A rehabilitation programme for patients with conversion paralysis has been introduced in which they are offered physical rehabilitation. During an eight month period between October 1984 and May 1985 six patients who had been diagnosed as dependent on wheelchairs owing to conversion paralysis for a mean of 3 years (range 1-6 years) were entered into the inpatient neurorehabilitation programme. All six patients were able to walk within a mean of 41 days (range 10-70 days), and then relinquished a variety of aids and allowances as a result of their regained mobility. They continued to be independent at outpatient review for a mean of 10 months (range 8-15 months).Successful rehabilitation from wheelchair dependency can be achieved by a cost effective, prolonged, inpatient neurorehabilitation programme.
Cortical magnetic stimulation was performed in a consecutive series of 10 patients presenting within 15 days of traumatic spinal cord injury. In those patients with complete paraplegia or quadriplegia, motor evoked potentials at presentation were absent below the level of the lesion. Six months after the injury, potentials had returned in the biceps brachii and abductor pollicis brevis muscles in some quadriplegic cases, but remained absent from the tibialis anterior in all of this group. None of those with a complete lesion made a significant functional recovery. Of the three patients with incomplete quadri plegia, two showed a significant recovery after 6 months. Motor evoked potentials were recordable below the level of the lesion at presentation in these cases, although the latencies were prolonged. In the remaining patient who failed to improve, potentials were unrecordable throughout the study. This small pilot study suggests that cortical magnetic stimulation may be useful in refining the prognosis in patients with an incomplete spinal cord injury.
A 25-YEAR-OLD male teacher, ironically, of disabled children, presented on 18 November 1977 to his local casualty department complaining of pain in the mid-dorsal region which had been present for 2 weeks. He described it as 'extremely severe' and found that the two most comfortable positions were standing upright or in a slightly flexed prone position over some cushions; it was extremely painful to be on his back. The pain was aggravated by coughing, sneezing and straining at stool and tended to radiate round to the front of the upper abdomen. The only finding of note was some tenderness over the spines of D8, 9 and 10. His dorsal and lumbar spines and pelvis were X-rayed and found to be normal. He was sent home with a prescription for some simple analgesics.Over the next 5 days he consulted his General Practitioner who thought that he might have rheumatism and prescribed a short course of steroids. The pain, however, became worse and on 23 November 19 77 he reappeared in the same casualty depart ment. In addition to his now 'excruciating' back pain he was complaining of constipation of one week's duration and a feeling that his legs were 'weak and wobbly', but there were no sensory symptoms and bladder function was normal. He was again X-rayed with normal results, and was again tender in the dorsal region, with no other abnormal find ings, and was given an enema and discharged. On the evening of 23 November 1977 he noticed progressive weakness of both legs together with intermittent pins and needles and numbness extending up to the umbilicus. On awaking the next morning he was unable to move his legs, he felt numb up to the waist and his own doctor found a palpable bladder extending up to the umbilicus. On arrival at his local casualty department for the third time he was found to have a flaccid paralysis of both legs, a bladder distended to the umbilicus, and a complete loss of sensation from D9 with a crisp sensory level. A catheter was inserted and he was transferred to the Neurological Unit at Pinderfields General Hospital, Wakefield, with a diagnosis of cord compression.He arrived at 5.00 p.m. on 24 November 1977 and we noted the flaccid paralysis and sensory loss with absent reflexes in the legs and no plantar response. There was a catheter in situ.In addition we noticed a small scar on the right buttock. The patient then disclosed that he had had a staphylococcal abscess drained I month previously. We performed an immediate myelogram and this showed (Fig. I) an extradural block at the lower border of D9. He was taken to theatre and an exploratory laminectomy revealed 10 ml of thick greenish pus in the extradural space extending from D8 to DIO and involving the lamina of D9. In addition there was granulation tissue compressing the theca in this region; this was removed piecemeal. Staphylococcus aureus was isolated from the pus.He made a good postoperative recovery but unfortunately there was no improvement in his neurological state, he remained completely paralysed from the waist with no return of bladde...
The spinal injury patients who were initially treated by suprapubic catheterisation and reported from this unit in 1976 have been reviewed. Fifteen had died by early 1982; only in two cases from renal causes. All but one of the 23 survivors seen has a normal blood urea, and 15 have normal intravenous pyelograms. Eight patients have abnormal IVPs; the abnormalities were insignificant in four, and have been treated in two. Two patients have unilateral nonfunctioning kidneys. These results suggest that no long term ill effects result from the technique. In view of its considerable administrative advantages suprapubic urinary drainage should become more widely used.
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