NeuroRehabilitation
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NeuroRehabilitation · Jan 2011
Review Historical ArticleDisorders of consciousness: what's in a name?
Following a coma, some patients may "awaken" without voluntary interaction or communication with the environment. More than 40 years ago this condition was coined coma vigil or apallic syndrome and later became worldwide known as "persistent vegetative state". About 10 years ago it became clear that some of these patients who failed to recover verbal or non-verbal communication did show some degree of consciousness--a condition called "minimally conscious state". ⋯ These neuroimaging studies have also demonstrated that a small subset of unresponsive "vegetative" patients may show unambiguous signs of consciousness and command following inaccessible to bedside clinical examination. These findings, together with negative associations intrinsic to the term "vegetative state" as well as the diagnostic errors and their potential effect on the treatment and care for these patients gave rise to the recent proposal for an alternative neutral and more descriptive name: unresponsive wakefulness syndrome. We here give an overview of PET and (functional) MRI studies performed in these challenging patients and stress the need for a separate ICD-9-CM diagnosis code and MEDLINE MeSH entry for "minimally conscious state" as the lack of clear distinction between vegetative state/unresponsive wakefulness syndrome and minimally conscious state may encumber scientific studies in the field of disorders of consciousness.
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NeuroRehabilitation · Jan 2011
ReviewDo racial and ethnic minority patients fare worse after SCI?: a critical review of the literature.
A number of researchers have identified differences in SCI outcomes between racial and ethnic groups, but findings have never been synthesized to give clinicians and researchers a coherent picture of the problem. The goals of the current project were to (1) conduct a critical literature review of studies specifically investigating racial and ethnic disparities in spinal cord injury care, services, and outcomes; (2) explore possible causative factors that may explain these disparities; (3) propose strategies that may reduce disparities and improve access, service, and outcomes for minority patients with SCI; and (4) generate ideas for future research in this area. ⋯ Results indicated that after an SCI, racial and ethnic minority groups have shorter hospital lengths of stay, higher rehospitalizations rates, higher levels of depression, more days in poor health, greater degrees of unemployment, more difficulties with mobility, lower self-reported subjective well-being and quality of life and life satisfaction, and greater risk of marital breakup. A variety of causative factors, intervention strategies, and directions for future research are presented.
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Neuroimaging at all stages of a traumatic brain injury (TBI) provides information about gross brain pathology. In this review, post-mortem TBI cases are matched to neuroimaging findings from TBI survivors to demonstrate the close correlation between observable pathology with in vivo neuroimaging to the underlying neuropathology. ⋯ The role of hippocampal atrophy and thalamic injury along with the vulnerability of the corpus callosum in TBI are also reviewed. The aim of this review is to provide pathological confirmation of observable neuroimaging abnormalities that relate directly to trauma-induced effects of the injury.
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NeuroRehabilitation · Jan 2011
Randomized Controlled Trial Clinical TrialFeasibility, safety and efficacy of an early aerobic rehabilitation program for patients after minor ischemic stroke: A pilot randomized controlled trial.
To examine the feasibility, safety and effectiveness of an early aerobic rehabilitation program for patients after minor ischemic stroke. ⋯ An early supervised aerobic training after minor ischemic stroke is feasible and well tolerated and, in a per-protocol analysis, was associated with improved walking endurance. Further studies with a larger sample size are needed to assess the effect of such a program on functional abilities, prevention of risk factors, and recurrent stroke.
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Case report. ⋯ In our department, spinal cord injuries after stab wounds are very rare, and they usually cause incomplete lesions that eventually lead to Brown-Séquard syndrome. In our patient, the spinal cord injury was due to a vasospasm of the vertebral artery, which was accompanied by good functional prognosis. MRI helped to define the physiopathologic mechanism of the injury and guided the appropriate treatment decision.