Brooks Rehabilitation Clinical Research Center

BACKGROUND: High-impact chronic pain (HICP) is defined as chronic pain that significantly hinders patients’ function and often results in elevated psychological distress. A multimodal approach inclusive of pain mechanism-based treatments and standard outcome tracking assists clinicians in treatment tailoring and supports effective patient management. CASE PRESENTATION: A 52-year-old male presented to physical therapy with over a 20-year history of chronic neck pain and radiating symptoms into bilateral upper extremities. The patient’s clinical picture showed signs of a mixed pain mechanism presentation, with nociplastic signs being predominant. OUTCOME AND FOLLOW-UP: After 27 visits across five months, a 12% improvement in the Neck Disability Index score was observed. Cervical and shoulder range of motion improved beyond measurements error. The patient returned to work and was able to participate in family and social events. DISCUSSION: This case demonstrates how standard outcome assessment and intervention tailoring was used to inform a pain mechanism-based treatment approach to manage a patient with HICP.

Postoperative rehabilitation is essential to post-transplantation recovery and a key component of comprehensive transplant care, with inpatient rehabilitation providing intensive, interdisciplinary support to restore function and enhance quality of life. In 2019, the Brooks Rehabilitation Transplant Program (BRTP) was implemented to address the specialized rehabilitation needs post solid organ transplantation as an interdisciplinary, comprehensive, and tailored model of care. Five main pillars comprise BRTP: (1) organizational commitment; (2) collaborative relationship with acute care providers; (3) early identification of appropriate patients; (4) interdisciplinary rehabilitation care tailored to transplant needs; and (5) continuous evaluation of quality outcomes. A retrospective observational cohort study evaluated both implementation and clinical outcomes over the program's first 5years. Implementation outcomes included feasibility, fidelity, and sustainability. The primary clinical outcomes were changes in the CMS standardized functional assessment Section GG Mobility and Self-care scores. Wilcoxon signed rank sum test was used to compare admission and discharge scores. Secondary outcomes included IRF length of stay, discharge to community, acquired pressure injuries, falls, and feeding tube removal. Between January 2019 and December 2023, 202 solid organ transplant patients participated in BRTP. For the 154 completing their inpatient rehabilitation facility (IRF) stay, significant functional improvements were observed for the Section GG Mobility and Self-Care composite scores and across all individual functional items (p<0.001). Ultimately, 82% of the cohort discharged to community, with eight returning to inpatient rehabilitation following an acute readmission and zero patients acquiring a pressure injury. Implementation outcomes indicated that the program was feasible, delivered with fidelity, and demonstrated sustainability over time. The BRTP provides effective, sustainable, evidence-based approaches to improve function and quality outcomes following transplantation.

BackgroundWearable sensor systems maximize visual and clinical feedback for physical therapists to enhance patient outcomes in rehabilitation medicine. However, physical therapists must adopt and accept new technologies for full integration into routine care to advance the use of technology in clinical care. Their role in technology design is critical in adopting and implementing technology. Interprofessional collaboration should be supported in the design of rehabilitation-assisted technologies.ObjectiveWe used the established tenets of the Technology Acceptance Model to describe physical therapists’ expectations and experiences before and after using a novel wearable system in outpatient physical therapy.MethodsThis multiple methods pilot study used a comparative pre-post survey and a qualitative semistructured focus group study design. Using purposive sampling, we recruited outpatient physical therapists to pilot the novel wearable technology, describe their expectations and experiences, and participate in a semistructured focus group discussion conducted to gather training and user experience information.ResultsThe study sample consisted of 5 physical therapists with an average age of 38.8 (SD 6.9) years and a work experience average of 12 (SD 7.7) years. Presurvey data show favorable expectations for usefulness and ease of use; however, favorability in both factors decreased after use. For perceived usefulness, all responses moved in the less favorable direction; mean difference −4.4 (SD 3.21); P=.04. All but 2 responses moved in the less favorable direction for overall perceived ease of use; mean difference −4.8 (SD 1.79); P=.04. Themed responses to open-ended questions in the postsurvey were feedback, setup time, accuracy, performance, and enhanced functional activities. Inductive content analysis of the focus group responses resulted in the following themes: system training, system benefits, system challenges, physical therapist perception of patients, and suggestions for improvement. The expectation for frequency of use decreased pre- to postexperience by 53% (mean −22, SD 14.40; P=.04).ConclusionsThe Technology Acceptance Model–based survey responses and focus group themes outcomes demonstrated that physical therapists’ expectations for using new technology were not met. Engaging physical therapists in piloting novel wearable technology highlights the importance of physical therapist engagement in developing, refining, and implementing wearable devices for rehabilitation.

We present a case report of a 42-year-old female with post-West Nile virus meningoencephalitis who exhibited unique, long-latency diaphragm potentials evoked by transcranial and cervical magnetic stimulation after exposure to acute intermittent hypoxia (AIH). The subject was recruited for a study investigating AIH effects on respiratory motor function in healthy individuals. She had contracted West Nile virus infection 5 years before assessment that resulted in hospitalization and persistent allodynia but was not reported to the research team. During the study, transcranial (TMS) and cervical (CMS) magnetic stimulation were performed before and 30–60 min after a single presentation of AIH [15, 1-min hypoxic episodes (~9% inspired O2), with 1-min normoxic intervals]. Diaphragm EMG was recorded using chest wall surface electrodes. At baseline, evoked diaphragm potentials were within normal ranges for both TMS (onset latency = 17.0 ± 1.1 ms; peak-to-peak amplitude = 220 ± 27 μV) and CMS (onset latency = 7.8 ± 0.6 ms; peak-to-peak amplitude = 336 ± 8 μV). However, long-latency TMS- and CMS-evoked potentials were observed 30–60 min post-AIH that were not present at baseline nor in healthy subjects. The onset of long-latency potentials ranged from 50 to 808 ms. While AIH is a potentially useful therapeutic strategy to enhance motor function after neurological disease or injury, it may elicit distinct effects in individuals with a history of neuroinfectious disease. Possible explanations for these unusual responses are discussed.

PURPOSE: Wearable sensor systems maximize visual and clinical feedback for patients and providers to enhance outcomes in rehabilitation medicine. However, clinicians must adopt and accept new technologies for full integration into routine care. The Technology Acceptance Model (TAM) is a theoretical framework that examines technology adoption by perceived usefulness and ease of use. This study used TAM to describe clinicians’ expectations and experiences before and after using a novel wearable system in outpatient physical therapy. METHODS: Five outpatient physical therapists (PT) were recruited. Each PT completed a survey before (pre-survey) and after (post-survey) exposure to the wearable system. The surveys included 18 questions based on the TAM, assessing perceived usefulness and ease of use. Exposure to the system, an automated rehabilitation system (ARS), included a two-hour training session, one month of practice, and use in regular physical therapy care for five new physical therapy patients (≥18 yrs, with no cognitive disabilities or diagnosis). The ARS uses inertial measurement unit sensors on the participant's body, affixed around the joint of interest, to measure joint range of motion (ROM) and display the movement on a screen as an avatar. A semi-structured focus group discussion was also held to gather training and user experience information. Summary data showing mean pre- and post-survey scores and responses for open-ended and focus group questions are presented. RESULTS: Pre-survey data show favorable expectations for usefulness and ease of use. For usefulness, all responses moved in the less favorable direction (mean difference = -4.4; SD = 2.9). All but two responses moved in the less favorable direction for ease of use (mean difference = -4.8; SD = 1.6). Responses to open-ended and focus group questions were grouped thematically into barriers (e.g., set-up challenges, need functional movements) and opportunities (e.g., home-based physical therapy, active ROM measurement, instant visual feedback). CONCLUSION: The TAM-based survey responses and thematic outcomes demonstrated clinicians’ interest in using new technology in usual care while also showing that the ARS did not meet their expectations. These results offer important insights for the development and refinement of systems.