Neurology Commons^™

High Doses Of Caffeine-Induced Cerebral Infarction Leading To Partial Locked-In Syndrome In A Young Adult: A Novel Association?, Vijay Sinha, Loc Lam, Michael V Nguyen

Faculty, Staff and Student Publications

INTRODUCTION: This is a case of a 30-year-old male with no prior medical conditions presented to the emergency department for presumed seizures after ingesting 900 mg of caffeine via pre-workout drinks and pills.

CASE PRESENTATION: The patient was described as having nearly 15 min of generalized seizure activity observed by emergency medical service, requiring midazolam. A head computerized tomography (CT) demonstrated a possible thrombus, and further, CT angiography and CT perfusion confirmed a basilar artery occlusion. He was treated with tissue plasminogen activator and underwent thrombectomy achieving TICI grade 3 in the left posterior cerebral artery and TICI grade 2b …

Multimodal Therapy And Use Of Adjunctive Therapies To Bont-A In Spasticity Management: Defining Terminology To Help Enhance Spasticity Treatment, Rajiv Reebye, Luis Jorge Jacinto, Alexander Balbert, Bo Biering-Sørensen, Stefano Carda, Nathalie Draulans, Franco Molteni, Michael W O'Dell, Alessandro Picelli, Andrea Santamato, Monica Verduzco-Gutierrez, Heather Walker, Joerg Wissel, Gerard E Francisco

Faculty, Staff and Student Publications

Spasticity management should be provided within the context of a comprehensive person-centered rehabilitation program. Furthermore, active goal setting for specific spasticity interventions is also important, with a well-established "more is better" approach. It is critical to consider adjunctive therapy and multimodal approaches if patients are not attaining their treatment goals. Often used interchangeably, there may be confusion between the terms adjunctive and multimodal therapy. Yet it is imperative to understand the differences between these approaches to achieve treatment goals in spasticity management. Addition of a secondary pharmacologic or non-pharmacologic treatment to optimize the efficacy of the initial modality, such as …

Safety And Feasibility Of Paired Vagus Nerve Stimulation With Rehabilitation For Improving Upper Extremity Function In People With Cervical Spinal Cord Injury: Study Protocol For A Pilot Randomized Controlled Trial, Nuray Yozbatiran, Gerard E Francisco, Radha Korupolu

Faculty, Staff and Student Publications

Introduction: Pairing vagus nerve stimulation with traditional rehabilitation therapies results in improved motor recovery in people with stroke. However, this approach has not yet been studied in people with spinal cord injury (SCI). Motor recovery continues to be challenging after SCI, and there is a need for innovative research strategies to enhance motor recovery after SCI. Hence, this pilot randomized controlled trial aims to evaluate the safety, feasibility, and potential efficacy of pairing vagus nerve stimulation (VNS) with rehabilitation therapy to restore the motor function of the paretic upper limbs in people with cervical SCI.

Methods and analysis: In this …

Proportional Sway-Based Electrotactile Feedback Improves Lateral Standing Balance, V S Raghav Hari Krishna, Jeonghee Kim, Shuo-Hsiu Chang, Yoonsuck Choe, Hangue Park

Faculty, Staff and Student Publications

INTRODUCTION: Plantar cutaneous augmentation is a promising approach in balance rehabilitation by enhancing motion-dependent sensory feedback. The effect of plantar cutaneous augmentation on balance has been mainly investigated in its passive form (e.g., textured insole) or on lower-limb amputees. In this study, we tested the effect of plantar cutaneous augmentation on balance in its active form (i.e., electrical stimulation) for individuals with intact limbs.

METHODS: Ten healthy subjects participated in the study and were instructed to maintain their balance as long as possible on the balance board, with or without electrotactile feedback evoked on the medial side of the heel, …

Impact Of Routine Urine Cultures On Antibiotic Usage In Those Undergoing A Routine Annual Spinal Cord Injury Evaluation, Sarah May, Annette Walder, Casey Hines-Munson, Ivy Poon, S Ann Holmes, Charlesnika T Evans, Barbara W Trautner, Felicia Skelton

Faculty, Staff and Students Publications

OBJECTIVE: The Veterans Health Administration (VHA), the largest single provider of spinal cord injury and disorder (SCI/D) care in the United States, currently mandates that every patient receives a screening urine culture during the annual evaluation, a yearly comprehensive history and physical examination. This testing has shown in a small subset of patients to overidentify asymptomatic bacteriuria that is then inappropriately treated with antibiotics. The objective of the current analysis was to assess the association of the annual evaluation on urine testing and antibiotic treatment in a national sample of Veterans with SCI/D.

DESIGN/METHOD: A retrospective cohort study using national …

Botulinum Toxin Type A Injections For Refractory Abdominal Dystonia: A Case Report, William J. Naber Ii, Jodi M. Wilhelm, Kurt A. Kuhlman, Gabriel Howard

Graduate Medical Education Research Journal

Background: A 58-year-old male with chronic bilateral treatment resistant abdominal spasms secondary complications of ascites/ alcoholic cirrhosis. Spasms would occur 4-5 times/day, lasting minutes to hours despite a 2-year course of therapeutic and pharmacological interventions. Due to treatment refraction, 6 uniformly spaced botulinum toxin type A (BTX-A) injections were placed per side, using electromyography for audible intramuscular syringe placement confirmation, while visual confirmation was made via ultrasound. During the initial trial, 6 evenly spaced injections were performed bilaterally, uniformly distributing 80U/side. Injections began bilaterally just medial to the junction of the inferior rib cage border/ anterior axillary line and progressed …

Importance Of Health Policy And Systems Research For Strengthening Rehabilitation In Health Systems: A Call To Action To Accelerate Progress, Walter R Frontera, Wouter Degroote, Abdul Ghaffar, Health Policy & Systems Research For Rehabilitation Group

Faculty, Staff and Student Publications

No abstract provided.

Effect Of Posterior Leaf Spring And Carbon Composite Ankle Foot Orthosis On Gait And Functional Mobility Of Stroke Survivors With Hemiplegia: A Randomized Clinical Trial, Zidikheri B. Msechu, Ahmad Zaheer Qureshi, Tim Drew

Internet Journal of Allied Health Sciences and Practice

Purpose: The study was carried out as a randomized clinical trial to assess the effect of posterior leaf spring ankle foot orthosis (PLS-AFO) and carbon composite ankle foot orthosis (C-AFO) on functional mobility, walking speed and satisfaction among stroke survivors with hemiplegia. Methods: Twenty-seven ambulatory stroke survivors with hemiplegia who had completed a rehabilitation program and were already using an ankle foot orthosis (AFO) were included in the study. Subjects were randomly assigned either PLS-AFO or C-AFO and assessment was done with and without their AFOs. Functional mobility, walking speed, and satisfaction were assessed using the Timed Up and …

Neurofeedback Within The Scope Of Occupational Therapy With Clients With Substance Use Disorder: A Scoping Review, Aundrea Culliver, Mary Ann Smith, Steven M. Gerardi, Colin Ross

Summer 2023 Virtual OTD Capstone Symposium

Substance use disorder (SUD) is a problematic pattern of use of a substance or substances, leading to impairments to health, social function, and control of a substance. This negatively affects everyday activities of daily living, and occupation performance that causes a disruption to physical, mental, and social health.

Now, Neurofeedback is a noninvasive biotherapy that uses audio or video feedback to reinforce healthy brain function. This type of intervention usually works by having a patient listen to music and putting electrodes on a patient’s head that pick up negative or positive brain activity or waves. And if the negative activity …

The Role Of Exercise In The Alleviation Of Neuropathic Pain Following Traumatic Spinal Cord Injuries: A Systematic Review And Meta-Analysis, Amirmohammad Toloui, Hamzah Adel Ramawad, Pantea Gharin, Alexander Vaccaro, Hamed Zarei, Mostafa Hosseini, Mahmoud Yousefifard, Vafa Rahimi-Movaghar

Rothman Institute Papers

OBJECTIVE: The objective of this systematic review and meta-analysis was to assess the efficacy of exercise in neuropathic pain following traumatic spinal cord injuries.

METHODS: The search was conducted in MEDLINE, Embase, Scopus, and Web of Science by the end of 2022. Two independent researchers included the articles based on the inclusion and exclusion criteria. A standardized mean difference was calculated for each data and they were pooled to calculate an overall effect size. To assess the heterogeneity between studies, I2 and chi-square tests were utilized. In the case of heterogeneity, meta-regression was performed to identify the potential source.

RESULTS: …

Examining The Latent Structure And Correlates Of Sensory Reactivity In Autism: A Multi-Site Integrative Data Analysis By The Autism Sensory Research Consortium, Zachary J. Williams, Roseann Schaaf, Karla K. Ausderau, Grace T. Baranek, D. Jonah Barrett, Carissa J. Cascio, Rachel L. Dumont, Ekomobong E. Eyoh, Michelle D. Failla, Jacob I. Feldman, Jennifer H. Foss-Feig, Heather L. Green, Shulamite A. Green, Jason L. He, Elizabeth A. Kaplan-Kahn, Bahar Keçeli-Kaysılı, Keren Maclennan, Zoe Mailloux, Elysa J. Marco, Lisa E. Mash, Elizabeth P. Mckernan, Sophie Molholm, Stewart H. Mostofsky, Nicolaas A.J. Puts, Caroline E. Robertson, Natalie Russo, Nicole Shea, John Sideris, James S. Sutcliffe, Teresa Tavassoli, Mark T. Wallace, Ericka L. Wodka, Tiffany G. Woynaroski

Department of Occupational Therapy Faculty Papers

BACKGROUND: Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these "supra-modal" traits in the autistic population.

METHODS: Leveraging a combined sample of 3868 autistic youth drawn from 12 distinct data sources (ages 3-18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to …

Electric Field Navigated 1-Hz Rtms For Poststroke Motor Recovery: The E-Fit Randomized Controlled Trial, Dylan J. Edwards, Charle Y. Liu, Kari Dunning, Felipe Fregni, Jarmo Laine, Benjamin E. Leiby, Lynn M. Rogers, Richard L. Harvey

Moss-Magee Rehabilitation Papers

BACKGROUND: To determine if low-frequency repetitive transcranial magnetic stimulation targeting the primary motor cortex contralateral (M1_CL) to the affected corticospinal tract in patients with hemiparetic stroke augments intensive training–related clinical improvement; an extension of the NICHE trial (Navigated Inhibitory rTMS to Contralesional Hemisphere Trial) using an alternative sham coil.

METHODS: The present E-FIT trial (Electric Field Navigated 1Hz rTMS for Post-stroke Motor Recovery Trial) included 5 of 12 NICHE trial outpatient US rehabilitation centers. The stimulation protocol remained identical (1 Hz repetitive transcranial magnetic stimulation, M1_CL, preceding 60-minute therapy, 18 sessions/6 wks; parallel arm randomized clinical …

Ot's Role In Facilitating Successful Role Transition For Informal Caregivers Of People Living With Dementia, Kiyatta Freeman, Monica Watford, Evyline Chioma

Summer 2023 Virtual OTD Capstone Symposium

The aim of this capstone project was to identify education and training needs for family caregivers of individuals living with dementia and create an educational workshop based on these identified needs. This workshop is a dementia training course focused on education on the dementia diagnosis and effective care strategies to promote occupational participation and safety for the care recipient and the caregiver. The aim is to improve care competency, reduce stress, and facilitate role transition.

The Importance Of Addressing Sleep As An Occupation Within Assisted Living Communities, Brittany Kiattitananan, Kendra Orcutt, Lisa Griggs-Stapleton

Summer 2023 Virtual OTD Capstone Symposium

Around 40-70% of older adults have difficulty sleeping (Sheth & Thomas, 2019). This poster presents an occupation-based sleep intervention program developed for residents of an assisted living community and serves to inform OT practitioners on addressing sleep in their own practice.

Implementation Of Tai Chi Among Individuals With Dementia In Long-Term Memory Care, Patricia I. Cordova, Lisa Griggs-Stapleton, Kim Broussard

Summer 2023 Virtual OTD Capstone Symposium

This project focused on a dementia population within long-term care, where increased disablement occurs. A Tai Chi program was implemented into the daily routine of individuals in a long-term memory care facility to improve dynamic sitting balance for the performance of daily occupations.

The Sandwich Generation Of Aging Parents With Dementia: An Occupation-Based Caregiver Program, Gabrielle Amaya, Lisa Griggs-Stapleton, Kylee Hall

Summer 2023 Virtual OTD Capstone Symposium

Despite the high prevalence of caregiver burnout, caregivers’ needs are unrecognized because the focus is on caregiver quality of life, experience, or service utilization (Frankenstein & Jahn, 2020). This program aims to identify ways to provide specific support to promote caregiver ADL participation through the use of a web-based training and education program.

Using Predictive Validity To Compare Associations Between Brain Damage And Behavior, John F Magnotti, Jaclyn S Patterson, Tatiana T Schnur

Faculty, Staff and Student Publications

Lesion-behavior mapping (LBM) provides a statistical map of the association between voxel-wise brain damage and individual differences in behavior. To understand whether two behaviors are mediated by damage to distinct regions, researchers often compare LBM weight outputs by either the Overlap method or the Correlation method. However, these methods lack statistical criteria to determine whether two LBM are distinct versus the same and are disconnected from a major goal of LBMs: predicting behavior from brain damage. Without such criteria, researchers may draw conclusions from numeric differences between LBMs that are irrelevant to predicting behavior. We developed and validated a predictive …

Treatment Of Adult Spasticity With Botox (Onabotulinumtoxina): Development, Insights, And Impact, Alberto Esquenazi, Wolfgang H. Jost, Catherine C. Turkel, Theodore Wein, Rozalina Dimitrova

Moss-Magee Rehabilitation Papers

Upper and lower limb spasticity (ULS, LLS) often occur following a stroke or in patients with other neurological disorders, leading to difficulties in mobility and daily living and decreased quality of life. Prior to the use of onabotulinumtoxinA, antispastic medications had limited efficacy and often caused sedation. Phenol injections were difficult for physicians to perform, painful, and led to tissue destruction. The success of onabotulinumtoxinA in treating cervical dystonia led to its use in spasticity. However, many challenges characterized the development of onabotulinumtoxinA for adult spasticity. The wide variability in the presentation of spasticity among patients rendered it difficult to …

Occupational Therapists' Perceptions Of Sensory Processing Evaluation Methods, Grace Hong, Jazminne Orozco Arteaga, Karen Park

Summer 2023 Virtual OTD Capstone Symposium

Background: This study aimed to obtain occupational therapists’ (OTs) experiences and perspectives on current evaluation tools who work with clients with sensory processing challenges in their clinical settings. Method: This research was a mixed-method study. Data was collected from surveys (n = 11) which had a mix of nominal, interval, close-ended, and open-ended questions. Following survey completion, participants were given the option to complete a semi-structured interview (n = 2) consisting of open-ended questions to clarify survey responses and gather additional information about their experiences. Results: The results indicated a high number of various barriers and limitations …

Predictors And Temporal Trends Of Withdrawal Of Life-Sustaining Therapy After Acute Stroke In The Florida Stroke Registry, Ayham Alkhachroum, Lili Zhou, Negar Asdaghi, Hannah Gardener, Hao Ying, Carolina M Gutierrez, Brian M Manolovitz, Daniel Samano, Danielle Bass, Dianne Foster, Nicole B Sur, David Z Rose, Angus Jameson, Nina Massad, Mohan Kottapally, Amedeo Merenda, Robert M Starke, Kristine O'Phelan, Jose G Romano, Jan Claassen, Ralph L Sacco, Tatjana Rundek

Faculty, Staff and Student Publications

Temporal trends and factors associated with the withdrawal of life-sustaining therapy (WLST) after acute stroke are not well determined.

DESIGN: Observational study (2008-2021).

SETTING: Florida Stroke Registry (152 hospitals).

PATIENTS: Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) patients.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Importance plots were performed to generate the most predictive factors of WLST. Area under the curve (AUC) for the receiver operating curve were generated for the performance of logistic regression (LR) and random forest (RF) models. Regression analysis was applied to evaluate temporal trends. Among 309,393 AIS patients, 47,485 ICH patients, and …

Efektivitas Manual Therapy Dan Ultrasound Terhadap Peningkatan Fungsi Gerak Bahu Pada Kasus Nyeri Bahu Et Causa Bursitis Subacromialis Dengan Parameter Spadi Di Rsud Muhammad Natsir, Fadhilah Az-Zahra, Ronal Lufitos, Faizah Abdullah Djawas

Jurnal Fisioterapi Terapan Indonesia

ABSTRACT: Adhesive Capsulitis is a disorder that occurs in the shoulder area in the form of inflammation of the joint capsule which causes a feeling of stiffness and pain. Glenohumeral joint mobilization with the Maitland mobilization technique is using passive mobilization with physiological oscillatory movements which can produce a stretching effect and release of adhesive on the ligament capsule in the shoulder so that the range of motion of the shoulder joint can be increased. Hold relax is an exercise therapy with the principle of reciprocal inhibition which aims to improve antagonistic pattern relaxation, and mobilization, and to reduce pain. …

Neurodynamic Technique Terhadap Penurunan Nyeri, Peningkatan Grip Strength, Dan Peningkatan Kemampuan Fungsional Pada Carpal Tunnel Syndrome, Safrin Arifin, Fathia Dheanisa

Jurnal Fisioterapi Terapan Indonesia

Carpal tunnel syndrome is a syndrome that occurs in 1-4% of the total population worldwide. This condition causes disruption of function and motion in the wrist that spreads to the fingers. Physiotherapy intervention is necessary to reduce the severity of symptoms in patients with CTS. Neurodynamic Techniques are nerve mobilization techniques that aim to restore homeostasis in the nerves so as to reduce pain and improve functional ability. Materials and methods. This research was conducted through searching several databases, found 31 articles which were then filtered and selected as many as 10 articles. However, of the 11 articles, further screening …

Aerobic Exercise Terhadap Peningkatan Endurance Pada Pasien Penyakit Jantung Koroner Dengan Pemeriksaan 6mwt : Studi Kasus, Dela Fariha Fuadi, Andrew Wijaya Saputra, Nabilla Nur Awaliah Dzatikhulwani

Jurnal Fisioterapi Terapan Indonesia

Background: Coronary heart disease (CHD) is a condition in which the heart's blood vessels (coronary arteries) are blocked by fat deposits. Based on data from Riskesdas (2018) it is revealed that cases of heart and blood vessel disease in Indonesia are increasing every year, increasing the mortality rate. This is due to the presence of risk factors that support the emergence of coronary heart disease. Objective: The aim of this paper is to evaluate the evaluation of aerobic exercise to increase endurance in patients with coronary heart disease by examining 6MWT. Method: This research is in the form of a …

Pengaruh Durasi Penggunaan Smartphone Di Kalangan Pelajar Terhadap Frekuensi Nyeri Leher, Irawan Wibisono, Didik Purnomo, Suci Amanati

Jurnal Fisioterapi Terapan Indonesia

Neck pain is a musculoskeletal problem that is often encountered in productive age, one of the triggers for neck pain is an unergonomic position for a long time. For example when using a smartphone, the position of the neck will tend towards the front. The use of smartphones in this technological era takes a long time. This is because smartphones have become part of student life. This study aims to determine the effect of the duration of smartphone use on the frequency of neck pain. This research method uses descriptive cross sectional with a total sample of 68 people, while …

Single Leg Depth Jump Kombinasi Core Plank Knee To Elbow Terhadap Power Otot Tungkai Atlet, Maya Triyanita, Siti Sardianti Dwi Tirta

Jurnal Fisioterapi Terapan Indonesia

Power limit training is defined as the movement to get a jump on athletes in doing the maximum jump smash. Badminton requires leg muscle explosive power because it is the muscle's ability to overcome loads and with a high speed of contraction. This study aims to determine the effect of the single leg depth jump exercise, the combination of the knee to elbow core plank, on increasing leg power in badminton athletes.

This study uses an experimental design method. This research was conducted on badminton athletes using a total sampling technique of 13 people, namely the Pliometric Simgle Leg Dept …

Vagus Nerve Stimulation Paired With Rehabilitation For Upper Limb Motor Impairment And Function After Chronic Ischemic Stroke: Subgroup Analysis Of The Randomized, Blinded, Pivotal, Vns-Rehab Device Trial, Jesse Dawson, Navzer D Engineer, Steven C Cramer, Steven L Wolf, Rushna Ali, Michael W O'Dell, David Pierce, Cecília N Prudente, Jessica Redgrave, Wuwei Feng, Charles Y Liu, Gerard E Francisco, Benjamin L Brown, Anand Dixit, Jen Alexander, Louis Demark, Vibor Krishna, Steven A Kautz, Arshad Majid, Brent Tarver, Duncan L Turner, Teresa J Kimberley

Faculty, Staff and Student Publications

BACKGROUND: Vagus Nerve Stimulation (VNS) paired with rehabilitation improved upper extremity impairment and function in a recent pivotal, randomized, triple-blind, sham-controlled trial in people with chronic arm weakness after stroke.

OBJECTIVE: We aimed to determine whether treatment effects varied across candidate subgroups, such as younger age or less injury.

METHODS: Participants were randomized to receive rehabilitation paired with active VNS or rehabilitation paired with sham stimulation (Control). The primary outcome was the change in impairment measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE) score on the first day after completion of 6-weeks in-clinic therapy. We explored the effect of VNS …

Occupation Based Program Enhancement: Promoting Social And Leisure Participation Post-Stroke, Emma Welch, Amy Lyons-Brown

Spring 2023 Virtual OTD Capstone Symposium

This presentation describes the importance of social and leisure participation for individuals who have had a stroke and explores the role of occupational therapy in promoting this area of occupation for the population.

Examining The Use Of Expressive Arts Therapies In Neurorehabilitation Treatment Planning, Rebecca J. Horner

Expressive Therapies Capstone Theses

Those undergoing neurorehabilitation after stroke and traumatic brain injury report a diminished sense of overall wellness. This paper examines the conceivable benefits of introducing expressive arts therapies, which is the therapeutic use and combination of the visual arts, movement, drama, music, writing and other intermodal creative processes, into physical therapy and neurorehabilitation treatment planning. Expressive arts therapies have the capacity to engage with an individual’s physical, emotional, social and spiritual states concurrently. They simultaneously offer the ability to promote an increased sense of well-being, address mind-body disconnects, and process trauma non-verbally.

The sections of this narrative literature review focus on …

Efficient Cancer Modeling Through Crispr-Cas9/Hdr-Based Somatic Precision Gene Editing In Mice, Wen Bu, Chad J Creighton, Kelsey S Heavener, Carolina Gutierrez, Yongchao Dou, Amy T Ku, Yiqun Zhang, Weiyu Jiang, Jazmin Urrutia, Wen Jiang, Fei Yue, Luyu Jia, Ahmed Atef Ibrahim, Bing Zhang, Shixia Huang, Yi Li

Faculty, Staff and Student Publications

CRISPR-Cas9 has been used successfully to introduce indels in somatic cells of rodents; however, precise editing of single nucleotides has been hampered by limitations of flexibility and efficiency. Here, we report technological modifications to the CRISPR-Cas9 vector system that now allows homology-directed repair-mediated precise editing of any proto-oncogene in murine somatic tissues to generate tumor models with high flexibility and efficiency. Somatic editing of either

Dancing Through Parkinson’S: Investigating The Impact Of Argentine Tango On Motor, Cognitive And Psychosocial Function, Suraj Pothineni, Fazal Choudhary

Rowan-Virtua Research Day

Background: People with Parkinson’s Disease (PD) undergo progressive motor, cognitive, and psychosocial symptoms, which decrease their quality of life (QOL). Adapted tango (AT) has recently emerged as a promising approach to ameliorating functional mobility, balance, and gait seen in people with PD.

Methods: A comprehensive literature review is conducted using databases such as PubMed, SCOPUS, and Embase. A wide variety of search terms are used, including but not limited to Parkinson’s disease, exercise, dance, tango, motor, cognitive, psychosocial effects, freezing of gait, and balance.

Results: People with PD who have undergone AT have improved in certain motor, cognitive and psychosocial …