Subcutaneous bupivacaine for treatment of spasticity: a case report.

In a previous report, we described heretofore undiscovered possibilities that neuropathic pain and spasticity may share some common pathophysiological mechanisms. Currently, systemically delivered local anesthetics are being used for the evaluation and treatment of neuropathic pain. We present a case describing the treatment of spasticity of spinal origin with continuous subcutaneous infusion of 0.75% bupivacaine in a patient who did not respond to traditional treatments and has become tolerant to intrathecal baclofen.

Ethical issues in treating pediatric rehabilitation patients.

Ethical issues pertaining to treating pediatric rehabilitation patients stem from at least three sources: the fact that children are not morally autonomous persons and must depend on the values and moral beliefs of others in ethically complex decision-making situations; the extent of parental authority in asserting problematic beliefs or imposing questionable demands affecting treatment decisions; and the way clinical uncertainty affects moral uncertainty in determining treatment approaches or alternatives. Although these problems are pervasive among all age groups of children with disabilities, this article will primarily examine their impact on the rehabilitation of children and adolescents. Principles and strategies for managing value-laden conflicts will be discussed along with how various ethical, social, and clinical constraints may nevertheless compromise a straightforward resolution of an ethically vexing situation.

Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients.

To test the clinical counterpart of the learned nonuse theory, 25 chronic hemiplegic stroke and head-injured patients with minimal to moderate upper extremity extensor muscle function were required to keep their uninvolved upper extremities within a hand-enclosed sling during waking hours over a 2-week interval. During this forced use period and for 1 year thereafter, changes in force or time-based measures among 21 functional tasks were compared to values at the sixth baseline session, a preintervention time when relearning had plateaued. Significant (P less than 0.05, Friedman's repeated measures followed by Tukey multiple comparison tests) changes were seen in 19 of the 21 tasks with most persisting at the 1-year follow-up. There were no apparent differences between right- and left-sided involvement or between stroke versus head injury clients (Mann-Whitney procedure). Ratings for quality of movement scored from videotapes presented in random order showed no change over time. These data suggest that learned nonuse does occur in select neurological patients and that this behavior can be reversed through application of a forced use paradigm.