Faculty Bibliography

OBJECTIVE: Assess the effectiveness of intramuscular electrical stimulation in reducing hemiplegic shoulder pain at 12 mos posttreatment. DESIGN: A total of 61 chronic stroke survivors with shoulder pain and subluxation participated in this multiple-center, single-blinded, randomized clinical trial. Treatment subjects received intramuscular electrical stimulation to the supraspinatus, posterior deltoid, middle deltoid, and upper trapezius for 6 hrs/day for 6 wks. Control subjects were treated with a cuff-type sling for 6 wks. Brief Pain Inventory question 12, an 11-point numeric rating scale was administered in a blinded manner at baseline, end of treatment, and at 3, 6, and 12 mos posttreatment. Treatment success was defined as a minimum 2-point reduction in Brief Pain Inventory question 12 at all posttreatment assessments. Secondary measures included pain-related quality of life (Brief Pain Inventory question 23), subluxation, motor impairment, range of motion, spasticity, and activity limitation. RESULTS: The electrical stimulation group exhibited a significantly higher success rate than controls (63% vs. 21%, P = 0.001). Repeated-measure analysis of variance revealed significant treatment effects on posttreatment Brief Pain Inventory question 12 (F = 21.2, P < 0.001) and Brief Pain Inventory question 23 (F = 8.3, P < 0.001). Treatment effects on other secondary measures were not significant. CONCLUSIONS: Intramuscular electrical stimulation reduces hemiplegic shoulder pain, and the effect is maintained for > or =12 mos posttreatment

Older individuals with TBI differ from younger adults with TBI in several ways, including their incidence rates, etiology of injury, nature of complications, lengths of hospitalization, functional outcomes, and mortality. Despite the greater likelihood of poorer functional outcomes, older adults with TBI often achieve good functional outcomes and can live in community settings after receiving appropriate rehabilitation services, although at higher costs and longer hospitalizations than younger individuals. The future of rehabilitation care for elderly patients after TBI is uncertain due to financial limitations associated with the implementation of the PPS payment system by CMS. Little is known regarding the long-term impact of TBI on individuals as they age, but this is an important issue as the population ages

OBJECTIVE: To assess the effectiveness of intramuscular neuromuscular electric stimulation (NMES) in reducing poststroke shoulder pain. DESIGN: Multicenter, single-blinded, randomized clinical trial. SETTING: Ambulatory centers of 7 academic rehabilitation centers in the United States. PARTICIPANTS: Volunteer sample of 61 chronic stroke survivors with shoulder pain and subluxation. INTERVENTION: Treatment subjects received intramuscular NMES to the supraspinatus, posterior deltoid, middle deltoid, and trapezius for 6 hours a day for 6 weeks. Control subjects were treated with a cuff-type sling for 6 weeks.Main outcome measure Brief Pain Inventory question 12 (BPI 12), an 11-point numeric rating scale administered in a blinded manner at the end of treatment, and at 3 and 6 months posttreatment. RESULTS: The NMES group exhibited significantly higher proportions of success based on the 3-point or more reduction in BPI 12 success criterion at the end of treatment (65.6% vs 24.1%, P<.01), at 3 months (59.4% vs 20.7%, P<.01), and at 6 months (59.4% vs 27.6%, P<.05). By using the most stringent 'no pain' criterion, the NMES group also exhibited significantly higher proportions of success at the end of treatment (34.4% vs 3.4%, P<.01), at 3 months (34.4% vs 0.0%, P<.001), and at 6 months (34.4% vs 10.3%, P<.05). CONCLUSIONS: Intramuscular NMES reduces poststroke shoulder pain among those with shoulder subluxation and the effect is maintained for at least 6 months posttreatment

OBJECTIVE: To examine the impact of age on health problems related to traumatic brain injury (TBI). DESIGN: Case-control study using a survey instrument. SETTING: Outpatient setting of a large urban tertiary care hospital. PARTICIPANTS: Young and old community dwellers with histories of TBI and control subjects matched for age. INTERVENTION: Structured interview using the Living Life After TBI assessment tool. MAIN OUTCOME MEASURE: Symptom reporting on 52 potential health problems. RESULTS: Individuals with TBI reported significantly more overall health problems than those without TBI. Younger subjects with TBI reported more problems than their nondisabled, age-matched peers with their patterns of sleep as well as with their metabolic/endocrine, neurologic, and musculoskeletal systems. CONCLUSIONS: Older people with TBI were more likely than nondisabled, age-matched peers to report problems with their metabolic/endocrine and neurologic systems. Younger people with TBI were more likely than older people with TBI to report difficulty falling asleep

Constraint-induced movement therapy (CIMT) is a promising approach to promoting recovery of functional arm movement after stroke. However, controlled studies have been limited to persons who sustained strokes at least 1 year before beginning the treatment protocol. This case study documents the neurologic history and motor recovery of a woman whose natural circumstances lend support to the principles of CIMT. The patient sustained a right midpontine vascular infarct and fell simultaneously, fracturing her right humerus. Orthopedic intervention for the fracture mirrored the protocol suggested by proponents of CIMT by immobilizing her right arm. Her significant recovery of left arm use over a 1-year period was more extensive than what would be typically expected after the type of cerebral infarct she incurred. Her case provides the first evidence in the literature that supports the principles of CIMT when it is applied immediately poststroke

Psychopharmacology is rapidly becoming an adjuvant treatment to traditional rehabilitation strategies for patients with stroke or brain injury because it helps to facilitate recovery in a time-efficient manner. Norepinephrine, dopamine, acetylcholine, and serotonin appear to play important roles in recovery from stroke or brain injury. Animal models have shown that blockade of these neurotransmitters inhibits recovery, whereas recovery is promoted by drugs that promote norepinephrine, dopamine, acetylcholine, and serotonin activity. Preliminary evidence from human trials supports these findings. Further study is needed, but expanded use of pharmacologic agents for stroke and brain-injured patients appears imminent