Recovery and return to activity following exertional heat stroke: considerations for the sports medicine staff.

OBJECTIVE: To describe the current scientific evidence of recovery and return to activity following exertional heat stroke (EHS). DATA SOURCES: Information was collected using MEDLINE and SPORTDiscus databases in English using combinations of key words, exertional heat stroke, recovery, rehabilitation, residual symptoms, heat tolerance, return to activity, and heat illness. STUDY SELECTION: Relevant peer-reviewed, military, and published text materials were reviewed. DATA EXTRACTION: Inclusion criteria were based on the article's coverage of return to activity, residual symptoms, or testing for long-term treatment. Fifty-two out of the original 554 sources met these criteria and were included in data synthesis. DATA SYNTHESIS: The recovery time following EHS is dependent on numerous factors, and recovery length is individually based and largely dependent on the initial care provided. CONCLUSION: Future research should focus on developing a structured return-to-activity strategy following EHS.

Rehabilitation of a patient with heat stroke: a case report.

The recent death of a famous football player raised public awareness of the fatal nature of heat stroke, which is actually the third leading cause of death among American athletes. We present a typical case of heat stroke to illustrate its clinical manifestation and recovery process; risk factors, treatment options, and the importance of prevention are also discussed. Although heat stroke is not a common admission diagnosis for inpatient rehabilitation, physiatrists need to be aware of its pathophysiology, rehabilitation management, and prevention.

Manifestaciones neurológicas y su impacto funcional en sujetos que han padecido un golpe de calor / Neurological manifestations and their functional impact in subjects who have suffered heatstroke

Introducción. El golpe de calor es una emergencia médica, potencialmente mortal, caracterizada por un incremento en la temperatura corporal por encima de 40 °C, que se acompaña de una afectación del sistema nervioso central secundaria a un fallo en el sistema termorregulador. De no intervenirse oportunamente, las consecuencias pueden ser fatales, produciéndose la muerte, pero también puede conllevar secuelas neurológicas permanentes y discapacitantes con afectación en la calidad de vida del individuo. Casos clínicos. Tras una búsqueda retrospectiva de los pacientes ingresados en una unidad de rehabilitación de daño cerebral con el diagnóstico de golpe de calor, presentamos a cinco sujetos. El espectro clínico comprendía una debilidad motora con una grave afectación de la coordinación y el equilibrio con ataxia y disartria, que estaban acompañados de una mayor o menor afectación cognitiva. Todos los pacientes eran dependientes para las actividades básicas de la vida diaria tanto antes como después del tratamiento rehabilitador. Conclusiones. La mejoría funcional de los cinco sujetos tras la realización de la rehabilitación fue nula, lo que les condicionó una dependencia total de terceras personas. Por ello, es primordial una prevención ante olas de calor, una actuación médica inmediata y, finalmente, una vez instaurado el cuadro, los esfuerzos rehabilitadores se han de encaminar a evitar complicaciones. En esta tesitura, es importante la existencia de programas sociales de apoyo a las familias y a los pacientes (AU)

Introduction. Heatstroke is a potentially fatal medical emergency characterised by an increase in body temperature above 40 °C and which is accompanied by negative effects on the central nervous system secondary to failure of the thermoregulatory system. If timely care is not provided, the consequences can be fatal and the patient dies, but they can also ¡result in permanent disabling neurological sequelae that compromise the individual’s quality of life. Case reports. Following a retrospective search on patients diagnosed with heatstroke who were admitted to a brain damage rehabilitation unit, we report the cases of five subjects. The clinical spectrum ranged from motor weakness with severely compromised coordination and balance with ataxia and dysarthria, which were accompanied by cognitive impairment of varying degrees of severity. All the patients required help in performing their basic activities of daily living both before and after treatment with rehabilitation. Conclusions. No functional improvement was observed in the five subjects after completing rehabilitation, which left them wholly dependent on some caregiver. It is therefore essential to prevent heatstroke, provide immediate medical care and, finally, once the clinical signs and symptoms have set in, rehabilitation treatment must be focused on preventing the appearance of complications. In such a situation the existence of social support for relatives and for patients plays a crucial role (AU)