Cardiometabolic Disease and Dysfunction Following Spinal Cord Injury
The risks and health hazards of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs) and disorders. Overweight/obesity, insulin resistance, hypertension, and dyslipidemia are highly prevalent after SCI. Both the CMS diagnosis and physical deconditioning worsen the prognosis for all-cause cardiovascular disease. Evidence suggests a role for physical activity to address these risks, although intense exercise may be required. A lifestyle plan incorporating both exercise and nutrition represents a preferred approach for health management. Improved surveillance for CMS risks and e...
Source: Physical Medicine and Rehabilitation Clinics of North America - July 3, 2020 Category: Rehabilitation Authors: Mark S. Nash, David R. Gater Source Type: research

Spinal Cord Injury
PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - July 3, 2020 Category: Rehabilitation Authors: John L. Lin Source Type: research

Copyright
ELSEVIER (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - July 3, 2020 Category: Rehabilitation Source Type: research

Contributors
SANTOS F. MARTINEZ, MD, MS (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - July 3, 2020 Category: Rehabilitation Source Type: research

Contents
Santos F. Martinez (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - July 3, 2020 Category: Rehabilitation Source Type: research

Physical Medicine and Rehabilitation Clinics of North America
Integrative Medicine and Rehabilitation (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - July 3, 2020 Category: Rehabilitation Source Type: research

Nerve and Tendon Transfers After Spinal Cord Injuries in the Pediatric Population
This article discusses the 2 most commonly used surgical strategies to restore upper extremity function: upper extremity tendon transfer and nerve grafting/transfer. Patient selection, physical examination, electrodiagnostic evaluation, and optimization of postoperative rehabilitation are important. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - June 9, 2020 Category: Rehabilitation Authors: Joshua A. Vova, Loren T. Davidson Source Type: research

Foreword
The field of Rehabilitation is proud and indebted to Dr Lin for his contribution to the Spinal Cord field as a clinician, researcher, and activist. As Dr Lin alludes to, we are in an exciting era with technology merging with clinical applicability. We must remain vigilant, however, to keep our basic core values and concepts that have developed over decades. I offer a personal thanks to Dr Lin for taking on the challenge of this issue. As customary, he has superseded expectations. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - June 8, 2020 Category: Rehabilitation Authors: Santos F. Martinez Source Type: research

30  Years After the Americans with Disabilities Act
This article discusses why employment is so important for persons with spinal cord injury and challenges that remain. Presented are previously unpublished employment data from a national ly representative US sample. Finally, the state of the art of vocational rehabilitation, including models proven to facilitate this critical rehabilitation outcome, is discussed. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - June 7, 2020 Category: Rehabilitation Authors: Lisa Ottomanelli, Lance L. Goetz, John O ’Neill, Eric Lauer, Trevor Dyson-Hudson Source Type: research

Hand Reconstruction in Children with Spinal Cord Injury
Comprehensive programs for children who sustain traumatic spinal cord injury should incorporate optimizing hand and upper extremity function along with the other traditional pillars of rehabilitation. Children ’s smaller anatomy, open growth plates, and future skeletal growth, combined with the age-related psychosocial impact of these injuries, require protocols suited to these age-related issues. There is a role for surgical reconstruction, as is the case for adults with traumatic tetraplegia, and surg ical outcomes are equally beneficial and long lasting. Strict adherence to surgical indications, and surgical strat...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 7, 2020 Category: Rehabilitation Authors: Allan Peljovich Source Type: research

Updates of the International Standards for Neurologic Classification of Spinal Cord Injury
This article details the ISNCSCI update from 2015 and revision in 2019. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - June 3, 2020 Category: Rehabilitation Authors: Steven Kirshblum, Brittany Snider, R üdiger Rupp, Mary Schmidt Read, International Standards Committee of ASIA and ISCoS Source Type: research

Cognitive Dysfunction in Persons with Chronic Spinal Cord Injuries
Cognitive dysfunction (CD) is pervasive in individuals who have chronic spinal cord injuries (SCI). Although classically associated with concomitant traumatic brain injuries, many other causes have been proposed, including premorbid neuropsychological conditions, mood disorders, substance abuse, polypharmacy, chronic pain and fatigue, sleep apnea, autonomic dysregulation, post-intensive care unit syndrome, cortical reorganizations, and neuroinflammation. The consequences of CD are likely widespread, affecting rehabilitation and function. CD in those with SCI should be recognized, and potentially treated, in order to provid...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 3, 2020 Category: Rehabilitation Authors: Donald F. Distel, Matthew Amodeo, Shawn Joshi, Benjamin A. Abramoff Source Type: research

Neurogenic Bowel Management Using Transanal Irrigation by Persons with Spinal Cord Injury
Neurogenic bowel has received surprisingly little attention. Among individuals with spinal cord injury, bowel function is considered a major physical and psychological problem that stems from the severe negative impact on social life and mobility. With transanal irrigation, individuals with neurogenic bowel have received an additional tool that may simplify life and improve independence. A recent survey showed that as many as 37% of the spinal cord injury patients interviewed had not heard about transanal irrigation. It should be a high priority at spinal cord injury centers to support patients with the right tools for pro...
Source: Physical Medicine and Rehabilitation Clinics of North America - June 2, 2020 Category: Rehabilitation Authors: Claes Hultling Source Type: research

Predicting Outcomes After Spinal Cord Injury
The aim of this article is to provide an overview of prognosis and outcomes after spinal cord injury (SCI), including variables that have an impact on neurologic assessment, extent and time frame of natural recovery, specific factors having an impact on prognosis of ambulation, the role of imaging and modalities for assessing the injured spinal cord, and strategies on presenting information to patients and families. The ability to predict outcome after spinal cord injury is important not only for individuals who sustained traumatic SCI and their families but also for rehabilitation professionals and researchers. (Source: P...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 26, 2020 Category: Rehabilitation Authors: Wesley Chay, Steven Kirshblum Source Type: research

Management Strategies for Spinal Cord Injury Pain Updated for the Twenty-First Century
This article reviews selected treatment strategies for SCI-associated neuropathic pain. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - May 22, 2020 Category: Rehabilitation Authors: Erik Shaw, Michael Saulino Source Type: research

Facing the Reality: Confronting the Challenges of Spinal Cord Injury Sequelae in 2020
Since the turn of the millennium, excitement has been abuzz in the field of spinal cord medicine. Much like in the preceding decades that heralded in methylprednisolone, GM1 ganglioside, and 4-aminopyridine, the subspecialty is now again ebullient with the untold promises of neurologic recovery from stem cells to gait improvement associated with spinal cord stimulators. While the limelight for spinal cord medicine focuses on infinity and beyond, at least a quarter of a million Americans, and many more around the world, face the reality of living with a spinal cord injury (SCI) and the myriad of comorbid conditions challeng...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 22, 2020 Category: Rehabilitation Authors: John L. Lin Tags: Preface Source Type: research

Noninvasive Respiratory Management of Spinal Cord Injury
Intubated ventilator-dependent patients with high-level spinal cord injury can be managed without tracheostomy tubes provided that they have sufficient cognition to cooperate and that any required surgical procedures are completed and they are medically stable. Intubation for a month or more than extubation to continuous noninvasive ventilatory support (NVS) can be safer long term than resort to tracheotomy. Noninvasive ventilation (NIV) is not conventionally being used for ventilatory support. Noninvasive interfaces include mouthpieces, nasal and oronasal interfaces, and intermittent abdominal pressure ventilators. NIV/NV...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 6, 2020 Category: Rehabilitation Authors: John R. Bach, Lindsay Burke, Michael Chiou Source Type: research

Therapeutic Interventions to Improve Mobility with Spinal Cord Injury Related Upper Motor Neuron Syndromes
Mobility is essential for quality of life and social participation. Some individuals with spinal cord injury have sufficient residual lower extremity motor control to walk. Improving walking function incorporates practice and training, and assistive devices or stimulation to augment function and balance. Overground robotic exoskeletons may have the potential to transform upright mobility in the future. Most individuals with spinal cord injury use a wheelchair for at least some of their mobility needs. Wheelchair skills training can open up new possibilities for participation. Regardless of the means of mobility, developing...
Source: Physical Medicine and Rehabilitation Clinics of North America - May 6, 2020 Category: Rehabilitation Authors: Edelle C. Field-Fote Source Type: research

Conventional Respiratory Management of Spinal Cord Injury
Respiratory complications often result from acute spinal cord injury. Ventilatory assistance/support is often required 12 hours to 6 days after admission and is typically delivered via translaryngeal tubes. When not weanable from ventilatory support, tracheostomy tubes are placed. They are often unnecessarily left with inflated cuffs that prevent effective communication and delay rehabilitation. Also, supplemental O2 is often provided irrespective of whether or not the patient is hypoxic. This renders the oximeter ineffective as a gauge of alveolar ventilation, airway secretion management, and residual lung disease and can...
Source: Physical Medicine and Rehabilitation Clinics of North America - April 24, 2020 Category: Rehabilitation Authors: John R. Bach, Lindsay Burke, Michael Chiou Source Type: research

Opioids
This article provides an overview of the basic physiology of opioids, reviews opioid pharmacology, and attempts to address several issues of current importance in the management of patients with established long-term opioid therapy. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - April 10, 2020 Category: Rehabilitation Authors: Andrew Friedman, Lorifel Nabong Source Type: research

Topical Analgesics
Topical analgesics are a growing area of clinical interest, given improvements in formulation drug delivery and local delivery of medicine, limiting risk for potential adverse systemic effects. Topical analgesics include medications for acute and chronic pain, such as musculoskeletal pain disorders, including sprains and strains; neuropathic pain; and muscle pain related to trauma. This review covers an update on formulations for acute and chronic pain, a discussion on advancements in drug delivery, and an update on recent treatment guidelines related to topical medications for osteoarthritis and neuropathic pain condition...
Source: Physical Medicine and Rehabilitation Clinics of North America - April 10, 2020 Category: Rehabilitation Authors: Steven Stanos Source Type: research

Pharmacologic Support in Pain Management
The most effective pain management strategies rely on a comprehensive approach that addresses each aspect of the biopsychosocial model. At times patients warrant treatment with medication management, interventional pain management techniques, physical and occupational therapy, cognitive behavioral techniques, pain education, and interdisciplinary care. A critical factor in successful pharmacologic pain management is the ability to not only establish an accurate diagnosis but also tailor the treatment to address the underlying pathophysiologic and behavioral changes presenting as pain and pain-related suffering: a mechanist...
Source: Physical Medicine and Rehabilitation Clinics of North America - April 10, 2020 Category: Rehabilitation Authors: Steven Stanos, James R. Babington Tags: Preface Source Type: research

Resetting Pain Management Strategies
The field of pain management continues to be quite challenging as both patients and physicians adapt to ever-changing strategies. What may have been the standard of treatment just a few years ago now is found to be unacceptable especially with pharmacologic support. The medical field was encouraged to be sensitive to the pharmacologic management and support of this patient population with an array of innovative variations and methods. Standard intermittent administration of medications turned into longer-acting agents, including implants. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - April 10, 2020 Category: Rehabilitation Authors: Santos F. Martinez Tags: Foreword Source Type: research

Pharmacologic Support in Pain Management
PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - April 10, 2020 Category: Rehabilitation Authors: Steven Stanos, James R. Babington Source Type: research

Copyright
ELSEVIER (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - April 10, 2020 Category: Rehabilitation Source Type: research

Contributors
SANTOS F. MARTINEZ, MD, MS (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - April 10, 2020 Category: Rehabilitation Source Type: research

Contents
Santos F. Martinez (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - April 10, 2020 Category: Rehabilitation Source Type: research

Forthcoming Issues
Spinal Cord Injury (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - April 10, 2020 Category: Rehabilitation Source Type: research

Muscle Relaxants for Acute and Chronic Pain
This article provides an overview of the different types muscles relaxants and their adverse effects. Appropriate medication selection based on clinical indications is also examined. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - March 13, 2020 Category: Rehabilitation Authors: Wilson J. Chang Source Type: research

Buprenorphine in the Treatment of Chronic Pain
This article reviews the pharmacology and clinical effectiveness of buprenorphine in the context of chronic pain treatment. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - March 13, 2020 Category: Rehabilitation Authors: Gregory D. Rudolf Source Type: research

Opioid Management
This article describes a pragmatic approach to clinical care of adults with chronic pain receiving long-term opioid therapy. Three components of care are emphasized: (1) medical and mental health assessment before initiating opioid therapy, (2) clinical surveillance during the course of long-term opioid therapy, and (3) clinical considerations and strategies governing opioid tapering. A pressing need exists for ongoing research to further clarify the optimal role that long-term opioid therapy has in treatment of chronic pain. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - March 11, 2020 Category: Rehabilitation Authors: W. Michael Hooten Source Type: research

Nonsteroidal Antiinflammatory Drugs for Acute and Chronic Pain
Understanding nonsteroidal antiinflammatory drug (NSAID) use and impact on common rheumatic and arthritic conditions is critical to reconciling their appropriate use with their potentially serious adverse effects. NSAIDs have a profound impact on the treatment of connective tissue disorders because of their ability to address the underlying cause with specific benefits of decreasing stiffness and inflammation, and improving mobility. NSAID use is twice as common as opioid use, and inappropriate use of NSAIDs is widespread. NSAID use should be monitored and the impact understood to mitigate the risks. NSAID discontinuation ...
Source: Physical Medicine and Rehabilitation Clinics of North America - March 10, 2020 Category: Rehabilitation Authors: Timothy J. Atkinson, Jeffrey Fudin Source Type: research

Pharmacologic Approach to Insomnia
Sleep management is essential to effective treatment of pain symptoms. Identification of the precise nature of sleep complaint, awareness of patient ’s age and co-morbid conditions and choice of the hypnotic medication class can help guide treatment approach. In addition to benzodiazepine and non-benzodiazepine medications acting at the GABA receptor, novel approaches, including orexin receptor agonists, may be safer and more promising pharmac ologic approaches. Pharmacologic interventions, when used cautiously for a limited period of time and in complement with behavioral and cognitive approaches, can serve to impro...
Source: Physical Medicine and Rehabilitation Clinics of North America - March 10, 2020 Category: Rehabilitation Authors: Lina Fine Source Type: research

Ethics and Regulation of Opioid Prescriptions for Management of Pain
Painful conditions affect a significant population in the United States. As the scientific understanding of the benefits and harms of opioid therapy has evolved, so too has the application of prescription opioid therapy for the treatment of pain. The rapid increase in the use of prescription and illicit opioids over the past decade has contributed to a public health crisis commonly referred to as the “opioid crisis.” In this article, the ethical approaches to treating patients with opioid pharmaceuticals as well as the development of regulation of opioid therapy in Washington State are reviewed. (Source: Physic...
Source: Physical Medicine and Rehabilitation Clinics of North America - March 10, 2020 Category: Rehabilitation Authors: James R. Babington, Micah Matthews Source Type: research

Evolving Pharmacotherapies for Pain
This article focuses primarily on new molecular entities in development targeting various chronic pain receptors and new delivery technologies. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - February 20, 2020 Category: Rehabilitation Authors: Rohit Nalamasu, Srinivas Nalamachu Source Type: research

The Expanding Role of Genetics in Cerebral Palsy
This article helps clinicians to determine which patients would benefit from a thorough genetic/metabolic evaluation and helps to delineate an approach for the work-up, with an emphasis on newer technologies and the evolving fields of fetal medicine and genetics. It provides guidance to providers to assist in clarifying an cause for some patient's symptoms. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Authors: Lisa T. Emrick, Shannon M. DiCarlo Source Type: research

Principles of Ankle-Foot Orthosis Prescription in Ambulatory Bilateral Cerebral Palsy
Maintenance of upright posture and gait mobility is frequently a goal in supporting children with cerebral palsy (CP). Ankle-foot orthoses (AFOs) can play an important role in normalizing gait function in this population. Properly designed orthotic interventions consider common ankle and foot deformities, range-of-motion limitations, and natural history of CP. Successful AFO prescription often requires interaction with complementary interventions such as physical therapy, spasticity management, and/or orthopedic management. Recognizing the impact of plantar flexion contractures and the effects of footwear on AFO alignment ...
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Authors: Ed Wright, Sally A. DiBello Source Type: research

Medical Updates in Management of Hypertonia
Identifying the subtypes of hypertonia is becoming increasingly important. Treatment strategies, including tone-modulating surgical interventions, medication type and dosing, and chemodenervation, may differ depending on the type of hypertonia present. It is important to delineate how hypertonia interferes with function and quality of life so that the appropriate intervention can be selected at the right time. Outcomes of treatment depend heavily on clear communication of goals. Botulinum toxin should not be used in isolation but as an adjunct to rehabilitation modalities. (Source: Physical Medicine and Rehabilitation Clin...
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Authors: Rochelle Dy, Desiree Roge Source Type: research

Comprehensive Care in Cerebral Palsy
Children with cerebral palsy (CP) will be cared for at some point by all pediatricians and many pediatric subspecialists due to this condition being the most common motor disability of childhood. Comprehensive care of the child with CP requires individuals with specialized training, and these children benefit from an interdisciplinary team approach to care. CP is heterogeneous due to varied causes, which necessitates individualized treatment plans. The CP specialist must be prepared to support the needs of the child with CP holistically and must dialogue regularly with members of the team and involve the family in decision...
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Authors: Aloysia Leisanne Schwabe Source Type: research

Orthopedic Conditions in Adults with Cerebral Palsy
This article describes the common orthopedic conditions in adults with CP and discusses who should perform orthopedic surgery on adults. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Authors: Megan R. Lomax, M. Wade Shrader Source Type: research

Preface
This issue of Physical Medicine and Rehabilitation Clinics of North America on cerebral palsy incorporates what for many of us is an example of what medicine at its finest can do in making a difference for a child with a lifelong condition. Individuals with different backgrounds and expertise work together to advance a child and their family along a continuum that includes anticipatory guidance, partnering to identify goals, and support to the patient and family through the ups and downs of diagnosis, treatment, and aging. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Authors: Aloysia Leisanne Schwabe Source Type: research

A Challenge for All
There are many facets to consider for the clinician treating cerebral palsy. These range from preventive efforts and identification of risk factors for prospective mothers to early intervention by the rehabilitation team to address strategies for delayed developmental milestones. There are a number of additional congenital and/or acquired conditions, which include not only neurodevelopmental challenges but also less obvious comorbidities, which may be multiorgan in nature. Vigilance and thoroughness to provide basic nutritional support, multispecialty assessments, and a cohesive plan with family input are paramount. (Sourc...
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Authors: Santos F. Martinez Tags: Foreword Source Type: research

Cerebral Palsy
PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Authors: Aloysia Leisanne Schwabe Source Type: research

Copyright
ELSEVIER (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Source Type: research

Contributors
SANTOS F. MARTINEZ, MD, MS (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Source Type: research

Contents
Santos F. Martinez (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Source Type: research

Forthcoming Issues
Pharmacologic Support in Pain Management (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - November 22, 2019 Category: Rehabilitation Source Type: research

Adaptive Sports, Arts, Recreation, and Community Engagement
This article discusses the history of adaptive sports and the benefits of adaptive sports and recreation. Barriers and medical challenges are also thoroughly discussed, including common musculoskeletal issues, methods to prevent musculoskeletal injury, pain, fatigue, maximal exertion, and other medical comorbidities and illness. The role of health care providers such as physiatrists is emphasized to provide support to individuals with CP who either are interested in starting exercise or a sport or are already an athlete. (Source: Physical Medicine and Rehabilitation Clinics of North America)
Source: Physical Medicine and Rehabilitation Clinics of North America - November 7, 2019 Category: Rehabilitation Authors: Stephanie Tow, Joslyn Gober, Maureen R. Nelson Source Type: research

Registry-based Research in Cerebral Palsy
Registries are a powerful tool for clinical research. Clinical registries for cerebral palsy can aid in comparative effectiveness research, especially using the practice-based evidence model. The Cerebral Palsy Research Network (CPRN) was initiated in 2014 as a patient-centered, multidisciplinary registry. The leadership group initiated a 4-stage participatory action research process: listen, reflect, plan/analyze, and take action. CPRN also joined with CP NOW, an advocacy group, to create a research agenda for cerebral palsy. With more than 20 centers and growing, CPRN hopes to generate evidence for developing best practi...
Source: Physical Medicine and Rehabilitation Clinics of North America - November 7, 2019 Category: Rehabilitation Authors: Edward A. Hurvitz, Paul H. Gross, Mary E. Gannotti, Amy F. Bailes, Susan D. Horn Source Type: research

Surgical Tone Reduction in Cerebral Palsy
This article overviews the surgical options for hypertonia management in cerebral palsy, both spasticity and dystonia. We review the history and use of intrathecal baclofen. We contrast its use with the indications for selective dorsal rhizotomy and review how it is the optimal technique to lower tone in the ambulatory spastic diplegic patient with cerebral palsy. This article reviews the advent of deep brain stimulation, with an emphasis on selection criteria and expected outcomes in this population. The article reviews the principles and use of selective peripheral neurotomy as it is applied to focal spasticity not requi...
Source: Physical Medicine and Rehabilitation Clinics of North America - November 7, 2019 Category: Rehabilitation Authors: Sruthi P. Thomas, Angela P. Addison, Daniel J. Curry Source Type: research