A new scientific statement says a remote exam using high-quality videoconferencing equipment is as effective as a bedside stroke evaluation.

Physicians must quickly evaluate stroke patients to determine if they’re eligible for time-sensitive treatment such as tissue plasminogen activator (tPA) that can save brain function and reduce disability. Stroke and brain imaging specialists are often required to perform the evaluation. However, the United States has only an average of four neurologists per 100,000 people, and not all of them specialize in stroke, according to the statement.

Telemedicine, or telestroke, uses interactive videoconferencing via webcams connected to a TV or computer screen, which allows the patient, family and the bedside and distant healthcare providers to see and hear each other in full color and in real time.

Telestroke is coupled with teleradiology, which allows remote review of brain images. This technology can broaden the reach of neurologists in a cost-effective and time-efficient manner.

“Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income or social circumstance,” said Lee Schwamm, M.D., lead author of a scientific statement and policy statement on telemedicine, and associate professor of neurology at Harvard Medical School and Vice Chairman of Neurology at Massachusetts General Hospital.

To be effective, however, there needs to be changes in how telemedicine activities are reimbursed, he said. For that, policy recommendations were released along with the scientific statement. The policy statement recommends:
Deploying telestroke systems to supplement resources where around-the-clock local, on-site acute stroke expertise is insufficient.

Increasing Medicare reimbursement for telestroke assessment, diagnosis and approval to use tPA to reflect the increased upfront costs of implementation.

Developing a mechanism for uniform, streamlined credentialing for telestroke providers and uniform national telemedicine licensure by state medical boards.

Increasing funding sources for stroke telemedicine programs which could include designating support from the federal American Recovery and Reinvestment Act of 2009.

Source:
Maggie Francis
American Heart Association

Researchers have called for a national database to be set up to identify major complications arising from epidural pain relief after a small number of serious problems were identified during a six-year UK study, according to the April issue of Anaesthesia.

They discovered that 12 of the 8,100 people studied developed major complications after receiving epidural pain relief following an operation. Six developed epidural abscesses, three suffered from meningitis and three had blood clots in the epidural space.

Twelve different anaesthetists sited the epidural catheters and the patients were managed on five different wards after surgery. All the epidural insertions met recommended aseptic techniques to minimise infection.

“Although relatively rare, these complications are serious and point to the need for regular surveys to be carried out after epidural pain relief to identify risk factors and the scale of the problem” says consultant anaesthetist Dr Iain Christie from Derriford Hospital, Plymouth, UK.

“For example, epidural abscesses can cause neurological damage and paralysis of the lower limbs if left untreated.”

The survey which took place between 2000 and 2005 gathered information from four key sources.

Researchers looked at the hospital’s patient information system to identify patients undergoing surgery and the acute pain service to identify all patients receiving epidural pain relief after surgery.

They also looked at any patients who had received a spinal MRI scan or undergone relevant microbiological investigations within 60 days of surgery.

Before they carried out the survey clinicians were aware of seven patients who had suffered major complications after epidural pain relief during the study period. The survey identified a further five.

“Patients have a much better outcome if they are diagnosed and treated before neurological symptoms develop” stresses Dr Christie. “It is particularly important to monitor leg weakness – as this is an important measure of spinal cord health – and ensure that patient information systems pick up any infections following discharge from hospital.”

The authors point out that other reported cases of epidural abscesses following epidural pain relief indicate that it is not just a local problem.

“We would strongly recommend that all acute pain services supervising epidural pain relief after surgery perform a regular survey to identify patients who have suffered one of these complications” stresses Dr Christie.

“The results should then be stored in a national database to provide a more accurate estimate of the risk of these complications. This register might also identify other relevant risk factors such as MRSA infections.

“The Royal College of Anaesthetists started its 3rd National Anaesthesia Audit in September 2006 and says that it plans to report the findings in 2008. We hope that the outcome of this project will be a national register.”

###

Notes:

* Major complications of epidural analgesia after surgery: result of a six-year study. Christie and McCabe. Anaesthesia. 62, 335-341.

* Anaesthesia, which was established in 1945, is the official journal of the Association of Anaesthetists of Great Britain and Ireland. It publishes original, peer-reviewed articles to an international audience on all aspects of general and regional anaesthesia, intensive care and pain therapy, including research on equipment. Consultant Anaesthetist Dr David Bogod of Nottingham University Hospitals NHS Trust, UK, is Editor in Chief of the journal, which is published by Blackwell Publishing Ltd. blackwellpublishing/ana

* In June 2006 Anaesthesia was named the highest ranked anaesthetic journal in Europe and the fifth highest worldwide (out of 22) by the prestigious ISI Journal Citation Reports ®. These reports evaluate the world’s leading journals and their impact and influence on the global research community. They cover 7,000 highly cited, peer reviewed journals in approximately 200 disciplines.

* Blackwell Publishing is the world’s leading society publisher, partnering with 665 medical, academic, and professional societies. Blackwell publishes over 800 journals and has over 6,000 books in print. The company employs over 1,000 staff members in offices in the US, UK, Australia, China, Singapore, Denmark, Germany and Japan and officially merged with John Wiley & Sons, Inc’s Scientific, Technical and Medical business in February 2007. Blackwell’s mission as an expert publisher is to create long-term partnerships with our clients that enhance learning, disseminate research, and improve the quality of professional practice. For more information on Blackwell Publishing, please visit blackwellpublishing/ or blackwell-synergy/.

Contact: Annette Whibley
Blackwell Publishing Ltd.

Whether on the trail, at the gym, or even on the front-porch steps, what happens inside your ankle in the milliseconds following a single misstep could sentence you to a lifetime of ankle trouble.

And it’s not just the ligaments left with lasting damage, finds Brigham Young University researcher Ty Hopkins and collaborators from the University of Michigan. Their new study points to a leg muscle whose speed and quality of protective response is permanently compromised after a sprain.

“The lateral muscles of the leg are key to ankle injury,” said Hopkins, a co-author on the study in the current issue of The American Journal of Sports Medicine. “They are key because they resist the movement that is involved in injury itself and position the foot during movement.”

The new study provides the latest clue as to why ankle instability persists in most cases long after the initial sprain.

Hopkins and his team recruited both weak- and strong-ankled people to walk down a runway custom built with eight trap doors. With legs cleanly shaven, each participant was hooked up to sensory equipment, launched down the runway, and told to match their steps to the beat of a metronome. As they strode to the other end, one of the trap doors would suddenly invert 30 degrees outward, tweaking their ankle just enough to trigger the series of muscle reactions in question.

While it sounds (and looks) like walking the plank, Hopkins is quick to point out that everyone walked away from the tests uninjured.

The participants’ bravery gave researchers data on the speed and quality of three protective muscle contractions signaled from different parts of the nervous system: the first from receptors within the leg muscle, the second from relays within the spinal cord and the third from the brain itself. Participants with a history of weak ankles had a significant delay for the first muscle response compared to a control group with no history of sprains.

The researchers found the muscles responded within 55 milliseconds in the control group. It took more time in the group with a history of ankle trouble – as much as 90 milliseconds. The delay sounds small but in some cases could mean the difference between a painful ankle sprain and going merrily on your way.

The strength of the muscle response was also diminished in participants with prior ankle injury. Researchers believe prior injuries leave the muscle receptors with less sensitivity, impairing their ability to react as quickly or strongly as the situation may call for.

“If there are muscles that prevent or reduce the extent of injury and they don’t work, you’re in big trouble,” Hopkins said. “We have got to somehow turn those muscles on.”

The researchers focused on a particular muscle – about as thick as an index finger – called the peroneus longus. When contracted, this muscle moves the foot in the opposite direction of an ankle injury.

“The peroneus longus by itself probably isn’t a very good protector simply because of its size, even if it contracted really well,” Hopkins said. “We are working on other projects now to look at the system of muscles involved with stabilizing the ankle.”

Hopkins and his team of researchers are continuing their search to find out why instability persists. With current research, as stated in the paper, a person should remain active to help maintain dynamic stability in their ankle. Hopkins believes that with more data they will be able to develop treatments and exercises to overcome functional ankle instability.

“Once we find out exactly why ankle instability persists, then it could be easy to correct,” Hopkins said.

Hopkins teaches exercise science at BYU and earned a Ph.D. in sports medicine and life sciences from Indiana State University. Riann Palmeri-Smith and Tyler Brown of the University of Michigan are also authors on the new study.

Source:
Joe Hadfield

Brigham Young University

Scientists have untangled two similar disabilities that often afflict stroke patients, in the process revealing that one may be treatable with drugs for Parkinson’s disease.

Researchers at Washington University School of Medicine in St. Louis showed that stroke damage in a brain region known as the putamen is strongly linked to motor neglect, a condition that makes patients slow to move toward the left side.

Like stroke patients with motor neglect, Parkinson’s patients are also slow to initiate responses involving movement. Scientists attribute this deficit in Parkinson’s disease to loss of neurons that use the neurotransmitter dopamine to regulate activity in the putamen.

“Earlier attempts to treat stroke patients with neglect with dopamine-like compounds have produced mixed results,” says lead author Ayelet Sapir, Ph.D., postdoctoral researcher in neurology. “It’s possible, though, that those unfavorable outcomes resulted from an inability to identify the patients most likely to benefit from the intervention. Our data indicate that patients with damage to the putamen may respond differently to this treatment than patients who have neglect from stroke damage to other parts of brain.”

Sapir describes the research, which appears in The Journal of Neuroscience, as part of a broader effort to precisely determine how strokes in different parts of the brain’s right hemisphere affect patients. She and others want to closely link damage in a given right brain region to a particular set of symptoms.

“This approach has been applied to strokes affecting the left hemisphere, where damage to various brain areas is linked to specific kinds of language deficits,” Sapir says. “Taking the same approach to studying lesions of the right hemisphere should help improve patient treatment by allowing us to develop therapeutic approaches targeted to specific brain circuits and neurochemical systems.”

Many problems after a right-brain stroke fall under the broad heading of neglect: inability to detect a stimulus or do something about it. Neglect is highly disabling since it interferes with a number of basic activities such as dressing, self-care and driving, Sapir notes.

Every year, approximately 3 to 5 million people with strokes on the right side of the brain between the ear and the temple develop a condition known as spatial neglect that hampers their ability to notice things on their left side. Patients may seem to be unaware of their left arm, for example, or might fail to eat from the left side of a food tray. The condition is most severe in the first few months following a stroke, but in some patients it becomes a chronic problem.

Some patients with strokes in this area develop a slightly different condition known as motor neglect. This causes them to be slow to act toward the left side of their environment. It might, for example, make them slow to swat at a bug that lands on their left side.

How to separate slowness to notice a stimulus (spatial neglect) from slowness to act on a stimulus (motor neglect) has been a persistent problem for neuroscientists. In a common laboratory test of neglect’s effects, patients watch a video screen for the appearance of a stimulus, usually a symbol or shape, on either the left or the right side of the screen. When they see a stimulus, they report which side it was on to researchers.

The challenge for researchers was that spatial neglect and motor neglect produced the same results-a patient who was slow to report stimuli appearing on the left side of the video screen. This was true for spatial neglect patients because they were slow to see the stimulus; motor neglect patients could see it but were slow to make the movements required to report that they had seen it.

To overcome this problem, Sapir had patients start the test with their hand on a button located to the left of the video screen. When they saw a stimulus, they reached toward the video screen and touched it on the side where the stimulus appeared.

Slowness to respond to stimuli appearing on the left side of the video screen, she theorized, would mean the patient had spatial neglect and was having trouble noticing the stimuli.

Patients who promptly noticed left-side stimuli could report that perception by reaching to their unimpaired right side.

Of 29 patients tested, six were able to respond promptly to left-side stimuli, suggesting they had motor neglect. When Sapir compared high-resolution magnetic resonance imaging brain scans from the two groups, she found a starkly consistent pattern: all the patients identified as having motor neglect had damage to the putamen, while those who still responded slowly to left-side stimuli did not.

Although the putamen isn’t damaged in Parkinson’s disease, scientists have identified it as a brain region that processes dopamine, the neurotransmitter that drops to low levels in Parkinson’s patients.

Scientists plan further study of how other types of neglect may be connected to damage to different brain areas. As an example, Sapir notes that when clinicians give recovering stroke patients a simple drawing to copy, some will leave out the left side of the drawing, while others will copy objects from all over the drawing, but leave out the left sides of individual objects. Whether this represents different kinds of neglect stemming from damage to different brain areas is not yet clear.

“Another possible kind of neglect has to do with putting a patient’s good hand on their bad side,” Sapir says. “When you do this to some patients, their ability to respond with their good hand decreases. It’s like a postural deficit.”

Sapir and her colleagues hope to eventually develop a battery of tests that will allow clinicians to dissociate the different kinds of neglect and develop new treatments.

###

Sapir A, Kaplan JB, He BJ, Corbetta M. Anatomical correlates of directional hypokinesia in patients with hemispatial neglect. The Journal of Neuroscience, April 4, 2007.

Contact: Michael C. Purdy
Washington University School of Medicine

We examined balance problems in athletes with acute lateral ankle sprains by recruiting 30 male athletes with right dominant side and traumatic ankle sprain through simple nonprobability sampling. We measured their sway index and limits of stability with the Biodex Balance System under different conditions.

Our results showed that balance ability in patients with acute lateral ankle sprain was significantly weaker when their eyes were closed rather than open.

We also found that after lateral ankle sprain, balance problems occur and are a result of proprioceptive deficits, especially the unconscious (reflexive) aspect of proprioception as opposed to the conscious (voluntary) aspect.

This factor probably plays an important role in recurrence of ankle sprain. Improvement in the conscious aspect can occur in the first month of treatment, but the unconscious aspect experiences a delay in healing of 3 to 6 months. Therefore, an effective rehabilitation program for managing proprioceptive deficits should be followed.

This article can be found in the Journal of Rehabilitation Research and Development Volume 43, Number 7, Page 819

About the Journal of Rehabilitation Research and Development (JRRD)

JRRD has been a leading research journal in the field of rehabilitation medicine and technology for more than 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines. JRRD’s mission is to responsibly evaluate and disseminate scientific research findings impacting the rehabilitative healthcare community.

The excitement of the 2009 Stanley Cup Playoffs will inspire young players and weekend warriors to hit the ice. But, traveling up to 30 miles an hour on a quarter inch blade of steel and stopping instantly will put anyone at risk for injury. According to American Physical Therapy Association (APTA) spokesperson Mark Mortland, PT, ATC, team physical therapist of the Pittsburgh Penguins, there are special precautions one can take to help avoid the multiple injuries that can occur in this high-speed, high-impact sport.

Whether due to impact or overuse, the range of ice hockey-related injuries varies greatly, almost more so than any other sport. “At the professional level, we do not see ‘common injuries’ because the whole body is susceptible to injury due to the nature of the game,” said Mortland “However, because these are pro athletes, they have access to higher levels of care than the ordinary, casual player. That said, there are steps young players and weekend warriors can take to help avoid getting hurt.”

APTA and Mortland recommend an exercise regimen that includes a dynamic warm-up, cool down, and overall core strengthening to help prevent injuries that keep you off the ice:

- Dynamic warm-up: Warming up should include a combination of dry floor and ice exercises. On the dry floor, running in place, lunges, high knee exercises (high, fast marching movements), and static stretching (stretching while standing in place) can be used to prepare for the game. On the ice, players should combine warm-up laps and sprints.

- Post-game / post-practice cool down:
It is important to stretch the muscles while they are still warm. Focus on static stretches (stretching while standing in place) of large muscle groups such as the hamstrings, quadriceps, gluteus, and hips.

- Overall core strength:
Developing strong abdominal muscles (crunches, sit-ups, and other core exercises) can help to avoid low back pain, a common injury often a result of the crouched positions of the players. Core strength also helps players better handle the crushing impacts one can endure during an enthusiastic game of hockey.

“The important thing to remember is that a proper exercise regimen can help prevent a variety of injuries that can result from any activity, aside from high-impact sports like ice hockey,” concluded Mortland. Physical therapists work with individuals to design specific exercise and treatment programs to cater to their specific needs. See your physical therapist for an individualized program or visit moveforwardpt to find a physical therapist near you.

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery or the side effects of prescription medications. APTA represents more than 72,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice, education, and research. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at moveforwardpt.

Source
American Physical Therapy Association

We compared characteristics and causes of death in 62,080 Washington State veterans who did and did not use Department of Veterans Affairs (VA) healthcare services 5 years before death. We found that 20 percent of the veterans used VA services; they were more often male, younger, less educated, more often divorced, and more often smokers. We also found that both female and male veterans who used VA healthcare were more likely to die from alcohol- and/or drug-related causes.

VA medical centers provide a range of addiction treatment services not typically offered in other healthcare systems, which may partly explain the higher likelihood of death due to substance use disorders.

Our findings suggest that the VA patient population is socially disadvantaged and more severely affected by substance use disorders than veterans who do not use VA healthcare services.

This article can be found in the Journal of Rehabilitation Research and Development Volume 43, Number 7, Page 825

About the Journal of Rehabilitation Research and Development (JRRD)

JRRD has been a leading research journal in the field of rehabilitation medicine and technology for more than 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines. JRRD’s mission is to responsibly evaluate and disseminate scientific research findings impacting the rehabilitative healthcare community.

Riders across the country will take to the streets on Friday, May 15 in celebration of National Bike to Work Day. In support of their efforts and enthusiasm, the American Physical Therapy Association (APTA) offers tips for reducing the risk of bicycle-related injury through proper bike fit.

APTA member Erik Moen, PT, CSCS, a Seattle-based “Elite Level” coach through the United States Cycling Federation, says, “The first thing I ask of any patient complaining of bicycling-related pain is to bring the bicycle in to check for a proper fit. In most instances, a poor bike fit is the root of their problem.”

Moen, who races on the road in cyclocross and in a cycling arena called a velodrome, says that the most common bike fit errors include saddle heights that are either too high or too low, handlebar reach that is either too long or too short, and misalignments of the pedal and shoe. He recommends cyclists do the following to ensure proper bike fit:

Seat/Saddle. Be sure the seat, or saddle, is level. If you are sliding too far forward from a forward-tilting saddle then too much weight is being placed on your hands, arms, and lower back. If the seat is tilted backwards then you may place undue strain on your lower back and possibly experience saddle-related pain. A physical therapist can measure proper saddle height by measuring knee angle at the most extended position of the knee in common pedaling.

The saddle should also be a comfortable distance from the handlebars. If it is too close then extra weight will be placed on the mid-back and arms; too far away and extra strain will be placed on the lower back and neck.

Handlebars. Handlebar position will affect hand, shoulder, neck, and back comfort. The higher the handlebars, the more weight will be placed on the saddle. Generally, taller riders should have lower handlebars in relation to the height of the saddle. According to Moen, “Proper handlebar position allows for shoulders to roughly make a 90 degree angle between the humerus and trunk.” Trunk angle for the road bike cyclist is 25-35 degrees and for comfort/recreational riding is 35-90 degrees. Moen notes that riders should re-examine their bicycle fit after bad falls or crashes, due to possible re-orientation of handlebars, brakehoods, cleats, or the saddle.

Knee to Pedal. A physical therapist can also measure the angle of the knee to the pedal. The closer the angle is to 35 degrees, the better function the cyclist will have and with less stress on the knee. For the road cyclist, the angle should be 30-35 degrees. The recreational cyclist should have a 35-45 degree angle.

Foot to Pedal. The ball of the foot should be positioned over the pedal spindle for the best leverage, comfort, and efficiency, Moen notes. A stiff-soled shoe is best for comfort and performance.

“Pedaling is a skilled activity that requires aerobic conditioning,” Moen says. “You should make it your goal to work toward pedaling at 80-90 revolutions per minute (advanced at 90-105 rpm). Pedaling at this rate will lessen your chance of injury.”

Physical Condition

“Good flexibility of the hamstrings, quadriceps, and gluteal muscles is crucial because these muscles generate the majority of the pedaling force and must ideally move through the pedal-stroke at 80-90 revolutions per minute.” He adds, “Proper stretching, balance, and flexibility exercises help with coordination of cycling-related skills such as breaking and cornering.” Moen also cautions that changes in riders’ strength and flexibility affect the ability to attain certain positions on the bicycle and also may require them to re-examine their bike fit.

Moen points to bicycle accessories on the market-such as softer handlebar tape, shock absorbers for the seat post and front fork, cut-out saddles, and wider tires-that help to bring comfort to the sport. “Cycling should be about enjoyment, not pain,” concludes Moen. “Proper bicycle fit will minimize discomfort and possible overuse injury, maximize economy, and ensure safe bicycle operation. Proper bicycle fit will make your ride a lot more pleasurable.”

Tips for avoiding bike-related injuries follow this press release. APTA’s online brochure, “Bike Right, Bike Fit” can be found in the “consumer tips” section of APTA’s consumer Web site, moveforwardpt.

APTA’s Tips For Avoiding Bike Fit Related Injuries

Postural Tips

- Change hand position on the handlebars frequently for upper body comfort.
- Keep a controlled but relaxed grip of the handlebars.
- When pedaling, your knee should be slightly bent at the bottom of the pedal stroke. Avoid rocking your hips while pedaling.

Common Bicycling Pains

- Anterior (Front) Knee Pain. Possible causes are having a saddle that is too low, pedaling at a low cadence (speed), using your quadriceps muscles too much in pedaling, misaligned bicycle cleat for those who use clipless pedals, and muscle imbalance in your legs (strong quadriceps and weak hamstrings).

- Neck Pain. Possible causes include poor handlebar or saddle position. A poorly placed handlebar might be too low, at too great a reach, or at too short a reach. A saddle with excessive downward tilt can be a source of neck pain.

- Lower Back Pain. Possible causes include inflexible hamstrings, low cadence,using your quadriceps muscles too much in pedaling, poor back strength, and too long or too-low handlebars.

- Hamstring Tendinitis. Possible causes are inflexible hamstrings, high saddle, misaligned bicycle cleat for those who use clipless pedals, and poor hamstring strength.

- Hand Numbness or Pain. Possible causes are short-reach handlebars, poorly placed brake levers, and a downward tilt of the saddle.

- Foot Numbness or Pain. Possible causes are using quadriceps muscles too much in pedaling, low cadence, faulty foot mechanics, and misaligned bicycle cleat for those who use clipless pedals.

- Ilio-Tibial Band Tendinitis. Possible causes are too-high saddle, leg length difference, and misaligned bicycle cleat for those who use clipless pedals.

Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery or the side effects of prescription medications. APTA represents more than 72,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Its purpose is to improve the health and quality of life of individuals through the advancement of physical therapist practice, education, and research. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. Learn more about conditions physical therapists can treat and find a physical therapist in your area at moveforwardpt

Source
American Physical Therapy Association

Long-term complications of critical illness include intensive care unit (ICU)-acquired weakness and neuropsychiatric disease – both of which could be related to the immobilisation caused by sedation. An Article published Online First and in an upcoming edition of The Lancet has found that interrupting sedation in the earliest days of treatment to give critically ill patients physical and occupational therapy leads to better outcomes than standard care.

In this randomised controlled trial, Dr John Kress (University of Chicago, USA) and colleagues analysed sedated adults in the ICU who had been on mechanical ventilation for less than 72 h, and were expected to continue for at least 24 h. Patients were assigned to the early exercise and mobilisation* (49 patients-intervention group) or standard care of daily interruption of sedation and therapy at the discretion of the ICU team (55 patients-control group). The study calculated the proportion of patients from each group that had independent functional status (IFS) at hospital discharge – defined as ability to do six tasks of daily living** and walk unaided.

The researchers found that 59% of patients in the intervention group achieved IFS, compared with 35% in the control group. Intervention patients also suffered from ICU delirium*** only half as long (2.0 days) as did control patients (4.0 days). Intervention patients also had more ventilator free days while in ICU in the 28 day follow-up (23.5 days vs 21.1 days for control).

The authors conclude: “A strategy for whole-body rehabilitation-consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness-was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care.”

They add: “This study highlights the robust outcomes that can be achieved with the coordinated efforts of multiple disciplines dedicated to the survival and mental and physical recovery of critically ill patients receiving mechanical ventilation.”

In an accompanying Comment, Dr Stephan M Jakob and Dr Jukka Takala, University Hospital, Switzerland, say: “Exercise should have a central role in the treatment of critically ill patients… Although physiotherapy is commonly administered to patients in intensive care during recovery from critical illness in the USA, the frequency and type of physiotherapy greatly varies between the type of hospital and clinical scenarios.”

Link to article

Source
The Lancet

Our study characterized veterans who received wheeled mobility equipment (WME) from the Veterans Health Administration (VHA) by analyzing the variance in wheelchair provision based on sex, race/ethnicity, diagnosis, and age.

A logistic regression analysis revealed associations between WME provision and age, sex, and race/ethnicity when diagnosis and number of comorbidities were controlled for. Hispanics, African Americans, and American Indians/Asians were more likely than Caucasians to receive standard wheelchairs (also the most frequently prescribed wheelchair for all diagnoses), while younger patients were more likely to receive ultralightweight wheelchairs.

Our purpose was to determine whether characteristics varied significantly according to the type of WME provided. The findings strongly suggested a disparity in the provision of wheelchairs by the VHA and that the standard of care for the provision of WME within the VHA is not of the same quality as in other populations.

This article can be found in the Journal of Rehabilitation Research and Development Volume 43, Number 7, Page 831

About the Journal of Rehabilitation Research and Development (JRRD)

JRRD has been a leading research journal in the field of rehabilitation medicine and technology for more than 40 years. JRRD, a peer-reviewed, scientifically indexed journal, publishes original research papers, review articles, as well as clinical and technical commentary from U.S. and international researchers on all rehabilitation research disciplines. JRRD’s mission is to responsibly evaluate and disseminate scientific research findings impacting the rehabilitative healthcare community.