Rehab Centers: A System for Portable Sleep Apnea Diagnosis Using an Embedded Data Capturing Module.

A system for portable sleep apnea diagnosis using an embedded data capturing module.

Filed under: Rehab Centers

J Clin Monit Comput. 2013 Feb 15;
Alshaer H, Levchenko A, Bradley TD, Pong S, Tseng WH, Fernie GR

Sleep apnea (SA) is a very common disease with serious health consequences, yet is very under-diagnosed, partially because of the high cost and limited accessibility of in-laboratory polysomnography (PSG). The purpose of this work is to introduce a newly developed portable system for the diagnosis of SA at home that is both reliable and easy to use. The system includes personal devices for recording breath sounds and airflow during sleep and diagnostic algorithms to process the recorded data. The data capturing device consists of a wearable face frame with an embedded electronic module featuring a unidirectional microphone, a differential microphone preamplifier, a microcontroller with an onboard differential analogue to digital converter, and a microSD memory card. The device provides continuous data capturing for 8 h. Upon completion of the recording session, the memory card is returned to a location for acoustic analysis. We recruited 49 subjects who used the device independently at home, after which each subject answered a usability questionnaire. Random data samples were selected to measure the signal-to-noise ratio (SNR) as a gauge of hardware functionality. A subset of 11 subjects used the device on 2 different nights and their results were compared to examine diagnostic reproducibility. Independent of those, system’s performance was evaluated against PSG in the lab environment in 32 subject. The overall success rate of applying the device in un-attended settings was 94 % and the overall rating for ease-of-use was ‘excellent’. Signal examination showed excellent capturing of breath sounds with an average SNR of 31.7 dB. Nine of the 11 (82 %) subjects had equivalent results on both nights, which is consistent with reported inter-night variability. The system showed 96 % correlation with simultaneously performed in-lab PSG. Conclusion: Our results suggest excellent usability and performance of this system and provide a strong rationale to further improve it and test its robustness in a larger study.
HubMed – rehab


Varus external rotation stress test for radiographic detection of deep deltoid ligament disruption with and without syndesmotic disruption: a cadaveric study.

Filed under: Rehab Centers

Foot Ankle Int. 2013 Feb; 34(2): 251-60
Femino JE, Vaseenon T, Phistkul P, Tochigi Y, Anderson DD, Amendola A

Background: External rotation stress is used intraoperatively for diagnosing medial ankle and syndesmotic instability in rotational ankle fractures after reduction and fixation of the fibula. However, external rotation includes hindfoot, midfoot, and ankle motion. The purpose of this study was to determine the effect of hindfoot positioning when using the external rotation stress test. Isolated deep deltoid ligament (DDL) instability and combined DDL and syndesmotic instability were modeled. An intact fibula was used as a surrogate for an anatomically fixed fibula fracture. Methods: Six cadaver specimens with full-length tib-fib articulations were used. Specimens were fixed into a Taylor Spatial Frame (Smith&Nephew, Memphis, TN) with 4 to 5 points of fixation in the tibia and the foot. Specimens were mounted in ankle and foot neutral position. Metal markers were placed at the medial gutter and syndesmosis. Anteroposterior (AP) and mortise radiographs were obtained in 3 positions: neutral hindfoot, valgus external rotation stress, and varus external rotation stress. For both valgus and varus external rotation stress, the frame was loosened and stressed to a hard end point and then locked. Three modes were studied: intact ligaments, DDL transected, and DDL+ syndesmosis transected. Digital radiographs were used to measure the displacement of the markers. Results: The varus external rotation stress test demonstrated significant widening of the medial gutter in specimens with isolated DDL instability, in both AP (P = .01) and mortise (P = .02) views. Both maneuvers demonstrated significant medial gutter widening with combined DDL and syndesmosis disruption (P ? .01), although the varus external rotation stress test produced nearly twice as much displacement (10.7 vs 5.4 mm). Syndesmotic widening was not significant with either maneuver. Conclusions: Varus external rotation stress was more effective than valgus external rotation stress in demonstrating displacement of markers at the medial gutter and on AP and mortise radiographs for both DDL and DDL with syndesmotic instability. Clinical Relevance: These findings may lead to improved clinical detection of rotational ankle instability from combined DDL and syndesmotic disruption, which may affect decision making for using syndesmotic fixation when using intraoperative stress fluoroscopy images. Occult DDL instability may be underdiagnosed, and this may affect future directions of the treatment of rotational ankle fractures and severe sprains.
HubMed – rehab


A Role for Cognitive Rehabilitation in Increasing the Effectiveness of Treatment for Alcohol Use Disorders.

Filed under: Rehab Centers

Neuropsychol Rev. 2013 Feb 15;
Bates ME, Buckman JF, Nguyen TT

Neurocognitive impairments are prevalent in persons seeking treatment for alcohol use disorders (AUDs). These impairments and their physical, social, psychological and occupational consequences vary in severity across persons, much like those resulting from traumatic brain injury; however, due to their slower course of onset, alcohol-related cognitive impairments are often overlooked both within and outside of the treatment setting. Evidence suggests that cognitive impairments can impede treatment goals through their effects on treatment processes. Although some recovery of alcohol-related cognitive impairments often occurs after cessation of drinking (time-dependent recovery), the rate and extent of recovery is variable across cognitive domains and individuals. Following a long hiatus in scientific interest, a new generation of research aims to facilitate treatment process and improve AUD treatment outcomes by directly promoting cognitive recovery (experience-dependent recovery). This review updates knowledge about the nature and course of cognitive and brain impairments associated with AUD, including cognitive effects of adolescent AUD. We summarize current evidence for indirect and moderating relationships of cognitive impairment to treatment outcome, and discuss how advances in conceptual frameworks of brain-behavior relationships are fueling the development of novel AUD interventions that include techniques for cognitive remediation. Emerging evidence suggests that such interventions can be effective in promoting cognitive recovery in persons with AUD and other substance use disorders, and potentially increasing the efficacy of AUD treatments. Finally, translational approaches based on cognitive science, neurophysiology, and neuroscience research are considered as promising future directions for effective treatment development that includes cognitive rehabilitation.
HubMed – rehab


Vacuum-Assisted Closure Therapy for a Complicated, Open, Above-the-Knee Amputation Wound.

Filed under: Rehab Centers

J Am Osteopath Assoc. 2013 Feb; 113(2): 174-6
Richter K, Knudson B

Negative-pressure wound therapy (NPWT) with a vacuum-assisted closure system has been successfully used in the management of various wounds on the trunk and distal extremities, including diabetic foot ulcers. However, reported successful NPWT cases have involved distal wounds that were below the knee. The authors report a case of an elderly diabetic patient with recalcitrant wounds in his left lower extremity from an above-the-knee amputation. The patient had undergone 27 surgical débridement or revision procedures over the course of 3 months. On entering rehabilitation, the patient had a full-thickness wound in his residual limb that measured 9 × 8 cm. The patient received NPWT with a vacuum-assisted closure system, which resulted in a fully healed residual limb. After 120 days, the patient was ready to begin prosthetic restoration.
HubMed – rehab



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