Biomedical subjects

Michelle Stern

Publications and source records attributed to Michelle Stern.

5 recordsLinked to original sources

PubMed2006

Neurogenic bowel and bladder in the older adult.

Special skills are needed in caring for an elderly patient with a neurogenic bowel and bladder. One not only has to take into account the age-related changes that occur, but also how these changes impact on a patient already struggling with bowel and bladder issues because of various neurogenic causes. Incontinence of bowel and bladder leads to a loss of quality of life and physicians should be educated on the treatment available to provide the best care for their patients.

Aged↗

PubMed2006

Post-anoxic myoclonus: a case presentation and review of management in the rehabilitation setting.

Post-anoxic myoclonus is a rare movement disorder manifested by diffuse action-triggered jerking movements that may result in significant disability. The incidence of this disorder is not clearly established, but over 122 cases have so far been reported in the literature. The pathogenesis is not entirely known, although it has been hypothesized that particular susceptibility of the Purkinje cells of cerebellum to anoxic injury may play a key role. A case is presented of an independently living 60-year-old woman admitted to the rehabilitation unit with diffuse myoclonus after sustaining a cardio-pulmonary arrest. She presented with severe jerking movements in all extremities with startle to noise and exacerbations upon attempting any purposeful actions. The patient's myoclonus was controlled by a variety of anti-epileptic medications. The patient initially responded to a combination of divalproex sodium and zonisamide, but relapsed in several weeks, requiring addition of levetriacetam and clonazepam. At a 1-year follow-up she demonstrated a significant improvement in ambulation and self-care activities. This case illustrates that, although patients with post-anoxic myoclonus cannot be fully cured, their quality of life can be significantly improved by rehabilitation interventions.

Anticonvulsants↗

PubMed2006

Rehabilitation implications of non-traumatic subarachnoid haemorrhage.

OBJECTIVE: Subarachnoid haemorrhage (SAH) remains an important cause of stroke in the rehabilitation population, whose incidence has not been changed by pre-morbid medical treatment. The understanding of the pathophysiological changes that occur after SAH has been more clearly defined, therefore the treatment and outcomes of these patients have undergone drastic changes over the past few years. The purpose of this review is to update and familiarize the rehabilitation professional on the state of the art treatment and common complications associated with this disease and how this may affect the rehabilitation programme. Also, the current literature on the outcomes of these patients will be reviewed to help advise the rehabilitation professional on potential predictors. DATA SOURCES: Literature review. STUDY SELECTION: Articles of relevance to the current management of SAH. DATA EXTRACTION: Information that was deemed significant in the understanding of the pathophysiology, treatment and results of outcomes in patients with SAH. DATA SYNTHESIS: Subarachnoid haemorrhage (SAH) is the one sub-type of stroke whose incidence has not declined. Due to advances in medical care, mortality rate is on the decline. Outcomes data was analysed to look for common predictors for this patient population. CONCLUSIONS: While the incidence of SAH has not declined, improving medical treatment has reduced mortality. The rehabilitation professional should be familiar with the latest advances, potential complications and likely outcomes in order to plan the most appropriate therapy course for these patients.

Humans↗

PubMed2005

Aging with multiple sclerosis.

The chronic and progressive nature of MS may be overwhelming to the patient and the family. It is vital for the clinician to develop a system of periodic evaluations and interventions that monitor the disease and address the effects on the patient's physical, psychologic, social, and vocational functioning. MS patients are susceptible to other diseases of aging, such as stroke, cancer, heart disease, and diabetes, and need to be evaluated and treated for these conditions. Obtaining appropriate routine medical care may become difficult in less mobile patients because many clinicians' offices are unable to accommodate handicapped patients. Careful coordination and referral to handicap-accessible centers may be required to ensure adequate treatment. Nearly half of MS patients die from complications of their disease. Other major causes of mortality are malignancy (16%), suicide (15%), and myocardial infarction (11%). Age-appropriate cancer screenings and cardiac evaluation are necessary. Depression is an important factor in geriatric MS patients despite the fact that most MS patients have an easier time adjusting to the aging process than the general population. There are many unanswered questions for the older MS population due to the paucity of research, but future studies may rectify this situation. Although there is no cure for MS, the clinician can play a key role in helping the patient and family adapt to the illness and improve their quality of life. Resources are available for the clinician, the patient, and family members.

Aging↗

PubMed2004

Symptomatic thoracic vertebral hemangioma: a case report and literature review.

Vertebral hemangiomas are relatively common, but those causing spinal cord compression are rare. A man in his early sixties with back pain that had not resolved with conservative treatment was seen in an outpatient physiatrist office. Subsequent workup with computed tomography scan showed a large hemangioma in the T5 vertebra extending to the posterior elements where his pain was located. Three weeks later, the patient had progressive weakness and numbness in his lower extremity. He subsequently underwent a T3-5 laminectomy, with a subtotal resection of the mass. He reported improvement in lower-extremity strength and sensation and completed a course of inpatient rehabilitation. Recognizing when to expect neurologic symptoms and the proper time to intervene can be very critical. From this case study and other similar instances, one can conclude that vertebral hemangiomas are not always benign and are capable of causing cord compression. Proper diagnosis and treatment may prevent the development of neurologic symptoms.

Back Pain↗