Rehab Centers: Percutaneous Soft Tissue Release for Treating Chronic Recurrent Myofascial Pain Associated With Lateral Epicondylitis: 6 Case Studies.

Percutaneous soft tissue release for treating chronic recurrent myofascial pain associated with lateral epicondylitis: 6 case studies.

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Evid Based Complement Alternat Med. 2012; 2012: 142941
Lin MT, Chou LW, Chen HS, Kao MJ

Objective. The purpose of this pilot study is to investigate the effectiveness of the percutaneous soft tissue release for the treatment of recurrent myofascial pain in the forearm due to recurrent lateral epicondylitis. Methods. Six patients with chronic recurrent pain in the forearm with myofascial trigger points (MTrPs) due to chronic lateral epicondylitis were treated with percutaneous soft tissue release of Lin’s technique. Pain intensity (measured with a numerical pain rating scale), pressure pain threshold (measured with a pressure algometer), and grasping strength (measured with a hand dynamometer) were assessed before, immediately after, and 3 months and 12 months after the treatment. Results. For every individual case, the pain intensity was significantly reduced (P < 0.01) and the pressure pain threshold and the grasping strength were significantly increased (P < 0.01) immediately after the treatment. This significant effectiveness lasts for at least one year. Conclusions. It is suggested that percutaneous soft tissue release can be used for treating chronic recurrent lateral epicondylitis to avoid recurrence, if other treatment, such as oral anti-inflammatory medicine, physical therapy, or local steroid injection, cannot control the recurrent pain. HubMed – rehab

 

American Medical Society for Sports Medicine position statement: concussion in sport.

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Br J Sports Med. 2013 Jan; 47(1): 15-26
Harmon KG, Drezner JA, Gammons M, Guskiewicz KM, Halstead M, Herring SA, Kutcher JS, Pana A, Putukian M, Roberts WO,

PURPOSE OF THE STATEMENT: ? To provide an evidence-based, best practises summary to assist physicians with the evaluation and management of sports concussion. ? To establish the level of evidence, knowledge gaps and areas requiring additional research.? Concussion is defined as a traumatically induced transient disturbance of brain function and involves a complex pathophysiological process. Concussion is a subset of mild traumatic brain injury (MTBI) which is generally self-limited and at the less-severe end of the brain injury spectrum.? Animal and human studies support the concept of postconcussive vulnerability, showing that a second blow before the brain has recovered results in worsening metabolic changes within the cell. ? Experimental evidence suggests the concussed brain is less responsive to usual neural activation and when premature cognitive or physical activity occurs before complete recovery the brain may be vulnerable to prolonged dysfunction. INCIDENCE: ? It is estimated that as many as 3.8 million concussions occur in the USA per year during competitive sports and recreational activities; however, as many as 50% of the concussions may go unreported. ? Concussions occur in all sports with the highest incidence in football, hockey, rugby, soccer and basketball. RISK FACTORS FOR SPORT-RELATED CONCUSSION: ? A history of concussion is associated with a higher risk of sustaining another concussion. ? A greater number, severity and duration of symptoms after a concussion are predictors of a prolonged recovery. ? In sports with similar playing rules, the reported incidence of concussion is higher in female athletes than in male athletes. ? Certain sports, positions and individual playing styles have a greater risk of concussion. ? Youth athletes may have a more prolonged recovery and are more susceptible to a concussion accompanied by a catastrophic injury. ? Preinjury mood disorders, learning disorders, attention-deficit disorders (ADD/ADHD) and migraine headaches complicate diagnosis and management of a concussion. DIAGNOSIS OF CONCUSSION: ? Concussion remains a clinical diagnosis ideally made by a healthcare provider familiar with the athlete and knowledgeable in the recognition and evaluation of concussion. ? Graded symptom checklists provide an objective tool for assessing a variety of symptoms related to concussions, while also tracking the severity of those symptoms over serial evaluations. ? Standardised assessment tools provide a helpful structure for the evaluation of concussion, although limited validation of these assessment tools is available. SIDELINE EVALUATION AND MANAGEMENT: ? Any athlete suspected of having a concussion should be stopped from playing and assessed by a licenced healthcare provider trained in the evaluation and management of concussions. ? Recognition and initial assessment of a concussion should be guided by a symptoms checklist, cognitive evaluation (including orientation, past and immediate memory, new learning and concentration), balance tests and further neurological physical examination. ? While standardised sideline tests are a useful framework for examination, the sensitivity, specificity, validity and reliability of these tests among different age groups, cultural groups and settings is largely undefined. Their practical usefulness with or without an individual baseline test is also largely unknown. ? Balance disturbance is a specific indicator of a concussion, but not very sensitive. Balance testing on the sideline may be substantially different than baseline tests because of differences in shoe/cleat-type or surface, use of ankle tape or braces, or the presence of other lower extremity injury. ? Imaging is reserved for athletes where intracerebral bleeding is suspected. ? There is no same day RTP for an athlete diagnosed with a concussion. ? Athletes suspected or diagnosed with a concussion should be monitored for deteriorating physical or mental status. NEUROPSYCHOLOGICAL TESTING: ? Neuropsychological (NP) tests are an objective measure of brain-behaviour relationships and are more sensitive for subtle cognitive impairment than clinical exam. ? Most concussions can be managed appropriately without the use of NP testing. ? Computerised neuropsychological (CNP) testing should be interpreted by healthcare professionals trained and familiar with the type of test and the individual test limitations, including a knowledgeable assessment of the reliable change index, baseline variability and false-positive and false-negative rates. ? Paper and pencil NP tests can be more comprehensive, test different domains and assess for other conditions which may masquerade as or complicate assessment of concussion. ? NP testing should be used only as part of a comprehensive concussion management strategy and should not be used in isolation. ? The ideal timing, frequency and type of NP testing have not been determined. ? In some cases, properly administered and interpreted NP testing provides an added value to assess cognitive function and recovery in the management of sports concussions. ? It is unknown if use of NP testing in the management of sports concussion helps prevent recurrent concussion, catastrophic injury or long-term complications. ? Comprehensive NP evaluation is helpful in the post-concussion management of athletes with persistent symptoms or complicated courses. RETURN TO CLASS: ? Students will require cognitive rest and may require academic accommodations such as reduced workload and extended time for tests while recovering from a concussion. RETURN TO PLAY: ? Concussion symptoms should be resolved before returning to exercise. ? A RTP progression involves a gradual, step-wise increase in physical demands, sports-specific activities and the risk for contact. ? If symptoms occur with activity, the progression should be halted and restarted at the preceding symptom-free step. ? RTP after concussion should occur only with medical clearance from a licenced healthcare provider trained in the evaluation and management of concussions. SHORT-TERM RISKS OF PREMATURE RTP: ? The primary concern with early RTP is decreased reaction time leading to an increased risk of a repeat concussion or other injury and prolongation of symptoms. LONG-TERM EFFECTS: ? There is an increasing concern that head impact exposure and recurrent concussions contribute to long-term neurological sequelae. ? Some studies have suggested an association between prior concussions and chronic cognitive dysfunction. Large-scale epidemiological studies are needed to more clearly define risk factors and causation of any long-term neurological impairment. DISQUALIFICATION FROM SPORT: ? There are no evidence-based guidelines for disqualifying/retiring an athlete from a sport after a concussion. Each case should be carefully deliberated and an individualised approach to determining disqualification taken. EDUCATION: ? Greater efforts are needed to educate involved parties, including athletes, parents, coaches, officials, school administrators and healthcare providers to improve concussion recognition, management and prevention. ? Physicians should be prepared to provide counselling regarding potential long-term consequences of a concussion and recurrent concussions.? Primary prevention of some injuries may be possible with modification and enforcement of the rules and fair play. ? Helmets, both hard (football, lacrosse and hockey) and soft (soccer, rugby) are best suited to prevent impact injuries (fracture, bleeding, laceration, etc.) but have not been shown to reduce the incidence and severity of concussions. ? There is no current evidence that mouth guards can reduce the severity of or prevent concussions. ? Secondary prevention may be possible by appropriate RTP management. LEGISLATION: ? Legislative efforts provide a uniform standard for scholastic and non-scholastic sports organisations regarding concussion safety and management.? Additional research is needed to validate current assessment tools, delineate the role of NP testing and improve identification of those at risk of prolonged post-concussive symptoms or other long-term complications. ? Evolving technologies for the diagnosis of concussion, such as newer neuroimaging techniques or biological markers, may provide new insights into the evaluation and management of sports concussion.
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Independent predictors of ischemic stroke in the elderly: Prospective data from a stroke unit.

Filed under: Rehab Centers

Neurology. 2012 Dec 12;
Forti P, Maioli F, Procaccianti G, Nativio V, Lega MV, Coveri M, Zoli M, Sacquegna T

ABSTRACT OBJECTIVE: Incidence of ischemic stroke (IS) increases with age. Knowledge of factors associated with IS acute outcomes in the oldest-old (?80 years) is needed to improve quality of care and resource allocation in this age group. METHODS: Data are for 769 consecutive IS patients aged ?60 years (436 aged ?80 years) admitted to an Italian stroke unit in a 4-year period. Demographics, prestroke disability (modified Rankin Scale ?3) and comorbidities, IS etiology and subtype, NIH Stroke Scale (NIHSS) score, clinical and laboratory admission parameters, and medical complications were prospectively registered. Independent predictors of in-hospital death, incident disability, length of stay, discharge without rehabilitation, and no direct discharge home were identified by multiple logistic regression. Risk profiles before and after age 80 were compared. RESULTS: Poor outcomes were more frequent in the oldest-old compared to the younger patients. NIHSS score, clinical parameters of IS severity (need for oxygen, indwelling catheter, or nasogastric tube), incident disability, and medical complications predicted most of the study outcomes in both age groups. After age 80, IS etiology and subtype proved additional independent determinants for most outcomes along with age, sex, and prestroke functional and health status. CONCLUSIONS: Characteristics related to neurologic impairment on admission were the main predictors of acute outcomes of IS in this cohort. Specific IS etiology and subtype influenced IS outcomes only after age 80. In oldest-old patients, demographics and prestroke functional and health status also influenced IS outcomes with peculiar associations.
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Adult-onset autosomal dominant leukodystrophy presenting with REM sleep behavior disorder.

Filed under: Rehab Centers

Neurology. 2012 Dec 12;
Flanagan EP, Gavrilova RH, Boeve BF, Kumar N, Jelsing EJ, Silber MH

Adult-onset autosomal dominant leukodystrophy (ADLD) is a slowly progressive hereditary disease of the white matter caused by duplication of the nuclear lamina protein lamin B1 on chromosome 5q23.2.(1) Patients usually present in the 4th-5th decade with autonomic symptoms followed by pyramidal and cerebellar dysfunction.(2) In ADLD, MRI head reveals symmetric T2-signal hyperintensities in the subcortical white matter, brainstem, and middle cerebellar peduncles.(2) REM sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment behavior and REM sleep without atonia.(3) It has been reported most commonly with synucleinopathies such as Parkinson disease and may precede the diagnosis by decades.(3) To our knowledge, RBD has not been reported with leukodystrophies. Herein we report a case of ADLD presenting with RBD as the initial symptom.
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Finding falls in ambulatory care clinical documents using statistical text mining.

Filed under: Rehab Centers

J Am Med Inform Assoc. 2012 Dec 15;
McCart JA, Berndt DJ, Jarman J, Finch DK, Luther SL

OBJECTIVE: To determine how well statistical text mining (STM) models can identify falls within clinical text associated with an ambulatory encounter. MATERIALS AND METHODS: 2241 patients were selected with a fall-related ICD-9-CM E-code or matched injury diagnosis code while being treated as an outpatient at one of four sites within the Veterans Health Administration. All clinical documents within a 48-h window of the recorded E-code or injury diagnosis code for each patient were obtained (n=26 010; 611 distinct document titles) and annotated for falls. Logistic regression, support vector machine, and cost-sensitive support vector machine (SVM-cost) models were trained on a stratified sample of 70% of documents from one location (dataset A(train)) and then applied to the remaining unseen documents (datasets A(test)-D). RESULTS: All three STM models obtained area under the receiver operating characteristic curve (AUC) scores above 0.950 on the four test datasets (A(test)-D). The SVM-cost model obtained the highest AUC scores, ranging from 0.953 to 0.978. The SVM-cost model also achieved F-measure values ranging from 0.745 to 0.853, sensitivity from 0.890 to 0.931, and specificity from 0.877 to 0.944. DISCUSSION: The STM models performed well across a large heterogeneous collection of document titles. In addition, the models also generalized across other sites, including a traditionally bilingual site that had distinctly different grammatical patterns. CONCLUSIONS: The results of this study suggest STM-based models have the potential to improve surveillance of falls. Furthermore, the encouraging evidence shown here that STM is a robust technique for mining clinical documents bodes well for other surveillance-related topics.
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