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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation medicine summit: building research capacity (executive summary). AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2006; 15:3-14. [PMID: 16533088 DOI: 10.1044/1058-0360(2006/002)] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were (a) researchers; (b) research culture, environment, and infrastructure; (c) funding; (d) partnerships; and (e) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A postsummit, multiorganizational initiative is called for to pursue the agendas outlined in this report.
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation Medicine Summit: Building Research Capacity--executive summary. Phys Ther 2006; 86:285-98; discussion 299-300. [PMID: 16445342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The general objective of the Rehabilitation Medicine Summit: Building Research Capacity was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were: (1) researchers, (2) research environment, infrastructure, and culture, (3) funding, (4) partnerships, and (5) metrics. The [approximately] 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small-group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation medicine summit: building research capacity executive summary. J Neuroeng Rehabil 2006; 3:1. [PMID: 16390550 PMCID: PMC1351393 DOI: 10.1186/1743-0003-3-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 01/03/2006] [Indexed: 11/30/2022] Open
Abstract
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: 1) researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and 5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report (see Additional File 1).
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tated DG. Rehabilitation medicine summit: Building research capacity. Disabil Rehabil 2006; 28:71-5. [PMID: 16393836 DOI: 10.1080/09638280500407175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation medicine summit: building research capacity. J Head Trauma Rehabil 2006; 21:1-7. [PMID: 16456387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multiorganizational initiative is called to pursue the agendas outlined in this article.
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation Medicine Summit: Building Research Capacity. Executive Summary. Arch Phys Med Rehabil 2006; 87:148-52. [PMID: 16401455 DOI: 10.1016/j.apmr.2005.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 10/19/2005] [Indexed: 10/25/2022]
Abstract
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were researchers; research culture, environment, and infrastructure; funding; partnerships; and metrics. Participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. Small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multiorganizational initiative is called for to pursue the agendas outlined in this report.
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation Medicine Summit: building research capacity. J Spinal Cord Med 2006; 29:70-81. [PMID: 16572568 PMCID: PMC1864789 DOI: 10.1080/10790268.2006.11753859] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called to pursue the agendas outlined in this report.
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation Medicine Summit. Am J Phys Med Rehabil 2005; 84:913-7. [PMID: 16327406 DOI: 10.1097/01.phm.0000190316.61035.5e] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were: 1) researchers; 2) research culture, environment, and infrastructure; 3) funding; 4) partnerships; and 5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multi-organizational initiative is called for to pursue the agendas outlined in this report.
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Selles RW, Li X, Lin F, Chung SG, Roth EJ, Zhang LQ. Feedback-Controlled and Programmed Stretching of the Ankle Plantarflexors and Dorsiflexors in Stroke: Effects of a 4-Week Intervention Program. Arch Phys Med Rehabil 2005; 86:2330-6. [PMID: 16344031 DOI: 10.1016/j.apmr.2005.07.305] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 07/01/2005] [Accepted: 07/13/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effect of repeated feedback-controlled and programmed "intelligent" stretching of the ankle plantar- and dorsiflexors to treat subjects with ankle spasticity and/or contracture in stroke. DESIGN Noncontrolled trial. SETTING Institutional research center. PARTICIPANTS Subjects with spasticity and/or contracture after stroke. INTERVENTIONS Stretching of the plantar- and dorsiflexors of the ankle 3 times a week for 45 minutes during a 4-week period by using a feedback-controlled and programmed stretching device. MAIN OUTCOME MEASURES Passive and active range of motion (ROM), muscle strength, joint stiffness, joint viscous damping, reflex excitability, comfortable walking speed, and subjective experiences of the subjects. RESULTS Significant improvements were found in the passive ROM, maximum voluntary contraction, ankle stiffness, and comfortable walking speed. The visual analog scales indicated very positive subjective evaluation in terms of the comfort of stretching and the effect on their involved ankle. CONCLUSIONS Repeated feedback-controlled or intelligent stretching had a positive influence on the joint properties of the ankle with spasticity and/or contracture after stroke. The stretching device may be an effective and safe alternative to manual passive motion treatment by a therapist and has potential to be used to repeatedly and regularly stretch the ankle of subjects with spasticity and/or contracture without daily involvement of clinicians or physical therapists.
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Frontera WR, Fuhrer MJ, Jette AM, Chan L, Cooper RA, Duncan PW, Kemp JD, Ottenbacher KJ, Peckham PH, Roth EJ, Tate DG. Rehabilitation Medicine Summit: Building Research Capacity-Executive Summary. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2005; 42:x-xxiii. [PMID: 16680608 DOI: 10.1682/jrrd.2005.12.0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The five elements of research capacity that guided the discussions were (1) researchers; (2) research culture, environment, and infrastructure; (3) funding; (4) partnerships; and (5) metrics. The 100 participants included representatives of professional organizations, consumer groups, academic departments, researchers, governmental funding agencies, and the private sector. The small group discussions and plenary sessions generated an array of problems, possible solutions, and recommended actions. A post-Summit, multiorganizational initiative is called to pursue the agendas outlined in this report.
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Chung SG, Van Rey EM, Bai Z, Rogers MW, Roth EJ, Zhang LQ. Aging-related neuromuscular changes characterized by tendon reflex system properties. Arch Phys Med Rehabil 2005; 86:318-27. [PMID: 15706561 DOI: 10.1016/j.apmr.2004.04.048] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To quantitatively evaluate changes in neuromuscular reflex system properties that are associated with aging. DESIGN Controlled, experimental. SETTING Research laboratory in a rehabilitation hospital. PARTICIPANTS Fourteen elderly (age, 69.4+/-7.1 y) and 18 young (age, 29.9+/-6.5 y) healthy subjects. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES With the subject relaxed, an instrumented reflex hammer was used to tap the Achilles tendon and record the tapping force, whereas the ankle plantarflexion torque and plantarflexor muscle electromyographic activity were recorded isometrically as measures of the reflex responses. Tendon reflex system properties were evaluated by using system identification techniques. Tendon tapping force was designated as system input and reflex-mediated torque and electromyographic activity as outputs. The dynamic relations between input and output were characterized by the system parameters of reflex-mediated torque and electromyographic gains, contraction and excitation rate, reflex-mediated torque and electromyographic delays, and electromechanic delay. RESULTS Various aging-related changes were found in the tendon reflex system properties, including decreased tendon reflex gain ( P =.029), slower contraction and half-relaxation rates ( P </=.018), and longer electromyographic activation delay, electromechanical delay and overall torque reflex delay ( P </=.025). In contrast, changes in the electromyographic properties were not significant, except for the longer electromyographic activation delay. CONCLUSIONS Aging is associated with significant changes in the neuromuscular reflex system properties. The changes were mainly associated with weaker and slower muscle force generation but not with significant decrease in motoneuronal excitability.
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Chung SG, Van Rey E, Bai Z, Roth EJ, Zhang LQ. Biomechanic changes in passive properties of hemiplegic ankles with spastic hypertonia11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:1638-46. [PMID: 15468024 DOI: 10.1016/j.apmr.2003.11.041] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate quantitatively biomechanic changes in the passive properties of hemiplegic spastic ankles. DESIGN Evaluation of spastic hypertonia by moving the ankle joint slowly between dorsiflexion and plantarflexion extreme positions under controlled joint torque and position. SETTING Institutional research center. PARTICIPANTS Twenty-four stroke patients with spastic ankles and 32 healthy controls. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Passive resistance torque at controlled dorsiflexion and plantarflexion positions, dorsiflexion and plantarflexion range of motion (ROM) at controlled torques, and quasistatic stiffness and energy loss in dorsiflexion and plantarflexion. RESULTS Spastic hypertonic ankles showed significant alterations of the passive properties in plantarflexion (P=.041) as well as in dorsiflexion (P=.016) directions. Compared with healthy controls, spastic ankles showed higher resistance torque (9.51+/-4.79Nm vs 6.21+/-3.64Nm, P=.016), higher quasistatic stiffness (.54+/-.19Nm/deg vs .35+/-.20Nm/deg, P=.001) at 10 degrees of dorsiflexion, larger normalized dorsiflexion energy loss (.068+/-.04J/deg vs .04+/-.02J/deg, P=.037), and decreased dorsiflexion ROM at 10Nm of resistance torque (10.77 degrees +/-8.69 degrees vs 20.02 degrees +/-11.67 degrees , P=.014). The resistance torque, ROM, and stiffness of spastic hypertonic ankles in plantarflexion showed similar changes (P<.05) to those in dorsiflexion. The passive ROM, joint stiffness, and resistance torque at controlled positions correlated with each other and also correlated with the Modified Ashworth Scale (P<.01). CONCLUSIONS Various biomechanic changes in both plantar- and dorsiflexors are associated with spastic hypertonia of chronic stroke patients, and they can be evaluated quantitatively under well-controlled conditions. With simplifications, the various measures in this study can potentially be used to obtain more comprehensive and quantitative evaluations of spastic hypertonia in a clinical setting.
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Harvey RL, Lovell LL, Belanger N, Roth EJ. The effectiveness of anticoagulant and antiplatelet agents in preventing venous thromboembolism during stroke rehabilitation: a historical cohort study. Arch Phys Med Rehabil 2004; 85:1070-5. [PMID: 15241752 DOI: 10.1016/j.apmr.2003.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the effectiveness of anticoagulant and antiplatelet agents in preventing venous thromboembolism (VTE) during stroke rehabilitation. DESIGN Historical cohort study. SETTING Acute inpatient rehabilitation hospital. PARTICIPANTS Consecutive patients (N=1506) with ischemic and hemorrhagic stroke admitted for rehabilitation. INTERVENTIONS Documented use of anticoagulants (warfarin or anticoagulant doses of heparin), heparin in prophylactic doses, and antiplatelet agents. MAIN OUTCOME MEASURE Occurrence of deep vein thrombosis detected by ultrasound or venography or pulmonary embolism detected by ventilation perfusion scan, spiral computed tomography, or pulmonary angiography. RESULTS Fifty-eight VTE events occurred (3.9% incidence or 1.36 events per 1000 patient days), with higher risk in patients with severe stroke. Only therapeutic anticoagulation had a statistically significant protective effect for VTE risk in univariate analysis (odds ratio [OR]=.44; 95% confidence interval [CI],.20-.98). After adjusting for multiple medication use and other factors, including age, stroke onset to admission interval, length of rehabilitation stay, cause of stroke, and admission National Institutes of Health Stroke Scale score, therapeutic anticoagulation gave strong protection against VTE (OR=.37; 95% CI,.15-.88), followed by heparin (OR=.48; 95% CI,.23-.98) but not by antiplatelet agents (OR=.79; 95% CI,.40-1.57). No medications were associated with significant bleeding complications. CONCLUSIONS Use of therapeutic anticoagulants or prophylactic heparin prevented VTE in stroke patients during inpatient rehabilitation.
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Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, Shephard T. Physical Activity and Exercise Recommendations for Stroke Survivors. Stroke 2004; 35:1230-40. [PMID: 15105522 DOI: 10.1161/01.str.0000127303.19261.19] [Citation(s) in RCA: 229] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, Shephard T. Physical Activity and Exercise Recommendations for Stroke Survivors. Circulation 2004; 109:2031-41. [PMID: 15117863 DOI: 10.1161/01.cir.0000126280.65777.a4] [Citation(s) in RCA: 251] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Heinemann AW, Roth EJ, Rychlik K, Pe K, King C, Clumpner J. The impact of stroke practice guidelines on knowledge and practice patterns of acute care health professionals. J Eval Clin Pract 2003; 9:203-12. [PMID: 12787184 DOI: 10.1046/j.1365-2753.2003.00380.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The Agency for Healthcare Research and Quality's Post-Stroke Rehabilitation Guidelines were developed to improve the quality, appropriateness and effectiveness of rehabilitation practices. An important goal of the guidelines process is to disseminate information to practitioners in order to encourage adoption of effective practices. To date, no systematic evaluation of these guidelines has been completed, nor has a programme been designed to evaluate the effectiveness of an educational programme about the guidelines. The objective was to evaluate changes in knowledge and practice following presentation of a lecture-based, educational programme about post-stroke rehabilitation guidelines. METHODS The research design was a single group, pre-test-post-test design without a comparison group. A knowledge and referral practices questionnaire was developed specifically for this study. RESULTS Lecture attendance was not associated with an increase in knowledge or referrals. However, we found that respondents who made more referrals at follow-up had a higher knowledge level at pre-test. Also, those who completed a follow-up assessment knew more about the guidelines at the initial assessment than did those who did not complete the follow-up assessment. In addition, doctors knew more about stroke rehabilitation than the non-doctors, both at the pre-test and follow-up. DISCUSSION AND CONCLUSIONS Encouraging behaviour change among doctors and allied health professionals in referrals and clinical practice is a complicated process. Providing individual follow-up and lengthier contacts, assuring that care providers receive high-quality evidence that guidelines improve care, and consulting with key decision-makers about guideline implementation might enhance behaviour change.
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Roth EJ. Motor recovery after stroke. Phys Med Rehabil Clin N Am 2003. [DOI: 10.1016/s1047-9651(02)00114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zhang LQ, Chung SG, Bai Z, Xu D, van Rey EMT, Rogers MW, Johnson ME, Roth EJ. Intelligent stretching of ankle joints with contracture/spasticity. IEEE Trans Neural Syst Rehabil Eng 2002; 10:149-57. [PMID: 12503779 DOI: 10.1109/tnsre.2002.802857] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An intelligent stretching device was developed to treat the spastic/contractured ankle of neurologically impaired patients. The device stretched the ankle safely throughout the range of motion (ROM) to extreme dorsiflexion and plantarflexion until a specified peak resistance torque was reached with the stretching velocity controlled based on the resistance torque. The ankle was held at the extreme position for a period of time to let stress relaxation occur before it was rotated back to the other extreme position. Stretching was slow at the joint extreme positions, making it possible to reach a larger ROM safely and it was fast in the middle ROM so the majority of the treatment was spent in stretching the problematic extreme ROM. Furthermore, the device evaluated treatment outcome quantitatively in multiple aspects, including active and passive ROM, joint stiffness and viscous damping and reflex excitability. The stretching resulted in considerable changes in joint passive ROM, stiffness, viscous damping and reflex gain. The intelligent control and yet simple design of the device suggest that with appropriate simplification, the device can be made portable and low cost, making it available to patients and therapists for frequent use in clinics/home and allowing more effective treatment and long-term improvement.
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Roth EJ, Lovell L, Harvey RL, Bode RK, Heinemann AW. Stroke rehabilitation: indwelling urinary catheters, enteral feeding tubes, and tracheostomies are associated with resource use and functional outcomes. Stroke 2002; 33:1845-50. [PMID: 12105364 DOI: 10.1161/01.str.0000020122.30516.ff] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to investigate the associations between tracheostomies, enteral feeding tubes, and indwelling urinary catheters and functional outcome measures, incidence of medical complications, and resource use in an inpatient stroke rehabilitation program. METHODS A cohort of 1553 patients consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke characteristics, impairment (National Institutes of Health Stroke Scale) and disability level (Functional Independence Measure [FIM]), preexisting medical conditions, and the presence of tracheostomies, enteral feeding tubes, and indwelling urinary catheters were recorded at admission. The occurrence of medical complications during rehabilitation, discharge disability level, length of rehabilitation stay, and rehabilitation hospital charges were recorded at discharge. RESULTS Compared with patients with no medical tubes, patients with 3 medical tubes had significantly higher National Institutes of Health Stroke Scale scores, lower admission and discharge FIM scores, reduced FIM efficiency scores (average FIM score change per day), and twice the number of medical complications. Patients with 3 medical tubes stayed 28 days longer in acute hospitalization and 20 days longer in rehabilitation compared with patients with no medical tubes. The presence of even a single medical tube was associated with longer length of stay, more medical complications during rehabilitation, and greater disability level at discharge. CONCLUSIONS The presence of > or =1 medical tubes is associated with more severe and disabling strokes, an increased number of medical complications, longer acute and rehabilitation hospitalizations, and greater resource use.
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King RB, Carlson CE, Shade-Zeldow Y, Bares KK, Roth EJ, Heinemann AW. Transition to home care after stroke: depression, physical health, and adaptive processes in support persons. Res Nurs Health 2001; 24:307-23. [PMID: 11746061 DOI: 10.1002/nur.1032] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A longitudinal design was used to examine adaptation in primary support persons (PSP) of stroke survivors during the transition from hospitalization (T1) to home care (T2). The major purposes of the study were (a) to examine changes in depression, physical health, and contextual and coping factors from hospitalization of the stroke survivor through the first 6-10 weeks of home care; and (b) to identify predictors of depression. Data (N = 136) were collected on depression, physical health, background, survivor illness, and social environmental variables; appraisal of impact; social support resources; and coping skills. Reduction in mean PSP depression was significant at T2, but the change in physical health was not significant. Significant changes occurred in survivor function, family functioning, and three of six coping skills. Hierarchical multiple regression analyses were used to predict depression. T1 variables accounted for 29% of the variance in T1 PSP depression, with gender and appraisal of impact the strongest of seven predictors. T1 depression, T2 health, family functioning, and avoidance coping were the strongest of seven predictors, explaining 50% of the variance in T2 depression. Findings highlight the importance of maintaining caregiver health and preventing depression and identify variables to target for the reduction of PSP depression.
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Roth EJ, Plastaras CT, Mullin MS, Fillmore J, Moses ML. A simple institutional educational intervention to decrease use of selected expensive medications. Arch Phys Med Rehabil 2001; 82:633-6. [PMID: 11346840 DOI: 10.1053/apmr.2001.22624] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether a simple educational intervention can influence use of prescription medications at an institution. DESIGN Cost-effectiveness analysis of prescribing behavior before and after an educational intervention. SETTING A large, urban, free-standing academic rehabilitation hospital. PARTICIPANTS Physicians, residents, and physician extenders. INTERVENTIONS The hospital's pharmacy department provided simple written educational material about cost differences of various prescription medications to attending and resident physicians, nurse leaders, and case managers. Telephoned reminders were given when targeted medications were prescribed. MAIN OUTCOME MEASURES Total prescription medication use was recorded monthly for 12 months before and after the intervention. Pharmaceuticals monitored were subcutaneously administered anticoagulants, histamine type 2 (H2) blockers, and nonsteroidal anti-inflammatory drugs (NSAIDs). RESULTS A 32% decrease in use of the more costly anticoagulant and a 20% increase in use of the less costly anticoagulant (p <.0001), representing an estimated annual savings of nearly $66,000. Use of more costly H2 antagonist decreased 50% and use of less costly H2 antagonist increased 128% (p <.0001). With written intervention only, use of more costly NSAIDs declined 28%, whereas use of less costly NSAIDs increased 58% (p <.0020). CONCLUSION Providing physicians with simple pharmaceutical cost information and telephone reminders decreased the use of targeted more costly medications.
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Roth EJ, Lovell L, Harvey RL, Heinemann AW, Semik P, Diaz S. Incidence of and risk factors for medical complications during stroke rehabilitation. Stroke 2001; 32:523-9. [PMID: 11157192 DOI: 10.1161/01.str.32.2.523] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aims of this study were to examine the frequency, types, and clinical factors associated with medical complications that occur during inpatient rehabilitation and to identify risk factors for complications that require a transfer to an acute care facility. METHODS A cohort of 1029 patients consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke information, impairment, preexisting medical conditions, and admission laboratory abnormalities were recorded. Medical complications, defined as new or exacerbated medical problems, were documented for each patient. Complications that required transfer off rehabilitation were noted. Univariate and multiple logistic regression analyses were used to determine factors that were associated with risk of medical complications and risk of transfer off rehabilitation. RESULTS Seventy-five percent of patients experienced >/=1 medical complication during rehabilitation. Significant factors for the development of any medical complication included greater neurological deficit (odds ratio [OR], 4.10; confidence interval [CI], 1.88 to 8.91), hypoalbuminemia (OR, 1.71; 95% CI, 1.15 to 2.52), and history of hypertension (OR, 1.81; 95% CI, 1.27 to 2.59). Nineteen percent of patients had a medical complication that required transfer to an acute care facility. Significant factors for transfers were elevated admission white blood cell counts (OR, 1.92; 95% CI, 1.32 to 2.79), low admission hemoglobin levels (OR, 1.89; 95% CI, 1.32 to 2.68), greater neurological deficit (OR, 2.46; 95% CI, 1.37 to 4.39), and a history of cardiac arrhythmia (OR, 1.79; 95% CI, 1.18 to 2.67). CONCLUSIONS Medical complications are common among patients undergoing stroke rehabilitation. A significant number of these medical complications may require a transfer to an acute facility.
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Roth EJ, Harvey RL, Heinemann AW, Lovell L. THE EFFECT OF THE NUMBER OF SECONDARY MEDICAL COMPLICATIONS ON FUNCTIONAL OUTCOMES AND RESOURCE UTILIZATION DURING STROKE REHABILITATION. Am J Phys Med Rehabil 2000. [DOI: 10.1097/00002060-200003000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen D, Hartwig DM, Roth EJ. Comparison of sperm quantity and quality in antegrade V retrograde ejaculates obtained by vibratory penile stimulation in males with spinal cord injury. Am J Phys Med Rehabil 1999; 78:46-51. [PMID: 9923429 DOI: 10.1097/00002060-199901000-00012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reduced fertility in men with spinal cord injury results from the inability to ejaculate and poor semen quality. Vibratory penile stimulation can induce ejaculation in many men with spinal cord injuries, but few studies have reported the effects of repeated vibratory stimulation on quantitative semen analysis tests. Fourteen spinal cord-injured males were enrolled in a prospective study to develop a quantitative profile of antegrade and retrograde ejaculate specimens collected during repeated vibratory stimulation. Antegrade specimens were obtained in 51 (84%) and retrograde specimens were obtained in all of the 61 trials (100%). Sperm were present in 70% and 64% of the antegrade and retrograde samples, respectively. Of the patients who underwent repeated vibratory stimulation attempts, three showed marked improvement in sperm counts and characteristics with repeated vibration and five showed normal fluctuation or no change in semen quality. Overall, there was a trend toward higher sperm counts in the antegrade samples (mean, 74.1 million) than in the retrograde samples (mean, 40 million), but no statistical significance was found. Mean sperm motility, sperm progressive motility, and percent normal sperm morphology were not significantly different between antegrade and retrograde specimens. Fructose and zinc, semen markers that reflect the presence of a true ejaculate, were present in all antegrade and retrograde specimens. In conclusion, (1) both antegrade and retrograde ejaculation occur with vibratory penile stimulation, with antegrade samples containing greater numbers of sperm but retrograde samples also having significant sperm counts, (2) repeated vibration may increase sperm concentration or may result in only minimal changes reflective of normal fluctuations, and (3) vibratory stimulation results in true ejaculation, as evidenced by semen markers.
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