American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Jun 2003
Interrater reliability of the International Association for the Study of Pain and Tunks' spinal cord injury pain classification schemes.
To determine the interrater reliability of the International Association for the Study of Pain and Tunks' spinal cord injury pain classification schemes. ⋯ Consistent with our previous research using the Donovan spinal cord injury pain classification scheme, considerable variability between raters was demonstrated using the International Association for the Study of Pain and Tunks' spinal cord injury pain classification schemes.
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Am J Phys Med Rehabil · Jun 2003
Review Case ReportsPudendal nerve entrapment as source of intractable perineal pain.
Perineal pain caused by pudendal nerve entrapment is a rarely reported entity, with only a handful of cases in the modern literature. A 25-yr-old male medical student had refractory unilateral orchialgia for 32 mo and concomitant proctalgia for 14 mo. Pain was positional in nature, exacerbated by sitting and partially relieved when standing or recumbent. ⋯ At surgery, the left pudendal nerve was found flattened in the pudendal canal of Alcock and in contact with the sharp inferior border of the sacrospinous ligament. After surgical decompression and rehabilitation, the patient experienced significant relief of pain and returned to medical school. This case suggests pudendal nerve entrapment should be considered in the differential diagnosis of chronic urogenital or anorectal pain, particularly if the pain is aggravated by sitting or if there is a history of bicycle riding.
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Am J Phys Med Rehabil · Jun 2003
Assessing clinical competence in physical medicine & rehabilitation residency programs.
Evaluation of resident clinical competence is a complex task. A multimodal approach is necessary to capture all of the dimensions of competence. Recent guidelines from the Accreditation Council for Graduate Medical Education delineate six general competencies that physicians should posses. Application of these guidelines presents challenges to residency program directors in defining educational experiences and evaluation methods. ⋯ Survey results indicate that physical medicine and rehabilitation program directors apply a variety of assessment tools in evaluating resident clinical competence. Although perceptions about the relative value of these tools vary, most programs report a high value to direct observation of residents by faculty. Of the six general competencies, program directors struggle the most with their evaluation of practice-based learning and improvement and systems-based practice.
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Am J Phys Med Rehabil · Jun 2003
Case ReportsStroke-induced trismus in a pediatric patient: long-term resolution with botulinum toxin A.
We present a case of prolonged resolution of stroke-induced trismus after botulinum toxin A treatment in a 9 1/2-yr-old boy. The patient had an idiopathic right posterior fossa hemorrhage with resultant spastic quadriparesis, ataxia, dysarthria, and dysphagia. He developed right-sided trismus with only fair response to stretch. ⋯ Four months later, he received botulinum toxin A to the bilateral masseter and temporalis muscles and to the right medial and lateral pterygoid muscles, with more improvement. His third and last botulinum toxin A treatment was to the bilateral masseter, temporalis, lateral, and medial pterygoid muscles in larger doses. He had an excellent response, maintaining an interincisal distance of 2.5 cm 1 yr later, with significant improvement in speaking and chewing.