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The AAP Education Committee is pleased to offer AAP Journal Club Podcasts featuring selected articles from the American Journal of Physical Medicine and Rehabilitation. Authors share insight, additional information and personal experiences from the development of the publication. Please enjoy!

 

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Top tags: SCI  spinal cord injury  aquatic lymphatic therapy  blauwet  boninger  breast cancer  Cheville  DeJong  depression  disability  Gait  Kennedy  Letellier  lymphedema  pressure ulcer  Prolotherapy  Rabago  rehabilitation  research  Robotic Leg Brace  Sabharwal  Sander  sports  Stein  Stroke  TBI  therapy  traumatic brain injury  Whyte 

An Exploratory Study Examining Clinical Measures of Adiposity Risk for Predicting Obesity in Adolescents with Physical Disabilities

Posted By Leigh Patrick, Wednesday, September 16, 2015



Dr. Stacy Stark interviews Brooks Wingo, author of the article entitled "An Exploratory Study Examining Clinical Measures of Adiposity Risk for Predicting Obesity in Adolescents with Physical Disabilities."

OBJECTIVE: The purposes of this study were to assess the accuracy of clinical measures for predicting adiposity when compared with a criterion standard of body fat percentage measured by dual-energy X-ray absorptiometry and to determine the most appropriate cut points for classifying obesity for each measure in adolescents with physical disability.

 

RESULTS: Although all clinical measures correlated with body fat as measured by dual-energy X-ray absorptiometry, current cut points are not adequate in this group. Using a body mass index of 20 kg/m2 (boys) and 19 kg/m2 (girls) was optimal but still misclassified a significant number of participants as non-obese in this group. Using the optimal cut points for waist circumference, which were 83 cm (boys) and 78 cm (girls), was the best predictor.

 


                                   


       Brooks Wingo is an Assistant Professor in the Department of Occupational Therapy at the University of

       Alabama at Birmingham. She received her PhD in Health Education and Promotion from the UAB

       School of Public Health in 2010 and completed a postdoctoral fellowship in Comparative

       Effectiveness in the UAB Center for Outcomes and Effectiveness Research and Education and

       the Department of Nutrition Science.  Her research focuses on understanding the role of

       dietary ambulatory children and adults. 




A PDF transcript of the podcast is available for download by selecting the attached file below.

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Gait Training with a Robotic Leg: A Randomized Controlled Pilot Study

Posted By Candace Street, Monday, May 4, 2015
Updated: Friday, May 1, 2015

Objective: Robot-aided exercise therapy is a promising approach to enhance walking ability in stroke survivors. This study was designed to test a new robotic knee brace for restoring mobility in stroke survivors.

Design: Twenty-four ambulatory individuals with chronic hemiparesis after stroke were enrolled in this pilot study. The participants were randomly assigned in equal numbers to either treatment with the experimental device or to a group exercise program and received a total of 18 hrs of their assigned therapy during a 6-wk training period. The primary outcome was gait velocity, as measured with the 10-m walk test. Secondary measures included 6-min walk test, Timed Up and Go test, Five-Times-Sit-to-Stand test, Romberg test, Emory Functional Ambulation Profile, Berg Balance scale, and the California Functional Evaluation 40.

Interview with Joel Stein, MD co-author of the AJPMR article Gait Training with a Robotic Leg Brace After Stroke: A Randomized Controlled Pilot Study

 

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Tags:  Gait  Robotic Leg Brace  Stein  Stroke  therapy 

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The Effects of Aqua Lymphatic Therapy on Arm Disability, Quality of Life and Pain in Women with Chronic Breast Cancer Related Lymphedema

Posted By Amy Schnappinger, Monday, August 18, 2014
Updated: Thursday, August 14, 2014



Dr. Andrea Cheville interviews Marie-Eve Letellier, MSc, author of the article entitled "The Effects of Aqua Lymphatic Therapy on Arm Disability, Quality of Life and Pain in Women with Chronic Breast Cancer Related Lymphedema."

Abstract
OBJECTIVES: Chronic lymphedema occurs frequently in breast cancer patients and is associated with  significant morbidity and reduced quality of life (QOL). In this pilot study we: 1) addressed whether conducting a larger RCT of aqua lymphatic therapy (ALT) would be feasible and 2) estimated the extent to which ALT combined with home based exercise, compared to home based exercise alone would reduce arm disability
in patients with breast cancer related lymphedema (BCRL).

DESIGN: Twenty five women with BCRL were randomized to either ALT in addition to a home land-based exercise program (ALT group) (n=13) or to a home land-based exercise program alone (control group) (n=12). Participants were evaluated prior to and following a 12-week intervention period comprised of weekly pool exercise sessions. Main outcome measures were arm volume, arm disability, pain and QOL.

RESULTS: At follow-up, there was no statistical difference between the control and ALT groups in any of the outcomes, except for present pain intensity. At the end of study period, there was no change in the lymphedematous limb volume in either group. Grip strength was improved in both groups. Only the ALT group showed a statistical significant difference with a reduction in pain intensity score and arm disability.
Furthermore, QOL significantly improved only in the ALT group.

CONCLUSIONS: Conducting a larger RCT would be feasible. In comparison to the beginning of the intervention, participants in the ALT group showed significant beneficial changes after 12 weeks of treatment, while the control group did not improve. ALT did not make the lymphedema volume worse and therefore may serve as a safe alternative to land-based treatments for BCRL.





Marie-Eve Letellier, M.Sc. Kinanthropology, is a kinesiologist who has training in Combined Decongestive Therapy (Vodder), Aqualymphatic Therapy (Tidhar), and Exercise Therapy following breast cancer (Lebed). After graduating with her masters in kinesiology in 2004, Ms. Letellier started working as a research assistant in breast cancer. This led her to discover the field of arm dysfunction, with a particular interest in lymphedema. She soon realized that there was a lack of awareness and therapists dealing with this issue. She the completed the training to become a lymphedema (Vodder) and aqualymphatic (Tidhar) therapist. In order to gain knowledge in both clinical and research fields, she is currently pursuing a doctoral degree in Rehabilitation Science at McGill University (supervisor: Dr. Nancy Mayo) looking at arm dysfunction after breast cancer. In addition, since 2008, she is in charge of the Kinesiology Clinic at the Cedars Breast Clinic, Royal Victoria Hospital (Montreal, Canada).


A PDF transcript of the podcast is available for download by selecting the attached file below.

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Tags:  aquatic lymphatic therapy  breast cancer  Cheville  Letellier  lymphedema 

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Relationship of Preinjury Depressive Symptoms to Outcomes 3 Months After Complicated and Uncomplicated Traumatic Brain Injury

Posted By Bernadette M. Rensing (Colvin), Monday, July 14, 2014
Updated: Friday, July 11, 2014



Dr.John Whyte interviews Dr. Angelle Sander, author of the article entitled "Relationship of Preinjury Depressive Symptoms to Outcomes 3 Months After Complicated and Uncomplicated Traumatic Brain Injury."

Abstract
OBJECTIVE: This study examines the effect of preinjury depressive symptoms on outcomes 3 mos after complicated and uncomplicated cases of mild traumatic brain injury.

DESIGN: Preinjury depressive symptoms, experienced in the 30 days before injury, as measured by retrospective self-report, were assessed within the first 2 wks after injury. The outcome measures assessed at 3 mos after injury included affective/behavioral, cognitive, and physical problems and health-related quality-of-life.

RESULTS: There were 177 patients who completed both the baseline and 3-mo follow-up interviews. The sample was categorized by severity of depressive symptoms in the month before injury as normal, mild, or moderate-severe. Compared with those reporting no preinjury depressive symptoms, persons reporting moderate-severe depressive symptoms had significantly worse outcomes on the Affective and Behavioral and the Cognitive subscales of the Head Injury-Family Interview Problem Checklist and on the 36-item Short-Form Health Survey Mental Component Summary score. The group reporting mild preinjury depressive symptoms scored worse on a measure of cognitive symptoms compared with those with no preinjury depressive symptoms. There was no interaction between preinjury depressive symptoms and severity of the mild traumatic brain injury (complicated or uncomplicated) for any of the outcomes.

CONCLUSION: Moderate to severe depressive symptoms in the month before injury seems to be a possible risk factor for poor affective/behavioral, cognitive, and mental health-related quality-of-life outcomes at 3 mos after mild traumatic brain injury. Clinicians and researchers should consider the impact of preinjury depression on the recovery process to provide at-risk patients adequate treatment soon after injury. were no differences in magnetic resonance imaging scores. Satisfaction was high; there were no adverse events.





Dr. Angelle Sander is Associate Professor and Director of the Division of Neuropsychology and Rehabilitation Psychology at Baylor College of Medicine and the Director of TIRR Memorial Hermann’s Brain Injury Research Center. She is the Project Director for the NIDRR-funded Rehabilitation Research and Training Center on Developing Strategies to Foster Community Integration and Participation for Individuals with TBI, Co-Project Director for the TBI Model System of TIRR, and Co-PI on a newly funded randomized controlled trial of Donepezil to improve functional memory after TBI. Dr. Sander has served as PI for randomized controlled trials on brief intervention for substance abuse following TBI and contextualized memory strategy training in persons with TBI. Specialty areas include family adjustment to TBI, cognitive rehabilitation, improving community participation of persons with TBI, intimacy and sexuality after TBI, assessing and treating substance abuse in persons with TBI, and racial/ethnic diversity in outcomes.

A PDF transcript of the podcast is available for download by selecting the attached file below.

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Tags:  depression  Sander  TBI  traumatic brain injury  Whyte 

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Factors Associated with Pressure Ulcer Risk in Spinal Cord Injury Rehabilitation

Posted By Amy Schnappinger, Monday, July 7, 2014
Updated: Thursday, July 3, 2014



Dr.Sunil Sabharwal interviews Dr. Gerben DeJong, author of the article entitled "Factors Associated with Pressure Ulcer in Spinal Cord Injury Rehabilitation"

Abstract
OBJECTIVE: The aim of this study was to identify patient and clinical factors most strongly associated with a spinal cord injury patient's risk for developing a pressure ulcer (PU) during rehabilitation.

DESIGN: This is a prospective observational cohort study conducted at an urban rehabilitation hospital-based specialized spinal cord injury center. The main outcome measure was the onset of a stage 2 or higher PU.

RESULTS: Study patients (N = 159) with new (n = 66) and patients with earlier (n = 99) spinal injuries had identical rates at which they acquired a new PU (stage >=2) in rehabilitation-13.1%. The patients who came to rehabilitation with a PU or myocutaneous flap exhibited a higher rate of developing yet another PU while in rehabilitation (30.2%) than those who came to rehabilitation without an existing PU or flap (6.9%). Logistic regression analysis identified two variables that best predicted a patient's risk at admission for developing a PU during rehabilitation (c = 0.77)-entering rehabilitation with a PU and admission Functional Independence Measure transfers score of less than 3.5.

CONCLUSIONS: The greatest risk of developing a new PU in rehabilitation is being admitted with an existing PU followed by admission Functional Independence Measure transfers score of less than 3.5. Using these two variables, one can develop a patient PU risk algorithm at admission that can alert clinicians for the need to enhance vigilance, skin monitoring, and early patient education.

 



Gerben DeJong, PhD, FACRM is a senior fellow and director of the Center for Post-acute Innovation and Research at the MedStar National Rehabilitation Network (MedStar NRH) in Washington, DC. Prior to rejoining MedStar NRH in late 2004, Dr. DeJong served a two-year stint with the University of Florida as a Research Professor in the Department of Health Services Research, Management and Policy. Until 2001, Dr. DeJong served for 16 years (1985-2001) as the Director of Research for the MedStar National Rehabilitation Network in Washington, DC, and as the founding director of the network's Center for Health & Disability Research. Dr. DeJong has conducted several large multi-center health outcome studies. He is the author or co-author of more than 250 papers on health policy, income maintenance, disability, post-acute rehabilitation, and health outcomes. He has been an avid student of the American post-acute health care system particularly its growth, development, and consolidation across the various post-acute industries. Dr. DeJong served as President of the American Congress of Rehabilitation Medicine in 2006-07. In 1985, he received the Licht Award for Excellence in Scientific Writing from the American Congress of Rehabilitation Medicine and, in 1998, he received the organization's highest award, the Gold Key Award.

A PDF transcript of the podcast is available for download by selecting the attached file below.

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Tags:  DeJong  pressure ulcer  Sabharwal  SCI  spinal cord injury 

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Hypertonic Dextrose and Morrhuate Sodium Injections (Prolotherapy) for Lateral Epicondylosis (Tennis Elbow)

Posted By Amy Schnappinger, Monday, April 14, 2014
Updated: Thursday, April 10, 2014



Dr.David (DJ) Kennedy interviews Dr. David Rabago, author of the article entitled "Hypertonic Dextrose and Morrhuate Sodium Injections (Prolotherapy) for Lateral Epicondylosis (Tennis Elbow)."

Abstract
OBJECTIVE: Chronic lateral epicondylosis is common, debilitating, and often refractory. Prolotherapy (PrT) is an injection therapy for tendinopathy. The efficacy of two PrT solutions for chronic lateral epicondylosis was evaluated.

DESIGN: This study is a three-arm randomized controlled trial. Twenty-six adults (32 elbows) with chronic lateral epicondylosis for 3 mos or longer were randomized to ultrasound-guided PrT with dextrose solution, ultrasound-guided PrT with dextrose-morrhuate sodium solution, or watchful waiting ("wait and see"). The primary outcome was the Patient-Rated Tennis Elbow Evaluation (100 points) at 4, 8, and 16 wks (all groups) and at 32 wks (PrT groups). The secondary outcomes included pain-free grip strength and magnetic resonance imaging severity score.

RESULTS: The participants receiving PrT with dextrose and PrT with dextrose-morrhuate reported improved Patient-Rated Tennis Elbow Evaluation composite and subscale scores at 4, 8, and/or 16 wks compared with those in the wait-and-see group (P < 0.05). At 16 wks, compared with baseline, the PrT with dextrose and PrT with dextrose-morrhuate groups reported improved composite Patient-Rated Tennis Elbow Evaluation scores by a mean (SE) of 18.7 (9.6; 41.1%) and 17.5 (11.6; 53.5%) points, respectively. The grip strength of the participants receiving PrT with dextrose exceeded that of the PrT with dextrose-morrhuate and the wait and see at 8 and 16 wks (P < 0.05). There were no differences in magnetic resonance imaging scores. Satisfaction was high; there were no adverse events.

CONCLUSIONS: PrT resulted in safe, significant improvement of elbow pain and function compared with baseline status and follow-up data and the wait-and-see control group. This pilot study suggests the need for a definitive trial.





David Rabago, MD is an assistant professor at the UW School of Medicine and Public Health, Department of Family Medicine. He divides his professional time between clinical and research activities. He has an active full spectrum continuity clinic. He is also active in teaching and clinical research. After residency training, Dr. Rabago received research training through a National Institutes of Health grant. His primary interest is therapy for chronic common musculoskeletal injury. Dr. Rabago is actively involved in the assessment of prolotherapy and other injection therapies for knee osteoarthritis and tendinopathy, and is the author of several peer reviewed publications in this area.

A PDF transcript of the podcast is available for download by selecting the attached file below.

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Tags:  Kennedy  Prolotherapy  Rabago 

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Sports Participation Individuals with Spinal Cord Injury (SCI)

Posted By Bernadette M. Rensing (Colvin), Friday, January 17, 2014
Updated: Friday, January 17, 2014
 

Dr. Michael Boninger interviews Dr. Cheri Blauwet, author of the article entitled "Participation in organized sports is positively associated with employment in adults with spinal cord injury."

Abstract
OBJECTIVE: The aim of this study was to determine the association between participation in organized sports programs and employment in adults with chronic spinal cord injury.

DESIGN: This is a cross-sectional study of 149 adults with chronic spinal cord injury. Motor level and completeness of injury were confirmed by physical examination. Information related to demographics, employment, level of education, body mass index, duration of injury, participation in individually planned exercise, and participation in organized sports was obtained using a standardized questionnaire. Multivariable logistic regression analyses were used to assess factors associated with employment.

RESULTS: In univariate analyses, employment was associated with younger age (P = 0.001) and a higher level of education (P = 0.01), whereas obesity decreased the likelihood of employment (P = 0.04). Participation in organized sports approached significance (P = 0.06). In the multivariable analysis and after adjusting for age, education, and body mass index, participation in organized sports was significantly associated with employment (odds ratio, 2.4; P = 0.04). Sex, duration of injury, wheelchair use, and participation in individually planned exercise were not significantly associated with employment (P = 0.16-0.94).

CONCLUSIONS: In the adults with chronic spinal cord injury, participation in organized sports was positively associated with employment. Further studies are necessary to determine the causative nature of this association and how various factors related to sports participation may contribute.

 


Cheri Blauwet, MD is a Sports Medicine Fellow at the Rehabilitation Institute of Chicago/Northwestern University Feinberg School of Medicine. She is a graduate of the Stanford University School of Medicine and completed her residency training in PM&R at Spaulding Rehabilitation Hospital/Harvard Medical School, where she served as Chief Resident. Additionally, she is a former Paralympic athlete in the sport of wheelchair racing, competing for the United States Team in three Paralypmic Games (Sydney '00, Athens '04, Beijing '08) and bringing home a total of seven Paralympic medals. She is also a two-time winner of both the Boston and New York City Marathons, and has been nominated for the ESPY Award, the Laureus World Sports Award, and Women's Sports Foundation Athlete of the Year. She is a member of the International Paralympic Committee Medical Commission and serves on the Board of Directors for the United States Anti-Doping Agency (USADA).

A PDF transcript of the podcast is available for download by selecting the attached file below.

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Tags:  blauwet  boninger  disability  rehabilitation  research  SCI  spinal cord injury  sports 

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