Begell House Inc.
Critical Reviews™ in Physical and Rehabilitation Medicine
CRP
0896-2960
11
2
1999
Recovery from Stroke
36
10.1615/CritRevPhysRehabilMed.v11.i2.10
Shigeru
Sonoda
Keio University Tsukigase Rehabilitation Center, 380-2, Tsukigase, Amagiyugashimacho, Tagatagun, Shizuoka-ken 410-3293 Japan
Recovery in stroke is reviewed. Motor recovery occurs mainly within 6 months after onset of stroke. However, improvement may occur even after 12 months from onset in patients who are severely paralyzed but retain some ability for movement. Rehabilitation, such as repetitive training or biofeedback, significantly enhances recovery; however, the effect of neurodevelopmental exercise is still controversial. Neurotrophic factors that prevent or slow the death of neurons have been induced by exercise and further developments are expected in this field. Mechanism of recovery consists of recovery of the damaged cells themselves, substitution, reorganization of the cerebral cortex, or utilization of another pathway, such as the ipsilateral route. The first trials to predict prognosis of stroke were made many years ago, and new trials are still being undertaken because no reliable prediction method has been developed. Although correlation coefficients, regression analysis, neural network, tree analysis, or Rasch conversion have been employed, there are as yet no satisfactory equations. Predictive equations formulated using one group of patients should be applied to other patients to evaluate their accuracy. Neurophysiological parameters, such as central motor conduction time or extent of Wallerian degeneration, are expected to be effective for prediction of recovery from stroke.
Persistent Postnatal Perineal Pain and Dyspareunia: A Review of Physical Pathology and Treatment
28
10.1615/CritRevPhysRehabilMed.v11.i2.20
E. J. C.
Hay-Smith
School of Physiotherapy, Division of Health Sciences, University of Otago, P. 0. Box 56, Dunedin, New Zealand
C. M. A.
Glazener
Health Service Research Unit, University of Aberdeen, Poiwarth Building, Medical School, Foresterhill, Aberdeen, AB25 2ZD, Scotland
Postnatal perineal pain and dyspareunia are common. For many women the problem will resolve spontaneously within 3 months of delivery. However, a small but significant minority develops persistent perineal pain and/or dyspareunia, and this has considerable impact on the sexual function of women and their partners. Some women may be more at risk of postnatal dyspareunia (e.g., primiparae, or after assisted vaginal delivery). Less than half with the problem are likely to actively seek treatment from, or be offered treatment by, a health care professional. Those in regular contact with postnatal women should consider taking a proactive role in identifying women with a range of postnatal morbidities, including persistent perineal pain and dyspareunia. There is very little literature outlining the assessment and management of dyspareunia in the postnatal population. Physiotherapists potentially have skills appropriate to the assessment and management of postnatal dyspareunia, particularly where the primary problem appears to be pain originating from scar tissue, but there is insufficient evidence available at present to support or dismiss this contention. In view of the lack of research currently available, it is not possible to make evidence-based recommendations for practice. Essentially, there is considerable need for further research in all aspects of postnatal dyspareunia.
Optimizing Outcome in the Injured Worker with Low Back Pain
32
10.1615/CritRevPhysRehabilMed.v11.i2.30
Scott F.
Nadler
Physical Medicine and Rehabilitation, University Rehabilitation Associates, 90 Bergen Street, Suite 3100, Newark, New Jersey 07103
Todd P.
Stitik
Physical Medicine and Rehabilitation, University Rehabilitation Associates, 90 Bergen Street, Suite 3100, Newark, New Jersey 07103
Gerard A.
Malanga
UMDNJ — Medical School, Kessler Institute for Rehabilitation, Pleasant Valley Way, West Orange, New Jersey 07052
Low back pain (LBP) is one of the most common musculoskeletal conditions in the general population. As opposed to injuries with specific, defined pathology, LBP is often incompletely delineated secondary to the complexity and number of structures involved. Consequently, the cost of managing this condition and others has led to the current status of health care in the U.S. Physicians involved in the care of the injured worker face significant challenges in the course of providing successful treatment. Most importantly, physicians must understand the complexity of the workers compensation system, including the roles of the injured worker, employer, case manager, and attorney. Communication and appropriate documentation will improve the management of injured workers, especially in the managed care setting. In addition, taking a sports medicine approach with prompt evaluation and initiation of treatment, active as opposed to passive rehabilitation and early return to work will be essential to successful treatment. Ultimately, the goal of treatment is to improve function with complete eradication of pain important, but not to be emphasized in the program. Following these principles will assist the physician in obtaining a good functional outcome in the injured worker.