Rehabilitation and Therapy Commons^™

Emerging Evidence For Intrathecal Management Of Neuropathic Pain Following Spinal Cord Injury, Jay Karri, James Doan, Christian Vangeison, Marissa Catalanotto, Ameet S Nagpal, Sheng Li

Faculty, Staff and Student Publications

A high prevalence of patients with spinal cord injury (SCI) suffer from chronic neuropathic pain. Unfortunately, the precise pathophysiological mechanisms underlying this phenomenon have yet to be clearly elucidated and targeted treatments are largely lacking. As an unfortunate consequence, neuropathic pain in the population with SCI is refractory to standard of care treatments and represents a significant contributor to morbidity and suffering. In recent years, advances from SCI-specific animal studies and translational models have furthered our understanding of the neuronal excitability, glial dysregulation, and chronic inflammation processes that facilitate neuropathic pain. These developments have served advantageously to facilitate exploration into …

The Investigation Between Voiding Function Medication And The Risk Of Bladder Cancer In Patients With Spinal Cord Injury, Kai-Hua Chen, Ting-Yao Wang, Chien-Min Chen, Chuan-Pin Lee, Yao-Hsu Yang, Chu-Hsu Lin, Kuan-Yu Kung, Vincent Chin-Hung Chen

Rehabilitation Practice and Science

Bladder cancer (BC) is a chronic complication of spinal cord injury (SCI). Limited studies have focused on the risks of BC in SCI patients using voiding function medication for bladder dysfunction. In this retrospective, national-wide, population-based cohort study, SCI patients with registration in the National Health Insurance Research Database (NHIRD) from 1998 to 2013 were included. We investigated the risk of BC in SCI patients administered voiding function medications and other comorbidities by 2-year landmark analysis. SCI patients were divided into medication user (bethanechol, oxybutynin, or tolterodine) and non-medication user groups at landmark period. They were followed until the development …

The Health Insurance Resources Utilization And Rehabilitation Intervention In Patients With Traumatic Spinal Cord Injury: A Pilot Study, Pao Huang, Jen-Hung Wang, Chih-Cheng Fan, Po-Ting Chen, Chung-Chao Liang

Rehabilitation Practice and Science

Spinal cord injury is associated with a substantial and long-term economic burden on both the patients and the national health insurance. Due to the advancements in medical techniques, the mortality rate of patients with spinal cord injury has decreased. Moreover, as the life expectancy has increased in Taiwan, patients with spinal cord injury may need long-term rehabilitation to restore their functions of daily living and prevent further complications. Nonetheless, long-term rehabilitation would increase the economic burden on the long-term care facilities, as expected. This study aimed to analyze the impact (from admission to 3-year follow-up after discharge) of medical expenses …

Coaching In Context: Implications For Practice & Parent Perspectives, Rachel Y. Kim, Otd, Otr/L, N. Gerhardt, Ms, Otr/L, Cbis, Bernadette Alpajora, Otd, Otr/L, Mj Mulcahey, Phd, Otr/L, Fasia, Clcp

Department of Occupational Therapy Posters and Presentations

Introduction

• Informal care partners experience high levels of guilt, stress, anxiety, depression, and overall decreased health and wellness1-3.
• There is a gap in accessibility of services for informal care partners of individuals with chronic conditions4.
• Care partners of individuals with chronic conditions need long-term support and skill-building for the health & well-being of their care recipient and themselves5.

Coaching in Context

• Coaching in Context (CinC) (Figure 1) is a client-driven approach that leverages client’s strengths and addresses challenges through problem-solving skills.
• Coaches connect with clients to build a trusting relationship. The coach uses skillful questioning to enable the client to …

Spinal Cord Injury-Movement Index (Sci-Mi) Fine Motor Item Pool: Development And Preliminary Validation, Rachel Y. Kim, Otd, Nicole Gerhardt, Ms, Otr/L, Mj Mulcahey, Phd, Otr/L, Fasia

Department of Occupational Therapy Posters and Presentations

Purpose: Describe the conceptual framework and preliminary results from pretesting for content validation of the Fine Motor Item Pool of the SCI-MI.

An Online Educational Resource On Adaptive Sports For People With Spinal Cord Injuries, Rachel Morgan, Steven M. Gerardi

Fall 2021 Virtual OTD Capstone Symposium

A spinal cord injury (SCI) has a serious impact on an individual’s participation in everyday life activities, leading to a high risk of a sedentary life-style. There is a paucity of research pertaining to adaptive sport participation post-injury and the role of occupational therapy (OT). Additionally, there are limited resources available that inform people with SCI on the benefits of adapted sports or where to go to engage in them. As such, this paper describes the development of a doctoral capstone project to address this need. The purpose of this capstone project was to create an educational web page that …

Highlighting Gaps In Spinal Cord Injury Research In Activity-Based Interventions For The Upper Extremity: A Scoping Review., Namrata Grampurohit, Alison Bell, Susan Duff, M. J. Mulcahey, Christina Calhoun Thielen, Gary Kaplan, Ralph J. Marino

Department of Occupational Therapy Faculty Papers

BACKGROUND: Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited.

OBJECTIVE: To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI.

METHODS: The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTseeker with the criteria: non-invasive activity-based interventions delivered atleast three times/week for two weeks, upper extremity functional outcomes, 13 years or older, English language, and neurological disorders three months post onset/injury.

RESULTS: The …

Perspectives Of Individuals With Chronic Spinal Cord Injury Following Novel Balance Training Involving Functional Electrical Stimulation With Visual Feedback: A Qualitative Exploratory Study, David J Houston, Janelle Unger, Jae W Lee, Kei Masani, Kristin E Musselman

Physical Therapy Publications

BACKGROUND: Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during periods of walking or standing. We recently reported the findings of a novel intervention combining functional electrical stimulation with visual feedback balance training (FES + VFBT) on standing balance abilities among five individuals with motor iSCI. However, the previous publication did not report the perceived impact of the intervention on the participants' lives. In this report, the experiences of these five individuals with incomplete spinal cord injury (iSCI) who had recently completed the four-week balance training program are described.

METHODS: Five individuals with a motor …

Intermittent Catheter Reimbursement In The United States: The Experience Of Nine Stakeholders Through The Lens Of Actor-Network Theory, Manon M. Schladen, Amanda K. Rounds, Terrence Mcmanus, Alexandra Bennewith, Henry Claypool, Suzanne L. Groah

The Qualitative Report

A narrow interpretation of “medical necessity” can result in poorer health as well as a more restricted life for people with disabilities. We examined the impact of US policy on reimbursement of intermittent catheters (ICs) on the lives of people with neurogenic bladder (NB) who require catheters to urinate. We conducted in-depth, longitudinal interviews with nine stakeholders. Actor-Network Theory was used to describe interactions among human agents, IC products, and policies in the reimbursement arena. Restrictions on the type and quantities of ICs reimbursed emerged as the most potent inhibitor to health and wellbeing among consumers with NB. IC suppliers, …

The Effect Of Perturbation-Based Balance Training And Conventional Intensive Balance Training On Reactive Stepping Ability In Individuals With Incomplete Spinal Cord Injury Or Disease: A Randomized Clinical Trial, Janelle Unger, Katherine Chan, Jae W Lee, B Catharine Craven, Avril Mansfield, Mohammad Alavinia, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability.

Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D.

Design: Randomized clinical trial.

Setting: Tertiary SCI/D rehabilitation center.

Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study.

Methods: Participants were randomly allocated …

Intermittent Theta Burst Stimulation: Application To Spinal Cord Injury Rehabilitation And Computational Modeling, Neil Mittal

Theses and Dissertations

Loss of motor function from spinal cord injuries (SCI) results in loss of independence. Rehabilitation efforts are targeted to enhance the ability to perform activities of daily living (ADLs), but outcomes from physical therapy alone are often insufficient. Neuromodulation techniques that induce neuroplasticity may push the limits on recovery. Neuromodulation by intermittent theta burst transcranial magnetic stimulation (iTBS) induces neuroplasticity by increasing corticomotor excitability, though this has most frequently been studied with motor targets and on individuals not in need of rehabilitation. Increased corticomotor excitability is associated with motor learning. The response to iTBS, however, is highly variable and unpredictable, …

The Effects Of The Rewalk^(Tm) Robotic System On Walking Capability In Paraplegic Spinal Cord Injury Patients In Taiwan, Alice Cw Tang, Shao An Lee, Albert Ck Chen, Ching Yu Wang, Wan Yu Chou, Show Chun Chen, Chih Lin Wu, Simon Fuk Tan Tang

Rehabilitation Practice and Science

Background: The ReWalk^(TM) system is an exoskeleton robotic device developed for ambulation assistance in patients with paraplegic spinal cord injury (SCI). The purpose of this study is to evaluate the safety and walking capability of the ReWalk^(TM) system for patients with paraplegic spinal cord injury in Taiwan. Methods: Eight patients with SCI and paraplegia were recruited for the study in a period from April 2015 to April 2016. The level of injuries ranged from T4 to T11. Assessments included the continuous walking time, the continuous walking distance, 6-minute walking test and 10-meter walking test after training for forty hours. Results: …

Increased Risk Of Arrhythmia In Patients With Cervical Spinal Cord Injury: A Nationwide Population-Based Matched Cohort Study, Chia-Hsuan Lin, Yan-Yuh Lee, Chun-En Kuo, Po-Cheng Chen

Rehabilitation Practice and Science

Objective: To investigate the risk of cardiac arrhythmias among adults with spinal cord injury (SCI). Methods: This is a retrospective population-based matched cohort study. Data were derived from the National Health Insurance Research Database. This study identified all patients diagnosed with SCI from January 1, 2000 to December 31, 2013. Patients with SCI were categorized into the cervical SCI (C-SCI) and other SCI (O-SCI) groups according to the level of injury. The cumulative incidence of cardiac arrhythmias was compared between patients with C-SCI, those with O-SCI, and those without SCI. Cox proportional hazards regression model was used to assess the …

A Rare Presentation Of Myelopathy In Novice Surfers: A Casereport And Literature Reviewarticle, Ming-Hsuan Huang, Shu-Fen Sun, Min-Hui Li, Ping-Hong Lai

Rehabilitation Practice and Science

Introduction: Surfer's myelopathy is a nontraumatic, ischemic spinal cord injury that predominantly affects the lower thoracic cord. Owing to its clinical rarity, its pathophysiology and treatment protocol remain controversial. Frequently discussed hypotheses regarding its cause include ischemic change due to trunk hyperextension and the Valsalva maneuver, leading to back pain, weakness in the lower extremities, and bowel and bladder dysfunction. The prognosis varies widely, ranging from full recovery to paraplegia. casereport: We report the case of a 22-year-old female patient experiencing progressive loss of strength in the lower extremities and soreness in her lower back while surfing for the first …

Coinstantaneous Brachial Plexus Injuries In A 55-Year-Old Man With Traumatic Spinal Cord Injury: A Casereport And Literature Reviewarticle, Hong-Yi Lin, Jia-Yin Guo, Su-Ju Tsai

Rehabilitation Practice and Science

脊髓損傷合併臂神經叢損傷臨床上少見且不易診斷與處置。過去研究的報告發生率約為0.6％到1.8％。在脊髓損傷的病人處置時，通常優先處理危及生命的傷害，且臂神經叢損傷的臨床表現也可能歸因於脊髓損傷而被忽略。本文報告一名55歲因車禍意外導致第四節脊髓損傷的男性病人，根據病人的身體檢查、神經學檢查發現右上肢深肌腱反射無反應，以及明顯不對稱的右上肢與左上肢肌力，經過神經傳導檢查及肌電圖檢查，確定該名病人為脊髓損傷合併臂神經叢損傷。同時罹患脊髓損傷及臂神經叢損傷的病人數量可能被低估，治療計畫及復健也更為複雜，早期診斷與適當治療是此類病人上肢功能恢復的重要關鍵。除了詳細探查脊髓損傷病人的臨床症狀、身體檢查、神經學檢查之外，電學診斷對於合併臂神經叢損傷的確診最有效益。

Ampakines Stimulate Phrenic Motor Output After Cervical Spinal Cord Injury, L. B. Wollman, Kristi A. Streeter, A. F. Fusco, E. J. Gonzalez-Rothi, M. S. Sandhu, J. J. Greer, D. D. Fuller

Physical Therapy Faculty Research and Publications

Activation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors increases phrenic motor output. Ampakines are a class of drugs that are positive allosteric modulators of AMPA receptors. We hypothesized that 1) ampakines can stimulate phrenic activity after incomplete cervical spinal cord injury (SCI), and 2) pairing ampakines with brief hypoxia could enable sustained facilitation of phrenic bursting. Phrenic activity was recorded ipsilateral (IL) and contralateral (CL) to C2 spinal cord hemisection (C2Hx) in anesthetized adult rats. Two weeks after C2Hx, ampakine CX717 (15 mg/kg, i.v.) increased IL (61 ± 46% baseline, BL) and CL burst amplitude (47 ± 26%BL) in 8 of 8 …

Dynamic Body-Weight Support To Boost Rehabilitation Outcomes In Patients With Non-Traumatic Spinal Cord Injury: An Observational Study, Justin P. Huber, Lumy Sawaki

Neurology Faculty Publications

BACKGROUND: Dynamic body-weight support (DBWS) may play an important role in rehabilitation outcomes, but the potential benefit among disease-specific populations is unclear. In this study, we hypothesize that overground therapy with DBWS during inpatient rehabilitation yields greater functional improvement than standard-of-care in adults with non-traumatic spinal cord injury (NT-SCI).

METHODS: This retrospective cohort study included individuals diagnosed with NT-SCI and undergoing inpatient rehabilitation. All participants were recruited at a freestanding inpatient rehabilitation hospital. Individuals who trained with DBWS for at least three sessions were allocated to the experimental group. Participants in the historical control group received standard-of-care (i.e., no DBWS). …

Bringing Function To Families: Ot’S Role In Parenting With Sci, Alexandra Economou, Ots, Molly Flannery, Ots, Nikki Tutelman, Ots, Courtney Wagner, Ots, Rebecca Sinko, Otd, Otr/L

Collaborative Research and Evidence shared Among Therapists and Educators (CREATE Day)

Objectives:

• Describe participation challenges that impact the role of parenting for parents with SCI
• Identify evidence-based intervention areas within the scope of OT that facilitate participation in the role of parenting with SCI
• Discuss the unique need and application for OT services to support parents with SCI

PICO Question:

What are interventions within the scope of OT practice that increase participation in the role of parenting with spinal cord injury (SCI)?

Unmasking Severe Hypotension After Intermittent Catheter For Distended Bladder In A Patient With Cervical Spinal Cord Injury, Dennis Nguyen, Neal Ekpoudia, Ellsworth Remson, Farzin Farhandnejad, Se Won Lee

Physical Medicine & Rehabilitation

See additional files.

Ectopic Pregnancy In A Woman With T9 Ais A Paraplegia Secondary To High-Grade Spinal Cord Pilocytic Astrocytoma, Elisabeth K. Acker

Graduate Medical Education (GME) Resident and Fellow Research Day Posters

Ectopic pregnancy in a woman with T9 AIS A (motor complete, sensory complete) paraplegia secondary to a high-grade spinal cord pilocytic astrocytoma

Background

In the United States, 20,000 women of childbearing age have a spinal cord injury (SCI). While SCI induces transient amenorrhea immediately after injury, women generally have normal reproductive function after SCI, and their fertility is unimpaired. Medications that commonly manage complications of SCI should be avoided or discontinued during pregnancy. Complications inherent to SCI, including urologic issues, are often exacerbated during pregnancy.

Methods

This is a case report on a female Veteran who initially presented to the …

Functional Electrical Stimulation Plus Visual Feedback Balance Training For Standing Balance Performance Among Individuals With Incomplete Spinal Cord Injury: A Case Series, David J Houston, Jae W Lee, Janelle Unger, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Individuals with an incomplete spinal cord injury (iSCI) are highly susceptible to falls during walking or standing. Our objective was to evaluate a therapeutic tool for standing balance that combined functional electrical stimulation, applied bilaterally to the plantarflexors and dorsiflexors, with visual feedback balance training (FES+VFBT). Five adults with iSCI completed 12 FES+VFBT sessions over 4 weeks. During the training sessions, participants completed each of the four balance exercises twice. Visual feedback of the center-of-pressure (COP) location was provided as participants completed the balance exercises and received FES to assist with performance of the exercises. A closed-loop FES system was …

Retrospective Study Of Neurogenic Bladder Complications In Patients With Chronic Spinal Cord Injury, Sheng-Min Chang, Sheng-Wei Zeng

Rehabilitation Practice and Science

Recent advances in medicine have greatly prolonged the average lifespan of patients with chronic spinal cord injury (SCI). However, many complications arise as the disease enters the chronic phase. SCI is known to cause limb weakness and paresthesia, it also causes multiple system abnormalities that cannot be easily ignored. Particularly troublesome issues develop due to the urinary system complications resulting from the neurogenic bladder. These include overactive bladder, detrusor external sphincter dyssynergia, vesicoureteral reflux, urolithiasis, urinary tract infection (UTI), and even chronic kidney disease. All these issues cause annoying problems that disturb the patient’s health and quality of life. The …

Impact Of Spinal Cord Injuries On Occupational Performance And Successful Role Acquisition During Motherhood, Caitlin Defrehn, Bs, Otas, Marie Quainoo, Ba, Otas, Sara Loesche, Ms, Otr/L, Cht

School of Continuing and Professional Studies Posters

OT services can be utilized to optimize a mother’s function, mobility and engagement during and after pregnancy

OTPs can help women with SCIs fulfill the role of mother by providing

• “training, adaptations, and resources” (para. 14)
• “evaluating and recommending wheelchair seating and positioning” (para. 6)
• Evaluating [mental], physical and environmental barriers in the home and community and recommending modifications (para. 8) (AOTA, 2015)

Current literature indicates that there are limited resources for mothers living with SCIs, especially regarding care of infants

Additional research is necessary to “examine the most effective strategies and adaptations” (p.2)

Quantifying Balance Control After Spinal Cord Injury: Reliability And Validity Of The Mini-Bestest, Katherine Chan, Janelle Unger, Jae Woung Lee, Gillian Johnston, Marissa Constand, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Context/Objective: Incomplete spinal cord injury (iSCI) causes deficits in balance control. The Mini-Balance Evaluation Systems Test (mini-BESTest) is a comprehensive measure; however, further testing of its psychometric properties among the iSCI population is needed. We evaluated the mini-BESTest’s test-retest reliability, and concurrent and convergent validity among individuals living with iSCI for more than one year.

Design: Cross-sectional study.

Setting: Rehabilitation hospital.

Participants: Twenty-one individuals with chronic motor iSCI (14 females, mean age 56.8 ± 14.0 years).

Interventions: None.

Outcome Measures: Participants completed the mini-BESTest at two sessions spaced two weeks apart. At the second session, participants …

Trends In Rates Of Asia Impairment Scale Conversion In Traumatic Complete Spinal Cord Injury, R. Marino, M. Leff, D. Cardenas, D. Chen, S. Kirshblum, B. Leiby

Department of Rehabilitation Medicine Posters

Objective: Recent studies on conversion of ASIA Impairment Scale (AIS) grades report higher rates of conversion than older studies. The purpose of this study is to examine the rate of conversion over time in persons with ASIA Impairment Scale (AIS) grade A spinal cord injury (SCI), accounting for level of injury.

Methods: Subjects were injured between 1995 and 2015, enrolled in the National SCI Database as Day-1 admissions, at least 16 years old at the time of injury, classified as AIS A, and had an initial examination within 2 weeks of injury. Change in AIS grade was determined for …

An Examination Of Mothering Occupations In The Context Of Spinal Cord Injury, Gohar Ghushchyan-Tigranyan

OT Student Capstones

An examination of mothering occupations in the context of spinal cord injury across cultures, motherhood is a desired life trajectory that is strongly influenced by cultural norms and expectations. Mental or physical injuries can become a barrier to fulfilling this life goal, leaving a great sense of loss and feeling of failure for women (Albright, Duggan, and Rahman, 2009). This paper aims to understand the lives of mothers with spinal cord injury, the physical challenges and adaptation that they found around the disability, and the psychosocial impact of mothering from a wheelchair. This project will also investigate professional involvement, such …

Independence Through Patient Education In A Spinal Cord Injury Population, Justin Mctish

Electronic Theses and Dissertations

The Know More, Live Better program was developed because the population of people with Spinal Cord Injuries (SCI) includes a substantial number of young people, who often readmit into hospitals for preventable causes such as pressure ulcers, respiratory infections, and bowel/bladder infections. These complications can be avoided through patient education. A needs assessment was conducted at the SCI unit at Good Shepherd Rehabilitation Hospital in Allentown, PA. This assessment included structured observation of patient education in the therapy process, semi-structured interviews about site needs and patient education topics completed with patients and occupational therapists on staff, and surveys of multi-disciplinary …

Rapid And Robust Restoration Of Breathing Long After Spinal Cord Injury, Philippa M. Warren, Stephanie C. Steiger, Thomas E. Dick, Peter M. Macfarlane, Warren J. Alilain, Jerry Silver

Spinal Cord and Brain Injury Research Center Faculty Publications

There exists an abundance of barriers that hinder functional recovery following spinal cord injury, especially at chronic stages. Here, we examine the rescue of breathing up to 1.5 years following cervical hemisection in the rat. In spite of complete hemidiaphragm paralysis, a single injection of chondroitinase ABC in the phrenic motor pool restored robust and persistent diaphragm function while improving neuromuscular junction anatomy. This treatment strategy was more effective when applied chronically than when assessed acutely after injury. The addition of intermittent hypoxia conditioning further strengthened the ventilatory response. However, in a sub-population of animals, this combination treatment caused excess …

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 …

Evolution Of Occupational Therapy Practice: Life History Of Diane Norell, Msw, Otr/L, Caelin Hansen, Jessie Zimmer

Oral History Posters

This life history is one of 31 life history interviews which are part of a larger project, Life Histories of Individuals Who Have Been Influential In Developing Occupational Therapy (OT) In North Dakota and Wyoming. The purpose of the project is to gather information about the history and evolution of occupational therapy (OT) practice in North Dakota and Wyoming through life history of individuals who have been influential in developing OT in these two states. It is anticipated that the life history process will be a powerful way to gather this information. This study is intended to provide current and …