Multi-stage management of multiple severe decubitus ulcers in a patient with spinal cord injury - a case report

Doniesienie przedstawia proces wieloetapowego leczenia ciężkich odleżyn u 26-letniego chorego z porażeniem czterokończynowym, które wystąpiło w przebiegu urazu odcinka szyjnego kręgosłupa 8 lat przed przyjęciem do oddziału. U pacjenta etapowo leczono trzy rozlegle i głębokie odleżyny obydwu okolic krętarzowych oraz okolicy krzyżowej. Z powodu destrukcji stawów biodrowych zaistniała także konieczność ich obustronnej resekcji. Po 7-miesięcznym leczeniu udało się wyleczyć wszystkie odleżyny. W ciągu ponad dwuletniej obserwacji chorego żadna z operowanych odleżyn nie uległa nawrotowi.The article presents the multi-stage treatment of severe decubitus ulcers in a male patient, 26 years of age, with posttraumatic tetraplegia resultingfrom a cervical spinal cord injury that had occurred 8 years prior to admission. The patient presented with extensive and deep ulcerations in the sacral region and both trochanteric regions. Due to the destruction of the bilateral hip resection was also necessary. The entire hospital stay lasted 7 months and resulted in complete healing of all three decubitus lesions. There was no recurrence of pressure ulcers during the 2-years observation period

White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 6. Knowledge and skills of PRM physicians

In the context of the White Book of Physical and Rehabilitation Medicine (PRM) in Europe, this paper deals with the fundamentals of PRM from a physiological perspective, looking at the human mechanisms both physical and behavioral which are at the base of PRM physicians' work. After a discussion on the development and evolution of PRM that leads to its unique and specific approach, the mechanisms considered include: - repairing processes (and potential of recovery evaluation): repairing processes are mainly related to the quantity and natural history of diseases and impairments, while potential of recovery is also linked to the individual and environmental factors; PRM physicians work on impairments to favor healing or recovery, and propose rehabilitation if there is a potential of recovery: this is related to the prognostic role of PRM physicians; - learning processes: PRM is the specialty of teaching new physical ways and behavioral approaches to make patients participate at best through improvement of impairments and modification of activities; in this perspective, during repair and rehabilitation processes, PRM physicians and the rehabilitation team are teachers of new motor and behavioral strategies; - compensatory processes (adaptation/habilitation/rehabilitation): PRM physicians teach patients how to adapt to the new (acquired) health condition using compensatory mechanisms based on other body structures/functions, behavioral changes and/or assistive devices (or technical aids) (prosthesis and orthosis); during growth PRM physicians aim at allowing a complete (and compensatory) development of the intact function, not to be impaired by the original disease; compensatory processes are related to activities; - management skills: PRM physicians are managers of people and resources; they manage patients and their caregivers, to teach and allow them to reach the best possible participation, also focusing on maintenance; they lead the team, with the aim to make it function at best for the sake of the patient; finally, they manage resource allocation for the functioning of patients and team; - communication skills: PRM physicians need to develop very good communication skills, so to teach, inform and educate patients and their caregivers: this will allow the proper behavioural changes and also the correct physical compensations

The approach of physiatrists to low back pain across Europe

Low back pain (LBP) is the most common type of musculoskeletal pain, thus it is one of the most commonly encountered conditions in Physical and Rehabilitation Medicine. The physicians who are primarily responsible for the nonsurgical management of LBP are physiatrists