Archives of physical medicine and rehabilitation
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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.
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Arch Phys Med Rehabil · Aug 2002
Case ReportsAccidental pneumothorax from a nasogastric tube in a patient with severe hemineglect: a case report.
Nasogastric tubes are frequently used for nutrition of patients with neurologic diseases. We report an instance of inadvertant placement of a standard nasogastric tube into the left pleural space in a patient with right parietotemporal intracerebral hemorrhage and severe hemineglect on the left side. The 2 confirmatory maneuvers-aspiration of fluid and auscultating the abdomen on insufflating air-were false-positive. We conclude that only radiologic confirmation of the position of nasogastric tubes and the awareness of the associated dangers will help minimize the occurrence of such events in patients with disorders of perception or altered consciousness.
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Arch Phys Med Rehabil · Aug 2002
Functional electric stimulation-assisted rowing: Increasing cardiovascular fitness through functional electric stimulation rowing training in persons with spinal cord injury.
To assess changes in peak functional aerobic power after a 36-session, progressive functional electric stimulation (FES) rowing hybrid training program for persons with spinal cord injury (SCI) and to examine the safety and acceptability of the ROWSTIM II device as well as the integrity of technical modifications to it. ⋯ Pre- and posttraining peak aerobic power values for ROWSTIM II training were comparable to previously reported values for hybrid cycle and upper-extremity exercise. We conclude that FES-assisted rowing is an effective, safe, and well-tolerated training system for persons with SCI.