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Kevin C. Chung - One of the best experts on this subject based on the ideXlab platform.
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leveraging the medical context to increase upper extremity reconstruction among patients with Tetraplegia a qualitative analysis
Archives of Physical Medicine and Rehabilitation, 2018Co-Authors: Chelsea A Harris, John Michael Muller, Melissa J Shauver, Kevin C. ChungAbstract:Abstract Objectives To (1) characterize patients' medical experiences from initial injury until they become candidates for upper extremity reconstruction (UER); and (2) identify points in this medical context that may be most amenable to interventions designed to increase UER utilization. Design A qualitative cross-sectional study using grounded theory methodology and constant comparative analysis of data collected through semistructured individual interviews. Setting Community. Participants A sample of individuals with C4 to C8 cervical spinal injuries (N=19) who sustained injuries at least 1 year before interview. Nine patients had undergone reconstruction, and 10 had not. The study sample was predominantly male (79%) and white (89%), and American Spinal Injury Association grades A through D were represented (A, 42%; B, 32%; C, 16%; D, 10%). Interventions Not applicable. Main Outcome Measures Participants' self-report of their medical experiences from the time of injury through the early recovery period. Results We identified 3 domains that formed patients' medical context before UER candidacy: (1) their ability to achieve and maintain health; (2) their relationship with health care providers; and (3) their expectations regarding clinicians' Tetraplegia-specific expertise. Trust emerged as a major theme driving potential intervention targets. Patients transferred to referral centers had higher trust in tertiary providers relative to local physicians. In the outpatient setting, patients' trust correlated with the Tetraplegia-specific expertise level they perceived the specialty to have (high for physical medicine and rehabilitation, intermediate for urology, low for primary care). Conclusions In appropriate candidates, UER produces substantial functional gains, but reconstruction remains underused in the tetraplegic population. By analyzing how patients achieve health and build trust in early recovery/injury, our study provides strategies to improve UER access. We propose that interventions targeting highly trusted points of care (transfer hospitals) and avoiding low-trust points (primary care physicians, home health) will be most effective. Urology may represent a novel entry point for UER interventions.
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Population-based utilities for upper extremity functions in the setting of Tetraplegia.
The Journal of hand surgery, 2009Co-Authors: Ashwin N. Ram, Catherine Curtin, Kevin C. ChungAbstract:Purpose People with Tetraplegia face substantial physical and financial hardships. Although upper extremity reconstruction has been advocated for people with Tetraplegia, these procedures are markedly underused in the United States. Population-based preference evaluation of upper extremity reconstruction is important to quantify the value of these reconstructive procedures. This study sought to establish the preferences for 3 health states: Tetraplegia, Tetraplegia with corrected pinch function, and Tetraplegia with corrected elbow extension function. Methods A computer-based, time trade-off survey was administered to a cohort of 81 able-bodied second-year medical students who served as a surrogate for the general public. This survey instrument has undergone pilot testing and has established face validity to evaluate the 3 health states of interest. Utilities were calculated based on an estimated 20 years of remaining life. Results The mean utility for the tetraplegic health state was low. On average, respondents gave up 10.8 ± 5.0 out of a hypothetical 20 years for perfect health, for a utility of Tetraplegia equal to 0.46. For recovery of pinch function, respondents gave up an average of 6.5 ± 4.3 years, with a corresponding health utility of 0.68. For recovery of elbow extension function, respondents gave up an average of 7.6 ± 4.5 years, with a corresponding health utility of 0.74. Conclusions This study established the preferences for 2 upper extremity surgical interventions: Tetraplegia with pinch and Tetraplegia with elbow extension. The findings from this study place a high value on upper-limb reconstructive procedures with Tetraplegia.
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Opinions on the Treatment of People With Tetraplegia: Contrasting Perceptions of Physiatrists and Hand Surgeons
The journal of spinal cord medicine, 2007Co-Authors: Catherine Curtin, Jared P. Wagner, David R. Gater, Kevin C. ChungAbstract:Background/Objective: Upper-extremity reconstruction for people with Tetraplegia is underused, and we felt that physicians' beliefs could be contributing to this phenomenon. This research sought to determine whether (a) physicians underestimate the importance of upper-extremity function for people with Tetraplegia, (b) physiatrists and hand surgeons disagree on the quality of life of those with Tetraplegia, (c) surgeons believe that social issues make people with Tetraplegia poor surgical candidates, and (d) the 2 specialties disagree on the benefits of upper-extremity reconstruction.
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Perceptions of people with Tetraplegia regarding surgery to improve upper-extremity function.
The Journal of hand surgery, 2007Co-Authors: Jared P. Wagner, Catherine Curtin, David R. Gater, Kevin C. ChungAbstract:Purpose In the United States, more than 100,000 Americans live with the disability of Tetraplegia. These individuals must struggle through long and complicated rehabilitations. Upper-extremity reconstructive surgery can improve use of the upper limb for appropriate candidates; however, a prior national study showed that these procedures rarely are performed. This cross-sectional survey identified the attitudes and beliefs of people with Tetraplegia that may dissuade potential candidates from receiving these procedures. Methods An oral survey was designed to determine priorities of reconstruction in individuals with Tetraplegia. This survey was administered to 50 people with Tetraplegia. Results Among those surveyed, 13 (26%) had never heard of upper-extremity reconstructive surgery, but 22 (44%) were interested in upper-extremity reconstruction. People with Tetraplegia who had a negative first impression of these procedures were far less likely to want reconstruction 0 (0%) vs. 11 (45%). Of patients who learned about these procedures from their physicians, 10 (67%) had a negative first impression after the physician consultation. Conclusions Although many people with Tetraplegia understand the benefits of upper-extremity reconstruction, a large number of them are unaware of or have unfavorable attitudes toward these procedures. These negative attitudes may account for the marked underuse of upper-extremity reconstructive procedures in the United States.
Jayne C. Carberry - One of the best experts on this subject based on the ideXlab platform.
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genioglossus reflex responses to negative upper airway pressure are altered in people with Tetraplegia and obstructive sleep apnoea
The Journal of Physiology, 2018Co-Authors: Nirupama Wijesuriya, Amy S Jordan, Peter D. Rochford, Jayne C. Carberry, Laura Gainche, David J Berlowitz, Mariannick Leguen, Fergal J Odonoghue, Warren R RuehlandAbstract:KEY POINTS Protective reflexes in the throat area (upper airway) are crucial for breathing. Impairment of these reflexes can cause breathing problems during sleep such as obstructive sleep apnoea (OSA). OSA is very common in people with spinal cord injury for unknown reasons. This study shows major changes in protective reflexes that serve to keep the upper airway open in response to suction pressures in people with Tetraplegia and OSA. These results help us understand why OSA is so common in people with Tetraplegia and provide new insight into how protective upper airway reflexes work more broadly. ABSTRACT More than 60% of people with Tetraplegia have obstructive sleep apnoea (OSA). However, the specific causes are unknown. Genioglossus, the largest upper-airway dilator muscle, is important in maintaining upper-airway patency. Impaired genioglossus muscle function following spinal cord injury may contribute to OSA. This study aimed to determine if genioglossus reflex responses to negative upper-airway pressure are altered in people with OSA and Tetraplegia compared to non-neurologically impaired able-bodied individuals with OSA. Genioglossus reflex responses measured via intramuscular electrodes to ∼60 brief (250 ms) pulses of negative upper-airway pressure (∼-15 cmH2 O at the mask) were compared between 13 participants (2 females) with Tetraplegia plus OSA and 9 able-bodied controls (2 females) matched for age and OSA severity. The initial short-latency excitatory reflex response was absent in 6/13 people with Tetraplegia and 1/9 controls. Genioglossus reflex inhibition in the absence of excitation was observed in three people with Tetraplegia and none of the controls. When the excitatory response was present, it was significantly delayed in the Tetraplegia group compared to able-bodied controls: excitation onset latency (mean ± SD) was 32 ± 16 vs. 18 ± 9 ms, P = 0.045; peak excitation latency was 48 ± 17 vs. 33 ± 8 ms, P = 0.038. However, when present, amplitude of the excitation response was not different between groups, 195 ± 26 vs. 219 ± 98% at baseline, P = 0.55. There are major differences in genioglossus reflex morphology and timing in response to rapid changes in airway pressure in people with Tetraplegia and OSA. Altered genioglossus function may contribute to the increased risk of OSA in people with Tetraplegia. The precise mechanisms mediating these differences are unknown.
David J Berlowitz - One of the best experts on this subject based on the ideXlab platform.
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Comparison of diurnal blood pressure and urine production between people with and without chronic spinal cord injury
Spinal Cord, 2018Co-Authors: Min Yin Goh, David J Berlowitz, Marnie Graco, Douglas J Brown, Melinda S. Millard, Edmund C. K. Wong, Rachel M. Schembri, Albert G. Frauman, Christopher J. O’callaghanAbstract:Study design Observational study. Objectives To quantify diurnal blood pressure (BP) patterns and nocturnal hypertension and to measure diurnal urine production in people with chronic spinal cord injury (SCI), compared with controls without SCI. Setting Chronic SCI population in the community in Victoria, Australia. Methods Participants were recruited by advertisement, and sustained SCI at least a year prior or were healthy able-bodied volunteers. Participants underwent ambulatory BP monitoring (ABPM), measurement of urine production, and completed questionnaires regarding orthostatic symptoms. Comparisons were made between participants with Tetraplegia or paraplegia and able-bodied controls. Participants with night:day systolic BP 100% as reverse dippers. Results Groups with Tetraplegia ( n = 51) and paraplegia ( n = 33) were older (42.1 ± 15 and 41.1 ± 15 vs. 32.4 ± 13 years, mean ± s.d.) and had a higher prevalence of males (88 and 85% vs. 60%) than controls ( n = 52). The average BP was 110.8 ± 1.5/64.4 ± 1.2 mmHg, 119.4 ± 2.1/69.8 ± 1.5 mmHg, and 118.1 ± 1.4/69.8 ± 1.0 mmHg in Tetraplegia, paraplegia, and controls, respectively. Of participants with Tetraplegia, paraplegia and controls, reverse dipping was observed in 45, 13, and 2% ( p
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genioglossus reflex responses to negative upper airway pressure are altered in people with Tetraplegia and obstructive sleep apnoea
The Journal of Physiology, 2018Co-Authors: Nirupama Wijesuriya, Amy S Jordan, Peter D. Rochford, Jayne C. Carberry, Laura Gainche, David J Berlowitz, Mariannick Leguen, Fergal J Odonoghue, Warren R RuehlandAbstract:KEY POINTS Protective reflexes in the throat area (upper airway) are crucial for breathing. Impairment of these reflexes can cause breathing problems during sleep such as obstructive sleep apnoea (OSA). OSA is very common in people with spinal cord injury for unknown reasons. This study shows major changes in protective reflexes that serve to keep the upper airway open in response to suction pressures in people with Tetraplegia and OSA. These results help us understand why OSA is so common in people with Tetraplegia and provide new insight into how protective upper airway reflexes work more broadly. ABSTRACT More than 60% of people with Tetraplegia have obstructive sleep apnoea (OSA). However, the specific causes are unknown. Genioglossus, the largest upper-airway dilator muscle, is important in maintaining upper-airway patency. Impaired genioglossus muscle function following spinal cord injury may contribute to OSA. This study aimed to determine if genioglossus reflex responses to negative upper-airway pressure are altered in people with OSA and Tetraplegia compared to non-neurologically impaired able-bodied individuals with OSA. Genioglossus reflex responses measured via intramuscular electrodes to ∼60 brief (250 ms) pulses of negative upper-airway pressure (∼-15 cmH2 O at the mask) were compared between 13 participants (2 females) with Tetraplegia plus OSA and 9 able-bodied controls (2 females) matched for age and OSA severity. The initial short-latency excitatory reflex response was absent in 6/13 people with Tetraplegia and 1/9 controls. Genioglossus reflex inhibition in the absence of excitation was observed in three people with Tetraplegia and none of the controls. When the excitatory response was present, it was significantly delayed in the Tetraplegia group compared to able-bodied controls: excitation onset latency (mean ± SD) was 32 ± 16 vs. 18 ± 9 ms, P = 0.045; peak excitation latency was 48 ± 17 vs. 33 ± 8 ms, P = 0.038. However, when present, amplitude of the excitation response was not different between groups, 195 ± 26 vs. 219 ± 98% at baseline, P = 0.55. There are major differences in genioglossus reflex morphology and timing in response to rapid changes in airway pressure in people with Tetraplegia and OSA. Altered genioglossus function may contribute to the increased risk of OSA in people with Tetraplegia. The precise mechanisms mediating these differences are unknown.
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Genioglossus reflex responses to negative upper airway pressure are altered in people with Tetraplegia and obstructive sleep apnoea
'Wiley', 2018Co-Authors: Nirupama Wijesuriya, David J Berlowitz, Warren R Ruehland, Gainche L, As Jordan, Leguen M, Pd Rochford, Fj O'donoghue, Jc Carberry, Je ButlerAbstract:© 2018 The Authors. The Journal of Physiology © 2018 The Physiological Society Key points: Protective reflexes in the throat area (upper airway) are crucial for breathing. Impairment of these reflexes can cause breathing problems during sleep such as obstructive sleep apnoea (OSA). OSA is very common in people with spinal cord injury for unknown reasons. This study shows major changes in protective reflexes that serve to keep the upper airway open in response to suction pressures in people with Tetraplegia and OSA. These results help us understand why OSA is so common in people with Tetraplegia and provide new insight into how protective upper airway reflexes work more broadly. Abstract: More than 60% of people with Tetraplegia have obstructive sleep apnoea (OSA). However, the specific causes are unknown. Genioglossus, the largest upper-airway dilator muscle, is important in maintaining upper-airway patency. Impaired genioglossus muscle function following spinal cord injury may contribute to OSA. This study aimed to determine if genioglossus reflex responses to negative upper-airway pressure are altered in people with OSA and Tetraplegia compared to non-neurologically impaired able-bodied individuals with OSA. Genioglossus reflex responses measured via intramuscular electrodes to ∼60 brief (250 ms) pulses of negative upper-airway pressure (∼−15 cmH2O at the mask) were compared between 13 participants (2 females) with Tetraplegia plus OSA and 9 able-bodied controls (2 females) matched for age and OSA severity. The initial short-latency excitatory reflex response was absent in 6/13 people with Tetraplegia and 1/9 controls. Genioglossus reflex inhibition in the absence of excitation was observed in three people with Tetraplegia and none of the controls. When the excitatory response was present, it was significantly delayed in the Tetraplegia group compared to able-bodied controls: excitation onset latency (mean ± SD) was 32 ± 16 vs. 18 ± 9 ms, P = 0.045; peak excitation latency was 48 ± 17 vs. 33 ± 8 ms, P = 0.038. However, when present, amplitude of the excitation response was not different between groups, 195 ± 26 vs. 219 ± 98% at baseline, P = 0.55. There are major differences in genioglossus reflex morphology and timing in response to rapid changes in airway pressure in people with Tetraplegia and OSA. Altered genioglossus function may contribute to the increased risk of OSA in people with Tetraplegia. The precise mechanisms mediating these differences are unknown
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Subjective sleep disturbances and quality of life in chronic Tetraplegia.
Spinal cord, 2015Co-Authors: Jo Spong, Marnie Graco, Douglas J Brown, Rachel Schembri, David J BerlowitzAbstract:This is a cross-sectional survey. The objective of this study was to evaluate the subjective sleep disturbances and quality of life in chronic Tetraplegia. This study was conducted in a community sample from Victoria, Australia. People with Tetraplegia were mailed a survey battery including the following: demographic questions; Karolinska Sleepiness Scale (KSS); Basic Nordic Sleepiness Questionnaire; Functional Outcomes of Sleep Questionnaire (FOSQ); Multivariate Apnoea Prediction Index and Assessment of Quality of Life (AQoL) Questionnaire. Scores were compared with the best available normative data. A total of 163 of 424 (38%) surveys were returned (77% male; 39% sensory and motor complete; mean age±s.d.=46±14 years; mean years since injury=11±8 years). The AQoL health utility score (0.31±0.29) was significantly lower than published population norms. FOSQ total (17.55±2.57) and KSS (3.93±2.27) scores were no different from the best available population data. People with Tetraplegia reported worse sleep habits, symptoms and quality than a normal population, as indicated on 17 of 21 questions on the Basic Nordic Sleep Questionnaire. Multivariate analysis found that greater injury severity (coefficient (95% CI)=0.14 (0.10, 0.18)), increasing age (−0.004 (−0.008, −0.001)) and worse sleep symptoms (−0.005 (−0.009, −0.0003)) were all significantly associated with reduced quality of life. People with chronic Tetraplegia experience more subjective sleep problems and worse quality of life than their able-bodied counterparts. Quality of life is related to injury severity, age and sleep symptoms. Treating the sleep disorders experienced by people living with Tetraplegia has the potential to improve their health and well-being.
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relationships between objective sleep indices and symptoms in a community sample of people with Tetraplegia
Archives of Physical Medicine and Rehabilitation, 2012Co-Authors: David J Berlowitz, Jo Spong, Ian Gordon, Mark E Howard, Douglas J BrownAbstract:Abstract Berlowitz DJ, Spong J, Gordon I, Howard ME, Brown DJ. Relationships between objective sleep indices and symptoms in a community sample of people with Tetraplegia. Objective To examine the relationships between injury severity, quality of life, sleep symptoms, objectively measured sleep, and sleep disorders in chronic Tetraplegia. Design Cross-sectional survey. Setting Community. Participants People with Tetraplegia (N=78; 59 men, 35 with motor and sensory complete Tetraplegia; mean age ± SD, 43±12.1; age range 18–70y), living in the state of Victoria, Australia, who were not currently being treated for sleep disorders and who completed both questionnaires and sleep studies comprised the study cohort. Intervention Questionnaire battery mailed to potential participants. Returned questionnaires were followed with full, home-based polysomnography. Main Outcome Measures Demographics and questionnaire responses. Results Quality of life (Assessment of Quality of Life instrument) was worse in the group with complete lesions compared with incomplete lesions ( P =.001; median=16; interquartile range, 9 vs 12 [12]), and the Apnea-Hypopnea Index was higher ( P =.002; interquartile range, 32.0 [25.2] vs 13.2 [24.8]). Ninety-one percent of those with complete lesions had obstructive sleep apnea (Apnea-Hypopnea Index >10) versus 55.8% of those with incomplete Tetraplegia. No effect of lesion level on the Apnea-Hypopnea Index was observed ( r =–.04, P =.73). In the complete group, the time taken from sleep onset until the first rapid eye movement sleep period was significantly delayed at over 2 hours. Multiple regression analyses showed substantially stronger relationships between daytime sleep complaints and abnormalities observed in the sleep study in those with complete lesions. Conclusions Obstructive sleep apnea is a major problem, particularly in those with complete Tetraplegia, and this single comorbidity is associated with reduced quality of life. In those with incomplete cervical lesions, the relationships between sleepiness, other sleep symptoms, and polysomnography indices are less precise.
William A. Bauman - One of the best experts on this subject based on the ideXlab platform.
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Self-reported effects of cold temperature exposure in persons with Tetraplegia
The journal of spinal cord medicine, 2016Co-Authors: John P. Handrakis, Dwindally Rosado-rivera, Kamaldeep Singh, Kirsten Swonger, Frank Azarelo, Alex T. Lombard, Ann M. Spungen, Steven Kirshblum, William A. BaumanAbstract:Objective: Cervical spinal cord injury (Tetraplegia) is known to interrupt sympathetic vasculature control, thereby preventing shunting of blood from the periphery to central organs when exposed to cold temperatures. As a result, persons with Tetraplegia are at risk to develop hypothermia. However, information regarding the discomfort experienced during the cooler months (late fall, winter, early spring) is overwhelmingly anecdotal. It is not known, with any certainty, how those with Tetraplegia perceive cold and if discomfort in colder environments restricts them from performing activities that they routinely would perform.Design: Prospective, two-group, self-report surveys.Setting: VA Medical Center and Kessler Institute for Rehabilitation.Participants: Forty-four subjects with Tetraplegia; 41 matched non-SCI controls.Outcome Measures: Tetraplegic and control groups responded “yes” or “no” when asked whether cold seasonal temperatures allowed comfort or negatively affected participation in routine activ...
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Biomarkers of inflammation in persons with chronic Tetraplegia
Journal of breath research, 2015Co-Authors: Miroslav Radulovic, Kamaldeep Singh, William A. Bauman, Jill M. Wecht, Michael F. Lafountaine, Nighat N. Kahn, Joshua C. Hobson, Christopher Renzi, Christina Yen, Gregory J. SchileroAbstract:In addition to lung volume restriction, individuals with chronic Tetraplegia exhibit reduced airway caliber and bronchodilator responsiveness similar to persons with asthma. In asthma, airflow obstruction is closely linked to airway inflammation. Conversely, little is known regarding the airway inflammatory response in Tetraplegia.To compare levels of biomarkers of inflammation in exhaled breath condensate (EBC) and serum in subjects with chronic Tetraplegia, mild asthma, and able-bodied controls.Prospective, observational pilot study.Thirty-four subjects participated: Tetraplegia (n = 12), asthma (n = 12), controls (n = 10). Biomarkers in EBC [8-isoprostane (8-IP), leukotriene B4 (LT-B4), prostaglandin E2 (PG-E2), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6)] and serum (8-IP, LT-B4, TNF-α, IL-6) were determined using commercially available EIA kits (Cayman Chemical Company, Ann Arbor, MI). Separate, one-way ANOVA with Bonferroni's post-hoc analyses were performed to determine group differences in demographic and dependent variables [EBC and serum biomarkers, fractional exhaled nitric oxide (FeNO), pulmonary function parameters, and specific airway conductance (sGaw)].The Tetraplegia group had significantly elevated 8-IP levels in EBC compared to the asthma (68 ± 38 versus 21 ± 13 pg ml−1; p < 0.001) and control groups (22 ± 13 pg ml−1; p < 0.01), respectively. FeNO levels were significantly elevated in the asthma compared to the control group (26 ± 18 versus 11 ± 4 ppb; p < 0.05), and trended higher than levels in the Tetraplegia group (15 ± 6; p = 0.08). Levels of serum biomarkers did not differ significantly among groups.Through analysis of EBC, levels of 8-IP were significantly elevated compared to levels found in individuals with mild asthma and healthy controls. Further studies are needed to extend upon these preliminary findings that suggest the presence of airway inflammation in subjects with chronic Tetraplegia, and how this relates to pulmonary dysfunction in this population.
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Exhaled Nitric Oxide Levels Are Elevated in Persons with Tetraplegia and Comparable to that in Mild Asthmatics
Lung, 2010Co-Authors: Miroslav Radulovic, Dwindally Rosado-rivera, Gregory J. Schilero, Jill M. Wecht, Michael Fountaine, William A. BaumanAbstract:The role of airway inflammation in mediating airflow obstruction in persons with chronic traumatic Tetraplegia is unknown. Measurement of the fraction of exhaled nitric oxide (FeNO) affords a validated noninvasive technique for gauging the airway inflammatory response in asthma, although it has never been assessed in persons with Tetraplegia. This study was designed to determine the FeNO in individuals with chronic Tetraplegia compared with that in patients with mild asthma and healthy able-bodied individuals. Nine subjects with chronic Tetraplegia, seven subjects with mild asthma, and seven matched healthy able-bodied controls were included in this prospective, observational, pilot study. All subjects were nonsmokers and clinically stable at the time of study. Spirometry was performed on all participants at baseline. FENO was determined online by a commercially available closed circuit, chemiluminescence method, using a single-breath technique. Subjects with Tetraplegia had significantly higher values of FeNO than controls (17.72 ± 3.9 ppb vs. 10.37 ± 4.9 ppb; P ≤ 0.01), as did subjects with asthma (20.23 ± 4.64 ppb vs. 10.37 ± 4.9 ppb, P ≤ 0.001). There was no significant difference in FeNO between subjects with Tetraplegia and those with asthma (17.72 ± 3.9 ppb vs. 20.23 ± 4.64 ppb, P ≤ 0.27). Individuals with chronic Tetraplegia have FeNO levels that are comparable to that seen in mild asthmatics and higher than that in healthy able-bodied controls. The clinical relevance of this observation has yet to be determined.
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Breathing pattern and ventilatory control in chronic Tetraplegia.
Lung, 2009Co-Authors: Ann M. Spungen, William A. Bauman, Marvin Lesser, F. Dennis MccoolAbstract:Blunted ventilatory responses to carbon dioxide indicate that respiratory control is impaired when ventilation is stimulated in individuals with Tetraplegia; however, respiratory control during resting breathing has not been extensively studied in this population. Our objective was to evaluate respiratory control and sigh frequency during resting breathing in persons with Tetraplegia. A prospective, two-group comparative study was performed. Breathing pattern was assessed in ten outpatients with chronic Tetraplegia and eight age- and gender-matched able-bodied controls. Subjects were noninvasively monitored for 1 h, while seated and at rest. Tidal volume (VT) was calculated from the sum of the anteroposterior displacements of the rib cage and abdomen and the axial displacement of the chest wall. Inspiratory time (TI), VT, and the ratio of VT to inspiratory time (VT/TI) were calculated breath by breath. A sigh was defined as any breath greater than two or more times an individual’s mean VT. Minute ventilation, VT/TI, and sigh frequency were reduced in Tetraplegia compared with controls (5.24 ± 1.15 vs. 7.16 ± 1.29 L/min, P < 0.005; 208 ± 45 vs. 284 ± 47 ml/s, P < 0.005; and 11 ± 7 vs. 42 ± 19 sighs/h, P < 0.0005, respectively). VT/TI was associated with sigh frequency in both groups (Tetraplegia: R = 0.88; P = 0.001 and control: R = 0.70; P < 0.05). We concluded that reductions in minute ventilation, VT/TI, and sigh frequency suggest that respiratory drive is diminished during resting breathing in subjects with Tetraplegia. These findings extend prior observations of disordered respiratory control during breathing stimulated by CO2 in Tetraplegia to resting breathing.
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Orthostatic Responses to Nitric Oxide Synthase Inhibition in Persons With Tetraplegia
Archives of physical medicine and rehabilitation, 2009Co-Authors: Jill M. Wecht, Dwindally Rosado-rivera, Miroslav Radulovic, Michael F. Lafountaine, Run-lin Zhang, William A. BaumanAbstract:Abstract Wecht JM, Radulovic M, LaFountaine MF, Rosado-Rivera D, Zhang R-L, Bauman WA. Orthostatic responses to nitric oxide synthase inhibition in persons with Tetraplegia. Objectives To determine the effects of 1.0mg/kg nitro-l-arginine methyl ester (L-NAME) on orthostatic mean arterial pressure (MAP), serum aldosterone, and plasma renin concentrations in persons with chronic Tetraplegia compared with nonspinal cord–injured controls. Design Prospective placebo-controlled intervention study. Setting James J. Peters Veterans Affairs Medical Center. Participants Patients (n=5) with Tetraplegia and controls (n=7) participated. The groups were matched for age, height, and weight; the average duration of injury in the Tetraplegia group was 22±14 years. Intervention Subjects with Tetraplegia visited the laboratory twice, receiving placebo on day 1 and L-NAME (1.0mg/kg) on day 2. The agents were infused via an intravenous catheter over 60 minutes with the patient in the supine position. Data were collected during the infusion and then during head-up tilt to 45° for 30 minutes. Control subjects visited the laboratory once for placebo infusion and the head-up tilt maneuver. Main Outcome Measure Orthostatic MAP. Results Orthostatic MAP was reduced after placebo infusion in subjects with Tetraplegia compared with controls (69±11 vs 89±9mmHg, respectively; P P Conclusions These data suggest that nitric oxide synthase inhibition may have clinical potential for treatment of orthostatic hypotension in persons with chronic Tetraplegia.
Catherine Curtin - One of the best experts on this subject based on the ideXlab platform.
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pinch and elbow extension restoration in people with Tetraplegia a systematic review of the literature
Journal of Hand Surgery (European Volume), 2009Co-Authors: Cynthia Hamou, Nirav R Shah, Lisa Diponio, Catherine CurtinAbstract:Purpose We conducted a systematic review of the literature to summarize the available data on reconstructive surgeries involving pinch reconstruction and elbow extension restoration in people with Tetraplegia. Methods English-language and French-language articles and abstracts published between 1966 and February 2007, identified through MEDLINE and EMBASE searches, bibliography review, and expert consultation, were reviewed for original reports of outcomes with pinch reconstruction and elbow extension restoration in tetraplegic patients after a spinal cord injury. Two reviewers independently extracted data on patient characteristics, surgical methods, and patient outcomes. Results Our search identified 765 articles, of which 37 met eligibility criteria (one article contained information on both elbow and pinch procedures). Results from 377 pinch reconstructions in 23 studies and 201 elbow extension restorations in 14 studies were summarized. The mean Medical Research Council score for elbow extension went from 0 to 3.3 after reconstruction. The overall mean postoperative strength measured after surgery for pinch reconstruction was 2 kg. Conclusions More than 500 patients having these procedures experienced a clinically important improvement for both procedures—one restoring elbow extension, and the other, pinch strength. Upper-limb surgeries markedly improved the hand function of people with Tetraplegia. Type of study/level of evidence Therapeutic IV.
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Population-based utilities for upper extremity functions in the setting of Tetraplegia.
The Journal of hand surgery, 2009Co-Authors: Ashwin N. Ram, Catherine Curtin, Kevin C. ChungAbstract:Purpose People with Tetraplegia face substantial physical and financial hardships. Although upper extremity reconstruction has been advocated for people with Tetraplegia, these procedures are markedly underused in the United States. Population-based preference evaluation of upper extremity reconstruction is important to quantify the value of these reconstructive procedures. This study sought to establish the preferences for 3 health states: Tetraplegia, Tetraplegia with corrected pinch function, and Tetraplegia with corrected elbow extension function. Methods A computer-based, time trade-off survey was administered to a cohort of 81 able-bodied second-year medical students who served as a surrogate for the general public. This survey instrument has undergone pilot testing and has established face validity to evaluate the 3 health states of interest. Utilities were calculated based on an estimated 20 years of remaining life. Results The mean utility for the tetraplegic health state was low. On average, respondents gave up 10.8 ± 5.0 out of a hypothetical 20 years for perfect health, for a utility of Tetraplegia equal to 0.46. For recovery of pinch function, respondents gave up an average of 6.5 ± 4.3 years, with a corresponding health utility of 0.68. For recovery of elbow extension function, respondents gave up an average of 7.6 ± 4.5 years, with a corresponding health utility of 0.74. Conclusions This study established the preferences for 2 upper extremity surgical interventions: Tetraplegia with pinch and Tetraplegia with elbow extension. The findings from this study place a high value on upper-limb reconstructive procedures with Tetraplegia.
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Opinions on the Treatment of People With Tetraplegia: Contrasting Perceptions of Physiatrists and Hand Surgeons
The journal of spinal cord medicine, 2007Co-Authors: Catherine Curtin, Jared P. Wagner, David R. Gater, Kevin C. ChungAbstract:Background/Objective: Upper-extremity reconstruction for people with Tetraplegia is underused, and we felt that physicians' beliefs could be contributing to this phenomenon. This research sought to determine whether (a) physicians underestimate the importance of upper-extremity function for people with Tetraplegia, (b) physiatrists and hand surgeons disagree on the quality of life of those with Tetraplegia, (c) surgeons believe that social issues make people with Tetraplegia poor surgical candidates, and (d) the 2 specialties disagree on the benefits of upper-extremity reconstruction.
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Perceptions of people with Tetraplegia regarding surgery to improve upper-extremity function.
The Journal of hand surgery, 2007Co-Authors: Jared P. Wagner, Catherine Curtin, David R. Gater, Kevin C. ChungAbstract:Purpose In the United States, more than 100,000 Americans live with the disability of Tetraplegia. These individuals must struggle through long and complicated rehabilitations. Upper-extremity reconstructive surgery can improve use of the upper limb for appropriate candidates; however, a prior national study showed that these procedures rarely are performed. This cross-sectional survey identified the attitudes and beliefs of people with Tetraplegia that may dissuade potential candidates from receiving these procedures. Methods An oral survey was designed to determine priorities of reconstruction in individuals with Tetraplegia. This survey was administered to 50 people with Tetraplegia. Results Among those surveyed, 13 (26%) had never heard of upper-extremity reconstructive surgery, but 22 (44%) were interested in upper-extremity reconstruction. People with Tetraplegia who had a negative first impression of these procedures were far less likely to want reconstruction 0 (0%) vs. 11 (45%). Of patients who learned about these procedures from their physicians, 10 (67%) had a negative first impression after the physician consultation. Conclusions Although many people with Tetraplegia understand the benefits of upper-extremity reconstruction, a large number of them are unaware of or have unfavorable attitudes toward these procedures. These negative attitudes may account for the marked underuse of upper-extremity reconstructive procedures in the United States.
