Sports Medicine Commons^™

Diagnosis And Management Of Cardiometabolic Disease After Spinal Cord Injury: Identifying Gaps In Physician Training And Practices, Chinenye Christa Nnoromele, Du Pham, Felicia Skelton, Ryan Solinsky

Faculty, Staff and Students Publications

CONTEXT: Cardiometabolic disease (CMD) frequently occurs in individuals with spinal cord injury (SCI), with growing awareness surrounding the expansive scope of this problem. As CMD has significant morbidity and mortality, early guidelines-based screening and management have been established. However, the extent to which these guidelines have been adopted are unclear.

OBJECTIVE: Describe physicians' screening and management pattern for CMD in patients with SCI, as compared to SCI-specific CMD screening guidelines, and elucidate variables linked to screening and management patterns.

METHODS: SCI medicine-boarded physicians were surveyed on screening timing for CMD following acute SCI, along with their practice pattern and comfort …

Exoskeletal-Assisted Walking In Veterans With Paralysis: A Randomized Clinical Trial, Ann M Spungen, Ellen J Dematt, Kousick Biswas, Karen M Jones, Zhibao Mi, Amanda J Snodgrass, Kel Morin, Pierre K Asselin, Christopher M Cirnigliaro, Steven Kirshblum, Peter H Gorman, Lance L Goetz, Katherine Stenson, Kevin T White, Alice Hon, Sunil Sabharwal, B Jenny Kiratli, Doug Ota, Bridget Bennett, Joseph E Berman, Denis Castillo, Kenneth K Lee, Byron W Eddy, M Kristi Henzel, Michelle Trbovich, Sally A Holmes, Felicia Skelton, Michael Priebe, Stephen L Kornfeld, Grant D Huang, William A Bauman

Faculty, Staff and Students Publications

IMPORTANCE: Robotic exoskeletons leverage technology that assists people with spinal cord injury (SCI) to walk. The efficacy of home and community exoskeletal use has not been studied in a randomized clinical trial (RCT).

OBJECTIVE: To examine whether use of a wheelchair plus an exoskeleton compared with use of only a wheelchair led to clinically meaningful net improvements in patient-reported outcomes for mental and physical health.

DESIGN, SETTING, AND PARTICIPANTS: This RCT of veterans with SCI was conducted at 15 Veterans Affairs medical centers in the US from September 6, 2016, to September 27, 2021. Data analysis was performed from March …

An Uncommon Culprit: Trapezius Dystonia As A Cause Of Thoracic Outlet Syndrome: A Case Report, Jamie Philp, Won Jae Jeong, Paul Paily

Faculty, Staff and Students Publications

Thoracic outlet syndrome (TOS) results from compression of the neurovascular bundle in the thoracic outlet. Several etiologies can contribute to the development of thoracic outlet syndrome, including both congenital and acquired causes. Historically, trapezius pathology has not been considered a cause of TOS; however, here we report a patient with neurogenic TOS plus ipsilateral trapezius hypertonicity and hypertrophy who had significant symptomatic improvement following botulinum toxin injections to trapezius.

Special Anatomy Series Imaging Inner Ear Structures With High-Frequency Ultrasound: Application To Physical Rehabilitation Space Medicine, Jeffrey Strakowski, Han Zhang, Millard Reschke, Faye Y Chiou-Tan

Faculty, Staff and Students Publications

OBJECTIVE: The objective of this paper is to document the feasibility of image acquisition, image optimization, and sonographic appearance of the exposed anatomic windows of cadaveric inner ear dissection for purposes of potential future clinical evaluation as part of the developing area of physical and rehabilitation space medicine.

METHODS: Cadaveric dissection of the inner ear was conducted with the goal of exposing areas relevant to vestibular balance. Middle and inner ear structures of 3 human cadavers were imaged with multiple broadband transducers, including emphasis with higher frequency transducers.

RESULTS: The images were best optimized with 17 MHz and 22 MHz …

Changes In Patterns Of Referral For Inpatient Rehabilitation Cancer Patients Due To Covid-19: A Retrospective Study, Ekta Gupta, Amy H Ng, Aline Rozman De Moraes, Jack B Fu, Jegy M Tennison, Maaheen Ahmed, Bryan M Fellman, Eduardo Bruera

Faculty, Staff and Students Publications

There is a paucity of literature on the effect of COVID-19 on hospital processes. We hypothesized that COVID-19 was associated with decreased cancer physiatry referrals in 2020. This is a retrospective cohort study of consecutive patients from April to July 2019 and 2020 admitted at an academic quaternary cancer center. The main outcomes were number of hospital admissions, rate, and characteristics of inpatient rehabilitation admissions and change in percentage of physiatry referrals as the primary endpoint. Results showed that in 2019, there were 387 referrals from 10,274 inpatient admissions (3.8%; 95% confidence interval, 2.4-4.2), compared with 337 referrals from 7051 …

Associations Of Chronic Pain With Psychosocial Outcomes After Traumatic Brain Injury: A Nidilrr And Va Tbi Model Systems Collaborative Project, Robin Hanks, Jessica M Ketchum, Mackenzie Peckham, Mitch Sevigny, Angelle M Sander, Aaron M Martin, Stephanie Agtarap, Cynthia L Beaulieu, Librada Callender, Flora M Hammond, Jean Lengenfelder, Amanda R Rabinowitz, William C Walker, Jeanne M Hoffman, Cynthia Harrison-Felix, Risa Nakase-Richardson

Faculty, Staff and Students Publications

OBJECTIVE: To examine the differences in participation, life satisfaction, and psychosocial outcomes among individuals with traumatic brain injury (TBI) endorsing current, past, or no chronic pain.

SETTING: Community.

PARTICIPANTS: Three thousand eight hundred four TBI Model Systems participants 1 to 30 years of age postinjury classified into 1 of 3 groups based on their pain experience: current pain, past pain, no pain completed a Pain Survey at their usual follow-up appointment which on average was approximately 8 years postinjury.

DESIGN: Multisite, cross-sectional observational cohort study.

MAIN OUTCOME MEASURES: Sociodemographic and injury characteristics and psychosocial outcomes (ie, satisfaction with life, depression, …

Identifying Design Opportunities For Adaptive Mhealth Interventions That Target General Well-Being: Interview Study With Informal Care Partners, Xinghui Yan, Mark W Newman, Sun Young Park, Angelle Sander, Sung Won Choi, Jennifer Miner, Zhenke Wu, Noelle Carlozzi

Faculty, Staff and Students Publications

BACKGROUND: Mobile health (mHealth) interventions can deliver personalized behavioral support to users in daily contexts. These interventions have been increasingly adopted to support individuals who require low-cost and low-burden support. Prior research has demonstrated the feasibility and acceptability of an mHealth intervention app (CareQOL) designed for use with informal care partners. To further optimize the intervention delivery, we need to investigate how care partners, many of whom lack the time for self-care, react and act in response to different behavioral messages.

OBJECTIVE: The goal of this study was to understand the factors that impact care partners' decision-making and actions in …

The Dosing Of Mobile-Based Just-In-Time Adaptive Self-Management Prompts For Caregivers: Preliminary Findings From A Pilot Microrandomized Study, Jitao Wang, Zhenke Wu, Sung Won Choi, Srijan Sen, Xinghui Yan, Jennifer A Miner, Angelle M Sander, Angela K Lyden, Jonathan P Troost, Noelle E Carlozzi

Faculty, Staff and Students Publications

BACKGROUND: Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers' health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood.

OBJECTIVE: The primary objective of this study is to evaluate the dose-response …

The Reliability And Validity Of The Tbi-Careqol System In Four Diverse Caregiver Groups, Noelle E Carlozzi, Sung Won Choi, Zhenke Wu, Srijan Sen, Jonathan Troost, Angela K Lyden, Jennifer A Miner, Christopher Graves, Angelle M Sander

Faculty, Staff and Students Publications

PURPOSE: Establishing the psychometric reliability and validity of new measures is an ongoing process. More work is needed in to confirm the clinical utility of the TBI-CareQOL measurement development system in both an independent cohort of caregivers of traumatic brain injury (TBI), as well as in additional caregiver groups.

METHODS: An independent cohort of caregivers of people with TBI (n = 139), as well as three new diverse caregiver cohorts (n = 19 caregivers of persons with spinal cord injury, n = 21 caregivers for persons with Huntington disease, and n = 30 caregivers for persons with cancer), completed 11 …

Initial Evidence For Reliable And Valid Use Of Scores On The 8-Item Econ-Qol Short Form To Measure Economic Quality Of Life In Caregivers Of Persons With Traumatic Brain Injury, Noelle E Carlozzi, Christopher Graves, Jonathan P Troost, Michael A Kallen, David S Tulsky, Robin A Hanks, Phillip A Ianni, Jennifer A Miner, Angelle M Sander

Faculty, Staff and Students Publications

OBJECTIVE: To provide reliability and validity data to support the clinical utility of Economic Quality of Life Measure (Econ-QOL) scores in caregivers of civilians and service members/veterans with traumatic brain injury (TBI).

DESIGN: Cross-sectional survey study.

SETTING: Three academic medical centers and a Veterans Affairs treatment facility.

PARTICIPANTS: 376 caregivers of civilians (n=213) and service members/veterans (n=163) with TBI (N=376).

INTERVENTIONS: N/A.

MAIN OUTCOME MEASURES: Econ-QOL and several patient-reported outcome measures (Traumatic Brain Injury Caregiver Quality of Life Caregiver-Specific Anxiety and Caregiver Strain, Patient-Reported Outcomes Measurement Information System sleep-related impairment, Neurological Quality of Life Measurement System positive affect and well-being) …

Challenges And Opportunities In Academic Physiatry: An Environmental Scan, David C Morgenroth, Tiffany Knowlton, Susan Apkon, Cheri A Blauwet, Anthony S Burns, Cecilia Córdova Vallejos, Walter Frontera, Sandra L Hearn, Prakash Jayabalan, Peter A Lim, Alex Moroz, Danielle Perret, Danielle Powell, Matt Puderbaugh, W Evan Rivers, Gwendolyn Sowa, Monica Verduzco-Gutierrez, Pablo A Celnik

Faculty, Staff and Students Publications

Environmental scans determine trends in an organization's or field's internal and external environment. The results can help shape goals, inform strategic decision making, and direct future actions. The Association of Academic Physiatrists convened a strategic planning group in 2020, composed of physiatrists representing a diversity of professional roles, career stages, race and ethnicity, gender, disability status, and geographic areas of practice. This strategic planning group performed an environmental scan to assess the forces, trends, challenges, and opportunities affecting both the Association of Academic Physiatrists and the entire field of academic physiatry (also known as physical medicine and rehabilitation, physical and …

Telemedicine Use Among Physiatrists During The Early Phase Of The Covid-19 Pandemic And Potential For Future Use, Sameer Siddiqui, Ellen Farr, Nathaniel Dusto, Liqi Chen, Masha Kocherginsky, Felicia Skelton, Monica Verduzco-Gutierrez, Sujin Lee

Faculty, Staff and Students Publications

No abstract provided.

The Behavioral Assessment Screening Tool For Mobile Health (Bastmhealth): Development And Compliance In Two Weeks Of Daily Reporting In Chronic Traumatic Brain Injury, Shannon B Juengst, Brittany Wright, Angelle M Sander, Samuel Preminger, Andrew Nabasny, Lauren Terhorst

Faculty, Staff and Students Publications

Objectives:

To develop and evaluate the feasibility of a short form of the Behavioral Assessment Screening Tool (BAST_mHealth) for high frequency in situ self-reported assessment of neurobehavioral symptoms using mobile health technology for community-dwelling adults with traumatic brain injury (TBI).

Design:

Prospective, repeated measures study of mHealth assessment of self-reported neurobehavioral symptoms in adults with and without a lifetime history of TBI over a two-week period.

Setting:

Community

Participants:

Community-dwelling adults with (n=52) and without (n=12) a lifetime TBI history consented to the study.

Interventions:

Not applicable

Main Outcome Measures:

BAST_mHealth subscales (2-items each): Negative Affect, Fatigue, …

The Association Between Payer Source And Traumatic Brain Injury Rehabilitation Outcomes: A Tbi Model Systems Study, Anthony H Lequerica, Angelle M Sander, Monique R Pappadis, Jessica M Ketchum, Marissa Jaross, Stephanie Kolakowsky-Hayner, Amanda Rabinowitz, Librada Callender, Michelle Smith

Faculty, Staff and Students Publications

OBJECTIVE: To examine the relationship between payer source for acute rehabilitation, residential median household income (MHI), and outcomes at rehabilitation discharge after traumatic brain injury (TBI).

SETTING: Acute inpatient rehabilitation facilities.

PARTICIPANTS: In total, 8558 individuals enrolled in the Traumatic Brain Injury Model Systems (TBIMS) National Database who were admitted to inpatient rehabilitation between 2006 and 2019 and were younger than 64 years.

DESIGN: Secondary data analysis from a multicenter longitudinal cohort study.

MAIN MEASURES: Payer source was divided into 4 categories: uninsured, public insurance, private insurance, and workers' compensation/auto. Relationships between payer source with residential MHI, rehabilitation length of …

Perceived Care Partner Burden At 1-Year Post-Injury And Associations With Emotional Awareness, Functioning, And Empathy After Tbi: A Tbi Model Systems Study, Daniel W Klyce, Kritzianel Merced, Alexander Erickson, Dawn M Neumann, Flora M Hammond, Angelle M Sander, Jennifer A Bogner, Tamara Bushnik, Joyce S Chung, Jacob A Finn

Faculty, Staff and Students Publications

BACKGROUND: People with traumatic brain injury (TBI) can lack awareness of their own emotions and often have problems with emotion dysregulation, affective disorders, and empathy deficits. These impairments are known to impact psychosocial behaviors and may contribute to the burden experienced by care partners of individuals with TBI.

OBJECTIVE: To examine the associations of emotional awareness, emotional functioning, and empathy among participants with TBI with care partner burden.

METHOD: This multisite, cross-sectional, observational study used data from 90 dyads (participants with TBI and their care partner) 1-year post-injury. Participants with TBI completed the Difficulty with Emotional Regulation Scale (DERS; Awareness, …

Advances In Prosthetic Technology: A Perspective On Ethical Considerations For Development And Clinical Translation, Hayden Gavette, Cody L Mcdonald, Kristin Kostick-Quenet, Ashley Mullen, Bijan Najafi, M G Finco

Faculty, Staff and Students Publications

Technological advancements of prostheses in recent years, such as haptic feedback, active power, and machine learning for prosthetic control, have opened new doors for improved functioning, satisfaction, and overall quality of life. However, little attention has been paid to ethical considerations surrounding the development and translation of prosthetic technologies into clinical practice. This article, based on current literature, presents perspectives surrounding ethical considerations from the authors' multidisciplinary views as prosthetists (HG, AM, CLM, MGF), as well as combined research experience working directly with people using prostheses (AM, CLM, MGF), wearable technologies for rehabilitation (MGF, BN), machine learning and artificial intelligence …

Association Between Fear Of Pain And Sports-Related Concussion Recovery In A Pediatric Population, Jennifer T Arnold, Elizabeth V Franklin, Zachary G Baker, Marian Abowd, Jonathan A Santana

Faculty, Staff and Students Publications

OBJECTIVE: To determine whether an association exists between fear of pain and recovery time from sports-related concussion in a pediatric population.

DESIGN: Prospective observational study.

SETTING: Primary outpatient sports medicine clinic of a large pediatric hospital.

PATIENTS: One hundred twenty-eight pediatric patients aged 8 to 18 years who presented to clinic with a primary diagnosis of concussion from September 2018 to March 2020. Inclusion criteria included presentation within 2 weeks of injury and symptomatic on initial visit. Patients who sustained a concussion because of motor vehicle collisions or assault were excluded.

INDEPENDENT VARIABLES: There was no intervention. Study participants who …