Rehab Centers: Liminality and Decision Making for Upper Limb Surgery in Tetraplegia: A Grounded Theory.

Liminality and decision making for upper limb surgery in tetraplegia: a grounded theory.

Filed under: Rehab Centers

Disabil Rehabil. 2012 Oct 19;
Dunn JA, Hay-Smith EJ, Whitehead LC, Keeling S

Purpose: To explore, from the perspective of the person with tetraplegia, the issues that influenced decision making about upper limb surgery and develop a conceptual framework describing the decision making process. Method: Purposive and theoretical sampling of 22 people with tetraplegia, followed by interviews. Ten people had upper limb surgery and 12 had not. Verbatim transcripts were analyzed with constructivist grounded theory. Results: Participants responded to the offer of surgery in one of three ways: yes, let me have it; no thanks; or possibly. Many influences on the decision about surgery had a temporal element, such as hope for the cure or recovery from SCI, inadequate physical or social supports while rehabilitating, life roles and goals, and the avoidance of re-hospitalization. The conceptual framework illustrated that many participants entered a liminal state within which they required a stimulus to review their decision about upper limb surgery. Conclusion: Decision making is a temporal process, and for some the process was a prolonged and liminal one. Therefore, multiple offers for surgery are required to allow for changing thoughts and circumstances throughout an individual’s lifetime. Flexibility with regard to timing for surgery and type of rehabilitation may increase the uptake, especially for women. [Box: see text].
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Botulinum toxin type A in the healing of chronic lesion following bilateral spasticity of gluteus muscle.

Filed under: Rehab Centers

Int Wound J. 2012 Oct 19;
Cigna E, Maruccia M, Fanelli B, Scuderi N

Use of botulinum toxin is expanding as the clinical studies demonstrate new potential therapeutic applications. In rehabilitation, botulinum toxin is above all used as adjunct therapy for the treatment of spasticity, but it may prove useful for other atypical clinical situations. A 17-year-old man had a sub-arachnoid haemorrhage following the rupture of cerebral aneurism. The patient presented gluteus maximus and medius bilaterally spasticity that produced a chronic lesion in the intergluteal cleft, a flexed wrist and a flexed elbow. As treatment for this spasticity, a total of 100 U botulinum toxin type A were injected into the glutei muscles. This treatment allowed for application of topical medication and subsequently, chronic lesion healing. Botulinum toxin A may be an important therapeutic aid for clinicians faced with treating persistent pathological conditions caused by spasticity.
HubMed – rehab

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