UPMC Physician Resources
Rehabilitation Recent Publications
Nandoe Tewarie RD, Hurtado A, Ritfeld GJ, Rahiem ST, Wendell DF, Barroso MM, Grotenhuis JA, Oudega M. J Bone marrow stromal cells elicit tissue sparing after acute but not delayed transplantation into the contused adult rat thoracic spinal cord. Neurotrauma. 2009 Dec;26(12):2313-22.
Bone marrow stromal cells (BMSC) transplanted into the contused spinal cord may support repair by improving tissue sparing. We injected allogeneic BMSC into the moderately contused adult rat thoracic spinal cord at 15 min (acute) and at 3, 7, and 21 days (delayed) post-injury and quantified tissue sparing and BMSC survival up to 4 weeks post-transplantation. BMSC survival within the contusion at 7 days post-transplantation was significantly higher with an acute injection (32%) and 3-day delayed injection (52%) than with a 7- or 21-day delayed injection (9% both; p < 0.01). BMSC survival at 28 days post-transplantation was close to 0 in all paradigms, indicating rejection. In contused rats without a BMSC transplant (controls), the volume of spared tissue gradually decreased until 46% (p < 0.001) of the volume of a comparable uninjured spinal cord segment at 49 days post-injury. In rats with BMSC, injected at 15 min, 3, or 7 days post-injury, spared tissue volume was significantly higher in grafted rats than in control rats at the respective endpoints (i.e., 28, 31, and 35 days post-injury). Acute and 3-day delayed but not 7- and 21-day delayed injection of BMSC significantly improved tissue sparing, which was strongly correlated (r = 0.79-1.0) to BMSC survival in the first week after injection into the contusion. Our data showed that neuroprotective effects of BMSC transplanted into a moderate rat spinal cord contusion depend strongly on their survival during the first week post-injection. Acutely injected BMSC elicit more tissue sparing than delayed injected BMSC.
*Wagner AK., Miller MA., Scanlon, J., Ren D., Kochanek PM., Conley YP. Adenosine A1 Receptor Gene Variant Associated with Post-traumatic Seizures after Severe TBI. Epilepsy Res. (2010) Aug;90(3):259-72.
Post-traumatic seizures (PTS) are a significant complication from traumatic brain injury (TBI). Adenosine, a major neuroprotective and neuroinhibitory molecule, is important in experimental epilepsy models. Thus, we investigated the adenosine A1 receptor (A1AR) gene and linked it with clinical data extracted for 206 subjects with severe TBI. Tagging SNPs rs3766553, rs903361, rs10920573, rs6701725, and rs17511192 were genotyped, and variant and haplotype associations with PTS were explored. We investigated further genotype, grouped genotype, and allelic associations with PTS for rs3766553 and rs10920573. Multivariate analysis of rs3766553 demonstrated an association between the AA genotype and increased early PTS incidence. In contrast, the GG genotype was associated with increased late and delayed-onset PTS rates. Multivariate analysis of rs10920573 revealed an association between the CT genotype and increased late PTS. Multiple risk genotype analysis showed subjects with both risk genotypes had a 46.7% chance of late PTS. To our knowledge, this is the first report implicating genetic variability in the A1AR with PTS, or any type of seizure disorder. These results provide a rationale for further studies investigating how adenosine neurotransmission impacts PTS, evaluating anticonvulsants in preventing and treating PTS, and developing and testing targeted adenosinergic therapies aimed at reducing PTS.
Wang W, Collinger JL, Perez MA, Tyler-Kabara EC, Cohen LG, Birbaumer N, Brose SW, Schwartz AB, Boninger ML, Weber DJ. Neural Interface Technology for Rehabilitation: Exploiting and Promoting Neuroplasticity. PMR Clinics NA Feb 2010;21(1):157-78.
This article reviews neural interface technology and its relationship with neuroplasticity. Two types of neural interface technology are reviewed, highlighting specific technologies that the authors directly work with: (1) neural interface technology for neural recording, such as the micro-ECoG BCI system for hand prosthesis control, and the comprehensive rehabilitation paradigm combining MEG-BCI, action observation, and motor imagery training; (2) neural interface technology for functional neural stimulation, such as somatosensory neural stimulation for restoring somatosensation, and non-invasive cortical stimulation using rTMS and tDCS for modulating cortical excitability and stroke rehabilitation. The close interaction between neural interface devices and neuroplasticity leads to increased efficacy of neural interface devices and improved functional recovery of the nervous system. This symbiotic relationship between neural interface technology and the nervous system is expected to maximize functional gain for individuals with various sensory, motor, and cognitive impairments, eventually leading to better quality of life.
Weber DJ, Skidmore ER, Niyonkuru C, Chang CL, Huber LM, Munin MC. Cyclic functional electrical stimulation does not enhance gains in hand grasp function when used as an adjunct to onabotulinumtoxin A and task practice therapy: a single-blind, randomized controlled pilot study. Arch Phys Med Rehabil. 2010 May;91(5):679-86.
OBJECTIVE: To determine whether onabotulinumtoxinA injections and
task practice training with or without functional electrical
stimulation (FES) improve upper limb motor function in chronic spastic
DESIGN: Randomized controlled trial.
SETTING: Outpatient spasticity clinic.
PARTICIPANTS: Participants (N=23) had chronic spastic hemiparesis with moderate-severe hand impairment based on Chedoke-McMaster Assessment greater than or equal to 2.
INTERVENTIONS: OnabotulinumtoxinA injections followed by 12 weeks of postinjection task practice. Participants randomly assigned to FES group were also fitted with an orthosis that provided FES.
MAIN OUTCOME MEASURES: Motor Activity Log (MAL)-Observation was the primary outcome. Secondary outcomes were Action Research Arm Test (ARAT) and MAL-Self-Report.
RESULTS: For the entire cohort, MAL-Observation mean item scores improved significantly from baseline to week 6 (P=.005) but did not remain significant at week 12. MAL-Self-Report mean item scores improved significantly (P=.009) from baseline to week 6 and remained significantly higher (P=.014) at week 12. ARAT total scores also improved significantly from baseline to week 6 (P=.018) and were sustained at week 12 (P=.032). However, there were no significant differences between the FES and no-FES groups for any outcome variable over time.
CONCLUSIONS: Rehabilitation strategies that combine onabotulinumtoxinA injections and task practice therapy are feasible and effective in improving upper-limb motor function and reducing spasticity in patients with chronic spastic hemiparesis. However, the cyclic FES protocol used in this study did not increase gains achieved with the combination of onabotulinumtoxinA and task practice alone.
Lee H*, Sowa G#, Vo N, Vadala G, O'Connell S, Studer R, Kang J. Effect of bupivacaine on intervertebral disc cell viability. Spine J 2010 Feb;10(2):159-66.
BACKGROUND CONTEXT: Bupivacaine is a local anesthetic commonly used
to relieve or control pain in interventional spine procedures.
Bupivacaine has been shown to be toxic to articular cartilage, which
has similarities to intervertebral disc (IVD) cartilage, raising
concern over a potentially negative effect of bupivacaine on the disc.
PURPOSE: To determine bupivacaine's effect on cell viability of IVD cells in vitro and to elucidate whether this is through apoptosis or necrosis.
STUDY DESIGN: In vitro controlled study of bupivacaine effect on cell viability in human and rabbit IVD cells.
SUBJECTS: Rabbit annulus fibrosus (AF) tissue, nucleus pulposus (NP) cells, and knee articular chondrocytes were isolated from New Zealand white rabbits. Human AF and NP cells were isolated from stage 3 to 4 degenerative disc surgical specimens.
OUTCOME MEASURES: Cell viability was assessed after exposure to bupivacaine via trypan blue staining or flow cytometry.
METHODS: Annulus fibrosus and NP cells were grown in monolayer and alginate beads, respectively, to simulate their physiologic environment. The cells were then exposed to bupivacaine or saline control at 60 and 120 minutes and examined for cell viability.
RESULTS: Rabbit NP cell death demonstrated a time and dose dependence in response to bupivacaine. In addition, cell death was greater than that observed for articular chondrocytes. Rabbit AF tissue also demonstrated increased cell death in response to bupivacaine exposure. Human NP cells demonstrated time-dependent cell death, with greater necrosis than apoptosis. Annulus fibrosus cells grown in monolayers also resulted in similar effects, with greater necrosis rather than apoptosis.
CONCLUSIONS: Despite its pain relieving properties, bupivacaine decreases cell viability in rabbit and human disc cells in a time-dependent manner. In addition, the changes observed are greater than that seen for articular chondrocytes. This increase in cell death appears to be related to an increase in necrosis rather than apoptosis. Whether bupivacaine exerts similar effects in vivo or how this relates to overall clinical outcome remains to be explored.
Munin MC, Putman K, Hsieh CH, Smout RJ, Tian W, DeJong G, Horn SD.
Analysis of rehabilitation activities within skilled nursing and inpatient rehabilitation facilities after hip replacement for acute hip fracture.
Am J Phys Med Rehabil. 2010 Jul;89(7):530-40.
OBJECTIVE: To characterize rehabilitation services in two types of
postacute facilities in patients who underwent hip replacement
following a hip fracture.
DESIGN: Multisite prospective observational cohort from 6 freestanding skilled nursing facilities and 11 inpatient rehabilitation facilities. Patients (n = 218) with hip fracture who had either hemiarthroplasty or total hip arthroplasty followed by rehabilitation at skilled nursing facilities or inpatient rehabilitation facilities were enrolled. Using a point-of-care methodology, we recorded data from actual physical therapy and occupational therapy sessions completed including functional outcomes during the postacute admission.
RESULTS: Onset time from surgical repair to rehabilitation admission was not significantly different between sites. Average skilled nursing facilities length of stay was 24.7 +/- 13.6 days, whereas inpatient rehabilitation facilities was 13.0 +/- 5.7 days (P < 0.01). Total hours of physical therapy and occupational therapy services per patient day were 1.2 in skilled nursing facilities and 2.0 in inpatient rehabilitation facilities. For weekdays only, these data changed to 1.6 in skilled nursing facilities and 2.6 hrs per patient in inpatient rehabilitation facilities (P < 0.01). Patients in inpatient rehabilitation facilities accrued more time for gait training and exercise in physical therapy, which was found to be 48% and 40% greater, respectively, through day 8. In occupational therapy, patients of inpatient rehabilitation facilities had more time allocated to lower body dressing and transfers.
CONCLUSIONS: Significant differences in rehabilitation activities were observed, and intensity was notably different within the first 8 therapy days even though baseline demographics and medical complexity were comparable across facility types. Our data suggest that after more complex hip replacement surgery, hip fracture patients can tolerate more intensive therapy earlier within the rehabilitation program.