Early Initiation Of Rehabilitation Research Articles

Preclinical treatment of patients with stroke

Stroke is the third leading cause of death and number one cause of disability in industrialised countries. Studies into the pathophysiology of acute ischaemic stroke have indicated that treatment options are likely to be optimized when early signs of stroke are recognized and treatment is initiated within 3 hours from symptom onset. Therefore, new conceptions heading towards early diagnosis, fast preclinical treatment, structured diagnostics, immediate initiation of acute therapy as well as early initiation of rehabilitation are required. It is well known that, for most patients, there is a long delay between the onset of symptoms and the start of therapy. Many factors are responsible for the time delay:signs and symptoms often go unrecognized and/or are minimized by patients, relatives and bystanders. Unlike trauma or myocardial infarction, stroke is not given a high priority by medical staff and/or emergency medical services (EMS). Although a small number of stroke patients is treated as emergency and attended to by the emergency medical services within this time window, this number could easily be increased by intensified public and emergency personnel education. At present the standard of care by the EMS personnel includes adequate cerebral oxygenation, treatment of cardiac arrhythmia, management of hypertension as well as therapy of hyperglycemia and hyperthermia. For the future, we hope that emergency medical services will be able to initiate therapies which must be administered within the first few hours of acute stroke after onset of symptoms. Early notification of hospitals would enable a particular stroke team to be present at the patient's admission.

General management of patients with ischaemic stroke

The management of patients with acute ischaemic stroke includes treatment of stroke itself, the management of medical problems, and the early initiation of rehabilitation. Current research focuses more on specific stroke treatment, such as reperfusion or prevention of extension of ischaemic brain damage, than on the management of general conditions and the treatment of medical complications associated with acute stroke. At present, a better prognosis of stroke is more often the consequence of good general management than of a specific therapy. General management of stroke includes cardiac and pulmonary care, fluid and ion balance restoration, metabolic maintenance, blood pressure control and prevention of bed sores and phlebitis. Treatment of elevated intracranial pressure and temperature control must also be considered in some cases. Several points, however, remain controversial, such as the treatment of arterial hypertension and the management of cardiac arrhythmia.

Current concepts in knee arthroscopy

Arthroscopic methods in the knee are used for diagnostic procedures and offer the surgeon a minimally invasive method for repairing a wide variety of injuries in both the acutely and chronically injured knee. These procedures are most often associated with minimal morbidity and early initiation of rehabilitation, and patients may return to work and their daily living activities at a faster rate than with conventional surgical methods. In the acute knee injury, arthroscopy has proven to be a valuable tool in defining the type and extent of the anterior cruciate ligament injury as well as providing definitive assessment of meniscal pathology. Partial menisectomy is the most commonly performed arthroscopic procedure in the knee, acounting for approximately 41% of the total arthroscopic procedures performed. Rapid advancement of arthroscopic techniques in chronic knee injuries, including patellofemoral disorders, osteochondritis dissecans, arthrofibrosis of the knee, degenerative arthritis and cruciate ligament injuries, has resulted in less surgical morbidity without disrupting uninvolved anatomy.

環軸椎脱臼における手術成績の検討

The operative results were studied on the comparison of the operative procedures in 43 patients with myelopathy due to atlanto-axial dislocation. Transoral anterior fusion was performed in 11 cases, transoral odontoidectomy in 5, McGraw's method in 13 and occipito-cervical fusion with a rectangular rod in 14. The cause of atlanto-axial dislocation was rheumatoid arthritis in 17, congenital anomaly in 17, trauma in 6 and idiopathic in 3. Occipito-cervical fusion with a rectangular rod was the best procedure for the improvement of the myelopathy. This procedure had a good effect on prevention of postoperative complications such as nonunion. This strong internal fixation allowed early initiation of rehabilitation with only simple cervical splints.

Occipitoatlantoaxial Fusion Utilizing a Rectangular Rod

Atlantoaxial subluxation has been treated conventionally by Gallie posterior fusion. This technique, however, has disadvantages such as the frequent occurrence of pseudarthrosis, a high probability of relapse, and the necessity of long-standing strict external fixation until bone fusion. To overcome these problems, posterior occipitoatlantoaxial fusion was performed using a rectangular rod that assures strong internal fixation in 16 patients with atlantoaxial subluxation. The condition was complicated by superior migration of the dens in five patients. Clinical and roentgenographic examinations before and after the operation showed improvements in neurological symptoms and in pain in the neck and occipital region in all patients. Bone fusion was observed in all patients and reduction, performed to the extent possible during the operation, was retained adequately. The present method, which provides strong internal fixation, allows bone fusion and early initiation of rehabilitation with a simple external support of the neck. It also facilitates laminectomy of C1 in patients with associated myelopathy. This procedure, therefore, is particularly effective in patients with marked instability or with rheumatoid arthritis and makes postoperative application of a halo vest or skull traction unnecessary.

Ｒｅｃｔａｎｇｕｌａｒ ｒｏｄによる後頭‐環軸椎後方固定術を行ったダウン症候群の１例

A case of Down's syndrome with atlantoaxial subluxation was reported. He was a 21-year-old male and had a wry neck. Hyperreflexia and pathological reflex in upper extremities were revealed but other neurological examinations were not performed because he was severely retarded. Cervical X-ray showed atlantoaxial subluxation with the ADI being 7mm (neutral position) and an unstable spine. It was hard to keep the patient at rest because of his mental retardation. He was treated with posterior fusion using rectangular rod. Bony fusion was obtained by 3 months. Since this procedure provides strong internal fixation, it allows early initiation of rehabilitation by the use of simple cervical splints and is advantageous for bone union.