29 research outputs found
A novel approach using potable diagnostic ultrasound to inform treatment choices for hemiplegic shoulder pain – A case study
Introduction: Hemiplegic shoulder pain (HSP) has a reported incidence of up to 84% of patients. The purpose of this case study is to report findings from a patient with HSP who received problem specific treatment and underwent real-time scanning of shoulder region with a portable diagnostic ultrasound. Treatment was modified to address the problems. Methods/Case Description:The patient was a 45 year-old woman with right sided-hemiparesis resulting from a clot. Patient was undergoing rehabilitation in a private clinic and reported shoulder pain. Patient was undergoing rehabilitation (over-arm exercises, electrical stimulation, stretches, Saebo exercises) however, continued to complain of shoulder pain (VAS-7). Ultrasound scanning was undertaken and following observations were made on both affected (AF) and unaffected (UAF) shoulders. Acromion-greater tuberosity (AGT) distance (AF-3.35 cm, UAF-2.04 cm), diameter of supraspinatus in resting state (AF -1.16 cm, UAF-1.42cm) and contracted state (AF-1.14cm, UAF-1.63cm). Modified treatment included: 1) Isometric exercises to supraspinatus muscle 2) Trigger point release for trapezius 3) Electrical stimulation to lateral deltoid and supraspinatus 4) avoid over-arm activitiesResults: Ultrasound measurement suggested reduction in AGT immediately following treatment. 8 weeks later, VAS score was 3 and patient reported using her arm more for various functional tasks. Diameter of supraspinatus in resting state (AF -1.30 cm, UAF-1.45cm) and contracted state (AF-1.42cm, UAF-1.70cm) suggested some improvement.Conclusions: Real-time ultrasound has potential benefits as an assessment tool to inform treatment choices for HSP. Further studies are required in this area
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Longitudinal analysis of physical function in older adults: the effects of physical inactivity and exercise training
Lack of exercise contributes to systemic inflammation and is a major cause of chronic disease. The long-term impact of initiating and sustaining exercise in late life, as opposed to sustaining a sedentary lifestyle, on whole-body health measures such as physical performance is not well known. This is an exploratory study to compare changes in physical performance among older adults initiating exercise late in life versus inactive older adults. Data from two observational cohorts were included in this analysis, representing two activity groups. The Active group cohort comprises older adults (n = 318; age 72.5 ± 7.2 years) enrolled in a supervised exercise program, “Gerofit.” The inactive group comprises older adults (n = 146; age 74.5 ± 5.5 years) from the Italian study “Act on Ageing” (AOA) who self-reported being inactive. Participants in both groups completed physical performance battery at baseline and 1-year including: 6-min walk test, 30-s chair stand, and timed up-and-go. Two-sample t-tests measured differences between Gerofit and AOA at baseline and 1-year across all measures. Significant between-group effects were seen for all performance measures (ps = 0.001). The AOA group declined across all measures from baseline to 1 year (range −18% to −24% change). The Gerofit group experienced significant gains in function for all measures (range +10% to +31% change). Older adults who initiated routine, sustained exercise were protected from age-related declines in physical performance, while those who remained sedentary suffered cumulative deficits across strength, aerobic endurance, and mobility. Interventions to reduce sedentary behaviors and increase physical activity are both important to promote multi-system, whole-body health
The Comprehensive Post-Acute Stroke Services (COMPASS) study: design and methods for a cluster-randomized pragmatic trial
Background: Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes.
Methods: Forty-one hospitals in North Carolina were randomized (as 40 units) to either implement the COMPASS care model or continue their usual care. The recruitment goal is 6000 patients (3000 per arm). Hospital staff ascertain and enroll patients discharged home with a clinical diagnosis of stroke or transient ischemic attack. Patients discharged from intervention hospitals receive 2-day telephone follow-up; a comprehensive clinic visit within 2 weeks that includes a neurological evaluation, assessments of social and functional determinants of health, and an individualized COMPASS Care PlanTM integrated with a community-specific resource database; and additional follow-up calls at 30 and 60 days post-stroke discharge. This model is consistent with the Centers for Medicare and Medicaid Services transitional care management services provided by physicians or advanced practice providers with support from a nurse to conduct patient assessments and coordinate follow-up services. Patients discharged from usual care hospitals represent the control group and receive the standard of care in place at that hospital. Patient-centered outcomes are collected from telephone surveys administered at 90 days. The primary endpoint is patient-reported functional status as measured by the Stroke Impact Scale 16. Secondary outcomes are: caregiver strain, all-cause readmissions, mortality, healthcare utilization, and medication adherence. The study engages patients, caregivers, and other stakeholders (including policymakers, advocacy groups, payers, and local community coalitions) to advise and support the design, implementation, and sustainability of the COMPASS care model.
Discussion: Given the high societal and economic burden of stroke, identifying a care model to improve recovery, independence, and quality of life is critical for stroke survivors and their caregivers. The pragmatic trial design provides a real-world assessment of the COMPASS care model effectiveness and will facilitate rapid implementation into clinical practice if successful
Trace elements in glucometabolic disorders: an update
Many trace elements, among which metals, are indispensable for proper functioning of a myriad of biochemical reactions, more particularly as enzyme cofactors. This is particularly true for the vast set of processes involved in regulation of glucose homeostasis, being it in glucose metabolism itself or in hormonal control, especially insulin. The role and importance of trace elements such as chromium, zinc, selenium, lithium and vanadium are much less evident and subjected to chronic debate. This review updates our actual knowledge concerning these five trace elements. A careful survey of the literature shows that while theoretical postulates from some key roles of these elements had led to real hopes for therapy of insulin resistance and diabetes, the limited experience based on available data indicates that beneficial effects and use of most of them are subjected to caution, given the narrow window between safe and unsafe doses. Clear therapeutic benefit in these pathologies is presently doubtful but some data indicate that these metals may have a clinical interest in patients presenting deficiencies in individual metal levels. The same holds true for an association of some trace elements such as chromium or zinc with oral antidiabetics. However, this area is essentially unexplored in adequate clinical trials, which are worth being performed