Added Value of an Intensive Multidisciplinary Functional Rehabilitation Programme for Chronic Low Back Pain Patients.

Added value of an intensive multidisciplinary functional rehabilitation programme for chronic low back pain patients.

Swiss Med Wkly. 2013; 143: 0
Steiner AS, Sartori M, Leal S, Kupper D, Gallice JP, Rentsch D, Cedraschi C, Genevay S

Several treatments exist for chronic low back pain (cLBP) patients although none has shown superiority. Among group treatments, muscle reconditioning programmes (MRPs) are the most commonly used. Multidisciplinary functional rehabilitation programmes (MFRPs) are an alternative.To compare a MFRP with a MRP as few studies compare these treatmentsThis was a prospective, nonrandomised, controlled study comparing cLBP patients participating in a MRP or MFRP in an outpatient setting. The predetermined primary outcome measure was the daily life activity subscale (DLA) of the Dallas Pain Questionnaire (DPQ) within one year after the end of the treatment.Twenty-one patients were included in the MRP and 24 in the MFRP. At inclusion, the groups were similar in terms of age (mean 40 years), sex (50%-60% males), sick leave duration (mean 6.0 months, standard deviation (SD) 4.4 months) and follow up (mean 9.0 months, SD 2.0 months). The DLA score decreased from 59.5% (SD 16.9) to 44.8% (SD 25.4), p <0.01, in the MFRP and from 62.3 (SD 20.3) to 58.8 (SD 20.7), p = 0.3, in the MRP. The between-groups difference at follow-up was 13.8, p = 0.05, and the difference in the mean improvement was -11.5 (5.9), p = 0.058. Seventy-eight percent of MFRP patients versus 47 % in the MRP group returned to work (p = 0.08).In a population of highly disabled cLBP patients, MFRP seems more effective in increasing function and return to work. Interpretation is limited by the small population included and by the type of trial.Randomised studies are needed to confirm these results and explore the cost-effectiveness of MFRP. HubMed – rehab


Direct Recordings from the Auditory Cortex in a Cochlear Implant User.

J Assoc Res Otolaryngol. 2013 Mar 22;
Nourski KV, Etler CP, Brugge JF, Oya H, Kawasaki H, Reale RA, Abbas PJ, Brown CJ, Howard MA

Electrical stimulation of the auditory nerve with a cochlear implant (CI) is the method of choice for treatment of severe-to-profound hearing loss. Understanding how the human auditory cortex responds to CI stimulation is important for advances in stimulation paradigms and rehabilitation strategies. In this study, auditory cortical responses to CI stimulation were recorded intracranially in a neurosurgical patient to examine directly the functional organization of the auditory cortex and compare the findings with those obtained in normal-hearing subjects. The subject was a bilateral CI user with a 20-year history of deafness and refractory epilepsy. As part of the epilepsy treatment, a subdural grid electrode was implanted over the left temporal lobe. Pure tones, click trains, sinusoidal amplitude-modulated noise, and speech were presented via the auxiliary input of the right CI speech processor. Additional experiments were conducted with bilateral CI stimulation. Auditory event-related changes in cortical activity, characterized by the averaged evoked potential and event-related band power, were localized to posterolateral superior temporal gyrus. Responses were stable across recording sessions and were abolished under general anesthesia. Response latency decreased and magnitude increased with increasing stimulus level. More apical intracochlear stimulation yielded the largest responses. Cortical evoked potentials were phase-locked to the temporal modulations of periodic stimuli and speech utterances. Bilateral electrical stimulation resulted in minimal artifact contamination. This study demonstrates the feasibility of intracranial electrophysiological recordings of responses to CI stimulation in a human subject, shows that cortical response properties may be similar to those obtained in normal-hearing individuals, and provides a basis for future comparisons with extracranial recordings. HubMed – rehab


Clinical effectiveness of primary and secondary headache treatment by transcranial direct current stimulation.

Front Neurol. 2013; 4: 25
Pinchuk D, Pinchuk O, Sirbiladze K, Shugar O

The clinical effectiveness of primary and secondary headache treatment by transcranial direct current stimulation (tDCS) with various locations of stimulating electrodes on the scalp was analyzed retrospectively. The results of the treatment were analyzed in 90 patients aged from 19 to 54?years (48 patients had migraine without aura, 32 – frequent episodic tension-type HAs, 10 – chronic tension-type HAs) and in 44 adolescents aged 11-16?years with chronic post-traumatic HAs after a mild head injury. Clinical effectiveness of tDCS with 70-150??A current for 30-45?min via 6.25?cm(2) stimulating electrodes is comparable to that of modern pharmacological drugs, with no negative side effects. The obtained result has been maintained on average from 5 to 9?months. It has been demonstrated that effectiveness depends on localization of stimulating electrodes used for different types of HAs. HubMed – rehab


Long-term trajectories of PTSD or resilience in former East German political prisoners.

Torture. 2012 Oct 19; 23(1):
Maercker A, Gäbler I, O’Neil J, Schützwohl M, Müller M

Studies on the long-term consequences of traumatization found different diagnostic trajectories: chronic, recovered, delayed and resilient. This distinction, however, was never studied in victims of torture or severe political persecution. We aimed to verify the trajectory classes of PTSD empirically and to analyze potential predictors of such trajectories. Former political prisoners from East Germany, first interviewed in 1995, were re-assessed fourteen years later. In 1995, retrospective symptom reports dating back to shortly after the prisoners’ release dates were assessed. Predictors of the four different trajectories were divided into pre-trauma, peri-trauma, and post-trauma factors. As a result, the four long-term trajectories were validated in the current sample with the following percentages: chronic (36%), resilient (27%), recovered (26%) and delayed (11%) trajectories. Trajectories were mainly distinguished by pre- and post-traumatic factors, e.g. pre-trauma education or post-trauma disclosure opportunities. We conclude that the four long-term trajectories of trauma sequelae deserve more attention to adequately deal with survivors of severe persecution. Furthermore, the specific predictors of long-term trajectory deserve more attention for re-integration or in rehabilitation. HubMed – rehab



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