Journal of rehabilitation research and development
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Blasts are responsible for about two-thirds of the combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom, which include at least 1,200 traumatic brain injuries. Blasts inflict damage to the brain directly and by causing injuries to other organs, resulting in air emboli, hypoxia, and shock. Direct injuries to the brain result from rapid shifts in air pressure (primary blast injury), from impacts with munitions fragments and other objects propelled by the explosion (secondary blast injury), and from collisions with objects and rapid acceleration of individuals propelled by the explosion (tertiary blast injury). ⋯ The damage attributable to the specific effects of a blast, however, has received little study, although it has been assumed to include the focal and diffuse lesions characteristic of closed head injuries. Available clinical studies of blast injuries show focal damage similar to that found in other types of closed head injuries but have not determined whether diffuse axonal injury also occurs. In this article, we will try to reach a better understanding of the specific pathology of blast-related brain injury by reviewing the available experimental studies and the autopsy reports of victims of terrorist attacks and military casualties dating back to World War I.
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Given the lack of evidence in support of pacing self-management for patients with chronic fatigue syndrome (CFS), we examined whether physical behavior and health status of patients with CFS would improve in response to a pacing self-management program. We performed an observational study of pacing self-management in seven CFS patients using a single-case study design. Stages A1 and A2 (7-day assessment periods) of the A1-B-A2 design corresponded to the baseline and posttreatment measurements of physical behavior (real-time activity monitoring) and health status (self-reported measures), respectively. ⋯ A statistically significant decrease in the mean time spent doing light activity (<3 metabolic equivalents) was observed, but a change in the way physical activity was spread throughout the day was not. We found that 3 weeks of pacing self-management was accompanied by a modest improvement in symptom severity and daily functioning. The outcome of the present study calls for a randomized controlled clinical trial to examine the effectiveness of pacing self-management for people with CFS.
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Randomized Controlled Trial
Transcutaneous electrical nerve stimulation for treatment of spinal cord injury neuropathic pain.
The aim of the study was to assess the short-term effects of high- and low-frequency (HF and LF, respectively) transcutaneous electrical nerve stimulation (TENS) for neuropathic pain following spinal cord injury (SCI). A total of 24 patients participated in the study. According to the protocol, half of the patients were assigned to HF (80 Hz) and half to LF (burst of 2 Hz) TENS. ⋯ However, 29% of the patients reported a favorable effect from HF and 38% from LF stimulation on a 5-point global pain-relief scale. Six of the patients (25%) were, at their request, prescribed TENS stimulators for further treatment at the end of the study. In conclusion, TENS merits consideration as a com plementary treatment in patients with SCI and neuropathic pain.
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To assess physical activity and disability in chronic obstructive pulmonary disease (COPD), we evaluated the use of an accelerometer and checklist to measure free-living physical activity. Seventeen males with stable COPD completed a daily activity checklist for 14 days. Ten subjects concurrently wore an Actiped accelerometer (FitSense, Southborough, Massachussetts) that records steps per day. ⋯ A higher number of daily checklist activities performed was associated with a higher force expiratory volume in 1 s percent predicted and lowerbody mass index, airflow obstruction, dyspnea, exercise capacity (BODE) index. Prospectively measuring free-living physical activity in COPD using an unobtrusive accelerometer and simple activity checklist is feasible. Low intrasubject variation was found in free-living physical activity, which is significantly associated with clinical measures of COPD status.
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This study examines the psychological characteristics of a cohort of individuals with spinal cord injury (SCI) and persisting pain referred to a tertiary pain management center. Forty-five individuals completed measures of pain, mood, disability, and both pain- and SCI-related psychological variables such as self-efficacy and catastrophizing. Compared with a general pain clinic population attending the same tertiary pain management center (n = 5,941), the sample was found to have lower pain intensity, comparable pain catastrophizing levels, and less activity interference due to pain. ⋯ Pain catastrophizing was associated with anxiety, depression, and activity interference due to pain; pain self-efficacy was close to being significantly associated with these variables also. SCI acceptance and self-efficacy were also associated with some of these variables. These findings suggest that the biopsychosocial model of pain is applicable in this sample and that further treatment benefits could be obtained through use of interventions targeting psychological and social variables within this model.