Nerve transfer surgery restores upper limb function in people with tetraplegia

13 young adults with tetraplegia are able to feed themselves, hold a drink, brush their teeth, and write as a result of a novel surgical technique which connects functioning nerves with injured nerves to restore power in paralyzed muscles. Nerve transfer surgery has enabled 13 young adults with complete paralysis to regain movement and function in their elbows and hands, according to the largest case series of this technique in people with tetraplegia (paralysis of both the upper and lower limbs), published in The Lancet.

During the surgery, Australian surgeons attached functioning nerves above the spinal injury to paralyzed nerves below the injury. Two years after surgery, and following intensive physical therapy, participants were able to reach their arm out in front of them and open their hand to pick up and manipulate objects. Restoring elbow extension improved their ability to propel their wheelchair and to transfer into bed or a car.

They can now perform everyday tasks independently such as feeding themselves, brushing teeth and hair, putting on make-up, writing, handling money and credit cards, and using tools and electronic devices.

Full story at news-medical.net

Common antidepressants interact with opioid med to lessen pain relief

Common antidepressants interact with the opioid pain medication tramadol to make it less effective for pain relief, according to a study from University Hospitals (UH). These findings have important implications for the opioid epidemic, suggesting that some patients suspected of drug-seeking may, in fact, be under-medicated and just are seeking more effective pain relief. They also could help explain why some people exceed the prescribed dose of tramadol, increasing their risk of addiction.

The study was published in the journal Pharmacotherapy.

Researchers reviewed the medication records of 152 patients at UH Cleveland Medical Center and UH Geauga Medical Center who received scheduled tramadol for at least 24 hours. All participants in the study were admitted as inpatients or observation status. Those patients who also were taking the antidepressants Prozac (fluoxetine), Paxil (paroxetine) or Wellbutrin (bupropion) required three times more pain medication per day to control “breakthrough” pain throughout the day, when compared with patients not taking those antidepressants.

Full story at NeuroScience News

Expanded Health Reimbursement Arrangement Rule May Widen Use of the Employer Offering

A final rule from the US Department of Health and Human Services (HHS) will expand small employers’ ability to offer Health Reimbursement Arrangements (HRAs), a change that may make it easier for more Americans to purchase health insurance that they don’t receive from their jobs. While it’s still too early to tell if the change will significantly impact patients seen by physical therapists (PTs), APTA’s advice is to keep an eye open, and be aware of the nuances of HRA payment.

The new rule, set to go into effect January 1, 2020, will allow qualified small employers to offer what’s being called an “Individual Coverage HRA” as an alternative to traditional group coverage plans. The idea behind HRAs is that employers provide a monthly tax-free allowance to employees, who can be reimbursed for health care-related expenses up to the allowance limit. The changes set to go into effect next year would permit HRAs to be used to pay for health insurance purchased on the individual market, and allow employers to offer “excepted benefit” HRAs to supplement employer-sponsored insurance—even if the employee isn’t enrolled in the group plan.

Full story at APTA

More seniors are dying in falls. Doctors could do more to reduce the risk.

Older adults worried about falling typically receive general advice: Take an exercise class. Get your vision checked. Stop taking medications for sleep. Install grab bars in the bathroom.

A new study suggests that sort of advice hasn’t proved to be very effective: Nearly three times more adults age 75 and older died from falls in 2016 than in 2000, according to a recent report in the Journal of the American Medical Association.

In 2016, 25,189 people in this age group died from falls, compared with 8,613 in 2000.  The rate of fatal falls for adults 75 and older more than doubled during this period, from 51.6 per 100,000 people in 2000 to 122.2 per 100,000 people in 2016, the report found.

Full story at news-medical.net

 

Vagus nerve stimulation may reduce the symptoms of rheumatoid arthritis

Electrostimulation of the vagus nerve may be key to reducing the symptoms of rheumatoid arthritis, according to findings that scientists presented at the Annual European Congress of Rheumatology in Madrid, Spain.

This research gives hope that there may be a new way to help treat this autoimmune condition.

The vagus nerve, which is a very long nerve that runs between the brain and the neck, chest, and abdomen, is a complex structure.

Full story at Medical News Today

Inhaling irritant that mimics air pollution changes defensive heart-lung reflex for hypertension

Air pollution significantly increases the risk for premature deaths, particularly in people with underlying cardiovascular disease, clinical and epidemiological studies have determined.

In healthy people, inhaling ozone or particle pollution triggers a defensive lung-heart reflex (pulmonary-cardiac reflex) that automatically slows heart rate to accommodate oxygen deficiency and help slow distribution of pollutants throughout the body. Yet, when patients with cardiovascular diseases breathe pollutants that same protective mechanism does not kick in. Instead, their heart rates intermittently speed up, known as tachycardia, and can evoke a potentially deadly irregular heart rhythm, known as premature ventricular contractions.

What accounts for the difference? University of South Florida Health (USF Health) researchers who study the role of sensory airway nerves in protective behaviors wanted to know.

Full story at news-medical.net

Deadly falls are on the rise for seniors, and prevention is key

Every second of every day in the United States an older adult falls. Every 11 seconds an older adult is treated in an emergency room for a fall. Every 19 minutes an older adult dies from a fall.

“How many times have you fallen in the past 12 months?”

That’s the first thing physical therapist Laura Wazen asks patients when they walk through the doors of her practice to undergo a balance assessment. And if statistics are any indication, it’s a question of growing importance. Deadly falls are on the rise.

Not every person who ends up at Equinox Physical Therapy thinks they have a balance problem – many are there because of pressure from either their family or doctor. She once had a patient deny they had a balance issue because they “only fell once or twice a day.”

Full story at newsllive.com

News From NEXT: McMillan Lecturer Outlines Keys to Excellence in the Physical Therapy Profession

Tom McPoil, PT, PhD, FAPTA, said he intentionally structured the title of the 50th McMillan Lecture—”Is Excellence in the Cards?” as a question “to raise an element of doubt or uncertainty in our quest to achieve excellence.” After all, he said during his delivery of the lecture on June 13 as part of the APTA NEXT Conference and Exposition in Chicago, he has several concerns regarding the profession’s ability to achieve excellence.

Before describing the reasons for his uncertainty, McPoil did recognize some of the profession’s remarkable accomplishments since he began his career in 1973. “We no longer serve as a subservient technician in the health care system, our students now obtain an exceptional education and are granted a doctoral degree, we can practice in a variety of specialty areas in multiple practice environments, and we have achieved the ability to practice autonomously with patients having direct access to our services,” he noted.

But he said there still is room for improvement from both clinical and academic perspectives, and the remainder of his lecture outlined those perspectives. From the clinical standpoint, he described 3 areas.

Full story at APTA

Researchers find physical activity in preschool years can affect future heart health

Physical activity in early childhood may have an impact on cardiovascular health later in life, according to new research from McMaster University, where scientists followed the activity levels of hundreds of preschoolers over a period of years.

They found that physical activity in children as young as three years old benefits blood vessel health, cardiovascular fitness and is key to the prevention of early risk indicators that can lead to adult heart disease.

The study, named “Health Outcomes and Physical activity in Preschoolers”, published today in the journal Pediatrics, is the first to demonstrate the benefits of physical activity on blood vessel health in preschoolers.

Full story at Medical Xpress

Kids with Headache after Stroke Might be at Risk for Another Stroke

A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence. Headache developed in over a third of participating children, on average six months after the stroke. Fifteen percent of patients suffered another stroke, typically in the first six to 12 months after the initial stroke. In the study, most children who experienced headache during stroke recurrence also had other associated neurologic symptoms, mostly weakness of one side of the body (hemiparesis) or facial asymmetry and brain malfunction (encephalopathy). Findings were published in Neurology: Clinical Practice, a journal of the American Academy of Neurology.

“In our study, post-stroke headache was more common in patients who experienced another stroke, which suggests that it might be a risk factor for stroke recurrence,” says co-lead author Jonathan Kurz, MD, PhD, pediatric neurologist in the Ruth D. Ken M. Davee Pediatric Neurocritical Care Program at Ann Robert H. Lurie Children’s Hospital of Chicago, and Instructor of Pediatrics at Northwestern University Feinberg School of Medicine. “More research is needed to test this hypothesis, and it remains unclear if headache treatment would lower the risk for stroke recurrence. Children with post-stroke headache might need closer observation or different strategies to prevent another stroke. This requires more study.”

Full story at luriechildrens.org