Physical Rehabilitation of the Critically Ill Trauma Patient in the ICU.
Physical Rehabilitation of the Critically Ill Trauma Patient in the ICU.
Crit Care Med. 2013 Jul; 41(7): 1790-1801
Engels PT, Beckett AN, Rubenfeld GD, Kreder H, Finkelstein JA, da Costa L, Papia G, Rizoli SB, Tien HC
OBJECTIVES:: To 1) review the existing evidence for early mobilization of the critically ill patients in the ICU with polytrauma; 2) provide intensivists with an introduction to the biomechanics, physiology, and nomenclature of injuries; 3) summarize the evidence for early mobilization in each anatomic area; and 4) provide recommendations for the mobilization of these patients. DATA SOURCES:: A literature search of the MEDLINE and EMBASE databases for articles published in English between 1980 and 2011. STUDY SELECTION:: Studies pertaining to physical therapy and rehabilitation in trauma patients were selected. Articles were excluded if they dealt with pediatrics, geriatrics, burn injuries, isolated hand injuries, chronic (i.e., not acute) injuries, nontraumatic conditions, and pressure/decubitus ulcers, were in a language other than English, were published only in abstract form, were letters to the editor, were case reports, or were published prior to 1980. DATA EXTRACTION:: Reviewers extracted data and summarized results according to anatomical areas. DATA SYNTHESIS:: Of 1,411 titles and abstracts, 103 met inclusion criteria. We found no articles specifically addressing the rehabilitation of polytrauma patients in the ICU setting or patients with polytrauma in general. We summarized the articles addressing the role of mobilization for specific injuries and treatments. We used this evidence, in combination with biologic rationale and physician and surgeon experience and expertise, to summarize the important considerations when providing physical therapy to these patients in the ICU setting. CONCLUSIONS:: There is a paucity of evidence addressing the role of early mobilization of ICU patients with polytrauma and patients with polytrauma in general. Evidence for the beneficial role of early mobilization of specific injuries exists. Important considerations when applying a strategy of early physical therapy and mobilization to this distinctive patient group are summarized. HubMed – rehab
Compartment Syndrome of the Upper Arm After Closed Reduction and Percutaneous Pinning of a Supracondylar Humerus Fracture.
J Pediatr Orthop. 2013 Jun 14;
Diesselhorst MM, Deck JW, Davey JP
BACKGROUND:: Supracondylar fractures of the humerus are the most frequently seen elbow fractures in children. One of the most feared complications of this fracture, that is, compartment syndrome of the forearm is seen rarely. Compartment syndrome of the upper arm is an even more rare occurrence and to date, has not been reported in association with an isolated supracondylar humerus fracture in a child. METHODS:: A 9-year-old boy was cared for at our facility for a severe (Gartland type III) supracondylar humerus fracture and developed a compartment syndrome in the perioperative period. A clinical, radiographic, and literature review of this case was undertaken to better define this occurrence. RESULTS:: This patient sustained a closed supracondylar humerus fracture in association with a motor and sensory deficit of the radial nerve. Because of the severity of the deformity, a provisional reduction was performed in the emergency department. Eleven hours after the injury, a routine closed reduction and percutaneous pinning was performed. Although significant swelling was noted at that time, compartment syndrome was not clinically suspected. He was observed as an inpatient because of this persistent swelling. Over the next day, he developed considerable tenderness over the anterior arm and mobile wad musculature, hence, compartment pressure measurements were made. These confirmed a compartment syndrome in the anterior compartment of the arm and equivocally in the mobile wad. An urgent compartment release of the arm was done, which resulted in full recovery. CONCLUSIONS:: This is the first report of a compartment syndrome of the arm after an isolated supracondylar humerus fracture in a child. The presence of the associated fracture made the classic signs of compartment syndrome difficult to assess. Ultimately, muscle tenderness and compartment pressure measurement were most helpful in making this diagnosis. A high index of suspicion should be maintained for compartment syndrome of the arm as well as the forearm when evaluating children with severe supracondylar humerus fractures. LEVEL OF EVIDENCE:: Level IV, case report. HubMed – rehab
Alzheimer’s Disease is Associated with Distinctive Semantic Feature Loss.
Neuropsychologia. 2013 Jun 14;
Flanagan KJ, Copland DA, Chenery HJ, Byrne GJ, Angwin AJ
A central topic of discussion in the exploration of semantic disturbance in AD concerns the relative contribution of semantic content (e.g., semantic features) and semantic process. Studies have suggested that semantic dysfunction in AD is the result of deficits to either semantic process, semantic content or both. Studies that have supported the loss of semantic content have been criticized for their use of verbal stimuli and cognitively challenging experimental tasks. The current study used a novel version of the yes-no recognition memory task to compare the processing of distinctive and non-distinctive features in participants with AD whilst controlling the cognitive demands of the task. The task involved five conditions which denoted the relationship between the items in the test and study phase. A ‘non-distinctive’ and a ‘distinctive’ condition were included where non-distinctive and distinctive semantic features were manipulated between study and test, respectively. Task accuracy of participants with AD decreased relative to control participants when distinctive features were manipulated between the study and test phase of the experiment. There was no significant difference between groups when non-distinctive features were manipulated. These findings provide evidence to support the loss of semantic content in AD. HubMed – rehab
The fatigue-motor performance paradox in multiple sclerosis.
Sci Rep. 2013 Jun 18; 3: 2001
Pardini M, Bonzano L, Roccatagliata L, Mancardi GL, Bove M
Subjective fatigue is a typical symptom in Multiple Sclerosis (MS) even in the earliest stages of the disease. The relationship between persistent fatigue and motor task performance is still unclear. Aim of this study was to better investigate this relationship at both the motor behavioral and neuroanatomical levels. Towards this goal, we combined a quantitative evaluation of an undemanding finger motor task with concurrent brain functional magnetic resonance imaging (fMRI) in a group of MS patients with minimal disability but reporting persistent subjective fatigue. We found an unexpected significant positive correlation between persistent subjective fatigue and task-related temporal accuracy, revealing a “fatigue-motor performance paradox”. fMRI analysis indicated that this association is potentially mediated by cerebellar and orbitofrontal cortex activity, suggesting a role of these regions in developing subjective fatigue. Our data point to a possible adaptive role for fatigue as the subjective correlate of increased resource demand for motor activities. HubMed – rehab
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