The Effects of Aerobic Exercise on Postconcussion Symptoms in Patients With Persistent Symptoms: A Critically Appraised Topic

2020 ◽  
Vol 25 (1) ◽  
pp. 4-11
Author(s):  
Timothy A. Kulpa ◽  
Jamie Mansell ◽  
Anne Russ ◽  
Ryan Tierney
Keyword(s):  
Aerobic Exercise ◽  
Treatment Plan ◽  
Rehabilitation Program ◽  
Bottom Line ◽  
Persistent Symptoms ◽  
Improved Outcomes ◽  
Cognitive Rest ◽  
Potential Clinical Utility ◽  
Active Rehabilitation ◽  
Postconcussion Symptoms

Context: Patients who do not fully recover from a concussion in 7–14 days may require an impairment-based rehabilitation program. Recent evidence indicates improved outcomes with active rehabilitation compared to passive physical and cognitive rest. Clinical Question: In patients with persistent symptoms (greater than 4 weeks) following concussion, how does aerobic exercise affect postconcussion symptoms? Clinical Bottom Line: There is moderate and sufficient SORT Level B evidence to support the inclusion of subsymptom threshold (SST) exercise in the multimodal treatment plan for patients suffering from persistent symptoms after concussion. All five included studies reported moderate to very large effects ranging from d = 0.72 to d = 10.64 in reducing symptoms after the implementation of SST aerobic exercise. Additionally, two studies also identified moderate and very large effects (d = 0.77, d = 2.56) favoring aerobic exercise over stretching interventions. These results indicate that this treatment has potential clinical utility and is a viable option to reduce symptoms in patients with postconcussion syndrome and persistent symptoms following concussion.

scholarly journals Early Controlled Exercise and Timing of Treatment Following Concussion: A Critically Appraised Topic

2020 ◽  
Vol 29 (3) ◽  
pp. 360-366 ◽  
Author(s):  
Nicholas Hattrup ◽  
Hannah Gray ◽  
Mark Krumholtz ◽  
Tamara C. Valovich McLeod
Keyword(s):  
Aerobic Exercise ◽  
Interdisciplinary Approach ◽  
Rehabilitation Program ◽  
Psychological State ◽  
Sufficient Evidence ◽  
Symptom Duration ◽  
Clinical Question ◽  
Bottom Line ◽  
Duration Of Symptoms ◽  
Symptom Intensity

Clinical Scenario: Recent systematic reviews have shown that extended rest may not be beneficial to patients following concussion. Furthermore, recent evidence has shown that patient with postconcussion syndrome benefit from an active rehabilitation program. There is currently a gap between the ability to draw conclusions to the use of aerobic exercise during the early stages of recovery along with the safety of these programs. Clinical Question: Following a concussion, does early controlled aerobic exercise, compared with either usual care or delayed exercise, improve recovery as defined by symptom duration and severity? Summary of Key Findings: After a thorough literature search, 5 studies relevant to the clinical question were selected. Of the 5 studies, 1 study was a randomized control trial, 2 studies were pilot randomized controlled trials, and 2 studies were retrospective. All 5 studies showed that implementing controlled aerobic exercise did not have an adverse effect on recovery. One study showed early aerobic exercise had a quicker return to school, and another showed a 2-day decrease in symptom duration. Clinical Bottom Line: There is sufficient evidence to suggest that early controlled aerobic exercise is safe following a concussion. Although early aerobic exercise may not always result in a decrease in symptom intensity and duration, it may help to improve the psychological state resulting from the social isolation of missing practices and school along with the cessation of exercise. Although treatments continue to be a major area of research following concussion, management should still consist of an interdisciplinary approach to individualized patient care. Strength of Recommendation: There is grade B evidence to support early controlled aerobic exercise may reduce the duration of symptoms following recovery while having little to no adverse events.

scholarly journals Cervicovestibular rehabilitation in adult with mild traumatic brain injury: a randomised controlled trial protocol

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Pierre Langevin ◽  
Philippe Fait ◽  
Pierre Frémont ◽  
Jean-Sébastien Roy
Keyword(s):  
Traumatic Brain Injury ◽  
Cervical Spine ◽  
Brain Injury ◽  
Neck Pain ◽  
Mild Traumatic Brain Injury ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Conventional Approach ◽  
Persistent Symptoms ◽  
Link Type

Abstract Background Mild traumatic brain injury (mTBI) is an acknowledged public health problem. Up to 25% of adult with mTBI present persistent symptoms. Headache, dizziness, nausea and neck pain are the most commonly reported symptoms and are frequently associated with cervical spine and vestibular impairments. The most recent international consensus statement (2017 Berlin consensus) recommends the addition of an individualized rehabilitation approach for mTBI with persistent symptoms. The addition of an individualized rehabilitation approach including the evaluation and treatment of cervical and vestibular impairments leading to symptoms such as neck pain, headache and dizziness is, however, recommended based only on limited scientific evidence. The benefit of such intervention should therefore be further investigated. Objective To compare the addition of a 6-week individualized cervicovestibular rehabilitation program to a conventional approach of gradual sub-threshold physical activation (SPA) alone in adults with persistent headache, neck pain and/or dizziness-related following a mTBI on the severity of symptoms and on other indicators of clinical recovery. We hypothesize that such a program will improve all outcomes faster than a conventional approach (between-group differences at 6-week and 12-week). Methods In this single-blind, parallel-group randomized controlled trial, 46 adults with subacute (3 to12 weeks post-injury) persistent mTBI symptoms will be randomly assigned to: 1) a 6-week SPA program or 2) SPA combined with a cervicovestibular rehabilitation program. The cervicovestibular rehabilitation program will include education, cervical spine manual therapy and exercises, vestibular rehabilitation and home exercises. All participants will take part in 4 evaluation sessions (baseline, week 6, 12 and 26) performed by a blinded evaluator. The primary outcome will be the Post-Concussion Symptoms Scale. The secondary outcomes will be time to clearance to return to function, number of recurrent episodes, Global Rating of Change, Numerical Pain Rating Scale, Neck Disability Index, Headache Disability Inventory and Dizziness Handicap Inventory. A 2-way ANOVA and an intention-to-treat analysis will be used. Discussion Controlled trials are needed to determine the best rehabilitation approach for mTBI with persistent symptoms such as neck pain, headache and dizziness. This RCT will be crucial to guide future clinical management recommendations. Trial registration ClinicalTrials.gov Identifier - NCT03677661, Registered on September, 15th 2018.

scholarly journals What’s going on following acute covid-19? Clinical characteristics of patients in an out-patient rehabilitation program

2021 ◽  
pp. 1-12
Author(s):  
Sergiu Albu ◽  
Nicolas Rivas Zozaya ◽  
Narda Murillo ◽  
Alberto Garcia-Molina ◽  
Cristian Andres Figueroa Chacón ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Acute Infection ◽  
Rehabilitation Program ◽  
Neuropsychological Impairment ◽  
Outpatient Rehabilitation ◽  
Screening Process ◽  
Icu Patients ◽  
Persistent Symptoms

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients present long-lasting physical and neuropsychological impairment, which may require rehabilitation. OBJECTIVES: The current cross-sectional study characterizes post COVID-19 sequelae and persistent symptoms in patients in an outpatient rehabilitation program. METHODS: Thirty patients [16 post-ICU and 14 non-ICU; median age = 54(43.8–62) years; 19 men] presenting sequelae and/or persistent symptoms (>3 months after acute COVID-19) were selected of 41 patients referred for neurorehabilitation. Patients underwent physical, neuropsychological and respiratory evaluation and assessment of impact of fatigue and quality of life. RESULTS: The main reasons for referral to rehabilitation were: fatigue (86.6%), dyspnea (66.7%), subjective cognitive impairment (46.7%) and neurological sequelae (33.3%). Post-ICU patient presented sequelae of critical illness myopathy and polyneuropathy, stroke and encephalopathy and lower forced vital capacity compared to non-ICU patients. Cognitive impairment was found in 63.3% of patients, with a similar profile in both sub-groups. Increased physical fatigue, anxiety and depression and low quality of life were prevalent irrespective of acute COVID-19 severity. CONCLUSIONS: The variability of post COVID-19 physical and neuropsychological impairment requires a complex screening process both in ICU and non-ICU patients. The high impact of persistent symptoms on daily life activities and quality of life, regardless of acute infection severity, indicate need for rehabilitation.

Sex-based differences in outcomes for adult patients presenting to the emergency department with a concussion

2021 ◽  
pp. 1-10
Author(s):  
Brian H. Rowe ◽  
Esther H. Yang ◽  
Lindsay A. Gaudet ◽  
Leeor Eliyahu ◽  
Daniela R. Junqueira ◽  
...  
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Motor Vehicle ◽  
Adult Population ◽  
Treatment Options ◽  
Multivariate Logistic Regression Model ◽  
Adult Women ◽  
Multivariate Logistic Regression ◽  
Persistent Symptoms ◽  
Postconcussion Symptoms

OBJECTIVE Patients with concussion frequently present to the emergency department (ED). Studies of athletes and children indicate that concussion symptoms are often more severe and prolonged in females compared with males. Given infrequent study of concussion symptoms in the general adult population, the authors conducted a sex-based comparison of patients with concussion. METHODS Adults (≥ 17 years of age) presenting with concussion to one of three urban Canadian EDs were recruited. Discharged patients were contacted by telephone 30 and 90 days later to capture the extent of persistent postconcussion symptoms using the Rivermead Post Concussion Symptoms Questionnaire (RPQ). A multivariate logistic regression model for persistent symptoms that included biological sex was developed. RESULTS Overall, 250 patients were included; 131 (52%) were women, and the median age of women was significantly higher than that of men (40 vs 32 years). Women had higher RPQ scores at baseline (p < 0.001) and the 30-day follow-up (p = 0.001); this difference resolved by 90 days. The multivariate logistic regression identified that women, patients having a history of sleep disorder, and those presenting to the ED with concussions after a motor vehicle collision were more likely to experience persistent symptoms. CONCLUSIONS In a community concussion sample, inconsequential demographic differences existed between adult women and men on ED presentation. Based on self-reported and objective outcomes, work and daily activities may be more affected by concussion and persistent postconcussion symptoms for women than men. Further analysis of these differences is required to identify different treatment options and ensure adequate care and management of injury.

scholarly journals Direct Costs of Occupational Asthma due to Sensitization in Quebec (1988 to 2002): Revisited

2011 ◽  
Vol 18 (1) ◽  
pp. e1-e5 ◽  
Author(s):  
Jean-Luc Malo ◽  
Maria-Victoria Zunzunegui ◽  
Jocelyne L’Archevêque ◽  
Shélanie Cardinal ◽  
Heberto Ghezzo
Keyword(s):  
Molecular Weight ◽  
Early Retirement ◽  
Occupational Asthma ◽  
Sociodemographic Factors ◽  
Direct Costs ◽  
Rehabilitation Program ◽  
Older Age ◽  
Low Molecular Weight ◽  
Active Rehabilitation ◽  
The Cost

BACKGROUND: In a previous study, the authors assessed direct costs for occupational asthma (OA) in a random sample of eight to 10 accepted claims per year for OA between 1988 and 2002. Compensation for loss of income (CLI) was found to be significantly higher for men and for OA caused by low-molecular-weight agents.OBJECTIVES AND METHODS: To identify sociodemographic factors that modulate CLI, the dossier of each claimant in the previous study was re-examined.RESULTS: Higher CLI costs were directly related to the duration of CLI (over which loss of income was reimbursed) (r=0.65). Costs of CLI were higher in patients 30 years of age or older at diagnosis, married subjects and individuals who were offered early retirement or were enrolled in an active interventional rehabilitation program. Higher CLI costs in men, but not in women, were associated with the following sociodemographic factors: older age, different rehabilitation program (early retirement and active program versus no specific program) and married status. Older age was found to be significant in the multivariate analysis performed for men. The cost of CLI was higher in workers with OA caused by low-molecular-weight agents. Although proportionally fewer men and younger workers were affected with OA caused by low-molecular-weight agents, the longer duration of CLI for this category of agent could explain the higher costs.CONCLUSION: Higher costs for CLI were associated in men (but not women) with older age, married status and type of rehabilitation program (early retirement and active rehabilitation). Higher costs of CLI for OA caused by low-molecular-weight agents were associated with a longer duration of CLI per se, and not with sociodemographic factors.

Surgery for Psychiatric Disorders

CNS Spectrums ◽  
2000 ◽  
Vol 5 (10) ◽  
pp. 43-52 ◽  
Author(s):  
G. Rees Cosgrove
Keyword(s):  
Surgical Intervention ◽  
Therapeutic Option ◽  
Treatment Plan ◽  
Psychiatric Rehabilitation ◽  
Rehabilitation Program ◽  
Psychiatric Disease ◽  
Complication Rates ◽  
Obsessive Compulsive ◽  
Stereotactic Techniques ◽  
Compulsive Disorder

AbstractThe modern therapeutic approach to most psychiatric diseases involves a combination of well-supervised psychotherapy, pharmacotherapy, and electroconvulsive therapy. Patients who fail to adequately respond to these modern treatment methods and remain severely disabled may be considered for surgical intervention. Cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy are the most common psychosurgical procedures performed today, with response rates in the 35% to 65% range. Modern stereotactic techniques have reduced complication rates, but controversy remains regarding the optimal surgical procedure. The major psychiatric diagnostic categories that might respond to surgery include treatment-refractory major affective disorders, obsessive-compulsive disorder, and chronic anxiety states. Surgery should be considered as one part of an entire treatment plan and must be followed by an appropriate psychiatric rehabilitation program. It should only be carried out by an expert multidisciplinary team consisting of a neurologist a neurosurgeon, and a psychiatrist with experience in these disorders. Surgical intervention remains a reasonable therapeutic option for select patients with a disabling psychiatric disease and may be underutilized.

Evaluation of an active rehabilitation program for concussion management in children and adolescents

Brain Injury ◽  
2017 ◽  
Vol 31 (13-14) ◽  
pp. 1753-1759 ◽  
Author(s):  
Danielle M. Dobney ◽  
Lisa Grilli ◽  
Helen Kocilowicz ◽  
Christine Beaulieu ◽  
Meghan Straub ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Rehabilitation Program ◽  
Concussion Management ◽  
Active Rehabilitation

scholarly journals Rehabilitation program combining physical exercise and heart rate variability biofeedback in hematologic patients: a feasibility study

2021 ◽  
Author(s):  
Claire Fournié ◽  
Chantal Verkindt ◽  
Georges Dalleau ◽  
Nicolas Bouscaren ◽  
Catherine Mohr ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Physical Exercise ◽  
Physical Function ◽  
Patient Adherence ◽  
Scratch Test ◽  
Rehabilitation Program ◽  
Walk Test ◽  
Heart Rate Variability Biofeedback ◽  
Persistent Symptoms

Abstract Purpose Hematologic patients have a poorer health-related quality of life due to the disease and its treatments. Non-pharmacological interventions represent an opportunity in tertiary cancer prevention to manage persistent symptoms and support patients in their return to active daily living. This interventional study aimed to evaluate the feasibility of a program combining physical exercise (PE) and heart rate variability biofeedback (HRVB) in hematologic patients. Method Hematologic patients in remission within 6 months participated in a 12-week rehabilitation program including 24 supervised sessions of PE associated with 10 supervised sessions of HRVB and daily home-based practice of paced breathing. We assessed patient adherence, fatigue, physical function, and heart rate variability. Results Twenty patients were included, 17 completed the protocol and 3 dropped out due to disease progression or time constraints; no adverse events or incidents were reported. Participation rates were 85% for PE and 98% for HRVB-supervised sessions. Significant improvements of physical capacity (6-min walk test, p < 0.001; 50-foot walk test, p < 0.001), muscle strength (grip force test, p < 0.01), and flexibility (toe-touch test, p < 0.001; back scratch test, p < 0.05) were measured. Coherence ratio (p < 0.001) and low-frequency spectral density of HRV signal (p < 0.003) increased significantly, suggesting improved autonomic function. Fatigue, static balance, and other time and frequency indicators of HRV were not improved (all p > 0.05). Conclusion A rehabilitation program combining PE and HRVB is feasible in hematologic patients and effective on physical function. Further research with a larger sample size is needed to investigate effectiveness on patients’ autonomic functions and their impacts on symptomatology.

scholarly journals Pulmonary Artery Intimal Sarcoma Diagnosed as Pulmonary Embolism

2021 ◽  
Vol 2 (3) ◽  
pp. 11-13
Author(s):  
Ali Abbood ◽  
Hareer Al Salihi ◽  
Olatunji Otegbeye ◽  
Mario Madruga ◽  
S. J. Carlan
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Treatment Plan ◽  
Pulmonary Arteries ◽  
Comorbid Condition ◽  
Initial Management ◽  
Intimal Sarcoma ◽  
Persistent Symptoms ◽  
Poorly Differentiated ◽  
Rare Malignancy

Background: Pulmonary artery intimal sarcoma (PAIS) is a rare malignancy of vasculature that carries a very poor prognosis that is often misdiagnosed as a pulmonary embolism due to overlapping clinical and radiological features. It is a very aggressive malignancy with surgery the mainstay of initial management. Chemotherapy is normally given postoperatively, although it is not clear if chemo and radiotherapy bring any improvement, some data report an increase in survival in patients who received multimodality therapy vs single therapy. Case: A 48 year-old female was initially diagnosed with a pulmonary embolism based on clinical presentation and imaging. She was treated vigorously but continued to show no improvement after two weeks. She underwent an open thrombectomy and a large concurrent pulmonary artery intimal sarcoma (PAIS) was found. The mass was adherent to the intima and extended into the left and right pulmonary arteries. The tumor was not fully resected and tissue results showed poorly differentiated sarcoma. A treatment plan was then initiated to include systemic chemotherapy. She developed metastatic disease despite receiving multimodal therapy and died with within 2 years from the initial diagnosis. Conclusion: Persistent symptoms in patients diagnosed and treated adequately for pulmonary artery thrombosis should indicate a possible comorbid condition including sarcoma. This is particularly the case in the older age group with imaging that suggests central embolism despite treatment.

scholarly journals Progressive hemifacial atrophy Parry Romberg syndrome characteristics of craniofacial morphology

2007 ◽  
Vol 54 (1) ◽  
pp. 52-61
Author(s):  
Angelina Nikodijevic-Latinovic
Keyword(s):  
Subcutaneous Tissue ◽  
Treatment Plan ◽  
Rehabilitation Program ◽  
Craniofacial Morphology ◽  
Dental Arch ◽  
Mandibular Ramus ◽  
Hemifacial Atrophy ◽  
Parry Romberg Syndrome ◽  
The Right ◽  
Facial Hemiatrophy

The aim of this case report was to analyze clinical finding in a patient with rare, Parry Romberg syndrome. The patient was diagnosed with progressive facial hemiatrophy that affected skin, subcutaneous tissue and underlying bony structures. Analysis of study models and cephalometric radiographs confirmed there was insufficient development of the facial right side: asymmetric narrow upper jaw, shorter mandibular ramus and corpus, upper frontal teeth asymmetry, crowding of the upper dental arch on the right side. An orthodontic treatment plan was proposed within the entire rehabilitation program that included collaboration with a maxillofacial and plastic surgeon.

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