Stroke during pregnancy poses a challenge to the rehabilitation team. A 10-year review of one hos... more Stroke during pregnancy poses a challenge to the rehabilitation team. A 10-year review of one hospital's records revealed five pregnancies complicated by stroke. The mean age was 29 years (range, 21 to 35 years). Cerebrovascular accidents associated with pregnancy may be due to many causes, with intracranial hemorrhage due to arteriovenous malformation or aneurysm, arterial occlusion due to thrombosis or embolus, venous thrombosis, and vasculitis representing the more common etiologies. Three of the strokes in this study were due to intracranial hemorrhage, and two were due to thrombosis secondary to CNS vasculitis. Two case studies and a review of the literature are presented. Stroke during pregnancy represents a high-risk obstetrical situation that may complicate the rehabilitation process.
Previous studies attempting to predict outcome after acute stroke have been limited by small samp... more Previous studies attempting to predict outcome after acute stroke have been limited by small sample sizes and inconsistent definitions of outcome. The functional status data from the Functional Independence Measure (FIM) as well as social and demographic information from 2,109 stroke survivors were reviewed to determine the possible risk factors for poor outcome. Four measures of outcome were used for this analysis: discharge placement, rate of change of functional status as measured by the FIM, total change in functional status from admission to discharge, and length of stay. The most significant risk factor for discharge to a location other than home was an admission FIM score of less than 60; the relative risk was 3.5. Several other factors, including race, marital status, and age, influenced this outcome. A low admission FIM score was also a significant risk factor for a low rate of change of functional status during the inpatient rehabilitation stay; the relative riskwas 2.2. A...
Journal of the California Dental Association, 2005
Upper extremity musculoskeletal disorders are common among dental professionals. The natural hist... more Upper extremity musculoskeletal disorders are common among dental professionals. The natural history of these disorders is not well-understood. These disorders are more common in older workers, but the prevalence among younger workers has not been well-studied. The objective of this study was to determine if dental/dental hygiene students had a similar prevalence of upper extremity musculoskeletal disorders compared to age-matched clerical workers. We hypothesize students will have a lower prevalence of upper extremity musculoskeletal disorders compared to clerical workers. This was a cross-sectional design. Dental and dental hygiene students from three schools were compared to clerical workers from three locations (an insurance company and two data processing plants). There were 343 dental and dental hygiene students and 164 age-matched clerical workers. Regional discomfort was the primary outcome. The secondary health outcomes were diagnoses of carpal tunnel syndrome and upper ext...
Journal of dental hygiene : JDH / American Dental Hygienists' Association, 2002
This study was undertaken to determine the prevalence of carpal tunnel syndrome (CTS) and upper e... more This study was undertaken to determine the prevalence of carpal tunnel syndrome (CTS) and upper extremity (UE) tendinitis among dental hygienists. In a cross-sectional study dental hygienists (n = 305) were screened using sensory nerve conduction, a focused physical examination of the UE, and a symptom questionnaire. CTS was diagnosed if the subject had slowing of the median nerve at the wrist and symptoms of numbness, tingling of pain in the median distribution. Localized tendinitis of the UE was diagnosed if the subject had focal symptoms and associated findings on physical examination. Three percent of the participating dental hygienists were diagnosed with CTS. Thirteen were diagnosed with shoulder tendinitis, while 6% had a tendinitis of the elbow and 7% had tendinitis of the hand or wrist. Twenty-eight percent had a diagnosis of some UE tendinitis or CTS. The prevalence of hand and finger symptoms in the dominant hand among dental hygienists in this study was high, but the pre...
Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wr... more Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wrist which may occur following chronic paraplegia. Thirty one chronic paraplegics, with a mean age of 37.9 years (range 20-68 years), and mean time since injury of 9.7 years (range 1-28 years), were studied with a comprehensive neurologic and electrodiagnostic (EDX) assessment. No patient had any clinical or EDX evidence of a peripheral polyneuropathy. The diagnosis of a median mononeuropathy at the wrist was determined by the following criteria: (a) prolonged median sensory distal latency greater than ipsilateral ulnar sensory distal latency greater than or equal to 0.5 msec; (b) a median mid-palmar sensory latency greater than ipsilateral ulnar mid-palmar sensory latency of greater than or equal to 0.3 msec; or (c) a median motor distal latency greater than or equal to 1.7 milliseconds as compared to the ipsilateral ulnar motor distal latency. Ulnar mononeuropathy at the wrist or across...
Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wr... more Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wrist which may occur following chronic paraplegia. Thirty one chronic paraplegics, with a mean age of 37.9 years (range 20–68 years), and mean time since injury of 9.7 years (range 1–28 years), were studied with a comprehensive neurologic and electrodiagnostic (EDX) assessment. No patient had any clinical or EDX evidence of a peripheral polyneuropathy. The diagnosis of a median mononeuropathy at the wrist was determined by the following criteria: (a) prolonged median sensory distal latency > ipsilateral ulnar sensory distal latency ≥ 0.5 msec; (b) a median mid-palmar sensory latency > ipsilateral ulnar mid-palmar sensory latency of ≥ 0.3 msec; or (c) a median motor distal latency ≥ 1.7 milliseconds as compared to the ipsilateral ulnar motor distal latency. Ulnar mononeuropathy at the wrist or across the elbow was also characterised. The EDX criteria for a median mononeuropathy at th...
The correlation between monofilament testing, symptom surveys, and electrodiagnostic studies for ... more The correlation between monofilament testing, symptom surveys, and electrodiagnostic studies for the diagnosis of axonal polyneuropathy has not been well studied. This investigation was done to assess the agreement between these procedures in a non-random sample of volunteers.
The objective of this study was to determine the relative contributions of work activity (time sp... more The objective of this study was to determine the relative contributions of work activity (time spent standing, walking or sitting), floor surface characteristics, weight, BMI, age, foot biomechanics, and other demographic and medical history factors to the prevalence of hip disorders. A cross-sectional observational study design was used to engine assembly plant workers. The main outcome measure was the finding of a hip disorder. The independent variables included baseline demographics, medical history, ergonomic exposures, psychosocial factors, shoe characteristics and foot biomechanics. Logistic regression revealed that increasing age, female gender, pes planus, smoking, history of a knee or hip injury, and a history of rheumatoid arthritis were significant risk factors while time on carpeted surfaces was protective. Hip disorders are associated with a history of biomechanical trauma to the hip but also from gait abnormalities such as pes planus.
Journal of Occupational and Environmental Medicine, 2005
This study defined the incidence rate of carpal tunnel syndrome (CTS) among active assembly worke... more This study defined the incidence rate of carpal tunnel syndrome (CTS) among active assembly workers and evaluated risk factors. This study followed 189 automobile assembly workers over 1 year. Incident cases were defined as workers who had no current or prior history of CTS and were subsequently diagnosed with CTS by means of active surveillance during the study. The estimated annual incidence rate ranged from 1% to 10%, depending on the case definition. Significant predictors for CTS include a higher baseline median-ulnar peak latency difference, history of wrist/hand/finger tendonitis, history of diabetes, nonneutral wrist and elbow postures, and a lower self-reported social support. This is similar to other prospective studies that demonstrate both ergonomic and medical history are independent risk factors for development of CTS.
Journal of Occupational and Environmental Medicine, 2004
Is not hiring otherwise-qualified workers who have an abnormal post-offer preplacement (POPP) med... more Is not hiring otherwise-qualified workers who have an abnormal post-offer preplacement (POPP) median nerve test a cost-effective strategy to reduce workers' compensation expenses related to carpal tunnel syndrome (CTS)? We performed a retrospective dynamic cohort study based on 2150 workers hired at a company between January 1996 and December 2001 and who underwent POPP median nerve testing. Workers were followed until they left the company or until follow-up ended in May 2003. Thirty-five cases of work-related CTS occurred during follow-up, and 9.13 cases could have been avoided. However, if the company had not hired workers with abnormal POPP nerve test results, it would have suffered a net loss of $357,353. Not hiring workers with abnormal POPP nerve tests to reduce costs of work-related CTS is not a cost-effective strategy for employers.
Stroke during pregnancy poses a challenge to the rehabilitation team. A 10-year review of one hos... more Stroke during pregnancy poses a challenge to the rehabilitation team. A 10-year review of one hospital's records revealed five pregnancies complicated by stroke. The mean age was 29 years (range, 21 to 35 years). Cerebrovascular accidents associated with pregnancy may be due to many causes, with intracranial hemorrhage due to arteriovenous malformation or aneurysm, arterial occlusion due to thrombosis or embolus, venous thrombosis, and vasculitis representing the more common etiologies. Three of the strokes in this study were due to intracranial hemorrhage, and two were due to thrombosis secondary to CNS vasculitis. Two case studies and a review of the literature are presented. Stroke during pregnancy represents a high-risk obstetrical situation that may complicate the rehabilitation process.
Previous studies attempting to predict outcome after acute stroke have been limited by small samp... more Previous studies attempting to predict outcome after acute stroke have been limited by small sample sizes and inconsistent definitions of outcome. The functional status data from the Functional Independence Measure (FIM) as well as social and demographic information from 2,109 stroke survivors were reviewed to determine the possible risk factors for poor outcome. Four measures of outcome were used for this analysis: discharge placement, rate of change of functional status as measured by the FIM, total change in functional status from admission to discharge, and length of stay. The most significant risk factor for discharge to a location other than home was an admission FIM score of less than 60; the relative risk was 3.5. Several other factors, including race, marital status, and age, influenced this outcome. A low admission FIM score was also a significant risk factor for a low rate of change of functional status during the inpatient rehabilitation stay; the relative riskwas 2.2. A...
Journal of the California Dental Association, 2005
Upper extremity musculoskeletal disorders are common among dental professionals. The natural hist... more Upper extremity musculoskeletal disorders are common among dental professionals. The natural history of these disorders is not well-understood. These disorders are more common in older workers, but the prevalence among younger workers has not been well-studied. The objective of this study was to determine if dental/dental hygiene students had a similar prevalence of upper extremity musculoskeletal disorders compared to age-matched clerical workers. We hypothesize students will have a lower prevalence of upper extremity musculoskeletal disorders compared to clerical workers. This was a cross-sectional design. Dental and dental hygiene students from three schools were compared to clerical workers from three locations (an insurance company and two data processing plants). There were 343 dental and dental hygiene students and 164 age-matched clerical workers. Regional discomfort was the primary outcome. The secondary health outcomes were diagnoses of carpal tunnel syndrome and upper ext...
Journal of dental hygiene : JDH / American Dental Hygienists' Association, 2002
This study was undertaken to determine the prevalence of carpal tunnel syndrome (CTS) and upper e... more This study was undertaken to determine the prevalence of carpal tunnel syndrome (CTS) and upper extremity (UE) tendinitis among dental hygienists. In a cross-sectional study dental hygienists (n = 305) were screened using sensory nerve conduction, a focused physical examination of the UE, and a symptom questionnaire. CTS was diagnosed if the subject had slowing of the median nerve at the wrist and symptoms of numbness, tingling of pain in the median distribution. Localized tendinitis of the UE was diagnosed if the subject had focal symptoms and associated findings on physical examination. Three percent of the participating dental hygienists were diagnosed with CTS. Thirteen were diagnosed with shoulder tendinitis, while 6% had a tendinitis of the elbow and 7% had tendinitis of the hand or wrist. Twenty-eight percent had a diagnosis of some UE tendinitis or CTS. The prevalence of hand and finger symptoms in the dominant hand among dental hygienists in this study was high, but the pre...
Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wr... more Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wrist which may occur following chronic paraplegia. Thirty one chronic paraplegics, with a mean age of 37.9 years (range 20-68 years), and mean time since injury of 9.7 years (range 1-28 years), were studied with a comprehensive neurologic and electrodiagnostic (EDX) assessment. No patient had any clinical or EDX evidence of a peripheral polyneuropathy. The diagnosis of a median mononeuropathy at the wrist was determined by the following criteria: (a) prolonged median sensory distal latency greater than ipsilateral ulnar sensory distal latency greater than or equal to 0.5 msec; (b) a median mid-palmar sensory latency greater than ipsilateral ulnar mid-palmar sensory latency of greater than or equal to 0.3 msec; or (c) a median motor distal latency greater than or equal to 1.7 milliseconds as compared to the ipsilateral ulnar motor distal latency. Ulnar mononeuropathy at the wrist or across...
Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wr... more Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wrist which may occur following chronic paraplegia. Thirty one chronic paraplegics, with a mean age of 37.9 years (range 20–68 years), and mean time since injury of 9.7 years (range 1–28 years), were studied with a comprehensive neurologic and electrodiagnostic (EDX) assessment. No patient had any clinical or EDX evidence of a peripheral polyneuropathy. The diagnosis of a median mononeuropathy at the wrist was determined by the following criteria: (a) prolonged median sensory distal latency > ipsilateral ulnar sensory distal latency ≥ 0.5 msec; (b) a median mid-palmar sensory latency > ipsilateral ulnar mid-palmar sensory latency of ≥ 0.3 msec; or (c) a median motor distal latency ≥ 1.7 milliseconds as compared to the ipsilateral ulnar motor distal latency. Ulnar mononeuropathy at the wrist or across the elbow was also characterised. The EDX criteria for a median mononeuropathy at th...
The correlation between monofilament testing, symptom surveys, and electrodiagnostic studies for ... more The correlation between monofilament testing, symptom surveys, and electrodiagnostic studies for the diagnosis of axonal polyneuropathy has not been well studied. This investigation was done to assess the agreement between these procedures in a non-random sample of volunteers.
The objective of this study was to determine the relative contributions of work activity (time sp... more The objective of this study was to determine the relative contributions of work activity (time spent standing, walking or sitting), floor surface characteristics, weight, BMI, age, foot biomechanics, and other demographic and medical history factors to the prevalence of hip disorders. A cross-sectional observational study design was used to engine assembly plant workers. The main outcome measure was the finding of a hip disorder. The independent variables included baseline demographics, medical history, ergonomic exposures, psychosocial factors, shoe characteristics and foot biomechanics. Logistic regression revealed that increasing age, female gender, pes planus, smoking, history of a knee or hip injury, and a history of rheumatoid arthritis were significant risk factors while time on carpeted surfaces was protective. Hip disorders are associated with a history of biomechanical trauma to the hip but also from gait abnormalities such as pes planus.
Journal of Occupational and Environmental Medicine, 2005
This study defined the incidence rate of carpal tunnel syndrome (CTS) among active assembly worke... more This study defined the incidence rate of carpal tunnel syndrome (CTS) among active assembly workers and evaluated risk factors. This study followed 189 automobile assembly workers over 1 year. Incident cases were defined as workers who had no current or prior history of CTS and were subsequently diagnosed with CTS by means of active surveillance during the study. The estimated annual incidence rate ranged from 1% to 10%, depending on the case definition. Significant predictors for CTS include a higher baseline median-ulnar peak latency difference, history of wrist/hand/finger tendonitis, history of diabetes, nonneutral wrist and elbow postures, and a lower self-reported social support. This is similar to other prospective studies that demonstrate both ergonomic and medical history are independent risk factors for development of CTS.
Journal of Occupational and Environmental Medicine, 2004
Is not hiring otherwise-qualified workers who have an abnormal post-offer preplacement (POPP) med... more Is not hiring otherwise-qualified workers who have an abnormal post-offer preplacement (POPP) median nerve test a cost-effective strategy to reduce workers' compensation expenses related to carpal tunnel syndrome (CTS)? We performed a retrospective dynamic cohort study based on 2150 workers hired at a company between January 1996 and December 2001 and who underwent POPP median nerve testing. Workers were followed until they left the company or until follow-up ended in May 2003. Thirty-five cases of work-related CTS occurred during follow-up, and 9.13 cases could have been avoided. However, if the company had not hired workers with abnormal POPP nerve test results, it would have suffered a net loss of $357,353. Not hiring workers with abnormal POPP nerve tests to reduce costs of work-related CTS is not a cost-effective strategy for employers.
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