Rehabilitation and Therapy Commons^™

A Randomized, Double-Blind, Placebo-Controlled Trial Of Daxibotulinumtoxina For Injection For The Treatment Of Upper Limb Spasticity In Adults After Stroke Or Traumatic Brain Injury, Atul T Patel, Michael C Munin, Ziyad Ayyoub, Gerard E Francisco, Rashid Kazerooni, Todd M Gross

Faculty, Staff and Student Publications

Background: Intramuscular injection of botulinum toxin type A is a first-line pharmacotherapy for adults with upper limb spasticity (ULS). However, reemergence of symptoms within 12 weeks of treatment is common and longer-lasting treatments are needed.

Objective: To evaluate the efficacy and safety of three doses of DaxibotulinumtoxinA for Injection (DAXI) for treatment of ULS in adults with stroke or traumatic brain injury.

Intervention: Intramuscular injections of placebo (N = 24), DAXI 250 U (N = 22), DAXI 375 U (N = 19), or DAXI 500 U (N = 18) to the suprahypertonic muscle (SMG) and other muscle groups.

Design: Randomized, …

Newly Credentialed Athletic Trainers' Onboarding Process During The Transition To Practice, Ashley B. Thrasher, Stacy E. Walker, Julie M. Cavallario

Rehabilitation Sciences Faculty Publications

Context: As new athletic trainers (ATs) transition into their roles, some employers provide orientation and onboarding to assist with the transition to practice. Research in which authors outline the ideal onboarding process for new ATs transitioning to practice is lacking.

Objective: To examine the onboarding process for new ATs.

Design: Grounded theory.

Setting: College or university, secondary school, and hospital or clinic.

Patients or other participants: Seventeen newly credentialed, employed ATs who recently graduated from professional masters' programs (11 female, 6 male; 25.6 ± 2.2 years) and 12 employers (6 female, 6 male; years in role supervising new ATs: 8.5 …

Clinician Perspectives On Virtual Reality Use In Physical Therapy Practice In The United States, Danielle T. Felsberg, Jared T. Mcguirt, Scott E. Ross, Louisa D. Raisbeck, Charlend K. Howard, Christopher K. Rhea

Rehabilitation Sciences Faculty Publications

The primary goal of physical rehabilitation is to assess movement impairments and restore function to improve overall quality of life. Virtual reality (VR) may provide the optimal environment to promote these goals due to its motivating and modifiable nature which can be difficult to accomplish through traditional real-world therapeutic methods. Current research of VR for rehabilitation has demonstrated that VR interventions can produce clinically meaningful change in motor outcomes. Despite this, adoption and usage of VR by physical therapy professionals is unclear due to the limited research in this area. Thus, the purpose of this study was to identify the …

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 …

A Case Report Of Long-Latency Evoked Diaphragm Potentials After Exposure To Acute Intermittent Hypoxia In Post-West Nile Virus Meningoencephalitis, Joseph F. Welch, Erica A. Dale, Jayakrishnan Nair, Paul W. Davenport, Emily J. Fox, Gordon S. Mitchell

Department of Physical Therapy Faculty Papers

We present a case report of a 42-year-old female with post-West Nile virus meningoencephalitis who exhibited unique, long-latency diaphragm potentials evoked by transcranial and cervical magnetic stimulation after exposure to acute intermittent hypoxia (AIH). The subject was recruited for a study investigating AIH effects on respiratory motor function in healthy individuals. She had contracted West Nile virus infection 5 years before assessment that resulted in hospitalization and persistent allodynia but was not reported to the research team. During the study, transcranial (TMS) and cervical (CMS) magnetic stimulation were performed before and 30-60 min after a single presentation of AIH [15, …

Comparing Functional Outcomes Between 3d Printed Acetabular Cups And Traditional Prosthetic Implants In Hip Arthroplasty: A Systematic Review And Meta Analysis, Ryan St. John, Seth Spicer, Mo Hadaya, Hanna Brancaccio, Seungkyu Park, Sean Mcmillan

Rowan-Virtua School of Osteopathic Medicine Departmental Research

OBJECTIVE: The primary research aim was to determine if the use of traditional or 3D printed prosthesis resulted in better functional outcome scores in hip arthroplasty.

METHODS: A systematic review and meta-analysis was conducted utilizing the PRISMA 2020 guidelines. Six databases (PubMed, Embase, Scopus, WebOfScience, and Cochrane Library, Google Scholar) were searched yielding 1117 article titles and abstracts. Rayyan.ai was used to detect duplicates (n = 246) and for manual screening for inclusion and exclusion criteria. Included were controlled studies of any publication time that assessed Harris Hip Score (HHS) at baseline and twelve months. Six papers were sought for …

Wearable Surface Electromyography System To Predict Freeze Of Gait In Parkinson's Disease Patients., Anna Moore, Jinxing Li, Christopher H Contag, Luke J Currano, Connor O Pyles, David A Hinkle, Vivek Shinde Patil

Neuroscience Articles

Freezing of gait (FOG) is a disabling yet poorly understood paroxysmal gait disorder affecting the vast majority of patients with Parkinson's disease (PD) as they reach advanced stages of the disorder. Falling is one of the most disabling consequences of a FOG episode; it often results in injury and a future fear of falling, leading to diminished social engagement, a reduction in general fitness, loss of independence, and degradation of overall quality of life. Currently, there is no robust or reliable treatment against FOG in PD. In the absence of reliable and effective treatment for Parkinson's disease, alleviating the consequences …

Benefits Of Multisensory Rooms In Schools To Control Behaviors In Children With Disabilities, Kye Smith, Cassandra Nelson

Fall 2024 OTD Capstone Symposium

This project explores the benefits of implementing multisensory rooms in schools to manage challenging behaviors in children with disabilities. Conducted at the Barack and Michelle Obama Ninth Grade Center in Lancaster, TX, the program involved participants aged 13-15 diagnosed with disabilities. A comprehensive needs assessment identified gaps in behavior management and overstimulation challenges. The program was designed using evidence-based strategies, including the Person-Environment-Occupation-Performance (PEOP) model, and incorporated techniques such as the Take Five Breathing Strategy, deep pressure input, chair yoga, and meditation.

Through pre- and post-surveys with students, parents, and teachers, the study evaluated the program's impact on functional independence …

Enhancing Data Standards To Advance Translation In Spinal Cord Injury, Vanessa K. Noonan, Suzanne Humphreys, Fin Biering-Sørensen, Susan Charlifue, Yuying Chen, James D. Guest, Linda A. T. Jones, Jennifer French, Eva Widerström-Noga, Vance P. Lemmon, Allen W. Heinemann, Jan M. Schwab, Aaron A. Phillips, Marzieh M. Rizi, John L. K. Kramer, Catherine R. Jutzeler, Abel Torres-Espin

Department of Physical Therapy Faculty Papers

Data standards are available for spinal cord injury (SCI). The International SCI Data Sets were created in 2002 and there are currently 27 freely available. In 2014 the National Institute of Neurological Disorders and Stroke developed clinical common data elements to promote clinical data sharing in SCI. The objective of this paper is to provide an overview of SCI data standards, describe learnings from the traumatic brain injury (TBI) field using data to enhance research and care, and discuss future opportunities in SCI. Given the complexity of SCI, frameworks such as a systems medicine approach and Big Data perspective have …

Atrial Fibrillation Status And Physical Rehabilitation In Older Patients With Acute Decompensated Heart Failure: An Analysis From The Rehab-Hf Trial, Douglas Corsi, Sean Dikdan, Naman Upadhyay, Haiying Chen, Dalane W Kitzman, Robert Mentz, David J Whellan, Daniel R Frisch

SKMC Student Presentations and Publications

BACKGROUND: The REHAB-HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) trial demonstrated that a transitional, tailored, progressive rehabilitation intervention improved physical function, 6-minute walk distance, frailty, quality-of-life, and depression in older patients hospitalized for acute decompensated heart failure. This analysis assessed the impact of atrial fibrillation (AF) on intervention benefits.

METHODS AND RESULTS: Of 349 enrolled patients hospitalized for acute decompensated heart failure (mean age 72.7±8.1 years), 176 (50.4%) had AF. Participants were randomly assigned to 12-week rehabilitation intervention or attention control. The primary outcome was Short Physical Performance Battery score at 3 months. Participants with AF were older …

Enhancing Recovery: Surgical Techniques And Rehabilitation Strategies After Direct Anterior Hip Arthroplasty, Alberto Di Martino, Christopher Keating, Micahel J. Butsick, Daniela Platano, Lisa Berti, Louis N. Hunter, Cesare Faldini

Department of Physical Therapy Faculty Papers

Total hip arthroplasty (THA) is a common surgical procedure for hip joint pathologies, with the direct anterior approach (DAA) gaining popularity due to potential benefits in postoperative recovery. This review aims to provide a comprehensive analysis of rehabilitation strategies following DAA THA, focusing on surgical techniques, postoperative care, and outcomes. The evolution of the DAA to THA is discussed, highlighting historical advancements and comparisons with other surgical approaches. Surgical techniques and considerations specific to the DAA are detailed, including outcomes and complications compared to alternative approaches. The role of the surgical technique in influencing postoperative rehabilitation is explored, emphasizing the …

Different Sensory Information Is Used For State Estimation When Stationary Or Moving., Aaron Wong, Alyssa Eyssalenne, Luke Carter, Amanda S Therrien

Moss-Magee Rehabilitation Papers

The accurate estimation of limb state is necessary for movement planning and execution. While state estimation requires both feedforward and feedback information, we focus here on the latter. Prior literature has shown that integrating visual and proprioceptive feedback improves estimates of static limb position. However, differences in visual and proprioceptive feedback delays suggest that multisensory integration could be disadvantageous when the limb is moving. We formalized this hypothesis by modeling feedback-based state estimation using the long-standing maximum likelihood estimation model of multisensory integration, which we updated to account for sensory delays. Our model predicted that the benefit of multisensory integration …

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 …

Delphi Analysis: Optimizing Anatomy Teaching And Ultrasound Training For Botulinum Neurotoxin Type A Injection In Spasticity And Dystonia, Kimberly Heckert, Bo Biering-Sørensen, Tobias Bäumer, Omar Khan, Fernando Pagan, Mitchell Paulin, Todd Stitik, Monica Verduzco-Gutierrez, Rajiv Reebye

Department of Rehabilitation Medicine Faculty Papers

Our objective was to provide expert consensus on best practices for anatomy teaching and training on ultrasound-guided botulinum neurotoxin type A (BoNT-A) injection for specialists involved in treating spasticity and dystonia. Nine experts (three neurologists; six physical medicine and rehabilitation physicians) participated in a three-round modified Delphi process. Over three rounds, experts reached consensus on 15 of 16 statements describing best practices for anatomy and BoNT-A injection training. They unanimously agreed that knowledge of the target audience, including their needs and current competency, is crucial when designing training programs. Experts also agreed that alignment between instructors is essential to ensure …

African American Patients Have A Higher Probability Of Cognitive Impairment After Incident Stroke: An Analysis Of National Electronic Health Record Data, Alicia Zha, Chenguang Zhang, Gen Zhu, Xinran Huang, Sahar Anjum, Yashar Talebi, Sean Savitz, Hulin Wu

Faculty, Staff and Student Publications

Background: Cognitive impairment (CI) and stroke are diseases with significant disparities in race and geography. Post stroke cognitive impairment (PSCI) can be as high as 15-70 % but few studies have utilized large administrative or electronic health records (EHR) to evaluate trends in PSCI. We utilized an EHR database to evaluate for disparities in PSCI in a large sample of patients after first recorded stroke to evaluate for disparities in race.

Methods: This is a retrospective cohort analysis of Cerner Health Facts® EHR database, which is comprised of EHR data from hundreds of hospitals/clinics in the US from 2009-2018. We …

The Beneficial Role Of Sunitinib In Tumor Immune Surveillance By Regulating Tumor Pd-L1, Vivian L Rose, Anaga Ajoy, Craig A Johnston, Gloria R Gogola, Pranav J Parikh

Faculty, Staff and Student Publications

Importance: There is a need for a pediatric hand function test that can be used to objectively assess movement quality. We have developed a toy-based test, the Bead Maze Hand Function (BMHF) test, to quantify how well a child performs an activity. This is achieved by assessing the control of forces applied while drawing a bead over wires of different complexity.

Objective: To study the psychometric properties of the BMHF test and understand the influence of age and task complexity on test measures.

Design: A cross-sectional, observational study performed in a single visit.

Setting: Clinical research laboratory.

Participants: Twenty-three participants …

Differences In Neural Activation Between Actual Tool Use And Pantomime: Evidence For Two Different Streams?, Simon Thibault, Raphaël Py

Moss-Magee Rehabilitation Papers

No abstract provided.

Prevalence Of Cardiovascular Conditions After Traumatic Brain Injury: A Comparison Between The Traumatic Brain Injury Model Systems And The National Health And Nutrition Examination Survey, Shanti Pinto, Bhaskar Thakur, Raj Kumar, Amanda Rabinowitz, Ross Zafonte, William C Walker, Kan Ding, Simon Driver, Umesh Venkatesan, Gilbert Moralez, Kathleen Bell

Department of Rehabilitation Medicine Faculty Papers

BACKGROUND: The purpose of this study is to compare the prevalence of self-reported cardiovascular conditions among individuals with moderate to severe traumatic brain injury (TBI) to a propensity-matched control cohort.

METHODS AND RESULTS: A cross-sectional study described self-reported cardiovascular conditions (hypertension, congestive heart failure [CHF], myocardial infarction [MI], and stroke) from participants who completed interviews between January 2015 and March 2020 in 2 harmonized large cohort studies, the TBI Model Systems and the National Health and Nutrition Examination Survey. Mixed-effect logistic regression models were used to compare the prevalence of cardiovascular conditions after 1:1 propensity-score matching based on age, sex, …

Parents' Perceptions Of Eye-Gaze Technology Use By Children With Complex Communication Needs, Sandra Masayko, Joy Mcgowan, Namrata Grampurohit

Department of Occupational Therapy Faculty Papers

PURPOSE: Some preschool students with complex communication needs explore eye-gaze computer technology (EGCT) and adopt computer-based augmentative and alternative communication (AAC). The objective of this study was to follow preschool explorers of EGCT who are now school aged to describe the children's use of technology and parents' perceptions of its utility for communication, participation, or leisure.

METHOD: Ten parents completed survey questions by Internet and phone and reported their perceptions of nine children's effectiveness in the use and acceptance of AAC and the support they received in implementing technology. The results are reported as a descriptive study.

RESULTS: All children …

Treatments Perceived To Be Helpful For Neuropathic Pain After Traumatic Spinal Cord Injury: A Multicenter Cross-Sectional Survey Study, Thomas N Bryce, Chung-Ying Tsai, Andrew D Delgado, Sara J Mulroy, Abigail Welch, Diana D Cardenas, Heather B Taylor, Elizabeth R Felix

Faculty, Staff and Student Publications

DESIGN: Cross-sectional survey.

OBJECTIVE: To evaluate the perceived helpfulness of pharmacological and non-pharmacological interventions and their combinations for neuropathic pain (NeuP) and subcategories of NeuP after spinal cord injury (SCI).

SETTING: Six Spinal Cord Injury Model System Centers.

METHODS: Three hundred ninety one individuals at least one year post traumatic SCI were enrolled. A telephone survey was conducted to determine the pharmacologic and non-pharmacologic treatments used in the last 12 months for each participant's three worst pains, whether these treatments were "helpful", and if currently used, each treatments' effectiveness.

RESULTS: Two hundred twenty participants (56%) reported 354 distinct NeuPs. Pharmacological …

Alteration In Resting-State Brain Activity In Stroke Survivors After Repetitive Finger Stimulation, Dorothy He, William A Sikora, Shirley A James, Jordan N Williamson, Louis V Lepak, Carolyn F Cheema, Evgeny Sidorov, Sheng Li, Yuan Yang

Faculty, Staff and Student Publications

Objective: This quasi-experimental study examined the effect of repetitive finger stimulation on brain activation in eight stroke and seven control subjects, measured by quantitative electroencephalogram.

Methods: We applied 5 mins of 2-Hz repetitive bilateral index finger transcutaneous electrical nerve stimulation and compared differences pre- and post-transcutaneous electrical nerve stimulation using quantitative electroencephalogram metrics delta/alpha ratio and delta-theta/alpha-beta ratio.

Results: Between-group differences before and after stimulation were significantly different in the delta/alpha ratio ( z = -2.88, P = 0.0040) and the delta-theta/alpha-beta ratio variables ( z = -3.90 with P < 0.0001). Significant decrease in the delta/alpha ratio and delta-theta/alpha-beta ratio variables after the transcutaneous electrical nerve stimulation was detected only in the stroke group (delta/alpha ratio diff = 3.87, P = 0.0211) (delta-theta/alpha-beta ratio diff = 1.19, P = 0.0074).

Conclusions: The decrease in quantitative electroencephalogram metrics in the stroke …

Examining The Effect Of Genes On Depression As Mediated By Smoking And Modified By Sex, Kirsten Voorhies, Julian Hecker, Sanghun Lee, Georg Hahn, Dmitry Prokopenko, Merry-Lynn Mcdonald, Alexander C Wu, Ann Wu, John E Hokanson, Michael H Cho, Christoph Lange, Karin F Hoth, Sharon M Lutz

Faculty, Staff and Student Publications

Depression is heritable, differs by sex, and has environmental risk factors such as cigarette smoking. However, the effect of single nucleotide polymorphisms (SNPs) on depression through cigarette smoking and the role of sex is unclear. In order to examine the association of SNPs with depression and smoking in the UK Biobank with replication in the COPDGene study, we used counterfactual-based mediation analysis to test the indirect or mediated effect of SNPs on broad depression through the log of pack-years of cigarette smoking, adjusting for age, sex, current smoking status, and genetic ancestry (via principal components). In secondary analyses, we adjusted …

Use Of Medication Management Strategies To Increase Medication Compliance In Person’S Who Have Suffered A Stroke, Mason Pace, Rebecca King

Spring 2024 Virtual OTD Capstone Symposium

The provided research provides education to increased independence in person with stroke for the occupation of medication adherence. Various exercises and education provided in the research to increase independence in persons with stroke.

Awareness And Advocacy For The Needs Of Nfl Athletes: A Qualitative Study, Bianca Castro, Susan Macdermott

Spring 2024 Virtual OTD Capstone Symposium

The presentation delves into understanding, investigating, and supporting the occupational needs of NFL athletes. Through thorough research and analysis, it was revealed that these athletes face distinct challenges and demands in their professional and personal lives, specifically in wellness, quality of life, and lifestyle balance. The study results provide knowledge and abilities to address and advocate the unique needs of NFL athletes. The evidence strongly emphasizes the advantages and benefits of occupational therapy services in non-traditional settings such as sports.

An Ot Needs Assessment For Children And Families Residing In Shelters, Jessie Siono, Susan Macdermott

Spring 2024 Virtual OTD Capstone Symposium

This study created a needs assessment is to determine the unique occupational deficits of children and their families in California experiencing homelessness within a shelter setting via recording their lived experiences. A local family shelter was analyzed via observation and interviews with staff and residents of the shelter. The results were compiled into a facility assessment to identify supports and barriers to occupation. Results were also utilized to complete an occupational needs assessment for families and children living in homeless shelters. The study determined the occupational needs and occurrences of occupational deficits that were experienced by residents of the family …

The Role Of Occupational Therapy In Enhancing Adaptive Golf, Jessica A. Garday, Susan Macdermott

Spring 2024 Virtual OTD Capstone Symposium

This project is focused on advocating on behalf of golfers with disabilities by providing an educational resource for golf administrators on enhancing adaptive golf at their facility. The project's deliverable was an in-service presentation highlighting the importance of adaptive golf and its positive impact on community, state, and national individuals. The in-service was delivered through the Southern California Professional Golf Association SCPGA Catalyst webinar series. The topics included grants for adaptive equipment, the financial impact of adaptive golf on the industry, community partnerships, and golf course design modifications utilizing the most cost-effective approaches. The student found that more education can …

The Role Of Computational Methods In Cardiovascular Medicine: A Narrative Review, Salvatore Facciorusso, Stefania Spina, Alessandro Picelli, Alessio Baricich, Gerard E Francisco, Franco Molteni, Jörg Wissel, Andrea Santamato

Faculty, Staff and Student Publications

Botulinum toxin type-A (BoNT-A) has emerged as a key therapeutic agent for the management of spasticity. This paper presents a comprehensive bibliometric and visual analysis of research concerning BoNT-A treatment of spasticity to elucidate current trends and future directions in this research area. A search was conducted in the Web of Science database for articles focused on the use of BoNT-A in spasticity published between 2000 and 2022. We extracted various metrics, including counts of publications and contributions from different countries, institutions, authors, and journals. Analytical methods in CiteSpace were employed for the examination of co-citations, collaborations, and the co-occurrence …

Occupational Therapy Students’ Perceptions Of Their Experience In A Role-Emerging Level Ii Fieldwork Within Higher Education Student Services, Marie-Christine Potvin, Alexis Morales, Erin West, Mika Kalimi, Jeanne M Coviello

Department of Occupational Therapy Faculty Papers

BACKGROUND: Role-emerging settings - those where occupational therapy (OT) services have not traditionally been provided - are common sites for practice placements of entry-level occupational therapy students. A growing body of literature has attempted to determine the value and drawbacks of such practice placements on the professional preparedness of OT students with mixed findings. Benefits have been identified, including increased cultural understanding, advocacy, creativity, initiative, and problem-solving skills. However, OT students have been reported to perceive such placement as limiting their professional growth and preparedness to practice compared to traditional placements.

METHODS: A phenomenological study was conducted seeking the perceptions …

Ot's Perspective On Type 1 Diabetes Management In College Students, Nimmy Thomas, Cassandra Nelson, Elizabeth Pyatak

Spring 2024 Virtual OTD Capstone Symposium

To create a program guide to provide resources for freshman-year students to seek accommodations or helpful tips for students with type 1 diabetes to have a smooth transition to college enhance overall health management, and participate in leisure activities.

Occupational Engagement In Recreational Sports For The Deaf And Hard Of Hearing: An Employee Guidebook, Colleen Mcerlean, Mary Ann Smith, Christopher Ebner

Spring 2024 Virtual OTD Capstone Symposium

An employee guidebook to help increase occupational engagement within recreational sports for the Deaf and Hard of Hearing population in the Austin, TX area.