Teresa L. Massagli

University of Washington Seattle, Seattle, WA, United States

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Publications (26)48.48 Total impact

  • Teresa L Massagli
    PM&R 02/2010; 2(2):87-90. DOI:10.1016/j.pmrj.2010.01.006 · 1.66 Impact Factor
  • Kevin N Hakimi, Teresa L Massagli
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    ABSTRACT: Spinal cord infarction is a well-described, but rare, etiology of myelopathy, especially in children. The most common syndrome, anterior spinal artery syndrome (ASAS), is caused by interruption of blood flow to the anterior spinal artery, producing ischemia in the anterior two-thirds of the cord, with resulting neurologic deficits. Causes of ASAS include aortic disease, thoracolumbar surgery, sepsis, hypotension, and thromboembolic disorders. Case reports of 2 patients. Two children developed spinal cord infarctions consistent with ASAS, mostly likely caused by previously undiagnosed thrombotic disorders. A child with prothrombin variant experienced acute bilateral lower limb weakness without any preceding event. Magnetic resonance imaging (MRI) revealed increased T2 signal in the anterior cord from midthoracic level to the conus medullaris. A child with protein S deficiency developed lower limb weakness 1 day after a posterior thoracolumbar fusion for idiopathic scoliosis. Computed tomography (CT) myelogram revealed no spinal cord compression. The prothrombin variant mutation is associated with a 2-fold risk of thrombotic events. Individuals with protein S deficiency have an 8-fold increased risk of thrombosis. As knowledge of the coagulation pathways grows, it is likely that more patients with spinal cord infarctions will be diagnosed with genetic thrombotic disorders as the etiology of their injury. We review these two disorders, prothrombin variant and protein S deficiency, and the considerations for long-term anticoagulation.
    The journal of spinal cord medicine 02/2005; 28(1):69-73. · 1.88 Impact Factor
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    ABSTRACT: To determine the incidence of psychiatric illness 3 years after mild traumatic brain injury (TBI) in children. Prospective cohort study with 3-year follow-up. Emergency department, hospital, and outpatient clinics in a large health maintenance organization. Children, 14 years old or less (n=490), who sustained a mild TBI in 1993. Three TBI unexposed subjects per TBI exposed patient were matched by sex, age, and enrollment at the time of injury (n=1470). Not applicable. Computerized records were examined to identify psychiatric diagnoses, psychiatric medication prescription, and utilization of psychiatric services for the year before TBI and 3 years after. Adjusted relative risks for incidence of psychiatric illness were estimated for those with and without a premorbid psychiatric disorder. The cumulative incidence estimates for any psychiatric illness in the 3 years after mild TBI were 30% in children exposed to mild TBI and 20% in unexposed children (P=.0001). Cumulative incidence estimates were particularly high in both TBI exposed (55%) and unexposed children (63%) who had psychiatric illness in the year before the index TBI (psychiatric history). The exposed and unexposed children with psychiatric history did not have significantly different estimates of incidence during follow-up for any of the studied indicators of psychiatric illness. In those with no psychiatric history, 26% of exposed and 16% of unexposed children (P<.0001) had evidence of a psychiatric illness in the 3 years after mild TBI. For those with no psychiatric history, the adjusted relative risk estimate of any psychiatric illness in TBI exposed versus unexposed children, in the first year after TBI, was 2.03 (95% confidence interval [CI], 1.4-2.9). Children with mild TBI but no psychiatric history were at higher risk for hyperactivity (diagnosis of hyperkinetic syndrome of childhood or prescription of psychostimulants) in the first year after injury (incidence, 3%; first year relative risk, 7.59; 95% CI, 2.7-21.6). In the 3 years after mild TBI, children with no evidence of prior-year psychiatric history were at significantly increased risk for psychiatric illness, particularly hyperactivity in the first year after injury. Prior-year psychiatric history conferred a significant independent risk for subsequent psychiatric illness. There was no evidence for an additional increase in risk in the 3-year follow-up that is attributable to mild TBI in children with prior psychiatric history.
    Archives of Physical Medicine and Rehabilitation 10/2004; 85(9):1428-34. DOI:10.1016/j.apmr.2003.12.036 · 2.44 Impact Factor
  • Jay J Han, Teresa L Massagli, Kenneth M Jaffe
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    ABSTRACT: Fibrocartilaginous embolism is a rare cause of spinal cord infarction. It is postulated that an acute vertical disk herniation of the nucleus pulposus material can lead to spinal cord infarction by a retrograde embolization to the central artery. An increased intradiskal pressure resulting from axial loading of the vertebral column with a concomitant Valsalva maneuver is thought to be the initiating event for the embolus. We present a previously healthy 16-year-old boy with sudden onset of back pain and progressive paraparesis within 36 hours after lifting exercises in a squat position. His clinical presentation and neuroimaging studies were consistent with spinal cord infarction resulting from a central artery embolus at the T8 spinal cord level. Laboratory investigation showed no evidence of infectious, autoimmune, inflammatory, or neoplastic causes. Although no histologic confirmation was obtained, lack of evidence for other plausible diagnoses in the setting of his clinical presentation and in the magnetic resonance imaging findings made fibrocartilaginous embolism myelopathy the most likely diagnosis. We postulated that some cases of transverse myelitis might actually be fibrocartilaginous embolism, making it a more prevalent cause of an acute myelopathy than commonly recognized. Relevant literature and current theories regarding the pathogenesis of fibrocartilaginous embolism myelopathy are reviewed.
    Archives of Physical Medicine and Rehabilitation 02/2004; 85(1):153-7. DOI:10.1016/S0003-9993(03)00289-2 · 2.44 Impact Factor
  • Jay J Han, Teresa L Massagli, Kenneth M Jaffe
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    ABSTRACT: Han JJ, Massagli TL, Jaffe KM. Fibrocartilaginous embolism—an uncommon cause of spinal cord infarction: a case report and review of the literature. Arch Phys Med Rehabil 2004;85:153-7.Fibrocartilaginous embolism is a rare cause of spinal cord infarction. It is postulated that an acute vertical disk herniation of the nucleus pulposus material can lead to spinal cord infarction by a retrograde embolization to the central artery. An increased intradiskal pressure resulting from axial loading of the vertebral column with a concomitant Valsalva maneuver is thought to be the initiating event for the embolus. We present a previously healthy 16-year-old boy with sudden onset of back pain and progressive paraparesis within 36 hours after lifting exercises in a squat position. His clinical presentation and neuroimaging studies were consistent with spinal cord infarction resulting from a central artery embolus at the T8 spinal cord level. Laboratory investigation showed no evidence of infectious, autoimmune, inflammatory, or neoplastic causes. Although no histologic confirmation was obtained, lack of evidence for other plausible diagnoses in the setting of his clinical presentation and in the magnetic resonance imaging findings made fibrocartilaginous embolism myelopathy the most likely diagnosis. We postulated that some cases of transverse myelitis might actually be fibrocartilaginous embolism, making it a more prevalent cause of an acute myelopathy than commonly recognized. Relevant literature and current theories regarding the pathogenesis of fibrocartilaginous embolism myelopathy are reviewed.
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    ABSTRACT: Massagli TL, Fann JR, Burington BE, Jaffe KM, Katon WJ, Thompson RS. Psychiatric illness after mild traumatic brain injury in children. Arch Phys Med Rehabil 2004;85:1428–34.
  • T L Massagli
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    ABSTRACT: Rehabilitation of the child with SCI involves setting and changing goals appropriate to the child's age, development, and family expectations. Unlike adults with SCI, who may be very close to expected levels of independence at discharge from inpatient rehabilitation, children often require years of outpatient therapy to achieve optimal outcomes. Children with SCI also are at risk for unique complications, which can alter their function. The rehabilitation community extends beyond the usual hospital based practice to include school and transitional services. The focus of rehabilitation changes across stages of development to initially enhance independence in mobility and self-care skills, and later to promote academic achievement, independent living, and employment.
    Physical Medicine and Rehabilitation Clinics of North America 03/2000; 11(1):169-82. · 1.09 Impact Factor
  • Teresa L. Massagli, Diana D. Cardenas
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    ABSTRACT: To review the use of pamidronate to treat immobilization hypercalcemia after acute spinal cord injury (SCI) in 9 cases. Retrospective case series. Two inpatient rehabilitation programs, one pediatric and one adult, in the Northwest Regional Spinal Cord Injury System. Patients with acute SCI who developed immobilization hypercalcemia that was treated with pamidronate. Nine patients (7 men, 2 women), ages 15 to 41 yrs, with SCI (8 tetraplegia, 1 paraplegia) were treated using pamidronate between 1994 and 1998. A single dose of 60 mg of pamidronate resolved the hypercalcemia or its symptoms in 7 (78%) patients within days. One patient required a second dose (90 mg) and one patient required three additional doses (the fourth at 90 mg) to achieve resolution of the hypercalcemia or symptoms. Side effects were mild and included drug-related fever in one patient and transient asymptomatic hypocalcemia in four patients. Pamidronate was effective in treating immobilization hypercalcemia caused by SCI. Its advantages include its effectiveness, the duration of treatment, ease of administration, and elimination of the need for long-term intravenous saline or daily medications.
    Archives of Physical Medicine and Rehabilitation 10/1999; 80(9):998-1000. DOI:10.1016/S0003-9993(99)90050-3 · 2.44 Impact Factor
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    ABSTRACT: The P300 response is a cognitive event-related potential recorded over the scalp. The tone-evoked P300 response has been used to predict outcomes of patients with brain injury. However, it may lead to false predictions because some normal people have a very small tone-evoked P300 response. It is hypothesized that speech may generate a more robust P300 response than tones. A voice-generator prototype was designed for this study. The rare speech signal was the word "mommy" in a female voice. The common signal was a 1000-Hz tone. Twenty-two normal adults (11 males, 11 females; age range, 18-60 yr) were tested for both speech-evoked and tone-evoked P300 responses. Speech-evoked P300 responses had significantly larger amplitudes (mean, 12.1 μV) than the tone-evoked responses (mean, 5.9 μV; P < 0.0001). Six subjects with brain injury were also tested using the same protocol: two subjects with severe brain injury showed no response to either stimulus. Both died within 1 wk after the testing. Although two subjects with moderate brain injury could not complete the testing because of agitated behavior, two other subjects with mild traumatic brain injury showed a larger speech-evoked than tone-evoked P300 response. The speech-evoked P300 response may be promising in predicting outcomes of patients with brain injury.
    American Journal of Physical Medicine & Rehabilitation 01/1999; 78(4):367-371. DOI:10.1097/00002060-199907000-00014 · 2.01 Impact Factor
  • B J Dudgeon, T L Massagli, B W Ross
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    ABSTRACT: The purpose of this study was to examine educational participation and accommodations for children with spinal cord injury (SCI) or disease in primary, secondary, and postsecondary educational settings. Written surveys were developed for students with SCI and their teachers. Fifty-three participants had SCI onset before age 18 years, were at least 4 years old and enrolled in a school program, and had residual motor disability without cognitive-behavioral impairments. Nearly all participants were enrolled full time in regular education classrooms. Seventy-five percent of primary-level participants and 32% of secondary-level participants were qualified for special education and related services, receiving teacher aide assistance as well as occupational and physical therapy services. Most participants were graduating from high school and pursing postsecondary education. Classroom performance and grades were reported as average or above average, but curriculum modifications were commonly made, and many participants required human assistance and assistive technology in functional and classroom tasks. Access barriers were often reported by participants using wheelchairs, and those using augmentative writing aids were not fluent with these devices. Accommodations in schools for students with SCI appear to support completion and advancement to higher levels of education, but these accommodations appear to be geared toward participation rather than levels of performance and productivity that may be realistic for work and other community settings.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 07/1997; 51(7):553-61. DOI:10.5014/ajot.51.7.553 · 1.70 Impact Factor
  • S K Swart, E M Kanny, T L Massagli, J M Engel
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    ABSTRACT: This study examined the congruence between pediatric occupational therapists' self-care interventions and occupational therapy's philosophical base, which focuses on performance of self-care skills as primary in evaluation and intervention. A questionnaire was mailed to 252 therapists serving children ages birth to 6 years. The questionnaire asked for therapists' perceptions about the importance, uniqueness, and frequency of 10 areas of intervention, including self-care. Perceived importance of self-care was found to be strongly related to perceived frequency of self-care intervention. Practice setting was significantly associated with perceptions of uniqueness of self-care, and team membership status was significantly associated with importance of self-care. Most respondents perceived self-care intervention to be important (86%) and unique (80%) to occupational therapy. Seventy percent regularly provided intervention for self-care. The therapists' perceptions reflected continued regard for self-care as an important and unique area of pediatric occupational therapy but were somewhat discrepant with the actual frequency of self-care interventions.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 05/1997; 51(4):289-96. DOI:10.5014/ajot.51.4.289 · 1.70 Impact Factor
  • Kathleen R. Bell, Teresa L. Massagli
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    ABSTRACT: Changes in the delivery of health care have resulted in new sites for rehabilitation of patients with severe brain injury (BI). Adjustments in the training of resident physicians in physical medicine and rehabilitation are likely to ensue. We utilized Likert scales and open-ended questions to survey residents who were assigned over a 2(1/2)-year period to a subacute BI rehabilitation unit (SRU). Residents were surveyed about their desire to participate in a SRU training site, and the usefulness of such a rotation, and compared the rotation to traditional settings in which patients with similar diagnoses were treated. The results indicated that significant positive changes in residents' attitudes towards this type of training site occurred (p = 0.01). The rotation was felt to be useful (p = 0.008) despite initial misgivings. Positive educational aspects were exposure to the unique problems of patients with severe BI (e.g. spasticity and agitation) and a sense of independence and competence in leadership roles. Problematic aspects included the management of medically unstable patients without supportive resources, and a lack of nurses trained in rehabilitation principles. Training of residents in the rehabilitation management of patients with severe BI can be perceived as a valuable educational experience by trainees.
    Brain Injury 01/1997; 10(12):875-81. DOI:10.1080/026990596123855 · 1.86 Impact Factor
  • Teresa L. Massagli, Brian J. Dudgeon, Brian W. Ross
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    ABSTRACT: To examine educational achievement and vocational success of children with SCI. Surveys administered to students and teachers, and content analysis of school records. Regional pediatric rehabilitation program. Participants were selected from 144 children with SCI treated from 1979 through 1992; 98 met inclusion criteria of onset of SCI before the age of 18 years, older than 3 years, residual paresis, and no cognitive impairment; 29% were lost to follow-up, and 53 of the 70 contacted were enrolled. School completion rates, absenteeism, grades, ratings of participation; education and living situations after high school; history of paid employment. The 53 responders were: 33 boys, 20 girls; 25 with paraplegia (47%), 28 with tetraplegia (53%); mean length of disability = 9.4 years; 12 primary students (23%), 19 secondary students (36%), and 22 postsecondary participants (41%). Students and teachers rated student participation and performance as average or above compared to peers; 84% of secondary students planned to attend college after graduation. Only 33% of high school students over age 15 had been employed. Ninety-one percent of postsecondary subjects had graduated from high school. Seven (32%) had graduated from college or a vocational program, 11 (50%) were enrolled in college full- or part-time, and 4 others (18%) were neither in school nor employed. Current employment rates were 71% of college graduates, 36% of those in college, and 0% of those who had never enrolled. Level of SCI was not related to employment. Students with SCI demonstrate adequate participation and performance in educational settings, but may benefit from more vocational counseling and opportunities for paid employment.
    Archives of Physical Medicine and Rehabilitation 11/1996; 77(10):995-9. DOI:10.1016/S0003-9993(96)90058-1 · 2.44 Impact Factor
  • D E Amos, T L Massagli
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    ABSTRACT: To determine whether medical school achievement is related to or predictive of performance in a physical medicine and rehabilitation (PM&R) residency, performance on PM&R board examinations, and entry into academic PM&R practice. In 1994-1995, data were extracted from the files of 205 former residents who trained for at least six months from 1959 to 1991 in the PM&R program at the University of Washington. Associations between medical school and residency and post-residency variables were sought using chi-square analyses, analysis of variance, and linear and logistic regression. Clinical residency performance was predicted by clerkship honors grades (p = .0001). Probation was predicted by failing a basic science course (p = .0001). Written board performance was related to Alpha Omega Alpha status (p = .04). Failing written boards on the first attempt was predicted by failing a basic science course (p = .05). Entry into an academic PM&R practice was predicted by an interest in such a practice in the personal statement of the residency application (p = .002) and by writing a thesis in medical school (p = .03). Because medical school achievements were related to performance during and shortly after residency training in PM&R, they can be used as partial predictors of success.
    Academic Medicine 06/1996; 71(6):678-80. DOI:10.1097/00001888-199606000-00025 · 3.47 Impact Factor
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    ABSTRACT: To determine: (1) the magnitude of neurobehavioral deficits following severe traumatic brain injury (TBI) in children, 3 weeks and 1 year after resolution of post-traumatic amnesia (PTA); (2) the relationship between deficits and injury severity; (3) the performance of cases compared to population norms versus individually matched controls. Prospective cohort study. Two regional university medical centers. Cases were 30 children 6 to 15 years old with severe TBI, measured by initial Glasgow Coma Scale (GCS) score and days to reach a GCS score of 15. Controls were individually matched for age, gender, and premorbid academic achievement. Subjects received the same neurobehavioral tests three weeks and one year after resolution of PTA. Outcomes included individual test scores and variables summarizing results in eight domains. Correlations were calculated between deficits, expressed as case-control differences, and injury severity. Cases showed substantial deficits and performed significantly more poorly than controls at both initial and 1-year testing. At initial testing, cases had an overall score two standard deviations below controls. At 1-year testing their overall score was one standard deviation below controls. Greater impairment was found in those who reached a GCS score of 15 after 1 month or who had an initial GCS of 3 to 5. The proportion of cases with deficits and the magnitude of deficits at both testing times was underestimated by using population norms instead of controls. Severe TBI results in significant, persistent deficits related to the level of severity. Comparisons with population norms instead of controls underestimates deficits.
    Archives of Physical Medicine and Rehabilitation 04/1996; 77(3):223-31. DOI:10.1016/S0003-9993(96)90102-1 · 2.44 Impact Factor
  • Teresa L. Massagli, Linda J. Michaud, Frederick P. Rivara
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    ABSTRACT: (1) To determine whether indices of traumatic brain injury (TBI) in children are associated with outcome at hospital discharge and 5 to 7 years later; (2) to describe persisting disabilities. Retrospective, uncontrolled study of a cohort of children with severe, nonpenetrating TBI. Consecutive admissions to a level 1 trauma center over 2 years. Seventy-five children younger than 17 years old were previously studied to identify predictors of disability at acute care discharge. Thirty-three of the 50 survivors (66%) were enrolled. A database of variables abstracted from medical records was available from the previous study. Subjects were surveyed about premorbid problems, school, employment, and current function, and school records were reviewed. Using all information, a Glasgow Outcome Scale (GOS) score was assigned 5 to 7 years after TBI. Associations between database variables and GOS score at discharge and follow-up were examined using nonparametric analyses. The odds ratio for good recovery was calculated for all significant associations. Late GOS was good recovery for 27%, moderate disability for 55%, and severe disability for 18%. Discharge GOS scores were related (p < or = .01) to the head Abbreviated Injury Scale score, Injury Severity Scale score, Glasgow Coma Scale (GCS) score measured in the field and at 6, 24, and 72 hours, the length of coma, and initial discharge site. Late GOS scores were related (p < or = .01) to the same variables except the field and 6-hour GCS scores, as well as pupillary responses in the field and the discharge GOS. At follow-up, 64% were independent in mobility, 70% in self-care, and 24% in cognitive items on the Functional Independence Measure. Seventy percent of children received special education services. Employment histories were poor. Most subjects were not receiving neurological or rehabilitation follow-up. Early and late outcome after severe TBI are related to variables measured at and after injury. Subjects had long-term educational and vocational problems but often did not utilize the medical model of neurorehabilitation.
    Archives of Physical Medicine and Rehabilitation 02/1996; 77(2):125-32. DOI:10.1016/S0003-9993(96)90156-2 · 2.44 Impact Factor
  • T L Massagli, K M Jaffe
    Pediatric Annals 02/1994; 23(1):29-30, 33-6. DOI:10.3928/0090-4481-19940101-08 · 0.29 Impact Factor
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    ABSTRACT: Pediatric traumatic brain injury constitutes an enormous public health problem, but little is known about the economic costs of such injury. Using charges as a proxy for cost, we prospectively collected data on initial hospital charges and professional fees for emergency department services, acute inpatient care, and acute inpatient rehabilitation for 96 patients with mild, moderate, and severe traumatic brain injuries. We also examined the relationship between these costs and injury severity and etiology. Acute care and rehabilitation median costs were $5,233 per child, $11,478 for hospitalized children, and $230 for those only seen in the emergency department. Median costs for injuries due to motor vehicles, bicycles, and falls were $15,213, $6,311, and $792, respectively. Using Glasgow Coma Scale criteria, median cost of mild, moderate, and severe traumatic brain injuries were $598, $12,022, and $53,332, respectively. Injury etiology added modestly but significantly to the prediction of cost over and above that predicted by injury severity alone. Rehabilitation costs accounted for 37% of the total for all children, but 45% of those with the most severe injuries.
    Archives of Physical Medicine and Rehabilitation 08/1993; 74(7):681-6. DOI:10.1016/0003-9993(93)90024-5 · 2.44 Impact Factor
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    ABSTRACT: A case of a 7-year-old boy with myelodysplasia who developed a local acute hypersensitivity reaction after exposure to latex gloves during electromyography is presented. Anaphylaxis from latex gloves has been recently reported, especially in patients with myelodysplasia. Allergens from rubber gloves can be introduced under the skin during EMG and could cause local or systemic acute hypersensitivity reactions. Electromyographers should elicit a history to rule out rubber allergy and use vinyl gloves if suspicion of allergy exists. © 1993 John Wiley & Soncs, Inc.
    Muscle & Nerve 05/1993; 16(5). DOI:10.1002/mus.880160520 · 2.31 Impact Factor
  • Lynn Wolf, Teresa Massagli, Kenneth Jaffe, Jean Deitz
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    ABSTRACT: Physical and occupational therapists play important roles in wheelchair prescription for children with disabilities. Matching a child's seating and functional needs with a particular power mobility device can be challenging, especially as more power wheelchair options become available. Information about potential performance in home and school settings cannot be inferred from manufacturer's basic descriptions of wheelchairs. In this article, we describe features of a newly available power wheelchair for children and young adults and also report on the evaluation of this wheelchair using a structured protocol to assess functional capacity. The focus of the study was the wheelchair's performance in commonly accessed environments. To allow evaluation of maximal performance of all features, an able-bodied child was the subject of this study. In this wheelchair, the subject was successful in performing indoor functional activities, maneuvering on smooth level surfaces, traversing rough terrain, and in negotiating curbs.
    Physical & Occupational Therapy in Pediatrics 10/1991; 11(3):57-72. DOI:10.1300/J006v11n03_04 · 1.42 Impact Factor

Publication Stats

374 Citations
48.48 Total Impact Points

Institutions

  • 1990–2010
    • University of Washington Seattle
      • • Department of Rehabilitation Medicine
      • • Department of Medicine
      Seattle, WA, United States
  • 1989–1996
    • Seattle Children's Hospital
      • • Children's Hospital and Medical Center
      • • Department of Rehabilitation Medicine
      Seattle, Washington, United States