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Richard R, Staley M, Miller S, Warden G. To splint or not to splint--past philosophy and present practice: part III. THE JOURNAL OF BURN CARE & REHABILITATION 1997; 18:251-5; discussion 250. [PMID: 9169951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Staley M, Richard R, Billmire D, Warden G. Head/face/neck burns: therapist considerations for the pediatric patient. THE JOURNAL OF BURN CARE & REHABILITATION 1997; 18:164-71. [PMID: 9095428 DOI: 10.1097/00004630-199703000-00013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Staley M, Richard R. Management of the acute burn wound: an overview. ADVANCES IN WOUND CARE : THE JOURNAL FOR PREVENTION AND HEALING 1997; 10:39-44. [PMID: 9204810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Goals for managing an acute burn wound are similar to those of other wounds such that infection and scar formation are minimized, a moist wound environment is provided, and the surrounding tissue is protected from trauma. A variety of cleansing techniques are used with burn wounds, including local wound care and nonsubmersion and immersion hydrotherapy. Topical agents have significantly decreased the development of burn wound sepsis since the 1960s, and now various experimental agents are being investigated to improve wound healing. The choice of dressings depends on many patient and wound-related factors, and synthetic, biologic, and biosynthetic dressings are used to treat the different depths of burn wounds. However, skin grafts and the newer cultured skin substitutes remain the mainstay for healing a full-thickness burn wound.
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Richard R, Staley M, Miller S, Warden G. To splint or not to splint: past philosophy and current practice--Part II. THE JOURNAL OF BURN CARE & REHABILITATION 1997; 18:64-71. [PMID: 9063791 DOI: 10.1097/00004630-199701000-00012] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Bonnet F, Algayres JP, Coutant G, Richard R, Schmoor P, Bili H, Daly JP. [Still disease in the elderly]. Rev Med Interne 1997; 18:170-1. [PMID: 9092038 DOI: 10.1016/s0248-8663(97)84685-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Staley M, Richard R. Critical pathways to enhance the rehabilitation of patients with burns. THE JOURNAL OF BURN CARE & REHABILITATION 1996; 17:S12-4. [PMID: 8951552 DOI: 10.1097/00004630-199611002-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Richard R, Steinlage R, Staley M, Keck T. Mathematic model to estimate change in burn scar length required for joint range of motion. THE JOURNAL OF BURN CARE & REHABILITATION 1996; 17:436-43; discussion 435. [PMID: 8889869 DOI: 10.1097/00004630-199609000-00013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Burn scar contracture results from an insufficient amount of extensible tissue to permit complete range of motion. The purpose of this study was to develop a mathematic model to estimate additional tissue length required for full range of motion in the presence of a scar contracture. Seven areas with a known predilection for burn scar contracture were assessed. Twenty-five volunteers with normal range of motion had the length of their limbs measured at predetermined angles. Changes in limb length through range of motion were documented. On the basis of these changes, a mathematic model was developed to estimate the additional amount of tissue length required to complete range of motion for each area. This information may be useful to determine burn patient rehabilitation potential or need for reconstructive surgery.
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Richard R, Staley M, Miller S, Warden G. To splint or not to splint--past philosophy and present practice: Part I. THE JOURNAL OF BURN CARE & REHABILITATION 1996; 17:444-53. [PMID: 8889870 DOI: 10.1097/00004630-199609000-00014] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purposes of this study were to document (1) the historical use of splints, (2) record the current practice of splint application, and (3) compare splint philosophy of the past with present practice. One hundred burn references were reviewed for information on the past use of splints. Present practice was determined on the basis of a survey of 99 burn centers. Information is presented as to when splints are applied to burn patients in their course of recovery for 12 body areas prone to scar contracture. The influence of burn depth is noted. A change in the practice of applying splints to burn patients appears to have occurred. Part I of this series describes the global results and details whether splints are necessary.
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Staley M, Richard R, Warden GD, Miller SF, Shuster DB. Functional outcomes for the patient with burn injuries. THE JOURNAL OF BURN CARE & REHABILITATION 1996; 17:362-8. [PMID: 8844359 DOI: 10.1097/00004630-199607000-00014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In health care, outcome measures have become important tools to assist with monitoring the efficacy of therapeutic interventions. This article defines functional outcomes and describes why therapists should begin monitoring the care of patients with burn injuries in terms of function. Suggestions are provided on the identification and documentation of functional outcomes for patients with burn injuries.
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Vayre F, Duriez P, Jego C, Richard R. [Intrathoracic textiloma after cardiac surgery. Apropos of a case]. ARCHIVES DES MALADIES DU COEUR ET DES VAISSEAUX 1996; 89:367-10. [PMID: 8734190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The authors report an exceptionally rare case of intrathoracic textiloma presenting with a recurrence of chest pain after myocardial revascularisation by double internal mammary artery bypass grafting. The diagnosis was suspected before reoperation from the results of echocardiography. CT scanning and magnetic resonance imaging. The authors discuss the clinical and paraclinical features and the treatment. The medico-legal aspects of this surgical complication are not negligeable.
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Duvallet A, Kouassi BYL, Verdier JC, Rosier SP, Richard R, Rieu M. Evaluation de la réponse cardiovasculaire lors d'un test fonctionnel musculaire chez le sujet transplanté cardiaque. Sci Sports 1996. [DOI: 10.1016/0765-1597(96)81286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rosier SP, Verdier JC, Richard R, Léger P, Rieu M. Etude chez le transplanté cardiaque: comparaison entre la fréquence cardiaque maximale mesurée en laboratoire et sur le ≪ terrain ≫ et la fréquence cardiaque maximale théorique. Sci Sports 1996. [DOI: 10.1016/0765-1597(96)81281-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Richard R, Shanesy CP, Miller SF. Dynamic versus static splints: a prospective case for sustained stress. THE JOURNAL OF BURN CARE & REHABILITATION 1995; 16:284-7. [PMID: 7673310 DOI: 10.1097/00004630-199505000-00012] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Application of constant tension to elongate tissue has been shown to be beneficial. A dynamic splint was used to achieve tissue creep and full elbow extension. Use of a static splint on the contralateral elbow did not allow elbow extension. This case report demonstrates for this patient the superiority of a dynamic elbow extension splint over a static splint when used to correct progressive loss of elbow range of motion.
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Richard R, van der Pligt J, de Vries N. Anticipated affective reactions and prevention of AIDS. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 1995; 34 ( Pt 1):9-21. [PMID: 7735735 DOI: 10.1111/j.2044-8309.1995.tb01045.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Controlling the AIDs epidemic may depend largely upon health education aimed at adolescents. A number of approaches have been applied to human immunodeficiency virus (HIV) preventive behaviour in adolescents, including the health belief model (Becker, 1974), protection motivation theory (Rogers, 1983), and the theory of planned behaviour (Ajzen, 1985, 1991). Since sexual behaviour is heavily influenced by emotions, a possible shortcoming of these models is that little attention is given to affective processes. In this study we investigated the role of anticipated, post-behavioural, affective reactions to (un)safe sexual behaviours in the context of the theory of planned behaviour (TPB). The results showed that anticipated affective reactions such as worry and regret predicted behavioural expectations over and above the components of the TPB. The implications for our understanding of adolescent sexual behaviour and for campaigns aimed at the reduction of risky sexual practices will be discussed.
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Richard R, Weber J, Mejjad O, Polin D, Dujardin F, Pasquis P, Le Loët X. Spatiotemporal gait parameters measured using the Bessou gait analyzer in 79 healthy subjects. Influence of age, stature, and gender. Study Group on Disabilities due to Musculoskeletal Disorders (Groupe de Recherche sur le Handicap de l'Appareil Locomoteur, GRHAL). REVUE DU RHUMATISME (ENGLISH ED.) 1995; 62:105-114. [PMID: 7600064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The Bessou gait analyzer provides quantitative measurements of spatiotemporal gait parameters. The purpose of this study was to determine whether and how these parameters are influenced by age, stature, and gender. Seventy-nine normal individuals (38 males aged 20 to 80 years and 41 females aged 20 to 80 years) were divided into ten-year age groups. Males and females were studied separately. In each subject, the Bessou gait analyzer was used to measure spatiotemporal gait parameters (spatial parameters: stride and step lengths; temporal parameters: cycle, stance and swing durations). Mean walking speed was calculated in each subgroup. In both males and females, all study parameter values were identical for the left and right sides. Females younger than 60 years had shorter stride and step lengths (M: 1.5 +/- 0.2 m; F: 1.3 +/- 0.1; p < 0.001) but faster pace values (M: 104.8 +/- 9.0 cycles/min; F: 115.6 +/- 7.6 cycles/min; p < 0.001) than males, and consequently mean walking speed was similar in females and males (M: 4.8 km/h +/- 0.8 km/h; F: 4.4 km/h +/- 0.6 km/h). In contrast, females older than 60 years walked at the same pace as males and consequently had slower walking speeds. Stride length was correlated with age, stature, and gender. However, age was correlated with stature, and only age and gender had independent effects on gait parameters in the multiple regression analysis. In subjects of similar age and gender, effects of stature may need to be taken into account.
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Revel F, Gallois H, Le Coz Y, Richard R, Ollivier JP. [Course of the left ventricular mass in a population of 893 hypertensive patients. Effects of treatment with perindopril]. Ann Cardiol Angeiol (Paris) 1994; 43:594-9. [PMID: 7864552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Left ventricular hypertrophy is now recognized to be a major and independent risk factor of mortality and morbidity. Although all classes of antihypertensives are able to reduce left ventricular mass, two recent metaanalyses have shown that ACE inhibitors are the most effective. The antihypertensive efficacy of perindopril in man is accompanied with a significant improvement in the functional properties of large arteries and with a reduction of LVH. This study was designed to assess the course of left ventricular mass by echocardiography in a population of 893 hypertensive patients with moderate left ventricular hypertrophy, treated with perindopril for 3 months. A significant fall in blood pressure was observed by the 6th week. The morphological and functional echocardiographic parameters on a large population provided more valid statistical results than in a small series. The left ventricular cavity was found to undergo symmetrical remodelling, adapted to the new haemodynamic status. The reduction of the thickness of the wall was in line with the reduction of the size of the ventricular chamber, and left ventricular mass was reduced by 8% (p < 0.001). Systolic function was preserved and diastolic function was improved. In particular, the E/A ratio was increased by 8% (p < 0.001) and the duration of isometric relaxation was decreased by 11 ms (p < 0.02). This improvement of filling was confirmed by the reduction of the diameter of the left atrium by 0.2 mm (p < 0.001). This open study in 893 patients therefore confirmed that perindopril corrects LVH in hypertensive patients.
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Cortet B, Richard R, Deprez X, Lucet L, Flipo RM, Le Loët X, Duquesnoy B, Delcambre B. Aspergillus spondylodiscitis: successful conservative treatment in 9 cases. J Rheumatol 1994; 21:1287-91. [PMID: 7966071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess the effectiveness of medical treatment by clinical, radiological, and biological analysis of outcome in 9 patients with aspergillus spondylodiscitis. METHODS Retrospective study including 9 patients with aspergillus discitis, in which 7 were immunosuppressed; 3 were heart transplant patients, 2 had acute lymphoblastic leukemia, 1 hairy cell leukemia and one was receiving prednisone for bronchial asthma. Four patients had isolated spinal aspergillosis infection. In 4 cases, disc space infection occurred after pulmonary aspergillosis. In the last case the spondylodiscitis occurred after aspergillus endocarditis and mycotic limb embolism. In all cases a percutaneous needle biopsy of the intervertebral disc was performed; the subsequent culture produced Aspergillus fumigatus in 8 cases and Aspergillus flavus in 1. Itraconazole was given to all patients (mean dose: 350 mg/day); it was given alone in 2 cases, in addition to 5 flucytosine and amphotericin B in 6 cases, and in addition to amphotericin B in the last case. RESULTS Improvement was obtained in the 9 cases, with full recovery in the absence of any surgical debridement after a mean treatment duration of 5.5 months and a mean followup delay of 16 months. CONCLUSION Early recognition of aspergillus spondylodiscitis in immunocompromised hosts is important. Itraconazole alone or in combination is an effective therapy. There may be an increased incidence of aspergillus discitis due to the increasing frequency of immunosuppression associated conditions including organ transplantation, chemotherapy, or acquired immune deficiency syndrome.
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van der Pligt J, Richard R. Changing adolescents' sexual behaviour: perceived risk, self-efficacy and anticipated regret. PATIENT EDUCATION AND COUNSELING 1994; 23:187-196. [PMID: 7971547 DOI: 10.1016/0738-3991(94)90034-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This article focuses on determinants of adolescent AIDS-related behaviour. First, we will focus on the perception of risk for AIDS and possible optimistic biases in perceived risk. The behavioural consequences of optimism or perceived invulnerability will be briefly discussed. Next, we will focus on other determinants of sexual risk behaviour, i.e. self-efficacy and anticipated regret. Gender differences in the predictive power of these factors will be discussed. Finally, we will summarize the results of a series of studies investigating the role of anticipated regret as a determinant of adolescent sexual risk behaviour. The possible contribution of stressing anticipated regret in prevention programs aiming adolescents to adopt safer sex practices will be discussed.
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Richard R, Schall S, Staley M, Miller S. Hand burn splint fabrication: correction for bandage thickness. THE JOURNAL OF BURN CARE & REHABILITATION 1994; 15:369-71. [PMID: 7929521 DOI: 10.1097/00004630-199407000-00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Richard R, Staley M, Miller SF. The effect of extremity range of motion on vital signs of critically ill patients and patients with burns: a pilot study. THE JOURNAL OF BURN CARE & REHABILITATION 1994; 15:281-4. [PMID: 8056821 DOI: 10.1097/00004630-199405000-00014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study was to evaluate the effects of range-of-motion exercise on vital signs of critically ill patients. The vital signs of 10 consecutive critically ill patients were evaluated during passive and active-assistive range-of-motion exercise. Vital signs monitored were heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure. The average length of an exercise session was 22.6 minutes. No clinically significant difference was found between pretreatment and treatment heart rate, systolic blood pressure, diastolic blood pressure, or mean arterial pressure. It appears from this study that passive and active-assistive range-of-motion exercise can be performed safely, without unnecessary physiologic stress, on critically ill patients.
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Richard R, Staley M, Daugherty MB, Miller SF, Warden GD. The wide variety of designs for dorsal hand burn splints. THE JOURNAL OF BURN CARE & REHABILITATION 1994; 15:275-80. [PMID: 8056820 DOI: 10.1097/00004630-199405000-00013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A search of the burn literature to find standard dimensions for fabrication of a typical splint to use with patients with a dorsal hand and finger burn is an elusive endeavor. The original impetus for such a search stemmed from a discussion with a student therapist on how to properly splint a burned hand. An ongoing interest was sustained when no one set of universal dimensions for a hand splint design was found to exist. In fact, the literature is replete with numerous individual recommendations on the dimensions to make such a hand splint. In general, dorsal hand burn splints can be classified either as position of function or antideformity splints. However, there is little agreement among authors about how to make these splints. The purpose of this investigation was to document the wide range and variable designs among splints for dorsal hand burns and present the findings for use as a resource guide when making decisions about their fabrication.
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Kahn HA, Faust GR, Richard R, Tedesco R, Cohen JR. Hypothermia and bleeding during abdominal aortic aneurysm repair. Ann Vasc Surg 1994; 8:6-9. [PMID: 8193002 DOI: 10.1007/bf02133399] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Patients undergoing abdominal aortic aneurysm repair routinely have a depressed core body temperature during surgery, and hypothermia is known to cause abnormalities in coagulation. This study was designed to determine whether platelet function is altered as a result of hypothermia or heparin during abdominal aortic aneurysm repair. Ten patients scheduled for abdominal aortic aneurysm surgery were prospectively studied. Bleeding times and temperature were measured every hour beginning preoperatively. Each patient was heparinized intraoperatively, and the effects reversed with protamine sulfate prior to closure. Despite efforts to keep the patients warm, all of them developed hypothermia (mean lowest core temperature 34.8 +/- 0.7 degrees C). A significant linear relationship between the change in core temperature and the change in bleeding time was demonstrated. In 7 of 10 cases the greatest change in bleeding time occurred when patients experienced the lowest mean core temperature and not when they were heparinized. These data suggest that hypothermia has a marked effect on platelet function during abdominal aortic aneurysm repair. Although heparin can cause abnormalities in platelet function, hypothermia may be a more important role in inhibiting normal platelet function. By preventing severe hypothermia (< 35 degree C), excessive bleeding associated with abdominal aortic aneurysm repair may be minimized without the concomitant risk of blood product transfusion.
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Verdier J, Kouassi B, Carricaburu J, Richard R, Duvallet A, Marconi C, Cerretelli P, Rieu M. Protocole d'évaluation de l'aptitude à l'effort du greffé cardiaque: épreuve d'effort par incrément sur bicyclette ergométrique. Sci Sports 1994. [DOI: 10.1016/s0765-1597(05)80158-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ause-Ellias KL, Richard R, Miller SF, Finley RK. The effect of mechanical compression on chronic hand edema after burn injury: a preliminary report. THE JOURNAL OF BURN CARE & REHABILITATION 1994; 15:29-33. [PMID: 8150839 DOI: 10.1097/00004630-199401000-00006] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Chronic hand edema after wound healing is a troublesome condition to treat in patients with burns. Stagnant edema can cause fibrosis, which impedes rehabilitation and may lead to deformity. Although favorable results have been reported with mechanical compression used in acute injuries, no literature was found on the effects of compression for the treatment of chronic hand-burn edema. Five male patients with nine chronically edematous burned hands were subject to mechanical compression at 55 mm Hg pressure. A single-cell unit was used for a 30-minute treatment at 4:1 treatment ratio. Goniometric and volumetric hand measurements were recorded both before and after treatment. Although patients expressed a subjective feeling of improvement, no statistical difference was found in finger joint range of motion nor in hand volume when comparing pretreatment and posttreatment measurements. Many different treatment protocols exist in the literature and are discussed.
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Richard R, Ford J, Miller SF, Staley M. Photographic measurement of volar forearm skin movement with wrist extension: the influence of elbow position. THE JOURNAL OF BURN CARE & REHABILITATION 1994; 15:58-61. [PMID: 8150844 DOI: 10.1097/00004630-199401000-00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An important function of skin is to allow joint range of motion to occur. An assumed clinical relationship exists between joint movement and skin pliability. The purpose of this research was to document skin movement of the forearm and wrist with photography, to quantify the amount of skin movement during wrist extension, and to investigate the influence of elbow positions on forearm skin movement. Twenty volunteers had markings placed on the skin of the volar forearm. Each subject performed the motion of wrist extension in two elbow test positions of flexion and extension. Photographs were taken of the skin markings at the beginning and end of wrist extension. A significant difference was found in the amount of forearm skin movement that occurred when the elbow was extended and flexed (p < 0.001). These results substantiate the use of multijoint range of motion during burn rehabilitation.
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