Rehab Centers: Clinical Reasoning and Advanced Practice Privileges Enable Physical Therapist Point-of-Care Decisions in the Military Health Care System: 3 Clinical Cases.
Clinical Reasoning and Advanced Practice Privileges Enable Physical Therapist Point-of-Care Decisions in the Military Health Care System: 3 Clinical Cases.
Filed under: Rehab Centers
Phys Ther. 2013 Feb 7;
Rhon D, Deyle GD, Gill NW
BACKGROUND AND PURPOSE: Physical therapists frequently make important point of care decisions for musculoskeletal (MSK) injuries and conditions. In the Military Health System (MHS) these decisions may occur while deployed in support of combat troops as well as in a more traditional hospital setting. Proficiency with the MSK examination including a fundamental understanding of the diagnostic role of MSK imaging is an important competency for physical therapists. The purpose of this paper is to present three cases managed by physical therapists in unique MHS settings, highlighting relevant challenges and clinical decision-making. CASE DESCRIPTION: Three cases are presented involving conditions where the physical therapist was significantly involved in the diagnosis and clinical management plan. The physical therapist’s clinical privileges, including the ability to order appropriate MSK imaging procedures, were helpful to clinical decisions facilitating timely management. The cases include patients with an ankle sprain and Maisonneuve fracture, a radial head fracture, and a pelvic neoplasm referred through medical channels as knee pain. OUTCOMES: Clinical pathways from point of care are discussed, as well as the reasoning that led to decisions impacting definitive care for each of these patients. In each case emergent treatment and/or important combat evacuation decisions were based on a combination of examination and management decisions. DISCUSSION: Physical therapists can provide important contributions to the primary management of patients with MSK conditions in a variety of settings within the MHS. In the cases described, advanced clinical privileges contributed to the success in this role.
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Postpneumococcal Moyamoya syndrome case report and review of the postinfective cases.
Filed under: Rehab Centers
BMJ Case Rep. 2013; 2013:
Pinardi F, Stracciari A, Spinardi L, Guarino M
Our aim was to describe a patient who experienced a postpneumococcal Moyamoya syndrome (MMS), with a great involvement of the posterior cerebral circulation, and to review the MMS postinfective cases. A 55-year-old Pakistani man with a history of pneumococcal meningitis 3 months before developed acute headache, left otalgia and body paresthesiae. Brain CT showed a right occipital ischaemic lesion. Seven days later, he developed acute left haemianopsia, haemiplegia, haemineglect and ‘frontal’ cognitive and behavioural symptoms. A second brain CT and MRI disclosed an increase in the occipital lesion and the appearance of a further one in the right frontal lobe. Cerebral CT and MRI-angiography were consistent with Moyamoya vessel alterations. Treatment with antiplatelets, methylprednisolone, followed by prednisone tapering, and motor rehabilitation began. Six months later, no relapses had occurred. Our case represents a delayed manifestation of postmeningitis vasculopathy. Meningitis may represent a risk factor for developing a disabling cerebrovascular disease like MMS.
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Secondary Degeneration Detected by Combining VBM and TBSS in Subcortical Strokes with Different Outcomes in Hand Function.
Filed under: Rehab Centers
AJNR Am J Neuroradiol. 2013 Feb 7;
Yin D, Yan X, Fan M, Hu Y, Men W, Sun L, Song F
BACKGROUND AND PURPOSE:Secondary degeneration of the pyramidal tract after focal motor pathway stroke has been observed by diffusion tensor imaging. However, the relationships between outcomes in hand function and secondary degeneration in widespread regions are not well understood. For the first time, we investigated the differences of secondary degeneration across the whole brain between subgroups of patients with stroke.MATERIALS AND METHODS:We selected 23 patients who had a subcortical stroke in the left motor pathway and displayed only motor deficits. The patients were divided into 2 subgroups: CPH (11 patients) and PPH (12 patients). Twelve healthy controls matched for age and handedness were also recruited. We used both optimized VBM and TBSS to explore differences of FA across the whole brain between CPH and PPH. Furthermore, ROI analysis was carried out in the identified regions detected by VBM analysis to further quantify the degree of secondary degeneration in the CPH and PPH and compare these with healthy controls.RESULTS:Compared with PPH, FA was significantly decreased in the CPH in widespread regions of the motor system remote from the primary lesion, including the ipsilesional brain stem, medial frontal gyrus, precentral gyrus, superior temporal gyrus, supplementary motor area, and contralesional postcentral gyrus. In addition, FA within these identified regions correlated with Fugl-Meyer Assessment scores (hand+wrist).CONCLUSIONS:This study suggests a potential biomarker for outcome differences in hand function after subcortical stroke.
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