Baylor Scott and White Institute for Rehabilitation

Driver, S., S. Juengst, E. E. McShan, M. Bennett, K. Bell and R. Dubiel (2019). “A randomized controlled trial protocol for people with traumatic brain injury enrolled in a healthy lifestyle program (GLB-TBI).” Contemp Clin Trials Commun 14: 100328. eCollection 2019 June.

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Weight gain is prevalent among people with traumatic brain injury (TBI) and may be attributable to environmental or injury-specific factors such as mobility impairment, endocrine dysfunction, behavioral and emotional disorders, and sensory loss. Few weight management programs exist to meet the unique needs of this population. Researchers modified a nationally recognized, evidence-based weight-loss program, Group Lifestyle Balance (GLB), to address the needs of over-weight and obese people post TBI (GLB-TBI). This current randomized controlled trial (RCT) examines the efficacy of the GLB-TBI on weight and secondary outcomes compared to an attention control educational support group. Furthermore, researchers have developed a mobile technology app to further engage participants in the program. This RCT will enroll and randomize 66 participants over a two-year period. It is anticipated that findings from this current RCT will contribute to the knowledge and evidence for an effective weight-loss intervention among this underserved population, with a goal of achieving full recognition by the Centers for Disease Control and Prevention-National Diabetes Prevention Program and subsequent Center for Medicare and Medicaid Services reimbursement for participation.

Juengst, S. B., V. Silva, Y. Goldin, K. Cicerone, J. Lengenfelder, N. Chiaravalloti, S. Driver, D. Mellick, G. Dart, C. L. Kew, A. Nabasny and K. R. Bell (2019). “Care partner problem solving training (CP-PST) for care partners of adults with traumatic brain injury during inpatient rehabilitation: Study protocol for a multisite, randomized, single-blind clinical feasibility trial.” Contemp Clin Trials 80: 9-15.

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Traumatic brain injury (TBI) often leads to immediate and chronic functional impairments that affect care partners, or those providing physical and/or emotional support to individuals with TBI. The many challenges associated with being a care partner often lead to caregiver burden and can compromise the well-being and quality of life of care partners and individuals with TBI under their care. Equipping care partners with problem-solving skills could facilitate and sustain their transition into this supportive role. Problem-solving training (PST) has demonstrated efficacy for providing such skills to care partners of individuals with TBI after discharge from inpatient rehabilitation. We propose that PST delivered to care partners during inpatient rehabilitation of individuals with TBI will provide care partners with the skills to manage their caregiving roles across the transition from hospital to home. Herein, we describe the methodology of a current randomized controlled trial that examines the feasibility and efficacy of PST plus TBI education compared to TBI education alone to improve care partner burden, emotional distress, and adaptive coping when delivered during the inpatient rehabilitation stay of individuals with moderate-severe TBI.

Clark, R. H. and V. N. Tolia (2019). “The Use of Oxygen at Discharge: Is It Safe? Is It Effective?” Pediatrics 143(5): e20190372.

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Oxygen is one of the most commonly used therapies in premature infants. Like all drugs, it can be both therapeutic and toxic. In his 2004 commentary, “A Cautionary Tale About Supplemental Oxygen: The Albatross of Neonatal Medicine,” Dr Silverman provided us with an important history lesson: what we believe to be true is not always true, and with great intent, we can do great harm. Over the last decade, clinical studies of oxygen dosing and oxygen saturation targets5 have only increased the intensity of Dr Silverman’s message. Although recommendations regarding oxygen use in the delivery room and in the NICU have changed on the basis of clinical trials and careful analysis of the evidence, the evidence regarding oxygen use after discharge is far less clear, and variation in practice is endemic. In their article “Home Oxygen and 2-Year Outcomes of Preterm Infants With Bronchopulmonary Dysplasia [BPD],” DeMauro et al have added to our understanding of the efficacy and safety of this practice. Many clinicians believe that home oxygen therapy improves growth, reduces pulmonary complications, and promotes better neurodevelopmental outcomes, although none of these beliefs are supported by high-quality evidence. In this propensity score–matched cohort study, DeMauro et al conclude that “postdischarge oxygen was associated with marginally improved growth and increased resource use but no difference in neurodevelopmental outcomes.” (Excerpt from text of this commentary, p. e20190372: 1.)

Ahmad, K. A., M. M. Bennett, P. Rayburn, C. A. Combs, R. H. Clark and V. N. Tolia (2019). “Outcomes of preterm infants conceived with in vitro fertilization.” J Perinatol 39(5): 717-722.

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OBJECTIVES: To determine if there is increased risk of prematurity-related complications for in vitro fertilization (IVF)-conceived preterm infants compared to matched controls. STUDY DESIGN: Cohort study of 23-34 weeks’ preterm infants from 329 US NICUs discharged from 2009 to 2016. Each IVF patient was matched to three controls. RESULTS: We identified 6,756 IVF-conceived preterm infants who were matched with 20,268 controls. IVF-conceived infants had no increase in non-respiratory morbidities but had significantly higher rates of bronchopulmonary dysplasia (8.4% vs 7%, p < 0.001) and significantly greater exposure to common chronic respiratory medications. CONCLUSIONS: In this large cohort of IVF-conceived preterm infants we found similar outcomes to controls with the exception of bronchopulmonary dysplasia and respiratory medication exposure. Further research is needed to explore the influence of in vitro fertilization on the development of neonatal respiratory disease.

Swank, C., S. Sikka, S. Driver, M. Bennett and L. Callender (2019). “Feasibility of integrating robotic exoskeleton gait training in inpatient rehabilitation.” Disabil Rehabil Assist Technol Mar 19: 1-9. [Epub ahead of print].

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OBJECTIVE: Learning to walk is a major goal of inpatient rehabilitation and robotic exoskeletons may provide a new gait training approach. Our purpose was to determine the feasibility of integrating the Ekso Gait Training device into inpatient rehabilitation in a neurologic population. DESIGN: Longitudinal cohort design and convenience sample including physical therapists trained to use the Ekso Bionics Ekso GT robotic exoskeleton or inpatients with stroke or SCI. Therapists completed a focus group and survey at baseline and 6 months after initial Ekso training. Patients completed a survey indicating their satisfaction with using the Ekso. RESULTS: Twenty-five patients used the Ekso an average of 4.5 sessions during their 38.5-day rehabilitation stay. Survey and focus group feedback revealed that therapists encountered measurement difficulties with the Ekso and limited treatment time influencing effectiveness of usage. After 6 months, therapists reported an improvement in feasibility. Patients tolerated Ekso sessions well, without any complications or adverse incidents, and reported improved mobility post session. CONCLUSION: Integrating Ekso gait training into clinical practice was not seamless but appears feasible. Barriers were addressed within the rehabilitation team and received administrative support in a process lasting several months. Patients enjoyed walking in Ekso and felt secure within the device. Implications for rehabilitation Integrating Ekso gait training into clinical practice during inpatient rehabilitation is feasible. Overcoming barriers to implementation required administrative support and clinician persistence over several months. Patients tolerated Ekso sessions well, without any complications or adverse incidents.