Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Apr 2007
Sequence of recovery during the course of emergence from the minimally conscious state.
To document and examine recovery profiles of persons during the course of emergence from a minimally conscious state (MCS) after traumatic brain injury (TBI). ⋯ During the course of data collection, issues were raised about differentiation between the MCS and posttraumatic amnesia. The data are also discussed within the context of the work of Giacino et al and the development of their scale to measure duration of the MCS. These data support the theory that functional communication and object manipulation are the 2 key indicators of emergence from MCS.
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Arch Phys Med Rehabil · Mar 2007
ReviewSpinal cord injury medicine. 2. Acute care management of traumatic and nontraumatic injury.
This self-directed learning module highlights the basic acute care management of traumatic and nontraumatic spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Acute traumatic SCI is optimally managed in a level 1 trauma center. Decompression of the neural elements, stabilization of the spine, and maintenance of tissue perfusion are fundamental to optimizing outcomes. SCI patients are at high risk of pressure ulcers, venous thromboembolism, stress ulceration, bowel impaction, dysphagia, and pulmonary complications. Physiatric interventions are needed to prevent these complications. Prognostication of neurologic outcome based on early examination is an important skill to aid in creating a rehabilitation plan and to test for efficacy of early interventions. Nontraumatic SCI is an increasing population in rehabilitation centers. Establishing a diagnosis and treatment plan is essential, in conjunction with prevention of complications and early physiatric intervention. ⋯ (a) To describe the diagnostic evaluation of traumatic and nontraumatic spinal cord injuries and (b) to summarize the medical, surgical, and physiatric interventions during acute hospitalization for these injuries.
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Arch Phys Med Rehabil · Mar 2007
ReviewSpinal cord injury medicine. 6. Economic and societal issues in spinal cord injury.
This self-directed learning module presents a variety of social and economic issues facing people with spinal cord injury (SCI). It is part of the study guide on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article focuses on the economic consequences of SCI, ethical issues in SCI, and the legislative efforts that have improved access and quality of life for people with disabilities. Costs of SCI include direct health care expenditures and lost earnings as a result of unemployment after SCI. Lifelong costs can be anticipated with the development of a comprehensive life care plan. Barriers to vocational reintegration continue to limit full participation for most people with SCI. Ethical issues central to SCI are related to the principles of autonomy and justice. As cure research becomes clinically applicable, the SCI community must work together to develop appropriate procedures to respect moral decision-making by all parties. Key legislation in the past century has resulted in important advances in the rights of people with disabilities. ⋯ (a) To review the economic consequences of spinal cord injury, including lifelong direct costs, life care planning, and factors affecting employment and (b) to identify current ethical issues facing the spinal cord injury community and review the advances made in the rights of people with disabilities in the United States through legislation.
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Arch Phys Med Rehabil · Mar 2007
Comparative StudyA comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke.
To compare the psychometric properties (including the test-retest reliability, responsiveness, and predictive validity) of the Smart Balance Master (SBM) system and the Postural Assessment Scale for Stroke patients (PASS) in patients with mild stroke. ⋯ The PASS and the equilibrium score and limits of stability scores of the SBM had acceptable test-retest reliability, responsiveness, and predictive validity in patients with mild stroke, but the psychometric properties of the weight-shifting tests of the SBM should be further examined before consideration of their usage in patients with stroke.
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Arch Phys Med Rehabil · Mar 2007
Case ReportsThe complications of scar formation associated with intrathecal pump placement.
A 40-year-old man had an intrathecal morphine-baclofen pump inserted for the treatment of severe dystonia affecting all limbs and severe low back pain. The etiology of his dystonic symptoms, despite thorough investigations, was uncertain. At age 45, the patient fell resulting in a cervical spinal cord injury. ⋯ The catheter tip exited the thecal sac in the upper thoracic spine and became embedded in a fibrotic scar. Displacement of the catheter tip of the intrathecal morphine-baclofen pump and subsequent formation of scar tissue resulted in decreased drug delivery, contributing to diminished pain control and functional status. Catheter displacement and epidural scar formation must be considered as a potential cause of ineffective pain control and decreased functional status in patients with intrathecal morphine-baclofen pumps.