Physical Medicine / OMM

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    The Effect and Mechanism of Botulinum Toxin Type A For Knee Osteoarthritis Through Ultrasound Guidance
    (2017-03-14) Baker, Stephen; salem, yasser; quiben, myla; Liu, Howe; Bao, Xiao
    Objective: Knee osteoarthritis (OA) is a chronic and progressive disease that affects the geriatric population. OA is characterized by cartilaginous degeneration, subcartilaginous bone reconstruction and osteophyte formation. It causes joint pain, swelling, joint dysfunction and affects the quality of life, even leading to depression. The treatment of knee osteoarthritis usually includes medications, physical therapy and traditional Chinese acupuncture. These treatments could be useful for most of OA. Refractory OA in which conventional treatment is ineffective could induce intensive pain, disability and reduce the life quality of the patient. Given that, we need obtain new methods with good curative effect for refractory OA. BoNT-A is the marketing name given to a neurotoxin and is found to be effective for partial muscle spasm of post-stroke. Recently the use of BoNT-A is extended to be used as pain management in conditions such as low back pain and myofascial pain. Usually, injection of BoNT-A is guided through an anatomical landmark or pain location. However, there is risk for injection without ultrasound-guidance such as fat pad disturbance. So, we plan to proceed the Intra-articular injection of BoNT-A through the ultrasound-guided method for refractory knee osteoarthritis of older individuals and study changes of the knee joint before and after intervention via MRI and radiograph imaging, and provide the new choice for refractory knee osteoarthritis of older individuals. Methods: Sixty patients with refractory knee osteoarthritis were randomly divided into three groups (A:saline, B: BoNT-A, C: sodium hyaluronate). Evaluation of WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) questionnaire score, VAS ((Visual Analogue Scale) score and SF-36 ((the MOS item short from health survey) at baseline, 4 weeks and 8 weeks follow-up were recorded respectively. Results: WOMAC, VAS and SF-36 were improved in group B and group C patients compared baseline to 4 weeks and 8 weeks respectively (P Conclusions: The treatments of Botulinum toxin type A were beneficial and safe for patients suffering from refractory knee OA.
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    Bladder Management of Traumatic Spinal Cord Injury in the Acute Trauma Setting
    (2017-03-14) Al-Farra, Tariq; Gwirtz, Patricia A.; Dena, Brian
    Purpose: Neurogenic bladder is a common complication of spinal cord Injury (SCI). This condition increases the risk of urinary tract infection, bladder stones, urinary incontinence, and renal failure. Immediately following SCI, patients are often medically stabilized with an indwelling catheter (IC) in place. If possible, efforts are made to transition from IC to Clean Intermittent Catheterization (CIC), which has been shown to have less risk of complications. Currently, no protocol exists for transition from IC to CIC due to research gaps in spinal cord injury rehabilitation. The purpose of this project is to describe the bladder management of newly diagnosed SCI patients in the acute trauma setting and to analyze factors related to their demographics, injury, and hospital course. Methods: Electronic medical records of patients admitted to Baylor University Medical Center (BUMC) followed by inpatient rehabilitation at Baylor Institute for Rehabilitation (BIR) in Dallas, TX were reviewed. A total of 59 patients met the following criteria: initial presentation and management of SCI at BUMC, immediate inpatient rehabilitation at BIR, traumatic SCI AIS A-E. Results: The age at time of injury was between 16-88 years of age with a mean of 45 (s.d. ± 22.5). The average length of stay at BUMC was between 4 to 66 days with a mean of 20 (s.d. ± 16.5). The most common mechanisms of injury were fall in 27 patients (45%), gun shot wound in 16 patients (27%), and motor vehicle collision in 10 patients (17%). A total of 54 patients (92%) had an IC placed at admission to BUMC. Bladder management at BUMC discharge was as follows: IC 24 (41%), CIC 16 (27%), and volitional voiding 19 (32%). Of the 54 patients, 24 patients (44%) had the IC removed before discharge, while 30 (56%) were discharged and admitted to BIR with IC. An IC was in place between 0 and 39 days with a mean of 9 (s.d. ± 9.6). Urinary tract infection (UTI) developed in 11 (19%) patients at BUMC. Conclusions: Over ninety percent of patients had an IC placed immediately following SCI. Of the patients that could not tolerate volitional voiding, 40% achieved the optimal method of CIC by the time of discharge from BUMC. This study describes the current clinical management of the bladder in SCI, and demonstrates that UTI was observed in 19% of patients. Further research is warranted to analyze additional factors related to complications from neurogenic bladder in SCI rehabilitation.
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    Variation of the Origins of the Phrenic and Long Thoracic Nerves – A Case Report
    (2017-03-14) Liu, Hao; Truong, Tony; Holmes, Clayton; Liu, Howe; Arguello, Eric
    Introduction: In humans the phrenic nerve originates from the convergence of 3 individual nerve branches off the spinal roots of C3-C5, while the long thoracic nerve originates from the convergence of 3 branches off the spinal roots of C5-C7. However, a variation of the origins of these two nerves was found in a cadaver during dissection. Methods: This study of anatomical variation was conducted on an 86-year-old male cadaver provided for physical therapy students in a gross anatomy lab. Students and faculty members dissected the cadaver. The variations were identified when the neck and brachial areas were exposed for students to study. Results: On the left neck area, a short communicating nerve trunk is found connecting the beginning parts of both the cervical plexus and upper trunk of the brachial plexus. The phrenic nerve is the only branch off this communicating nerve and travels along the anterior surface of anterior scalene muscle. At the origin of this phrenic nerve, a small muscular branch divides and passes posteriorly to innervate the middle scalene muscle. On the right axillary area, the long thoracic nerve is found to branch off from the end of the posterior cord or initial part of the radial nerve of the brachial plexus and then travels distally and inferiorly to innervate the serratus anterior muscle. Conclusions: Findings of variation of the phrenic and long thoracic nerves in this study may provide additional information for clinicians to understand potential injury related to these two nerves. It is possible that an overstretch to the upper trunk of brachial plexus like with Erb-Duchenne palsy or a lesion to the posterior cord or initial portion of the radial nerve may cause involvement of injury to the phrenic and long thoracic nerves