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During the late 19th century and the 20th century, many allied health and technical professions, joined physicians and nurses in their formal medical and surgical comprehensive work. The professionalization process of the various medical and surgical fields demanded true incorporation of allied health professions into the medical infrastructure. Non-academic professions such as the "feldsher ", barber-surgeon, bone-setters and the midwife, transferred into realms of the academic medical and the health professions fields.

The contributions of Australians on shell shock are absent from the literature. However, two Australians were pioneers in the treatment of shell shock: George Elton Mayo (1880–1949) and Dr Thomas Henry Reeve Mathewson (1881–1975). They used psychoanalytic approaches to treat psychiatric patients and introduced the psychoanalytic treatment of people who suffered from shell shock. Their ‘talking cure’ was highly successful and challenged the view that shell shock only occurred in men who were malingering and/or lacking in fortitude. Their work demonstrated that people experiencing mental illness could be treated in the community at a time when they were routinely treated as inpatients. It also exemplified the substantial benefits of combining science with clinical knowledge and skill in psychology and psychiatry.

This study assessed the contributions of prior war captivity trauma, the appraisal of the current COVID-19 danger and its resemblance to the prior trauma, and long-term trajectories of posttraumatic stress disorder (PTSD) to risk for PTSD during the COVID-19 pandemic. Capitalizing on a 29-year longitudinal study with four previous assessments, two groups of Israeli veterans - ex-Prisoners-of-War (ex-POWs) of the 1973 Yom Kippur War and comparable combat veterans of the same war - were reassessed during the COVID-19 pandemic. Previous data were collected on their PTSD trajectory 18, 30, 35, and 42 years after the war and exposure to stressful life events after the war. Currently, we collected data on their PTSD during the COVID-19 pandemic and their appraisal of similarities of past trauma with the current pandemic. Previously traumatized ex-POWs were found to be more vulnerable and had significantly higher rates of PTSD and more intense PTSD during the current pandemic than comparable combat veterans. Moreover, veterans in both groups who perceived the current adversity (captivity, combat) as hindering their current coping were more likely to suffer from PTSD than veterans who perceived it as a facilitating or irrelevant experience. In addition, chronic and delayed trajectories of PTSD among ex-POWs increased the risk for PTSD during the pandemic, and lifetime PTSD mediated the effects of war captivity on PTSD during the current pandemic. These findings support the stress resolution perspective indicating that the response to previous trauma - PTSD and its trajectories - increased the risk of PTSD following subsequent exposure to stress.

The Israeli everyday medical slang includes foreign names. Some of these terms had already been translated to Hebrew, but are rarely in use. Terms such as "staung, schpadel, penrose, pinzette, tourniquet, gauze pad, PEG or retractor" are most frequently in use in foreign languages, as well as nouns like pasteurization, mesmerizing (hypnotizing) which originated from their historical developer. The authors believe that we will also continue to use these original foreign terms and eponyms in the future.

Dr. Joseph Weill was a French Jewish doctor who made significant contributions to the knowledge of hunger disease in the refugee camps in southern France during World War II. He was involved with the clandestine network of escape routes for Jewish children from Nazi-occupied France to Switzerland. Take home messages • During the Holocaust, in the ghettoes and death camps, a few research projects, mainly on hunger and infectious diseases, were performed by Jewish physicians and scientists • Jewish and non-Jewish prisoners were incarcerated within the notorious system of internment camps in southern France • Dr. Joseph Weill (1902-1988), a French Jewish physician and a distinguished member of the Résistance managed to enter the internment camps and medically assist the inmates in addition to performing systematic research and follow-up of those who presented with hunger disease.

Hospital beds are essential equipment for any hospital and clinical work. Various types of beds are in regular use in different medical branches. We survey historical points regarding the development of different types of beds, and medical eponyms, which connected to hospital beds. We must pay attention to the complications of prolonged confinement to bed.

The rapid evolution of Brain-Computer Interface (BCI) technology and the exponential growth of BCI literature during the past 20 years is a consequence of increasing computational power and the achievements of statistical learning theory and machine learning since the 1960s. Despite this rapid scientific progress, the range of successful clinical and societal applications remained limited, with some notable exceptions in the rehabilitation of chronic stroke and first steps towards BCI-based assisted verbal communication in paralysis. In this contribution, we focus on the effects of noninvasive and invasive BCI-based verbal communication on the quality of life (QoL) of patients with amyotrophic lateral sclerosis (ALS) in the locked-in state (LIS) and the completely locked-in state (CLIS). Despite a substantial lack of replicated scientific data, this paper complements the existing methodological knowledge and focuses future investigators’ attention on (1) Social determinants of QoL and (2) Brain reorganization and behavior. While it is not documented in controlled studies that the good QoL in these patients is a consequence of BCI-based neurorehabilitation, the proposed determinants of QoL might become the theoretical background needed to develop clinically more useful BCI systems and to evaluate the effects of BCI-based communication on QoL for advanced ALS patients and other forms of severe paralysis.

The Swiss neurologist Otto Veraguth (1870-1944), described a (forgotten) physical sign, which is pathognomonic to chronic depression and melancholia: an omega-shaped skin fold in between the eye-lids. This description followed electro-physiologist experiments on the electrical properties of the skin in various mental and emotional situations.

Chronic pain induces a multitude of harmful effects; recently it has been suggested that chronic pain is also associated with premature aging, manifested in shortened telomere length (TL). However, evidence for this hypothesis is scarce and inconsistent. The aim was twofold: 1) Investigate whether chronic pain is associated with premature aging, and 2) Determine whether physical exercise (PE) moderates this association if it exists. Participants were 116 male subjects, with (n = 67) and without chronic pain (n = 49). Blood samples for TL analysis were collected and participants were interviewed and completed questionnaires. As a part of the cohort, we included people with physical disability; this variable was controlled in the analysis. The TL of individuals with chronic pain was significantly shorter than that of pain-free individuals. Regression analysis revealed a significant moderating effect of PE on chronic pain and TL, above and beyond the effects of disability, age, and weight. Whereas chronic pain was associated with shorter telomeres in participants who did not exercise, this association was nonsignificant among participants who did exercise. The results suggest that chronic pain is associated with premature ageing; however, PE may mitigate this association and may protect individuals against the harmful effects of chronic pain. Perspective The study suggests that it is important to monitor signs of premature ageing among chronic pain patients as they are at risk. However, chronic pain patients may benefit from regular PE in this respect as it may moderate premature ageing.

War is usually accompanied by devastating consequences such as famine, diseases, social and economic destruction and more. Research projects or accounts on hunger were rarely made during the war itself. This review describes these attempts with an emphasis on the heroic "Hunger Disease " research that was carried out within the Warsaw ghetto.

Spinal cord injury (SCI) etiology can be either traumatic or non-traumatic. Non-traumatic SCI is of growing importance, with studies indicating increased incidence, partly because of population aging. Approximately 9% of these injuries are secondary to an infectious cause. SCI has significant implications on the patient's quality of life. A successful rehabilitation process focuses on maximizing independence and setting achievable goals according to the patient's needs and desires. The medical staff should be familiar with the natural history of such injuries while taking into consideration the existing support systems available to the patient and minimizing the damage to life cycles as best possible with the aid of a transdisciplinary team approach. In this article, we will review the main viral causes of SCI injury. We will discuss the epidemiology, clinical aspects and the unique meanings of this subgroup in the rehabilitation process.

Shmuel Springer,1 Itamar Friedman,2 Avi Ohry3,4 1Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel; 2ProMedoss, Charlotte, NC, USA; 3Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 4Reuth Rehabilitation and Medical Center, Tel Aviv, Israel Background: Age-related changes in coordinated movement pattern of the thorax and pelvis may be one of the factors contributing to fall risk. This report describes the feasibility of using a new thoracopelvic assisted movement device to improve gait and balance in an elderly population with increased risk for falls. Methods: In this case series, 19 older adults were recruited from an assisted living facility. All had gait difficulties (gait speed MDC in their clinical measures after 6 treatment sessions, and more than half improved >MDC after 12 sessions. Six subjects (32%) improved their Timed Up and Go time by >4 seconds after 6 sessions, and 10 (53%) after 12 sessions. After the intervention, 4 subjects (21%) improved their 10-meter Walk Test velocity from limited community ambulation (0.4–0.8 m/s) to functional community ambulation (>0.8 m/s). Conclusion: Thoracopelvic assisted movement training that mimics normal walking pattern may have clinical implications, by improving skills that enhance balance and gait function. Additional randomized, controlled studies are required to examine the effects of this intervention on larger cohorts with a variety of subjects. Keywords: gait, balance, older adults, training

Objective This study sheds light on the importance of long-term follow-up of trauma survivors, posttraumatic stress disorder (PTSD) trajectories, and early detection of health risk factors in trauma survivors. The present study prospectively assessed the following over 23 years: (1) the association of psychological and physiologic stress during captivity with elevated C-reactive protein (CRP) levels and metabolic syndrome (MetS), which includes hypertension; elevated levels of insulin, triglycerides, and fasting glucose; decreased levels of high-density lipoprotein cholesterol; and obesity and (2) the implication of PTSD trajectories in elevated CRP levels and MetS. Methods Measurements were taken in 1991, 2003, 2008, and 2015. Participants were 116 Israeli combat veterans of the 1973 Yom Kippur War (of these, 101 were former prisoners of war [ex-POWs] and 15 were comparable controls). The medical assessments relevant for this study were body mass index, fasting blood glucose levels, and diabetes, blood pressure or a diagnosis of hypertension, high-density lipoprotein cholesterol and triglyceride levels, and medication intake. In addition, the PTSD Inventory was used to assess PTSD symptoms and trajectories over time according to DSM-IV-TR PTSD criteria. Results Captivity-in particular, the captivity stressors of weight loss, physical suffering, psychological suffering, and humiliation-was implicated in both elevated CRP levels and MetS, significantly so with elevated CRP levels (P = .01, R² = 0.33). Captivity-induced PTSD, in particular chronic and delayed PTSD trajectories, was associated with elevated CRP levels and MetS, significantly so for MetS (P = .05). Conclusions Monitoring inflammation using markers like CRP level in trauma survivors can be beneficial, particularly if PTSD is chronic or delayed. Clinicians treating trauma survivors should raise awareness of the importance of such measures in light of long-term health vulnerabilities.

Background Previous findings have demonstrated the link between trauma, its psychopathological aftermath and cellular aging, as reflected in telomere length. However, as long-term examinations of psychopathology following trauma are scarce, very little is known regarding the repercussions of depression and PTSD trajectories of psychopathology for telomeres. The current study examined the implications of war captivity and depression/PTSD trajectories on telomere length. Methods Ninety-nine former prisoners of war (ex-POWs) from the 1973 Yom Kippur War were evaluated for depression and PTSD at 18, 30, 35 and 42 years after the war. Data on leukocyte telomere length of ex-POWs and 79 controls was collected 42 years after the war. Results Ex-POWs had shorter telomeres compared to controls (Cohen's d = .5 indicating intermediate effect). Ex-POWs with chronic depression had shorter telomeres compared to those with delayed onset of depression (Cohen's d = 4.89), and resilient ex-POWs (Cohen's d = 3.87), indicating high effect sizes. PTSD trajectories were not implicated in telomere length (Partial eta 2 = .16 and p = .11). Conclusion The findings suggest that the detrimental ramifications of war captivity are extensive, involving premature cellular senesces. These findings further point to the wear-and-tear effect of long-term depression, but not PTSD, on telomere length. Explanations for the findings are discussed.

Traumatic injury to the spinal cord during spinal or epidural anesthesia is usually secondary to either direct needle penetration or intra-neural injection of local anesthetics. Two women were admitted to a rehabilitation department with paraparesis and hypoesthesia after delivery. One had undergone a lower segment cesarean section under spinal anesthesia and the other, a spontaneous delivery under epidural anesthesia. After discharge from the rehabilitation treatment, they both experienced some weakness in the lower limbs. The patho-physiological basis of this complication seems to be either direct damage to the spinal cord by intra-neural injection of local anesthetics, or local ischemia.

The Nuremberg Nazi doctors' trial, established ethical standards for human experimentation. Pre-Nazi Germany was well advanced in all sciences. The murderous Nazi ideology used eugenics and "scientific racism" to eliminate those whom they regarded as inferiors. Scores of medical eponyms named after Nazi doctors are still in use. We must always mention these physicians' contributions to the "white murderers" atrocities during the Nazi rule.

Many Jewish doctors in the Holocaust - in ghettos, concentration and extermination camps and in the forests - displayed courage, valor and sacrifice in the resistance front against the Nazis and their allies. The scope of their actions was broad: active resistance in the underground and rebellion movements or in the lines of partisans in the forests; hiding and saving Jews; smuggling medicines; preparing false medical records; secretly conducting surgery and other treatments; refusing the demands to submit lists of patients and workers, thus sentencing them to death; staying by the sick and the needy in the ghettos, even when they could escape, and many more. All this was done out of truth to their conscience, sometimes even beyond their commitment to the doctor's oath, placing themselves in uncertain situations, in distress, hunger, oppression and humiliation, risking their own lives and those of their families. It is admirable how those degrees of courage, bravery, willpower and sacrifice could develop out of such terrible physical and mental distress. The resistance was an extensive wide-ranging occurrence among the Jewish doctors and not one of just a few individuals. This article presents a number of examples of diverse forms of resistance, of individuals as well as of groups of physicians.

Rationale It has been recognized that exposure to mass trauma tends to increase the time spent watching television (TV) news. Yet, research on the effects of this tendency on individuals’ well-being yielded inconclusive findings. Objective The aim of this longitudinal study is to examine the effects of prior trauma and posttraumatic stress disorder (PTSD) on changes in the amount of TV news watching and its effect on subsequent PTSD. More specifically, we examined the interrelations of prior exposure to war captivity, long-term PTSD trajectories, and amount of change TV news watching with PTSD severity during the COVID-19 pandemic, among aging Israeli combat veterans. Methods One-hundred-and-twenty Israeli ex-prisoners of war (ex-POWs) from 1973 Yom Kippur War and 65 matched controls (combat veterans from the same war) were followed up at five points of time: 1991 (T1), 2003 (T2), 2008 (T3), 2015 (T4), and in April–May 2020 (T5), during the outbreak of the COVID-19 pandemic. Results Ex-POWs had higher odds of COVID-19 related increase in TV news watching, which, in turn, contributed to PTSD severity at T5. In addition, delayed PTSD trajectory was associated with COVID-19 related increase in TV news watching, which, in turn, contributed to more severe PTSD at T5. Conclusions These findings highlight the negative implications of TV news watching during a mass trauma for traumatized individuals. More specifically, they demonstrate its potential pathogenic role in exacerbating prior PTSD among trauma survivors.

Background. The process of a comprehensive rehabilitation of the disabled person may be more complicated when the diagnosis becomes vague and uncertain. Unknown data about the patient’s past, mental, physical or vocational background, may cast a different light on the process. The patient’s diagnosis sometimes becomes an enigma. Using the model of Venn, the patient’s situation shifts from one circle to another. The only logical solution in these cases is to use the Occam’s Razor. Purpose. To draw the attention of rehabilitation medicine professionals to the problem of clients whose diagnoses are vague and uncertain and to share with the readers my personal thoughts on this topic. Methods. Reviewing literature and sharing with the readers the author’s 43 years of clinical experience in the field of rehabilitation medicine. Results and Conclusions. A PubMed query revealed 1479 articles with the words „diagnostic enigma”. The search term „diagnostic enigma in rehabilitation medicine” resulted only in four articles. In the long process of rehabilitation of disabled patients, some patients’ diagnoses change during the hospitalization phase and some diagnoses become unclear. The rehabilitation process becomes complicated and sometimes incomplete. Implications for Rehabilitation Medicine: 1. In most instances, patients are referred to rehabilitation medicine facilities with definite diagnoses. 2. The long process of a comprehensive rehabilitation of the disabled person may be more complicated when, prior to the discharge, the final diagnosis becomes vague and uncertain. 3. Facts about the patient’s past mental, physical or vocational background may cast a different light on the process. The patient’s diagnosis sometimes becomes an enigma.

Five patients developed symmetrical paraparesis due to a combination of: compartment syndrome, rhabdomyolysis, renal failure, and demyelinative sensory-motor polyneuropathy, after prolonged sleep in a sitting position. The long deep sleep was induced by consumption of alcohol or drugs. Long-term follow-up showed that these patients remained paraparetic. No damage to the autonomic nervous system was found. Although some suspected that these patients developed "intensive care neuropathy", we suggest that this syndrome is different, and should be regarded as a "new syndrome".

As of 1.1.2013, out of 24,811 persons awarded the status of Righteous Among the Nations, 245 (1%) were physicians and 31 were medical students. They were active in helping and saving Jews in various ways: surgery for hiding signs of Jewish identity, hospitalizations, smuggling medical supplies into the ghettos, providing false documents, hiding people and active fighting. We must remember them and pay them homage. We are equally obligated to the Jewish physicians, who saved the lives of other Jews during the Holocaust, at the risk of their own lives.

The presence of unintentional muscular activity, with or without overt movement, in the homologue muscle contralateral to the limb being activated voluntarily, has been documented in both healthy and hemi-paretic populations. This activity has been termed contra-lateral motor irradiation (CMI), mirror movement, associated movement, motor overflow or synkinesis.To characterize the CMI phenomenon amongst healthy controls and patients with varying degrees of motor ability and also to assess the ability to consciously control this phenomenon.A cross-sectional design was used to study sub-acute (within 6 weeks of the insult) stroke patients; assessments were performed within two weeks of commencing rehabilitation and again after 4 weeks. Healthy controls were assessed once. A simple motor task, unilateral extension of wrist and fingers, was examined. Concomitant muscular activity of the homologue muscle on the contralateral upper limb was the focus of interest; EMG activation was monitored on both sides. The Fugl-Meyer test was used to assess the residual motor capacity of the upper limb.CMI was demonstrated only in the non-paretic hand during voluntary activation of the paretic hand. The study group, unlike the control group, was unable to consciously reduce CMI.Although the mechanisms underlying CMI are poorly understood, they reflect an important aspect of inter-hemispheric relationship in motor control. In stroke patients, CMI monitoring by surface EMG can be used to assess its characteristics following damage to different elements of the motor system.

Vast literature has been published on the experiences of soldiers in war and in enemy captivity, but less light has been cast on the late physical, emotional, familial and social effects. Professor Zahava Solomon's long academic and professional career was devoted to the thorough and comprehensive study of the long term sequelae of war captivity. Her studies confirmed that repatriated Israeli prisoners of the Yom Kippur War, are exposed to premature aging processes and develop premature serious physical and mental morbidities.

Humans are social creatures and therefore exhibit a pervasive need for others. Hence, when benevolent human contact is scarce, this dearth may be compensated imaginatively. War captivity is an extreme example of such deprivation and one wherein dissociative hallucinations have been exhibited. Although hallucinations may serve to virtually summon benevolent others and thus provide the prisoner of war (POW) with a platform for compensation, the contents of such hallucinations have yet to be investigated. The current qualitative study is the first to examine whether the content of such hallucinations may harbor positive effects. Guided by the notion that people search for compensation in lack of companionship, we scrutinized testimonies of former POWs for accounts of hallucinatory experiences. A narrative analysis was utilized in an attempt to understand the meaning of the hallucinations for the POW. Findings reveal that benevolent figures and concomitant acts of care are exhibited in war captivity hallucinatory experiences. Thus, it is argued that the content of such hallucinations may be protective. These findings are discussed in light of the literature concerning peritraumatic dissociative experiences. In addition, attachment theory is suggested as a plausible framework for understanding these findings. Finally, limitations of the study are discussed, and future researched is suggested.

The Rehabilitation Medicine specialists are frequently confronted with paralyzed patients due to a conversion-somatoform etiology. This article describes our model of diagnosing, treating and rehabilitating these patients.

The Swiss physician Adolf Lukas Vischer described a psychiatric syndrome among prisoners of war, the ‘barbed-wire disease’ that follows a long-term incarceration and which involved boredom, confusion, clouding of consciousness and amnesia. Vischer first identified this as an important clinical issue. Later in life, he became one of the first geriatricians and gerontologists.

Teofil Simchowicz (1879-1957) was a Polish-Jewish neurologist who studied medicine at the Warsaw University, and worked under the founder of modern Polish school of neurology, Edward Flatau (1868-1932). It was Flatau who encouraged him to join Alois Alzheimer (1864-1915) in Munich. Simchowicz focused his research on the neuropathological changes in dementia. He emigrated with his wife to Palestine, where he continued to work as a consulting neurologist. Simchowicz coined the terms senile plaques, senile index, and granulovacuolar degeneration - discovered in the hippocampus in patients with Alzheimer's disease, and described the nasomental reflex. Simchowicz was a prolific researcher in the field of neuropathology, especially neurodegeneration but also in clinical neurology.

The field of physical medicine and rehabilitation in Israel was developed in different ways. Some services were developed as a part of comprehensive rehabilitation centers like the Loewenstein Hospital and others were developed as a part of specific disciplines, like the Polio-Rehabilitation Center at Assaf Harofeh hospital. Moreover, the various fields of rehabilitation medicine were developed at different rates. The origin of each stemmed from different circumstances. Sometimes they were developed with a direct connection to a national event and sometimes separately. Occasionally, the field was developed as a result of one person's initiation and others as a result of the establishment's recognition of the value and the essentiality of the field. This essay will focus, in a chronological manner, on the development of the medical rehabilitation fields, that took place in the two leading rehabilitation centers in Israel, the Loewenstein Hospital and at Tel Hashomer. These rehabilitation centers were established in Israel close to the establishment of the State of Israel and their activity will be discussed until 1974, the year in which the Israeli society had to deal with the results of the Yom Kippur war, which had drastic implications on rehabilitation medicine.

Ludwig Guttmann in 1944 at Stoke Mandeville Hospital established comprehensive care of spinal patients. His methods were extremely successful and he was responsible for the establishment of the comprehensive treatment of spinal injuries throughout Europe and large areas of the world. He was a Jew who had fled Nazi Germany, and he evinced strong loyalty to the State of Israel. In December 1949, he was invited by the Government of Israel to visit and advise on the status of rehabilitation of casualties who had suffered neurological injuries in the War of Independence (1948–49). His work is mentioned in his correspondence with Prime Minister Ben Gurion as well as in the Prime Minister's diaries. This episode offers a unique insight into Guttmann's approach to rehabilitation in his early years.

Electrostimulation for the treatment of pressure sores remains problematic and controversial. We studied the decubitus direct current treatment (DDCT) electrostimulation treatment of pressure sores stage 3 degree, with respect to rates of ulcer closure and wound area reduction. This was a multicenter, double-blind, randomized, placebo-controlled study involving 11 departments of geriatric and rehabilitation medicine including 63 patients. We compared a placebo treated group (PG) with an active treatment group (TG). Treatment lasted for 8 consecutive weeks, followed by a 12-week-period of follow-up. At day 57 (end of treatment) and at day 147 (end of follow-up), there was no difference between the groups with regards to rates of complete closure of ulcers (p=0.28 and 0.39, respectively), as well as for the mean time needed to achieve complete wound closure (p=0.16). Absolute ulcer area reduction and speed rate of wound area reduction (reflected by change from baseline ulcer area, percentage) were better in participants allocated in the treatment group only until day 45 (standardized estimate for trend of healing speed -0.44 and -0.14 for TG and PG, respectively). Afterwards, there were no differences between the two groups. A logistic regression analysis favored complete healing in TG, compared with PG (odds ratio 1.6, CI 0.4-4.73). Analysis of per protocol patients revealed that time needed for wound closure was 52% longer in PG (p=0.03, compared with TG). The results suggest that DDCT treatment for pressure ulcers grade 3 degree, in addition to the conservative wound care, may be useful in accelerating the healing process during the first period of care.

It is still unclear whether the quality of painful thermal sensation is determined only by conduction in specific, dedicated nociceptive channels (i.e. C or Adelta nociceptors) or whether it is a result of integrated activity in both nociceptive and non-nociceptive systems. To evaluate this question, we conducted quantitative and qualitative somatosensory testing in spinal cord injury subjects who suffered from partial or complete loss of thermal sensibility. Testing was performed in skin areas, below the level of the lesion, which were either lacking any thermal sensibility, lacking only one thermal sensation (either heat or cold) or having normal thermal sensations. We found that, in areas lacking any thermal sensibility, warm and cold stimuli produced a sensation of pricking pain, which had no thermal quality and was detected at significantly higher thresholds than in normal controls (48.5 +/- 1.8 and 9.7 +/- 5.1 degrees C for noxious heat- and noxious cold-induced pricking pain, respectively). Normal thermal pain sensations, consisting of normal perception of thermal quality and normal mean pain thresholds, were present both in normal skin areas (42.1 +/- 1.9 and 27.6 +/- 2.25 degrees C for heat and cold pain, respectively) and in areas in which only one thermal modality remained intact, when tested for that modality. Thus, testing for heat pain in areas in which only warm sensation was intact, or cold pain when only cold was intact produced normal qualities and thresholds of pain (42.8 +/- 3.4 and 24.4 +/- 6.2 degrees C for heat and cold pain, respectively). No spatial summation of pricking pain was observed, in contrast to the marked summation of heat pain in normal areas. In areas with only a single intact thermal modality, the quality of the perceived non-painful sensation was not determined by the thermal stimulus but by the intact modality (paradoxical sensation). Cold stimuli were perceived as warm in areas in which only warm sensation was preserved, and vice versa. A similar pattern was also seen for pain perception in areas with intact warm sensation. In these areas, both noxious heat and cold elicited a sensation of heat pain. No consistent pattern of heat-elicited pain was observed in areas in which only cold sensation was intact. These data suggest that the integrity of non-noxious thermal systems is essential for the normal perception of thermal pain, and that the subjective sensation of pain depends on the integration of information from nociceptive and non-nociceptive channels.

We describe two patients who developed a severe spinal cord damage long time after cessation of irradiation therapy. The various and unique rehabilitation medicine aspects are discussed and the literature is surveyed.

The pathophysiology of the chronic pain following spinal cord injury (SCI) is unclear. In order to study it's underlying mechanism we characterized the neurological profile of SCI subjects with (SCIP) and without (SCINP) chronic pain. Characterization comprised of thermal threshold testing for warmth, cold and heat pain and tactile sensibility testing of touch, graphesthesia and identification of speed of movement of touch stimuli on the skin. In addition, spontaneously painful areas were mapped in SCIP and evoked pathological pain--allodynia, hyperpathia and wind-up pain evaluated for both groups. Both SCIP and SCINP showed similar reductions in both thermal and tactile sensations. In both groups thermal sensations were significantly more impaired than tactile sensations. Chronic pain was present only in skin areas below the lesion with impaired or absent temperature and heat-pain sensibilities. Conversely, all the thermally impaired skin areas in SCIP were painful while painfree areas in the same subjects were normal. In contrast, chronic pain could be found in skin areas without any impairment in tactile sensibilities. Allodynia could only be elicited in SCIP and a significantly higher incidence of pathologically evoked pain (i.e. hyperpathia and wind-up pain) was seen in the chronic pain areas compared to SCINP. We conclude that damage to the spinothalamic tract (STT) is a necessary condition for the occurrence of chronic pain following SCI. However, STT lesion is not a sufficient condition since it could also be found in SCINP. The abnormal evoked pain seen in SCIP is probably due to neuronal hyperexcitability in these subjects. The fact that apparently identical sensory impairments manifest as chronic pain and hyperexcitability in one subject but not in another implies that either genetic predisposition or subtle differences in the nature of spinal injury determine the emergence of chronic pain following SCI.

We present a patient with gradual development of camptocormia, three years before a non-Hodgkin's lymphoma was diagnosed. Lymphomas are known to produce neuromuscular symptoms through several indirect mechanisms. Recent studies regard camptocormia as a primary disease of the paravertebral muscles. To our knowledge this is the first report associating camptocormia with malignancy. The possibility of a paraneoplastic syndrome is discussed.

Physicians and surgeons were always involved in revolutions, wars and political activities, as well as in various medical humanities. Tragic fate met these doctors, whether in the Russian prisons gulags, German labor or concentration camps, pogroms or at the hands of the Inquisition.

I feel that the highlight of my research activities is bringing the topic of ‘premature morbidity and aging’ (senectus praecox), in people with spinal cord injury (SCI) and other disabilities, into public awareness.1

The current study aims to (1) assess the long-term impact of war captivity on mortality and various health aspects and (2) evaluate the potential mediating role of posttraumatic stress disorder (PTSD) and depressive symptoms. Israeli ex-prisoners of war (ex-POWs) (N = 154) and a matched control group of combat veterans (N = 161) were assessed on health conditions and self-rated health 18 years post-war (1991: T1). The whole population of ex-POWs, and the T1 sample of controls were then contacted 35 years after the war (2008: T2), and invited to participate in a second wave of measurement (ex-POWs: N = 171; controls: N = 116) Captivity was implicated in premature mortality, more health-related conditions and worse self-rated health. PTSD and depressive symptoms mediated the relationship between war captivity and self-rated health, and partially mediated the relationship between war captivity and health conditions, and these effects were amplified with age. Aging ex-POWs who develop psychiatric symptomatology should be considered a high-risk group entering a high-risk period in the life cycle. It is important to monitor ex-POWs and provide them with appropriate medical and psychological treatment as they age.

Prior to the historical appearance of modern comprehensive rehabilitation medicine, people with disabilities were treated at their families' residence or by religious establishments. It is interesting to note some famous severely disabled who succeeded not only to survive against all odds but rather to contribute to their societies and to enter the pages of encyclopedias. The following case studies are randomly selected to reflect the historical position on disability and rehabilitation. The stories of Claudius, Herman von Reichenau, Gottfried von- Berlichingen, Georges Couthon, Aleijadinho, are given along with information on some other famous rulers, Kings and Popes who suffered from various disabilities and deformities.

In 1913, Dr. Jacob Mackiewicz, a Polish-Jewish neurologist, described a clinical sign (a maneuver) which indicates a femoral nerve injury or L4 root injury. He called it the "cruralis phenomenon", but in the German and Slavic literature, the sign is named after him: "the patient lies prone, the examiner lifts the thigh in one hand, with the other hand, bends the patient's knee slowly; this maneuver causes severe pain in the anterior part of the thigh and over the groin".

Physical diagnosis is considered to be a cornerstone in clinical medicine. Examination of the ears is frequently forgotten although, in many clinical situations, it may help: in gout (tophi), lupus, congenital anomalies, trauma and in local malignancies. We may add another physical-acquired sign: the Frank's sign in which a diagonal notch in the ear lobe is found in patients with coronary heart disease.

This is the extraordinary story of a British born orthopedist, Dr. SigmundWolfsohn (1765-1850), who came to Vienna, manufactured artificial limbs and surgical appliances, and created the magnificent colossal dancing and entertainment palace--the "Apollosaal"

Via our description of a seemingly heterogeneous group of four patients who presented to our rehabilitation facility with a rather unusual clinical presentation of compartment syndrome with development of a flaccid paraparesis and rhabdomyolysis immediately after awakening from a prolonged sleep episode in an unusual posture - which might, in fact, be a 'new syndrome' - we have also come to address an important issue linking our group of patients - specifically, the complexities which present to a rehabilitative facility in the cases of unusual and unclear diagnoses. Eventually, all four of our patients remained severely disabled. All had suffered sensorimotor axonal demyelinative polyneuropathies and two patients had subclinical hypothyroidism. Prior to the prolonged sleep episode, they had all consumed alcohol and drugs. Using these four rather demanding diagnostic rehabilitative cases we address the ever-important issue of timely mutual communication and patience. For when a rehabilitative facility is confronted with patients whose diagnoses are not clear, the scope of the long-term comprehensive rehabilitation management faces some major obstacles with respect to how the rehabilitative team can succeed in designing a 'tailor-made' rehabilitation program for these patients, which often-times proves to be a rather tricky task requiring innovative and creative efforts on the parts of all those involved in the care of the patient. Quite a challenging task, indeed, yet one genuinely necessary to attempt to achieve so that the patient, family and, of course, the 'payer agency/provider' can all prepare themselves, realistically so as to obtain the best overall rehabilitative outcome for these patients. We conclude that what is most necessary for these unique patients is patience.

Retrospective analysis of civilians with spinal cord injuries (SCIs) due to terror explosions. To analyze and describe the clinical characteristics and rehabilitation outcomes of civilians with SCI due to explosions admitted for in-patient rehabilitation from 2000–2004. SCI rehabilitation service, Tel Hashomer, Israel. Retrospective chart review. Civilians with SCI due to terror-related gunshot wounds (GSWs) served as a control group. Eleven civilians with SCI caused by penetrating atypical foreign objects (PAFOs) and eight with GSWs were identified. The male-to-female ratio was approximately 2:1. Foreign objects were present within the spinal canal in seven patients, causing bone injury without canal penetration in three, and one patient had both bone injury and canal penetration. The most common level of injury was thoracic. Seven had complete motor SCI. Three individuals improved in American Spinal Injury Association status: one individual improved from B to C (cervical); one from C to D (thoracic); and the third from D to E (lumbar). Despite the similar acute hospital length of stay and functional independence measure (FIM) scores on admission, the PAFO group had a shorter rehabilitation length of stay with higher FIM scores and higher FIM efficiency at discharge. Although the pathophysiology of PAFO blast injuries is similar to the high-velocity GSWs or the high-energy military munition injuries, better rehabilitation outcomes were seen, with slightly higher FIM efficiency and efficacy at discharge. This result is likely to be caused by less neurological tissue damage at impact.