Physical medicine and rehabilitation clinics of North America
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Phys Med Rehabil Clin N Am · Nov 2011
ReviewDiagnosis of concussion: the role of imaging now and in the future.
The primary role of neuroimaging in the clinical context of sports-related concussion is the exclusion of a more severe, unsuspected intracranial injury. Computed tomography remains the test of choice for this purpose. ⋯ New imaging techniques are currently being developed to detect the molecular and cellular changes underlying concussion that are invisible with standard structural imaging. In the future, these techniques may be used as tools for directing rehabilitation after concussion and aiding in the decision of when it is safe for an athlete to return to play.
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Electrodiagnostic studies play an important role in the evaluation of radiculopathy. This article reviews the use of standard nerve conduction studies, late responses, evoked potentials, and needle electrode examination in the electrodiagnostic evaluation of neck pain.
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Burn rehabilitation cannot be reviewed without a significant focus on the hand. Although the surface area of the hand is only 3%, the functional consequences cause extreme impairment. A comprehensive team approach from initial evaluation through long-term follow up is essential to maximize the functional outcome in this population.
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The goals of burn wound care are removal of nonviable tissue, prevention of infection, and facilitation of wound healing, while controlling pain and maximizing outcome. This article reviews the basic pathophysiology of burn wounds; describes the evaluation of the depth, location, and extent of the wound; and discusses the myriad of wound care products on the market including their strengths and weaknesses. This article guides the reader through wound assessment and designing the appropriate treatment plan.
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Hypertrophic scars are common complications of burn injury and other soft tissue injuries. Excessive extracellular matrix combined with inadequate remodeling of scar tissue results in an aesthetically and functionally unsatisfactory, painful, pruritic scar that can impair function. ⋯ An interdisciplinary clinical program is necessary for best outcomes. Challenges to be met by the rehabilitation community include research into the quantification of burn scar measurement, the effects of mechanical forces on wound healing and scar management, and the best combination of surgical, pharmacologic, and therapy interventions to maximize outcome from reconstructive procedures.