Jennifer Unterreiner MS, DPTc PT May 5, 2012
|
|
- Francis Lambert
- 8 years ago
- Views:
Transcription
1 Jennifer Unterreiner MS, DPTc PT May 5, 2012
2 Spinal cord injury (SCI) results in permanent disability, and loss of movement or sensation below the site of injury (Mayo Clinic, 2011) Loss of movement or sensation below the level of injury greatly impacts a patients function and independence (Umphred, 2007, O Sullivan and Schmidt, 2000)
3 Approximately 12,000 new cases of spinal cord injury per year Mean age of injury approximately 40.2 years National SCI Statistical Center 6/09
4 PTs are faced with the challenge of how to treat these patients These patients do not respond to typical strengthening protocols utilized by PTs Histological changes occur after SCI that result in increased fatigability and decreased endurance of the muscles (Newham et al., 2007)
5 Lesion to the spinal cord that results in paralysis, decreased sensation, bowel/ bladder dysfunction and hyperreflexia Two types of SCI: complete and incomplete Affects a variety of the body systems depending on level of injury Umphred, 2007, O Sullivan and Schmidt, 2000
6 Utilizes functional electrical stimulation to bilateral quadriceps, gluteals, and hamstrings Stimulates peripheral nerves to evoke patterned movement Provides assistance or resistance Hypothesized to improve muscular strength and endurance Hamzaid et al., 2009, Wilder et al., 2002
7 3 types of motor units: Slow Fast/Fatigue Resistant Fast/Fatigable 3 types of muscle fibers: Slow Type I Fast Type IIA Fast Type IIX Caiozzo, V., 2011, Lee, M. 2009
8 Type I fibers are slow oxidative fibers Low force production and fatigability Type IIA fibers are fast, oxidative and glycolytic fibers Intermediate force production and fatigability Fast relaxation times Type IIX are fast glycolytic fibers High force production and fatigability Fast relaxation times Caiozzo, V., 2011, Lee, M. 2009
9 SCI patients have an increase in fast twitch fibers, Type II, within a few months of injury Increase in Type II fibers leads to increased fatigability in muscles Changes may be associated with decreased endurance, muscle atrophy and increased muscle fatigue Gerrits, HL. et al., 2002, Chilibeck, PD., et al., 1999
10 Power Output (PO): amount of force produced Relaxation time: amount of time it takes for the excited muscle to return to its baseline level after a contraction Fiber area: Cross-sectional area representing the size of the muscle fibers Percent of Type II fibers: ratio of the fiber composition of a given muscle
11 SCI patients have decreased strength below the level of the lesion Patients are unable to elicit strength changes through standard protocols These patients require an intervention that bypasses the lack of response The FES bike has been hypothesized to produce physiological and physical changes including muscular strength and endurance (Newham et al., 2007)
12 Research regarding the FES bike has looked at a variety of outcome measures Lack of functional outcomes Currently there are mixed results regarding the use and effectiveness of the FES bike
13 To evaluate the effectiveness of the FES bike in improving power output and modifying muscle histology in patients with an SCI
14 P Patients post SCI I FES bike C No true comparison O Muscle function and histology This is a foreground/intervention question
15 Hypothesis 1 Null: FES bike has no effect on muscle function/ power output Alternative: FES bike has a positive effect on muscle function/ power output Hypothesis 2 Null: FES bike has no effect on histological muscle composition Alternative: FES bike has a positive effect on histological muscle composition
16 At least 5 level 2C or higher studies To reject both null hypotheses Accept both alternative hypotheses
17 Inclusion Criteria: English Patients post SCI at any level both complete and incomplete SCI patients who received FES to the lower extremities Published in the last 15 years Level of evidence 2C or higher Exclusion Criteria: Neurological diagnoses other than SCI Lower motor neuron injuries/ Cauda equina syndrome Classify subjects with a system other than ASIA Outcomes in muscles other than the quadriceps
18 Databases: PubMed PEDro CINAHL Search Terms: alone and in combination Spinal cord injury Functional electrical stimulation or FES Functional outcomes Histological changes Completed recursive search of articles Articles were reviewed by a secondary reviewer to confirm inclusion criteria
19 Mean and standard deviation from the individual studies for the individual outcomes Effect size and 95% CI for each study Q statistics for heterogeneity Determine use of random or fixed effects model Individual studies were weighted according to inverse variance Pooled effect size and 95% CI Jewell, 2008
20 Articles recovered from electronic/ recursive search: (n=371) Articles excluded due to irrelevance: (n=310) Articles retrieved for further review: (n=27) Articles selected for inclusion in evidence based review: (n=5) Duplicates removed: (n=34) Articles removed due to not meeting the inclusion criteria: (n=22) o All articles included are level 2B of evidence
21 Study Participants Intervention Conclusion Duffell et al. (2008) Eser et al. (2003) Mohr et al. (1997) Chillibeck et al. (1999) Gerrits et al. (2000) 11 subjects ASIA A All Paraplegics 19 subjects ASIA A All Paraplegics 10 subjects ASIA A Tetra- and Paraplegics 6 subjects ASIA B Tetra- and Paraplegics 7 subjects ASIA A and B Tetra- and Paraplegics 1 hour/day 5 days/week for 1 year 260 hours 30 min/day 336 days/week hours for 24 weeks 30 min/day 378 days/week hours for 1 year 30 min/day 312 days/week hours for 8 weeks 30 min/day 3 days/week 9 hours for 6 weeks quadriceps torque, power output and fatigue Increase power resistance, no change in contractile output speed power output, greater improvements at higher stimulation frequencies Increase fatigue resistance power output, muscle area, fatigue resistance, and oxygen uptake Increase fiber area power output, fiber area and capillary number Differing conclusions on fatigue resistance and power relaxation output, relaxation time time
22 Q statistic allowed for use of fixed effects model for all outcomes except power output Effect sizes: Minimal < 0.3 Moderate < 0.7 Large > 0.8 Jewell, 2008
23 0.38 (-0.32,1.08) Favors intervention
24 -0.15 (-0.85, 0.54) Favors intervention
25 -0.4 (-1.07, 0.26) Favors intervention
26 2.42 (1.24, 3.59) Favors intervention
27 3.64 (2.64, 4.65) Favors intervention
28 Not directly addressed Need to take into consideration signs and symptoms of autonomic dysreflexia and orthostatic hypotension Closely monitor the patients skin in order to prevent burns from the electrodes
29 PROS Potential to improve function and independence Act to counter some of the negative effects of immobility that occur as a result of SCI CONS Intense time commitment on the part of the patient and the PT Patient required to purchase their own unit Unit costs upwards of $13,000
30
31 No established minimal clinically important difference (MCID) for these outcomes Mild to moderate improvements in fiber area, Type II fibers and relaxation time Increase in Power Output by W
32 H O1 : FES bike has no effect on muscle function/power output Able to reject null hypothesis FES bike leads to a significant improvement in power output, greater after 1 year Positive trend in data for relaxation time H O2 : FES bike has no effect on histological muscle composition Unable to reject null hypothesis FES bike does not result in significant improvements in fiber area or percent Type II fibers
33 Changes in power output suggest that there might be other changes occurring at the cellular and molecular level May help combat the co-morbidities that are associated with inactivity Pneumonia UTI s Pressure ulcers Depression Psychosocial issues Kennedy et al., 2011, Hoffman et al., 2011
34 Length of time required for patients to participate in the intervention may be difficult to reach in a typical clinical setting May be more feasible in a wellness type setting to improve patient access
35 Small number of studies included with small sample sizes Heterogeneity of subjects included in the studies Acute versus chronic Complete versus incomplete Tetra- versus Paraplegia Range in frequency and duration of the intervention across the studies
36 Repeating the included studies with larger sample sizes Completing studies with subjects who have similar demographics More consistent application of similar protocols to determine appropriate dosing Including functionally based outcomes
37 FES bike does produce power output changes in patients post SCI Unclear effect on histology and how use of the FES bike translates to functional improvements Use of the FES bike for longer periods of time may lead to greater improvements
38 Diane Allen, PT, DPT, PhD Andrew Lui, PT, DPT Jet Lee, PT, PhD Morgan Johnson, MS, DPTc Amanda Powell, MS, DPTc UCSF/SFSU DPT Class of 2012 Family and friends
39 1. Duffell, LD, Donaldson, N., Perkins, TA, Rushton, DN, Hunt, KJ, et al. Long- Term Intensive Electrically Stimulated Cycling by Spinal Cord-Injured People: Effect on Muscle Properties and Their Relation to Power Output. Muscle Nerve. 2008:38: Eser, P.C., Donaldson, N., Knecht, H., Stussi, E. Influence of Different Stimulation Frequencies on Power Output and Fatigue During FES-Cycling in Recently Injured SCI People. IEEE Trans Neural Syst Rehabil Eng. 2003:3: Mohr, T., Andersen, JL, Biering-Sorensen, F., Galbo, H., Bangsbo, J. et al. Long term adaptation to electrically induced cycle training in severe spinal cord injured individuals. Spinal Cord. 1997:35: Chilibeck, P.D., Jeon, J., Weiss, C., Bell, G., Burnham, R. Histochemical changes in muscle of individuals with spinal cord injury following functional electrical stimulated exercise training. Spinal Cord. 1999:37: Gerrits, H.L., de Haan, A., Sargeant, A.J., Dallmeijer, A., Hopman, MTE. Altered contractile properties of the quadriceps muscle in people with spinal cord injury following functional electrical stimulated cycle training. Spinal Cord. 2000:38:
40 6. Mayo Clinic. Spinal Cord Injury. Available at: Accessibility verified January 2, Atrice, MB., Morrison, SA., McDowell, SL., Ackerman, PM., Foy, TA. Traumatic Spinal Cord Injury. In: Umphred, DA. Neurological Rehabilitation. 5 th ed. St. Louis, MO: Mosby Elsevier; 2007: Hamzaid, NA, Davis, GM. Health and fitness benefits of functional electrical stimulation- evoked leg exercise for spinal cord-injured individuals: A position review. Top Spinal Cord Inj Rehabil. 2009; 14: Wilder, RP, Jones, EV, Wind, TC, Edlich, RF. Functional electrical stimulation cycle ergometer exercise for spinal cord injured patients. J Long Term Eff Med Implants. 2002; 12: National SCI Statistical Center. Facts and Figures at a Glance. Available at: Accessibility verified January 2, 2012.
41 11. Kennedy, P., Phil, D., Lude, P., Elfstrom, ML., Smithson, EF. Psychological contributions to functional independence: A longitudinal investigation of spinal cord injury rehabilitation. Arch Phys Med Rehabil. 2011; 32: Schmitz, TJ. Traumatic Spinal Cord Injury. In: O Sullivan, SB, Schmidt, TJ. Physical Rehabilitation: Assessment and Treatment. 4 th ed. Philadelphia, PA: F.A. Davis Company; 2000: V. Caiozzo, Ph.D. The Cellular and Molecular Basis of Muscle Mechanics: Molecules to Motion. University of California, San Francisco. Physical Therapy 212: Muscle and Nerve Biology. September M. Lee, Ph.D. Skeletal Muscle Structure and Function. San Francisco State University. Kinesology 746: Exercise Physiology. June Jewell, DV. Guide to Evidence-Based Physical Therapy Practice. Sudbury, MA: Jones and Bartlett, 2008
42 16. Sheffler, LR., Chae, J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve. 2007; 35: Newham, DJ., Donaldson, N de N. FES cycling. Acta Neurochir Suppl. 2007: 97: Smoot, B. PT, DPTSc. Designing Clinical Research Sampling: Who Will be Studied? University of California, San Francisco. Physical Therapy 251: Research Design. July Hoffman, JM., Bombardier CH., Graves, DE., Kalpakjian, CZ., Krause, JS. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil. 2011; 92:
43
Exercise and FES cycle fact sheet
Exercise and FES cycle fact sheet FES = Functional Electrical Stimulation. An electrical current is passed through paralysed muscle causing it to contract. The electrical current uses the peripheral nerves
More informationThe Use of the Lokomat System in Clinical Research
International Neurorehabilitation Symposium February 12, 2009 The Use of the Lokomat System in Clinical Research Keith Tansey, MD, PhD Director, Spinal Cord Injury Research Crawford Research Institute,
More informationSubject: Functional Electrical Stimulation for Spinal Cord Injury 8/27/14
Subject: Functional Electrical Stimulation for Spinal Cord Injury Guidance Number: MCG-205 Revision Date(s): Original Effective Date: 8/27/14 SUMMARY Spinal Cord Injury (SCI): According to the international
More informationby Argyrios Stampas, MD, Carolin Dohle, MD, and Elizabeth Dominick, PT, DPT, NCS
by Argyrios Stampas, MD, Carolin Dohle, MD, and Elizabeth Dominick, PT, DPT, NCS Therapist Jennifer Metz (right) helps a patient use a body-weight support treadmill system. Up and Moving Blending dedication
More informationChapter 6. Components of Elasticity. Musculotendinous Unit. Behavioral Properties of the Musculotendinous Unit. Biomechanics of Skeletal Muscle
Chapter 6 Behavioral Properties of the Musculotendinous Unit 1) extensibility: ability to be stretched or to increase in length 2) elasticity: ability to return to normal resting length following a stretch
More informationadj., departing from the norm, not concentric, utilizing negative resistance for better client outcomes
Why Eccentrics? What is it? Eccentric adj., departing from the norm, not concentric, utilizing negative resistance for better client outcomes Eccentrics is a type of muscle contraction that occurs as the
More informationThe Influence of Functional Electrical Stimulation (FES) Cycling on Spasticity in Adolescents with Spinal Cord Injury
1 The Influence of Functional Electrical Stimulation (FES) Cycling on Spasticity in Adolescents with Spinal Cord Injury Prepared by:rebecca Martin, OTR/L, OTD 1, Meredith Bourque, PT, DPT 1, Glendaliz
More informationICD-9-CM coding for patients with Spinal Cord Injury*
ICD-9-CM coding for patients with Spinal Cord Injury* indicates intervening codes have been left out of this list. OTHER DISORDERS OF THE CENTRAL NERVOUS SYSTEM (340-349) 344 Other paralytic syndromes
More informationPhysiological mobilization of very acute SCI patients effects on the cardiovascular system
International Neurorehabilitation Symposium, University Irchel, Zuerich, Switzerland, 12.2.-13.02.2009 Physiological mobilization of very acute SCI patients effects on the cardiovascular system R. Rupp,
More informationSpine Care Centre (SCC) protocols for Multiple Sclerosis Update 1 August 2015
Spine Care Centre (SCC) protocols for Multiple Sclerosis Update 1 August 2015 Introduction Multiple sclerosis (MS) affects nerves in the brain and spinal cord, causing a wide range of symptoms including
More informationHospitalizations and Medical Care Costs of Serious Traumatic Brain Injuries, Spinal Cord Injuries and Traumatic Amputations
Hospitalizations and Medical Care Costs of Serious Traumatic Brain Injuries, Spinal Cord Injuries and Traumatic Amputations FINAL REPORT JUNE 2013 J. Mick Tilford, PhD Professor and Chair Department of
More informationWebinar title: Know Your Options for Treating Severe Spasticity
Webinar title: Know Your Options for Treating Severe Spasticity Presented by: Dr. Gerald Bilsky, Physiatrist Medical Director of Outpatient Services and Associate Medical Director of Acquired Brain Injury
More informationSpinal Cord Injury Education. An Overview for Patients, Families, and Caregivers
Spinal Cord Injury Education An Overview for Patients, Families, and Caregivers Spinal Cord Anatomy A major component of the Central Nervous System (CNS) It is 15 to 16 inches long, and weighs 1 to 2 ounces
More informationAn Evaluation of Spinal Cord Injury (SCI) Associated with Motor Vehicle Crashes including Rollovers
An Evaluation of Spinal Cord Injury (SCI) Associated with Motor Vehicle Crashes including Rollovers Eileen Bulger, MD Robert Kaufman, BS Chris Mack, MS Stephen Burns, MD University of Washington Traumatic
More informationMultiple Sclerosis (MS)
Multiple Sclerosis (MS) Purpose/Goal: Care partners will have an understanding of Multiple Sclerosis and will demonstrate safety and promote independence while providing care to the client with MS. Introduction
More informationThe Detection of Neural Fatigue during intensive conditioning for football: The Potential of Transcranial Magnetic Stimulation
The Detection of Neural Fatigue during intensive conditioning for football: The Potential of Transcranial Magnetic Stimulation Carl Wells PhD Sport Science Lead, Perform, National Football Centre, St.
More informationHerniated Disk. This reference summary explains herniated disks. It discusses symptoms and causes of the condition, as well as treatment options.
Herniated Disk Introduction Your backbone, or spine, has 24 moveable vertebrae made of bone. Between the bones are soft disks filled with a jelly-like substance. These disks cushion the vertebrae and keep
More informationWhat is Multiple Sclerosis? Gener al information
What is Multiple Sclerosis? Gener al information Kim, diagnosed in 1986 What is MS? Multiple sclerosis (or MS) is a chronic, often disabling disease that attacks the central nervous system (brain and spinal
More informationFact Sheet. Queensland Spinal Cord Injuries Service. Pain Management Following Spinal Cord Injury for Health Professionals
Pain Management Following Injury for Health Professionals and Introduction Pain is a common problem following SCI. In the case where a person with SCI does have pain, there are treatments available that
More informationNursing. Management of Spinal Trauma. Content. Objectives. Objectives
7 cervical vertebrae Content 12 thoracic vertebrae Nursing 5 sacral vertebrae Management of Spinal Trauma Kwai Fung Betty Siu Ward Manager O&T Dept TKOH Date : 22nd April 2007 5 lumbar vertebrae 4 coccygeal
More informationKimberly Anderson-Erisman, PhD Director of Education University of Miami & Miami Project to Cure Paralysis
Webinar title: What is the Vibe? Vibration Therapy as a Rehabilitation Tool Presenter/presenters: Kimberly Anderson-Erisman, PhD Director of Education University of Miami & Miami Project to Cure Paralysis
More information#11-005 Developing a Point of Access for SCI Research at Roper Ms. Cathy Therrell, MSN, RN, NEA-BC
#11-005 Developing a Point of Access for SCI Research at Roper Ms. Cathy Therrell, MSN, RN, NEA-BC Project Goals and Aims: The stated goals of the SCIRF 11-005 funded project are 1) to develop a research
More informationSpinal Cord Injury. North American Spine Society Public Education Series
Spinal Cord Injury North American Spine Society Public Education Series What Is a Spinal Cord Injury? A spinal cord injury is a condition that results from damage or trauma to the nerve tissue of the spine.
More informationFaculty/Presenter Disclosure
The Long-Term Rehabilitation Management of Stroke Patients Robert Teasell MD FRCPC Professor, Dept PM&R Schulich School of Medicine University of Western Ontario CFPC CoI Templates: Slide 1 Faculty/Presenter
More informationSpinal Cord Injury Rehabilitation Functional Expectations and Ambulation Potential. Diane Johnston, MSPT
Spinal Cord Injury Rehabilitation Functional Expectations and Ambulation Potential Diane Johnston, MSPT Objectives for the course Participants will have a general understanding of the epidemiology of Spinal
More informationNeuromuscular Adaptations to Training
Neuromuscular Adaptations to Training Baechle Chapter 4, pp. 143-151, 151, Powers & Howley pp. 253-255 255 Lecture Overview Neural Adaptations Skeletal Muscle Adaptations Connective Tissue Anatomy Connective
More informationNeural Plasticity and Locomotor Recovery: Robotics in Research
International Neurorehabilitation Symposium February 12, 2009 Neural Plasticity and Locomotor Recovery: Robotics in Research Keith Tansey, MD, PhD Director, Spinal Cord Injury Research Crawford Research
More informationUniversity Rehabilitation Institute Republic of Slovenia. Helena Burger, Metka Teržan University Rehabilitation Institute, Ljubljana, Slovenia
University Rehabilitation Institute Republic of Slovenia Helena Burger, Metka Teržan University Rehabilitation Institute, Ljubljana, Slovenia 2 3 Introduction * Primary level PT only * Secondary level:
More informationMary LaBarre, PT, DPT,ATRIC
Aquatic Therapy and the ACL Current Concepts on Prevention and Rehab Mary LaBarre, PT, DPT,ATRIC Anterior Cruciate Ligament (ACL) tears are a common knee injury in athletic rehab. Each year, approximately
More informationSample Treatment Protocol
Sample Treatment Protocol 1 Adults with acute episode of LBP Definition: Acute episode Back pain lasting
More informationTreatment of Dysarthria in Patients with Multiple Sclerosis. Barbara Bryant Jane Vyce
Treatment of Dysarthria in Patients with Multiple Sclerosis Barbara Bryant Jane Vyce What is MS? An autoimmune disease Destruction of myelin Destruction of axons What is MS? Etiology/Pathophysiology Cause
More informationMedical and Rehabilitation Trends in Spinal Cord Injury. Guy W. Fried, M.D. Magee Rehabilitation Hospital
Medical and Rehabilitation Trends in Spinal Cord Injury Guy W. Fried, M.D. Magee Rehabilitation Hospital Objectives Discuss: SCI Epidemiology Potential Functional Outcomes Complications of SCI SCI Trends
More information2014 Neurologic Physical Therapy Professional Education Consortium Webinar Course Descriptions and Objectives
Descriptions and Neuroplasticity Health care providers are facing greater time restrictions to render services to the individual with neurological dysfunction. However, the scientific community has recognized
More informationModule 1: The Somato-Motor System: Tendon Tap reflex
Module 1: The Somato-Motor System: Tendon Tap reflex Module Objectives: 1. Describe the anatomic pathway of a tendon tap reflex. 2. Explain how a tendon tap reflex assessment assists in diagnosis of a
More informationCURRICULUM VITAE. Licensure Information 2006 - present Physical Therapist: KS # 11-03585 2002 - present Physical Therapist: MO # 2003000615
CURRICULUM VITAE Jason Rucker, PT, PhD Date of Preparation: January 18 th, 2016 Clinical Assistant Professor Department of Physical Therapy and Rehabilitation Science University of Kansas Medical Center
More informationDoctor of Physical Therapy Program Course Descriptions
Doctor of Physical Therapy Program Course Descriptions PHT 600 Anatomy Lec. 3/Lab 6/Credit 6 In this course, the student will learn the basic techniques of dissection and the components of the musculoskeletal
More informationCombination of Lokomat Therapy and FES on SCI person - Case Study. Pille-Riika Lepik, PT Hille Maas, PT, MSc
Combination of Lokomat Therapy and FES on SCI person - Case Study Pille-Riika Lepik, PT Hille Maas, PT, MSc Adeli Rehabilitation Centre Services: PT, OT, SLT, PSC, MD, SW, ATT Main catogories of health
More informationLumbar Disc Herniation/Bulge Protocol
Lumbar Disc Herniation/Bulge Protocol Anatomy and Biomechanics The lumbar spine is made up of 5 load transferring bones called vertebrae. They are stacked in a column with an intervertebral disc sandwiched
More informationThe Anatomy of Spinal Cord Injury (SCI)
The Anatomy of Spinal Cord Injury (SCI) What is the Spinal Cord? The spinal cord is that part of your central nervous system that transmits messages between your brain and your body. The spinal cord has
More informationClosed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario
Page 1 Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario Injury Descriptions Developed from Newfoundland claim study injury definitions No injury Death Psychological
More informationTYPE OF INJURY and CURRENT SABS Paraplegia/ Tetraplegia
Paraplegia/ Tetraplegia (a) paraplegia or quadriplegia; (a) paraplegia or tetraplegia that meets the following criteria i and ii, and either iii or iv: i. ii. iii i. The Insured Person is currently participating
More informationREHABILITATION SERVICES
REHABILITATION SERVICES Table of Contents GENERAL... 2 TERMS AND ABBREVIATIONS... 2 PRIOR AUTHORIZATION REQUIREMENTS FOR MEDICAID REIMBURSEMENT OF INPATIENT REHABILITATION SERVICES (Updated 4/1/11)...
More informationPrepared by: Kaitlin MacDonald, MOT, OTR/L 1, Stephanie Ramey, MS, OTR/L 1, Rebecca Martin, OTR/L, OTD 1 and Glendaliz Bosques 1,2, MD
1 The Relationship between Power and Manual Wheelchair Mobility and Upper Extremity Pain in Youths with Low Level Cervical Spinal Cord Injury Prepared by: Kaitlin MacDonald, MOT, OTR/L 1, Stephanie Ramey,
More informationPromising Treatments for SCI: What s on The Horizon. SCI: A Devastating Injury. Case: Mr. MC 9/21/2015. Epidemiology: Costs:
Promising Treatments for SCI: What s on The Horizon Shawn Song, MD SCI Fellow University of Washington/VA Puget Sound Healthcare System SCI: A Devastating Injury Epidemiology: Incidence of ~12,000 patients/year.
More informationOccupational and Physical Therapy Management of Spinal Cord Injury
Occupational and Physical Therapy Management of Spinal Cord Injury Saturday, October 26 & Sunday, October 27, 2013 8 AM 5 PM - Check in at 7:45 AM Medical Staff Auditorium Greenville Memorial Hospital
More information1 REVISOR 5223.0070. (4) Pain associated with rigidity (loss of motion or postural abnormality) or
1 REVISOR 5223.0070 5223.0070 MUSCULOSKELETAL SCHEDULE; BACK. Subpart 1. Lumbar spine. The spine rating is inclusive of leg symptoms except for gross motor weakness, bladder or bowel dysfunction, or sexual
More informationELECTROMYOGRAPHY (EMG), NEEDLE, NERVE CONDUCTION STUDIES (NCS) AND QUANTITATIVE SENSORY TESTING (QST)
AND QUANTITATIVE SENSORY TESTING (QST) Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical
More informationBrain-Computer Interface Driven Functional Electrical Stimulation System for Overground Walking in Spinal Cord Injury Participant
Brain-Computer Interface Driven Functional Electrical Stimulation System for Overground Walking in Spinal Cord Injury Participant Christine E. King 1, Po T. Wang 1, Colin M. McCrimmon 1, Cathy C.Y. Chou
More informationSexuality Issues in MS Nursing
Sexuality Issues in MS Nursing Dr. Edna Astbury-Ward, PhD, M.Sc. RGN, Dip. H.E, Cert Sexual & Relationship Therapy, Cert Counselling. Chronic diseases and degenerative conditions are often strongly linked
More informationCollege of Health and Human Services Department of Physical Therapy
College of Health and Human Services Department of Physical Therapy Neurological Evaluation & Treatment II (PT244) Fall Semester 2009 COURSE CREDIT: 4 units: 2 hours lecture, 6 hours of lab per week CLASSROOM:
More information6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.
High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty
More informationDIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN. Arnold J. Weil, M.D., M.B.A. Non-Surgical Orthopaedics, P.C. Atlanta, GA
DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN Arnold J. Weil, M.D., M.B.A. Non-Surgical Orthopaedics, P.C. Atlanta, GA MEDICAL ALGORITHM OF REALITY LOWER BACK PAIN Yes Patient will never get better until case
More informationA systematic review of focused topics for the management of spinal cord injury and impairment
A systematic review of focused topics for the management of spinal cord injury and impairment icahe, University of South Australia For the NZ Spinal Cord Impairment Strategy Introduction This was the third
More informationCollege of Health Sciences. Physical Therapy
* 603 PHARMACOLOGY I. (1) Fundamental concepts of pharmacology and their impact on the physical therapy management of patients. This course focuses on the integration of basic science, research, and clinical
More informationSTROKE CARE NOW NETWORK CONFERENCE MAY 22, 2014
STROKE CARE NOW NETWORK CONFERENCE MAY 22, 2014 Rehabilitation Innovations in Post- Stroke Recovery Madhav Bhat, MD Fort Wayne Neurological Center DISCLOSURE Paid speaker for TEVA Neuroscience Program.
More informationLUMBAR. Hips R L B R L B LUMBAR. Hips R L B R L B LUMBAR. Hips R L B R L B
1 Patient Name In order to properly assess your condition, we must understand how much your BACK/LEG (SCIATIC) PAIN has affected your ability to manage everyday activities. For each item below, please
More informationAutonomic dysfunctions in Paralympic athletes.
Sochi 2014, Russia Rosa Khutor, March 10, 2014 Autonomic dysfunctions in Paralympic athletes. Andrei Krassioukov MD, PhD, FRCPC Professor, Dep. of Medicine, Div. Physical Medicine & Rehabilitation, Associate
More informationExercise therapy and multiple sclerosis a powerful non-pharmacological intervention
Malmö, November 2014 Exercise therapy and multiple sclerosis a powerful non-pharmacological intervention Ulrik Dalgas, PhD Department of Public Health Section of Sport Science Aarhus University Denmark
More informationNeck Pain & Cervicogenic Headache Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice
Neck Pain & Cervicogenic Headache Integrating Research into Practice: San Luis Sports Therapy s Approach to Evidence-Based Practice PROBLEM: Neck Pain and Cervicogenic Headache 66% Proportion of individuals
More informationDoctor of Physical Therapy Degree Curriculum:
Doctor of Physical Therapy Degree Curriculum: SUMMER SEMESTER 1 st YEAR (BOTH SESSIONS) DPT 744 Gross Human Anatomy I 2 credits DPT 744L Gross Human Anatomy I Lab 1 credit DPT 745 Gross Human Anatomy II
More informationTransmittal 55 Date: MAY 5, 2006. SUBJECT: Changes Conforming to CR3648 for Therapy Services
CMS Manual System Pub 100-03 Medicare National Coverage Determinations Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 55 Date: MAY 5, 2006 Change
More informationSpinal Cord Injury A D U L T S C I
Spinal Cord Injury A D U L T S C I Introduction Spinal Cord Injury (SCI) is a low-incidence, high cost disability SCI requires tremendous change in an individual s lifestyle 10,000 new cases in the USA
More informationCAPTURE Collaboration and Proactive Teamwork Used to Reduce. Best Practices in Safe Transfers and Mobility to Decrease Fall Risk
CAPTURE Collaboration and Proactive Teamwork Used to Reduce Falls Best Practices in Safe Transfers and Mobility to Decrease Fall Risk August 20, 2013 10 a.m. CST Dawn M. Venema, PT, PhD Jill Hassel, DPT
More informationMusculoskeletal System
CHAPTER 3 Impact of SCI on the Musculoskeletal System Voluntary movement of the body is dependent on a number of systems. These include: The brain initiates the movement and receives feedback to assess
More informationToday s Care. Tomorrow s Cure.
Today s Care. Tomorrow s Cure. The NeuroRecovery Network (NRN) is a cooperative network of cutting-edge rehabilitation centers designed to provide and develop therapies to promote functional recovery and
More informationUnderstanding the Pain Trajectory During Treadmill Testing in Peripheral Artery Disease
Understanding the Pain Trajectory During Treadmill Testing in Peripheral Artery Disease Diane Treat-Jacobson, PhD, RN, FAHA, FAAN Susan J. Henly, PhD, RN Ulf G. Bronas, PhD, ATC, ATR Arthur S. Leon, MD,
More informationJohn E. O Toole, Marjorie C. Wang, and Michael G. Kaiser
Hypothermia and Human Spinal Cord Injury: Updated Position Statement and Evidence Based Recommendations from the AANS/CNS Joint Sections on Disorders of the Spine & Peripheral Nerves and Neurotrauma &
More informationTeppe Treppe: A staircase increase in tension production after repeated simulation, even though the muscle is allowed to relax between twitches.
Part II, Muscle: Mechanisms of Contraction and Neural Control, Chapter 12 Outline of class notes Objectives: After studying part II of this chapter you should be able to: 1. Discuss how contractile force
More informationALL ABOUT SPASTICITY. www.almirall.com. Solutions with you in mind
ALL ABOUT SPASTICITY www.almirall.com Solutions with you in mind WHAT IS SPASTICITY? The muscles of the body maintain what is called normal muscle tone, a level of muscle tension that allows us to hold
More informationSpine Section Strategic Plan
Spine Section Strategic Plan I. INTRODUCTION A. Definition of the subspecialty or section The section is comprised of those members of the American Academy of Neurology who have an interest in treating
More informationOpen vs. Closed Kinetic Chain Exercises for Patellofemoral Pain Syndrome: An Evidence Based Review
Open vs. Closed Kinetic Chain Exercises for Patellofemoral Pain Syndrome: An Evidence Based Review Thomas Tsai, DPTc DPT Candidate Spring Symposium 2012 Significance of Patellofemoral Pain Syndrome (PFPS)
More informationRehabilitation of spinal cord injury in the national rehabilitation center for the disabled of Japan: pro le of a spinal service
Spinal Cord (1997) 35, 720 ± 724 1997 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/97 $12.00 Rehabilitation of spinal cord injury in the national rehabilitation center for
More informationBACK PAIN MEASURES GROUP OVERVIEW
2014 PQRS OPTIONS F MEASURES GROUPS: BACK PAIN MEASURES GROUP OVERVIEW 2014 PQRS MEASURES IN BACK PAIN MEASURES GROUP: #148. Back Pain: Initial Visit #149. Back Pain: Physical Exam #150. Back Pain: Advice
More informationNervous System: Spinal Cord and Spinal Nerves (Chapter 13) Lecture Materials for Amy Warenda Czura, Ph.D. Suffolk County Community College
Nervous System: Spinal Cord and Spinal Nerves (Chapter 13) Lecture Materials for Amy Warenda Czura, Ph.D. Suffolk County Community College Primary Sources for figures and content: Eastern Campus Marieb,
More informationDELIVERING SOCIAL WORK SERVICES TO SCI&D PATIENTS THROUGH VIDEO CONFERENCING TECHNOLOGY
DELIVERING SOCIAL WORK SERVICES TO SCI&D PATIENTS THROUGH VIDEO CONFERENCING TECHNOLOGY E X PA N D I N G T H E H O R I Z O N S B Y: J O Y C E W I L L I A M S, M S S W, L C S W, M S C S C A R O L G I B
More informationKimberly Anderson-Erisman, PhD Director of Education University of Miami & Miami Project to Cure Paralysis
Webinar title: Direct Nerve Stimulation What is it really and what is the potential? Presenter/presenters: Kimberly Anderson-Erisman, PhD Director of Education University of Miami & Miami Project to Cure
More informationSpinal cord injury hospitalisation in a rehabilitation hospital in Japan
1994 International Medical Society of Paraplegia Spinal cord injury hospitalisation in a rehabilitation hospital in Japan Y Hasegawa MSW, l M Ohashi MD, l * N Ando MD, l T. Hayashi MD, l T Ishidoh MD,
More informationSpinal cord injuries in young children: a review of children injured at 5 years of age and younger
DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY ORIGINAL ARTICLE Spinal cord injuries in young children: a review of children injured at 5 years of age and younger JENNIFER SCHOTTLER 1 LAWRENCE C VOGEL 1,2 PETER
More informationPTHA 2535. Rehabilitation ********** PHYSICAL THERAPIST ASSISTANT PROGRAM HEALTH OCCUPATIONS DIVISION LEVELLAND CAMPUS SOUTH PLAINS COLLEGE.
COURSE SYLLABUS PTHA 2535 Rehabilitation ********** PHYSICAL THERAPIST ASSISTANT PROGRAM HEALTH OCCUPATIONS DIVISION LEVELLAND CAMPUS SOUTH PLAINS COLLEGE Fall 2012 1 COURSE SYLLABUS COURSE TITLE: REHABILITATION
More informationCURRICULUM VITAE. Andrew T. Yannaccone, PT, PhD Address: 3307 North Broad Street, Jones Hall, Room 608 Philadelphia, PA 19446 Phone: 215-707-4897
CURRICULUM VITAE Name: Andrew T. Yannaccone, PT, PhD Address: 3307 North Broad Street, Jones Hall, Room 608 Philadelphia, PA 19446 Phone: 215-707-4897 Name of Educational Program and Institution: Department
More informationFacilitating the Self-Management of Spinal Cord Injury
Facilitating the Self-Management of Spinal Cord Injury Michelle A. Meade, Ph.D. University of Michigan Department of Physical Medicine & Rehabilitation Center for Managing Chronic Disease mameade@umich.edu
More informationShort-term Maximal-Intensity Resistance Training Increases Volitional Function and Strength in Chronic Incomplete Spinal Cord Injury: A Pilot Study
RESEARCH ARTICLES Short-term Maximal-Intensity Resistance Training Increases Volitional Function and Strength in Chronic Incomplete Spinal Cord Injury: A Pilot Study Arun Jayaraman, PT, PhD, Christopher
More informationTHE LUMBAR SPINE (BACK)
THE LUMBAR SPINE (BACK) At a glance Chronic back pain, especially in the area of the lumbar spine (lower back), is a widespread condition. It can be assumed that 75 % of all people have it sometimes or
More informationOutpatient Neurological Rehabilitation Victoria General Hospital. Pam Loadman BSC.P.T., MSc. Physiotherapist
Outpatient Neurological Rehabilitation Victoria General Hospital Pam Loadman BSC.P.T., MSc. Physiotherapist OPN - overview Who we see: Inclusion criteria Diagnoses Who we are: Clinicians involved What
More informationEMG and the Electrodiagnostic Consultation for the Family Physician
EMG and the Electrodiagnostic Consultation for the Family Physician Stephanie Kopey, D.O., P.T. 9/27/15 The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Marketing Committee
More informationVariable-frequency-train stimulation of skeletal muscle after spinal cord injury
JRRD Volume 41, Number 1, Pages 33 40 January/February 2004 Journal of Rehabilitation Research & Development Variable-frequency-train stimulation of skeletal muscle after spinal cord injury C. Scott Bickel,
More informationBowel and Bladder Dysfunction in MS. Tracy Walker, WOCN, MSCN, FNP C Nurse Practitioner MS Institute at Shepherd Center. Bladder Dysfunction
Bowel and Bladder Dysfunction in MS Tracy Walker, WOCN, MSCN, FNP C Nurse Practitioner MS Institute at Shepherd Center Bladder Dysfunction Approximately 75% of people with MS experience bladder problems
More informationOvertraining with Resistance Exercise
ACSM CURRENT COMMENT Overtraining with Resistance Exercise One of the fastest growing and most popular types of exercise in recent years is resistance exercise, whether used for the purpose of general
More informationUrodynamics in Neuro-Urology
Urodynamics in Neuro-Urology R Hamid MD (Res), FRCS (Urol) Consultant Urologist London Spinal Injuries Unit, Stanmore & University College London Hospitals Micturition Micturition can be visualized as
More informationThe Science Behind MAT
The Science Behind MAT Muscle Activation Techniques (MAT) is a system designed to evaluate and treat muscular imbalances, I will expand on the process of evaluation in response and the use of isometrics
More informationDr. O Meara s. Anterior Knee Pain (PatelloFemoral Syndrome) Rehabilitation Protocol www.palomarortho.com
Dr. O Meara s Anterior Knee Pain (PatelloFemoral Syndrome) Rehabilitation Protocol www.palomarortho.com Anterior Knee Pain (PatelloFemoral Syndrome) Rehabilitation Protocol Hamstring Stretching & Strengthening
More informationMississippi College School of Nursing NUR 424 (Nursing IV Theory)
Mississippi College School of Nursing NUR 424 - Nursing IV Theory Course: NUR 424 (Nursing IV Theory) Credit: 4 Semester Hours (Contact Hours - 60) Placement in Curriculum: Senior, second semester Prerequisite:
More informationModule F SKELETAL SYSTEM & ARTICULATIONS
Module F SKELETAL SYSTEM & ARTICULATIONS Topic from General functions of bone & the skeletal system Structural components microscopic anatomy Structural components gross anatomy Physiology of embryonic
More informationOHTAC Recommendation
OHTAC Recommendation Multiple Sclerosis and Chronic Cerebrospinal Venous Insufficiency Presented to the Ontario Health Technology Advisory Committee in May 2010 May 2010 Issue Background A review on the
More informationRehabilitation Guidelines for Patellar Tendon and Quadriceps Tendon Repair
UW Health Sports Rehabilitation Rehabilitation Guidelines for Patellar Tendon and Quadriceps Tendon Repair The knee consists of four bones that form three joints. The femur is the large bone in the thigh
More informationPlyometric Training. Plyometric Training. chapter
chapter 16 Plyometric Training Plyometric Training David H. Potach, PT; MS; CSCS,*D; NSCA-CPT,*D Donald A. Chu, PhD; PT; ATC; CSCS,*D; NSCA-CPT,*D; FNSCA Chapter Objectives Explain the physiology of plyometric
More informationStoke Mandeville Hospital (National Spinal Injuries Centre)
Stoke Mandeville Hospital (National Spinal Injuries Centre) Patient Education Department Patient Education Programme September 2008 (Review September 2009) This booklet is for patients. The Patient Education
More informationFirst Year. PT7040- Clinical Skills and Examination II
First Year Summer PT7010 Anatomical Dissection for Physical Therapists This is a dissection-based, radiographic anatomical study of the spine, lower extremity, and upper extremity as related to physical
More informationGENERAL ADMISSION CRITERIA INPATIENT REHABILITATION PROGRAMS
Originator: Case Management Original Date: 9/94 Review/Revision: 6/96, 2/98, 1/01, 4/02, 8/04, 3/06, 03/10, 3/11, 3/13 Stakeholders: Case Management, Medical Staff, Nursing, Inpatient Therapy GENERAL ADMISSION
More information