West Orange, NJ. February 28, 2013. The March 2013 issue of Archives of Physical Medicine & Rehabilitation, the medical journal of the American Congress of Rehabilitation Medicine, features an article by Kessler researchers Pasquale Frisina, PhD, Ann Kutlik, BA, and A.M. Barrett, MD. Left-sided brain injury associated with more hospital-acquired infections during inpatient rehabilitation (http://dx.doi.org/10.1016/j.apmr.2012.10.012) has implications for further research into brain-mediated immune defenses, infection control practices and cognitive rehabilitation strategies to improve outcomes after stroke and traumatic brain injury. The study was supported by Kessler Foundation and the National Institutes of Health (grant nos. R01NS055808, K24HD062647).
The authors, a team of stroke specialists from Kessler Foundation and Kessler Institute for Rehabilitation, report findings of a retrospective study of 2236 inpatients with brain lesions caused by traumatic brain injury or stroke. Hospital-acquired infection (HAI), a common complication that adversely affects outcomes and costs, was defined as infection diagnosed within 48 to 72 hours of admission. Of the 163 patients identified as having hospital-acquired infections, 60.1% had left-sided lesions. This finding was consistent with the hypothesis that a left-dominant brain immune network (LD-BIN) may influence the occurrence of HAI during inpatient rehabilitation for stroke and TBI.
These findings may help healthcare providers predict who is most susceptible to HAI, according to lead author Pasquale Frisina, PhD, which could help reduce mortality rates, control costs of care and improve outcomes. "The study indicates that antisepsis may not be the best or sole method to manage infection risk after stroke and brain injury," said Dr. Frisina. "Future research should focus on ways to optimize the LD-BIN to improve health. These may include brain stimulation techniques such as direct electrical stimulation of the prefrontal brain or behavioral techniques such as mental/cognitive exercise." He added that this investigative approach might lead to novel interventions aimed at increasing infection resistance, rather than on reducing or eradicating pathogens.
"Clinicians rarely think about the brain and immunity," noted A.M. Barrett, MD, "but the balance between left and right brain activity is known to affect our infection resistance. I'm proud to be part of scientific activities that ask these kinds of innovative questions, and get answers that become the basis for new, improved processes for clinical care."
About the Authors
Pasquale Frisina, PhD, is director of quality management at Kessler Institute for Rehabilitation in West Orange, NJ, and assistant professor in the department of geriatrics and adult development at Mount Sinai School of Medicine in New York. Ann Kutlik, BA, is research and outcomes coordinator at Kessler Institute. A.M. Barrett, MD, is Director, Stroke Rehabilitation Research at Kessler Foundation and Chief, Neurorehabilitation Program Innovation, Kessler Institute of Rehabilitation in West Orange. Dr. Barrett is also professor of Physical Medicine and Rehabilitation at the University of Medicine and Dentistry, New Jersey Medical School, in Newark, N.J.
About Kessler Institute
Kessler Institute for Rehabilitation, a division of Select Medical, provides comprehensive care and specialized treatment to address the complex needs of individuals with spinal cord injury, brain injury, stroke, amputation, neurological diseases, cardiac recovery and orthopedic/musculoskeletal conditions. Kessler is one of only eight federally designated Model Systems in the nation for the treatment and research of both traumatic brain and spinal cord injuries. Ranked as one of the top two rehabilitation hospitals in the nation and the best in the East by U.S. News & World Report, Kessler has three hospital campuses in West Orange, Saddle Brook and Chester, N.J., and more than 80 outpatient centers throughout the state.
About Kessler Foundation
Kessler Foundation, a major nonprofit organization in the field of disability, is a global leader in rehabilitation research that seeks to improve cognition, mobility and long-term outcomes, including employment, for people with neurological disabilities caused by diseases and injuries of the brain and spinal cord. Kessler Foundation leads the nation in funding innovative programs that expand opportunities for employment for people with disabilities.
About the Archives of Physical Medicine and Rehabilitation
The Archives of Physical Medicine and Rehabilitation advances the art and science of interdisciplinary rehabilitation, and is the premier source for researchers and clinicians to obtain authoritative information on the therapeutic utilization of physical, behavioral, and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities. The journal publishes original, peer-reviewed articles that report on important trends and developments in physical medicine and rehabilitation and are relevant to all members of medical rehabilitation teams, including physicians, nurses, counselors, therapists and case managers. Archives began publication in 1920; it publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Archives is the most highly cited journal in Rehabilitation, has the highest Eigenfactor in the category, and has an Impact Factor that has increased eight of the past nine years. (2011 Journal Citation ReportsŪ, Thomson Reuters). In 2009, the Archives of Physical Medicine and Rehabilitation was identified by the Special Libraries Association as one of the 100 most influential journals of Biology & Medicine over the last 100 years. www.archives-pmr.org
About the ACRM | American Congress of Rehabilitation Medicine
ACRM serves a global community of researchers and clinicians striving to deliver evidence-based rehabilitation interventions to people with disabling conditions, such as traumatic brain injury, spinal cord injury, stroke, and neurological disorders, such as multiple sclerosis. ACRM is committed to the dissemination of research and educating providers while supporting advocacy efforts to ensure adequate public funding of research endeavors. www.acrm.org
Kessler Foundation: Carolann Murphy, PA; 973.324.8382; CMurphy@KesslerFoundation.org
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