Monica M. Bennett Ph.D.

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].

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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, L. Callender, M. Bennett, K. Patterson, J. Gillespie, P. Kapoor and S. Driver (2020). “The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation-a randomized controlled trial.” Clin Rehabil 34(4): 504-514.

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OBJECTIVE: Individuals post stroke are inactive, even during rehabilitation, contributing to ongoing disability and risk of secondary health conditions. Our aims were to (1) conduct a randomized controlled trial to examine the efficacy of a “Patient-Directed Activity Program” on functional outcomes in people post stroke during inpatient rehabilitation and (2) examine differences three months post inpatient rehabilitation discharge. DESIGN: Randomized control trial. SETTING: Inpatient rehabilitation facility. SUBJECTS: Patients admitted to inpatient rehabilitation post stroke. INTERVENTIONS: Patient-Directed Activity Program (PDAP) or control (usual care only). Both groups underwent control (three hours of therapy/day), while PDAP participants were prescribed two additional 30-minute activity sessions/day. MAIN MEASURES: Outcomes (Stroke Rehabilitation Assessment of Movement Measure, Functional Independence Measure, balance, physical activity, Stroke Impact Scale) were collected at admission and discharge from inpatient rehabilitation and three-month follow-up. RESULTS: Seventy-three patients (PDAP (n = 37); control (n = 36)) were included in the primary analysis. Patients in PDAP completed a total of 23.1 +/- 16.5 sessions (10.7 +/- 8.5 upper extremity; 12.4 +/- 8.6 lower extremity) during inpatient rehabilitation. No differences were observed between groups at discharge in functional measures. PDAP completed significantly more steps/day (PDAP = 657.70 +/- 655.82, control = 396.17 +/- 419.65; P = 0.022). The Stroke Impact Scale showed significantly better memory and thinking (PDAP = 86.2 +/- 11.4, control = 80.8 +/- 16.7; P = 0.049), communication (PDAP = 93.6 +/- 8.3, control = 89.6 +/- 12.4; P = 0.042), mobility (PDAP = 62.2 +/- 22.5, control = 53.8 +/- 21.8; P = 0.038), and overall recovery from stroke (PDAP = 62.1 +/- 19.1, control = 52.2 +/- 18.7; P = 0.038) for PDAP compared to control. At three months post discharge, PDAP (n = 11) completed significantly greater physical activity (P = 0.014; 3586.5 +/- 3468.5 steps/day) compared to control (n = 10; 1760.9 +/- 2346.3 steps/day). CONCLUSION: Functional outcome improvement was comparable between groups; however, PDAP participants completed more steps and perceived greater recovery.

McMinn, K. R., E. V. Thomas, K. R. Martin, J. N. Khetan, E. E. McShan, M. M. Bennett, J. Solis, A. L. Jones, M. B. Powers and A. M. Warren (2020). “Psychological morbidity and functional impairment following traumatic pelvic injury.” Injury Feb 11. [Epub ahead of print].

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Pelvic injuries often result from high-energy trauma and lead to significant functional impairment. While the physical outcomes of these injuries have been widely studied, the psychological consequences remain largely unexplored. The purpose of this study was to examine psychosocial and functional outcomes of patients with pelvic trauma in the year after injury. The sample (N=32) consisted of adult patients with traumatic pelvic injures, as defined by ICD-9 codes, who were admitted to a Level I Trauma Center for at least 24 h. Participants were primarily female (53%) with a mean age of 48.7 years (SD=17.9). Demographic, injury-related, and psychosocial data (e.g., posttraumatic stress disorder (PTSD), depression, alcohol use, quality of life, pain, return to work) were gathered at the time of hospitalization as well as at 3-, 6-, and 12 month follow-ups. Mixed regression models were used to examine the outcome variables over time. There were significant decreases in pain and alcohol use at each follow-up compared to baseline. However, despite the decrease, the levels of pain and alcohol use remained high. Physical and mental health also decreased significantly, indicating worsened functioning and lowered quality of life. Neither PTSD nor depression changed significantly over time, indicating that participants’ symptoms were not likely to improve. These data suggest that sustaining a traumatic pelvic injury increases the risk of diminished quality of life, both mentally and physically. Even one-year post-injury, participants experienced moderate physical pain and higher levels of PTSD, depression, and problematic alcohol use than would be expected in the general population. These findings highlight the need for an interdisciplinary approach to treating patients with pelvic injuries, including psychological screening and intervention in acute care and throughout recovery.

Swank, C., M. Trammell, L. Callender, M. Bennett, K. Patterson, J. Gillespie, P. Kapoor and S. Driver (2020). “The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation-a randomized controlled trial.” Clin Rehabil Jan 15. [Epub ahead of print].

Full text of this article.

OBJECTIVE: Individuals post stroke are inactive, even during rehabilitation, contributing to ongoing disability and risk of secondary health conditions. Our aims were to (1) conduct a randomized controlled trial to examine the efficacy of a “Patient-Directed Activity Program” on functional outcomes in people post stroke during inpatient rehabilitation and (2) examine differences three months post inpatient rehabilitation discharge. DESIGN: Randomized control trial. SETTING: Inpatient rehabilitation facility. SUBJECTS: Patients admitted to inpatient rehabilitation post stroke. INTERVENTIONS: Patient-Directed Activity Program (PDAP) or control (usual care only). Both groups underwent control (three hours of therapy/day), while PDAP participants were prescribed two additional 30-minute activity sessions/day. MAIN MEASURES: Outcomes (Stroke Rehabilitation Assessment of Movement Measure, Functional Independence Measure, balance, physical activity, Stroke Impact Scale) were collected at admission and discharge from inpatient rehabilitation and three-month follow-up. RESULTS: Seventy-three patients (PDAP (n = 37); control (n = 36)) were included in the primary analysis. Patients in PDAP completed a total of 23.1 +/- 16.5 sessions (10.7 +/- 8.5 upper extremity; 12.4 +/- 8.6 lower extremity) during inpatient rehabilitation. No differences were observed between groups at discharge in functional measures. PDAP completed significantly more steps/day (PDAP = 657.70 +/- 655.82, control = 396.17 +/- 419.65; P = 0.022). The Stroke Impact Scale showed significantly better memory and thinking (PDAP = 86.2 +/- 11.4, control = 80.8 +/- 16.7; P = 0.049), communication (PDAP = 93.6 +/- 8.3, control = 89.6 +/- 12.4; P = 0.042), mobility (PDAP = 62.2 +/- 22.5, control = 53.8 +/- 21.8; P = 0.038), and overall recovery from stroke (PDAP = 62.1 +/- 19.1, control = 52.2 +/- 18.7; P = 0.038) for PDAP compared to control. At three months post discharge, PDAP (n = 11) completed significantly greater physical activity (P = 0.014; 3586.5 +/- 3468.5 steps/day) compared to control (n = 10; 1760.9 +/- 2346.3 steps/day). CONCLUSION: Functional outcome improvement was comparable between groups; however, PDAP participants completed more steps and perceived greater recovery.

Dubiel, R., B. Williams, E. Sullivan, L. Callender, M. Bennett and S. Driver (2019). “Prevalence of 25-Hydroxyvitamin D deficiency in the acute rehabilitation population following traumatic brain injury1.” NeuroRehabilitation Dec 18. [Epub ahead of print].

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OBJECTIVE: To determine the prevalence of vitamin D deficiency among individuals with traumatic brain injury (TBI) undergoing acute inpatient rehabilitation. SETTING: Inpatient Rehabilitation. PARTICIPANTS: Participants were admitted from November 1st, 2010 through June 30th, 2015 with diagnosis of mild-severe TBI and had serum 25 OH vitamin D levels checked upon admission. 369 out of 845 met inclusion. DESIGN: Retrospective cohort. MAIN MEASURES: 25 OH vitamin D, vitamin D treatment. RESULTS: The majority of patients were male (67%), Caucasian (89%) with private insurance (61%) and a mean age of 43.5+/-21.0 years. 25 OH vitamin D levels were categorized: deficient (<20 ng/mL), insufficient (20-29.9 ng/mL), and sufficient (>/=30 ng/mL). There were 95 (26%) patients that were deficient, 131 (36%) that were insufficient, and 143 (39%) that were sufficient. Race/ethnicity was found to be significant (p = 0.0145) with the largest percentage of Hispanics found in the insufficient and deficient categories, and the largest percentage of Blacks in the deficient category. Most patients with deficient or insufficient vitamin D levels were prescribed vitamin D replacement during their rehab stay (p < 0.0001). CONCLUSION: The majority of patients undergoing acute inpatient rehabilitation were found to have insufficient or deficient vitamin D levels, therefore it should be routinely screened and treated as indicated.