Adaptation to stroke: a longitudinal study of depressive symptoms, physical health, and coping process.

The purposes of this study were to describe the natural history of adaptation to stroke and to identify survivor and caregiver predictors of depressive symptoms. Data were collected for 53 stroke survivors at four times from acute rehabilitation (T1) to 2 years post discharge (T4). Significant improvement occurred in depressive symptoms and perception of health, but change in the rate of depression was not significant. Family functioning became less healthy. Significant predictors of greater levels of depressive symptoms were lower levels of total support, finding meaning, and avoidance coping (T1) and lower levels of family functioning and belonging support (T4). Treatments to promote adaptation can be developed based on these predictors.

Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications.

Some patients with fibromyalgia also exhibit the neurological signs of cervical myelopathy. We sought to determine if treatment of cervical myelopathy in patients with fibromyalgia improves the symptoms of fibromyalgia and the patients' quality of life. A non-randomized, prospective, case control study comparing the outcome of surgical (n = 40) versus non-surgical (n = 31) treatment of cervical myelopathy in patients with fibromyalgia was conducted. Outcomes were compared using SF-36, screening test for somatization, HADS, MMPI-2 scale 1 (Hypochondriasis), and self reported severity of symptoms 1 year after treatment. There was no significant difference in initial clinical presentation or demographic characteristics between the patients treated by surgical decompression and those treated by non-surgical means. There was a striking and statistically significant improvement in all symptoms attributed to the fibromyalgia syndrome in the surgical patients but not in the non-surgical patients at 1 year following the treatment of cervical myelopathy (P

Adaptation to stroke: Comparison of spouses of stroke survivors with and without aphasia.

The purpose of this study was to compare adaptation to a partner's stroke in spouses of aphasic stroke survivors (SASS) and spouses of nonaphasic stroke survivors (SNASS) over time. Cognitive appraisal of the impact of stroke, difficult adaptive tasks, and depression were examined in 15 SASS and 20 SNASS. Data were collected prior to discharge from rehabilitation and at 6 to 10 weeks and 1 year postdischarge. For the entire group, depression scores decreased significantly (p < .05) over time. The reduction in depression was equivalent in both groups. Differences and similarities in patterns of change in appraisal of stroke and in adaptive tasks are discussed.

Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia.

OBJECTIVE: While patients with fibromyalgia report symptoms consistent with cervical myelopathy, a detailed neurological evaluation is not routine. We sought to determine if patients with fibromyalgia manifest objective neurological signs of cervical myelopathy. METHODS: Two hundred and seventy patients, 18 years and older, who carried the diagnosis of fibromyalgia but who had no previously recognized neurological disease underwent detailed clinical neurological and neuroradiological evaluation for the prevalence of objective evidence of cervical myelopathy and radiological evidence of cerebellar tonsillar herniation (Chiari 1 malformation) or cervical spinal canal stenosis. RESULTS: Patients were primarily women (87%), of mean age 44 years, who had been symptomatic for 8 years (standard deviation, 6.3 years). The predominant complaints were neck/back pain (95%), fatigue (95%), exertional fatigue (96%), cognitive impairment (92%), instability of gait (85%), grip weakness (83%), paresthesiae (80%), dizziness (71%) and numbness (69%). Eighty-eight percent of patients reported worsening symptoms with neck extension. The neurological examination was consistent with cervical myelopathy: upper thoracic spinothalamic sensory level (83%), hyperreflexia (64%), inversion of the radial periosteal reflex (57%), positive Romberg sign (28%), ankle clonus (25%), positive Hoffman sign (26%), impaired tandem walk (23%), dysmetria (15%) and dysdiadochokinesia (13%). MRI and contrast-enhanced CT imaging of the cervical spine revealed stenosis. The mean antero-posterior (AP) spinal canal diameter at C2/3, C3/4, C4/5, C5/6, C6/7 and C7/T1 was 13.5 mm, 11.8 mm, 11.5 mm, 10.4 mm, 11.3 mm and 14.5 mm respectively, (CT images). In 46% of patients, the AP spinal diameter at C5/6 measured 10 mm, or less, with the neck positioned in mild extension, i.e., clinically significant spinal canal stenosis. MRI of the brain revealed tonsillar ectopia >5 mm in 20% of patients (mean=7.1+/-1.8 mm), i.e., Chiari 1 malformation. CONCLUSION. Our findings indicate that some patients who carry the diagnosis of fibromyalgia have both signs and symptoms consistent with cervical myelopathy, most likely resulting from spinal cord compression. We recommend detailed neurological evaluation of patients with fibromyalgia in order to exclude cervical myelopathy, a potentially treatable condition.