Sasha E. Knowlton

University of North Carolina at Chapel Hill

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Julie K. Silver

Wake Forest University

Jeffrey C. Schneider

Harvard University

Alexandra I. Gundersen

Harvard University

Ross Zafonte

Brigham and Women's Hospital

Julia M. Reilly

Memorial Sloan Kettering Cancer Center

Christian M. Custodio

Cornell University

Lisa Marie Ruppert

Memorial Sloan Kettering Cancer Center

Betty Chernack

University of Pennsylvania

Jennifer Baima

University of Massachusetts Chan Medical School

Monica Verduzco‐Gutierrez

The University of Texas Health Science Center at San Antonio

Cooperative Institutions

Harvard University

Spaulding Rehabilitation Hospital

Massachusetts General Hospital

Brigham and Women's Hospital

Foundation for Physical Medicine and Rehabilitation

University of North Carolina at Chapel Hill

Cornell University

University of Washington

Rutgers, The State University of New Jersey

Northwestern University

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Medical and Cardiac Risk Stratification and Exercise Prescription in Persons With Cancer

American Journal of Physical Medicine & Rehabilitation (2023)

Sasha E. Knowlton Adrian Cristian Romer B. Orada Jonas Sokolof

Abstract Cancer patients are recommended to exercise at all stages of disease given the multiple health and functional benefits of physical activity. Certain safety precautions, including a preparticipation medical evaluation and periodic re-evaluations, should be undertaken before creating an exercise program based on individual cancer and treatment history. When designing an exercise program, physiatrists should use similar principles of frequency, intensity, timing, and type for cancer patients that are used for noncancer patients. Special attention to risks of cardiac and pulmonary disease along with risks of sarcopenia, thrombocytopenia, anemia, neutropenia, fracture risk, neurotoxicity, lymphedema, and metastases should be made. This article will outline these specific risks and necessary modifications to the exercise prescription for cancer patients that can be used to enable safe participation in recommended exercise.

Exercise prescription

Cardiotoxicity

Risk Stratification

Medical History

10.1097/phm.0000000000002381

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Variables affecting functional improvement in chordoma patients admitted to an inpatient rehabilitation facility: A retrospective review

Journal of Spinal Cord Medicine (2017)

Sasha E. Knowlton Richard Goldstein Kevin C. O’Connor Joseph H. Schwab Francis J. Hornicek

Study Design: Retrospective chart review of patients after surgical resection of chordoma admitted to an inpatient rehabilitation facility.Objective: To evaluate the characteristics associated with improving two or more functional levels and therefore classifying as a substantial responder after an inpatient rehabilitation facility stay in post-resection chordoma patients.Setting: Acute inpatient rehabilitation facility in the United States.Methods: A total of 40 patients were admitted to an inpatient rehabilitation facility from 2010–2015 after chordoma resection. Demographics, tumor management information, lengths of stay and functional independence measures on admission and discharge were collected. Substantial responders were identified as individuals who improved two or more functional levels based on total FIM score change. Logistic regression was used to analyze the available data for association of quantitative and categorical variables with being a substantial responder.Results: The categorical variables analyzed in this study (sex, readmission to an acute hospital, Charlson Comorbidity Index, tumor level, nerve sacrifice, recurrent tumor and metatases) were not associated with being a substantial responder. The quantitative variables age and length of stay at the inpatient rehabilitation facility were individually associated with being a substantial responder, while length of stay at the acute hospital was not.Conclusions: Patients who were younger were more likely to be classified as substantial responders. Patients with longer lengths of stay at the inpatient rehabilitation facility were also more likely to be classified as substantial responders.

Chordoma

10.1080/10790268.2017.1321820

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Identifying pre-habilitation targets for the mitigation of long-term side effects of chemotherapy in patients with early breast cancer

Supportive Care in Cancer (2024)

Lyndsay Cooper Allison M. Deal Coral H. Aman Annie Page Hyman B. Muss

Pain medicine

Habilitation

10.1007/s00520-024-08739-1

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Citations (2)

Characteristics and functional outcomes of chordoma patients admitted for inpatient rehabilitation

Disability and Rehabilitation (2017)

Sasha E. Knowlton Ross Zafonte Kevin C. O’Connor Joseph H. Schwab Francis J. Hornicek

To describe the population and functional changes observed after an inpatient rehabilitation facility stay in chordoma patients Materials and Methods: We conducted a consecutive series retrospective review of patients with chordoma, admitted to an academic inpatient rehabilitation facility after surgical resection from 2010 to 2015. Information regarding demographic, tumor- and surgery-specific data, lengths of stay, complications, admission and discharge functional independence measure scores was collected.A total of 40 patients with a diagnosis of chordoma were admitted to an inpatient rehabilitation facility postoperatively were included for analysis. Thirty-three patients had initial resection of chordoma, seven patients had resection of recurrent chordoma, and eight patients had metastatic disease on admission to an inpatient rehabilitation facility. The average change in total and motor functional independence measure scores after an inpatient rehabilitation facility stay was 33.7 and 26.1, respectively. The acute hospital transfer rate was 32.5% and the postoperative complication rate was 62.5%.This study is the first to describe the population and functional improvement in the chordoma population who are admitted to an inpatient rehabilitation facility postoperatively. While there is a high rate of acute hospital transfer and postoperative complications, these values are comparable to prior studies in this population. With the increasing prevalence of cancer survivors, improving function during and after cancer treatment is extremely important. Implications for Rehabilitation Chordoma patients who are admitted to inpatient rehabilitation facilities after surgical tumor resection experience improvement in multiple functional domains. Chordoma patients admitted to inpatient rehabilitation facilities experience a high rate of acute hospital transfer, but it is comparable to other cancer rehabilitation populations. Understanding the characteristics of the postoperative chordoma population is essential to direct future studies regarding cancer rehabilitation.

Chordoma

Functional Independence Measure

10.1080/09638288.2017.1334233

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Citations (1)

Poster 488 Dural Ectasia, Sacral Fracture and Low Back Pain in a Woman at 34 Weeks Gestation: A Case Report

PM&R (2014)

Sasha E. Knowlton Joanne Borg‐Stein

10.1016/j.pmrj.2014.08.857

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Trigger Fingers as a Side-Effect of Aromatase Inhibitors: A Case Report

Archives of Physical Medicine and Rehabilitation (2014)

Sasha E. Knowlton Julie K. Silver

10.1016/j.apmr.2014.07.140

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Citations (2)

Functional Outcomes in Lung Cancer Rehabilitation

Elsevier eBooks (2022)

Alexandra I. Gundersen Sasha E. Knowlton

Prehabilitation

Specialty

10.1016/b978-0-323-83404-9.00015-3

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The Use of Ultrasound in Palliative Care and Hospice

American Journal of Hospice and Palliative Medicine® (2016)

Betty Chernack Sasha E. Knowlton Minna J. Kohler

Palliative care aims to reduce symptom burden and enhance quality of life for those with terminal disease. Ultrasound has become an increasingly popular diagnostic and therapeutic modality due to its low cost, ease of portability, safety, and good patient acceptance. A review of the literature to date shows that as a diagnostic tool, as a therapeutic modality, and as a tool to accurately guide palliative procedures, ultrasound can have many roles in palliative care and hospice. Based on our clinical experience, musculoskeletal ultrasound can be of benefit to patients with terminal disease. Examples include adhesive capsulitis in advanced neurologic disease and chronic osteomyelitis in a patient with metastatic colon cancer. Ideally, further studies investigating the use of ultrasound in the palliative care population will be conducted in the future to enhance the availability of diagnostic and therapeutic capabilities of this particular modality.

Modality (human–computer interaction)

Capsulitis

10.1177/1049909115625960

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Citations (15)

Prehabilitation: An Emerging Standard in Exercise Oncology

Springer eBooks (2020)

Nicole L. Stout Julie K. Silver Jennifer Baima Sasha E. Knowlton Xiaorong Hu

Prehabilitation

Modalities

10.1007/978-3-030-42011-6_6

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Citations (12)

Strategies to improve the experience of patients with brain tumors in the inpatient rehabilitation setting: development of a care coordination checklist

Disability and Rehabilitation (2023)

Sasha E. Knowlton Shirley L. Shih Kate Brizzi Abigail Spaulding Melissa Ross

To develop a checklist to facilitate coordination of care and communication of patients with brain tumors and assess the benefit of the checklist using a quality improvement survey.Rehabilitation teams are challenged to respond to the unique needs of patients with brain tumors as this population requires coordinated care across multiple disciplines with frequent communication. To improve care of this patient population in an IRF setting, we developed a novel checklist using a multidisciplinary team of clinicians. Our checklist aims to improve communication between multiple treatment teams, achieve appropriate goals during the IRF stay, involve services as needed and arrange post-discharge services for patients with brain tumors. We then used a quality improvement survey among clinicians to assess the efficacy and general opinion of the checklist.A total of 15 clinicians completed the survey. 66.7% felt that the checklist improved care delivery, and 66.7% felt the checklist improved communication between providers internally and with external institutions. More than half felt the checklist improved the patient experience and care delivery.A care coordination checklist has the potential to address the unique challenges experienced by patients with brain tumors to improve overall care for this population.IMPLICATIONS FOR REHABILITATIONSuccessful clinical care and rehabilitation of patients with brain tumors requires the coordinated efforts of an interdisciplinary team that often spans multiple care settings.A care coordination checklist has the potential to address the unique challenges experienced by patients with brain tumors to improve overall care for this population in the inpatient rehabilitation setting.

10.1080/09638288.2023.2183991

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