PM&R: Live from the Annual Meeting of the American Academy of Physical Medicine and Rehabilitation in Orlando, Florida

8 Responses to PM&R: Live from the Annual Meeting of the American Academy of Physical Medicine and Rehabilitation in Orlando, Florida

1. Rick says:

   November 18, 2011 at 10:53 am

   What is the latest on a “bionic” eye? Father of blind child in one eye and legally blind in other.

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   • Tracy says:

     December 13, 2011 at 3:43 pm

     From Dr. Raymond Iezzi M.D. “There is alot of research in the area of sensory substitution of restoring sight in the blind. For those that have healthy optic nerves, there is a retinal prosthesis that is in routine clinical use in Europe and is in FDA clinical trials for patients with advanced retinitis pigmentosa. For those that have optic tract disease, some scientists are developing cortical visual prostheses. These devices would be implanted directly into the visual cortex. These are a bit futher off, however.”

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2. Nick Gibbs says:

   November 19, 2011 at 7:24 am

   Given how easy they are to get & just how hard they can be to spot how exactly do you know you or someone else has a mild one?

   You can get them from near anything & it’s very possible to not know, I’m just after some finer detials so we know better on when to be checked out.

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   • Tracy says:

     January 6, 2012 at 11:18 am

     Dr. Rizzo responds:
     First, concussions will typically be associated with some sort of trauma–either a blow to the head or some other contact that “shakes the brain” (although this is less likely in sports, it can be seen in explosions or other violent trauma e.g. car accidents)

     If there is any suspicion of an injury to the brain the person should be assessed. Being knocked out, being woozy, foggy, not remembering are all obvious problems that should prompt further assessment.

     Not being able to do something that you could before: hop on one foot, run, cut, jump or other activities that require coordination. If you stop doing something that you could do, you should be assessed. This would also include remembering, doing tasks at work or school or being organized. This presumes you were organized before.

     Subtle problems that may represent something more serious would include new irritability, being tired, or changes in personality.

     Regardless of whether the person can put up with the symptoms, the symptoms should go away and the person should be back to “normal” before going back to play a sport.

     I hope this helps.

     Tom

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3. Gabriel says:

   November 19, 2011 at 8:47 am

   What is the current guideline to have a head CT scan after a concussion ? LOC for more than 5 mins? #2 If the patient had a concussion, went to ER . No CT scan done, but continues having mild to moderate headache . This person needs a CT? Assuming that the neuro exam and there’s not other symptoms for botjs questions. #3 Should the patient avoid NSAIDS and sedatives analgesics after a concussion even if the head CT was normal? If so, what do you recommend besides Tylenol?

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   • Tracy says:

     December 13, 2011 at 3:40 pm

     This is from Mayo Expert:
     Concussion is a functional problem, not a structural abnormality (eg, subdural hematoma, intracerebral hemorrhage). Therefore, in general, computed tomography and other advanced imaging methods are not helpful in making a diagnosis. However, advanced imaging of the brain is indicated when a person has a focal neurologic deficit, severe symptoms, persistent symptoms, or worsening of symptoms.

     From Dr. Thomas Rizzo: With persistent symptoms, evaluation by a neurologist is warranted and advanced imaging if, the neurologist thinks it will change the management. I think that many headache specialists would eventually get an MRI or CT scan, but it is not unusual for the study to be normal. Current guidelines are to gradually reintroduce activities as long as symptoms are under control. E.g. No Headache with daily activity, ok to go to practice but only to walk through; ok with walking then increased effort, etc. Symptoms can last for months (Sidney Crosby is an example). I would only use Tylenol as sedating medications can confuse the picture. NSAIDS are okay if there is no concern about bleeding.

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4. JAMES CHURCH says:

   November 19, 2011 at 9:57 am

   I had a PEG tube put in in December of 2010. It was removed in August 2011 due to infection,and multiple cases of the balloon deflating and the PEG coming out, So I live on Ensure. The port never healed resulting in a Fistula which is staying infected. Immune to antibiotics. Any suggestions on this one? Surgery is extremely dangerous due to other medical conditions.

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   • Tracy says:

     December 13, 2011 at 3:41 pm

     Dr. Rizzo responds “Not really my area. Lots of unanswered questions: How to get the PEG to stay in or to convert it to a tube that is into the duodenum; not clear what the story is with the infected fistula and how this could be treated differently. Not clear why surgery would be so dangerous–PEGs can be just about put in at the bedside under local anesthetic. This question should be directed to an GI endoscopist who puts in PEGs. “

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