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Marin EL, Bifulco SS, Fast A. Obesity. A risk factor for knee dislocation. Am J Phys Med Rehabil 1990; 69:132-4. [PMID: 2363903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Complete dislocation of the knee joint is a severe injury that is commonly the result of high-velocity injuries and often associated with disruption of the popliteal artery. We report two cases in which obesity appeared to be the principal cause of knee dislocation with vascular compromise. Preventive measures in extremely obese patients are recommended.
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Fast A, Weiss L, Ducommun EJ, Medina E, Butler JG. Low-back pain in pregnancy. Abdominal muscles, sit-up performance, and back pain. Spine (Phila Pa 1976) 1990; 15:28-30. [PMID: 2139238 DOI: 10.1097/00007632-199001000-00008] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An attempt was made to determine the effect of pregnancy on the abdominal muscles and to correlate changes in abdominal muscles strength with low-back pain during pregnancy. The study included 328 women. Group A consisted of 164 pregnant women; group B consisted of 164 non-pregnant women. The race, age, height, weight, parity, profession, time devoted to physical fitness per week, abdominal length, and relation between the abdominal length to height were recorded. A detailed history relating to backache prior to and during pregnancy was obtained. Each woman was asked to perform a single sit-up. The results of the study indicate that about 10% of pregnant women develop severe low-back pain that interferes with daily life activities. About 49% of the non-pregnant women complained of LBP. The pain did not interfere with activities of daily living. During pregnancy, due to overstretching of the abdominal muscles, the ability to perform a sit-up is significantly decreased. Whereas all non-pregnant women could perform a sit-up, 16.6% of pregnant women could not perform a single sit-up. There was no statistically significant correlation between the sit-up performance and backache. It may be concluded that during pregnancy the abdominal muscles become insufficient.
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Floman Y, Gomori JM, Fast A. Isthmic spondylolisthesis in pycnodysostosis. JOURNAL OF SPINAL DISORDERS 1989; 2:268-71. [PMID: 2520085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Pycnodysostosis is an inborn skeletal syndrome manifested by short stature with a concomitant spinal deformity and by dense sclerotic fragile bones. We report a 35-year-old woman with pycnodysostosis and isthmic spondylolisthesis. Pycnodysostosis should be added to the differential diagnosis of spondylolisthesis.
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29
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Fast A, Weiss L, Parikh S, Hertz G. Night backache in pregnancy. Hypothetical pathophysiological mechanisms. Am J Phys Med Rehabil 1989; 68:227-9. [PMID: 2529882 DOI: 10.1097/00002060-198910000-00005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
One hundred women responded to a questionnaire dealing with night backache during pregnancy. All the women were in the second half of their pregnancy. Sixty seven per cent of the women reported discomfort and/or backache during the night. We hypothesize that hypervolemia combined with obstruction of the inferior vena cava, caused by the enlarging uterus, is the underlying pathomechanism leading to night backache. Patients with inadequate venous collateral circulation may develop excessive pressure within the venous system, the vertebral bodies and overdistension of venous channels distal to the occluded zone. These changes may lead to hypoxemia, metabolic disturbances, irritation of unmyelinated nerves and result in night backache.
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30
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Schleenbaker RE, Edmonds-Kitch A, Fast A. Motorcycle accidents and their outcome. Commentary. Am J Phys Med Rehabil 1989; 68:252-3. [PMID: 2803685 DOI: 10.1097/00002060-198910000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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31
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Fast A, Parikh S, Ducommun EJ. Dermatitis-sympathetic dysfunction in carpal tunnel syndrome. A case report. Clin Orthop Relat Res 1989:124-6. [PMID: 2791381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 52-year-old woman complained of numbness affecting the thumb, index, and middle fingers of both hands. The patient was managed with night splints with partial relief of symptoms. As a house cleaner, the patient was routinely exposed to water and detergents. About a year later, the patient developed contact dermatitis in the fingertips innervated by the median nerves. Electromyographic studies confirmed the presence of bilateral carpal tunnel syndrome. The temperature of all the fingertips was measured. The median innervated fingertips were warmer than those innervated by the ulnar nerves. The median sympathetic fibers may be compromized by compression in the carpal tunnel. This caused vasodilation, increased finger temperature, and lack of sweating in the median innervated fingers. Due to regular exposure to water and detergents, the susceptible dry fingertips developed contact dermatitis. The patient was managed conservatively, and the rash and numbness disappeared.
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32
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Fast A, Parikh S, Marin EL. The shoulder abduction relief sign in cervical radiculopathy. Arch Phys Med Rehabil 1989; 70:402-3. [PMID: 2719545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A patient with C6 cervical radiculopathy reported that sustained shoulder abduction significantly diminished this upper extremity pain. The patient was instructed to adopt this position for prolonged periods during rest and at work. Pain relief was temporary and lasted as long as the arm was in abduction. Relief of pain, induced by arm abduction, may be observed in cervical radiculopathy in which the lower cervical roots are involved. Reduced tension at the nerve root is the probable underlying mechanism that leads to pain relief. Shoulder abduction can be used not only as a diagnostic sign but also may be incorporated in the conservative management of patients suffering from cervical radiculopathy affecting the lower cervical roots.
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33
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Shames JL, Fast A. Gluteal abscess causing sciatica in a patient with systemic lupus erythematosus. Arch Phys Med Rehabil 1989; 70:410-1. [PMID: 2719548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Low back pain and sciatica may be caused by pathology remote from disc and lumbosacral vertebral segments. We report on a 59-year-old patient with systemic lupus erythematosis whose history illustrates this point. The patient was evaluated and diagnosed to have a septic arthritis of the wrist and lumbar spinal stenosis, for which she was treated. The patient's failure to respond to therapy led to further evaluation. A massive gluteal abscess was identified and drained, and with appropriate antibiotic therapy, the patient recovered. Patients with lupus have increased likelihood of infection, and their evaluation should include a search to discover unusual locations in cases that are unresponsive to standard and seemingly appropriate therapy.
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34
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Fast A. Low back disorders: conservative management. Arch Phys Med Rehabil 1988; 69:880-91. [PMID: 2972268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Painful disorders of the low back may arise from a large variety of mechanisms and there is no simple, single solution to them. They have a great social and economic cost in industrialized countries. The major syndromes of low back pain and sciatica are reviewed, including myofascial pain syndromes, disc herniations, radiculopathies, spinal stenosis and facet syndromes. Non-operative management is reviewed, including bed rest, medications, traction, manipulation, external supports, physical modalities, therapeutic exercise, trigger point injection and chemonucleolysis. Prevention should become the main goal of physicians dealing with this multifaceted problem.
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35
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Abstract
Cervical manipulation may result in serious neurologic injury arising specifically from trauma to the vertebrobasilar system. The vertebral arteries are susceptible to trauma at three locations: in the transverse foraminae, at the atlantoaxial joint, and at the occipitoatlantal joint. Because of frequent inequality in the size of the two vertebral arteries, damage to the larger artery may lead to ischemia of the brain stem. Vertebral artery obstruction may be produced by extension with rotation, even within normal ranges of motion. Neurologic injury following manipulation requires accurate diagnosis and prompt manipulation requires accurate diagnosis and prompt anticoagulant therapy.
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36
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Nyska M, Klin B, Margulies JY, Fast A, Floman Y. Disseminated intravascular coagulopathy in patients with cancer undergoing operation for pathological fractures of the hip. INTERNATIONAL ORTHOPAEDICS 1987; 11:179-81. [PMID: 3623752 DOI: 10.1007/bf00271444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Disseminated intravascular coagulopathy is a serious complication of numerous pathological conditions, particularly metastatic cancer. It is rarely encountered in orthopaedic surgery. Prompt recognition and treatment is required to prevent death. We describe two patients with pathological fractures of the proximal femur due to metastatic disease who died from disseminated intravascular coagulation after operation. A high index of suspicion, careful monitoring of the clotting mechanism and prompt treatment are required.
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37
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Fast A, Marin EL. Diagnosis of carpal tunnel syndrome. BRITISH JOURNAL OF RHEUMATOLOGY 1987; 26:233. [PMID: 3580719 DOI: 10.1093/rheumatology/26.3.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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38
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Abstract
Two hundred women were interviewed within 24-36 hours after giving birth. The patients were not examined. It was found that 56% of the patients suffered from low-back pain during pregnancy. The percentage of Caucasians was statistically higher in the back pain group. The percentage of Hispanics was statistically higher in the no pain group. Among the variables that were compared in both groups were the age, the weight gained by the mothers during pregnancy, the baby's weight, the number of previous pregnancies, number of prior children. None of the variables reached a statistically significant level. The pain group complained of pain the low-back area, which radiated in 45.5% of cases to the lower extremities. In about one-third of the patients the pain increased as the day wore on, whereas in another one-third the pain increased during the night and disturbed sleep. Standing, sitting, forward bending, lifting, and walking tended to increase the pain. Most of the patients started suffering from back pain between the fifth and seventh months of pregnancy. Several theories to explain the occurrence of backache during pregnancy are discussed.
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39
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Fast A, Parikh S, Marin EL. Spine fractures in ankylosing spondylitis. Arch Phys Med Rehabil 1986; 67:595-7. [PMID: 3767633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patients with ankylosing spondylitis are susceptible to spine fracture, usually in the cervical spine. Less frequently, the thoracic and lumbar spine is affected. The fracture line may involve anterior and posterior elements. Frequently, it extends through the entire width of the spine. As a result the fracture tends to be unstable and may cause neurologic damage. Prompt immobilization and reduction of the dislocated spine followed by stabilization may prevent neurologic damage. We report a 45-year-old man who fell and sustained a fracture dislocation of L2 vertebra. The patient was operated and stabilized with Harrington rods. A deep wound infection developed, which did not respond to antibiotic therapy and led to removal of the rods. In spite of bed immobilization with a body jacket the fracture remained unstable and dislocated. As a result the patient sustained severe neurologic damage. Many fractures in patients with ankylosing spondylitis occur following minor trauma. We feel that a very important aspect of ankylosing spondylitis management is prevention of these fractures. Alerting patients of their spine fragility and teaching then how to evade situations leading to spinal trauma may help in avoiding this situation.
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40
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Floman Y, Fast A, Pollack D, Yosipovitch Z, Robin GC. The simultaneous application of an interspinous compressive wire and Harrington distraction rods in the treatment of fracture-dislocation of the thoracic and lumbar spine. Clin Orthop Relat Res 1986:207-15. [PMID: 3698379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
During open reduction of thoracolumbar fracture-dislocation, the normal constraints to distraction and lengthening may be ruptured and allow instrumentation to exert deleterious traction of the spinal cord. An interspinous wire across the unstable segment together with a Harrington rod may be used to prevent potential overdistribution of the spinal cord. Thirty-six patients with fracture-dislocation of the thoracolumbar spine were treated by open reduction with Harrington rods and interspinous wiring. Of 15 patients with a partial cord lesion, four made complete recovery, and nine of the remaining 11 became ambulators. Six patients with a complete paraplegia did not improve; 15 patients remained neurologically intact following the procedure. The compressive wire and Harrington rods act in concert and enable correction of kyphosis and restoration of vertebral and discal height while protecting the cord against traction. The technique is safe and does not add to operative time.
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41
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Fast A, Robin GC, Floman Y. Surgical treatment of lumbar spinal stenosis in the elderly. Arch Phys Med Rehabil 1985; 66:149-51. [PMID: 3977565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Unrelenting sciatica or intermittent neurogenic claudication in the elderly may be caused by degenerative lumbar spinal stenosis. This rather common condition is produced by advanced multilevel disc degeneration leading to facet hypertrophy, infolding of ligamentum flavum, descent of the pedicles, and occasional disc herniation. The symptoms of lumbar spinal stenosis usually do not improve with time. Despite the advanced age of some patients, surgical decompression may offer significant relief. Of 19 patients who underwent lumbar decompressive laminectomy, 18 showed sufficient improvement to return to normal daily activities.
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42
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Fast A, Alon M, Weiss S, Zer-Aviv FR. Avascular necrosis of bone following short-term dexamethasone therapy for brain edema. Case report. J Neurosurg 1984; 61:983-5. [PMID: 6491744 DOI: 10.3171/jns.1984.61.5.0983] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The authors present a case of avascular necrosis of both femoral and humeral heads which developed after short-term steroid treatment for brain edema. A vascular necrosis of bone may develop after short-term as well as after maintenance steroid therapy. Early diagnosis with bone scanning and management may in some cases prevent joint destruction.
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43
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Fast A, Otremsky Y, Pollack D, Floman Y. Protrusio acetabuli in Marfan's syndrome: report on two patients. J Rheumatol 1984; 11:549-51. [PMID: 6481730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Marfan's syndrome is a hereditary disorder of connective tissue, involving the ophthalmic, cardiovascular and musculoskeletal systems. Two cases are described in which protrusio acetabuli was a major problem. Otto pelvis should be considered as one of the musculoskeletal manifestations of Marfan's syndrome.
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44
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Nyska M, Floman Y, Fast A. Osseous involvement in de Quervain's disease. Clin Orthop Relat Res 1984:159-61. [PMID: 6723135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Osseous involvement is usually not appreciated in de Quervain's stenosing tenosynovitis. A case of stenosing tenosynovitis accompanied by significant local osteoporosis in the radial styloid area and a corresponding positive area on a technetium-99m polyphosphonate bone scan provoked the authors' interest in this entity. In seven consecutive patients with de Quervain's disease, six had evidence of osseous involvement of the radial styloid as demonstrated by roentgenographic studies and/or technetium bone scanning. In the process of differential diagnosis of a lytic lesion in the radial styloid area, de Quervain's tenosynovitis should be included.
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45
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Blank A, Ferber I, Shapira Y, Fast A. Electrically elicited blink reflex in children. Arch Phys Med Rehabil 1983; 64:558-9. [PMID: 6639318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Blink reflex was studied in 12 neurologically intact infants and children aged 2 weeks to 3 years. A coaxial needle electrode inserted in the outer lower quadrant of the orbicularis oculi muscle was used for recording. Responses were elicited by a 50-100V current delivered through a stimulating electrode placed on the supraorbital groove. Absence of contralateral R2 response was a consistent finding. Ipsilateral R2 responses were elicited in 50% of the cases. R1 response was present in all instances and showed latency values similar to adults. The amplitudes of both R1 and R2 were lower than reported in adult population. The blink reflex may be an indication of the degree of myelination of the brain stem, facial and trigeminal pathways in children.
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46
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Fast A. [The electrically evoked blink reflex and its clinical significance]. HAREFUAH 1983; 105:238-9. [PMID: 6681392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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47
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Gordon RL, Fast A, Aner H, Shifrin E, Siew FP, Floman Y. Control of massive retroperitoneal bleeding associated with pelvic fractures by angiographic embolization. ISRAEL JOURNAL OF MEDICAL SCIENCES 1983; 19:185-8. [PMID: 6841046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Continuous retroperitoneal bleeding may be an immediate life-threatening complication of pelvic fractures. While surgical control of the bleeding vessels has been advocated in these cases, today angiographic embolization of the branches of the internal iliac arteries is proving to be the treatment of choice. This is a relatively simple, safe, prompt and effective method of controlling the hemorrhage. It avoids the disadvantages of surgery, general anesthesia, loss of the tamponade effect of the retroperitoneum when opened, and the not uncommon difficulty of identifying and ligating the bleeding vessels. Two cases in which massive retroperitoneal bleeding associated with pelvic fractures was controlled by angiographic embolization are described, illustrating the importance of early angiography.
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48
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Margulies JY, Rubinstein N, Fast A, Floman Y. Osteoporosis and seizures leading to central acetabular fracture dislocation. ISRAEL JOURNAL OF MEDICAL SCIENCES 1983; 19:85-7. [PMID: 6832958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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49
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Fast A, Floman Y. [Conservative treatment of lumbar disc disease]. HAREFUAH 1982; 102:495-8. [PMID: 7160694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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50
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Robinsohn E, Reis ND, Fast A. The weight relieving walker-scooter (WRWS or Robi-Roller): a new walking aid for outdoor life. INTERNATIONAL REHABILITATION MEDICINE 1980; 2:96-9. [PMID: 7451027 DOI: 10.3109/09638288009163966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patients suffering from the restriction of their locomotor function due to disease of the weight-bearing joints or ischaemic intermittent claudication, but who are otherwise relatively healthy, are enabled to achieve a remarkable improvement in the quality of their lives by the use of a new weight-relieving walker-scooter. The device is described. Simple experiments using the walker-scooter are recorded. The importance of ambulation is stressed, and the place of various walking aids is discussed.
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