American journal of physical medicine & rehabilitation
-
Am J Phys Med Rehabil · Jul 1997
Incidence of fever in the rehabilitation phase following brain injury.
There appears to be a high incidence of fever after brain injury. The most common cause for fever is infection. The incidence of fever occurring as a result of hypothalamic thermoregulatory dysfunction after brain injury is less clear. ⋯ Twenty-four percent of subjects experienced fevers, with each of the populations having similar occurrence rates. Unexplained fever events were found in the traumatic brain injury (7%) and aneurysmal subarachnoid hemorrhage (8%) subpopulations only. No unexplained fever event was associated with a temperature greater than 100.8 degrees F.
-
Am J Phys Med Rehabil · Jul 1997
Case ReportsAmyotrophic lateral sclerosis. Successful treatment of mucous plugging by mechanical insufflation-exsufflation.
Bronchial mucous plugging is the main precipitating factor of acute respiratory failure for patients with neuromuscular disease. Manually assisted coughing and mechanical insufflation-exsufflation can effectively eliminate airway secretions without resorting to tracheal intubation provided that bulbar muscle function is sufficient to permit assisted peak cough flows of 160 l/min or greater. We now report successful use of mechanical insufflation-exsufflation to prevent acute respiratory failure for a patient with amyotrophic lateral sclerosis with no measurable peak cough flow.
-
Am J Phys Med Rehabil · Mar 1997
Case ReportsHiccups associated with lateral medullary syndrome. A case report.
We present a case of persistent hiccups (singultus) after a lateral medullary cerebrovascular accident. The patient presented with a two-day history of nausea and vomiting. Clinically, the patient had a loss of pain and temperature on the left side of the face, a loss of pain and temperature on the right side of the trunk, a mild left hemiparesis, and a left-sided ataxia. ⋯ After a search of the European literature revealed that baclofen was recommended as the drug of choice for stopping persistent hiccups, the patient was given 5 mg of baclofen by mouth three times per day, and the hiccups abated within 48 hours. The baclofen was discontinued after one week of therapy, and the hiccups did not return. We recommend consideration of baclofen for the treatment of persistent hiccups after lateral medullary syndrome because of its desirable side effects and reported success rate compared with other drugs used to treat chronic hiccups.
-
Am J Phys Med Rehabil · Mar 1997
ReviewModeling case mix adjustment of stroke rehabilitation outcomes.
Case mix adjustment models for long-term stroke rehabilitation outcomes should be developed (1) to facilitate equitable comparisons of outcomes across treatment settings, thereby reducing disincentives for treating complex cases, (2) to improve triage into the most appropriate level of rehabilitative care after discharge from acute care, and (3) to confirm that case mix factors are equated in treatment effectiveness studies and by random assignment across conditions in clinical trials. Case mix adjustment is necessary for valid quality improvement processes. A conceptual model of case mix adjustment of long-term rehabilitation outcomes is presented that (1) is diagnosis-specific, (2) includes demographic variables as important case mix factors, (3) encompasses triage into rehabilitation as well as treatment processes as aspects of quality of rehabilitative care, (4) contains outcomes measuring functional status as well as mortality and morbidity, and (5) keys timing of outcomes to onset of conditions requiring rehabilitation rather than discharge from rehabilitation. ⋯ Random factors in the model illustrate that case mix adjustment can never be perfect. Nevertheless, it is essential. A brief review of the stroke literature on prediction of long-term outcomes suggests that additional work is needed to specify relevant case mix indicators.
-
Am J Phys Med Rehabil · Nov 1996
Anatomy of the iliolumbar ligament: a review of its anatomy and a magnetic resonance study.
Data of the postmortem studies of the iliolumbar ligament are controversial because of the number, complexity, and variability of the structures present in the lumbosacral region. The objective of this work was to study the anatomy of the iliolumbar ligament to resolve some clinical problems: (1) do anatomic bases exist that can explain the lumbar painful syndrome termed "iliolumbar syndrome?" (2) do iliolumbar ligament varieties exist that can influence lumbosacral joint stability? Magnetic resonance was used to analyze the anatomic structure of the iliolumbar ligament of live human beings. Thirty iliolumbar ligaments of 15 volunteers were analyzed with magnetic resonance. ⋯ This posterior band is thinner than the anterior, with a smaller insertional base on the iliac crest, which explains its lesser resistance to torsional overloading and also explains the frequency of this painful syndrome. It is probable that the spatial disposition of the iliolumbar ligament influences its antitorsional role. Further anatomic and biomechanic studies are needed.