Abstract：
:This essay complements the scientific and practice scope of the American Academy of Neurology Guideline on Disorders of Consciousness by providing a discussion of the ethical, palliative, and policy aspects of the management of this group of patients. We endorse the renaming of "permanent" vegetative state to "chronic" vegetative state given the increased frequency of reports of late improvements but suggest that further refinement of this class of patients is necessary to distinguish late recoveries from patients who were misdiagnosed or in cognitive-motor dissociation. Additional nosologic clarity and prognostic refinement is necessary to preclude overestimation of low probability events. We argue that the new descriptor "unaware wakefulness syndrome" is no clearer than "vegetative state" in expressing the mismatch between apparent behavioral unawareness when patients have covert consciousness or cognitive motor dissociation. We advocate routine universal pain precautions as an important element of neuropalliative care for these patients given the risk of covert consciousness. In medical decision-making, we endorse the use of advance directives and the importance of clear and understandable communication with surrogates. We show the value of incorporating a learning health care system so as to promote therapeutic innovation. We support the Guideline's high standard for rehabilitation for these patients but note that those systems of care are neither widely available nor affordable. Finally, we applaud the Guideline authors for this outstanding exemplar of engaged scholarship in the service of a frequently neglected group of brain-injured patients.
journal_name
Arch Phys Med Rehabiljournal_title
Archives of physical medicine and rehabilitationauthors
Fins JJ,Bernat JLdoi
10.1016/j.apmr.2018.07.003subject
Has Abstractpub_date
2018-09-01 00:00:00pages
1927-1931issue
9eissn
0003-9993issn
1532-821Xpii
S0003-9993(18)30460-Xjournal_volume
99pub_type
杂志文章abstract：:Graft-versus-host disease (GVHD) is a multisystemic disorder that affects 30%-80% of patients who undergo allogeneic hematopoietic stem cell transplantation 10%-15% of GVHD patients develop sclerotic features affecting the skin or deeper tissues, leading to functional limitations and poor quality of life. There is lim...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/j.apmr.2020.10.141
更新日期：2020-12-23 00:00:00
abstract：OBJECTIVE:To assess the long-term efficacy of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients. DESIGN:Intervention study (before-after trial) with an observational design and 2-year follow-up. SETTING:Spasticity group in a university hospital. PARTICIPANTS:Hemiplegic pa...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 临床试验,杂志文章
doi：10.1016/j.apmr.2010.04.010
更新日期：2010-07-01 00:00:00
abstract：OBJECTIVE:To develop a procedure that adjusts scoring of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) for the items related to spinal cord injury (SCI) that skew interpretations with this population, and to assess the accuracy of interpretations resulting from this procedure, standard MMPI-2 scoring, and ...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1053/apmr.2000.6287
更新日期：2000-09-01 00:00:00
abstract：OBJECTIVE:Although fatigue is a common debilitating complaint in multiple sclerosis (MS), its relationship to the cardiopulmonary exercise response has yet to be defined. DESIGN:A patient with MS manifested primarily by profound fatigue undergoes complete pulmonary function testing and a maximal incremental cycle ergo...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/s0003-9993(95)80515-x
更新日期：1995-06-01 00:00:00
abstract：OBJECTIVE:To investigate changes in axonal flow after nerve root compression by using immunohistochemical techniques to detect calcitonin gene-related peptide (CGRP), which is thought to be involved in pain sensation. DESIGN:Experimental, controlled study. SETTING:University medical school in Japan. ANIMALS:Forty ad...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/j.apmr.2004.03.037
更新日期：2005-03-01 00:00:00
abstract：:Herniated thoracic disc after minor trauma, causing paraparesis in an 11-year-old boy, proved difficult to diagnose. Myelogram and computer tomography of the thoracic spine appeared normal, but magnetic resonance imaging demonstrated a small herniation at T4-T5. Disc material adherent to the dura was found at laminect...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：
更新日期：1987-11-01 00:00:00
abstract：:Previous reports of catecholamine metabolism in spinal cord injury (SCI) have found elevated levels of urinary norepinephrine metabolites. These data have been cited as evidence of a sustained increase in peripheral norepinephrine activity in this population. A study was designed to test this hypothesis and to control...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：
更新日期：1982-09-01 00:00:00
abstract：OBJECTIVE:To determine which variables influence the receipt of physical rehabilitation services (ie, physical, occupational, speech therapy) for a population of people with chronic and disabling conditions. DESIGN:A convenience sample of 502 adults with cerebral palsy (CP), multiple sclerosis (MS), and spinal cord in...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/j.apmr.2007.08.122
更新日期：2008-01-01 00:00:00
abstract：:Based on the author's experience with more than 20 cases of immobilization hypercalcemia following spinal cord injury, current concepts of this condition are presented. Symptoms may be mild or severe: laboratory findings are essential for differential diagnosis in older individuals, in whom preinjury Paget's disease a...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：
更新日期：1986-01-01 00:00:00
abstract：:Limited guidelines exist for rehabilitation programs for individuals with diabetes mellitus, blindness, and associated autonomic neuropathy. Abnormalities in autonomic function have been postulated to interfere with exercise conditioning and may predispose individuals to exercise-induced hypoglycemia. Twenty-nine indi...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：
更新日期：1989-08-01 00:00:00
abstract：OBJECTIVES:Our primary objective was to test the hypothesis that a highly structured training method for wheelchair curb-climbing requires less training time than conventional training. Our secondary objectives were to test the hypotheses that this training method increases success rate, reduces the need for spotter in...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.apmr.2008.04.028
更新日期：2008-12-01 00:00:00
abstract：OBJECTIVES:To describe the prevalence of amputation-related pain; to ascertain the intensity and affective quality of phantom pain, residual limb pain, back pain, and nonamputated limb pain; and to identify the role that demographics, amputation-related factors, and depressed mood may contribute to the experience of pa...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/j.apmr.2005.03.031
更新日期：2005-10-01 00:00:00
abstract：OBJECTIVE:To determine whether dextrose prolotherapy offers clinical benefits in patients with shoulder pain and bursitis. DESIGN:Double-blinded, randomized controlled trial. SETTING:Outpatient rehabilitation department of a single medical center. PARTICIPANTS:Patients (N=50) who had received a diagnosis of shoulder...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/j.apmr.2020.08.010
更新日期：2021-02-01 00:00:00
abstract：OBJECTIVE:To investigate the course of mechanical efficiency of handrim wheelchair propulsion during rehabilitation of subjects with (in)complete paraplegia and tetraplegia. DESIGN:Subjects were tested at the start of active rehabilitation (t1), 3 months later (t2), and when discharged from inpatient rehabilitation (t...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章,多中心研究
doi：10.1016/j.apmr.2004.11.025
更新日期：2005-07-01 00:00:00
abstract：:A semi-flexible socket fitted to a series of 47 consecutive below-knee amputees is evaluated, and the problems in assessing prosthetic components and appropriate methodology are discussed. The results suggest that this type of socket deserves wider use and further evaluation in active amputees, where comfort, perspira...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：
更新日期：1975-09-01 00:00:00
abstract：:Knowledge of upper limb activity in the natural environment is critical for evaluating the effectiveness of rehabilitation services. Wearable sensors allow efficient collection of these data and have the potential to be less burdensome than self-report measures of activity. Sensors can capture many different variables...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/j.apmr.2019.01.004
更新日期：2019-06-01 00:00:00
abstract：OBJECTIVES:To review the experimental evidence and development of concepts in knee kinematics and to present a synthesis of current theories. DATA SOURCES:Historical literature from private collections and published journals, from Galen in 160 AD, and Weber and Weber in 1860, through to current research in knee kinema...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章,评审
doi：10.1016/s0003-9993(03)00281-8
更新日期：2003-12-01 00:00:00
abstract：OBJECTIVES:To compare the measurement properties and responsiveness to change of the Patient Health Questionnaire-9 (PHQ-9), the Hopkins Symptom Checklist-20 (HSCL-20), and the Hamilton Depression Rating Scale (HAM-D) in people with spinal cord injury (SCI) diagnosed with major depressive disorder (MDD). DESIGN:Second...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章,多中心研究,随机对照试验
doi：10.1016/j.apmr.2016.01.017
更新日期：2016-06-01 00:00:00
abstract：OBJECTIVE:This study was performed to compare the effects of a vapocoolant spray and a eutectic mixture of local anesthetics (EMLA) cream on reducing pain during intra-articular (IA) injection of the shoulder. DESIGN:Double-blind randomized placebo-controlled clinical trial. SETTING:University hospital. PARTICIPANTS...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.apmr.2020.04.021
更新日期：2020-10-01 00:00:00
abstract：OBJECTIVE:To investigate risk factors associated with subjective complaints of dizziness in 12 elderly patients with Parkinson disease (PD), in whom no obvious cause for this symptom could be found. DESIGN:A case-controlled study, with patients prospectively recruited in a nonblinded fashion. SETTING:Patients were se...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/s0003-9993(96)90013-1
更新日期：1996-07-01 00:00:00
abstract：OBJECTIVE:To examine the validity of the assertion that men and women do not differ significantly on the Assessment of Motor and Process Skills (AMPS), a functional assessment tool used to evaluate the interaction between component motor and process skills and IADL (instrumental or domestic activities of daily living) ...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/s0003-9993(96)90062-3
更新日期：1996-10-01 00:00:00
abstract：OBJECTIVE:To determine the most reliable method to measure the length of the radial nerve during a nerve conduction study (NCS). DESIGN:Cadaveric investigation. SETTING:A practical anatomy research laboratory in a university. PARTICIPANTS:Fresh cadavers (N=10), with 1 cadaver for study design and 9 for data. INTERV...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/j.apmr.2016.08.464
更新日期：2017-03-01 00:00:00
abstract：:This double-blind study of the effects of diazepam on painful cervical muscle spasms compared with those of phenobarbital and an inert placebo employed clinical, electrogoniometric and electromyographic recording methods for evaluation and computer analysis. The clinical results were equivocal but the technological re...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 临床试验,杂志文章
doi：
更新日期：1983-03-01 00:00:00
abstract：OBJECTIVE:To evaluate the effect of 4 weeks of pulmonary rehabilitation (PR) versus chest physical therapy (CPT) on the preoperative functional capacity and postoperative respiratory morbidity of patients undergoing lung cancer resection. DESIGN:Randomized single-blinded study. SETTING:A teaching hospital. PARTICIPA...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.apmr.2012.08.206
更新日期：2013-01-01 00:00:00
abstract：OBJECTIVES:To confirm and extend previous results involving repetitive transcranial magnetic stimulation (rTMS) aimed at alleviating refractory central neuropathic pain (CNP). To evaluate pain relief in detail and to assess ongoing benefits after one year of treatment. DESIGN:Prospective observational study. SETTING:...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/j.apmr.2018.04.013
更新日期：2018-11-01 00:00:00
abstract：OBJECTIVE:To conduct an in-depth examination of the environmental and behavioral circumstances associated with falls and near-falls experienced by elderly individuals and to evaluate the usefulness of reenactment as a method for studying falls. DESIGN:Observational and self-report data of incidents were obtained throu...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：10.1016/s0003-9993(97)90261-6
更新日期：1997-02-01 00:00:00
abstract：:This was an exploratory study in the social-leisure activity levels of married and single individuals after stroke. A 60-item behavioral frequency scale was administered to 42 married and 31 single subjects. Single persons showed higher levels of participation in performing personal care, home management and social in...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：
更新日期：1982-07-01 00:00:00
abstract：:A study is presented of a biomechanical comparison of two different aided gait patterns used by rheumatoid arthritis patients after knee joint surgery. Subjects using alternating and step-to gait patterns were compared when ambulating with forearm-support crutches. Data were collected via instrumented walking aids and...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：
更新日期：1990-04-01 00:00:00
abstract：:The purpose of this study was to assess the rate of self-reported substance use, consequent problems, perceived need for treatment, and receipt of treatment by persons with long-term spinal cord injury (SCI). Information was obtained from 86 persons with traumatic SCI who were between 13 and 58 years of age at injury,...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：
更新日期：1991-06-01 00:00:00
abstract：:To determine if reproducible and reliable measurements of intra-articular temperature could be performed in an animal model, surface and intra-articular measurements were studied in 30 rabbits. Anterior insertion of a thermometer probe into the joint cavity was found to be a reliable method for measuring intra-articul...
journal_title：Archives of physical medicine and rehabilitation
pub_type： 杂志文章
doi：
更新日期：1983-03-01 00:00:00
