Drugs Used in Neurorehabilitation

2018 ◽  
Author(s):  
Eelco F. M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Intensive Care Unit ◽  
Spinal Cord ◽  
Long Term Care ◽  
Disorders Of Consciousness ◽  
Term Care ◽  
Rehabilitation Programs ◽  
Dopaminergic Agents ◽  
Cord Injury ◽  
Specialized Care

Neurologic rehabilitation arguably starts in the neurosciences intensive care unit. Specialized care is often needed in acute spinal cord injury, particularly if long-term care appears imminent. Much of neurorehabilitation is done without pharmaceuticals, but good options are available in patients with persistent disorders of consciousness, spasticity, and early depression after stroke. Disorders of consciousness are major concerns in neurorehabilitation centers because they obviate traditional rehabilitation programs. Improvement can be achieved with a neurostimulant which would improve attention span to therapy This chapter discusses dopaminergic agents and other neurostimulants for disorders of consciousness and long-term drugs for spasticity to improve outcomes.

Pressure Ulcer Prevalence by Level of Paralysis in Patients With Spinal Cord Injury in Long-term Care

2019 ◽  
Vol 32 (3) ◽  
pp. 122-130 ◽  
Author(s):  
Linda J. Cowan ◽  
Hyochol Ahn ◽  
Micah Flores ◽  
Joshua Yarrow ◽  
Lelia S. Barks ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Long Term Care ◽  
Term Care ◽  
Cord Injury

Long-Term Care Services Needs for Spinal-Cord Injury Patients in Taiwan

2001 ◽  
Vol 9 (4) ◽  
pp. 127-138 ◽  
Author(s):  
I-Chuan Li ◽  
I-Nai, Lien ◽  
Yueh-Chun Lin
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Long Term Care ◽  
Term Care ◽  
Care Services ◽  
Cord Injury

Swallowing Evaluation and Ventilator Dependency—Considerations and Contemporary Approaches

2011 ◽  
Vol 20 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Lori M. Burkhead
Keyword(s):  
Intensive Care Unit ◽  
Best Practices ◽  
Long Term Care ◽  
Term Care ◽  
The Past ◽  
Life Saving ◽  
Number Of Patients ◽  
Care Facilities ◽  
Swallowing Evaluation

With the advent of advanced life-saving practices, speech-language pathologists will continue to see a surge in the number of patients dependent on ventilators in both the acute and chronic phases of the health care continuum. Today, there are more individuals requiring ventilators, whether in the intensive care unit (ICU), in long-term care facilities, or in the community. In the past, it has been common to delay rehabilitation efforts in the ICU patient who requires a ventilator, based on the rationale that patients are too sick. This excuse no longer fits with contemporary knowledge regarding best practices in the ICU. Additionally, this argument is moot with regard to patients with diagnoses that will mandate long-term ventilator use. Our profession must understand and be able to address the unique concerns and needs regarding swallowing in those with either transient or chronic ventilator dependency.

scholarly journals Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e035752
Author(s):  
Jonviea D Chamberlain ◽  
Inge E Eriks-Hoogland ◽  
Kerstin Hug ◽  
Xavier Jordan ◽  
Martin Schubert ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Community Dwelling ◽  
Term Care ◽  
Term Survival ◽  
Vital Status ◽  
Risk Of Mortality ◽  
Cord Injury

IntroductionStudy drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation.MethodsThis retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality.Results1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI.ConclusionThe differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.

scholarly journals Characteristics, Outcomes, and Cost Patterns of High-Cost Patients in the Intensive Care Unit

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Peter M. Reardon ◽  
Shannon M. Fernando ◽  
Sasha Van Katwyk ◽  
Kednapa Thavorn ◽  
Daniel Kobewka ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Subarachnoid Hemorrhage ◽  
Respiratory Failure ◽  
Cost Reduction ◽  
Long Term Care ◽  
Term Care ◽  
Icu Length Of Stay ◽  
Younger Age ◽  
Procedural Complication

Background. ICU care is costly, and there is a large variation in cost among patients.Methods. This is an observational study conducted at two ICUs in an academic centre. We compared the demographics, clinical data, and outcomes of the highest decile of patients by total costs, to the rest of the population.Results. A total of 7,849 patients were included. The high-cost group had a longer median ICU length of stay (26 versus 4 days,P<0.001) and amounted to 49% of total costs. In-hospital mortality was lower in the high-cost group (21.1% versus 28.4%,P<0.001). Fewer high-cost patients were discharged home (23.9% versus 45.2%,P<0.001), and a large proportion were transferred to long-term care (35.1% versus 12.1%,P<0.001). Patients with younger age or a diagnosis of subarachnoid hemorrhage, acute respiratory failure, or complications of procedures were more likely to be high cost.Conclusions. High-cost users utilized half of the total costs. While cost is associated with LOS, other drivers include younger age or admission for respiratory failure, subarachnoid hemorrhage, or after a procedural complication. Cost-reduction interventions should incorporate strategies to optimize critical care use among these patients.

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