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   Table of Contents - Current issue
January-March 2022
Volume 5 | Issue 1
Page Nos. 1-40

Online since Wednesday, February 16, 2022

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Poststroke aphasia treatment: A review of pharmacologic therapies and noninvasive brain stimulation techniques p. 1
Allison Nuovo Capizzi, Jean E Woo, Elaine Magat
Aphasia is a common complication of stroke, often causing significant morbidity. To the authors' knowledge, no stroke recovery practice guidelines incorporating pharmacologic or noninvasive brain stimulation (NIBS) therapies for poststroke aphasia (PSA) exist. The aim of this article is to provide a comprehensive review of the evidence regarding pharmacologic and NIBS treatment in PSA. An exhaustive single database search assessing treatment for PSA was performed from 2010 to 2020, resulting in 1876 articles. Articles evaluating either pharmacologic management or NIBS were included. Case reports, case series, original research, systematic reviews, and meta-analyses were allowed. Pharmacologic treatment studies included were represented by the following medication classes: cholinergic, dopaminergic, gamma-aminobutyric acid agonists and derivatives, N-methyl-D-aspartate receptor antagonists, serotonergic, and autonomic agents. NIBS treatment studies regarding transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) were evaluated. No strong evidence was found for any medication to improve PSA. However, the benefit of a medication trial may outweigh the risk of side effects as some evidence exists for functional recovery. Regarding NIBS, weak evidence exists for the treatment effect of tDCS and rTMS on PSA. While additional research is needed, the literature shows promise, especially in chronic phase of stroke when traditional treatment options may be exhausted. More evidence with larger studies and standardized study design is needed.
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Ultrasound visualization of torsional anatomic changes in the neck: Applications to cervical rotational torticollis p. 16
Filemon C Tan, Jeffrey A Strakowski, Faye Y Chiou-Tan
Introduction: The objective of this paper is to demonstrate changes in the sonographic appearance of muscles in region of the neck with cervical movement from neutral anatomic position to right rotational torsion. Methods: Sonographic images were obtained in a 56-year-old healthy female. Muscles selected are common targets for botulinum toxin A injection in treatment for cervical dystonia. Sonographic images were obtained with the transducer placed over the muscle of interest with the neck in both anatomic-neutral and right-rotated positions. Cine loop video was also recorded at each site to track muscles throughout torsion. Results: The results show that in rotational torsion, (1) the brachial plexus becomes difficult to view due to anisotropy when examining the scalenes. The relationship between the anterior and middle scalenes and brachial plexus becomes less distinct with cervical rotation beyond neutral position. (2) The positional relationship of the sternocleidomastoid (SCM) and the ipsilateral splenius capitus is altered. (3) The jugular vein changes from collapsed to distended in the contralateral SCM view. (4) The position of the trapezius is not altered significantly. Conclusion: The sonographic appearance of soft tissue structures about the neck differs significantly with cervical movement from an anatomic neutral position to a position of right torsion. Knowledge of the dynamic positional changes of the muscles in this region in relation to each other, as well as the neurovascular structures, with cervical movement and torsion can potentially improve diagnostic assessment as well as accuracy of interventional procedures.
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The state of spinal cord injury respiratory rehabilitation in Latin America p. 21
Isaac Hernández Jiménez, Melina Longoni Di Giusto, Camilo Castillo, Daniela Ramos-Usuga, Keith Tansey, Juan Carlos Arango-Lasprilla
Objectives: To describe the current state of pulmonary rehabilitation of patients with Spinal Cord Injury (SCI) in Latin America (LA) during the COVID-19 pandemic. Methods: 468 rehabilitation professionals working with SCI patients from 20 countries in LA answered an online survey related to their training, qualifications, medical practices, and resources. Results: Less than half of pulmonary rehabilitation professionals reported working with SCI patients. Of these, more than half indicated that they had not received training in pulmonary rehabilitation of these patients and did not feel qualified to provide this kind of care. In fact, only 23.4% of those surveyed indicated treating patients with SCI who require mechanical ventilation. Around 60% of providers reported having a multidisciplinary team trained and qualified to practice pulmonary rehabilitation in patients with SCI. Finally, the majority indicated having less than 5 beds to carry out this practice. Conclusions: This manuscript highlights the limited professional training and resource availability in LA to assist patients with SCI requiring pulmonary rehabilitation and provides recommendations to improve the current situation.
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Exploring the value of neuro-oncological rehabilitation within a neurorehabilitation setting p. 27
Teng Cheng Khoo, Alasdair FitzGerald
Background: Cancer rehabilitation is gaining recognition in response to treatment advances, with more survivors living with functional impairments. This study aims to describe the outcomes from neuro-oncological rehabilitation within an inpatient neurorehabilitation setting, focusing on patients with malignancy. Subjects and Methods: A review of neuro-oncological admissions from 2009 to 2017 was performed comparing length of stay (LOS), changes in United Kingdom Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) scores, discharge outcome, and survival between patients with benign and malignant diagnoses. Results: One hundred and twenty patients were included (40% with malignancy). Eighteen percent required transfer back to acute setting due to cancer- or treatment-related complications. Having malignancy was associated with a higher rate of acute transfer (34% vs. 7%, x2 = 13.8, P < 0.01). LOS was not significantly different between the two groups (median difference: 5 days, 95% confidence interval [CI]: −8–18, P = 0.187). While UK FIM + FAM change was significantly lower in the malignant group, the corresponding lower UK FIM + FAM efficiency was not (mean difference: 16, 95% CI: 1–31, P = 0.043 and 0.18, −0.42–0.05, P = 0.114, respectively). The median survival in the malignant group was 3.2 months (95% CI: 2.0–8.4), with survival up to 40.4 months. Conclusion: While patient outcomes with benign and malignant diagnoses were similar, the UK FIM + FAM does not capture the full benefit of rehabilitation. Given that patients with malignancy have limited survival, quality of life measures and goal attainment scaling may be more appropriate. Effective and efficient inpatient neuro-oncological rehabilitation in malignancy is deliverable, but collaboration with both oncology and palliative care services is crucial.
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Spinal cord dysfunction secondary to a sports/exercise event: Two case reports p. 33
Edwardo Ramos, Ana Ortiz-Santiago, Ady Correa-Mendoza
Purpose: The objective of this paper is to present two young patients with SCDys after participation in a sports/exercise event. The authors aim to raise awareness of these unusual causes with potentially fatal results. The authors want to review literature regarding the diagnosis and treatment and particular rehabilitation issues of SCDys. Methods: Two cases of young patients with a history of SCDys consulted the pediatric rehabilitation medicine service. Results: Physical examination revealed incomplete paraparesis and neurogenic bladder. Both final diagnoses were confirmed by magnetic resonance imaging or computerized tomography scan. Treatment was aimed at avoiding further/permanent neurological complications in both cases, taking into consideration their respective etiologies. Conclusion: SCDys is a nontraumatic spinal cord injury that has different etiologies. This paper presents a SCDys due to an unusual etiology.
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Rehabilitation of spontaneous muscle ruptures in a healthy young goalkeeper p. 36
Eduardo Freitas Ferreira, Diogo Portugal, Nuno Silva, Catarina Peixoto, André Ladeira, Catarina Matos, Leonor Prates
Spontaneous muscle ruptures in young adults without previous diseases or risk factors are extremely rare. No previous reports describing simultaneous spontaneous ruptures of multiple muscles in the healthy young adult have been published, emphasizing the lack of protocolized rehabilitation programs. In this article, the authors report a case of simultaneous spontaneous multiple muscle tears in a healthy goalkeeper, proposing a rehabilitation approach. A 19-year-old male goalkeeper presented to the emergency department with intense acute low back pain initiated spontaneously after raising from bed and originating gait difficulties. Magnetic resonance imaging demonstrated muscle ruptures in the left iliacus, piriformis, and paravertebral. Investigation for systemic causes of muscle tears was negative. The patient pursued a customized and phased rehabilitation program for a total of 6 months. In the re-evaluation at the end of the rehabilitation program, the patient presented no pain, had full range of motion and full muscle strength, and presented great stability and coordination. He was referred to sports medicine to pursue reintegration as a goalkeeper with functional sports-specific training. Although no cause for the ruptures was identified, the patients' sports-related activity may lead to microtear formation and trigger spontaneous tears. Thus, sports biomechanics may explain the underlying pathogenesis of these injuries. This case also highlights that an individualized rehabilitation program optimizes activity, participation, and professional reintegration.
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