Futility in Rehabilitation

Spill, Gayle R.; Vente, Teresa; Frader, Joel; Smith, Sean R.; Giacino, Joseph T.; Zafonte, Ross; Coppard, Brenda M.; Jensen, Gail M.; Mukherjee, Debjani

doi:10.1002/pmrj.12152

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…Though these transformations are often times unpredictable, we agree with the following suggestion by Spill et al to ensure rehabilitation goals and interventions are updated continuously, "revisiting the plan with patients and caregivers regularly is necessary to ensure that the interventions being applied continue to have a reasonable likelihood of success." 29 The results of this study should be interpreted carefully, as the study was not powered to draw definitive conclusions. Not all individuals with evidence of progression of disease or recurrence of GBM will benefit from inpatient rehabilitation.…”

Section: Discussionmentioning

confidence: 95%

“…Rehabilitation of cancer patients is not without complications, as there may be unexpected changes in function or treatment during the period of acute rehabilitation. Though these transformations are often times unpredictable, we agree with the following suggestion by Spill et al to ensure rehabilitation goals and interventions are updated continuously, “revisiting the plan with patients and caregivers regularly is necessary to ensure that the interventions being applied continue to have a reasonable likelihood of success.”…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of Functional Outcomes between Patients Admitted to Inpatient Rehabilitation after Initial Diagnosis Versus Recurrence of Glioblastoma Multiforme

Reilly

Gundersen

Silver

et al. 2020

PM&R

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Background: Prior studies of inpatient rehabilitation of patients with brain tumor demonstrate similar functional gains as compared to other rehabilitation populations. There are few studies specifically examining the rehabilitation of patients with glioblastoma. Objective: To compare functional outcomes between matched patients admitted to acute inpatient rehabilitation after initial diagnosis of glioblastoma (iGBM) and after diagnosis of recurrent glioblastoma (rGBM). Design: A retrospective, case-matched study using descriptive statistics compared demographic information and functional outcomes as designated by the Functional Independence Measure (FIM) score. Setting: A single, freestanding inpatient rehabilitation hospital. Patients: Over a 20-month period, 25 patients with iGBM were matched with 25 patients admitted to an inpatient rehabilitation facility with rGBM by the following criteria: (1) side of lesion (left/right hemisphere), (2) admission total FIM score within 10 points, (3) age within 10 years, and (4) gender. Nineteen of the 25 patients in each group were matched meeting all criteria, and 6 of the 25 patients were matched meeting three out of four criteria. Interventions: Not applicable. Main Outcome Measure: The primary outcome measures were differences in functional outcomes as measured by FIM scores. Results: There were no statistically significant differences (P < .05) between the groups in mean admission FIM scores, discharge FIM scores, FIM gains, and FIM efficiencies. There were no statistically significant differences in the development of complications during acute rehabilitation and transfer rate to acute care hospital. Sixty-four percent of patients in both groups were able to be discharged home. Conclusions: This study demonstrated no statistically significant differences in functional outcomes between matched patients admitted with iGBM compared to rGBM. Further studies are indicated to examine the rehabilitation outcomes of patients with rGBM in inpatient rehabilitation.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

A Comparison of Functional Outcomes between Patients Admitted to Inpatient Rehabilitation after Initial Diagnosis Versus Recurrence of Glioblastoma Multiforme

Reilly

Gundersen

Silver

et al. 2020

PM&R

View full text Add to dashboard Cite

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“…In regards to the complex vascular reconstructive procedure in this patient with the intention of preserving the affected limb, it could be considered a futile 6 task due to the severity of the brachial plexus injuries, unfavorable functional prognosis for the limb, and the uncertainty in the effectiveness of the treatments.…”

Section: Scapulothoracic Dissociation and Blunt Vertebral Vascular Inmentioning

confidence: 99%

“…Blunt trauma to the vertebral artery is a rare entity with an incidence of 0.24% to 2.0% in cervical 4 , trauma cases and a mortality rate between 20-40%, which has decreased due to early diagnosis and identification of lesion characteristics 5 . This case report presents an unusual case of a patient where these two entities converge. We analyze the main points of intervention and decision-making that were effective in the management of the patient 6 .…”

Section: Introductionmentioning

confidence: 99%

Disociación escapulo-torácica y trauma cerrado de arteria vertebral: reporte de un caso.

Vega-Peña¹,

Dueñas²,

Bobadilla

2020

Colomb Med

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Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient’s improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

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“…Indeed, decisions about whether to limit or continue life-sustaining treatment of DoC patients are heavily influenced by assessments of consciousness presence and its recovery capacities [21,22]. Expectations of poor consciousness recovery and associated attributions of therapeutic futility typically underlie the decision to discontinue life-sustaining treatment [23]. This highlights how important consciousness/unconsciousness boundary is to the idea of personhood/selfhood and to what makes life worth living [1,6].…”

Section: Introductionmentioning

confidence: 99%

Patients with Disorders of Consciousness: Are They Nonconscious, Unconscious, or Subconscious? Expanding the Discussion

Fingelkurts

2023

Brain Sciences

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Unprecedented advancements in the diagnosis and treatment of patients with disorders of consciousness (DoC) have given rise to ethical questions about how to recognize and respect autonomy and a sense of agency of the personhood when those capacities are themselves disordered, as they typically are in patients with DoC. At the intersection of these questions rests the distinction between consciousness and unconsciousness. Indeed, evaluations of consciousness levels and capacity for recovery have a significant impact on decisions regarding whether to discontinue or prolong life-sustaining therapy for DoC patients. However, in the unconsciousness domain, there is the confusing array of terms that are regularly used interchangeably, making it quite challenging to comprehend what unconsciousness is and how it might be empirically grounded. In this opinion paper, we will provide a brief overview of the state of the field of unconsciousness and show how a rapidly evolving electroencephalogram (EEG) neuroimaging technique may offer empirical, theoretical, and practical tools to approach unconsciousness and to improve our ability to distinguish consciousness from unconsciousness and also nonconsciousness with greater precision, particularly in cases that are borderline (as is typical in patients with DoC). Furthermore, we will provide a clear description of three distant notions of (un)consciousness (unconsciousness, nonconsciousness, and subconsciousness) and discuss how they relate to the experiential selfhood which is essential for comprehending the moral significance of what makes life worth living.

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Futility in Rehabilitation

Cited by 6 publications

References 22 publications

A Comparison of Functional Outcomes between Patients Admitted to Inpatient Rehabilitation after Initial Diagnosis Versus Recurrence of Glioblastoma Multiforme

A Comparison of Functional Outcomes between Patients Admitted to Inpatient Rehabilitation after Initial Diagnosis Versus Recurrence of Glioblastoma Multiforme

Disociación escapulo-torácica y trauma cerrado de arteria vertebral: reporte de un caso.

Patients with Disorders of Consciousness: Are They Nonconscious, Unconscious, or Subconscious? Expanding the Discussion

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