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  • 1
    Online Resource
    Online Resource
    Validation of a Brief Cognitive Screening Examination in an Adult Acute Inpatient Rehabilitation Population
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Topics in Geriatric Rehabilitation Vol. 36, No. 2 ( 2020-04), p. 122-126
    Details
    In: Topics in Geriatric Rehabilitation, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 2 ( 2020-04), p. 122-126
    Abstract: To establish validity of a Brief Cognitive Screening Examination (BCSE) to identify patients requiring further cognitive testing. Methods: A total of 100 adult inpatients at a university acute inpatient rehabilitation facility were given the Mini-Mental State Examination (MMSE), Clock Draw Test (CDT), and BCSE. The BCSE is a 2-minute test to assess registration, concentration, working memory, and calculation. Results: Univariate linear regression analysis demonstrated that BCSE scores of 16 predicted the MMSE score of 28 ( P 〈 .01) and BCSE of 12 or less predicted the MMSE less than 24 ( P 〈 .01). Conclusion: The BCSE is a valid, time-efficient, bedside cognitive screen that identifies patients who would benefit from further cognitive evaluation.
    Type of Medium: Online Resource
    ISSN: 0882-7524
    URL: Article
    DOI: 10.1097/TGR.0000000000000267
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2093174-8
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  • 2
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    Predictive Outcome Modeling of Preoperative Clinical Symptoms and Electrodiagnostic Data in Tarsal Tunnel Surgery
    Georg Thieme Verlag KG ; 2021
    In:  Journal of Brachial Plexus and Peripheral Nerve Injury Vol. 16, No. 01 ( 2021-01), p. e37-e45
    Details
    In: Journal of Brachial Plexus and Peripheral Nerve Injury, Georg Thieme Verlag KG, Vol. 16, No. 01 ( 2021-01), p. e37-e45
    Abstract: Background The relationship between tarsal tunnel syndrome (TTS), electrodiagnostic (Edx) findings, and surgical outcome is unknown. Analysis of TTS surgical release outcome patient satisfaction and comparison to Edx nerve conduction studies (NCSs) is important to improve outcome prediction when deciding who would benefit from TTS release. Methods Retrospective study of 90 patients over 7 years that had tarsal tunnel (TT) release surgery with outcome rating and preoperative tibial NCS. Overall, 64 patients met study inclusion criteria with enough NCS data to be classified into one of the following three groups: (1) probable TTS, (2) peripheral polyneuropathy, or (3) normal. Most patients had preoperative clinical provocative testing including diagnostic tibial nerve injection, tibial Phalen's sign, and/or Tinel's sign and complaints of plantar tibial neuropathic symptoms. Outcome measure was percentage of patient improvement report at surgical follow-up visit. Results Patient-reported improvement was 92% in the probable TTS group (n = 41) and 77% of the non-TTS group (n = 23). Multivariate modeling revealed that three out of eight variables predicted improvement from surgical release, NCS consistent with TTS (p = 0.04), neuropathic symptoms (p = 0.045), and absent Phalen's test (p = 0.001). The R 2 was 0.21 which is a robust result for this outcome measurement process. Conclusion The best predictors of improvement in patients with TTS release were found in patients that had preoperative Edx evidence of tibial neuropathy in the TT and tibial nerve plantar symptoms. Determining what factors predict surgical outcome will require prospective evaluation and evaluation of patients with other nonsurgical modalities.
    Type of Medium: Online Resource
    ISSN: 1749-7221
    URL: Article
    DOI: 10.1055/s-0041-1731747
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2021
    detail.hit.zdb_id: 2253037-X
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  • 3
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    Online Resource
    Abstract 76: Estimating The Impact Of Hospital-level Variation In The Use Of Inpatient Rehabilitation Facilities Versus Skilled Nursing Facilities On Individual Stroke Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Stroke Vol. 54, No. Suppl_1 ( 2023-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 54, No. Suppl_1 ( 2023-02)
    Abstract: Introduction: Observational studies indicate that stroke rehabilitation at Inpatient Rehabilitation Facilities (IRFs) is superior to Skilled Nursing Facilities (SNFs). Nationally, IRF vs. SNF use varies widely at the hospital level, but the impact on individual patients is unclear. Our objective was to quantify the effect of the admitting hospital on the probability of receiving IRF or SNF care for individual stroke patients. Methods: Medicare claims data (2011-2014) was used to generate a cohort of acute ischemic and hemorrhagic stroke patients who were discharged to IRFs or SNFs. We generated 2 multivariable effects logistic regression models. Model 1 predicted IRF admission (vs. SNF) using only patient-level factors as fixed effects, whereas Model 2 added a hospital random effect. The impact of the admitting hospital on an individual patients’ probability of IRF care was estimated by taking the difference in predicted probabilities (p^) between the 2 models. Hospital effects were categorized as moderate (10-19%) or large ( 〉 20%) based on the change in size of p^. The magnitude and direction of the random effect terms in Model 2 was used to categorize individual hospitals as being either neutral, SNF-, or IRF- favoring. Results: The cohort included 1,816 acute care hospitals which discharged 135,415 patients to IRFs (n=66,548) or SNFs (n= 68,867). Half of the hospitals were categorized as neutral (n=870, 47.9%) with the remaining being SNF- favoring (n=485, 26.7%) or IRF- favoring (n=461, 25.4%). For half of all patients, acute care hospital had a moderate influence on the type of rehabilitation that they received. For SNF and IRF-favoring hospitals, there were large (55% and 37% of patients) or moderate (30% and 42% of patients) hospital effects on discharge setting for the majority of patients. Conclusion: For the majority of stroke patients, which acute care hospital they happen to be admitted to meaningfully impacts the type of rehabilitation care they receive
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.54.suppl_1.76
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Accessory Flexor Digitorum Longus Presenting as Tarsal Tunnel Syndrome: A Case Series
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Clinical Journal of Sport Medicine Vol. 32, No. 3 ( 2022-05), p. e316-e318
    Details
    In: Clinical Journal of Sport Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 32, No. 3 ( 2022-05), p. e316-e318
    Abstract: Tarsal tunnel syndrome (TTS) typically occurs from extrinsic or intrinsic sources of compression on the tibial nerve. We present 3 cases of patients, all of whom have a prolonged time to diagnosis after evaluation with multiple specialties, with foot pain ultimately secondary to an accessory flexor digitorum longus muscle causing TTS. The literature describing the association between TTS and accessory musculature has been limited to single case reports and frequently demonstrate abnormal electrodiagnostic testing. In our series, 2 cases had normal electrodiagnostic findings despite magnetic resonance imaging (MRI) that later revealed TTS and improvement with eventual resection. A normal electromyogram should not preclude the diagnosis of TTS and MRI of the ankle; it should be considered a useful diagnostic tool when examining atypical foot pain.
    Type of Medium: Online Resource
    ISSN: 1050-642X
    URL: Article
    DOI: 10.1097/JSM.0000000000001025
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2045233-0
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  • 5
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    Online Resource
    Can Carpal Tunnel Syndrome be Appropriately Diagnosed in a Cold Hand?
    Michigan State University College of Osteopathic Medicine Statewide Campus System ; 2021
    In:  Spartan Medical Research Journal Vol. 6, No. 2 ( 2021-8-30)
    Details
    In: Spartan Medical Research Journal, Michigan State University College of Osteopathic Medicine Statewide Campus System, Vol. 6, No. 2 ( 2021-8-30)
    Abstract: The diagnosis of carpal tunnel syndrome (CTS) with nerve conduction studies traditionally involves warming the hand to avoid misleading prolongation of distal latency (DL). Comparing the median nerve DL to the ulnar and radial nerves using the combined sensory index (CSI) has been reported to improve the accuracy of CTS diagnosis. During this study, the authors examined the effect of hand temperature on the CSI and diagnosis of CTS. METHODS The authors conducted a prospective, controlled, cohort study with 20 asymptomatic control patients and 21 symptomatic patients with confirmed CTS. Symptomatic patients underwent nerve conduction studies with the CSI calculated under both cold and warm conditions. RESULTS Control subjects with warm hands had an average CSI of 0.0 milliseconds (ms), and -0.3ms with cold hands. CTS subjects with warm hands had an average CSI of 3.2ms, and 3.7ms with cold hands. Although hand temperature was shown to slow sample latencies, differences calculated with the CSI did not misclassify any of the 41 sample subjects. CONCLUSIONS During this study, cold temperature did not result in misclassification of either control patients or CTS patients when CSI was diagnostically used. Based on these results, peak latency comparisons in cold hands can be considered as diagnostically reliable as under standard hand temperature ranges for the diagnosis of CTS, with caution warranted in borderline cases. This diagnostic technique can save time for the patient, physician, and care team without compromising quality of care. Future larger sample blinded studies at multiple electrodiagnostic sites are indicated.
    Type of Medium: Online Resource
    ISSN: 2474-7629
    URL: Article
    DOI: 10.51894/001c.25941
    Language: English
    Publisher: Michigan State University College of Osteopathic Medicine Statewide Campus System
    Publication Date: 2021
    detail.hit.zdb_id: 3064139-1
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  • 6
    Online Resource
    Online Resource
    Rationale for a Clinical Trial That Compares Acute Stroke Rehabilitation at Inpatient Rehabilitation Facilities to Skilled Nursing Facilities: Challenges and Opportunities
    Elsevier BV ; 2022
    In:  Archives of Physical Medicine and Rehabilitation Vol. 103, No. 6 ( 2022-06), p. 1213-1221
    Details
    In: Archives of Physical Medicine and Rehabilitation, Elsevier BV, Vol. 103, No. 6 ( 2022-06), p. 1213-1221
    Type of Medium: Online Resource
    ISSN: 0003-9993
    URL: Article
    DOI: 10.1016/j.apmr.2021.08.004
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2040858-4
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  • 7
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    Dissecting mechanisms of fecal microbiota transplantation efficacy in disease
    Elsevier BV ; 2024
    In:  Trends in Molecular Medicine ( 2024-1)
    Details
    In: Trends in Molecular Medicine, Elsevier BV, ( 2024-1)
    Type of Medium: Online Resource
    ISSN: 1471-4914
    URL: Article
    DOI: 10.1016/j.molmed.2023.12.005
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
    detail.hit.zdb_id: 2155736-6
    SSG: 12
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  • 8
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    An Additional Electrodiagnostic Tool for Ulnar Neuropathy: Mixed across the Elbow
    Georg Thieme Verlag KG ; 2020
    In:  Journal of Brachial Plexus and Peripheral Nerve Injury Vol. 15, No. 01 ( 2020-01), p. e16-e21
    Details
    In: Journal of Brachial Plexus and Peripheral Nerve Injury, Georg Thieme Verlag KG, Vol. 15, No. 01 ( 2020-01), p. e16-e21
    Abstract: Background Diagnosing ulnar neuropathy at the elbow (UNE) remains challenging despite guidelines from national organizations. Motor testing of hand intrinsic muscles remains a common diagnostic method fraught with challenges. Objective The aim of the study is to demonstrate utility of an uncommon nerve conduction study (NCS), mixed across the elbow, when diagnosing UNE. Methods Retrospective analysis of 135 patients, referred to an outpatient University-based electrodiagnostic laboratory with suspected UNE between January 2013 and June 2019 who had motor to abductor digiti minimi (ADM), motor to first dorsal interosseus (FDI), and mixed across the elbow NCS completed. To perform the mixed across the elbow NCS, the active bar electrode was placed 10-cm proximal to the medial epicondyle between the biceps and triceps muscle bellies. The median nerve was stimulated at the wrist followed by stimulation of the ulnar nerve at the ulnar styloid. The difference between peak latencies, labeled the ulnar-median mixed latency difference (U-MLD), was used to evaluate for correlation between the nerve conduction velocities (NCV) of ADM and FDI. Results Pearson r-values = −0.479 and −0.543 (p  〈  0.00001) when comparing U-MLD to ADM and FDI NCV across the elbow, respectively. The negative r-value describes the inverse relationship between ulnar velocity across the elbow and increasing U-MLD. Conclusion Mixed across the elbow has moderate–strong correlation with ADM and FDI NCV across the elbow. All three tests measure ulnar nerve function slightly differently. Without further prospective data, the most accurate test remains unclear. The authors propose some combination of the three tests may be most beneficial when diagnosing UNE.
    Type of Medium: Online Resource
    ISSN: 1749-7221
    URL: Article
    DOI: 10.1055/s-0040-1714742
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
    detail.hit.zdb_id: 2253037-X
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  • 9
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    Online Resource
    Frequency of Electrodiagnostically Measurable Berrettini Anastomosis
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Clinical Neurophysiology Vol. 37, No. 3 ( 2020-05), p. 214-219
    Details
    In: Journal of Clinical Neurophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 37, No. 3 ( 2020-05), p. 214-219
    Abstract: Ulnar sensory palmar crossover to digit three (D3), the Berrettini anastomosis, is measurable in routine electrodiagnostic nerve conduction studies. The crossover is reported as occurring in 60% of anatomic dissections, but the frequency of measurable ulnar crossover to D3 and its potential as a nerve conduction pitfall is not established. The purpose of this article was to present descriptive statistics regarding the frequency of measurable Berrettini anastomosis in nerve conduction studies. Methods: A retrospective chart review and data analysis was completed on 248 patients representing 411 extremities with a main outcome measure of ulnar sensory stimulated nerve conduction simultaneous waveform recording on D3 and digit four (D4). Consistent electrodiagnostic technique with waveform recording data analysis in a private practice and independent university waveform verification was completed on sequential patients referred for upper extremity electrodiagnostic testing. Results: Measurable ulnar stimulated D3 sensory nerve action potentials were demonstrated in 34% of patients with amplitudes of 27%, the simultaneously recorded corresponding ulnar D4 amplitudes representing electrophysiological evidence of ulnar sensory crossover. Conclusions: The Berrettini anastomosis can frequently be seen as a small amplitude sensory nerve action potential response, but at times can be observed with an amplitude greater than 10 μV. It is possible that patients with an absent or significantly delayed median nerve response may have simultaneous inadvertent spread of stimulus to ulnar axons measurable on D3 that may be interpreted as a falsely normal response. All electromyographers need to be aware of this potential pitfall.
    Type of Medium: Online Resource
    ISSN: 0736-0258
    URL: Article
    DOI: 10.1097/WNP.0000000000000622
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2065729-8
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  • 10
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    Online Resource
    Emulating 3 Clinical Trials That Compare Stroke Rehabilitation at Inpatient Rehabilitation Facilities With Skilled Nursing Facilities
    Elsevier BV ; 2022
    In:  Archives of Physical Medicine and Rehabilitation Vol. 103, No. 7 ( 2022-07), p. 1311-1319
    Details
    In: Archives of Physical Medicine and Rehabilitation, Elsevier BV, Vol. 103, No. 7 ( 2022-07), p. 1311-1319
    Type of Medium: Online Resource
    ISSN: 0003-9993
    URL: Article
    DOI: 10.1016/j.apmr.2021.12.029
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2040858-4
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