ABSTRACT
Although the diagnosis of and therapy for acute disseminated encephalomyelitis (ADEM) have been extensively investigated, the role of rehabilitation in modifying its functional outcome has received little attention in the literature so far. We report a case of pediatric ADEM who showed complete functional recovery following early rehabilitative treatment, started in the Intensive Care Unit.
Subject(s)
Attention , Encephalomyelitis, Acute Disseminated/rehabilitation , Physical Therapy Modalities , Recovery of Function/physiology , Child , Encephalomyelitis, Acute Disseminated/physiopathology , Encephalomyelitis, Acute Disseminated/psychology , Humans , MaleABSTRACT
BACKGROUND: It is useful to perform neurophysiologic electromyography and electroneurography (EMG/ENG) on patients with peripheral facial palsy during the acute phase of paralysis in order to assess the severity of their nerve lesion and thus plan rehabilitation treatment and evaluate its results. AIM: To evaluate the motor recovery of patients with Bell's palsy with respect to the severity of their neurological lesion and to compare the results of two different rehabilitation treatments, with electromyographic biofeedback (EMG-BFB) and mirror visual biofeedback (mirror-BFB), in patients with Bell's palsy and neurophysiologic pattern of axonotmesis. STUDY DESIGN: Cohort study on retrospective clinical records. POPULATION: 102 patients with Bell's facial palsy were clinically assessed according to the House scale both during the acute phase of paralysis and 12 months after onset. METHODS: All patients underwent EMG/ENG examination 3-4 weeks after the onset of paralysis; 29 patients had an EMG pattern of neurapraxia and were not given rehabilitation treatment; 73 patients who presented with signs of denervation had an EMG pattern of axonotmesis. The group, which was homogenous in terms of lesion severity, was divided into two parts: 38 patients were treated with electromyographic biofeedback (EMG-BFB) and 35 were treated with mirror visual feedback (mirror-BFB). RESULTS: All 29 patients with neurapraxia made a full spontaneous recovery; Although the 73 patients with axonotmesis received different types of rehabilitation treatment, they obtained similar results regarding quality of recovery, development of synkinesis, rehabilitation timing and resources used. CONCLUSION AND CLINICAL REHABILITATION IMPACT: Rehabilitation treatment is not necessary for patients with neurapraxia. The two biofeedback methods used to treat patients with axonotmesis resulted in similar rehabilitation outcomes.
Subject(s)
Bell Palsy/rehabilitation , Electromyography/methods , Feedback, Sensory , Neurofeedback/methods , Adolescent , Adult , Aged , Bell Palsy/classification , Bell Palsy/physiopathology , Child , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Recovery of Function , Severity of Illness Index , Young AdultABSTRACT
Phospholipid fatty acid composition and bilirubin UDP-glucuronyltransferase activity from liver microsomal membrane were studied in normal and in bile duct ligated rats. Incubation of normal microsomes with 15 microM bilirubin (considered as physiological concentration) yielded 60% bilirubin diglucuronide; in 2 days post-cholestatic rats, they showed 20% bilirubin diglucuronide which was undetectable in 8 days post-cholestatic group. When compared to controls, after 2 days of cholestasis, microsomal phospholipids showed a clear decrease in linoleic and arachidonic acids and an increment in palmitic and stearic acids. 8 days post-cholestatic rats presented a marked increase in palmitic, oleic and docosaexaenoic acids, while linoleic and arachidonic acids decreased. Cholestasis produced disturbances in microsomal phospholipids fatty acid composition; but these changes are unable to explain entirely the severe damage observed in bilirubin diglucuronide formation.
