Reviewed by: Stephen Halpin, Senior Clinical Research Fellow and Consultant in Rehabilitation Medicine, Academic Department of Rehabilitation Medicine, University of Leeds.
In the best tradition of Oxford Handbooks, this is a small book that packs a heavy punch. This third edition represents a significant expansion in scope and detail compared to the second edition of 2009. With over 650 pages miraculously compressed into less than two and a half centimetres, this edition adeptly fulfils its role in providing for jobbing clinicians a succinct, easily navigable overview of key clinical topics at their fingertips.
The volume is structured in two sections, the first of which ‘Common Clinical Approaches’ provides 25 chapters on cross-cutting areas from Communication, to Chronic Pain, Sexual Function and Mobility and Gait. Section 2 addresses ‘Condition-Specific Approaches’ in 16 chapters including Traumatic Brain Injury, Multiple Sclerosis, Prolonged Disorders of Consciousness and Amputee Rehabilitation. Where there is overlap, this is usefully signposted within the text, directing the reader to other relevant chapters. The text is helpfully presented, easy to scan and interspersed with many useful illustrations and diagrams.
The devotion of two chapters to musculoskeletal conditions, as well as the inclusion of Cancer Rehabilitation and Geriatric Rehabilitation reflects the editors’ timely desire to see the focus of rehabilitation as a medical specialty in the UK broaden to address conditions of greatest population burden. They will also be useful to rehabilitation practitioners in the traditional areas of neurological and spinal cord rehabilitation who find themselves working with increasingly complex conditions and co-morbidities.
Between the second and third editions the title has shifted from Clinical Rehabilitation to Rehabilitation Medicine, which is indicative of a change of emphasis towards greater rigorous pathophysiological detail and is accompanied by an authoritative, brisk editorial style. Medics, from students and junior doctors to specialists in Rehabilitation Medicine (but also Geriatrics, Neurology, Stroke Medicine and beyond) will be the main users of this handbook, but it also has much to offer to the whole multi-professional rehabilitation team.
The chapter authors are largely drawn from the UK and Australia, and sections on models of care and organisation of services reflect those settings. Inevitably, some details have already been superseded by new guidelines, for example that in TIA risk stratification, but in general this edition does an excellent job of succinctly bringing the reader up to date, and signposting further reading.
In its main aim of concisely presenting both the core principles and practical clinical details of Rehabilitation Medicine practice across an expanded scope of conditions, this handbook has certainly succeeded and it will undoubtedly become a familiar sight in MDT rooms and doctors’ offices across the rehabilitation landscape.
Fatigue after traumatic brain injury (TBI) is common, but often overlooked. But for people fighting their fatigue after brain injury day after day, fatigue is a major problem. This post-injury mental fatigue is characterized by limited energy reserves to accomplish ordinary daily activities. Persons who have not experienced this extreme exhaustion which may appear suddenly, and without previous warning during mental activity, do not understand the problem. This is especially difficult to understand as the fatigue may appear even after seemingly trivial mental activities which, for uninjured persons, are regarded as relaxing and pleasant, as reading a book or having a conversation with friends. A normal, well-functioning, brain performs mental activities simultaneously throughout the day, but after a brain injury, it takes greater energy levels to deal with cognitive and emotional situations.
In this chapter, we highlight mental fatigue after TBI. In the case of long-lasting mental fatigue, it could be the only factor that keeps people from returning to the full range of activities that they pursued prior to their injury with work, studies and social activities. We describe mental fatigue and suggest diagnostic criteria and we also give a theoretical explanation for this. At the end of the chapter, we discuss treatment strategies and give some examples of possible therapeutic alternatives which may alleviate the mental fatigue.
Normally, the brain works in an energy-efficient manner and prominent energy reserves are present. This is due to well-functioning ion channel and amino acid transport systems and other effective physiological processes. After brain injury, some of these systems are down-regulated, and when mental energy requirements are high the physiological processes do not function to their full capacity; these cease to function efficiently with a resultant energy loss. This may be an explanation as to why the mental fatigue appears.
1.1. When does mental fatigue occur?
Annually, about 100-300/100 000 individuals sustain a TBI, and most of the injuries are mild in severity . A majority of patients recover within one to three months following mild TBI [2, 3].
Fatigue is one of the most important long-lasting symptoms following TBI, and is most severe immediately after head injury. However it is difficult to arrive at any clear figure as to how common fatigue or, in particular, mental fatigue is. The reason for this is that different results have been obtained, and these are attributable to differences in definitions and differences in the methodology in the various studies. In follow-up studies, the frequency of prolonged fatigue varies from 16 up to 73 % [4–6]. There is no correlation between persistent fatigue and severity of the primary injury, age of the person at injury or time since injury [7, 8]. For those suffering from fatigue 3 months after the accident the fatigue remained relatively stable during longer periods . In particular, for those subjects who were suffering from the syndrome one year after the accident improvement in the fatigue was limited .
In the above reports, fatigue is discussed in terms of a single construct, i.e. not differentiated between the physical or mental aspects. In this chapter, we consider mental fatigue as a separate construct and we discuss its relationship to cognitive and emotional symptoms.
1.2. Mental fatigue is not a separate diagnostic entity
Mental fatigue is not an illness, rather it represents a mental sequel, probably due to a disturbance of higher brain functions, either physical or psychological in origin. It is included in, and defined within the diagnoses Mild cognitive impairment (F06.7), Neurasthenia (F48.0) and Posttraumatic brain syndrome (F07.2) .
1.3. Typical characteristics of mental fatigue
A typical characteristic of pathological mental fatigue after TBI is that the mental exhaustion becomes pronounced during sensory stimulation or when cognitive tasks are performed for extended periods without breaks. There is a drain of mental energy upon mental activity in situations in which there is an invasion of the senses with an overload of impressions, and in noisy and hectic environments. The person feels that their brain is overloaded after a tiny load. Another typical feature is a disproportionally long recovery time needed to restore the mental energy levels after being mentally exhausted. The mental fatigue is also dependent on the total activity level as well as the nature of the demands of daily activities. Fatigue often fluctuates during the day depending on the activities carried out. Thus, this fatigue is a dynamic process with variations in the mental energy level. The fatigue can appear very rapidly and, when it does, it is not possible for the affected person to continue the ongoing activity. Common associated symptoms include: impaired memory and concentration capacity, slowness of thinking, irritability, tearfulness, sound and light sensitivity, sensitivity to stress, sleep problems, lack of initiative and headache .
For many persons, this mental fatigue is the dominating factor which limits the person’s ability to lead a normal life with work and social activities. For most people, fatigue subsides after a period of time while, for others, this pathological fatigue persists for several months or years even after the brain injury has healed. Interestingly, however is that as many as 30% of family or friends interpreted fatigue as laziness .
Theories as to the mechanisms accounting for mental fatigue including our own theory, suggest that cognitive activities require more resources and are more energy-demanding after brain injury than usual [13, 14]. Thus, more extensive neural circuits are used in TBI victims compared to controls during a given mental activity . This indicates an increased cerebral effort after brain injury.
Therapist Luann Jacobs describes mild TBI and the lack of energy and lack of endurance that many can experience. As they are able to do what is normal and what appears normal, they run the risk that their symptoms will be misunderstood .
“Mild brain injury is a real misnomer, as it conveys the idea that nothing much is a problem when quite the opposite is more often true. It is called “mild” because, in fact, the mildly brain injured can walk, talk, eat and dress independently, often times drive a car, shop, cook, go to school, or even work.
What the term fails to account for is the inherent limits of how often, for how long (endurance), and the all-important, how consistently (e.g., every day, once a week) these activities can be performed. Even more elusive is the concept of how many of these daily activities can be done sequentially in a given day as is normal in the lives of people who are not brain injured.
The fatigue they feel defies description, going far beyond and far deeper than anything a non-brain-injured person would consider profound exhaustion.”
Outpatient therapy providers are under tremendous pressure to improve patient outcomes while at the same time lowering the cost of care. Although much of the focus around value-based care has been on driving clinician performance to meet key measures, it is just as crucial to look at ways to improve patient engagement as you evaluate strategies for the future. After all, studies show that engaged patients lead to better overall outcomes.
Patient engagement, however, is also one of the toughest areas to manage. While therapy is a critical component in the healing process, many patients are dealing with an injury or condition that will require weeks, if not months, of therapy. This can impact a patient’s motivation and willingness to follow their treatment through to the end. The important question to ask is “How can I successfully motivate my patients every step of the way?”
Download this free E-book from Net Health to learn four ways that you can motivate patients to stay active in their recovery so you can improve quality, generate better outcomes, AND boost clinic performance.
Many pharmacological treatments were proved effective in the treatment of panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD); still many patients do not achieve remission with these treatments. Neurostimulation techniques have been studied as promising alternatives or augmentation treatments to pharmacological and psychological therapies. The most studied neurostimulation method for anxiety disorders, PTSD, and OCD was repetitive transcranial magnetic stimulation (rTMS). This neurostimulation technique had the highest level of evidence for GAD. There were also randomized sham-controlled trials indicating that rTMS may be effective in the treatment of PTSD and OCD, but there were conflicting findings regarding these two disorders. There is indication that rTMS may be effective in the treatment of panic disorder, but the level of evidence is low. Deep brain stimulation (DBS) was most studied for treatment of OCD, but the randomized sham-controlled trials had mixed findings. Preliminary findings indicate that DBS could be affective for PTSD. There is weak evidence indicating that electroconvulsive therapy, transcranial direct current stimulation, vagus nerve stimulation, and trigeminal nerve stimulation could be effective in the treatment of anxiety disorders, PTSD, and OCD. Regarding these disorders, there is no support in the current literature for the use of neurostimulation in clinical practice. Large high-quality studies are warranted.
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Elsevier Health Sciences, Apr 14, 2011 – Medical – 318 pages
Learning Radiology: Recognizing the Basics, 2nd Edition, is an image-filled, practical, and clinical introduction to this integral part of the diagnostic process. William Herring, MD, a skilled radiology teacher, masterfully covers everything you need to know to effectively interpret medical images. Learn the latest on ultrasound, MRI, CT, and more, in a time-friendly format with brief, bulleted text and abundant high-quality images. Then ensure your mastery of the material with additional online content, bonus images, and self-assessment exercises at http://www.studentconsult.com.
Identify a wide range of common and uncommon conditions based upon their imaging findings.Quickly grasp the fundamentals you need to know through easy-access bulleted text and more than 700 images.
Arrive at diagnoses by following a pattern recognition approach, and logically overcome difficult diagnostic challenges with the aid of decision trees.
This book is the first comprehensive, authoritative reference that provides a broad and comprehensive overview of Enhanced Recovery After Surgery (ERAS). Written by experts in the field, chapters analyze elements of care that are both generic and specific to various surgeries. It covers the patient journey through such a program, commencing with optimization of the patient’s condition, patient education, and conditioning of their expectations.
Organized into nine parts, this book discusses metabolic responses to surgery, anaesthetic contributions, and optimal fluid management after surgery. Chapters are supplemented with examples of ERAS pathways and practical tips on post-operative pain control, feeding, mobilization, and criteria for discharge.
Enhanced Recovery After Surgery: A Complete Guide to Optimizing Outcomes is an indispensable manual that thoroughly explores common post-operative barriers and challenges.
Each year, 795,000 stroke patients suffer a new or recurrent stroke and 235,000 severe traumatic brain injuries (TBIs) occur in the US. These patients are susceptible to a combination of significant motor, sensory, and cognitive deficits, and it becomes difficult or impossible for them to perform activities of daily living due to residual functional impairments. Recently, sensorimotor rhythm (SMR)-based brain–computer interface (BCI)-controlled functional electrical stimulation (FES) has been studied for restoration and rehabilitation of motor deficits. To provide future neuroergonomists with the limitations of current BCI-controlled FES research, this chapter presents the state-of-the-art SMR-based BCI-controlled FES technologies, such as current motor imagery (MI) training procedures and guidelines, an EEG-channel montage used to decode MI features, and brain features evoked by MI.
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Rehabilitation is a process of recovery of an individual from disabling or functionally limiting condition, whether temporary or irreversible, participates to regain maximal function, independence, and restoration . The purpose of rehabilitation is to prevent and slow down the loss of function of the body, improve and restore the function, compensation for the lost function, and maintenance of the current function.
Hemiparesis is a symptom of residual weakness in half of the body, including the upper extremity, which affects the majority of post stroke survivors. Upper limb function is essential for daily life and reduction in movements can lead to tremendous decline in quality of life and independence. Current treatments, such as physiotherapy, aim to improve motor functions, however due to increasing NHS pressure, growing recognition on mental health, and close scrutiny on disease spending there is an urgent need for new approaches to be developed rapidly and sufficient resources devoted to stroke disease. Fortunately, a range of digital technologies has led to revived rehabilitation techniques in captivating and stimulating environments. To gain further insight, a meta-analysis literature search was carried out using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) method. Articles were categorized and pooled into the following groups; pro/anti/neutral for the use of digital technology. Additionally, most literature is rationalised by quantitative and qualitative findings. Findings displayed, the majority of the inclusive literature is supportive of the use of digital technologies in the rehabilitation of upper extremity following stroke. Overall, the review highlights a wide understanding and promise directed into introducing devices into a clinical setting. Analysis of all four categories; (1) Digital Technology, (2) Virtual Reality, (3) Robotics and (4) Leap Motion displayed varying qualities both—pro and negative across each device. Prevailing developments on use of these technologies highlights an evolutionary and revolutionary step into utilizing digital technologies for rehabilitation purposes due to the vast functional gains and engagement levels experienced by patients. The influx of more commercialised and accessible devices could alter stroke recovery further with initial recommendations for combination therapy utilizing conventional and digital resources.
Academic Press, Oct 19, 2019 – Science – 286 pages
Intelligent Biomechatronics in Neurorehabilitation presents global research and advancements in intelligent biomechatronics and its applications in neurorehabilitation. The book covers our current understanding of coding mechanisms in the nervous system, from the cellular level, to the system level in the design of biological and robotic interfaces. Developed biomechatronic systems are introduced as successful examples to illustrate the fundamental engineering principles in the design. The third part of the book covers the clinical performance of biomechatronic systems in trial studies. Finally, the book introduces achievements in the field and discusses commercialization and clinical challenges.
As the aging population continues to grow, healthcare providers are faced with the challenge of developing long-term rehabilitation for neurological disorders, such as stroke, Alzheimer’s and Parkinson’s diseases. Intelligent biomechatronics provide a seamless interface and real-time interactions with a biological system and the external environment, making them key to automation services.
Written by international experts in the rehabilitation and bioinstrumentation industries
Covers the current understanding of nervous system coding mechanisms, which are the basis for biological and robotic interfaces
Demonstrates and discusses robotic rehabilitation effectiveness and automatic evaluation