American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Sep 2020
Review Case ReportsParalysis following Lumbar Interlaminar Epidural Steroid Injection in the Absence of Hematoma: A Case of Congestive Myelopathy due to Spinal Dural Arteriovenous Fistula and a Review of the Literature.
Paraplegia after interlaminar epidural steroid injection is a rare event and has typically been described after epidural hematoma or direct spinal cord injury. We present a case of an 87-yr-old man who experienced transient lower limb weakness after a lumbar interlaminar epidural steroid injection due to an alternative cause, congestive myelopathy related to an underlying vascular malformation, namely, a spinal dural arteriovenous fistula. ⋯ Notably, this case of paralysis occurred in association with the lowest volume of epidural injectate reported in the literature to date (4 ml); importantly, this volume is consistent with the current clinical practice guideline standards for the safe performance of interlaminar epidural steroid injections. Physicians should be aware of this potential complication of epidural steroid injection and remain vigilant for the possibility after a procedure, even when performed according to current practice standards.
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Am J Phys Med Rehabil · Sep 2020
Changes to Rehabilitation Service Delivery and the Associated Physician Perspectives During the COVID-19 Pandemic: A Mixed-Methods Needs Assessment Study.
This project aimed to determine the impact of and needs from physician members of the Canadian Association of Physical Medicine & Rehabilitation during the early response to the COVID-19 global pandemic. The purpose of this project was to develop a framework for addressing the pandemic tailored to the needs of Canadian physiatrists. A convergent mixed-methods design was used for this needs assessment quality project. ⋯ This project provided insight into the impact of COVID-19 and current needs of Canadian Association of Physical Medicine & Rehabilitation physicians. The results were used to develop a solutions framework including guidance on use of virtual care and holding education webinars on high-yield topics. Next steps include a follow-up survey on change in preparedness and member satisfaction with the Canadian Association of Physical Medicine & Rehabilitation response.
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Am J Phys Med Rehabil · Sep 2020
Meta AnalysisNoninvasive Brain Stimulation Does Not Improve Neuropathic Pain in Individuals With Spinal Cord Injury: Evidence From a Meta-Analysis of 11 Randomized Controlled Trials.
The aim of the study was to examine the effectiveness of noninvasive brain stimulation on neuropathic pain in individuals with spinal cord injury. ⋯ In individuals with spinal cord injury, no significant effects of noninvasive brain stimulation on neuropathic pain and depression were observed. Cranial electrotherapy stimulation may be beneficial for the management of anxiety. These findings do not support the routine use of noninvasive brain stimulation for neuropathic pain in individuals with spinal cord injury.