Monica M. Bennett Ph.D.

Sewell, E. K., S. E. G. Hamrick, R. M. Patel, M. Bennett, V. N. Tolia and K. A. Ahmad (2021). “Association between anti-seizure medication and outcomes in infants.” J Perinatol.

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OBJECTIVE: To compare treatment failure between: (1) infants treated with phenobarbital versus levetiracetam for first-line treatment and (2) infants treated with phenytoin versus levetiracetam for second-line treatment following phenobarbital. STUDY DESIGN: This retrospective cohort study included infants with seizures receiving phenobarbital or levetiracetam as the initial anti-seizure medication. Treatment failure was defined as the need for additional anti-seizure medication within 24-72 h and compared using mixed-effect logistic regression after adjustment for confounding factors, including center. RESULTS: In this cohort of 6842 infants, the incidence of treatment failure was 31% vs. 38% in infants receiving first-line phenobarbital versus levetiracetam (adjusted OR: 0.70; 95% CI 0.58-0.84). There was no significant difference in second-line treatment failure (adjusted OR: 1.31; 95% CI 0.92-1.86). CONCLUSIONS: First-line treatment of neonatal seizures with phenobarbital is associated with a lower rate of treatment failure than levetiracetam. There was no significant difference in second-line treatment failure.

Warren, A.M., Zolfaghari, K., Fresnedo, M., Bennett, M., Pogue, J., Waddimba, A., Zvolensky, M., Carlbring, P. and Powers, M.B. (2021). “Anxiety sensitivity, COVID-19 fear, and mental health: results from a United States population sample.” Cogn Behav Ther Feb 17;1-13. [Epub ahead of print].

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The COVID-19 pandemic has resulted in unprecedented consequences. Transdiagnostic factors, such as anxiety sensitivity, could be an important component to understand how individuals experience COVID-19 specific fear, depression and anxiety. A US representative sample (5,023) completed measures including the Anxiety Sensitivity Index-3, the Fear of COVID-19 Scale, the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-8. Analyses controlled for age, sex, race, marital status, education level, working status, household income, and COVID-19 exposure. Results were consistent with prediction. First, higher ASI-3 Total scores were associated with above average COVID-19 fear (β = 0.19). Second, the ASI-3 physical concerns subscale was the strongest predictor of COVID-19 fear; one SD increase on the ASI-3 physical concerns subscale was associated with almost a twofold risk of reaching above average levels of COVID-19 (OR = 1.93). Third, higher ASI-3 Total scores were associated with higher anxiety (β = 0.22) and depression (β = 0.20). Finally, COVID-19 fear mediated the relationship between ASI-3 Total scores and anxiety (17% of effect mediated) as well as ASI-3 Total scores and depression (16% of effect mediated). These data support the role of anxiety sensitivity in predicting fear of COVID-19 and resulting mental health.

DiPasquale, J., Trammell, M., Clark, K., Fowler, H., Callender, L., Bennett, M. and Swank, C. (2021). “Intensity of usual care physical therapy during inpatient rehabilitation for people with neurologic diagnoses.” Pm r Feb 18. [Epub ahead of print].

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INTRODUCTION: Early, intense rehabilitation is essential to promote recovery after stroke, spinal cord injury (SCI), and traumatic brain injury (TBI). However, intensity of usual care rehabilitation interventions during inpatient rehabilitation are poorly characterized. OBJECTIVE: We described the intensity of usual care rehabilitation interventions completed during the subacute phase of recovery from neurologic injury. DESIGN: Observational. SETTING: Inpatient Rehabilitation Facility. INTERVENTIONS: 22 usual care physical therapy interventions were grouped into 6 categories: gait (4 activities), functional (2), strengthening (4), aerobic (6), balance (4), and wheelchair (2). PATIENTS: Patients admitted to inpatient rehabilitation with a primary diagnosis of stroke, SCI or TBI within 6 months of injury. MAIN OUTCOME MEASURE(S): Cardiovascular intensity (physiological and perceived) was recorded during rehabilitation activity sessions. Physiological intensity was assessed by heart rate response (HRR) via a Polar A370 Fitness Watch and characterized as very light (<30%), light (30%-39%), moderate (40%-59%), vigorous (60%-89%), and near maximal (≥90%). Perceived intensity was assessed using the Rate of Perceived Exertion scale (RPE). RESULTS: Patients [stroke n = 16 (number of activity sessions = 388 / average session duration = 15.1 minutes); SCI n = 15 (299 / 27.3 minutes); TBI n = 15 (340 / 13.4 minutes)] participated. For patients with stroke, moderate-to-vigorous HRR was attained between 42% (aerobic exercise) to 55% (wheelchair propulsion) of activity sessions. For patients with SCI, moderate-to-vigorous HRR was attained between 29% (strength training) to 46% (gait training) of activity sessions. For patients with TBI, moderate-to-vigorous HRR was attained between 29% (balance activities) to 47% (gait training) of activity sessions. Associations between HRR and RPE were very weak across stroke (r = 0.12), SCI (r = 0.18), and TBI (r = 0.27). CONCLUSIONS: Patients with stroke, SCI, and TBI undergoing inpatient rehabilitation achieve moderate-to-vigorous intensity during some usual care activities such as gait training. Patient perception of intensity was dissimilar to physiological response.

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.

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.