL by Magstim.

Electromyographic detection of paraspinal muscle metastasis. Correlation with magnetic resonance imaging.

Electromyographic (EMG) examination demonstrating marked segmental compromise of the posterior primary ramus distal to the spinal root with relative sparing of the anterior ramus may be the earliest objective evidence of paraspinal muscle metastasis. Antecedent studies are often initially normal, failing to disclose the underlying cause of back pain. Although paraspinal muscle metastasis has been histopathologically demonstrated at postmortem, attempts to image the suspected malignancy with computed tomography have been unsuccessful because the tumor in muscle remains isodense. This study reports the use of magnetic resonance imaging (MRI) to substantiate the existence of EMG-suspected paraspinal muscle metastasis. An EMG pattern of segmental posterior primary ramus denervation is not pathognomonic of metastasis. A confirmatory MRI, however, does permit earlier treatment with palliative radiation therapy.

Use of a polyethylene body jacket to prevent feeding tube removal in an agitated patient with anoxic encephalopathy.

UNLABELLED: Maintaining a feeding tube in place in the agitated patient following a traumatic brain injury or anoxic encephalopathy is a familiar problem. However, a survey of the literature employing the MEDLINE system provided no solutions. This case study of a 36-yr-old patient with anoxic encephalopathy illustrates a new method of preventing feeding tube removal using a modified polyethylene body jacket. The patient had repeatedly pulled out his gastrostomy tube despite the use of four-way restraints, a posey, behavior modification and anti-psychotic medications at levels near sedation. A polyethylene jacket with an S-shaped tunnel for feeding tube exit was constructed to cover the abdomen. FINDINGS: 1) The patient was unable to disturb the feeding tube. 2) The recessed design of the jacket's tunnel did not traumatize the feeding tube or obstruct fluid flow. 3) Nursing staff encountered no problems in placing or removing the orthosis. 4) Skin integrity was maintained. 5) The orthosis did not interfere with therapies.

Beaumont Lifestyle Inventory of Social Support. Can it predict disposition prior to an inpatient rehabilitation admission?

Predicting which rehabilitation patients will ultimately be discharged to a nursing home is a difficult task because methods used to evaluate preexisting home environment and quantify social support have been inadequate. To address this problem, the Beaumont Lifestyle Inventory of Social Support (BLISS) was developed. This questionnaire examines the family's willingness to care for, supervise and provide financial assistance to the patient. Organized into 10 weighted questions, BLISS results in a maximum score of 12. A prospective study was conducted to determine the correlation of the BLISS score with discharge disposition. Prior to rehabilitation admission, continuing care coordinators administered the BLISS to an involved family member of each patient. After 6 months, all BLISS forms were scored and compared with discharge disposition. Seventy-nine patients were included in this study and six (7.6%) were discharged to nursing homes. Comparison of BLISS scores obtained in patients discharged home versus nursing home revealed averages of 9.3 and 4.0, respectively (P less than 0.0006). These findings indicate that BLISS can quantify a patient's social situation and provide a predetermination of the social factors that lead to nursing home discharge. Consequently, BLISS will be a useful screening tool during the rehabilitation selection process.