Treadmill training after spinal cord injury: it's not just about the walking

Body weight-supported treadmill training (BWSTT) is being used throughout the world as a method for improving functional ambulation after spinal cord injury (SCI). This therapy, however, is very labor-intensive, and recent evidence suggests that it may not be superior to other more conventional forms of rehabilitation for improving locomotor ability. Recognizing that the value of BWSTT may extend well beyond its potential to improve functional ambulation is important, and the physiological and psychological benefits associated with this whole-body upright exercise may justify its use in both the acute and chronic SCI populations.     

Heart failure: it's not just for men

Heart failure is end-stage cardiac disease, developing in 46% of women within 6 years of having a myocardial infarction, and is the leading cause of all hospitalizations and readmissions in women over the age of 65 years. Since women present with atypical symptoms leading to inaccurate diagnosing of heart disease, education becomes a key component in increasing women's ability to self-manage heart failure symptoms and to become proactive in health-promoting behaviors. Health care providers are responsible for communicating discharge education including risk factors, causes, classification and staging, clinical presentation, diagnostic testing, and management of heart failure to assist women in managing this terminal disease and improving their quality of life.     

Polycystic ovary syndrome: it's not just infertility

Recent diagnostic and pharmacologic developments have focused renewed attention on polycystic ovary syndrome. Clinical features of the syndrome include anovulation, hyperandrogenism and menstrual dysfunction, but several other abnormalities, including hyperinsulinemia, luteinizing hormone hypersecretion, elevated testosterone levels and acyclic estrogen production, have been documented. Accompanying obesity and lipid abnormalities compound the risk of developing diabetes mellitus or cardiovascular disease, and chronic anovulation increases the risk for endometrial cancer. A careful history and physical examination should guide diagnostic testing. Slowly progressive hyperandrogenic symptoms with anovulation of peripubertal onset often represent polycystic ovary syndrome. Treatment goals include symptom management and the identification and prevention of potential cardiovascular risks. Treatment should take into account the patient's desire for fertility. Advances in transvaginal ultrasonography and infertility treatments, including newer medications, have facilitated assisted reproduction in patients with polycystic ovary syndrome. Ongoing pharmacologic research focusing on the treatment of insulin resistance appears promising in reversing the longterm complications of the syndrome.