Functional electrical stimulation (FES) for spinal cord injury.

Restoration of respiratory motion by stimulation of the phrenic nerve was investigated. Respiratory motion was restored successfully by introducing a breathing pacemaker to a patient with respiratory disturbance due to upper cervical spinal cord injury. Breathing pacemakers are considered to be more similar to physiological conditions compared to mechanical ventilators.

Satisfaction with upper-extremity surgery in individuals with tetraplegia.

Objective: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery.

Design: Survey.

Setting: Two Spinal Cord Injury Model Systems centers.

The effect of head position, electrode site, movement and smoothing window in the determination of a reliable maximum voluntary activation of the upper trapezius muscle.

Quantitative measures derived from raw myoelectric signal (MES) data must be normalized to allow for comparisons both within and between subjects. The most common method of normalization involves dividing the root mean square (RMS) amplitude of the MES recorded during a given activity by the RMS of the MES elicited during a maximal voluntary isometric contraction (MVIC) of that particular muscle. The objective of this study was to use surface-recorded MES amplitude to determine the combination of electrode site, test position, head posture, and smoothing window that elicits the highest and most reliable MES amplitudes during an MVIC of the upper trapezius (UT) muscle.

Indications and future directions for upper limb neuroprostheses in tetraplegic patients: a review.

The development of the upper extremity neuroprosthesis has been a challenging and rewarding contribution to the management of the SCI patient. The authors' experience and that of their clinical trial teams has verified that this technology is a strong alternative to conventional reconstruction and conservative management. In the future, even more powerful tools will emerge from the laboratory as these devices and collaborative surgical procedures evolve.

The influence of elbow position on the range of motion of the wrist following transfer of the brachioradialis to the extensor carpi radialis brevis tendon.

Background: In patients who have an injury of the cervical spinal cord, the brachioradialis tendon may be transferred to the extensor carpi radialis brevis tendon to restore voluntary wrist extension. We hypothesized that the active range of motion of the wrist depends on the position of the elbow after this transfer because the brachioradialis changes length substantially during elbow flexion, which implies the maximum force that the muscle can produce varies with elbow position. The objectives of this study were to determine whether the position of the elbow influences the range of motion of the wrist following transfer of the brachioradialis to the extensor carpi radialis brevis tendon and to evaluate the effect of surgical tensioning.

Occupational histories of cancer patients in a Canadian cancer treatment center and the generated hypothesis regarding breast cancer and farming.

Occupational exposures increase cancer risks. The Windsor Regional Cancer Centre in Windsor, Ontario, was the first Canadian cancer treatment center to collect the work histories of its patients, which were recorded using a computer-based questionnaire. Breast cancer cases represented the largest respondent group.

Implementation of an implantable joint-angle transducer.

An implantable joint-angle transducer (IJAT) was implemented to provide command-control information from the wrist for functional neuromuscular stimulation (FNS) neuroprostheses. The IJAT uses the Hall effect to sense joint angle. The objectives of this study were to evaluate (1) chronic functionality, (2) safety and biocompatibility, (3) repeatability of the implantation procedure, and (4) clinical feasibility.

Management of the paralyzed elbow in tetraplegia.

The management of the paralytic conditions in tetraplegia requires understanding neural pathophysiology. A comprehensive rehabilitative and surgical plan requires a multidisciplinary approach. Prior to redistributing the muscle forces across the elbow, a supple osseo-articular platform must be created.

Nutritional supplementation with MyoVive repletes essential cardiac myocyte nutrients and reduces left ventricular size in patients with left ventricular dysfunction.

Background: Congestive heart failure depletes the myocardium of carnitine, coenzyme Q10 (CoQ10), and taurine--substances known to influence mitochondrial function and cell calcium. We hypothesized that feeding patients a nutritional supplement that contained carnitine, CoQ10, and taurine would result in higher myocardial levels of these nutrients and improve left ventricular function.

Methods: Forty-one patients who underwent aortocoronary artery bypass with an ejection fraction < or =40% at referral were randomly assigned to a double-blind trial of supplement or placebo.

Implementing a performance evaluation system in a correctional managed care pharmacy.

The development and implementation of a departmental performance evaluation system for a correctional managed care pharmacy are described. Health care services for approximately 150,000 offenders within the Texas Department of Criminal Justice are provided through an arrangement with two university systems, the University of Texas Medical Branch (UTMB) and Texas Tech University Health Sciences Center. UTMB provides all distributive pharmacy services through a central pharmacy located in Huntsville, Texas.

An advanced neuroprosthesis for restoration of hand and upper arm control using an implantable controller.

An advanced neuroprosthesis that provides control of grasp-release, forearm pronation, and elbow extension to persons with cervical level spinal cord injury is described. The neuroprosthesis includes implanted and external components. The implanted components are a 10-channel stimulator-telemeter, leads and electrodes, and a joint angle transducer; the external components are a control unit and transmitter-receiver coil.

Neuroprostheses for the upper extremity.

Functional electrical stimulation (FES) neuroprostheses can be used to replace lost motor and sensory function in persons with neurological disorders. FES technology has subsequently been shown effective and safe in restoring hand function in adults with spinal cord injury. The freehand system consists of an implanted receiver-stimulator, an external shoulder position sensor, and an external control unit.

Efficacy of an implanted neuroprosthesis for restoring hand grasp in tetraplegia: a multicenter study.

Objective: To evaluate an implanted neuroprosthesis that allows tetraplegic users to control grasp and release in 1 hand.

Design: Multicenter cohort trial with at least 3 years of follow-up. Function for each participant was compared before and after implantation, and with and without the neuroprosthesis activated.

Impact of automation on pharmacist interventions and medication errors in a correctional health care system.

The implementation and impact of an automated check-and-sortation system in a correctional health care system are described. In February 1998 the Managed Health Care Division of the University of Houston College of Pharmacy submitted a proposal to the Texas State Board of Pharmacy for installing an automated check-and-sortation device in its distributive system serving Texas Department of Criminal Justice offenders. The new system would eliminate final visual verification of medication orders by pharmacists and thereby give them more time for in-depth reviews of patient profiles and for recommending clinical interventions.

Conditioned nutritional deficiencies in the cardiomyopathic hamster heart.

Background: Evidence indicates that nutritional factors may be important in the maintenance of myocyte structure and energetics. The failing myocardium has been reported to exhibit a depletion of several nutrients that are important for the maintenance of intracellular calcium homeostasis and cellular energetics, and levels of oxidative stress. This nutrient depletion may contribute to the progressive deterioration in myocardial structure and function observed in heart failure.

[Thrombosed aneurysm of the femoral vein mimicking a strangulated crural hernia].

Venous aneurysms are usually difficult to diagnose, especially when they are located in the inguinal area where they can be misinterpreted as inguinal or femoral hernias. We report the case of a 70-year-old man with a painful thrombosed aneurysm of the femoral vein that was clinically undistinguishable from a strangulated hernia. The ultrasonogram, performed 2 months before the acute pain when the femoral swelling was painless, seemed to confirm the incorrect diagnosis of femoral hernia, and the aneurysm was finally labeled as such during surgical exploration.

A controlled clinical trial of vitamin E supplementation in patients with congestive heart failure.

Background: Oxidative stress is increased in patients with congestive heart failure and can contribute to the progressive deterioration observed in these patients. Increased oxidative stress is the result of either an increased production of free radicals or a depletion of endogenous antioxidants, such as vitamin E.

Objective: We aimed to determine whether vitamin E supplementation of patients with advanced heart failure would modify levels of oxidative stress, thereby preventing or delaying the deterioration associated with free radical injury.

Identifying and prioritizing gaming workers' health and safety concerns using mapping for data collection.

Background: This research was prompted by the clinical presentation of workers from a variety of gaming occupations with injuries and illnesses and multiple health and safety concerns.

Methods: Using participatory action research principles, 51 gaming workers in Ontario and 20 gaming workers in Manitoba were consulted during a series of focus group sessions. Mapping exercises were used to survey the participants about their health concerns, perceived occupational hazards and the impact of working conditions on their personal lives.

The tissue distribution of tumor necrosis factor-alpha in rats: a compartmental model.

Tumor necrosis factor (TNF) is widely accepted to be the mediator of the cascade of metabolic abnormalities associated with both critical and chronic illness. TNF binding to cell surface receptors mediates its physiologic actions, although the exact mechanism of TNF action is unknown. Therefore, this study was designed to investigate the in vivo metabolism of TNF using a mathematical model to examine tissue uptake and loss of TNF over time.

Reduction of costs of disability using neuroprostheses.

The lifetime costs associated with spinal cord injury are substantial. Assistive technology that reduces complications, increases independence, or decreases the need for attendant services can provide economic as well as medical or functional benefit. This study describes two approaches for estimating the economic consequences of implanted neuroprostheses utilizing functional electrical stimulation.

Pin reduction and fixation of volar fracture fragments of distal radius fractures via the flexor carpi radialis tendon.

Background: The objective of this study was to evaluate a technique for reduction and stabilization of residually displaced volar fragments in intraarticular distal radius fractures.

Methods: A consecutive series of patients with AO type C3 distal radius fractures treated by one surgeon were studied. Percutaneously placed pins were placed through the flexor carpi radialis tendon to reduce and stabilize volar fracture fragments of distal radius fractures when closed reduction was unsuccessful.

[Improved function of the hand in persons with tetraplegia using electric stimulation via implanted electrodes].

Functional Electrical Stimulation (FES) is a controlled use of electrical stimulation of muscle contractions to obtain function. FES is utilised today in the treatment of spinal cord injured individuals for diaphragmatic pacing, bladder and bowel management, ejaculation, walking and hand function, as well as conditioning. We present The Freehand System, which consists of implanted electrodes to arm and hand muscles.