Is Kyphosis Related to Mobility, Balance, and Disability?
Is Kyphosis Related to Mobility, Balance, and Disability?
Am J Phys Med Rehabil. 2013 Apr 29;
Eum R, Leveille SG, Kiely DK, Kiel DP, Samelson EJ, Bean JF
OBJECTIVE: The aim of this study was to determine the association of increased kyphosis with declines in mobility, balance, and disability among community-living older adults. DESIGN: The 18-mo follow-up visit data from 2006 to 2009 for 620 participants from the population-based Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly Boston Study of older adults was used. Cross-sectional multivariable regression analyses were performed to assess the relationship between kyphosis (measured using the kyphosis index) and measures of mobility performance (Short Physical Performance Battery), balance (Berg Balance Scale score), and disability (self-reported difficulty walking a quarter of a mile or climbing a flight of stairs). The authors then evaluated the men and the women separately. Adjustment variables included demographic factors (age, sex, race, and education), body mass index, self-rated health, comorbidities (heart disease, diabetes, stroke, and depressive symptoms), back pain, knee pain, and falls self-efficacy. RESULTS: After full adjustment, greater kyphosis index was associated with lower Short Physical Performance Battery scores (adjusted ? = -0.08, P = 0.01) but not with lower Berg Balance Scale (adjusted ? = -0.09, P = 0.23) or self-reported disability (adjusted ? = 1.00; 95% confidence interval, 0.93-1.06) scores. In sex-specific analyses, kyphosis index was associated with only the Short Physical Performance Battery in the women. CONCLUSIONS: Greater kyphosis is associated with poorer mobility performance but not with poorer balance or self-reported disability. This association with the Short Physical Performance Battery was observed only among the women. Mechanisms by which increased kyphosis influences physical performance should be explored prospectively. HubMed – rehab
Use of Rimabotulinum Toxin for Focal Hypertonicity Management in Children with Cerebral Palsy with Nonresponse to Onabotulinum Toxin.
Am J Phys Med Rehabil. 2013 Apr 29;
Brandenburg JE, Krach LE, Gormley ME
OBJECTIVE: The aim of this study was to review the effect of rimabotulinum toxin (BoNT-B) for focal hypertonicity management in children with cerebral palsy and secondary nonresponse to onabotulinum toxin treated at the authors’ tertiary care academic medical center. DESIGN: A retrospective review of the medical treatment of children was conducted at the authors’ institution (March 16, 2001, to August 2, 2002) using the key words botulinum toxin B and Myobloc (Solstice Neurosciences Inc, South San Francisco, CA). Demographic information was analyzed using descriptive statistics (number [percentage] and mean [range]). The Pearson ? test was used to evaluate differences in incidence of adverse events. RESULTS: Eighty-two children had BoNT-B injections (116 treatments). Overall, 26.8% (19/71) of the children or their parents/guardians reported no or minimal response to the injections, with 89.5% (17/19) of these children having secondary nonresponse to onabotulinum toxin. Adverse events were frequent but did not require hospitalization of any patient. No significant differences were found in incidence of adverse events related to BoNT-B dosing, medical fragility, or Gross Motor Function Classification System level. CONCLUSIONS: More than one-fourth of the children receiving BoNT-B injections had nonresponse, with most having previous nonresponse to onabotulinum toxin. Adverse events related to BoNT-B injections were frequent and unpredictable but not severe. HubMed – rehab
A Patient-Centered Care Ethics Analysis Model for Rehabilitation.
Am J Phys Med Rehabil. 2013 Apr 29;
Hunt MR, Ells C
There exists a paucity of ethics resources tailored to rehabilitation. To help fill this ethics resource gap, the authors developed an ethics analysis model specifically for use in rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a process model to guide careful moral reasoning for particularly complex or challenging matters in rehabilitation. The Patient-Centered Care Ethics Analysis Model for Rehabilitation was developed over several iterations, with feedback at different stages from rehabilitation professionals and bioethics experts. Development of the model was explicitly informed by the theoretical grounding of patient-centered care and the context of rehabilitation, including the International Classification of Functioning, Disability and Health. Being patient centered, the model encourages (1) shared control of consultations, decisions about interventions, and management of the health problems with the patient and (2) understanding the patient as a whole person who has individual preferences situated within social contexts. Although the major process headings of the Patient-Centered Care Ethics Analysis Model for Rehabilitation resemble typical ethical decision-making and problem-solving models, the probes under those headings direct attention to considerations relevant to rehabilitation care. The Patient-Centered Care Ethics Analysis Model for Rehabilitation is a suitable tool for rehabilitation professionals to use (in real time, for retrospective review, and for training purposes) to help arrive at ethical outcomes. HubMed – rehab
Discontinuation of Anticoagulation Therapy in Patients Who Have Experienced an Acute Intramuscular Bleed and Are Also at Risk for a Stroke.
Am J Phys Med Rehabil. 2013 Apr 29;
Laban MM, Hughes C