prog

ressREH

AB

UPMC Rehabilitation Institute In This Issue

FA L L 2 0 1 5

2 RegenerativeRehabilitationUpdate

3 PathwayHumanCNSStemCellTransplantStudy

4 AdvancedUpperLimbProstheticResearch

5 TransitionalRehabUnits

6 RecentPublications

7 Awards

8 UPMCVideoRounds

ItrsquosAcademic

Intheabsenceofadditionalpunctuationorexplanationthephrase

ldquoitrsquosacademicrdquousuallyreferstoadiscussionaboutatopicthatwill

impactalmostnothingThepictureisoneofprofessorial-lookingmen

withglassesandatleastafewhavebeardsactivelyengagedinabasically

meaninglessdiscussionBeingacademicinthismeaningofthewordisnot

somethingwewouldeverstriveforScarilysomeofthechangesfacing

academicPMampRdepartmentsmakeonewonderifwersquollberelegatedtothe

meaninglessTherearebundledpaymentsiteneutralpaymentacademicmedicalcenters

excludedfromlargeinsurancecontractsandquestionsaboutfuturefundingforgraduate

medicaleducationMedicinetodayisdominatedbydiscussionsrelatedtocutsnarrow

networksandovertreatmentIrsquomnotsayingwedonrsquotneedtohavethesedifficult

conversationsbuteducationandresearcharenotfront-and-centerofthedailydeluge

Thisdelugecanbedepressing

ThenIreadthearticlesinthisinstallmentofRehab ProgressandIfeelbetterThisisthe

definitionofacademicIsignedupforItrsquosaboutresidentsgettinggreattrainingwriting

papersandwinningawardsthatrecognizetheireffortsItrsquosaboutnewresearchthatcan

trulychangethewayprosthetichandsworkandmoreimportantlyfeelItrsquosaboutdefining

anentirelynewfieldofmedicinemdashRegenerativeRehabilitationwhichhasthepotentialto

changethewaywedelivercareMostlyitisaboutgreatfacultywhoarewillingtomakea

littlelessmoneytohavetheprivilegeofbeingcalledanacademicphysiatrist

AndhellipIknowgreatworklikethisisgoingoninPMampRdepartmentsacrossthecountry

Inadditionwehavetrainedtheall-importantnon-academicphysiatristswhoareproviding

greatcarethroughoutthecountryandtheworldWersquoreAcademic

Sincerely

Michael L Boninger MD

Director UPMCRehabilitationInstitute

Professor and UPMC Endowed Chair DepartmentofPhysicalMedicineandRehabilitation

AffiliatedwiththeUniversityofPittsburghSchoolofMedicineUPMCisrankedamongthenationrsquosbesthospitalsbyUS News amp World Report

About the UPMC Rehabilitation Institute

bull UPMC is ranked by US News amp World Report as one of the top hospitals in the

country for rehabilitation

bull Stroke rehabilitation at the UPMC Rehabilitation Institute is certified by

The Joint Commission

bull Our experts combine extensive clinical experience with advanced technology

and research to offer our patients cutting-edge treatments

bull We are one of only seven institutions with both SCI and TBI Model System

designations from the NIDRR

2 R e H A BP R o g R e S S

RegenerativeRehabilitationUpdateFabrisia Ambrosio PhD

ldquoThe best way to predict your future is to create itrdquo

mdash Abraham Lincoln

Physical rehabilitation has foundations in the targeted

application of mechanical stimuli to enhance intrinsic

tissue healing potential It is a given that rehabilitation practice

must constantly evolve to include innovative scientific and

technological advances that can positively impact clinical care

This responsibility to change leads to questions like ldquoHow can

we be in tune with the latest scientific developmentsrdquo ldquoAre we

prepared to offer our patients the finest carerdquo

Regenerative medicine is the process of creating

living functional tissues to repair or replace tissue

or organ function lost due to age disease damage

or congenital defects Rehabilitation is the process

of maximizing an individualrsquos functional capacity

after an illness or trauma Both fields hold great

potential to drive progress in the treatment of

a host of acute and chronic pathologies

These fields are inextricably intertwined mdash an intersection

of disciplines that is becoming known as Regenerative

Rehabilitation Regenerative rehabilitation is defined as ldquothe

integration of principles and approaches in rehabilitation and

regenerative medicine with the ultimate goal of developing

innovative and effective methods that promote the restoration

of function through tissue regeneration and repairrdquo

Integration of rehabilitation approaches with regenerative

medicine strategies can accelerate underlying tissue

restoration after injury and disease For example to promote

intrinsic healing of the host and to help integrate donor

transplants in a useful and functional way the application

of modalities or graded exercise programs may augment

normally occurring developmental sequences at the donor-

host interface An understanding of the basic science behind

physical treatments as well as regenerative medicine will help

guide the development of targeted rehabilitation programs

and reduce trial-and-error in treatments and studies

In 2011 the UPMC Rehabilitation Institute along with the

McGowan Institute for Regenerative Medicine and the

School of Health and Rehabilitation Sciences both at the

University of Pittsburgh partnered with the Palo Alto VA to

hold the First Symposium on Regenerative Rehabilitation

This annual symposium brings together scientists and

clinicians working in the fields of rehabilitative and

regenerative medicine The enthusiasm with which this

annual meeting has been received over the last four years

illustrates the strong biomedical rationale for the emerging

field of regenerative rehabilitation Indeed since the first calls

to rehabilitation colleagues highlighting the need for

increased communication and interaction between the

fields of rehabilitation and regenerative medicine (Ambrosio

et al 2010 Ambrosio and Russell 2010) there has been a

burgeoning national and international interest in the concept

In 2013 delegates from several institutions across the

country including the University of Pittsburgh Stanford

University the University of Washington Emory University

Wake Forest University the Mayo Clinic and the University

Hospital of Pisa convened to hold the First Annual Meeting of

the Regenerative Rehabilitation Consortium This Consortium

serves as a coordinated communication and planning nucleus

that seeks to systematize the process of writing white

papers designing rehabilitation online education modules

promoting collaborative efforts and disseminating cutting-

edge discoveries through the annual Symposium

In 2015 Kyoto University Kyoto Japan held its first

Workshop on Regenerative Rehabilitation with Fabrisia Ambrosio PhD assistant professor and original consortium

member delivering the keynote lecture This workshop

was successful in its goal of introducing the concept of

regenerative rehabilitation to students in rehabilitation

graduate training programs at Kyoto University

The future of regenerative rehabilitation is bright and the

integration of these two fields rehabilitative and regenerative

medicine will increase the efficiency of interventions designed

to optimize physical functioning to the benefit of a wide range

of individuals with disabilities For more information on the

Fourth Annual Symposium on Regenerative Rehabilitation

that was held on September 24-26 at the Mayo Clinic in

Rochester Minnesota visit the website at httpwwwmirmupmceduSymposiumdefaultasp or contact

Katy Wharton

McGowan Institute for Regenerative Medicine

450 Technology Drive Suite 300

Pittsburgh PA 15219

E-mail whartonkmupmcedu

Phone +1 412-624-5293

Fax +1 412-624-5228

2 R e H A BP R o g R e S S

RegenerativeRehabilitationUpdateFabrisia Ambrosio PhD

ldquoThe best way to predict your future is to create itrdquo

mdash Abraham Lincoln

Physical rehabilitation has foundations in the targeted

application of mechanical stimuli to enhance intrinsic

tissue healing potential It is a given that rehabilitation practice

must constantly evolve to include innovative scientific and

technological advances that can positively impact clinical care

This responsibility to change leads to questions like ldquoHow can

we be in tune with the latest scientific developmentsrdquo ldquoAre we

prepared to offer our patients the finest carerdquo

Regenerative medicine is the process of creating

living functional tissues to repair or replace tissue

or organ function lost due to age disease damage

or congenital defects Rehabilitation is the process

of maximizing an individualrsquos functional capacity

after an illness or trauma Both fields hold great

potential to drive progress in the treatment of

a host of acute and chronic pathologies

These fields are inextricably intertwined mdash an intersection

of disciplines that is becoming known as Regenerative

Rehabilitation Regenerative rehabilitation is defined as ldquothe

integration of principles and approaches in rehabilitation and

regenerative medicine with the ultimate goal of developing

innovative and effective methods that promote the restoration

of function through tissue regeneration and repairrdquo

Integration of rehabilitation approaches with regenerative

medicine strategies can accelerate underlying tissue

restoration after injury and disease For example to promote

intrinsic healing of the host and to help integrate donor

transplants in a useful and functional way the application

of modalities or graded exercise programs may augment

normally occurring developmental sequences at the donor-

host interface An understanding of the basic science behind

physical treatments as well as regenerative medicine will help

guide the development of targeted rehabilitation programs

and reduce trial-and-error in treatments and studies

In 2011 the UPMC Rehabilitation Institute along with the

McGowan Institute for Regenerative Medicine and the

School of Health and Rehabilitation Sciences both at the

University of Pittsburgh partnered with the Palo Alto VA to

hold the First Symposium on Regenerative Rehabilitation

This annual symposium brings together scientists and

clinicians working in the fields of rehabilitative and

regenerative medicine The enthusiasm with which this

annual meeting has been received over the last four years

illustrates the strong biomedical rationale for the emerging

field of regenerative rehabilitation Indeed since the first calls

to rehabilitation colleagues highlighting the need for

increased communication and interaction between the

fields of rehabilitation and regenerative medicine (Ambrosio

et al 2010 Ambrosio and Russell 2010) there has been a

burgeoning national and international interest in the concept

In 2013 delegates from several institutions across the

country including the University of Pittsburgh Stanford

University the University of Washington Emory University

Wake Forest University the Mayo Clinic and the University

Hospital of Pisa convened to hold the First Annual Meeting of

the Regenerative Rehabilitation Consortium This Consortium

serves as a coordinated communication and planning nucleus

that seeks to systematize the process of writing white

papers designing rehabilitation online education modules

promoting collaborative efforts and disseminating cutting-

edge discoveries through the annual Symposium

In 2015 Kyoto University Kyoto Japan held its first

Workshop on Regenerative Rehabilitation with Fabrisia Ambrosio PhD assistant professor and original consortium

member delivering the keynote lecture This workshop

was successful in its goal of introducing the concept of

regenerative rehabilitation to students in rehabilitation

graduate training programs at Kyoto University

The future of regenerative rehabilitation is bright and the

integration of these two fields rehabilitative and regenerative

medicine will increase the efficiency of interventions designed

to optimize physical functioning to the benefit of a wide range

of individuals with disabilities For more information on the

Fourth Annual Symposium on Regenerative Rehabilitation

that was held on September 24-26 at the Mayo Clinic in

Rochester Minnesota visit the website at httpwwwmirmupmceduSymposiumdefaultasp or contact

Katy Wharton

McGowan Institute for Regenerative Medicine

450 Technology Drive Suite 300

Pittsburgh PA 15219

E-mail whartonkmupmcedu

Phone +1 412-624-5293

Fax +1 412-624-5228

3UPMC Rehabilitation Institute

PathwaymdashStudyofHumanCNSStemCellTransplantationinSpinalCordInjury

Stem Cells Inc has recruited the UPMC Rehabilitation Institute (RI)

along with other top-level research hospitals and institutions to

participate in a clinical proof-of-concept trial to determine if neural stem

cells can help improve spinal cord function and regain a level of strength

and sensation in patients with cervical spinal cord injury (SCI) Known as

the Pathway Study it is the first clinical study designed to evaluate both

the safety and efficacy of transplanting stem cells into

the cervical spinal cord Michael Munin MD professor

and vice chair of Clinical Program Development in the

Department of PMampR is principal investigator of the trial

at the UPMC Rehabilitation Institute

ldquoThis study represents a totally new paradigm in treating

cervical spinal cord injury ldquosays Dr Munin ldquoWe are

frequently asked by patients and families if there are

ways to repair an injured spinal cord The Pathway

Study is testing this concept through the use of stem

cell injectionsrdquo

This groundbreaking research is predicated on a recent

Phase III trial completed in May 2014 testing the safety

of transplanting tissue-derived adult CNS stem cells into

12 patients with thoracic (T2-T11) level spinal cord injury

Data from this study showed no safety concerns and

there was improvement in several patients The gains

included conversion from complete to incomplete injury

in two patients and voluntary toe movement in another patient

The Pathway Study will determine the effectiveness safety and benefits

of transplanting tissue-derived adult CNS stem cells above and below

the site of cervical spinal cord injury The primary efficacy outcome after

transplanting stem cells will be changes in sensory and motor function

using the International Standards for Neurological Classification of Spinal

Cord Injury (ISNCSCI)

Stem cells have been shown to repair replace or supplement damaged or

diseased cells with healthy cells in both preclinical and clinical trials Adult

stem cells can produce all functional cell types found within the tissue

from which they are derived Stem Cells Inc is using tissue-derived CNS

stem cells because they are naturally programmed to become mature

functional CNS cells and can be directly transplantable into the spinal

cord The premise is that the stem cells will differentiate

to the CNS cell types needed to repair replace or

supplement cells damaged as a result of spinal injury

Eligibility criteria state that subjects are 16 weeks to 2

years out from injury and fall into one of three ISNCSCI

classifications depending on injury level AIS A AIS B

and AIS C People who are interested in participating in

the study should complete a secure online questionnaire

to determine eligibility This questionnaire and other

information about the Pathway Study can be found at

httpswwwsciresearchstudycom

Patients who undergo transplantation will have five

follow-up visits after the surgery For up to a year after

the surgery these visits will take place every one to three

months and will involve physical exams blood tests and

MRI scans Participants in the transplant group also will

be given immunosuppressant medications to prevent their

immune systems from rejecting the transplanted cells

Patients assigned to the control group will be seen routinely over the

course of a year and undergo the same basic physical exams and MRIs

as the patients who had surgery

More information regarding the Pathway Study can be found at

httpswwwsciresearchstudycom or Dr Munin can be reached

directly at muninmcupmcedu

NUCLeUS

AXoN

NeRVeeNDINgS

MYeLINSHeATH

DAMAgeDMYeLINSHeATH

oLIgoDeNDRoCYTeS

4 R e H A BP R o g R e S S

AdvancedUpperLimbProstheticResearchattheUniversityofPittsburghUPMC

The Defense Advanced Research Projects Agency

(DARPA) recently awarded funding of its Hand

Proprioception and Touch Interfaces (HAPTIX) program to

the Department of Physical Medicine amp Rehabilitation at the

University of Pittsburgh The programrsquos aim is to develop a

fully integrated upper limb prosthetic arm with sensory and

motor capabilities that approach those of a natural limb

Robert Gaunt PhD assistant professor of PMampR will

direct teams of engineers scientists and clinicians from

the University of Pittsburgh West Virginia University

and Ripple LLC in developing advanced technology to

integrate movement and sensory functions in an upper limb

neuroprostheses that approach those of a natural arm

ldquoAdvanced prosthetic limbs that behave like the hand and

arm they are replacing have been an unrealized promise for

many years largely because until recently the technologies

to really accomplish this goal simply havenrsquot been availablerdquo

Dr Gaunt said ldquoTo make the most of these new capabilities

we have to integrate the prosthetic limb into the remaining

neural circuitry so the patient can use it like a regular hand

that for example can pick up a pen gently hold an egg or

turn a stuck doorknobrdquo

Present day commercially available myoelectric prostheses

use surface EMG recordings to infer user intent and they are

advanced compared to the less technological body-powered

devices Unfortunately function has not improved enough

for the user to incorporate the myoelectric device into daily

life in a fashion similar to a normal hand This shortcoming is

largely due to the lack of fine signal quality and consistency

of surface EMG recordings making the devices awkward and

causing difficulty performing ADLs

Added to these shortcomings is the lack of sensory feedback

that has been cited by patients as a major dissatisfaction

Sensory feedback is the key to a fully integrative prosthetic

arm Without sensory perception even the most advanced

limbs will remain as numb extracorporeal ldquotoolsrdquo rather

than fully integrated functional limbs

Motor Control

Muscle activity will be recorded from implanted

intramuscular electromyography (iEMG) electrodes at

multiple points in the forearm muscles Multiple iEMG

contacts will resolve the multiple actions of composite

muscles and increase the dynamic range of recordings

over varying physiological recruitment levels These iEMG

recordings will be used to drive advanced musculoskeletal

5UPMC Rehabilitation Institute

models of the forearm and hand using well-documented

principles of motor control physiology to form prosthesis

command signals

Building and training the algorithms that will decode the

EMG signals recorded from these intramuscular electrodes

into motor commands

will require a large

dataset of iEMG

signals for various hand

movements Extensive

EMG kinematic and

kinetic datasets taken

from 10 able-bodied

participants during a

variety of hand

postures and tasks will

be collected The

signals will be recorded

using fine-wire EMG

electrodes implanted

per cu ta neously in the

muscles of the forearms of volunteers EMG activity high

precision motion tracking data from the hand and arm and

forces from instrumented devices during sessions of object

manipulation tasks will be collected simultaneously

Sensory Control

Sensory information will be introduced by selectively

stimulating primary sensory afferents at the dorsal root

ganglia (DRG) through clinically approved percutaneous

leads Stimulation in the cervical DRG has three benefits in

terms of control signal acquisition

1 The majority of sensory afferents from the hand and

arm project into two to three adjacent DRG providing a

compact target for accessing the complete set of sensory

afferents from the limb

2 The DRG are considerably less mobile than more distal

portions of the peripheral nerve and the vertebral bodies

provide mechanical protection from disruption and injury

3 Open surgery will not be required to install the devices

on the cervical DRG as there are well-established clinical

procedures that are minimally invasive

The motor and sensory information will be combined

producing a closed-loop prosthetic control If successful this

proposed technology will provide an unprecedented level of

sensation and control not currently available in any prosthetic

system and will facilitate greater functional incorporation of

upper extremity prosthetic devices into the lives of amputees

AdvancedUpperLimbProstheticResearch

UPMCRehabilitationInstituteexpandstoIncludeFourNewTransitionalRehabUnits

As the health care landscape continues to evolve so does the UPMC Rehabilitation Institutersquos

commitment to patient care and recovery The Rehabilitation Institute is opening four new

transitional rehab units located within existing skilled nursing facilities

The transitional rehab units (TRUs) are designed for relatively short stays on average two to four

weeks for patients recovering from surgery illness or accidents These patients need additional care

resources and intensive therapy before returning home but are able to transition out of an acute

facility The goals are straightforward help patients return to their previous level of activity or better

and return them home as soon as possible

ldquoAs health care is evolving itrsquos very important for patients to get the most appropriate level of

care after they are discharged from the hospitalrdquo says Cara Camiolo-Reddy MD medical director

for the UPMC rehabilitation network ldquoThrough the transitional rehabilitation units we are helping

to expand and elevate the already excellent care provided at the skilled nursing facilities by creating

new partnerships with all the health care professionals involved in a patientsrsquo care mdash from the point

of admission to their return home That collaboration ensures that patients have continuity of

excellent care at every stage of their rehabilitationrdquo

The UPMC Rehabilitation Institute is part of one of the largest rehabilitation networks in Pennsylvania and one of the largest in the country

Fast Facts

bullMorethan200acuterehabilitationbedsineightlocations

bullMorethan70outpatientlocationsthroughoutwesternPennsylvania

bullMorethan150short-staybedsinskillednursingfacilities

6 R e H A BP R o g R e S S

RecentPublicationsBrain Injury

Acute Inflammatory Biomarker Profiles Predict Depression Risk Following Moderate to Severe Traumatic Brain Injury Juengst SB

Kumar RG Failla MD Goyal A Wagner AK J Head Trauma Rehabil

2015 May-Jun30(3)207-18 doi 101097HTR0000000000000031

PubMed [citation] PMID 24590155

Brain-Derived Neurotrophic Factor (BDNF) in Traumatic Brain Injury-Related Mortality Interrelationships between Genetics and Acute Systemic and Central Nervous System BDNF Profiles Failla MD

Conley YP Wagner AK Neurorehabil Neural Repair 2015 May 15

doipii 1545968315586465 [Epub ahead of print] PubMed [citation]

PMID 25979196

Post-Traumatic Brain Injury Cognitive Performance Is Moderated by Variation Within ANKK1 and DRD2 Genes Failla MD Myrga JM Ricker

JH Dixon CE Conley YP Wagner AK J Head Trauma Rehabil 2015 Apr 29

[Epub ahead of print] PubMed [citation] PMID 25931179

Neurobiological Model of Stimulated Dopamine Neurotransmission to Interpret Fast-Scan Cyclic Voltammetry Data Harun R Grassi CM

Munoz MJ Torres GE Wagner AK Brain Res 2015 Mar 2159967-84

doi 101016jbrainres201412020 Epub 2014 Dec 16 Review PubMed

[citation] PMID 25527399

Acute CSF Interleukin-6 Trajectories After TBI Associations with Neuroinflammation Polytrauma and Outcome Kumar RG Diamond ML

Boles JA Berger RP Tisherman SA Kochanek PM Wagner AK Brain

Behav Immun 2015 Mar45253-62 doi 101016jbbi201412021 Epub

2014 Dec 31 PubMed [citation] PMID 25555531

Variation in the BDNF Gene Interacts With Age to Predict Mortality in a Prospective Longitudinal Cohort With Severe TBI Failla MD Kumar RG

Peitzman AB Conley YP Ferrell RE Wagner AK Neurorehabil Neural Repair

2015 Mar-Apr29(3)234-46 doi 1011771545968314542617 Epub

2014 Jul 24 PubMed [citation] PMID 25063686 PMCID PMC4305354

Variable Neuroendocrine-Immune Dysfunction in Individuals With Unfavorable Outcome After Severe Traumatic Brain Injury Santarsieri M

Kumar RG Kochanek PM Berga S Wagner AK Brain Behav Immun 2015

Mar4515-27 doi 101016jbbi201409003 Epub 2014 Sep 16 PubMed

[citation] PMID 25218898 PMCID PMC4342288

Deciphering of Mitochondrial Cardiolipin Oxidative Signaling in Cerebral Ischemia-Reperfusion Ji J Baart S Vikulina AS Clark RS Anthonymuthu

TS Tyurin VA Du L St Croix CM Tyurina YY Lewis J Skoda EM Kline AE

Kochanek PM Wipf P Kagan VE Bayır H J Cereb Blood Flow Metab 2015

Feb35(2)319-28 doi101038jcbfm2014204 Epub 2014 Nov 19

PubMed [citation] PMID 25407268PMCID PMC4426750

Clinical Studies and Reports

National Spina Bifida Patient Registry Factors Associated With Pressure Ulcers in Individuals With Spina Bifida Kim S Ward E Dicianno BE

Clayton GH Sawin KJ Beierwaltes P Thibadeau J Arch Phys Med Rehabil

2015 Mar 18 doipii S0003-9993(15)00221-X 101016japmr201502029

[Epub ahead of print] PubMed [citation] PMID 25796136

Lateral Antebrachial Cutaneous Nerve Entrapment After Shoulder Arthroscopy A Case Report Yung H Lagemann GM Lin A Orebaugh SL

Cortazzo MH PMampR 2015 Mar 13 doipii S1934-1482(15)00140-9

101016jpmrj201503009 [Epub ahead of print] PubMed [citation]

PMID 25772722

Herbie Yung MD (first author) is a

third-year resident and is mentored by

Megan Cortazzo MD (second author)

an assistant professor in the Department

of Physical Medicine amp Rehabilitation

The article describes a case of lateral

antebrachial cutaneous nerve (LABCN)

entrapment following biceps tenodesis procedure and the route of

diagnosis and treatment

To the authorsrsquo knowledge this is the first case of LABCN entrapment

being attributed to biceps tenodesis The case report describes various

treatments used with unsatisfactory results and the eventual surgical

resolution to the nerve entrapment

For a short video showing release of the nerve go to httpwwwsciencedirectcomsciencearticlepiiS1934148215001409

The article can be found at httpwwwpmrjournalorgarticleS1934-1482(15)00140-9fulltext

Clinical Experience With Continuous Intrathecal Baclofen Trials Prior to Pump Implantation Phillips MM Miljkovic N Ramos-Lamboy M

Moossy JJ Horton J Buhari AM Munin MC PMampR 2015 Mar 28 doipii

S1934-1482(15)00172-0101016jpmrj201503020 [Epub ahead of

print] PubMed [citation] PMID 25828204

Adults With Childhood-Onset Chronic Conditions Admitted to US Pediatric and Adult Intensive Care Units Edwards JD Vasilevskis EE

Yoo EJ Houtrow AJ Boscardin WJ Dudley RA Okumura MJ J Crit Care

2015 Feb30(1)201-6 doi101016jjcrc201410016 Epub 2014 Oct 25

PubMed [citation] PMID 25466316PMCID PMC4268241

Computer Keyboarding Biomechanics and Acute Changes in Median Nerve Indicative of Carpal Tunnel Syndrome Toosi KK Hogaboom NS

Oyster ML Boninger ML Clin Biomech (Bristol Avon) 2015 Apr 23

doipii S0268-0033(15)00115-1101016jclinbiomech201504008

[Epub ahead of print] PubMed [citation] PMID 25933812

5UPMC Rehabilitation Institute

models of the forearm and hand using well-documented

principles of motor control physiology to form prosthesis

command signals

Building and training the algorithms that will decode the

EMG signals recorded from these intramuscular electrodes

into motor commands

will require a large

dataset of iEMG

signals for various hand

movements Extensive

EMG kinematic and

kinetic datasets taken

from 10 able-bodied

participants during a

variety of hand

postures and tasks will

be collected The

signals will be recorded

using fine-wire EMG

electrodes implanted

per cu ta neously in the

muscles of the forearms of volunteers EMG activity high

precision motion tracking data from the hand and arm and

forces from instrumented devices during sessions of object

manipulation tasks will be collected simultaneously

Sensory Control

Sensory information will be introduced by selectively

stimulating primary sensory afferents at the dorsal root

ganglia (DRG) through clinically approved percutaneous

leads Stimulation in the cervical DRG has three benefits in

terms of control signal acquisition

1 The majority of sensory afferents from the hand and

arm project into two to three adjacent DRG providing a

compact target for accessing the complete set of sensory

afferents from the limb

2 The DRG are considerably less mobile than more distal

portions of the peripheral nerve and the vertebral bodies

provide mechanical protection from disruption and injury

3 Open surgery will not be required to install the devices

on the cervical DRG as there are well-established clinical

procedures that are minimally invasive

The motor and sensory information will be combined

producing a closed-loop prosthetic control If successful this

proposed technology will provide an unprecedented level of

sensation and control not currently available in any prosthetic

system and will facilitate greater functional incorporation of

upper extremity prosthetic devices into the lives of amputees

AdvancedUpperLimbProstheticResearch

UPMCRehabilitationInstituteexpandstoIncludeFourNewTransitionalRehabUnits

As the health care landscape continues to evolve so does the UPMC Rehabilitation Institutersquos

commitment to patient care and recovery The Rehabilitation Institute is opening four new

transitional rehab units located within existing skilled nursing facilities

The transitional rehab units (TRUs) are designed for relatively short stays on average two to four

weeks for patients recovering from surgery illness or accidents These patients need additional care

resources and intensive therapy before returning home but are able to transition out of an acute

facility The goals are straightforward help patients return to their previous level of activity or better

and return them home as soon as possible

ldquoAs health care is evolving itrsquos very important for patients to get the most appropriate level of

care after they are discharged from the hospitalrdquo says Cara Camiolo-Reddy MD medical director

for the UPMC rehabilitation network ldquoThrough the transitional rehabilitation units we are helping

to expand and elevate the already excellent care provided at the skilled nursing facilities by creating

new partnerships with all the health care professionals involved in a patientsrsquo care mdash from the point

of admission to their return home That collaboration ensures that patients have continuity of

excellent care at every stage of their rehabilitationrdquo

The UPMC Rehabilitation Institute is part of one of the largest rehabilitation networks in Pennsylvania and one of the largest in the country

Fast Facts

bullMorethan200acuterehabilitationbedsineightlocations

bullMorethan70outpatientlocationsthroughoutwesternPennsylvania

bullMorethan150short-staybedsinskillednursingfacilities

6 R e H A BP R o g R e S S

RecentPublicationsBrain Injury

Acute Inflammatory Biomarker Profiles Predict Depression Risk Following Moderate to Severe Traumatic Brain Injury Juengst SB

Kumar RG Failla MD Goyal A Wagner AK J Head Trauma Rehabil

2015 May-Jun30(3)207-18 doi 101097HTR0000000000000031

PubMed [citation] PMID 24590155

Brain-Derived Neurotrophic Factor (BDNF) in Traumatic Brain Injury-Related Mortality Interrelationships between Genetics and Acute Systemic and Central Nervous System BDNF Profiles Failla MD

Conley YP Wagner AK Neurorehabil Neural Repair 2015 May 15

doipii 1545968315586465 [Epub ahead of print] PubMed [citation]

PMID 25979196

Post-Traumatic Brain Injury Cognitive Performance Is Moderated by Variation Within ANKK1 and DRD2 Genes Failla MD Myrga JM Ricker

JH Dixon CE Conley YP Wagner AK J Head Trauma Rehabil 2015 Apr 29

[Epub ahead of print] PubMed [citation] PMID 25931179

Neurobiological Model of Stimulated Dopamine Neurotransmission to Interpret Fast-Scan Cyclic Voltammetry Data Harun R Grassi CM

Munoz MJ Torres GE Wagner AK Brain Res 2015 Mar 2159967-84

doi 101016jbrainres201412020 Epub 2014 Dec 16 Review PubMed

[citation] PMID 25527399

Acute CSF Interleukin-6 Trajectories After TBI Associations with Neuroinflammation Polytrauma and Outcome Kumar RG Diamond ML

Boles JA Berger RP Tisherman SA Kochanek PM Wagner AK Brain

Behav Immun 2015 Mar45253-62 doi 101016jbbi201412021 Epub

2014 Dec 31 PubMed [citation] PMID 25555531

Variation in the BDNF Gene Interacts With Age to Predict Mortality in a Prospective Longitudinal Cohort With Severe TBI Failla MD Kumar RG

Peitzman AB Conley YP Ferrell RE Wagner AK Neurorehabil Neural Repair

2015 Mar-Apr29(3)234-46 doi 1011771545968314542617 Epub

2014 Jul 24 PubMed [citation] PMID 25063686 PMCID PMC4305354

Variable Neuroendocrine-Immune Dysfunction in Individuals With Unfavorable Outcome After Severe Traumatic Brain Injury Santarsieri M

Kumar RG Kochanek PM Berga S Wagner AK Brain Behav Immun 2015

Mar4515-27 doi 101016jbbi201409003 Epub 2014 Sep 16 PubMed

[citation] PMID 25218898 PMCID PMC4342288

Deciphering of Mitochondrial Cardiolipin Oxidative Signaling in Cerebral Ischemia-Reperfusion Ji J Baart S Vikulina AS Clark RS Anthonymuthu

TS Tyurin VA Du L St Croix CM Tyurina YY Lewis J Skoda EM Kline AE

Kochanek PM Wipf P Kagan VE Bayır H J Cereb Blood Flow Metab 2015

Feb35(2)319-28 doi101038jcbfm2014204 Epub 2014 Nov 19

PubMed [citation] PMID 25407268PMCID PMC4426750

Clinical Studies and Reports

National Spina Bifida Patient Registry Factors Associated With Pressure Ulcers in Individuals With Spina Bifida Kim S Ward E Dicianno BE

Clayton GH Sawin KJ Beierwaltes P Thibadeau J Arch Phys Med Rehabil

2015 Mar 18 doipii S0003-9993(15)00221-X 101016japmr201502029

[Epub ahead of print] PubMed [citation] PMID 25796136

Lateral Antebrachial Cutaneous Nerve Entrapment After Shoulder Arthroscopy A Case Report Yung H Lagemann GM Lin A Orebaugh SL

Cortazzo MH PMampR 2015 Mar 13 doipii S1934-1482(15)00140-9

101016jpmrj201503009 [Epub ahead of print] PubMed [citation]

PMID 25772722

Herbie Yung MD (first author) is a

third-year resident and is mentored by

Megan Cortazzo MD (second author)

an assistant professor in the Department

of Physical Medicine amp Rehabilitation

The article describes a case of lateral

antebrachial cutaneous nerve (LABCN)

entrapment following biceps tenodesis procedure and the route of

diagnosis and treatment

To the authorsrsquo knowledge this is the first case of LABCN entrapment

being attributed to biceps tenodesis The case report describes various

treatments used with unsatisfactory results and the eventual surgical

resolution to the nerve entrapment

For a short video showing release of the nerve go to httpwwwsciencedirectcomsciencearticlepiiS1934148215001409

The article can be found at httpwwwpmrjournalorgarticleS1934-1482(15)00140-9fulltext

Clinical Experience With Continuous Intrathecal Baclofen Trials Prior to Pump Implantation Phillips MM Miljkovic N Ramos-Lamboy M

Moossy JJ Horton J Buhari AM Munin MC PMampR 2015 Mar 28 doipii

S1934-1482(15)00172-0101016jpmrj201503020 [Epub ahead of

print] PubMed [citation] PMID 25828204

Adults With Childhood-Onset Chronic Conditions Admitted to US Pediatric and Adult Intensive Care Units Edwards JD Vasilevskis EE

Yoo EJ Houtrow AJ Boscardin WJ Dudley RA Okumura MJ J Crit Care

2015 Feb30(1)201-6 doi101016jjcrc201410016 Epub 2014 Oct 25

PubMed [citation] PMID 25466316PMCID PMC4268241

Computer Keyboarding Biomechanics and Acute Changes in Median Nerve Indicative of Carpal Tunnel Syndrome Toosi KK Hogaboom NS

Oyster ML Boninger ML Clin Biomech (Bristol Avon) 2015 Apr 23

doipii S0268-0033(15)00115-1101016jclinbiomech201504008

[Epub ahead of print] PubMed [citation] PMID 25933812

6 R e H A BP R o g R e S S

RecentPublicationsBrain Injury

Acute Inflammatory Biomarker Profiles Predict Depression Risk Following Moderate to Severe Traumatic Brain Injury Juengst SB

Kumar RG Failla MD Goyal A Wagner AK J Head Trauma Rehabil

2015 May-Jun30(3)207-18 doi 101097HTR0000000000000031

PubMed [citation] PMID 24590155

Brain-Derived Neurotrophic Factor (BDNF) in Traumatic Brain Injury-Related Mortality Interrelationships between Genetics and Acute Systemic and Central Nervous System BDNF Profiles Failla MD

Conley YP Wagner AK Neurorehabil Neural Repair 2015 May 15

doipii 1545968315586465 [Epub ahead of print] PubMed [citation]

PMID 25979196

Post-Traumatic Brain Injury Cognitive Performance Is Moderated by Variation Within ANKK1 and DRD2 Genes Failla MD Myrga JM Ricker

JH Dixon CE Conley YP Wagner AK J Head Trauma Rehabil 2015 Apr 29

[Epub ahead of print] PubMed [citation] PMID 25931179

Neurobiological Model of Stimulated Dopamine Neurotransmission to Interpret Fast-Scan Cyclic Voltammetry Data Harun R Grassi CM

Munoz MJ Torres GE Wagner AK Brain Res 2015 Mar 2159967-84

doi 101016jbrainres201412020 Epub 2014 Dec 16 Review PubMed

[citation] PMID 25527399

Acute CSF Interleukin-6 Trajectories After TBI Associations with Neuroinflammation Polytrauma and Outcome Kumar RG Diamond ML

Boles JA Berger RP Tisherman SA Kochanek PM Wagner AK Brain

Behav Immun 2015 Mar45253-62 doi 101016jbbi201412021 Epub

2014 Dec 31 PubMed [citation] PMID 25555531

Variation in the BDNF Gene Interacts With Age to Predict Mortality in a Prospective Longitudinal Cohort With Severe TBI Failla MD Kumar RG

Peitzman AB Conley YP Ferrell RE Wagner AK Neurorehabil Neural Repair

2015 Mar-Apr29(3)234-46 doi 1011771545968314542617 Epub

2014 Jul 24 PubMed [citation] PMID 25063686 PMCID PMC4305354

Variable Neuroendocrine-Immune Dysfunction in Individuals With Unfavorable Outcome After Severe Traumatic Brain Injury Santarsieri M

Kumar RG Kochanek PM Berga S Wagner AK Brain Behav Immun 2015

Mar4515-27 doi 101016jbbi201409003 Epub 2014 Sep 16 PubMed

[citation] PMID 25218898 PMCID PMC4342288

Deciphering of Mitochondrial Cardiolipin Oxidative Signaling in Cerebral Ischemia-Reperfusion Ji J Baart S Vikulina AS Clark RS Anthonymuthu

TS Tyurin VA Du L St Croix CM Tyurina YY Lewis J Skoda EM Kline AE

Kochanek PM Wipf P Kagan VE Bayır H J Cereb Blood Flow Metab 2015

Feb35(2)319-28 doi101038jcbfm2014204 Epub 2014 Nov 19

PubMed [citation] PMID 25407268PMCID PMC4426750

Clinical Studies and Reports

National Spina Bifida Patient Registry Factors Associated With Pressure Ulcers in Individuals With Spina Bifida Kim S Ward E Dicianno BE

Clayton GH Sawin KJ Beierwaltes P Thibadeau J Arch Phys Med Rehabil

2015 Mar 18 doipii S0003-9993(15)00221-X 101016japmr201502029

[Epub ahead of print] PubMed [citation] PMID 25796136

Lateral Antebrachial Cutaneous Nerve Entrapment After Shoulder Arthroscopy A Case Report Yung H Lagemann GM Lin A Orebaugh SL

Cortazzo MH PMampR 2015 Mar 13 doipii S1934-1482(15)00140-9

101016jpmrj201503009 [Epub ahead of print] PubMed [citation]

PMID 25772722

Herbie Yung MD (first author) is a

third-year resident and is mentored by

Megan Cortazzo MD (second author)

an assistant professor in the Department

of Physical Medicine amp Rehabilitation

The article describes a case of lateral

antebrachial cutaneous nerve (LABCN)

entrapment following biceps tenodesis procedure and the route of

diagnosis and treatment

To the authorsrsquo knowledge this is the first case of LABCN entrapment

being attributed to biceps tenodesis The case report describes various

treatments used with unsatisfactory results and the eventual surgical

resolution to the nerve entrapment

For a short video showing release of the nerve go to httpwwwsciencedirectcomsciencearticlepiiS1934148215001409

The article can be found at httpwwwpmrjournalorgarticleS1934-1482(15)00140-9fulltext

Clinical Experience With Continuous Intrathecal Baclofen Trials Prior to Pump Implantation Phillips MM Miljkovic N Ramos-Lamboy M

Moossy JJ Horton J Buhari AM Munin MC PMampR 2015 Mar 28 doipii

S1934-1482(15)00172-0101016jpmrj201503020 [Epub ahead of

print] PubMed [citation] PMID 25828204

Adults With Childhood-Onset Chronic Conditions Admitted to US Pediatric and Adult Intensive Care Units Edwards JD Vasilevskis EE

Yoo EJ Houtrow AJ Boscardin WJ Dudley RA Okumura MJ J Crit Care

2015 Feb30(1)201-6 doi101016jjcrc201410016 Epub 2014 Oct 25

PubMed [citation] PMID 25466316PMCID PMC4268241

Computer Keyboarding Biomechanics and Acute Changes in Median Nerve Indicative of Carpal Tunnel Syndrome Toosi KK Hogaboom NS

Oyster ML Boninger ML Clin Biomech (Bristol Avon) 2015 Apr 23

doipii S0268-0033(15)00115-1101016jclinbiomech201504008

[Epub ahead of print] PubMed [citation] PMID 25933812

7UPMC Rehabilitation Institute

Advanced Joystick Algorithms for Computer Access Tasks Dicianno BE Mahajan H Cooper RA PMampR 2015 Jan 13 doipii S1934-

1482(15)00005-2101016jpmrj201412009 [Epub ahead of print]

PubMed [citation] PMID 25595664

Hospital-Acquired Pneumonia Is an Independent Predictor of Poor Global Outcome in Severe Traumatic Brain Injury Up to 5 Years After Discharge Kesinger MR Kumar RG Wagner AK Puyana JC Peitzman AB Billiar TR

Sperry JL J Trauma Acute Care Surg 2015 Feb78(2)396-402 doi 101097

TA0000000000000526 PubMed [citation] PMID 25757128

Health Care Trends

Perspectives on the Evolution of Mobile (Mhealth) Technologies and Application to Rehabilitation Dicianno BE Parmanto B Fairman AD

Crytzer TM Yu DX Pramana G Coughenour D Petrazzi AA Phys Ther 2015

Mar95(3)397-405 doi 102522ptj20130534 Epub 2014 Jun 12 PubMed

[citation] PMID 24925075

Spinal Cord Injury and RelatedBrain-Computer Interfaces

Biological Responses to FlexionExtension in Spinal Segments Ex-vivo Hartman RA Yurube T Ngo K Merzlak NE Debski RE Brown BN Kang JD

Sowa GA J Orthop Res 2015 Apr 10 doi 101002jor22900 [Epub ahead of

print] PubMed [citation]PMID 25865090

Ten-Dimensional Anthropomorphic Arm Control in a Human Brain-Machine Interface Difficulties Solutions and Limitations Wodlinger B

Downey JE Tyler-Kabara EC Schwartz AB Boninger ML Collinger JL

J Neural Eng 2015 Feb12(1)016011doi 1010881741-2560121016011

Epub 2014 Dec 16 PubMed [citation] PMID25514320

Microstimulation of Afferents in the Sacral Dorsal Root Ganglia Can Evoke Reflex Bladder Activity Bruns TM Weber DJ Gaunt RA Neurourol

Urodyn 2015 Jan34(1)65-71 doi 101002nau22514 Epub 2014 Jan 24

PubMed [citation] PMID 24464833 PMCID PMC4110198

Biocompatibility of a Coacervate-Based Controlled Release System for Protein Delivery to the Injured Spinal Cord Acta Biomater Rauck BM

Novosat TL Oudega M Wang Y 2015 Jan11204-11 doi101016

jactbio201409037 Epub 2014 Oct 8PubMed [citation] PMID

25266504 PMCID PMC4256151

Sports Medicine

Factors Related to Injury in Youth and Adolescent Baseball Pitching With an Eye Toward Prevention Popchak A Burnett T Weber N Boninger ML

Am J Phys Med Rehabil 2015 May94(5)395-409 doi 101097

PHM0000000000000184 PubMed [citation] PMID 25251251

AWARDS

American Congress of Rehabilitation Medicine

Michael L Boninger MD professor

and chair Department of Physical

Medicine amp Rehabilitation is the

recipient of the 2015 John Coulter

Stanley Award recognizing his

professional achievements that

contributed significantly to the field

of PMampR Dr Boningerrsquos Coulter

lecture ldquoNeuroprosthetics to

Wheelchairs the Good the Bad

and the Ugly of Assistive Technologyrdquo was presented at the

Annual ACRM meeting on October 29 2015 in Dallas Texas

Association of Academic Physiatrists (AAP)

Prakash Jayabalan MD PhD

received the AAP McLean Outstanding Resident Award

which honors a resident who

demonstrates outstanding

academic performance in

academic leadership teaching

education and research

Dr Jayabalan also was the

recipient of the 2013 Electrode Store Best Resident Paper

Jessica Ziebarth DO (PGY4)

was the 2015 recipient of the

Electrode Store Best Resident Paper ldquoThe Impact of Early Mobility on Length of Stay in the Acute Care Hospital Settingrdquo

Drs Jayabalan and Ziebarth

join the ranks of past UPMC

Rehabilitation Institute PMampR residents recognized by the

AAP Brad Dicianno MD (rsquo05) received the 2004 AAP

Best Paper Presentation by a Resident After joining the

department faculty in 2005 Dicianno went on to receive the

Electrode Store Faculty category and Young Academician

awards Stephen J OrsquoConnell DO (rsquo10) was presented with

the AAP Outstanding Oral Scientific Paper Presentation

Award in 2009 and Angela Garcia MD (rsquo10) received the

2011 Ernest W Johnson Excellence in Research Writing

Award from AAP

RecentPublications

prog

ress

copy2015 UPMCUSNW416741HMMP1115

UPMC Rehabilitation Institute

Pittsburgh PA

Michael L Boninger MD

Director

ADDReSSCoRReSPoNDeNCeTo

Michael C Munin MD

Senior Editor

KaufmannMedicalBuilding

Suite201

PittsburghPA15213

muninmcupmcedu

Affiliate Links

UPMCRehabilitationInstitute

UPMCcomRehabInstitute

SchoolofMedicineDepartmentof

PhysicalMedicineandRehabilitation

wwwrehabmedicinepittedu

UPMCPhysicianResources

UPMCPhysicianResourcescomRehab

SchoolofHealthandRehabilitation

SciencesDepartmentofRehabilitation

ScienceandTechnology

wwwshrspittedurst

UPMCCenterforAssistiveTechnology

UPMCcomCAT

HumanengineeringResearchLaboratories

wwwherlpittorg

Forconsultsandreferrals

pleasecallUPMCrsquos24-hour

physicianonDemandservice

at1-866-884-8579

Aworld-renownedhealthcareproviderandinsurer

Pittsburgh-basedUPMCisinventingnewmodels

ofaccountablecost-effectivepatient-centeredcare

Itprovidesmorethan$888millionayearinbenefits

toitscommunitiesincludingmorecaretotheregionrsquos

mostvulnerablecitizensthananyotherhealthcare

institutionThelargestnongovernmentalemployerin

PennsylvaniaUPMCintegratesmorethan60000

employeesmorethan20hospitalsmorethan500

doctorsrsquoofficesandoutpatientsitesamorethan

27-million-memberhealthinsurancedivisionand

internationalandcommercialoperationsAffiliated

withtheUniversityofPittsburghSchoolsoftheHealth

SciencesUPMCranksNo13intheprestigiousUS

News amp World ReportannualHonorRollofAmericarsquos

BestHospitalsFormoreinformationgotoUPMCcom

UPMCPhysicianResourcescom Rehab

About the UPMC Rehabilitation Institute

bull UPMC is ranked by US News amp World Report as one of the top hospitals in the

country for rehabilitation

bull Stroke rehabilitation at the UPMC Rehabilitation Institute is certified by

The Joint Commission

bull Our experts combine extensive clinical experience with advanced technology

and research to offer our patients cutting-edge treatments

bull We are one of only seven institutions with both SCI and TBI Model System

designations from the NIDRR

UPMC ViDeo RoUNDS

Video Rounds is a series of informative and educational short videos created for physicians and

covering a variety of medical and surgical disciplines including

Brain Injury Biomarker ResearchAmy Wagner MD

Dr Wagner endowed research chair Physical Medicine and Rehabilitation has extensively

researched brain injury biomarkers and explains how this field of research can be valuable when

applied to rehabilitation medicine and specifically traumatic brain injury

httpswwwyoutubecomwatchv=S92NxsMf6Icampfeature=youtube

Creating a Medical Home for Musculoskeletal Conditions Gwendolyn Sowa MD PhD

Dr Sowa associate professor in the Department of Physical Medicine and Rehabilitation

at UPMC is spearheading the creation and development of a musculoskeletal medical home

This model aims to provide patients with a comprehensive approach to care to advance

recovery and to improve quality of life

httpswwwyoutubecomwatchv=x-y3gX2w9m4ampfeature=youtube

UPMC Rehab Grand Rounds Fall 2015Traumatic Brain Injury and Post-Traumatic Epilepsy Current Practice and Future Proposals for an Individualized ApproachTo view this issue of Rehab Grand Rounds and the video and slide

presentations please visit httpwwwupmcphysicianresourcescomcme-courserehab-grand-rounds-fall-2015

UPMCREHAB GRAND ROUNDS

Affiliated with the University of Pittsburgh School of Medicine UPMC is

ranked among the nationrsquos best hospitals by US News amp World Report

FA L L 2 0 1 5

Accreditation Statement The University of Pittsburgh Schoolof Medicine is accredited by theAccreditation Council for ContinuingMedical Education (ACCME) toprovide continuing medicaleducation for physiciansThe University of Pittsburgh Schoolof Medicine designates this enduringmaterial for a maximum of 5 AMAPRA Category 1 Creditstrade Eachphysician should only claim creditcommensurate with the extent oftheir participation in the activityOther health care professionals areawarded 05 continuing educationunits (CEU) which are equivalent to 5 contact hours

Disclosures Doctors Galang Ferimer and Wagner have reported no relevant relationships with proprietary entities producing health care goods or services

Instructions To take the CME evaluation and receive credit please visitUPMCPhysicianResourcescomRehab and click on the courseRehab Grand Rounds Fall 2015

Traumatic Brain Injury and Post-TraumaticEpilepsy Current Practice and Future Proposals for an Individualized ApproachGAry GALAnG MDAssistant Professor Department of Physical Medicine and Rehabilitation

University of Pittsburgh School of MedicineStephAnIe FerIMer MDResident Physician Department of Physical Medicine and Rehabilitation

University of Pittsburgh School of MedicineAMy WAGner MDAssociate Professor and Endowed Research Chair Department of Physical Medicine and Rehabilitation University of Pittsburgh School of Medicine

Clinical VignetteMB a 40-year-old left-hand dominant male mechanic with no significant past medical history sustained a traumatic brain injury (TBI) after an ATV accident MB was an unhelmeted driver whose vehicle flipped over a steep ravine He lost consciousness for approximately five minutes as reported by a fellow rider who was with him MB was pinned under the ATV and sustained multiple crush injuries as well as second degree burns to his legs The EMT documented a Glasgow Coma Scale (GCS) of 7 (eye response-2 verbal response-1 motor response-4) at the scene of the collision Pupils were equal and reactive MB required intubation to maintain an airway He was transported by helicopter to our level I trauma facility 100 miles from the scene of injury At the hospital CT head without contrast was obtained which showed extensive facial fractures and left subdural or subarachnoid hemorrhage (see Figure 1)

FIGURE 1 Ct scan image with an example of a left subdural or subarachnoid hemorrhage after receiving IV contrast

prog

ress

copy2015 UPMCUSNW416741HMMP1115

UPMC Rehabilitation Institute

Pittsburgh PA

Michael L Boninger MD

Director

ADDReSSCoRReSPoNDeNCeTo

Michael C Munin MD

Senior Editor

KaufmannMedicalBuilding

Suite201

PittsburghPA15213

muninmcupmcedu

Affiliate Links

UPMCRehabilitationInstitute

UPMCcomRehabInstitute

SchoolofMedicineDepartmentof

PhysicalMedicineandRehabilitation

wwwrehabmedicinepittedu

UPMCPhysicianResources

UPMCPhysicianResourcescomRehab

SchoolofHealthandRehabilitation

SciencesDepartmentofRehabilitation

ScienceandTechnology

wwwshrspittedurst

UPMCCenterforAssistiveTechnology

UPMCcomCAT

HumanengineeringResearchLaboratories

wwwherlpittorg

Forconsultsandreferrals

pleasecallUPMCrsquos24-hour

physicianonDemandservice

at1-866-884-8579

Aworld-renownedhealthcareproviderandinsurer

Pittsburgh-basedUPMCisinventingnewmodels

ofaccountablecost-effectivepatient-centeredcare

Itprovidesmorethan$888millionayearinbenefits

toitscommunitiesincludingmorecaretotheregionrsquos

mostvulnerablecitizensthananyotherhealthcare

institutionThelargestnongovernmentalemployerin

PennsylvaniaUPMCintegratesmorethan60000

employeesmorethan20hospitalsmorethan500

doctorsrsquoofficesandoutpatientsitesamorethan

27-million-memberhealthinsurancedivisionand

internationalandcommercialoperationsAffiliated

withtheUniversityofPittsburghSchoolsoftheHealth

SciencesUPMCranksNo13intheprestigiousUS

News amp World ReportannualHonorRollofAmericarsquos

BestHospitalsFormoreinformationgotoUPMCcom

UPMCPhysicianResourcescom Rehab

About the UPMC Rehabilitation Institute

bull UPMC is ranked by US News amp World Report as one of the top hospitals in the

country for rehabilitation

bull Stroke rehabilitation at the UPMC Rehabilitation Institute is certified by

The Joint Commission

bull Our experts combine extensive clinical experience with advanced technology

and research to offer our patients cutting-edge treatments

bull We are one of only seven institutions with both SCI and TBI Model System

designations from the NIDRR

UPMC ViDeo RoUNDS

Video Rounds is a series of informative and educational short videos created for physicians and

covering a variety of medical and surgical disciplines including

Brain Injury Biomarker ResearchAmy Wagner MD

Dr Wagner endowed research chair Physical Medicine and Rehabilitation has extensively

researched brain injury biomarkers and explains how this field of research can be valuable when

applied to rehabilitation medicine and specifically traumatic brain injury

httpswwwyoutubecomwatchv=S92NxsMf6Icampfeature=youtube

Creating a Medical Home for Musculoskeletal Conditions Gwendolyn Sowa MD PhD

Dr Sowa associate professor in the Department of Physical Medicine and Rehabilitation

at UPMC is spearheading the creation and development of a musculoskeletal medical home

This model aims to provide patients with a comprehensive approach to care to advance

recovery and to improve quality of life

httpswwwyoutubecomwatchv=x-y3gX2w9m4ampfeature=youtube

UPMC Rehab Grand Rounds Fall 2015Traumatic Brain Injury and Post-Traumatic Epilepsy Current Practice and Future Proposals for an Individualized ApproachTo view this issue of Rehab Grand Rounds and the video and slide

presentations please visit httpwwwupmcphysicianresourcescomcme-courserehab-grand-rounds-fall-2015

UPMCREHAB GRAND ROUNDS

Affiliated with the University of Pittsburgh School of Medicine UPMC is

ranked among the nationrsquos best hospitals by US News amp World Report

FA L L 2 0 1 5

Accreditation Statement The University of Pittsburgh Schoolof Medicine is accredited by theAccreditation Council for ContinuingMedical Education (ACCME) toprovide continuing medicaleducation for physiciansThe University of Pittsburgh Schoolof Medicine designates this enduringmaterial for a maximum of 5 AMAPRA Category 1 Creditstrade Eachphysician should only claim creditcommensurate with the extent oftheir participation in the activityOther health care professionals areawarded 05 continuing educationunits (CEU) which are equivalent to 5 contact hours

Disclosures Doctors Galang Ferimer and Wagner have reported no relevant relationships with proprietary entities producing health care goods or services

Instructions To take the CME evaluation and receive credit please visitUPMCPhysicianResourcescomRehab and click on the courseRehab Grand Rounds Fall 2015

Traumatic Brain Injury and Post-TraumaticEpilepsy Current Practice and Future Proposals for an Individualized ApproachGAry GALAnG MDAssistant Professor Department of Physical Medicine and Rehabilitation

University of Pittsburgh School of MedicineStephAnIe FerIMer MDResident Physician Department of Physical Medicine and Rehabilitation

University of Pittsburgh School of MedicineAMy WAGner MDAssociate Professor and Endowed Research Chair Department of Physical Medicine and Rehabilitation University of Pittsburgh School of Medicine

Clinical VignetteMB a 40-year-old left-hand dominant male mechanic with no significant past medical history sustained a traumatic brain injury (TBI) after an ATV accident MB was an unhelmeted driver whose vehicle flipped over a steep ravine He lost consciousness for approximately five minutes as reported by a fellow rider who was with him MB was pinned under the ATV and sustained multiple crush injuries as well as second degree burns to his legs The EMT documented a Glasgow Coma Scale (GCS) of 7 (eye response-2 verbal response-1 motor response-4) at the scene of the collision Pupils were equal and reactive MB required intubation to maintain an airway He was transported by helicopter to our level I trauma facility 100 miles from the scene of injury At the hospital CT head without contrast was obtained which showed extensive facial fractures and left subdural or subarachnoid hemorrhage (see Figure 1)

FIGURE 1 Ct scan image with an example of a left subdural or subarachnoid hemorrhage after receiving IV contrast