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Botticello AL, Murphy LF, Boninger M, Bryce TN, Charlifue S, Coker J, Roach MJ, Scott M, Worobey L. Residential Mobility and Reasons for Moving Among People Living With Spinal Cord Injury: Results of a Multisite Survey Study. Top Spinal Cord Inj Rehabil 2023; 29:108-121. [PMID: 38076496 PMCID: PMC10704213 DOI: 10.46292/sci23-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Residential mobility after spinal cord injury (SCI) has not been extensively examined despite a growing interest in investigating the relationship between neighborhood exposures and community living outcomes. Objectives This study explores residential mobility patterns, the annual move rate, and reasons for moving among a community-living sample of adults with SCI. Methods A survey was conducted with 690 people at six SCI Model Systems centers in the United States between July 2017 and October 2020. The outcomes included move status in the past 12 months, move distance, and the primary reason for moving. A sample from the 2019 American Community Survey (ACS) 5-year pooled estimates was obtained for comparative analysis. Descriptive statistics were used to summarize the distributions of the outcomes and differences between the samples. Results The annual move rate for adults with SCI was 16.4%, and most moves were within the same county (56.6%). Recent movers were more likely to be young adults, be newly injured, and have low socioeconomic status. Housing quality, accessibility, and family were more frequently reported motivations for moving compared to employment. Young adults more commonly moved for family and accessibility, whereas middle-aged adults more commonly moved for housing quality. No notable difference was observed in the annual move rate between the SCI and the general population samples. Conclusion These findings suggest an age-related pattern of residential relocation after SCI, which may be indicative an extended search for optimal living conditions that meet the housing and accessibility needs of this population.
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Affiliation(s)
- Amanda L. Botticello
- Kessler Foundation, West Orange, New Jersey
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Lauren F. Murphy
- Kessler Foundation, West Orange, New Jersey
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Thomas N. Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York
| | | | | | - Mary Joan Roach
- Case Western University, Cleveland, Ohio
- MetroHealth System, Cleveland, Ohio
| | - Michael Scott
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Lynn Worobey
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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2
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Minder U, Arnet U, Müller E, Boninger M, Bossuyt FM. Changes in neuromuscular activation, heart rate and rate of perceived exertion over the course of a wheelchair propulsion fatigue protocol. Front Physiol 2023; 14:1220969. [PMID: 37920802 PMCID: PMC10619735 DOI: 10.3389/fphys.2023.1220969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
Shoulder pain is common in persons with spinal cord injury and has been associated with wheelchair use. Fatigue related compensation strategies have been identified as possibly impacting the development of shoulder injury and pain. The purpose of this study was to investigate the progression of performance fatigability (i.e., decline in objective measure of performance including neuromuscular activation and increase in heart rate) and perceived fatigability (i.e., increased perceived exertion) during a 15-min fatigue protocol including maximum voluntary overground wheelchair propulsion. Fifty participants with paraplegic spinal cord injury completed three 4-min rounds of wheelchair propulsion, separated by 90 s of rest, on a figure-8 course consisting of two turns and full stops per lap in their manual wheelchairs (ClinicalTrials.gov: NCT03153033). Electromyography (EMG) signal of five muscles acting on the shoulder joint, heart rate (HR), and rate of perceived exertion (RPE) were measured at the beginning and end of every 4 min of propulsion. Root Mean Square (RMS) and Mean Power Frequency were calculated from EMG data. There was a significant increase in %RMS of the pectoralis major pars sternalis and trapezius pars descendens, HR, and RPE with greatest changes during the first 4 min of the protocol. The observed changes in neuromuscular activation in only two of the shoulder muscles may impact muscular imbalances and the development of shoulder injuries and should be further studied. The current study gives clearer insight into the mechanisms of performance fatigability and perceived fatigability throughout a wheelchair propulsion fatigue protocol.
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Affiliation(s)
- Ursina Minder
- Neuro-musculoskeletal Functioning and Mobility Groupe, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Ursina Arnet
- Neuro-musculoskeletal Functioning and Mobility Groupe, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Erich Müller
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Fransiska M. Bossuyt
- Neuro-musculoskeletal Functioning and Mobility Groupe, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zurich, Switzerland
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3
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Verbaarschot C, Karapetyan V, Greenspon C, Boninger M, Bensmaia S, Sorger B, Gaunt R. Context is key to evoking natural touch experiences using intracortical microstimulation of the human somatosensory cortex. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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4
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Sherrier M, Schroeder A, Davis WA, Boninger M, Helkowski W. Creating a Resident Research Track in Synergy With the Rehabilitation Medicine Scientist Training Program. Am J Phys Med Rehabil 2022; 101:S57-S61. [PMID: 33990482 PMCID: PMC8589858 DOI: 10.1097/phm.0000000000001791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Physician scientists play an important role in the translation of research findings to patient care; however, their training faces numerous challenges. Residency research track programs represent an opportunity to facilitate the training of future physician scientists in physical medicine and rehabilitation, although optimal program organization and long-term outcomes remain unknown. The Rehabilitation Medicine Scientist Training Program is a National Institutes of Health-funded program aimed at addressing the shortage of physician researchers in the field of physical medicine and rehabilitation by providing instruction, mentorship, and networking opportunities for a successful research career. While the opportunities provided through the Rehabilitation Medicine Scientist Training Program provide critical education and guidance at a national level, trainees are most successful with availability of strong local support and mentorship. The purpose of this article was to present a realistic and easily applicable structure for a physical medicine and rehabilitation residency research track that can be used in concert with the Rehabilitation Medicine Scientist Training Program.
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Affiliation(s)
- Matthew Sherrier
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213
| | - Allison Schroeder
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Minneapolis, MN, 55403
| | - W. Austin Davis
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213
| | - Wendy Helkowski
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213
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5
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Chen Y, Zanca JM, Heinemann AW, Boninger M, Botticello AL, Morse LR. Current Research Outcomes from the Spinal Cord Injury Model Systems. Arch Phys Med Rehabil 2022; 103:619-621. [DOI: 10.1016/j.apmr.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022]
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6
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Rekant J, Fisher LE, Boninger M, Gaunt RA, Collinger JL. Amputee, clinician, and regulator perspectives on current and prospective upper extremity prosthetic technologies. Assist Technol 2022:1-13. [PMID: 34982647 DOI: 10.1080/10400435.2021.2020935] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Existing prosthetic technologies for people with upper limb amputation are being adopted at moderate rates. Once fitted for these devices, many upper limb amputees report not using them regularly or at all. The primary aim of this study was to solicit feedback about prosthetic technology and important device design criteria from amputees, clinicians, and device regulators. We compare these perspectives to identify common or divergent priorities. Twenty-one adults with upper limb loss, 35 clinicians, and 3 regulators completed a survey on existing prosthetic technologies and a conceptual sensorimotor prosthesis driven by implanted myoelectric electrodes with sensory feedback via spinal root stimulation. The survey included questions from the Trinity Amputation and Prosthesis Experience Scale, the Disabilities of the Arm, Shoulder, and Hand, and novel questions about technology acceptance and neuroprosthetic design. User and clinician ratings of satisfaction with existing devices were similar. Amputees were most accepting of the proposed sensorimotor prosthesis (75.5% vs clinicians(68.8%), regulators(67.8%)). Stakeholders valued user-centered outcomes like individualized task goals, improved quality of life, device reliability, and user safety; regulators emphasized these last two. The results of this study provide insight into amputee, clinician, and regulator priorities to inform future upper-limb prosthetic design and clinical trial protocol development.
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Affiliation(s)
- Julie Rekant
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lee E Fisher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Michael Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.,Human Engineering Research Labs, VA Center of Excellence, Department of Veteran Affairs, Pittsburgh, PA, USA
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Neural Basis of Cognition, Pittsburgh, PA, USA.,Human Engineering Research Labs, VA Center of Excellence, Department of Veteran Affairs, Pittsburgh, PA, USA
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7
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Hogaboom N, Dyson-Hudson T, Sisto SA, Boninger M. Sensitivity and Specificity of Common Physical Examination Maneuvers for Supraspinatus Tendinopathy in Wheelchair Users With Paraplegia. Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Hughes CL, Flesher SN, Weiss JM, Downey JE, Boninger M, Collinger JL, Gaunt RA. Neural stimulation and recording performance in human sensorimotor cortex over 1500 days. J Neural Eng 2021; 18. [PMID: 34320481 DOI: 10.1088/1741-2552/ac18ad] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/28/2021] [Indexed: 01/12/2023]
Abstract
Objective.Intracortical microstimulation (ICMS) in somatosensory cortex can restore sensation to people with spinal cord injury. However, the recording quality from implanted microelectrodes can degrade over time and limitations in stimulation longevity have been considered a potential barrier to the clinical use of ICMS. Our objective was to evaluate recording stability of intracortical electrodes implanted in the motor and somatosensory cortex of one person. The electrodes in motor cortex had platinum tips and were not stimulated, while the electrodes in somatosensory cortex had sputtered iridium oxide film (SIROF) tips and were stimulated. Additionally, we measured how well ICMS was able to evoke sensations over time.Approach. We implanted microelectrode arrays with SIROF tips in the somatosensory cortex (SIROF-sensory) of a human participant with a cervical spinal cord injury. We regularly stimulated these electrodes to evoke tactile sensations on the hand. Here, we quantify the stability of these electrodes in comparison to non-stimulated platinum electrodes implanted in the motor cortex (platinum-motor) over 1500 days with recorded signal quality and electrode impedances. Additionally, we quantify the stability of ICMS-evoked sensations using detection thresholds.Main results. We found that recording quality, as assessed by the number of electrodes with high-amplitude waveforms (>100µV peak-to-peak), peak-to-peak voltage, noise, and signal-to-noise ratio, decreased over time on SIROF-sensory and platinum-motor electrodes. However, SIROF-sensory electrodes were more likely to continue to record high-amplitude signals than platinum-motor electrodes. Interestingly, the detection thresholds for stimulus-evoked sensations decreased over time from a median of 31.5μA at day 100-10.4μA at day 1500, with the largest changes occurring between day 100 and 500.Significance. These results demonstrate that ICMS in human somatosensory cortex can be provided over long periods of time without deleterious effects on recording or stimulation capabilities. In fact, the sensitivity to stimulation improved over time.
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Affiliation(s)
- Christopher L Hughes
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Sharlene N Flesher
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jeffrey M Weiss
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - John E Downey
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL, United States of America
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jennifer L Collinger
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Robert A Gaunt
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States of America
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9
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Hughes CL, Flesher SN, Weiss JM, Boninger M, Collinger JL, Gaunt RA. Perception of microstimulation frequency in human somatosensory cortex. eLife 2021; 10:65128. [PMID: 34313221 PMCID: PMC8376245 DOI: 10.7554/elife.65128] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/22/2021] [Indexed: 12/11/2022] Open
Abstract
Microstimulation in the somatosensory cortex can evoke artificial tactile percepts and can be incorporated into bidirectional brain–computer interfaces (BCIs) to restore function after injury or disease. However, little is known about how stimulation parameters themselves affect perception. Here, we stimulated through microelectrode arrays implanted in the somatosensory cortex of two human participants with cervical spinal cord injury and varied the stimulus amplitude, frequency, and train duration. Increasing the amplitude and train duration increased the perceived intensity on all tested electrodes. Surprisingly, we found that increasing the frequency evoked more intense percepts on some electrodes but evoked less-intense percepts on other electrodes. These different frequency–intensity relationships were divided into three groups, which also evoked distinct percept qualities at different stimulus frequencies. Neighboring electrode sites were more likely to belong to the same group. These results support the idea that stimulation frequency directly controls tactile perception and that these different percepts may be related to the organization of somatosensory cortex, which will facilitate principled development of stimulation strategies for bidirectional BCIs.
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Affiliation(s)
- Christopher L Hughes
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, United States
| | - Sharlene N Flesher
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, United States.,Department of Neurosurgery, Stanford University, Stanford, United States.,Department of Electrical Engineering, Stanford University, Stanford, United States
| | - Jeffrey M Weiss
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States
| | - Michael Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Human Engineering Research Laboratories, VA Center of Excellence, Department of Veterans Affairs, Pittsburgh, United States
| | - Jennifer L Collinger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States.,Human Engineering Research Laboratories, VA Center of Excellence, Department of Veterans Affairs, Pittsburgh, United States
| | - Robert A Gaunt
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, United States.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, United States.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, United States.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, United States
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10
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Ernecoff NC, Altieri-Dunn SC, Bilderback A, Wilson CL, Saxon S, Ahuja Yende N, Arnold RM, Boninger M. Evaluation of a Home-Based, Nurse Practitioner-led Advanced Illness Care Program. J Am Med Dir Assoc 2021; 22:2389-2393. [PMID: 34115993 DOI: 10.1016/j.jamda.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In the United States, people with serious illness often experience gaps and discontinuity in care. Gaps are frequently exacerbated by limited mobility, need for social support, and challenges managing multiple comorbidities. The Advanced Illness Care (AIC) Program provides nurse practitioner-led, home-based care for people with serious or complex chronic illnesses that specifically targets palliative care needs and coordinates with patients' primary care and specialty health care providers. We sought to investigate the effect of the AIC Program on hospital encounters [hospitalizations and emergency department (ED) visits], hospice conversion, and mortality. DESIGN Retrospective nearest-neighbor matching. SETTING AND PARTICIPANTS Patients in AIC who had ≥1 inpatient stay within the 60 days prior to AIC enrollment to fee-for-service Medicare controls at 9 hospitals within one health system. METHODS We matched on demographic characteristics and comorbidities, with exact matches for diagnosis-related group and home health enrollment. Outcomes were hospital encounters (30- and 90-day ED visits and hospitalizations), hospice conversion, and 30- and 90-day mortality. RESULTS We included 110 patients enrolled in the AIC Program matched to 371 controls. AIC enrollees were mean age 77.0, 40.9% male, and 79.1% white. Compared with controls, AIC enrollees had a higher likelihood of ED visits at 30 [15.1 percentage points, confidence interval (CI) 4.9, 25.3; P = .004] and 90 days (27.8 percentage points, CI 16.0, 39.6; P < .001); decreased likelihood of hospitalization at 30 days (11.4 percentage points, CI -17.7, -5.0; P < .001); and a higher likelihood of converting to hospice (22.4 percentage points, CI 11.4, 33.3; P < .001). CONCLUSIONS The AIC Program provides care and coordination that the home-based serious illness population may not otherwise receive. IMPLICATIONS By identifying and addressing care needs and gaps in care early, patients may avoid unnecessary hospitalizations and receive timely hospice services as they approach the end of life.
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Affiliation(s)
- Natalie C Ernecoff
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | | | | | | | - Susan Saxon
- Palliative and Supportive Institutive, UPMC, Pittsburgh, PA, USA
| | - Namita Ahuja Yende
- Innovative Homecare Solutions, UPMC, Pittsburgh, PA, USA; UPMC Health Plan, Pittsburgh, PA, USA; Division of Geriatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert M Arnold
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Palliative and Supportive Institutive, UPMC, Pittsburgh, PA, USA
| | - Michael Boninger
- Innovative Homecare Solutions, UPMC, Pittsburgh, PA, USA; Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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11
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Botticello AL, Murphy L, Bogner J, Boninger M, Bryce TN, Chen Y, Heinemann AW, Roach MJ. Who Moves After SCI? Individual, Health, and Neighborhood Predictors of Residential Mobility Among Participants in the National Spinal Cord Injury Model Systems Database. Arch Phys Med Rehabil 2021; 103:822-831. [PMID: 34004163 DOI: 10.1016/j.apmr.2021.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate residential mobility among community-living adults with spinal cord injury (SCI) and the individual, health, and neighborhood factors associated with the propensity to relocate. DESIGN Retrospective analysis of data from the National SCI Model Systems (SCIMS) Database collected between 2006 and 2018 and linked with the American Community Survey 5-year estimates. SETTING Community. INTERVENTIONS Not applicable. PARTICIPANTS People with traumatic SCI (N=4599) who participated in 2 waves of follow-up and had residential geographic identifiers at the census tract level. MAIN OUTCOME MEASURES Moving was a binary measure reflecting change in residential locations over a 5-year interval. Move distance distinguished nonmovers from local movers (different tracts within the same county) and long-distance movers (to different county or state). Move quality included 4 categories: stayed/low poverty tract, stayed/high poverty tract, moved/low poverty tract, and moved/high poverty tract. RESULTS One in 4 people moved within a 5-year interval (n=1175). Of the movers, 55% relocated to a different census tract within the same county and 45% relocated to a different county or state. Thirty-five percent of all movers relocated to a high poverty census tract. Racial and ethnic minorities, people from low-income households, and younger adults were more likely to move, move locally, and relocate to a high poverty neighborhood. High poverty and racial/ethnic segregation in the origin neighborhood predicted an increased risk for remaining in or moving to a high poverty neighborhood. CONCLUSIONS Although people with SCI relocated at a lower rate than has been reported in the general population, moving was a frequent occurrence postinjury. People from vulnerable groups were more likely to remain in or relocate to socioeconomically disadvantaged neighborhoods, thus increasing the risk for health disparities and poorer long-term outcomes among minorities and people from low-income households. These findings inform policy makers' considerations of housing, health care, and employment initiatives for individuals with SCI and other chronic disabilities.
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Affiliation(s)
- Amanda L Botticello
- Kessler Foundation, West Orange, NJ; Rutgers New Jersey Medical School, Rutgers University, Newark, NJ.
| | - Lauren Murphy
- Kessler Foundation, West Orange, NJ; Rutgers New Jersey Medical School, Rutgers University, Newark, NJ
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas N Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yuying Chen
- University of Alabama at Birmingham, Birmingham, AL
| | - Allen W Heinemann
- Shirley Ryan AbilityLab and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mary Joan Roach
- Case Western Reserve University, Cleveland, OH; MetroHealth System, Cleveland, OH
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12
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Ernecoff NC, Bilderback A, Bellon J, Arnold RM, Boninger M, Kavalieratos D. Associations between Reason for Inpatient Palliative Care Consultation, Timing, and Cost Savings. J Palliat Med 2021; 24:1525-1538. [PMID: 33761279 DOI: 10.1089/jpm.2020.0636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Specialty palliative care (SPC) provides patient-centered care to people with serious illness and may reduce costs. Specific cost-saving functions of SPC remain unclear. Objectives: (1) To assess the effect of SPC on inpatient costs and length of stay (LOS) and (2) to evaluate differences in costs by indication and timing of SPC. Design: Case-control with in patients who received an SPC consultation and propensity matched controls. Setting: One large U.S. integrated delivery finance system. Measurements: Using administrative data, we assessed costs associated with inpatient stays, a subset of whom received an SPC consultation. Consultations were stratified by reasons based on physician discretion: goals of care, pain management, hospice evaluation, nonpain symptom management, or support. The primary outcome was total operating costs and the secondary outcome was hospital LOS. Results: In total, 1404 patients with SPC consultations associated with unique hospital encounters were matched with 2806 controls. Total operating costs were lower for patients who received an SPC consultation when the consultation was within 0 to 1 days of admission ($6,924 vs. $7,635, p = 0.002). Likewise, LOS was shorter (4.3 vs. 4.7 days, p < 0.001). Upon stratification by reason, goals-of-care consultations early in the hospital stay (days 0-1) were associated with reduced total operating costs ($7,205 vs. $8,677, p < 0.001). Costs were higher for pain management consultations ($7,727 vs. $6,914, p = 0.047). Consultation for hospice evaluation was associated with lower costs, particularly when early (hospital days 0-1: $4,125 vs. $7,415, p < 0.001). Conclusions: SPC was associated with significant cost saving and decreased LOS when occurring early in a hospitalization and used for goals-of-care and hospice evaluation.
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Affiliation(s)
- Natalie C Ernecoff
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | | | - Robert M Arnold
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Palliative and Supportive Institutive, UPMC, Pittsburgh, Pennsylvania, USA
| | - Michael Boninger
- Innovative Homecare Solutions, UPMC.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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13
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Jorge A, Royston D, Tyler-Kabara EC, Boninger M, Collinger J. Neural Control of Individual Finger Movements Using Intracortical Recordings From a Person With Tetraplegia. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Intracortical microelectrode arrays have allowed people to control robotic arm movements such as reaching and grasping. However, to restore dexterous movement, control of fingers will be required. We aimed to control individual finger movements of a virtual-reality hand on a person with tetraplegia.
METHODS
A 31-yr-old man with a C5/6 ASIA B spinal cord injury was implanted with two 88-channel intracortical microelectrode arrays (4 × 4 mm footprint, 1.5 mm shank-length) in the left motor cortex. Across 4 d, a 6-class linear discriminant classifier was used as an online decoder that output finger velocity commands every 20 ms. We quantified the number of channels and location significantly modulating each attempted finger movement using a Kolmogorov-Smirnov test. We also report the success rate to reach targets for flexing each of the five fingers and thumb abduction.
RESULTS
On average, there were 28 channels modulated by attempted finger movement on the lateral array as compared to 19 on the medial array. Attempted thumb flexion exhibited the highest (n = 18, P < .05) while ring finger had the fewest (n = 13, P < .05) modulated channels. The mean success rate was 61 ± 15% (chance: 17%). The participant was successful for 81% of the thumb flexion trials, while thumb abduction, index, middle, ring and pinky flexion achieved average accuracies of 75%, 63%, 49%, 38%, and 56% respectively. Of the failed trials, 93% failed due to co-activation of adjacent fingers, with middle and ring being the most interdependent. For example, the ring finger successfully flexed on 93% of the “ring finger” trials (high sensitivity), but middle was co-activated during 53% of the same trials (low specificity) resulting in trial failure.
CONCLUSION
A person with tetraplegia was able to use a brain-computer interface to control individual digits of a virtual robotic hand. Failed trials typically resulted from movement of adjacent fingers. This co-dependence should be accounted for in future control schemes.
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Múnera S, Pearlman J, Toro M, Worobey L, Boninger M, Cooper RA. Development and efficacy of an online wheelchair maintenance training program for wheelchair personnel. Assist Technol 2019; 33:49-55. [PMID: 31169455 DOI: 10.1080/10400435.2019.1619632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To develop an online version of the wheelchair maintenance training program (WMTP) and compare learning outcomes from the in-person and online programs using the wheelchair maintenance training questionnaire (WMT-Q), administered before and after the intervention. DESIGN Iterative development of an online version of the WMTP and implementation. SETTING Online. PARTICIPANTS 26 graduate and undergraduate students. INTERVENTION Web-based training. These results are compared with those from another study of the in-person WMTP with 10 participants. MAIN OUTCOME MEASURES Feedback survey and WMT-Q. RESULTS The training program was well-received and valued by all 26 participants. A significant increase in all scores after the online training program was found, based on pre-/post-intervention scores. In manual wheelchair open-ended questions, knowledge increased from 16% to 21%, p < .05; in power wheelchair open-ended questions, from 9% to 31%, p < .05; in multiple-choice questions related to knowledge, from 27% to 59%, p < .05; confidence increased from 8% to 80%, p < .05; and capacity from 12% to 88%, p < .05. There was no statistical difference in WMT-Q scores between individuals who participated in the in-person and online programs. CONCLUSION This study indicates that there was a similar-increased knowledge for participants, indicating that web-based training may be a viable approach for delivering maintenance training.
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Affiliation(s)
- Sara Múnera
- El Comité de Rehabilitación , Medellín, Colombia
| | - Jon Pearlman
- Department of Rehabilitation Science and Technology, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Maria Toro
- School of Physical Therapy, Universidad CES , Medellín, Colombia
| | - Lynn Worobey
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Michael Boninger
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh , Pittsburgh, Pennsylvania, USA
| | - Rory A Cooper
- Human Engineering Research Laboratories, VA Pittsburgh Healthcare System , Pittsburgh, Pennsylvania, USA
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Hogaboom NS, Fyffe D, Botticello AL, Worobey L, Boninger M. Perceived Healthcare Discrimination is Associated With Major and Minor Depression in Wheelchair Users With SCI. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Hogaboom NS, Onishi K, Worobey L, Boninger M. Shoulder Joint Cytokine Increases Correlated With Rotator Cuff Pathology Ultrasound Markers After Wheelchair Use. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Bossuyt FM, Arnet U, Cools A, Boninger M. Subacromial Space Reduction in Wheelchair Users: the Role of Loading and Subject Characteristics. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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van Hedel HJA, Severini G, Scarton A, O'Brien A, Reed T, Gaebler-Spira D, Egan T, Meyer-Heim A, Graser J, Chua K, Zutter D, Schweinfurther R, Möller JC, Paredes LP, Esquenazi A, Berweck S, Schroeder S, Warken B, Chan A, Devers A, Petioky J, Paik NJ, Kim WS, Bonato P, Boninger M. Correction to: Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies. J Neuroeng Rehabil 2018; 15:36. [PMID: 29739468 PMCID: PMC5941668 DOI: 10.1186/s12984-018-0378-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 12/05/2022] Open
Affiliation(s)
- Hubertus J A van Hedel
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.
| | - Giacomo Severini
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, at Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,University College Dublin, Dublin, Ireland
| | - A Scarton
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, at Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - A O'Brien
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, at Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - T Reed
- Acute Neurological Rehabilitation Unit, Wellington Hospital, London, UK
| | | | - T Egan
- Shirley Ryan AbilityLab, Chicago, USA
| | - A Meyer-Heim
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland
| | - J Graser
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland
| | - K Chua
- Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Republic of Singapore
| | - D Zutter
- Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - R Schweinfurther
- Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - J C Möller
- Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Liliana P Paredes
- Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - A Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab, Philadelphia, USA
| | - S Berweck
- Clinic for Neuropediatrics and Neurological Rehabilitation, Epilepsy center for children and adolescents, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - S Schroeder
- Paediatric Neurology, Developmental Medicine and Social Paediatrics, Ludwig Maximilian University, Hauner Children's Hospital, Munich, Germany
| | - B Warken
- Paediatric Neurology, Developmental Medicine and Social Paediatrics, Ludwig Maximilian University, Hauner Children's Hospital, Munich, Germany
| | - A Chan
- Sheltering Arms Physical Rehabilitation Center, Richmond, USA
| | - A Devers
- Sheltering Arms Physical Rehabilitation Center, Richmond, USA
| | - J Petioky
- Rehabilitation Centre Kladruby, Kladruby, Czech Republic
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - W S Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - P Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, at Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - M Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh and VA Pittsburgh Health Care System, Pittsburgh, USA
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van Hedel HJA, Severini G, Scarton A, O'Brien A, Reed T, Gaebler-Spira D, Egan T, Meyer-Heim A, Graser J, Chua K, Zutter D, Schweinfurther R, Möller JC, Paredes LP, Esquenazi A, Berweck S, Schroeder S, Warken B, Chan A, Devers A, Petioky J, Paik NJ, Kim WS, Bonato P, Boninger M. Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies. J Neuroeng Rehabil 2018; 15:30. [PMID: 29625628 PMCID: PMC5889593 DOI: 10.1186/s12984-018-0366-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 03/06/2018] [Indexed: 01/15/2023] Open
Abstract
Background The application of rehabilitation robots has grown during the last decade. While meta-analyses have shown beneficial effects of robotic interventions for some patient groups, the evidence is less in others. We established the Advanced Robotic Therapy Integrated Centers (ARTIC) network with the goal of advancing the science and clinical practice of rehabilitation robotics. The investigators hope to exploit variations in practice to learn about current clinical application and outcomes. The aim of this paper is to introduce the ARTIC network to the clinical and research community, present the initial data set and its characteristics and compare the outcome data collected so far with data from prior studies. Methods ARTIC is a pragmatic observational study of clinical care. The database includes patients with various neurological and gait deficits who used the driven gait orthosis Lokomat® as part of their treatment. Patient characteristics, diagnosis-specific information, and indicators of impairment severity are collected. Core clinical assessments include the 10-Meter Walk Test and the Goal Attainment Scaling. Data from each Lokomat® training session are automatically collected. Results At time of analysis, the database contained data collected from 595 patients (cerebral palsy: n = 208; stroke: n = 129; spinal cord injury: n = 93; traumatic brain injury: n = 39; and various other diagnoses: n = 126). At onset, average walking speeds were slow. The training intensity increased from the first to the final therapy session and most patients achieved their goals. Conclusions The characteristics of the patients matched epidemiological data for the target populations. When patient characteristics differed from epidemiological data, this was mainly due to the selection criteria used to assess eligibility for Lokomat® training. While patients included in randomized controlled interventional trials have to fulfill many inclusion and exclusion criteria, the only selection criteria applying to patients in the ARTIC database are those required for use of the Lokomat®. We suggest that the ARTIC network offers an opportunity to investigate the clinical application and effectiveness of rehabilitation technologies for various diagnoses. Due to the standardization of assessments and the use of a common technology, this network could serve as a basis for researchers interested in specific interventional studies expanding beyond the Lokomat®.
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Affiliation(s)
- Hubertus J A van Hedel
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.
| | - Giacomo Severini
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, at Spaulding Rehabilitation Hospital, Charlestown MA, USA.,University College Dublin, Dublin, Ireland
| | - Alessandra Scarton
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, at Spaulding Rehabilitation Hospital, Charlestown MA, USA
| | - Anne O'Brien
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, at Spaulding Rehabilitation Hospital, Charlestown MA, USA
| | - Tamsin Reed
- Acute Neurological Rehabilitation Unit, Wellington Hospital, London, UK
| | | | - Tara Egan
- Shirley Ryan AbilityLab, Chicago, USA
| | - Andreas Meyer-Heim
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland
| | - Judith Graser
- Rehabilitation Center for Children and Adolescents, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland
| | - Karen Chua
- Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Republic of Singapore
| | - Daniel Zutter
- Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Raoul Schweinfurther
- Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - J Carsten Möller
- Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Liliana P Paredes
- Rehaklinik Zihlschlacht, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab, Philadelphia, USA
| | - Steffen Berweck
- Clinic for Neuropediatrics and Neurological Rehabilitation, Epilepsy center for children and adolescents, Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Sebastian Schroeder
- Paediatric Neurology, Developmental Medicine and Social Paediatrics, Ludwig Maximilian University, Hauner Children's Hospital, Munich, Germany
| | - Birgit Warken
- Paediatric Neurology, Developmental Medicine and Social Paediatrics, Ludwig Maximilian University, Hauner Children's Hospital, Munich, Germany
| | - Anne Chan
- Sheltering Arms Physical Rehabilitation Center, Richmond, USA
| | - Amber Devers
- Sheltering Arms Physical Rehabilitation Center, Richmond, USA
| | - Jakub Petioky
- Rehabilitation Centre Kladruby, Kladruby, Czech Republic
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, at Spaulding Rehabilitation Hospital, Charlestown MA, USA
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh and VA Pittsburgh Health Care System, Pittsburgh, USA
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20
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Degenhart AD, Hiremath SV, Yang Y, Foldes S, Collinger JL, Boninger M, Tyler-Kabara EC, Wang W. Remapping cortical modulation for electrocorticographic brain-computer interfaces: a somatotopy-based approach in individuals with upper-limb paralysis. J Neural Eng 2018; 15:026021. [PMID: 29160240 PMCID: PMC5841472 DOI: 10.1088/1741-2552/aa9bfb] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Brain-computer interface (BCI) technology aims to provide individuals with paralysis a means to restore function. Electrocorticography (ECoG) uses disc electrodes placed on either the surface of the dura or the cortex to record field potential activity. ECoG has been proposed as a viable neural recording modality for BCI systems, potentially providing stable, long-term recordings of cortical activity with high spatial and temporal resolution. Previously we have demonstrated that a subject with spinal cord injury (SCI) could control an ECoG-based BCI system with up to three degrees of freedom (Wang et al 2013 PLoS One). Here, we expand upon these findings by including brain-control results from two additional subjects with upper-limb paralysis due to amyotrophic lateral sclerosis and brachial plexus injury, and investigate the potential of motor and somatosensory cortical areas to enable BCI control. APPROACH Individuals were implanted with high-density ECoG electrode grids over sensorimotor cortical areas for less than 30 d. Subjects were trained to control a BCI by employing a somatotopic control strategy where high-gamma activity from attempted arm and hand movements drove the velocity of a cursor. MAIN RESULTS Participants were capable of generating robust cortical modulation that was differentiable across attempted arm and hand movements of their paralyzed limb. Furthermore, all subjects were capable of voluntarily modulating this activity to control movement of a computer cursor with up to three degrees of freedom using the somatotopic control strategy. Additionally, for those subjects with electrode coverage of somatosensory cortex, we found that somatosensory cortex was capable of supporting ECoG-based BCI control. SIGNIFICANCE These results demonstrate the feasibility of ECoG-based BCI systems for individuals with paralysis as well as highlight some of the key challenges that must be overcome before such systems are translated to the clinical realm. ClinicalTrials.gov Identifier: NCT01393444.
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Affiliation(s)
- Alan D. Degenhart
- Systems Neuroscience Institute, University of Pittsburgh, PA, USA
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Shivayogi V. Hiremath
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Therapy, Temple University, Philadelphia, PA, USA
| | - Ying Yang
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen Foldes
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
| | - Jennifer L. Collinger
- Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- McGowan Institute for Regenerative Medicine, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, Pittsburgh, PA, USA
| | - Elizabeth C. Tyler-Kabara
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei Wang
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Clinical and Translational Science Institute, Pittsburgh, PA, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Barnes-Jewish Hospital, St. Louis, MO, USA
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21
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Yang Y, Dickey MW, Fiez J, Murphy B, Mitchell T, Collinger J, Tyler-Kabara E, Boninger M, Wang W. Sensorimotor experience and verb-category mapping in human sensory, motor and parietal neurons. Cortex 2017; 92:304-319. [PMID: 28575757 DOI: 10.1016/j.cortex.2017.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 03/15/2017] [Accepted: 04/25/2017] [Indexed: 12/23/2022]
Abstract
Semantic grounding is the process of relating meaning to symbols (e.g., words). It is the foundation for creating a representational symbolic system such as language. Semantic grounding for verb meaning is hypothesized to be achieved through two mechanisms: sensorimotor mapping, i.e., directly encoding the sensorimotor experiences the verb describes, and verb-category mapping, i.e., encoding the abstract category a verb belongs to. These two mechanisms were investigated by examining neuronal-level spike (i.e. neuronal action potential) activities from the motor, somatosensory and parietal areas in two human participants. Motor and a portion of somatosensory neurons were found to be involved in primarily sensorimotor mapping, while parietal and some somatosensory neurons were found to be involved in both sensorimotor and verb-category mapping. The time course of the spike activities and the selective tuning pattern of these neurons indicate that they belong to a large neural network used for semantic processing. This study is the first step towards understanding how words are processed by neurons.
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Affiliation(s)
- Ying Yang
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA; School of Electronics, Electrical Engineering and Computer Science, Queen's University, Belfast, United Kingdom
| | - Michael Walsh Dickey
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Geriatric Research Education and Clinical Center, V.A. Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Julie Fiez
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, Pittsburgh, PA, USA
| | - Brian Murphy
- School of Electronics, Electrical Engineering and Computer Science, Queen's University, Belfast, United Kingdom
| | - Tom Mitchell
- Machine Learning Department, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Jennifer Collinger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, Pittsburgh, PA, USA; Human Engineering Research Laboratories, Department of Veterans Affairs, Pittsburgh, PA, USA
| | - Elizabeth Tyler-Kabara
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, Pittsburgh, PA, USA; Human Engineering Research Laboratories, Department of Veterans Affairs, Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei Wang
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Barnes-Jewish Hospital, St. Louis, MO, USA.
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Kryger M, Wester B, Pohlmeyer EA, Rich M, John B, Beaty J, McLoughlin M, Boninger M, Tyler-Kabara EC. Flight simulation using a Brain-Computer Interface: A pilot, pilot study. Exp Neurol 2016; 287:473-478. [PMID: 27196543 DOI: 10.1016/j.expneurol.2016.05.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/06/2016] [Indexed: 11/27/2022]
Abstract
As Brain-Computer Interface (BCI) systems advance for uses such as robotic arm control it is postulated that the control paradigms could apply to other scenarios, such as control of video games, wheelchair movement or even flight. The purpose of this pilot study was to determine whether our BCI system, which involves decoding the signals of two 96-microelectrode arrays implanted into the motor cortex of a subject, could also be used to control an aircraft in a flight simulator environment. The study involved six sessions in which various parameters were modified in order to achieve the best flight control, including plane type, view, control paradigm, gains, and limits. Successful flight was determined qualitatively by evaluating the subject's ability to perform requested maneuvers, maintain flight paths, and avoid control losses such as dives, spins and crashes. By the end of the study, it was found that the subject could successfully control an aircraft. The subject could use both the jet and propeller plane with different views, adopting an intuitive control paradigm. From the subject's perspective, this was one of the most exciting and entertaining experiments she had performed in two years of research. In conclusion, this study provides a proof-of-concept that traditional motor cortex signals combined with a decoding paradigm can be used to control systems besides a robotic arm for which the decoder was developed. Aside from possible functional benefits, it also shows the potential for a new recreational activity for individuals with disabilities who are able to master BCI control.
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Affiliation(s)
- Michael Kryger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brock Wester
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Eric A Pohlmeyer
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Matthew Rich
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Brendan John
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - James Beaty
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Michael McLoughlin
- The Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Center for the Neural Basis of Cognition, Pittsburgh, PA, USA; Department of Veterans Affairs Medical Center, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth C Tyler-Kabara
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Hiremath SV, Tyler-Kabara EC, Wheeler J, Moran DW, Gaunt RA, Collinger JL, Foldes ST, Weber DJ, Chen W, Boninger M, Wang W. Use of Cortical Surface Stimulation towards Reliable Sensation in Human. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Krishnan S, Karg P, Boninger M, Vodovotz Y, Constantine G, Sowa G, Brienza DM. Early detection of pressure ulcer development following traumatic spinal cord injury using inflammatory mediator concentrations. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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25
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Sicari BM, Rubin JP, Dearth CL, Wolf MT, Ambrosio F, Boninger M, Turner NJ, Weber DJ, Simpson TW, Wyse A, Brown EHP, Dziki JL, Fisher LE, Brown S, Badylak SF. An acellular biologic scaffold promotes skeletal muscle formation in mice and humans with volumetric muscle loss. Sci Transl Med 2014; 6:234ra58. [PMID: 24786326 DOI: 10.1126/scitranslmed.3008085] [Citation(s) in RCA: 318] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Biologic scaffolds composed of naturally occurring extracellular matrix (ECM) can provide a microenvironmental niche that alters the default healing response toward a constructive and functional outcome. The present study showed similarities in the remodeling characteristics of xenogeneic ECM scaffolds when used as a surgical treatment for volumetric muscle loss in both a preclinical rodent model and five male patients. Porcine urinary bladder ECM scaffold implantation was associated with perivascular stem cell mobilization and accumulation within the site of injury, and de novo formation of skeletal muscle cells. The ECM-mediated constructive remodeling was associated with stimulus-responsive skeletal muscle in rodents and functional improvement in three of the five human patients.
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Affiliation(s)
- Brian M Sicari
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
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Reis JP, Ballerini K, O'Farrell S, Jasch C, Boninger M, Duerden M, Kirschner KL. Is an appropriate wheelchair becoming out of reach? - Part 2. PM R 2014; 6:934-44. [PMID: 25441718 DOI: 10.1016/j.pmrj.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/05/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Judy Panko Reis
- Health Policy Team at Access Living of Chicago, Chicago, IL(∗)†
| | | | - Sean O'Farrell
- Kellstadt Graduate School of Business, DePaul University, Chicago, IL‡
| | - Christine Jasch
- Technology Center for the Environment, Computers and Communication at Rehabilitation Institute of Chicago, Chicago, IL§
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine; University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA‖
| | - Marc Duerden
- Durable Medical Equipment Medicare Administrative Contractors, Jurisdiction B (National Government Services) for Center for Medicare and Medicaid Services; Indiana University School of Medicine¶
| | - Kristi L Kirschner
- Departments of Medical Humanities and Bioethics, and Physical Medicine and Rehabilitation, Northwestern University Feinberg, School of Medicine, Chicago, IL#.
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Nagy J, Winslow A, Brown JM, Adams L, O'Brien K, Boninger M, Nemunaitis G. Pushrim kinetics during advanced wheelchair skills in manual wheelchair users with spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 18:140-2. [PMID: 23459027 DOI: 10.1310/sci1802-140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the peak force during wheelchair propulsion of individuals with spinal cord injury propelling over obstacles from the Wheelchair Skills Test. PARTICIPANTS/METHODS Twenty-three individuals with spinal cord injury (SCI) who are full-time manual wheelchair users were included in this prospective study. A SmartWheel (Three Rivers Holdings, LLC) was used to analyze each push while subjects negotiated standardized obstacles used in the Wheelchair Skills Test, including tile, carpet, soft surface, 5° and 10° ramps, 2 cm, 5 cm, and 15 cm curbs. RESULTS When the peak forces of the advanced skills were compared to level 10 m tile/10 m carpet, there was a statistically significant increase in all peak forces (P value ranged from .0001 to .0268). DISCUSSION It is well documented that a large number of individuals with SCI develop upper limb pain. One of the recommendations to preserve the upper limb is to minimize force during repetitive tasks. CONCLUSION Advanced wheelchair skills require an increase in force to accomplish. The increase in forces ranged from 18% to 130% over that required for level 10 m tile/10 m carpet.
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Affiliation(s)
- Jennifer Nagy
- MetroHealth Rehabilitation Institute of Ohio , Cleveland , Ohio
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Heinemann AW, Steeves JD, Boninger M, Groah S, Sherwood AM. State of the science in spinal cord injury rehabilitation 2011: informing a new research agenda. Spinal Cord 2012; 50:390-7. [DOI: 10.1038/sc.2012.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Boninger M, French J, Abbas J, Nagy L, Ferguson-Pell M, Taylor SJ, Rodgers M, Saunders N, Peckham H, Marshall R, Sherwood A. Technology for mobility in SCI 10 years from now. Spinal Cord 2012; 50:358-63. [PMID: 22249329 DOI: 10.1038/sc.2011.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To identify technological advances and that are likely to have a great impact on the quality of life and participation in individuals with spinal cord injury (SCI). METHODS In this paper we use the International Classification of Function to frame a discussion on how technology is likely to impact SCI in 10 years. In addition, we discuss the implication of technological advances on future research. RESULTS/CONCLUSION Although technology advances are exciting, a large challenge for the research community will be how to effectively apply and deploy this technology. Advances occurring in the next 10 years that reduce cost of technology may be more important to the population with SCI than brand new technologies. Social context is everything. As a research community we must advocate for better systems of care. Advocating now for better care will lead to a world in 2020 that is ready to adopt new technologies that are truly transformative.
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Affiliation(s)
- M Boninger
- Department of Physical Medicine and Rehabilitation, Pittsburgh, PA 15213, USA.
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DeJong G, Hoffman J, Meade M, Bombardier C, Deutsch A, Nemunaitis G, Roach M, Tate D, Boninger M, Chen Y, Hsieh J, Jette A, Wierbicky J, Chiodo A, Forchheimer M. Postrehabilitative Health Care for Individuals with SCI: Extending Health Care into the Community. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1702-46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Livengood H, Skidmore E, Huber L, Cox S, Bleakley S, Boninger M. Applying Robotics in a Clinical Rehabilitation Setting for Upper Limb Neurological Impairment. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1701-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brown E, Legar A, Goodpaster B, Fitzgerald GK, Huard J, Boninger M, Ambrosia F. *Poster 125: Effect of Electrical Stimulation on the Regenerative Potential of Human Muscle Precursor Cells: A Case Report. Arch Phys Med Rehabil 2010. [DOI: 10.1016/j.apmr.2010.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Parsonnet J, Gruppuso PA, Kanter SL, Boninger M. Required vs. elective research and in-depth scholarship programs in the medical student curriculum. Acad Med 2010; 85:405-8. [PMID: 20182112 DOI: 10.1097/acm.0b013e3181cccdc4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The ability to understand and integrate new knowledge into clinical practice is a necessary quality of good physicians. Student participation in in-depth scholarship could enhance this skill in physicians while also creating a larger cadre of physician-scientists prepared to advance the field of medicine. However, because no definitive data exist demonstrating that in-depth scholarship in medical school leads to improved patient care or to productive academic careers, whether such scholarship should be required as part of the medical school curriculum is unclear. In this article, the authors present both sides of this debate. Theoretical benefits to students of a required scholarly program include closer mentorship by individual faculty, enhanced capabilities in critical interpretation of research findings, and increased confidence to investigate conundrums encountered in clinical care. Society may also benefit by having physicians available to create and apply new knowledge related to biomedicine. These theoretical benefits must be balanced, however, by pragmatic considerations of required scholarly projects including their impact on medical school applications, their effect on the medical curriculum, their costs, the availability of mentors, and their effects on the school's educational culture.
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Affiliation(s)
- Julie Parsonnet
- Stanford University School of Medicine, Stanford, California 94305-5107, USA.
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Affiliation(s)
- Michael Boninger
- Department of Physical Medicine and Rehabilitation, Medical Student Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Boninger M, Troen P, Green E, Borkan J, Lance-Jones C, Humphrey A, Gruppuso P, Kant P, McGee J, Willochell M, Schor N, Kanter SL, Levine AS. Implementation of a longitudinal mentored scholarly project: an approach at two medical schools. Acad Med 2010; 85:429-437. [PMID: 20182115 DOI: 10.1097/acm.0b013e3181ccc96f] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
An increasing number of medical schools have implemented or are considering implementing scholarly activity programs as part of their undergraduate medical curricula. The goal of these programs is to foster students' analytical skills, enhance their self-directed learning and their oral and written communication skills, and ultimately to train better physicians. In this article, the authors describe the approach to implementing scholarly activities at a school that requires this activity and at a school where it is elective. Both programs have dealt with significant challenges including orienting students to a complex activity that is fundamentally different than traditional medical school courses and clerkships, helping both students and their mentors understand how to "stay on track" and complete work, especially during the third and fourth years, and educating students and mentors about the responsible conduct of research, especially involving human participants. Both schools have found the implementation process to be evolutionary, requiring experience before faculty could significantly improve processes. A required scholarly activity has highlighted the need for information technology (IT) support, including Web-based document storage and student updates, as well as automatic e-mails alerting supervisory individuals to student activity. Directors of the elective program have found difficulty with both ensuring uniform outcomes across different areas of study and leadership changes in a process that has been largely student-driven. Both programs have found that teamwork, regular meetings, and close communication have helped with implementation. Schools considering the establishment of a scholarly activity should consider these factors when designing programs.
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Affiliation(s)
- Michael Boninger
- Department of Physical Medicine and Rehabilitation, Medical Student Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Rice I, Gagnon D, Gallagher J, Boninger M. Hand rim wheelchair propulsion training using biomechanical real-time visual feedback based on motor learning theory principles. J Spinal Cord Med 2010; 33:33-42. [PMID: 20397442 PMCID: PMC2853327 DOI: 10.1080/10790268.2010.11689672] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND/OBJECTIVE As considerable progress has been made in laboratory-based assessment of manual wheelchair propulsion biomechanics, the necessity to translate this knowledge into new clinical tools and treatment programs becomes imperative. The objective of this study was to describe the development of a manual wheelchair propulsion training program aimed to promote the development of an efficient propulsion technique among long-term manual wheelchair users. METHODS Motor learning theory principles were applied to the design of biomechanical feedback-based learning software, which allows for random discontinuous real-time visual presentation of key spatiotemporal and kinetic parameters. This software was used to train a long-term wheelchair user on a dynamometer during 3 low-intensity wheelchair propulsion training sessions over a 3-week period. Biomechanical measures were recorded with a SmartWheel during over ground propulsion on a 50-m level tile surface at baseline and 3 months after baseline. RESULTS Training software was refined and administered to a participant who was able to improve his propulsion technique by increasing contact angle while simultaneously reducing stroke cadence, mean resultant force, peak and mean moment out of plane, and peak rate of rise of force applied to the pushrim after training. CONCLUSIONS The proposed propulsion training protocol may lead to favorable changes in manual wheelchair propulsion technique. These changes could limit or prevent upper limb injuries among manual wheelchair users. In addition, many of the motor learning theory-based techniques examined in this study could be applied to training individuals in various stages of rehabilitation to optimize propulsion early on.
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Affiliation(s)
- Ian Rice
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dany Gagnon
- Ecole de Readaptation, Universite de Montreal, Montreal, Quebec, Canada
| | | | - Michael Boninger
- University of Pittsburgh, Pittsburgh, Pennsylvania
,Please address correspondence to Michael Boninger, MD, Human Engineering Research Laboratories (151R-1), VA Pittsburgh Healthcare System, 7180 Highland Drive, Building 4, 2nd Floor East, 151R-1, Pittsburgh, PA 15206, 412 365 4850, 412 365 4858 (e-mail: )
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Gagnon D, Koontz A, Mulroy S, Nawoczenski D, Butler-Forslund E, Granstrom A, Nadeau S, Boninger M. Biomechanics of Sitting Pivot Transfers Among Individuals with a Spinal Cord Injury: A Review of the Current Knowledge. Top Spinal Cord Inj Rehabil 2009. [DOI: 10.1310/sci1502-33] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fitzgerald SG, Kelleher A, Teodorski E, Collins DM, Boninger M, Cooper RA. The development of a nationwide registry of wheelchair users. Disabil Rehabil Assist Technol 2009; 2:358-65. [DOI: 10.1080/17483100701745752] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rice I, Impink B, Niyonkuru C, Boninger M. Manual wheelchair stroke characteristics during an extended period of propulsion. Spinal Cord 2008; 47:413-7. [DOI: 10.1038/sc.2008.139] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ding D, Leister E, Cooper R, Spaeth D, Cooper R, Kelleher A, Boninger M. A wheelchair usage monitoring/logging system. Conf Proc IEEE Eng Med Biol Soc 2007; 2005:6897-9. [PMID: 17281860 DOI: 10.1109/iembs.2005.1616091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Real life information on wheelchair usage is important for investigating the effectiveness of certain features, evaluate users' performance, and eventually improve the safety and reliability of wheelchairs. The purpose of the study is to develop a wheelchair usage monitoring/logging system that travels with wheelchair users in their daily activity settings and collects data independently. The system consists of a wheel rotation logging module, a GPS logging module, and a seating posture logging module. It obtains data on how far wheelchair users drive, where they have been, and how long they spend in various seating positions. The initial testing results showed that the system can be used as a clinical compliance tool to determine how clients are using their wheelchairs, and if they are effectively using seat features to relieve seating pressure.
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Affiliation(s)
- Dan Ding
- Member, IEEE, University of Pittsburgh, Pittsburgh, PA 15260, and Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA 15206 (phone: 412-365-4885; fax: 412-365-3858; )
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Mercer JL, Boninger M, Koontz A, Ren D, Dyson-Hudson T, Cooper R. Shoulder joint kinetics and pathology in manual wheelchair users. Clin Biomech (Bristol, Avon) 2006; 21:781-9. [PMID: 16808992 DOI: 10.1016/j.clinbiomech.2006.04.010] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 04/10/2006] [Accepted: 04/13/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Manual wheelchair users rely heavily on their upper limbs for independent mobility which likely leads to a high prevalence of shoulder pain and injury. The goal of this study was to examine the relationship between shoulder forces and moments experienced during wheelchair propulsion and shoulder pathology. METHODS Kinetic and kinematic data was recorded from 33 subjects with paraplegia as they propelled their wheelchairs at two speeds (0.9 and 1.8 m/s). Shoulder joint forces and moments were calculated using inverse dynamic methods and shoulder pathology was evaluated using a physical exam and magnetic resonance imaging scan. FINDINGS Subjects who experienced higher posterior force (Odds Ratio (OR)=1.29, P=0.03), lateral force (OR=1.35, P=0.047), or extension moment (OR=1.35, P=0.09) during propulsion were more likely to exhibit coracoacromial ligament edema. Individuals who displayed larger lateral forces (OR=4.35, P=0.045) or abduction moments (OR=1.58, P=0.06) were more likely to have coracoacromial ligament thickening. Higher superior forces (OR=1.05, P=0.09) and internal rotation moments (OR=1.61 P=0.02) at the shoulder were associated with increased signs of shoulder pathology during the physical exam. INTERPRETATION Specific joint forces and moments were related to measures of shoulder pathology. This may indicate a need to reduce the overall force required to propel a wheelchair in order to preserve upper limb integrity. Potential interventions include changes to wheelchair setup, propulsion training, or alternative means of mobility.
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Affiliation(s)
- Jennifer L Mercer
- Human Engineering Research Laboratories, 151R1-H, VA Rehabilitation Research and Development Center, VA Pittsburgh Healthcare Systems, 7180 Highland Drive, PA 15206, USA
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Dvorznak M, Cooper R, Boninger M. Kinematic analysis for determination of bioequivalence of a modified Hybrid III test dummy and a wheelchair user. J Rehabil Res Dev 2005; 42:343-51. [PMID: 16187246 DOI: 10.1682/jrrd.2004.07.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We investigated whether a modified 50th-percentile Hybrid III test dummy (HTD) (First Technology Safety Systems, Plymouth, MI) would have motion similar to a wheelchair test pilot (TP) with T8 paraplegia. Test cases were seated in a Quickie P100 electrically powered wheelchair (Sunrise Medical, Inc., Phoenix, AZ) driven at three speeds (0.8, 1.4, and 2.0 m/s). Three braking conditions-joystick release, joystick full reverse, and emergency power-off-were used to stop the wheelchair. The subsequent upper-body motion was recorded for the creation of kinematic exposure profiles of the wheelchair riders. The maximum concentration (Cmax) and area under the trunk angular displacement, velocity, and acceleration curves (AUC0-Cmax) were calculated. Assessments of average, individual, and population bioequivalence were conducted after data were subjected to natural logarithmic transforms. Only the Cmax of the trunk angular acceleration of the HTD and TP was average bioequivalent (0.82-1.04). Both Cmax and AUC0-Cmax measures for all kinematic exposures between the TP and HTD were individual and population bioequivalent (95% upper-confidence bound < 0, linearized bioequivalence criteria). This indicates that the HTD is a suitable surrogate for a wheelchair user in low-speed, low-impact wheelchair studies.
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Affiliation(s)
- Michael Dvorznak
- Human Engineering Research Laboratories/Center of Excellence in Wheelchairs and Related Technologies, Department of Veterans Affairs, Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA
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Abstract
BACKGROUND Autonomic dysreflexia (AD) is a common problem in patients with spinal cord injury (SCI) above the T6 neurologic level and may cause serious medical complications if untreated. Previous studies have focused on patients with complete SCI. DESIGN Prospective analysis of a historic cohort. A retrospective review of a subset of the cohort also was performed. OBJECTIVES To examine the percentage of persons with complete and incomplete tetraplegia who developed AD and determine whether patients with incomplete injuries were at risk for developing AD; and to study the onset of AD and determine the time period that patients are at risk for developing AD. METHODS Data were collected prospectively on 332 patients with tetraplegia to determine American Spinal Injury Association (ASIA) impairment score, neurologic level, presence of AD, and length of hospital stay. The charts of 34 patients who developed AD were then reviewed retrospectively for further data such as onset and contributing factors of AD. Also obtained were data from the National SCI Statistical Center database for comparison of percentage of patients with complete and incomplete injuries who developed AD. RESULTS Patients with motor-complete SCI (ASIA A or ASIA B) had a higher percentage of AD (P = 0.001) during their initial hospitalization than did patients with motor-incomplete SCI. However, patients with motor-incomplete injuries also were at risk for developing AD. The onset of AD occurred between 1 and 6 months after injury. CONCLUSION Patients with incomplete tetraplegia are at risk for developing AD. As hospital lengths of stay decrease, patients may be discharged before onset of symptoms. Patient and family education about AD is, therefore, increasingly important for all patients with tetraplegia.
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Affiliation(s)
- Wendy M Helkowski
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Mills T, Holm MB, Trefler E, Schmeler M, Fitzgerald S, Boninger M. Development and consumer validation of the Functional Evaluation in a Wheelchair (FEW) instrument. Disabil Rehabil 2002; 24:38-46. [PMID: 11827153 DOI: 10.1080/09638280110066334] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of the study is to develop an outcome measurement tool to investigate functional performance of consumers using seating and wheelchair systems as their primary seating and mobility device. The instrument is undergoing systematic development in three phases. The results of Phase 1 will be reported. METHOD Manual and power wheelchair users were interviewed using a modified version of a client-centred outcome measure. An item bank was derived based on the interview data. Subjects were then asked to validate item categories of the new instrument, and finally to self-administer the first version of the instrument. RESULTS Subjects reported 154 self-care, productivity, and leisure occupational performance issues related to their current seating-mobility system. Based on their input, 10 categories (i.e. transfers, reach, accessing task surfaces, transportation-portability, human-machine interface, architectural barriers, transportation-accessibility, transportation-securement, natural barriers and accessories) were validated for inclusion in the new outcome measure, Functional Evaluation in a Wheelchair (FEW). CONCLUSION The items on the FEW focus on the interaction between the consumer, the technology, and the milieu. Consumers viewed the overall importance of FEW categories for seating-mobility system users differently than when they self-administered the FEW.
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Affiliation(s)
- T Mills
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA 15260, USA. tamst75+@pitt.edu
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