ResearchPad - physical-medicine-rehabilitation https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Severe Kidney Injury After a 110-km Trail Race]]> https://www.researchpad.co/article/elastic_article_10498 We present a case of severe, acute kidney injury, rhabdomyolysis and dehydration in a 49-year-old, competitive trail runner, after a 110-km trail race in mountainous terrain. Six days after the event, he presented to the hospital with fatigue, weight gain and oedema. Biochemically the diagnosis of severe, acute kidney injury was made, with increased serum creatinine levels of 13.4 mg/dL (normal range 0.67-1.17 mg/dL). He remained hospitalised for two weeks, and improved with conservative measures, without the need for renal replacement therapy. Likely risk factors included ingestion of non-steroidal anti-inflammatory drugs prior to the event, dehydration and prolonged running in mountainous environment at moderate altitude. Renal function largely returned to baseline levels four months after initial presentation. This case highlights that severe kidney injury can occur, even days after ultra-running events, especially in the presence of associated risk factors. If repeated cases of acute kidney injury can trigger chronic kidney injury is currently unclear and further research in this area is warranted. In the meantime, efforts should be made to educate athletes, coaches and health care professionals about the dangers of acute kidney injury and associated risk factors.

]]>
<![CDATA[Complete Revascularization of Reimplanted Talus After Isolated Total Talar Extrusion: A Case Report]]> https://www.researchpad.co/article/N6c7ab12a-2551-475c-a049-7224380db3ea Total traumatic extrusion of the talus is a rare and disabling ankle injury. Treatment may include talar reimplantation or talar body removal, but an optimal treatment protocol has not yet been established. Several case reports showed that disruption of the vascular supply and contamination could lead to major complications, such as infection and avascular necrosis, with the high risk of these complications being associated with both the traumatic ankle injury itself and subsequent talar reimplantation. No report to date has described the revascularization of a completely extruded talus, as shown by serial MRI, a less invasive surgical strategy consisting of immediate reimplantation, early administration of antibiotics, and a short period of cast immobilization followed by early motion exercises. The present study describes complete revascularization and good clinical outcomes in a 30-year-old man who underwent talus reimplantation after isolated total talar extrusion.

]]>
<![CDATA[A Review of the Theoretical Fascial Models: Biotensegrity, Fascintegrity, and Myofascial Chains]]> https://www.researchpad.co/article/Nde4ae89a-aeee-4122-a8f4-0ca24baf853a

The fascial tissue includes solid and liquid fascia (body fluids such as blood and lymph). The fascia's nomenclature is the subject of debate in the academic world, as it is classified starting from different scientific perspectives. This disagreement is not a brake but is, in reality, the real wealth of research, the multidisciplinarity of thought and knowledge that leads to a deeper understanding of the topic. Another topic of discussion is the fascial model to conceptualize the human body, that is, how the fascial tissue fits into the living. Currently, there are some models: biotensegrity, fascintegrity, and myofascial chains. Biotensegrity is a mechanical model, which takes into consideration the solid fascia; fascintegrity considers the solid and the liquid fascia. Myofascial chains converge attention on the movement and transmission of force in the muscle continuum. The article is a reflection on fascial models and how these are theoretical-scientific visions that need to be further investigated.

]]>
<![CDATA[Combatting Sedentary Lifestyles: Can Exercise Prescription in the Emergency Department Lead to Behavioral Change in Patients?]]> https://www.researchpad.co/article/Ne0792fe3-db83-4d5d-877f-d36137dfab98

Introduction

Emergency department (ED) patients with chronic disease are known to benefit from exercise; however, there are few studies examining the prescription of exercise in the ED. We asked, is exercise prescription in the ED feasible and effective?

Methods

In this pilot prospective block randomized trial, consented patients were divided into control and intervention groups. The control group received routine care. The intervention group received combined written and verbal prescriptions for moderate exercise of 150 minutes/week. Both groups were followed up by phone at two months. The primary outcome was achieving 150 minutes of exercise per week. Secondary outcomes included change in exercise and differences in reported median weekly exercise.

Results

Follow-up was completed for 23/28 patients (11 control; 12 intervention). Baseline reported median (with interquartile range) weekly exercise was similar between groups: control 0 (0-0) minutes, intervention 0 (0-45) minutes. There was no difference between groups for the primary outcome at two months (control 3/11; intervention 4/12, relative risk [RR] 1.33 (95% confidence interval [CI] 0.38-4.6; p=1.0). There was a significant increase in median exercise from baseline in both groups, but no difference between the groups (control 75 (10-225) minutes; intervention 120 (52.5-150) minutes; NS). A post hoc comparison of patients actually receiving intervention vs. no intervention revealed a significant increase in patients meeting the primary outcome (no intervention 0/8; intervention 7/15, RR 2.0 (95% CI 1.2-3.4); p=0.05).

Conclusion

The improvement seen in patients receiving the exercise prescription intervention, and the increase in reported exercise in both groups suggests that exercise prescription for ED patients may be beneficial.

]]>
<![CDATA[Physical Therapy and Rehabilitation Approaches in Patients with Carpal Tunnel Syndrome]]> https://www.researchpad.co/article/N75c2b84f-0ce8-4580-97c0-abb9265157a3

Physical therapy involves a set of factors and methods that affect the biological processes in the body. It is widely used, relatively inexpensive, non-invasive, and easy to apply. Physiotherapy is also used in the treatment of patients with carpal tunnel syndrome (CTS). This syndrome represents the most common compressive mononeuropathy of the upper limb and leads to significant disability. Hence, its successful treatment leads to significant benefits for both the patient and society. There is no established algorithm for the use of physical therapy in these patients. In this publication, we present the physiotherapeutic methods used for the treatment of CTS both before and after surgical treatment.

]]>
<![CDATA[Lumbar Radicular Pain Response to First Injection with Non-particulate Steroid]]> https://www.researchpad.co/article/Nde279dc9-1a57-41f4-8f80-1d7622f1f2e0

Introduction

Recent studies on the use of transforaminal epidural steroid injection (TFESI) to treat lumbar radicular pain have highlighted controversies pertaining to the choice of corticosteroid agent utilized in lumbosacral TFESI, in terms of both safety and efficacy. The primary objective was to characterize the radicular pain response after a first transforaminal injection with dexamethasone. The secondary objective was to document the response of those who failed to respond to a dexamethasone injection when particulate steroid was utilized for a second injection.

Methods

It was a retrospective study of 94 consecutive patients undergoing transforaminal injection for lumbosacral radicular pain. At two-week follow-up, patients rated their pain response on a clinically oriented five-point survey. First injection non-responders were given a second injection with particulate steroid and again completed the survey.

Results

Approximately one-third (N = 31/94) of patients received no meaningful relief from a single injection with dexamethasone. No patients achieved lasting and complete pain relief after a single injection. Of initial non-particulate steroid non-responders, approximately two-thirds (N = 19/28) demonstrated a notable or complete response to a second injection with particulate steroid.

Conclusions

We are now able to better inform patients with regard to their anticipated pain response to an initial dexamethasone injection. Only one-third of patients realized more significant and lasting relief after a single injection. Of those who did not demonstrate a more meaningful response, a second injection with particulate steroid resulted in more pronounced pain relief in two-thirds of patients.

]]>
<![CDATA[Time and Repetitions Needed to Train Patients with Knee Pain on a Home Exercise Program: Are Learning Styles Important?]]> https://www.researchpad.co/article/Na4516eeb-a00e-4082-923d-b221862f7a1c

Objective

This study was designed to identify the amount of time and number of repetitions needed to explain a home exercise program recommended for most of our patients, as well as to gauge how many items patients managed to remember at their 15-day follow-up. We also considered whether the learning method had any effect on these results.

Methods

Sixty-two patients with mechanical knee pain who were admitted to our clinic were included in this study. Patients were categorized into the following three groups: group 1 with a dominant physical learning style, group 2 with a dominant auditory learning style, and group 3 with a dominant visual learning style. Heel slide, quadriceps isometric, quadriceps stretching, adductor isometric, abductor isometric, and quadriceps isotonic exercises were explained and demonstrated to all patients by the same physiotherapist, and the required time (in seconds) and repeats of exercises until the patients learned them were recorded. Remembered/forgotten exercises at the follow-up, which occurred 15 days later, were identified.

Results

A statistically significant difference was observed between groups in terms of how many seconds were needed for learning the quadriceps isometric exercises (p: 0.042). In the inter-group comparison, the difference was significant when groups 2 and 3 were compared (p: 0.046). There was a significant difference between groups in terms of how many repeats were needed for learning heel sliding (p: 0.000). Moreover, there was a significant difference between group 3 and groups 1 and 2 in the inter-group comparison (p: 0.000, p: 0.000). There was also a significant difference between groups in terms of recalling the adductor isometric exercises. Patients in group 2 were able to fully recall all these exercises.

Conclusion

It was found that the quadriceps isometric, heel slide, and adductor isometric exercises were more quickly learned, while the quadriceps stretching exercise was forgotten. We concluded that learning style is not highly important in exercise learning or recall.

]]>
<![CDATA[Comparing the Effect of Incentive Spirometry with Acapella on Blood Gases in Physiotherapy After Coronary Artery Bypass Graft]]> https://www.researchpad.co/article/N073b2c32-2a65-44c1-b3d2-3e0d8ae759a5

Objective

To compare the effect of incentive spirometry with Acapella (Smiths Medical Inc, Carlsbad, California) in physiotherapy after coronary artery bypass surgery.

Methods

A randomized controlled trial comparing incentive spirometry with Acapella was conducted in the intensive care unit of Chaudhary Pervaiz Elahi Institute of Cardiology (CPEIC) Multan. The study began from December 2017 to August 2019 after getting approval from the ethical committee of the hospital. Informed written consent was taken from all 270 patients who were included in the study. Patients who underwent coronary artery bypass graft (CABG) were divided into two groups by the lottery method. The primary end-point of the study was to check the blood gases on Day 3 after the procedure at room air and compare it with the baseline and with blood gases immediately after the procedure. SPSS 23 (IBM Corp., Armonk, NY) was used to analyze the data of this study. For qualitative variables in data such as gender, place of living, patients with any comorbidities, and education status were statistically analyzed in percentage and frequencies. For numerical variables, such as age, body mass index, blood gases values, distance covered in a six-minute walk test, and spirometry values were analyzed and statistically measured as mean and standard deviation. A P-value of less than .05 was considered significant.

Results

The mean partial pressure of oxygen (PaO2) of incentive spirometry was 58.1±2.31 and 67.2±3.24 after extubation and after three days, respectively. While the PaO2 of Acapella was 56.3±3.43 and 66.4±3.54 after extubation and after three days, respectively. The mean PCO2 of incentive spirometry was 41.4±3.26 and 36.1±2.11 after extubation and after three days, respectively. While the partial pressure of carbon dioxide (PCO2) of Acapella was 39.4±2.55 and 37.5±3.58 after extubation and after three days, respectively. The differences were statistically significant at p-value ≤0.05.

Conclusion

It was concluded that both Acapella and incentive spirometry treatment after coronary artery bypass graft improved blood gases.

]]>
<![CDATA[Ultrasound-guided Percutaneous Peripheral Nerve Stimulation for the Treatment of Complex Regional Pain Syndrome Type 1 Following a Crush Injury to the Fifth Digit: A Rare Case Report]]> https://www.researchpad.co/article/Nbe0eb686-cf4c-4000-bc8e-b0bfb38b6c90

This case report presents an application of percutaneous peripheral nerve stimulation to the left ulnar nerve to treat a patient with complex regional pain syndrome type 1 following a crush injury to the left fifth digit. Conventional treatment had failed to ameliorate the patient's condition. After a successful seven-day trial with an ulnar peripheral nerve catheter, which followed an unsuccessful capsulectomy of the metacarpophalangeal and proximal interphalangeal joints of the left fifth digit with tenolysis of the flexor tendons, the patient underwent an uneventful implantation of a percutaneous peripheral nerve stimulator parallel with the trajectory of the left ulnar nerve just distal to the ulnar tunnel. Two weeks after implantation of the percutaneous peripheral nerve stimulator, the patient reported a reduction in the pain, with the intensity score coming down from 7 out of 10 to 0-1 out of 10 on the numeric rating scale (NRS). The patient was able to initiate pain-free active motion of her left fifth digit. At the 3-month follow-up consultation, the patient reported maintenance of the reduction of pain in her left upper extremity with the implanted percutaneous peripheral nerve stimulator, as well as improved performance in her daily activities. Despite the success achieved in this particular case, further clinical series involving larger numbers of patients are warranted in order to assess the definitive role of percutaneous peripheral nerve stimulation for the treatment of neuropathic pain of the upper and lower extremities, which has been previously unresponsive to medical and/or surgical treatment.

]]>
<![CDATA[The V-Sign: A Simple Radiographic Sign of Shoulder Subluxation]]> https://www.researchpad.co/article/Nbf9db1ae-fe60-48da-93fd-41aff1a2d176

Introduction

Shoulder subluxation is a common finding associated with orthopedic pathology. This study assesses the inter- and intra-observer reliability of a new radiographic sign used to identify glenohumeral subluxation.

Methods

Shoulders of 55 consecutive patients presenting with shoulder pain were reviewed for the presence of a “V-sign”. Three shoulder surgeons reviewed all radiographs at three separate time periods in a randomized fashion. Inter- and intra-observer reliabilities were calculated.

Results

The V-sign was identified in 26 (47%) shoulders. Intra-rater reliability was satisfactory for all the three surgeons, with kappa values of 0.85, 0.78, and 0.77, respectively. Inter-rater reliability was similarly satisfactory, with a value of 0.71. The surgeons demonstrated 100% agreement on the direction of subluxation when a V-sign was documented.

Discussion

The V-sign is a reproducible radiographic sign that can be used to detect glenohumeral subluxation in patients presenting with shoulder pain.

]]>
<![CDATA[Misdirected Patients in Orthopedic Outpatient Clinics: A Retrospective Four Years Data Analysis (23435 Patients)]]> https://www.researchpad.co/article/N81119f97-3d53-4d05-86c8-97033f36e262

Objective

To identify the frequency of misdirected patients in orthopedic outpatient clinics.

Methodology

This was a retrospective study done in a private hospital of Jeddah. Computer records of patients attending the orthopedic outpatient department (OPD) during the period of 2013-2017 were collected. Data were analysed using IBM SPSS version 23 (IBM Corp, Armonk, NY). Descriptive statistics are presented as frequency and percentages.

Results

Out of the 23435 cases, 6944 (29.6%) cases should not be seen primarily in orthopedic clinic, 13638 (58.2%) were the cases that may or may not be seen primarily in orthopedic clinic, whereas, there were 2853 (12.2%) who must be seen mainly by orthopedic specialist.

Conclusion

This study revealed that a huge number of patients who visited orthopedic OPD does not need primarily orthopedic consultation. So, it is recommended to direct the patients to the right specialist in outpatient clinics to avoid the unnecessary burden on orthopedic clinics. The triage of referrals or walk-in patients may help to prevent this issue.

]]>
<![CDATA[Topical Approach to Delivering Targeted Therapies in Lymphedema Treatment: A Systematic Review]]> https://www.researchpad.co/article/N2a451498-efdf-4d41-9c52-b33e49439f84

It is estimated that 140 to 200 million people are affected by lymphedema worldwide. Many studies have proposed targeted therapies that can be delivered systemically or locally to treat lymphedema. Since lymphedema primarily affects the skin and subcutaneous tissues, topical approaches to therapy should be considered as an attractive proposition as they can avoid systemic complications. In light of this, we conducted a systematic review of publications that analyzed the use of topical approaches to delivering targeted therapies in the treatment of lymphedema. We hypothesized that topical approaches resulted in the satisfactory treatment of lymphedema. We conducted a systematic review of publications on PubMed. The main eligibility criterion was that the articles should primarily investigate the use of topical approaches to delivering targeted therapies in the treatment of lymphedema. Consequently, we excluded papers that investigated any other delivery approaches or medical conditions. Of the 174 potential studies found in the literature, six were found to fulfill our eligibility criteria. All these studies were experimental ones on small animals (mice). The authors generally proposed different types of therapies, which could be clustered into two main groups: 1) induction of lymphangiogenesis [vascular endothelial growth factor C (VEGF-C) hydrogel or fibroblast growth factor]; and 2) modulation of inflammation (tacrolimus or topical collagen gel or troxerutin-phosphatidylcholine). All studies presented positive outcomes, demonstrating that topical therapy is a promising route for delivering growth factors and anti-inflammatory agents in the treatment of lymphedema. However, studies were conducted under heterogeneous protocols, and the safe application of these therapies in humans has not been assessed. Further studies are necessary to confirm the benefits and safety of targeted topical therapy on patients with lymphedema.

]]>
<![CDATA[Does Prolonged Use of Walkers in Shoulder Arthroplasty Patients Lead to Accelerated Failure Rates?]]> https://www.researchpad.co/article/N43aeeb19-86ce-4930-8daa-c49b78cd8101

Introduction: The effect of weight-bearing on a shoulder arthroplasty (SA) remains unclear, and recommendations regarding the use of a walker in SA patients have not been established. The purpose of this study was to determine outcomes and survivorship of SA in patients who routinely use a walker.

Methods: Fifty-three primary SA (10 hemiarthroplasties (HAs), 33 anatomic total shoulder arthroplasties (TSAs), 10 reverse shoulder arthroplasties (RSAs)) in 41 walker-dependent patients were followed for a minimum of three years (mean 64 months, range, 36-156). The average age at SA was 76 years. Shoulders were assessed for pain, range of motion (ROM), satisfaction, Neer ratings, American Shoulder and Elbow Surgeons (ASES) score, complications, survivorship, and radiographic outcomes.

Results: At most recent follow-up, 40 shoulders (75%) were pain free, elevation and external rotation improved significantly (P < .0001), and 87% of the patients were satisfied. Postoperative ASES scores averaged 74 (range, 38-92) points. There were 25 excellent, 16 satisfactory, and 12 unsatisfactory results based on modified Neer ratings. Four shoulders (7.5%) required reoperation at a mean of 40 months after the index arthroplasty. Radiographically, there were six cases of glenoid loosening in the anatomic SA group (25%), and two cases of severe glenoid erosion in the HA group (25%).

Conclusion: Routine use of a walker does not appear to lead to a markedly increased rate of SA failure at mid-term follow-up. Concerning radiographic findings were more common after HA and anatomic TSA than after RSA. Longer follow-up is required to determine the long-term impact of walker use on SA.

]]>
<![CDATA[Use of Gene Transfer Vectors in Lymphedema Treatment: A Systematic Review]]> https://www.researchpad.co/article/N46c29c4c-b52d-4e64-aa88-ba4e8fd4a0a0

Different delivery mechanisms have been proposed in the literature for targeted therapies in the treatment of lymphedema. They vary from simple and direct injection to sophisticated induction of gene expression in a targeted tissue. We conducted a systematic review of publications assessing the use of viral vectors for gene transfer in lymphedema treatment. We hypothesized that viral vectors are an effective way to deliver targeted therapy in lymphedema treatment. We conducted a comprehensive systematic review of the published literature on targeted therapies associated with lymphedema surgery using the PubMed database. Eligibility criteria excluded papers that reported use of viral vectors for other medical conditions. Abstracts, presentations, reviews, meta-analyses, and non-English language articles were also excluded. From 21 potential articles found in the literature, fourteen fulfilled study eligibility criteria. Positive outcomes in terms of lymphangiogenesis were seen. The viral vectors used included adenovirus and recombinant adeno-associated virus. Most of the genes expressed were growth factors, but expression of dominant-negative transforming growth factor-β1 receptor-II or Prox1 was also proposed. Five studies targeted genetic expression on lymphedema tissue, five on transplanted lymph nodes, two on skeletal muscle, and one on adipose-derived stem cells. Publications assessing use of viral vectors for gene transfer in lymphedema treatment demonstrated that it is an effective mechanism of delivering targeted therapies. However, to date, all studies were experimental and further studies must be performed before translating these therapies into clinical practice.

]]>
<![CDATA[Idiopathic Basal Ganglia Calcification: Fahr’s Syndrome, a Rare Disorder]]> https://www.researchpad.co/article/Ne6600cc5-5500-4af1-8e2b-59d9c15fa925

Fahr’s syndrome is a rare neurological disorder with varied clinical manifestations. It is characterized by the progressive deposition of calcium in the walls of the blood vessels of basal ganglia and dentate nuclei of the cerebellum in young and middle-aged people. It is important for neurologists, geneticists, psychiatrists, dentists, and other appropriate care specialists to have a thorough knowledge of this syndrome as any of them could be the first person to diagnose the disease. This case report of Fahr’s syndrome presents the signs and symptoms of the patient and the treatment for oral conditions were done.

]]>
<![CDATA[The Effectiveness of Prehabilitation (Prehab) in Both Functional and Economic Outcomes Following Spinal Surgery: A Systematic Review]]> https://www.researchpad.co/article/5b694588463d7e3776ea3ad8

Rehabilitation prior to orthopedic surgery (prehab) has been studied with more frequency and studies have shown reduced costs and improved functional outcomes among patients who have undergone total hip arthroplasty (THA) and total knee arthroplasty (TKA). This literature review is to determine whether prehab improves functional outcomes and reduces costs following spinal surgery.

PubMed, CINHAL via EBSCO and EMBASE via Ovid were searched with publication date restrictions from May 2006 to May 2016 for the terms ‘physical therapy’, ‘physiotherapy’, ‘prehabilitation’ or ‘prehab’, ‘spine’ or ‘spinal’, and ‘preoperative’ or ‘pre-op’.

The search yielded 737 eligible articles which were screened by two independent reviewers. Randomized controlled trials (RCT) with adults who participated in preoperative exercise interventions as part of a prehab or preoperative exercise program for spinal surgery versus standard care were included.

Methodology and results of the studies were critically appraised in conformity with PRISMA guidelines.

Three RCTs were included, all of which analyzed outcomes of prehab following lumbar spinal surgery. Two of the articles were of high quality and three were of low quality. None of the studies demonstrated a statistically significant difference in pain scores or disability questionnaires in the intervention groups postoperatively, however, no negative effects were reported either. With neuroscience education, patient’s reported feeling prepared for surgery and expressed positive outlook regarding the intervention. Two of the studies found perioperative intervention reduced the total cost of healthcare spending associated with spinal surgery. Due to the heterogeneity of the outcome measures, a meta-analysis was not possible.

There is lack of significant evidence looking at functional outcomes using physical therapy prior to spinal surgery. Prehab should continue to be researched prior to spinal surgery to determine effectiveness in patient outcomes.

]]>
<![CDATA[Obstructive Sleep Apnea: An Unusual Cause of Hemorrhagic Stroke]]> https://www.researchpad.co/article/5b45c62e463d7e5426b74ce6

Stroke is one of the most common causes of mortality and morbidity worldwide. Hemorrhagic stroke comprises 10-20% of strokes. Here, we present a case report of hemorrhagic stroke that may have been secondary to untreated Obstructive Sleep Apnea (OSA) in a young man with no other cardiovascular risk factors or features of metabolic syndrome. A 32-year-old man was admitted for hemorrhagic stroke. An initial thorough workup for the etiology of stroke was inconclusive. Eventually, a polysomnography was done, which demonstrated OSA suggesting that untreated OSA may have contributed to his stroke. OSA may cause hemorrhagic stroke by nocturnal blood pressure surge. So, all physicians should consider doing polysomnography for unexplained hemorrhagic stroke or in patients at risk. Diagnosing and treating OSA would be critical in preventing hemorrhagic stroke and its recurrences.

]]>
<![CDATA[Thenar Compartment Syndrome: What If a Compartment Pressure Measuring Device is Absent?]]> https://www.researchpad.co/article/5b589a11463d7e4c743d09a9

Compartment syndrome (CS) is a threatening condition characterized by excessive tissue pressure accumulation associated with acute trauma. Compartment syndrome causes a significant reduction in blood flow with subsequent muscle and nerve ischemic necrosis. Recently, reports have described the importance of intramuscular pressure measurements as a basis for CS diagnosis. Unfortunately, the measuring devices that were utilized produced results with unsatisfactory reliability, making a diagnosis and subsequent treatment challenging. Here, we report the use of an anesthesia pressure monitoring device with greater precision for pressure measurements, as well as real-time monitoring of intraoperative compartment pressure decompression efficacy. This device enabled the accurate diagnosis and rapid treatment of a thenar compartment syndrome (TCS) in the left hand of a diabetic female in an emergency setting. She presented extreme pain in the thumb flexion-extension (FE). Her condition was complicated by diabetic cellulitis, primarily of Staphylococcus aureus. Consequently, successful microsurgery in the thenar space, together with debridement, resulted in remarkable pain relief during FE of the thumb metacarpophalangeal (MCP) and interphalangeal (IP) joints, as well as the disappearance of the infection by Day 10. Subsequent one- to two-year follow-up assessments revealed marked recovery.

]]>