Common pain syndromes in stroke patients: review of two cases.

Due to multiple neurological and musculoskeletal factors, stroke patients are at significant risk for the development of disabling pain syndromes. This article provides examples of two commonly encountered clinical situations, poststroke shoulder and poststroke hip pain. Appropriate use of imaging, medications, modalities, and injections are discussed for the purpose of enhancing management strategies that decrease pain and increase overall function.

Amantadine treatment of hemispatial neglect: a double-blind, placebo-controlled study.

Objective: The resemblance of some aspects of the hemispatial neglect syndrome (hypokinesia, decreased arousal) to aspects of Parkinsonian syndromes, and the success of amantadine in treating disorders of attention, prompted a placebo-controlled, double-blind trial of amantadine, an inhibitor of the N-methyl D-aspartate (NMDA) glutamate receptor that modulates dopamine transmission, in four patients with chronic hemispatial neglect.

Design: Patients received placebo or 100 mg of amantadine twice a day in an ABA design. Dependent measures of drug effect included an extensive battery of tests assessing arousal, hemiinattention, hemihypokinesia, personal neglect, disability, anosognosia, family burden, and naturalistic action.

On pure word deafness, temporal processing, and the left hemisphere.

Pure word deafness (PWD) is a rare neurological syndrome characterized by severe difficulties in understanding and reproducing spoken language, with sparing of written language comprehension and speech production. The pathognomonic disturbance of auditory comprehension appears to be associated with a breakdown in processes involved in mapping auditory input to lexical representations of words, but the functional locus of this disturbance and the localization of the responsible lesion have long been disputed. We report here on a woman with PWD resulting from a circumscribed unilateral infarct involving the left superior temporal lobe who demonstrated significant problems processing transitional spectrotemporal cues in both speech and nonspeech sounds.

Home forced use in an outpatient rehabilitation program for adults with hemiplegia: a pilot study.

The objective of this study was to examine the effectiveness of a program of traditional outpatient neurological rehabilitation that included home forced use. In total, 17 patients with chronic stroke and 1 patient with subacute stroke (mean time poststroke = 27.6 months) completed an individualized program consisting of seven 2-hour treatment sessions composed of 1 hour of occupational therapy and 1 hour of physical therapy.

Constraint-induced therapy for a child with hemiplegic cerebral palsy: a case report.

A 12-year-old boy with hemiplegic cerebral palsy (CP) presented with decreased function in his left upper extremity. He was treated with a 3-week protocol of constraint-induced therapy (CIT) consisting of six 2-hour sessions of physical and occupational therapy, plus home practice. Improvements in upper-extremity function were found in the mean and median time for completion of the Wolf Motor Function Test immediately posttreatment and at 8-month follow-up.

Stroke Transition after Inpatient Rehabilitation.

This article describes a 3-year study testing the efficacy of a system of home-based, case-managed care for stroke survivors returning to the community following inpatient poststroke rehabilitation. The Stroke Transition after Inpatient Rehabilitation (STAIR) study was a randomized, controlled trial of a postdischarge management strategy carried out in a group of 55 stroke patients, aged 65 or older, who did not have serious residual cognitive or language impairments and returned to the community following inpatient rehabilitation with the assistance of a primary caregiver. The program was shown to facilitate improvement in the general social activity level of the patients in the experimental group at 6 months compared to the control, and there was a trend for this effect to persist at 1 year.

Geriatric rehabilitation. 4. Assessment, preservation, and enhancement of fitness and function.

This self-directed learning module highlights the assessment, preservation, and enhancement of fitness and function in the older adult. It is part of the chapter on geriatric rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information on functional assessment, deconditioning, exercise testing and physiology, gait disorders and falls, sports injuries, and industrial injuries in the older adult.

Geriatric rehabilitation. 3. Mid- and late-life effects of early-life disabilities.

This self-directed learning module highlights mid- and late-life effects of early-life disabilities. It is part of the chapter on geriatric rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information on how to evaluate, prevent, and manage late complications seen in adults and older adults with cerebral palsy, spina bifida, spinal cord injury, multiple sclerosis, juvenile rheumatoid arthritis, and early-life amputations, including psychosocial and other quality-of-life issues.

Geriatric rehabilitation. 2. Diagnosis and management of acquired disabling disorders.

This self-directed learning module highlights the diagnosis and rehabilitation management of acquired disabling disorders. It is part of the chapter on geriatric rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information on the physiology of aging; rehabilitation management of pathologic conditions of the older adult affecting the cardiovascular, pulmonary, skeletal, connective tissue, and neurologic systems; rehabilitation issues relating to psychologic functioning of the older adult; pharmacologic concerns of the older adult; and response to illness with aging.

Geriatric rehabilitation. 1. Social, attitudinal, and economic factors.

This self-directed learning module highlights the social, attitudinal, and economic factors that are important in the rehabilitation of the older adult. It is part of the chapter on geriatric rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information on the epidemiology of aging and disability, geriatric rehabilitation treatment environments, social support systems, reimbursement issues, and ageism.

Lower extremity hemorrhage in spinal cord injured patients receiving therapeutic anticoagulation.

Six episodes of lower extremity hemorrhage occurred in five spinal cord injured patients receiving therapeutic anticoagulation. Factors contributing to hemorrhage included excessive anticoagulation in two episodes and soft tissue trauma during vigorous range of motion (ROM) exercises in three. The three episodes without clinical evidence of trauma were initially misdiagnosed as recurrent deep venous thrombosis.