Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Nov 2007
Case ReportsProlonged, severe intrathecal baclofen withdrawal syndrome: a case report.
Intrathecal baclofen (ITB) withdrawal is a well-recognized complication when drug delivery is disrupted for any reason. ITB withdrawal varies widely in its severity and poses the very real possibility of death if not promptly managed. Cases of withdrawal lasting greater than 1 or 2 weeks, however, are sparse. ⋯ Typical management of baclofen withdrawal is reviewed. To date, the literature has not discussed the potential role for opiates in managing baclofen withdrawal, yet a growing body of literature is examining the interplay between opiates and gamma-aminobutyric acid B pathways. A potential role for opiates in managing severe baclofen withdrawal is proposed.
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Arch Phys Med Rehabil · Nov 2007
Randomized Controlled Trial Comparative StudyEfficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial.
To compare the effects of a neutral wrist and metacarpophalangeal (MCP) splint with a wrist cock-up splint, with and without exercises, for the treatment of carpal tunnel syndrome (CTS). ⋯ Our results validate the use of wrist splints for the treatment of CTS, and suggest that a splint that supports the wrist and MCP joints in neutral may be more effective than a wrist cock-up splint.
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Arch Phys Med Rehabil · Nov 2007
Clinical correlates of elevated serum concentrations of cytokines and autoantibodies in patients with spinal cord injury.
To determine the serum cytokine profiles of patients with spinal cord injury (SCI) and varying clinical presentations relative to healthy, able-bodied, age-matched control subjects. ⋯ Elevated levels of circulating proinflammatory cytokines and autoantibodies are present in the serum of SCI subjects without medical complications, and are further elevated in SCI subjects with neuropathic pain, UTI, or pressure ulcers, relative to healthy, able-bodied control subjects. These findings may be indicative of a protective autoimmunity, simply a consequence of occult or evident infection, or evidence of cytokine dysregulation that may contribute to an immune-mediated impairment of axonal conduction.
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Arch Phys Med Rehabil · Nov 2007
Case ReportsDevelopment of spontaneous intracranial hypotension concurrent with grade IV mobilization of the cervical and thoracic spine: a case report.
Spontaneous intracranial hypotension (SIH) has been clinically defined as the development of severe orthostatic headaches caused by an acute cerebrospinal fluid (CSF) leak. Typically, intracranial hypotension occurs as a complication of lumbar puncture, but recent reports have identified cases caused by minor trauma. We report a case of SIH secondary to a dural tear caused by a cervical and thoracic spine mobilization. ⋯ A conservative management approach of bedrest and increased caffeine intake had no effect on the dural tear. The headache, hearing loss, and arm symptoms resolved completely after 2 epidural blood patches were performed. Practitioners performing manual therapy should be aware of this rare, yet potential complication of spinal mobilizations and manipulations.
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Arch Phys Med Rehabil · Nov 2007
ReviewGrowth and payment adequacy of medicare postacute care rehabilitation.
In the early 1990s, Medicare experienced rapid growth in the number of providers furnishing postacute care (PAC). Spending grew at an even faster pace than the supply of providers. By the late 1990s, the U. ⋯ This article presents growth trends in providers and Medicare spending. It discusses the Medicare Payment Advisory Commission's (MedPAC) assessment of payment adequacy for 2006 and 2007 for the 4 postacute sectors and problems with the PPSs that result in misaligned payments and costs. This article also reviews MedPAC's studies to compare patient-assessment instruments for 3 of the 4 settings and to compare outcomes across settings for joint-replacement patients.