Physical Medicine and Rehabilitation Clinics of North America

Published by WB Saunders
Online ISSN: 1047-9651
Publications
Article
Imaging of the lumbar spine is the most common application of magnetic resonance (MR) imaging in many radiologic practices. MR imaging has replaced computed tomography (CT) and CT myelography as the primary mode of spinal imaging and has relegated myelography to a secondary role in the evaluation of lumbar spinal disorders. At the same time, however, it has become evident that the correlation between gross anatomic findings as depicted on MR images and the clinical signs and symptoms detected by the clinician may be lacking. Defining the precise anatomic source of patients' complaints on the basis of imaging studies must be approached judiciously because a significant proportion of the population has disc disease as depicted on imaging studies, yet many have no clinical findings.
 
Article
Providing rehabilitation services for the person with an amputation has become more difficult in today's health care environment. Amputation rehabilitation calls for specialized, multidisciplinary rehabilitation training. In examining the principles of amputation rehabilitation, one must understand the lessons learned from the Veterans Affairs Amputation System of Care and return to the founding principles of rehabilitation medicine. Persons with amputations must be reevaluated in a tight program of follow-up care.
 
Article
We review in this article the most recent edition of the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides) from a physiatric perspective. Important general changes within the framework from the 4th to the 5th edition are highlighted. Those sections of the AMA Guides most often consulted by physiatrists are examined in critical detail, including sections dealing with the spine, upper and lower extremities, neurologic impairments, and impairments due to pain.
 
Article
Eating and swallowing are complex behaviors involving volitional and reflexive activities of more than 30 nerves and muscles. They have two crucial biologic features: food passage from the oral cavity to stomach and airway protection. The swallowing process is commonly divided into oral, pharyngeal, and esophageal stages, according to the location of the bolus. The movement of the food in the oral cavity and to the oropharynx differs depending on the type of food (eating solid food versus drinking liquid). Dysphagia can result from a wide variety of functional or structural deficits of the oral cavity, pharynx, larynx, or esophagus. The goal of dysphagia rehabilitation is to identify and treat abnormalities of feeding and swallowing while maintaining safe and efficient alimentation and hydration.
 
Article
Dual-energy x-ray absorptiometry (DEXA) is a safe, noninvasive, inexpensive tool for managing patients with neuromuscular diseases. Regional and whole-body DEXA can be used to guide clinical treatments, such as determining body composition to guide nutritional recommendations, as well as to monitor disease progression by assessing regional and whole-body lean tissue mass. DEXA can also be used as an outcome measure for clinical trials.
 
Article
Computer access technology (CAT) allows people who have trouble using a standard computer keyboard, mouse, or monitor to access a computer. CAT is critical for enhancing the educational and vocational opportunities of people with disabilities. Choosing the most appropriate CAT is a collaborative decision-making process involving the consumer, clinician(s), and third party payers. The challenges involved and potential technological solutions are discussed.
 
Article
Children with a diagnosis of cerebral palsy often have significant physical limitations that prevent exploration and full participation in the environment. Assistive technology systems can provide opportunities for children with physical limitations to interact with their world, enabling play, communication, and daily living skills. Efficient access to and control of the technology is critical for successful use; however, establishing consistent access is often difficult because of the nature of the movement patterns exhibited by children with cerebral palsy. This article describes a 3-phase model of evaluation and intervention developed and used by Assistive Technology Services at the Aaron W. Perlman Center, Cincinnati Children's Hospital Medical Center, to establish successful access to technology systems in children with cerebral palsy.
 
Article
The employment statistics for people with disabilities are dismal and particularly low for those with cerebral palsy. As practitioners working with young people who have moderate to severe cognitive and physical challenges, including those with cerebral palsy, the authors assert that there are best practices that make a difference. There are states and programs showing successful outcomes. Those who create partnerships among education, businesses, and rehabilitation agencies are seeing direct positive results in employment outcomes for people with disabilities, as well as cultural and perceptional changes in businesses and people who have hiring capability. This article reviews the relevant literature; conclusions are drawn and recommendations made to improve the employment outcomes for youth with cerebral palsy in their transition to adult life.
 
Article
Acetabular labral tears are a major cause of hip dysfunction in young patients and a primary precursor to hip osteoarthritis. In addition, labral disease more commonly occurs in women and can present with nonspecific symptoms. It is possible to diagnose, quantify, and treat labral tears before the onset of secondary joint deterioration. However, the diagnosis requires a high index of suspicion, special attention to subtle patterns of presentation, and timely consideration for imaging studies. Treatment options are still evolving and include a wide array of nonsurgical and surgical techniques. Treatment should also address secondary dysfunction that can be associated with hip pathology. An initial trial of conservative management is recommended and failure to progress is an indication for surgical consultation.
 
Article
With the growing number of female athletes, an increase is occurring in the number of sports-related injuries, which can cause physical, psychological, academic, and financial suffering. Female athletes are reported to be two to eight times more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Further research on risk factors and preventative strategies for the female ACL is needed, because the cause of the disparity in injury rates remains equivocal and controversial. Individualized treatment for the injured knee is necessary and can include either conservative treatment or reconstructive surgery.
 
Article
The acquired demyelinating neuropathies can be divided into those with an acute onset and course and those with a more chronic course. The acute neuropathies present as Guillain-Barré syndrome and include acute inflammatory demyelinating polyradiculoneuropathy (AIDP), Miller Fisher syndrome, acute motor axonal neuropathy (AMAN), acute motor and sensory axonal neuropathy (AMSAN), and acute pandysautonomia. The chronic neuropathies are collectively known as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and include MADSAM (multifocal acquired demyelinating sensory and motor neuropathy, also know as Lewis-Sumner syndrome) and DADS (distal acquired demyelinating symmetric neuropathy) as variants. The clinical features, pathology, pathogenesis, diagnosis, treatment, rehabilitation, and prognosis of these neuropathies are discussed.
 
Article
The element of time is a crucial factor in the electrodiagnostic presentation of PN. The characteristic changes seen in various neuropathies evolve over time. If testing is performed very early in the course of the disease, abnormalities may not yet be present, in part, because the range of normal values for NCS parameters is broad. In addition, if the process is asymmetric, the affected nerves may not be sampled. Very late in the course of the disease, a multifocal process may appear diffuse and symmetric as the areas of focal involvement coalesce. A primarily, demyelinating process may begin to demonstrate secondary axonal involvement. In very severe neuropathies, it may become difficult to evoke any NCS responses to characterize the neuropathy. It is essential to place the electrodiagnostic findings within the context of the clinical progression to avoid drawing erroneous conclusions. Sometimes, the true nature of the neuropathy is clear only after sequential testing. The etiologic diagnoses of acquired polyneuropathy are vast. A well-crafted electrodiagnostic evaluation can categorize neuropathies into more specific diagnostic groups by identifying the descriptive diagnosis, significantly narrowing the list of possible etiologic diagnoses. Electrodiagnostic testing, which always starts with a pertinent history and physical examination, should always be viewed as a continuation and quantification of the physical examination. Only by knowing the extent and pattern of the clinical involvement is it possible to formulate a thorough electrodiagnostic evaluation. This knowledge is especially important in cases in which the presentation is multifocal, because the neuropathy can be missed entirely if the affected nerves are not evaluated. When evaluating a neuropathy, there are three important questions to answer: (1) Is the process diffuse or multifocal? (2) Is it demyelinating or axonal? (3) Does it predominantly involve the motor or sensory nerves? By assessing the neuropathy along these three axes, the large number of possible etiologic diagnoses becomes much more manageable.
 
Article
For diagnostic evaluation of a neuromuscular disease, the clinician must be able to obtain a relevant patient and family history and perform focused general, musculoskeletal, neurologic, and functional physical examinations to direct further diagnostic evaluations. Laboratory studies for hereditary neuromuscular diseases include the relevant molecular genetic studies. The electromyogram and nerve-conduction studies remain an extension of the physical examination, and help to guide further diagnostic studies such as molecular genetics and muscle and nerve biopsies. All diagnostic information needs are to be interpreted within the context of relevant historical information, family history, physical examination, laboratory data, electrophysiology, pathology, and molecular genetics.
 
Article
The AC joint and its surrounding structures often are the cause of shoulder pain. Trauma can damage the ligaments that stabilize the joint, resulting in AC separation. Types I and II AC separations are treated conservatively, whereas types IV through VI injuries generally are treated surgically. Over the years, there has been controversy regarding the management of type III injuries. At present, there seems to be a trend toward treating type III injuries nonoperatively. The AC joint also is subject to degenerative changes with age, overuse, and prior trauma. Surgical resection of the distal clavicle can be considered for severe cases that do not respond to conservative treatment. Atraumatic osteolysis of the distal clavicle is a condition that has become more predominant as the popularity of weight training has increased. Avoidance of exacerbating activities and exercises generally is sufficient to reduce symptoms. For patients who are unwilling to forego these activities, surgical resection of the clavicle has been shown to have favorable results.
 
Article
Symptoms of multiple sclerosis can create mild to severe changes in a person's abilities to perform activities of daily living. Occupational therapy assessment and treatment of impairments related to movement, sensory-related symptoms, fatigue, and cognitive impairments can have a significant impact on the quality of life of persons with multiple sclerosis.
 
Article
Acupuncture is a growing field of interest to patients, medical students, and physicians. This article outlines the educational efforts and requirements to teach and practice acupuncture in the United States. A rationale for integrating acupuncture into physical medicine and rehabilitation residency programs is included. This article provides a structure for determining the type of education goals and plans most suited to a particular residency.
 
Article
Patients with spinal cord injuries respond well to acupuncture when treated for pain, perhaps in the case of quadriplegia more strongly than usual. Responses to acupuncture can be dramatic and immediate and the complication rate is virtually zero in well-trained hands. The acupuncture program at Lyndhurst Centre is successful because the treatments are performed in the physical therapy department by therapists certified by the Acupuncture Foundation of Canada Institute, under the direction of a physician with acupuncture experience and expertise.
 
Article
Of the multitude of treatment options for the management of neck pain, no obvious single treatment modality has been shown to be most efficacious. As such, the clinician should consider alternative treatment modalities if a modality is engaging, available, financially feasible, potentially efficacious, and is low risk for the patient. As evidence-based medicine for neck pain develops, the clinician is faced with the challenge of which treatments to encourage patients to pursue. Treatment modalities explored in this article, including chiropractic, acupuncture, TENS, massage, yoga, Tai Chi, and Feldenkrais, represent reasonable complementary and alternative medicine methods for patients with neck pain.
 
Article
This article reviews the theories and applications of acupuncture to musculoskeletal pain management. First, Chinese theories of acupuncture are discussed briefly. Next, current understanding of nociception and central pain modulation is discussed in detail,followed by discussion of the physiologic effect of acupuncture analgesia. Other theories of acupuncture analgesia are presented based on neuromodulation of the central nervous system. Finally,the efficacy of acupuncture for many musculoskeletal pain syndromes,including spine-related pain, soft tissue pain, neuropathic pain, arthritis of the knee, and upper extremity tendinitis, is reviewed. The article concludes with a discussion of methodologic issues related to conducting randomized, placebo-controlled trials of acupuncture and goals for future research in this area of pain management.
 
Article
Auricular acupuncture is a treatment system based on normalizing the body's pain and dysfunction through stimulation of points on the ear. Resulting amelioration of pain and illness is believed to be through the reticular formation through the sympathetic and parasympathetic nervous systems. Scalp acupuncture is one of the newest systems of microacupuncture therapy and anesthesia developed in the People's Republic of China; here the needle is inserted and stimulated in the areas directly above the corresponding nerve center. Hand acupuncture is a recently developed type of microreflex system that can be used exclusively or in addition to body acupuncture. Hand acupuncture is indicated to treat all ailments for which acupuncture is traditionally recommended.
 
Article
Burns are ubiquitous injuries in modern society, with virtually all adults having sustained a burn at some point in their lives. The skin is the largest organ of the body, basically functioning to protect self from non-self. Burn injury to the skin is painful, resource-intensive, and often associated with scarring, contracture formation, and long-term disability. Larger burns are associated with morbidity and mortality disproportionate to their initial appearance. Electrical and chemical burns are less common injuries but are often associated with significant morbidity.
 
Article
The National Institutes of Health (NIH) stroke scale is a standardized neurologic examination developed to quantitate the patient's deficits in clinical trials for new stroke therapies. It is used on admission to determine patient eligibility for thrombolytic therapy, throughout the acute hospital stay, and at 3 months to assess neurologic recovery. The NIH stroke scale scores correlates with initial infarct volume, cerebral perfusion, and functional outcome.
 
Article
Occlusion of the vertebrobasilar system is a life-threatening illness with a poor prognosis. The diagnosis should be considered in any patient presenting with coma of unclear origin, or in patients with brainstem findings that defy simple vascular localization. Appropriate diagnostic tests should be obtained urgently so an effective plan of therapy can be implemented. Collective experience using intraarterial thrombolysis for vertebrobasilar occlusion suggests that these agents can be used relatively safely with an acceptable risk of hemorrhage. Mortality can be reduced when recanalization is achieved. The time window for safe and effective treatment is likely longer than that seen for anterior circulation infarcts. In order to better define the risks and outcomes with regard to hemorrhage and recanalization, intraarterial thrombolysis for vertebrobasilar thrombosis needs to be studied in a randomized, controlled fashion.
 
Article
This article provides a description of the clinical infrastructure of a stroke center, including staffing requirements, technical capabilities, and recommended clinical protocols. These recommendations have been developed to assist in establishing new acute stroke centers that can deliver quality care and to aid in evaluating the relative strengths and weaknesses of existing stroke centers.
 
Article
The average length of hospital stay for acute stroke has been declining gradually in the United States. Medical care traditionally given in the acute setting often is continued in a rehabilitation unit or skilled nursing facility. This article outlines the necessary knowledge base for specialists in rehabilitation regarding acute stroke medical care and management.
 
Article
Respiratory disorders are the leading cause of death for persons with both acute and chronic spinal cord injury (SCI), and much of the morbidity and mortality associated with respiratory disorders is related to acute respiratory infections. Pneumonia is the best recognized respiratory infection associated with mortality in this population. Recent evidence supports some management strategies that differ from those recommended for the general population. Upper respiratory tract infections and acute bronchitis may be precipitating factors in the development of pneumonia or ventilatory failure in patients with chronic SCI. This review emphasizes management principles for treatment and prevention of respiratory infections in persons with SCI.
 
Article
The knee is the body part most commonly injured as a consequence of collisions, falls, and overuse occurring from childhood sports. The number of sports-related injuries is increasing because of active participation of children in competitive sports. Children differ from adults in many areas, such as increased rate and ability of healing, higher strength of ligaments compared with growth plates, and continued growth. Growth around the knee can be affected if the growth plates are involved in injuries. This article discusses fractures, anterior and posterior cruciate ligament injuries, and meniscal and patellar conditions.
 
Article
Children with disabilities and chronic conditions are more likely than their healthy peers to be admitted to emergency rooms, to be hospitalized, and to require pediatric intensive care. Although many of these admissions are attributable to disease burden, a significant percentage are unscheduled stays for an acute illness that is directly related to a known condition. Such admissions are foreseeable, and therefore may be avoidable. An understanding of typical patterns of events that lead to acute illness in children with chronic conditions might suggest strategies to prevent these illnesses or to minimize the severity of unpreventable illnesses when they occur. When viewed as a marker for avoidable morbidity, an "unanticipated" hospitalization of a child with a chronic condition or disability thus provides an important opportunity for health care quality improvement at the community level.
 
Article
The authors' two studies using cDNA microarrays to profile the transcriptome pattern in response to endurance and resistance exercise have shed new light on exercise-mediated adaptation in skeletal muscle. Given that the two modes of exercise that the authors used represented the "extremes" of the exercise continuum, most forms of therapeutic exercise likely fall somewhere between them. One potential value of the data would be to provide transcriptome "signatures" that could be used to screen a variety of interventions that may enhance the pattern, including nutritional, pharmacologic, or alternative exercise paradigms. The data also could be used as a standard by which to compare the exercise response from a variety of patient populations to identify which components of the response could be altered by the disease in question. Future work is needed to map out the timeline of the response and to determine whether specific transcriptome patterns lead to idiosyncratic proteomic and phenotypic responses after a period of exercise training.
 
Article
Individuals experience multiple changes as a result of amputation. These changes not only are physical in nature but also may include psychological, financial, and comfort changes across the spectrum of an individual's life. It is important to assess the emotional responses that an individual may experience postsurgery and throughout the rehabilitation process. Grieving is a natural and normal emotional response postamputation. Grief resolution is one of the primary areas of focus in counseling amputees. This article examines various factors and strategies used in the adaptation and recovery from amputation.
 
Article
The purpose of this article is to summarize the main categories of pain-relieving medications. The authors review a number of analgesic preparations and treatments, with special emphasis on advantages, precautions, limitations, and various routes of administration.
 
Article
This article reviews the early influences of Medicare on the delivery of rehabilitation services, and discusses the changes in payment for hospital-based rehabilitation in the 1997 Balanced Budget Act. Among these changes is a prospective payment system for rehabilitation hospitals and units. This article also addresses Health Care Financing Administration's efforts to comply with this portion of the Act. Finally, some of the impacts that might result from these payment policies are discussed.
 
Article
Regardless of what our beliefs about sex and disability may be, as health care providers we can promote the health and well being of our patients with disabilities in several ways. First and perhaps foremost, physical and programmatic barriers to accessing general health care including routine gynecologic care must be dramatically reduced. The promise of Title III of the Americans with Disabilities Act must be aggressively extended to our health care system to ensure equal access to routine health care for all. Second, knowledge of community resources that can support the healthy development and exercise of responsible and satisfying sexuality is critical. For example, health care providers should know about adaptive and assistive technologies as well as the use of personal care assistants to support the healthy although sometimes nontypical expression of one's sexuality. Centers for Independent Living are community resources that are often underutilized by the medical profession. These centers--run by and for people with disabilities--are likely resources and allies for providing education, role models, and peer mentoring around relationships, intimacy, sexuality, sexual expression, and parenting with a disability. Finally, sex education is a must and should include the following: Basic facts of life, reproduction, and sexual intercourse; Human growth and development Human reproduction and anatomy Self-pleasuring/masturbation and the use of sexual aids Intimacy and privacy Pregnancy and child birth Contraception and abortion Family life and parenthood Sexual response and consensual sex Sexual orientation Sexual abuse HIV/AIDS and other sexually transmitted diseases. The question should not be whether sex education is provided to persons with disabilities, but rather how it is most effectively provided. Health sex education must include the development of effective communication skills, decision-making skills, assertiveness, and the ability to say "no." It must also include ways to create satisfying relationships. For more information about sex education as it relates to people with disabilities, the following abbreviated resource list may be helpful: http://www.sexualhealth.com http://www.lookingglass.com Ludwig S, Hingsburger, D. Being sexual: an illustrated series on sexuality and relationships. SIECCAN, 850 Coxwell, Aven., East York, Ontario, M4C 5R1 Tel: 416-466-5304; Fax: 416-778-0785. Sexuality Information and Education Council of the United States (SIECUS), 130 West 42nd Street, Suite 350, New York, NY 10036. Tel: 212-819-9770. National Information Center for Children and Youth with Disabilities (NICHCY), P.O. Box 1492, Washington, DC 20013; Tel/TTY: 800-695-0285; Fax: 202-884-8641; Internet: www.nichcy.org Non-Latex Supplies (Ask your pharmacist if not available) Trojan-Supra: http://www.trojancondoms.com Durex-Avanti: http://www.durex.com Female Health Company-FC Female Condom http://www.femalehealth.com Pasante--EzOn http://www.postalcondoms.co.uk (available in Canada and U.K.).
 
Article
The shoulder and elbow represent two of the most commonly injured joints in the adolescent population. Specific injuries vary by sport and can involve various structures, depending on the mechanism of injury. Unlike the adult shoulder, the immature skeletal structure of the adolescent athlete can lead to several unique injuries. By understanding the special demands placed on the immature shoulder, the sports physician can more effectively treat the resultant injury. This article reviews the diagnosis and management of unique injuries to the shoulder and elbow in the adolescent athlete.
 
Article
With the exception of Rhode Island, all states require high school athletes to undergo a preparticipation examination. These examinations may vary from state to state, however. This article covers the basics of the history, physical examination, special tests, and issues surrounding clearance for various diagnoses.
 
Article
Approximately 2 million sports and recreation concussive injuries occur per year in the United States, which may be an underestimate because of inconsistent data reporting. The field of concussion management has evolved rapidly over the last 10 years, and with these advances comes new understanding of the significant symptomatic and cognitive impairments of concussion. These sequelae are more fully realized and may last longer than previously thought. Data have emerged regarding pathophysiology of concussion, risk factors, outcome, effects of repetitive injury, subtypes of concussive injury, and treatment protocols. This evidence calls for more conservative management of concussion, particularly in younger athletes, and demonstrates the shortcomings of concussion guidelines.
 
Article
Low back pain is a common problem among young athletes. These individuals are at risk for significant structural injuries or nonmechanical problems that can be associated with their symptoms. Any athlete who has severe, persisting, or activity-limiting symptoms must be evaluated thoroughly. Clinicians must have a working knowledge of the developmental issues, injury patterns, and particular conditions that may affect a given athlete and be able to work with patients in addition to families, coaches, trainers, and others involved in the care and training of the injured athlete.
 
Article
A myriad problems in the foot and ankle are specific to child and adolescent athletes. The anatomy of young athletes with respect to the presence of a growth plate makes their injury patterns different from those seen in adults. The main general injury patterns seen in the feet and ankles of children are related to growth and development or occur from overuse syndromes or acute trauma. In this article we outline in an anatomically oriented manner most of the common problems in this population.
 
Article
In the treatment of patients with problematic spasticity, it is important to consider the following steps: 1. Establish the functional impact of the spasticity. 2. Identify the functional goal to be achieved by treatment. 3. Eliminate any remediable spasticity aggravating factors. 4. Evaluate the effects of previous antispasticity treatments. 5. Consider nonpharmacologic and pharmacologic treatments. 6. Initiate therapy with a low dosage, and titrate judiciously. 7. Stop the titration when functional goal is achieved. 8. If goal is not achieved or if side effects are intolerable, consider a second medication.
 
Article
There is now preliminary evidence that with greater life span in individuals with NMDs, complications of obesity and reduced physical activity will gain increasing importance in reducing quality of life. Preventing and treating cardiovascular disease and type 2 diabetes mellitus and their precursor, metabolic syndrome, is even more challenging than in able-bodied individuals. Understanding the physical, emotional, and socioeconomic issues affecting many individuals with NMDs and other physical disabilities is the first step in finding a solution.
 
Article
More individuals with spina bifida are living into adulthood, and unique challenges arise as they age. These patients have multiple organ system involvement in addition to physical impairments, disabilities, cognitive involvement, and psychosocial challenges. There is a growing need for transitional care for adults with spina bifida. This article explores the 5 key elements for a transition program to adult care: preparation, flexible timing, care coordination, transitional clinic visits, and health care providers who are interested in taking care of adults with disabilities. Copyright © 2015 Elsevier Inc. All rights reserved.
 
Article
There are approximately 12,000 new cases of traumatic spinal cord injury (SCI) annually. In 2010, there were approximately 265,000 individuals living with SCI. Over time, the average age of people with SCI has steadily risen, and it is now 40.7 years. There are multiple medical complications that are commonly seen in individuals with SCI. These include, but are not exclusively limited to, pneumonia, decubiti ulcers, undiagnosed fractures, urinary tract infections, autonomic dysreflexia, deep venous thrombosis, and pulmonary embolism. This article addresses the issue of patient safety in the care of adults living with an SCI.
 
Article
This article reviews and summarizes the literature on patient safety issues in the rehabilitation of adults with an amputation. Safety issues in the following areas are discussed; the prosthesis, falls, wound care, pain, and treatment of complex patients. Specific recommendations for further research and implementation strategies to prevent injury and improve safety are also provided. Communication between interdisciplinary team members and patient and caregiver education are crucial to executing a safe treatment plan. The multidisciplinary rehabilitation team members should feel comfortable discussing safety issues with patients and be able to recommend preventive approaches to patients as appropriate.
 
Article
Advances in medical and surgical care over the past 20 years have resulted in children who formerly would have died at birth or in infancy now surviving into adulthood, many with significant, permanent physical disabilities, including those due to cerebral palsy (CP). Increased awareness of these problems is needed by adult health care providers, who will be providing direct care to these individuals, and also by pediatric providers, who may be able to anticipate and prevent some of the long-term problems. This article reviews the common medical-surgical problems and their management in adults with CP. In addition the life experience of a 44 year-old with CP is described from a personal perspective.
 
Article
This article discusses challenges faced by clinicians and researchers when measuring ambulation in individuals with central neurologic disorders within 3 distinct environments: clinical, laboratory, and community. Even the most robust measure of ambulation is affected by the environment in which it is implemented and by the clinical or research question and the specificity of the hypothesis being investigated. The ability to accurately measure ambulation (one of the most important metrics used to show transition into a community environment) is essential to measure treatment effectiveness and rehabilitation outcomes in populations with central neurologic disorders.
 
Article
Parents of children with disabilities encounter stresses unlike those of families with typically developing children. Medical professionals must appreciate that they are not only treating the child but also the family. A state-of-the-art understanding of their patient's disability is implied, but they must also understand the dynamics of raising a child with a disability, appreciate the different models of health care delivery, and provide guidance in transition to adulthood in healthcare as well as life (education, living arrangements, conservancy, etc). An awareness of the physical and mental health impacts on the parents of a child with a chronic disability should also be appreciated. Copyright © 2015 Elsevier Inc. All rights reserved.
 
Top-cited authors
Jeffrey Bruce Palmer
  • Johns Hopkins University
Koichiro Matsuo
  • Matsumoto Dental University
Sheila Dugan
  • Rush University Medical Center
Gregory T Carter
  • St Luke's Rehabilitation Institute
Michael Fredericson
  • Stanford University