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1.  A New Model for Predicting Surgical Feeding Tube Placement in Patients with an Acute Stroke Event 
Stroke; a journal of cerebral circulation  2013;44(11):10.1161/STROKEAHA.113.002402.
Background and Purpose
The need for surgical feeding tube placement after acute stroke can be uncertain and associated with further morbidity.
Retrospective data were recorded and compared across patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). We identified all feeding tubes placed as percutaneous endoscopic gastrostomy tubes (PEG). A prediction score for PEG tube placement was developed separately for AIS and ICH patients using logistic regression models of variables known by 24 hours from admission.
Of 407 patients included, 51 (12.5%) underwent PEG tube placement (25 AIS and 26 ICH). The odds of an AIS patient with PEG score ≥3 of getting a PEG are greater than those with PEG score <3 (Odds Ratio 15.68, 95% CI 4.55-54.01). The odds of an ICH patient with PEG score ≥3 of getting a PEG are greater than those with PEG score <3 (Odds Ratio 12.49, 95% CI 1.54-101.29).
The PEG score, comprised by variables known within the first day of admission, may be a powerful predictor of PEG placement in patients with acute stroke.
PMCID: PMC3885340  PMID: 23963332
Percutaneous Endoscopic Gastrostomy; PEG; surgical feeding tube; acute ischemic stroke; intracerebral hemorrhage
2.  Predictors of Recovery of Functional Swallow After Gastrostomy Tube Placement for Dysphagia in Stroke Patients After Inpatient Rehabilitation: A Pilot Study 
Annals of Rehabilitation Medicine  2014;38(4):467-475.
To determine predictors of early recovery of functional swallow in patients who had gastrostomy (percutaneous endoscopic gastrostomy [PEG]) placement for dysphagia and were discharged to inpatient rehabilitation (IPR) after stroke.
A retrospective study of prospectively identified patients with acute ischemic and hemorrhagic stroke from July 2008 to August 2012 was conducted. Patients who had PEG during stroke admission and were discharged to IPR, were studied. We compared demographics, stroke characteristics, severity of dysphagia, stroke admission events and medications in patients who remained PEG-dependent after IPR with those who recovered functional swallow.
Patients who remained PEG dependent were significantly older (73 vs. 54 years, p=0.009). Recovery of swallow was more frequent for hemorrhagic stroke patients (80% vs. 47%, p=0.079). Age, adjusting for side of stroke (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.82-0.98; p=0.016) and left-sided strokes, adjusting for age (OR, 15.15; 95% CI, 1.32-173.34; p=0.028) were significant predictors of swallow recovery. Patients who recovered swallowing by discharge from IPR were more likely to be discharged home compared to those who remained PEG-dependent (90% vs. 42%, p=0.009).
Younger age and left-sided stroke may be predictive factors of early recovery of functional swallow in patients who received PEG. Prospective validation is important as avoidance of unnecessary procedures could reduce morbidity and healthcare costs.
PMCID: PMC4163586  PMID: 25229025
Gastrostomy; Acute ischemic stroke; Rehabilitation; Dysphagia
Currently, the popular approach to post-concussion management of the athlete relies upon the use of a multidisciplinary team of healthcare providers, all typically coordinated by a physician. That core team is often supplemented by nurses, psychotherapists, coaches, teachers, the athletic director, and, of course, family members. However, access to such a model is frequently limited by financial, geographical, and numerous other factors. In the absence of such resources, a thorough clinical evaluation and management by an available, ongoing healthcare provider, quite often the sports physical therapist, becomes necessary.
The authors recommend that the professional who coordinates the athlete's post-concussion healthcare should focus efforts upon a comprehensive assessment and tailored treatment plan specific to the athlete's post-concussive symptoms. Assessment of both pre-morbid function and post-injury physical, cognitive, psychosocial, emotional, and behavioral issues, including the patient's support system, can assist the clinician with identifying specific constraints to sport, academic, social, and vocational activity participation. Hence, the assessment provides structure to the athlete's individualized treatment plan. Successful specialized interventions that address the multi-faceted impairments of sport related concussion frequently require knowledge of resources in a variety of other healthcare professions, in order to facilitate appropriate and necessary treatment referrals.
Initial assessment should be followed by repeat monitoring throughout treatment, and spanning a variety of environments, in order to ensure the athlete's full recovery prior to return, not only to sport participation, but also to involvement in social, academic, and/or employment related life activities.
Level of Evidence:
PMCID: PMC3414075  PMID: 22893863
evaluation; rehabilitation; sport concussion

Results 1-3 (3)