Electromyographic abnormalities in neurologic injury associated with pelvic fracture: case reports and literature review

The incidence of neurologic injury associated with pelvic fractures is estimated at 10%. Studies have demonstrated that patients with double vertical pelvic fractures (combined injury to the anterior third of the pelvic ring and the sacroiliac area) are most at risk, with a 46% incidence of neurologic injury. Patients with pelvic fractures usually have many other associated injuries and medical complications, making the patients' neurologic deficits difficult to assess and thus easy to overlook in the acute setting. Three such patients are described. Electromyography was useful in confirming their diagnoses, thus allowing appropriate management.

Biofeedback and functional electric stimulation in stroke rehabilitation

The study examined the efficacy of functional electric stimulation (FES) and biofeedback (BFB) treatment of gait dysfunction in patients with hemiplegia after stroke. These two therapeutic modalities were tested alone and in combination in a prospective, controlled, randomized trial. The authors hypothesized that in concurrent use, these two modalities would complement one another. Thirty-six hemiplegic patients undergoing rehabilitation after stroke were accepted for study and randomized into four groups to receive either control, FES, BFB, or combined therapies. Each patient received 30 minutes of treatment three times per week for six weeks, in addition to their general rehabilitation program. Quantitative gait analysis was performed biweekly on each subject during the experimental therapy and for four weeks afterward. Thirty-two subjects completed the study. Combined therapy with BFB and FES resulted in improvements in both knee and ankle minimum flexion angles during swing phase that were statistically significant with p = 0.05 and p = 0.02, respectively. Velocity of gait, cycle time, and symmetry of stance phases also improved. The length of time elapsed since the stroke did not prove to be a significant factor.

Fine tuning of swing phase of hydraulic knees using gait laboratory

Recent technologic advances now permit instant gait analysis, making clinical use of the gait laboratory feasible. In this study, the ambulation of two amputees with hydraulic knee prostheses is evaluated by measuring ground reactive forces and by tracking the motion of lights attached to limb segments. A PDP 11/34 minicomputer records, integrates, and processes data received from an 8-channel force plate and from two high-speed solid-state array cameras. Information in the form of ground reactive forces, angular displacements and angular velocities of normal and prosthetic limbs is displayed on a monitor and graphed on an X-Y plotter. Adjustments are made immediately to the hydraulic mechanism so that optimal function of the prosthetic equipment can be objectively determined.

Postpartum cervical myofascial pain syndrome: review of four patients

Four postpartum patients with complaints of headache and neck pain were examined. All had received epidural analgesia and had a long second stage associated with prolonged pushing. Many similarities to postdural puncture headache were noted. The headache started the day after delivery and involved the occipital region primarily, along with the neck and shoulder girdle areas. However, the pain did not change with positional changes and was associated with marked tenderness of muscles at specific anatomic points. A diagnosis of cervical myofascial pain was made. All patients responded quickly to physical therapy. The authors suggest that many patients initially considered to have postdural puncture headache may actually have postpartum cervical myofascial pain.

Late changes in the motor unit after acute poliomyelitis

Patients who have suffered an acute attack of poliomyelitis may develop a clinically evident progression of weakness later in life. A syndrome known as forme fruste amyotrophic lateral sclerosis occurs in severely affected older polio patients. Neither process is well understood. Ten subjects who had had polio at least 22 years prior to examination and had no complaints of rapid progression of weakness were studied. Single-fiber recordings were made from the extensor digitorum communis or the tibialis anterior muscle. Fiber densities were increased in all patients. Eight of 10 patients showed marked abnormalities in jitter in more than 50% of the recordings examined. There was a significant association between the percentage of recordings with abnormal jitter and the time since the attack of polio. Blocking was seen in more than 30% of the recordings examined in 6 of 10 patients. There was a significant association between the percentage of recordings demonstrating blocking and both the chronological age and the number of years since the attack of polio. These abnormalities may represent disintegration with aging in the reinnervated motor units.