Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Sep 2002
Herpes zoster of the head and limbs: electroneuromyographic and clinical findings in 158 consecutive cases.
To quantify electromyographic and neurographic changes and to correlate them with the clinical data of outpatients with herpes zoster. ⋯ Sensory axonal neuropathy, often associated with similar motor involvement, can be shown by classical electrophysiologic methods in herpes zoster. The severity of damage to motor fibers was related to damage to sensory fibers, but no relation was found between peripheral axon damage and PHN. The site of motor system damage may be the ventral roots, plexus, or peripheral nerve. The probability of complications and the severity of sensory and motor peripheral axonal damage were increased in older patients. Appropriate antiviral therapy seems to reduce the incidence of segmental zoster paresis and the severity of damage to the peripheral fibers. A reduced extent of herpetic rash was the only factor to correlate with a good outcome of PHN.
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Arch Phys Med Rehabil · Sep 2002
Case ReportsDysphonia associated with epidural steroid injection: a case report.
A 46-year-old patient with left-side low back pain developed symptoms of dysphonia and throat irritation 24 hours after receiving a fluoroscopically guided steroid injection into the epidural space. A direct laryngoscopy performed before a second injection detected no abnormalities. ⋯ Full clinical resolution of the dysphonia was apparent by laryngoscopy 15 days after the second injection. The mechanism of dysphonia after epidural steroid injection is unknown, but it may result from a systemic steroid effect.
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Arch Phys Med Rehabil · Sep 2002
Traumatic brain injury rehabilitation: are there alternatives to randomized clinical trials?
Randomized clinical trials (RCTs) are widely considered to be the gold standard of evidence for treatment efficacy, but they have not been widely applied to rehabilitation or, more specifically, traumatic brain injury rehabilitation. Ethical, scientific, and resource factors may limit the application of RCTs. Thus, rigorous observational alternatives to the RCT would be of great value. ⋯ It appears nearly impossible to successfully apply observational designs when the factors leading to the applications of different treatments are strongly related to the patient's perceived prognosis. However, observational designs may be successfully applied when regional or temporal variations in care are studied. Moreover, a number of developments in measurement, study design, and statistical analysis may expand the role of observational studies in answering questions of rehabilitation efficacy and effectiveness.
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Arch Phys Med Rehabil · Sep 2002
Case ReportsUpper-extremity deep vein thrombosis associated with peripherally inserted central catheters in acute spinal cord injury: a report of 2 cases.
Catheter-associated upper-extremity deep vein thrombosis (DVT) carries a 12% to 36% risk of pulmonary embolism (PE). Acute spinal cord injury (SCI) is a thrombophilic state resulting from altered fibrinolytic and platelet function and abnormal concentrations of clotting factors. Patients with SCI are frequently burdened with the classic risk factors of Virchow's triad including stasis, hypercoagulability, and intimal trauma. ⋯ A high index of suspicion is necessary to make the diagnosis, and prompt aggressive anticoagulation is warranted absent contraindications. Little is known about the prevalence of and the morbidity associated with upper-extremity DVT in the SCI population. Our experience suggests that catheter-related, upper-extremity venous thromboembolism in SCI deserves further study.