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1.
PLoS One ; 15(2): e0228474, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32023323

RESUMO

OBJECTIVE: To investigate the functional and cognitive outcomes during early intensive neurorehabilitation and to compare the recovery patterns of patients presenting with cognitive motor dissociation (CMD), disorders of consciousness (DOC) and non-DOC. METHODS: We conducted a single center observational cohort study of 141 patients with severe acquired brain injury, consecutively admitted to an acute neurorehabilitation unit. We divided patients into three groups according to initial neurobehavioral diagnosis at admission using the Coma Recovery Scale-Revised (CRS-R) and the Motor Behavior Tool (MBT): potential clinical CMD, [N = 105]; DOC [N = 19]; non-DOC [N = 17]). Functional and cognitive outcomes were assessed at admission and discharge using the Glasgow Outcome Scale, the Early Rehabilitation Barthel Index, the Disability Rating Scale, the Rancho Los Amigos Levels of Cognitive Functioning, the Functional Ambulation Classification Scale and the modified Rankin Scale. Confirmed recovery of conscious awareness was based on CRS-R criteria. RESULTS: CMD patients were significantly associated with better functional outcomes and potential for improvement than DOC. Furthermore, outcomes of CMD patients did not differ significantly from those of non-DOC. Using the CRS-R scale only; approximatively 30% of CMD patients did not recover consciousness at discharge. INTERPRETATION: Our findings support the fact that patients presenting with CMD condition constitute a separate category, with different potential for improvement and functional outcomes than patients suffering from DOC. This reinforces the need for CMD to be urgently recognized, as it may directly affect patient care, influencing life-or-death decisions.

2.
Rev Med Suisse ; 16(676-7): 68-71, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961088

RESUMO

New studies confirm the possibility of late thrombolysis. Meta-analyses have confirmed that CGRP inhibitors are efficacious for migraines. Cladribine is a new oral treatment for relapsing-remitting multiple sclerosis. Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a new clinical entity accounting for cognitive decline in old patients. The timing of levodopa introduction has no effect on the long-term course of idiopathic Parkinson's disease. Hypophosphatemia helps distinguish between seizures and syncopes in the emergency department. A second course of intravenous immunoglobulins provides no benefit for severe Guillain Barre syndrome. Outdoor therapy improves clinical scales in patients with disorder of consciousness. Ultrasound guided lumbar puncture improves the yield of the procedure.


Assuntos
Síndrome de Guillain-Barré , Esclerose Múltipla Recidivante-Remitente , Neurologia , Cladribina , Humanos , Imunoglobulinas Intravenosas , Neurologia/tendências
3.
NeuroRehabilitation ; 44(4): 545-554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282434

RESUMO

BACKGROUND: Neurosensory stimulation is effective in enhancing the recovery process of severely brain-injured patients with disorders of consciousness. Multisensory environments are found in nature, recognized as beneficial to many medical conditions. Recent advances detected covert cognition in patients behaviorally categorized as un- or minimally responsive; a state described as cognitive motor dissociation (CMD). OBJECTIVE: To determine effectiveness of a neurosensory stimulation approach enhanced by outdoor therapy, in the early phases of recovery in patients presenting with CMD. METHODS: A prospective non-randomized crossover study was performed. A two-phase neurosensory procedure combined identical individually goal assessed indoor and outdoor protocols. All sessions were video-recorded and observations rated offline. The frequency of volitional behavior was measured using a behavioral grid. RESULTS: Fifteen patients participated in this study. The outdoor group patients had statistically significant higher number of intentional behaviors than the indoor group on seven features of the grid. Additionally, for all items assessed, total amount of behaviors in the outdoor condition where higher than those in the indoor condition. CONCLUSIONS: Although preliminary, this study provides robust evidence supporting the effectiveness and appropriateness of an outdoor neurosensory intervention in patients with covert cognition, to improve adaptive goal-oriented behavior. This may be a step towards helping to restore functional interactive communication.


Assuntos
Lesões Encefálicas/terapia , Transtornos Cognitivos/terapia , Cognição/fisiologia , Recuperação de Função Fisiológica/fisiologia , Terapia Recreacional/métodos , Sensação/fisiologia , Adulto , Idoso , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Estado de Consciência/fisiologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional/métodos , Terapia Ocupacional/psicologia , Modalidades de Fisioterapia/psicologia , Estudos Prospectivos , Terapia Recreacional/psicologia , Adulto Jovem
4.
Neuroimage Clin ; 24: 101940, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31357147

RESUMO

Behavioral assessments of consciousness based on overt command following cannot differentiate patients with disorders of consciousness (DOC) from those who demonstrate a dissociation between intent/awareness and motor capacity: cognitive motor dissociation (CMD). We argue that delineation of peri-personal space (PPS) - the multisensory-motor space immediately surrounding the body - may differentiate these patients due to its central role in mediating human-environment interactions, and putatively in scaffolding a minimal form of selfhood. In Experiment 1, we determined a normative physiological index of PPS by recording electrophysiological (EEG) responses to tactile, auditory, or audio-tactile stimulation at different distances (5 vs. 75 cm) in healthy volunteers (N = 19). Contrasts between paired (AT) and summed (A + T) responses demonstrated multisensory supra-additivity when AT stimuli were presented near, i.e., within the PPS, and highlighted somatosensory-motor sensors as electrodes of interest. In Experiment 2, we recorded EEG in patients behaviorally diagnosed as DOC or putative CMD (N = 17, 30 sessions). The PPS-measure developed in Experiment 1 was analyzed in relation with both standard clinical diagnosis (i.e., Coma Recovery Scale; CRS-R) and a measure of neural complexity associated with consciousness. Results demonstrated a significant correlation between the PPS measure and neural complexity, but not with the CRS-R, highlighting the added value of the physiological recordings. Further, multisensory processing in PPS was preserved in putative CMD but not in DOC patients. Together, the findings suggest that indexing PPS allows differentiating between groups of patients whom both show overt motor impairments (DOC and CMD) but putatively distinct levels of awareness or motor intent.

5.
J Stroke Cerebrovasc Dis ; 28(8): 2148-2154, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31129105

RESUMO

BACKGROUND: In stroke patients, early complications such as swallowing disorders (SD) and bronchopneumonia (BP) are frequent and may worsen outcome. The aim of this study was to evaluate the prevalence of SD in acute ischemic stroke (AIS) and the risk of BP, as well as to identify factors associated with these conditions. METHODS: We retrospectively studied all AISs over a 12-month period in a single-center registry. We determined the frequency of SD in the first 7 days and of BP over the entire hospital stay. Associations of SD and BP with patient characteristics, stroke features, dental status, and presence of a feeding tube were analyzed in multivariate analyses. RESULTS: In the 340 consecutive patients, the overall frequency of SD and BP was 23.8% and 11.5%, respectively. The multivariate analyses showed significant associations of SD with NIHSS scores >4, involvement of the medulla oblongata and wearing a dental prosthesis (area under the receiver-operator curve (AUC) of 76%). BP was significantly associated with NIHSS scores >4, male sex, bilateral cerebral lesions, the presence of SD, and the use of an enteral feeding tube (AUC 84%). In unadjusted analysis, unfavorable 12-month outcome and mortality were increased in the presence of SD. CONCLUSION: In AIS, SD and BP are associated with stroke severity and localization and wearing a dental prosthesis increases the risk of SD. Given that patients with SD have an increased risk of poor outcome and mortality, high-risk patients warrant early interventions, including more randomized trials.


Assuntos
Isquemia Encefálica/epidemiologia , Broncopneumonia/epidemiologia , Transtornos de Deglutição/epidemiologia , Deglutição , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Broncopneumonia/diagnóstico , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Prótese Dentária/efeitos adversos , Nutrição Enteral/efeitos adversos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
6.
Ann Neurol ; 85(3): 443-447, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30661258

RESUMO

Disorders of consciousness (DOC) are a common consequence of severe brain injuries, and clinical evaluation is critical to provide a correct diagnosis and prognosis. The revised Motor Behavior Tool (MBT-r) is a clinical complementary tool aiming to identify subtle motor behaviors that might reflect residual cognition in DOC. In this prospective study including 30 DOC patients in the early stage after brain injury, we show that the revised MBT-r has an excellent inter-rater agreement and has the ability to identify a subgroup of patients, underestimated by the Coma Recovery Scale-Revised, showing residual cognition and a subsequent recovery of consciousness. ANN NEUROL 2019;85:443-447.


Assuntos
Lesões Encefálicas/fisiopatologia , Cognição , Transtornos da Consciência/fisiopatologia , Atividade Motora , Adulto , Idoso , Idoso de 80 Anos ou mais , Lesões Encefálicas/complicações , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/fisiopatologia , Coma/etiologia , Coma/fisiopatologia , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/etiologia , Feminino , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Hipóxia Encefálica/complicações , Hipóxia Encefálica/fisiopatologia , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/etiologia , Estado Vegetativo Persistente/fisiopatologia , Estudos Prospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
7.
Rehabil Nurs ; 44(6): 319-327, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29300227

RESUMO

PURPOSE: The aim of this study was to identify and compare the needs of families of patients with acquired brain injury (ABI) in acute care and rehabilitation settings. DESIGN: A descriptive exploratory study was conducted. METHODS: Data were collected in the acute care setting and in the rehabilitation setting during meetings with families (n = 54) of patients with ABI using the Family Needs Questionnaire. FINDINGS: In both settings, families identified obtaining information about ABI or the patients' health as the most important need, followed by support from health professionals. CONCLUSION: For families, accessing information about the disease situation was important regardless of patients being in the acute care or rehabilitation phase. To provide tailored care for these families, it is important to assess information needs systematically early in the acute phase of hospitalization. CLINICAL RELEVANCE: A paradigm shift is desirable to include families in care, identify their needs, and support them in a more tailored way.

8.
Conf Proc IEEE Eng Med Biol Soc ; 2018: 4681-4684, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30441394

RESUMO

To investigate whether a motor attempt EEG paradigm coupled with functional electrical stimulation can detect command following and, therefore, signs of conscious awareness in patients with disorders of consciousness, we recorded nine patients admitted to acute rehabilitation after a brain lesion. We extracted peak classification accuracy and peak session discriminant power (PSDP) and we assessed their correlation to the established coma recovery scale revised (CRS-R) and the agreement with diagnosis based on the novel motor behavior tool (MBT). Only PSDP correlated significantly with CRS-R and it also outperformed peak accuracy regarding the MBT. We conclude that PSDP might be more suitable than accuracy to complement CRS-R and MBT in evaluating ambiguous cases and in detecting cognitive motor dissociation.


Assuntos
Estado de Consciência , Conscientização , Coma , Transtornos da Consciência , Eletroencefalografia , Humanos
9.
Rech Soins Infirm ; (128): 79-91, 2017 Mar.
Artigo em Francês | MEDLINE | ID: mdl-28944633

RESUMO

Background : in a neurosurgery unit, nurses selected the Critical Pain Observation Tool (CPOT) based on evidence to assess pain in brain-injured patients. However, months after implementation, nursing managers have observed an underutilization.Objectives : support a care team to overcome the pitfalls encountered during the implementation of the CPOT scale for brain-injured patients in neurosurgery unit.Methods : the Lescarbeau, Payette and St-Arnaud's Integrated Model of Consultation was selected. In addition to a scientific literature review, self-administered questionnaire and three interview guides were developed to gather the views of caregivers.Results : the process allowed to identify pitfalls at level of interprofessional collaboration CPOT scale and implementation processes. Improving interprofessional collaboration and adaptation of CPOT scale for brain-injured patients were withholding action priorities.Discussion : a rigorous methodology, the mutual recognition of clinical skills and the development of relationship of trust are prerequisites for the success of clinical innovation.Conclusion : the Integrated Intervention Model is a methodology of choice allowing to take into consideration both evidence and preferences of all actors at every step of the process led to informed choices and priorities setting for a successful implementation.


Assuntos
Lesões Encefálicas/enfermagem , Medição da Dor/enfermagem , Dor/diagnóstico , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico , Cuidadores/normas , Cuidados Críticos/métodos , Humanos , Entrevistas como Assunto , Dor/enfermagem , Medição da Dor/normas , Encaminhamento e Consulta/normas , Inquéritos e Questionários
10.
Funct Neurol ; 32(2): 63-68, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28676138

RESUMO

To date, medical education lacks Europe-wide standards on neurorehabilitation. To address this, the European Federation of NeuroRehabilitation Societies (EFNR) here proposes a postgraduate neurorehabilitation training scheme. In particular, the European medical core curriculum in neurorehabilitation should include a two-year residency in a neurorehabilitation setting where trainees can gain practical experience. Furthermore, it should comprise six modules of classroom training organized as weekend seminars or summer/winter schools. In conclusion, after defining the European medical core curriculum in neurorehabilitation, the next activities of the EFNR will be to try and reach the largest possible consensus on its content among all national societies across Europe in order to further validate it and try to extend it to the other, non-medical, professionals on the neurorehabilitation team in line with their core curricula defined by each professional association.


Assuntos
Currículo , Educação Médica , Reabilitação Neurológica , Educação Médica/métodos , Educação Médica/normas , Europa (Continente) , Humanos , Doenças do Sistema Nervoso/reabilitação , Reabilitação Neurológica/educação , Reabilitação Neurológica/métodos , Reabilitação Neurológica/normas , Sociedades Médicas/normas
11.
BMJ Case Rep ; 20162016 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-27599806

RESUMO

UNLABELLED: A 53-year-old man developed significant mass effect secondary to an ischaemic stroke and was treated with decompressive craniectomy. During the first few days postsurgery he developed orthostatic vertigo with nausea. After a month, with increasing mobilisation and rehabilitation, he started reporting of severe abdominal pain. No aetiology could be found despite extensive local work up and the symptoms were resistant to any symptomatic treatment. Within days postcranioplasty there was a complete resolution of all the symptoms. CONCLUSION: the sinking flap syndrome can cause abdominal pain and orthostatic vertigo.


Assuntos
Dor Abdominal/etiologia , Craniectomia Descompressiva/efeitos adversos , Complicações Pós-Operatórias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Reoperação/métodos , Síndrome , Vertigem/etiologia
12.
PLoS One ; 11(6): e0156882, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27359335

RESUMO

INTRODUCTION: Attaining an accurate diagnosis in the acute phase for severely brain-damaged patients presenting Disorders of Consciousness (DOC) is crucial for prognostic validity; such a diagnosis determines further medical management, in terms of therapeutic choices and end-of-life decisions. However, DOC evaluation based on validated scales, such as the Revised Coma Recovery Scale (CRS-R), can lead to an underestimation of consciousness and to frequent misdiagnoses particularly in cases of cognitive motor dissociation due to other aetiologies. The purpose of this study is to determine the clinical signs that lead to a more accurate consciousness assessment allowing more reliable outcome prediction. METHODS: From the Unit of Acute Neurorehabilitation (University Hospital, Lausanne, Switzerland) between 2011 and 2014, we enrolled 33 DOC patients with a DOC diagnosis according to the CRS-R that had been established within 28 days of brain damage. The first CRS-R assessment established the initial diagnosis of Unresponsive Wakefulness Syndrome (UWS) in 20 patients and a Minimally Consciousness State (MCS) in the remaining13 patients. We clinically evaluated the patients over time using the CRS-R scale and concurrently from the beginning with complementary clinical items of a new observational Motor Behaviour Tool (MBT). Primary endpoint was outcome at unit discharge distinguishing two main classes of patients (DOC patients having emerged from DOC and those remaining in DOC) and 6 subclasses detailing the outcome of UWS and MCS patients, respectively. Based on CRS-R and MBT scores assessed separately and jointly, statistical testing was performed in the acute phase using a non-parametric Mann-Whitney U test; longitudinal CRS-R data were modelled with a Generalized Linear Model. RESULTS: Fifty-five per cent of the UWS patients and 77% of the MCS patients had emerged from DOC. First, statistical prediction of the first CRS-R scores did not permit outcome differentiation between classes; longitudinal regression modelling of the CRS-R data identified distinct outcome evolution, but not earlier than 19 days. Second, the MBT yielded a significant outcome predictability in the acute phase (p<0.02, sensitivity>0.81). Third, a statistical comparison of the CRS-R subscales weighted by MBT became significantly predictive for DOC outcome (p<0.02). DISCUSSION: The association of MBT and CRS-R scoring improves significantly the evaluation of consciousness and the predictability of outcome in the acute phase. Subtle motor behaviour assessment provides accurate insight into the amount and the content of consciousness even in the case of cognitive motor dissociation.


Assuntos
Transtornos da Consciência/diagnóstico , Recuperação de Função Fisiológica/fisiologia , Adolescente , Adulto , Idoso , Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Prognóstico , Resultado do Tratamento , Adulto Jovem
13.
Rev Med Suisse ; 12(516): 848, 850-2, 2016 Apr 27.
Artigo em Francês | MEDLINE | ID: mdl-27281944

RESUMO

New treatment modalities in oncology, radiation oncology and surgery have led to a significant improvement in life expectancy for cancer patients. Some will however develop severe neurologic deficits that will impact their quality of life. To limit this impact, it is essential to offer optimal neurorehabilitation. In this context, a pilot project of early and intensive neurorehabilitation for brain tumor patients has been set up. A collaboration between the teams of neurooncology, acute neurorehabilitation and neurosurgery from the CHUV and the Clinique La Lignière allows an intensive and direct neurorehabilitation following neurosurgery. This neuroreeducation has allowed 75% of the patients included in this program to return home.


Assuntos
Neoplasias Encefálicas/reabilitação , Doenças do Sistema Nervoso/reabilitação , Reabilitação Neurológica/métodos , Comportamento Cooperativo , Humanos , Doenças do Sistema Nervoso/etiologia , Equipe de Assistência ao Paciente/organização & administração , Projetos Piloto , Qualidade de Vida , Suíça
14.
Curr Opin Neurol ; 28(6): 587-94, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26544027

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to provide an update on the latest challenges addressed by neurorehabilitation initiated very early after the brain damage, such as dealing with disorders of consciousness in terms of diagnosis, prognosis and rehabilitative treatment, or determining best timing for first rehabilitative intervention, best therapeutic approaches and best modalities. RECENT FINDINGS: Early management of patients with severe brain damage requires a multidisciplinary rehabilitative approach that encompasses clinical skills in various fields, standard therapies, and assistive technologies.Despite a high rate of misdiagnosis and poor outcome prediction in disorders of consciousness, the observation of subtle motor signs may be a promising way to reach accurate diagnosis and better outcome prediction. Neurosensory stimulation remains the current treatment to promote emergence from disorders of consciousness.Early timing of neurological rehabilitation is definitively efficient, but a safety period should be respected. Some standard therapies and assistive technologies have demonstrated explicit evidence in neurological recovery and high treatment dose is needed to emphasize the therapeutic effect, but several controversies persist in treatment evidence. SUMMARY: Current advancements have provided growing evidence for early neurorehabilitation, which should be definitively applied, but further studies are explicitly needed to diminish persistent controversies in the field.


Assuntos
Lesões Encefálicas/reabilitação , Transtornos da Consciência/reabilitação , Reabilitação Neurológica/métodos , Equipamentos de Autoajuda , Lesões Encefálicas/complicações , Transtornos da Consciência/etiologia , Humanos , Reabilitação Neurológica/normas
15.
NeuroRehabilitation ; 36(3): 323-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26409335

RESUMO

BACKGROUND: Bilateral ptosis is a very interesting clinical challenge for doctors because of the multiple possible localizations of a lesion which can lead to this neurological sign. OBJECTIVES: Through this case report, we aim to determine the difference between an apraxia of lid opening (ALO) with difficulty in initiating the act of lid elevation, in spite of adequate understanding, motor control and cranial nerve pathways, and a bilateral ptosis with a lesion in the oculomotor nucleus or blepharospasm. METHODS: The case report of a 50-year-old patient presenting bilateral ptosis and multiple ischemic lesions in the brainstem and bilateral frontal lobe lesions after the emergency removal of a large frontal tumor. RESULTS: Our patient had an ALO according to the neurological follow-up and showed the ability, after a few weeks, of initiating the act of opening her eyes with her hand. The ophthalmic evaluation confirmed that in her case the ALO was associated with a nuclear lesion of the oculomotor nerve secondary to a midbrain lesion. CONCLUSION: Our case report confirms multiple differential diagnoses in bilateral ptosis and the importance of clinical examination in spite of good neurological imaging.


Assuntos
Blefaroptose/diagnóstico , Blefaroptose/reabilitação , Mesencéfalo/patologia , Nervo Oculomotor/patologia , Blefaroptose/etiologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/reabilitação , Diagnóstico Diferencial , Feminino , Seguimentos , Lobo Frontal/patologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade
16.
J Hand Ther ; 28(4): 356-62; quiz 363, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26206167

RESUMO

STUDY DESIGN: Clinical measurement. PURPOSE: The test-retest reliability of maximal grip strength measurements (MGSM) is examined in subjects for 12 weeks post-stroke together with maximal grip strength recovery and the maximal-grip and upper-extremity strength measurements' relationship with capacity and performance test scores. METHODS: A Jamar dynamometer and the Motricity Index (MI) were used for strength measurements. The Chedoke Arm and Hand Activity Inventory and ABILHAND questionnaire for evaluating capacities and performances. RESULTS: MGSM were reliable (Intraclass Correlation Coefficients = 0.97-0.99, Minimal Detectable Differences = 2.73-4.68 kg). Among the 34 participants, 47% did not have a measurable grip strength one week post-stroke but 50% of these recovered some strength within the first eight weeks. The MGSM and MI scores were correlated with scores of tests of capacity and performance (Spearman's Rank Correlation Coefficients = 0.69-0.94). CONCLUSIONS: MGSM are reliable in the first weeks after a stroke. LEVEL OF EVIDENCE: N/A.


Assuntos
Força da Mão/fisiologia , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Reprodutibilidade dos Testes , Reabilitação do Acidente Vascular Cerebral
18.
NeuroRehabilitation ; 34(4): 809-17, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24784495

RESUMO

BACKGROUND/PURPOSE: A new coordinated interdisciplinary unit was created in the acute section of the department of clinical neurosciences, the Acute NeuroRehabilitation (NRA) unit. The objective was to evaluate the impact of the unit and its neurosensory programme on the management of tracheostomy patients in terms of reduction in the average time taken for weaning, weaning success rate and therapeutic efficiency. METHODS: This 49-month retrospective study compares 2 groups of tracheostomy patients before (n = 34) and after (n = 46) NRA intervention. The outcome measures evaluate the benefits of the NRA unit intervention (time to decannulation, weaning and complication rates) and the benefits of the coordination (time to registration in a rehabilitation centre and rate of non-compliance with standards of care). RESULTS: Weaning failure rate was reduced from 27.3% to 9.1%, no complications or recannulations were observed in the post-intervention group after weaning and time to decannulation following admission to our unit decreased from 19.13 to 12.75 days. The rate of non-compliance with patient standards of care was significantly reduced from 45% to 30% (Mann-Whitney p = 0.003). DISCUSSION/CONCLUSIONS: This interdisciplinary weaning programme helped to reduce weaning time and weaning failure, without increased complications, in the sample studied. Coordination improved the efficiency of the interdisciplinary team in the multiplicity and complexity of the different treatments.


Assuntos
Protocolos Clínicos , Remoção de Dispositivo/métodos , Traqueostomia , Protocolos Clínicos/normas , Remoção de Dispositivo/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/organização & administração , Posicionamento do Paciente , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Tempo , Traqueostomia/efeitos adversos , Resultado do Tratamento
20.
BMJ Case Rep ; 20142014 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-24536053

RESUMO

A 69-year-old man presented with a sudden headache followed by unconsciousness. There was no head injury. The Glasgow Coma Scale (GCS) score was 3/15 and there was a left mydriasis, unreactive to light. The CT-scan showed a left acute subdural haematoma causing a remarkable mass effect. A supratentorial hemispheric craniotomy was performed. Nevertheless, after several weeks at the intensive care unit (ICU), the patient was still unresponsive to external stimuli and did not show any motor activity. A comfort care attitude was decided on with the family and the patient was extubated. However, a few days later, the patient subsequently showed a surprisingly favourable course, with improved wakefulness. Indeed, the GCS score improved, and the treatment plan was modified so that the patient benefited from rehabilitation. The MRI showed a right cerebral peduncle lesion, consistent with a Kernohan-Woltman notch phenomenon (KWNP). Six months later, the patient was able to walk and live quite normally.


Assuntos
Erros de Diagnóstico , Hematoma Subdural Agudo/diagnóstico , Tegmento Mesencefálico/patologia , Inconsciência/diagnóstico , Idoso , Anisocoria/etiologia , Craniotomia , Hematoma Subdural Agudo/complicações , Hemiplegia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Midríase/etiologia , Tomografia Computadorizada por Raios X , Inconsciência/etiologia
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