Physiatry

ACQUIRED BRAIN INJURY REHABILITATION

Brief Description

The Acquired Brain Injury (ABI) Rehabilitation Program is a regional program for the Greater Toronto Area that seeks to meet the rehabilitation needs of patients who have sustained a brain injury in adult life. Since brain injury can affect all aspects of a person's physical, intellectual and emotional function, all manner of impairments can exist.  An extensive database has been set up to monitor the patients' function and progress through the rehab process. Follow-up exams are done at one year to assess their ongoing progress. The research program assesses the effectiveness of rehabilitation strategies through measurement of outcomes in this population. The research group is also interested in medical and pharmacological treatments to enhance brain injury recovery. 

Principal Investigators

Recent Original Research Publications

Zafonte RD, Cullen N, Lexell J. Serotonin agents in the treatment of acquired brain injury. J Head Trauma Rehab 17:322-334, 2002.

Cayen B, Cullen N.  Intracerebral hemorrhage in previously healthy adults following aerobic and anaerobic exercise. Brain Injury 16:397-405, 2002.

Masanic CA, Bayley MT, VanReekum R, Simard M. Open-label study of donepezil in traumatic brain injury. Arch Phys Med Rehab. 82:896-901, 2001.

Zafonte RZ, Lexell J, Cullen NK. Possible applications for dopaminergic agents following traumatic brain injury: part II.  J Head Trauma Rehab. 16:2001.

Zafonte RZ, Cullen NK, Lexell J. Possible applications for dopaminergic agents following traumatic brain injury: part I.  J Head Trauma Rehab. 15:1179-1182, 2000.

Future Directions

The area of outcomes research in adult acquired brain injury is in its relative infancy. Therefore, several lines of investigation will be pursued in future studies, including.

• characterization of the natural recovery of this common impairment. Given the diverse nature of brain damage and its many etiologies, there are a number of subcategories that have yet to be explored, including the pattern of recovery that takes place after a brain damaging event for a given impairment.
• comparison of how traumatically induced brain injury patients recover versus non- traumatically brain injured patients.
• comparison of  various service delivery models to determine the most effective treatment protocols (e.g. length of stay, rehabilitation therapy, community rehab) and the costs associated with those outcomes.

AMPUTEE REHABILITATION

Brief Description

Amputation is a frequent complication of a number of disorders including  diabetes, peripheral vascular disease and cancer. The Division of Physiatry is fortunate that the rehabilitation of these patients for much of the Toronto area is based at two of the affiliated rehabilitation centres (West Park Healthcare Centre and St. John's Rehabilitation Hospital). Following amputation, rehabilitation addresses the fitting of the limb with a prosthesis and training in its use. The research has two major foci: functional outcomes after prosthetic fitting; and evaluation of prosthetic technology itself.

Principal Investigators

Recent Original Research Publications

Brooks D, Parsons J, Hunter J, Devlin M, Walker J. The two-minute walk test as a measure of functional improvement in persons with lower limb amputation. Arch Phys Med Rehabil 82: 1478-1483, 2001.

Devlin M, Sinclair L, Colman D, Parsons J, Nizio H, Campbell J. Patient preference and gait efficiency in a geriatric tansfemoral amputee population using a freeswinging versus a locked prosthetic knee joint. Arch Phys Med Rehabil 83:246-9,2002.

Meikle B, Devlin M, Garfinkel S. Program interruptions in amputee rehabilitation. Arch Phys Med Rehabil 83: 1222-8, 2002.

Hunter J, Brooks D, Parsons J, Devlin M. The reliability of the 2 minute walk teat as a measure of functional improvement in persons with lower limb amputation. Arch Phys Med Rehabil (in press).

Boulias C, Devlin M, Meikle B, Garfinkel S. Driving habits of lower extremity amputees. Arch Phys Med Rehabil (in press).

Future Directions

We will continue ongoing research directed at outcomes in amputee rehabilitation, including return to work in amputees (comparing work-related and non-work related groups) and functional outcome in tumour versus trauma-related amputees.

PAIN AND MUSCUlOSKELETAL REHABILITATION

Brief Description

The Comprehensive Pain Program has had a long-standing focus in pain syndromes that were previously considered "non organic" in nature. Recent findings suggest that there are central nervous alterations in these patients that are associated with non-dermatomal symptoms. Certain genetic phenotypes also appear to be associated with development of some chronic pain syndromes. A recent focus has been on alternative medical approaches to pain management.

Principal Investigators

Recent Original Research Publications

Mellegers M, Furlan A, Mailis A. Gabapentin for neuropathic pain: systematic review of controlled and uncontrolled literature. Clin J Pain 17:284-295, 2001.

Furlan A, Lui PW, Mailis A. Chemical sympathectomy for neuropathic pain. Does it work? Case report and systematic literature review. Clin J Pain 17:327-336, 2001.

Mailis A, Bennett GJ. Dissociation between cutaneous and deep sensibility in central post-stroke pain. Pain 98;331-334, 2002.

Mailis A, Giannoylis I, Downar J, Kwan CL, Mikulis DJ, Crawley AP, Nicholson K, Davis KD. Altered central somatosensory processing in chronic pain patients with “hysterical anesthesia”. Neurology (in press).

Ko GD, Berbrayer D, Lo JK.  Fibromyalgia patients with headache effectively treated with Botulinum toxin type A: a case series.  Arch Phys Med Rehabil 82:1321, 2001.

Hanada E. Efficacy of rehabilitative therapy in regional musculoskeletal conditions. Best Practice & Res Clin Rheumatology (in press).

Future Directions

The program will continue to develop an extended program for phenotyping and genotyping neuropathic pain populations; continue its evidence-based medicine and systematic literature reviews; undertake further functional imaging studies (fMRI and SPECT) in patients with chronic pain and “hysterical” anesthesia and paralysis; and will undertake surface EMG assessments of patients with chronic low back pain (failed surgery), before and after physiatric interventions (Botox, prolotherapy, corticosteroid injections), an initial case series, and then a double-blinded RCT comparing Botox with placebo.