Traumatic Etiology Research Articles

Imaging of renal emergencies: Review of infectious, hemorrhagic, vascular, and traumatic etiologies.

Diagnostic imaging allows for accurate and early recognition of acute renal pathologies, thus allowing for appropriate clinical triage, life-saving treatments, and preservation of renal function. In this review, we discuss the clinical presentation and imaging findings of renal emergencies with infectious, hemorrhagic, vascular, and traumatic etiologies.

Resection of Giant Cemento-Ossifying Fibroma of Jaws by Intraoral Approach—A Case Report and Review

Introduction: The World Health Organization in 1971 first classified fibro-osseous lesions (FOLs) as cementum forming tumors of jaws as ossifying fibroma (OF), cement-osseous dysplasia, and fibrous dysplasia. Various theories have been put forward regarding the origin of cemento-ossifying fibroma (COF) but current interests are oriented toward traumatic and developmental etiologies. The COFs are a slow-growing osteoexpansile tumor which grows to a considerable size. The tumor usually arises from tooth bearing and periodontal ligament region basically of odontogenic origin. Background: An inordinate, bony hard swelling, present united in both the jaws showing radiopaque-radiolucent mass, corticated margins, with expansion of buccal as well as lingual cortex gives a delusional image for the provisional diagnosis for surgeon, particularly to decide the surgical approach. These traits showing similarity with FOLs, more particularly cemento-OF, owing to its odontogenic or periodontal origin. Case Report: In this case, a 42-year-old female presented with abovementioned features was first taken for biopsy and then planned for simultaneous surgical resection of pathology for both jaws, from an intraoral approach giving a scar-free result. Preclusion of immediate complications was dealt with reconstruction of mandible with 2.5-mm titanium reconstruction plate. Conclusion: The diagnosis of cement-OF is based on clinical-radiographic-histopathologic evaluation. If remain untreated, these tumor can grow up to an average size of 80 mm, therefore, demanding an early surgical intervention. In our case, intraoral approach leads to almost no residual fibrosed tissue. The patient is further being planned for rehabilitation with either free fibula graft or 3-dimensional mandibular prosthesis.

Do not try at home alone; spontaneous pneumomediastinum due to handstand

Introduction: Spontaneous pneumomediastinum (SP) is the accumulation of air in the mediastinum without a surgical or traumatic etiology. It is thought that the basic mechanism triggering SP is the pressure difference that develops after a strong Valsalva maneuver.
 Case report: We presented a 50-year-old male patient was admitted to the emergency department with sudden onset chest and epigastric pain that started after standing up for a handstand. He had atrial fibrillation with rapid ventricular response with a hearth rate of 285 beat/min. Heart rate control was achieved after medical treatment. His computerised tomography was consistent with air in mediastinum. First line treatment was started and the patient was transferred to the thoracic surgery ward. 
 Conclusion: Spontaneous pneumomediastinum is one of the rare diagnoses that should be considered in patients presenting with chest pain and shortness of breath. It is important to correctly evaluate what may be associated with the valsalva maneuver among the sportive movements performed at home, and to keep in mind that SP can also occur in different age groups in order to make the correct diagnosis.

Ocular Trauma during the COVID-19 Pandemic in Sanglah Hospital, Denpasar, Bali From March 2020 to March 2021

BACKGROUND: The coronavirus disease 2019 (COVID-19) is an infectious disease characterized by severe acute respiratory syndrome caused by the coronavirus 2. The implementation of lockdown and social distancing is the efforts made by the government to prevent the spread of this virus. The COVID-19 pandemic has affected the incidence rate of ocular trauma in several means. AIM: This study aimed to evaluate the factors that can cause ocular trauma, from the patient’s characteristics, clinical presentation, etiology, and mechanism of ocular trauma of patients who came to the emergency unit of Sanglah Central General Hospital (RSUP) during the COVID-19 pandemic. METHODS: This study is an observational analytic study with simple random sampling method to evaluate the characteristics of patients with ocular trauma from March 2020 to March 2021. The secondary data were obtained from the medical records including age, gender, address, examination data (visual acuity, duration between trauma and time of seeking medical care, diagnosis, trauma etiology, trauma mechanism, and surgery performed on the patient). RESULTS: In this study the most common was the presence of corpus alienum/foreign body in the cornea, chemical trauma, corneal erosion, canaliculi rupture, and keratitis which are usually caused by photoelectric injury. During the COVID-19 pandemic, new regulations were implemented including patient screening, COVID-19 test before undergoing surgery, patient treatment, and also the use of personal protective equipment for the examiners. Moreover, there were behavioral changes of the people caused by the enforcement of lockdown system and also people’s fear of going to the hospital, especially to a COVID-19 referral hospital such as Sanglah General Hospital; therefore, some patients delayed seeking medical treatment and refused to have surgery at Sanglah General Hospital. CONCLUSION: Our study concluded that the trend of ocular trauma in the COVID-19 era tends to occur in the male population and involves trauma to the cornea, with the most common etiology is caused by the presence of foreign bodies such as gram, wood, or metal. Our finding also showed that despite the implementation of social distancing policies in the COVID-19 pandemic situation, ocular trauma can still be found related to the implementation of the lockdown that has been relaxed during this research.

Validation of Veterans RAND 12-Item Physical Function Survey in Minimally Invasive Transforaminal Lumbar Interbody Fusion.

Veterans RAND 12-item (VR-12) physical component score (PCS) has been validated in both veteran and US citizen populations; however, its use for spine surgery populations has not been evaluated. This study aims to correlate the VR-12 PCS survey with legacy patient-reported outcome measures (PROMs) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). A prospective surgical database was retrospectively assessed for MIS TLIFs performed at 1 level from March 2015 to June 2019. Inclusion criteria were elective procedures for degenerative spinal pathology. Patients were excluded if they had surgery for metastatic, traumatic, or infectious etiologies or had incomplete preoperative 12-item Short Form (SF-12) PCS or Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) survey. Additionally, patients with any incomplete VR-12 PCS surveys through 1 year were excluded. Demographics and perioperative characteristics were recorded. Mean postoperative PROM scores and score difference from preoperative baseline were calculated at each postoperative timepoint through 1 year. The relationship of VR-12-PCS with SF-12-PCS and PROMIS PF was evaluated with a Pearson's correlation coefficient and time-independent partial correlation. A total of 59 patients underwent single-level MIS TLIFs. The cohort was 44.1% women with an average age of 53.8 years, and 52.5% were obese (body mass index ≥30 kg/m2). The VR-12 PCS, SF-12 PCS, and PROMIS PF surveys had significant improvements from baseline to the 6 month through 1 year postoperative timepoints (P ≤ 0.001, all). All timepoints revealed strong VR-12-PCS correlations with SF-12-PCS and PROMIS PF (all P ≤ 0.001). VR-12 PCS, SF-12 PCS, and PROMIS PF scores all indicate statistically significant improvements in physical function for patients following MIS TLIF. VR-12 PCS was strongly correlated with the historically validated SF-12 PCS system as well as with the more recent PROMIS PF survey. Our observations give weight to utilizing the VR-12 PCS survey as a valid measure of physical function among patients undergoing MIS TLIF. This study validates VR-12 PCS to measure physical function for TLIF patients.

Perceived traumatic and stressful etiology of obsessive-compulsive disorder

A growing body of research has highlighted connections between obsessive-compulsive disorder (OCD) symptoms and traumatic and stressful life events. However, findings regarding the impact of traumatic and stressful events on posttraumatic stress symptoms are mixed, with some studies suggesting that the perception of an event as traumatic—regardless of the strict definition of trauma—may be most predictive of outcomes. Despite this, research has yet to ask individuals with OCD, themselves, why they believe their OCD developed; instead, findings linking trauma exposure and OCD are largely causally extrapolated. The current study examined the perceptions of OCD etiology in 45 individuals with OCD enrolled in residential treatment and qualitative responses were coded as traumatic, stressful, or other (i.e., non-event) etiologies. Nearly half of the sample (44.4%) believed their OCD developed following an identifiable event, six of whom identified a distinguishable traumatic event (13.3% overall). Individuals with perceived traumatic etiologies consistently endorsed engagement in more types of obsessions and compulsions, particularly in the past, and implicated themes of symmetry/exactness, repeating, checking, scrupulosity, pathological doubt, and hoarding. Findings suggest that events that occur pre-OCD onset may be likely to be perceived as the catalyst for OCD and may ultimately impact the theme and severity of symptoms in intuitive ways. • This study examined individual's subjective perceptions of why their OCD developed. • Nearly half of the sample attribute their OCD etiology to an identifiable event. • Traumatic etiology is more strongly related to symptoms than stressful etiology. • Traumatic etiology is related to obsessions and compulsions, especially in the past. • Traumatic etiology is consistently related to symmetry obsessions and compulsions.

Focused research in emergency medical systems in Asia: a necessity for trauma system advancement

Abstract Since trauma is a growing health problem worldwide, emergency trauma care including emergency medical services (EMS) is becoming an integral part of the healthcare system. The optimal EMS which will improve access to trauma care, will be different in each country because of different healthcare systems, trauma etiology, and economic situations. To adopt models that have succeeded in developed countries is not always appropriate. In order to identify the optimal EMS model in developing countries, comparing the systems among many countries in detail and examining their advantages and disadvantages would be necessary. Therefore, this article tries to identify important elements of EMS to achieve mature EMS systems based on comparisons of 7 Asian countries, and discusses the need to conduct more detailed and extensive comparisons.

Analysis of Patients With Blowout Fracture Caused by Baseball Trauma

Abstract The purpose of this study was to investigate the characteristics of blowout fractures caused by baseball trauma. The authors reviewed 337 cases of blowout fracture surgeries and included 330 eyes of 330 patients who underwent blowout fracture reconstruction between January 2017 and December 2020, in the Department of Ophthalmology at Korea university Hospital. Medical records including patient demography, trauma etiology, accompanied ocular disease, and preoperative computed tomography images were evaluated. Patients were categorized into 2 groups: a group with blowout fracture caused by baseball trauma and another group with trauma due to other causes. Two-wall blowout fracture (orbital floor fracture and medial wall fracture) was most common (63.16%) in the baseball group, followed by medial wall fracture (21.05%). In contrast, orbital floor fracture accounted for the largest proportion (42.11%) among other causes, and 2-wall blowout fracture accounted for the second largest proportion (31.83%). The most common accompanied ocular disease was traumatic hyphema and traumatic iridocyclitis (36.84%) in the baseball blowout fracture group. in contrast, subconjunctival hemorrhage was the most common ocular disease in the other-causes group (16.08%). The frequency of traumatic hyphema and irido-cyclitis was significantly different among the 2 groups (P < 0.05). Distribution of blowout fracture sites and frequent ocular disease differed between baseball blowout fracture patients and other-cause blowout fracture patients.

Uterine atony: Current trends in invasive treatment

Uterine atony is the leading cause of postpartum hemorrhage. The etiological mechanism has not been fully clarified. Various predisposing risk factors either pre-existing in pregnancy or appearing during pregnancy have been blamed to date for causing postpartum hemorrhage and uterine atony. The diagnosis of uterine atony is clinical. The diagnosis presupposes the confirmed emptying of the endometrial cavity and the exclusion of traumatic etiology bleeding from the genital system. The multidisciplinary treatment after the early recognition of bleeding it is useful to focus on achieving satisfactory uterine contraction with administration matrix contraceptives (oxytocin, erysipelas alkaloids, prostaglandin, carbetocin) and in maintaining its hemodynamic stability with the use of preservatives (massages, double compression of the uterus) and surgical techniques . The tamponade balloon Bakri, the package from gauzes, several types of hemostatic sutures, ligation of internal iliac arteries, uterine arteries embolism and obstetric hysterectomy are older and newer techniques included in the modern invasive treatment of uterine atony .In this article based on recent bibliography is attempted a review of this obstetric complication, regarding its basic principles of invasive treatment, the timely and correct application of which can yield the best possible result and ensure the best health of mother.

Magnetic Resonance Imaging as a Diagnostic and Research Tool in Patients with Olfactory Dysfunction: A Systematic Review.

Patients with acquired, idiopathic olfactory dysfunction (OD) commonly undergo magnetic resonance imaging (MRI) evaluation to rule out intracranial pathologies. This practice is highly debated given the expense of MRI relative to the probability of detecting a treatable lesion. This, combined with the increasing use of MRI in research to investigate the mechanisms underlying OD, provided the impetus for this comprehensive review. The purpose of this systematic review was to both assess the utility of MRI in diagnosis of idiopathic OD and to describe MRI findings among mixed OD etiologies to better understand its role as a research tool in this patient population. A literature search of PubMed, Embase, Cochrane, Web of Science, and Scopus for studies with original MRI data for patients with OD was completed. Studies exclusively investigating patients with neurocognitive deficits or those studying traumatic or congenital etiologies of OD were excluded. From 1758 candidate articles, 33 studies were included. Four studies reviewed patients with idiopathic OD for structural pathologies on MRI, of which 17 of 372 (4.6%) patients had a potential central cause identified, and 3 (0.8%) had an olfactory meningioma or olfactory neuroblastoma. Fourteen studies (42.4%) reported significant correlation between olfactory bulb volume and olfactory outcomes, and 6 studies (18.8%) reported gray matter volume reduction, specifically in the orbitofrontal cortex, anterior cingulate cortex, insular cortex, parahippocampal, and piriform cortex areas, in patients with mixed OD etiologies. Functional MRI studies reported reduced brain activation and functional connectivity in olfactory network areas. MRI uncommonly detects intracranial pathology in patients with idiopathic OD. Among patients with mixed OD etiologies, reduced olfactory bulb and gray matter volume are the most common abnormal findings on MRI. Further research is required to better understand the role of MRI and its cost-effectiveness in patients with acquired, idiopathic OD.

Temporary Posterior C1-C2 Instrumentation without Fusion for Treatment of Displaced Atlantoaxial Fractures

To describe open reduction internal fixation (ORIF) with posterior C1-C2 instrumentation without fusion to treat displaced atlantoaxial fractures with later instrumentation removal. A retrospective review identified 14 patients (mean age 44 years) with displaced atlantoaxial fractures treated with ORIF without fusion. Patient demographics, fracture morphology, trauma etiology, instrumentation levels, timing of hardware removal, and complications were collected. Patients were maintained in a cervical collar, and healing was confirmed via imaging before instrumentation removal. Fractures included type III odontoid, C2 pars, C1 ring, and complex C1 or C2 fractures. All cases used C1 lateral mass screws and C2 pars or pedicle screws with a C1 cross-link. Two patients had C3 lateral mass screws. All patients showed fracture healing on imaging within 4 months after ORIF. Instrumentation removal was performed in 13 patients. No complications were noted. Displaced atlantoaxial fractures have been traditionally managed with halo-vest immobilization closed reduction or ORIF with fusion. ORIF without fusion and subsequent hardware removal is an alternative approach. This strategy preserves mobility at C1-C2, avoids halo-vest immobilization, and appears to be a safe option for treatment of atlantoaxial fractures.

Idiopathic subglottic stenosis – a familial association and review of practice

Idiopathic subglottic stenosis describes subglottic stenosis where no inflammatory, traumatic, iatrogenic or other causative aetiology can be identified. The present study aimed to outline our institution's experience of patients diagnosed with idiopathic subglottic stenosis and describe a very rarely reported familial association. A retrospective review was conducted of prospectively maintained medical records from 2011 to 2020. Patient clinical, radiological and intra-operative data were reviewed to assess for defined endpoints. Ten patients with idiopathic subglottic stenosis were identified in this series. One familial pairing was identified, with two sisters presenting with the condition. Successful treatment with carbon dioxide laser and dilatation was achieved in most cases. Idiopathic subglottic stenosis represents a rare, clinically challenging pathology. Management with endoscopic laser and balloon dilatation is an effective treatment. This paper highlights a very rare familial association, and describes our experience in treating idiopathic subglottic stenosis.

Новые лабораторные тесты для оценки эффективности лечения больных с хроническим остеомиелитом костей стопы в условиях использования метода чрескостного остеосинтеза

Introduction The use of laboratory tests to monitor the treatment of patients with chronic osteomyelitis has a lot of clinical relevance. The purpose of the study was to identify laboratory tests for assessing metabolic processes in patients with purulent lesions of the foot bones for monitoring the dynamics of the recovery processes in the course of treatment. Methods The studies were carried out in 36 patients with chronic osteomyelitis of the calcaneus and adjacent bones of the foot of traumatic etiology. All patients were treated with the method of the Ilizarov transosseous osteosynthesis. Biochemical and coagulation parameters were studied. Results It was found that in patients with purulent lesions of the foot bones, the elevated levels of blood serum lactate were most frequently detected before surgery (52.8 %, 95 % CI: 36.6-68.6). The incidence of elevated CRP was 27.7 % (95 % CI: 14.6-43.3) on average, and one third of patients had elevated fibrinogen levels (33.3 %, 95-CI: 19.1-49, 3). During the treatment period, the incidence of elevated lactate levels in patients did not change but the incidence of elevated CRP levels increased significantly which was observed in 77.8 % of patients on the 3rd post-surgery day. By discharge from the hospital, elevated values of CRP and lactate occurred in 11.1 % of patients. It is assumed that the greatest diagnostic significance is the assessment of the level of lactate in the dynamics of the treatment in target patients. Discussion Based on the results of the studies, a laboratory sign was found that indicates the effectiveness of surgical treatment in patients with chronic osteomyelitis of the foot bones using the method of transosseous osteosynthesis. Such a sign is a decrease in the initially elevated concentration of lactate in the blood serum of patients in the postoperative period. The detected sign meets the requirements for its applicability in laboratory tests: 1) this sign is the most common in the target group of patients; 2) the dynamics of changes in the level of lactate correlates with the ongoing treatment; 3) this test is an indicator of a significant physiological process: oxidative metabolic processes in patients with the studied pathology.

Recurrent Syncopal Episodes Due to Atlanto-Axial Instability – An Unusual Presentation of Os Odontoideum

Os odontoideum is a rare cause of atlantoaxial instability. Despite being first described in 1886, its pathogenesis is still unclear, with theories for both congenital and traumatic etiologies. We report on an atypical presentation of this pathology, in a patient who was being investigated for recurrent syncopal episodes during performance of everyday activities, and who was unexpectedly found to have an os odontoideum. The patient underwent occipito-cervical fusion and had complete resolution of all her symptoms postoperatively.

Addressing Arthroscopic-Assisted Acromioclavicular Joint Reconstruction in the Beach Chair Position With Concomitant Labral Pathology in the Lateral Decubitus Position

High-grade Acromioclavicular (AC) injuries are complete dislocations, involving ruptures of the AC and coracoclavicular ligaments. They occur following trauma after a fall, direct-blow to an adducted arm, or indirectly by falling onto an abducted, outstretched extremity. Given this traumatic etiology, additional intra-articular pathologies can arise and may go unnoticed because of the painful and prominent AC joint (ACJ). Previous studies have evaluated patients with high-grade ACJ injuries with diagnostic arthroscopy at the time of an ACJ reconstruction. They found associated injuries to the labrum/biceps, rotator cuff, and articular cartilage. The arthroscopic-assisted ACJ reconstruction (AA-ACJR) technique has made it possible to identify the associated injuries and treat them concurrently. The previous studies have performed this reconstruction in the beach chair position (BCP) and have addressed the concomitant pathology in the same position. As opposed to the BCP, the lateral decubitus position (LDP) allows for easier application of traction to the arm and, thus, improves visualization of the glenoid, especially the inferior and posteroinferior portions. It is imperative to gain appropriate access to the inferior glenoid for anchor placement to address this component of traumatic instability. We present the technique for addressing high-grade ACJ injuries with AA-ACJR in the BCP preceded by labral repair in the LDP.

ORAL SMALL FIBER NEUROPATHY IN LYME DISEASE: IS BOTULINUM TOXIN TYPE-A A THERAPEUTIC OPTION IN ITS MANAGEMENT?—A CASE REPORT

<h3>Objective</h3> Small fiber neuropathy (SFN) has been associated with posttreatment Lyme disease syndrome (PTLDS), a chronic widespread pain condition with an enormous impact on quality of life. SFN has been associated with hyperalgesia and allodynia, as seen in fibromyalgia. In PTLDS, peripheral and central pain mechanisms involving SFN are likely present, with neuropeptide imbalance, leading to increased nociceptive signaling. Refractory SFN cases are challenging to manage, and Botulinum toxin type-A (BTX-A) could be a treatment option with long-lasting results and fewer side effects. BTX-A analgesic effects may be related to the disruption of vesicular transport into the synapse, inhibiting local/peripheral and central release of algogenic neurotransmitters, preventing neurogenic inflammation and peripheral sensitization. <h3>Case Summary</h3> A 41-year-old woman was assessed in January 2019 at the Oral Medicine clinic for constant severe palatal pain. In January 2018 she was diagnosed and treated for Lyme disease after thorough specialist investigation. Subsequently, she was diagnosed with fibromyalgia, trigeminal neuralgia, and SFN, among other conditions related to PTLDS. Therapeutic trials with amitriptyline and pregabalin were partially palliative, but the palatal pain persisted. She correlated the pain with "swelling and inflammation." Clinical examination revealed no mucosal lesion but a mild erythema and edema on the incisal papilla, along with hyperalgesia and allodynia on the rugae; blocking of the nasopalatine nerve relieved the pain. A traumatic etiology was ruled out using an occlusal splint, and neuropathic pain (SFN) was our tentative diagnosis. Topical compounded neuropathic pain ointment was partially palliative. A trial of 30 units local BTX-A injections resulted in improvement of her symptoms. The total dose injected was increased to 50 units in subsequent sessions, at 3-month intervals. After the second session, she had a significant improvement, reporting the "best 30 days in three years." In January 2021, she confirmed the progressive improvement of her condition. <h3>Conclusions</h3> These results indicate that BTX-A may be an alternative in managing oral neuropathic pain in Lyme disease. To our knowledge this is the first report of the use of BTX-A for this condition. Further research is needed to provide evidence to these assumptions and the conception of clinical guidelines.

Prevalence, multimodal imaging and genotype-phenotype assessment of trauma related subretinal fibrosis in stargardt disease.

Stargardt disease produces lipofuscin accumulation predisposing to subretinal fibrosis (SRFib) after ocular trauma. Noninvasive imaging techniques allow in vivo assessment. The purpose of this study is to determine the prevalence of SRFib in a cohort of Stargardt patients, the presence of history of ocular trauma, the clinical features and possible genotype-phenotype associations in Stargardt patients with SRFib. We evaluated retrospectively 106 Stargardt patients and analysed the multimodal imaging and the genotype of patients with SRFib. Six patients exhibited SRFib, three of them with history of ocular trauma. Multimodal imaging showed extensive SRFib principally in the temporal midperipheral retina with no fluid associated. SRFib was better defined by short wavelength autofluorescence and spectral domain optical coherence tomography and appeared clinically stable over time. There was no particular genotype associated to SRFib. SRFib occurs in a significant percentage of patients with Stargardt disease and can be diagnosed through multimodal imaging regardless the history of trauma, further sustaining the importance of an appropriate imaging in such patients. No genotype-phenotype association has been established, supporting the traumatic etiology in half of cases. The remaining cases may be classified as idiopathic or have a minimal trauma occurring early in life that may be not recalled by the patients.

Normalized kinematic walking symmetry data for individuals who use lower-limb prostheses: considerations for clinical practice and future research.

ABSTRACT Introduction Individuals who use unilateral transtibial or transfemoral prostheses have negative secondary health effects associated with decreased kinematic (e.g., spatiotemporal and joint angle) walking symmetry between prosthetic and intact limbs. Research studies have quantified kinematic walking symmetry, but studies can be difficult to compare owing to the inclusion of small sample sizes and differences in participant demographics, biomechanical parameters, and mathematical analysis of symmetry. This review aims to normalize kinematic walking symmetry research data across studies by level of limb loss and prosthetic factors to inform considerations in clinical practice and future research. Methods A search was performed on March 18, 2020, in PubMed, Scopus, and Google Scholar to encompass kinematic walking symmetry literature from the year 2000. First, the most common participant demographics, kinematic parameters, and mathematical analysis of symmetry were identified across studies. Then, the most common mathematical analysis of symmetry was used to recalculate symmetry data across studies for the five most common kinematic parameters. Results Forty-four studies were included in this review. The most common participant demographics were younger adults with traumatic etiology who used componentry intended for higher activity levels. The most common kinematic parameters were step length, stance time, and sagittal plane ankle, knee, and hip range of motion. The most common mathematical analysis was a particular symmetry index equation. Conclusions Normalization of data showed that symmetry tended to decrease as level of limb loss became more proximal and to increase with prosthetic componentry intended for higher activity levels. However, most studies included 10 or fewer individuals who were active younger adults with traumatic etiologies. Clinical Relevance Data summarized in this review could be used as reference values for rehabilitation and payer justification. Specifically, these data can help guide expectations for magnitudes of walking symmetry throughout rehabilitation or to justify advanced prosthetic componentry for active younger adults under 65 years of age with traumatic etiologies to payers.

Effects of an Inpatient Physical Rehabilitation Program Designed for Persons with Amputations of Traumatic or Vascular Etiologies

ABSTRACT Introduction Rehabilitation after amputation is essential, and descriptions of inpatient rehabilitation programs for individuals with amputation are scarce. Therefore, the objective of this study was to describe the effects of an inpatient physical rehabilitation program on mobility, balance, function, and gait of individuals with unilateral lower-limb amputations. Materials and Methods This was a retrospective before-after study. Data were extracted from medical records of individuals with lower-limb amputation admitted for inpatient intensive rehabilitation programs. Data on etiology, functional mobility (by timed up and go [TUG]), balance and functionality (amputee mobility predictor [AMP]), and gait (2-minute walk test [2MWT]) were collected before and after prosthetic fitting phase of an inpatient rehabilitation program. Patient information was stratified as traumatic and vascular etiologies, and after descriptive analysis, general outcomes and intragroup results were compared with t-test and followed by linear regressions analysis for a better understanding of the demographic and clinical roles on treatment evolution. Results Group comparison evidenced differences of age between traumatic and vascular groups, as traumatic amputations had greater incidence among younger individuals, regardless of the prosthesis phase. Before the prosthesis fitting and regardless of the groups, there were significant improvements on AMP, 2MWT, and TUG, and the differences between both groups were influenced by their baseline conditions. After prosthesis fitting, significant improvements were identified, regardless of the etiology. Conclusions This study provides evidence that individuals with amputation who are admitted to an intensive hospitalized physical rehabilitation program experience benefits in mobility, balance, functionality, and gait capacity irrespective of causality or if the prosthesis was provided. Gains evidenced in the preprosthetic phase were continued in the postprosthetic phase. Clinical Relevance Inpatient rehabilitation programs for individuals with amputation are beneficial for improving the functionality of these individuals. This type of multidisciplinary rehabilitation provides functional improvements to the patient from the preprosthetic to the prosthetic phases, favoring global rehabilitation in a short period, which can reduce treatment time and provide better living conditions for the patient.

Should Consistent Command-Following Be Added to the Criteria for Emergence From the Minimally Conscious State?

ObjectiveTo determine whether consistent command-following (CCF) should be added to the diagnostic criteria for emergence from the minimally conscious state (eMCS). DesignRetrospective cohort study. SettingInpatient rehabilitation hospital. ParticipantsPatients (N=214) with acquired brain injury resulting in disorders of consciousness (DoC) admitted to a specialized rehabilitation program. Main Outcome MeasuresDifference between time to recovery of CCF and time to recovery of functional object use (FOU) or functional communication (FC), the 2 existing criteria for eMCS as measured by the Coma Recovery Scale–Revised (CRS-R). ResultsOf 214 patients (median age, 53 years [interquartile range {IQR}, 34-66 years], male: 134 [62.6%], traumatic etiology: 115 [53.7%], admission CRS-R total score: 10 [IQR, 7-13]) admitted to rehabilitation without CCF, FOU, or FC, 162 (75.7%) recovered CCF and FOU or FC during the 8-week observation period. On average, recovery of CCF, FOU, and FC was observed within 1 day of one another, approximately 46 days (IQR, 38.25-58 days) post injury. One hundred and sixteen patients (71.6%) recovered FOU or FC prior to or at the same time as CCF. ConclusionsIn patients recovering from DoC, CCF reemerges around the same time as FOU and FC. This finding may reflect the shared dependency of these behaviors on cognitive processes (eg, language comprehension, attention, motor control) that are essential for effective interpersonal interaction and social participation. Our results support the addition of CCF to the existing diagnostic criteria for eMCS, but further validation in an independent sample should be conducted.