Moss Rehabilitation Hospital

Moderate to severe traumatic brain injury (msTBI) results in physical, cognitive, behavioral, and psychosocial difficulties. Those who receive inpatient rehabilitation following a msTBI need assistance after discharge. Patients and their families often struggle to find information, manage symptoms, and identify and access relevant services. Inadequate transition services from hospital-based care to the community can perpetuate and amplify the consequences of msTBI. There is a critical need for enhanced transitional care following hospital discharge. The goal of the current study was to compare two existing models for supporting the transition in the United States: 1. The Commission on Accreditation of Rehabilitation Facilities (CARF) model focused on transition planning prior to discharge (denominated Rehabilitation Discharge Plan [RDP]) and 2. The Veterans Health Administration model which provides a more intensive approach, extending beyond discharge, to enhance transitional care services (denominated Rehabilitation Transition Plan [RTP]). A six-center, 1:1 randomized pragmatic clinical trial with masked outcome assessment was conducted to compare the effectiveness of these two approaches. All participants received the RDP, including: 1. Patient and family education; 2. Written discharge instructions reviewed with the patient and family prior to discharge; and 3. A brief phone call from an inpatient care provider post discharge to identify any immediate problems. Those randomized to the RTP intervention also received up to 12 scheduled contacts during the 6 months following discharge from a trained care manager to assess needs, provide education, and resource facilitation. The primary outcomes were societal participation (participation assessment with recombined tools-objective) and quality of life (quality of life after brain injury scale) at 6 months post discharge. We hypothesized that patients randomized to RTP would report better participation and health-related quality of life (HRQoL) at the end of intervention and at 1-year post discharge compared with patients randomized to RDP. Second, we hypothesized that patients randomized to RTP would experience a steeper trajectory of improvement in participation and HRQoL over 12 months compared to patients randomized to RDP. A total of 925 patients were randomized. The results showed no significant differences between the two interventions on societal participation or HRQoL. Likewise, analysis of trajectory of outcomes did not show treatment group differences, and most patient participants had minimal change across all time points. Preinjury limitations, Medicaid insurance, and lower function contributed to worse outcomes but there was evidence for an interaction with the intervention for clinical sites and whether participants had an enrolled caregiver, which differed by group (increased participation with no enrolled caregiver in RTP, and better HRQoL with a caregiver for RDP). A key limitation of the study was the length of the intervention, with our patient, family, and professional partners reporting that 6 months might be insufficient to address the many needs that arise after msTBI.

Abstract Purpose of Review This review synthesizes recent developments in vagus nerve stimulation (VNS) for stroke rehabilitation from 2021–2025, emphasizing the transition from experimental approaches to clinical implementation following FDA approval of implantable VNS. Recent Findings The 2021 FDA approval of the Vivistim Paired VNS System marked a watershed moment in stroke neuromodulation, providing the first regulatory-approved VNS therapy for upper extremity motor recovery. Long-term follow-up studies demonstrate sustained benefits at one year, with 66% of patients achieving clinically meaningful improvements. Concurrently, investigational transcutaneous approaches continue to evolve, though they remain limited by protocol heterogeneity and anatomical specificity concerns. Summary Implantable VNS paired with rehabilitation represents a paradigm shift in stroke care, offering evidence-based neuromodulation therapy for patients with chronic upper limb impairment. While transcutaneous approaches show promise in research settings, their clinical translation requires standardization and larger controlled trials. Current evidence strongly supports implantable VNS as a viable therapeutic option for carefully selected patients, while highlighting the importance of distinguishing proven treatments from investigational approaches in clinical practice.

Abstract Purpose of Review Post-traumatic stress disorder (PTSD) and anxiety commonly occur after traumatic brain injury (TBI), and this may be due in part to a unique neurophysiologic mechanism involving the autonomic nervous system (ANS). This paper will review the relationship between TBI induced ANS dysfunction and neuropsychiatric outcomes, commonly used measurements of ANS dysfunction, and the efficacy of ANS focused treatments to alleviate symptoms of PTSD and anxiety. Recent Findings TBI induced elevations in sympathetic activity can be measured through heart rate variability and may contribute to anxiety disorders, including PTSD. Biofeedback, sleep restoration, and yoga have been found to reduce sympathetic activity and effectively treat PTSD and anxiety in individuals with TBI. There is minimal current research supporting the use of vagal nerve stimulation. Summary Managing post-TBI PTSD and anxiety by actively decreasing sympathetic output is a promising treatment modality.

To describe clinical uses of the class of alpha-2 receptor agonist medications in the treatment of traumatic brain injury sequelae. Clinicians treating patients with traumatic brain injuries (TBI) will often see patients who have been prescribed alpha-2 agonists or may consider initiating use. Narrative review. This class of medication has a number of different indications (and side effects), and drugs within this class also have some unique properties that can be important factors in clinical decision-making. Although this class of medications has been available for many years, there is still much emerging information that is pertinent for the treatment of patients with TBI.

This case report of a veteran with a history of multiple traumatic brain injuries, posttraumatic stress, and chronic pain highlights the MossRehab Institute for Brain Health (MRIBH) model of care: a collaborative, interdisciplinary, intensive outpatient treatment program. Unique to this case was the severity of symptomatology and the concerted engagement by the clinicians, who fully tailored and adjusted their approaches based on team rounds and daily exchanges. The client's main concerns of headaches, difficulty sleeping, difficulty with memory and cognition, depression, anxiety, posttraumatic stress, anger, and chronic musculoskeletal pain were addressed and significantly improved within three weeks. The outcome of this case is promising and suggests that the highly individualized and collaborative interdisciplinary approach provided at MRIBH is particularly beneficial for veterans with chronic TBI and PTSD and can provide a roadmap for the treatment of specific clinical scenarios.

This article summarizes proceedings of the State of the Science (SOS) Conference on Information and Communication Technology (ICT) Access for Mobile Rehabilitation, convened by the Rehabilitation Engineering Research Center on Mobile Rehabilitation (mRehab RERC), which is funded by the U.S. National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR). The conference sought to assess the current state of the field and identify future research and development priorities for the field of mobile rehabilitation. The conference comprised four sessions addressing the following broad areas: (1) adherence to and effectiveness of home therapeutic exercise programs (HEPs); (2) technology for remote monitoring to support rehabilitation in the home and community (mRehab); (3) analytic techniques for using "big data" generated by remote monitoring to customize home exercise; and (4) barriers and facilitators to adoption of mRehab technology. Priorities for further research and development were identified using a three-stage process of gathering and refining expert opinions informed by the Delphi method for identifying future states in specific fields of inquiry. Results: Eight research and six technology development priorities were identified in the third and last stage of refinement of the initial set of priorities identified during the SOS Conference.

Calf muscle weakness is a common symptom in slowly progressive neuromuscular disorders that lead to walking problems like instability and increased walking effort. The mainstay of treatment to improve walking in this population is the provision of ankle-foot-orthoses (AFOs). Since we are not aware of an up-to-date and complete overview of the effects of AFOs used for calf muscle weakness in slowly progressive neuromuscular disorders, we reviewed the evidence for the effectiveness of AFOs to improve walking in this patient group, in order to support clinical decision-making. To review the evidence for the effects of ankle-foot orthoses (AFOs) for improving walking in adults with calf muscle weakness due to slowly progressive neuromuscular disorders. On 10 February 2023, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, Embase, MEDLINE, ClinicalTrials.gov, and WHO ICTRP. We looked for randomised controlled trials (RCTs), including randomised cross-over studies and quasi-RCTs, and non-randomised studies (NRSs) that examined the effects of AFO interventions compared with shoes-only walking in adults with calf muscle weakness due to neuromuscular disorders. We used the methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We summarised findings for the primary outcome (objectively measured walking effort, assessed as walking energy cost) and secondary outcomes (perceived walking effort, physical mobility, gait parameters, AFO use, satisfaction with the AFO, and adverse events). We grouped results according to the type of AFO material and synthesised them in meta-analysis where possible. We used the GRADE approach to rate the certainty of the evidence. We included four randomised cross-over studies and six NRSs with 186 participants in total (the smallest study had 8 participants and the largest had 37). All studies were designed as self-controlled studies and examined the effects of custom-made and/or prefabricated AFOs. The AFOs were made of carbon (5 studies), polypropylene (5 studies), silicone (1 study), metal (1 study), elastic materials (2 studies), or leather combined with other materials (1 study). Outcome measures with AFOs were assessed during a single session (in some studies, people already used the study AFO in daily life), when the AFO was delivered, or at three-week or three-month follow-up. We judged one study to be at moderate risk of bias, and nine studies to be at high or serious risk of bias, primarily due to bias arising from period and carryover effects, selection bias, the inability to blind participants and assessors, missing data, and selective reporting. We found that carbon AFOs may reduce walking energy cost (mean difference (MD) -0.86 J/kg/m, 95% confidence interval (CI) -1.33 to -0.39; 2 studies, 45 participants; low-certainty evidence), and may increase walking speed (MD 0.19 m/s, 95% CI 0.11 to 0.27; 4 studies, 71 participants; low-certainty evidence) compared to shoes-only walking. We found that leather AFOs may increase walking speed (MD 0.25 m/s, 95% CI 0.07 to 0.43; 1 study, 11 participants; low-certainty evidence). Little or no effect on walking speed was found with polypropylene AFOs (MD 0.00 m/s, 95% CI -0.11 to 0.11; 2 studies, 25 participants; low-certainty evidence) and elastic AFOs (MD 0.03 m/s, 95% CI -0.12 to 0.18; 1 study, 14 participants; low-certainty evidence). Carbon AFOs may also enhance satisfaction while walking (1 study, 16 participants; low-certainty evidence). We were unable to draw conclusions about perceived walking effort (one study, 8 participants), balance (two studies, 21 participants), and AFO use (two studies, 51 participants), as the evidence is very uncertain. Finally, two studies (45 participants) reported on adverse events (low-certainty evidence). The available evidence for ankle-foot orthoses (AFOs) to improve walking in adults with calf muscle weakness comes from a limited number of small studies with heterogeneity in intervention characteristics and outcome assessment, and is of low to very low certainty. The evidence suggests that carbon AFOs may reduce walking energy cost (effort), increase walking speed, and enhance satisfaction, and leather AFOs may increase walking speed, while polypropylene and elastic AFOs may make little or no difference to walking speed. We are unable to draw conclusions about the effects of AFOs on perceived walking effort, balance, and use. Nor can we draw conclusions about adverse effects of using AFOs. The variety in the findings for AFOs made of different materials suggests further investigation is warranted to explore how different AFO materials impact walking improvement in people with calf muscle weakness due to slowly progressive neuromuscular disorders.