U-M Physical Medicine & Rehabilitation

Topics

Andrea Aagesen, DO

Title of Presentation: The Role of Core Strength and Stability in Injury Recovery and Prevention

The core strength and stability that is provided by truck, pelvic, and hip musculature is an important consideration for back and lower extremity injuries. Studies suggest that deficient core strength and stability increases the risk of lower extremity injuries and is associated with acute and chronic back injuries. Improving core strength and stability is an essential component of injury rehabilitation. Clinically evaluating core strength and stability prior to returning to activity may decrease the risk of sustaining additional lower extremity or back injuries.

Andrea Cheville, MD

Title of Presentation: Cancer Rehabilitation: A Novel Paradigm for Functional Optimization in Chronic Disease

The societal burden of disability is increasingly driven by chronic, medical multi-morbidity. The erosive effects of complex illness cause insidious, progressive functional decline, often punctuated by acute decompensations from which patients incompletely recover.  This trajectory differs from the catastrophic functional declines following traumatic and ischemic injuries that patients on acute rehabilitation units.  Traditional models of rehabilitation service delivery are consequently mis-matched to the needs of chronically ill patients.  These patients generally require continuous rather than the episode-based care, and  the accepted linear models of disablement which link discrete impairments, disabilities and handicaps, imperfectly apply to the complex interplay of concurrent impairments and function-degrading symptoms experienced by patients with multi-morbidity.  Cancer patients are an important exemplar population by virtue of their prevalence, high incidence of impairments, and intense symptom burden.  Their functional decline has been extensively studied. Despite reports of rampant disability and widespread under-use of rehabilitation services, novel delivery models better matched to cancer patients’ needs have been limitedly developed or tested.  The reasons for this are complex and will be briefly addressed.

Collaborative care delivery models, initially developed to identify and manage depression in primary care setting, offer a potetial means to address the limited function-directed care provided to patients with cancer and other chronic illnesses.  Collaborative care involves a mid-level provider, supervised by a physician specialist, who coordinates guideline-based care via a primary or specialty clinical team.  The approach has been robustly validated for mood disorders and pain.  Only recently has it been applied to functional preservation in patients with late stage cancer.  This effort will be described, as well as lessons learned, generalizeability, and potential future applications. The roles that rehabilitation clinicians, ranging from therapists to physicians, may fulfill in collaborative care models will also be discussed.  Last, the alignment of emergent value-based, bundled care approaches, such as the Oncology Care Model, with collaborative care delivery will be described.

JT Eckner, MD

Title of presentation: The Role of Neck Strength in Sport-Related Concussion

Greater neck size and strength may be associated with a lower risk of sport related concussion (SRC).  It is thought that a bigger, stronger neck can mitigate the head accelerations that occur during a sport collision.  It follows that neck strengthening exercise may reduce athletes’ risk for SRC.  This presentation will discuss the theory and evidence in support of neck strengthening exercise as a concussion prevention strategy.  The results of Dr. Eckner’s pilot work in this area will also be presented.

Rebecca McConnell, DO

Title of presentation: Comprehension of visual displays of Functional Independence Measures (FIMs) in patients with spinal

Visual aids have been shown to communicate health information effectively to patients in multiple areas of health care, but displays for the Functional Independence Measure (FIM) have never been evaluated as a provider to patient communication tool. The cognitive interview process was used to assess the comprehension of visual displays and FIMs, and whether FIM scores and their visual presentation are perceived to be helpful to patients for future acute rehabilitation use.

Danielle Shapiro, PhD

Title of presentation: Social Media Activity as a Naturalistic Measure of Recovery from Brain Injury

Acquired brain injury, including traumatic brain injury (TBI), is common and impacts several areas of functioning, often including social skills and relationships. Social deficits resulting from a TBI can be devastating for adolescents and young adults, who occupy a “sensitive period” of social development and, therefore, are particularly vulnerable to social exclusion and isolation. Among adolescents who have sustained a TBI, social dysfunction is associated with other functional outcomes, including physical and psychological morbidity. While social outcomes are extremely important to recovery from brain injury, it is notoriously difficult to measure and intervene in social processes. Current measures used to assess social skills and relationship quality are limited by self- or caregiver-reporting biases and a lack of premorbid and naturalistic data. Similarly, interventions aimed at improving social skills and interactions among adolescents tend to scale poorly and are restricted to face-to-face interactions. The current study aims to take an initial step toward addressing these shortcomings. In this study, we collected pilot data on a new method for measuring social processes among adolescents and young adults who have sustained an acquired brain injury. Specifically, we downloaded social media activity, including text posts, private messages, and photo data, from Facebook and Twitter. This method has the advantage over traditional approaches of documenting naturalistic interactions among peers and providing access to archived premorbid data. Preliminary findings suggest that this approach is feasible and acceptable. Additional preliminary findings will be discussed. 

Denise Tate, PhD

Title of presentation: Spinal Cord Injury Bowel and Bladder Complications and Their Impact on Quality of Life

Neurogenic bowel and bladder dysfunction is a chronic condition hindering the functioning and the quality of life (QOL) of persons with spinal cord injury (SCI). We examined major bowel and bladder complications and their association with QOL reported by SCI participants enrolled in two federally funded studies. We assessed these factors using the Bowel and Bladder Treatment Inventory (BBTI) developed by our research team and based on the International Spinal Cord Injury Datasets. The most common neurogenic dysfunctions were bladder and bowel incontinence, urinary tract infections and constipation. Impact on QOL was measured using the BBTI in relation to satisfaction with life and impact on life management, PROMIS and SCI-QOL. Our results showed a number of factors associated with complications and their effect on QOL. Behavioral, support factors and access to resources were critical in mediating the impact of these complications QOL. Preventing these complications by early identification of patients at risk as well as treatment monitoring can be successfully accomplished by using efficient clinical data assessments ready to use by clinicians and included in patients’ electronic medical records. This presentation will discuss some of these major points and implications for the future.

Jasmine Zheng, MD

Title of Presentation: In Good Hands: The Future of Upper Extremity Prosthetics

This talk will include a brief history of upper limb prosthetics and the current state of technology. We will also explore the complexities of designing the "ideal" prosthesis and how current technologies align with the needs of those who wear upper limb prostheses.