Frontiers in Autonomic Disorders: Innovations in Diagnosis,Treatment, and Rehabilitation
The Department of Physical Medicine and Rehabilitation held its 27th Annual Scientific Day, highlighting the work of residents, fellows, and faculty on autonomic disorders. This year’s symposium featured guest speaker Dr. Tae Chung, Assistant Professor of PM&R and Neurology at Johns Hopkins.
Presentation: “Beyond Tachycardia: The PM&R Approach to POTS and Dysautonomia”
Speaker: Tae Hwan Chung, M.D., Phala Helm Distinguished Speaker
The presentation focused on the confluence of symptoms in postural orthostatic tachycardia syndrome (POTS) and how PM&R is naturally positioned to be the most helpful specialty based on the comprehensive and holistic nature of the syndrome. He discussed how physiatry can address the “brain fog,” migraines, muscle pain, orthostasis, chronic fatigue, and exercise intolerance that is often seen with POTS. He also discussed other syndromes that overlap with POTS, including EDS Type 3, MCAS, and SIBO. Dr. Chung reviewed treatment options and the challenges that both the patient and provider can face.
Presentation: “Autonomic Disorders: POTS & PANs & Synucleinopathies”
Speaker: Steven Vernino, M.D., Ph.D., FAAN, FAAS
The presentation reviewed nomenclature and vocabulary for disorders of the autonomic nervous system, . Through cases and highlighting various studies, Dr. Vernino discussed the diagnosis and treatment of POTS, peripheral autonomic neuropathy (PANs), amyloidosis, and neurodegenerative autonomic disorders. He also highlighted the multidisciplinary approach to treat this patient population.
Presentation: “Novel Neuroimmune Mechanism(s) of Cardiovascular Decline After TBI”
Speaker: Benjamin Young, Ph.D.
Dr. Young reviewed the epidemiology of long-term mortality and cardiovascular disease after TBI and the importance of cardiovascular health in the recovery of this patient population. He also discussed potential pathophysiological mechanisms leading to the cardiovascular decline and emerging understanding of neuroimmune mechanism(s). He briefly reviewed early data from his research.
Resident & Fellow Presentations
“Utilizing Dietician-guided Intervention to Combat Neurogenic Obesity in People With Spinal Cord Injury”
Elisabeth Frankini, D.O., M.P.H.
The presentation reviewed why patients with chronic spinal cord injury (SCI) are at a high risk for developing obesity. The ongoing research, utilizing mixed-methods study design, will examine if the lifestyle change portion of the National Diabetes Prevention Program (DPP) can be implemented for patients with chronic SCI to help prevent and treat obesity.
“Exploring the Impact of Vitamin D on Outcomes in Burn Survivors”
Eunyeop Kim, M.D.
Dr. Kim discussed this study that found a high prevalence of vitamin D deficiency in survivors of a burn injury. She then reviewed the results of a double-blind, randomized controlled trial that supplemented vitamin D in those who had low levels and measured outcomes using the Burn Model System PROMIS survey tool. The study found high-dose vitamin D supplementation (4,000 IU) was potentially superior in improving mental health outcomes, symptoms (pain/itch), sleep quality, and early social reintegration.
“Opioid Utilization and Weaning Patterns During Inpatient Rehabilitation”
Casey Salandra, D.O., M. Imran Murtuza, M.D., John Hunton, M.D.
Discussion focused on this study examining the opioid prescribing patterns at two inpatient rehabilitation facilities, with a focus primarily on differences in opioid weaning patterns between male and female patients, differences in opioid weaning among CMS impairment groups, the relationship between opioid weaning and length of stay at inpatient rehabilitation, and opioid weaning differences between low-risk vs high-risk patients (as determined by morphine milligram equivalents, or MME). Results demonstrated that almost a quarter of patients were completely weaned off opioids, while almost three-quarters had a decrease in MME. Almost 20% of patients had an increase in MME; this was seen more often in females. The presenters/researchers also found that the female sex was an independent risk factor for MME increase during inpatient rehabilitation.