Decompression illness type II with stroke: challenging situation in acute neurorehabilitation.

A professional 55-year-old female experienced diver, who surfaced after the second dive, had a lucid interval before dropping Glasgow Coma Scale (GCS) to 3/15. She was admitted to intensive care unit and commenced on hyperbaric oxygen therapy. Her initial computed tomography of the head was normal but her magnetic resonance imaging of the brain at 48 hours showed extensive bilateral cortical watershed territory infarcts. She developed acute respiratory distress syndrome which resolved within a few days. Her GCS gradually improved from 3/15 to 6/15, was repatriated to United Kingdom after about 2 weeks of the insult and admitted to a tertiary care hospital where she had myoclonic seizures and was started on anti-epileptics. Then she was transferred to the Rehabilitation Medicine Ward of Leicester General Hospital, with GCS 14/15 with poor sitting balance, for her management and rehabilitation. She had weakness of right upper and lower limbs, dysarthria, neuropathic bilateral shoulder pains, pressure ulcer of left heel, bladder and bowel incontinence and cognitive issues. She improved to have significant neurological recovery within next 3 months, became ambulant independently and bladder and bowel continent. Her Barthel index (from 4 to 17), Montreal Cognitive Assessment Test, Adembrook Cognitive Examination and Berg Balance scale (from 33/56 to 44/56) improved significantly. Early diagnosis, treatment and rehabilitation can have a significant impact on the recovery of decompression illness.

[Is it possible to dive again after decompression sickness?] / Peut-on replonger après un accident de désaturation ?

Decompression sickness in underwater diving exposes the diver to a risk of clinical sequelae which require specific care. In the absence of sequelae or after clinical recovery, the question of diving again may be raised. As part of a secondary prevention approach, the hyperbaric practitioner measures the physical, psychological and social impact of re-exposure to pressure and the immersion of the patient-diver.

Resolution and severity in decompression illness.

omegaWe review the terminology of decompression illness (DCI), investigations of residual symptoms of decompression sickness (DCS), and application of survival analysis for investigating DCI severity and resolution. The Type 1 and Type 2 DCS classifications were introduced in 1960 for compressed air workers and adapted for diving and altitude exposure with modifications based on clinical judgment concerning severity and therapy. In practice, these proved ambiguous, leading to recommendations that manifestations, not cases, be classified. A subsequent approach assigned individual scores to manifestations and correlated total case scores with the presence of residual symptoms after therapy. The next step used logistic regression to find the statistical association of manifestations to residual symptoms at a single point in time. Survival analysis, a common statistical method in clinical trials and longitudinal epidemiological studies, is a logical extension of logistic regression. The method applies to a continuum of resolution times, allows for time varying information, can manage cases lost to follow-up (censored), and has potential for investigating questions such as optimal therapy and DCI severity. There are operational implications as well. Appropriate definitions of mild and serious manifestations are essential for computing probabilistic decompression procedures where severity determines the DCS probability that is acceptable. Application of survival analysis to DCI data would require more specific case information than is commonly recorded.

Spinal decompression sickness presenting as partial Brown-Sequard syndrome and treated with robotic-assisted body-weight support treadmill training.

OBJECTIVE: To describe the rehabilitation outcome of a case of spinal decompression sickness presenting as partial Brown-Sequard syndrome treated with robotic-assisted body-weight support treadmill training. STUDY DESIGN: Case report. BACKGROUND: Type II decompression sickness patients commonly suffer from myelopathy with gait disturbances necessitating rehabilitation. Robotic-assisted body-weight support treadmill training has been shown to improve the rehabilitation outcome of incomplete spinal cord injury. Its usefulness has not been described in decompression sickness myelopathy. METHODS: Robotic-assisted body-weight support treadmill training was administrated using the Lokomat. Primary outcomes were American Spinal Cord Association scale, Spinal Cord Independence Measurement, Berg Balance Test, and Walking Index for Spinal Cord Injury. RESULTS: The patient was admitted 3 weeks after the diving injury, with severe paraparesis and a T11 sensory neurological level, resembling partial Brown-Sequard syndrome. After 3 months of rehabilitation including 18 Lokomat sessions, American Spinal Cord Association score improved from C to D, Spinal Cord Independence Measurement improved from 50 to 90 out of 100. Berg Balance Test improved from 35 to 43 out of 56 and Walking Index for Spinal Cord Injury improved from 1 to 15 out of 20. Upon discharge he could walk with one crutch for more than 1 km. CONCLUSION: Robotic-assisted body-weight support treadmill training for spinal decompression sickness rehabilitation might be beneficial.

[Results of aromatherapeutic rehabilitation of women after extended exposure in altitude chamber for recompression treatment].

In recent years recreational diving has gained popularity among women. Occasional decompression sickness and pulmonary barotraumata are cured with the use of recompression tables. To evaluate factors in therapeutic recompression, experiment Rusalka-2004 (Mermaid) was performed with participation of a female crew "descended" at air pressure of 70 m H2O and maintained in hyperoxic (pO2 = 0.45-0.5 kgs/cm2) heliox at 40-0 m H2O for four days. On "ascent" the crew was given a course of aroma rehabilitation. To assess effects of this therapy, entries in a dedicated questionnaire were made and the Spilberger-Khanin SAM (self-appraisal-activity-mood) test and a modification of the Dembau--Rubinshtein self-appraisal method were fulfilled on the daily basis. The best result was achieved in the subjects who were particularly favourable to this sensory stimulation and made own choice of scents of 100% natural essences.

Magnitud del síndrome de descompresión y los factores socioculturales que inciden en su causa, prevención y rehabilitación entre la población indígena de la Región Autónoma del Atlántico Norte / Magnitude of the decompression syndrome and the sociocultural factors that impact in their cause, prevention and rehabilitation among the indigenous population of the Autonomous Region of the North Atlantic

El presente estudio pretende "Analizar la Magnitud del Síndrome de Descompresión y los Factores Socioculturales que inciden en su Prevención y Rahabilitación entre la Población Indígena de la Región Autónoma del Atlántico Norte". Este analisis se realiza desde un enfoque intercultural, con el fin de entender mejor el proceso salud-enfermedad y la percepción de la población metas y su interrelación con los procesos institucionales.

[Toxic-metabolic and physically-induced myelopathies]. / Toxisch-metabolisch und physikalisch induzierte Myelopathien.

The differential diagnosis in patients with spinal cord disorders is sometimes very difficult. There is an overview about important toxic-metabolic myelopathies, like drugs, ergotamines, Kichererbsen, avitaminosis, diving accidents and radiation exposition. Beside the cause- and the senso-motoric therapy, disturbances bladder-, bowel-, sexual and cardiovascular disorders needs a specialised therapy.

Rehabilitation of Caisson's disease with spinal cord involvement.

Fifteen cases of Caisson's Disease or Decompression Sickness with spinal cord involvement treated at the Department of Rehabilitation Tan Tock Seng Hospital, from 1973 to 1978 are described. All the cases had bladder and bowel function involvement. Five cases developed bone complications, one of whom was referred to us primarily for rehabilitation after he had an operation for collapsed right femoral head which occurred two years after the incident.