NeuroRehabilitation
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NeuroRehabilitation · Jan 2012
Case ReportsA case of anti-NMDAR (N-methyl-D-aspartate receptor) encephalitis: a rehabilitation perspective.
Anti-NMDAR (N-Methyl-D-Aspartate Receptor) Encephalitis is a rare occurring autoimmune disease that is mediated by antibodies against the NR1 subunit of the NMDA receptor. While this condition has a known predilection for young females with ovarian tumors, heightened awareness has led to increasing recognition of this condition in other population groups as well. Afflicted patients typically evolve through a multi-staged course of neurological, behavioral, cognitive and physical deficits. ⋯ As the recovery of patients with anti-NMDAR encephalitis is often protracted, the role of the rehabilitation is important particularly beyond its acute stages. We describe a case of anti-NMDAR encephalitis in a 17-year-old girl who presented to our rehabilitation centre for management in the gradual recovery phase of her condition. This case illustrates the multiple challenges faced in the rehabilitation of such a patient.
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NeuroRehabilitation · Jan 2012
Predictors of long-term health-related quality of life in patients with aneurysmal subarachnoid hemorrhage.
To determine the predictive value of physical and psychological factors assessed three months after aneurysmal subarachnoid hemorrhage (SAH) for health-related quality of life (HRQoL) one year after the SAH. ⋯ Female gender, cognitive complaints, cognitive functioning and passive coping style assessed at 3 months after SAH are important predictors of HRQoL 1 year after SAH. Early interventions to improve cognitive and emotional functioning should be evaluated for their ability to improve long-term HRQoL after SAH.
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The term persistent vegetative state (PVS) refers to the only circumstance in which an apparent dissociation of both components of consciousness is found, characterized by preservation of wakefulness with an apparent loss of awareness. Several authors have recently demonstrated by functional neuroimaging studies that a small subset of unresponsive "vegetative" patients may show unambiguous signs of consciousness and command following that is inaccessible to clinical examination at the bedside. The term "estado vegetativo" used in Spanish to describe the PVS syndrome by physicians came from the English-Spanish translation. ⋯ The European Task Force on Disorders of Consciousness has recently proposed a new term, unresponsive wakefulness syndrome (UWS), to assist society in avoiding the depreciatory term vegetative state. Our group has embraced the use of the new term UWS and might suggest that we change our concept and use of the term MCS to minimally responsive wakefulness state (MRWS), or minimally aware wakefulness state (MAWS). Medical terms must be current and avoid any pejorative description of patients, which will promote our abilities to serve humankind and challenge neuroscientists to offer society new and realistic hopes for neurorehabilitation.
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NeuroRehabilitation · Jan 2012
ReviewCentral sensitization as a component of post-deployment syndrome.
Many service members and veterans report chronic unexplained symptoms such as pain, fatigue and memory complaints, which have most recently been characterized as post-deployment syndrome (PDS). Chronic widespread pain is a component of this syndrome, producing significant disability and considerable health care costs. ⋯ Here, we provide support for PDS as a consequence of pain and sensory amplification secondary to neuroplastic changes within the central nervous system, a phenomenon often termed central sensitization. We also discuss how factors such as stress and genetics may promote chronic widespread pain in veterans and service members who develop PDS.
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Tremendous advances in neuroimaging methods and analytic techniques hold great promise in providing the rehabilitation clinician with a much greater understanding of brain pathology and its potential influence on rehabilitation outcome. This special issues of NeuroRehabilitation overviews the field. Contemporary neuroimaging methods are reviewed specifically in traumatic brain injury (TBI), anoxic brain injury (ABI) and stroke. Innovative methods combined with standard quantitative metrics and traditional clinical assessment provide the rehabilitation clinician with multiple methods to best understand the nature and extent on underlying neuropathology and how to use this information in guiding rehabilitation therapies and predicting outcome.