Rehabilitation Institute of Michigan

ObjectiveRefractory pain of the shoulder hinders independence and decreases quality of life. Sixty-day peripheral nerve stimulation (PNS) treatment has shown the ability to provide substantial and sustained relief in patients with chronic shoulder pain. The present study aims to identify key patient and treatment characteristics that may be utilized by physicians to optimize patient outcomes.DesignAn institutional review board–approved retrospective chart review evaluated patients who previously underwent 60-day PNS treatment for their chronic shoulder pain. Patient and treatment characteristics were extracted from electronic medical records and analyzed alongside patient-reported outcomes provided at the end of treatment.ResultsOverall, 221 patients were included in the study. Of patients with available outcomes, 75% (n = 132/176) reported substantial (i.e., ≥50%) pain relief at end of treatment. PNS treatment effectiveness was consistent when stratified by several factors, including the chronicity of pain, patient age, and the cause of pain. Regression analyses identified characteristics associated with successful outcomes.ConclusionsThe study highlights the effectiveness of 60-day peripheral nerve stimulation treatment across a variety of shoulder pain types and medical histories. These findings complement previous studies and real-world evidence supporting PNS in the management of chronic shoulder pain and provide insights that may inform patient selection and optimization of 60-day PNS treatment.

Approaches to caregiving interventions are often "one-size-fits-all," yet family caregivers for individuals with dementia have unique caregiving styles with which they enact daily care. This study describes the development of CG-STYLE, the first person-centered assessment of caregiving style. Development phases of this measure included mixed-methods exploratory research, iterative item development and refinement, cognitive interviews, expert review, literacy and translatability review, and field testing of the items in 209 family/friend caregivers for an individual with dementia. Item response theory and classical test theory analyses were run. Confirmatory factor analysis affirms the unidimensionality of 7 item banks of the measure: orientation toward the care partner, adaptability, understanding of dementia, emotional expression (positive, negative), and behavioral management (adaptive, maladaptive). A person-centered assessment measure can help tailor services and interventions to best fit unique styles of care, ultimately improving the well-being of the caregiver and the quality of care for the individual with dementia.

Nausea and vomiting, whether acute or chronic, often result from disturbances in the central, autonomic, and enteric nervous systems. Both space motion sickness and gastrointestinal motility disorders share overlapping mechanisms involving autonomic dysfunction, abnormal gastric myoelectric activity, and delayed gastric emptying. Conventional medical and surgical treatments often provide incomplete relief or cause undesirable side effects, which has encouraged investigation into nonpharmacologic approaches. This study evaluates the therapeutic potential of Autogenic Feedback Training Exercise, a behavioral intervention developed by the National Aeronautics and Space Administration, as an adjunctive treatment for patients with gastrointestinal motility disorders and related autonomic dysfunction. Findings from clinical and experimental research involving astronauts, pilots, and individuals with gastrointestinal motility disorders were reviewed. The training combines cognitive imagery and biofeedback techniques to help subjects voluntarily regulate physiological responses such as heart rate, blood pressure, and skin conductance. Sessions typically last thirty minutes and include alternating relaxation and arousal exercises over several weeks. Autogenic Feedback Training Exercise increased motion sickness tolerance and reduced sympathetic activation while improving physiological stability. In individuals with gastrointestinal motility disorders, it enhanced gastric emptying, improved electro gastrographic activity, and lessened symptom severity, particularly in those with mild to moderate delay in gastric emptying. When combined with gastric electrical stimulation, outcomes further improved through enhanced autonomic and enteric regulation. Autogenic Feedback Training Exercise offers a promising, noninvasive approach for restoring autonomic balance and improving gastrointestinal function. Remote delivery through telemedicine may expand access for patients with chronic illness.

This study evaluated existing clinical practice guidelines (CPGs) for the physical therapy (PT) management of hip osteoarthritis (HOA) or knee osteoarthritis (KOA) and assessed their quality and applicability for integration into practice. A systematic review of clinical practice guidelines A literature search was conducted for PubMed, CINAHL, Cochrane Database of Systematic Reviews, and SPORTDiscus to locate CPGs published through October 25, 2024. Characteristics of the guidelines were extracted, including country of origin, organization, team members, levels of evidence, grading systems, target audience, and PT recommendations. The methodological quality and clinical applicability of each CPG were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and AGREE Recommendation Excellence (REX) tools, respectively. Seven CPGs were included in this review. There was consensus among CPGs in recommending an examination and evaluation consisting of assessing range of motion of the affected joint, balance, and activity tolerance in people with HOA or KOA. The most common intervention across all CPGs included exercise interventions to improve the strength and mobility of the affected extremity. However, there was minimal information and a lack of consensus on the specific types or dosages for these exercises across the CPGs. This review synthesized and elucidated common recommendations for the PT management of HOA or KOA. The recommendations largely provided exercise interventions; however, they lacked consistency on exercise dosages across the CPGs.

Subjective cognitive decline (SCD) may be an early indicator of Alzheimer disease and related dementias (ADRD), yet its association with plasma biomarkers remains unclear among middle-aged and older adults (aged 50-86 years). To examine associations between plasma biomarkers of amyloid, tau, neuroaxonal damage, and glial activation with SCD in a heterogeneous cohort of Hispanic and/or Latino adults. This cross-sectional study used survey-weighted data from the Study of Latinos-Investigation of Neurocognitive Aging, an ancillary study of the Hispanic Community Health Study/Study of Latinos. Participants were aged 50 to 86 years and resided in 4 major US cities. Data were collected from 2016 to 2018 and analyzed between December 2024 and June 2025. Plasma biomarkers included amyloid-beta (Aβ42/40), phosphorylated tau-181 (ptau-181), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP), quantified using Simoa (Quanterix HD-X) and log-transformed (ln) to reduce skewness. SCD was assessed using the short-form Everyday Cognition Scale (ECog-12), evaluating global-, executive-, and memory-related SCD, and a single-item cognitive concerns question. Survey-weighted linear and logistic regression models tested associations between biomarkers and SCD, adjusting for demographic, cardiovascular, kidney, and APOE genotype covariates. Among 5712 adults (mean [SD] age, 63.47 (8.15) years; unweighted 3663 [53.92%] female), higher ln(ptau-181) was associated with ECog-12 memory (unstandardized β = 0.088; 95% CI, 0.005-0.170). Higher ln(NfL) levels were associated with greater ECog-12 global (unstandardized β = 0.169; 95% CI, 0.074-0.265), executive (unstandardized β = 0.182; 95% CI, 0.087-0.277), and memory (unstandardized β = 0.156; 95% CI, 0.065-0.248) domains. Higher ln(GFAP) levels were associated with greater ECog-12 global (unstandardized β = 0.109; 95% CI, 0.019-0.198) and executive (unstandardized β = 0.121; 95% CI, 0.031-0.211) domains. Ln(Aβ42/40) was not associated with SCD domains. Cognitive concerns significantly modified the associations between ln(NfL) and ECog-12 domains, with more pronounced associations among those reporting cognitive concerns. No biomarkers were associated with the single-item cognitive concerns score. In this study of middle-aged and older Hispanic and/or Latino adults, plasma biomarkers of p-tau181, NfL, and GFAP, but not Aβ42/40, were associated with greater SCD. These findings underscore their potential utility in early ADRD detection strategies.

Abstract ObjectiveThis study's purpose was to determine if parental perceptions of their adult children's communication, behavior, and socialization skills were significantly associated with caregiver burden after controlling for income and age of the child with an autism spectrum disorder (ASD).BackgroundMost parents provide support to their children with ASD across the lifespan. This study focused on informing knowledge gaps in caregiving literature in determining which ASD characteristics contribute to caregiver burden.MethodData gathered from 320 parents of adult children with ASD were used to conduct regression analysis to understand how caregiver burden was influenced by three core characteristics of ASD while controlling for age and income.ResultsBehavior of the adult child predicted caregiver burden and its four types, whereas communication predicted time dependence burden. Caregivers with higher income reported less total and developmental burden and those with older children reported less time dependence burden.ConclusionFindings demonstrate that behavioral challenges of an adult child with ASD contribute significantly to the parental perceptions of caregiver burden, warranting support for aging parents.ImplicationsProfessionals should be encouraged and supported to provide services to parents who support their adult children with decreased communication abilities, behavioral, and/or socialization challenges daily.

The 2024 Alzheimer's Association (AA) research diagnostic criteria for Alzheimer's Disease (AD) considers fluid biomarkers, including promising blood-based biomarkers for detecting AD. This study aims to identify dementia subtypes and their cognitive and neuroimaging profiles in older adults with dementia in the Democratic Republic of Congo (DRC) using biomarkers and clinical data. Forty-five individuals with dementia over 65 years old were evaluated using the Community Screening Instrument for Dementia and the informant-based Alzheimer's Questionnaire. Core AD biomarkers (Aβ42/40 and p-tau181) and non-specific neurodegeneration biomarkers (NfL, GFAP) were measured in blood plasma. Neuroimaging structures were assessed using magnetic resonance imaging (MRI). Dementia subtypes were determined based on plasma biomarker pathology and vascular markers. Biomarker cutoff scores were identified to optimize sensitivity and specificity. Individuals were stratified into one of four dementia subtypes - AD only, non-AD vascular, non-AD other, or mixed - based on combinations of abnormalities in these markers. Among the 45 individuals with dementia, mixed dementia had the highest prevalence (42.4%), followed by AD-only (24.4%), non-AD other dementia (22.2%), and non-AD vascular dementia subtypes (11.1%). Both cognitive and neuroimaging profiles aligned poorly with biomarker classifications in the full sample. Cognitive tests varied across dementia subtypes. The cognitive profile of the AD-only and mixed groups suggested relatively low cognitive performance, while the non-AD and other groups had the best scores on average. Consistent with studies in other settings, our preliminary findings suggest that neurodegenerative plasma biomarkers may help to identify dementia subtypes and provide insight into cognitive and neuroimaging profiles among older adults in the DRC.

Cervical spinal cord injury (SCI) results in significant sensorimotor impairments below the injury level, notably in the upper extremities (UEs), impacting daily activities and quality of life. Regaining UE function remains the top priority for individuals post-cervical SCI. Recent advances in understanding adaptive plasticity within the sensorimotor system have led to the development of novel non-invasive neurostimulation strategies, such as spinal cord transcutaneous stimulation (scTS), to facilitate UE motor recovery after SCI. This comprehensive review investigates the neuromotor control of UE, the typical recovery trajectories following SCI, and the therapeutic potential of scTS to enhance UE motor function in individuals with cervical SCI. Although limited in number with smaller sample sizes, the included research articles consistently suggest that scTS, when combined with task-specific training, improves voluntary control of arm and hand function and sensation. Further, the reported improvements translate to the recovery of various UE functional tasks and positively impact the quality of life in individuals with cervical SCI. Several methodological limitations, including stimulation site selection and parameters, training strategies, and sensitive outcome measures, require further advancements to allow successful translation of scTS from research to clinical settings. This review also summarizes the current literature and proposes future directions to support establishing approaches for scTS as a viable neuro-rehabilitative tool.

Stroke survivors are one of the largest consumer groups of rehabilitation services. Despite improvement in daily activities while in inpatient rehabilitation, many have difficulty performing daily activities at home after discharge. The difference in performance between a standard clinical context and at home is poorly understood. To better understand differences in activity performance during transition from inpatient rehabilitation facility (IRF) to home, we examined daily activity performance scores from 2 different environments (IRF and home) at the same time point (discharge). This was a cross-sectional analysis using baseline data from a randomized controlled trial. Participants were stroke survivors aged ≥50 who planned to discharge home from the IRF. The Functional Independence Measure and Section GG codes (both converted to International Classification of Functioning, Disability, and Health scores) were conducted per protocol first at home and then in the IRF at discharge (≤3 days apart, order not randomized). Among 57 participants, activity scores at home were significantly worse than scores at IRF discharge. Over 40% of participants had discharge scores indicating no-to-mild impairment for shower/tub transfer, walking, and going up/down stairs, while home visit scores indicated moderate-to-complete impairment for those activities. The greatest differences in scores were for shower/tub transfer (median difference 1.5, 95% CI 1.00-2.00) and going up/down stairs (median difference 1.50, 95% CI 1.00-2.00). The environment plays an important role in stroke survivors' functioning at home. Future studies should further examine how the environment impacts activity performance upon returning home following stroke.