Grip and Hand Strength Training
Although the underlying pathophysiology of lower urinary tract symptoms is best determined by urodynamic studies, many patients have other contributing factors and or comorbidities that should be addressed to effect successful treatment. For example, urodynamic study in a women with urinary incontinence may disclose detrusor-external sphincter dyssynergia which could be managed with anticholinergics and intermittent self catheterization, but spasticity of the hip adductors and poor hand function prevent her from catheterizing through the urethra. A practical solution is to create a continent abdominal stoma that the patient can catheterize without even having to transfer.
Children, following traumatic brain injury, show alterations of both sensory and motor skills. However, there are very few research studies comparing traumatically brain-injured children with controls regarding their sensorimotor function. Moreover, norms on children are noticeably lacking. The Grip Strength and Finger Tapping Tests discussed above can be used in children ages 6 to 8 and ages 12 and older, if the norms of Spreen and Strauss are used.110 However, as we will see next, the NEPSY can be used for sensorimotor function assessment in children ages 3 to 12.
The use of a chronic indwelling catheter is never desirable because of its complications including epididymitis, urethrocutaneous fistula, traumatic hypospadias, and squamous cell carcinoma. Yet, chronic catheterization remains the most common form of management in patients who are tetraplegic and bedridden. Many female patients, unable to use an external collecting device, are managed with catheter drainage because they fail pharmacologic therapy and or have limited hand function. McGuire followed 35 women managed with either an indwelling catheter or CIC for 2-12 yr following spinal-cord injury and found a significant reduction in the incidence of autonomic dysreflexia, febrile UTIs, pyelonephritic scarring by I VP, and bladder stones in patients managed with intermittent catheterization. This same study showed 92 of women with long-term indwelling catheters eventually had incontinence around the catheter and 54 had urethral erosion, whereas none on CIC had these complications (51)....
Physical fitness, anthropometric, and metabolic parameters were compared by Hanne et al.24 in 49 vegetarian and 49 non-vegetarian male and female Israeli athletes who were matched for age, sex, body size, and athletic activities. No significant differences were found between groups for pulmonary function, aerobic and anaerobic capacity, arm and leg circumferences, hand grip and back strength, hemoglobin, and total serum protein. The authors concluded that the specific influence of the vegetarian diet on physical performance is confounded by several factors, including the type of vegetarian diet ingested, the training regimen, and other lifestyle practices.
The Valsalva maneuver decreases cardiac output and increases heart rate. Standing decreases all other murmurs. MR murmurs are increased by hand grip (increases systemic vascular resistance), and right-sided heart murmurs are increased by inspiration. 176. The answer is e. (Seidel, 4 e, p 440.) S3 is a low-pitched sound that occurs early in diastole at the termination of the rapid filling phase. It may be found in normal children or persons with large cardiac outputs. If heard, it usually indicates ventricular decompensation. Low-pitched sounds are best heard with the bell of the stethoscope with the patient lying in the left lateral recumbent position. S3 and S4 gallops may be made louder by increasing venous return (raising leg) or increasing arterial pressure (hand grip).
Complete or incomplete nonviable amputations of the wrist or distal third of the forearm are ideal for revas-cularization and replantation because with success hand function is restored, since both flexion and extension of the digits can be achieved by the proximal uninvolved muscles (Fig. 14.3.4). Good protective sensation of the hand is also readily achieved with primary or secondary repair of the median and ulnar nerves. In contrast, amputations at the upper third of the forearm and level of the elbow are more challenging due to the severity of injury and soft tissue damage. Although above-elbow amputations are easier from the technical perspective as only one artery of large diameter (brachial) needs to be anastomosed, they are associated with extensive bone, muscle and nerve damage. This makes the preoperative evaluation and management more demanding and postoperative treatment more difficult with a high rate of infection.
The answer is a. (Sabiston, 15 e, pp 1479-1485.) The ulnar nerve innervates 15 of the 20 intrinsic muscles of the hand. The musculocuta-neous, radial, ulnar, and median nerves are all important to hand function. The musculocutaneous and radial nerves allow forearm supination the radial nerve alone innervates the extensor muscles. The median nerve is the eye of the hand because of its extensive contribution to sensory perception it also maintains most of the long flexors, the pronators of the forearm, and the thenar muscles.
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