Faculty Bibliography

Moroz A, Bogey RA, Bryant PR, Geis CC, O'Neill BJ. Stroke and neurodegenerative disorders. 2. Stroke: comorbidities and complications. 2004;85(3 Suppl 1):S11-4. This self-directed learning module highlights diagnosis and treatment of comorbidities and complications encountered by patients with stroke. It is part of the study guide on stroke and neurodegenerative disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on cardiopulmonary complications and examines neurologic sequelae, risk factors for falls, and prevention strategies. It also discusses upper-limb pain, fatigue, and depression and highlights diagnosis and management of genitourinary complications.Overall article objective To summarize common comorbidities and complications encountered by patients after stroke

The purpose of this study was to test the efficacy of an interdisciplinary geriatric outreach, rehabilitation, and education program for seniors. Community-dwelling Chinese seniors in lower Manhattan were recruited through outreach activities (17 educational workshops, three community health fairs, media interviews) and community physician referrals to offer rehabilitation services. The instrument administered at entry and exit included questions about pain intensity, quality of life, activities of daily living (ADLs), and an assessment of a variety of intrinsic and extrinsic barriers to life participation. The sample included 70 seniors (53 women) with a mean age of 70.5 +- 7.48 years (range 60-93 years old) of whom 86% were Cantonese-speaking Chinese. The barriers-to-life participation assessment revealed cultural, communication, transportation, and physical environmental barriers as well as insufficient financial resources. Thirty-four patients who completed the program showed a significant improvement in quality of life. Patients' reports reflected a high degree of satisfaction with the program. Interdisciplinary team-oriented patient care, including a physiatrist, social worker, and rehabilitation staff, may result in good outcomes and high patient satisfaction in ambulatory community seniors

Application of principles of rehabilitation medicine to community health is an area of great importance to the care of the elderly. New York City has a high percentage of Chinese immigrants. The complexity of age and cultural and communication difficulties require special attention, and an interdisciplinary approach is essential for success. The 'Convalescence Care for Seniors of Lower Manhattan,' a program located at New York University Downtown Hospital, is able to reach out successfully to an underserved Chinese population in Lower Manhattan. Through educational workshops, health fairs, and physician referrals, patients were able to receive the benefit of a functional approach

OBJECTIVE: Venous thromboembolism after total-knee arthroplasty represents a common early postoperative complication resulting in significant morbidity. Despite this, the optimal prophylactic regimen is controversial. The prevalence of venous thromboembolism has been cited as high as 35% in patients receiving pharmacologic prevention alone. We investigated the efficacy of a comprehensive prevention protocol encompassing the use of epidural anesthesia, aspirin, venous foot compression pumps, and early mobilization in a series of consecutive total-knee arthroplasties. DESIGN: A series of 100 consecutive total-knee arthroplasty patients were enrolled into the prospective trial. All patients were allowed full weight bearing on the first postoperative day and ambulation as tolerated. Venous foot compression pumps and aspirin were used immediately after surgery in the totality of subjects. Seventy-five percent of the patients were transferred to an acute rehabilitation service during the first postoperative week. The presence of deep-vein thrombosis was subsequently determined with the routine use of venous duplex scans. RESULTS: Three patients (3%) demonstrated evidence of distal deep-vein thrombosis. No patient had symptomatic pulmonary embolism. CONCLUSION: The combination of epidural anesthesia, aspirin, immediate postoperative venous foot compression pumps, and early ambulation together seem to be a more effective approach to prevent the occurrence of thromboembolic events after knee replacements than pharmacologic prevention alone

Thromboembolism following total hip arthroplasty is a common complication that may result in significant morbidity and mortality. Despite this, optimal prophylactic regimen is controversial. We investigated the efficacy of a comprehensive approach encompassing the use of aspirin, intermittent compression devices ('foot pumps'), and early mobilization in a cohort of 200 consecutive patients after non-cemented total hip replacements. The surgical procedures were carried out under epidural anesthesia in most cases (91%). All patients were allowed full weight bearing and received ambulation training starting on the first post-operative day. Ankle-high pneumatic boots ('foot pumps') and aspirin (325 mg p.o./qd) were used immediately after surgery. The presence of deep vein thrombosis was determined with the routine use of venous duplex scans on post-operative day number 5 to 10 (mean 6.8). The duration of the follow-up was 3 months. No patients were lost to follow-up. Four distal DVT's (2%) were detected in three patients. None of the patients developed symptomatic pulmonary embolism during the follow-up period. There were no major wound complications. Venous thromboembolic disease after hip replacement surgery is largely associated with postoperative immobilization and venous stasis. It is the authors' opinion that a prevention strategy should include mechanical as well as pharmacological measures. The concomitant use of epidural anesthesia, 'foot pumps', aspirin and early full weight bearing ambulation may be effective in further reducing the incidence of DVT after surgery

Over the past several decades numerous researchers have revisited the model of the biomechanics of the hip first predicated by John Koch in 1917. The contributions of Blount (1956), Frankel (1960), Pauwels (1976), Toridis (1969), Rybicki (1972), Fetto (1994, 1995), Ling (1996), and Lu (1997, 1998) among others created a more complete picture. The present article briefly reviews the previous biomechanical concept and its clinical inconsistencies and offers a model that includes the dynamic and static input of the soft tissues. The action of the iliotibial band (ITB) and the vastus lateralis-gluteus medius complex (as static and dynamic tension bands lateral to the femur) counterbalance the varus bending torque of the loads acting on the hip, transforming the tensile stresses in the lateral femur (as hypothesized by Koch) into compressive stresses. The inclusion of the soft tissues, extending the previous model, widens our understanding of the forces acting on the hip. Thus, a variety of clinical observations can be better explained in a comprehensive theoretical framework

Performance-induced pain in musicians can be a debilitating and career-threatening problem. However, solutions such as early intervention and prevention have been shown ro be efficacious. In addition to clinical examinations, an objective measurement of pain while playing would be a valuable assessment tool in monitoring a performer's pain complaint, as subjective observations are more often difficult to obtain and interpret. Computerized infrared imaging (CII) is an objective and noninvasive test that records cutaneous temperature. A close interrelationship between pain fibers and cutaneous temperature exist. To examine the use of CII in evaluating musicians with performance-induced pain, the authors report a case study of professional clarinetist seen with complaints of right sided performance-induced pain. Infrared images obtained before, during, and after playing indicated changes in asymmetry that correlated with his pain complaints. This cases report introduces CII as an effective objective assessment tool for evaluating musicians with performance-induced pain

Reflex sympathetic dystrophy (RSD) or complex regional pain syndrome type 1, is characterized by spontaneous pain or allodynia and hyperalgesia disproportionate to the inciting event, multiperipheral nerve involvement, edema, vasomotor or sudomotor change, and possible loss of function. It has been described in relation to various insults, including a number of infectious and inflammatory conditions. We report a case of a patient who developed RSD 1 week after an exacerbation of hidradenitis suppurativa, a rare chronic inflammatory disease of apocrine sweat glands. The patient responded well to a combination of range-of-motion exercises, thermal modalities, and oral steroids. Hidradenitis suppurativa should be considered when searching for an etiology of new onset RSD