Physical medicine and rehabilitation clinics of North America
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Phys Med Rehabil Clin N Am · Aug 2014
ReviewUpdates for the International Standards for Neurological Classification of Spinal Cord Injury.
The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is the most widely used classification in the field of spinal cord injury medicine. Since its first publication in 1982, multiple revisions refining the recommended examination, scaling, and classification have taken place to improve communication, consistency, and clarity. This article describes a brief historical perspective on the development and changes over the years leading to the current ISNCSCI, detailing the most recent updates of 2011 and the worksheet 2013 as well as issues facing the ISNCSCI for the future.
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Phys Med Rehabil Clin N Am · Aug 2014
ReviewChronic neuropathic pain in SCI: evaluation and treatment.
Chronic neuropathic pain develops in approximately 40% of people after a spinal cord injury (SCI) and is notoriously difficult to treat. Because of the frequent presence of more than one pain type and the complex mechanisms and symptoms associated with pain in individuals with SCI, a thorough evaluation is important. This review includes an overview of the most recent guidelines for evaluating and classifying pain, suggestions for standardizing outcome measures for clinical use, and a review of the positive and negative evidence for pharmacologic and nonpharmacologic interventions to consider when treating individuals with SCI and chronic neuropathic pain.
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Phys Med Rehabil Clin N Am · Aug 2014
ReviewSpasticity and the use of intrathecal baclofen in patients with spinal cord injury.
Muscle spasms and spasticity constitute a significant problem in patients with spinal cord injury, interfering with rehabilitation and leading to impairments in quality of life in addition to medical complications. Administration of intrathecal baclofen (ITB) is indicated when spasticity continues to produce a clinical disability despite trials of oral treatments and other alternatives in patients who have functional goals and/or pain without contractures. Severe spasticity of spinal origin has been shown to respond dramatically to long-term ITB when used in appropriate patients with spasticity.
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After cervical spinal cord injuries, many patients are unable to sustain independent ventilation because of a disruption of diaphragm innervation and respiratory functioning. If phrenic nerve function is preserved, the patient may be able to tolerate exogenous pacing of the diaphragm via electrical stimulation. Previously this was accomplished by stimulation directly to the phrenic nerves, but may be accomplished less invasively by percutaneously stimulating the diaphragm itself. The benefits, when compared with mechanical ventilation, include a lower rate of pulmonary complications, improved venous return, more normal breathing and speech, facilitation of eating, cost-effectiveness, and increased patient mobility.
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Applying therapeutic hypothermia (TH) for the purposes of neuroprotection, originally termed "hibernation," started nearly 100 years ago. Because TH cooling systems have improved to the point where it is practical and safe for general application, interest in providing such treatment in conditions such as spinal cord injury, traumatic brain injury, stroke, and cardiac arrest has increased. This article reviews the mechanisms by which TH mitigates secondary neurologic injury, the clinical scenarios where TH is being applied, and reviews selected published studies using TH for central nervous system neuroprotection.