Stem Cell-Protein Combination Reverses Poststroke Brain Damage in Mice

Could brain damage poststroke be reversed? Researchers in a National Institutes of Health (NIH)-funded study say they have found a combination of human stem cells and a protein that created new, functional neurons in the brains of stroke-induced mice.

In the August 22 edition of Nature Medicine, researchers from the University of Southern California outline how they combined 2 methods that individually have demonstrated limited success as treatments for neurologic injury poststroke: surgical grafting of human neural stem cells in the damaged area and administration of the 3KL3A-APC protein, which is derived from the human-activated protein-C.

Full story of stem cell-protein and poststroke brain damage at APTA

CMS Education Efforts on Jimmo Ruled Inadequate

Though the Jimmo v Sibelius settlement reached in 2013 was supposed to have done away with the fallacy of the “improvement standard” as a basis for Medicare claims denials, many of the entities that make decisions about claims haven’t been sufficiently educated on this reality, according to a US District Court judge. In the ruling, Judge Christina Reiss describes how the Centers for Medicare and Medicaid Services (CMS) did not live up to its responsibilities to educate stakeholders, and instead supplied “non-responsive answers” to questions, and “arguably incorrect” information on claims denials for skilled maintenance therapy.

The August 17 opinion and order is a victory for the Center for Medicare Advocacy (CMA) and Vermont Legal Aid, which together represented 7 individual plaintiffs and 7 organizations in a complaint filed in March of this year. The complaint alleged that CMS did not comply with the requirement that it adequately educate stakeholders on why claims could not be denied simply because a patient has not demonstrated improvement. APTA submitted a declaration of support for this action, writing that the CMS education efforts were “introductory in nature” and “have not been sufficient” to educate members.

Full story of CMS education and Jimmo case at APTA

TIME Article: US Must Rethink Pain Treatment, Become ‘Insistent’ on Physical Therapy

A recent opinion piece in TIME magazine says that when it comes to pain treatment, unless a “fundamental mindset” is changed—a change that includes being “insistent” on the use of physical therapy in pain management—no real progress will be made in the fight to end the opioid abuse epidemic in the United States.

In “We’re All Responsible For Our Opioid Reliance—Even Patients,” Andre Machado, chairman of the Neurological Institute at the Cleveland Clinic, describes how opioids are little more than a “quick fix” for pain that miss what should be the true goal of pain treatment, which he describes as “recovery of function, not complete resolution of pain.”

“This crisis is a failure of our health care ecosystem and our quick-fix culture,” Machado writes. “We can all share the blame: physicians who feel anxious to meet patients’ expectations, pharma companies that oversell opioid benefits (and downplay the risks), insurers that fail to flag patients receiving high volumes of opioid prescriptions (and not properly reimbursing therapy) and patients who demand passive treatment.”

Full story of US rethinking pain treatment at APTA

Video of Popular Roundtable Discussion on Physical Therapy and Pain Management Now Available

To get this year’s Rothstein Roundtable started, moderator Anthony Delitto PT, PhD, asked a simple question: is physical therapy a “good choice” for pain management?

In many ways, the answer he received from panelist Michael Parkinson, MD, set the tone for the rest of the discussion.

Parkinson’s reply: “Yes, but.”

Now available at the Physical Therapy (PTJ) website: a video of the entire Rothstein Roundtable held at the 2016 NEXT Conference and Exposition in June. Delitto and Parkinson are joined by Arlene Greenspan, PT, DrPH, of the US Centers for Disease Control and Prevention (CDC) and Dave Elton of the United Health Group – Optum, as well as 2016 Maley lecturer Steven George, PT, PhD, to discuss the question, “Opioids Versus Physical Therapy: Should Physical Therapy Be the First Choice for Pain Management?” The ensuing conversation, held in front of a capacity audience, was a highlight of the conference.

Full story of physical therapy and pain management at APTA

Systematic Review: Commercial Video Games Likely a Good Option for Rehab

While researchers and designers continue to work on advanced video games and hardware intended specifically for rehabilitation, a new systematic review says that there’s sufficient research to support the idea that off-the-shelf games available on commercial gaming systems are useful as an adjunct to more traditional rehab approaches.

Researchers writing in the International Journal of Rehabilitation Research described findings from their analysis of 126 research articles published between 2008 and 2015, all of which focused on the use of commercially available gaming systems (VGs)—Nintendo Wii, Sony PlayStation, and Microsoft Xbox—as a component of rehabilitation. A total of 4,240 patients were included in the studies, which looked at VG use in connection with stroke recovery, cerebral palsy (CP), Parkinson disease (PD), balance training, problems associated with aging, and weight control.

Full story of commercial video games an option for rehab at APTA

Researchers Say Brain-Controlled Exoskeleton Training Sparked Neurological Improvement in Individuals With Paraplegia

While pursuing a brain-controlled exoskeleton technology for individuals with paraplegia, researchers at Duke University uncovered something unexpected: in what they call “unprecedented neurological recovery,” researchers found that patients actually experienced neurological improvements in sensation and voluntary muscle control during the brain-machine interface (BMI) training period. A few patients were even upgraded from complete to incomplete paraplegia classification after 12 months of work with the BMI.

The findings, presented in the journal Scientific Reports, were uncovered after researchers monitored progress in 8 patients with spinal cord injury (SCI) as they participated in the Walk Again program. The program employs noninvasive electrode monitoring that allows the patient to control movements—first in a virtual reality setting, but, ultimately, by way of a brain-controlled exoskeleton capable of providing tactile information delivered to the patients’ forearms. The exoskeleton was featured at the 2014 World Cup soccer tournament, when 29-year-old Juliano Pinto, who has complete paralysis of his lower trunk, completed the ceremonial kickoff at the event.

Full story of brain control for individuals with paraplegia at APTA

APTA’s Participation on Utilization Management Vendor Group Opens Channels for Increased Communication

APTA’s participation on an advisory committee to 1 of the country’s largest utilization management (UM) companies is shedding more light on what is likely to be a growing trend in payment that will have direct impact on physical therapists (PTs). It’s the first time the association has been included in a UM advisory panel on an ongoing basis.

In July, American Specialty Health (ASH) hosted an on-site meeting of its Professional Affairs Healthcare Advisory Committee (PAHAC), a group designed not only to facilitate communication between the UM company and practitioners, but to provide input to ASH on ways to improve UM for patients and providers. APTA attendees to the meeting included Richard Katz, PT, DPT, California Physical Therapy Association (CPTA) payment chair and member of the APTA Private Practice Session (PPS) reimbursement committee; Dennis Langton, PT, member of the CPTA reimbursement committee; Jenelle Lauchman, PT, DPT, president of the Nevada Physical Therapy Association; and Elise Latawiec, PT, MPH, APTA practice management senior specialist.

Full story of APTA’s participation on utilization management groups at APTA

NYT: Racial Disparities in Pain Treatment

As if the national conversation over how pain is treated isn’t already complex enough, The New York Times (NYT) points out another important facet of the problem: regardless of where approaches may be heading in the future, pain treatment as it stands now is far from equal among racial minorities and whites.

“Finding Good Pain Treatment Is Hard. If You’re Not White, It’s Even Harder” combines interviews with research findings to highlight what NYT describes as a “persistent” problem: “Minorities tend to receive less treatment for pain than whites, and suffer more disability as well.” Among the findings reported in the story:

  • Blacks have been affected by the prescription opioid epidemic at “much lower rates” than whites.

Full story of racial disparities in pain treatment at APTA

SNF, IRF Final Rules Increase Payment—And Reporting Requirements

In final rules for 2017, the Centers for Medicare and Medicaid Services (CMS) has followed through on its proposed push for more quality reporting and new payment models for skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs). Those rules, issued last week, also include a 2.4% increase in payments to SNFs, and a 1.9% increase for IRFs.

APTA has created summaries of the rules, available online (for the SNF final rule visit APTA’s Medicare Payment and Policies for Skilled Nursing Facilities pageand look under the “APTA Summaries” header; for the IRF final rule, visit the APTA Medicare Payment and Policies for Hospital Settings page, and scroll down to the “APTA Summaries” section under “Inpatient Rehabilitation”). Here are some of the highlights.

Full story of SNF and IRF final rules increase payment at APTA

Bike Riding Most Common Sports-Related Reason for ED Visits and Inpatient Admissions

A recent analysis of sports-related emergency department (ED) and hospital inpatient stays is giving new credence to the phrase “as easy as falling off a bike.” Apparently it’s pretty easy, with bicycling-related injuries leading the way in hospital use.

The analysis, produced by the Healthcare Cost and Utilization Project (H-CUP), tracked 2013 data on 2.8 million ED visits and 105,490 inpatient admissions for injuries related to a long list of sports activities that included everything from the usual suspects to bungee jumping-related injuries, to injuries experienced at “school recess and summer camp.” Researchers sliced and diced the data in a variety of ways to come up with a picture of who’s getting hurt doing what, and in which ways.

Full story of bike riding most common for ED visits at APTA