Laryngectomy Rehabilitation in the United Kingdom.
Laryngectomy rehabilitation in the United Kingdom.
Curr Opin Otolaryngol Head Neck Surg. 2013 Apr 24;
Owen S, Paleri V
PURPOSE OF REVIEW: Organ preservation treatment paradigms have led to profound changes in the management of locally advanced laryngeal cancer. Whereas there has been a reduction in primary total laryngectomies, the proportion of patients needing laryngectomy after failed chemoradiation has increased. These changes have affected the rehabilitation service requirements and outcomes following rehabilitation in this group of patients. It is particularly important to understand the current issues as UK service commissioning and funding arrangements are undergoing significant changes at this time. RECENT FINDINGS: There is evidence of change to functional outcomes and rehabilitation of communication and swallowing in relation to current treatment protocols for laryngeal cancer. Other factors such as an ageing population in the UK are also affecting outcomes and service delivery. Centralized delivery of head and neck cancer services and speech and language therapy-led practice has resulted in implications on service delivery and training. Surgical voice restoration continues to be the most common method of communication rehabilitation in the UK for laryngectomees. SUMMARY: Laryngectomy rehabilitation has become increasingly complex. Whilst there are some well established guidelines for treatment, these may be out of date and further work is required to evaluate the outcomes and needs of this complex and vulnerable group of patients. HubMed – rehab
Experimental Pain Responses Support Peripheral and Central Sensitization in Patients With Unilateral Shoulder Pain.
Clin J Pain. 2013 Apr 23;
Coronado RA, Simon CB, Valencia C, George SZ
OBJECTIVE:: The aims of this study were to (1) examine the pattern of experimental pain responses in the affected and nonaffected extremities in patients with shoulder pain and (2) explore the intraindividual association between sensitization states derived from experimental pain testing. METHODS:: Experimental pain responses from 58 patients with shoulder pain (17 women, aged 18 to 52 y) were compared with those from 56 age-matched and sex-matched pain-free volunteers (16 women, aged 21 to 58 y). Experimental pain responses included pressure pain threshold (PPT), thermal pain threshold and tolerance, and suprathreshold heat pain response. Comparisons were made between the affected and nonaffected extremities of clinical participants and the average response of extremities in control participants. Peripheral and central sensitization indexes were computed for clinical participants using standardized scores and percentile cutoffs on the basis of the data from the control sample. Experimental pain responses in clinical participants observed beyond the 25th and 75th percentile of control sample responses were used for investigation of intraindividual association of sensitization states. RESULTS:: PPT at the acromion and masseter on the affected side of clinical participants were diminished compared with that on their nonaffected side (P<0.015). Bilateral sensitivity in clinical participants was noted for PPT at the acromion and suprathreshold heat pain response (P<0.015). Peripheral and central sensitization indexes demonstrated that individuals with shoulder pain present with variable patterns of peripheral and central sensitization. CONCLUSIONS:: Collectively, experimental pain responses supported peripheral and central sensitization in response to pressure and thermal stimuli. No clear association was made between individuals exhibiting peripheral or central sensitization, thus suggesting heterogeneity in pain processing in this clinical population. HubMed – rehab
Diagnosis and surgical treatment of progressive pseudorheumatoid dysplasia in an adult with severe spinal disorders and polyarthropathy.
Joint Bone Spine. 2013 Apr 22;
Yang X, Song Y, Kong Q
Progressive pseudorheumatoid dysplasia (PPD) is a rare autosomal-recessive disorder. The polyarthritis of PPD has been detailed before. However, the spinal disorder and surgical treatment been rarely mentioned. A 44-year-old patient who has been misdiagnosed as juvenile rheumatoid arthritis (JRA) and given unilateral total hip replacement yet, suffers mainly from severe spinal disorder this time. The platyspondyly, Scheuermann-like lesions of the spine and JRA-like features of the peripheral joints were found on radiographic films, combining negative inflammatory and rheumatoid factors, which most suggested the diagnosis of PPD. As the homozygous nucleotide deletion was found in WISP3 gene, diagnosis of PPD was definite. Neurological examination and further imaging examination indicated severe compression of thoracic and lumbar spinal cord which might lead to his conspicuous spinal disorder. Decompressive laminectomy, posterior fusion and fixation were performed. And an excellent clinical outcome was achieved 1year after the decompression and fusion: leg pain and hypoesthesia resolved and osseous fusion performed. This is the first reported decompression in the adult spine of PPD. Surgical treatment could receive satisfactory result in PPD, however, it is a palliative therapy which has less help to prevent the development of this disease. Early diagnosis and rehabilitation interventions remain the most important. Clinical, radiographic and genetic features in PPD are crucial in the differential diagnosis. HubMed – rehab
Pilot Study: Elevated circulating levels of the pro-inflammatory cytokine macrophage migration inhibitory factor in chronic spinal cord injury patients.
Arch Phys Med Rehabil. 2013 Apr 22;
Stein A, Panjwani A, Sison C, Rosen L, Chugh R, Metz C, Bank M, Bloom O
OBJECTIVE: To test the hypothesis that the pro-inflammatory cytokine macrophage migration inhibitory factor (MIF) is elevated in the circulation of chronic spinal cord injury (SCI) patients relative to uninjured subjects. The secondary aim was to identify additional immune mediators that are elevated in chronic SCI subjects. DESIGN: Prospective, observational pilot study. SETTING: Outpatient clinic of a Department of Physical Medicine and Rehabilitation and research institute in an academic medical center. PARTICIPANTS: Individuals with chronic (>1 year from initial injury) SCI (N=22) and age- and sex-matched uninjured subjects (N=19). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Plasma levels of MIF, as determined by a commercially available multiplex suspension immunoassay. The relationship between MIF levels and clinical/demographic variables was also examined. As a secondary outcome, we evaluated other cytokines, chemokines and growth factors. RESULTS: MIF levels were significantly higher in plasma of chronic SCI than in control subjects (P<0.0015). Elevated MIF levels were not correlated significantly with any one clinical or demographic characteristic. SCI subjects also exhibited significantly higher plasma levels of MIG/CXCL9 (P<0.03), MCSF (P<0.035), IL-3 (P<0.044) and SCGF-? (P<0.016). Among SCI subjects, the levels of SCGF-? increased with time from initial injury. CONCLUSIONS: These data confirm the hypothesis that MIF is elevated in chronic SCI subjects and identify additional novel immune mediators that are also elevated in these subjects. This study suggests the importance of examining the potential functional roles of MIF and other immune factors in chronic SCI subjects. HubMed – rehab