Technology and occupational therapy in the rehabilitation of the bedridden quadriplegic

In recent years, home health care services have been expanded considerably. These services, combined with current technological advances, allow severely disabled, even bedbound, people to remain at home. This report demonstrates how one individual, although bedridden and quadriplegic, has successfully adapted his home environment. His functional independence has been markedly improved through computers, environmental control units, innovative carpentry, and adaptations by the occupational therapist. His need for attendant care has been reduced and his quality of life significantly enhanced through increased control of his surroundings. This paper suggests innovative and technological solutions to environmental problems at home. These ideas may aid the home health care occupational therapist in treating individuals who are bedbound.     

Cardiac arrhythmias from a malpositioned Greenfield filter in a traumatic quadriplegic

A case study is presented of premature Greenfield filter discharge with intracardiac migration and resulting life-threatening arrhythmias. These arrhythmias also interfered with the patient's transition from ventilatory support via orotracheal intubation to noninvasive positive airway pressure ventilatory support methods. The patient's arrhythmias were controlled by a demand cardiac pacemaker and cardiac glycoside therapy. No anticoagulants were used. She had no further filter migration nor significant complications for 16 months after hospital discharge.     

创伤性脑损伤的临床康复

创伤性脑损伤(traumaticbraininjury,TBI)在欧美发病率较高,初步统计是创伤性脊髓损伤的30～40倍,在某些方面,接近于脑卒中的发病率。病因多为交通事故、体育活动、工伤和暴力袭击。患者主要为青年男性,美国统计,15～24岁青年男性的发病率≥550人/100000人口。严重TBI的良好结局依赖于长期的综合性康复治疗,大多数患者的社会生活能力较差,家庭和社会为此负担较大。     

Pushing the frames of reference in traumatic brain injury rehabilitation

Cognitive rehabilitation is an empirically based field driven by multiple sources of activities and knowledge bases. Drawing on frames of reference provided by rehabilitation, neuropsychology, and rehabilitation psychology, cognitive rehabilitation has evolved to a point where studies have been generated to qualify for consideration in tables of evidence. At the center of cognitive rehabilitation is the effort to teach people to overcome or adapt to limitations. While rehabilitation has traditionally been focused on activity, a recent trend in the literature is to incorporate the individuals experience into a frame of reference for rehabilitation. Emphasizing the experience of the person in the situation fits into cognitive rehabilitation and raises the bar for rehabilitation not only in viewing rehabilitation as an activity to relieve burdens but also in terms of how rehabilitants come to grips with limitations. Dealing with limitations is an important indicator of mental health.     

Physiologic comparison between conventional mechanical ventilation and transtracheal open ventilation in acute traumatic quadriplegic patients

OBJECTIVE: To evaluate the efficacy of mechanical ventilation administered through a small-bore, uncuffed tracheotomy tube, so-called transtracheal open ventilation (TOV), in comparison with conventional mechanical ventilation via a cuffed tracheal tube (endotracheal invasive ventilation, EIV). DESIGN: Physiologic study. SETTING: Intensive care unit of a referral trauma center. PATIENTS: Ten acute quadriplegic patients. INTERVENTIONS: In acute quadriplegic patients receiving EIV, TOV was subsequently applied via an uncuffed, small-bore tube (internal diameter of 4 or 5 mm). MEASUREMENTS AND MAIN RESULTS: Compared with EIV, arterial blood gases were not significantly different after 1 hr of TOV (Pao2/Fio2, 222.8 +/- 60.9 vs. 218.5 +/- 60.3; Paco2, 37.8 +/- 7.1 torr [5.04 +/- 0.95 kPa] vs. 35.5 +/- 6.8 torr [4.73 +/- 0.91 kPa], for EIV and TOV, respectively). Respiratory rate (19.5 +/- 4.7 vs. 19.6 +/- 5 breaths/min) and inspiratory effort (pressure-time product of esophageal pressure during a 1-min period, 125.9 +/- 48.4 vs. 112.8 +/- 36.4 cm H2O.sec.min) were also no different between the two modes. After 24 hrs of TOV, compared with EIV and TOV after 1 hr, respiratory rate and arterial blood gases remained stable, and the pressure-time product of esophageal pressure during a 1-min period was slightly, but significantly, reduced (83.5 +/- 16.6 cm H2O.sec.min, p < .05). CONCLUSIONS: In acute quadriplegic patients receiving mechanical ventilation, TOV was as effective as EIV in providing ventilatory support.     

电磁疗在创伤性骨折康复中的应用效果

目的:探讨电磁疗即脉冲磁刺激及中频脉冲电疗治疗在创伤性骨折康复中的临床效果.方法:选择创伤性骨折患者100例,随机分成对照组及试验组各50例.对照组采用常规治疗方法,试验组在常规治疗方法基础上增加脉冲磁刺激及中频脉冲电疗治疗.结果:试验组能迅速的消除肢体肿胀,减轻患肢疼痛,有效地促进骨折愈合.结论:脉冲磁刺激及中频脉冲电疗疗效明显,且无副作用,适用于创伤性骨折.     

创伤性颅脑损伤康复治疗患者相关因素的回顾性分析

目的了解接受康复治疗的创伤性颅脑损伤(TBI)患者的一般情况、康复治疗时间、并发症等情况。方法回顾性分析北京博爱医院神经康复科1993年9月~2004年7月入院的所有TBI病例。结果共有280例TBI住院患者,平均发病年龄(33.1±11.4)岁,男女比为4.28∶1,职业构成以机关干部为主(占34.6%),报销方式也以公费医疗最多(占71.1%)。受伤原因以交通事故为主(占66.4%)。入院时距离受伤日期10 d~6年,平均288 d,在伤后3月内入院行康复治疗者占25.0%。继发癫痫者占15.7%,住院期间发现有脑积水者占18.9%。结论目前我国因TBI住院康复治疗的群体主要为城市男性居民、享受公费医疗待遇者;TBI急性期和亚急性期的康复流程体系也有待建立和完善。     

颅脑创伤单元模式在偏瘫患者康复中的应用

目的：探讨在颅脑创伤单元模式下对偏瘫患者进行分期康复训练的效果。方法选取2012年6月-2013年5月收治的颅脑损伤并发偏瘫患者120例,其中选取60例常规治疗模式患者为对照组,建立颅脑创伤单元模式后选取60例为观察组。入院24 h内及5周后分别行格拉斯哥昏迷量表（GCS）、改良的Rankin量表（MRS）、Barthel指数（BI）评分。两组均接受一般神经外科常规治疗,对照组采用常规护理;观察组采用颅脑创伤单元模式下的分期康复指导。结果两组患者治疗前后GCS、MRS、BI 3个方面评分差异均有统计学意义,治疗后观察组 GCS、MRS、BI 分别为（8．25±5．01）,（3．49±2．13）,（45．84±15．48）分,优于对照组治疗后（10．21±4．11）,（3．00±1．24）,（54．72±17．74）分,差异有统计学意义（t值分别为2．343,2．074,2．922;P＜0．05）。干预组BI＞65分比例为65．0％、回家自理者占70．0％,均高于对照组（40．0％,41．7％）,两组比较差异有统计学意义（χ2值分别为7．519,9．766;P＜0．01）。结论在颅脑创伤单元模式中,更强调医护联合,护士进行专业康复指导,保证了患者在入院时即开始正规康复治疗,为日后进一步系统的康复治疗做好准备,最大限度避免影响预后不良事件的发生,使患者在病情稳定之后,能够顺利进入下一阶段的康复治疗,缩短急性期住院时间,改善康复预后,使患者获得最大限度的功能恢复。     

Patient safety in rehabilitation medicine: traumatic brain injury

This article describes patient safety after traumatic brain injury (TBI). Patient safety in rehabilitation after TBI is important. Thorough assessment on initial evaluation, vigilance for medical and procedural errors, appropriate communication between medical professionals, and evaluation of systems-based practices increases patient safety. It is the responsibility of the rehabilitation treatment team to ensure that appropriate measures are taken to reduce risk of adverse events. This article is intended to promote discussion of patient safety after TBI within rehabilitation teams and to help improve outcomes throughout the spectrum of recovery.