Background: Acquired brain injury (ABI) can result in severe physical impairment causing difficulty with moving which, if not actively managed, can lead to contracture and deformity. Delayed access to rehabilitation may result in more contracture, with potential to increase duration of rehabilitation, cost and therapy time required. Objective: Describe the amount of therapy input for patients undergoing specialist in-patient rehabilitation following ABI, the differences in the type of therapy received by people with and without contracture and/or spasticity, and the impacts on functional outcomes including care needs and cost of care. Materials and Methods: A cohort analysis of prospectively collected data from 426 patients with ABI in a UK tertiary inpatient rehabilitation program. The Neurological impairment Scale (NIS) was used to identify the presence of spasticity or contracture. The Northwick Park Therapy Dependency Assessment (NPTDA) was used to calculate the therapy hours and type of treatment provided to people with and without spasticity and/or contracture. Outcomes (change in function and independence) were compared including the UK Functional Assessment Measure (UK FIM+FAM). Results: The Male/Female ratio was 63:37% with a mean age: 44.0(SD 13) years and a mean length of stay in specialist inpatient rehabilitation: 103 (SD 49) days. Aetiology: Stroke (63%), Trauma (20%); Hypoxia (7%): Other (10%). Patients with contractures were significantly more dependent than those without, both on admission and discharge. They stayed on average 31 days longer (95%CI 21.1, 40.5) (P=0.001) with an additional mean episode cost of £25,588 (95%CI £18.085, 34,043) (P<0.001). Despite this, they made similar overall functional gains resulting in similar long-term savings in the cost of ongoing care. Conclusion: Routine collection of the NPTDA supported quantification of the impact of spasticity and contracture on therapy inputs, length of stay, functional gains, and costs. People with contractures following ABI require more therapy time in rehabilitation to achieve similar functional gains, but nevertheless were cost-efficient to treat.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: The human corpus callosum (CC) is a primary commissural tract in the brain and serves as a major communication pathway between the cerebral hemispheres. Objective: The objective of this paper is to enhance understanding of the anatomic structure, topographic organization, function, and clinical relevance of the CC. Methods: To achieve this, we reviewed the literature for pertinent histological, anatomical, and advanced neuroimaging studies, and the findings were synthesized to provide the basis for the creation of novel color-coded schematic diagrams. Results: A standard midline sagittal magnetic resonance image was used to illustrate schematics of the CC partitioned into seven anatomic segments and the vascular supply of the CC from the anterior and posterior cerebral circulation. We further highlighted the microstructural features across each segment of the CC as well as the topographical organization of callosal fibers in connection with cortical regions of the brain. Finally, we applied these visual summaries as a guide for the discussion of the clinical relevance of the CC. Summary: Understanding the microstructural properties and related functional capacities of the CC is critical to understanding its clinical relevance. Consequently, having a clear and concise visual representation of complex callosal microstructural and anatomical features may be useful to the rehabilitation clinician in understanding overall clinical patterns seen in healthy populations across all ages and patients with neurologic injuries and pathologies with possible callosal involvement.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Platelet-rich plasma (PRP) may aid functional recovery in compressive neuropathies. Objective: To compare the effect of autologous PRP with corticosteroid injection in patients with refractory carpal tunnel syndrome (CTS). Materials and Methods: This was a randomized controlled trial on 84 adults, who received either single-dose, ultrasound-guided PRP or corticosteroid. Boston Carpal Tunnel Questionnaire and cross-sectional area of median nerve were assessed at 0, 4, and 12 weeks. Results: A statistically significant 54.76% improvement (P < 0.05) in functional status was observed in both the groups at 12 weeks. Conclusion: PRP is as effective as corticosteroids in relieving pain and improving function in CTS.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Arthrogryposis multiplex congenita (AMC) is a congenital disorder characterized by nonprogressive multiple joint contractures affecting one or more areas of the body, muscle weakness, and fibrosis. This term includes a heterogeneous group of diseases, neurological, neuromuscular, and genetic or mechanical origin. Two types of classification have been developed: A clinical one (types I, II, and III) and an etiological one. A multidisciplinary approach is needed for better care and appropriate follow-up. It is a case of AMC type 2A. A girl, with an antecedent of low levels of amniotic fluid, presented at birth with multiple malformations and stiffness of several articulations: bilateral clubfoot, bilateral clubhand, temporomandibular joint involvement, postural torticollis, and congenital hip dislocation. She had also a small persistence of arterial canal and ambiguous external genitalia. The care was performed by a multidisciplinary team including a physiatrist, pediatric surgeon, physiotherapist, prosthetist, and orthotist. In infants with arthrogryposis, joint stiffness is maximal at birth. The first step is passive mobilizations before surgical joint treatment. Azbell et al. found in their study that at 9 months of age, many of this infant's impairments of body structure and function, functional activity limitations, and participation restrictions improved. The program of stretching, muscle strengthening, facilitation of motor skills, orthopedic intervention, and parent education may have contributed to this infant's progress. Prospective intervention studies exploring specific intervention strategies are needed to establish the plan of care for these patients. Arthrogryposis describes a set of joint contractures present from birth and nonprogressive. The common physiopathological mechanism is fetal immobility syndrome. Multidisciplinary care is necessary and should be early and continued to gain maximum autonomy and facilitate social integration.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]