[Orthodontic Treatment of Patients Medicated With Bisphosphonates-a Clinical Case Report.]

[Orthodontic treatment of patients medicated with bisphosphonates-a clinical case report.]

Filed under: Rehab Centers

J Orofac Orthop. 2013 Jan 10;
Krieger E, d’Hoedt B, Scheller H, Jacobs C, Walter C, Wehrbein H

INTRODUCTION: Bisphosphonates (BP) are an established medication, e.g., for the prevention/therapy of osteoporosis. The effects of the changed bone metabolism for orthodontic treatments are unknown. CASE REPORT: A 66-year-old woman underwent a total oral rehabilitation. The therapy included (1) tooth extractions, (2) periodontal treatment, (3) insertion of dental implants, (4) provisional implant restorations, (5) orthodontic treatment, and (6) definite implant restorations. The orthodontic tooth movements were in- and retrusion of the upper frontal teeth, intrusion of the lower front teeth, using the dental implants as skeletal anchorage. After implant insertion and one month before beginning the orthodontic treatment, osteoporosis was diagnosed in this patient and, without notification to our facility, BP treatment was initiated by her general practitioner (alendronate oral, 70 mg/week), with an overall duration of intake of 7 months. After 13 months, the orthodontic treatment was successfully accomplished; however enlarged periodontal gaps, sclerotic bone areas, and mild apical root resorptions of the upper frontal teeth were found in this patient. CONCLUSION: Currently, there are no recommendations for orthodontic patients undergoing BP therapy. Orthodontic tooth movement in this low-risk patient with a short duration of intake and a low-dose BP medication was possible. Because of the reduced bone metabolism and the higher amount of side effects, the treatment should be performed with extremely light forces and frequent monitoring.
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Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation.

Filed under: Rehab Centers

J Neurol. 2013 Jan 9;
Witsch J, Galldiks N, Bender A, Kollmar R, Bösel J, Hobohm C, Günther A, Schirotzek I, Fuchs K, Jüttler E

We aimed to determine long-term disability and quality of life in patients with Guillain-Barré syndrome (GBS) who required mechanical ventilation (MV) in the acute phase. Our retrospective cohort study included 110 GBS patients admitted to an intensive care unit and requiring MV (01/1999-08/2010) in nine German tertiary academic medical centers. Outcome was determined 1 year or longer after hospital admission using the GBS disability scale, Barthel index (BI), EuroQuol-5D (EQ-5D) and Fatigue Severity Scale. Linear/multivariate regression analysis was used to analyze predicting factors for outcome. Mean time to follow up was 52.6 months. Hospital mortality was 5.5 % and long-term mortality 13.6 %. Overall 53.8 % had a favorable outcome (GBS disability score 0-1) and 73.7 % of survivors had no or mild disability (BI 90-100). In the five dimensions of the EQ-5D “mobility”, “self-care”, “usual activities”, “pain” and “anxiety/depression” no impairments were stated by 50.6, 58.4, 36.4, 36.4 and 50.6 % of patients, respectively. A severe fatigue syndrome was present in 30.4 % of patients. Outcome was statistically significantly correlated with age, type of therapy and number of immunoglobulin courses. In GBS-patients requiring MV in the acute phase in-hospital, and long-term mortality are lower than that in previous studies, while long-term quality of life is compromised in a large fraction of patients, foremost by immobility and chronic pain. Efforts towards improved treatment approaches should address autonomic dysfunction to further reduce hospital mortality while improved rehabilitation concepts might ameliorate long-term disability.
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An ergonomic modular foot platform for isometric force/torque measurements in poststroke functional assessment: A pilot study.

Filed under: Rehab Centers

J Rehabil Res Dev. 2012 Aug; 49(6): 949-60
Mazzoleni S, Van Vaerenbergh J, Stokes E, Fazekas G, Dario P, Guglielmelli E

The main goal of this article is to present the design, technical development, and preliminary validation of an innovative mechatronic device for force/torque measurements taken from the human foot using pilot data. The device, formed by a mobile platform equipped with two six-axis force/torque sensors, was used to perform accurate quantitative measurements during isometric exercises, aimed at performing functional assessment tests in poststroke patients undergoing a rehabilitation treatment. Results from pilot data provide a validation of the device. A large clinical trial has been planned to test whether the platform can be used in the clinical practice. We suggest that measurements of ground reaction forces taken from the foot of poststroke patients during the initiation of activities of daily living tasks can provide information about their motor recovery and enlighten possible areas of application, ranging from isometric motor exercise in neurorehabilitation to foot-based human-machine interface.
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Delirium in an adult acute hospital population: predictors, prevalence and detection.

Filed under: Rehab Centers

BMJ Open. 2013; 3(1):
Ryan DJ, O’Regan NA, Caoimh RÓ, Clare J, O’Connor M, Leonard M, McFarland J, Tighe S, O’Sullivan K, Trzepacz PT, Meagher D, Timmons S

To date, delirium prevalence and incidence in acute hospitals has been estimated from pooled findings of studies performed in distinct patient populations.To determine delirium prevalence across an acute care facility.A point prevalence study.A large tertiary care, teaching hospital.311 general hospital adult inpatients were assessed over a single day. Of those, 280 had full data collected within the study’s time frame (90%).Initial screening for inattention was performed using the spatial span forwards and months backwards tests by junior medical staff, followed by two independent formal delirium assessments: first the Confusion Assessment Method (CAM) by trained geriatric medicine consultants and registrars, and, subsequently, the Delirium Rating Scale-Revised-98 (DRS-R98) by experienced psychiatrists. The diagnosis of delirium was ultimately made using DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria.Using DSM-IV criteria, 55 of 280 patients (19.6%) had delirium versus 17.6% using the CAM. Using the DRS-R98 total score for independent diagnosis, 20.7% had full delirium, and 8.6% had subsyndromal delirium. Prevalence was higher in older patients (4.7% if <50 years and 34.8% if >80 years) and particularly in those with prior dementia (OR=15.33, p<0.001), even when adjusted for potential confounders. Although 50.9% of delirious patients had pre-existing dementia, it was poorly documented in the medical notes. Delirium symptoms detected by medical notes, nurse interview and patient reports did not overlap much, with inattention noted by professional staff, and acute change and sleep-wake disturbance noted by patients.Our point prevalence study confirms that delirium occurs in about 1/5 of general hospital inpatients and particularly in those with prior cognitive impairment. Recognition strategies may need to be tailored to the symptoms most noticed by the detector (patient, nurse or primary physician) if formal assessments are not available. HubMed – rehab

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