- Email: [email protected]
No. 268 Special Treatment of Patients With Low Back Pain
PM&R
No. 267 Correlation Analysis Between Digital Photography Measurement of Trunk Deformity and Self-Image Perception in Patients With Idiopathic Scoliosis. Judith Sánchez Raya; Antonia Matamalas Drover; Elisa D’ Agata; Joan Bago Granell. Objective: To assess the validity of a clinical assessment tool of the trunk deformity based on photographs as compared to self-assessed appearance questionnaires. Study Design: Concurrent validity between postural indexes obtained from digital photographs and self-assessed appearance questionnaires. Setting: Tertiary university traumatology and rehabilitation hospital of Barcelona, Spain. Participants: 80 consecutive patients (68 females and 12 males) aged 12 to 40 years old (average 20.3 years old) were included. Mean Cobb angle was 45.9o (range 25.1o to 77.2o). Intervention: Front and back digital photographs of patients with idiopathic scoliosis (Cobb angle >25o) were obtained. Main outcomes measures: shoulder, armpit, and waist angles in addition to trunk asymmetry indices were calculated on front and back photographs with Surgimap software. All patients completed SRS-22, SAQ, QLSDP, and TAPS questionnaires. The Spearman’s rank correlation coefficient (r) was used to estimate concurrent validity between both methods. Level of Evidence: III. Results: A significant correlation was found between waist height angle and TAPS (r¼-0.31 to -0.34); SAQ appearance subscale (r¼0.27 to 0.35), and SAQ total score (r¼0.25 to 0.29). No correlation between shoulder imbalance and self perception image was found. No correlation between TAPS, SAQ, and other photography measurements was found. A significant correlation was found between shoulder height angle and trapezium angle ratio and SRS-22 questionnaire on front photograph (pain: range from -0.26 to -0.34 /subtotal:-0.23). Conclusion: Waist height angle measured with digital photography is moderately correlated with perceived trunk appearance. Trunk asymmetry is poorly correlated with self-assessed appearance. Picture scales are better correlated with photographs than verbal rating scales.
No. 268 Special Treatment of Patients With Low Back Pain. Michaela Tomanová, MD, MBA1; Lee Cabell EDD2. (1Rehabilitation Clinic Brandýs Nad Orlicí Czech Republic and 2Seton Hall University, New Jersey USA). Objective: Low back pain (LBP) is a social and economic problem that affects 60% to 85% of the population. The infinity method treatment (IMT) utilizes therapeutic movements either through active movements by a patient or passive movements facilitated by a therapist which are conducted through either conscious or unconscious participation by the patient. The three-dimensional rehabilitation therapy movements are performed in a series of figure eight circle and spiral motions to stabilize the whole body and lumbar region in LBP patients. The objective of the study was to test the efficacy of rehabilitation on LBP patients treated with IMT for five to seven weeks five times per week for a minimum of 30 minutes each session. Design: Repeated measures design. Setting: Rehabilitation clinic. Participants: 24 LBP patients (65.50 10.67 yrs). Interventions: While the patient was standing we measured barefoot plantographic and posturographic parameters i.e. plantar pressure, weight distribution, and center of force (COF) with a pressure mat system Matscan before and after the treatment. Data were analyzed with the paired t-test. Main Outcome Measures: All the dependent variables were significant after treatment. Results: The values of lowered dependent variables after treatment were: measured area of COF (mean paired difference of 2.80 cm2) p<0.0001; variation of COF after treatment (mean paired difference 0.01 cm) p<0.002; A-P weight distribution (mean paired difference 0.96 cm) p<0.0001; M-L weight distribution (mean paired difference 1.45 cm) p<0.0001. Conclusions: The IMT provides stability, body balance and a corrected body posture while standing. There is better weight distribution on the sole of the feet and also better overall body center of gravity position than before IMT.
Vol. 6, Iss. 8S2, 2014
S145
No. 269 Special Rehabilitation Treatment of Patients With Low Back Pain. Michaela Tomanova; Lee Cabell; Marcela Lippert-Grüner. Objective: Our special rehabilitation treatment, the infinity method treatment (IMT), utilizes therapeutic movements either through active movements by a patient or passive movements facilitated by a therapist which are conducted through either conscious or unconscious participation by the patient. The three-dimensional rehabilitation therapy movements stabilize the whole body and lumbar region in low back pain (LBP) patients. The objective of the study was to test the efficacy of rehabilitation on LBP patients treated with IMT for five to seven weeks, five times per week, for a minimum of 30 minutes each session. Design: Repeated measures design. Setting: Rehabilitation clinic. Participants: 24 LBP patients (65.50 10.67 yrs). Interventions: While the patient was standing on a pressure mat system (MatScan), we measured barefoot plantar pressure, weight distribution, and center of force (COF) before and after the treatment. Data were analyzed with the paired t-test. The visual analog scale (VAS) of spine subjective pain scores was measured before and after the treatment and was analyzed with the Wilcoxon signed-ranks test. Main Outcome Measures: All the dependent variables were significant after treatment. Results: The values of lowered dependent variables after treatment were: measured area of COF (mean paired difference of 2.80 cm2) p<0.0001; A-P weight distribution (mean paired difference 0.96 cm) p<0.0001; M-L weight distribution (mean paired difference 1.45 cm) p<0.0001;VAS (mean paired difference 2.50) p<0.0001. Conclusions: The IMT provides stability, body balance, and a corrected body posture. There is better weight distribution on the sole of the feet and better overall body center of gravity position than before IMT including lower spine pain in LBP patients. No. 270 Full Recovery From Spinal Cord Injury and Cauda Equina Syndrome After Epidural Steroid Injection: A Case Report and Review of Literature. Yinfei Rachel Xu; Stuart B. Kahn; Junney Baeza Dager; Sheeraz A. Qureshi. Disclosure: None. Setting: Tertiary care rehabilitation unit. Description: Patient is a 79-year-old morbidly obese female with chronic lower back pain (LBP) secondary to severe multilevel spondylosis and herniations L3 through S1 causing canal and foraminal stenosis. She underwent fluoroscopy-guided T12-L1 interlaminar epidural steroid injection (ESI) at a spine center for pain symptoms correlating to a new T11-12 herniation. Afterwards, she developed left leg paralysis, paresthesia and excruciating LBP. In the emergency room, MRI confirmed enlargement of the thoracic herniation causing spinal cord shift and signal intensity within cord. The patient showed symptomatic improvement so emergent surgical decompression was deferred and she was admitted to acute inpatient rehabilitation. Her exam revealed incomplete L1 SCI grade C and admission FIMä score of 46/105. Three weeks later, pain became intolerable and cauda equina syndrome (CES) developed, warranting surgery. Assessment/ Results: Post-operatively, patient made effective gains though she remained weak in legs with bowel and bladder symptoms. Comprehensive rehabilitative measures were continued and by four-month outpatient follow-up, patient had made a full recovery with a FIMä score gain of 59 points. Discussion: In spine injuries, medical decisions are complex and require interdisciplinary conversations, close clinical observation, and up-todate knowledge of literature. We will explore the possible mechanisms of injury, review literature pertaining to indications for ESI and discuss in detail the controversial timing for surgical intervention in acute SCI, CES and central cord syndrome. Regardless of management decisions, physician must help patients set realistic expectations for outcome and provide rehabilitative, surgical, neuropsychological and social services as an integral part of care. Conclusion: Through interdisciplinary management of a suboptimal outcome, care can be optimized to facilitate the best potential for recovery.
No. 267 Correlation Analysis Between Digital Photography Measurement of Trunk Deformity and Self-Image Perception in Patients With Idiopathic Scoliosis. Judith Sánchez Raya; Antonia Matamalas Drover; Elisa D’ Agata; Joan Bago Granell. Objective: To assess the validity of a clinical assessment tool of the trunk deformity based on photographs as compared to self-assessed appearance questionnaires. Study Design: Concurrent validity between postural indexes obtained from digital photographs and self-assessed appearance questionnaires. Setting: Tertiary university traumatology and rehabilitation hospital of Barcelona, Spain. Participants: 80 consecutive patients (68 females and 12 males) aged 12 to 40 years old (average 20.3 years old) were included. Mean Cobb angle was 45.9o (range 25.1o to 77.2o). Intervention: Front and back digital photographs of patients with idiopathic scoliosis (Cobb angle >25o) were obtained. Main outcomes measures: shoulder, armpit, and waist angles in addition to trunk asymmetry indices were calculated on front and back photographs with Surgimap software. All patients completed SRS-22, SAQ, QLSDP, and TAPS questionnaires. The Spearman’s rank correlation coefficient (r) was used to estimate concurrent validity between both methods. Level of Evidence: III. Results: A significant correlation was found between waist height angle and TAPS (r¼-0.31 to -0.34); SAQ appearance subscale (r¼0.27 to 0.35), and SAQ total score (r¼0.25 to 0.29). No correlation between shoulder imbalance and self perception image was found. No correlation between TAPS, SAQ, and other photography measurements was found. A significant correlation was found between shoulder height angle and trapezium angle ratio and SRS-22 questionnaire on front photograph (pain: range from -0.26 to -0.34 /subtotal:-0.23). Conclusion: Waist height angle measured with digital photography is moderately correlated with perceived trunk appearance. Trunk asymmetry is poorly correlated with self-assessed appearance. Picture scales are better correlated with photographs than verbal rating scales.
No. 268 Special Treatment of Patients With Low Back Pain. Michaela Tomanová, MD, MBA1; Lee Cabell EDD2. (1Rehabilitation Clinic Brandýs Nad Orlicí Czech Republic and 2Seton Hall University, New Jersey USA). Objective: Low back pain (LBP) is a social and economic problem that affects 60% to 85% of the population. The infinity method treatment (IMT) utilizes therapeutic movements either through active movements by a patient or passive movements facilitated by a therapist which are conducted through either conscious or unconscious participation by the patient. The three-dimensional rehabilitation therapy movements are performed in a series of figure eight circle and spiral motions to stabilize the whole body and lumbar region in LBP patients. The objective of the study was to test the efficacy of rehabilitation on LBP patients treated with IMT for five to seven weeks five times per week for a minimum of 30 minutes each session. Design: Repeated measures design. Setting: Rehabilitation clinic. Participants: 24 LBP patients (65.50 10.67 yrs). Interventions: While the patient was standing we measured barefoot plantographic and posturographic parameters i.e. plantar pressure, weight distribution, and center of force (COF) with a pressure mat system Matscan before and after the treatment. Data were analyzed with the paired t-test. Main Outcome Measures: All the dependent variables were significant after treatment. Results: The values of lowered dependent variables after treatment were: measured area of COF (mean paired difference of 2.80 cm2) p<0.0001; variation of COF after treatment (mean paired difference 0.01 cm) p<0.002; A-P weight distribution (mean paired difference 0.96 cm) p<0.0001; M-L weight distribution (mean paired difference 1.45 cm) p<0.0001. Conclusions: The IMT provides stability, body balance and a corrected body posture while standing. There is better weight distribution on the sole of the feet and also better overall body center of gravity position than before IMT.
Vol. 6, Iss. 8S2, 2014
S145
No. 269 Special Rehabilitation Treatment of Patients With Low Back Pain. Michaela Tomanova; Lee Cabell; Marcela Lippert-Grüner. Objective: Our special rehabilitation treatment, the infinity method treatment (IMT), utilizes therapeutic movements either through active movements by a patient or passive movements facilitated by a therapist which are conducted through either conscious or unconscious participation by the patient. The three-dimensional rehabilitation therapy movements stabilize the whole body and lumbar region in low back pain (LBP) patients. The objective of the study was to test the efficacy of rehabilitation on LBP patients treated with IMT for five to seven weeks, five times per week, for a minimum of 30 minutes each session. Design: Repeated measures design. Setting: Rehabilitation clinic. Participants: 24 LBP patients (65.50 10.67 yrs). Interventions: While the patient was standing on a pressure mat system (MatScan), we measured barefoot plantar pressure, weight distribution, and center of force (COF) before and after the treatment. Data were analyzed with the paired t-test. The visual analog scale (VAS) of spine subjective pain scores was measured before and after the treatment and was analyzed with the Wilcoxon signed-ranks test. Main Outcome Measures: All the dependent variables were significant after treatment. Results: The values of lowered dependent variables after treatment were: measured area of COF (mean paired difference of 2.80 cm2) p<0.0001; A-P weight distribution (mean paired difference 0.96 cm) p<0.0001; M-L weight distribution (mean paired difference 1.45 cm) p<0.0001;VAS (mean paired difference 2.50) p<0.0001. Conclusions: The IMT provides stability, body balance, and a corrected body posture. There is better weight distribution on the sole of the feet and better overall body center of gravity position than before IMT including lower spine pain in LBP patients. No. 270 Full Recovery From Spinal Cord Injury and Cauda Equina Syndrome After Epidural Steroid Injection: A Case Report and Review of Literature. Yinfei Rachel Xu; Stuart B. Kahn; Junney Baeza Dager; Sheeraz A. Qureshi. Disclosure: None. Setting: Tertiary care rehabilitation unit. Description: Patient is a 79-year-old morbidly obese female with chronic lower back pain (LBP) secondary to severe multilevel spondylosis and herniations L3 through S1 causing canal and foraminal stenosis. She underwent fluoroscopy-guided T12-L1 interlaminar epidural steroid injection (ESI) at a spine center for pain symptoms correlating to a new T11-12 herniation. Afterwards, she developed left leg paralysis, paresthesia and excruciating LBP. In the emergency room, MRI confirmed enlargement of the thoracic herniation causing spinal cord shift and signal intensity within cord. The patient showed symptomatic improvement so emergent surgical decompression was deferred and she was admitted to acute inpatient rehabilitation. Her exam revealed incomplete L1 SCI grade C and admission FIMä score of 46/105. Three weeks later, pain became intolerable and cauda equina syndrome (CES) developed, warranting surgery. Assessment/ Results: Post-operatively, patient made effective gains though she remained weak in legs with bowel and bladder symptoms. Comprehensive rehabilitative measures were continued and by four-month outpatient follow-up, patient had made a full recovery with a FIMä score gain of 59 points. Discussion: In spine injuries, medical decisions are complex and require interdisciplinary conversations, close clinical observation, and up-todate knowledge of literature. We will explore the possible mechanisms of injury, review literature pertaining to indications for ESI and discuss in detail the controversial timing for surgical intervention in acute SCI, CES and central cord syndrome. Regardless of management decisions, physician must help patients set realistic expectations for outcome and provide rehabilitative, surgical, neuropsychological and social services as an integral part of care. Conclusion: Through interdisciplinary management of a suboptimal outcome, care can be optimized to facilitate the best potential for recovery.