Compressive radial neuropathy induced by 'hooking' manoeuvre in a tetraplegic person.

STUDY DESIGN: Case report. OBJECTIVE: To describe a case of radial nerve compression neuropathy caused by a common wheelchair technique (hooking manoeuvre) used by a tetraplegic person to maintain truncal stability on a wheelchair. SETTING: Department of Rehabilitation Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia. METHOD AND RESULTS: A 45-year-old man with American Spinal Injury Association Impairment Scale A C6 for the last 32 years developed progressive weakness of the right upper limb that was associated with pain in the shoulder and arm. Serial physical examinations demonstrated motor and sensory deterioration. Magnetic resonance imaging of the spinal cord showed no evidence of syringomyelia. Electrodiagnostic study showed motor and sensory neuropathy of the right radial nerve in the axillary region. CONCLUSION: The act of hooking the arm behind the wheelchair push handle causes trauma leading to radial nerve compression neuropathy. Because this technique is used frequently by wheelchair users, future studies should examine the prevalence of radial neuropathy in this population and develop alternative methods to maintain balance on the wheelchair.

Spinal pseudomeningocoele: a diagnostic dilemma.

STUDY DESIGN: Case report. OBJECTIVE: To describe the difficulty in diagnosing spinal pseudomeningocoele. SETTING: Department of Rehabilitation Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia. CASE REPORT: A case of progressive sacral swelling in a paraplegic man who sustained spinal cord injury 14 years ago is presented. Although his clinical features were suggestive of pseudomeningocoele, we were unable to confirm the diagnosis preoperatively. CONCLUSION: Traumatic spinal pseudomeningocoele is very rare. Even with the available modern diagnostic imaging techniques, it is still difficult to diagnose a spinal pseudomeningocoele.

The applications of International Classification of Functioning, Disability and Health (ICF) by World Health Organization (WHO) in rehabilitation medicine practice

Context: Rehabilitation Medicine is dedicated to optimise patients function and health in the most comprehensive manner. ICF, the latest International Classification by World Health Organization (WHO) is a conceptual framework for the assessment of functioning, disability and health. The purpose of this paper is to describe the applications of ICF in Rehabilitation Medicine practice in the Medical Rehabilitation Unit, University of Malaya Medical Centre (UMMC), Kuala Lumpur. Issues: ICF consists of body function, structure, activity, participation and environmental factor. ICF categories are exhaustive, but are not practical to be used entirely and not applicable in clinical practice on their own. How is ICF used from the clinical perspective? It has to be adapted to make it usable. In Rehabilitation Medicine settings, the following are ways ICF is applied in clinical practice: research in terms of validating the use of available ICF Core Sets and development of new ICF Core Set; clinical practice based on the ICF-based sheet; and educational tools. Conclusion: The practice of Rehabilitation Medicine is in line and compatible with the concept of ICF and can serve as a new important language that can improve the practice of Rehabilitation Medicine. It can be a universal language in functioning, disability and health and can improve understanding in addressing issues on disability within the medical community, improve multi professionals’ communication among patients, healthcare providers and stakeholders.