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Neurosurgery Clinics of North America Jul 2022A multidisciplinary approach to pain management includes evaluation by a variety of healthcare professionals who possess differing levels of expertise and who often... (Review)
Review
A multidisciplinary approach to pain management includes evaluation by a variety of healthcare professionals who possess differing levels of expertise and who often consult with one another. The "core" multidisciplinary team commonly consists of primary care providers, anesthesiologists, psychologists, nurses, and physical and occupational therapists, with additional involvement from surgeons, neurologists, internists, physiatrists, psychiatrists, social workers, dietitians, and pharmacists. Multiple studies have supported the use of multidisciplinary programs as effective, cost-efficient, and superior to single-discipline treatments or outpatient nonmultidisciplinary rehabilitation; however, barriers to their implementation exist due to significant associated costs and need for longitudinal care.
Topics: Humans; Pain Management; Patient Care Team
PubMed: 35718393
DOI: 10.1016/j.nec.2022.02.002 -
The Journal of Head Trauma... 2019To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain...
OBJECTIVE
To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) based on the perspectives of providers who work in the ICU setting.
PARTICIPANTS
Members (n = 66) of the Neurocritical Care Society and the American Congress of Rehabilitation Medicine.
DESIGN
An anonymous electronic survey of the timing of rehabilitation for patients with TBI in the ICU.
MAIN MEASURES
Questions asked about type and timing of rehabilitation in the ICU, extent of family involvement, participation of physiatrists in patient care, and barriers to early rehabilitation.
RESULTS
Sixty-six respondents who reported caring for patients with TBI in the ICU completed the survey; 98% recommended rehabilitative care while patients were in the ICU. Common reasons to wait for the initiation of physical therapy and occupational therapy were normalization of intracranial pressure (86% and 89%) and hemodynamic stability (66% and 69%).
CONCLUSIONS
The majority of providers caring for patients with TBI in the ICU support rehabilitation efforts, typically after a patient is extubated, intracranial pressure has normalized, and the patient is hemodynamically stable. Our findings describe current practice; future studies can be designed to determine optimal timing, intensity, and patient selection for early rehabilitation.
Topics: Brain Injuries, Traumatic; Clinical Decision-Making; Hemodynamics; Hospitalization; Humans; Intensive Care Units; Intracranial Pressure; Occupational Therapy; Patient Care Team; Physical Therapy Modalities; Speech Therapy; Surveys and Questionnaires; Time-to-Treatment
PubMed: 30829824
DOI: 10.1097/HTR.0000000000000477 -
The American Journal of Occupational... 2021The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown.
OBJECTIVE
To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke.
DESIGN
Randomized, crossover-controlled, assessor-blinded study.
SETTING
Rehabilitation clinic.
PARTICIPANTS
Patients (N = 24) with moderate motor and sensory deficits.
INTERVENTION
Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period.
OUTCOMES AND MEASURES
Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability.
RESULTS
RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050).
CONCLUSIONS AND RELEVANCE
RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke.
WHAT THIS ARTICLE ADDS
The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.
Topics: Activities of Daily Living; Hand; Humans; Recovery of Function; Robotics; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 33399050
DOI: 10.5014/ajot.2021.038232