Alternate four-point sweep-through gait--a technique for patients with combined neuromuscular and visual impairments: case reports.

This article reports on two patients with combined neuromuscular and visual impairments who used a modification of the classic alternate four-point crutch gait, which allowed them to simultaneously explore the upcoming environment for obstacles or change in terrain while maintaining sufficient support for their lower limbs. The technique should be useful for patients with diabetic neuropathy/retinopathy combinations, multiple sclerosis with optic neuritis, and neurosarcoidosis and in elderly patients with multiple disabilities.

Morbidly obese patients with pulmonary disease--a retrospective study of four cases: a brief report.

Morbid obesity is a common chronic condition that predisposes affected individuals to a decrease in functional status. The purpose of this case series is to highlight the benefit of institutional rehabilitation for this subgroup of patients. A 6-mo retrospective review of 117 consecutive admissions to the rehabilitation unit of a municipal hospital center was conducted. A total of four patients (3.4%) met the criteria for morbid obesity. We present the brief case histories of these four subjects. All showed significant functional improvement and were able to return home after a mean length of stay of 61 days. They each required specialized rehabilitation intervention and specialized equipment such as extra large beds and oversize walkers. All four subjects had obstructive pulmonary disease, accounting for their initial hospital admission. This study demonstrates that inpatient rehabilitation improves functional status in morbidly obese patients. Further research regarding physiatric intervention in the morbidly obese patient is needed.

Use of alternative therapies by rehabilitation outpatients.

OBJECTIVE: To document the prevalence and patterns of use of alternative medical therapies as well as their perceived effectiveness by patients in a rehabilitation medicine outpatient practice. DESIGN: Cross-sectional survey by written questionnaire. SETTING: An urban rehabilitation medicine outpatient referral office. PATIENTS: A random sample of 103 patients referred for rehabilitation outpatient care, while waiting for their appointment, were given a questionnaire addressing their use of alternative therapies. MAIN OUTCOME MEASURES: Use of alternative therapies and their perceived effectiveness. RESULTS: One or more alternative medical therapies had been used by 29.1% of subjects in the past 12 months for their presenting problem. The most common therapies were massage, chiropractic, vitamin and mineral supplementation, and acupuncture. Musculoskeletal pain syndromes involving the spine and extremities were the most common problems for which patients sought both physiatric and alternative care. Of the patients who used alternative treatments 53% reported some degree of efficacy. CONCLUSIONS: A significant proportion of rehabilitation medicine patients use and frequently perceive a benefit from alternative therapies, particularly massage, chiropractic, vitamin and mineral supplementation, and acupuncture. Incorporating alternative therapies into physiatric practice is a desirable future direction for the specialty.

Use of a motorized wheelchair in conjunction with a guide dog for the legally blind and physically disabled.

There is limited literature concerning use of wheelchairs by patients with combined visual impairment and neuromuscular diseases. This case report describes the use of a motorized wheelchair and guide dog by a legally blind patient with severe visual loss due to oculocutaneous albinism. He had concomitant decreased functional mobility from degenerative joint disease of both knees, which limited his ambulation capability. After careful consideration of risks and a successful trial of its use in the corridors of our institution, as well as successfully traveling with it outdoors, he was given a motorized wheelchair. He has continued to use it safely and successfully along with his guide dog. Combined visual and neuromuscular diseases will be encountered with increasing frequency because of the aging population, and it is therefore important for physiatrists to be able to provide assistive devices for such individuals. Vision loss is not an absolute contraindication to motorized wheelchair use.

Dickens and disability.

The novels of Charles Dickens include many vivid portraits of individuals with physical disabilities or deformities, and these conditions are often used symbolically to highlight some of the author's recurring themes. Disabled children are depicted as innocent victims, while their older counterparts are most often viewed as corrupt victimizers whose physical deformities are outward manifestations of their inner depravity. Punishment for moral failings in non-disabled characters frequently takes the form of paralysis and/or aphasia resulting from a cerebrovascular accident. In this context the wheelchair becomes a potent metaphor of imprisonment as a form of retributive justice.

Physical disability among American medical students.

The present survey aimed to assess the prevalence and nature of physical disabilities among medical school graduates and to investigate the academic performance of these new physicians with disabilities. A questionnaire was sent to the deans of student affairs of each of the then existing 128 United States and Puerto Rican medical schools, addressing the profiles of students with physical disabilities in the 1987 through 1990 graduating classes. Seventy-seven (60%) United States and Puerto Rican medical schools responded to the questionnaire, of which 67 were able to complete it. A total of 67 students with physical disabilities (40 males and 27 females) were reported. Three of the 67 students were excluded from the study because their conditions did not match our definition of physical disability. The remaining 64 students (38 males and 26 females), ranging from 0 to 10 per school, comprised 0.19% of the 33,138 students who graduated from the 67 medical schools during these 4 academic yr. The disabilities represented by the 64 students encompassed a wide spectrum of etiologies, including neurologic (39%), musculoskeletal (20%), medical-surgical (13%), visual (13%), and auditory (9%) problems. The majority of students with disabilities had above average (36%) to average (48%) academic standings. The actual prevalence of medical students with disabilities might be higher than reported because of the underreporting of the less noticeable types of disabilities.

Pain characteristics and their management in persons with AIDS.

Discussion of pain problems in persons with AIDS has been limited in medical and nursing literature, yet pain is a major source of suffering and concern for patients. Common pain characteristics are described in 100 persons with CDC-defined AIDS, using the 1987 definition. The two most frequently cited types of pain for both drugs users and nondrug users with AIDS were abdominal pain and neuropathic pain. Drug users experienced pain due to esophagitis and headaches more frequently than nondrug users, while nondrug users experienced Kaposi's sarcoma-related pain more often. Treatment responses were individualized, with drug users requiring more frequent use of opiates. General treatment strategies are suggested with special emphasis on the unique needs of PWAs.

Severe visual impairment on a rehabilitation unit: incidence and implications.

Eleven of the first 191 admissions (5.8%) to a rehabilitation inpatient unit met the criteria for legal blindness; two additional patients (1%) had severe visual impairment (visual acuity above 20/200 but less than 20/70 with corrective lenses). All but three of these patients were ambulatory with a walkerette or cane when discharged to their homes. The commonest causes of blindness were macular degeneration, cataract, glaucoma, and diabetic retinopathy. Despite being older (mean age 79.7 years compared to 70.4 years for all 191 admissions) and having visual impairment superimposed on their primary rehabilitation diagnosis, these patients' lengths of stay (LOS) were not prolonged (mean LOS = 33.1 days compared to 35.9 days for all 191 admissions). It is concluded that severe visual impairment is not uncommon among rehabilitation inpatients, particularly those aged 70 or older. Health care professionals working in rehabilitation should become more familiar with, and proficient in, the basic principles and treatment techniques used in the rehabilitation of visually impaired persons.

The physically disabled physician.

This article reviews the available literature on physically disabled physicians and discusses the attitudinal, environmental, and political barriers they may encounter. Information on 215 physicians and 92 medical students with a wide range of disabilities was analyzed. Currently available personal and technological resources are outlined and special issues pertaining to medical education are highlighted. Greater awareness and acceptance by medical peers are essential for professional success.

Physical disability among physicians: an analysis of 259 cases.

This article presents data on 259 physicians and medical students with a wide range of physical disabilities and specialty training. Three out of four were in active medical practice despite their disability, most often in the specialties of internal medicine, family practice, or psychiatry. Neurological disorders accounted for over half the sample, with spinal cord injury, multiple sclerosis, stroke, and post-polio weakness being the most commonly encountered diagnoses. These data indicate that physically disabled physicians are more numerous than the previous literature would suggest that they are capable of practising in many professional specialties.

Reversible electroencephalogram changes associated with administration of baclofen in a quadriplegic patient: case report.

We present the case of a spastic quadriplegic who developed mental symptoms which resolved when his Baclofen was discontinued. Of interest was the presence of EEG abnormalities similar to those described in cats receiving this drug. These abnormalities, previously unreported in humans, resolved upon discontinuing Baclofen therapy.

Paraplegia following epidural anesthesia. A case report and a literature review.

This article reports the case of a man who developed a pure motor paraplegia following epidural anesthesia with a pattern of slow recovery over subsequent months. Reviewing the available literature on post-epidural paraplegia we noted a number of potential etiologies and analyzed their role in its causation. On the basis of this analysis we have identified five distinct clinical groups and a constellation of factors which can lead to an increased risk of post-epidural paraplegia in susceptible surgical patients.

Ulnar nerve compression by heterotopic ossification in a head-injured patient.

Although heterotopic ossification (HO) at the elbow is a frequent occurrence following head injury, nerve compression by heterotopic bone is quite rare. We report the case of a 22-year-old woman with head injury and well-documented HO at the left elbow who developed signs and symptoms of an ulnar neuropathy four months after her original injury. Electrodiagnostic studies confirmed the presence of a severe ulnar nerve lesion at the level of the elbow. Anterior transposition of the left ulnar nerve showed the nerve to have been compressed by heterotopic bone.

Electrotherapy for acceleration of wound healing: low intensity direct current.

Accelerated wound healing has been an observed effect of low intensity direct current (LIDC) in the range of 200 microA to 800 microA, but present electrotherapeutic equipment has been less than optimal in providing this range of stimulation. A small and portable LIDC stimulator was specially constructed and used in a study of the effects of LIDC on wound healing rates among inpatients here. Thirty patients with indolent ulcers located either below the knee or in the sacral area were randomly assigned to the LIDC protocol or to more conventional wound therapy. The patients in each treatment group were matched by age, diagnosis, wound size, and wound etiology. Comparison revealed 1.5 to 2.5 times faster healing in those receiving LIDC, which was statistically significant. The wounds treated with LIDC required less debridement and the healed scars were more resilient. Additionally, no wound infections occurred and patients reported less discomfort at the wound site. Low intensity direct current appears to be a convenient, reproducible, and effective method for improved healing of chronic open wounds and warrants more widespread use in the clinical setting.