Relationship of Pharyngeal Water Content and Jugular Volume With Severity of Obstructive Sleep Apnea in Renal Failure.

Relationship of pharyngeal water content and jugular volume with severity of obstructive sleep apnea in renal failure.

Filed under: Rehab Centers

Nephrol Dial Transplant. 2012 Nov 7;
Elias RM, Chan CT, Paul N, Motwani SS, Kasai T, Gabriel JM, Spiller N, Bradley TD

BackgroundIn patients with end-stage renal disease (ESRD), fluid overload may contribute to their high prevalence of obstructive sleep apnea (OSA) by increasing the amount of fluid displaced from the legs into the neck overnight, and possibly compressing the upper airway (UA). Indeed, in ESRD patients, the amount of overnight rostral fluid displacement from the legs is related to the frequency of apneas and hypopneas per hour of sleep (apnea-hypopnea index, AHI). We, therefore, hypothesized that in ESRD patients, the greater the UA-mucosal water content (UA-MWC) and internal jugular vein volume (IJVVol), the higher the AHI.MethodsWe studied 20 patients with ESRD on thrice weekly hemodialysis who had undergone diagnostic polysomnography (age 41.0 ± 12.3 years, with a body mass index (BMI) of 25.8 ± 6.3 kg/m(2) and an AHI of 20.2 ± 26.8). The leg fluid volume (LFV) was measured by bioelectric impedance. The IJVVol and MWC were measured by UA magnetic resonance imaging (MRI).ResultsThe only significant independent correlates of the AHI were IJVVol (r = 0.801, P < 0.0001) and UA-MWC (r = 0.720, P = 0.0005) which together explained 72% of its variability.ConclusionsThese data suggest that fluid overload via increased IJVVol, and UA-MWC, contributes to the pathogenesis of OSA in patients with ESRD. These findings help us to explain the high prevalence of OSA in ESRD patients, and attenuation of OSA in association with nocturnal dialysis. They also suggest the need for randomized trials to determine whether more aggressive fluid removal in ESRD patients will alleviate OSA. HubMed – rehab


Diagnosis of Radiographically Occult Lumbar Spondylolysis in Young Athletes by Magnetic Resonance Imaging.

Filed under: Rehab Centers

Am J Sports Med. 2012 Nov 7;
Kobayashi A, Kobayashi T, Kato K, Higuchi H, Takagishi K

BACKGROUND:The early stages of spondylolysis are extremely difficult to diagnose on plain radiography. Although several studies have examined changes in active spondylolysis on magnetic resonance imaging (MRI), no studies to date have determined the onset frequency of active spondylolysis detectable on MRI but occult on plain radiography. Moreover, the clinical features of active spondylolysis described in the literature do not facilitate the differentiation of this condition from other causes of low back pain. PURPOSE:This study aimed to evaluate the usefulness of MRI in diagnosing active spondylolysis early and in determining the prevalence of active spondylolysis in cases where findings were not detected on plain radiography. In addition, specific clinical features to aid in the early detection of active spondylolysis were evaluated. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Patients were 200 consecutive young athletes (144 boys and 56 girls; mean age, 14.1 ± 1.5 y) with low back pain. All patients were examined by plain radiography (188 with negative findings and 12 with unclear findings of spondylolysis) and MRI. Computed tomography (CT) was performed only for patients with high intensity changes of the pedicle observed on MRI. The presence or absence of low back pain was examined during lumbar spine extension and flexion. The Kemp test on the right and left sides and percussion of the vertebral spinous process were also performed. RESULTS:Ninety-seven (48.5%) patients showed evidence of active spondylolysis on MRI, findings that had been missed by plain radiography. These pars defects were organized into the following categories based on CT findings: nonlysis stage, 52; very early stage, 37; late early stage, 22; progressive stage, 10; and terminal stage, 0. No significant physical examination factors were identified that could assist in the early detection of active spondylolysis. CONCLUSION:The MRI results suggest a high rate of active spondylolysis in young athletes with low back pain who test negative for spondylolysis on plain radiography. Magnetic resonance imaging appears to be useful in the early diagnosis of active spondylolysis, especially as we found no significant physical examination factors that could assist in early detection.
HubMed – rehab


Vertebral rotation in adolescent idiopathic scoliosis calculated by radiograph and back surface analysis-based methods: correlation between the Raimondi method and rasterstereography.

Filed under: Rehab Centers

Eur Spine J. 2012 Nov 8;
Mangone M, Raimondi P, Paoloni M, Pellanera S, Di Michele A, Di Renzo S, Vanadia M, Dimaggio M, Murgia M, Santilli V

PURPOSE: The aim of the present research is to evaluate the relationship between an X-ray-based method (i.e. the Raimondi method) and rasterstereography in the evaluation of vertebral rotation (VR) in a sample of adolescent idiopathic scoliosis (AIS) patients. METHODS: A total of 25 patients (9 males; mean age 14 ± 3 years; mean height 160.7 ± 11.9 cm; mean weight 52.4 ± 10.7 kg) were considered for the present analysis. The mean Cobb angle was 30° ± 9°. The evaluation of VR on radiographs was made using the Raimondi method regolo (Marrapese Editore-Demi S.r.1., Rome). Rasterstereography was performed by means of Formetric 4D(®) (Diers International GmbH, Schlangenbad, Germany). Correlations between rasterstereographic and radiographic measurement of VR were calculated, both for the whole sample and for thoracic and lumbar spinal segments considered separately, as well as for subgroups of patients with a Cobb angle <30° and ?30° using Spearman's correlation coefficient by rank (r (s)). RESULTS: When applied to the entire spine, measurement of VR by means of the two methods highlighted a significant correlation in the whole group (r = 0.52; p < 0.0001), as well as in the <30° Cobb (r = 0.47; p = 0.0001) and ?30° Cobb (r = 0.42; p < 0.0001) subgroups. A significant correlation was found also when lumbar and thoracic VR were considered as separated groups (r = 0.30, p = 0.024 and r = 0.47, p = 0.002, respectively). CONCLUSIONS: Rasterstereographic evaluation of VR shows a good correlation with the Raimondi method, thereby confirming the possibility to use this non-invasive method for deformity assessment in AIS patients. HubMed – rehab


Changes in Bimanual Coordination During the First 6 Weeks After Moderate Hemiparetic Stroke.

Filed under: Rehab Centers

Neurorehabil Neural Repair. 2012 Nov 7;
Metrot J, Mottet D, Hauret I, van Dokkum L, Bonnin-Koang HY, Torre K, Laffont I

BACKGROUND: . Better understanding of how bimanual coordination changes over the first weeks of recovery after stroke is required to address the potential utility for bimanual rehabilitation. Three-dimensional kinematic analysis can provide quantitative assessment of unimanual and bimanual movements. OBJECTIVE: . To assess the natural evolution of reaching kinematics during standard poststroke rehabilitation, focusing on bimanual coordination. METHODS: . A total of 12 hemiparetic, moderately impaired patients were included within 30 days after a first unilateral ischemic/hemorrhagic stroke; 7 kinematic assessments were performed once a week for 6 weeks and at 3 months after inclusion. The reach-to-grasp task was performed in 3 different conditions: unimanual with the healthy limb (UN), unimanual with the paretic limb (UP), and bimanual (BN/BP). RESULTS: . For the paretic limb, movement fluency (number of movement units and total movement time) was lower for bimanual reaching compared with unimanual reaching. For bimanual reaching, (1) movement kinematics were similar for both limbs, (2) recovery patterns of both limbs followed a similar profile with a plateau phase at 6 weeks poststroke, and (3) intertrial variability of between-hands synchronization decreased over sessions, although the mean delays remained the same. CONCLUSIONS: . Bimanual coordination started to become efficient 6 weeks after onset of stroke, so for patients such as those we tested, this time could be most opportune to start bimanual-oriented rehabilitation. The challenge in future research includes determining the characteristics of patients who may best benefit from bimanual therapy.
HubMed – rehab



Most Drug and Alcohol rehab centers focus on Mind, Body and Spirit –…The Spirit part here is often overlooked. Your loved one is going to a treatment center to do two things, listen and talk. If a good portion of the listening and talking doesn’t line up with their beliefs or values, then we are wasting a great deal of valuable time and money.


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