Patient Profile: Neurological
Browse resources on patients with neurological conditions that are commonly observed in the acute inpatient rehab setting.
Please click on a topic or see what catches your interest down below.
Neurological Collection
Conditions
Guillain-Barre Syndrome
From the authors: "Guillain-Barré syndrome (GBS) is a rare but serious post-infectious immune-mediated neuropathy. It results from the autoimmune destruction of nerves in the peripheral nervous system causing symptoms such as numbness, tingling, and weakness that can progress to paralysis."
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+ Nguyen TP, Taylor RS. Guillain-Barre Syndrome. [Updated 2023 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan
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From the authors: "Subarachnoid hemorrhages are life-threatening and result from the accumulation of blood between the arachnoid and pia mater."
+ "Ziu E, Khan Suheb MZ, Mesfin FB. Subarachnoid Hemorrhage. [Updated 2023 Jun 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan
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Ischemic Stroke
From the authors: "The etiology of ischemic stroke is due to either a thrombotic or embolic event that causes a decrease in blood flow to the brain. In a thrombotic event, the blood flow to the brain is obstructed within the blood vessel due to dysfunction within the vessel itself, usually secondary to atherosclerotic disease, arterial dissection, fibromuscular dysplasia, or inflammatory condition. In an embolic event, debris from elsewhere in the body blocks blood flow through the affected vessel."
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+ Hui C, Tadi P, Patti L. Ischemic Stroke. [Updated 2022 Jun 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan
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Multiple Sclerosis
From the authors: "Multiple sclerosis, the most prevalent neurological disability, is an autoimmune-mediated disorder that affects the central nervous system (CNS) and often leads to ... neuronal dysfunction such as autonomic and sensorimotor defects, visual disturbances, ataxia, fatigue, difficulties in thinking, and emotional problems."
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+ Ghasemi N, Razavi S, Nikzad E. Multiple Sclerosis: Pathogenesis, Symptoms, Diagnoses and Cell-Based Therapy. Cell J. 2017;19(1):1-10. doi:10.22074/cellj.2016.4867
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Parkinson’s Disease
From the authors: "Parkinson’s disease (PD) is a complex progressive neurodegenerative disease characterized by tremor, rigidity, and bradykinesia, with postural instability appearing in some patients as the disease progresses."
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+ Kouli A, Torsney KM, Kuan WL. Parkinson’s Disease: Etiology, Neuropathology, and Pathogenesis. In: Stoker TB, Greenland JC, editors. Parkinson’s Disease: Pathogenesis and Clinical Aspects [Internet]. Brisbane (AU): Codon Publications; 2018 Dec 21. Chapter 1.
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Peripheral Neuropathy
From the authors: "Peripheral neuropathies encompass disorders of peripheral nerve cells and fibers, which manifest secondary to a wide range of pathologies...The most frequently encountered symptoms of peripheral neuropathy include numbness and paresthesias; pain, weakness, and loss of deep tendon reflexes may accompany these symptoms."
+ Hammi C, Yeung B. Neuropathy. [Updated 2022 Oct 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan
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Traumatic Brain Injury
From the authors: "Traumatic brain injuries can result from both blunt and penetrating mechanisms...The primary insult to the brain cannot be undone and results in brain tissue damage, impaired cerebral blood flow (CBF) regulation, and alterations in brain metabolism with upregulation of inflammatory mediators, oxidative stress, and vasospasm. These processes ultimately lead to cell death and generalized brain edema."
+ Vella MA, Crandall ML, Patel MB. Acute Management of Traumatic Brain Injury. Surg Clin North Am. 2017;97(5):1015-1030. doi:10.1016/j.suc.2017.06.003
Treatments
From the authors: "Craniotomy refers to the temporary removal of a bone flap from the calvarium to access intracranial contents...typically indicated for relief of elevated intracranial pressures in patients with cerebral edema, evacuation of intracranial hemorrhage, or drainage of intracranial abscesses. Craniectomy, a similar yet distinct entity, refers to the removal of the bone flap without replacement. Craniectomy is also done for decompression of intracranial contents, for example, after brain infarcts or traumatic brain injuries, and may be done post-surgically after craniotomy for bone flap infections."
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+ Chughtai, K.A., Nemer, O.P., Kessler, A.T. et al. Post-operative complications of craniotomy and craniectomy. Emerg Radiol 26, 99–107 (2019). https://doi.org/10.1007/s10140-018-1647-2
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From the authors: "The cornerstone of effective stroke care continues to be timely reperfusion treatment...The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients."
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+ Hurford R, Sekhar A, Hughes TAT, Muir KW. Diagnosis and management of acute ischaemic stroke. Pract Neurol. 2020;20(4):304-316. doi:10.1136/practneurol-2020-002557
Rehabilitation
Early Mobilization Program for Patients With Aneurysmal Subarachnoid Hemorrhage
+ Brian F. Olkowski, Mary Ann Devine, Laurie E. Slotnick, Erol Veznedaroglu, Kenneth M. Liebman, Melissa L. Arcaro, Mandy Jo Binning, Safety and Feasibility of an Early Mobilization Program for Patients With Aneurysmal Subarachnoid Hemorrhage, Physical Therapy, Volume 93, Issue 2, 1 February 2013, Pages 208–215, https://doi.org/10.2522/ptj.20110334
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From the authors: "Survivors of acute stroke who receive up to 2 rehabilitation sessions per day for 5 d/wk early in their hospitalization have better functional recovery at 3 months after stroke."
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+ Ching-Yi Wang, Yueh-Chi Chen, Chun-Hou Wang, Early Rehabilitation in Acute Care Inpatient Wards May Be Crucial to Functional Recovery 3 Months After Ischemic Stroke, Physical Therapy, Volume 101, Issue 1, January 2021, pzaa197, https://doi.org/10.1093/ptj/pzaa197
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Length of Hospital Stay in the Acute Rehabilitation of Individuals with Guillain Barre Syndrome
From the authors: "Factors associated with longer LOS were presence of muscle belly tenderness (MBT), severe lower extremity weakness, and lower FIM mobility subscores upon admission and discharge; axonal damage, ventilator dependence, and need for ankle foot orthoses (AFOs) at discharge approached significance. This study looks ... to provide the physical therapist with helpful information to guide and support clinical decision-making regarding expected mobility and rehabilitation LOS."
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+ Foster, Elizabeth C. MS, PT, NCS1; Mulroy, Sara J. PT, PhD2. Muscle Belly Tenderness, Functional Mobility, and Length of Hospital Stay in the Acute Rehabilitation of Individuals with Guillain Barre Syndrome. Journal of Neurologic Physical Therapy 28(4):p 154-160, December 2004.
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Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home
From the authors: "Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization."
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+ Dennis R Louie, Lisa A Simpson, W Ben Mortenson, Thalia S Field, Jennifer Yao, Janice J Eng, Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home, Physical Therapy, Volume 102, Issue 1, January 2022, pzab246, https://doi.org/10.1093/ptj/pzab246
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The Effect of Balance Training on Balance Performance in Individuals Poststroke: A Systematic Review
From the authors: "We found moderate evidence that balance performance can be improved following individual, “one-on-one” balance training for participants in the acute stage of stroke, and either one-on-one balance training or group therapy for participants with subacute or chronic stroke...in the acute stage, intensive balance training for 2 to 3 times per week may be sufficient, whereas exercising for 90 minutes or more per day, 5 times per week may be excessive."
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+ Lubetzky-Vilnai, Anat PT, MSc; Kartin, Deborah PT, PhD. The Effect of Balance Training on Balance Performance in Individuals Poststroke: A Systematic Review. Journal of Neurologic Physical Therapy 34(3):p 127-137, September 2010. | DOI: 10.1097/NPT.0b013e3181ef764d
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Effects of Intermittent Versus Continuous Walking on Distance Walked and Fatigue in MS
From the authors: "Subjects with MS walked farther, and with less fatigue, when walking intermittently rather than continuously. Persons with MS may be able to tolerate a greater dose of walking training if the walking bouts are intermittent."
+ Karpatkin, Herb PT, DSc, NCS, MSCS; Cohen, Evan T. PT, MA, PhD, NCS; Rzetelny, Adam PhD; Parrott, J. Scott PhD; Breismeister, Breanne DPT; Hartman, Ryan DPT, C/NDT; Luu, Ronald DPT; Napolione, Danielle DPT. Effects of Intermittent Versus Continuous Walking on Distance Walked and Fatigue in Persons With Multiple Sclerosis: A Randomized Crossover Trial. Journal of Neurologic Physical Therapy 39(3):p 172-178, July 2015. | DOI: 10.1097/NPT.0000000000000091
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Physical Therapist Management of Parkinson Disease: A CPG From APTA
From the authors: "Physical therapists should implement gait training to reduce motor disease severity and improve stride length, gait speed, mobility, and balance in individuals with PD. "
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+ Jacqueline A Osborne, Rachel Botkin, Cristina Colon-Semenza, Tamara R DeAngelis, Oscar G Gallardo, Heidi Kosakowski, Justin Martello, Sujata Pradhan, Miriam Rafferty, Janet L Readinger, Abigail L Whitt, Terry D Ellis, Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association, Physical Therapy, Volume 102, Issue 4, April 2022, pzab302, https://doi.org/10.1093/ptj/pzab302
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Constraint-Induced Movement Therapy after Stroke
From the authors: "Meta-analysis showed strong evidence favoring both types of CIMT in terms of motor function, arm-hand activities and self-reported arm-hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas no evidence was found for constraining alone (Forced Use (FU) therapy)."
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+ Kwakkel G, Veerbeek JM, van Wegen EE, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol. 2015;14(2):224-234. doi:10.1016/S1474-4422(14)70160-7
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CPG for Rehabilitation in TBI: A Critical Appraisal
From the authors: "Key rehabilitation recommendations included education, physical rehabilitation, integrated computer-based management, repetitive task-specific practice in daily living activities, safe equipment usage, cognitive/behavioral feedback, compensatory memory/visual strategies, swallowing/communication, and psychological input for TBI survivors."
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+ Su Yi Lee, Bhasker Amatya, Rodney Judson, Melinda Truesdale, Jan D Reinhardt, Taslim Uddin, Xiang-Hu Xiong & Fary Khan (2019) Clinical practice guidelines for rehabilitation in traumatic brain injury: a critical appraisal, Brain Injury, 33:10, 1263-1271, DOI: 10.1080/02699052.2019.1641747