David Crandell | Harvard University (original) (raw)

Papers by David Crandell

Frontiers in rehabilitation sciences, Feb 16, 2023

Supplemental material, sj-docx-4-nnr-10.1177_15459683211017509 for Effects of Combined and Alone ... more Supplemental material, sj-docx-4-nnr-10.1177_15459683211017509 for Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial by Muhammed Enes Gunduz, Kevin Pacheco-Barrios, Camila Bonin Pinto, Dante Duarte, Faddi Ghassan Saleh Vélez, Anna Carolyna Lepesteur Gianlorenco, Paulo Eduardo Portes Teixeira, Stefano Giannoni-Luza, David Crandell, Linamara Rizzo Battistella, Marcel Simis and Felipe Fregni in Neurorehabilitation and Neural Repair

Supplemental material, sj-docx-1-nnr-10.1177_15459683211017509 for Effects of Combined and Alone ... more Supplemental material, sj-docx-1-nnr-10.1177_15459683211017509 for Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial by Muhammed Enes Gunduz, Kevin Pacheco-Barrios, Camila Bonin Pinto, Dante Duarte, Faddi Ghassan Saleh Vélez, Anna Carolyna Lepesteur Gianlorenco, Paulo Eduardo Portes Teixeira, Stefano Giannoni-Luza, David Crandell, Linamara Rizzo Battistella, Marcel Simis and Felipe Fregni in Neurorehabilitation and Neural Repair

Supplemental material, sj-docx-3-nnr-10.1177_15459683211017509 for Effects of Combined and Alone ... more Supplemental material, sj-docx-3-nnr-10.1177_15459683211017509 for Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial by Muhammed Enes Gunduz, Kevin Pacheco-Barrios, Camila Bonin Pinto, Dante Duarte, Faddi Ghassan Saleh Vélez, Anna Carolyna Lepesteur Gianlorenco, Paulo Eduardo Portes Teixeira, Stefano Giannoni-Luza, David Crandell, Linamara Rizzo Battistella, Marcel Simis and Felipe Fregni in Neurorehabilitation and Neural Repair

Supplemental material, sj-docx-2-nnr-10.1177_15459683211017509 for Effects of Combined and Alone ... more Supplemental material, sj-docx-2-nnr-10.1177_15459683211017509 for Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial by Muhammed Enes Gunduz, Kevin Pacheco-Barrios, Camila Bonin Pinto, Dante Duarte, Faddi Ghassan Saleh Vélez, Anna Carolyna Lepesteur Gianlorenco, Paulo Eduardo Portes Teixeira, Stefano Giannoni-Luza, David Crandell, Linamara Rizzo Battistella, Marcel Simis and Felipe Fregni in Neurorehabilitation and Neural Repair

The purpose of the current study was to examine the perceived improvement on fitness, self-confid... more The purpose of the current study was to examine the perceived improvement on fitness, self-confidence, and mood among participants in a sport-based therapeutic recreation program. The program was administered by a rehabilitation hospital and participants consisted of inpatients, outpatients, and community members with a variety of physical disabilities, including cerebral palsy, spinal cord injury, stroke, and traumatic brain injury. As part of an internal program evaluation, we assessed perceived improvement on flexibility, muscular strength, muscular endurance, balance, self-confidence, and mood. Participants reported improvement on all variables regardless of age, gender, or hospital status (e.g., inpatient). The current findings warrant future empirical research on actual fitness and affective changes that result from noncompetitive sport-based programming.

Plastic and Reconstructive Surgery - Global Open, 2021

Summary: Extremity amputation remains a common intervention for limb-threatening conditions. With... more Summary: Extremity amputation remains a common intervention for limb-threatening conditions. With advancement in surgical technique to address deleterious postoperative sequelae of limb removal, there is a salient need to develop and operationalize interdisciplinary care frameworks to provide more comprehensive care to an otherwise challenging patient population. Herein, we describe our interdisciplinary approach to the management of amputee patient populations at our institution, referred to as the Interdisciplinary Care for Amputees Network (ICAN). This novel framework focuses on 3 fundamental areas: combined preoperative patient evaluation, orthoplastic surgical intervention, and multi-specialty postoperative functional and psychosocial rehabilitation. Importantly, the successful implementation of a combined orthoplastic clinic requires establishing a working relationship among providers to leverage increased provider familiarity. This, coupled with sufficient clinic space, dedic...

Neurorehabilitation and Neural Repair, 2021

Phantom limb pain (PLP) is a frequent complication in amputees, which is often refractory to trea... more Phantom limb pain (PLP) is a frequent complication in amputees, which is often refractory to treatments. We aim to assess in a factorial trial the effects of transcranial direct current stimulation (tDCS) and mirror therapy (MT) in patients with traumatic lower limb amputation; and whether the motor cortex plasticity changes drive these results. In this large randomized, blinded, 2-site, sham-controlled, 2 × 2 factorial trial, 112 participants with traumatic lower limb amputation were randomized into treatment groups. The interventions were active or covered MT for 4 weeks (20 sessions, 15 minutes each) combined with 2 weeks of either active or sham tDCS (10 sessions, 20 minutes each) applied to the contralateral primary motor cortex. The primary outcome was PLP changes on the visual analogue scale at the end of interventions (4 weeks). Motor cortex excitability and cortical mapping were assessed by transcranial magnetic stimulation (TMS). We found no interaction between tDCS and MT...

PAIN Reports, 2020

Introduction: Opioid consumption for those in comprehensive inpatient rehabilitation units is hig... more Introduction: Opioid consumption for those in comprehensive inpatient rehabilitation units is high because of the complexity of their injuries. Notably, pain in rehabilitation leads to worsened clinical outcomes because of maladaptive behaviors and poor engagement during therapies. It is critical to developing evidence-based pharmacobehavioral interventions. Based on principles of classical conditioning, conditioning open-label placebo (COLP) is a promising approach for reducing opioid use in comprehensive inpatient rehabilitation, and this technique takes advantage of the possibility of association learning and opioid pharmacology to promote evoked placebo-driven analgesia. Objectives: In this brief report, we evaluate the feasibility of COLP as a pharmacobehavioral intervention to decrease total opioid consumption in patients with pain hospitalized at Spaulding Rehabilitation Hospital. Methods: Inpatients with spinal cord injury and polytrauma (n 5 20) with moderate to severe pain were randomized to receive COLP (n 5 10) or treatment-as-usual for 6 consecutive days. Opioid utilization was measured by morphine equivalents using the morphine equivalent dose conversion; pain severity was assessed using the numerical visual analog scale. Results: Conditioning open-label placebo significantly reduced total opioid consumption by the end of the intervention period (P # 0.001). Pain reduction was also significant for the COLP group (P 5 0.005), whereas the treatment-as-usual group demonstrated a trend towards pain reduction (P 5 0.05). Conclusions: This study presents the first data in the use of a pharmacobehavioral intervention that capitalize on the benefits of open-label placebo and classical drug conditioning for opioid dose reduction in a population with moderate to severe pain exposed to intensive inpatient rehabilitation.

Psychiatry Research: Neuroimaging, 2020

The neural mechanism of phantom limb pain (PLP) is related to the intense brain reorganization pr... more The neural mechanism of phantom limb pain (PLP) is related to the intense brain reorganization process implicating plasticity after deafferentation mostly in sensorimotor system. There is a limited understanding of the association between the sensorimotor system and PLP. We used a #

Frontiers in Medicine, 2020

Context: Persistent fatigue, pain, and neurocognitive impairment are common in individuals follow... more Context: Persistent fatigue, pain, and neurocognitive impairment are common in individuals following treatment for Lyme borreliosis (LB). Poor sleep, depression, visual disturbance, and sensory neuropathies have also been reported. The cause of these symptoms is unclear, and widely accepted effective treatment strategies are lacking. Objectives: To identify symptom clusters in people with persistent symptoms previously treated for LB and to examine the relationship between symptom severity and perceived disability. Methods: This was a retrospective chart review of individuals with a history of treatment of LB referred to The Dean Center for Tick-Borne Illness at Spaulding Rehabilitation Hospital between 2015 and 2018 (n = 270) because of persistent symptoms. Symptoms and functional impairment were collected using the General Symptom Questionnaire-30 (GSQ-30), and the Sheehan Disability Scale. Clinical tests were conducted to evaluate for tick-borne co-infections and to rule out medical disorders that could mimic LB symptomatology. Exploratory factor analysis was performed to identify symptom clusters. Results: Five symptom clusters were identified. Each cluster was assigned a name to reflect the possible underlying etiology and was based on the majority of the symptoms in the cluster: the neuropathy symptom cluster, sleep-fatigue symptom cluster, migraine symptom cluster, cognitive symptom cluster, and mood symptom cluster. Symptom severity for each symptom cluster was positively associated with global functional impairment (p < 0.001). Conclusion: Identifying the interrelationship between symptoms in post-treatment LB in a cluster can aid in the identification of the etiological basis of these symptoms and could lead to more effective symptom management strategies. Zubcevik et al. Symptom Clusters in Lyme Borreliosis Key Message: This article describes symptom clusters in individuals with a history of Lyme borreliosis. Five clusters were identified: sleep-fatigue, neuropathy, migrainelike, cognition, and mood clusters. Identifying the interrelationship between symptoms in each of the identified clusters could aid in more effective symptom management through identifying triggering symptoms or an underlying etiology.

Current Trauma Reports, 2020

Purpose of the Review To provide a comprehensive overview of care and rehabilitation of those wit... more Purpose of the Review To provide a comprehensive overview of care and rehabilitation of those with traumatic limb loss, from preoperative to lifelong care. Recent Findings Comprehensive care including peer support and monitoring for the development of secondary conditions which compound disability is essential after traumatic amputation. Conditions that commonly develop after traumatic limb loss include heterotopic ossification, intact limb knee osteoarthritis, low back pain, and reduction in cardiopulmonary reserve. Summary Optimal care for people after traumatic limb loss requires a multidisciplinary team to provide perioperative and lifelong care. In addition to ensuring optimal rehabilitation based on the individual's vocational and avocational goals, current function, concomitant injuries, and amputation level, their psychological recovery must not be overlooked. To optimize quality of life and independence, lifelong follow-up with a physiatrist is essential to care for complications and secondary conditions, as well as to promote an active lifestyle.

Journal of Visualized Experiments, 2019

Mirror therapy (MT) has been proposed as an effective rehabilitative strategy to alleviate pain s... more Mirror therapy (MT) has been proposed as an effective rehabilitative strategy to alleviate pain symptoms in amputees with phantom limb pain (PLP). However, establishing the neural correlates associated with MT therapy have been challenging given that it is difficult to administer the therapy effectively within a magnetic resonance imaging (MRI) scanner environment. To characterize the functional organization of cortical regions associated with this rehabilitative strategy, we have developed a combined behavioral and functional neuroimaging protocol that can be applied in participants with a leg amputation. This novel approach allows participants to undergo MT within the MRI scanner environment by viewing real-time video images captured by a camera. The images are viewed by the participant through a system of mirrors and a monitor that

Archives of Physical Medicine and Rehabilitation, 2018

Participants were adults (NZ20) with ABI who were referred to the adapted-yoga program by their c... more Participants were adults (NZ20) with ABI who were referred to the adapted-yoga program by their clinical occupational or physical therapist as part of the discharge plan from rehabilitation. Interventions: Once enrolled, participants attended adapted-yoga at the YMCA 1X/week for 12 weeks. The adapted-yoga class consisted of breath work, postures, and guided relaxation. The adapted-yoga class was slowly progressive to include seated, standing, and supine postures. Main Outcome Measure(s): Baseline and 12-week assessments included: 1) Berg Balance Scale (BBS), 2) Activity Specific Balance Confidence Scale (ABC), 3) 6-Minute Walk Test (6MWT), 4) Dynamic Gait Index (DGI), and 5) ICF Measure of Activity and Participation (IMPACT). Data were analyzed with SPSS 23.0 using; 1) descriptive statistics for demographic data, and 2) paired t-test for pre/post data (pZ0.05). Results: Twenty participants completed the study. Results showed significant improvements in balance confidence (ABC, 54% to 64%, pZ0.004), balance (BBS, 28 to 39, p<0.001; & DGI, 10 to 15, p<0.001), and activity (IMPACT-A, 36 to 32, pZ0.005) No significant changes were found for walking distance (6MWT, pZ0.091) and participation (IMPACT-P, pZ0.659). Conclusions: An adapted-yoga program for adults with ABI offered in the community as a post-rehabilitation activity may be beneficial for improving balance, balance confidence, and activity.

International Journal of Clinical Trials, 2017

Phantom limp pain (PLP) was first described in 1551. To date, its mechanisms and novel interventi... more Phantom limp pain (PLP) was first described in 1551. To date, its mechanisms and novel interventions remain mostly untested. Only limited conclusions can be drawn from few and small sized randomized clinical trials (RCTs) on PLP. In this scenario, enhanced recruitment strategies are crucial in order to overcome inherent challenges to recruit and enroll PLP subjects for clinical trials. Although there are many general methods to enhance recruitment and also retention, in this article we discuss these methods based on a common topic; dissemination. We summarize and discuss ten strategies of recruitment related to the dissemination of information based on the notion that increased trial awareness may lead to both improved recruitment and also external generalizability. In addition, we include insights based on our experience recruiting PLP patients for the purposes of a large-scale and on-going NIH-sponsored clinical trial. Although specific regulatory considerations need to be conside...

PM&R, 2016

Objective: Traditional methods of increasing Vitamin D are not optimal and absorption is often a ... more Objective: Traditional methods of increasing Vitamin D are not optimal and absorption is often a challenge. This study tested a novel patchless delivery (TransEpi technology) to increase Vitamin D levels in subjects with Vitamin D insufficiency (25(OH)D) Design: Open label, single-arm study. Setting: University diagnostic center tested and verified serum analyses (Screening, Baseline, Days 35, 42 and 56) on subjects (n1⁄46). Safety and tolerability were assessed by serum levels and investigator assessed ordinal scale. Participants: Healthy male/female adults. Interventions: Technology containing Vitamin D3 was applied for 35 days with other sources of Vitamin D controlled or restricted (no oral supplements, SPF30+ sunscreen required, no change in pre-study lifestyle). Main Outcome Measures: Numerically significant increases in 25(OH) D serum levels and safety/ tolerability. Results: Overall 40%-50% increases (mean 44.5%) in Vitamin D insufficient subjects after 35 days application including a Cystic Fibrosis (CF) subject (+51% increase) who achieved normalized Vitamin D (35.3 ng/mL) and was previously unable for several years to normalize Vitamin D on oral supplements (2,000 IU/b.i.d.). Vitamin D insufficiency in CF patients is >90% despite oral supplementation. There were no adverse events and tolerability was good. Conclusions: Adequate levels of Vitamin D improves performance and muscle strength and decreases the risk of fractures, osteoporosis, cancers, cardiovascular/metabolic and respiratory disorders. TransEpi technology appears to be an effective delivery to increase Vitamin D levels in patients with malabsorption issues without exposure to UVA/UVB and/or when accompanied by sun-protecting ingredients. Further studies of the technology are ongoing. Level of Evidence: Level II

JMIR research protocols, Jan 6, 2016

Despite the multiple available pharmacological and behavioral therapies for the management of chr... more Despite the multiple available pharmacological and behavioral therapies for the management of chronic phantom limb pain (PLP) in lower limb amputees, treatment for this condition is still a major challenge and the results are mixed. Given that PLP is associated with maladaptive brain plasticity, interventions that promote cortical reorganization such as non-invasive brain stimulation and behavioral methods including transcranial direct current stimulation (tDCS) and mirror therapy (MT), respectively, may prove to be beneficial to control pain in PLP. Due to its complementary effects, a combination of tDCS and MT may result in synergistic effects in PLP. The objective of this study is to evaluate the efficacy of tDCS and MT as a rehabilitative tool for the management of PLP in unilateral lower limb amputees. A prospective, randomized, placebo-controlled, double-blind, factorial, superiority clinical trial will be carried out. Participants will be eligible if they meet the following i...