Rehab Centers: Learning Through Clinical Decision Support and Collaboration.

Learning through clinical decision support and collaboration.

Filed under: Rehab Centers

Adv Skin Wound Care. 2013 Feb; 26(2): 54
Salcido RS

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Lumbar Stiffness Disability Index: pilot testing of consistency, reliability, and validity.

Filed under: Rehab Centers

Spine J. 2013 Jan 18;
Hart RA, Gundle KR, Pro SL, Marshall LM

BACKGROUND CONTEXT: The primary goal of surgical arthrodesis is to eliminate the motion of spinal segments in an effort to alleviate pain, improve deformity, and reduce disability. However, decreased spinal mobility may impair performance of activities of daily living (ADLs) due to the resulting stiffness or the lack of mobility of the fused segment. Current clinical outcome instruments do not seek information regarding the impact of spinal stiffness on functional ability. Therefore, a patient-reported outcome questionnaire measuring the impact of lumbar stiffness on functional abilities was devised and assessed for internal consistency, retest repeatability, and external validity. PURPOSE: To develop and validate an outcome instrument to measure the collateral effect of stiffness after lumbar fusion on functional ability. STUDY DESIGN: Cross-sectional pilot study. PATIENT SAMPLE: Consecutive cohort of lumbar spine fusion patients from a single surgeon’s practice. OUTCOME MEASURES: Lumbar Stiffness Disability Index (LSDI) and Cobb angle measurements from digital radiographs. METHODS: We developed and evaluated a 10-item questionnaire, referred to as the LSDI, which seeks information on the impact of spinal stiffness on ADLs after lumbar spinal arthrodesis. The questionnaire yields a score from 0 to 100, with higher scores indicating greater difficulty resulting from lumbar spinal stiffness in performing 10 different ADLs. The study sample comprised 32 lumbar arthrodesis patients at a minimum of 1 year postoperatively. All patients completed the questionnaire twice via telephone interviews conducted 4 weeks apart. Internal consistency was assessed using the Cronbach alpha, and retest reliability was measured using an intraclass correlation coefficient (ICC). External validity of the questionnaire was evaluated by correlating the scores with lumbar range of motion (LROM) as measured from the angular change between the inferior end plate of T12 and the superior end plate of S1 on standardized digital flexion and extension lateral radiographs. RESULTS: The study sample included 22 women (69%) and 10 men (31%) with an average age of 63 years. The questionnaire demonstrated high internal consistency (Cronbach alpha=0.89). Retest reliability was also high (ICC=0.87). External validity was demonstrated by a statistically significant inverse relationship between LROM and LSDI scores (r=-0.71; p<.001). CONCLUSIONS: This pilot study demonstrates that the LSDI questionnaire is a reliable and valid instrument for assessing functional limitations due to lumbar stiffness among spinal arthrodesis patients. The questionnaire is proposed for use in prospective evaluation of lumbar stiffness impacts after arthrodesis. HubMed – rehab


The time course of serotonin 2C receptor expression after spinal transection of rats: an immunohistochemical study.

Filed under: Rehab Centers

Neuroscience. 2013 Jan 18;
Ren LQ, Wienecke J, Chen M, Møller M, Hultborn H, Zhang M

In the spinal cord 5-HT systems modulate the spinal network via various 5-HT receptors. 5-HT2A and 2C receptors are likely the most important 5-HT receptors for enhancing the motoneuron excitability by facilitating the persistent inward current, and thus play an important role for the pathogenesis of spasticity after spinal cord injury. In conjunction with our 5-HT2A receptor study, using a same sacral spinal transection rat model we have in this study examined 5-HT2C receptor immunoreactivity (5-HT2CR-IR) changes at seven different time intervals after spinal injury. We found that 5-HT2CR-IR was widely distributed in different regions of the spinal gray matter and was predominantly located in the neuronal somata and their dendrites although it seemed also present in axonal fibers in the superficial dorsal horn. 5-HT2CR-IR in different regions of the spinal gray matter was seen to be increased at 14 days after transection (with an average ?1.3-fold higher than in sham-operated group) but did not reach a significant level until at 21 days (?1.4-fold). The increase sustained thereafter and a plateau level was reached at 45 days (?1.7-fold higher), a value similar as that at 60 days. When 5-HT2CR-IR analysis was confined to the ventral horn motoneuron somata (including a proportion of proximal dendrites) a significant increase was not detected until 45 day post-operation. 5-HT2CR upregulation in the spinal gray matter is confirmed with Western blot in the rats 60 days post-operation. The time course of 5-HT2CR up-regulation in the spinal gray matter and motoneurons was positively correlated with the development of tail spasticity (clinical scores). This indicates that 5-HT2CR is probably an important factor underlying this pathophysiological development by increasing the excitability of both motoneurons and interneurons.
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Partial recovery of visual extinction by pavlovian conditioning in a patient with hemispatial neglect.

Filed under: Rehab Centers

Cortex. 2012 Dec 6;
Domínguez-Borràs J, Armony JL, Maravita A, Driver J, Vuilleumier P

Patients with parietal lesions and unilateral spatial neglect (USN) are unable to detect or respond to information in the contralesional side of space. However, some residual sensory processing may still occur and overcome inattention symptoms when contralesional stimuli are perceptually or biologically salient, as shown for emotional faces or voices. These effects have been attributed to enhanced neural responses of sensory regions to emotional stimuli, presumably driven by feedback signals from limbic regions such as the amygdala. However, because emotional faces and voices also differ from neutral stimuli in terms of physical features, the affective nature of these effects still remains to be confirmed. Here we report data from a right parietal patient in whom left visual extinction was reduced for contralesional visual stimuli following pavlovian aversive conditioning, relative to the same stimulus before conditioning, and relative to similar but non-conditioned stimuli. This reduction of visual extinction was thus mediated by the emotional meaning of stimuli acquired through implicit learning. Functional magnetic resonance imaging also showed that conditioned visual stimuli elicited greater activation in right visual cortex, relative to the non-conditioned stimuli, together with differential activations in amygdala. These results support the hypothesis that emotional appraisal, not only the processing of perceptual features, may partly restore attention to salient information in contralesional space. These findings open new perspectives to improve rehabilitation strategies in neglect, based on affective and motivational signals.
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