Search

The evaluation need not be a daunting task. Success depends primarily on an understanding of the kind of information third party payors are looking for. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxx EXPRESS STOP Impairment [...]

AbstractObjective: This study describes a research training program that implemented several processes and structures with the aim of increasing the quality and quantity of resident research in physical medicine and rehabilitation. Another aim of the program was to address the Accreditation Council for Graduate Medical Education (ACGME) Practice-Based Learn ing and lmprovement competency.Design: Educational program.Results: Data on resident research activity for 11 years before the implementation of the research program were compared with 4 years of data after implementation. There were statistically significant increases in both the total number of publications (P = 0.03) and the number of empirical, data-based publications after implementation of the program (P = 0.03).Conclusions: The findings from this study suggest that a structu red research training program may have a salutary effect on increasing the quality and quantity of resident research.

AbstractBackground: Neuropathic pain is a common complaint after traumatic spinal cord injury (SCI). Gabapentin, a synthetic structural analogue of GABA, has been shown to have beneficial effects in the treatment of neuropathic pain in other diagnostic groups; however, no standardized clinical trial has been performed to evaluate its efficacy after SCI.Design: A 1 0-week, prospective, randomized, double-blind, crossover, and placebo-controlled clinical trial.Objective: To determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain.Methods: Seven subjects with neuropathic pain, who were more than 30 days post-SCI, completed the study. Two groups received a 4-week course of gabapentin and placebo in a randomized crossover design with a 2-week washout period. The Neuropathic Pain Scale was used to record daily pain levels. Data were analyzed using the Wilcoxon signed rank test.Results: Gabapentin has some beneficial effects on certain types of neuropathic pain. There was a significant decrease of "unpleasant feeling" and a trend toward a decrease in both the "pain intensity" and "burning sensation" at the fourth week of gabapentin treatment compared with those on the placebo. No significant difference was found among other pain descriptors during the gabapentin and placebo treatment, although this may have been limited by the small sample size and low maximum dosage of gabapentin.Conclusions: Gabapentin reduces certain types of neuropathic pain in the SCI population. Future studies with larger sample sizes, higher dosages, and quicker titration will help further determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain.

AbstractThis is a physician’s reflection of his experience with terminal illness as an opportunity for personal and professional growth. This excerpt was adapted with permission from Alumni Pulse, the newsletter of the Department of Physical Medicine and Rehabilitation (PMR) of the University of Medicine and Dentistry of New jersey-New jersey Medical School (UMDNj-NjMS). The author is an alumnus of the residency class of 1996.

Shin DY, Ehrenberg B, Whyte J, Bach J, DeLisa JA: Evoked potential assessment: utility in prognosis of chronic head injury. Arch Phys Med Rehabil 70:189–193, 1989.

Electrical stimulation has been used increasingly in the past 20 years to provide function to persons who suffer from spinal cord injury. Functional electrical stimulation systems for the creation of upper extremity function in quadriplegics have been developed, as have systems enabling complete and incomplete paraplegics to ambulate. In addition, a computerized closed loop bicycle ergometer has been used clinically to allow active lower extremity exercise in persons with spinal cord injury. In this article, the physiological effects and methods of electrical stimulation are discussed, as well as the current status and prospects for clinical use of each type of system.

AbstractSummary:Evidence-based medicine is a strong movement in this century, and randomized clinical trials continue to be the best level of evidence for establishing cause-effect relationships between treatment interventions and outcomes. The field of physical medicine and rehabilitation has many excellent research questions on the effects of treatment but seems to rely mostly on weak observational methods (eg, chart review, case series, and single-group designs) for answers. This paper highlights 3 basic and relatively simple principles of good experimental design: control, randomization, and replication that were developed by R. A. Fisher for large, complex, agricultural field trials. The principles diffused readily into many scientific arenas, and Fisher even applied the principles in his backyard studies into Mendelian genetics. The thoughts of R. A. Fisher, arguably the most influential statistician of the 20th century, on the promise and challenges of randomized clinical trials in medicine should motivate rehabilitation clinicians to do their own small-scale controlled trials, with Institutional Review Board approval, when faced with equally realistic and plausible treatment options for their patients.

We describe a novel technique for assessing conduction in the lateral cutaneous nerve of the calf (LCNC), a branch of the common peroneal nerve, based on a study of 32 healthy subjects. Both antidromic and orthodromic techniques were used in each of the 64 limbs to obtain a sensory nerve action potential (SNAP) of the LCNC over a distance of 12 cm. In 60 limbs (93.7%) a SNAP was obtainable with either the antidromic or orthodromic technique. In 21 limbs (32.8%), the SNAP was obtained both antidromically and orthodromically. In 33 limbs (51.6%), the SNAP was obtained only antidromically, and in 6 (9.4%), only orthodromically. In four limbs, the response was unobtainable. Mean antidromic onset latency was 2.1 ms ± SD 0.3, peak latency was 2.6 ms ± SD 0.4, amplitude (without averaging) was 4.3 μV ± SD 2.5, and conduction velocity was 60 m/s ± SD 10. Mean orthodromic onset latency was 2.3 ms ± SD 0.3, peak latency was 2.7 ms ± SD 0.3, amplitude was 5.0 μV ± SD 2.2, and conduction velocity was 52 m/s ± SD 5. Utilization of this technique allows for more detailed localization of common peroneal nerve injury based on whether it is proximal or distal to the origin of the LCNC. © 2000 John Wiley & Sons, Inc. Muscle Nerve 23: 1277–1279, 2000.

BackgroundNatural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention.ObjectivesTo examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability.DesignQualitative literature review and secondary data analysis.ResultsAbsolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested.ConclusionHealth-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health-related rehabilitation following natural disaster is urgently required.