Journal of rehabilitation medicine. Clinical communications最新文献

Objective: To describe a case of paraparesis caused by both peripheral neuropathy and spinal cord injury following a lightning strike, highlighting imaging findings and neurophysiological results to improve understanding and management.

Design: A case report.

Patient: A 29-year-old male without significant medical or surgical history, struck by lightning.

Methods: Neurological evaluation, imaging of the spinal cord, electromyography studies, and somatosensory evoked potential assessments were performed. Imaging findings and peripheral nerve evaluations were compared to the existing literature on lightning-related injuries.

Results: Spinal cord imaging showed hyperintensities with a quadrifocal white matter involvement. Neurophysiological study revealed peripheral motor impairment.

Conclusion: This case documents paraparesis resulting from both central and peripheral nervous system damage following a lightning strike. Unique spinal cord imaging results and neurophysiological studies contribute to the understanding of nerve damage mechanisms. Given the increasing frequency of lightning strikes, these findings may help refining clinical management and patient education strategies.

Objective: We showed that a tailored strengthening intervention based on the size of motor evoked potentials (MEPs) in the affected arm was effective in improving function in chronic stroke survivors. Here, we investigated whether the short-term gains in arm function were maintained at 1-year follow-up.

Subjects: Twenty-five participants at the chronic stage of a stroke.

Methods: Participants were classified in the light (LI; MEPs 50-120 μV, n = 8) and high (HI; MEPs > 120μV, n = 17) intensity training groups. The strengthening protocol consisted of adjusted exercises for the affected arm (3X/week; 4 weeks). The Fugl-Meyer Stroke Assessment (FMA), Grip strength (GS) and Box and Block test (BBT) were assessed at baseline, post-intervention and at 1-year follow-up. Changes in clinical measures were compared using repeated-measures ANOVA.

Results: A significant effect of time was noted on all outcome measures [FMA: p < 0.001; BBT: p = 0.05; GS: p < 0.001], but the LI group improved more on the FMA (p = 0.003) and maintained their gains at 1-year follow-up (p = 0.527) than the HI group.

Conclusion: The size of MEPs in the affected arm could be a significant factor in influencing responses to strengthening exercises post-stroke and allow gains to be maintained up to 1 year post-intervention.

Objective: To evaluate the benefits of inpatient rehabilitation for a patient with post-COVID-19 pulmonary fibrosis and to provide guidance for rehabilitation professionals, as many conventional therapeutic interventions are not tolerated and are poorly defined.

Design: A case report.

Subjects/patients: A 72-year-old man with a COVID-19-related idiopathic pulmonary fibrosis exacerbation.

Results: The patient was admitted to inpatient rehabilitation with hypoxia and poor endurance for functional activities. Rehabilitation activities were focused on providing patient/family education, energy conservation, low level activities to build strength, problem solving for mobility, and discharge planning within safe medical parameters. Rehabilitation therapies were graded to meet the patient's physiologic needs and focused on patient and family training. The patient made limited functional gains and continued to have high oxygen needs but achieved his goal of returning home.

Conclusion: Patients with COVID-19-related idiopathic pulmonary fibrosis exacerbations can be treated in acute rehabilitation effectively. With more patients developing post-COVID-19 pulmonary fibrosis, appropriate rehabilitation strategies are important for safe discharge planning. Prioritizing patient/family education may allow these more medically fragile patients to return home.

Objective: To examine an early decannulation protocol in adult severe acquired brain injury (SABI) patients.

Design: Retrospective, observational cohort study.

Subjects/patients: Tracheotomized SABI patients ≥ 18 years admitted to a neurorehabilitation unit.

Methods: Primary outcome measure was difference in survival rate within first year of discharge. Secondary outcome measures were respiratory infections treated with antibiotics, rate of re-cannulation, time from admission to decannulation, length of stay, difference in rate of re-admission due to pneumonia within first year of discharge and difference in rate of tracheal tube dependency within first year of discharge.

Results: No statistical significance in survival rate within the first 12 months from discharge was found. Median time from admission to decannulation was 32 days (interquartile range [IQR] 14-61) vs 9 days (IQR 0-13) in the control and intervention group, respectively (p < 0.0003). Median length of stay was 66 days (IQR 54-92) in the control group vs 60 (IQR 48-75) days in the intervention group (p = 0.168).

Conclusion: A new early decannulation protocol omitting evaluation of tolerance to tracheostomy tube capping and fiberoptic endoscopic evaluation of swallowing was non-inferior to previous procedures in survival rate within first year of discharge. The early decannulation protocol allowed for significantly earlier decannulation.

Introduction: Traumatic brain injury is a significant global health concern. It often results from high-velocity accidents and leads to diffuse axonal injury, causing consciousness disorders and potentially permanent cognitive and behavioural changes. Individuals with traumatic brain injury often exhibit weight gain, potentially leading to obesity. This weight increase is influenced by cognitive dysfunction, reduced physical activity and metabolic changes.

Case report: A 23-year-old woman suffered a traumatic brain injury after a traffic accident, with an initial Glasgow Coma Scale score of 5/15. Positive neurological improvement was observed during her stay in the intensive care unit and the neurosurgical department. Subsequently, she was transferred to the rehabilitation department, where she faced significant challenges, including mood fluctuations, cognitive impairments and substantial weight gain. Her body mass index (BMI) increased from 23 kg/m² pre-accident to a maximum of 36 kg/m², despite interventions like medications and lifestyle changes. Blood tests revealed insulin-resistance and metformin initiated a successful weight reduction.

Conclusion: Managing weight gain following traumatic brain injury requires effective interventions that acknowledge its complexity and multifaceted nature, including lifestyle modifications, behavioural therapy and potentially pharmacotherapy or bariatric surgery. Further research is essential to better understand underlying mechanisms and evaluate intervention effectiveness in this specific patient population.

Background: Heterotopic ossification is a common complication after joint replacement surgery, such as hip or knee arthroplasty. In the intensive care unit, it is most commonly associated with traumatic brain injury or spinal cord injury. To prevent recurrence, surgical resection of heterotopic ossification is recommended once the ectopic bone has fully matured, which is estimated to occur after at least 12 months.

Case presentation: This case describes a young woman with no relevant previous medical history who developed severe bilateral heterotopic ossification on the anteromedial sides of her knees after an intensive care unit stay. Passive flexion of both knees was limited to 50°. X-ray was a simple diagnostic tool. Predisposing factors were extended immobilization, prolonged systematic inflammatory condition and mechanical ventilation. Due to the failure of initial conservative therapy, the heterotopic ossification was resected early, 4 months after onset of first symptoms. Following an intensive rehabilitation program, a normal, pain-free gait and full range of motion of both knees were achieved 9 months after surgery.

Conclusion: This case report demonstrates that early resection of heterotopic ossification can result in a good clinical and functional outcome.

Objective: To assess the effect of radial extracorporeal shockwave therapy on the reduction of local hypertonia in patients with cerebral palsy.

Design: Explorative pre-post intervention study.

Subjects/patients: Forty-five patients with cerebral palsy.

Methods: All patients received 3 sessions of radial extracorporeal shockwave therapy with a time interval of 1 week for each session. The outcomes were V1 and V3 of the Tardieu scale, the Timed Up and Go test, and the 10-metre walk test. The measurements were collected at baseline, immediately after the last session of shockwaves, at 12 and 24 weeks after baseline.

Results: The statistical analysis used was a mixed linear model of repeated measures. The degrees on the Tardieu scale increased significantly in all the treated muscles. The results of the Timed Up and Go test and the 10 m walk test confirmed a significant functional effect after the shockwave therapy (p < 0.001).

Conclusion: Functional improvement in patients treated with extracorporeal shockwave therapy has been observed to last up to 24 weeks.

Objective: In response to the high prevalence and morbidity associated with long COVID (LC), outpatient rehabilitation programmes were created across jurisdictions. We aimed to characterize baseline symptoms and impairments of patients attending outpatient LC rehabilitation.

Design: This study was a retrospective quality-improvement analysis.

Subjects/patients: Patients attending outpatient LC rehabilitation at the Oxfordshire Post-Covid Service.

Methods: Data included age/sex and 6 questionnaires performed at baseline: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Dyspnoea-12 (D12), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Assessment-7 (GAD-7), Visual Analogue Scale (VAS) of self-rated health, and the Work And Social Adjustment Scale (WSAS). All scores were dichotomized (indicating presence/absence of clinically significant pathology). Potential differences between age (2 tests.

Results: A total of 422 patients were included (mean/standard deviation [SD] age = 47.1/13.2;132/31.3% male). A total of 76% had significant fatigue (FACIT-F), 69% had breathlessness (D12), 55% had depression (PHQ-9), 34% had anxiety (GAD-7), 41% self-reported poor health (VAS), and 57% had work/social life dysfunction (WSAS). D12 scores differed between age groups (older > younger, χ² = 3.19/p = 0.048), with no differences observed on other scales.

Conclusion: In this preliminary study, a high proportion of LC outpatients had significant impairments across domains. The findings of this study reaffirm the need for high-quality, multidisciplinary LC rehabilitation, and may be used to help build a standardized set of outcome measures moving forward.

Objective: Immune-mediated necrotizing myopathy associated with anti-signal recognition particle antibodies is a rare and debilitating condition characterized by significant muscle weakness and resultant disability. Although there are existing recommendations for physical therapy and exercise for patients with myositis in current literature, effective rehabilitation guidelines for such patients have not been fully established.

Case report: A 42-year-old woman presented with subacute onset proximal upper and lower limb weakness and dysphagia. She was diagnosed with anti-SRP immune-mediated necrotizing myopathy and was promptly initiated on aggressive immunosuppressive therapy. Despite this, she had significant impairment in function, including the inability to ambulate.

Intervention and outcome: The patient underwent an intensive structured inpatient rehabilitation programme consisting of strength and endurance exercises combined with functional exercises and robot-assisted gait training. This resulted in major improvements in objective outcomes including Functional Independence Measure, Modified Barthel Index, 10-metre-walk test and 6-minute-walk test scores. The programme was well tolerated by the patient with no adverse events.

Conclusion: This case details the crucial role of a structured rehabilitation programme in the holistic management of a patient with anti-SRP immune-mediated necrotizing myopathy. It also highlights the use of robotics in gait training, resulting in successful functional outcomes for the patient.