Physical therapy
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Descending nociceptive inhibitory pathways often malfunction in people with chronic pain. Conditioned pain modulation (CPM) is an experimental evaluation tool for assessing the functioning of these pathways. Spinal cord stimulation (SCS), a well-known treatment option for people with failed back surgery syndrome (FBSS), probably exerts its pain-relieving effect through a complex interplay of segmental and higher-order structures. ⋯ This study revealed a bilateral effect of SCS that suggests the involvement of higher-order structures, such as the periaqueductal gray matter and rostroventromedial medulla (key regions in the descending pathways), as previously suggested by animal research.
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The quality of clinical practice guidelines (CPGs) is important to ensure guideline adoption by clinicians. ⋯ Few CPGs for the management of limb amputations were of high quality, and few recommendations were strong. To improve the quality of future CPGs, guideline developers should report funding and competing interests of members, provide information to aid in the practical application of CPGs, and use a systematic approach to search for evidence and derive strength of recommendations.
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Randomized Controlled Trial
Comparison of Effects of Manual and Mechanical Airway Clearance Techniques on Intracranial Pressure in Patients With Severe Traumatic Brain Injury on a Ventilator: Randomized, Crossover Trial.
Physical therapist intervention can play a significant role in the prevention of mechanical and infectious complications in patients with traumatic brain injury (TBI) who are mechanically ventilated. ⋯ Manual chest percussion technique in patients with severe TBI was associated with statistically significant transient increases in ICP and hemodynamics, compared with the mechanical method. However, such transient increases in ICP by either technique were not clinically relevant in patients with moderate-to-severe TBI without intracranial hypertension on a mechanical ventilator.
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Patient/resident-handling tasks are physically demanding and associated with musculoskeletal disorders (MSDs) among nursing personnel. The routine performance of such tasks by physical therapists and occupational therapists during treatment can cause similar problems. ⋯ MSD prevalence and claim costs in therapy personnel are high enough to deserve more attention. The low use of patient/resident-lifting equipment in therapy could increase the risk for MSDs. Future studies with comprehensive ergonomic analysis of therapist tasks and recommendations to reduce injuries are warranted.
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Research with physical therapists reveals high rates of work-related musculoskeletal injuries, especially low back pain, with early career onset. Less focus has been given to upper limb disorders (ULDs) in these professionals, who frequently perform repetitive arm/hand and precision finger motions during work. ⋯ The high prevalence of ULD and symptoms warrants attention from occupational health and safety personnel. Training in injury prevention and risk assessment should be provided during education and as part of continuing education.