REHAB IN REVIEW WWW.REHABINREVIEW.COM ™ Volume 21 Number 12 Published by Physicians December 5, 2013 In Physical Medicine and Rehabilitation PHYSICAL AND COGNITIVE COGNITIVE IMPAIRMENT AFTER Conclusion: This study found FUNCTIONING OF CRITICAL ILLNESS that cognitive impairment following NONAGENARIANS ICU admission is common, with the Previous studies have length of ICU delirium associated with In high income countries, the demonstrated that survivors of critical more severe cognitive deficits at population of individuals living into illness often have poorly understood three and 12 months. their tenth decade is rapidly cognitive dysfunction. These data expanding. This study compared the largely derive from small cohort Pandharipande, T., et al. Long-Term physical and cognitive function of two, studies, restricted to a single disease Cognitive Impairment after Critical complete Danish birth cohorts of process. This study was designed to Illness. N Engl J Med. 2013, October nonagenarians, born 10 years apart. better understand the prevalence of 3; 369(14): 1306-1316. The 1905 cohort study took place long-term cognitive impairment after from August to October 1998, critical illness. including all Danes born in 1905, The Bringing to Light the Risk LEG COMPRESSION AND (n=3,600), 92 to 93 years of age at Factors and Incidence of SKI PERFORMANCE the time of the survey. The 1915 Neuropsychological Dysfunction in cohort study took place 12 years ICU Survivors (BRAIN-ICU) study Given the uneven surfaces and later, and included 2,509 Danes, 94 included adults admitted to a medical high speeds involved in Alpine to 95 years of age at the time of the or surgical ICU with respiratory downhill skiing, athletes are subjected survey. All were assessed for basic failure, cardiogenic shock or septic to strong passive vibrations and activities of daily living, physical shock. Two primary independent risk shocks, activating a large number of performance, cognitive function and factors were studied, including the motor neurons. This can cause an depressive symptomatology. duration of delirium, and the use of early onset of muscle fatigue. As The chance of surviving from birth sedative or analgesic medications compression garments have been to 93 years of age was 20% higher in during hospitalization. The patients shown to attenuate longitudinal and 1915 than in 1905, and that of were assessed for cognitive function anterior – posterior oscillation of reaching 95 years of age was 32% by trained psychology professionals muscles, this study was designed to higher in 1915. The 1915 cohort completing assessments of global investigate whether compression performed better than did the 1905 cognition at three and 12 months garments might positively affect cohort in cognitive function in both after hospital discharge. The primary performance. Cognitive Composite Scores assessment tool was the Repeatable Twelve competitive elite male (p=0.0003) and on the Mini-Mental Battery for the Assessment of skiers were recruited to participate. State exam (p<0.0001), as well as in Neuropsychological Status (RBANS). All were initially tested with 3-min assessments of activities of daily Of the 821 patients recruited, six trials in a downhill tuck position living (p<0.0001). No consistent percent had cognitive impairment involving the simulation of skiing differences were noted between prior to ICU admission. While in the using the application of passive cohorts on physical performance ICU, 74% demonstrated delirium. Of vibration to the soles of both feet. The tests. those able to participate in the three- skiers then performed three trials in Conclusion: This Danish study, month follow-up, 40% displayed random order, one each wearing leg comparing two cohorts of cognition scores equal to those with garments that exerted zero, 20 mm nonagenarians, one born in 1915 and moderate traumatic brain injury, and Hg or 40 mm Hg compression. Data one in 1905, found that those born 26% had scores similar to those with were recorded including the later had a better chance of surviving mild Alzheimer's disease. At 12 electromyographic activities of to their 90s, and when they did, had months, 34% had scores similar to different muscles, cardiorespiratory better cognitive and activities of daily moderate traumatic brain injury and data, changes in total hemoglobin, living function. 24% to those with mild Alzheimer's tissue oxygenation and oscillator disease. The duration of delirium was movement of the vastus lateralis, Christiansen, K., et al. Physical and associated with poorer cognition, blood lactate and perceptual data. Cognitive Function of People Older including executive function, at three The knee angle during the exercise than 90 Years: A Comparison of Two and 12 months. The use of sedative was 10° less when subjects were in Danish Cohorts Born 10 Years Apart. or analgesic medication was not the 20 or 40 mmHg compression Lancet. 2013, November 2; 382: associated with cognitive function at protocol compared with no 1507–1513. follow up. compression(p=0.01). During passive vibration, the EMG activities of the © Rehab in Review Editor-in-Chief David T. Burke, M.D., M.A. tibialis anterior, gastroc medialis, similar improvements in pain and Emory University, Atlanta, GA rectus femoris and vastus medialis disability scores. Executive Editor were lower, and the gluteus maximus Conclusion: This study of Randolph L. Roig, M.D. was higher in the compression patients with chronic subacromial Emory University, Atlanta, GA groups than in the control group. bursitis found similar improvements in Copy Editor Immediately after 3 minutes of pain and function between groups Roberta Alysoun Bell, Ph.D. Emory University, Atlanta, GA passive vibration, with compression, receiving palpation guided, and those the tissue saturation index was lower receiving ultrasound guided, steroid Contributing Editors *Amy Cao, M.D. than without compression, while re- injections. BCM/UT Alliance, Houston, TX oxygenation after 90 seconds of *Jennifer Knowlton, M.D. recovery was enhanced by Hsieh, L., et al. Is Ultrasound Guided East Carolina University, Greenville, NC compression. The Borg scale Injection More Effective in Chronic Subacromial Bursitis? Med Sci Sport *Mikhail Zhukalin, D.O. reflected less perceived exertion in Anna Cruz, M.D. the compression groups than in the Exer. 2013, Dec; 45(12): 2205-2213. Chukwuemeka Ibekwe, M.D. Mitchel Leavitt, M.D. control group. Cleo D. Stafford II, M.D., M.S. Conclusion: This study of alpine Donnie Staggs, M.D. COMBINATION TRAMADOL, Christopher Williams, M.D. skiers found that leg compression Emory University, Atlanta, GA allowed the athletes to maintain a PARACETAMOL, CAFFEINE AND deeper tuck position with less TAURINE FOR BACK PAIN *Cyrus Kao, M.D. *Pablo Vazquez, M.D. perceived exertion and with no Nicole Hanrahan, M.D. differences in whole-body oxygen Michael J. Ingraham, M.D. Acute low back pain (LBP) is a Rajat Mathur, M.D. consumption or blood lactate common complaint in the clinical Georgetown/MedStar National Rehab, Washington, DC concentration. setting. Guidelines for first-line care include analgesic medications and *Alexander Drakh, D.O. Christine Cao, M.D. Sperlich, B et al Is Leg Compression advice to stay active. Clinical use of Lindsay T. Elliot, D.O. Beneficial for Alpine Skiers? BMC combination analgesic drugs has Jerry Miller, M.D. LSU Medical Center, New Orleans, LA Sports Science, Medicine and been studied, including tramadol 37.5 Rehabilitation. 2013, 5:18 mg/paracetamol 325mg. This study *Joshua S. Sole, M.D. Mayo Clinic, Rochester, MN evaluated the efficacy of a novel combination drug including tramadol *Richard Chang, M.D., MPH Mount Sinai Med. Ctr., New York, NY ULTRASOUND GUIDANCE 37.5 mg/paracetamol 325 mg/caffeine FOR CHRONIC 30 mg/taurine 250 mg. *Arpit A. Patel, D.O. SUBACROMIAL BURSITIS Nassau University Med Center The study included 500 patients with acute LBP, randomized to one of *Christina Marciniak, M.D. Ashwin Babu, M.D. Chronic, subacromial bursitis is a two groups. Group A received the Mary Caldwell, D.O. common clinical condition which can study combination medication, and Leda Ghannad, M.D. Amy Mathews, M.D. be treated with corticosteroid group B received the tramadol/ Nicole Rup, M.D. injections. Traditionally, these paracetamol tablet. Both groups took N.W.U../R.I.C., Chicago, IL injections have been administered their medications every six hours for *David Woznica, M.D. using the palpation guided technique, five consecutive days. On day six, the NYP, Columbia-Cornell, NY, NY although the accuracy of these patients returned to the clinic, with *Samaira Khan, D.O. injections is not ideal. This study assessments including self-reported NYU/Rusk Inst. of Rehab Med, NY, NY assessed the functional effect of pain relief scales and pain intensity *Craig Best, D.O. using ultrasound (US) to aid with scales. *Kashif Saeed, M.D. Rush Univ. Medical Center, Chicago, IL these injections. The study group obtained 81% Eligible patients with chronic treatment satisfaction scores, as *Alice Hon, M.D. Arpit Arora, M.D. subacromial bursitis were randomized compared with 45% in the tramadol/ Priya Bolikal, M.D. to one of two treatment groups. paracetamol group (p<0.001). Pain Lawrence P. Lai, M.D., MS Victoria Lin, M.D. Group 1 received corticosteroid intensity was decreased by 83% in Rutgers/Kessler Rehab, Newark, NJ injections with US guidance, while the treatment group, and by 66% in *Alan Vo, D.O. group 2 received the same injections the tramadol/paracetamol group Sinai Hospital, UMD, Baltimore, MD with palpation guidance. The primary (p<0.001). Conclusion: This study of *Vikram Arora, D.O. outcome measures were a visual Ron Avraham, M.D. analogue scale for pain and active patients with acute low back pain Shivani Dua, M.D. Matthew Santiago, M.D. and passive range of motion of the found that treatment with a Reed Williams, M.D. affected shoulder. The outcome medication combining tramadol, Temple Univ./UPenn., Philadelphia, PA assessors were held blind to the paracetamol, caffeine and taurine *Anupam Sinha, D.O.