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1.
Am J Phys Med Rehabil ; 95(4): 270-6, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26334418

ABSTRACT

BACKGROUND: The aim of this study was to evaluate the efficacy of the Mann Assessment of Swallowing Ability (MASA) to predict the results of videofluoroscopic swallowing studies. METHOD: Children with cerebral palsy with suspicion of aspiration were enrolled. The Functional Dysphagia Scale (FDS) was used to quantify the swallowing dysfunction in videofluoroscopic swallowing studies. Correlation between MASA and FDS scores and differences in these two scores between aspirators and nonaspirators and between silent and overt aspirators were analyzed. RESULTS: Sixteen patients, level IV or V according the Gross Motor Function Classification System, were included. Thirteen patients (81.3%) had aspiration, and 9 (69.2%) were silent aspirators. The MASA scores between aspirators and nonaspirators were not different (median values of total scores, 107.0 and 94.0). The aspirators had higher FDS pharyngeal subtotal scores (P = 0.024) and slightly higher total FDS scores (P = 0.059). The differences in these two scales between silent and overt aspirators were not significant. Correlation coefficients between oral phase subtotal FDS scores and MASA subtotal scores in oral preparation, oral phase, and oral phase total were -0.713 (P < 0.05), -0.428 (P = 0.098), and -0.665 (P < 0.05), respectively. No correlation was found between the pharyngeal subtotal scores in these two scales. CONCLUSION: MASA was not useful in differentiating aspirators and nonaspirators and between silent and overt aspirators in severely disabled cerebral palsy, but it could predict oral dysfunction in videofluoroscopic swallowing studies.


Subject(s)
Cerebral Palsy/complications , Deglutition Disorders/etiology , Fluoroscopy , Respiratory Aspiration/diagnosis , Video Recording , Adolescent , Barium Sulfate , Child , Contrast Media , Deglutition , Deglutition Disorders/complications , Female , Humans , Male , Respiratory Aspiration/etiology , Severity of Illness Index , Young Adult
2.
Radiol Med ; 117(3): 500-6, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22020425

ABSTRACT

PURPOSE: The authors sought to study the relationship between Doppler ultrasonography and deterioration of renal function in patients with spinal cord injury. MATERIALS AND METHODS: Nineteen patients who underwent follow-up with radioisotopic renography were evaluated. Median patient age was 50 [interquartile ratio (IQR) 35-57] years, and time since injury was 4.7 (IQR 1.3-9.2) years. Following Doppler ultrasound, patients were divided into groups based on baseline renal resistive index (RRI): normal RRI (≤ 0.7), group 1 (n=14); and abnormal RRI (> 0.7), group 2 (n=5), and were followed up with radioisotopic renography 1 or more years later. Annual change in effective renal plasma flow (ERPF) was analysed. RESULTS: The 38 kidneys (two for each patient) were stratified by initial RRI, with 28 in group 1 and ten in group 2. Result of univariate generalised estimation equation (GEE) analysis for the factors affecting the change in effective renal plasma flow (ERPF) indicated that the high RRI value (RRI > 0.7) correlated with the change in ERPF. ERPF value in group 2 was significantly decreased (p=0.01) by an average of 60.33 ml/min (standard error = 23.26). CONCLUSIONS: An RRI > 0.7 is a risk factor for future renal function deterioration in patients with spinal cord injury. Thus, annual Doppler ultrasonography to assess the RRI and the degree of hydronephrosis is recommended.


Subject(s)
Kidney/physiopathology , Spinal Cord Injuries/physiopathology , Ultrasonography, Doppler , Adult , Follow-Up Studies , Humans , Middle Aged , Radioisotope Renography , Renal Plasma Flow
3.
Arch Phys Med Rehabil ; 87(11): 1526-9, 2006 Nov.
Article in English | MEDLINE | ID: mdl-17084130

ABSTRACT

OBJECTIVE: To present the results of scintigraphic evaluation, using the Gaussian curve fitting method, via 3 parameters of oropharyngeal swallow: (1) pharyngeal transit time, (2) premature pharyngeal entry, and (3) postswallow pharyngeal stasis while ingesting liquid. DESIGN: A descriptive study. SETTING: A rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Eighteen healthy subjects. INTERVENTION: All 18 subjects received scintigraphic swallow examination to evaluate dynamic swallow process of 5 mL of liquid. MAIN OUTCOME MEASURES: The Gaussian curve fitting method was used to calculate the pharyngeal transit time, premature pharyngeal entry, and postswallow pharyngeal stasis. RESULTS: The mean pharyngeal transit time was .71 seconds. The maximal percentage of premature pharyngeal entry was 3%. The maximal percentage of postswallow pharyngeal stasis was 9%. CONCLUSIONS: The Gaussian curve fitting can be used as an objective and time-saving method to calculate the parameters in scintigraphic swallowing examination. Our results approximate other researchers' reports.


Subject(s)
Deglutition Disorders/diagnostic imaging , Deglutition , Pharynx/diagnostic imaging , Aged , Female , Humans , Male , Middle Aged , Normal Distribution , Radionuclide Imaging
4.
Arch Phys Med Rehabil ; 85(9): 1509-12, 2004 Sep.
Article in English | MEDLINE | ID: mdl-15375826

ABSTRACT

OBJECTIVES: To assess renal resistive index (RI) changes in patients with spinal cord injury (SCI) who have obstructive uropathy and to determine if an RI of 0.7 or more is useful in identifying such patients. DESIGN: Prospective cross-sectional study. SETTING: Rehabilitation hospital affiliated with a medical university. PARTICIPANTS: A convenience sample of 99 kidneys of 51 SCI patients (38 men, 13 women; mean age, 38.8+/-14.0 y) with neuropathic bladder dysfunction. INTERVENTIONS: Ultrasonic examination to assess the degree of hydronephrosis, Doppler sonography to calculate renal vascular RIs, and radioisotopic renography to assess renal function and to determine excretory curves. Kidneys were assigned to control or obstructive uropathy groups, and RIs were compared for statistical significance (Student t test) and to assess whether an RI of 0.7 is a distinguishing criterion. MAIN OUTCOME MEASURES: RI and sensitivity. RESULTS: Average RIs were .58+/-.07 in the control group (71 kidneys) and .65+/-.08 in the uropathy group (28 kidneys) (P<.001). The sensitivity of using an RI of 0.7 or more to identify patients with obstructive uropathy was 39%. The c statistic of the receiver operating characteristic curve was .72. CONCLUSIONS: RIs increased in SCI patients with obstructive uropathy. In patients with SCI, urinary findings fit the chronic partial obstruction pattern. A renal RI of 0.7 or more was a poor indicator of obstructive uropathy in such patients.


Subject(s)
Hydronephrosis/diagnostic imaging , Severity of Illness Index , Spinal Cord Injuries/complications , Ultrasonography, Doppler/methods , Ureteral Obstruction/diagnostic imaging , Adolescent , Adult , Aged , Case-Control Studies , Chronic Disease , Cross-Sectional Studies , Diagnosis, Differential , Discriminant Analysis , Female , Humans , Hydronephrosis/classification , Hydronephrosis/etiology , Male , Middle Aged , Prospective Studies , ROC Curve , Renal Circulation , Sensitivity and Specificity , Ultrasonography, Doppler/standards , Ureteral Obstruction/classification , Ureteral Obstruction/etiology , Urodynamics , Urography/methods , Urography/standards , Vascular Resistance
5.
Arch Phys Med Rehabil ; 85(1): 65-9, 2004 Jan.
Article in English | MEDLINE | ID: mdl-14970970

ABSTRACT

OBJECTIVE: To compare the renal excursion detected by ultrasonography with the diaphragmatic excursion recorded by fluoroscopy in estimating the diaphragmatic function in patients with high cervical cord injury. DESIGN: Prospective, blinded comparative study. SETTING: A rehabilitation hospital affiliated with a medical university. PARTICIPANTS: Fifteen consecutively admitted patients with high cervical cord injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Chest radiographs, fluoroscopy of diaphragmatic motion, and ultrasonography of renal motion. RESULT: Of the 15 patients, 2 were diagnosed with hemidiaphragm paralysis using fluoroscopy and renal ultrasonography. The average diaphragmatic excursion was 59 mm (range, 30-83 mm) in 28 nonparalyzed hemidiaphragms. The average renal excursion was 49 mm (range, 28-61 mm). The correlation coefficient for fluoroscopic hemidiaphragm excursion and ultrasonographic renal excursion was .853. CONCLUSION: Ultrasonographic renal excursion and fluoroscopic diaphragmatic excursion correlated highly. With the fluoroscopy results as the criterion standard, the diagnostic sensitivity and specificity were both 100% for renal sonography. With the advantages of convenience of use, no radiation exposure, and high reproducibility, renal ultrasonography is recommended as a first-line screening and long-term follow-up tool for assessment of diaphragmatic function.


Subject(s)
Diaphragm/physiology , Kidney/physiology , Spinal Cord Injuries/physiopathology , Adolescent , Adult , Diaphragm/diagnostic imaging , Fluoroscopy , Humans , Kidney/diagnostic imaging , Linear Models , Male , Middle Aged , Prospective Studies , Ultrasonography
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