Competent Care for Persons With Spinal Cord Injury and Dysfunction in Acute Inpatient Rehabilitation.
Competent Care for Persons With Spinal Cord Injury and Dysfunction in Acute Inpatient Rehabilitation.
Top Spinal Cord Inj Rehabil. 2012; 18(2): 149-166
Emerich L, Parsons KC, Stein A
The Relationship Between Residue and Aspiration on the Subsequent Swallow: An Application of the Normalized Residue Ratio Scale.
Dysphagia. 2013 Mar 5;
Molfenter SM, Steele CM
Postswallow residue is widely considered to be a sign of swallowing impairment and is assumed to pose risk for aspiration on subsequent swallows. We undertook a preliminary retrospective study to investigate the link between postswallow residue and penetration-aspiration on the immediately occurring subsequent clearing swallow (i.e., without introduction of a new bolus). Videofluoroscopy clips for 156 thin-liquid single bolus swallows by patients with neurogenic dysphagia were selected for study because they displayed multiple swallows per bolus. Residue for each subswallow (n = 407) was analyzed using the Normalized Residue Ratio Scale for the valleculae (NRRSv) and piriform sinuses. The association between residue presence at the end of a swallow and penetration-aspiration on the next swallow was examined. Postswallow residue in one or both pharyngeal spaces was significantly associated with impaired swallowing safety on the subsequent clearing swallow for the same bolus. However, when analyzed separately by residue location, only vallecular residue was significantly associated with impaired swallowing safety on the next clearing swallow. The distribution of NRRSv scores by swallowing safety demonstrated an NRRSv cut-point of 0.09, above which there was a 2.07 times greater relative risk of penetration-aspiration. Postswallow vallecular residue, measured using the NRRS, is significantly associated with penetration-aspiration on subsequent clearing swallows. A clinically meaningful cut-point of 0.09 on the NRRSv scale demarcates this risk. Further research with different bolus consistencies is needed. HubMed – rehab
Assessment of Early Tibiofemoral Joint Space Width Changes After Anterior Cruciate Ligament Injury and Reconstruction: A Matched Case-Control Study.
Am J Sports Med. 2013 Mar 4;
Tourville TW, Johnson RJ, Slauterbeck JR, Naud S, Beynnon BD
BACKGROUND:Progression of primary knee osteoarthritis (OA) is often quantified by measuring structural alterations of the joint such as those in tibiofemoral joint space width (JSW) over time. Limited information is available regarding changes that occur during the onset and progression of posttraumatic OA (PTOA) that are often associated with anterior cruciate ligament (ACL) injury. Furthermore, there is a paucity of information regarding JSW changes in healthy patients, making JSW interpretation challenging during early PTOA progression. PURPOSE:To evaluate tibiofemoral JSW after ACL injury, ACL reconstruction, and rehabilitation compared with healthy, matched controls. STUDY DESIGN:Cohort study; Level of evidence, 2. METHODS:A total of 39 ACL-injured patients and 32 matched controls were evaluated. Injured patients were assessed at presurgical baseline and after ACL reconstruction (mean follow-up, 46 months), as were controls. Bilateral, standing, fluoroscopy-assisted, and posterior-anterior metatarsal-phalangeal view knee radiographs were obtained at each visit and JSW was measured. RESULTS:The JSW differences between knees in control patients were not significantly different and did not change over time. Baseline JSW differences in the ACL group were significantly different than in controls. Three patients (7.9% of total) had an increased JSW difference, and 1 patient (2.6%) had a decreased medial JSW difference. In the lateral compartment, 6 patients (15.8%) had a decreased JSW difference. At follow-up, 2 patients in the ACL group (5%) had a decreased medial JSW difference, and 3 (7.9%) had a significantly increased difference in relation to controls. Lateral compartment analyses revealed 7 (18.4%) patients with a significantly decreased JSW difference and no patients with an increased difference compared with controls. CONCLUSION:One third of ACL-injured knees underwent significant JSW change soon after injury; consequently, evaluation of within-knee JSW changes over time in ACL-injured patients may not be appropriate with a study based on case-control analysis. The JSWs in the healthy knee of ACL-injured patients do not change over time, allowing this knee to be used as a control for the injured knee. This is important when evaluating the earliest stages of PTOA after ACL injury, when patients are asymptomatic and intervention may be most beneficial. HubMed – rehab