Journal of rehabilitation medicine. Clinical communications最新文献

Objective: Sleep disturbance in hospital is common. This pilot randomized controlled trial assessed a sleep clinical pathway compared with standard care in improving sleep quality, engagement in therapy and length of stay in musculoskeletal inpatient rehabilitation.

Methods: Participants (n = 51) were randomized to standard care ("control", n =29) or sleep clinical pathway ("intervention", n = 22). Outcome measures included: Pittsburgh Sleep Quality Index (PSQI), Hopkins Rehabilitation Engagement Rating Scale (HRERS), Fatigue Severity Scale (FSS), Patient Satisfaction with Sleep Scale, and actigraphy. Assessment time-points were at admission and before discharge from rehabilitation.

Results: No significant differences were found between groups for any outcome measure. As a cohort (n = 51), there were significant improvements from admission to discharge in sleep quality (PSQI (-2.31; 95% confidence interval (95% CI) -3.33 to -1.30; p <0.001)], fatigue (FSS (-8.75; 95% CI -13.15 to -4.34; p <0.001)], engagement with therapy (HRERS-Physiotherapists (+1.37; 95% CI 0.51-3.17; p =0.037), HRERS-Occupational Therapists (+1.84; 95% CI 0.089-2.65; p = 0.008)), and satisfaction with sleep (+0.824; 95% CI 0.35-1.30; p = 0.001). Actigraphy findings were equivocal.

Conclusion: The sleep clinical pathway did not improve sleep quality compared with standard care. Larger studies and studies with alternate methodology such as "cluster randomization" are needed.

Objective: To investigate whether intervention to prevent falls is necessary in prior polio patients, by identifying the frequency, circumstances and consequences of falls among patients in Sweden with prior polio.

Subjects: Patients with prior polio diagnosis.

Methods: A falls history questionnaire was completed by patients with prior polio visiting the outpatient clinic at the Department of Rehabilitation Medicine, Danderyd University Hospital, Stock-holm, Sweden, or participating in group activities organized by the patient organization.

Results: A total of 80 patients answered the questionnaire; 32 men and 48 women. Eighty-one percent (n = 63/77) of respondents walked outdoors, but rarely more than 1 km, or only inside and near the house. Three-quarters of patients had fallen one or more times over the past year and one-quarter of patients had fallen 5 times or more. The falls often occurred during daytime in an environment known to the patient. Sixty-nine percent (n = 40/58) of respondents had been injured due to falling during the past year. The most common injuries were minor injuries.

Conclusion: Falls are common in patients in Sweden with prior polio. Interventions to prevent falls in people with prior polio are therefore clinically relevant.

Objective: To evaluate the effects of analgesia by sacral surface electrical stimulation on lower abdominal pain in women with primary dysmenorrhoea.

Design: Explorative study.

Participants: Eleven female university students, who regularly experience difficulty in their university work due to menstrual pain, or who use analgesics for more than one day each month, were recruited.

Methods: Sacral surface electrical stimulation, 5 Hz for 15 min, was performed after the onset of menstruation. Electrodes were placed on the skin, directly above the second and fourth sacral foramina. Visual analogue scale and degree of pain (calculated by using a low current to assess pain) were determined before and after electrical stimulation.

Results: Visual analogue scale score and degree of pain decreased significantly immediately after electrical stimulation (p < 0.001). A correlation was observed between visual analogue scale score and degree of pain before and after electrical stimulation (r=0.516, p <0.001). No side-effects were observed in any participant.

Conclusion: Sacral surface electrical stimulation may provide immediate pain relief in women with dysmenorrhoea and lower abdominal pain.

Context: Serotonin syndrome is a drug-induced condition related to an increased level of serotonin in the brain, which may induce neuromuscular, autonomic and mental symptoms.

Case report: A 40-year-old woman with hereditary spastic paraparesis (Strumpell-Lorrain disease) with an implanted intrathecal baclofen pump for severe spasticity. Two days after starting a medication known to inhibit serotonin re-uptake (paroxetine), she developed a sudden increase in lower limb spasticity with continuous spasms, fever, tachycardia and hypertension. Intrathecal baclofen withdrawal was excluded, confirming serotonin syndrome.

Conclusion: Medications that inhibit serotonin reuptake may induce serotonin syndrome, resulting in increased spasticity in patients with spinal cord lesions, and should be prescribed with caution.

Objectives: Hyper-Acute Rehabilitation Units (HA-RUs) provide multidisciplinary rehabilitation to patients with acute neurological injuries. This includes managing patients with tracheostomies. This is the first study of its kind to examine clinical outcomes in patients with brain injury and tracheostomy managed in a HARU.

Methods: Retrospective analysis of clinical outcomes in tracheostomy patients admitted to a HARU over a 2-year period.

Results: A total of 208 patients were admitted to the HARU, of whom 99 (60 males and 39 females) had a tracheostomy either at admission or during their stay in the HARU. Mean Glasgow Coma Scale score at admission was 11 (range 5-15) and at discharge was 13 (range 8-15). Mean Functional Independence Measure and Functional Assessment Measure (FIM+FAM) score improved from 52 at admission to 95 at discharge. Mean FIM+FAM cognitive admission cognitive sub-score improved from 23 to 42, and mean motor sub-score from 29 to 42. Changes in scores were deemed to be clinically significant as per thresholds reported in the literature. Of the total patients in this study, 79% were successfully decannulated and 21% needed long-term tracheostomy.

Conclusion: Patients with tracheostomy following brain injury can be appropriately managed in a HARU and show clinically significant improvement in functional outcomes.

Background: Creating a custom prosthetic device is challenging. The requirements of the patient's life must be taken into consideration when manufacturing the device. After having met the requirements for an autonomous daily life, adjustments can be made for recreational activities.

Subject and methods: A 67-year-old patient with an above-elbow amputation following a hunting accident wanted to use a rifle to hunt again. We considered her desires, the short stump, and the constraints of the type of hunting and environment, bearing in mind the safety of the patient and other hunters.

Results and conclusion: An orthopaedic prosthetic system was developed to allow her to pick up the rifle, aim (sight), and shoot with recoil. The 2 rifle supports are fixed onto a bolero vest. The supports are made of carbon fibre, which is lightweight, and the gun can be aimed between them. Appropriate safety was achieved. The efficiency depends on the patient. There are few publications regarding amputation cases of this type, in which the specification goals were precision and the ability to walk with the prosthesis. Multi-disciplinary collaboration enabled us to create a device that met the requirements of this case.

Objective: To assess and describe the involvement of all speech subsystems, including respiration, phonation, articulation, resonance, and prosody, in an individual with cervical spinal cord injury.

Methods: Detailed speech and voice assessment was performed that included Frenchay Dysarthria Assessment, cranial nerve examination, voice (per-ceptual and instrumental) and nasometric evalua-tion, and intelligibility and communicative effecti-veness.

Results: Impaired respiratory and phonatory con-trol correlated with the physical impairment of C4 and C5 prolapsed intervertebral disc. Cranial nerve examination indicated nerve IX and XI pathology. Phonatory deficits such as imprecise consonants and mild sibilant distortions were apparent. Voice analysis revealed a hoarse, breathy voice with re-duced loudness and no problems with resonance. Reading and speaking rate was reduced, and over-all a mild reduction in communicative effectiveness was perceived.

Conclusion: Assessment of the speech subsystems produced a comprehensive picture of the patient's condition and impairments in one or more areas was identified. Treatment options to improve speech outcomes were provided.

Objective: To examine the feasibility and practicality of whole body vibration therapy for individuals with dystonic or spastic dystonic cerebral palsy.

Design: Pilot study.

Subjects: Children and adults with dystonic or spastic dystonic cerebral palsy.

Methods: Study participants received total body vibration therapy when standing still on a vibration platform for 3 bouts, duration 3-min, of vibration (20 Hz, 2 mm amplitude), 4 days per week for 4 weeks in addition to their usual therapy. All participants were assessed at baseline and completion of the study using the Gross Motor Function Measure Item Set, Timed Up and Go test, Barry-Albright Dystonia Scale, Edinburgh Visual Gait Score, and Pediatric Evaluation of Disability Inventory.

Results: Ten participants (mean age 18.60 years (standard deviation (SD) 14.68); 9 males, Gross Motor Function Classification System level II-IV) completed the study with more than 90% attendance rate. All participants tolerated the protocol with no adverse events.

Conclusion: The vibration treatment protocol was feasible and safe for all participants. With no significant differences found in all the outcome measures, future studies with more rigorous study designs are required before this intervention is recommended for this population group.