Bruce E. Becker

Aquatic Therapy: Scientific Foundations and Clinical Rehabilitation Applications

The aquatic environment has broad rehabilitative potential, extending from the treatment of acute injuries through health maintenance in the face of chronic diseases, yet it remains an underused modality. There is an extensive research base supporting aquatic therapy, both within the basic science literature and clinical literature. This article describes the many physiologic changes that occur during immersion as applied to a range of common rehabilitative issues and problems. Because of its wide margin of therapeutic safety and clinical adaptability, aquatic therapy is a very useful tool in the rehabilitative toolbox. Through a better understanding of the applied physiology, the practitioner may structure appropriate therapeutic programs for a diverse patient population.

Poster 345: The Impact of an Aquatic Exercise Protocol on Physiologic Measures Within an Asthmatic Population: A Case Series

Disclosures: M. Warnick, Ipsen, US, Employment. Objective: To assess reconstitution techniques, dosing, and injectors’ perceptions of potential adverse events (AE) when using botulinum toxin type A to treat pediatric cerebral palsy in the European Union (EU). Design: Telephone interviews were conducted with botulinum toxin type A experienced injectors about their experience and knowledge of this intervention. The survey included questions about reconstitution dilution volumes, botulinum toxin type A doses and AEs. Setting: Twenty-minute telephone interviews with EU physicians. Participants: Botulinum toxin type A experienced injectors in 5 EU countries (France [n 18], Germany [n 20], Greece [n 6], Sweden [n 4], and the UK [n 26]). Interventions: Not applicable. Main Outcome Measures: Reconstitution dilution volumes used, the average total dose and maximum dose used, and AEs. Results: The reconstitution dilution volume was typically reported as 2.5 mL/500 U. The average total Dysport doses reported by the physicians during the interviews were 375 U, 544 U, 700 U, 400 U, and 600 U for France, Germany, Greece, Sweden, and the UK, respectively. The mean maximum dose reported by the physicians during the interviews were 637 U, 906 U, 600 U, 467 U, and 1148 U for France, Germany, Greece, Sweden, and the UK, respectively. When treating pediatric cerebral palsy with botulinum toxin type A, 17% to 40% of the surveyed physicians in the different countries specified potential AEs. The most common AE noted for patients with pediatric cerebral palsy was leg muscle weakness (29%-100% of physicians). Conclusions: Most surveyed physicians reported using a reconstitution dilution volume of 2.5 mL/500 U (ie, 200 U/mL), but they reported using a range of average total botulinum toxin type A doses in the different countries (range, 375-700 U). Leg muscle weakness was the most common potential AE specified by physicians for pediatric cerebral palsy.

Re: Use of Regional Blockade to Facilitate Inpatient Rehabilitation of Recalcitrant Complex Regional Pain Syndrome

o the Editor, I greatly enjoyed the most recent issue of PM&R, and espeially the article on regional blockade of complex regional pain yndrome type 1 to facilitate inpatient rehabilitation. The conept is not new, however. While serving my internship at rooke Army Medical Center (BAMC) during the height of the iet Nam conflict, I spent many months on the BAMC orthoedic service, which at that time was the recipient of nearly 20% f all Viet Nam casualties. As a consequence of this large patient opulation, we had an entire service dealing with what was still alled causalgia, a name often attributed to the Civil War sureon Silas Weir Mitchell, but that he related was given to his till-classic description of the clinical picture by his friend and olleague, Prof. Robley Dunglison [1]. During the American ivil War (1861-1865), Mitchell studied peripheral nerve injuies with colleagues George Read Morehouse and William Wiliams Keen. Three monographs resulted from this work, the ost important of which was “Gunshot Wounds and Other njuries of Nerves” published in 1864, which remains in publiation even today. Our service typically had between 6 and 10 soldiers at any ne time, mostly with lower limb injuries. One of the career rthopedists on the service had a deep interest in causalgia, and e developed a protocol for treatment that involved implantaion of an indwelling catheter proximate to the nerve involved 1