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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 1984, researchers analyzed data on 231 18-45 year old women with a spinal cord injury who underwent initial rehabilitation at Craig Hospital in Englewood, Colorado to examine sexual issues. More than 50% of the women reported that health workers did not provide them sufficient sexuality information during rehabilitation, but those who underwent rehabilitation after 1977 were more satisfied with it than those before 1977. They tended to be satisfied with the care they received from their physicians after the injury. Most women were comfortable talking about sexuality with family, friends, and/or other women with spinal cord injuries. Some women were concerned with increases in vaginal discharges (53%) and perspiration (27%) after the injury. Clinicians must realize that the needs of women with spinal cord injuries are different than those of men. Spasticity during sexual relations, pregnancy, childbirth, and the postpartum period troubled some women, e.g., it interfered with sexual intercourse in 21% of the women. Yet 2 newborns were addicted to valium which is used to control spasticity. Other issues were self-confidence and lack of spontaneity. Nevertheless 69% of all women were satisfied with sexual experiences. 60% of the women had amenorrhea after their injury and the mean time for menses resumption was 5 months. The preinjury pregnancy rate was 1.3/person compared with only .34 after the injury. Women with incomplete paraplegia had a higher postinjury pregnancy rate than those with complete quadriplegia (.63 vs. .15; p.001). 50% of the 47 women who had full-term infants delivered vaginally. 49% did not use any anesthesia. Pregnancy complications and complications during labor and delivery were bladder and bowel problems, autonomic hyperreflexia, decubitus ulcers, urinary tract infections, edema, anemia, spotting, fatigue, cardiac irregularity, and preeclampsia.
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PMID:Sexual issues of women with spinal cord injuries. 163 Aug 47

A new method is proposed for pressure sore prevention using electrical muscle stimulation (EMS). Potential mechanisms through which EMS may act for this purpose are discussed, including both short-term/dynamic and chronic effects. Measurements of maximum pressure variation in three able-bodied subjects using low levels of stimulation were performed. Pressure distribution changes were also measured. Fatigue effects on pressure redistribution were studied for four able-bodied subjects as well as for one C4, complete spinal cord injured individual. The results indicate that EMS produces sizeable pressure reduction under the ischial tuberosity, with redistribution occurring over other parts of the seating surface in able-bodied subjects. Fatigue effects were not observed in the four able-bodied subjects even after prolonged stimulation. Fatigue was observed with the spinal cord injured subject, but only after extensive stimulation. These studies demonstrate the feasibility of using EMS at relatively low intensity to vary seating interface pressure. The results warrant continued investigation of EMS to assist in pressure sore prevention.
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PMID:Electrical muscle stimulation for pressure variation at the seating interface. 260 Aug 64

Out of a regional traumatic spinal cord injury population consisting of 379 individuals, 353 (93.1%) participated in the present study. Subjects were individually interviewed using semi-structured protocols. In addition, previous medical records were available for over 96% of subjects, and were used in all these cases to minimise recall bias. Cause of injury, prevalence of present medical symptoms and occurrence of medical complications in the post-acute, post-discharge phase were recorded. Neurological classification was verified by physical examination according to ASIA/IMSOP standards. Many subjects had experienced complications since discharge from initial hospitalisation, especially urinary tract infections, decubitus ulcers, urolithiasis, and neurological deterioration. Prevalence of medical symptoms was also high. More than 41% of subjects with spastic paralysis reported excessive spasticity to be associated with additional functional impairment and/or pain. Almost two-thirds of subjects reported significant pain, with a predominance of neurogenic-type pain. Bladder and bowel dysfunction were each rated by nearly 41% of subjects as a moderate to severe life problem. As expected, sexual dysfunction was also commonly reported. Prevalence of reported symptoms by general systems review was high, particularly fatigue, constipation, ankle oedema, joint and muscle problems, and disturbed sleep. However, lack of adequate normative data precludes comparison with the general population. The frequent occurrence of reported medical problems and complications support advocacy of comprehensive, life-long care for SCI patients. The commonly reported problems of neurogenic pain and neurological deterioration, in particular, require more attention, as these symptoms are not seldom ominous, either by virtue of their impact on quality of life, or because of underlying pathology.
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PMID:The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population. 764 55

Although a number of operative positions have been described for approaching midline posterior fossa tumors, all have potential disadvantages and complications. We describe a modified lateral decubitus position for the removal of posterior fossa tumors. The position allows blood and cerebrospinal fluid to drain from the operative wound and provides a straight-on view of the posterior fossa contents. It also allows the surgeon to sit comfortably during tumor removal, thereby reducing operator fatigue. We have found this to be a reliable and valuable approach for posterior fossa pathology.
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PMID:A modified lateral decubitus position for surgical approaches to midline posterior fossa lesions: technical note. 929 47

The interdisciplinary approach to the management of MS patients includes the services of both physical and occupational therapy. These professions complement one another in their concerted effort to mobilize the patient, thereby minimizing the symptoms of progressive weakness, fatigue, and spasticity. The ambulant patient is far less likely to develop complications of inactivity such as contractures, decubitus ulcers, venous thrombosis, or osteoporosis (with its associated fatigue fractures), as well as bowel or bladder complications.
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PMID:Physical and occupational therapy in the treatment of patients with multiple sclerosis. 989 12

The sleep apnea syndrome (SAS), which is defined by more than 5 apneas or hypopneas per hour of sleep (9), is quite a frequent affection which concerns 1.4 to 10% of general population (1.7). The major daytime complaints of the SAS are daytime sleepiness, memory and attention disorders, headaches and asthenia especially in the morning, and sexual impotence (9). The nocturnal manifestations are dominated by sonorous and generally long standing snoring, increased by dorsal decubitus and intake of alcohol, with repeated interruptions by respiratory arrests. These manifestations are always noted but rarely spontaneously reported. The sleep, non refreshing, is agitated and perturbed by numerous awakenings. The findings of the clinical examination are poor: obesity is found in 2/3 of the cases and arterial hypertension in 1/2 of the cases (20). Polygraphic recording during sleep only permits an absolute diagnosis. This frequent affection is a real problem of public health because of its numerous complications (3, 10, 12, 13, 18, 21). Symptoms of depression are often found when a patient with a SAS is examined and conversely, symptoms which evoke a SAS can be found in the clinical examination of depressed patients. We decided so to study the thymic and anxious status of 24 patients investigated for a SAS and submitted to a polygraphic recording during sleep. Four clinical parameters were studied: DSM III-R diagnosis criteria, Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HARS) and thymasthenia rating scale of Lecrubier, Payan and Puech. We also reported Total Sleep Time (TST = 6.5 +/- 1.5), Apnea Hypopnea Index (AHI = 26.7 +/- 21.6), number (2.1 +/- 2.8/h) and duration (174.2 +/- 150.8 s/h) of hypoxic events. Results showed that among 24 patients, 8 were depressed according to DSM III-R diagnosis criteria and had MADRS > 25, 22 were anxious, 11 had a major anxiety (HARS > 15) and 15 presented thymasthenia (SET > 15). Significative correlations existed between anxiety and depression (r = 0.82; p < 0.0001), depression and thymasthenia (r = 0.77; p < 0.0001) and thymasthenia and anxiety (r = 0.75; p < 0.0001). Among the 8 depressed patients a correlation existed between AHI and depression (r = 0.72; p = 0.04), but no correlation was found between depression and hypoxic events. These results were comparable to those of Guilleminault (10), Reynolds (21), Kales (12), Bliwise (3), Klonoff (13) and Millman (18) who studied relations between SAS and depression. The evaluation of thymasthenia gave a more precise typology of the depressive state associated to SAS: the type of the mood disorder is more "blunted" and "anhedonic" than "sorrowful", particularly characterised by asthenia, lack of energy, reduction of interests (leisures, libido, work), loss of initiative, difficulties to organise tasks, fall of performances and reduction of pleasure usually felt in pleasant events (15). The physic symptomatology dominated the psychic one. The sleep disorganization, more than metabolic consequences of apneas, could be involved in this associated depressive state. Other neuropsychiatric troubles can be associated to the SAS. In fact, cognitive troubles (2, 8, 14, 16, 19, 22, 24) and personality disorders (12, 18) have been described. Our data confirm previous observations suggesting a frequent association between SAS, depression, fatigue and anxiety. Clinicians should consequently be aware that a depression with severe complaints of fatigue should deserve an investigation oriented towards SAS. Conversely, when a SAS is diagnosed, it is necessary to look for a possible depression in order to set up the most appropriate treatment. The frequency of SAS, like depression's one, increases with age. Prescription and consummation of sedative psychotropic drugs increase too with age. Since respiratory depressant effects of these drugs have been clearly demonstrated, it is important to evoke SAS when depressive and/or anxious states are diagnosed and not to aggravate it. An efficacious treatment of SAS can also cure the associated depressive state, but this one can persist. It is necessary, in this case, to select a non sedative antidepressant.
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PMID:[Depressive symptomatology and sleep apnea syndrome]. 1240 78

Pressure sores are a medical problem for wheelchair users worldwide. In developing countries this problem is more critical because of lack of access to specialized technologies and medical assessment. Seat cushions to relieve pressure represent one of best ways to prevent pressure sores for people with spinal cord injury, amputation, cerebral palsy, and other disabilities that require use of wheelchairs for long periods of time. The purpose of this study was to evaluate the performance of a low cost cushion, called the Tuball, designed for low-income communities in developing countries. The Tuball is made from bicycle inner tubes and plastic balls. Its durability and pressure-relieving characteristics were compared with the ROHOTM cushion and the foam cushions now used in Brazil. A sample of 30 participants tested the three cushions: 15 persons with paraplegia and 15 matched able-bodied persons evaluated the capacity of the cushions to distribute pressure. This study also addressed the use of samples of persons without disabilities to test wheelchair cushions.The Tuball cushion provided significantly better pressure distribution than the foam cushion. A t-test was used to compare disabled persons and non-disabled persons as samples in testing cushions. No difference between pressure distribution between non-disabled and disabled participants was found in testing the ROHO cushion or the foam cushion. However, both capacities of pressure distribution and HICPR varied between non-disabled and disabled participants for the Tuball cushion. To determine the useful life of the Tuball cushion, a fatigue test was conducted to simulate sitting and transfer. Both the Tuball and ROHO cushions withstood the equivalent of at least 1 year of use, whereas the foam cushion broke down.
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PMID:Evaluation of pressure and durability of a low-cost wheelchair cushion designed for developing countries. 1279 9

This study reports on secondary data, depression, fatigue and health-related quality of life (HRQOL), collected on people with advanced multiple sclerosis (MS) as part of a larger study of the impact of a telerehabilitation intervention on people with severe mobility impairment. People with spinal cord injuries (SCIs) (n=111) and the prevention of pressure sores were the primary group of interest of the project. The focus here is on data collected from people with advanced MS (n=27), who were included as an exploratory cohort, as they experience increased risk of pressure ulcer development as their level of mobility declines. The study consisted of a nine-week intervention with three randomized groups: video, telephone, and standard care. Aside from information on pressure sores, data were also collected on fatigue, depression, and HRQOL for a two-year follow-up period. For the video group HRQOL scores trended higher and fatigue and depression scores lower for 24 months. Fatigue scores were significantly lower for the video group at month six, 12, and 18. In the sample overall, fatigue symptoms were far more prominent than depressive symptoms and affected 100% higher rates of depression than women. At baseline, controlling for Extended Disability Status Score (EDSS), depression and fatigue were correlated. However, contrary to indications from previous cross-sectional studies, no consistent relationship was observed over time between the two. Telerehabilitation interventions for people with advanced MS warrant further investigation. Findings here suggest that such interventions may be beneficial, although the results need affirmation through larger samples. In addition, the higher prevalence of male depression merits serious attention.
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PMID:Depression, fatigue, and health-related quality of life among people with advanced multiple sclerosis: results from an exploratory telerehabilitation study. 1286 75

Despite the well-documented medical, physical, and psychological complications associated with this care management option, bed rest remains a frequently prescribed treatment modality for conditions such as pressure ulcers. Cognitive and psychosocial complications of bed rest include depression, learned helplessness, perceptual changes, and fatigue. Physically, complications can include contractures, muscle atrophy, osteoporosis, pathologic fractures, urinary tract infections, decreased cardiac reserve, decreased stroke volume, resting and post-exercise tachycardia, orthostatic hypotension, pulmonary embolism, deep venous thrombosis, pneumonia, anorexia, constipation, and bowel impaction. Furthermore, the literature does not contain evidence supporting the use of bed rest to facilitate healing of pressure ulcers. More suitable approaches to pressure ulcer care include limiting bed rest, initiating occupational therapy, integrating meaningful tasks into daily activities, increasing outside stimulation, involving patients in care decisions and addressing their concerns, optimizing nutritional status, and managing pressure and shear throughout daily activities. Recommendations for implementing alternatives to bed rest are addressed.
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PMID:Is bed rest an effective treatment modality for pressure ulcers? 1550 81

Depression and symptom severity are predictive of survival in cancer patients, but are often correlated with each other. This paper compares the physical symptom profiles of depressed and nondepressed cancer patients and further examines the predictive ability of multiple symptoms on depressive status. Data were collected from 121 hospitalized patients with breast, oesophageal and head and neck cancer. Patients were categorized as depressed (n = 30) or nondepressed (n = 91) using the Hospital Anxiety and Depression Scale. Occurrence of symptoms was evaluated with the Patient Disease Symptom/Sign Assessment Scale. The most prevalent symptom in the total sample was insomnia (occurrence rate = 67%). Insomnia, pain, anorexia, fatigue, and wound or pressure sore occurred significantly more often in depressed patients, with no difference in occurrence rates of nausea/vomiting and dyspnoea. Significantly more symptoms were observed in depressed than in nondepressed patients (mean = 3.77 versus 2.52). Both groups showed similar rankings of symptom occurrence rates. Patients simultaneously experiencing insomnia, pain, anorexia and fatigue had a higher risk of depression (odds ratio = 5.03).
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PMID:Physical symptom profiles of depressed and nondepressed patients with cancer. 1562 68


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