Physical medicine and rehabilitation clinics of North America
-
Phys Med Rehabil Clin N Am · Aug 2020
ReviewNoninvasive Respiratory Management of Spinal Cord Injury.
Intubated ventilator-dependent patients with high-level spinal cord injury can be managed without tracheostomy tubes provided that they have sufficient cognition to cooperate and that any required surgical procedures are completed and they are medically stable. Intubation for a month or more than extubation to continuous noninvasive ventilatory support (NVS) can be safer long term than resort to tracheotomy. ⋯ Noninvasive interfaces include mouthpieces, nasal and oronasal interfaces, and intermittent abdominal pressure ventilators. NIV/NVS should never been used without consideration of mechanical insufflation-exsufflation for airway secretion clearance.
-
Phys Med Rehabil Clin N Am · May 2020
ReviewOpioid Management: Initiating, Monitoring, and Tapering.
Numerous guidelines targeting safe use of opioids for chronic pain have been published but substantial challenges persist in clinical application of best practice recommendations. This article describes a pragmatic approach to clinical care of adults with chronic pain receiving long-term opioid therapy. Three components of care are emphasized: (1) medical and mental health assessment before initiating opioid therapy, (2) clinical surveillance during the course of long-term opioid therapy, and (3) clinical considerations and strategies governing opioid tapering. A pressing need exists for ongoing research to further clarify the optimal role that long-term opioid therapy has in treatment of chronic pain.
-
Phys Med Rehabil Clin N Am · Nov 2019
ReviewConcept Changes and Standardizing Tools in Community-Based Rehabilitation.
Community-based rehabilitation (CBR) has changed considerably over 4 decades, resulting in a rights-based approach, holding local authorities accountable for service delivery. For medical rehabilitation in low-resource countries, there is concern about how this service gap will be covered. ⋯ The creation of standardizing tools favors this process because it provides the building blocks to scale up, setting standards for implementation research. Finally, an International Classification of Functioning, Disability, and Health-based assessment and intervention model for CBR is proposed.
-
Earlier rehabilitation interventions, like community-based rehabilitation (CBR), could not make a remarkable impact because they ran parallel to the health system, but the newer model establishes health-related rehabilitation as an integral part of the health care system at all levels and thus should be implemented as such. Collaborating with other players relevant to the CBR matrix, such as social and vocational services, can be imparted for the empowerment of a disabled group at the village level through the CBR center. A multipurpose rehabilitation worker, through skill transfer or task shifting, can start rehabilitation at the primary health center.
-
Phys Med Rehabil Clin N Am · May 2019
ReviewSpinal Cord Epidural Stimulation for Lower Limb Motor Function Recovery in Individuals with Motor Complete Spinal Cord Injury.
Spinal cord epidural stimulation (scES) combined with activity-based training can promote lower limb motor function recovery in chronic, motor complete spinal cord-injured individuals. Task- and individual-specific scES parameters modulate the excitability of human spinal circuitry so that sensory information and residual descending input can serve as sources of control for generating motor patterns appropriate for standing, stepping, and volitionally moving the lower limb. Task-specific activity-based training with scES is crucial for promoting neural plasticity and motor function improvement. Future studies with more individuals and advanced stimulation technology are needed to better understand the recovery potential in this population.