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Clinical matters

This category includes posts that discuss a particular clinical issue such as unconsciousness, pain, or spasticity

Prolonged disorders of consciousness (PDOC); history and update.

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First published: February 6, 2022 The diagnosis and management of patients with prolonged disorders of consciousness is an area of expertise acquired by rehabilitation specialists starting in 1992 with the Bland case. There were few developments until 2010. Change accelerated, culminating in 2018 with a Supreme Court ruling that removed the requirement to involve the […]

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Chronic non-malignant pain

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Tamar Makin, in 2021, prefaced her Essay with, “It has long been established that phantom limb pain is a real physiological condition. Why then do we tolerate mystery and myth when it comes to phantom limb pain treatment?” This statement always makes me ask, “What limb pain is not real?” Yet many patients and many

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Pain in PDOC

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First published: July 30, 2021 Last modified: July 30, 2021 PDOC stands for Prolonged Disorder of Consciousness; the term covers two previously defined states: vegetative and minimally conscious. This post considers the question, “Does a person in a prolonged disorder of consciousness experience pain?” This question covers both pain caused by care or treatment and

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Do no harm

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I have learned much about making decisions about people in a prolonged disorder of consciousness from The Honourable Justice Hayden, Vice President of the Court of Protection. This post discusses a comment made at the most recent case I attended. He referred, indirectly’ to the saying in the Hippocratic corpus: “‘The physician must… have two

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Covid, FND, and models

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“Helping the Public Understand Adverse Events Associated With COVID-19 Vaccinations. Lessons Learned From Functional Neurological Disorder.” (here) Published today (9th April 2021), I think this viewpoint is brave; mentioning Covid-19 and functional disorders in the same title; challenging, because it suggests the bravery is warranted; and, to me, fascinating because it shows how the biomedical

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NICE on chronic pain

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On 7 April 2021, the National Institute for Health and Care Excellence, or NICE, published its guidelines on the diagnosis and management of chronic pain (NG193). I published the first version of this post the same day. Two years later (26 July 2023), I am revising my post because much was poorly written, and there

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NICE – post-Covid guide

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One December 18th 2020 the UK National Institute for Health and Clinical Excellence (NICE) published its guidance on managing the long-term effects of COVID-19. (here) On re-reading it, they are in reality suggesting that everyone should have access to “integrated, multidisciplinary rehabilitation services“. They also state (correctly) that one cannot know who has actually had

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Rehabilitation for Long-Covid

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Medical services responded rapidly to the very obvious, severe acute challenge of increasing numbers of people severely ill with Covid-19. The challenge to rehabilitation services is likely to be ten times as big, given that long-covid arises after less severe acute illness as well as after severe illness. Yet, despite the longer lead time which

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