Pub Date : 2022-10-01DOI: 10.4103/ijprm.jisprm-000179
M. Srivastava, Anil Gupta, G. Yadav, Dileep Kumar, Sudhir Mishra, Sugandha Jauhari
Introduction: In patients with traumatic spinal cord injury (SCI), a complex interplay of sociodemographic and injury-related factors can impact on outcomes such as rehabilitation length of stay (r-LOS), functional status, and discharge following rehabilitation procedures. Every year 2.55 lakhs of people suffer from SCI globally. Objectives: To describe the r-LOS in patients with traumatic paraplegia and associated correlates. Materials and Methods: A retrospective study was conducted among traumatic paraplegics admitted in the rehabilitation unit of a government tertiary care hospital of Lucknow, Uttar Pradesh, between January 1, 2016, and December 31, 2017. All medical records of traumatic paraplegics fulfilling the inclusion criteria were used for data extraction and analysis. A data-gathering instrument was developed and was thereafter used to capture the relevant information from the patients' individual medical records. Results: Mean and median duration of r-LOS was 98.4 ± 37.2 and 98.3 (31.3) days, respectively. Significant predictors were age, employment status, location of residence, operation, and complications at/during hospitalization (P < 0.05). More than half (55.6%) of the traumatic paraplegic patients were of neurological category A. Among those who had r-LOS > 98 days, 94.2% had pressure ulcers in the sacral region, followed by 85.7% ischial and majority were grades 3 and 4. Conclusion: The most common cause of injury was falls from height. Pressure ulcer was the most common complication of paraplegics. Age, employment status, and location of residence were the epidemiological factors, while the history of operation and pressure ulcers were the clinical factors affecting the length of hospital stay.
{"title":"Rehabilitation length of stay among traumatic paraplegics – A retrospective analysis","authors":"M. Srivastava, Anil Gupta, G. Yadav, Dileep Kumar, Sudhir Mishra, Sugandha Jauhari","doi":"10.4103/ijprm.jisprm-000179","DOIUrl":"https://doi.org/10.4103/ijprm.jisprm-000179","url":null,"abstract":"Introduction: In patients with traumatic spinal cord injury (SCI), a complex interplay of sociodemographic and injury-related factors can impact on outcomes such as rehabilitation length of stay (r-LOS), functional status, and discharge following rehabilitation procedures. Every year 2.55 lakhs of people suffer from SCI globally. Objectives: To describe the r-LOS in patients with traumatic paraplegia and associated correlates. Materials and Methods: A retrospective study was conducted among traumatic paraplegics admitted in the rehabilitation unit of a government tertiary care hospital of Lucknow, Uttar Pradesh, between January 1, 2016, and December 31, 2017. All medical records of traumatic paraplegics fulfilling the inclusion criteria were used for data extraction and analysis. A data-gathering instrument was developed and was thereafter used to capture the relevant information from the patients' individual medical records. Results: Mean and median duration of r-LOS was 98.4 ± 37.2 and 98.3 (31.3) days, respectively. Significant predictors were age, employment status, location of residence, operation, and complications at/during hospitalization (P < 0.05). More than half (55.6%) of the traumatic paraplegic patients were of neurological category A. Among those who had r-LOS > 98 days, 94.2% had pressure ulcers in the sacral region, followed by 85.7% ischial and majority were grades 3 and 4. Conclusion: The most common cause of injury was falls from height. Pressure ulcer was the most common complication of paraplegics. Age, employment status, and location of residence were the epidemiological factors, while the history of operation and pressure ulcers were the clinical factors affecting the length of hospital stay.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"149 - 155"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44377386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijprm.jisprm-000172
Ana Raposo, Armanda Lobarinhas
Fibular hemimelia is the most frequent congenital defect of the long bones. It has a wide spectrum of clinical and radiological presentations ranging from minor hypoplasia to complete absence of the fibula. Treatment options range between orthotic support, limb reconstruction, and amputation. In the current article, we present a complex clinical case of a young patient with fibular hemimelia. The patient presented a dysmetria of the lower limbs of 21 cm, also an equinovalgus foot position, and several malformations of the foot and toes. She walked with adapted orthosis and crutches, which was proved difficult for her, and esthetically undesirable. Due to the impairment on her quality of life, she was referred initially to bone-lengthening surgery. However, this surgery did not obtain satisfactory results, in both esthetic and functional levels. Hence, the patient was referred to amputation, with a better outcome after. In this clinical case, and reviewing the current literature, we aim to reflect on the implications of the different surgical options in the treatment of fibular hemimelia, and the role of physical medicine and rehabilitation in the functional recovery of these patients. We invite readers to reflect on some questions: Is amputation the best treatment in cases of serious fibular hemimelia? Should a bone-lengthening procedure be attempted before amputation? Should the amputation be delayed? To amputate or not to amputate?
{"title":"Amputate or not amputate? A fibular hemimelia case report","authors":"Ana Raposo, Armanda Lobarinhas","doi":"10.4103/ijprm.jisprm-000172","DOIUrl":"https://doi.org/10.4103/ijprm.jisprm-000172","url":null,"abstract":"Fibular hemimelia is the most frequent congenital defect of the long bones. It has a wide spectrum of clinical and radiological presentations ranging from minor hypoplasia to complete absence of the fibula. Treatment options range between orthotic support, limb reconstruction, and amputation. In the current article, we present a complex clinical case of a young patient with fibular hemimelia. The patient presented a dysmetria of the lower limbs of 21 cm, also an equinovalgus foot position, and several malformations of the foot and toes. She walked with adapted orthosis and crutches, which was proved difficult for her, and esthetically undesirable. Due to the impairment on her quality of life, she was referred initially to bone-lengthening surgery. However, this surgery did not obtain satisfactory results, in both esthetic and functional levels. Hence, the patient was referred to amputation, with a better outcome after. In this clinical case, and reviewing the current literature, we aim to reflect on the implications of the different surgical options in the treatment of fibular hemimelia, and the role of physical medicine and rehabilitation in the functional recovery of these patients. We invite readers to reflect on some questions: Is amputation the best treatment in cases of serious fibular hemimelia? Should a bone-lengthening procedure be attempted before amputation? Should the amputation be delayed? To amputate or not to amputate?","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"161 - 164"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48822582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-01DOI: 10.4103/ijprm.jisprm-000161
A. Holdoway, E. Arsava, S. Ashford, E. Cereda, R. Dziewas, G. Francisco
Stroke and the resulting long-term disability impose a substantial socio-economic burden. Stroke survivors have nutritional challenges at many stages along their care pathway, and the role of nutritional therapy and medical nutrition in stroke recovery is often overlooked. Appropriate nutrition is a prerequisite for optimizing short-term outcome and recovery from stroke and should be integral across the continuum of care, with management intervention if needed. Nutrition should be reviewed as part of the care for all people post-stroke. If nutrition support is required, it should be initiated at the acute phase and adjusted according to the ability to eat and drink throughout the care pathway. A range of complications arising post-stroke including malnutrition, dysphagia, sarcopenia, and pressure injuries can be prevented or improved by timely appropriate nutritional therapy. This also improves physical and mental function, increases strength and mobility which facilitates effective neurorehabilitation, reduces the risk of infection and pressure injuries, promotes wound healing, and improves the quality of life. An appropriately trained nutrition specialist or dietitian should assess and monitor the individual, but all members of the multidisciplinary team have a role in delivering, monitoring, and supporting the nutritional status and changing needs of the stroke survivor. This review by authors from multidisciplinary fields in stroke care is a consensus based on serial, open discussion meetings. The review explores the interrelationship between malnutrition, sarcopenia, nutrition, and pressure injuries, and seeks to raise awareness among all health professionals who manage the stroke survivor, of the supportive role of nutritional therapy.
{"title":"Nutrition management across the stroke continuum of care to optimize outcome and recovery","authors":"A. Holdoway, E. Arsava, S. Ashford, E. Cereda, R. Dziewas, G. Francisco","doi":"10.4103/ijprm.jisprm-000161","DOIUrl":"https://doi.org/10.4103/ijprm.jisprm-000161","url":null,"abstract":"Stroke and the resulting long-term disability impose a substantial socio-economic burden. Stroke survivors have nutritional challenges at many stages along their care pathway, and the role of nutritional therapy and medical nutrition in stroke recovery is often overlooked. Appropriate nutrition is a prerequisite for optimizing short-term outcome and recovery from stroke and should be integral across the continuum of care, with management intervention if needed. Nutrition should be reviewed as part of the care for all people post-stroke. If nutrition support is required, it should be initiated at the acute phase and adjusted according to the ability to eat and drink throughout the care pathway. A range of complications arising post-stroke including malnutrition, dysphagia, sarcopenia, and pressure injuries can be prevented or improved by timely appropriate nutritional therapy. This also improves physical and mental function, increases strength and mobility which facilitates effective neurorehabilitation, reduces the risk of infection and pressure injuries, promotes wound healing, and improves the quality of life. An appropriately trained nutrition specialist or dietitian should assess and monitor the individual, but all members of the multidisciplinary team have a role in delivering, monitoring, and supporting the nutritional status and changing needs of the stroke survivor. This review by authors from multidisciplinary fields in stroke care is a consensus based on serial, open discussion meetings. The review explores the interrelationship between malnutrition, sarcopenia, nutrition, and pressure injuries, and seeks to raise awareness among all health professionals who manage the stroke survivor, of the supportive role of nutritional therapy.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"121 - 128"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48391297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jisprm.jisprm-000164
Reni Benny, S. Venkataraman, A. Chanu, U. Singh, D. Kandasamy, Raghavendra Lingaiah
Background: Platelet-rich plasma (PRP) may aid functional recovery in compressive neuropathies. Objective: To compare the effect of autologous PRP with corticosteroid injection in patients with refractory carpal tunnel syndrome (CTS). Materials and Methods: This was a randomized controlled trial on 84 adults, who received either single-dose, ultrasound-guided PRP or corticosteroid. Boston Carpal Tunnel Questionnaire and cross-sectional area of median nerve were assessed at 0, 4, and 12 weeks. Results: A statistically significant 54.76% improvement (P < 0.05) in functional status was observed in both the groups at 12 weeks. Conclusion: PRP is as effective as corticosteroids in relieving pain and improving function in CTS.
{"title":"A randomized controlled trial to compare the effect of ultrasound-guided, single-dose platelet-rich plasma and corticosteroid injection in patients with carpal tunnel syndrome","authors":"Reni Benny, S. Venkataraman, A. Chanu, U. Singh, D. Kandasamy, Raghavendra Lingaiah","doi":"10.4103/jisprm.jisprm-000164","DOIUrl":"https://doi.org/10.4103/jisprm.jisprm-000164","url":null,"abstract":"Background: Platelet-rich plasma (PRP) may aid functional recovery in compressive neuropathies. Objective: To compare the effect of autologous PRP with corticosteroid injection in patients with refractory carpal tunnel syndrome (CTS). Materials and Methods: This was a randomized controlled trial on 84 adults, who received either single-dose, ultrasound-guided PRP or corticosteroid. Boston Carpal Tunnel Questionnaire and cross-sectional area of median nerve were assessed at 0, 4, and 12 weeks. Results: A statistically significant 54.76% improvement (P < 0.05) in functional status was observed in both the groups at 12 weeks. Conclusion: PRP is as effective as corticosteroids in relieving pain and improving function in CTS.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"90 - 96"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49222052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/jisprm.jisprm-000159
Uvieoghene O. Ughwanogho, K. Taber, F. Chiou-Tan
Introduction: The human corpus callosum (CC) is a primary commissural tract in the brain and serves as a major communication pathway between the cerebral hemispheres. Objective: The objective of this paper is to enhance understanding of the anatomic structure, topographic organization, function, and clinical relevance of the CC. Methods: To achieve this, we reviewed the literature for pertinent histological, anatomical, and advanced neuroimaging studies, and the findings were synthesized to provide the basis for the creation of novel color-coded schematic diagrams. Results: A standard midline sagittal magnetic resonance image was used to illustrate schematics of the CC partitioned into seven anatomic segments and the vascular supply of the CC from the anterior and posterior cerebral circulation. We further highlighted the microstructural features across each segment of the CC as well as the topographical organization of callosal fibers in connection with cortical regions of the brain. Finally, we applied these visual summaries as a guide for the discussion of the clinical relevance of the CC. Summary: Understanding the microstructural properties and related functional capacities of the CC is critical to understanding its clinical relevance. Consequently, having a clear and concise visual representation of complex callosal microstructural and anatomical features may be useful to the rehabilitation clinician in understanding overall clinical patterns seen in healthy populations across all ages and patients with neurologic injuries and pathologies with possible callosal involvement.
{"title":"Special anatomy series: Updates in structural, functional, and clinical relevance of the corpus callosum: What new imaging techniques have revealed","authors":"Uvieoghene O. Ughwanogho, K. Taber, F. Chiou-Tan","doi":"10.4103/jisprm.jisprm-000159","DOIUrl":"https://doi.org/10.4103/jisprm.jisprm-000159","url":null,"abstract":"Introduction: The human corpus callosum (CC) is a primary commissural tract in the brain and serves as a major communication pathway between the cerebral hemispheres. Objective: The objective of this paper is to enhance understanding of the anatomic structure, topographic organization, function, and clinical relevance of the CC. Methods: To achieve this, we reviewed the literature for pertinent histological, anatomical, and advanced neuroimaging studies, and the findings were synthesized to provide the basis for the creation of novel color-coded schematic diagrams. Results: A standard midline sagittal magnetic resonance image was used to illustrate schematics of the CC partitioned into seven anatomic segments and the vascular supply of the CC from the anterior and posterior cerebral circulation. We further highlighted the microstructural features across each segment of the CC as well as the topographical organization of callosal fibers in connection with cortical regions of the brain. Finally, we applied these visual summaries as a guide for the discussion of the clinical relevance of the CC. Summary: Understanding the microstructural properties and related functional capacities of the CC is critical to understanding its clinical relevance. Consequently, having a clear and concise visual representation of complex callosal microstructural and anatomical features may be useful to the rehabilitation clinician in understanding overall clinical patterns seen in healthy populations across all ages and patients with neurologic injuries and pathologies with possible callosal involvement.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"81 - 89"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44504331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/ijprm.jisprm-000166
S. Ashford, Barbara Singer, H. Rose, L. Turner-Stokes
Background: Acquired brain injury (ABI) can result in severe physical impairment causing difficulty with moving which, if not actively managed, can lead to contracture and deformity. Delayed access to rehabilitation may result in more contracture, with potential to increase duration of rehabilitation, cost and therapy time required. Objective: Describe the amount of therapy input for patients undergoing specialist in-patient rehabilitation following ABI, the differences in the type of therapy received by people with and without contracture and/or spasticity, and the impacts on functional outcomes including care needs and cost of care. Materials and Methods: A cohort analysis of prospectively collected data from 426 patients with ABI in a UK tertiary inpatient rehabilitation program. The Neurological impairment Scale (NIS) was used to identify the presence of spasticity or contracture. The Northwick Park Therapy Dependency Assessment (NPTDA) was used to calculate the therapy hours and type of treatment provided to people with and without spasticity and/or contracture. Outcomes (change in function and independence) were compared including the UK Functional Assessment Measure (UK FIM+FAM). Results: The Male/Female ratio was 63:37% with a mean age: 44.0(SD 13) years and a mean length of stay in specialist inpatient rehabilitation: 103 (SD 49) days. Aetiology: Stroke (63%), Trauma (20%); Hypoxia (7%): Other (10%). Patients with contractures were significantly more dependent than those without, both on admission and discharge. They stayed on average 31 days longer (95%CI 21.1, 40.5) (P=0.001) with an additional mean episode cost of £25,588 (95%CI £18.085, 34,043) (P<0.001). Despite this, they made similar overall functional gains resulting in similar long-term savings in the cost of ongoing care. Conclusion: Routine collection of the NPTDA supported quantification of the impact of spasticity and contracture on therapy inputs, length of stay, functional gains, and costs. People with contractures following ABI require more therapy time in rehabilitation to achieve similar functional gains, but nevertheless were cost-efficient to treat.
{"title":"The impact of spasticity and contractures on dependency and outcomes from rehabilitation","authors":"S. Ashford, Barbara Singer, H. Rose, L. Turner-Stokes","doi":"10.4103/ijprm.jisprm-000166","DOIUrl":"https://doi.org/10.4103/ijprm.jisprm-000166","url":null,"abstract":"Background: Acquired brain injury (ABI) can result in severe physical impairment causing difficulty with moving which, if not actively managed, can lead to contracture and deformity. Delayed access to rehabilitation may result in more contracture, with potential to increase duration of rehabilitation, cost and therapy time required. Objective: Describe the amount of therapy input for patients undergoing specialist in-patient rehabilitation following ABI, the differences in the type of therapy received by people with and without contracture and/or spasticity, and the impacts on functional outcomes including care needs and cost of care. Materials and Methods: A cohort analysis of prospectively collected data from 426 patients with ABI in a UK tertiary inpatient rehabilitation program. The Neurological impairment Scale (NIS) was used to identify the presence of spasticity or contracture. The Northwick Park Therapy Dependency Assessment (NPTDA) was used to calculate the therapy hours and type of treatment provided to people with and without spasticity and/or contracture. Outcomes (change in function and independence) were compared including the UK Functional Assessment Measure (UK FIM+FAM). Results: The Male/Female ratio was 63:37% with a mean age: 44.0(SD 13) years and a mean length of stay in specialist inpatient rehabilitation: 103 (SD 49) days. Aetiology: Stroke (63%), Trauma (20%); Hypoxia (7%): Other (10%). Patients with contractures were significantly more dependent than those without, both on admission and discharge. They stayed on average 31 days longer (95%CI 21.1, 40.5) (P=0.001) with an additional mean episode cost of £25,588 (95%CI £18.085, 34,043) (P<0.001). Despite this, they made similar overall functional gains resulting in similar long-term savings in the cost of ongoing care. Conclusion: Routine collection of the NPTDA supported quantification of the impact of spasticity and contracture on therapy inputs, length of stay, functional gains, and costs. People with contractures following ABI require more therapy time in rehabilitation to achieve similar functional gains, but nevertheless were cost-efficient to treat.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"97 - 104"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44027661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01DOI: 10.4103/2349-7904.357691
Ranaivondrambola Tatiana, Randrianasolo Pascale, T. Servino, S. Duval
Arthrogryposis multiplex congenita (AMC) is a congenital disorder characterized by nonprogressive multiple joint contractures affecting one or more areas of the body, muscle weakness, and fibrosis. This term includes a heterogeneous group of diseases, neurological, neuromuscular, and genetic or mechanical origin. Two types of classification have been developed: A clinical one (types I, II, and III) and an etiological one. A multidisciplinary approach is needed for better care and appropriate follow-up. It is a case of AMC type 2A. A girl, with an antecedent of low levels of amniotic fluid, presented at birth with multiple malformations and stiffness of several articulations: bilateral clubfoot, bilateral clubhand, temporomandibular joint involvement, postural torticollis, and congenital hip dislocation. She had also a small persistence of arterial canal and ambiguous external genitalia. The care was performed by a multidisciplinary team including a physiatrist, pediatric surgeon, physiotherapist, prosthetist, and orthotist. In infants with arthrogryposis, joint stiffness is maximal at birth. The first step is passive mobilizations before surgical joint treatment. Azbell et al. found in their study that at 9 months of age, many of this infant's impairments of body structure and function, functional activity limitations, and participation restrictions improved. The program of stretching, muscle strengthening, facilitation of motor skills, orthopedic intervention, and parent education may have contributed to this infant's progress. Prospective intervention studies exploring specific intervention strategies are needed to establish the plan of care for these patients. Arthrogryposis describes a set of joint contractures present from birth and nonprogressive. The common physiopathological mechanism is fetal immobility syndrome. Multidisciplinary care is necessary and should be early and continued to gain maximum autonomy and facilitate social integration.
{"title":"Multidisciplinary management of arthrogryposis multiplex congenita type 2A case","authors":"Ranaivondrambola Tatiana, Randrianasolo Pascale, T. Servino, S. Duval","doi":"10.4103/2349-7904.357691","DOIUrl":"https://doi.org/10.4103/2349-7904.357691","url":null,"abstract":"Arthrogryposis multiplex congenita (AMC) is a congenital disorder characterized by nonprogressive multiple joint contractures affecting one or more areas of the body, muscle weakness, and fibrosis. This term includes a heterogeneous group of diseases, neurological, neuromuscular, and genetic or mechanical origin. Two types of classification have been developed: A clinical one (types I, II, and III) and an etiological one. A multidisciplinary approach is needed for better care and appropriate follow-up. It is a case of AMC type 2A. A girl, with an antecedent of low levels of amniotic fluid, presented at birth with multiple malformations and stiffness of several articulations: bilateral clubfoot, bilateral clubhand, temporomandibular joint involvement, postural torticollis, and congenital hip dislocation. She had also a small persistence of arterial canal and ambiguous external genitalia. The care was performed by a multidisciplinary team including a physiatrist, pediatric surgeon, physiotherapist, prosthetist, and orthotist. In infants with arthrogryposis, joint stiffness is maximal at birth. The first step is passive mobilizations before surgical joint treatment. Azbell et al. found in their study that at 9 months of age, many of this infant's impairments of body structure and function, functional activity limitations, and participation restrictions improved. The program of stretching, muscle strengthening, facilitation of motor skills, orthopedic intervention, and parent education may have contributed to this infant's progress. Prospective intervention studies exploring specific intervention strategies are needed to establish the plan of care for these patients. Arthrogryposis describes a set of joint contractures present from birth and nonprogressive. The common physiopathological mechanism is fetal immobility syndrome. Multidisciplinary care is necessary and should be early and continued to gain maximum autonomy and facilitate social integration.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"114 - 118"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70587383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.4103/2349-7904.347808
R. Reebye, A. Balbert, D. Bensmail, H. Walker, J. Wissel, T. Deltombe, G. Francisco
Spasticity management should be part of a well-coordinated and comprehensive rehabilitation program that is patient-centric and goal-specific. There are a variety of options available for the treatment of spasticity. A usual approach is starting with the least invasive treatment modalities initially and gradually increasing to more complex interventions as this is required. This curriculum considers oral antispasticity drugs in terms of mechanism of action, clinical use, efficacy, and adverse events. It also presents other treatment options, such as chemical neurolysis using phenol and alcohol and chemodenervation using botulinum toxin A (BoNT-A). Therapeutic intramuscular injections of BoNT-A require sound patient selection, accurate muscle selection, and precise localization. The common methods for achieving these are described. The importance of physiotherapy is explained, along with the necessity to combine treatment modalities to address spasticity and the various components of the upper motor neuron syndrome. Recognizing differences in various health-care systems across countries and regions, the authors aim to present various treatment options. While this section of the curriculum highlights the importance of an interdisciplinary effort in managing spasticity, it is understandable that not all treatment options are available uniformly. The challenge to clinicians is to make the most of the management options on hand to optimize outcomes.
{"title":"Module 2: Nonsurgical management of Spasticity","authors":"R. Reebye, A. Balbert, D. Bensmail, H. Walker, J. Wissel, T. Deltombe, G. Francisco","doi":"10.4103/2349-7904.347808","DOIUrl":"https://doi.org/10.4103/2349-7904.347808","url":null,"abstract":"Spasticity management should be part of a well-coordinated and comprehensive rehabilitation program that is patient-centric and goal-specific. There are a variety of options available for the treatment of spasticity. A usual approach is starting with the least invasive treatment modalities initially and gradually increasing to more complex interventions as this is required. This curriculum considers oral antispasticity drugs in terms of mechanism of action, clinical use, efficacy, and adverse events. It also presents other treatment options, such as chemical neurolysis using phenol and alcohol and chemodenervation using botulinum toxin A (BoNT-A). Therapeutic intramuscular injections of BoNT-A require sound patient selection, accurate muscle selection, and precise localization. The common methods for achieving these are described. The importance of physiotherapy is explained, along with the necessity to combine treatment modalities to address spasticity and the various components of the upper motor neuron syndrome. Recognizing differences in various health-care systems across countries and regions, the authors aim to present various treatment options. While this section of the curriculum highlights the importance of an interdisciplinary effort in managing spasticity, it is understandable that not all treatment options are available uniformly. The challenge to clinicians is to make the most of the management options on hand to optimize outcomes.","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"23 - 37"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43088379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.4103/jisprm.jisprm-000154
T. Deltombe, G. Francisco
{"title":"Comprehensive curriculum on spasticity assessment and management","authors":"T. Deltombe, G. Francisco","doi":"10.4103/jisprm.jisprm-000154","DOIUrl":"https://doi.org/10.4103/jisprm.jisprm-000154","url":null,"abstract":"","PeriodicalId":75125,"journal":{"name":"The journal of the International Society of Physical and Rehabilitation Medicine","volume":"5 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46621988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.4103/2349-7904.347810
Nicholas C. Ketchum, S. Carda, M. O'Dell, P. Säterö, J. Jacinto, T. Deltombe, G. Francisco
With many recent advancements in spasticity treatment, more patients are surviving critical illness and injury but are left with ongoing disability that needs constant treatment. Such treatment will change as the patient's condition evolves. Constant appraisal of treatment efficacy and patient progress is therefore an important component of spasticity management, and physicians need to be familiar with how to troubleshoot treatment regimens when outcomes of that regimen become suboptimal. This module considers how to optimize the use and outcomes of major treatment modalities and provides drug and device maintenance algorithms to guide the treating team.
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