American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Mar 2013
ReviewChanging trends in the management of end-stage neuromuscular respiratory muscle failure: recommendations of an international consensus.
Respiratory management of patients with end-stage respiratory muscle failure of neuromuscular disease has evolved from no treatment and inevitable respiratory failure to the use of up to continuous noninvasive intermittent positive pressure ventilatory support (CNVS) to avert respiratory failure and to permit the extubation of "unweanable" patients without tracheostomy. An international panel experienced in CNVS was charged by the 69th Congress of the Mexican Society of Pulmonologists and Thoracic Surgeons to analyze changing respiratory management trends and to make recommendations. ⋯ CNVS and extubation of unweanable patients to CNVS are increasingly being used to prolong life while avoiding invasive interfaces.
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This report describes a case of cauda equina syndrome possibly caused by arachnoiditis due to levobupivacaine after spinal-epidural anesthesia. A 39-yr-old woman delivered by cesarean section under a combined spinal-epidural anesthesia. After an uneventful procedure and surgery, she complained of weakness in her lower extremities, which increased in a few hours. ⋯ The patient was included in an intense rehabilitation program with a diagnosis of cauda equina syndrome and recovered completely in 8 wks. Practitioners should be aware of neurologic complications of spinal-epidural anesthesia. Early detection and treatment of the complication are important to minimize the risk of adverse outcome.
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Am J Phys Med Rehabil · Jan 2013
The effects of interdisciplinary team assessment and a rehabilitation program for patients with chronic pain.
The aim of this study was to evaluate the effects of interdisciplinary team assessment and a 4-wk rehabilitation program in chronic pain patients. ⋯ Both interdisciplinary assessment and rehabilitation program seem to be effective in chronic pain rehabilitation, at least for women. Further studies are needed to investigate potential sex differences, as well as content and duration for optimal pain rehabilitation programs.
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This study aimed to examine the association of hemiplegic shoulder pain (HSP) with central hypersensitivity through pressure-pain thresholds (PPTs) in healthy, distant tissues. ⋯ The subjects with HSP have lower local and distal PPTs than the subjects without HSP. This study suggests that chronic shoulder pain may be associated with widespread central hypersensitivity, which has been previously found to be associated with other chronic pain syndromes. This further understanding can then help develop better treatment options for those with this HSP.