News Article | October 26, 2015
People who suffer a stroke face many physical and emotional hurdles on their long road to recovery. But now, there may be a glimmer of hope for those with one common stroke symptom: partial arm paralysis that leaves the affected limb frozen to the person's side like a broken wing. Researchers have found that strong pulses of magnetic energy to the brain, called transcranial magnetic stimulation (TMS), can be used as probes to identify undamaged, untapped brain regions that may be recruited to move the arm. The stimulation did not cure stroke patients of their paralysis. But because the probing altered their arm movement, the researchers said it might be possible, with longer-lasting stimulation, to "teach" the brain how to use these areas to move the paralyzed arm. Rachael Harrington, a Ph.D. student at Georgetown University Medical Center in Washington, D.C., presented this research Tuesday (Oct. 20) at the annual meeting of the Society for Neuroscience in Chicago. Stroke is the fifth leading cause of death in the United States, killing about 130,000 Americans annually, according to the Centers for Disease Control and Prevention. A stroke occurs when blood flow to the brain is cut off, starving brain cells of oxygen. The majority of strokes are ischemic, which means they are caused by a clot in a blood vessel. Only about 15 percent of strokes are hemorrhagic (caused by a burst in a blood vessel), but these strokes are behind about 40 percent of all stroke deaths, according to the CDC. Regardless of stroke type, nearly 90 percent of stroke sufferers will have mild to severe paralysis of a limb on one side of their body, such as an arm and a wrist, or a leg and an ankle. Standard treatment for this paralysis is dedicated physical, occupational and speech therapy for several hours each week. [10 Things You Didn't Know About the Brain] In 2012, scientists at the University of Victoria in British Columbia, Canada, discovered that strength training for stroke patients solely on their stronger side somehow also strengthens their weaker side. Still, for many stroke patients, no amount of exercise can "defrost" their frozen limb, and no other treatments exist. In the new study, Harrington examined the effect of TMS on 30 stroke patients, working with Michelle Harris-Love, an associate professor at George Mason University and director of the Mechanisms of Therapeutic Rehabilitation Laboratory at the MedStar National Rehabilitation Hospital in Washington, D.C. Half of the patients in the study had mild impairment in arm movement, and the other half had severe impairment. In experiments, the researchers asked the patients to reach for an object upon seeing a "go" signal, while the researchers applied magnetic stimulation to a part of the brain called the dorsal premotor cortex. This region was unaffected by the stroke. The research team discovered that the TMS probe had a more profound effect on the severely impaired group compared to the mildly impaired group. This suggests that, for those severely impaired by a stroke, there may be latent brain pathways that can be targed with probes and then stimulated to help them remap the brain. Harrington explained that those with mild impairment already could move their arm a little by tapping into brain regions immediately around the damaged area. But for those with severe impairment, the brain damage caused by the stroke is too extensive to do so. Targeted stimulation, tied to a command to move the arm, may train an entirely different part of the brain to move the limb. The researchers hope that, with repeated stimulation, they can train the brain to control the impaired arm. Ideally, the stimulation should be incorporated into the standard rehabilitation exercises, particularly occupational therapy, when the patient is relearning how to perform basic tasks, such as brushing their teeth or pouring a glass of water, the researchers said. "Stimulating this area repeatedly may force the brain to use this latent area," Harrington said. "Neurons that fire together wire together," she added, citing a famous phrase in neuroscience to imply that the brain can make new associations to remap itself to undertake basic commands.
News Article | November 2, 2016
WASHINGTON, DC--(Marketwired - Nov 2, 2016) - MedStar National Rehabilitation Network has announced it recently implemented WebPT -- the leading electronic medical record (EMR) software for physical, occupational and speech therapists -- throughout its network of 50 outpatient sites in the Washington, D.C., Baltimore, Southern Maryland, Delaware, and Northern Virginia. WebPT's cloud-based documentation, billing, scheduling and practice management software will help streamline therapist workflows and business operations across MedStar's entire network, ultimately allowing providers to spend more time with patients. "The greatest thing about our therapists using this product is that it will allow us to be even more interactive with our patients and not spend extra time on the charting process," said John Brickley, PT, MA, MedStar NRH Rehabilitation Network Vice President, Ambulatory Operations & Network Development. "This will benefit the communities we serve to an even greater extent and allow for patients to have even greater access to the services we provide to them." In addition to allowing therapists to quickly access patient charts and schedule future appointments, WebPT provides a suite of compliance features, customization options and business reporting tools. Through its partnership with MedStar, WebPT looks forward to helping rehab therapists in a vast array of specialties provide better care and improve the patient experience. "MedStar is a prestigious player in the rehab therapy space, and we're so honored to welcome them to the WebPT community," said Heidi Jannenga, PT, DPT, ATC/L, president and co-founder of WebPT. "As a rapidly-growing network of multidisciplinary therapy clinics offering a comprehensive selection of specialty services and programs, MedStar needed a practice management solution that was easy to use at the individual therapist level, as well as easy to scale across multiple locations. The fact that their extensive search led them to WebPT is extremely validating for us as we continue to add more hospitals and large multi-site practices to our customer base of more than 8,700 clinics nationwide." About MedStar National Rehabilitation Network The MedStar National Rehabilitation Network (MedStar NRH) is a regional system of rehabilitation care that offers inpatient, day treatment and outpatient services in Washington, D.C., Maryland and Northern Virginia. The Network's interdisciplinary team of rehabilitation experts provides comprehensive services to help people recover as fully as possible following illness and injury. Rehabilitation medicine specialists, psychologists, physical and occupational therapists and speech-language pathologists work hand-in-hand with other rehab professionals to design treatment plans tailored to each patient's unique needs. Rehabilitation plans feature a team approach and include the use of state-of-the-art technology and advanced medical treatment based on the latest rehabilitation research. The Network provides comprehensive programs specifically designed to aid in the rehabilitation of adults and children recovering from neurologic and orthopedic conditions such as amputation, arthritis, back and neck pain, brain injury, cancer, cardiac conditions, concussion, fibromyalgia, foot and ankle disorders, hand and upper extremity problems, post-polio syndrome, stroke, spinal cord injury and disease and sports and work-related injuries. Inpatient and day treatment programs are provided at MedStar National Rehabilitation Hospital located in Northwest Washington, D.C., and at more than 40 outpatient sites conveniently located throughout the region. MedStar NRH is consistently ranked by physicians in U.S. News & World Report as one of America's "Best Hospitals" for Rehabilitation and is fully accredited by The Joint Commission and the Commission on Accreditation of Rehabilitation Facilities (CARF), as well as with CARF accredited specialty programs for Amputations, Brain Injury, Spinal Cord Injury and Stroke. For more on MedStar NRH and to find a location near you, log on to MedStarNRH.org. With more than 62,000 members and 8,700 clinics, WebPT is the leading EMR for physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs). Offering a simple, affordable solution, WebPT makes it easy for therapists to transition from paper and outdated software to a user-friendly, cloud-based system. With WebPT, therapists, directors and front office staff all have access to their patients' medical records anywhere, anytime. Based in downtown Phoenix, WebPT has a 99.9 percent uptime rate as well as a 99.2 percent customer retention rate. Learn more at WebPT.com.
Hancock A.B.,George Washington University |
Krissinger J.,Aegis USA |
Owen K.,National Rehabilitation Hospital
Journal of Voice | Year: 2011
Despite the plethora of research documenting that the voice and quality of life (QoL) are related, the exact nature of this relationship is vague. Studies have not addressed people who consider their voice to influence their life and identity, but would not be considered to have a voice "disorder" (e.g., transgender individuals). Individuals seeking vocal feminization may or may not have vocal pathology and often have concerns not addressed on the standard psychosocial measures of voice impact. Recent development of a voice-related QoL measure specific to the needs of transgender care (Transgender Self-Evaluation Questionnaire [TSEQ]) affords opportunity to explore relationships between self-perceived QoL and perceptions of femininity and likability associated with transgender voice. Twenty male-to-female transgender individuals living as a female 100% of the time completed the TSEQ and contributed a speech sample describing Norman Rockwell's "The Waiting Room" picture. Twenty-five undergraduate listeners rated voice femininity and voice likability after audio-only presentation of each speech sample. Speakers also self-rated their voices on these parameters. For male-to-female transgender clients, QoL is moderately correlated with how others perceive their voice. QoL ratings correlate more strongly with speaker's self-rated perception of voice compared with others' perceptions, more so for likability than femininity. This study complements previous research reports that subjective measures from clients and listeners may be valuable for evaluating the effectiveness of treatment in terms of how treatment influences voice-related QoL issues for transgender people. © 2011 The Voice Foundation.
Shveiky D.,Washington Hospital Center |
Aseff J.N.,National Rehabilitation Hospital |
Iglesia C.B.,Washington Hospital Center
Journal of Minimally Invasive Gynecology | Year: 2010
The objective of this article was to review the literature regarding brachial plexus injury (BPI) in laparoscopic and robotic surgery. BPI complicates gynecologic laparoscopic surgery with an estimated incidence of 0.16%. Nevertheless, as the numbers of advanced laparoscopic and robotic procedures increase, the anticipated risk of this complication may rise as well. Robotic surgery often requires steeper Trendelenburg positioning and longer operative times when compared with traditional laparoscopic surgery. In this article we review the anatomy, pathophysiology, diagnosis, and treatment of position-related BPI in the context of laparoscopic and robotic gynecologic surgery. We suggest a multidisciplinary approach to the diagnosis and treatment of BPI. Recommendations for prevention of this complication are also provided. © 2010 AAGL.
Brennan D.M.,National Rehabilitation Hospital
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference | Year: 2011
Constraint-Induced Movement Therapy (CI therapy) has been shown to be an effective approach for improving arm function in stroke survivors with mild to severe hemiparesis. Given the time-intensive nature of the intervention, and the inherent costs and travel required to receive in-clinic treatment, the accessibility and availability of CI therapy is limited. To facilitate home-based CI therapy, a telerehabilitation platform has been developed. It consists of a table-top workstation configured with a range of physical task devices (e.g. pegboard, object flipping, threading, vertical reaching). A desktop PC is used to acquire data from sensors embedded in the task devices; display visual instructions, stimuli, and feedback to the patient during tasks; and provide videoconferencing and remote connection capabilities so the therapist can interact with and monitor the patient during at-home therapy sessions. This system has potential to greatly expand access to CI therapy and make it a more realistic option for a larger number of stroke survivors with upper extremity impairment.
Frankoff D.J.,National Rehabilitation Hospital |
Hatfield B.,National Rehabilitation Hospital
Topics in Stroke Rehabilitation | Year: 2011
Research indicates that augmentative and alternative communication (AAC) approaches can be used effectively by patients and their caregivers to improve communication skills. This article highlights strategies and tools for re-establishing communication competence by considering the complexity and diversity of communication interactions in an effort to maximize natural speech and language skills via a range of technologies that are implemented across the continuum of care rather than as a last resort. © 2011 Thomas Land Publishers, Inc.
Conlon R.,National Rehabilitation Hospital
Journal of Ultrasound | Year: 2012
Introduction: This paper reports my experience as a teacher of clinical ultrasound (US) in an African hospital. While US in tropical countries has received some attention and a few papers - though possibly fewer than deserved by this issue-are available in the medical literature on this subject, very little has been done in terms of assessment of teaching. Materials and methods: Given the increasing number of groups, NGOs and volunteers that go to Africa and other resource limited settings to do this, I thought that sharing my experience with those who have walked or are thinking of walking the same path could be mutually beneficial. Results: The first section of the article presents the situation where I've been working in the past 13 years, the second section details our teaching programme. Discussion: This report describes the rationale for the implementation of ultrasound training programmes in rural areas of Africa and lessons learnt with 13 years experience from the UK with recommendations for the way forward. © 2012 Elsevier Srl.
Halstead L.S.,National Rehabilitation Hospital
Archives of Physical Medicine and Rehabilitation | Year: 2011
This is an overview of the history of the late effects of polio in this country from 1980 to the present in the context of the broader and much longer history of acute poliomyelitis. Books, articles, conference proceedings, and other relevant historical resources that dealt with polio-related issues from January 1, 1980, through December 31, 2009, were reviewed. The mean number of articles published per year was calculated for 5-year intervals beginning in 1980; the number of postpolio support groups and polio-dedicated clinics was compiled from directories published annually by Post-Polio Health International at 5-year intervals from 1985 to 2010. Beginning in the mid-1980s, the number of articles published each year increased dramatically, peaking during the years 1995 to 1999 when a mean of 48.2 articles were published each year. This figure steadily declined over the next 14 years. Support groups and clinics showed a similar pattern of rise and fall, with a maximum of 298 support groups and 96 clinics in 1990 and a decline to 131 and 32, respectively, by 2010. During the 1980s and early 1990s, there was a period of optimism that energized research, clinical, and self-help initiatives. As the limits of these efforts became apparent during the late 1990s and early 2000s, resources and activities declined as the postpolio community continued to age and decrease in size. Regardless of these trends, there are still thousands of survivors who continue to require skilled physiatric management as they cope with advancing age and declining function. © 2011 American Congress of Rehabilitation Medicine.
Pitts E.P.,National Rehabilitation Hospital
Topics in Stroke Rehabilitation | Year: 2011
Purpose: This study looked at the medication ordering error frequency and the length of inpatient hospital stay in a subpopulation of stroke patients (n=60) as a function of time of patient admission to an inpatient rehabilitation hospital service. Method: A total of 60 inpatient rehabilitation patients, 30 arriving before 4 PM, and 30 arriving after 4 PM, with an admitting diagnosis of stroke were randomly selected from a larger sample (N=426). Results: There was a statistically signifi cant increase in medication ordering errors and the number of inpatient rehabilitation hospital days in the group of patients who arrived after 4 PM. © 2011 Thomas Land Publishers, Inc.
O'Reilly A.,National Rehabilitation Hospital
Aphasiology | Year: 2016
Background: Apraxic agraphia is a writing disorder that is characterised by poor letter formation that cannot be attributed to impaired letter shape knowledge or to sensorimotor, extrapyramidal, or cerebellar dysfunction. Like apraxia of speech (AOS) and speech production, apraxic agraphia reflects a difficulty in programming the skilled movements for writing production. There is currently limited research into its assessment and management. Many of the current treatment approaches used in the management of AOS are consistent with the principles of motor learning. Given the observable comparisons between AOS and apraxic agraphia, it is reasonable to consider application of the treatment principles for AOS in the treatment of apraxic agraphia. Aims: The aims of the present study are (1) to demonstrate the diagnosis of apraxic agraphia and draw comparisons between the characteristics of apraxic agraphia and AOS; and (2) to investigate the effectiveness of a treatment plan for apraxic agraphia based on the treatment principles in the management of AOS and the principles of motor learning. Methods&Procedures: The current paper utilises a case study design to address the above aims, using a single participant, Mrs. M. Assessment and diagnosis of apraxic agraphia is outlined. Treatment comprised of a novel treatment hierarchy incorporating the treatment principles for AOS and the principles of motor learning. Writing legibility before and after treatment was used as the primary outcome measure, and was calculated as an average percentage score based on assessment of writing samples of five independent non-clinicians. Outcomes &Results: Assessment indicated that Mrs. M presented with apraxic agraphia. Following treatment based on the principles of motor learning, legibility at word level improved from 12% to 100% and in connected writing from 22% to 100%. Conclusions: Results support the hypothesis that apraxic agraphia is comparable to AOS and results from impairment in graphemic-motor programming for writing. Following engagement in a proposed treatment hierarchy based on the treatment of motor learning, Mrs. M demonstrated a clinically significant improvement in her writing legibility. The results of this case provide a primary indication that the principles of motor learning as applied in AOS management are also relevant and appropriate in the management of apraxic agraphia. Limitations and future directions are discussed. © 2015 Taylor & Francis.