Objective: To examine the effect of long-term lower extremity functional electrical stimulation (FES) cycling on the physical integrity and functional recovery in people with chronic spinal cord injury (SCI). Design: Retrospective cohort, mean follow-up 29.1 months, and cross-sectional evaluation. Setting: Washington University Spinal Cord Injury Neurorehabilitation Center, referral center. Participants: Twenty-five people with chronic SCI who received FES during cycling were matched by age, gender, injury level, and severity, and duration of injury to 20 people with SCI who received range of motion and stretching. Intervention: Lower extremity FES during cycling as part of an activity-based restorative treatment regimen. Main outcome measure: Change in neurological function: motor, sensory, and combined motor-sensory scores (CMSS) assessed by the American Spinal Injury Association Impairment scale. Response was defined as ≥1 point improvement. Results: FES was associated with an 80% CMSS responder rate compared to 40% in controls. An average 9.6 CMSS point loss among controls was offset by an average 20-point gain among FES subjects. Quadriceps muscle mass was on average 36% higher and intra/inter-muscular fat 44% lower, in the FES group. Hamstring and quadriceps muscle strength was 30 and 35% greater, respectively, in the FES group. Quality of life and daily function measures were significantly higher in FES group. Conclusion: FES during cycling in chronic SCI may provide substantial physical integrity benefits, including enhanced neurological and functional performance, increased muscle size and force-generation potential, reduced spasticity, and improved quality of life.
South Asian immigrant mothers' perceptions of their children's disabilities had important similarities and differences to mothers living in South Asia. Healthcare professionals can assist families in managing and coping with their child's disabilities by exploring their unique values and beliefs and identifying achievable outcomes together.
Sarcoidosis is an inflammatory disease of unknown etiology associated with the development of granulomatous nodules in various organs, most commonly the lungs, eyes, and skin. It rarely affects the central nervous system, with the spinal cord being least common area of involvement. However, when sarcoidosis does affect the central nervous system, it is often the first presentation of the disease, making diagnosis more difficult. Physical examination findings are consistent with spinal cord pathology, and imaging often suggests spinal cord tumor. We present a case of an otherwise healthy young woman with a granulomatous mass in her cervico-thoracic spinal cord presumed to be sarcoid and review the clinical findings, diagnosis, treatment, and prognosis associated with this rare disease.
Despite evidence of the role of rehabilitation in the management of HIV related disability, few rehabilitation professionals work in HIV care. Barriers include a dearth of knowledge about potential roles of rehabilitation professionals and an absence of research evidence. This study evaluated the extent to which case-based emails with links to an online guide to HIV rehabilitation increased awareness and capacity in rehabilitation professionals. 26 rehabilitation professionals were emailed 6 case studies highlighting salient issues related to HIV and rehabilitation and directing participants to the guide. Following the intervention, each participant completed an interview to assess uptake and impact of the guide. The interviews underwent a qualitative content analysis. Participants increased or reinforced their knowledge, increased confidence in the management of HIV, and recognized the relevance of prior knowledge and skills to HIV care. Clinical cases integrated as an email intervention can promote learning and use of an electronic evidence-informed resource.
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