Prognosis For Recovery Of Function Research Articles

Occupational therapy and end-of-life care: Development of high-density foam orthosis as comfort measure

An orthosis is a rehabilitation device applied to a body segment (with one or more joints), whose function is to stabilize, immobilize, prevent, or correct deformities, and maximize patient functionality.However, in end-of-life care and palliative rehabilitation, changes are needed for orthosis prescription, once the main objective is comfort and symptom management. The aim of this article is to present a specific model of high-density foam orthosis developed in a Brazilian hospice for terminally ill patients, and discuss about the roles and strategies in palliative rehabilitation. This orthosis model is proposed for patients with advanced disease and no prognosis of functional recovery. It is manually made with high-density foam, cotton fabric, board velcro, EVA (ethylene vinyl acetate), hot glue, folding or electric knife. The foam is cut with the folding knife according to the required orthosis model, then covered with fabric and EVA. Board velcro is added to place the device on the patient. Positive results can be described: adherence to the use of the orthosis, minimal discomfort reported, muscular relaxation/tonus regulation, pain management and reduction of edema. Rehabilitation is an integral part of Palliative Care, and in case of terminally ill patients, comfort is the main objective of the care plan. The intervention of Occupational Therapy and the use of foam orthosis is an important strategy to achieve this goal.

Connectome-based predictive modeling for functional recovery of acute ischemic stroke

Patients of acute ischemic stroke possess considerable chance of recovery of various levels in the first several weeks after stroke onset. Prognosis of functional recovery is important for decision-making in poststroke patient care and placement. Poststroke functional recovery has conventionally been based on demographic and clinical variables such as age, gender, and severity of stroke impairment. On the other hand, the concept of connectome has become a basis of interpreting the functional impairment and recovery of stroke patients. In this research, the connectome-based predictive modeling was used to provide predictive models for prognosing poststroke functional recovery. Predictive models were developed to use the brain connectivity at stroke onset to predict functional assessment scores at one or three months later, or to use the brain connectivity one-month poststroke to predict functional assessment scores at three months after stroke onset. The brain connectivity was computed from the resting-state fMRI signals. The functional assessment scores used in this research included modified Rankin Scale (mRS) and Barthel Index (BI). This research found significant models that used the brain connectivity at onset to predict the mRS one-month poststroke and to predict the BI three-month poststroke for patients with supratentorial infarction, as well as predictive models that used the brain connectivity one-month poststroke to predict the mRS three-month poststroke for patients with supratentorial infarction in the right hemisphere. The connectome-based predictive modeling could provide clinical value in prognosis of acute ischemic stroke.

789 Role of Speech Therapy (SLP) in the rehabilitation of a complicated case of glossoparesis (GP)

IntroductionGlossoparesis is defined as a neurodegenerative process resulting in progressive dysphagia and dysarthria. The deinervation of the tongue and related structures results in flaccid muscle function unilaterally and bilaterally, this process is difficult to treat and rehabilitate and prognosis is considered poor. We encountered this in a patient that had a complicated case of necrotizing fasciitis (NF) that arose from an abscessed tooth.The purpose of this case report is to summarize the overall approach to a rehabilitation plan which resulted in successful return to speech and partial swallow.MethodsThe patient was diagnosed with an abscessed tooth which resulted in Necrotizing fasciitis of the face, neck and chest. Multiple surgical interventions resulted in removal of necrotic tissue and reconstructive interventions were implemented. Initial prognosis of return of function was noted as “poor” per ENT services. Ear, Nose and Throat (ENT) specialist noted that prognosis for recovery of function is unknown but was low.Speech Therapy was also consulted and an individualized plan of care to address the deficits assessed was developed. Initial prognosis of return of functional speech / swallow was guarded. It was felt to be highly appropriate to provide the patient with therapeutic options.Speech Therapy sessions included use of Neuromuscular Electrical Stimulation, Thermal Stimulation, Tactile Stimulation, Therapeutic Massage to affected regions, Deep Pharyngeal Neuromuscular Stimulation, finger occlusion trials for speech production attempts to ready patient for use of Passy Muir Valve, Oral Motor Exercises, Laryngeal Elevation Tasks, Vocal Stretching / Relaxation tasks and oral trials of ice chips as musculature function improved.ResultsThrough the use of these multiple modalities of skilled speech therapy intervention, the patient had return of functional verbal communication prior to discharge to a skilled rehabilitation program.ConclusionsUpon initial evaluation, the true potential for return of function was questioned. It is paramount that patient be given an opportunity to succeed - to be included in the plan of care - to be provided with opportunities to return to their prior level of function or as close as possible. There is little to no research regarding return of function for patients affected by glossoparesis.

Early clinical predictors of functional recovery following traumatic spinal cord injury: a population-based study of 143 patients.

Traumatic spinal cord injuries (TSCI) are associated with uncertainty regarding the prognosis of functional recovery. The aim of the present study was to evaluate the potential of early clinical variables to predict the degree of functional independence assessed by Spinal Cord Independence Measure III (SCIM-III) up to 1year after injury. Prospectively collected data from 143 SCI patients treated in Western Denmark during 2012-2019 were retrospectively analysed. Data analysis involved univariate methods and multivariable linear regression modelling total SCIM-III scores against age, gender, body mass index (BMI), comorbidity, American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades A-B and C-D, ASIA Motor Score (AMS), timing of surgical treatment and occurrence of medical complications. Statistical significance was set at p < .05. Univariate analyses indicated that variables significantly associated with decreased functional independence included increased age (p = .023), increased BMI (p = .012), pre-existing comorbidity (p = .001), AIS grades A-B (p < .001), decreased AMS (p < .001) and occurrence of medical complications (p < .001). However, in the multivariable regression model were pre-existing comorbidity (p = .010), AIS grades A-B (p < .001), low AMS (p < .001) and late surgical treatment (p = .018) significant predictors of decreased functional independence 1year after injury. TSCI patients with greatest potential for functional recovery up to 1year after injury seem to be patients that immediately after trauma present with few or no comorbidities, who sustain motor-incomplete injuries and undergo early decompressive surgery.

Chapter 12 - Role of the neurotologist in posterior fossa meningioma surgery

Posterior fossa meningiomas that impinge on structures of the temporal bone or clivus may be difficult to access for optimal resection that maximizes tumor control and minimizes short- and long-term morbidities. To address this challenge, the contemporary neurosurgery-neurotology team works collaboratively by managing patients jointly at every stage of care: preoperative evaluation, intraoperative intervention, and postoperative treatment. The neurotologist is important at all stages of posterior fossa meningioma surgery. First, detailed preoperative evaluation of auditory, facial, vestibular, and lower cranial nerve integrity enables assessment of new neurologic deficit risk, prognosis of functional recovery, and pros and cons of candidate surgical approaches. Second, intraoperative partitioning of surgical steps by provider and adopting an overlapping tumor resection philosophy creates an efficient and confident surgical team built on trust. Third, postoperative closure of cerebrospinal fluid leak and treatment of facial weakness, audiovestibular dysfunction, and voicing and swallowing impairments organized by the neurotologist reduces the impact of negative outcomes. The role of the neurotologist in posterior fossa meningioma surgery is to deliver nuanced evaluative metrics, facilitate shared decision making, perform precise bone and soft tissue microsurgery, and mitigate perioperative morbidities.

Fractura de cadera en el paciente anciano: factores pronóstico de mortalidad y recuperación funcional al año

ObjectiveThe aim of this study is to identify the risks factors for mortality and functional recovery in elderly patients admitted to hospital with a hip fracture. Materials and methodsLongitudinal prospective study in patients 80 years old or more and patients between 75 and 79 in residential home care with a hip fracture and with a past medical history of dementia or followed-up by the Geriatric Unit. A total of 359 patients were included, and the demographic data, previous functional status, comorbidity, type of fracture, and dementia were recorded. The data collected during admission included time to surgery, delirium, functional recovery, length of stay, placement at discharge, and mortality. Patients were followed-up for one year and details were collected on placement at the end of follow-up, functional recovery, medical complications, and mortality. ResultsThe baseline characteristics of the patients with a strong association with mortality after a hip fracture were old age (> 92 years), medical complications delaying surgery (HR 2.17; 95% CI; 1.27-3.73), diagnosis of dementia (HR 1.78; 95% CI; 1.15-2.75), or heart failure (HR 1.75; 95% CI; 1.12-2.75). The fitted multivariable regression models showed that functional impairment before the hip fracture or lack of functional recovery are associated with higher mortality, and patients with increased age, delirium, dementia, and previous functional impairment showed worse functional recovery. ConclusionIn the elderly patients with a hip fracture, increased age, comorbidity and previous functional status is associated with mortality. Functional recovery prognosis will depend on age, previous functional status, past medical history of dementia, and the presence of delirium during admission.

Femoral nerve and lumbar plexus injury after minimally invasive lateral retroperitoneal transpsoas approach: electrodiagnostic prognostic indicators and a roadmap to recovery.

Injury to the lumbosacral (LS) plexus is a well-described complication after lateral retroperitoneal transpsoas approaches to the spine. The prognosis for functional recovery after lumbosacral plexopathy or femoral/obturator neuropathy is unclear. We designed a retrospective case-control study with patients undergoing one-level lateral retroperitoneal transpsoas lumbar interbody fusion (LLIF) between January 2011 and June 2016 to correlate electrodiagnostic assessments (EDX) to physiologic concepts of nerve injury and reinnervation, and attempt to build a timeline for patient evaluation and recovery. Cases with post-operative obturator or femoral neuropathy were identified. Post-operative MRI, nerve conduction studies (NCS), electromyography (EMG), and physical examinations were performed at intervals to assess clinical and electrophysiologic recovery of function. Two hundred thirty patients underwent LLIF. Six patients (2.6%) suffered severe femoral or femoral/obturator neuropathy. Five patients (2.2%) had immediate post-operative weakness. One of the six patients developed delayed weakness due to a retroperitoneal hematoma. Five out of six patients (83%) demonstrated EDX findings at 6weeks consistent with axonotmesis. All patients improved to at least MRC 4/5 within 12months of injury. In conclusion, neurapraxia is the most common LS plexus injury, and complete recovery is expected after 3months. Most severe nerve injuries are a combination of neurapraxia and variable degrees of axonotmesis. EDX performed at 6weeks and 3, 6, and 9months provides prognostic information for recovery. In severe injuries of proximal femoral and obturator nerves, observation of proximal to distal progression of small-amplitude, short-duration (SASD) motor unit potentials may be the most significant prognostic indicator.

Acute granulocyte macrophage-colony stimulating factor treatment modulates neuroinflammatory processes and promotes tactile recovery after spinal cord injury

Neuroinflammation is known to play a key role in the prognosis of functional recovery after spinal cord injury (SCI). The involvement of microglial and mast cells in early and late stages of inflammation has been receiving increasing attention. This study was aimed at determining the influence of a pro-inflammatory cytokine, the granulocyte macrophage-colony stimulating factor (GM-CSF), on microglia and mast cell activation, glial scar formation and functional recovery following SCI. Rats were randomly injected with saline or GM-CSF one hour after a C4–C5 medio-lateral hemisection. To assess functional impairment and recovery, the rats were subjected to sensorimotor tasks for one month. Then, responses evoked by forepaw stimulation in the primary somatosensory cortex were recorded. We also quantified the changes in GM-CSF, IL-1β, IL-6 and BDNF levels, the gliosis and lesion volume as well as microglial and mast cell density, and mast cell surface. Our findings show that GM-CSF promotes cortical reactivation and recovery of tactile abilities, whereas it does not influence motor performances. A transient decrease in pro-inflammatory cytokines after GM-CSF treatment was also observed, whereas the endogenous GM-CSF level was unchanged. While the beneficial role of GM-CSF in reducing glial scar is confirmed, our findings reveal that neuroinflammatory events mediated by microglial and mast cells as well as the alteration of IL-1β and IL-6 levels are paralleled with an improvement in tactile recovery. These mechanisms could limit the duration and intensity of homeostatic imbalance and promote the plasticity of spared tissues.

Good outcome is possible after months of refractory convulsive status epilepticus: Lesson learned

Determining a prognosis for functional recovery after prolonged status epilepticus can be difficult. Prior case studies have shown that despite seizure control, functional outcomes are typically poor unless a reversible cause is identified. Herein we present a case of idiopathic status epilepticus with a surprisingly good outcome after a 125-day drug-induced coma.

Acute spinal subarachnoid haematoma following spinal anaesthesia treated conservatively: case report

Acute spinal subarachnoid haematoma following spinal anaesthesia treated conservatively: case report

Transfixing Ligature in Lumbar (L1-L2) Vertebral Dislocation in a Dog

A case of vertebral lumbar dislocation (L1-L2) in a German Shorthaired Pointer was analysed concerning aetiology, neurological status, radiographic appearance and treatment. The lesions were observed in the lumbar vertebral region (L1-L2) where caudal vertebral segment was displaced. The cause of vertebral dislocation was vehicular trauma. Clinical signs were represented by decubital position, tumefaction in lumbar region, deformity, instability and pain at palpation. Also the pain sensation was observed distal to region dislocated. The vertebral dislocation was confirmed radiologically. Dorsal and dorsolateral surgical approaches are applicable to the lumbosacral and thoracolumbar spine. Because compression of the spinal cord was not observed, we did not performe laminectomy. In this case, the dog was treated by a dynamic fixation technique which requires a minimal instrumentarium. After a manual repositioning of the dislocated vertebrae, two pins were placed laterally to the vertebral spinous processes and were fixed by wires passed through spinous processes. Although the dog was hospitalized significantly longer than the conservatively managed patients, after three weeks it was functional recovered without any postoperative complications. Our results confirm that dogs with pain sensation distal to dislocation site prior to surgery have a good prognosis for functional recovery. The lumbar dislocated vertebrae stabilized with pins and wires fixation techniques is a good choice in case of vertebral dislocation.

On the prognosis of outcome after stroke.

The study was aimed at improving the accuracy of prognosis for recovery of function in patients suffering a first stroke. Two-hundred and forty-eight patients were enrolled. The mean interval since the stroke was 23 days. Patients entered a rehabilitation program lasting 60 days. The predictive value of 12 factors were analysed, namely motor, cognitive and sphincter subitems of Functional Independence Measure at admission (FIM-a), age, sex, education, body mass index (BMI), depression, neglect, aphasia, ideomotor and constructive apraxia. FIM score at discharge was the dependent variable. A multiple regression revealed that only age, cognitive and sphincter subitems of FIM-a, neglect and ideomotor apraxia were significantly associated with outcome. Moreover, these factors accounted for only 72% of the variance in outcome scores. A decision of unfavourable prognosis on the basis of a FIM-a value lower than 40 was incorrect in 2.8% of the patients in this study and in 8.2% of those having a FIM score lower than 40. The use of statistical methods to examine the outcome after stroke is useful for expressing probability on a group basis but is unsuitable for determining the prognosis of individual patients. Such data should not be used for fiscal management. A significant minority of patients presenting with a FIM lower than 40 can regain a useful measure of independence. The errors in prognosis based upon available methods, although small, have unacceptable effects in human terms if they lead to the clinical decisions which deny patients rehabilitation. All of the patients should therefore be admitted for rehabilitation after their first stroke. Severe comorbidity requires special attention.

Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness

To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self-care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge. Observational. Tertiary care hospital, community teaching hospital. Older (aged >or=70) patients nonelectively admitted to general medical services (1993-1998). Number of ADL disabilities at preadmission baseline and 1, 3, 6, and 12 months after discharge. Outcomes were death, sustained decline in ADL function, and recovery to baseline ADL function at each time point. By 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Of those discharged at baseline function, 17.8% died, 15.2% were alive but with worse than baseline function, and 67% were at their baseline function (P<.001). Of those discharged with new or additional ADL disability, the presence or absence of recovery by 1 month was associated with long-term outcomes. Age, cardiovascular disease, dementia, cancer, low albumin, and greater number of dependencies in instrumental ADLs independently predicted failure to recover. For older adults discharged with new or additional disability in ADL after hospitalization for medical illness, prognosis for functional recovery is poor. Rehabilitation interventions of longer duration and timing than current reimbursement allows, caregiver support, and palliative care should be evaluated.

Psychiatric outcome of localized head injury in children.

Previous studies have shown a high prevalence of psychiatric disturbance in children with brain injury. Studies on localized lesions have suggested that injury to the young organism carries a better prognosis for recovery of function than injury at a later age. The present study was designed to investigate these phenomena systematically. A representative sample of children (n = 98) who had been hospitalized for treatment of a compound depressed fracture, associated with a dural tear and visible damage to the underlying cortex, was identified from the records of neurosurgical units throughout the United Kingdom. The children were aged between 3 months and 12 years at the time of injury and between 5 and 15 years at the time of examination. The interval between injury and examination varied but the sample was designed to include only children who had been injured at least two years before examination. The children were examined neurologically and psychometrically, a detailed account of their current psychiatric state was obtained from one or both parents, and their mental state was assessed in a standard psychiatric examination. Preliminary data are presented which relate psychiatric, educational and intellectual status at the time of examination to site and severity of injury, age at injury, and to a number of psychosocial variables.

MO35 Post-traumatic coma: re-evaluation of the SEP patterns in the prognosis of functional recovery vs. severe disability

MO35 Post-traumatic coma: re-evaluation of the SEP patterns in the prognosis of functional recovery vs. severe disability

Usefulness of the tail-flick reflex in the prognosis of functional recovery in paraplegic rats

Background This study examines whether return of the TFR is predictive of locomotor recovery after complete SCI in rats. Methods We evaluated TFRs in 39 adult female rats. The spinal cords of rats were compressed at T9 with Yasargil clips. The TFR and BBB were performed on each rat after surgery, at 24 hours, on the fourth day, and weekly. Results On the first day, all of these 39 rats had a BBB score of 0. Of these, the TFR in response to tail pinch was present in 16 (41%) cases. Of the 16 rats, 12 (75%) showed a gradual increase in BBB scores during subsequent weeks. However, in the 23 animals in which the TFR was absent, none showed improvement in BBB score or return of hindlimb movements. Conclusions We conclude that after complete SCI, return of the TFR correlates strongly with return of motor activity.

Spinal fracture and luxation in dogs and cats

The purpose of this retrospective study was to review cases of spinal fractures or luxations (SFL) treated with various modalities in order to describe fracture location, neurological status, treatment, outcome and complications in a patient population at a single centre. The medical records of dogs and cats that had been diagnosed with a SFL between C1 and L7 between January 1995 and June 2005 were reviewed in order to collect pertinent data. Ninety-five cases were included in this study. The severity of spinal cord injury was graded on a scale from 0 to 5. Vehicular trauma was the most common cause of SFL. Spinal fractures were localized between C1-C5 in 10 cases, C6-T2 in one case, T3-L3 in 54 cases, L4-L7 in 36 cases. Thirty patients that were euthanatized without treatment had a median neurological score of 5. Twenty-eight patients, all of which had motor function, were treated conservatively and there was not any change in their median neurological grade at the time of discharge. Thirty-seven patients had surgery, 27 of which were non ambulatory. Thirty-five of 37 were stabilized using pins and/or screws and PMMA or various other techniques. The median neurological grade of surgically treated patients improved by one point between the time of initial diagnosis and discharge. Implant removal was performed in five cases. The patients that were treated with pins and/or screws and PMMA were significantly more improved than conservatively managed patients at the time of discharge, although the surgically treated patients were hospitalized significantly longer than the conservatively managed patients. Our results suggest that dogs that retain pain sensation prior to surgery have a good prognosis for functional recovery. In this study, the dogs that were treated conservatively retained purposeful movement and had a good prognosis for recovery.

Prognostication and management of patients who are comatose after cardiac arrest

The development of cardiopulmonary resuscitation by Peter Safar and others has had the unintended consequence of increasing the number of patients surviving in coma from hypoxic-ischemic encephalopathy. Neurologists often assess the prognosis for functional recovery of these patients, communicate this prognostic information to the patient’s family, and help manage the patient through the initial post-arrest period and through subsequent recovery, rehabilitation, or transition to palliative management. Prognostication in the United States has predominantly been based on physical findings elicited at defined time points after resuscitation, typically using data from the work of the Cornell group.1,2 In the past 25 years, many have attempted to improve prognostication by adding electrophysiologic or biochemical tests. Of the electrophysiologic studies tested, short-latency somatosensory evoked potentials (SSEPs) emerged as the most robust predictor of poor outcome: loss of the cortical …

Functional palatomaxillary reconstruction

Palatomaxillary defects are inherently more complex than defects of the mandible due to the 3-dimensional shape and the location in the midface region, at a distance from most of the recipient vessels used in free tissue transfer. However, the same reconstructive principles that have been applied in oromandibular defects can be utilized for palatomaxillary defects. The prognosis for functional recovery in these reconstructions is outstanding due to the fact that the tongue is unaffected in midface tumors. The authors review the previously introduced staging system that assists in reporting and communication, and most importantly in treatment planning. The options for management of Class 1, 2, and 3 defects are discussed in detail. Dental restoration using dental implants for support and anchorage provides the foundation for functional dental rehabilitation.

Does the Presence of Ideomotor Apraxia Affect the Prognosis of Functional Recovery in a Women Who has a Stroke?

A 74-year-old woman was transferred from a local acute care hospital to the stroke rehabilitation unit in my rehabilitation center. She had been admitted to the hospital 9 days earlier after experiencing unsteady gait and left hemiparesis for 24 hours. A computed tomography (CT) scan of the head in the acute care facility indicated that the patient had a right-sided parietal infarct and that she had a pre-existing left frontal infarct that had gone undetected until the current episode. She had a history of non–insulin-dependent diabetes mellitus, emphysema and recurring bronchitis, hyperlipidemia, and hypertension. The patient was treated with aspirin and 2 liters of oxygen per minute delivered through a nasal cannula. Medications prescribed during hospitalization and continued during rehabilitation included Lasix* (furosemide, a diuretic) and Sectral† (acebutolol hydrochloride, a beta blocker) to treat hypertension, Zocor‡ (simvastatin) to treat hyperlipidemia, and Aerolate§ (theophylline, a bronchodilator) to treat emphysema. The patient lived alone in a single-level, 6-room house that required climbing 5 steps to enter. Two years earlier, she had retired from her job as a factory worker on disability compensation because of pulmonary disease. She was independent in all mobility and self-care activities prior to admission; however, she had stopped driving years earlier after an accident. Her sister regularly drove her to the grocery store. Her diet largely consisted of prepared, processed food that was reheated in a microwave. She spent most of her time crocheting and watching television. She continued to smoke 1.5 packs of cigarettes a day. Her goal was to return home independently. Because she did not have insurance, the social worker on the stroke rehabilitation unit began the paperwork for Medicaid coverage. My examination of the patient revealed several perceptual deficits. She was unable to discriminate left from right during mobility tasks …