Steven R Flanagan, M.D.

Medical aspects of disability : a handbook for the rehabilitation professional
Flanagan, Steven R; Zaretsky, Herbert H; Moroz, Alex
New York : Springer, c2011,
Part I: An introduction to key topics and issues -- Introduction / Kate Parkin, John R. Corcoran, and Tara Denham --Part II: Disabling conditions and disorders -- Disabling conditions seen in AIDS and HIV infection / Jennifer Sayanlar, Fran R. Wallach, and Adam B. Stein -- Alzheimer's disease / Barry Reisberg ... [et al.] -- Traumatic brain injury / Brian Im ... [et al.] -- Rehabilitation in burns / Alan W. Young, W. Scott Dewey, and Steven E. Wolf -- The role of rehabilitation in cancer patients / Reema Batra and Parul Jajoo -- Cardiovascular disorders / Ana Mola, Jonathan H. Whiteson, and Mariano J. Rey -- Chronic pain syndromes / Christopher G. Gharibo and M. Fahad Khan -- Diabetes mellitus / David G. Marrero -- Epilepsy / Robert T. Fraser, John W. Miller, and Erica K. Johnson -- Speech, language, hearing, and swallowing disorders / Nancy Eng and Patricia Kerman Lerner -- Hematological disorders / Bruce G. Raphael -- Developmental disabilities / Richard J. Morris and Yvonne P. Morris -- Neuromuscular disorders / Jeffrey M. Cohen, Marissa Cohler, and Ludmilla Bronfin -- Musculoskeletal disorders / Joseph E. Herrera, Jung Woo Ma, and Pete-Gaye Nation -- Pediatric disorders: cerebral palsy and spina bifida / Joan T. Gold and David Salsberg -- Geriatric rehabilitation / Monwara Hassan, Adrian Cristian, and Teina Daley -- Introduction to peripheral vascular disorders / Glenn R. Jacobowitz -- Limb deficiency / Jeffrey M. Cohen and Joan E. Edelstein -- Organ transplantation and rehabilitation / Jeffrey M. Cohen, Mark Young, and Bryan O'Young -- Psychiatric disabilities / Marina Kukla and Gary R. Bond -- Pulmonary disorders / Frederick A. Bevelaqua and Susan Garritan -- Chronic kidney disease / Kotresha Neelakantappa and Jerome Lowenstein -- Rheumatic diseases / Sicy H. Lee and Steven B. Abramson -- Spinal cord injury / Jung Ahn and Jeffrey Berliner -- Stroke / Michal Eisenberg and Ira Rashbaum -- Visual impairments / Bruce P. Rosenthal and Roy Gordon Cole --Part III: Special topics -- Complementary and alternative medicine / Alex Moroz and Robert A. Schulman -- Rehabilitation nursing: educating patients toward independence / Jeanne Dzurenko -- Social work in physical medicine and rehabilitation / Patrick Inniss -- The computer revolution, disability, and assistive technology / Mark A. Young and Bryan O'Young -- Trends in medical rehabilitation delivery and payment systems / Mary C. Ellis and Kristofer J. Hagglund -- Legislation and rehabilitation professionals / Susanne M. Bruyere, Sara A. Van Looy, and Thomas P. Golden -- Accreditation--a quality framework in the consumer-centric era / Brian J. Boon -- Challenges and opportunities for quality in rehabilitation / Dale C. Strasser -- Telerehabilitation: solutions to distant and international care / Andrew J. Haig -- Future directions of rehabilitation research / Tamara Bushnik
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Frequency analysis unveils cardiac autonomic dysfunction after mild traumatic brain injury
Hilz, Max J; Defina, Philip A; Anders, Stefan; Koehn, Julia; Lang, Christoph J; Pauli, Elisabeth; Flanagan, Steven R; Schwab, Stefan; Marthol, Harald
2011 Sep;28(9):1727-1738, Journal of neurotrauma
Abstract Long-term mortality is increased after mild traumatic brain injury (mTBI). Central cardiovascular-autonomic dysregulation resulting from subtle, trauma-induced brain lesions might contribute to cardiovascular events and fatalities. We investigated whether there is cardiovascular-autonomic dysregulation after mTBI. In 20 mTBI patients (37+/-13 years, 5-43 months post-injury) and 20 healthy persons (26+/-9 years), we monitored respiration, RR intervals (RRI), blood pressures (BP), while supine and upon standing. We calculated the root mean square successive RRI differences (RMSSD) reflecting cardiovagal modulation, the ratio of maximal and minimal RRIs around the 30th and 15th RRI upon standing (30:15 ratio) reflecting baroreflex sensitivity (BRS), spectral powers of parasympathetic high-frequency (HF: 0.15-0.5 Hz) RRI oscillations, of mainly sympathetic low-frequency (LF: 0.04-0.15 Hz) RRI oscillations, of sympathetic LF-BP oscillations, RRI-LF/HF-ratios reflecting sympathovagal balance, and the gain between BP and RRI oscillations as additional BRS index (BRS(gain)). We compared supine and standing parameters of patients and controls (repeated measures analysis of variance; significance: p<0.05). While supine, patients had lower RRIs (874.2+/-157.8 vs. 1024.3+/-165.4 ms), RMSSDs (30.1+/-23.6 vs. 56.3+/-31.4 ms), RRI-HF powers (298.1+/-309.8 vs. 1507.2+/-1591.4 ms(2)), and BRS(gain) (8.1+/-4.4 vs. 12.5+/-8.1 ms.mmHg(-1)), but higher RRI-LF/HF-ratios (3.0+/-1.9 vs. 1.2+/-0.7) than controls. Upon standing, RMSSDs and RRI-HF-powers decreased significantly in controls, but not in patients; patients had lower RRI-30:15-ratios (1.3+/-0.3 vs. 1.6+/-0.3) and RRI-LF-powers (2450.0+/-2110.3 vs. 4805.9+/-3453.5 ms(2)) than controls. While supine, mTBI patients had reduced cardiovagal modulation and BRS. Upon standing, their BRS was still reduced, and patients did not withdraw parasympathetic or augment sympathetic modulation adequately. Impaired autonomic modulation probably contributes to cardiovascular irregularities post-mTBI
— id: 138015, year: 2011, vol: 28, page: 1727, stat: Journal Article,

The state of neurorehabilitation: past, present, and future
Flanagan, Steven R
2010 Jun;2(6):485-487, PM&R
— id: 150010, year: 2010, vol: 2, page: 485, stat: Journal Article,

Rehabilitation of traumatic brain injury
Levine, Jaime M; Flanagan, Steven R
2010 Dec;33(4):877-891, Psychiatric clinics of North America
Rehabilitation following traumatic brain injury (TBI) is best provided by an interdisciplinary team of health care providers that takes advantage of the unique skills of multiple specialists, as well as their combined strengths that address problems that cut across disciplines. The setting where rehabilitation is provided is determined by the medical stability of patients, their ability to tolerate intensive therapies, and their likelihood of community reintegration within a reasonable period of time. Successful rehabilitation requires prompt recognition and treatment of TBI-related medical, cognitive, and behavioral problems to promote recovery and enhance community reintegration, using a combination of rehabilitation modalities and medications
— id: 114836, year: 2010, vol: 33, page: 877, stat: Journal Article,

A randomized controlled trial of sertraline for the treatment of depression in persons with traumatic brain injury
Ashman, Teresa A; Cantor, Joshua B; Gordon, Wayne A; Spielman, Lisa; Flanagan, Steve; Ginsberg, Annika; Engmann, Clara; Egan, Matthew; Ambrose, Felicia; Greenwald, Brian
2009 May;90(5):733-740, Archives of physical medicine & rehabilitation
OBJECTIVE: To examine the efficacy of sertraline in the treatment of depression after traumatic brain injury (TBI). DESIGN: Double-blind, randomized controlled trial. SETTING: Research center at a major urban medical center. PARTICIPANTS: Subjects were a referred and volunteer sample of 52 participants with TBI, a diagnosis of major depression disorder (MDD), and a score on the Hamilton Rating Scale for Depression (HAM-D) of 18 or greater. The majority of the sample was male (58%), had less than 14 years of education (73%), had incomes below $20,000 (82%), and were from minority backgrounds (75%). Approximately one third of the sample had mild brain injuries, and two thirds had moderate to severe brain injuries. The mean age was 47+/-11, and the mean time since injury was 17+/-14 years. One participant withdrew from the study because of side effects. INTERVENTION: Daily oral sertraline in doses starting at 25mg and increasing to therapeutic levels (up to 200mg) or placebo for 10 weeks. MAIN OUTCOME MEASURES: The HAM-D, the Beck Anxiety Inventory, and the Life-3 quality of life (QOL). RESULTS: No statistically significant differences were found at baseline between drug and placebo groups on baseline measures of depression (24.8+/-7.3 vs 27.7+/-7.0), anxiety (16.4+/-12.3 vs 24.0+/-14.9), or QOL (2.96+/-1.0 vs 2.9+/-0.9). The income level of those receiving placebo was significantly lower than those participants receiving medication. Analyses of covariance revealed significant changes from preintervention to posttreatment for all 3 outcome measures (P<.001) but no group effects. Random-effects modeling did not find any significant difference in patterns of scores of the outcome measures between the placebo and medication groups. CONCLUSIONS: Both groups showed improvements in mood, anxiety, and QOL, with 59% of the experimental group and 32% of the placebo group responding to the treatment, defined as a reduction of a person's HAM-D score by 50%
— id: 106341, year: 2009, vol: 90, page: 733, stat: Journal Article,

Managing agitation associated with traumatic brain injury: behavioral versus pharmacologic interventions?
Flanagan, Steven R; Elovic, Elie P; Sandel, Elizabeth
2009 Jan;1(1):76-80, PM&R
— id: 104362, year: 2009, vol: 1, page: 76, stat: Journal Article,

Pharmacological treatment for cognitive disorders of neurovascular origin
Flanagan, Steven; Gordon, Wayne A
Neurovascular neuropsychology New York, NY, US: Springer Science + Business Media, 2009,
(from the chapter) Neurovascular disease is the most common cause of adult disability, resulting in both physical and cognitive impairments as well as behavioral disturbances. Physical problems, such as hemiplegia have an obvious impact on mobility and ability to participate in activities of daily living. However, cognitive impairments, while often less obvious on superficial examination, have a tremendous impact on the same skills. In fact, in the absence of physical impairments, cognitive dysfunction often results in an inability to participate in desired roles. Enhancing traditional rehabilitation techniques with pharmacological interventions has been an area of interest and research for several decades. Ideally, pharmacological intervention following stroke should speed the rehabilitation process, in addition to improving overall outcomes.This is becoming increasingly important now that modern health care systems have placed increasing emphasis on both shorter hospitalizations and more efficient treatments. This chapter highlights the efficacy of pharmacological treatment for cognitive disorders of neurovascular origin.
— id: 5179, year: 2009, vol: , page: 1846, stat: Chapter,

Orthostatic Challenge Reveals Subtle Sympathetic Cardiac Dysfunction in Patients with Mild Traumatic Brain Injury
Hilz, MJ; Anders, S; Aurnhammer, F; Marthol, H; Baltadhzieva, R; Schroeder, T; Rossmeissl, A; Flanagan, S
2009 ;72(11):A447-A447, Neurology
— id: 104737, year: 2009, vol: 72, page: A447, stat: Journal Article,

Patients with mild traumatic brain injury show subtle sympathetic cardiac dysfunction during orthostatic challenge
Hilz, MJ; Anders, S; Aurnhammer, F; Marthol, H; Baltadzhieva, R; Schroeder, T; Rossmeissl, A; Schwab, S; Flanagan, S; De Fina, P
2009 ;16(2):53-53, European journal of neurology
— id: 104738, year: 2009, vol: 16, page: 53, stat: Journal Article,

Ocular Pressure Test Shows Subtle Autonomic Cardiovascular Dysfunction in Patients with Mild Traumatic Brain Injury
Hilz, MJ; Aurnhammer, F; Anders, S; Marthol, H; Blaszczynska, P; Schroeder, T; Rossmeissl, A; Flanagan, S
2009 ;72(11):A406-A406, Neurology
— id: 104736, year: 2009, vol: 72, page: A406, stat: Journal Article,

Patients with mild traumatic brain injury have subtle autonomic cardiovascular dysfunction with ocular pressure test
Hilz, MJ; Aurnhammer, F; Anders, S; Marthol, H; Blaszczynska, P; Schroeder, T; Rossmeissl, A; Schwab, S; Flanagan, S; De Fina, P
2009 ;16(2):375-375, European journal of neurology
— id: 104739, year: 2009, vol: 16, page: 375, stat: Journal Article,

Rehabilitation of orthopaedic and neurologic boxing injuries
Lefkowitz, Todd; Flanagan, Steven; Varlotta, Gerard
2009 Oct;28(4):623-39, vii, Clinics in sports medicine
Clinical decision making for injured boxers follows the same therapeutic principles as the treatment plan for other injured athletes. Just as surgical techniques have improved, so has the scientific basis for implementing therapeutic exercises progressed to return the athletes to their former level of competition
— id: 104356, year: 2009, vol: 28, page: 623, stat: Journal Article,

Objective measurement of fatigue following traumatic brain injury
Ashman, Teresa A; Cantor, Joshua B; Gordon, Wayne A; Spielman, Lisa; Egan, Matthew; Ginsberg, Annika; Engmann, Clara; Dijkers, Marcel; Flanagan, Steven
2008 Jan-Feb;23(1):33-40, Journal of head trauma rehabilitation
OBJECTIVES: To quantify posttraumatic brain injury (post-TBI) mental fatigue objectively by documenting changes in performance on neuropsychological tests as a result of sustained mental effort and to examine the relationship between objectively measured mental fatigue and self-reported situational and day-to-day fatigue. PARTICIPANTS: The study included 202 community-dwelling individuals with mild-severe TBI and 73 noninjured controls. MEASURES: Measures included Cambridge Neuropsychological Test Automated Battery, Global Fatigue Index, and situational fatigue rating. METHOD: Subjects were administered a 30-minute computerized neuropsychological test battery 3 times. The second and third administrations of the battery were separated by approximately 2 hours of interviews and administration of self-report measures. RESULTS: The neuropsychological test scores were factor analyzed, yielding 3 subscales: speed, accuracy, and executive function. Situational fatigue and day-to-day fatigue were significantly higher in individual with TBI group than in individuals without TBI and were associated with speed subscale scores. Individuals with TBI evidenced a significant decline in performance on the accuracy subscale score. These declines in performance related to sustained mental effort were not associated with subjective fatigue in the TBI group. While practice effects on the speed and accuracy scores were observed in non-brain-injured individuals, they were not evidenced in individuals with TBI. CONCLUSIONS: Findings were largely consistent with previous literature and indicated that while subjective fatigue is associated with poor performance in individuals with TBI, it is not associated with objective decline in performance of mental tasks
— id: 84783, year: 2008, vol: 23, page: 33, stat: Journal Article,

Congenital and acquired brain injury. 1. Epidemiology, pathophysiology, prognostication, innovative treatments, and prevention
Brown, Allen W; Elovic, Elie P; Kothari, Sunil; Flanagan, Steven R; Kwasnica, Christina
2008 Mar;89(3 Suppl 1):S3-S8, Archives of physical medicine & rehabilitation
This self-directed learning module reviews the current epidemiology of traumatic brain injury (TBI), its pathophysiology, prognostication after injury, currently available innovative early approaches to diagnosis and treatment, and effective methods of prevention. It is intended to provide the rehabilitation clinician with current knowledge to accurately inform patients, families, significant others, referring physicians, and payers and to aid in clinical decision making while caring for patients after TBI. OVERALL ARTICLE OBJECTIVE: To describe current knowledge in traumatic brain injury epidemiology, pathophysiology, prognostication, acute treatment, and prevention
— id: 83262, year: 2008, vol: 89, page: S3, stat: Journal Article,

Fatigue after traumatic brain injury and its impact on participation and quality of life
Cantor, Joshua B; Ashman, Teresa; Gordon, Wayne; Ginsberg, Annika; Engmann, Clara; Egan, Matthew; Spielman, Lisa; Dijkers, Marcel; Flanagan, Steve
2008 Jan-Feb;23(1):41-51, Journal of head trauma rehabilitation
OBJECTIVES: To examine the relationships between post-TBI fatigue (PTBIF) and comorbid conditions, participation in activities, quality of life, and demographic and injury variables. PARTICIPANTS: 223 community-dwelling individuals with mild to severe TBI and 85 noninjured controls. MEASURES: Global Fatigue Index (GFI), Beck Depression Inventory (BDI-II), McGill Pain Questionnaire (MPQ), Pittsburgh Sleep Quality Inventory (PSQI), Participation Objective Participation Subjective (POPS), SF-36, Life-3. METHOD: Data were collected through interviews and administration of self-report measures as part of a study of PTBIF. RESULTS: Fatigue was more severe and prevalent in individuals with TBI, and more severe among women. It was not correlated with other demographic and injury variables. Once overlap in measurement instruments' content was removed, depression, pain, and sleep problems accounted for approximately 23% of the variance in fatigue in those with TBI compared to 58% of the variance in the control group. PTBIF was correlated with health-related quality of life and overall quality of life, but was not generally related to participation in major life activities. CONCLUSIONS: PTBIF has significant impact on well-being and quality of life and cannot be accounted for by comorbid conditions alone, suggesting that it is related to brain injury itself. It appears to be unrelated to demographic and injury variables other than gender. PTBIF does not limit the quantity and frequency of participation. Future research should focus on the relationship between fatigue and the quality of participation
— id: 84784, year: 2008, vol: 23, page: 41, stat: Journal Article,

Congenital and acquired brain injury. 4. Outpatient and community reintegration
Elovic, Elie P; Kothari, Sunil; Flanagan, Steven R; Kwasnica, Christina; Brown, Allen W
2008 Mar;89(3 Suppl 1):S21-S26, Archives of physical medicine & rehabilitation
This self-directed learning module highlights the rehabilitation aspects of care for people with traumatic brain injury (TBI) after the acute phase. It focuses on issues important to community reentry, outpatient care, and return to work. It is part of the chapter on TBI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the formulation of rehabilitation plans to address the issues of cognitive dysfunction, behavioral disturbances, and community reintegration. Topics covered include pharmacologic and nonpharmacologic approaches to cognitive and affective disorders, intimacy, social isolation, mobility, and return to work. Finally, the critical issues of legal competency and obtaining informed consent in the population with cognitive impairment are discussed. OVERALL ARTICLE OBJECTIVE: To summarize the issues that affect outpatient care, independence, and community reentry after traumatic brain injury
— id: 83260, year: 2008, vol: 89, page: S21, stat: Journal Article,

Traumatic brain injury: future assessment tools and treatment prospects
Flanagan, Steven R; Cantor, Joshua B; Ashman, Teresa A
2008 Oct;4(5):877-892, Neuropsychiatric Disease & Treatment
Traumatic brain injury (TBI) is widespread and leads to death and disability in millions of individuals around the world each year. Overall incidence and prevalence of TBI are likely to increase in absolute terms in the future. Tackling the problem of treating TBI successfully will require improvements in the understanding of normal cerebral anatomy, physiology, and function throughout the lifespan, as well as the pathological and recuperative responses that result from trauma. New treatment approaches and combinations will need to be targeted to the heterogeneous needs of TBI populations. This article explores and evaluates the research evidence in areas that will likely lead to a reduction in TBI-related morbidity and improved outcomes. These include emerging assessment instruments and techniques in areas of structural/chemical and functional neuroimaging and neuropsychology, advances in the realms of cell-based therapies and genetics, promising cognitive rehabilitation techniques including cognitive remediation and the use of electronic technologies including assistive devices and virtual reality, and the emerging field of complementary and alternative medicine
— id: 96067, year: 2008, vol: 4, page: 877, stat: Journal Article,

Congenital and acquired brain injury. 2. Medical rehabilitation in acute and subacute settings
Flanagan, Steven R; Kwasnica, Christina; Brown, Allen W; Elovic, Elie P; Kothari, Sunil
2008 Mar;89(3 Suppl 1):S9-14, Archives of physical medicine & rehabilitation
This self-directed learning module reviews common clinical problems and issues pertaining to early management of persons with traumatic brain injury (TBI). It is part of the study guide on brain injury medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Acute TBI is frequently complicated by agitation, dystonia, and numerous orthopedic and neurologic comorbidities, often causing a decrement in function, which requires careful assessment and treatment. Individuals with acute brain injury typically receive rehabilitation in a setting determined by numerous factors, including medical stability and tolerance to rehabilitation interventions. OVERALL ARTICLE OBJECTIVES: To describe (a) common traumatic brain injury-related comorbidities and treatment strategies, (b) potential causes of declining patient performance, and (c) appropriate settings for rehabilitation interventions
— id: 83263, year: 2008, vol: 89, page: S9, stat: Journal Article,

Congenital and acquired brain injury. 5. Emerging concepts in prognostication, evaluation, and treatment
Kothari, Sunil; Flanagan, Steven R; Kwasnica, Christina; Brown, Allen W; Elovic, Elie P
2008 Mar;89(3 Suppl 1):S27-S31, Archives of physical medicine & rehabilitation
This self-directed learning module describes recent developments in the field of traumatic brain injury (TBI) rehabilitation. In particular, it focuses on the implications of recent technological advances for evaluation, prognostication, and treatment. It is part of the chapter on TBI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on neuroplasticity and its implications for rehabilitation interventions, the role of innovative neuroimaging modalities, improvements in our ability to prognosticate made possible by newer technologies, technologically based enhancement of motor rehabilitation, and the role of alternative and complementary medicine in TBI rehabilitation. OVERALL ARTICLE OBJECTIVE: To describe recent advances in our ability to evaluate, prognosticate, and treat traumatic brain injury
— id: 83261, year: 2008, vol: 89, page: S27, stat: Journal Article,

Congenital and acquired brain injury. 3. Spectrum of the acquired brain injury population
Kwasnica, Christina; Brown, Allen W; Elovic, Elie P; Kothari, Sunil; Flanagan, Steven R
2008 Mar;89(3 Suppl 1):S15-S20, Archives of physical medicine & rehabilitation
This self-directed learning module highlights the subpopulations of traumatic brain injury (TBI) that are treated by the rehabilitation practitioner. It is part of the chapter on TBI in the self-directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Specifically, this article focuses on the management of patients with mild TBI, children, and individuals with acquired brain injury from other etiologies, such as anoxic events or neoplastic lesions. The clinical spectrum of TBI, from the most severe presentation to the mildest, requires similar clinical skills to evaluate and manage. OVERALL ARTICLE OBJECTIVE: To describe the spectrum of brain injury populations based on age, severity, and etiology
— id: 83259, year: 2008, vol: 89, page: S15, stat: Journal Article,

MRI findings in the painful poststroke shoulder
Shah, Rajiv R; Haghpanah, Sepideh; Elovic, Elie P; Flanagan, Steven R; Behnegar, Anousheh; Nguyen, Vu; Page, Stephen J; Fang, Zi-Ping; Chae, John
2008 Jun;39(6):1808-1813, Stroke
BACKGROUND AND PURPOSE: We describe the structural abnormalities in the painful shoulder of stroke survivors and their relationships to clinical characteristics. Method- Eighty-nine chronic stroke survivors with poststroke shoulder pain underwent T1- and T2-weighted multiplanar, multisequence MRI of the painful paretic shoulder. All scans were reviewed by one radiologist for the following abnormalities: rotator cuff, biceps and deltoid tears, tendinopathies and atrophy, subacromial bursa fluid, labral ligamentous complex abnormalities, and acromioclavicular capsular hypertrophy. Clinical variables included subject demographics, stroke characteristics, and the Brief Pain Inventory Questions 12. The relationship between MRI findings and clinical characteristics was assessed through logistic regression. RESULTS: Thirty-five percent of subjects exhibited a tear of at least one rotator cuff, biceps or deltoid muscle. Fifty-three percent of subjects exhibited tendinopathy of at least one rotator cuff, bicep or deltoid muscle. The prevalence of rotator cuff tears increased with age. However, rotator cuff tears and rotator cuff and deltoid tendinopathies were not related to severity of poststroke shoulder pain. In approximately 20% of cases, rotator cuff and deltoid muscles exhibited evidence of atrophy. Atrophy was associated with reduced motor strength and reduced severity of shoulder pain. CONCLUSIONS: Rotator cuff tears and rotator cuff and deltoid tendinopathies are highly prevalent in poststroke shoulder pain. However, their relationship to shoulder pain is uncertain. Atrophy is less common but is associated with less severe shoulder pain
— id: 83264, year: 2008, vol: 39, page: 1808, stat: Journal Article,

Poststroke shoulder pain: its relationship to motor impairment, activity limitation, and quality of life
Chae, John; Mascarenhas, Don; Yu, David T; Kirsteins, Andrew; Elovic, Elie P; Flanagan, Steven R; Harvey, Richard L; Zorowitz, Richard D; Fang, Zi-Ping
2007 Mar;88(3):298-301, Archives of physical medicine & rehabilitation
OBJECTIVE: To assess the relationship between poststroke shoulder pain, upper-limb motor impairment, activity limitation, and pain-related quality of life (QOL). DESIGN: Cross-sectional, secondary analysis of baseline data from a multisite clinical trial. SETTING: Outpatient rehabilitation clinics of 7 academic medical centers. PARTICIPANTS: Volunteer sample of 61 chronic stroke survivors with poststroke shoulder pain and glenohumeral subluxation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We measured poststroke shoulder pain with the Brief Pain Inventory question 12 (BPI 12), a self-reported 11-point numeric rating scale (NRS) that assesses 'worst pain' in the last 7 days. Motor impairment was measured with the Fugl-Meyer Assessment (FMA). Activity limitation was measured with the Arm Motor Ability Test (AMAT) and the FIM instrument. Pain-related QOL was measured with BPI question 23, a self-reported 11-point NRS that assesses pain interference with general activity, mood, walking ability, normal work, interpersonal relationships, sleep, and enjoyment of life. RESULTS: Stepwise regression analyses indicated that poststroke shoulder pain is associated with the BPI 23, but not with the FMA, FIM, or AMAT scores. CONCLUSIONS: Poststroke shoulder pain is associated with reduced QOL, but not with motor impairment or activity limitation
— id: 83234, year: 2007, vol: 88, page: 298, stat: Journal Article,

Intramuscular electrical stimulation for shoulder pain in hemiplegia: does time from stroke onset predict treatment success?
Chae, John; Ng, Alan; Yu, David T; Kirsteins, Andrew; Elovic, Elie P; Flanagan, Steven R; Harvey, Richard L; Zorowitz, Richard D; Fang, Zi-Ping
2007 Nov-Dec;21(6):561-567, Neurorehabilitation & neural repair
BACKGROUND: A randomized clinical has shown the effectiveness of intramuscular electrical stimulation for the treatment of poststroke shoulder pain. OBJECTIVE: Identify predictors of treatment success and assess the impact of the strongest predictor on outcomes. METHOD: This is a secondary analysis of a multisite randomized clinical trial of intramuscular electrical stimulation for poststroke shoulder pain. The study included 61 chronic stroke survivors with shoulder pain randomized to a 6-week course of intramuscular electrical stimulation (n = 32) versus a hemisling (n = 29). The primary outcome measure was Brief Pain Inventory Question 12. Treatment success was defined as > or = 2-point reduction in this measure at end of treatment and at 3, 6, and 12 months posttreatment. Forward stepwise regression was used to identify factors predictive of treatment success among participants assigned to the electrical stimulation group. The factor most predictive of treatment success was used as an explanatory variable, and the clinical trials data were reanalyzed. RESULTS: Time from stroke onset was most predictive of treatment success. Subjects were divided according to the median value of stroke onset: early (<77 weeks) versus late (> 77 weeks). Electrical stimulation was effective in reducing poststroke shoulder pain for the early group (94% vs 7%, P < .001) but not for the late group (31% vs 33%). Repeated-measure analysis of variance revealed significant treatment (P < .001), time from stroke onset (P = .032), and treatment by time from stroke onset interaction (P < .001) effects. CONCLUSIONS: Stroke survivors who are treated early after stroke onset may experience greater benefit from intramuscular electrical stimulation for poststroke shoulder pain. However, the relative importance of time from stroke onset versus duration of pain is not known
— id: 83238, year: 2007, vol: 21, page: 561, stat: Journal Article,

"Brain Injury Medicine: Principles and Practice"
Flanagan S
2007 ;356:2333-2334, New England journal of medicine
— id: 85088, year: 2007, vol: 356, page: 2333, stat: Journal Article,

Pharmacological treatment of insomnia for individuals with brain injury
Flanagan, Steven R; Greenwald, Brian; Wieber, Stasia
2007 Jan-Feb;22(1):67-70, Journal of head trauma rehabilitation
— id: 83230, year: 2007, vol: 22, page: 67, stat: Journal Article,

Traumatic brain injury in the elderly: diagnostic and treatment challenges
Flanagan, Steven R; Hibbard, Mary R; Riordan, Brian; Gordon, Wayne A
2006 May;22(2):449-468 x, Clinics in geriatric medicine
The purpose of this review is to introduce geriatric practitioners to issues and challenges presented in the elderly after onset of traumatic brain injury (TBI). Issues discussed include the magnitude of TBI in the elderly, mechanisms of onset, issues specific to both acute and rehabilitation care for the elderly with TBI, and specific physical and behavioral manifestations of TBI that may need to be addressed on an inpatient or outpatient basis. General guidelines are provided for the diagnosis and treatment of older individuals who have TBI, with specific clinical scenarios illustrating key points
— id: 83216, year: 2006, vol: 22, page: 449, stat: Journal Article,

Intramuscular electrical stimulation for hemiplegic shoulder pain: a 12-month follow-up of a multiple-center, randomized clinical trial
Chae, John; Yu, David T; Walker, Maria E; Kirsteins, Andrew; Elovic, Elie P; Flanagan, Steven R; Harvey, Richard L; Zorowitz, Richard D; Frost, Frederick S; Grill, Julie H; Fang, Zi-Ping
2005 Nov;84(11):832-842, American journal of physical medicine & rehabilitation
OBJECTIVE: Assess the effectiveness of intramuscular electrical stimulation in reducing hemiplegic shoulder pain at 12 mos posttreatment. DESIGN: A total of 61 chronic stroke survivors with shoulder pain and subluxation participated in this multiple-center, single-blinded, randomized clinical trial. Treatment subjects received intramuscular electrical stimulation to the supraspinatus, posterior deltoid, middle deltoid, and upper trapezius for 6 hrs/day for 6 wks. Control subjects were treated with a cuff-type sling for 6 wks. Brief Pain Inventory question 12, an 11-point numeric rating scale was administered in a blinded manner at baseline, end of treatment, and at 3, 6, and 12 mos posttreatment. Treatment success was defined as a minimum 2-point reduction in Brief Pain Inventory question 12 at all posttreatment assessments. Secondary measures included pain-related quality of life (Brief Pain Inventory question 23), subluxation, motor impairment, range of motion, spasticity, and activity limitation. RESULTS: The electrical stimulation group exhibited a significantly higher success rate than controls (63% vs. 21%, P = 0.001). Repeated-measure analysis of variance revealed significant treatment effects on posttreatment Brief Pain Inventory question 12 (F = 21.2, P < 0.001) and Brief Pain Inventory question 23 (F = 8.3, P < 0.001). Treatment effects on other secondary measures were not significant. CONCLUSIONS: Intramuscular electrical stimulation reduces hemiplegic shoulder pain, and the effect is maintained for > or =12 mos posttreatment
— id: 83209, year: 2005, vol: 84, page: 832, stat: Journal Article,

The impact of age on traumatic brain injury
Flanagan, Steven R; Hibbard, Mary R; Gordon, Wayne A
2005 Feb;16(1):163-177, Physical medicine & rehabilitation clinics of North America
Older individuals with TBI differ from younger adults with TBI in several ways, including their incidence rates, etiology of injury, nature of complications, lengths of hospitalization, functional outcomes, and mortality. Despite the greater likelihood of poorer functional outcomes, older adults with TBI often achieve good functional outcomes and can live in community settings after receiving appropriate rehabilitation services, although at higher costs and longer hospitalizations than younger individuals. The future of rehabilitation care for elderly patients after TBI is uncertain due to financial limitations associated with the implementation of the PPS payment system by CMS. Little is known regarding the long-term impact of TBI on individuals as they age, but this is an important issue as the population ages
— id: 83190, year: 2005, vol: 16, page: 163, stat: Journal Article,

The relationship between age and the self-report of health symptoms in persons with traumatic brain injury
Breed, Sabrina T; Flanagan, Steven R; Watson, Kathleen R
2004 Apr;85(4 Suppl 2):S61-S67, Archives of physical medicine & rehabilitation
OBJECTIVE: To examine the impact of age on health problems related to traumatic brain injury (TBI). DESIGN: Case-control study using a survey instrument. SETTING: Outpatient setting of a large urban tertiary care hospital. PARTICIPANTS: Young and old community dwellers with histories of TBI and control subjects matched for age. INTERVENTION: Structured interview using the Living Life After TBI assessment tool. MAIN OUTCOME MEASURE: Symptom reporting on 52 potential health problems. RESULTS: Individuals with TBI reported significantly more overall health problems than those without TBI. Younger subjects with TBI reported more problems than their nondisabled, age-matched peers with their patterns of sleep as well as with their metabolic/endocrine, neurologic, and musculoskeletal systems. CONCLUSIONS: Older people with TBI were more likely than nondisabled, age-matched peers to report problems with their metabolic/endocrine and neurologic systems. Younger people with TBI were more likely than older people with TBI to report difficulty falling asleep
— id: 83181, year: 2004, vol: 85, page: S61, stat: Journal Article,

Defeating depression
Gordon WA; Flanagan S; Hibbard M; Ashman T
2004 ;20(3):56-56 June, Advance for occupational therapy practioners
— id: 86143, year: 2004, vol: 20, page: 56, stat: Journal Article,

Intramuscular neuromuscular electric stimulation for poststroke shoulder pain: a multicenter randomized clinical trial
Yu, David T; Chae, John; Walker, Maria E; Kirsteins, Andrew; Elovic, Elie P; Flanagan, Steven R; Harvey, Richard L; Zorowitz, Richard D; Frost, Frederick S; Grill, Julie H; Feldstein, Michael; Fang, Zi-Ping
2004 May;85(5):695-704, Archives of physical medicine & rehabilitation
OBJECTIVE: To assess the effectiveness of intramuscular neuromuscular electric stimulation (NMES) in reducing poststroke shoulder pain. DESIGN: Multicenter, single-blinded, randomized clinical trial. SETTING: Ambulatory centers of 7 academic rehabilitation centers in the United States. PARTICIPANTS: Volunteer sample of 61 chronic stroke survivors with shoulder pain and subluxation. INTERVENTION: Treatment subjects received intramuscular NMES to the supraspinatus, posterior deltoid, middle deltoid, and trapezius for 6 hours a day for 6 weeks. Control subjects were treated with a cuff-type sling for 6 weeks.Main outcome measure Brief Pain Inventory question 12 (BPI 12), an 11-point numeric rating scale administered in a blinded manner at the end of treatment, and at 3 and 6 months posttreatment. RESULTS: The NMES group exhibited significantly higher proportions of success based on the 3-point or more reduction in BPI 12 success criterion at the end of treatment (65.6% vs 24.1%, P<.01), at 3 months (59.4% vs 20.7%, P<.01), and at 6 months (59.4% vs 27.6%, P<.05). By using the most stringent 'no pain' criterion, the NMES group also exhibited significantly higher proportions of success at the end of treatment (34.4% vs 3.4%, P<.01), at 3 months (34.4% vs 0.0%, P<.001), and at 6 months (34.4% vs 10.3%, P<.05). CONCLUSIONS: Intramuscular NMES reduces poststroke shoulder pain among those with shoulder subluxation and the effect is maintained for at least 6 months posttreatment
— id: 83182, year: 2004, vol: 85, page: 695, stat: Journal Article,

Stroke prognosis, treatment and rehabilitation
Flanagan S; Tuhrim S
Geriatric palliative care Oxford : Oxford University Press, 2003,
— id: 4807, year: 2003, vol: , page: 282, stat: Chapter,

Management of traumatic brain injury-related agitation
Eisenberg ME; Im B; Swift P; Flanagan SR
2002 ;21:215-229, Critical reviews in physical medicine & rehabilitation
— id: 136932, year: 2002, vol: 21, page: 215, stat: Journal Article,

Evidence for increased antagonist strength and movement speed following botulinum toxin injections in spasticity
Gracies, JM; Weisz, DJ; Yang, BY; Flanagan, S; Simpson, D
2001 ;56(8):A3-A3, Neurology
— id: 86142, year: 2001, vol: 56, page: A3, stat: Journal Article,

Constraint-induced motor relearning after stroke: a naturalistic case report
Sabari, J S; Kane, L; Flanagan, S R; Steinberg, A
2001 Apr;82(4):524-528, Archives of physical medicine & rehabilitation
Constraint-induced movement therapy (CIMT) is a promising approach to promoting recovery of functional arm movement after stroke. However, controlled studies have been limited to persons who sustained strokes at least 1 year before beginning the treatment protocol. This case study documents the neurologic history and motor recovery of a woman whose natural circumstances lend support to the principles of CIMT. The patient sustained a right midpontine vascular infarct and fell simultaneously, fracturing her right humerus. Orthopedic intervention for the fracture mirrored the protocol suggested by proponents of CIMT by immobilizing her right arm. Her significant recovery of left arm use over a 1-year period was more extensive than what would be typically expected after the type of cerebral infarct she incurred. Her case provides the first evidence in the literature that supports the principles of CIMT when it is applied immediately poststroke
— id: 83132, year: 2001, vol: 82, page: 524, stat: Journal Article,

Psychostimulant treatment of stroke and brain injury
Flanagan, S R
2000 Mar;5(3):59-69, CNS spectrums
Psychopharmacology is rapidly becoming an adjuvant treatment to traditional rehabilitation strategies for patients with stroke or brain injury because it helps to facilitate recovery in a time-efficient manner. Norepinephrine, dopamine, acetylcholine, and serotonin appear to play important roles in recovery from stroke or brain injury. Animal models have shown that blockade of these neurotransmitters inhibits recovery, whereas recovery is promoted by drugs that promote norepinephrine, dopamine, acetylcholine, and serotonin activity. Preliminary evidence from human trials supports these findings. Further study is needed, but expanded use of pharmacologic agents for stroke and brain-injured patients appears imminent
— id: 83258, year: 2000, vol: 5, page: 59, stat: Journal Article,

Sexual dysfunction after traumatic brain injury
Hibbard MR; Gordon WA; Flanagan S; Haddad L; Labinsky E
2000 ;15(2):107-120, Neurorehabilitation
Objective: The frequency of self reported sexual difficulties was examined in a group of 322 individuals with traumatic brain injury (TBI) ($N = 193$ men; 129 women) and contrasted with reports of sexual difficulties in 264 individuals without disability (152 men; 112 women) residing in the community. Physiological, physical, and body images problems impacting sexual functioning were examined individually and then summed into a sexual dysfunction score. Mood, quality of life, health status and presence of an endocrine disorder were examined as predictors of sexual difficulties post TBI. Study design: In this retrospective study, data about sexual difficulties were analyzed separately for men and women with TBI and without disability. ANOVAs with post hoc analysis for continuous variables, chi-square analyses for categorical variables, and ANCOVAs for predictors of sexual difficulties were utilized. Results: When contrasted to individuals without disability, individuals with TBI reported more frequent: (1) physiological difficulties influencing their energy for sex, sex drive, ability to initiate sexual activities and achieve orgasm; (2) physical difficulties influencing body positioning, body movement and sensation, and (3) body image difficulties influencing feelings of attractive and comfort with having a partner view one's body during sexual activity. Additional gender specific TBI findings were observed. In comparison to gender matched groups without disability, men with TBI reported less frequent involvement in sexual activity and relationships, and more frequent difficulties in sustaining an erection; women with TBI reported more frequent difficulties in sexual arousal, pain with sex, masturbation and vaginal lubrication. While groups differed in core demographic variables, age was the only demographic variable that was related to reports of sexual difficulties in individuals with TBI and men without disability. Age at onset and severity of injury were negatively related to reports of sexual difficulties in individuals with TBI. In men with TBI and without disability, the most sensitive predictor of sexual dysfunction was level of depression. For women without disability, an endocrine disorder was the most sensitive predictor of sexual dysfunction. For women with TBI, an endocrine disorder and level depression combined were the most sensitive predictors of sexual difficulties. Conclusion: Individuals post TBI report frequent physiological, physical and body images difficulties which negatively impact sexual activity and interest. For men post TBI, predictors of sexual difficulties included age at interview, age at injury, and having milder injuries, however, depression was the most sensitive predictor of sexual dysfunctions. For women post TBI, predictors of their sexual difficulties included age at injury and having milder injuries, however, depression and an endocrine disorder combined were the most sensitive predictors of sexual dysfunction. Implications of this study include the need for broad-based assessment of sexual dysfunction, and the implementation of treatment studies to enhance sexual functioning post TBI
— id: 84782, year: 2000, vol: 15, page: 107, stat: Journal Article,

Physiatric management of mild traumatic brain injury
Flanagan, S
1999 May;66(3):152-159, Mount Sinai journal of medicine
Mild traumatic brain injury (MTBI) is a common condition, afflicting as many as 1.5 million Americans yearly. Most individuals sustain MTBI as a result of motor vehicle collisions, but it may also occur as a result of falls, physical assault or sporting accidents. Problems related to MTBI include various pain syndromes, cognitive impairments, disorders of affect, cranial nerve dysfunction, and vertigo, arising from injury to the brain, head, or cervical spine. Symptoms are usually transient, although a small percentage of afflicted individuals develop long-lasting problems, often preventing them from leading productive lives. Recognition of these problems as arising from MTBI is difficult due to the frequent lack of abnormal findings on diagnostic tests and failure to identify a history of head trauma. The American Congress of Rehabilitation Medicine has defined MTBI, an important first step in identifying individuals who need treatment. Diagnosis is usually made by directed questions regarding trauma history and careful procurement and interpretation of appropriate tests. Once a diagnosis is made, proper care can be prescribed in order to lead patients toward more productive lives
— id: 84781, year: 1999, vol: 66, page: 152, stat: Journal Article,

Parathyroid hormone suppression in spinal cord injury patients is associated with the degree of neurologic impairment and not the level of injury
Mechanick, J I; Pomerantz, F; Flanagan, S; Stein, A; Gordon, W A; Ragnarsson, K T
1997 Jul;78(7):692-696, Archives of physical medicine & rehabilitation
OBJECTIVE: To demonstrate that after spinal cord injury (SCI) suppression of the parathyroid-vitamin D axis is associated with the degree of neurologic impairment and not the level of injury. DESIGN: A retrospective analysis of clinical and biochemical data obtained from hospital records of patients with SCI compared to a control group of patients with traumatic brain injury (TBI). SETTING: The inpatient rehabilitation unit of a tertiary care hospital. SUBJECTS: The medical records of 82 consecutive admissions to the rehabilitation unit with a diagnosis of SCI or TBI were reviewed. Patients with SCI were classified by the American Spinal Injury Association (ASIA) impairment scale and then grouped based on the completeness and level of injury. MAIN OUTCOME MEASURE: Comparisons of serum parathyroid hormone (PTH), 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D (1,25-D) were planned. Multiple comparisons were performed for total and ionized serum calcium levels, serum phosphorus levels, and 24-hour urinary calcium excretion rates to reflect changes in mineral homeostasis. Multiple comparisons were also performed for serum albumin, prolactin, thyroid function tests, and AM cortisol levels, as well as 24-hour urinary urea nitrogen and cortisol excretion rates to reflect metabolic responses to stress. RESULTS: Patients with SCI had significant suppression in PTH (p < .000009) and 1,25-D (p < .02) levels with elevated phosphorus (p < 0.03) and prolactin (p < .03) levels compared to patients with TBI. Also, more patients with SCI were hypoalbuminemic (p < .003) than patients with TBI. Patients with complete SCI (ASIA A) had more suppressed PTH (p < .03) and higher urinary urea nitrogen (p < .05) levels than SCI patients with incomplete injuries (ASIA B-D). Patients with complete, but not incomplete, SCI had lower albumin levels than patients with TBI (p < .05). These differences were not found between patients with tetraplegic and paraplegic SCI. ASIA motor scores did not correlate with any of the measured parameters but when used as a covariate did abolish differences in PTH and 1,25-D among the study groups by ANOVA. CONCLUSION: In patients with SCI, the degree of neurologic impairment, and not the level of injury, is associated with PTH suppression and markers of metabolic stress
— id: 84786, year: 1997, vol: 78, page: 692, stat: Journal Article,

Long-term side effects of imipramine in responders and nonresponders
Corwin, J; Peselow, E; Flanagan, S
1996 NOV ;32(3):425-425, Psychopharmacology bulletin
— id: 52728, year: 1996, vol: 32, page: 425, stat: Journal Article,

"Community-based employment following traumatic brain injury - Thomas,D, Menz,F, McAlees,D"
Flanagan, S; Gordon, WA
1996 ;11(1):103-104, Journal of head trauma rehabilitation
— id: 84787, year: 1996, vol: 11, page: 103, stat: Journal Article,

Rehabilitation issues
Ragnarsson KT; Flanagan SR; Ross MK
The textbook of penetrating trauma Baltimore : Williams & Wilkins, 1996,
— id: 4806, year: 1996, vol: , page: 1099, stat: Chapter,

Rehabilitation of the geriatric orthopaedic patient
Flanagan, S R; Ragnarsson, K T; Ross, M K; Wong, D K
1995 Jul;(316):80-92, Clinical orthopaedics & related research
Older patients who are referred for rehabilitation after undergoing orthopaedic procedures have numerous age-related conditions that may interfere with physical performance and safety. The general rehabilitation goals are to return each patient to the premorbid functional level of mobility and self-care, teach the exercises that are to be performed after hospital discharge, reduce the risk of falls, and ensure that the patient is discharged to a safe environment. Before elective surgery, the elderly orthopaedic patient should be instructed to perform breathing exercises to prevent pulmonary complications and active lower limb exercises to maintain good circulation and joint mobility, and be instructed in functional activities for mobilization in and out of bed. Postoperatively, the interdisciplinary rehabilitation team must facilitate early resumption of active exercises and self-care tasks and discourage prolonged bed rest and dependency on nursing staff and family members. Physical and occupational therapy should be provided to restore mobility and self-care functions. If discharge to home is planned, the home environment should be assessed and modifications recommended to reduce the risk of falls and ensure independent functioning to the extent possible. When the rehabilitation goals have been obtained, the patient should be discharged from the hospital, but additional therapy may be required, either at home or at an outpatient facility
— id: 83294, year: 1995, vol: , page: 80, stat: Journal Article,

Blunted growth hormone response to intravenous arginine in subjects with a spinal cord injury
Bauman, W A; Spungen, A M; Flanagan, S; Zhong, Y G; Alexander, L R; Tsitouras, P D
1994 Mar;26(3):152-156, Hormone & metabolic research
The influence of the activities of daily living on human growth hormone (hGH) release and plasma insulin-like growth factor (IGF-I) levels is not known. Individuals with spinal cord injury (SCI) and paralysis generally have reduced levels of activity compared with ambulatory subjects. We studied sixteen subjects with SCI and sixteen nonSCI subjects matched for age, gender and body mass index (BMI) as controls. After an intravenous infusion of arginine hydrochloride (30 g/subject over 30 minutes), mean plasma hGH values at 30 and 60 minutes were significantly lower in the group with SCI compared with the control group (3.4 +/- 0.7 versus 10.7 +/- 2.5 ng/ml, p < 0.01; and 5.2 +/- 1.5 versus 12.5 +/- 2.7 ng/ml, p < 0.05). Also, peak and sum hGH responses were significantly lower in the group with SCI than in the control group (5.8 +/- 1.5 versus 14.1 +/- 2.8 ng/ml, p < 0.01; and 15.2 +/- 3.1 versus 34.8 +/- 7.2 ng/ml, p < 0.02). Controlling for age and BMI, the results remained significant. However, the mean plasma IGF-I level was significantly lower in SCI subjects younger than 45 years old than in the similar subgroup of age-restricted controls (202 +/- 19 versus 324 +/- 27 ng/ml, p < 0.05), whereas, a comparison of subgroups of subjects 45 years or older did not reveal a significant difference. These findings support the hypothesis that decreased daily physical activity results in depression of the hGH/IGF-I axis in younger individuals with SCI and may be considered to be a state of premature aging.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 84785, year: 1994, vol: 26, page: 152, stat: Journal Article,

INTERFERON-GAMMA AND REGULATION OF HUMAN KERATIN GENES - A POTENTIAL ROLE IN WOUND-HEALING
BLUMENBERG, M; JIANG, CK; FLANAGAN, S; FREEDBERG, IM
1993 APR ;41(2):A185-A185, Clinical research
— id: 54261, year: 1993, vol: 41, page: A185, stat: Journal Article,

T-LYMPHOCYTES REGULATE TRANSCRIPTION OF KERATIN GENES
FLANAGAN, S; JIANG, CK; FREEDBERG, IM; BLUMENBERG, M
1993 APR ;41(2):A440-A440, Clinical research
— id: 54292, year: 1993, vol: 41, page: A440, stat: Journal Article,

T-LYMPHOCYTES REGULATE TRANSCRIPTION OF KERATIN GENES
FLANAGAN, S; JIANG, CK; FREEDBERG, IM; BLUMENBERG, M
1993 APR ;100(4):502-502, Journal of investigative dermatology
— id: 54239, year: 1993, vol: 100, page: 502, stat: Journal Article,