Journal of rehabilitation research and development
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Chronic whiplash is a debilitating condition characterized by increased sensitivity to painful stimuli, maladaptive illness beliefs, inappropriate attitudes, and movement dysfunctions. Previous work in people with chronic low back pain and chronic fatigue syndrome indicates that pain neurophysiology education is able to improve illness beliefs and attitudes as well as movement performance. This single-case study (A-B-C design) with six patients with chronic whiplash associated disorders (WAD) was aimed at examining whether education about the neurophysiology of pain is accompanied by changes in symptoms, daily functioning, pain beliefs, and behavior. ⋯ Results showed a significant decrease in kinesiophobia (Tampa Scale for Kinesiophobia), the passive coping strategy of resting (Pain Coping Inventory), self-rated disability (Neck Disability Index), and photophobia (WAD Symptom List). At the same time, significantly increased pain pressure thresholds and improved pain-free movement performance (visual analog scale on Neck Extension Test and Brachial Plexus Provocation Test) were established. Although the current results need to be verified in a randomized, controlled trial, they suggest that education about the physiology of pain is able to increase pain thresholds and improve pain behavior and pain-free movement performance in patients with chronic WAD.
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Vascular endothelial growth factor (VEGF) is important in improving wound healing. We evaluated the effect of sensory (direct current, 600 microamperes) and motor (monophasic current, pulse duration 300 microseconds, 100 Hz, 2.5-3.0 mA) intensities of cathodal electrical stimulation (ES) current to release VEGF in muscle and skin in the wound site. We randomly assigned 48 male Sprague-Dawley rats into one control and two experimental groups (sensory and motor ESs). ⋯ No difference was found in the muscle VEGF levels on the third and seventh days. The results showed that sensory ES increases the release of more VEGF in skin. This mechanism may be one through which a sensory type of current is more effective in promoting wound healing.
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Randomized Controlled Trial
Trendelenburg chest optimization prolongs spontaneous breathing trials in ventilator-dependent patients with low cervical spinal cord injury.
Chest optimization, an evidence-based protocol-guided multimodal chest physiotherapy consisting of body positioning, sputum mobilization, bronchodilation, and lung hyperinflation, may be routinely administered to ventilator-dependent patients with low cervical spinal cord injury (CSCI) for improving pulmonary functional outcomes that facilitate weaning from mechanical ventilation. We undertook this study to determine whether position-specific chest optimization was associated with changes in spontaneous breathing trial (SBT) duration. Cardiac output (CO), alveolar minute volume (MValv), carbon dioxide elimination (VCO(2)), and static chest compliance (Cst) were measured during chest optimization; then MValv and rapid shallow breathing index (RSBI) were measured during SBT. ⋯ Trendelenburg chest optimization (TCO) was associated with significant increases in SBT (p < 0.001), CO (p < 0.001), MValv (p < 0.003), VCO(2) (p < 0.001), and Cst (p < 0.002). SBT following TCO was associated with significant increases in MValv (p < 0.03) and RSBI (p < 0.002). These preliminary findings suggest the importance of proper recumbent body positioning during evidence-based, protocol-guided multimodal chest physiotherapy for ventilator-dependent patients with low CSCI.
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We evaluated an Internet-mediated, pedometer-based program to promote walking in chronic obstructive pulmonary disease (COPD). First, we assessed the accuracy of the Omron HJ-720ITC pedometer (OMRON Healthcare, Inc; Bannockburn, Illinois) in 51 persons with COPD. The Bland-Altman plot showed a median difference of 3 steps (5th and 95th quintiles, -8.0 and 145.0, respectively). ⋯ The Omron is accurate in persons with COPD with usual walking speeds > 0.94 m/s. Accuracy is more variable at lower speeds, but the Omron captures more than 80% of manual step counts in most persons. In this preliminary study, an Internet-mediated walking program using the Omron significantly increased step counts in COPD.
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Comparative Study
Self-reported cognitive symptoms following mild traumatic brain injury are poorly associated with neuropsychological performance in OIF/OEF veterans.
Mild traumatic brain injury (mTBI) is not uncommon among Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans, and many individuals within this group report lingering cognitive difficulties following their injury. For Department of Veterans Affairs clinicians, an accurate assessment of cognitive symptoms is important in providing appropriate clinical care. Although self-assessment is commonly employed to screen for difficulties in cognitive functioning, little is known about the accuracy of self-report in this population. ⋯ Self-reported cognitive functioning was not significantly correlated with objective cognitive abilities, suggesting that objective neuropsychological testing should be used when cognitive weakness is suspected. Perceived cognitive deficits were associated with depression, anxiety, and posttraumatic stress disorder, illustrating the additional importance of adequate assessment and treatment of psychiatric symptoms. Clinicians tended to overestimate the association between self-report and test performance.