1/118. Virtual reality in paraplegia: a VR-enhanced orthopaedic appliance for walking and rehabilitation.spinal cord injuries (SCIs) have a profound physical, social and emotional cost to patients and their families. Obviously SCIs severely disrupt normal patterns of interaction with the environment. Firstly, the opportunities for active interaction are inevitably diminished due to motor or sensory impairment. Moreover, such problems may increase as the time since injury lengthens and the patient becomes more withdrawn and isolated in all spheres of activity. However, advances in Information technology are providing new opportunities for rehabilitation technology. These advances are helping people to overcome the physical limitations affecting their mobility or their ability to hear, see or speak. In this chapter an overview is given of the design issues of a VR-enhanced orthopaedic appliance to be used in SCI rehabilitation. The basis for this approach is that physical therapy and motivation are crucial for maintaining flexibility and muscle strength and for reorganizing the nervous system after SCIs. First some design considerations are described and an outline of aims which the tool should pursue given. Finally, the design issues are described focusing both on the development of a test-bed rehabilitation device and on the description of a preliminary study detailing the use of the device with a long-term SCI patient.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/118. Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement.This report describes a third case of squamous cell carcinoma of the suprapubic cystostomy tract. The first case reported in 1993 concerned a squamous cell carcinoma arising adjacent to the suprapubic cystostomy site and extending anteriorly to the abdominal wall in a 80-year-old man, 5 years after suprapubic urinary diversion for urethral stricture. A second case published in 1995 described a 50-year-old paraplegic man (T11-T12 spinal cord injury) in whom a suprapubic cystostomy tract squamous cell carcinoma developed after 25 years of urinary diversion. The tumour involved the cystostomy tract primarily with extension into the bladder but did not penetrate the bladder wall muscle. Our patient is in fact the second one to have a suprapubic cystostomy tract squamous carcinoma not involving the bladder.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
3/118. paraplegia following intraoperative celiac plexus injection.The technique for percutaneous and open neurolytic celiac plexus injection, using ethanol or phenol, for relief of intractable pancreatic cancer pain has been well described. Prospective randomized studies, demonstrating safety and efficacy with few complications, have led to widespread acceptance and use of this palliative procedure. The complications of neurolytic celiac plexus injection are rare, and are usually minor. However, transient or permanent paraplegia has been reported previously in 10 cases. The case described herein represents the third reported case of permanent paraplegia following open intraoperative neurolytic celiac plexus injection using 50% ethanol. The literature surveying the indications for this procedure, routes of administration, known complications, and their pathophysiology are reviewed.- - - - - - - - - - ranking = 0.02673693873517keywords = cancer (Clic here for more details about this article) |
4/118. High expression of MHC I in the tibialis anterior muscle of a paraplegic patient.A long-term paraplegic man presented exclusively (>99%) myosin heavy chain I (MHC I) in the tibialis anterior muscle (TA). This was coupled to a slow speed of contraction, a high resistance to fatigue, and a rapid resynthesis of phosphocreatine after an electrically evoked fatiguing contraction when compared with the TA muscles of 9 other paraplegic individuals. In contrast, the MHC composition of his vastus lateralis, gastrocnemius, and soleus muscles was that expected of a muscle from a spinal cord injured individual. This information may be of clinical importance in terms of the expected morphological and functional adaptations of skeletal muscle to different types of electrical stimulation therapy.- - - - - - - - - - ranking = 9keywords = muscle (Clic here for more details about this article) |
5/118. Implanted functional electrical stimulation system for mobility in paraplegia: a follow-up case report.A 16-channel functional electrical stimulation (FES) system has been implanted in a person with T10 paraplegia for over a year. The system consists of two eight-channel radio frequency controlled receiver-stimulators delivering stimuli through a network of 14 epimysial and two intramuscular electrodes. Using this system and a walker for support, the subject was able to stand up for 8 min and walk regularly for 20 m. The standing duration was limited by arm fatigue since upper extremities supported an average of 25% of body weight. This was due to suboptimal hip extension and some undesired recruitment of rectus femoris and sartorius with stimulation of quadriceps electrodes. The left quadriceps exhibited rapid fatigue that limited walking distance and duration. The metabolic energy requirements were well within the aerobic limits of the sedentary paraplegic population. At one-year follow-up evaluation all electrodes are functional except one intramuscular electrode. The implant caused no adverse physiological effects and the individual reported health benefits such as increased energy and overall fitness as a result of the FES system use. With further improvements in muscle response through innovative surgical techniques, the 16-channel implanted FES system can be a viable addition to exercise and mobility function in persons with paraplegia.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
6/118. Spinal lesions, paraplegia and the surgeon.Thirty-six patients with spinal cord lesions and varying degrees of paraplegia were seen by the surgical team at the Angau Memorial Hospital, Lae, over a thirty month period. Because the continued presence of a spinal lesion may lead to progressive cord destruction and ischaemic myelopathy, prompt treatment is advocated. The depressing results that have followed treatment of fracture dislocations of the cervical spine and secondary neoplasm with paraplegia is recorded and some suggestions are made that may improve the outlook in future cases. Early and major surgery is advocated in the treatment of spinal abscesses, tumours, Pott's paraplegia and unstable fracture dislocations of the lumbar spine.- - - - - - - - - - ranking = 0.0048590851577306keywords = neoplasm (Clic here for more details about this article) |
7/118. Unusual consequences of heroin overdose: rhabdomyolysis, acute renal failure, paraplegia and hypercalcaemia.A 29-yr-old man, known to be a heroin addict, was found at home totally unrousable, bent on his hips in the lotus position. On admission, he required frequent ventricular defibrillation, external pacing and infusion of calcium. A diagnosis of rhabdomyolysis caused by heroin and cocaine overdose was made. He developed paraplegia below T12, acute renal failure, acute compartment syndrome in one leg and a coagulation defect. Despite a fasciotomy, a through-knee amputation of the leg was required. Haemodialysis was required for 26 days, and this period was complicated by increased serum calcium concentrations, which was treated with disodium pamindrate. calcium deposits were palpable in the muscles and could be seen in vessels on limb x-rays. After 34 days, he was eventually discharged to a general surgical ward and subsequently into the community.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
8/118. Delayed paraplegia caused by the gradual collapse of an infected vertebra.A case of delayed paraplegia caused by a gradual and progressive collapse of a vertebra after healing of pyogenic spondylitis is reported. A 73-year-old man was treated for a hematogenously seeded pyogenic spondylitis of the first lumbar vertebra. magnetic resonance imaging showed a high signal intensity of the involved vertebra and adjacent discs and a paravertebral abscess without disc space narrowing. Eight months after healing of the infection, the patient had muscle weakness and paresthesia of the lower extremities, which gradually increased. The plane radiographs revealed a kyphotic deformity of 36 degrees with a collapse of the first lumbar vertebra.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
9/118. Interventricular methotrexate therapy for carcinomatous meningitis due to breast cancer: a case with leukoencephalopathy.A 46-year-old woman presented with paraplegia and severe lumbago. She had had a radical mastectomy for left breast cancer 10 years earlier, and 6 months prior to presentation she completed CMF chemotherapy for treatment of retroperitoneal metastasis. CT and MRI to identify potential causes of the paraplegia and lumbago showed leptomeningeal carcinomatosis due to dissemination from invasive recurrence of the retroperitoneal tumor. An Ommaya reservoir was inserted, and infusion of intrathecal methotrexate (MTX; 5 mg twice weekly) began. Her clinical symptoms improved after receiving 53 mg MTX. However, after receiving 83 mg MTX, the patient became dizzy from leukoencephalopathy. Although administration of prednisolone mostly resolved her symptom, the patient died 9 months after the diagnosis of carcinomatous meningitis.- - - - - - - - - - ranking = 0.13368469367585keywords = cancer (Clic here for more details about this article) |
10/118. anesthesia for cesarean section in a patient with paraplegia resulting from tumour metastases to spinal cord.PURPOSE: Spinal cord injured patients present multiple unique challenges to the anesthesiologist. These include choice of muscle relaxant and management of autonomic hyperreflexia. We report the anesthetic management for Cesarean delivery in a patient who was paraplegic due to spinal canal metastases. Preeclampsia and fever complicated this case. CLINICAL FEATURES: The patient presented at 29 wk gestation with progressive paraplegia at the T10 level due to metastatic osteosarcoma. She had a decompressive laminectomy without improvement in her paralysis. She subsequently developed preeclampsia at 31 wk gestation, and underwent Cesarean delivery for breech presentation under general anesthesia. Anatomical concerns left us unsure of the efficacy or safety of neuraxial anesthesia. CONCLUSIONS: Preeclampsia and autonomic hyperreflexia are generally indications for regional anesthesia for cesarean section. Tumour in her spinal canal and laboratory abnormalities including thrombocytopenia and a potential urosepsis dissuaded us from this option. Additionally, rapid sequence induction and intubation were not preferred due to paraplegia, leading us to secure the airway fibreoptically.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
| | Next -> |