Rehabilitation and Therapy Commons^™

An Umbrella Review Of Self-Management Interventions For Health Conditions With Symptom Overlap With Traumatic Brain Injury, Angelle Sander, Monique Pappadis, Tamara Bushnik, Nancy Chiaravalloti, Simon Driver, Robin Hanks, Kirk Lercher, Dawn Neumann, Amanda Rabinowitz, Ronald T Seel, Erica Weber, Rick Ralston, John Corrigan, Kurt Kroenke, Flora Hammond

Department of Rehabilitation Medicine Faculty Papers

OBJECTIVE: To synthesize evidence for the effectiveness of self-management interventions for chronic health conditions that have symptom overlap with traumatic brain injury (TBI) in order to extract recommendations for self-management intervention in persons with TBI.

DESIGN: An umbrella review of existing systematic reviews and/or meta-analyses of randomized controlled trials or nonrandomized studies targeting self-management of chronic conditions and specific outcomes relevant to persons with TBI.

METHOD: A comprehensive literature search of 5 databases was conducted using PRISMA guidelines. Two independent reviewers conducted screening and data extraction using the Covidence web-based review platform. Quality assessment was conducted using criteria adapted from …

Interventions To Optimize Spinal Cord Perfusion In Patients With Acute Traumatic Spinal Cord Injury: An Updated Systematic Review, Nathan Evaniew, Benjamin Davies, Farzin Farahbakhsh, Michael G. Fehlings, Mario Ganau, Daniel E. Graves, James D. Guest, Radha Korupolu, Allan R. Martin, Stephen L. Mckenna, Lindsay A. Tetreault, Aditya Vedantam, Erika D. Brodt, Andrea C. Skelly, Brian K. Kwon

Department of Rehabilitation Medicine Faculty Papers

STUDY DESIGN: Systematic review update.

OBJECTIVES: Interventions that aim to optimize spinal cord perfusion are thought to play an important role in minimizing secondary ischemic damage and improving outcomes in patients with acute traumatic spinal cord injuries (SCIs). However, exactly how to optimize spinal cord perfusion and enhance neurologic recovery remains controversial. We performed an update of a recent systematic review (Evaniew et al, J. Neurotrauma 2020) to evaluate the effects of Mean Arterial Pressure (MAP) support or Spinal Cord Perfusion Pressure (SCPP) support on neurological recovery and rates of adverse events among patients with acute traumatic SCI.

METHODS: We …

Remote Ischaemic Conditioning Combined With Bimanual Task Training To Enhance Bimanual Skill Learning And Corticospinal Excitability In Children With Unilateral Cerebral Palsy: A Study Protocol Of A Single Centre, Phase Ii Randomised Controlled Trial, Swati M Surkar, John D Willson, Jessica M Cassidy, Shailesh Kantak, Charity G Patterson

Department of Rehabilitation Medicine Faculty Papers

INTRODUCTION: Children with unilateral cerebral palsy (UCP) have difficulty in bimanual coordination that restricts the child's independence in daily activities. Although several efficacious interventions to improve bimanual coordination exist, these interventions often require higher training doses and have modest effect sizes. Thus, there is a critical need to find an effective priming agent that, when paired with task-specific training, will facilitate neurobiological processes to enhance the magnitude of training effects and subsequently improve functional capabilities of children with UCP. The aim of this study is to determine the effects of a novel priming agent, remote ischaemic conditioning (RIC), combined with …

Bimanual Movement Characteristics And Real-World Performance Following Hand-Arm Bimanual Intensive Therapy In Children With Unilateral Cerebral Palsy, Shailesh S. Gardas, Christine Lysaght, Amy Gross Mcmillan, Shailesh Kantak, John D. Willson, Charity G. Patterson, Swati M. Surkar

Department of Rehabilitation Medicine Faculty Papers

The purpose of this study was to quantify characteristics of bimanual movement intensity during 30 h of hand-arm bimanual intensive therapy (HABIT) and bimanual performance (activities and participation) in real-world settings using accelerometers in children with unilateral cerebral palsy (UCP). Twenty-five children with UCP participated in a 30 h HABIT program. Data were collected from bilateral wrist-worn accelerometers during 30 h of HABIT to quantify the movement intensity and three days pre- and post-HABIT to assess real-world performance gains. Movement intensity and performance gains were measured using six standard accelerometer-derived variables. Bimanual capacity (body function and activities) was assessed using …

Anna Magee’S Vision 100 Years Past 1923-2023!, Christopher Formal, John F. Ditunno Jr.

Department of Rehabilitation Medicine Faculty Papers

Anna Magee's vision of Magee Rehabilitation Hospital has been realized in three phases. The first spanned the writing of her will until groundbreaking of the new hospital. This was followed by the early years as an entirely independent institution. The third phase began with its association with Thomas Jefferson University, and continues to this day with integration into a complete system of patient care, education, and research. Magee owes its existence to the philanthropy of Anna Magee and it continues to fortify her legacy and fulfill her vision of an institution where patients whose acute illness has passed can receive …

Developing Guiding Principles For Technology-Based Rehabilitation Program By Engaging People With Motor Incomplete Tetraplegia, Alison Bell, Namrata Grampurohit, Gabrielle Kains, Ralph J. Marino

Department of Rehabilitation Medicine Faculty Papers

Background: Technology-aided rehabilitation is well established in the field of neurologic rehabilitation. Despite the widespread availability, the development of technology-based interventions that incorporate perspectives of the people who will use them is lacking.

Objectives: This qualitative study aims to understand how people with chronic motor incomplete cervical spinal cord injury view rehabilitation technology to improve upper extremity function and neuromuscular recovery to inform future intervention development.

Methods: Seven participants with chronic upper extremity impairment due to spinal cord injury/dysfunction trialed five rehabilitation technology devices. After a 30-45 min trial for each device, participants engaged in a semi-structured interview. Interviews were …

Combination Intrathecal Drug Therapy Strategies For Pain Management, Jay Karri, Mani Singh, Devas J Modi, Vwaire Orhurhu, Caleb Seale, Michael Saulino, Anuj Marathe, Darrell Vydra, Jonathan M Hagedorn, Brian Bruel, Alaa Abd-Elsayed

Department of Rehabilitation Medicine Faculty Papers

Background: Numerous combination intrathecal drug therapy (CIDT) strategies exist and are utilized for varying pain syndromes, typically when monotherapy dose escalation or medication alternation is deemed untenable or unfeasible. Unfortunately, the supportive evidence basis for the use of these strategies and specific drug combinations is generally lacking and unclear, with many medications being used for off-label indications.

Objective: In this manuscript, we provide a robust exploration and analysis of the literature to provide an evidence-based narrative for the use of CIDT strategies in regard to clinical indications, pharmacologic parameters, specific drug combinations, safety profiles, and future directions.

Study design: Narrative …

Anna Justina Magee: A Woman Of Determination And Vision, John F. Ditunno Jr., Chris S. Formal

Department of Rehabilitation Medicine Faculty Papers

This article tells the story of Anna J. Magee (AJM), the founder of the Magee Rehabilitation Hospital in Philadelphia, one of the country’s premier medical rehabilitation institutions. AJM’s life was shaped by her family, her times, and her city. The daughter of one of the founders of the Pennsylvania Railroad, she emerged in the late 19th century as an independent woman of elite Philadelphian society, demonstrating a special devotion to St. Stephen’s Episcopal Church at 10^th and Market Streets and, inspired by her personal physician, a determination to serve the rehabilitative needs of physically disabled patients, regardless of their …

Effect Of A Virtual Reality-Enhanced Exercise And Education Intervention On Patient Engagement And Learning In Cardiac Rehabilitation: Randomized Controlled Trial., Victoria Gulick, Daniel Graves, Shannon Ames, Pavitra Parimala Krishnamani

Department of Rehabilitation Medicine Faculty Papers

BACKGROUND: Cardiac rehabilitation (CR) is clinically proven to reduce morbidity and mortality; however, many eligible patients do not enroll in treatment. Furthermore, many enrolled patients do not complete their full course of treatment. This is greatly influenced by socioeconomic factors but is also because of patients' lack of understanding of the importance of their care and a lack of motivation to maintain attendance.

OBJECTIVE: This study aims to explore the potential benefits of virtual reality (VR) walking trails within CR treatment, specifically with regard to patient knowledge retention, satisfaction with treatment, and the overall attendance of treatment sessions.

METHODS: New …

Risk Factors For Stress Fractures In Female Runners: Results Of A Survey, Therese Johnston, Allison E Jakavick, Caroline A Mancuso, Kathleen C Mcgee, Lily Wei, Morgan L Wright, Jeremy Close, Md, Ayako Shimada, Benjamin E Leiby

Department of Rehabilitation Medicine Faculty Papers

Background: Few studies compare women with and without stress fractures and most focus on younger, elite runners.

Hypothesis/purpose: Compare risk factors between female runners with and without a stress fracture history.

Study design: Case control.

Methods: An online survey targeting women age ≥18 years was distributed primarily via social media. Questions included demographics, running details, cross training, nutrition, injury history, medical/menstrual history, and medications. Women with stress fracture histories answered questions about location, number, and changes made. Data were compared between groups using t-tests, chi-square tests, or Fisher's exact tests. Multivariable logistic regression models simultaneously investigated associations of multiple factors …

A Survey Of Internal And Family Medicine Residents: Assessment Of Disability-Specific Education And Knowledge., Michael D Stillman, Nethra Ankam, Michael Mallow, Maclain Capron, Steve Williams

Department of Rehabilitation Medicine Faculty Papers

BACKGROUND: The literature suggests that primary care physicians are inadequately educated in the care of people with disabilities. No study to date has evaluated whether internal medicine (IM) and family medicine (FM) residents have received disability-specific education or their level of comfort in caring for people with physical disabilities.

OBJECTIVES: To assess IM and FM residents' receipt of disability-specific education during medical school and residency; to evaluate their self-reported comfort in managing secondary conditions associated with physical disabilities and in coordinating therapies and services for individuals with disabilities; to gauge their interest in receiving disability-specific education.

METHODS: An on-line survey …

Applying The Who Icf Framework To The Outcome Measures Used In The Evaluation Of Long-Term Clinical Outcomes In Coronavirus Outbreaks, Kajal Patel, Sofia Straudi, Ng Yee Sien, Nora Fayed, John L. Melvin, Manoj Sivan

Department of Rehabilitation Medicine Faculty Papers

(1) Objective: The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) classification is a unified framework for the description of health and health-related states. This study aimed to use the ICF framework to classify outcome measures used in follow-up studies of coronavirus outbreaks and make recommendations for future studies. (2) Methods: EMBASE, MEDLINE, CINAHL and PsycINFO were systematically searched for original studies assessing clinical outcomes in adult survivors of severe acute respiratory distress syndrome (SARS), middle east respiratory syndrome (MERS) and coronavirus disease-19 (COVID-19) after hospital discharge. Individual items of the identified outcome measures were linked …

Differential Rates Of Intravascular Uptake And Pain Perception During Lumbosacral Epidural Injection Among Adults Using A 22-Gauge Needle Versus 25-Gauge Needle: A Randomized Clinical Trial, Robin Raju, Michael Mehnert, David Stolzenberg, Jeremy Simon, Theodore Conliffe, Jeffrey Gehret

Department of Rehabilitation Medicine Faculty Papers

BACKGROUND: Inadvertent intravascular injection has been suggested as the most probable mechanism behind serious neurological complications during transforaminal epidural steroid injections. Authors believe a smaller gauge needle may lead to less intravascular uptake and less pain. Theoretically, there is less chance for a smaller gauge needle to encounter a blood vessel during an injection compared to a larger gauge needle. Studies have also shown smaller gauge needle to cause less pain. The aim of the study was to quantify the difference between a 22-gauge needle and 25-gauge needle during lumbosacral transforaminal epidural steroid injection in regards to intravascular uptake and …

Competency-Based Curriculum Development To Meet The Needs Of People With Disabilities: A Call To Action., Nethra S. Ankam, Md, Glendaliz Bosques, Carley Sauter, Steven Stiens, Maya Therattil, Faren H. Williams, Caleb C. Atkins, R. Samuel Mayer

Department of Rehabilitation Medicine Faculty Papers

People with disabilities constitute 22.2% of the population in the United States, and virtually all physicians have people with disabilities in their clinical practice across a wide range of diagnostic groups. However, studies demonstrate that people with disabilities are inadequately served by the health care system, leading to high costs and poor outcomes. The authors argue that one cause of this discrepancy is that medical students receive limited training in the care of people with disabilities and may therefore not be able to adequately meet the competencies that underlie the Core Entrustable Professional Activities for Entering Residency. To address these …

Using Concept Mapping To Develop A Human Rights Based Indicator Framework To Assess Country Efforts To Strengthen Rehabilitation Provision And Policy: The Rehabilitation System Diagnosis And Dialogue Framework (Resyst), Dimitrios Skempes, John L. Melvin, Per Von Groote, Gerold Stucki, Jerome Bickenbach

Department of Rehabilitation Medicine Faculty Papers

Background: Rehabilitation is crucial for the realization of the right to health and a proper concern of global health. Yet, reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators. To ensure universal health coverage and meet the central imperative of "leaving no one behind" countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged, including people with disability. This article describes the process of developing an expert guided indicator framework to …

Cannabis Shenanigans: Advocating For The Restoration Of An Effective Treatment Of Pain Following Spinal Cord Injury., Daniel E. Graves, Phd

Department of Rehabilitation Medicine Faculty Papers

Cannabis is an effective treatment for pain following spinal cord injury that should be available to patients and researchers. The major argument against the rescheduling of cannabis is that the published research is not convincing. This argument is disingenuous at best, given that the evidence has been presented and rejected at many points during the political dialog. Moreover, the original decision to criminalize cannabis did not utilize scientific or medical data. There is tension between the needs of a society to protect the vulnerable by restricting the rights of others to live well and with less pain. It is clear …

Scaling Up Rehabilitation - Towards An International Policy Agenda., Christoph Gutenbrunner, Jerome Bickenbach, Kristian Borg, Boya Nugraha, John L. Melvin, Gerold Stucki

Department of Rehabilitation Medicine Faculty Papers

No Abstract (Guest Editorial).

Rehabilitation: The Health Strategy Of The 21st Century., Gerold Stucki, Jerome Bickenbach, Christoph Gutenbrunner, John L. Melvin

Department of Rehabilitation Medicine Faculty Papers

There is strong evidence that population ageing and the epidemiological transition to a higher incidence of chronic, non-communicable diseases will continue to profoundly impact societies worldwide, putting more pressure on healthcare systems to respond to the needs of the people they serve. These trends argue for the need to address what matters to people about their health: limitations in their functioning that affect their day-to-day actions and goals in life. From its inception, rehabilitation, 1 of the 4 health strategies identified in the Declaration of Alma Ata in 1978, has had functioning as its outcome of interest. Its practitioners are …

Strengthening Health-Related Rehabilitation Services At National Levels., Christoph Gutenbrunner, Jerome Bickenbach, John L. Melvin, Jorge Lains, Boya Nugraha

Department of Rehabilitation Medicine Faculty Papers

OBJECTIVE: One of the aims of the World Health Organization's Global Disability Action Plan is to strengthen rehabilitation services. Some countries have requested support to develop (scale-up) rehabilitation services. This paper describes the measures required and how (advisory) missions can support this purpose, with the aim of developing National Disability, Health and Rehabilitation Plans.

RECOMMENDATIONS: It is important to clarify the involvement of governments in the mission, to define clear terms of reference, and to use a systematic pathway for situation assessment. Information must be collected regarding policies, health, disability, rehabilitation, social security systems, the need for rehabilitation, and the …

Linking Spinal Cord Injury Rehabilitation Between The World Wars: The R. Tait Mckenzie Legacy., John F. Ditunno, Jr

Department of Rehabilitation Medicine Faculty Papers

Spinal cord injury (SCI) medicine emerged after World War II due to mass casualties, which required specialized treatment centers. This approach to categorical care, however, was first developed during World War I, led by pioneers R. Tait McKenzie and George Deaver, who demonstrated that soldiers disabled by paralysis could return to society through fitness/mobility, recreational and vocational training. McKenzie, a Canadian and the first professor of physical therapy in the US, influenced Deaver and military physicians in Britain, Canada, and the U.S. with his achievements and publications. Although early mortality from SCI was high, advances in the treatment of skin …

A Clinical Practice Guideline For The Management Of Patients With Acute Spinal Cord Injury: Recommendations On The Use Of Methylprednisolone Sodium Succinate, Michael G. Fehlings, Jefferson R. Wilson, Lindsay A. Tetreault, Bizhan Aarabi, Paul A. Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory W. Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark R. Kotter, Shekar N. Kurpad, Brian Kwon, Ralph J. Marino, Allan R. Martin, Eric M. Massicotte, Geno J. Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Andrea C. Skelly, Anoushka Singh, Eve Tsai, Alexander R. Vaccaro, Albert Yee, James S. Harrop

Department of Rehabilitation Medicine Faculty Papers

Introduction: The objective of this guideline is to outline the appropriate use of methylprednisolone sodium succinate (MPSS) in patients with acute spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MPSS in acute SCI. A multidisciplinary Guideline Development Group used this information, in combination with their clinical expertise, to develop recommendations for the use of MPSS. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: The main conclusions …

Type And Timing Of Rehabilitation Following Acute And Subacute Spinal Cord Injury: A Systematic Review, Anthony S. Burns, Ralph J. Marino, Sukhvinder Kalsi-Ryan, James W. Middleton, Lindsay A. Tetreault, Joseph R. Dettori, Kathryn E. Mihalovich, Michael G. Fehlings

Department of Rehabilitation Medicine Faculty Papers

Objectives: The objective of this study was to conduct a systematic review of the literature to address the following clinical questions: In adult patients with acute and subacute complete or incomplete traumatic SCI, (1) does the time interval between injury and commencing rehabilitation affect outcome?; (2) what is the comparative effectiveness of different rehabilitation strategies, including different intensities and durations of treatment?; (3) are there patient or injury characteristics that affect the efficacy of rehabilitation?; and (4) what is the cost-effectiveness of various rehabilitation strategies? Methods: A systematic search was conducted for literature published through March 31, 2015 that evaluated …

Franklin Delano Roosevelt: The Diagnosis Of Poliomyelitis Revisited., John F. Ditunno, Jr, Bruce E. Becker, Gerald J. Herbison

Department of Rehabilitation Medicine Faculty Papers

Revisiting the ailments of famous historical persons in light of contemporary medical understanding has become a common academic hobby. Public discussion of Franklin Delano Roosevelt's (FDR) diagnosis of poliomyelitis after his sudden onset of paralysis in 1921 has received just such a revisitation. Recently, this 2003 historical analysis has been referenced widely on the Internet and in biographies, raising speculation that his actual diagnosis should have been Guillain-Barré Syndrome, a noncontagious disease of the peripheral nervous system rather than poliomyelitis. The authors of that 2003 analysis used a statistical analysis of his case by selectively choosing some of his reported …

Development Of Syringomyelia From Retained Bullet Fragment Following Spinal Cord Injury, Akinpelu Beckley, Md, Mba, Christina V. Oleson, Md, Christopher S. Formal, Md

Department of Rehabilitation Medicine Faculty Papers

Objective

To investigate potential complications of retained bullet fragments in the spinal canal following traumatic spinal cord injury (SCI).

Dr. R. Tait Mckenzie: Pioneer And Legacy To Physiatry., John F. Ditunno, Jr, Richard E. Verville

Department of Rehabilitation Medicine Faculty Papers

No abstract provided.

Lessons Learned Through Leadership, John L. Melvin, Md, Mmsc

Department of Rehabilitation Medicine Faculty Papers

This paper identifies a number of principles I have adopted when assuming leadership roles. They evolved from experiences that suggested they would help me be more effective in these roles. I have found through using them that they are indeed helpful to me as a leader and to the organizations I lead. When comparing notes with other leaders, I find they seem to apply to others as well.

Technology Improving Spinal Cord Injured Outlook: Our Experience With The Diaphragmatic Pacing System, Amanda Morina, Pt, Dpt, Ncs, Catharine Farnan-Kennedy, Ms, Crrn, Onc, Cbis

Department of Rehabilitation Medicine Faculty Papers

Introduction

Technology is always changing and that is a certainty. Integrating it into a population in a cost effective manner is always a challenge. One of the benefits of technology is the power to improve quality of life for those who are spinal cord injured. Five years ago in 2009, our rehabilitation team had the opportunity to partner with a young spinal cord injured patient with a newly implanted diaphragmatic pacer device (DPS). Since then we have had several patients with chronic spinal cord injury with this technology. The following poster will review the literature related to this device in …

Implementation Of A Four Year Rehabilitation Curriculum For Medical Students, Nethra S. Ankam, Md

Department of Rehabilitation Medicine Faculty Papers

In 2009 the Vice-Dean of Undergraduate Medical Education modified the 4th year curriculum by eliminating the required clerkship in Rehabilitation Medicine, and the Department was tasked with the creation of a four year curricular thread. While disappointing, this was a blessing in disguise. For years, we attempted to fit a great deal of content into an ever decreasing timespan, to increasingly disinterested students. Our teachers were also burned out with the sheer volume of students.

Through collaboration with other course directors, we inserted content where it fit the developmental needs of the students. We were also able to introduce students …

The International Society Of Physical And Rehabilitation Medicine: The Way Forward - Ii., Marta Imamura, Christoph Gutenbrunner, Gerold Stucki, Jianan Li, Jorge Lains, Walter Frontera, John Olver, Levent Özçakar, Joel Delisa, Linamara Rizzo Battistella, John L. Melvin

Department of Rehabilitation Medicine Faculty Papers

This paper reports on recent changes and future plans concerning the International Society of Physical and Rehabilitation Medicine. Issues discussed are its structural organization, collaboration and recognition, liaison with the World Health Organization , work in strengthening science, and its future agenda.

Two Phase 3, Multicenter, Randomized, Placebo-Controlled Clinical Trials Of Fampridine-Sr For Treatment Of Spasticity In Chronic Spinal Cord Injury., D. D. Cardenas, J. F. Ditunno, V. Graziani, A. B. Mclain, D. P. Lammertse, P. J. Potter, M. S. Alexander, R. Cohen, A. R. Blight

Department of Rehabilitation Medicine Faculty Papers

STUDY DESIGN: Two randomized, double-blind, placebo-controlled trials.

OBJECTIVE: To evaluate the efficacy and safety of fampridine sustained-release tablets (fampridine-SR) 25 mg twice daily for moderate-to-severe spasticity in patients with chronic spinal cord injury (SCI).

SETTING: United States and Canada.

METHODS: Patients with incomplete chronic SCI were randomized to twice daily fampridine-SR 25 mg or placebo, with a 2-week single-blind placebo run-in, a 2-week titration, 12 weeks of stable dosing, 2 weeks of downward titration and 2 weeks of untreated follow-up. Co-primary end points were the change from baseline, averaged over the double-blind treatment period, for Ashworth score (bilateral knee flexors …