[PARAPARESIS DUE TO RHABDOMYOLYSIS AND A COMPARTMENT SYNDROME IN FIVE PATIENTS WHO HAD BEEN IN A PROLONGED SLEEP IN A SITTING POSITION].

INTRODUCTION: Five patients developed symmetrical paraparesis due to a combination of: compartment syndrome, rhabdomyolysis, renal failure, and demyelinative sensory-motor polyneuropathy, after prolonged sleep in a sitting position. The long deep sleep was induced by consumption of alcohol or drugs. Long-term follow-up showed that these patients remained paraparetic. No damage to the autonomic nervous system was found. Although some suspected that these patients developed "intensive care neuropathy", we suggest that this syndrome is different, and should be regarded as a "new syndrome".

[FROM THEORY TO THE CLINIC - IS IT POSSIBLE TO DETECT DIFFERENT TYPES OF ANOMIA ACCORDING TO THE LEXICAL RETRIEVAL MODEL?]

INTRODUCTION: The lexical retrieval model describes the process of naming - from the level of an abstract concept representation to the production of the word. Lexical retrieval includes several distinct levels. A deficit in any of these levels causes anomia, a naming deficit, and deficits in different levels cause different types of anomia. AIMS: To examine whether the theoretical model can be applied in the clinic. Namely, whether it is possible to identify, for a specific patient, the exact impaired lexical retrieval level, and to show that different patients are impaired in different levels. METHODS: The performance of 24 participants with aphasia, with lexical retrieval deficits, were analyzed. The analysis included performance on a naming test - including analysis of error types and of the effects that modulate naming errors. We also analyzed the performance in other language tasks that examine the different levels of lexical retrieval, including tasks that do not involve naming. RESULTS: Different types of anomia were found for the different participants. The various types of anomia are reflected in different sorts of naming errors, in different effects that modulate naming errors, and in different performance patterns in the other language tasks. CONCLUSIONS: The theoretical model of lexical retrieval can underpin descriptions of clinical phenomena. The findings support the view that the relations between theory and clinic are bidirectional - theories constitute an anchor for the description of clinical phenomena, and clinical findings can support, or refute, theory. DISCUSSION: The distinction between the different types of anomia is important for choosing the appropriate treatment for each patient.

[CHANGES IN THE WAY WE OBSERVE, ASSESS AND TREAT APHASIA: FROM THE TRADITIONAL APPROACH TO THE PSYCHOLINGUISTIC AND SOCIAL APPROACHES].

INTRODUCTION: Aphasia is an acquired language impairment, initially identified and described before the 19th century. According to traditional models (Wernicke-Lichtheim-Geschwind) the aphasic symptoms can be clustered into particular syndromes, such as Broca's, Wernicke's, Conduction aphasias, and more. Each syndrome is allegedly associated with a specific anatomical site. The major motivation for this model was to use the behavioral symptoms to learn about language and brain relationships. However, current advanced imaging techniques identify more precisely the loci of the deficit. Moreover, the model frequently fails to adequately describe the clinical symptoms, a description that is crucial for understanding the language deficit and for choosing the relevant treatment. For more than three decades, two alternative models are being used in the clinical setting and in research. First, the psycholinguistic model, which describes the normal stages that are involved in language processing. On the basis of this model it is possible to detect, for each individual with aphasia, the specific impaired stage or stages underlying the language deficits. Second, the social model of aphasia based on the ICF definitions of the World Health Organization. According to this model, it is suggested that the speech therapy intervention should focus not only on the language deficits but also on communication per se in order to enable the individual with aphasia to communicate with others despite the language deficits. In the current paper we will review these two models and their clinical implications.

From Georgia to Jerusalem: some Medical Aspects of "The Knight in the Panther's Skin" by Shota Rustaveli.

The Georgian poet Rustaveli wrote his epic poem The Knight in the Panther's Skin around 1200. He knew the works of Hippocrates and Galen, and believed in the unity of body and soul.Thereare many references to health and medicine in the poem, and we shall highlight some of them. In 1185 Rustaveli left Georgia and settled in Jerusalem. There he lived and died at the Monastery of the Cross, where he was buried.

A new syndrome sheds light on old medical & rehabilitative dilemmas: paraparesis due to rhabdomyolysis and bilaterally symmetric compartment syndrome in four patients. Cases study.

Via our description of a seemingly heterogeneous group of four patients who presented to our rehabilitation facility with a rather unusual clinical presentation of compartment syndrome with development of a flaccid paraparesis and rhabdomyolysis immediately after awakening from a prolonged sleep episode in an unusual posture - which might, in fact, be a 'new syndrome' - we have also come to address an important issue linking our group of patients - specifically, the complexities which present to a rehabilitative facility in the cases of unusual and unclear diagnoses. Eventually, all four of our patients remained severely disabled. All had suffered sensorimotor axonal demyelinative polyneuropathies and two patients had subclinical hypothyroidism. Prior to the prolonged sleep episode, they had all consumed alcohol and drugs. Using these four rather demanding diagnostic rehabilitative cases we address the ever-important issue of timely mutual communication and patience. For when a rehabilitative facility is confronted with patients whose diagnoses are not clear, the scope of the long-term comprehensive rehabilitation management faces some major obstacles with respect to how the rehabilitative team can succeed in designing a 'tailor-made' rehabilitation program for these patients, which often-times proves to be a rather tricky task requiring innovative and creative efforts on the parts of all those involved in the care of the patient. Quite a challenging task, indeed, yet one genuinely necessary to attempt to achieve so that the patient, family and, of course, the 'payer agency/provider' can all prepare themselves, realistically so as to obtain the best overall rehabilitative outcome for these patients. We conclude that what is most necessary for these unique patients is patience.

[Our experience with rehabilitation of patients with Pott's tuberculous paraplegia].

Spinal tuberculosis with paraplegia is rarely seen in Israel. All the 10 patients that were hospitalized in our rehabilitation departments had contracted the disease abroad prior to their immigration to Israel. The comprehensive rehabilitation process must include close cooperation between pulmonary physicians, orthopedic surgeons and rehabilitation medicine specialists. An updated review of the relevant literature is presented.