Date: Thursday, October 23, 2025 @ 12:45 p.m. - 2:15 p.m. M.T.
Location: Kiosk 8

Poster Presenter(s):

• William J. Lew, Medical Student, University of Hawaii, John A. Burns School of Medicine

Primary Author(s):

• Di Huang, M.D., Johns Hopkins Bloomberg School of Public Health 

Co-Authors:

• David Cifu, M.D., Chair, VA Commonwealth Univ/Med Coll of VA
• Brent Shimoda, Medical Student, University of Hawaii, John A Burns School of Medicine
• Eli M. Snyder, Medical Student, University of Hawaii at Manoa, John A. Burns School of Medicine
• Kai Sheng Khor, M.D., Postdoctoral Research Fellow, Johns Hopkins University PM&R Program
• Henry L. Lew, M.D., Ph.D., Professor, VCU and U of Hawaii

Disclosure(s):

• David Cifu, M.D.: No financial relationships to disclose
• William J. Lew, Other: No financial relationships to disclose
• Eli M. Snyder, Other: No financial relationships to disclose
• Kai Sheng Khor, M.D.: No financial relationships to disclose
• Henry L. Lew, M.D., Ph.D.: No financial relationships to disclose

Background and/or Objectives:

Return-to-play (RTP) readiness is key in managing baseball injuries, particularly ulnar collateral ligament (UCL) injuries and concussions. UCL injuries from repetitive throwing stress and concussions from external head impacts present significant challenges to athletes. Despite existing RTP criteria, inconsistencies persist in clinical practice. This systematic review compares RTP criteria for UCL injuries and concussions, evaluating rehabilitation processes, objective testing methods, and challenges in ensuring safe return to sport.

Design: Systematic review following the PROSPERO protocol (CRD42024607322) and PRISMA guidelines.

Setting: Data were collected from studies examining RTP criteria and outcomes for UCL injuries and concussions in baseball players across various competitive levels.

Participants: Eligible studies included athletes with UCL injuries managed either surgically or nonoperatively and those with sport-related concussions. 41 articles were included after full-text screening.

Interventions: Analysis of rehabilitation strategies, RTP assessment tools, and success rates for UCL injuries and concussions.

Main Outcome Measures: Primary outcomes included RTP rates, recovery timelines, predictive assessment tools, and secondary injury rates. For UCL injuries, RTP success was measured by return to prior level of competition and recurrence of injuries. For concussions, neurocognitive recovery and adherence to sport-specific RTP protocols were analyzed.

Results: RTP after UCL surgical reconstruction in professional pitchers ranged from 79-91%, with 71-90% returning to the same level of play. Recovery took 12–18 months, with a 46% secondary injury rate. Nonoperative management in high school players had a 83.6% success rate, with stress ultrasound proving useful in predicting outcomes. Concussion RTP protocols varied, with MLB requiring a 7-day minimum, while other leagues used symptom-based assessments. Neurocognitive and reactive testing were key RTP determinants, with recovery timelines ranging from weeks to months.

Conclusions: RTP criteria for UCL injuries rely on functional milestones, while concussion RTP prioritizes cognitive recovery. Integrating biomechanical and neurocognitive assessments may improve safety. Standardized RTP models are needed to optimize both physical and cognitive readiness.

Date: Thursday, October 23, 2025 @ 5:00 p.m. - 6:30 p.m. M.T.
Location: Open Kiosks

Poster Presenter(s):

• Basima Ali, Medical Student, Florida State University College of Medicine

Co-Authors:

• Daniel Khokhar, D.O., Resident, Johns Hopkins PM&R

Disclosure(s):

• Basima Ali: No financial relationships to disclose
• Daniel Khokhar, D.O.: No financial relationships to disclose

Case Diagnosis: A 72-year-old male with dysphagia following an acute right middle cerebral artery (MCA) stroke.

Case Description or Program Description: The patient was admitted for post-stroke rehabilitation with left-sided weakness, dysarthria, and severe dysphagia requiring PEG tube placement. His history included TAVR complicated by an embolic shower stroke. During rehabilitation, he developed acute blood loss anemia due to an upper gastrointestinal bleed, which was treated with argon plasma coagulation.

A video fluoroscopic swallow study (VFSS) on 1/27/25 revealed severe oral dysphagia with poor bolus control, incomplete epiglottic inversion, and reduced laryngeal vestibular closure, leading to strict NPO status. Mild pharyngeal dysphagia was present, though no aspiration was observed. A repeat VFSS on 2/4/25 demonstrated marked improvement, with moderate oral dysphagia and mild esophageal dysphagia, allowing initiation of thin liquids, and minced moist diet.

Setting: Acute inpatient rehabilitation facility.

Assessment/Results: A multidisciplinary rehabilitation approach was implemented, including:

• Oral motor exercises (labial and lingual strengthening, buccal air hold).
• Swallow strengthening exercises (effortful swallow, chin tuck against resistance).
• Dietary modifications (texture progression from minced moist to easy-to-chew foods).
• Aspiration precautions (upright positioning, slow-paced intake, oral hygiene).
• Frazier Free Water Protocol (permitting water after stringent oral care).
• Medical optimization (IV hydration, proton pump inhibitor therapy, PEG tube weaning).

By 2/21/25, the patient demonstrated safe oral intake without aspiration and was successfully transitioned from PEG tube dependence to full oral nutrition.

Discussion (relevance): Dysphagia following stroke poses risks for aspiration pneumonia, malnutrition, and hospital readmission. This case highlights the role of serial VFSS evaluations, targeted swallowing therapy, and structured dietary progression. A comprehensive approach integrating SLP intervention, aspiration precautions, and medical support is critical for restoring safe swallowing function.

Conclusions: Early dysphagia assessment, structured rehabilitation, and medical optimization significantly improve post-stroke swallowing outcomes. A multidisciplinary strategy is essential to reduce aspiration risk, facilitate diet progression, and enhance patient recovery

Date: Saturday, October 25, 2025 2 12:00 p.m. - 1:30 p.m. M.T. 
Location: Original Research Theater

Poster Presenter(s):

• Kai Sheng Khor, M.D., Postdoctoral Research Fellow, Johns Hopkins University PM&R

Co-Author(s):

• Jonny Huang, DPT, Johns Hopkins University PM&R Program
• Azin Etemadimanesh, M.D., Research Coordinator, Johns Hopkins University PM&R 
• Robert W. Nickl, Ph.D., Research Associate, Johns Hopkins School of Medicine
• Steve Bonwit, Physical Therapist Assistant, Johns Hopkins University PM&R
• Preeti Raghavan, M.D., Associate Professor, Johns Hopkins University School of Medicine

Disclosure(s):

• Kai Sheng Khor, M.D.: No financial relationships to disclose
• Jonny Huang, DPT: No financial relationships to disclose

Background and/or Objectives: Post stroke shoulder pain (PSSP) occurs in 30-70% of patients with stroke and contributes to disability and impaired motor recovery. The limitation in shoulder external rotation range of motion (ROM) is strongly correlated with the degree of PSSP. This study characterizes the state of the shoulder muscles that contribute to the ROM limitation in PSSP on the paretic and non-paretic sides using instrumented physical exam and ultrasound assessments.

Design: Prospective study

Setting: Outpatient clinical research lab

Participants: 40 chronic stroke survivors with PSSP without central pain

Interventions: N/A

Main Outcome Measures: PSSP was diagnosed using the Hand Behind the Neck Maneuver. Pain-pressure thresholds in the shoulder internal and external rotator muscles (pectoralis major and infraspinatus) were measured using an algometer, muscle stiffness was assessed using the stiffness rating scale and PACT Sense, and muscle echointensity was assessed using the Heckmatt and Modified Heckmatt Rating Scales on the paretic and non-paretic sides. Questionnaires were administered to assess pain interference, catastrophizing, anxiety, and depression.

Results: There were significant differences in the paretic shoulder internal and external rotator muscles compared to the non-paretic side. For the pectoralis major, the mean (±SD) for the paretic vs. non-paretic sides were: pain-pressure thresholds (8.17±3.23 vs. 10.35±3.94), stiffness rating scale scores (2.56±0.67 vs. 0.68±0.65) and PACT Sense stiffness scale scores (8.37±1.38 vs. 6.93±1.70). For the infraspinatus, the mean (±SD) for the paretic vs. non-paretic sides were: pain-pressure thresholds (11.05±3.98 vs. 13.36±4.67), stiffness rating scale scores (1.71±0.78 vs. 0.59±0.63) and PACT Sense stiffness scale scores (11.12±2.14 vs. 11.10±1.95). There were also significant differences (p < 0.05) in muscle echointensity between paretic and non-paretic infraspinatus and pectoralis major muscles.

Conclusions: PSSP is characterized by muscle pain and stiffness, which can contribute to the limitation in ROM and pain. Treatments to alleviate muscle pain and stiffness may be helpful in relieving PSSP.

Date: Saturday, October 25, 2025 @ 12:00 p.m. - 1:30 p.m. M.T.
Location: Kiosk 9

Primary Author(s):

• Alejandra Cardenas Rojas, M.D., Resident Physician - PGY3, Johns Hopkins University PM&R

• Robert W. Nickl, Ph.D., Research Associate, Johns Hopkins School of Medicine
• Meredith Drake, PT, DPT, Johns Hopkins Hospital
• Jaelah Hurt, NIBS Rehabilitation Technician, Johns Hopkins Hospital
• Aara Chandrashekaran, MS, CCC-SLP, Johns Hopkins Medicine
• Daniel Krasna, M.D., Assistant Professor, Johns Hopkins Medicine
• Rajani Sebastian, Ph.D., Associate Professor, Johns Hopkins University
• Ning Cao, M.D., Medical Director, Johns Hopkins University School of Medicine

• Alejandra Cardenas Rojas, M.D.: No financial relationships to disclose
• Meredith Drake, PT, DPT: No financial relationships to disclose
• Aara Chandrashekaran, MS, CCC-SLP: No financial relationships to disclose
• Daniel Krasna, M.D.: No financial relationships to disclose
• Rajani Sebastian, Ph.D.: No financial relationships to disclose

Background and/or Objectives: Non-invasive brain stimulation (NIBS), including transcranial direct-current stimulation (tDCS), has shown moderate evidence of efficacy (level B) for motor rehabilitation in patients with stroke, with most studies occurring in laboratory settings. This study examines feasibility of administering tDCS as an adjuvant to physical therapy (PT) in the clinical setting.

Design: Observational, open-label study of stroke patients enrolled in the NIBS Clinical Program

Setting: Outpatient clinical setting

Participants: Twenty-six participants with chronic stroke have received tDCS as an adjuvant to PT in the NIBS Program since 2018 (average age 55 years (SD 15), 15 females, 21 White/Caucasian). Inclusion criteria were impaired mobility and ability to engage in therapy (5 times/week).

Interventions: Patients received 15 tDCS sessions combined with high-intensity evidence-based PT focused on gait and balance training (5 times/week). Sessions were approximately 60 minutes (tDCS for first 20-25 minutes, intensity 2mA). Seventeen participants (65%) received anodal stimulation to the primary motor cortex and 9 to the cerebellum (35%). Thirteen patients had an ipsilateral M1 montage (76%). Orbitofrontal cortex was the most common cathode placement (62%), followed by T12 of spine.

Main Outcome Measures: AM-PAC Mobility Outpatient Short Form, 5 Times Sit-to-stand (5TSTS), 10 Meter and 2 Minute Walk Test, and Berg Balance Scale before and after the program

Results: Patients showed significant improvements in self-reported AMPAC mobility raw and standardized scores with mean changes of 4.8 and 3.6 respectively (p=0.001), improvement of 2 minute-walk test (delta = 36.75 ft, p=0.0002) and balance by 5.32 points (p < 0.0001). Significant time reductions in the 5TSTS (delta = -10.475s; p=0.01) and improvement of 10 meter walk test (m/s) (delta =0.06, p=0.01).

Conclusions: These preliminary data suggest that it is feasible to implement tDCS, a low-cost, non-invasive, and non-painful technique, in a clinical neurorehabiliation program. In addition, tDCS coupled with high-intensity therapy has the potential to improve gait, balance, and patient-reported outcomes.

Date: Saturday, October 25, 2025 @ 8:00 a.m. - 9:15 a.m. M.T.
Location: Kiosk 7

Poster Presenter(s):

• Amna Haider, D.O., Resident Physician, Johns Hopkins University PM&R Program

Primary Author(s):

• Jennifer Viola, D.O., Resident Physician, Johns Hopkins University PM&R Program
• R. Samuel Mayer, M.D., Professor, Dept of PM&R, Johns Hopkins University School of Medicine

Co-Author(s):

• Bingqing Ye, Business Analytics Program Manager, Johns Hopkins Hospital
• Kelly N. Daley, PT, Dir. Clinical Informatics and Analytics, Johns Hopkins Medicine
• Jenny Xu, M.D., Resident Physician, Johns Hopkins University PM&R Program

Disclosure(s):

• R. Samuel Mayer, M.D.: No financial relationships to disclose
• Jenny Xu, M.D.: No financial relationships to disclose

Background and/or Objectives: Intrathecal baclofen (ITB) is an effective spasticity treatment for people who are unable to tolerate oral medications or have refractory spasticity that is administered into the cerebrospinal fluid through a catheter from an implanted intrathecal baclofen pump (ITBP). There are variations in the literature on the average ITBP dose used to treat spasticity associated with various conditions and no specific dosing guidelines. This study investigates effective ITBP dosing among patients treated for spasticity at Johns Hopkins Medicine.

Design: Retrospective chart review

Setting: Outpatient clinic visits

Participants: 49 adults who had at least one outpatient ITBP refill visit from 2022 to 2024

Interventions: Not applicable

Main Outcome Measures: Stable effective dose of ITB is defined as three outpatient visits for participants treated for spasticity in the diagnostic categories of spinal cord injury (SCI), traumatic brain injury (TBI) and stroke, demyelinating disease (multiple sclerosis, transverse myelitis, neuromyelitis optica), cerebral palsy (CP), and inherited and/or neurodegenerative neurological conditions with the same dose at all three visits.

Results: Of the 49 participants, 21 (42.9%) had a stable effective dose of ITB. The average dose for participants with a stable ITB dose was 472.135 mcg/day, and the average dose for all participants at the most recent outpatient visit was 384.5033 mcg/day. 26.3% of ambulatory participants and 53.3% of non-ambulatory participants had a stable effective dose of ITB. The average dose for ambulatory and non-ambulatory participants at the most recent outpatient visit was 278.6379 mcg/day, and 453.8634 mcg/day, respectively.

Conclusions: There were no statistically significant differences among participants treated for spasticity due to SCI, TBI and stroke, demyelinating disease, CP, and inherited and/or neurodegenerative conditions. Ambulatory patients used smaller ITB doses and were less likely to be on a stable dose.

Date: Saturday, October 25, 2025 @ 8:00 a.m. - 9:30 a.m. M.T.
Location: Kiosk 8

Poster Presenter(s):

•  Alec Birnbaum, Medical Student, Rowan-Virtua School of Osteopathic Medicine/Rowan University

Co-Author(s):

• Yashas Sattur, Medical Student, Rowan University School of Osteopathic Medicine
• Brandon Goodwin, D.O., Resident Physician, Johns Hopkins University
• Ahmed D. Al Mahrizi, Medical Student, Faculty of Medicine & Surgery, University of Malta
• Jensen C. Clark, Medical Student, Rowan University School of Osteopathic Medicine
• Neil Patel, M.D., Resident Physician, HMHN

Disclosure(s):

• Alec Birnbaum, Other: No financial relationships to disclose
• Yashas Sattur, Other: No financial relationships to disclose

Background and/or Objectives: The objective of this study is to evaluate whether dexmedetomidine improves functional outcomes in traumatic brain injury (TBI) patients compared to conventional sedatives.

Design: Systematic review and meta-analysis following PRISMA 2020 guidelines (PROSPERO: CRD42025629712)

Setting: Intensive care units from 6 studies across 5 countries.

Participants: 44 patients with moderate-to-severe TBI (mean age 42.3 years; 68% male).

Interventions: Dexmedetomidine (0.2-1.5 μg/kg/hr) versus propofol (4 studies), benzodiazepines (1 study), or placebo (1 study).

Main Outcome Measures: Glasgow Outcome Scale (GOS) or Extended (GOS-E) at 3-6 months post-injury.

Results: Analysis of 6 studies (3 randomized controlled trials, 3 observational cohorts) demonstrated a small-to-moderate treatment effect favoring dexmedetomidine (Cohen’s d = 0.44; 95% CI: 0.19-0.69; p< 0.001), equivalent to a 1.5-point improvement on GOS-E. Moderate heterogeneity (I²=62.4%) was attributed to variable dosing protocols and outcome timing. GRADE analysis indicated very low certainty of evidence due to moderate bias risk and small sample sizes.

Conclusions: Dexmedetomidine shows clinically meaningful functional improvements in TBI patients, with effect sizes comparable to early neurorehabilitation interventions. These findings support its potential role in bridging acute neuroprotection through reduced neuroinflammation and long-term recovery via preserved cognitive capacity. Multicenter trials using standardized GOS-E assessments at 6 months are needed to confirm optimal clinical utility.

Date: Saturday, October 25, 2025 @ 8:00 a.m. - 9:15 a.m. M.T.
Location: Kiosk 4

Poster Presenter(s):

•  Kai Sheng Khor, M.D., Postdoctoral Research Fellow, Johns Hopkins University PM&R Program

Co-Author(s)

• Di Huang, M.D., Johns Hopkins Bloomberg school of Public Health
• Jonny Huang, DPT, Johns Hopkins University PM&R Program
• Preeti Raghavan, M.D., Associate Professor, Johns Hopkins University School of Medicine

Disclosure(s):

•  Kai Sheng Khor, M.D.: No financial relationships to disclose
• Jonny Huang, DPT: No financial relationships to disclose

Case Diagnosis: Complex Myofascial Pain Syndrome

Case Description or Program Description: A 46-year-old male presented with chronic neck and right arm pain with stiffness following a sudden right trapezius muscle strain with pain radiation and numbness to the little finger in 2021. Shortly afterwards he began to experience migraines, photosensitivity, and phonophobia. Despite undergoing cubital tunnel release, thoracic outlet decompression, and physical therapy, he reported minimal improvement and ultimately becoming unable to work by late 2022. Before his disability, the patient worked as a systems engineer and was physically active, performing approximately 300 pull-ups per day, three times a week. On physical examination in January 2023, the fingers and dorsum of the right hand and wrist showed noticeable swelling and skin discoloration. The upper trapezius was swollen and light touch to the right upper limb elicited hyperesthesia without allodynia. Active and passive movements of the proximal interphalangeal, metacarpophalangeal, and wrist joints were restricted, and abduction and flexion of the shoulder was limited to 90 degrees passively and actively. The muscles of the chest, upper back and upper limbs were stiff, tender and cord-like to palpation.

Setting: Tertiary Care Hospital

Assessment/Results: After one year of treatment, the patient reported significant pain reduction, near-normal range of motion, and resolution of migraines and photophobia. By mid-2024, his migraines had completely resolved, and he successfully returned to work.

Discussion (relevance): Overuse injury due to excessive pull-ups, likely caused trapezius muscle injury and multiple areas of myofascial densification resulting in myofascial pain syndrome and blood flow restriction, which resulted in swollen hands and skin discoloration. The patient was referred for hyaluronidase injections followed by fascial manipulation therapy to relieve the myofascial densifications.

Conclusions: This case underscores the debilitating effects of severe complex myofascial pain and stiffness and potential treatment with hyaluronidase injections and fascial manipulation.

Date: Saturday, October 25, 2025 @ 8:00 a.m. - 9:15 a.m. M.T.
Location: Kiosk 4

Co-Author(s):

• Michael Suarez, D.O., Resident Physician, Johns Hopkins University PM&R Program
• Samantha Wu, M.D., Resident Physician, Johns Hopkins University PM&R Program

Primary Author(s):

• Ahmed Khawer, D.O., Resident PhysicianJohns Hopkins University PM&R Program

Disclosure(s):

• Ahmed Khawer, D.O.: No financial relationships to disclose

Case Diagnosis: Postural Orthostatic Tachycardia Syndrome (POTS)

Case Description or Program Description: A 41-year-old female with a 10 year history of POTS presented to the interventional pain clinic. Her symptoms first began 5 years prior to her diagnosis, without a specific precipitating event. Her symptoms included fatigue, dizziness, nausea, IBS (multiple episodes of diarrhea per day), mental clouding, sporadic elevated HR ranging between 150-200 beats per minute, temperature dysregulation, and anxiety; inhibiting her ability to perform her activities of daily living (ADLs) or stand for more than 20 minutes. Previous treatment included an abdominal binder, metoprolol, duloxetine, amitriptyline, dextroamphetamine, low dose naltrexone, dietary changes and hydration, with minimal relief of symptoms. Given the failure of conservative management, the clinical team decided to pursue a left stellate ganglion block. The patient tolerated the procedure well with no complications.

Setting: Comprehensive pain management center

Assessment/Results: Two weeks post-procedure, the patient reported that she had significant symptomatic improvement, including total resolution of syncope and dizziness, the ability to stand for greater than 30 minutes, pulse in the normal range under 100 BPM, improved nausea, improved IBS symptoms, and resolution of hot flashes. She described her results as “life changing”, now with the ability to stand upright for more than 30 minutes without orthostatic symptoms for which she had not experienced in over 10 years.

Discussion (relevance): This is the first reported case, to our knowledge, of the successful use of a stellate ganglion block to aid in the treatment of POTS.

Conclusions: The application of a stellate ganglion block led to a remarkable reduction in the symptoms of POTS in this patient, showcasing its promise as a novel therapeutic strategy.

Date: Saturday, October 25, 2025 @ 8:00 a.m. - 9:15 a.m. M.T.
Location: Kiosk 2

Poster Presenter(s):

• Daniel Khokhar, D.O., Resident Physician, Johns Hopkins PM&R

Primary Author(s):

• Michael Richmann, OMS-4, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine

Co-Author(s):

• Vivek Patel, M.D., Resident Physician, Lakeland Regional Health
• Anas Bizanti, M.D., Associate program director of internal medicine residency, Lakeland Regional Health
• Ridhwan Mohammad, M.D., Resident Physician, Lakeland Regional Health
• Jacob Jernigan, D.O., Internal medicine resident, Lakeland Regional Health

Disclosure(s):

• Daniel Khokhar, D.O.: No financial relationships to disclose

Case Diagnosis: Shy Drager Syndrome

Case Description or Program Description: Shy-Drager Syndrome, now classified under Multiple System Atrophy (MSA) with predominant autonomic dysfunction, is a rare neurodegenerative disorder characterized by parkinsonism, cerebellar ataxia, and multisystem autonomic failure. This report details the case of a 71-year-old male with a history of polyneuropathy, chronic pain, and colon cancer in remission, who was previously exposed to Agent Orange. He presented to the ED with recurrent falls, orthostatic instability, and progressive left-sided weakness. Although not officially diagnosed with Shy-Drager Syndrome, his symptoms raised suspicion for the condition. This case underscores the importance of early recognition of neurodegenerative disorders, particularly in individuals with exposure to toxic environmental agents.

Setting: Inpatient Acute Care

Assessment/Results: Presumed Diagnosis of Shy Drager Syndrome and rehab recommendations given

Discussion (relevance): The patient’s symptoms align with Multiple System Atrophy (MSA) with autonomic dysfunction, featuring parkinsonism, autonomic failure, and cerebellar ataxia. Agent Orange exposure supports this likelihood, though chemotherapy-induced neuropathy remains a consideration. MSA diagnosis is challenging due to symptom overlap and a lack of biomarkers, requiring extensive clinical evaluation. Management focuses on symptom relief, physical conditioning, and autonomic support.

Conclusions: This case highlights the diagnostic complexity of rare neurocognitive disorders such as Multiple System Atrophy with predominant autonomic dysfunction, commonly referred to as Shy-Drager Syndrome. The addition of multiple risk factors such as exposure to Agent Orange and chemotherapy complicate the diagnosis further. Although MSA is the leading theory, alternative etiologies such as chemotherapy-induced polyneuropathy cannot be ruled out at this time. Further diagnostic testing such as nerve conduction studies and autonomic function testing would help clinicians hone in on a diagnosis, but unfortunately they have not been performed yet in this patient. Additionally, even if MSA was properly diagnosed, no definitive cure exists at this time, so the patient would mostly be getting treatment for symptomatic relief, which they are already getting.

Date: Saturday, October 25, 2025 @ 8:00 a.m. - 9:15 a.m. M.T.
Location: Kiosk 1

Primary Author(s):

• Vrushank Shah, Medical Student, Rowan-Virtua SOM

Co-Author(s):

• Komal Luthra, M.D., Resident Physician, Johns Hopkins University PM&R Program
• R. Samuel Mayer, M.D., Professor, Dept of PM&R, Johns Hopkins University School of Medicine

Disclosure(s):

• Vrushank Shah: No financial relationships to disclose
• R. Samuel Mayer, M.D.: No financial relationships to disclose

Case Diagnosis: A 75-year-old female with a history of bipolar I disorder, hyperlipidemia, and prior stroke presented with altered mental status, body stiffness, and tremors, ultimately diagnosed with catatonia in the setting of a punctate left hippocampal stroke.

Case Description or Program Description: The patient was admitted with acute-onset altered mental status, exhibiting rigidity, tremors, and mutism. MRI revealed a punctate left hippocampal stroke; however, neurology did not attribute her symptoms to the stroke. Psychiatry was consulted and diagnosed catatonia, likely exacerbated by her psychiatric medications. Following discontinuation of her psychiatric regimen, her symptoms resolved, confirming the diagnosis.

Setting: Inpatient hospital admission at a tertiary care center.

Assessment/Results: The patient’s catatonia resulted in a prolonged hospital course complicated by tracheostomy placement, percutaneous endoscopic gastrostomy tube placement, urinary tract infection, pneumonia, and septic shock. Cessation of psychiatric medications including lithium and risperidone led to symptom resolution. Given the generalized deconditioning experienced by this patient, she required acute comprehensive inpatient rehabilitation after medical stabilization. This case highlights the need for careful consideration of neurological findings in conjunction with psychiatric and medication-related factors to ensure an accurate diagnosis and appropriate management.
 
Discussion (relevance): This case underscores the diagnostic challenge of altered mental status in patients with pre-existing psychiatric conditions as well as the interplay between neurological and psychiatric conditions in elderly patients with mood disorders. It also emphasizes the medical complications of catatonia, necessitating the need for inpatient rehabilitation to restore strength and physical function.

Conclusions: This case highlights catatonia as a rare but significant presentation in a patient with bipolar disorder and hippocampal stroke. It reinforces the need for multidisciplinary evaluation and treatment by neurology, psychiatry, and physical medicine and rehabilitation medicine in cases of unexplained neurological symptoms consistent with catatonia.

Date: Saturday, October 25, 2025 @ 12:00 p.m. - 1:30 p.m. M.T.
Location: Kiosk 10

Primary Author(s):

• Liana Shehata, OMS III, Futures Forward Research Institute (FFRI)

Poster Presenter(s):

• Valerie Rome, Medical Student, Rowan University School of Osteopathic Medicine

Co-Author(s):

• Brandon Goodwin, D.O., Resident Physician, Johns Hopkins University
• Sahba Oboudiyat, D.O., Attending Physician, University of Pennsylvania

Disclosure(s):

• Liana Shehata, Other: No financial relationships to disclose

Background and/or Objectives: The purpose of this study is to conduct a comprehensive analysis of adverse events (AEs) associated with peripheral nerve stimulation (PNS) devices, due to the attraction gained as a non-opioid treatment modality for chronic pain management. By systematically examining these reports, we aim to identify recurrent AEs, recognize trends over time, and establish potential risk factors linked to these events. This analysis aims to enhance our understanding of the safety profile of PNS devices and‬‭ enable the development of strategies to mitigate associated risks.‬‬

Design: Retrospective descriptive analysis.

Setting: The Manufacturer and User Facility Device‬‭ Experience (MAUDE) database.‬

Participants: Adverse event reports involving PNS devices submitted between January 2013 and March 2024, filtered by product code “GZF.”

Interventions: peripheral nerve stimulation (PNS)

Main Outcome Measures: Event type classification (injury, malfunction, death), device- and patient-related problem categories, and manufacturer/device frequency distributions.

Results: The MAUDE database contained 2,469 reports about PNS devices where 98.9% fell under the injury category. The most common device-related issues included nonspecific adverse events (n=1,609), lead migration (n=113), and device malfunction. The patient complaints that appeared most often included inadequate pain relief (n=730), infections (n=197), erosion (n=164) and discomfort (n=101)

Conclusions: The 10-year safety evaluation demonstrates that inadequate pain control, infections and hardware complications continue to be prevalent issues in PNS treatment. The results demonstrate the requirement for standardized AE reporting systems alongside operator training programs and long-term safety monitoring registries. The study provides important safety recommendations for PNS device implementation in pain management despite the constraints of passive surveillance data.

Date: Thursday, October 23, 2025 @ 2:15 p.m. - 3:30 p.m. M.T.
Location: SPCC, Ground Level, Grand Ballroom G/I

Director:

• Ning Cao, M.D. 

Description: Explore the latest technological advancements and innovative techniques transforming neurorehabilitation. This session features expert-led discussions and demonstrations on cutting-edge tools, neurostimulation methods, robotics, virtual reality, and other emerging therapies designed to enhance patient outcomes. Ideal for inpatient clinicians seeking to advance neurorehabilitation practices through technology-driven solutions.

Date: Thursday, October 23, 2025 @ 6:00 p.m. - 6:30 p.m. M.T. 
Location: SPCC, Ground Level, Halls ABCD, Learning Center

Director:

• Mohammed Emam, M.D.

Description: This lab will consist of Sports Medicine board-certified faculty, and will cover the evidence-based evaluation and management of both common and rare (but essential to know) sports-related injuries. The session will start with a brief presentation followed by a breakout session. Participants will be divided into small groups and rotate between stations that include spine boarding, concussion evaluation and management, e-FAST ultrasound protocol training, fracture and dislocation management, pneumothorax management, and exercise associated collapse.

Learning Objectives:

• Describe the role of the team physician, including those concerning clinical versus nonclinical issues.
• Explain the protocol for game-day preparedness, including appropriate medical supplies, communication with clinical and non-clinical personnel, and environmental awareness.
• Identify signs of a catastrophic or emergent injury, and how to safely and effectively assess and manage affected athletes.
• Compare and contrast return to play conditions based on injury, sport, and position
  
   

Research and presentation topics included:

• Weight Bearing Protocol Rehabilitation after Lower Limb Osseointegration in a Patient: A Case Report
• Anterior Scalene Block Alleviates Dyspnea: A Case Report
• Improved Motor Activation of C7 Myotome In Previous Incomplete Cervical Spinal Injury Via Spinal Cord Stimulation
• Psilocybin and Chronic Neuropathic Pain: A Systematic Review
• Improved Motor Activation of C7 Myotome In Previous Incomplete Cervical Spinal Injury Via Spinal Cord Stimulation
• Psilocybin and Chronic Neuropathic Pain: A Systematic Review
• Anterior Scalene Block Alleviates Dyspnea: A Case Report
• Weight Bearing Protocol Rehabilitation after Lower Limb Osseointegration in a Patient with Severe Acrocyanosis: A Case Report
• Improved upper extremity function in previous cervical spinal cord injury via spinal cord stimulation: A case report
• Bone Marrow Aspirate Concentrate injection with PRP augmentation in a Complex Bucket Handle Meniscus Tear: A Case Report
• Instrumented Assessment of Precision Grasp Captures Sensory Motor Impairments in Individuals with Multiple Sclerosis
• A Unique Approach to Peripheral Nerve Stimulator Implantation in Achondroplasia: A Case Report
• Physical Medicine and Rehabilitation Transdisciplinary Education Program: A Pilot Study
• Emerging Guidelines and Clinical Trials: What Matters in Cancer Rehab?
• Learning Center: Diagnostic and Interventional Ultrasonography for Common Entrapment Neuropathies of the Upper Extremity
• Mononeuropathies: Static and Dynamic Evaluation, Interventional Ultrasound Procedures
• Foot and Ankle Ultrasonography to Improve Physical Examination Skills
• Sideline Medicine: Assessment and Management of Acute On-field Injuries
• Closing Plenary Session Featuring Phyztalks

Research and presentation topics included:

• Pain, Functional, and Structural Improvements in Lumbosacral Radiculopathy Due to Disc Herniation After Epidural Platelet-rich-plasma Injection
• 8% Topical Capsaicin Patch Placement to Treat post-covid-19 Neuropathic Pain: A Case Report
• Spasticity Practice Guidelines for Physiatrists: The Latest in Assessing, Diagnosis, and Treating Spasticity in Adults and Children
• Diagnostic and Interventional ultrasonography for common entrapment neuropathies of the upper extremity
• A Cross-sectional Survey of Cancer Rehabilitation Physiatrists Across the United States Regarding Outcome Measure Collection
• Essential Updates in the Physiatric Management of Post COVID Conditions: Fatigue, Cardiovascular, Pulmonary & Pain Disorders
• Essential Updates in the Physiatric Management of Post COVID Conditions: Autonomic, Neurologic, Cognitive and Pediatric Disorders
• Stroke Recovery and Rehabilitation: Debating the Controversies
• Making Sense of Muscle Wasting

View abstracts (PDF)

• ALS Following COVID-19 Infection: A Case Report
• Equivalence of In-person and Telehealth Administration of the Physical and Neurological Examination of Subtle Signs Timed Motor Subscale in Youth Recovered from Concussion and Healthy Controls
• Service Utilization and Unmet Needs of Children and Young Adults with a History of Disorder of Consciousness After Brain Injury
• Update: Swallowing Disorders Research at Johns Hopkins Rehabilitation Network