Category: stroke

Beyond Opioids: The Future of Pain Management

March 14, 2018 — Cindi Scheib wanted to die.

A three-day weekend spent jumping and dancing on Labor Day 2014 had left her with a neck injury – specifically the cervical spine – that was possibly an exacerbation of an unrecognized mountain biking injury earlier that year. To make matters worse, her doctor performed the surgery to fix the injury on the wrong part of her spine.

Now 54, Scheib has lived with constant neck pain and other unusual sensations throughout her body ever since. These sensations, including electrical shocks down her spine, buzzing, vibrating, burning sensations, ringing in her ears and sensitivity to normal noises, had gotten so bad, she said, that “I wanted to go to bed and not wake up tomorrow. This life was so bad, so horrible, that I couldn’t imagine how I was going to live the rest of whatever life I had,” says the Harrisburg, PA, nurse.

Full story at WedMD

How the brain regulates variability in motor functions

Anyone who has ever tried to serve a tennis ball or flip a pancake or even play a video game knows, it is hard to perform the same motion over and over again. But don’t beat yourself up—errors resulting from variability in motor function is a feature, not a bug, of our nervous system and play a critical role in learning, research suggests.

Variability in a tennis serve, for example, allows a player to see the effects of changing the toss of the ball, the swing of the racket, or the angle of the serve—all of which may lead to a better performance. But what if you’re serving ace after ace after ace? Variability in this case would not be very helpful.

If variability is good for learning but bad when you want to repeat a successful action, the brain should be able to regulate variability based on recent performance. But how?

Full story at Medical Xpress

Yoga and physical therapy effective in treating co-occurring sleep disturbance, back pain

Yoga and physical therapy (PT) are effective approaches to treating co-occurring sleep disturbance and back pain while reducing the need for medication, according to a new study from Boston Medical Center (BMC). Published in the Journal of General Internal Medicine, the research showed significant improvements in sleep quality lasting 52 weeks after 12 weeks of yoga classes or 1-on-1 PT, which suggests a long-term benefit of these non-pharmacologic approaches. In addition, participants with early improvements in pain after 6 weeks of treatment were three and a half times more likely to have improvements in sleep after the full, 12-week treatment, highlighting that pain and sleep are closely related.

Sleep disturbance and insomnia are common among people with chronic low back pain (cLBP). Previous research showed that 59% of people with cLBP experience poor sleep quality and 53% are diagnosed with insomnia disorder. Medication for both sleep and back pain can have serious side effects, and risk of opioid-related overdose and death increases with use of sleep medications.

Full story at News-Medical.net

Patient-Driven Groupings Model: An Opportunity for Physical Therapists

When it comes to Centers for Medicare and Medicaid Services (CMS) changes, I have come to believe that there are 3 sides of the story: the CMS version, the providers’ version, and the truth, which is usually somewhere in the middle. The Patient-Driven Groupings Model (PDGM) that will govern home health payment beginning January 2020 is a good example of what I’m talking about.

PDGM shook the therapy world when it was announced that the number of therapy visits will not be considered or weighed into each 30-day period pricing for home care within a 60-day episode. As usual, providers, fearful of losing money, started to lay off therapy staff without really understanding what CMS intended.

Most of us understand that therapy visit thresholds were used to determine the additional pricing to the base rate for a home care 60-day episode. Home health providers have paid particular attention to this fact, realizing that the number of therapy visits at certain thresholds adds value to the base amount of the home care episodic rate. Back when the therapy threshold was 10 visits, home care agencies tried to have a minimum of 10 visits to capture that dollar amount. When the threshold increased to 13 visits, that number soon became the norm of therapy visits for every patient. Later, the therapy threshold moved to 19 visits. Home care agencies started to add multiple therapy services to attain that number and discharged every patient after 19 visits.

Full story at APTA

Final Home Health Rule Cements PDGM, Allows PTAs to Perform Maintenance Therapy

When it comes to its most talked-about provisions, the US Centers for Medicare and Medicaid Services’ (CMS) final rule for home health payment under Medicare isn’t much of a change from the proposed version released earlier this year, meaning that an entirely new payment system will indeed be rolled out beginning January 1. But other parts of the rule have been tweaked—and in several areas, those tweaks represent wins for the physical therapy profession and the patients it serves in home health settings.

It’s official: PDGM is on for 2020.
There wasn’t much debate about whether this would happen, but the final rule eliminates any doubt: the Patient-Driven Groupings Model (PDGM) will be the system under which CMS pays home health agencies (HHAs). It’s a big change, and APTA offers extensive information on the details of the model, but the bottom line is that the PDGM moves care from 60-day to 30-day episodes and eliminates therapy service-use thresholds from case-mix parameters. The system classifies episodes according to a set of 5 major buckets and subsets within those buckets. Patients are assigned a status within the 5 major areas, and within some of those areas they can be assigned to more detailed clinical categories—the combination of categories assigned to a patient generates a particular case-mix grouping. CMS says it will monitor how HHAs are operating under the PDGM, including the provision of therapy services.

Full story at APTA

Stroke rates continue decline in the U.S.

Rates of stroke among U.S. adults over age 65 have steadily decreased over the past 30 years, according to a study that tracked participants from the 1980s through December 2017.

Rates of decline were consistent across decades, sex and race, the study authors report in JAMA Neurology.

“Stroke is the main cause of disability in adult populations and one of the main causes of death in developed countries,” said lead study author Silvia Koton of Tel Aviv University in Israel and Johns Hopkins University in Baltimore, Maryland.

“The importance of stroke, a disease more common in older than younger ages, is likely to increase with the aging of the global population, therefore, it is important to evaluate trends,” she told Reuters Health by email.

Full story at Reuters

National Athletic Trainers’ Association Releases Official Statement of Recommendations to Reduce the Risk of Injury Related to Sport Specialization for Adolescent and Young Athletes

DALLAS, TX – In anticipation of National Youth Sports Specialization Awareness Week (third full week in October) the National Athletic Trainers’ Association (NATA) released an official statement with health-focused recommendations to reduce the risk of injury due to youth sports specialization, which is often defined as year-round participation in a single sport, usually at the exclusion of other sports.

The statement was endorsed by Professional Football Athletic Trainers Society (PFATS), Professional Hockey Athletic Trainers Society (PHATS), Professional Soccer Athletic Trainers Society (PSATS), National Basketball Athletic Trainers’ Association (NBATA), Professional Baseball Athletic Trainers Society (PBATS), and the NATA Intercollegiate Council for Sports Medicine (ICSM).

Full story at Newswise

BU researcher receives NIH grant for clinical research in rheumatology

David Felson, MD, MPH, professor of medicine and epidemiology at Boston University Schools of Medicine (BUSM) and Public Health (BUSPH), was awarded a National Institute of Health (NIH) P30 Center Grant.

The five-year, $3.6 million award will allow for further clinical research in rheumatology at the Boston University Core Center for Clinical Research, and will provide broad clinical research expertise to a large multidisciplinary group of investigators whose research focuses on osteoarthritis and gout with a secondary emphasis on scleroderma, spondyloarthritis, osteoporosis and musculoskeletal pain.

The Center includes researchers from BU, Boston Children’s Hospital, the Beth Israel Deaconess Hospital, Massachusetts Institute of Technology, Northeastern University and different groups at Harvard University. This group is comprised of individuals with backgrounds in rheumatology, physical therapy, engineering, epidemiology, biostatistics, genetics, evolutionary biology and behavioral science, who critically review projects, provide methodologic guidance to research and creates new multidisciplinary collaborations.

Full story at News Medical

Exercise especially important for older people with heart disease

It is well-known that exercise is good for cardiac health, but older adults tend to fall through the cracks when it comes to rehabilitation programs. Now, a study has shown that these individuals have the most to gain.

Heart disease is the leading cause of death for both men and women in the United States, being responsible for 1 in 4 deaths. Every year, approximately 610,000 people in the U.S. die of heart disease, while about 735,000 people have a heart attack.

Adults over the age of 65 years are more likely than younger people to have heart disease because the heart changes with age. Heart disease is a significant cause of disability, according to the National Institute on Aging, who note that it affects the ability of millions of older people to be active and have a good quality of life.

Full story at Medical News Today

Dog ownership associated with longer life, especially among heart attack and stroke survivors

Dog ownership may be associated with longer life and better cardiovascular outcomes, especially for heart attack and stroke survivors who live alone, according to a new study and a separate meta-analysis published in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.

“The findings in these two well-done studies and analyses build upon prior studies and the conclusions of the 2013 AHA Scientific Statement ‘Pet Ownership and Cardiovascular Risk’ that dog ownership is associated with reductions in factors that contribute to cardiac risk and to cardiovascular events,” said Glenn N. Levine, M.D., chair of the writing group of the American Heart Association’s scientific statement on pet ownership. “Further, these two studies provide good, quality data indicating dog ownership is associated with reduced cardiac and all-cause mortality. While these non-randomized studies cannot ‘prove’ that adopting or owning a dog directly leads to reduced mortality, these robust findings are certainly at least suggestive of this.”

Full story at Medical Xpress