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rehabilitation

Indications for Rehabilitation in Acute Low Back Pain: Making a Correct Referral

Indications for Rehabilitation in Acute Low Back Pain: Making a Correct Referral

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2
Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH, is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. In addition, she trained as a physiotherapist and maintained an active license for 30 years. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.

Greg McIntosh, MSc, completed his Masters in Epidemiology from the University of Toronto’s Faculty of Medicine. He is currently the Director of Clinical Research for CBI Health Group and research consultant to the Canadian Spine Society.

Abstract
This article helps clinicians decide on appropriate referral to rehabilitation professionals while answering some of the common questions that clinicians are often asked by low back patients. The evidence for appropriate rehabilitation techniques will be interwoven into this article to promote a critical appraisal approach to evaluating rehabilitation outcomes. At the conclusion of this paper, clinicians should be able to identify best practices for rehabilitation referral.
Key Words: Low back pain, indications, rehabilitation, inter-professional referral.

Functional Gains for Stroke Survivors in Response to Functional Electrical Stimulation

Functional Gains for Stroke Survivors in Response to Functional Electrical Stimulation

Teaser: 

Janis J. Daly, PhD, MS, Director, Cognitive and Motor Learning Laboratory; Associate Director, FES Center of Excellence, Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Research Career Scientist, DVA, Washington, DC; Associate Professor, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

For those with persistent gait and upper limb deficits after stroke, it is difficult to obtain recovery of motor control and functional capability in response to standard care methods. Functional electrical stimulation (FES) is a promising intervention. Surface FES for wrist and hand muscles can result in improved impairment sufficient to produce important gains in functional capability. In addition, an FES gait training system with multiple channels and implanted electrodes has shown a statistically significant additive advantage for the recovery of coordinated gait components versus a comparable comprehensive gait training treatment without FES. Results were sufficiently robust to show important gains in quality of life.
Key words: stroke, functional electrical stimulation, neuromuscular electrical stimulation, functional neuromuscular stimulation, functional recovery, rehabilitation.

Behavioural Interventions Can Minimize Functional Decline in Mild Cognitive Impairment and Dementia

Behavioural Interventions Can Minimize Functional Decline in Mild Cognitive Impairment and Dementia

Teaser: 


Angela K. Troyer, PhD, CPsych, Department of Psychology, Baycrest Centre for Geriatric Care, Toronto, ON.
Kelly J. Murphy, PhD, CPsych, Department of Psychology, Baycrest Centre for Geriatric Care, Toronto, ON.

Functional decline in dementia causes increased dependence on others and negatively impacts quality of life. Emerging evidence indicates that functional debility can be delayed or minimized by promoting an active lifestyle and using memory strategies. Older adults with active lifestyles maintain higher cognitive abilities and have reduced risks of developing dementia. Furthermore, individuals with dementia show improved cognitive and functional abilities following participation in physically and mentally stimulating activities. Memory strategy application can improve situation-specific memory performance in individuals with mild cognitive impairment and dementia, and has been shown to positively impact perceptions of well-being and functional ability in these individuals.
Key words: active lifestyle, dementia, memory intervention, mild cognitive impairment, rehabilitation.

Sudden Deafness, Part 2: Rehabilitation

Sudden Deafness, Part 2: Rehabilitation

Teaser: 

Jerome D. Schein, PhD, Professor Emeritus, New York University, New York, NY, USA; Adjunct Professor, University of Alberta, Edmonton, AB.
Maurice H. Miller, PhD, Department of Speech-Language Pathology & Audiology Steinhardt School of Education, New York University, New York, NY, USA.

For persons whose hearing does not return in 60–90 days following idiopathic sudden sensorineural hearing loss (ISSNHL), audiologic rehabilitation should be provided. This article describes aspects of audiologic rehabilitation, including counselling, information about lifestyle changes, and techniques (such as amplification) for overcoming the communication handicap ISSNHL imposes. Advantages and limitations of various hearing aids are presented.
Key words: audiology, counselling, hearing aids, otology, rehabilitation, sensorineural, hearing loss.

Sudden Deafness, Part 1: Diagnosis and Treatment

Sudden Deafness, Part 1: Diagnosis and Treatment

Teaser: 

Maurice H. Miller, PhD, Department of Speech-Language Pathology & Audiology/Steinhardt School of Education, New York University, New York, NY, USA.
Jerome D. Schein, PhD, Professor Emeritus, New York University, New York, NY, USA; Adjunct Professor, University of Alberta, Edmonton, AB.

Hearing loss that occurs instantaneously or over a period of a few days without immediately apparent cause is called Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL). In part 1 of this series, the diagnosis and initial treatment of this condition are described in relation to most patients’ demands for active and aggressive intervention. Part 2 (to follow in the next issue) will address rehabilitation.
Key words: audiology, deafness, diagnosis, hearing aids, idiopathic, otology, rehabilitation, unilateral and bilateral hearing loss, sensorineural.

The Role of Rehabilitation in Parkinson’s Disease: A Review of the Evidence

The Role of Rehabilitation in Parkinson’s Disease: A Review of the Evidence

Teaser: 

K.H.O. Deane, BSc, PhD and C.E. Clarke, BSc, MD, FRCP, Department of Neurosciences, The University of Birmingham and City Hospital, Birmingham, UK.

Many clinicians, therapists and patients support the use of rehabilitation in the treatment of Parkinson's disease. However, systematic reviews reveal a lack of conclusive evidence to support the use of common forms of rehabilitation therapy in this movement disorder. Lack of evidence of efficacy is not proof of lack of effect. Large pragmatic randomized controlled trials are required to determine the effectiveness and safety of rehabilitation therapies for people with Parkinson's disease.
Key words: Parkinson's disease, occupational therapy, physiotherapy, speech therapy, rehabilitation.

Amplification: The Treatment Choice for Presbycusis

Amplification: The Treatment Choice for Presbycusis

Teaser: 

 

Doron Milstein, PhD, Hofstra University, Long Island, NY, USA.
Barbara E. Weinstein, PhD, Graduate School and University Center, CUNY, New York, NY, USA.

Hearing loss diminishes quality of life. The elderly rely on auditory input to maintain social contact and awareness of their environment, such that hearing loss in this age group can lead to isolation and withdrawal from the community. Most elderly individuals do not take advantage of available audiological services nor do they use hearing aids (HAs), the treatment of choice for their hearing loss. Modern HAs utilise digital technology and computer software to improve speech intelligibility. Current research reveals that HAs are effective in minimising the negative consequences of hearing loss in the daily functioning of the elderly. The availability of sophisticated technology allows for more efficient HA fitting, and allows the audiologist to spend more time counseling.
Key words: presbycusis, hearing aid technologies, rehabilitation, assistive listening devices.

Rehabilitation in the Elderly Stroke Patient

Rehabilitation in the Elderly Stroke Patient

Teaser: 

Robert W Teasell, MD, FRCPC, Professor and Chair-Chief, Department of Physical Medicine & Rehabilitation, St Joseph's Health Care, London, University of Western Ontario, London, ON.

Timothy J Doherty, MD, PhD, FRCPC, Assistant Professor, Department of Physical Medicine and Rehabilitation, The University of Western Ontario, London, ON.

Defining Stroke Rehabilitation
Rehabilitation has been defined as an active process by which those disabled by injury or disease can realize their optimal physical, mental and social potential with integration into the most appropriate discharge environment. Comprehensive stroke rehabilitation programs are staffed by a full range of rehabilitation professionals--nurses, physical and occupational therapists, speech-language pathologists, psychologists, social workers, recreational therapists and physicians. An interdisciplinary team skilled in the care of stroke patients provides a comprehensive rehabilitation program for each patient. Brandstater and Basmajian,1 and Roth et al.

Rehabilitation of Unilateral Neglect

Rehabilitation of Unilateral Neglect

Teaser: 

Gail A. Eskes, PhD
Department of Psychology,
Queen Elizabeth II Health Sciences Centre Assistant Professor,
Psychiatry and Medicine (Neurology),
Adjunct Professor, Psychology,
Dalhousie University, Halifax, NS.

Beverly C. Butler, BSc
Department of Psychology,
Dalhousie University, Halifax, NS.

 

Introduction
Unilateral neglect is a cognitive and behavioural syndrome after brain damage that can have serious consequences for patient recovery, rehabilitation success and long-term reintegration to independent living. Outcome studies commonly identify neglect and related sequelae as significant predictors of poor outcome in stroke patients in terms of increased need for assistance in self-care activities and decreased quality of life.

Definition and Clinical Presentation
Unilateral neglect is most commonly defined as a failure to orient, report or respond to stimuli located in the space or body contralateral to a brain lesion (often due to stroke or brain injury), despite adequate sensorimotor ability to do so.1 The neglect syndrome is fundamentally different from, although sometimes confused with, hemianopia, hemisensory loss or hemiplegia.

Stroke Rehabilitation: Geriatric Rehab or Dedicated Stroke Rehab Units?

Stroke Rehabilitation: Geriatric Rehab or Dedicated Stroke Rehab Units?

Teaser: 

There is no doubt that the best outcomes from stroke are achieved with the utilization of a coordinated interdisciplinary approach. This starts from the moment a stroke victim is identified. There is some evidence that a coordinated approach to pre-admission care--i.e. public education, centralized intake to facilitate thrombolysis, availability of neuroradiology, etc.--has a favourable effect on subsequent stroke morbidity. There can also be no doubt that the proper experienced care of a stroke team in the acute hospital is vital to the final outcome. First, the team ensures that an accurate diagnosis is made, and that proper supportive care (nutrition, including swallowing assessment if necessary, early mobilization, attention to skin and continence issues, etc.) and secondary prevention measures (anticoagulation, aspirin, etc.) are commenced.

Some patients can be discharged from hospital directly to their homes, and rely on either outpatient or home rehabilitation programs (if appropriate outpatient diagnostic and follow-up services are available, acute hospital admission is sometimes not necessary in the first place). These are generally patients with minor or no residual deficits. I include education as part of the rehabilitation model, so no patient would be discharged without some form of rehabilitation, even if no traditional speech, physical or occupational therapy is required. Other patients have such severe strokes that, almost immediately, the prognosis is known to be dismal. These patients are usually referred directly to long-term care programs.

However, there is a large number of intermediary patients who benefit from a formal inpatient rehabilitation program. Almost all of these patients are older, which begs the question, 'Should they be admitted to a geriatric rehab program or a stroke program?' Despite being the director of a large and excellent geriatric rehab program, I feel that the bulk of stroke patients should be handled in dedicated stroke units. The reasons for this are straightforward. Geriatric units are, by definition, generalist units. We have to care for patients with multiple problems and multiple medical diagnoses. This is our strength, but also our weakness. Like most skills, stroke rehabilitation is made better by larger volumes and more focus. Geriatric units do well on the motor problems associated with stroke, as these are not that different from those of patients with falls, fractures and deconditioning, who are our bread and butter. However, complex perceptual deficits require a degree of expertise that often overwhelms non-specialized units. However, for selected cases, there is a place for geriatric units in stroke rehabilitation. These are elderly patients who already had functional problems, and then have a stroke, which serves as 'the straw that breaks the camel's back.' These cases usually require attention to multiple problems, not just the stroke, and are better suited to the generalist nature of geriatric rehab. If stroke rehab and geriatric rehab programs are physically close, back and forth consultations are facilitated (even well selected stroke rehab patients can develop geriatric-type syndromes).

In my institution, there is reasonable consensus on most patients. However, one group falls through the cracks. This is previously healthy patients who have had a severe stroke, but who do have the potential to benefit from rehab. These patients often have stroke syndromes that would challenge the most experienced of stroke rehab professionals, and are often beyond the skill set available in geriatric rehab. Unfortunately, the tyranny of length of stay (LOS) is the enemy of these patients. Too specialized for geriatric rehab, they require too many resources from stroke units. I feel that this represents the failure of proper population-based planning. We need to have enough 'long-stay' stroke rehab beds to accommodate these patients. It does not make sense to prevent the most skilled professionals from caring for the most difficult strokes.

This issue has numerous articles on stroke, contributed by an international line-up of authors. Drs. Kennedy and Buchan discuss acute therapy in ischemic stroke, while Dr. Patten gives us information on some of the psychosocial issues involved. There are also articles on tests (reaction time) that predict recovery from acute stroke (Loranger and Doyon), gender issues in stroke (Clark), and the management of dysphagia in patients post-stroke (Perry). Several authors review the use of medications for primary and secondary stroke prophylaxis, including an article on the treatment of hyperlipidemia (Aronow), thrombolysis in elderly patients (O'Mahony), antithrombotic drugs for secondary stroke prophylaxis (Bennett and Bennett) and new frontiers in the treatment of stroke (Gladstone et al).

As well, we have our usual potpourri of geriatric articles. The topic of our ethics column this month is the ethics of receiving our flu vaccination (Sheehan and Gordon). The mental health column focuses on an atypical psychotic disorder, Capgras Syndrome (Sloan). In the Biology of Aging column, Dr. Mattson provides information on neuroplasticity and how the brain adapts to aging. The cancer column examines quality surgical cancer care in Ontario (Gagliardi)--a topic that has recently been much in the news--and for our Dementia column, Drs. Tong and Corey-Bloom from the University of California San Diego, review galantamine, a new medication for the treatment of Alzheimer disease.

Enjoy this issue.