RESUMEN
BACKGROUND: Heterotopic ossification (HO) is a frequent complication after traumatic brain injury (TBI). The current preliminary study is intended to provide additional data on the potential roles that brain injury severity, concomitant orthopaedic trauma, and specific intensive care complicating events may play in the prediction of HO in patients who have sustained severe TBI. METHODS: A prospective cohort study in patients with severe TBI. RESULTS: Ninety-seven of the 176 patients were eligible for follow-up; 13 patients (13%) developed 19 clinically relevant HOs at 1 or more sites. Univariate analysis indicated that patients with HO remained in coma longer (P < .001) and were ventilated during a longer period (P = .002). Autonomic dysregulation (relative risk = 6.11, 95% confidence interval: 2.53-14.76) and surgically treated extremity fractures (relative risk = 5.02, 95% confidence interval: 1.68-15.04) also showed significant associations with the development of HO. CONCLUSION: Prolonged coma duration and mechanical ventilation, coexistent surgically treated bone fractures and clinical signs of autonomic dysregulation should be given further consideration as potential risk factors for developing clinically relevant HO. Larger-scale studies are needed to develop a valid risk profile that takes into account the interrelationships between variables.
Asunto(s)
Lesiones Encefálicas/complicaciones , Osificación Heterotópica/etiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Índices de Gravedad del TraumaRESUMEN
PURPOSE: To assess the effectiveness of a residential community reintegration programme for participants with chronic sequelae of severe acquired brain injury that hamper community functioning. DESIGN: Prospective cohort study. SUBJECTS: Twenty-four participants with acquired brain injury (traumatic n = 18; stroke n = 3, tumour n = 2, encephalitis n = 1). Participants had impaired illness awareness, alcohol and drug problems and/or behavioural problems. INTERVENTION: A skills-oriented programme with modules related to independent living, work, social and emotional well-being. METHODS: The Community Integration Questionnaire, CES-Depression, EuroQOL, Employability Rating Scale, living situation and work status were scored at the start (T0), end of treatment (T1) and 1-year follow-up (T2). RESULTS: Significant effects on the majority of outcome measures were present at T1. Employability significantly improved at T2 and living independently rose from 42% to over 70%. Participants working increased from 38% to 58% and the hours of work per week increased from 8 to 15. CONCLUSION: The Brain Integration Programme led to a sustained reduction in experienced problems and improved community integration. It is concluded that even participants with complex problems due to severe brain injury who got stuck in life could improve their social participation and emotional well-being through a residential community reintegration programme.
Asunto(s)
Lesiones Encefálicas/rehabilitación , Servicios de Salud Comunitaria/organización & administración , Evaluación de Programas y Proyectos de Salud , Ajuste Social , Adolescente , Adulto , Lesiones Encefálicas/psicología , Enfermedad Crónica , Empleo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Calidad de VidaRESUMEN
This case report presents a 51 year old female patient who had a train accident in 1999. She suffered bilateral trans-tibial and bilateral trans-radial amputations. In this paper, the evolution of the right transradial amputation where eventually a Krukenberg procedure was performed, is described as is its good functional outcome after rehabilitation treatment. After this first procedure the patient also asked for the Krukenberg procedure for her left arm.
Asunto(s)
Muñones de Amputación/cirugía , Amputados/rehabilitación , Colgajos Quirúrgicos , Actividades Cotidianas , Muñones de Amputación/patología , Amputación Traumática , Traumatismos del Brazo/cirugía , Miembros Artificiales , Atrofia , Femenino , Fuerza de la Mano , Humanos , Hipertrofia , Pierna , Persona de Mediana Edad , Traumatismo Múltiple/cirugía , Músculo Esquelético/patología , Recuperación de la Función , Tendones/trasplanteRESUMEN
Ten years after the ISPO consensus conference on amputation surgery, a search of relevant publications in the Rehabilitation-prosthetics-literature over the years 1990-2000 was performed. The main key-words in this research were: "lower limb, amputation, human and rehabilitation". One hundred and four (104) articles were assessed by reading and from these the authors selected 24 articles. These articles are summarised, under several subheadings in this review article, focussing especially on quality of life, functional outcome and predictive factors.
Asunto(s)
Amputación Quirúrgica/rehabilitación , Miembros Artificiales , Actividades Cotidianas , Anciano , Amputación Quirúrgica/métodos , Femenino , Humanos , Pierna , Masculino , Persona de Mediana Edad , Pronóstico , Ajuste de PrótesisRESUMEN
Two patients are described who developed heterotopic ossification after a minor trauma. The clinical symptoms, pathophysiology and treatment are discussed. We conclude that disabilities and handicaps will be limited by rehabilitation, which includes training of still available functions, and compensation for the lost functions by offering adaptive equipment and adjusting the circumstances. The treatment of patients with heterotopic ossification requires a multidisciplinary approach.