Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · May 2008
Comparative StudyNeuropsychologic and functional outcome after complicated mild traumatic brain injury.
To investigate the extent to which neuropsychologic and functional outcome after complicated mild traumatic brain injury (TBI) parallels that of moderate TBI recovery. ⋯ When classifying severity of TBI based on GCS scores, consideration of a moderate injury designation should be given to persons with an intracranial bleed and a GCS score between 13 and 15.
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Arch Phys Med Rehabil · May 2008
The Moss Attention Rating Scale for traumatic brain injury: further explorations of reliability and sensitivity to change.
To examine the interrater agreement and responsiveness to change of the Moss Attention Rating Scale (MARS), 22-item version, during acute inpatient rehabilitation after traumatic brain injury (TBI). ⋯ The 22-item MARS showed good interrater agreement among PT, OT, and SLP and lower but still acceptable agreement between nursing and the other disciplines. Two of the 3 factor scores also showed good agreement. The 22-item total score and all 3 factor scores were highly sensitive to change occurring during inpatient rehabilitation. These results show that the 22-item MARS is a reliable instrument for the observational rating of attentiveness in an acute TBI rehabilitation sample. Lower agreement between nursing and the other disciplines suggests that the less structured environment of the nursing unit compared with therapy sessions reduces interrater agreement. The utility of the factor scores, particularly the least reliable sustained and/or consistent attention factor, requires additional investigation. Further research on construct validity and impact of the use of the MARS on clinical practice are warranted.
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Arch Phys Med Rehabil · May 2008
Review Meta AnalysisDoes aquatic exercise relieve pain in adults with neurologic or musculoskeletal disease? A systematic review and meta-analysis of randomized controlled trials.
To evaluate the literature on the effectiveness of aquatic exercise in relieving pain in adults with neurologic or musculoskeletal disease. ⋯ There is sound evidence that there are no differences in pain-relieving effects between aquatic and land exercise. Compared with no treatment, aquatic exercise has a small pain-relieving effect; however, the small number of good-quality studies and inconsistency of results means that insufficient evidence limits firm conclusions. Future studies should aim for focused research questions on specific aquatic exercise techniques, using robust methodologic designs and detailed reporting of temperature, depth, and care setting.
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Arch Phys Med Rehabil · May 2008
Randomized Controlled Trial Comparative StudyComparative impact of 2 botulinum toxin injection techniques for elbow flexor hypertonia.
To compare 2 techniques of botulinum toxin injection for elbow flexor hypertonia. ⋯ In 31 adults with acquired brain injury, single motor point and multisite distributed injections of low-dose, high-volume BTX-A had similar impact. Findings suggest that low-dose, high-volume strategies may have a potential role in reducing drug cost and helping clinicians stay within accepted limits for total body dose in patients with upper motoneuron syndrome requiring many injections.
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Arch Phys Med Rehabil · May 2008
Multicenter StudyRepeated treatments with botulinum toxin type a produce sustained decreases in the limitations associated with focal upper-limb poststroke spasticity for caregivers and patients.
To assess the safety and evaluate the effects of repeated treatments with botulinum toxin type A (BTX-A) on functional disability, quality of life (QOL), and muscle tone of patients with upper-limb poststroke spasticity, as well as its effect on caregivers. ⋯ Up to 5 treatments with BTX-A every 12 weeks for up to 56 weeks in patients with poststroke spasticity was well tolerated and significantly improved muscle tone, lessened disability, and improved patients' QOL. Further research is required to examine the effectiveness of repeated injections of BTX-A in patients with poststroke spasticity.