Chad Swank Ph.D.

Swank, C., Trammell, M., Bennett, M., Ochoa, C., Callender, L., Sikka, S. and Driver, S. (2020). “The utilization of an overground robotic exoskeleton for gait training during inpatient rehabilitation-single-center retrospective findings.” Int J Rehabil Res 43(3): 206-213.

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Overground robotic exoskeleton gait training is increasingly utilized during inpatient rehabilitation yet without clear guidelines. We describe clinical characteristics associated with robotic exoskeleton gait training and examine outcomes of people with spinal cord injury and stroke who completed usual rehabilitation care with or without robotic exoskeleton gait training. Retrospective review of medical records over a 36 months period. Inpatients with spinal cord injury or stroke and ≥1 robotic exoskeleton gait training session were included. After obtaining a complete list of robotic exoskeleton gait training participants, medical records were reviewed for comparable matches as determined by gait functional independence measure score <4, age 18-100 years, meeting exoskeleton manufacturer eligibility criteria, and participating in usual care only. Functional independence measure was collected on all patients. For spinal cord injury, we collected the walking index for spinal cord injury II. For stroke, we collected the Stroke Rehabilitation Assessment of Movement Measure. Fifty-nine people with spinal cord injury (n = 31 robotic exoskeleton gait training; n = 28 usual care) and 96 people post-stroke (n = 44 robotic exoskeleton gait training; n = 52 usual care) comprised the medical record review. Fifty-eight percent of patients with spinal cord injury and 56% of patients post-stroke completed 5+ robotic exoskeleton gait training sessions and were included in analyses. Robotic exoskeleton gait training dosage varied between our patients with spinal cord injury and patients post-stroke. Robotic exoskeleton gait training utilization during inpatient rehabilitation required consideration of unique patient characteristics impacting functional outcomes. Application of robotic exoskeleton gait training across diagnoses may require different approaches during inpatient rehabilitation.

Driver, S., McShan, E., Swank, C., Grobe, K., Calhoun, S., Bailey, R. and Kramer, K. (2020). “Creating an appropriate adaptation of a healthy lifestyle intervention for people after stroke.” Brain Inj Aug 19;1-7. [Epub ahead of print.].

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PRIMARY OBJECTIVE: To describe (1) an evidence-based approach to promoting a healthy lifestyle, the Diabetes Prevention Program Group Lifestyle Balance intervention, and (2) our work with input from an Advisory Board of stakeholders to modify the program to meet the unique needs of people post stroke. RESEARCH DESIGN: Community-Based Participatory Research. METHODS AND PROCEDURES: An Advisory Board of stakeholders was convened to modify the Group Lifestyle Balance intervention to meet the unique needs of people post stroke. MAIN OUTCOMES AND RESULTS: The primary adaptations that emerged from the Advisory Board included (1) curriculum emphasis on heart health after stroke, (2) care partner participation, (3) physical activity, dietary, and weight loss modifications specific to people after stroke, and (4) general programmatic recommendations (e.g., wider age range of participants; eligibility based on time since stroke; alternative modes of delivery). CONCLUSIONS: Feedback from the diverse group of stakeholders provides the basis for modifying an evidence-based healthy lifestyle intervention to meet the unique needs of people after stroke. Future research efforts should examine the efficacy and effectiveness of the adapted program to prevent weight gain after stroke and reduce the risk of chronic conditions including diabetes, metabolic syndrome, and heart disease.

Karakkattil, P. S., E. Trudelle-Jackson, A. Medley and C. Swank (2020). “Effects of two different types of ankle-foot orthoses on gait outcomes in patients with subacute stroke: a randomized crossover trial.” Clin Rehabil 34(8): 1094-1102.

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OBJECTIVE: To identify whether patients in the subacute stage of stroke, with foot drop, would have better gait outcomes when using a double-adjustable AFO (DA AFO) or a posterior leaf spring AFO (PLS AFO) at baseline without practice and to determine whether one week of practice would significantly change gait outcomes with either of the AFOs. DESIGN: Within-subject 2 × 2 repeated measures design. SETTING: Postacute and outpatient rehabilitation center. PARTICIPANTS: Twenty individuals with mean age of 57 years (SD: 12.0 years) with subacute stroke. INTERVENTIONS: Participants were measured using DA AFO and PLS AFO at baseline. Follow-up measurements were taken after one week of practice with each type of AFO in randomly assigned order. OUTCOME MEASURES: Gait endurance (6-Minute Walk Test (6MWT)), gait symmetry, and gait velocity at self-selected and fast-paced velocity measured using GAITRite gait analysis system and patient report of AFO preference. RESULTS: At baseline, no significant differences were found between the 2 AFOs (P > 0.05). There was no significant interaction (P > 0.05) of AFO and practice for gait endurance, symmetry, and velocity. Main effect of practice was significant for gait endurance (P < 0.001), self-selected velocity (P = 0.001), and fast-paced velocity (P < 0.001). In all, 16 participants preferred using DA AFO for walking. CONCLUSIONS: No difference between DA AFO and PLS AFO was found on measures of gait endurance, symmetry, and velocity at baseline or after practice. With practice over time, participants improved in gait endurance and velocity regardless of AFO type.

Swank, C., M. Trammell, M. Bennett, C. Ochoa, L. Callender, S. Sikka and S. Driver (2020). “The utilization of an overground robotic exoskeleton for gait training during inpatient rehabilitation-single-center retrospective findings.” Int J Rehabil Res Apr 8. [Epub ahead of print].

Full text of this article.

Overground robotic exoskeleton gait training is increasingly utilized during inpatient rehabilitation yet without clear guidelines. We describe clinical characteristics associated with robotic exoskeleton gait training and examine outcomes of people with spinal cord injury and stroke who completed usual rehabilitation care with or without robotic exoskeleton gait training. Retrospective review of medical records over a 36 months period. Inpatients with spinal cord injury or stroke and >/=1 robotic exoskeleton gait training session were included. After obtaining a complete list of robotic exoskeleton gait training participants, medical records were reviewed for comparable matches as determined by gait functional independence measure score <4, age 18-100 years, meeting exoskeleton manufacturer eligibility criteria, and participating in usual care only. Functional independence measure was collected on all patients. For spinal cord injury, we collected the walking index for spinal cord injury II. For stroke, we collected the Stroke Rehabilitation Assessment of Movement Measure. Fifty-nine people with spinal cord injury (n = 31 robotic exoskeleton gait training; n = 28 usual care) and 96 people post-stroke (n = 44 robotic exoskeleton gait training; n = 52 usual care) comprised the medical record review. Fifty-eight percent of patients with spinal cord injury and 56% of patients post-stroke completed 5+ robotic exoskeleton gait training sessions and were included in analyses. Robotic exoskeleton gait training dosage varied between our patients with spinal cord injury and patients post-stroke. Robotic exoskeleton gait training utilization during inpatient rehabilitation required consideration of unique patient characteristics impacting functional outcomes. Application of robotic exoskeleton gait training across diagnoses may require different approaches during inpatient rehabilitation.

Cookinham, B. and C. Swank (2020). “Concussion History and Career Status Influence Performance on Baseline Assessments in Elite Football Players.” Arch Clin Neuropsychol 35(3): 257-264.

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OBJECTIVE: To determine if concussion history and career status is associated with neurocognitive performance in elite football players. METHODS: The study design was a cross-sectional single assessment. Fifty-seven elite football players (age 29.39 +/- 7.49 years) categorized as draft prospects, active professional players, and retired professional players were assessed on the Sport Concussion Assessment Tool – third edition (SCAT-3), in an outpatient therapy setting. RESULTS: Common symptoms were the following: fatigue (45.6%), trouble falling asleep (35.1%), difficulty remembering (33.3%) and irritability (22.8%); 36.8% reported no symptoms. The low concussion (0-1) group reported fewer symptoms (U = 608.50, p < .001), less symptom severity (U = 598.00, p = -.001), and produced greater scores on the Standardized Assessment of Concussion (SAC) total scores compared to the multiple concussion (2+) group (U = 253.00, p = .024), but no differences were observed on modified Balance Error Scoring System (m-BESS) scores (U = 501.50, p = .066) on the Mann-Whitney U test. The Kruskal-Wallis test and post-hoc analysis indicated retired players were significantly different from draft prospects and current professional players for total symptom scores (p < .001), total symptom severity (p < .001), SAC total scores (p = .030), and m-BESS (p < .001). CONCLUSIONS: Concussion history and career status appear associated with total symptoms, symptom severity, performance on the SAC, and the m-BESS in elite football players. With this in mind, future research is recommended to determine longitudinal impact for elite football players.