Exercise therapy for a patient with persistent dyspnea after combined traumatic diaphragmatic rupture and phrenic nerve injury.

We present a case report of a patient with a history of diaphragmatic rupture who had persistent dyspnea for 9 months after primary surgical repair of a right diaphragmatic rupture caused by a car accident. A phrenic nerve conduction study was performed, which demonstrated a rare accompanying ipsilateral phrenic nerve injury with resultant hemidiaphragmatic paralysis. Aerobic exercise therapy for the purpose of improving endurance and dietary modification for weight reduction were prescribed and continued for 6 months. The exercise intensity was prescribed based on the percentage of maximum heart rate as confirmed by an exercise tolerance test. The duration of exercise was gradually increased. In this case, the long-persistent dyspnea was successfully alleviated via nonoperative management to the point that the patient could resume regular activities of daily living.

Feasibility of Applying the Extended ICF Core Set for Stroke to Clinical Settings in Rehabilitation: A Preliminary Study.

OBJECTIVE: To evaluate the potential feasibility of application of the extended International Classification of Functioning, Disability and Health (ICF) Core Set for stroke. METHODS: We retrospectively reviewed the medical records of 40 stroke outpatients (>6 months after onset) admitted to the Department of Rehabilitation Medicine for comprehensive rehabilitation. Clinical information of the patients were respectively evaluated to link to the 166 second-level categories of the extended ICF Core Set for stroke. RESULTS: Clinical information could be linked to 111 different ICF categories, 58 categories of the body functions component, eight categories of the body structures component, 38 categories of the activities and participation component, and seven categories of the environmental factors component. CONCLUSION: The body functions component might be feasible for application of the extended ICF Core Set for stroke to clinical settings. The activities and participation component and environmental factors component may not be directly applied to clinical settings without additional evaluation tools including interview and questionnaire.

Medical management for intractable pain arising from primary sjögren syndrome involving both brain and spinal cord: a case report.

Primary Sjögren syndrome, which involves lesions in both the brain and spinal cord, is rarely reported. Related symptoms, such as intractable pain due to central nervous system involvement, are very rare. A 73-year-old woman diagnosed with primary Sjögren syndrome manifested with subacute encephalopathy and extensive transverse myelitis. She complained of severe whole body neuropathic pain. Magnetic resonance imaging demonstrated a non-enhancing ill-defined high intensity signal involving the posterior limb of the both internal capsule and right thalamus on a T2 fluid-attenuated inversion recovery image. Additionally, multifocal intramedullary ill-defined contrast-enhancing lesion with cord swelling from the C-spine to L-spine was also visible on the T2-weighted image. Her intractable pain remarkably improved after administration of concomitant oral doses of gabapentin, venlafaxine, and carbamazepine.