Pneumorrhachis: A rare cause of headache in a patient with a traumatic spinal cord injury due to gunshot wound.

CONTEXT: A pneumorrhachis (PR) is a rare phenomenon in which air is found in the spinal canal. There are multiple etiologies, including iatrogenic, nontraumatic, and traumatic. Most traumatic PR are asymptomatic and resolve on their own, but a subset are symptomatic and require urgent surgical intervention. This case describes a traumatic PR in which a headache was the primary symptom. FINDINGS: A 17-year-old male sustained a gunshot wound to the left flank with associated bilateral pulmonary lacerations, multiple rib fractures, and T5-7 vertebral body fractures with displaced bony fragments causing spinal cord injury with resultant paraplegia (T3 AIS-A) was admitted to inpatient rehabilitation. Three weeks into his course of rehabilitation, he developed throbbing headaches that were found to be caused by a subarachnoid PR. He underwent a T4-7 laminectomy with repair of dural tear and theco-pleural-bronch-fistula closure, and his headaches subsequently resolved. DISCUSSION/CLINICAL RELEVANCE: This case demonstrated that a headache can be a presenting symptom of a subarachnoid PR.

Ankle passive and active movement training in children with acute brain injury using a wearable robot.

OBJECTIVE: To evaluate the feasibility and effectiveness of a wearable robotic device in guiding isometric torque generation and passive-active movement training for ankle motor recovery in children with acute brain injury. PARTICIPANTS/SETTING: Ten inpatient children with acute brain injury being treated in a rehabilitation hospital. DESIGN: Daily robot-guided ankle passive-active movement therapy for 15 sessions, including isometric torque generation under real-time feedback, stretch-ing, and active movement training with motivating games using a wearable ankle rehabilitation robot. MAIN MEASURES: Ankle biomechanical improvements induced by each training session including ankle range of motion (ROM), muscle strength, and clinical (Fugl-Meyer Lower-Extremity (FMLE), Pediatric Balance Scale (PBS)) and biomechanical (ankle ROM and muscle strength) outcomes over 15 training sessions. RESULTS: As training progressed, improvements in biomechanical performance measures followed logarithmic curves. Each training session increased median dorsiflexion active range of motion (AROM) 2.73° (standard deviation (SD) 1.14), dorsiflexion strength 0.87 Nm (SD 0.90), and plantarflexion strength 0.60 Nm (SD 1.19). After 15 training sessions the median FMLE score had increased from 14.0 (SD 10.11) to 23.0 (SD 11.4), PBS had increased from 33.0 (SD 19.99) to 50.0 (SD 23.13) (p < 0.05), median dorsiflexion and plantarflexion strength had improved from 0.21 Nm (SD 4.45) to 4.0 Nm (SD 7.63) and 8.33 Nm (SD 10.18) to 18.45 Nm (SD 14.41), respectively, median dorsiflexion AROM had improved from -10.45° (SD 12.01) to 11.87° (SD 20.69), and median dorsiflexion PROM increased from 20.0° (SD 9.04) to 25.0° (SD 8.03). CONCLUSION: Isometric torque generation with real-time feedback, stretching and active movement training helped promote neuroplasticity and improve motor performance in children with acute brain injury.

Pilot study: investigating the effects of Kinesio Taping in an acute pediatric rehabilitation setting.

OBJECTIVES: The purpose of this pilot study is to describe the use of the Kinesio Taping method for the upper extremity in enhancing functional motor skills in children admitted into an acute rehabilitation program. METHOD: Fifteen children (10 females and 5 males; 4 to 16 years of age), who were receiving rehabilitation services at the Rehabilitation Institute of Chicago participated in this study. For 13 of the inpatients, this was the initial rehabilitation following an acquired disability, which included encephalitis, brain tumor, cerebral vascular accident, traumatic brain injury, and spinal cord injury. The Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment) was used to measure upper-limb functional change prior to use of Kinesio Tape, immediately after application of the tape, and 3 days after wearing tape. Children's upper-limb function was compared over the three assessments using analysis of variance. RESULTS: The improvement from pre- to posttaping was statistically significant, F(1, 14) = 18.9; p < .02. CONCLUSION: These results suggest that Kinesio Tape may be associated with improvement in upper-extremity control and function in the acute pediatric rehabilitation setting. The use of Kinesio Tape as an adjunct to treatment may assist with the goal-focused occupational therapy treatment during the child's inpatient stay. Further study is recommended to test the effectiveness of this method and to determine the lasting effects on motor skills and functional performance once the tape is removed.

Pain management in a pediatric rehabilitation setting.

This article reviews the current understanding of pain evaluation as applied to children who have chronic illness and disabilities. Utilizing a collaborative medical approach, psychiatric principles of management are discussed. Case scenarios are presented to outline application of general strategies of clinical management.

Caffeine as a neurostimulant: Two pediatric acquired brain injury cases.

OBJECTIVE: This report describes two pediatric patients undergoing acute inpatient rehabilitation for acquired brain injury. DESIGN: The first patient was a 16-year-old African American female with an acquired brain injury from multiple intracranial hemorrhages secondary to an arteriovenous malformation. The second patient was a 16 year-old African American male who sustained a traumatic brain injury due to assault. In both cases, the patients had difficulty participating in therapy due to significant attention/arousal impairments. RESULTS: Both patients demonstrated functional improvements after the initiation of caffeine 80 mg daily. The first patient's function improved from being unable to communicate to being able to signal yes/no with thumb movements. The functional independence measurement (FIM) scores of the second patient improved dramatically after caffeine was initiated. His function improved from being totally dependent in ambulation, wheelchair ambulation, and communication to only requiring moderate assistance with ambulation and supervision with wheelchair ambulation and communication after 3 weeks of treatment. The second patient's attention/arousal and FIM scores declined when caffeine was stopped for 3 days and improved once administration of caffeine resumed. There were no adverse events reported for either patient. CONCLUSION: Caffeine is a safe and inexpensive neurostimulant that may be used to treat attention/arousal impairments. Additional research is warranted to determine criteria of use, optimal timing, duration, and dosing of caffeine administration and to investigate whether caffeine improves chronic functional outcomes after ABI in pediatric acquired brain injury patients.

Functional improvement after pediatric spinal cord injury.

OBJECTIVE: To describe the functional gain (FGain) with pediatric spinal cord injury inpatient rehabilitation and to identify the relationship of various factors to FGain in pediatric spinal cord injury inpatient rehabilitation. DESIGN: Retrospective chart review of a series of 91 children with spinal cord injury admitted from 1993 to 1998 in a freestanding rehabilitation hospital. Admission and discharge functional status were assessed with the Pediatric Functional Independence Measure (WeeFIM) instrument for children 7 yr. The outcome measure is the FGain (difference between the discharge and admission functional status). RESULTS: Significant gains in functional status were observed in all patients. FGain was not significantly related to age, sex, length of inpatient rehabilitation, pathogenesis, or completeness or neurologic level of injury. However, there was a trend for higher FGain for patients with incomplete spinal cord injury and traumatic spinal cord injury. CONCLUSIONS: Functional improvement occurs with pediatric spinal cord injury inpatient rehabilitation. There is a trend for higher FGain in patients with less severe injury and traumatic injury. The lack of relationship between FGain and length of inpatient rehabilitation suggests that a variety of other factors influence the relationship between FGain and length of inpatient rehabilitation.