Saturday, October 01, 2016

Constraint Induced Therapy improved function for up to 6 months in a randomized trial!



To investigate the long-term effects of home-based constraint induced therapy (CIT) on motor control underlying functional change in children with unilateral cerebral palsy (CP).


Randomized controlled trial.


Home based.


Children with unilateral CP (N=45; aged 6–12y) were randomly assigned to receive home-based CIT (n=23) or traditional rehabilitation (TR) (n=22).


Both groups received a 4-week therapist-based intervention at home. The home-based CIT involved intensive functional training of the more affected upper extremity during which the less affected one was restrained. The TR involved functional unimanual and bimanual training.

Main Outcome Measures

All children underwent kinematic and clinical assessments at baseline, 4 weeks (posttreatment), and 3 and 6 months (follow-up). The reach-to-grasp kinematics were reaction time (RT), normalized movement time, normalized movement unit, peak velocity (PV), maximum grip aperture (MGA), and percentage of movement where MGA occurs. The clinical measures were the Peabody Developmental Motor Scales, Second Edition (PDMS-2), Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), and Functional Independence Measure for children (WeeFIM).


The home-based CIT group showed a shorter RT (P<.05) and normalized movement time (P<.01), smaller MGA (P=.006), and fewer normalized movement units (P=.014) in the reach-to-grasp movements at posttreatment and follow-up than the TR group. The home-based CIT group improved more on the PDMS-2 (P<.001) and WeeFIM (P<.01) in all posttreatment tests and on the BOTMP (P<.01) at follow-up than the TR group.


The home-based CIT induced better spatial and temporal efficiency (smoother movement, more efficient grasping, better movement preplanning and execution) for functional improvement up to 6 months after treatment than TR.

Friday, September 16, 2016

Here we Grow! Seeking Pediatric Neurology/Sleep NP PA

Clinical Nurse Specialist (Sleep Medicine & Neurology) / Nurse Practitioner
Physician Assistant


Houston Specialty Clinic - Neurology and Sleep Specialists, a regional leader in specialty care has experienced great demand. We offer academic quality care and personal access. We take care of people experiencing illness or seeking answers to specialty level concerns.

 Our practice is seeking an extender to offer an enhanced scale advanced specialty care in neurologic illness in children.

Job Summary: Under general direction, provides advanced practice nursing care in collaboration with the neurologists in the evaluation and treatment of pediatric neurologic illness and sleep disorders; serves as a resource person for staff; presents lectures, seminars, programs, or conferences; responsible for collaboration, facilitation, and implementation of research projects; provides direct clinical service to patients and families including psychosocial assessment, crisis intervention, counseling, supportive therapy, behavior modification, care management, and patient education.

While focusing on outpatient care, duties may include any and/or all of the following:

  1. Participates in delivering direct patient care; provides instructions and teaching to patients and families; assists in outpatient clinics with examinations and assessments; follows up on lab, test, and procedure results and prescriptions; informs patients of medication changes; informs physicians of patients' questions; evaluates patients' qualifications for clinical research studies; provides initial contact with patients' primary physician; establishes referral database; communicates with referring physicians for follow-up care and referrals.
  2. May attend rounds in the hospital; collaborates with health care team members in planning, implementing, and evaluating comprehensive patient care; provides direct clinical service to patients and families including psychosocial assessment, crisis intervention, counseling, supportive therapy, behavior modification, care management, and patient education; develops patient programs for consumer relations and patient satisfaction issues; provides conflict resolution; consults and implements in-service programs and research protocols; researches improvements in patient management, including coordination between services and conservation of resources; facilitates and participates in meetings and projects.
  3. Serves as a resource person and a nurse consultant for staff; presents lectures, seminars, or conferences; collaborates, facilitates, and implements research projects; develops an annual plan for professional development; attends conferences; maintains and improves current knowledge and competency in advanced practice nursing;.
  4. Perform other duties as assigned.


  • Knowledge of clinical practice nursing
  • Verbal/written communication skills
  • Interpersonal/human relations skills
  • Patient assessment skills
  • Public speaking skills
  • Research skills
  • Ability to respond to questions in a tactful and professional manner
  • Ability to instruct/teach/tutor
  • Ability to maintain confidentiality


Education and experience equivalent to:

Masters degree in nursing and certification in specialty area of a Clinical Nurse Specialist or Nurse Practitioner; supplemented with two (2) years related experience. Texas RN License and certification as an Advanced Practice Nurse required.


TX PA licensure supplemented with two (2) years related experience

Physical Requirements – Typical for an outpatient clinic. May require some driving to satellite clinics.
Competitive Salary & Productivity Bonus Commensurate with Experience
HSC offers eligible employees a broad package of benefits such as health care, dental plan, vision plan, 401K.

Contact Dr Joshua Rotenberg
Fax 713-465-4522

Sunday, September 04, 2016

Hickey Causes Fatal Stroke in teen

Teenager dies from stroke 'caused by love bite from his girlfriend'


The hickey — or love bite — caused a blood clot, which traveled to his brain

Family blame older girlfriend, who has disappeared
A teenage boy has died from a stroke that is understood to have been caused by a love bite from his girlfriend
Julio Macias Gonzalez, 17, had convulsions while eating dinner with his family in Mexico City, after spending the evening with his 24-year-old girlfriend, local media reported.
Emergency services were called, but the boy died at the scene. 
According to Mexican media reports, doctors believe the suction of the love bite resulted in a blood clot, which travelled to Mr Gonzalez’s brain and caused the stroke.
The boy’s parents blamed his girlfriend for the death, and she is thought to be in hiding.

Saturday, September 03, 2016

What is an LP or a lumbar puncture? What is a spinal tap?

This is an excellent instructive video on what is an LP? What is a spinal tap?

What is a Lumbar Puncture

Watch this video to understand a lumbar puncture  Video here

Wednesday, August 31, 2016

Autism? Developmental Delay? Epilepsy? When to use Exome Sequencing - Now Official AAN Policy

Emerging in my practice in 2013, exome has now become an everyday child neurology practice tool like MRI.  - JR

Clinical Exome sequencing in neurologic disease

  1. Bruce H. Cohen, MD
  1. Correspondence to:
  1. Neurol Clin Practvol. 6 no. 2 164-176


Purpose of review: The landscape of genetic diagnostic testing has changed dramatically with the introduction of next-generation clinical exome sequencing (CES), which provides an unbiased analysis of all protein-coding sequences in the roughly 21,000 genes in the human genome. Use of this testing, however, is currently limited in clinical neurologic practice by the lack of a framework for appropriate use and payer coverage.
Recent findings: CES can be cost-effective due to its high diagnostic yield in comparison to other genetic tests in current use and should be utilized as a routine diagnostic test in patients with heterogeneous neurologic phenotypes facing a broad genetic differential diagnosis. CES can eliminate the need for escalating sequences of conventional neurodiagnostic tests.
Summary: This review discusses the role of clinical exome sequencing in neurologic disease, including its benefits to patients, limitations, appropriate use, and billing. We also provide a reference template policy for payer use when considering testing requests.
Clinical exome sequencing (CES) is a new state-of-the-art molecular diagnostic genetic test. It has the potential to rapidly and efficiently detect disease-causing genetic mutations within any gene in the human genome and is therefore becoming widely used in clinical practice. This template policy addresses the health benefits, limitations, and appropriate use of this type of testing in patients with neurologic disease.

Friday, August 19, 2016

Can Parkinsonian Symptoms Be Brought On by Traumatic Brain Injury?

TBI linked to Parkinson’s and Parkinson-related brain defects

Researchers at the Group Health Research Institute relates research to Muhammad Ali—and how we can prevent late-life injuries and falls for our families and ourselves.-JR

by Eric B. Larson, MD, MPH, executive director of Group Health Research Institute and vice president for research at Group Health
Traumatic brain injury (TBI), including concussion, is a big problem in older adulthood, the stage of life when accidents—especially falls—happen most often. Yet we hear a lot about TBI from sports, particularly football head injuries in younger people.
Muhammad Ali, who recently died, had a symptom complex called Parkinsonism. It’s very likely that multiple blows to the head from boxing set the stage for this condition. A new study that I helped to lead confirms concern over effects of TBI that threaten the structure and function of brain cells.

Here’s what we found—and didn’t find

With colleagues from the University of Washington (UW), Mt. Sinai School of Medicine, Cleveland Clinic, Rush University Medical Center, and the University of Utah, Paul Crane, MD, MPH, and I recently published “Association between Traumatic Brain Injury and Late Life Neurodegenerative Conditions and Neuropathological Findings" iJAMA Neurology. Dr. Crane is a professor of general internal medicine at the UW School of Medicine, an adjunct professor of health services at the UW School of Public Health, and an affiliate investigator at Group Health Research Institute (GHRI).

How to prevent falls

On a practical level, though, this research should remind us of just how important it is to prevent falls and other accidents. Here’s how you can prevent falls:
  • Get regular exercise for general conditioning, strength, and balance training. 
  • Avoid drugs that impair balance and judgment, such as narcotics, anticholinergics, and tranquilizers, and avoid over-treating high blood pressure and diabetes.
  • Eliminate hazards in your environment—like inadequate lighting, rugs and cords that can cause tripping.
  • Wear shoes or slippers with good soles that are not too thick. The ACT study has shown that older people are much more likely to fall in the home if they walk barefoot or in stocking feet.  
  • At some point, consider using a cane or walker to avoid falls.

Wednesday, August 17, 2016

Helping Our School-Age Children Sleep Better when 23% have sleep problems!

Revisiting the importance of  healthy sleep habits in school-age children.
Common sleep problems and some strategies for resolving them... -JR

Helping Our School-Age Children Sleep Better
By Peri Klass, M.D.

"Everyone knows that getting a baby to sleep through the night can be a big challenge for parents. But sleep problems are common among preschool and school-age children, too. As we ask children to function in school, academically and socially, fatigue can affect their achievement and behavior.

Australian research on sleep problems in children has included work aimed at the “school transition” year in which children adjust to a school schedule. In a study of 4,460 children, 22.6 percent had sleep problems, according to their parents, at that transition age of 6 to 7 years. “We were surprised, we thought it was all baby sleep” that was the problem, said Dr. Harriet Hiscock, a pediatrician who is a senior research fellow at the Murdoch Childrens Research Institute at the Royal Children’s Hospital in Melbourne who was one of the authors of the study.

The most common sleep issues for children around the age of school entry, Dr. Hiscock said, definitely include limit-setting issues — that is, some of them need their parents to make the rules and routines clear. But there are also children with what sleep specialists call “sleep onset association disorder,” in which a child has become habituated to falling asleep only in a certain context, requiring the presence of a parent, or needing to have the TV on, to cite two common examples. Very anxious children are also often problem sleepers. And then there are children beset by nightmares, night terrors and early morning waking.

Many parts of the brain work less well when children are tired. “The prefrontal cortex is very sensitive to sleep deprivation, and it is key to the brain mechanisms which underlie executive function and some of the attention  processes,” she said. “The amygdala is affected by sleep deprivation and is essential for emotional processes.”"