Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. This national guideline provides suggestions regarding the PR methods during the clinical stages of COVID-19 and post-COVID-19 with its possible benefits, contraindications, and disadvantages.

Quality of life, body image, and mobility in lower-limb amputees using high-tech prostheses: A pragmatic trial.

BACKGROUND: High-tech prostheses are supposed to achieve better functional recovery over mechanical-controlled prostheses in lower-limb amputees. However, quantitative data are insufficient. OBJECTIVE: We aimed to evaluate changes in quality of life, life satisfaction, perception of body image, and functional performance of lower-limb amputees when using a mechanical-controlled prosthesis versus a microprocessor-controlled knee (MPK) or transtibial vacuum-assisted suspension system (VASS) prosthesis. METHODS: In this pragmatic study, 57 lower-limb amputees were assessed with the Satisfaction with the Prosthesis Questionnaire (SATPRO), revised Amputee Body Image Scale (ABIS-R), Trinity Amputation and Prosthesis Experience Scales (TAPES), Medical Outcomes Study Short Form-36 (SF-36) and 6-min walk test (6MWT). All assessments were performed under 2 conditions (i.e., using a mechanical-controlled prosthesis vs. an MPK/VASS prosthesis. RESULTS: Amputees who used an MPK/VASS prosthesis showed significant increases in all SF-36 subscale scores and all subscale scores of TAPES except adjustment to limitation (P=0.156). The amputees showed clinically relevant improvements in 6MWT (P<0.001) and in SATPRO and ABIS-R scores (P<0.001). CONCLUSION: Lower-limb amputees using an MPK/VASS prosthesis had better life satisfaction, quality of life and functional performance than those using a mechanical-controlled prosthesis.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration.

The Effectiveness of Fluidotherapy in Poststroke Complex Regional Pain Syndrome: A Randomized Controlled Study.

OBJECTIVE: To evaluate whether combining fluidotherapy to conventional rehabilitation program provides additional improvements on pain severity, upper extremity functions, and edema volume in patients with poststroke complex regional pain syndrome (CRPS). DESIGN: Randomized controlled trial. SETTING: Training and research hospital. PARTICIPANTS: Thirty hemiplegic patients with subacute stage CRPS type-1 of the upper extremity. INTERVENTIONS: The patients randomly divided into 2 groups. Both groups received a 3 week conventional rehabilitation program (5 days/week, 2-4 hours/day). Experimental group received 15 sessions additional fluidotherapy application to the affected upper extremity (40 °C, 20 minutes in continuous mode, 5 sessions/week). MAIN OUTCOME MEASURES: We evaluated the distal upper arm edema with a volumeter. Other used clinical assessment scales were Brunnstrom recovery stages of the arm and hand for motor recovery, motor items of the functional independence measure for functional status, visual analog scale for pain severity, and the painDETECT questionnaire for presence and the severity of neuropathic pain. RESULTS: The mean age of the participants was 64.3 ± 11.66 (28-84). At the post-treatment evaluation, significant improvements were revealed regarding to the edema volume, pain visual analog scale, painDETECT and functional independence measure scores, and the Brunnstrom stages of upper extremity and hand in both groups (P < .05). But among the parameters mentioned above, only the decrease in edema volume and the painDETECT scores were greater in fluidotherapy group than the control group (P < .05). CONCLUSIONS: Addition of the fluidotherapy to the conventional rehabilitation program provides better improvements on neuropathic pain and edema volume in subacute stage poststroke CRPS.

Horseback riding therapy in addition to conventional rehabilitation program decreases spasticity in children with cerebral palsy: A small sample study.

OBJECTIVE: To evaluate the short-term effects of horseback riding therapy in addition to a conventional rehabilitation program in children with cerebral palsy. METHODS: Nine children receiving horseback riding therapy in addition to conventional rehabilitation (Group 1) and seven children receiving conventional rehabilitation alone (Group 2) were assessed at baseline and 5 weeks later. Assessed were: modified functional reach test (MFRT), hip abduction angle, the Ashworth Scale for hip adductor muscle spasticity, knee distance test, and the Gross Motor Function Classification System (GMFCS). RESULTS: The percentage change in hip adductor spasticity on the Ashworth Scale was 22% in Group 1 and 0% in Group 2 (significant difference; p = 0.016). Comparison of changes on the MFRT, GMFCS, knee distance test and hip abduction angle showed that the differences between Groups 1 and 2 were not significant. CONCLUSIONS: In these children, horseback riding therapy in addition to conventional rehabilitation resulted in significant improvement in adductor spasticity on short-term follow-up.

Greater trochanteric pain syndrome: frequency and associated factors in patients with stroke.

BACKGROUND: Greater trochanteric pain syndrome (GTPS) is a common cause of lower extremity pain and is estimated to affect between 10% and 25% of the population. Despite all the research, there are no data in the literature about GTPS in the stroke population. OBJECTIVE: The aim of the study was to determine frequency and related factors of GTPS in patients with stroke. METHODS: Eighty-six patients with stroke were recruited from an inpatient rehabilitation department. Presence or absence of lateral thigh or hip pain was recorded. All patients with stroke (with or without self-reported pain) were examined using clinical criteria for the diagnosis of GTPS. RESULTS: Lateral thigh or hip pain was reported on initial interviews by 29 of 86 patients. GTPS was diagnosed by means of structured physical examination maneuvers in 17 patients with stroke and self-reported pain and 11 patients with stroke without self-reported pain. Twenty-eight patients (32.6%) had GTPS. The following factors were significantly associated with GTPS: lower extremity spasticity, depression, and iliotibial band syndrome. No correlation was found between GTPS and age, sex, lesion localization, motor status, neglect, sensory loss, time since stroke, low back pain, knee and hip osteoarthritis, or health-related quality of life. CONCLUSION: In this study, we showed that patients with stroke have a high percentage of GTPS. Early diagnosis and treatment of pain from GTPS are important in this population, because GTPS may limit applicability of motor training and affect rehabilitation outcomes.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

OBJECTIVES: To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). METHODS: A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. RESULTS: Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. CONCLUSIONS: Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

Femoral cartilage thickness measurements in healthy individuals: learning, practicing and publishing with TURK-MUSCULUS.

BACKGROUND AND OBJECTIVES: Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population.The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS. METHODS: This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25-40 years) were recruited within the collaboration of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects' knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle). RESULTS: A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p< 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses. CONCLUSION: Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.

Ultrasonographic measurement of femoral cartilage thickness in patients with spinal cord injury.

OBJECTIVE: To assess femoral cartilage thickness in patients with spinal cord injury (SCI). SUBJECTS: Forty-six patients with SCI (35 men, 11 women; mean age: 33.6 years (standard deviation 8.1) and 46 age-, sex- and body mass index (BMI)-matched healthy subjects were enrolled. METHODS: Patients were evaluated with the American Spinal Injury Association (ASIA) Impairment Scale, Modified Ashworth Scale, Walking Index for Spinal Cord Injury, and Functional Independence Measurement. Mid-point ultrasonographic femoral cartilage thickness measurements were taken from the right lateral condyle, right intercondylar area, right medial condyle, left medial condyle, left intercondylar area and left lateral condyle. RESULTS: Ultrasonographic measurements revealed significantly thicker values in the intercondylar areas (bilaterally) and the medial condyle (left knee) of patients with SCI compared with those of controls. When the subgroups were compared with their paired healthy controls, measurements pertaining to the motor complete group were found to be significantly thicker in the intercondylar areas (bilaterally) and the medial condyle (left knee). Cartilage thickness values correlated negatively with the duration of immobilization (for bilateral intercondylar areas), and with BMI and ASIA level (for bilateral lateral condyles). CONCLUSION: Femoral cartilage thicknesses were found to change after SCI, and to have a negative correlation with disease duration and severity. Future studies including histological evaluations may elucidate whether such changes are favourable for the knee joints of patients with spinal cord injury.

Ultrasonographic measurement of the femoral cartilage thickness in hemiparetic patients after stroke.

The aim of the study was to evaluate the femoral cartilage thicknesses of hemiparetic patients after stroke using musculoskeletal ultrasonography and to determine whether there is any correlation between cartilage thicknesses and the clinical characteristics of the patients. Femoral cartilage thicknesses of both knees were measured in 87 (33 women, 54 men) hemiparetic patients. The mean age of the patients was 61.8 years (SD 11.1 years, range 32-87 years) and the mean duration of stroke was 12.3 months (SD 10.5 months, range 1-36 months). The outcome was measured in terms of motor recovery (Brunnstrom stages), spasticity (Modified Ashworth Scale), walking ability (Functional Ambulation Categories), and motor functioning (Functional Independence Measurement instrument). Ultrasonographic measurements were made axially from the suprapatellar window using linear probes while the patients' knees were held in maximum flexion. Three (midpoint) measurements were taken from both knees [lateral condyle (LFC), intercondylar area, and medial condyle (MFC)]. The mean cartilage thicknesses were found to be less on the paretic side (statistically significant only for LFC) when compared with the nonparetic side. Cartilage thickness values were found to be negatively correlated with the duration of immobilization (with paretic side LFC) and BMI (with both sides' MFC) and positively correlated with the Functional Independence Measurement motor score (with paretic side LFC) and the Functional Ambulation Categories scores (with both sides' LFC and MFC). Femoral cartilage is thinner on the paretic side in stroke patients. As the thickness values correlate with the duration of the disease and the ambulatory status of the patients, we suggest that early mobilization would be important in maintaining their cartilage integrity.

Short or long fusion after thoracolumbar burst fractures does not alter selected gait parameters: a preliminary study.

We evaluated the gait characteristics of patients who had short or long-segment fusion after thoracolumbar burst fractures. The study included 12 patients (5 male, 7 female) who had vertebral fusion after traumatic thoracolumbar region (T12-L2) burst fractures. Patients were divided into two groups based on fixation type (short or long segment). Twelve healthy age and sex-matched subjects (seven male, five female) served as controls. Quantitative gait data, including all time-distance (walking velocity, cadence, step time, step length, double support time), kinematic (joint rotation angles of pelvis, hip, knee, and ankle), and kinetic data (moments of hip in sagittal and coronal plane) were collected. Three patients had a T12, six patients an L1, and three patients had an L2 lesion. Patients in the two groups were similar in terms of age, sex, and time since operation. No significant differences were found in the time-distance, kinematic, and kinetic gait characteristics between the two groups. This preliminary study reveals that the gait characteristics of patients with short and long-segment fusion after thoracolumbar burst fractures were similar to those of healthy subjects and did not differ from each other. However, the present results should be interpreted with caution due to the small sample size. Future studies with larger groups are needed to provide additional data to validate these findings.

Gait symmetry in patients with unilateral partial hip arthroplasty.

OBJECTIVES: In this study gait deviations symmetry and asymmetry in patients with unilateral partial hip arthroplasty was determined. PATIENTS AND METHODS: Gait characteristics and time since operation (11.9+/-6.1; range 7 to 29 months) of 16 patients (9 females, 7 males; mean age 61.5+/-16.5 years; range 27 to 86 years) with unilateral partial hip arthroplasty were evaluated. Ten healthy volunteers (3 females, 7 males; mean age 54.1+/-11.9 years; range 35 to 65 years) were included in the study as control group. Quantitative gait data was collected with the Vicon 370 System (Oxford Metrics, Oxford, UK). Spatio-temporal (walking velocity, cadence, step time, step length, double support time) and kinematic (joint rotation angles of pelvis and hip in sagittal plane) data were processed by using Vicon Clinical Manager software package. Spatio-temporal and kinematic gait symmetry indices of both groups were calculated. RESULTS: Spatio-temporal and kinematic gait characteristics, but not the symmetry indices, of patients with unilateral partial hip arthroplasty were different from the control group (p>0.05). CONCLUSION: Findings of this study reveal that patients with unilateral partial hip arthroplasty had various gait deviations compared to healthy subjects, but that symmetry was preserved.

Factors associated with functional disability in patients with rheumatoid arthritis.

To determine factors associated with functional disability in patients with rheumatoid arthritis (RA). A total of 100 RA patients were reviewed retrospectively. Multiple regression analysis was used to investigate associations between the dependent variable (health assessment questionnaire) and independent variables (age, disease duration, hand grip strength values, VAS and DAS-28 scores). Main factors associated with functional disability were disease activity score as reflected in a high score on the DAS-28 (r=0.68, p<0.001) and disease duration (r=0.23, p<0.05). Increased age, decreased grip strength and high pain level were associated with lower functional ability, but none of these was a predictor of disability in the regression model. The results indicate that age, disease duration, disease activity, pain intensity and hand grip strength are related to physical disability in patients with RA. However, only disease activity has an impact on physical function. Thus, treatment of RA patients should focus on early inhibition of disease activity in order to achieve a good functional outcome.

The short-term efficacy of laser, brace, and ultrasound treatment in lateral epicondylitis: a prospective, randomized, controlled trial.

The aims of this study were to evaluate the effects of low-level laser therapy (LLLT) and to compare these with the effects of brace or ultrasound (US) treatment in tennis elbow. The study design used was a prospective and randomized, controlled, single-blind trial. Fifty-eight outpatients with lateral epicondylitis (9 men, 49 women) were included in the trial. The patients were divided into three groups: 1) brace group-brace plus exercise, 2) ultrasound group-US plus exercise, and 3) laser group-LLLT plus exercise. Patients in the brace group used a lateral counterforce brace for three weeks, US plus hot pack in the ultrasound group, and laser plus hot pack in the LLLT group. In addition, all patients were given progressive stretching and strengthening exercise programs. Grip strength and pain severity were evaluated with visual analog scale (VAS) at baseline, at the second week of treatment, and at the sixth week of treatment. VAS improved significantly in all groups after the treatment and in the ultrasound and laser groups at the sixth week (p<0.05). Grip strength of the affected hand increased only in the laser group after treatment, but was not changed at the sixth week. There were no significant differences between the groups on VAS and grip strength at baseline and at follow-up assessments. The results show that, in patients with lateral epicondylitis, a brace has a shorter beneficial effect than US and laser therapy in reducing pain, and that laser therapy is more effective than the brace and US treatment in improving grip strength.

Repeatability and variation of quantitative gait data in subgroups of patients with stroke.

We aimed to determine the repeatability and variation of quantitative gait data in patients with stroke and to compare the subgroups in terms of gait variability. Time-distance and kinematic characteristics of gait were evaluated in 90 inpatients (30 women) with hemiparesis (mean+/-S.D. age 57.7+/-12.5 years and time since stroke 5.99+/-6.46 months). Subgroups were based on "gender", "side of paresis", "lesion type", "motor recovery level", "sensory status", "time since stroke" and "walking velocity". Repeatability was adequate to excellent in all stroke subgroups (ICC range 0.48-0.98). Walking velocity was the most repeatable gait parameter after stroke. Variation in step length was significantly higher in women than in men (CV 16% versus 9%, p<0.05). Slow walkers (walking velocity <0.34 m/s) had a higher variation than fast walkers in step length (CV 12.5% versus 7.5%, p<0.01), single support time (CV 11.9% versus 6.3%, p<0.05), peak hip extensions in stance (CV 11.5% versus 3.7%, p<0.01) and knee flexion in swing (CV 11.8% versus 6.5%, p<0.05). In our stroke patients, their age, time since injury, lesion characteristics, impaired proprioception or level of motor recovery had no effect on gait variability. For better interpretation of quantitative gait data, clinicians should consider that variation in step length, single support time, peak hip extension in stance and knee flexion in swing differs according to walking velocity after stroke.

Repeatability of lower limb three-dimensional kinematics in patients with stroke.

The within- and between-session repeatability of time-distance and sagittal plane kinematic gait parameters were evaluated in 20 hemiparetic patients with sub-acute stroke. A test-retest design was used in which the patients were tested during two sessions within a 2h period. Each session comprised three consecutive trials. The intraclass correlation coefficients (ICCs) for time-distance parameters ranged from 0.82 to 0.99. The within- and between-session repeatability of pelvis, hip, knee and ankle kinematic waveforms were high: the mean coefficient of multiple correlations (CMCs) ranged from 0.85 to 0.95. The within-session coefficient of variation (CV%) for time-distance parameters ranged from 3.9 to 14.1, whereas, between-session CV% ranged from 6.1 to 17.2, showing similar but higher variability. The within- and between-session CV% for sagittal plane kinematics of the paretic lower limb ranged from 3.6 to 32.4. The results indicate that time-distance parameters and sagittal plane gait kinematics of the paretic lower limb, measured by the Vicon 370 gait analysis system, are repeatable and can be used to assess treatment effects after stroke.

Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study.

OBJECTIVE: To evaluate the effects of sensory-amplitude electric stimulation (SES) of the paretic leg on motor recovery and gait kinematics of patients with stroke. DESIGN: Randomized, controlled, double-blind study. SETTING: Rehabilitation ward and gait laboratory of a university hospital. PARTICIPANTS: A total of 30 consecutive inpatients with stroke (mean age, 63.2 y), all within 6 months poststroke and without volitional ankle dorsiflexion were studied. INTERVENTION: Both the SES group (n=15) and the placebo group (n=15) participated in a conventional stroke rehabilitation program 5 days a week for 4 weeks. The SES group also received 30 minutes of SES to the paretic leg without muscle contraction 5 days a week for 4 weeks. MAIN OUTCOME MEASURES: Brunnstrom stages of motor recovery and time-distance and kinematic characteristics of gait. RESULTS: Brunnstrom stages improved significantly in both groups (P<.05). In total, 58% of the SES group and 56% of the placebo group gained voluntary ankle dorsiflexion. The between-group difference of percentage change was not significant (P>.05). Gait kinematics was improved in both groups, but the between-group difference was not significant. CONCLUSIONS: In our patients with stroke, SES of the paretic leg was not superior to placebo in terms of lower-extremity motor recovery and gait kinematics.

Pulmonary involvement in lifelong non-smoking patients with rheumatoid arthritis and ankylosing spondylitis without respiratory symptoms.

Pulmonary involvement seen in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) has been detected increasingly by using highly sensitive diagnostic techniques such as high-resolution computed tomography (HRCT). However, HRCT findings in healthy controls and the effects of smoking and drugs have not been well studied. The aim of this controlled study was to evaluate the relationships between disease-specific clinical, laboratory, HRCT and pulmonary function test (PFT) findings in 20 RA patients using methotrexate (MTX) and 20 AS patients using sulphasalazine who were non-smokers and exhibited asymptomatic respiratory signs. For this purpose, a total of 60 persons (40 patients and 20 healthy controls) were included in this study. A restrictive pattern on PFT was detected in four patients (20%) with AS, one patient with RA and one control (p<0.05). Fourteen patients (70%) with RA and ten patients (50%) with AS had positive HRCT findings. Only one patient (5%) in the control group had abnormal HRCT findings (p<0.05). Interstitial lung disease (ILD) was the most frequently seen HRCT finding in both the RA (35%) and AS (20%) groups. The chest expansion measurement, the score of the visual analogue scale (VAS) for pain and C-reactive protein (CRP) levels were statistically significantly better in patients with AS having normal HRCT than in those with abnormal findings (p<0.05). There was no correlation detected between HRCT and duration of disease, disease activity markers, functional indexes and PFT in patients with RA and AS. HRCT is a sensitive tool in detecting ILD in patients with RA and AS with no signs and symptoms of pulmonary involvement and may be an integral part of such work-up. However, future prospective studies are needed to better determine if HRCT is in fact a predictor of subsequent MTX toxicity.

Fever during post-acute rehabilitation in patients with brain injury.

OBJECTIVE: To investigate the incidence of fever during the post-acute rehabilitation phase in patients with brain injury. DESIGN: Prospective study. SUBJECTS: Seventy-four patients with brain injury. METHODS: Patients were evaluated for the presence of fever during the rehabilitation phase. Demographics, time since injury, acute hospital and rehabilitation stay, brain injury and clinical characteristics were recorded for all subjects. RESULTS: Of the study group, 36 patients (36/74; 48.6%) had at least 1 event qualified as fever. The most common cause of fever was urinary tract infection. There were only 2 patients considered as having central fever. Fever was significantly more frequent in patients with a greater number of neurological impairments, more severe neurological impairments and a lower level of independence. The rehabilitation stay was prolonged in patients with fever. The average length of rehabilitation stay was 62.5 days and 49.8 days in patients with or without fever, respectively. CONCLUSION: Infection is the most common cause of fever after brain injury and the incidence of central fever is low.