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Study highlights: , Dec 15, 2011 (GlobeNewswire via COMTEX) — Adding robotic assistance to standard rehab was more effective than traditional methods in helping severely impaired stroke survivors regain the ability to walk. — The additional therapy was not beneficial for those with less impairment.

DALLAS, Dec. 15, 2011 (GLOBE NEWSWIRE) — Severely impaired stroke survivors could walk better when a robotic assist system was added to conventional rehabilitation, according to a study in Stroke: Journal of the American Heart Association.

Italian researchers evaluated two-year mobility outcomes in 48 stroke survivors who had been discharged from a hospital and were unable to walk at the study’s start. Half underwent conventional overground gait rehabilitation and half had conventional rehab plus electromechanical robotic gait training for several months.

“After two years, five times more patients who underwent robotic assistance training were able to walk without assistance, but only the most severely impaired,” said Giovanni Morone, M.D., lead researcher and a physiatrist specialist and temporary assistant professor at the Santa Lucia Foundation, Institute for Research Hospitalization and Health Care in Rome. “In others it seemed to make little difference, so the patient selection for this type of treatment is most important.”

Earlier studies have shown similar advantages combining robotic and conventional therapy early on, but this is the first study to examine whether or not these improvements persist.

The robotic devices are electromechanical platforms attached to a patient’s feet that are controlled by a physical therapist. The therapist uses a controller to carefully measure a patient’s status and to progressively set bearing weight and their walking pace.

In the new study, patients were evaluated during their hospital stay, at discharge, and two years later. They were classified by the degree of their disability, and separated into either high- or low- mobility groups.

The team used three standard tests to evaluate patients’ ability to walk and other task performance, including normal daily activities. During treatment, all patients underwent two therapy sessions each day for five days per week for three months. The robotic gait assistance group also had 20 sessions of robotic gait training during the first month along with abbreviated conventional therapy for the extended period.

Only patients with the greatest degree of motor impairment who underwent robotic training showed improvement in walking without assistance two years after their discharge.

Although other studies have found robotic assistance can help improve patients for six months, larger trials in patients who could still walk have found that training with either robotic assistance devices or body-weight supported treadmill training are not superior to having patients walk outdoors, and may even be less effective.

“It could be time to change the research question from whether or not robotic-assisted walking training is effective, to who will benefit the most,” said Morone. “Doctors need to select the right patients and remember that this is an adjunct to traditional gait training.”

Future studies should attempt to more finely correlate these treatment options with the degree of motor impairment, as well as the stroke post-onset timeline for recovery, he added.

Co-authors are Marco Iosa, Ph.D., Maura Bragoni, Ph.D., Domenico De Angelis, M.D., Vincenzo Venturiero, Ph.D., Paola Coiro, M.D., Luca Pratesi, M.D., and Stefano Paolucci, M.D., of the Santa Lucia Foundation, and Raffaella Riso, M.D., Physical Medicine and Rehabilitation Unit, “Sapienza” University of Rome, Sant’Andrea Hospital, Rome.

The study was funded by the Italian Ministry of Health and Santa Lucia Foundation.

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Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding .

The New York Giants will start preparations for this week’s game against Washington without defensive linemen Justin Tuck and Osi Umenyiora, while center David Baas is also not yet ready to practice.

Tuck has been bothered by neck, groin and ankle injuries all season, but his latest issue is a toe problem. He hurt his toe during last Sunday’s game against Dallas.

“It’s discomfort, it’s sore, it’s an issue,” said Giants head coach Tom Coughlin on Wednesday. “But hopefully it’s going to be able to get under control.”

Umenyiora has missed the last two games with an ankle injury he sustained in Week 12 against New Orleans. Baas has also missed two games with a neck injury and severe headaches.

NEW YORK—The exclusive remedy provision in workers compensation law does not bar an employee from collecting uninsured motorist benefits from a self-insured employer, New York state’s high court has ruled.

In the case of Elrac Inc. vs. Birtis Exum, Mr. Exum was in an automobile accident with another car while working for Elrac, a self-insured subsidiary of Enterprise Rent-a-Car Co.The other car’s driver had not purchased liability insurance, according to Tuesday’s New York Court of Appeals ruling. So Mr. Exum notified Elrac that he intended to seek uninsured motorist benefits from the employer through arbitration.

Elrac sought to stay the arbitration, and a trial court granted the petition. But in 2010, an appellate court reversed and allowed arbitration to proceed.

Elrac appealed to New York’s highest court, arguing that because Mr. Exum is entitled to workers comp benefits in this injury case, he is barred from recovering uninsured motorist benefits.

Exception to the rule

While New York state law says an employer’s liability for workers comp benefits “shall be exclusive and in place of any other liability whatsoever,” the high court found that wording “cannot be taken literally” in all cases.

“Specifically, the statute cannot be read to bar all suits to enforce contractual liabilities,” the court ruled. “If an employer agrees, as part of a contract with an employee, to provide life insurance or medical insurance, and breaches that contract, an action to recover damages for the breach would not be barred.”

Likewise, “There is no policy reason why Exum’s uninsured motorist protection should decrease because he happened to be driving the car of a self-insurer,” the court ruled in affirming the appellate court’s decision to allow arbitration to proceed.

Physical rehabilitation has been in the spotlight lately. Recent news stories about U.S. Rep. Gabby Giffords’ ongoing recovery from a gunshot wound focused on her continuing medical rehabilitation care. Journalist Bob Woodruff and his wife, Lee, continue to laud rehabilitation for advancing his recovery from a severe injury caused by a roadside bomb in Iraq.

Today, the spotlight needs to move to everyday people — like your mother, your uncle, your elderly neighbor — who may not have access to rehabilitation care in the future if they suffer a stroke, a brain injury or a simple broken bone. As part of the deficit reduction discussion, Congress is proposing cuts that would reduce patient access to quality, medically necessary, inpatient rehabilitation care, which in turn could potentially reduce the number of rehabilitation providers in this country.

Medical rehabilitation is the physical, occupational and speech therapy that a patient may receive after being in an acute-care hospital. Rehabilitation also includes specialized care provided by physical medicine and rehabilitation physicians and certified rehabilitation nurses.

The physical rehabilitation provided at post-acute care organizations, such as Good Shepherd Rehabilitation Network, helps patients who have strokes, brain injuries, spinal cord injuries, joint replacements, broken bones and other injuries. Rehabilitation can improve the quality of life for patients with multiple sclerosis or other neurological conditions.

Rehabilitation for traumatic accidents and severe illness typically takes weeks or months, but the hard work is worth it for the patients, their families and the health care system in general. Rehabilitation improves patient outcomes by improving functional skills and restoring independence. Rehabilitation also reduces health care costs by maximizing patient health and preventing subsequent medical complications and hospital readmissions. In many cases, rehabilitation is the difference between returning to a productive life — whether it is work, school or home — or becoming dependent on relatives or institutions, such as nursing homes, for care.

A recently released Moran Co. report shows that the number of Medicare beneficiaries utilizing inpatient rehabilitation hospitals and units has dropped by 26 percent since 2004. This statistic is cause for alarm. These reductions in utilization clearly are linked to government policy changes that limit the type of sick or injured patients who may be admitted to an inpatient rehabilitation hospital/unit.

Washington’s latest proposed cuts would further reduce access to rehabilitation. They include decreases in Medicare and Medicaid payments to inpatient rehabilitation providers, while further limiting the types of patients who may receive inpatient rehabilitation care. This would make it difficult for many older Americans to receive the quality, post-acute care that would allow them to return to their homes and families.

As the population ages and the baby boomers’ medical needs swell, access to quality inpatient and outpatient rehabilitation is not optional. I encourage you to read a recent article posted online by Lee Woodruff. . Lee watched as her husband went through the long road to recovery during rehabilitation . She brings a personal perspective to the importance of rehabilitation and the dangers of the proposed cuts.

One of the issues Lee emphasizes is that reducing the number of Americans who are able to access rehabilitation may ultimately lead to fewer rehabilitation facilities in this country. While Good Shepherd remains a viable, nationally recognized post-acute care provider, government regulations that restrict access and reduce reimbursements for patient care threaten our future. Good Shepherd’s senior leaders and board of trustees are working to meet the challenges presented by lower reimbursements and patient access issues, to ensure that our patients continue to receive the highest quality post-acute care.

SALT LAKE CITY — It often starts small but can grow to the point of being a real pain in the back, keeping a person from normal function and enjoying everyday activity.

But back pain can be treated.

“Back and neck pain affects nearly everyone at some point in their lives,” said Dr. Scott Swasey, a specialist with Intermountain Medical Center’s Physical Medicine and Rehabilitation Clinic.

Swasey said prompt and appropriate treatment may be key to avoiding chronic, long-term and debilitating pain.

“Once pain becomes chronic, it is difficult to diagnose,” he said, adding that he recommends people see a physician as soon as the pain “keeps a person from doing what they do every day.”

Swasey, along with Brad Dalton, a physical therapist with Intermountain WorkMed, will take questions from the general public about back pain and available treatment options during Saturday’s Deseret News/Intermountain Healthcare Hotline. From 10 a.m. until noon, anyone can call 800-925-8177 or post questions on the Deseret News’ Facebook page.

At Intermountain’s Physical Medicine and Rehabilitation Clinic, treatment is offered in a multidisciplinary approach, involving at times a physical therapist, pain psychologist, neurosurgeon and/or a spine surgeon, among others.

Swasey said oftentimes there is no singular solution to pain management.

Back pain, the most common cause of disability in people under age 45, can be spurred by problems with the joints in the spine or pelvis that become displaced or stiff, or discs in the spine that do the same, or even by nerve issues. It can remain localized in the back or can be felt in other areas of the body, specifically the limbs or extremities.

There are multiple treatment options, including steroidal injections that provide temporary relief or even surgical procedures that diminish pain long term, Swasey said. But in a 40-minute initial evaluation and examination, he asks patients about their sleep habits first.

He said sleep disorders, as well as depression and anxiety issues, can lead to back pain — or at least be major contributing factors that need attention before pain can be treated effectively.

“It’s all about prevention,” Swasey said, and avoiding the potential for chronic pain.

Maintaining a health diet and regular exercise can help keep back pain at bay, as well as avoiding prolonged inactivity or a sedentary lifestyle, according to the American Pain Society.

Posture, comfortable shoes, mattress firmness and the tendency to stretch or warm up muscles and joints before activity are also factors that can stave off injury or pain.

Smoking and pregnancy are also contributing factors to back pain.

As an Army physician, Swasey said he would see soldiers soon after their injuries and because of what he believes was a quick application of treatment, 90 percent of them were back working, pain-free, within a week.

While he is open to using medication to treat pain in patients, Swasey said he is careful, not only to avoid addiction, but a bigger problem of unwanted side effects, sometimes leading to impairment of normal breathing patterns and even death.

Sleep issues are important to him as a doctor, as he believes they can lead to back pain without an inciting event, such as throwing it out during various physical activity.

Research is only just starting to link the two, but Swasey said it is apparent in what he sees in his office on a regular basis.

“If your pain is bad enough that it’s impairing what you need to do in life, you need to be seen,” he said. “It used to be that we would let it get better on its own, but in my experience, the sooner you get the appropriate treatment the better.”

The solution might be simple, but seeking medical attention, he said, could also help prevent the recurrence of back pain, which is common in people who’ve had it before.

Saturday: Living with back pain