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Unlu Akyuz E, Cankurtaran D, Tezel N. The patients with intrathecal baclofen pump in the age of COVID-19: a single center study. Int J Neurosci 2023:1-7. [PMID: 37855598 DOI: 10.1080/00207454.2023.2273769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/17/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE Intrathecal baclofen pump treatment is employed in the treatment of various diseases. Despite the benefits of intrathecal baclofen pump, patients may occasionally encounter severe complications. These complications may necessitate urgent assessment or intervention for patients with intrathecal baclofen pumps. This study aimed to evaluate the intrathecal baclofen pump-related problems, the utilization of health services, physical-psychosocial status, and the quality of life of patients with intrathecal baclofen pumps during the coronavirus disease 2019 pandemic. MATERIALS AND METHODS We conducted a cross-sectional, phone-based survey study between 1 June 2021 and 15 July 2021 with a sample of 23 patients with intrathecal baclofen pumps. The patients' quality of life before the implantation of the pump, after one year of implantation, and during the pandemic was evaluated with the 3-level version of EQ-5D. RESULTS Catheter migration developed in one of the patients, after which the pump was changed. While the dose of baclofen was altered in eight (38.1%) patients during the pandemic period, the filling period was modified in three (14.3%) patients. While 61.9% of the patients reported that their general health, mobility, spasticity and joint mobility were worse than before the pandemic, 90.5% of the patients stated that their communication and mood were worse than before the pandemic. The 3-level version of EQ-5D and EQ-Visual Analogue Scale scores of the patients were significantly decreased during pandemic (p < .05). CONCLUSIONS Due to the complications of the intrathecal baclofen pump, its management should continue uninterruptedly during the pandemic period.
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Affiliation(s)
- Ece Unlu Akyuz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Nihal Tezel
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
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Tamburin S, Filippetti M, Mantovani E, Smania N, Picelli A. Spasticity following brain and spinal cord injury: assessment and treatment. Curr Opin Neurol 2022; 35:728-740. [PMID: 36226708 DOI: 10.1097/wco.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Spasticity is a common sequela of brain and spinal cord injury and contributes to disability, reduces quality of life, and increases economic burden. Spasticity is still incompletely recognized and undertreated. We will provide an overview of recent published data on the definition, assessment, and prediction, therapeutic advances, with a focus on promising new approaches, and telemedicine applications for spasticity. RECENT FINDINGS Two new definitions of spasticity have been recently proposed, but operational criteria should be developed, and test-retest and inter-rater reliability should be explored. Cannabinoids proved to be effective in spasticity in multiple sclerosis, but evidence in other types of spasticity is lacking. Botulinum neurotoxin injection is the first-line therapy for focal spasticity, and recent literature focused on optimizing its efficacy. Several pharmacological, interventional, and nonpharmacological therapeutic approaches for spasticity have been explored but low-quality evidence impedes solid conclusions on their efficacy. The recent COVID-19 pandemic yielded guidelines/recommendations for the use of telemedicine in spasticity. SUMMARY Despite the frequency of spasticity, robust diagnostic criteria and reliable assessment scales are required. High-quality studies are needed to support the efficacy of current treatments for spasticity. Future studies should explore telemedicine tools for spasticity assessment and treatment.
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Affiliation(s)
- Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Mirko Filippetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
- Canadian Advances in Neuro-Orthopaedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada
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Loy E, Scheidler A, Packham T, Dow H, Winston P. Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS. Can J Pain 2022; 6:77-84. [PMID: 35694140 PMCID: PMC9176228 DOI: 10.1080/24740527.2022.2063113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The COVID-19 pandemic has led to an increased reliance on virtual care in the rehabilitation setting for patients with conditions such as complex regional pain syndrome (CRPS). Aims The aim of this study was to perform a quality improvement initiative to assess patient satisfaction and ensure that outcomes following virtual assessment, diagnosis, and treatment of CRPS with prednisone are safe and effective. Methods An online survey was distributed to 18 patients with CRPS who had been seen virtually between March and December 2020 through a rehabilitation clinic and treated with oral prednisone. Thirteen participants completed the survey, which was designed de novo by our team to evaluate participant perceptions and satisfaction regarding the virtual care experience. Also included in the survey was a CRPS-specific validated patient-report questionnaire (Hamilton Inventory for CRPS: PR-HI-CRPS), which allowed participants to describe their specific symptoms and associated functional and psychosocial impacts, both previously (pretreatment baseline) and at the time of survey (posttreatment). Results CRPS symptoms and related impacts were scored as significantly improved from baseline following treatment with prednisone. Likert scale results from survey responses related to patients' experiences and satisfaction with the virtual care process were analyzed; the majority of patients reported satisfaction with a virtual appointment for evaluation of CRPS, as well as with subsequent treatment decisions based on virtual assessment. Conclusions This quality improvement study suggests that virtual care is a potential option for a patient-accepted approach to overcoming challenges with in-person care imposed by the COVID-19 pandemic and could help inform future considerations in addressing geographic and patient-specific disparities in access to specialist care for CRPS.
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Affiliation(s)
- Emma Loy
- Faculty of Medicine, University of British Columbia, Vancouver, BritishColumbia, Canada
| | - Anna Scheidler
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Heather Dow
- Canadian Association of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada
| | - Paul Winston
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BritishColumbia, Canada,CONTACT Dr. Paul Winston Division of Physical Medicine and Rehabilitation, University of British Columbia, 1 Hospital Way, Victoria General Hospital, Victoria, BCV8Z 6R5, Canada
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Dogruoz Karatekin B, İcagasioglu A, Sahin SN, Kacar G, Bayram F. How Did the Lockdown Imposed Due to COVID-19 Affect Patients With Cerebral Palsy? Pediatr Phys Ther 2021; 33:246-249. [PMID: 34323865 PMCID: PMC8478098 DOI: 10.1097/pep.0000000000000818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The novel coronavirus infection (SARS-CoV-2) caused disruption of the treatment and follow-up evaluations of children with cerebral palsy. AIM The change in mobility, pain, functional status, and spasticity was investigated who were followed in a pediatric rehabilitation unit after the lockdown. METHODS One hundred ten children were evaluated. Pain, severity of spasticity, botulinum toxin administration dates, and continuity of home exercises were recorded. The functional status was evaluated with the Functional Independence Measure for Children (WeeFIM). RESULTS The WeeFIM self-care and mobility subscale scores and total scores were significantly worse. Only 5 of the participants had pain in the previous evaluations; in the last evaluation, 29 had pain complaints. The pain and spasticity severity of the participants whose botulinum toxin administration was delayed were significantly increased. CONCLUSIONS The children with cerebral palsy should be followed with telemedicine at short intervals, and when necessary, in the hospital.
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Affiliation(s)
- Bilinc Dogruoz Karatekin
- Physical Medicine and Rehabilitation Clinic (Drs Dogruoz Karatekin, Sahin, Kacar, and Bayram), Istanbul Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey; Department of Physical Medicine and Rehabilitation (Dr İcagasioglu), Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Afitap İcagasioglu
- Physical Medicine and Rehabilitation Clinic (Drs Dogruoz Karatekin, Sahin, Kacar, and Bayram), Istanbul Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey; Department of Physical Medicine and Rehabilitation (Dr İcagasioglu), Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Seyma Nur Sahin
- Physical Medicine and Rehabilitation Clinic (Drs Dogruoz Karatekin, Sahin, Kacar, and Bayram), Istanbul Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey; Department of Physical Medicine and Rehabilitation (Dr İcagasioglu), Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Gülnihal Kacar
- Physical Medicine and Rehabilitation Clinic (Drs Dogruoz Karatekin, Sahin, Kacar, and Bayram), Istanbul Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey; Department of Physical Medicine and Rehabilitation (Dr İcagasioglu), Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Fethullah Bayram
- Physical Medicine and Rehabilitation Clinic (Drs Dogruoz Karatekin, Sahin, Kacar, and Bayram), Istanbul Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey; Department of Physical Medicine and Rehabilitation (Dr İcagasioglu), Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
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Botulinum Toxin Services for Neurorehabiliation: Recommendations for Challenges and Opportunities during the COVID-19 Pandemic. Toxins (Basel) 2021; 13:toxins13080584. [PMID: 34437456 PMCID: PMC8402461 DOI: 10.3390/toxins13080584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic severely impacted the function of medical facilities and rehabilitation services worldwide, including toxin services delivering Botulinum toxin treatments for neuromuscular conditions such as spasticity, dystonia, and sialorrhea. The aim of this paper is to understand how toxin services have dealt with the situation and what strategies have been adopted to continue services. The recommendations are based on a virtual round table held with toxin services experts from different European countries who shared their experiences and discussed the best practices. The challenges for toxin services were reviewed based on the experts' experiences and on relevant literature from 2020 and 2021. A set of recommendations and best practices were compiled, focusing firstly on guidance for clinical practice, including assessing patients' health and risk status and the urgency of their treatment. Secondly, it was discussed how patients on botulinum toxin therapy can be cared for and supported during the pandemic, and how modern technology and tele-medicine platforms can be generally used to optimize effectiveness and safety of toxin treatments. The technological advances prompted by the COVID-19 crisis can result in better and more modern patient care in the future.
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Şentürk M, El Tahan MR, Shelley B, Szegedi LL, Piccioni F, Licker MJ, Karzai W, Gil MG, Neskovic V, Vanpeteghem C, Pelosi P, Cohen E, Sorbello M, MBChB JB, Stoica R, Mourisse J, Brunelli A, Jimenez MJ, Drnvsek-Globoikar M, Yapici D, Morsy AS, Kawagoe I, Végh T, Navarro-Ripoll R, Marczin N, Paloczi B, Unzueta C, Gregorio GD, Wouters P, Rex S, Mukherjee C, Paternoster G, Guarracino F. Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee. J Cardiothorac Vasc Anesth 2021; 35:3528-3546. [PMID: 34479782 PMCID: PMC8313821 DOI: 10.1053/j.jvca.2021.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 02/07/2023]
Abstract
The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.
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Affiliation(s)
- Mert Şentürk
- Dep. of Anesthesiology & Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Mohamed R El Tahan
- Cardiothoracic Anesthesiology, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Ben Shelley
- Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital/West of Scotland Heart and Lung Centre, University of Glasgow Academic Unit of Anaesthesia, Pain and Critical Care, Scotland
| | - Laszlo L Szegedi
- Department of Anesthesiology, CUB Hôpital Erasme, ULB Université Libre de Bruxelles, Brussels, Belgium
| | - Federico Piccioni
- Anesthesia and Intensive Care Unit, Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marc-Joseph Licker
- Anesthesia, Pharmacology and Intensive Care, University Hospital Geneva, Geneva, Switzerland
| | - Waheedullah Karzai
- Chefarzt, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee, Bad Berka, Germany
| | | | - Vojislava Neskovic
- Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | | | - Paolo Pelosi
- Università degli Studi di Genova, UNIGE, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Genoa, Italy
| | - Edmond Cohen
- Anesthesiology, Perioperative & Pain Medicine, Thoracic Surgery Specialty, Anesthesiology Icahn School of Medicine at Mount Sinai, New York, NY; Anesthesia and Intensive Care, AOU Policlinico Vittorio Emanuele San Marco, Catania, Italy
| | - Massimiliano Sorbello
- Anesthesia, Pharmacology and Intensive Care, University Hospital Geneva, Geneva, Switzerland
| | - Johan Bence MBChB
- Cardiothoracic Anaesthesiology, University Hospitals of Leicester Glenfield Hospital, Leicester, UK
| | - Radu Stoica
- Faculty of Medicine, Titu Maiorescu, Bucharest; Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | - Jo Mourisse
- Anesthesiology and ICU, Monza Oncolgy Hospital, Bucharest; Department of Anesthesia, Pain and Palliative Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Alex Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Maria-José Jimenez
- Anesthesiology, Centro Medico Teknon, Universitat de Barcelona, Barcelona, Spain
| | | | - Davud Yapici
- Anesthesia and Intensive Care, Mersin University School of Medicine, Mersin, Turkey
| | - Ahmed Salaheldin Morsy
- Department of Anesthesia, King Fahd Hospital of the Imam Abdulrahman bin Faisal University, Al Khober, Saudi Arabia
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan; Outcomes Research Consortium, Cleveland, OH
| | - Tamás Végh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | | | - Nandor Marczin
- Department of Anesthesiology, Ljubjljana University Medical Centre, Ljubljana, Slovenia; Section of Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Anesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
| | - Balazs Paloczi
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Carmen Unzueta
- Department of Anesthesiology, Hospital de la Santa Creu i San Pau, Barcelona, Spain
| | - Guido Di Gregorio
- Anesthesia and Critical Care Azienda Ospedaliera Università di Padova, Padova, Italy
| | - Patrick Wouters
- Department of Anesthesia and Perioperative Medicine, Ghent University, Ghent, Belgium
| | - Steffen Rex
- Clinic Department of Anesthesiology, University Hospitals Leuven, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Chirojit Mukherjee
- Department of Anaesthesia & Intensive Care, Helios Clinic for Cardiac Surgery, Karlsruhe, Germany
| | - Gianluca Paternoster
- Division of Cardiac Resuscitation, Cardiovascular Anesthesia and Intensive Care San Carlo Hospital (Potenza) Italy Via Potito Petrone, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Yılmaz Yalçınkaya E, Karadağ Saygı E, Özyemişci Taşkıran Ö, Çapan N, Kutlay Ş, Sonel Tur B, El Ö, Ünlü Akyüz E, Tekin S, Ofluoğlu D, Zİnnuroğlu M, Akpınar P, Özekli Mısırlıoğlu T, Hüner B, Nur H, Çağlar S, Sezgin M, Tıkız C, Öneş K, İçağasıoğlu A, Aydın R. Consensus recommendations for botulinum toxin injections in the spasticity management of children with cerebral palsy during COVID-19 outbreak. Turk J Med Sci 2021; 51:385-392. [PMID: 33350298 PMCID: PMC8203129 DOI: 10.3906/sag-2009-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/21/2020] [Indexed: 12/21/2022] Open
Abstract
Spasticity is the most common motor disturbance in cerebral palsy (CP). Lockdown in the COVID-19 outbreak has profoundly changed daily routines, and similarly caused the suspension of spasticity treatment plans. Besides, the delay in botulinum toxin (BoNT) injection, which is important in the management of focal spasticity, led to some problems in children. This consensus report includes BoNT injection recommendations in the management of spasticity during the COVID-19 pandemic in children with CP. In order to develop the consensus report, physical medicine and rehabilitation (PMR) specialists experienced in the field of pediatric rehabilitation and BoNT injections were invited by Pediatric Rehabilitation Association. Items were prepared and adapted to the Delphi technique by PMR specialists. Then they were asked to the physicians experienced in BoNT injections (PMR specialist, pediatric orthopedists, and pediatric neurologists) or COVID-19 (pediatric infectious disease, adult infectious disease). In conclusion, the experts agree that conservative management approaches for spasticity may be the initial steps before BoNT injections. BoNT injections can be administered to children with CP with appropriate indications and with necessary precautions during the pandemic.
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Affiliation(s)
- Ebru Yılmaz Yalçınkaya
- Department of Physical Medicine and Rehabilitation, Gaziosmanpaşa Training and Research Hospital , University of Health Sciences, İstanbul, Turkey
| | - Evrim Karadağ Saygı
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Özden Özyemişci Taşkıran
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Nalan Çapan
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Şehim Kutlay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Birkan Sonel Tur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özlem El
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ece Ünlü Akyüz
- Department of Physical Medicine and Rehabilitation, DışkapıTraining and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Süda Tekin
- Department Infectious Disease, Faculty of Medicine, Koç University, İstanbul, Turkey
| | - Demet Ofluoğlu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bahçeşehir University, İstanbul, Turkey
| | - Murat Zİnnuroğlu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Pınar Akpınar
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Health Science University, İstanbul, Turkey
| | - Tuğçe Özekli Mısırlıoğlu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, İstanbul Cerrahpaşa University, Istanbul, Turkey
| | - Berrin Hüner
- Department of Physical Medicine and Rehabilitation, Gaziosmanpaşa Training and Research Hospital , University of Health Sciences, İstanbul, Turkey
| | - Hakan Nur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Sibel Çağlar
- Department of Physical Medicine and Rehabilitation, Bakırköy Sadi KonukTraining and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Melek Sezgin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Canan Tıkız
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Kadriye Öneş
- Department of Physical Medicine and Rehabilitation, İstanbul Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Afitap İçağasıoğlu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Resa Aydın
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, İstanbul University, İstanbul, Turkey
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Chen Y, Kathirithamby DR, Li J, Candelario-Velazquez C, Bloomfield A, Ambrose AF. Telemedicine in the Coronavirus Disease 2019 Pandemic: A Pediatric Rehabilitation Perspective. Am J Phys Med Rehabil 2021; 100:321-326. [PMID: 33480609 DOI: 10.1097/phm.0000000000001698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
ABSTRACT In the spring of 2020, coronavirus disease 2019 evolved into a worldwide pandemic, forcing traditional face-to-face healthcare to a standstill. Telemedicine was quickly adopted as a major tool for pediatric rehabilitation services. This article describes the national legislative response of the United States to the coronavirus disease 2019 pandemic and the opportunities and challenges of implementing telemedicine in pediatric rehabilitation outpatient settings, consultations, as well as physician and patient education. The feasibility of performing a remote pediatric musculoskeletal and neurological tele-evaluation is also discussed. Although challenges exist, telemedicine has demonstrated its potential and has proven to be a practical system. Future developments in technology and accessibility, in addition to support from government and third-party payers, have the potential to make telemedicine an effective and vital platform in a coordinated healthcare system.
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Affiliation(s)
- Yuxi Chen
- From the Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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9
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Santamato A, Facciorusso S, Spina S, Cinone N, Avvantaggiato C, Santoro L, Ciritella C, Smania N, Picelli A, Gasperini G, Molteni F, Baricich A, Fiore P. Discontinuation of botulinum neurotoxin type-A treatment during COVID-19 pandemic: an Italian survey in post stroke and traumatic brain injury patients living with spasticity. Eur J Phys Rehabil Med 2020; 57:424-433. [PMID: 33263248 DOI: 10.23736/s1973-9087.20.06478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The COVID-19 pandemic has affected health-care systems worldwide, including the outpatient spasticity care with botulinum neurotoxin toxin type A (BoNT-A). AIM The aim of this study was to investigate the impact of discontinuation of BoNT-A treatment on patients living with spasticity during the COVID-19 quarantine. DESIGN A multicentric cross-sectional study. SETTING Outpatients setting. POPULATION Patients with spasticity after stroke and traumatic brain injury treated with BoNT-A. METHODS A phone-based survey was conducted from March to May, 2020. Based on the International Classification of Functioning, Disability and Health (ICF), an ad hoc questionnaire CORTOX (CORonavirus TOXin survey) was developed to investigate patients' experiences following the discontinuation of their usual treatment for spasticity due to the lockdown and its implication on their health perception. It assessed patients' condition and explored different ICF domains related to spasticity: unpleasant sensations, mobility, self-care, facilitators and psychosocial factors. The sum of those represented the CORTOX score (Max 142). The questionnaire also collected data about the impact of COVID-19 on patients' wellbeing (mood, sleep, relationships, community life, motivation). RESULTS A total of 151 participants completed the survey. Most participants (72.2%) experienced a worsening in perceived spasticity, 53% got worse in independence and 70.9% had a negative impact on quality of life. The mean CORTOX score was 52.85±27.25, reflecting a perceived worsening in all ICF domains investigated. Moderate to strong correlations were found between different sub-scores of the questionnaire and severity of spasticity (P<0.001). COVID-19 psychosocial related factors were associated with loss of independence (P<0.05) but only mood was associated with worsening of spasticity (P<0.001). The lack of rehabilitation therapy was significantly associated with the worsening of independence but not with the worsening of spasticity. Finally, respondents reported that BoNT-A was useful to their condition and should not be discontinued. CONCLUSIONS The discontinuation of BoNT-A treatment was associated with worsening of activities and participation and perceived spasticity. COVID-19 related problems and rehabilitation showed an association with loss of independence. CLINICAL REHABILITATION IMPACT This study will provide useful information in the field of spasticity management using a patient's centred approach, with consistent quantitative and qualitative information.
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Affiliation(s)
- Andrea Santamato
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy - .,"Fondazione Turati", Rehabilitation Center, Vieste, Foggia, Italy -
| | - Salvatore Facciorusso
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Stefania Spina
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Nicoletta Cinone
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Christian Avvantaggiato
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Luigi Santoro
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Chiara Ciritella
- Spasticity and Movement Disorders "ReSTaRt" Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Nicola Smania
- Department of Neurosciences, Neuromotor and Cognitive Rehabilitation Research Center, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Neuromotor and Cognitive Rehabilitation Research Center, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation Unit, Maggiore della Carità University Hospital, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Pietro Fiore
- Neurorehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Bari, Bari, Italy
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Abstract
The COVID-19 global pandemic has resulted in significant changes to delivery of care in the field of physiatry. Most prominently, in-person visits have fast tracked to virtual visits. As we are forced to quickly adopt this new technology for our doctor-patient interactions, many questions remain with regard to structuring telemedicine visits for optimal outcomes. Little has been written on virtual evaluations of patients with spasticity. The intent of this article was to provide a framework for conducting a virtual spasticity assessment via telemedicine. We will provide tips on how to conduct a person-centered virtual examination assessment and how to document goals related to the virtual assessment.
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