Milne Institute Completed Research

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Completed Research

This case report describes one patient’s experience with COVID-19 associated Guillian-Barré Syndrome (GBS) and highlights the complex rehabilitation needs required to regain independence following a diagnosis of COVID-19 associated GBS.

A double blind, randomized, placebo-controlled phase II trial for Novartis (siponimod) in patients with intracerebral hemorrhage

Impaired balance-regulation after stroke puts both patients and therapists at risk for injury during rehabilitation. Body-weight-support systems minimize this risk and allow patients to safely practice balance activities during therapy. The goal of this pilot study was to determine what effect the novel Training Responses in Postural Rehabilitation (TRiP) balance perturbation module for the ZeroG body-weight support system has on rehabilitating patients’ balance control following an acute stroke. NCT04919161

Gaylord is joining eight other Model Systems nationwide, led by the University of Pittsburgh, to explore wheelchair equipment and services provided to individuals with SCI of different ethnic, economic, and social backgrounds. The goal of this study is to improve the quality of wheelchairs prescribed for individuals with SCI. In addition, the proposed research may benefit all individuals who use manual wheelchairs and power wheelchairs in the future, given recent changes in health care policy of competitive bidding that limit financial reimbursement for medical services and supplies. The impact of changes in coverage are likely to be profound, but can only be measured if they are tracked.

For this study, we will collect information on Assistive Technology (AT) used by individuals with SCI, specifically wheelchair make, model, failures, and repairs. This data will enable us to track the impact of insurance market changes, find differences in wheelchair failures, and present this information to wheelchair users. This study also collects information regarding any perceived prejudices you may have experienced in your healthcare system.

For more information, including a consent form for the study, contact Diana Pernigotti at 203-679-3563 or [email protected]

A study post ischemic stroke participants to determine if a 12-week partial meal replacement program, compared to dietary counseling, can result in weight loss after stroke without affecting physical function.

Our paper, "Patient Outcomes and Lessons-Learned from Treating Patients with Severe COVID-19 at a Long-Term Acute Care Hospital," describes the treatment strategies and precautions used at our facility during the early days of the pandemic while treating and rehabilitating patients after a COVID-19 diagnosis. Further, we examined how specific risk factors (i.e., age, sex, and BMI) affected disease severity and patient recovery (i.e., patient length of stay) in this population. Next, we review our COVID-19 patients' outcomes treated by Respiratory Therapy, Physical and Occupational Therapy, and Speech-Language Pathology. Lastly, we discuss our observations and how our findings relate to rehabilitation for this population.

The SCI-FI instrument was designed specifically for persons with SCI, regardless of level or severity of injury. The content of the SCI-FI is based upon an extensive review of the literature, input from patients with SCI, and clinician focus groups, and is grounded within the International Classification of Function, Disability, and Health framework.

With the development of the SCI-FI/AT, we now have available SCI-FI scales that evaluate a person’s ability to function using adaptive technology in the areas of Basic Mobility, Self-Care, Ambulation, Fine Motor, and Wheelchair function. There are 178 total items in the final SCI- FI/AT domain item banks. Short forms are aptly named as a short paper-based version of the full item banks of each functional domain of the SCI-FI/AT, which is currently administered via computer as a computer adaptive test (CAT).

Aim 1 –Create a SCI-FI/AT inpatient short form that can be completed efficiently by clinicians on patients while they are in the inpatient rehabilitation setting.

Aim 2 – We will conduct a pilot study to evaluate the inter-rater reliability of having clinicians complete the SCI-FI/AT inpatient short forms with a sample of patients in the SNERSCIC SCIMS network.

This study involves inpatient clinicians and they will be asked individually for participation. For more information about the development of the SCI-FI over the past 10 years. Read about previous SCI-FI studies here.

A research study conducted to determine if patients who have dysphagia, resulting in a thickened liquid diet or NPO status, can safely tolerate thin liquid water at the inpatient level of care and if so, to what degree of benefit. This study incorporated a modified Frazier Free Water Protocol which has been widely researched and used by speech language pathologists in the healthcare field.  The goal of the study was to determine if patients with dysphagia can have thin liquid water without any adverse reactions to improve overall quality of life and swallow function.

Since most individuals with spinal cord injury have a level of compromise to their respiratory system, introducing the EKSO may help limit complications of the respiratory system in as little as eight sessions. Preliminary data is showing EKSO can affect endurance as seen in the improvements in 6MPT and further supported by the increase in mean steps taken per session of the EKSO without an increase in RPE in as little as eight sessions. The EKSO does not appear to impact pain.

The MCMC project uses telehealth techniques to improve the health and function of people with traumatic SCI. MCMC will help individuals with SCI find and maintain quality primary care, including preventive screenings and prevention of secondary conditions through conversations with a human Peer-Health Coach for identified problems; and an accompanying user-friendly resource book.

This internal quality improvement study gathered data and provided “real-life” feedback to the device manufacturers to improve user and patient experience in the device. Data was gathered regarding new features of the Ekso GT and the information was analyzed by Ekso staff and incorporated into the feedback on the product design and revision.

This project will evaluate the validity, sensitivity, and responsiveness to change of the SCI-QOL measurement system. The sensitivity of the scales to detect change and the direction of change of key areas of functioning including activity limitations will be examined as well as secondary medical complications, emotional functioning, and social participation. These variables will be assessed at multiple points during the recovery process and injury “trajectories” of change will be developed from shortly after injury through the initial years of living with a disability.

The SCI Model Systems National Database uses the Functional Independence Measure (FIM) as a tool to assess and track function. But there are concerns about the appropriateness of using the FIM in the SCI population because it may miss differences in function among people with SCI who have different levels of injury severity. Seven Model Systems Centers conducted a study over the past five years and developed a new measure that includes functional activities relevant and important to persons across all levels and severity of SCI injury. We are now continuing this study with nine Spinal Cord Injury Model Systems programs to enhance and evaluate the this new tool, called the Spinal Cord Injury Functional Index (SCI-FI).

The purpose of this project is to improve the quality and equity of assistive technology provision and outcomes for individuals with SCI. By understanding utilization and impact of assistive technology, raising awareness of variation in wheelchair quality and identify factors associated with variation in quality and equity of care and outcomes, this project will identify areas of need in the procurement of SCI specific technology needs.

The Insulin Resistance Intervention after Stroke Trial (IRIS) was a randomized, double-blind, placebo-controlled trial that is testing the hypothesis that reducing insulin resistance and its sequelae with thiazolidinedione therapy will prevent stroke and myocardial infarction among patients with a recent ischemic stroke or transient ischemic attack. Pioglitazone reduced the relative risk of the primarily outcome (fatal & non-fatal stroke and MI) by 24% (p=0.007) vs. placebo.

Admission FIM score was found to be a strong factor on discharge destination. These results support the few earlier findings that demonstrate individuals with a higher admission FIM score are more likely to be discharged to the community.   As is evidenced by the numbers there was wide variability in admission FIM scores, which were taken into account in this study therefore the generalizability, is great for individuals who have suffered a CVA.

This study was reclassified by the CT Department of Public Health from a research study to a an on-going surveillance project.

Bias no-leak speaking valces have been FDA approved for daytime use for patients with tracheostomy tubes, while such approval was not been given for nighttime use. However, there is a paucity of research that supports this recommendation and it is a much asked question if patients could safely sleep while wearing the valve. We hypothesized that nocturnal use of a bias-closed no leak speaking valve is safe and does not affect the quality of sleep.

This study was designed to determine the relationship between standardized neuropsychological measures and vestibular physical therapy measures in a multidisciplinary concussion clinic setting.

The goal of this study was to collate records of people using the EKSO robotic device to describe the demographics of its use and describe tolerance of its use and efficacy.

The use of Kinesiology Tape, when compared to an AFO and to no intervention, was compared to improving functional mobility and balance in patients with hemiplegia following a stroke.

Recent Publications

Which Road to Recovery?: Factors Influencing Postacute Stroke Discharge Destinations: A Delphi Study. The criteria for determining the level of postacute care for patients with stroke are variable and inconsistent. The purpose of this study was to identify key factors influencing the selection of postacute level of care for these patients using the Delphi process. A panel of experts from key stakeholders was organized to develop, review, and refine a list of factors influencing postacute level of care selection. This study provides an expert, consensus based set of key factors to be considered when determining where stroke patients are discharged for postacute care.  https://www.ahajournals.org/doi/abs/10.1161/STROKEAHA.121.034815

Knowledge translation intervention increased the use of outcome measures by physical therapists in inpatient rehabilitation, Wendy Romney, PT, DPT, PhD, NCS; Michelle Wormley, PT, PhD, Diana Veneri, PT, EdD; Andrea Oberlander, PT, DPT; Peter Grevelding, PT, MSPT, NCS; Jennifer Rice , PT, MPT; Jennifer Moore, PT, DHS, NCS. Published online: 12 Mar 2021, https://www.tandfonline.com/doi/full/10.1080/09593985.2021.1898065

Are Stroke Survivors Discharged to the Recommended Postacute Setting?, Joel Stein, MD, Pamela Borg-Jensen, MPH, Alyse Sicklick, MD, Barry M. Rodstein, MD, Robin Hedeman, OTR, MHA, Janet Prvu Bettger, ScD, Roseanne Hemmitt, BA, Brian M. Silver, MD, Henry C. Thode, PhD, Zainab Magdon-Ismail, DrPH, Published:April 06, 2020, DOI: https://doi.org/10.1016/j.apmr.2020.03.006

Clinical utility of the TOMMe10 scoring criteria for detecting suboptimal effort in an mTBI veteran sample, Anthony Rinaldi, Jada J. Stewart-Willis, David Scarisbrick, https://www.tandfonline.com/doi/abs/10.1080/23279095.2020.1803870?journalCode=hapn21

Preprints

Patient Outcomes and Lessons-Learned from Treating Patients with Severe COVID-19 at a Long-Term Acute Care Hospital. Pete Grevelding, Henry C. Hrdlicka, Stephen Holland, Lorraine Cullen, Amanda Meyer, Catherine Connors, Darielle Cooper, Allison Greco. medRxiv 2021.06.10.21255008; doi: https://doi.org/10.1101/2021.06.10.21255008

Inducing Body Weight Supported Postural Perturbations during Gait and Balance Exercises to Improve Balance after Stroke: A Pilot Study. Amanda Meyer, Erica Cutler, Jill Hellstrand, Emily Meise, Kaitlyn Rudolf, Henry C Hrdlicka, Peter Grevelding, Matthew Nankin. medRxiv 2021.06.11.21257723; doi: https://doi.org/10.1101/2021.06.11.21257723

Connors C, McNeill S, Hrdlicka HC. Occupational and Physical Therapy Strategies for COVID-Related Guillain-Barré Syndrome: A Case Report. JMIR Preprints. 28/05/2021:30794; doi: https://preprints.jmir.org/preprint/30794

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