Impact of benchmarking and clinical decision making tools on rehabilitation length of stay following spinal cord injury

Spinal cord injury (SCI) patients suffer from diverse gait deficits depending on the severity of their injury. Gait assessments can objectively track the progress during rehabilitation and support clinical decision making, but a comprehensive gait analysis requires far more complex setups and time-consuming protocols that are not feasible in the daily clinical routine. As using inertial sensors for mobile gait analysis has started to gain ground, this work aimed to develop a sensor-based gait analysis for the specific population of SCI patients that measures the spatio-temporal parameters of typical gait laboratories for day-to-day clinical applications. The proposed algorithm uses shank-mounted inertial sensors and personalized thresholds to detect steps and gait events according to the individual gait profiles. The method was validated in nine SCI patients and 17 healthy controls walking on an instrumented treadmill while wearing reflective markers for motion capture used as a gold standard. The sensor-based algorithm (i) performed similarly well for the two cohorts and (ii) is robust enough to cover the diverse gait deficits of SCI patients, from slow (0.3 m/s) to preferred walking speeds.

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Correlational Dueling Bandits with Application to Clinical Treatment in Large Decision Spaces

Proceedings of the Twenty-Sixth International Joint Conference on Artificial Intelligence ◽

10.24963/ijcai.2017/389 ◽

2017 ◽

Cited By ~ 2

Author(s):

Yanan Sui ◽

Joel W. Burdick

Keyword(s):

Decision Making ◽

Spinal Cord ◽

Clinical Decision Making ◽

Clinical Decision ◽

Sequential Decision Making ◽

Sequential Decision ◽

Decision Space ◽

Cord Injury ◽

Effectiveness And Efficiency ◽

Comparative Feedback

We consider sequential decision making under uncertainty, the optimization over large decision space with noisy comparative feedback. This problem can be formulated as a K-armed Dueling Bandits problem where K is the total number of decisions. When K is very large, existing dueling bandits algorithms suffer huge cumulative regret before converging on the optimal arm. This paper studies the dueling bandits problem with a large number of dependent arms. Our problem is motivated by a clinical decision making process in large decision space. We propose an efficient algorithm CorrDuel for the problem which makes decisions to simultaneously deliver effective therapy and explore the decision space. Many sequential decision making problems with large and structured decision space could be facilitated by our algorithm. After evaluated the fast convergence of CorrDuel in analysis and simulation experiments, we applied it on a live clinical trial of therapeutic spinal cord stimulation. It is the first applied algorithm towards spinal cord injury treatments and experimental results show the effectiveness and efficiency of our algorithm.

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A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00911-6 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Courtney Celian ◽

Veronica Swanson ◽

Maahi Shah ◽

Caitlin Newman ◽

Bridget Fowler-King ◽

...

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

New Technologies ◽

Clinical Decision ◽

Relative Advantage ◽

Personal Attributes ◽

Design Work ◽

Cognitive Limitations ◽

Knowledge And Beliefs ◽

Cord Injury

Abstract Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists’ real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR). Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to consider the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians’ comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects.

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Rehabilitation Length of Stay and Functional Improvement among People with Traumatic Spinal Cord Injury

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.08.336 ◽

2019 ◽

Vol 100 (10) ◽

pp. e114

Author(s):

Yu-Hsiang Kao ◽

Yu-Ying Chen ◽

Anne Deutsch ◽

Huacong Wen ◽

Tung-Sung Tseng

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Length Of Stay ◽

Functional Improvement ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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Factors affecting length of stay in hospital of patients with traumatic spinal cord injury in China

Journal of Rehabilitation Medicine ◽

10.2340/16501977-2761 ◽

2020 ◽

Vol 52 (11) ◽

pp. jrm00123

Author(s):

Z Zhang ◽

F Wang ◽

Y Wu

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Length Of Stay ◽

Traumatic Spinal Cord Injury ◽

Factors Affecting ◽

Cord Injury

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Intraabdominal Injury is Common in Blunt Trauma Patients who Sustain Spinal Cord Injury

The American Surgeon ◽

10.1177/000313480707301025 ◽

2007 ◽

Vol 73 (10) ◽

pp. 1035-1038

Author(s):

Ali Salim ◽

Marcus Ottochian ◽

Ryan J. Gertz ◽

Carlos Brown ◽

Kenji Inaba ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Length Of Stay ◽

Blunt Trauma ◽

Injury Severity ◽

Unit Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Cord Injury ◽

Intraabdominal Injury

The evaluation of the abdomen in patients with spinal cord injury (SCI) is challenging for obvious reasons. There are very little data on the incidence and complications of patients who sustain SCI with concomitant intraabdominal injury (IAI). To determine the incidence and outcomes of IAI in blunt trauma patients with SCI, a trauma registry and record review was performed between January 1998 and December 2005. Baseline demographic data, Injury Severity Score, and associated IAI were collected. Two groups were established and outcomes were analyzed based on the presence or absence of IAI. Intraabdominal and hollow viscus injures were found in 15 per cent and 6 per cent, respectively, of 292 patients with blunt SCI. The presence of intraabdominal injury varied according to the level of the SCI: 10 per cent of cervical, 23 per cent of thoracic, and 18 per cent of lumbar SCI. The overall mortality was 16 per cent. The presence of intraabdominal injury was associated with longer intensive care unit length of stay (13 versus 6 days, P < 0.01), hospital length of stay (23 versus 18 days, P < 0.05), higher complication rate (46% versus 33%, P = 0.09), and higher mortality (44% versus 11%, P < 0.01) when compared with patients with SCI without IAI. Intraabdominal injuries are common in blunt SCI. Liberal evaluation with computed tomography is necessary to identify injuries early.

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Return to Play after Cervical Spine Injuries: A Consensus of Opinion

Global Spine Journal ◽

10.1055/s-0036-1582394 ◽

2016 ◽

Vol 6 (8) ◽

pp. 792-797 ◽

Cited By ~ 5

Author(s):

John C. France ◽

Michael Karsy ◽

James S. Harrop ◽

Andrew T. Dailey

Keyword(s):

Decision Making ◽

Cervical Spine ◽

Clinical Decision Making ◽

Clinical Symptoms ◽

Clinical Decision ◽

Return To Play ◽

Spine Injury ◽

Cervical Cord ◽

Clinical Scenarios ◽

Cord Injury

Study Design Survey. Objective Sports-related spinal cord injury (SCI) represents a growing proportion of total SCIs but lacks evidence or guidelines to guide clinical decision-making on return to play (RTP). Our objective is to offer the treating physician a consensus analysis of expert opinion regarding RTP that can be incorporated with the unique factors of a case for clinical decision-making. Methods Ten common clinical scenarios involving neurapraxia and stenosis, atlantoaxial injury, subaxial injury, and general cervical spine injury were presented to 25 spine surgeons from level 1 trauma centers for whom spine trauma is a significant component of their practice. We evaluated responses to questions about patient RTP, level of contact, imaging required for a clinical decision, and time to return for each scenario. The chi-square test was used for statistical analysis, with p < 0.05 considered significant. Results Evaluation of the surgeons’ responses to these cases showed significant consensus regarding return to high-contact sports in cases of cervical cord neurapraxia without symptoms or stenosis, surgically repaired herniated disks, and nonoperatively healed C1 ring or C2 hangman's fractures. Greater variability was found in recommendations for patients showing persistent clinical symptomatology. Conclusion This survey suggests a consensus among surgeons for allowing patients with relatively normal imaging and resolution of symptoms to return to high-contact activities; however, patients with cervical stenosis or clinical symptoms continue to be a challenge for management. This survey may serve as a basis for future clinical trials and consensus guidelines.

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