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Tosto-Mancuso J, Rozanski G, Patel N, Breyman E, Dewil S, Jumreornvong O, Putrino D, Tabacof L, Escalon M, Cortes M. Retrospective case-control study to compare exoskeleton-assisted walking with standard care in subacute non-traumatic brain injury patients. NeuroRehabilitation 2023; 53:577-584. [PMID: 38143393 DOI: 10.3233/nre-230168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Advanced technologies are increasingly used to address impaired mobility after neurological insults, with growing evidence of their benefits for various populations. However, certain robotic devices have not been extensively investigated in specific conditions, limiting knowledge about optimal application for healthcare. OBJECTIVE To compare effectiveness of conventional gait training with exoskeleton-assisted walking for non-traumatic brain injury during early stage rehabilitation. METHODS Clinical evaluation data at admission and discharge were obtained in a retrospective case-control design. Patients received standard of care physical therapy either using Ekso GT or not. Within- or between-group statistical tests were performed to determine change over time and interventional differences. RESULTS This study analyzed forty-nine individuals (33% female), 20 controls and 29 Ekso participants who were equivalent at baseline. Both groups improved in Functional Independence Measure scores and ambulation ability (p < .00001 and p < .001, respectively). Control subjects demonstrated significantly different distance walked and assistance level values at discharge from those who were treated with the exoskeleton (p < .01). CONCLUSION Robotic locomotion is non-inferior for subacute functional recovery after non-traumatic brain injury. Conventional therapy produced larger gait performance gains during hospitalization. Further research is needed to understand specific factors influencing efficacy and the long-term implications after rehabilitation.
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Affiliation(s)
- Jenna Tosto-Mancuso
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabriela Rozanski
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nehal Patel
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erica Breyman
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sophie Dewil
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Oranicha Jumreornvong
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Putrino
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura Tabacof
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Miguel Escalon
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mar Cortes
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Fry A, Chan HW, Harel N, Spielman L, Escalon M, Putrino D. Evaluating the clinical benefit of brain-computer interfaces for control of a personal computer. J Neural Eng 2022; 19. [PMID: 35325875 DOI: 10.1088/1741-2552/ac60ca] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/24/2022] [Indexed: 11/11/2022]
Abstract
Brain-computer interfaces (BCIs) enabling the control of a personal computer could provide myriad benefits to individuals with disabilities including paralysis. However, to realize this potential, these BCIs must gain regulatory approval and be made clinically available beyond research participation. Therefore, a transition from engineering-oriented to clinically oriented outcome measures will be required in the evaluation of BCIs. This review examined how to assess the clinical benefit of BCIs for the control of a personal computer. We report that: 1) a variety of different patient-reported outcome measures can be used to evaluate improvements in how a patient feels, and we offer some considerations that should guide instrument selection. 2) Activities of daily living can be assessed to demonstrate improvements in how a patient functions, however, new instruments that are sensitive to increases in functional independence via the ability to perform digital tasks may be needed. 3) Benefits to how a patient survives has not previously been evaluated, but establishing patient-initiated communication channels using BCIs might facilitate quantifiable improvements in health outcomes.
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Affiliation(s)
- Adam Fry
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
| | - Ho Wing Chan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
| | - Noam Harel
- James J Peters VA Medical Center, 130 W Kingsbridge Rd, New York, New York, 10468, UNITED STATES
| | - Lisa Spielman
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
| | - Miguel Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
| | - David Putrino
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, New York, New York, 10029, UNITED STATES
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Delgado A, Tabacof L, Escalon M, Huang V, Spielman L, Bryce T. Opioid Prescription Trends in Emergency Departments for Persons with Spinal Cord Injury Between 2006 and 2017. Arch Phys Med Rehabil 2020. [DOI: 10.1016/j.apmr.2020.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Striker G, Delgado A, Escalon M, Lercher K, Shetreat-Klein A, Santiago R, Patel N. Glioblastoma Multiforme: Functional Outcomes in a Three Year Retrospective Cohort Study of an Acute Inpatient Rehabilitation Hospital. Arch Phys Med Rehabil 2020. [DOI: 10.1016/j.apmr.2020.09.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chun A, Levy I, Yang A, Delgado A, Tsai CY, Leung E, Taylor K, Kolakowsky-Hayner S, Huang V, Escalon M, Bryce TN. Treatment of at-level spinal cord injury pain with botulinum toxin A. Spinal Cord Ser Cases 2019; 5:77. [PMID: 31632735 PMCID: PMC6786298 DOI: 10.1038/s41394-019-0221-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/23/2019] [Accepted: 09/01/2019] [Indexed: 12/25/2022] Open
Abstract
Study design Randomized, double-blinded, placebo-controlled, cross-over study. Objective To explore whether botulinum toxin A (BoNTA) could be effective for treating at-level spinal cord injury (SCI) pain. Setting Outpatient SCI clinic, New York, USA. Methods Participants were randomized to receive subcutaneous injections of either placebo or BoNTA with follow-up (office visit, telephone, or e-mail) at 2, 4, 8, and 12 weeks to assess the magnitude of pain relief post injection. Crossover of participants was then performed. Those who received placebo received BoNTA, and vice versa, with follow-up at 2, 4, 8, and 12 weeks. Results Eight participants completed at least one of the two crossover study arms. Four completed both arms. The median age of the eight participants was 45 years (range 32-61 years) and 75% were male. All had traumatic, T1-L3 level, complete SCI. Although our data did not meet statistical significance, we noted a higher proportion of participants reporting a marked change in average pain intensity from baseline to 8 and 12 weeks post-BoNTA vs. post-placebo (33% vs. 0%). At 2 and 4 weeks post-BoNTA, almost all participants reported some degree of reduced pain, while the same was not seen post-placebo (83% vs. 0%). Conclusion The subcutaneous injection of BoNTA may be a feasible approach for the control of at-level SCI pain and is worthy of further study. Sponsorship The onabotulinumtoxinA (BOTOX) used in this study was provided by Allergan (Irvine, CA).
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Affiliation(s)
- Audrey Chun
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Isaiah Levy
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Ajax Yang
- The Spine and Pain Institute of New York, New York, NY USA
| | - Andrew Delgado
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
- Graduate School of Biomedical Sciences, ISMMS, New York, NY USA
| | - Chung-Ying Tsai
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Eric Leung
- Department of Physical Medicine and Rehabilitation, Department of Pain Medicine, Northwell Health Physician Partners, Bay Shore, NY USA
| | - Kristell Taylor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Stephanie Kolakowsky-Hayner
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Vincent Huang
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Miguel Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
| | - Thomas N. Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY USA
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Maher MT, LiMonta JM, Delgado AD, Taylor K, Bryce TN, Escalon M, Huang V, Wecht JM. Lower Extremity Venous Compliance in Newly Injured Individuals with Spinal Cord Injury. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000562472.25031.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Adamov E, Escalon M, Bryce TN. Poster 445 Rehabilitation of Central and Peripheral Neurosarcoidosis: A Case Report. PM R 2014. [DOI: 10.1016/j.pmrj.2014.08.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Escalon M, Calfa CJ, Farias M, Lopez E, Patel S, Patel V, Raez LE. Ethnic disparities in head and neck carcinomas (HNC):“The Hispanic Paradox”. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.17023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Calfa CJ, Escalon M, Zafar S, Lopez E, Patel V, Patel S, Feun L, Raez LE. Beyond race: The impact of ethnicity on the treatment outcome of locally advanced head and neck cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.16500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16500 Background: Self identified racial groups share an unequal burden of head and neck cancer . Recent evidence suggests that outcome among races is different and the causes are multifactorial. Nonetheless, differences among ethnic groups have not been reported. Herein, we decided to analyze differences in treatment response and outcome among our white and Hispanic patient population treated for locally advanced head and neck cancer. Methods: Patients were identified using the tumor registry. We reviewed retrospectively the data from medical records. 100 white Hispanics (WH) and 50 white non-Hispanics (WNH) diagnosed with locally advanced head and neck cancer and treated at our institution from 2004 to 2005, were eligible for the study. Standard statistical analysis, including Kaplan-Meier survival curve and Cox proportional hazard models were used. P value of <0.05 was considered for statistical significance. Results: Preliminary results reveal that, in our study population, median age at diagnosis, gender, performance status (ECOG 0–2) and squamous cell histology did not differ significantly between the two groups. Stage 4 at diagnosis was more commonly observed in Hispanics as opposed to WNH (85.7% vs 68.6%) (P = 0.1). Surgery was more commonly used as an initial treatment option in Hispanics than WNH (42.8% vs 28.6%) (P = 0.18) while chemotherapy was less likely to be used (78.6% vs. 91.4%) (P = 0.15). Hispanics were more likely to smoke than WNH (P = 0.0003) and were equally exposed to chronic alcohol use. Patients from the Hispanic group were more likely to respond to therapy than whites by Chi-squared analysis but this difference was not statistically significant (P = 0.09). No differences were seen in disease free survival. Kaplan-Meier estimate of median overall survival was 16 months for Hispanics vs. 25 months for whites but this difference did not reach statistical significance (P = 0.26). Final analysis will be available at the time of the annual meeting. Conclusion: In our experience, a trend for decrease overall survival was noted in the Hispanic ethnic group. This may be in part due to more advanced stage at presentation. Nonetheless, in order to definitively answer this question, further research is warranted. No significant financial relationships to disclose.
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Affiliation(s)
- C. J. Calfa
- University of Miami, Miller School of Medicine, Miami, FL
| | - M. Escalon
- University of Miami, Miller School of Medicine, Miami, FL
| | - S. Zafar
- University of Miami, Miller School of Medicine, Miami, FL
| | - E. Lopez
- University of Miami, Miller School of Medicine, Miami, FL
| | - V. Patel
- University of Miami, Miller School of Medicine, Miami, FL
| | - S. Patel
- University of Miami, Miller School of Medicine, Miami, FL
| | - L. Feun
- University of Miami, Miller School of Medicine, Miami, FL
| | - L. E. Raez
- University of Miami, Miller School of Medicine, Miami, FL
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Liu NS, Escalon M, Yang Y, Smith TA, Dang NH. Prognostic factors in patients with T-cell non-Hodgkin's lymphoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- N. S. Liu
- M. D. Anderson Cancer Center, Houston, TX
| | - M. Escalon
- M. D. Anderson Cancer Center, Houston, TX
| | - Y. Yang
- M. D. Anderson Cancer Center, Houston, TX
| | | | - N. H. Dang
- M. D. Anderson Cancer Center, Houston, TX
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