Prognostication and Trajectories of Recovery in Disorders of Consciousness.

Historically, there has been a pessimistic view regarding outcomes for patients with disorders of consciousness (DoC). There is a paucity of clinical diagnostic tools and prognostic protocols. Guidelines for the care of patients with DoC require behavioral observation, time, resources, and knowledge of the population.

Best Practices for Intrathecal Baclofen Therapy: Patient Selection.

Introduction: When spasticity interferes with comfort, function, activities of daily living, mobility, positioning, or caregiver assistance, patients should be considered for intrathecal baclofen (ITB) therapy.

Methods: An expert panel consulted on best practices.

Results: ITB can be considered for problematic spasticity involving muscles/muscle groups during all phases of diseases, including progressive neurologic diseases.

Intrathecal baclofen therapy for spastic hypertonia in chronic traumatic brain injury.

Objective: To describe the outcome of intrathecal baclofen (ITB) therapy in treating spastic hypertonia and its sequelae in individuals with chronic (>14 years) traumatic brain injuries (TBI).

Design: Case series.

Setting: Free-standing rehabilitation hospital.

Forced use as a potential cause of gastrocnemius tears during neurologic rehabilitation: a report of 2 cases.

Broadly defined, forced-use therapy uses specific techniques designed to engage the patient with brain injury in activities that disallow overcompensation with the noninvolved or less involved body segments while forcing the use of the more involved segments. Some applications may involve placing the patient's hemiparetic extremity in a closed-chain weight-bearing activity with therapist support. We describe 2 cases of gastrocnemius muscle tears that occurred during inpatient neurologic rehabilitation that may be attributed to forced use of the hemiplegic lower extremity.

Intrathecal baclofen management of poststroke spastic hypertonia: implications for function and quality of life.

Objectives: To evaluate the impact of intrathecal baclofen (ITB) on function and quality of life (QOL) and to obtain efficacy and safety data in poststroke spastic hypertonia.

Design: Prospective open-label multicenter trial with follow-up at 3 and 12 months.

Setting: Twenty-four stroke treatment centers in the United States.

Spasticity: the misunderstood part of the upper motor neuron syndrome.

Spasticity is a sensorimotor phenomenon related to the integration of the nervous system motor responses to sensory input. Although most commonly considered a velocity-dependent increase to tonic stretch, it is related to hypersensitivity of the reflex arc and changes that occur within the central nervous system, most notably, the spinal cord. Injury to the central nervous system results in loss of descending inhibition, allowing for the clinical manifestation of abnormal impulses.

Clinical caveats on medical assessment and treatment of pain after TBI.

The diagnosis and management of pain in the patient with traumatic brain injury (TBI) can be difficult in light of the limitations imposed by the cognitive, language, and behavioral deficits. With patients in the acute rehabilitation setting, one must be vigilant for the often subtle signs and symptoms of pain. Causes more commonly seen in the population with TBI as a consequence of the injury itself include dysautonomia, neuropathic pain, spasticity, and heterotopic ossification.

Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin.

Object: The goal of this study was to ascertain the long-term effectiveness and safety of intrathecal baclofen (ITB) in the treatment of spasticity of cerebral origin in children and young adults.

Methods: A prospective, multicenter study was conducted in 68 patients who had been enrolled in the initial evaluation of ITB therapy and were willing to participate in long-term surveillance. Seventy-three percent of the patients were younger than 16 years of age at the time of study entry.