Rhode Island medical journal (2013)最新文献

Speech-language pathologists (SLPs) provide communicative and cognitive rehabilitation for people with brain injuries, and this article describes current assessment and treatment after a brain injury. Cognitive problems can affect attention, concentration, and memory, as well as metacognitive skills to self-monitor, control, and adjust one's thinking. Speech-language pathology (SLP) rehabilitation is initiated in acute inpatient settings and then through a continuum of inpatient rehabilitation, skilled nursing facility, home care, and outpatient settings. Speech-language pathology helps adults with brain injury return to work; sports-related concussion care is provided in school settings. SLPs use assessment tools with normative comparisons to determine severity levels and treatment plans. Patient-centered approaches are used for assessment and treatment plans, to identify specific functional needs that may direct the treatment towards specific functional outcomes.

Glioblastoma (GBM) is an aggressive brain tumor, commonly occurring in the frontal and temporal lobes. GBM is characterized by low survival rates, high recurrence rates, and unclear risk factors, making management a significant challenge. Anatomic magnetic resonance imaging (MRI), including T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR), is the gold standard for diagnosis of GBM. These techniques have lower accuracy in evaluating treatment response, as pseudoprogression and radionecrosis can mimic true tumor progression (TrTP). Advanced imaging options that offer physiologic information, such as diffusion- weighted imaging, MR perfusion, MR spectroscopy, and Positron Emission Tomography (PET), have shown promise in aiding diagnosis and treatment response monitoring. The first-line treatment for GBM is maximal safe neurosurgical resection, followed by adjuvant radiotherapy and temozolomide, an oral DNA alkylating agent. Current research is focused on optimizing imaging to evaluate TrTP and developing novel treatments to increase survival rates.

Introduction: Hip osteoarthritis (OA) is a common cause of hip pain in adults and a frequent presentation in primary care, emergency departments, and orthopedic clinics. To improve patient triage and optimize clinical efficiency, we developed a nine-item intake survey designed to assess patient symptoms and prior treatments. This study aimed to evaluate the survey's ability to differentiate hip OA from other hip pathologies and assess its correlation with treatment recommendations.

Methods: New patients presenting with hip pain were administered a nine-item multiple choice survey. Each response was assigned a score, and the total cumulative score was recorded. Diagnoses and treatment recommendations, including total hip arthroplasty (THA), were documented. Logistic regression was used to assess associations between the survey scores and both diagnosis and treatment recommendations. Receiver operating characteristic (ROC) analysis and Youden's J statistics were applied to determine the optimal survey score threshold for diagnosing hip OA.

Results: The survey effectively distinguished hip osteoarthritis from other hip pathologies based upon cumulative score. ROC analysis identified a total score of ≥9 as the optimal threshold, maximizing sensitivity (83.3%) and specificity (55.9%) for diagnosing hip OA. The positive predictive value for this threshold was 78.6%. Additionally, higher total survey scores were significantly associated with the recommendation for THA.

Conclusion: This study demonstrates that a simple nine-item, patient-reported survey can reliably differentiate hip OA from other hip conditions and may assist in guiding treatment decisions. Implementing such tools in primary care, emergency medicine, and orthopedic settings could enhance early diagnosis and streamline referrals.

Level of evidence: III.

Individuals with moderate to severe traumatic brain injury (TBI) often experience impairments in balance, gait, and dual-task ability, limiting their functional independence and community reintegration. These deficits arise from disruptions across sensory, motor, and cognitive systems, requiring comprehensive physical therapy (PT) assessment and intervention. PT evaluations incorporate strength, coordination, and sensory integration measures using standardized outcome measures such as the Berg Balance Scale, Functional Gait Assessment, and dual-task assessments such as the Timed Up and Go (cognitive). Treatment strategies include high-intensity training, gait and balance training, and vestibular rehabilitation, each targeting specific deficits to promote neuroplasticity and recovery. Technological interventions like the LiteGait®, virtual reality, and the Bioness Integrated Therapy System enhance therapy outcomes by improving safety, cognition, and balance. PTs must address psychosocial barriers and collaborate across disciplines to support holistic recovery. Ongoing evaluation using outcome measures guides treatment progression and readiness for community reintegration, highlighting PT's critical role in restoring functional independence post-TBI.

Heterotopic ossification (HO) is abnormal bone deposition, most commonly in the hip or elbow, that can significantly impair patients due to pain, stiffness, and contractures, which prevents them from carrying out activities of daily living. A traumatic brain (TBI) or spinal cord injury may prompt the formation of heterotopic ossification, creating so-called neurogenic heterotopic ossification (NHO). The pathophysiology of this condition is not fully understood, but probably involves a complex interplay between a biological scaffold of demineralized bone, CNS signaling, and local tissue signal mediators that often result from trauma. This environment is conducive to HO formation. Diagnosis relies on laboratory testing, plain radiographs, and advanced imaging such as triple phase bone scan or computed tomography scan. Treatment involves medical management with anti-inflammatory drugs, bisphosphonates, radiation therapy, or surgical excision, although outcomes are variable both in regards to prevention and treatment. A mainstay of treatment is physical therapy to maintain range of motion. This paper also presents a case study of a poly-traumatized patient with a TBI and multi-level spinal column injury who developed NHO after acetabular fixation.

Severe traumatic brain injuries (TBI) are caused by external forces that damage brain tissue and result in prolonged cognitive, sensory and motor deficits. This case report highlights the neurocognitive, motor, and sensory results of severe traumatic brain injury as well as several sequelae that often complicate TBI.

Neurologic conditions such as brain injuries, cerebral palsy, stroke and multiple sclerosis involve injury of upper motor neurons, which can manifest as spasticity. The resulting hypertonicity and imbalance of forces between muscle groups leads to deformities that impair patient function and can cause significant long-term complications. Symptoms of spasticity can be managed with nonoperative techniques such as physiotherapy, bracing, or medications. Other approaches such as intrathecal baclofen pumps and selective dorsal rhizotomy have also demonstrated efficacy in controlling spasticity. Spasticity that has failed nonoperative management can be treated with orthopedic surgeries that correct deformities by either restoring joint anatomy or re-balancing the forces of spastic muscle groups. Improved mobility and reduced pain after these procedures can help patients with their rehabilitation, function, and independence.

Mental health among first responders is often impacted by repeated exposure to stressors and traumatic events. As a result, Emergency Medical Services (EMS) professionals have a higher risk of suicide than the general public.1 With each state having different EMS cultures and operations, the Rhode Island Department of Health (RIDOH) Center for EMS identified a need to assess the mental health of EMS professionals in Rhode Island. A survey was distributed to EMS professionals in Rhode Island to evaluate their mental health and identify demographic gaps, as well as assess the risk of suicide for EMS professionals. Survey results provided evidence of concerning mental health among first responders in Rhode Island, with 15.4 percent of responders reporting suicidal ideation in the past 12 months. The results suggest that increased programming to provide resources and awareness is necessary to improve mental health and ensure the longevity of EMS professionals' careers.

The management of benign symptomatic thyroid nodules can pose a challenge when weighing treatment options. While surgical resection has been the gold standard, the risks and consequences of partial or total thyroidectomy may outweigh the benefits of the procedure. Additionally, a significant number of patients are not surgical candidates due to comorbidities, potential risks, or personal preference. Radiofrequency ablation (RFA) has emerged as a minimally invasive, low-risk alternative to traditional surgery, and it has demonstrated to have high efficacy in nodule volume reduction, symptom resolution, and cosmetic improvement. Hence, the use of RFA for treatment of benign thyroid nodules has been supported by both international and national professional groups. This paper hopes to promote the use of RFA for treatment of benign solid thyroid nodules in the Rhode Island population as well as outline its potential clinical application.