Physical therapy
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In this study, we investigated the applicability of thermography as a technique for evaluating the painful postcerebrovascular accident (CVA) shoulder in hemiplegic patients. A thermographic series was taken of the upper extremities and upper trunk of 27 female subjects. The four groups we evaluated were nonhemiplegic subjects (n = 9), post-CVA subjects with recovered function (n = 6), hemiplegic subjects with upper extremity motor impairment (n = 6), and hemiplegic subjects with both motor impairment and ipsilateral shoulder pain (n = 6). ⋯ The majority of the abnormal thermographic series of post-CVA subjects showed a 1 degree to 5 degree C coolness on the involved side. No consistent thermographic patterns emerged that could be related to the severity or location of pain. Further studies are needed to evaluate the efficacy of thermography as a means of determining the relationship between ipsilateral post-CVA coolness and hemiplegic shoulder pain.
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Pulmonary compromise is a leading cause of morbidity in patients with spinal cord injury (SCI). Because these patients have such complex and massive needs, routine respiratory care is not always given the priority it deserves in a rehabilitation program. Our institution established a committee to formulate guidelines for the routine respiratory care of patients in our interdisciplinary Acute Spinal Cord Injury Program. ⋯ The purposes of the guidelines were to increase staff awareness of the need for routine, prophylactic respiratory care of patients with SCI; to be an effective teaching tool for staff, thus resulting in a reduction of respiratory complications; and also to be a teaching tool for patients and their families so that routine respiratory care could be continued in the home. After using the guidelines for over a year, we believe that the quality of the respiratory care we provide our patients with SCI has improved. The respiratory care is more comprehensive, consistent, and coordinated among disciplines.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of transcutaneous electrical nerve stimulation characteristics on clinical pain.
We compared the effects of four treatment variables on the pain reduction produced by transcutaneous electrical nerve stimulation and attempted to establish indications for TENS based on patient history and pain evaluation items. Treatment variables were the therapist and the three TENS stimulus characteristics--pulse width, frequency, and amplitude. We randomly assigned 192 consecutive adult patients suffering from painful conditions to one of four physical therapists and one of 12 stimulus characteristic combinations. ⋯ The amplitude effect, however, was borderline (p = .056), and subthreshold stimulation proved more effective than stimulation to tolerance (p = .05). Extensive multiple linear regression analyses failed to provide indications for TENS based on patient information and pain evaluation items. Therefore, pain remains the only indication for TENS, and we recommend subthreshold rather than higher amplitude stimulation on the initial TENS trial.
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Comparative Study
Effect of different forms of transcutaneous electrical nerve stimulation on experimental pain.
The purpose of this study was to compare the effects of five different types of transcutaneous electrical nerve stimulation on experimentally induced pain threshold and tolerance in healthy subjects. Fourteen subjects received the following treatments on different days: low frequency TENS, burst frequency TENS, hyperstimulation TENS, high frequency TENS with a low voltage galvanic stimulator, and high frequency TENS with a high voltage galvanic stimulator to the left upper extremity. Pain threshold and tolerance were tested with electric current on a fingertip of the left upper extremity before each treatment, immediately after each treatment, and 20 minutes after the end of each treatment. ⋯ No significant effects of treatment or time for pain threshold or tolerance were found. A significant interaction between treatment and time for pain threshold was found. Further study is needed to compare the effects of these treatments in patients with clinical pain.
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Randomized Controlled Trial Clinical Trial
Effects of auricular transcutaneous electrical nerve stimulation on experimental pain threshold.
This study was conducted to examine the effects of high intensity transcutaneous electrical nerve stimulation at auricular acupuncture points on experimental pain threshold. Forty-five healthy adult male and female subjects were assigned randomly to one of two treatment groups or to a control group. Subjects in the two treatment groups received high intensity TENS to either appropriate or inappropriate (placebo) acupuncture points on one ear. ⋯ The comparable placebo and control groups, again, did not exhibit significant pretest-posttest differences in experimental pain threshold. The results suggest that, if applied accurately, auricular TENS can increase pain threshold. Further research is needed to assess the effects of this technique on patient groups.