Stuart A Yablon

Stuart A Yablon
Mary Free Bed Rehabilitation Hospital · Brain Injury Program

M.D.

About

148
Publications
20,560
Reads
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5,422
Citations
Citations since 2017
14 Research Items
2657 Citations
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20172018201920202021202220230100200300400500
20172018201920202021202220230100200300400500
20172018201920202021202220230100200300400500
Additional affiliations
April 2016 - present
University of Mississippi Medical Center
Position
  • Professor
September 2011 - March 2015
Glenrose Rehabilitation Hospital
Position
  • Medical Lead, Brain Injury Program
September 2011 - March 2015
University of Alberta
Position
  • Professor (Associate)
Education

Publications

Publications (148)
Article
In response to the need to better define the natural history of emerging consciousness after traumatic brain injury (TBI) and to better describe the characteristics of the condition commonly labeled Post-traumatic Amnesia, a case definition and diagnostic criteria for the Post- traumatic Confusional State (PTCS) were developed. This project was com...
Article
Objectives: To examine the prevalence, onset threshold, and response magnitude of stretch reflex response (SRR) in the knee extensors and flexors before and after an intrathecal baclofen (ITB) bolus injection in patients with moderate-to-severe hypertonia. Materials and methods: SRRs were elicited by reciprocal passive knee extension/flexion mov...
Article
Persons who have disorders of consciousness (DoC) require care from multidisciplinary teams with specialized training and expertise in management of the complex needs of this clinical population. The recent promulgation of practice guidelines for patients with prolonged DoC by the American Academy of Neurology (AAN), American Congress of Rehabilita...
Article
Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC). Methods: Recommendations were based on systematic review evidence, relat...
Article
Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition for the minimally conscious state (MCS) by reviewing the literature on the diagnosis, natural history, prognosis, and treatment of disorders of consciousness lasting at least 28 days. Methods: Articles...
Article
Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC). Methods: Recommendations were based on systematic review evidence, relat...
Article
Objective: To update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition for the minimally conscious state (MCS) by reviewing the literature on the diagnosis, natural history, prognosis, and treatment of disorders of consciousness lasting at least 28 days. Methods: Articles...
Article
While the duration and severity of post-traumatic confusional state (PTCS) following traumatic brain injury have well-established implications for long-term outcomes, little is known about the underlying pathophysiology and their role in functional outcomes. Here we analysed the delta-to-alpha frequency band power ratios (DAR) from localized scalp...
Article
Objective: To characterize the concurrent activation of rectus femoris (RF) and medial gastrocnemius (MG) muscles (extensor coactivation) during gait in subjects with pronounced resting hypertonia after acquired brain injury (ABI) and examine changes after intrathecal baclofen (ITB) bolus injection. Methods: Magnitude and duration of extensor co...
Poster
Electrophysiological Markers of Post-traumatic Confusional State and its Recovery.
Article
Objective: To update the 2008 American Academy of Neurology (AAN) guidelines regarding botulinum neurotoxin for blepharospasm, cervical dystonia (CD), headache, and adult spasticity. Methods: We searched the literature for relevant articles and classified them using 2004 AAN criteria. Results and recommendations: Blepharospasm: Onabotulinumtox...
Article
. Intrathecal baclofen (ITB) bolus injection effectively decreases spinal excitability but the impact on lower limb muscle activation during gait has not been thoroughly investigated. . Examine activation of medial gastrocnemius (MG) and tibialis anterior (TA) muscles during gait before and after ITB bolus injection in patients with resting hyperto...
Article
Objective: To compare the rate and nature of rehospitalization in a cohort of patients enrolled in the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) who have disorders of consciousness (DOC) at the time of rehabilitation admission with those in persons with moderate or severe traumatic br...
Article
Objective: To assess the incidence of medical complications in patients with recent traumatic disorders of consciousness (DOCs). Design: Data on adverse events in a placebo controlled trial of amantadine hydrochloride revealed no group difference, which allowed these events to be reanalyzed descriptively as medical complications experienced by t...
Article
Objective: To characterize the 5-year outcomes of patients with traumatic brain injury (TBI) not following commands when admitted to acute inpatient rehabilitation. Design: Secondary analysis of prospectively collected data from the National Institute on Disability and Rehabilitation Research-funded Traumatic Brain Injury Model Systems (TBIMS)....
Article
Objective To prospectively characterize the prevalence, course, and impact of acute sleep abnormality among traumatic brain injury (TBI) neurorehabilitation admissions.DesignProspective observational study.SettingFreestanding rehabilitation hospital.ParticipantsPrimarily severe TBI (median emergency department Glasgow Coma Scale [GCS] score=7; N=20...
Article
Objectives: To (1) determine factors associated with psychotic-type symptoms in persons with moderate or severe traumatic brain injury (TBI) during early recovery and (2) investigate the prognostic significance of early psychotic-type symptoms for patient outcome. Setting: Acute neurorehabilitation inpatient unit. Participants: A total of 168...
Article
Scant research has examined the relationship between posttraumatic confusion (PTC) and cooperation during rehabilitation from moderate to severe traumatic brain injury. In this study, PTC and cooperation were examined in a prospective cohort of 74 inpatients with traumatic Brain Injury. Confusion was measured using the Confusion Assessment Protocol...
Article
Assess spinal reflex excitability after increasing intrathecal baclofen (ITB) flow by manipulation of drug concentration and mode of administration. The effect of concentration was assessed by comparing changes in H-reflex (H/M ratio) 1-6h after a 50μg ITB bolus at 50μg/ml concentration administered manually via lumbar puncture (LP, duration 1-2min...
Article
This study aimed to provide clinical injection data and real-world patient-reported and clinical outcomes for the chemodenervation and neurolytic treatment of muscle overactivity including spasticity in patients with traumatic brain injury and stroke. This study used a prospective multicenter observational design. The participants were 487 patients...
Article
Objective: To examine the velocity-dependent change in medial gastrocnemius (MG) activity during the stance phase of gait in patients with moderate to severe resting hypertonia after stroke or traumatic brain injury (TBI). Design: Cohort study. Setting: Motion analysis laboratory in a tertiary-care rehabilitation hospital. Participants: Conv...
Article
Amantadine hydrochloride is one of the most commonly prescribed medications for patients with prolonged disorders of consciousness after traumatic brain injury. Preliminary studies have suggested that amantadine may promote functional recovery. We enrolled 184 patients who were in a vegetative or minimally conscious state 4 to 16 weeks after trauma...
Article
Examine (1) coactivation between tibialis anterior (TA) and medial gastrocnemius (MG) muscles during stance phase of gait in patients with moderate-to-severe resting hypertonia after stroke or traumatic brain injury (TBI) and (2) the relationship between coactivation and stretch velocity-dependent increase in MG activity. Gait and surface EMG were...
Article
Full-text available
Few studies address the course of recovery from prolonged disorders of consciousness (DOC) after severe traumatic brain injury (TBI). This study examined acute and long-term outcomes of persons with DOC admitted to acute inpatient rehabilitation within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Progra...
Article
Full-text available
Duration of post-traumatic amnesia (PTA) correlates with global outcomes and functional disability. Russell proposed the use of PTA duration intervals as an index for classification of traumatic brain injury (TBI) severity. Alternative duration-based schemata have been recently proposed as better predictors of outcome to the commonly cited Russell...
Article
Clinical trials demonstrate that onabotulinumtoxinA reduces upper limb post-stroke spasticity, with therapeutic response influenced by injected dose. Individual studies provide limited insight regarding muscle group-specific dose-response relationships. Our objective was to characterize dose-response relationships between onabotulinumtoxinA and mus...
Article
To characterize gait characteristics of adults with traumatic brain injury (TBI) and lower limb muscle hypertonia, distinguishing gait adaptations inherent to TBI motor impairment from those of healthy subjects walking at slower speed. Temporospatial and kinematic data of 31 patients with TBI (41 ± 30 months post-injury) walking at self-selected sp...
Article
Intrathecal baclofen (ITB) effectively reduces muscle hypertonia; however, associated complications influence its utility and acceptance. To systematically review the literature on procedure- and device-related complications associated with ITB infusion therapy for adult muscle hypertonia of spinal or cerebral origin. The authors searched the PubMe...
Article
Deep venous thrombosis (DVT) is a major cause of mortality and morbidity after traumatic brain injury (TBI). There is no consensus regarding appropriate screening, prophylaxis, or treatment during acute rehabilitation. This prospective observational study evaluated prophylactic anticoagulation during rehabilitation in patients with TBI aged 16 year...
Article
To evaluate lower extremity joint range of motion (ROM) during gait before and after intrathecal baclofen (ITB) bolus administration, and to explore the relation between changes in ROM and concurrent changes in gait speed and muscle hypertonia. Case series. Tertiary care rehabilitation center. Adults (N=28) with muscle hypertonia due to stroke, tra...
Article
Sherer M, Yablon SA, Nakase-Richardson R. Patterns of recovery of posttraumatic confusional state in neurorehabilitation admissions after traumatic brain injury. To provide preliminary descriptions of patterns of resolution of symptoms of acute confusion after traumatic brain injury (TBI). Prospective, descriptive, cohort study. Inpatient neuroreha...
Article
Guidelines for defining the minimally conscious state (MCS) specify behaviors that characterize emergence, including "reliable and consistent" functional communication (accurate yes/no responding). Guidelines were developed by consensus because of lack of empirical data. To evaluate the utility of the operational threshold for emergence from posttr...
Article
Intrathecal administration of baclofen is a well-established technique for modulating hypertonia secondary to upper motor neuron pathology. Despite the nearly 2 decades of widespread clinical use, this intervention presents many challenges to even experienced clinicians. The purpose of this clinical review is to describe some of the intricacies and...
Article
Early investigations classified traumatic brain injury (TBI) severity according to posttraumatic amnesia (PTA) duration, designating "greater than 7 days" as the most severe. PTA durations of more than 7 days are common in neurorehabilitation populations. Moreover, no study has derived a PTA severity schema anchored to late outcome. The purpose of...
Article
While spasticity is commonly treated with oral agents or botulinum neurotoxin (BoNT) injection, these treatments have not been systematically compared. This study performed a randomised, double-blind, placebo-controlled trial to compare injection of BoNT-Type A into spastic upper limb muscles versus oral tizanidine (TZD), or placebo, in 60 subjects...
Article
Full-text available
Classification of traumatic brain injury (TBI) severity guides management and contributes to determination of prognosis. Common indicators of TBI severity include Glasgow Coma Scale (GCS) scores, length of coma (LOC) and duration of post-traumatic amnesia (PTA). To compare GCS, LOC and PTA by examining distributions and intercorrelations and develo...
Article
Published guidelines for defining the "minimally conscious state" (MCS) included behaviours that characterise emergence, specifically "reliable and consistent" functional interactive communication (accurate yes/no responding) and functional use of objects. Guidelines were developed by consensus because of the lack of empirical data to guide definit...
Article
To investigate the prognostic significance of severity of post-traumatic confusion (PTC) and its constituent symptoms for early and late outcome after traumatic brain injury (TBI). Prospective cohort study. Inpatient brain injury rehabilitation program. A total of 168 patients meeting study criteria from 195 consecutive Traumatic Brain Injury Model...
Article
Full-text available
Measurement of the duration of post-traumatic amnesia (PTA) is common practice, serving as an important index of the severity of traumatic brain injury (TBI) and a predictor of functional outcome. However, controversy exists regarding the nature of PTA; some studies indicate that it is a confusional state with symptoms that extend beyond disorienta...
Article
Full-text available
To determine factors that influence the strength of therapeutic alliance for patients with traumatic brain injury (TBI) attending post-acute brain injury rehabilitation (PABIR) and to examine the association of therapeutic alliance with outcome after PABIR. Prospective cohort study. The study sample consisted of 69 of 95 patients with TBI admitted...
Article
The purpose of this study was to investigate the incidence of neutralizing antibody (NAb) formation in patients with poststroke spasticity treated with a specific formulation of botulinum toxin type A (BoNTA). Data from 3 previous clinical trials of BoNTA in patients with upper and/or lower limb spasticity were pooled and evaluated. Study 1 was a r...
Article
Implanted programmable pumps that infuse intrathecal baclofen (ITB) markedly enhance the ability of clinicians to manage severe spasticity in appropriately selected patients. Studies addressing the efficacy of this treatment modality have primarily used clinical outcome measures of impairment, particularly reduction in stiffness as measured by the...
Article
To determine national patterns of screening, prophylaxis, and treatment of deep venous thrombosis (DVT) following traumatic brain injury (TBI) within the Traumatic Brain Injury Model Systems (TBIMS). e-mail survey instrument. Multicenter Regional TBIMS. Fifteen of the 16 rehabilitation centers within the TBIMS responded to the survey (94% response...
Poster
Poster 56: Venous Thromboembolic Disease in Neurorehabilitation Admissions With Acquired Brain Injury: Impact of Acute-Care Hospital Screening. S. Yablon (University of Mississippi, Jackson, MS), D. Esposito, A. Badr, M. Sherer, J. Lee, K. Goodson, F. Spinoza, W. Rock. Disclosure: None declared. Objective: To investigate the influence of acute-care...
Article
Full-text available
To examine the relationship between CT abnormalities and early neuropsychological outcome following traumatic brain injury (TBI) using quantitative CT analyses, data reduction methods for neuropsychological results and specific hypotheses based on literature review. Observational, prospective cohort study using acute (emergency) CT data and neurops...
Article
Full-text available
To determine the impact of urbanicity of residence and occurrence of medical complications on outcome after traumatic brain injury (TBI). A consecutive series of persons admitted for inpatient TBI rehabilitation followed for 1 year post-injury. Inpatient brain injury rehabilitation programme in the southeastern US. One hundred and eleven persons wi...
Article
To determine the relationship between the H-reflex (H/M ratio) and continuous intrathecal baclofen (CITB) dose after pump implantation for control of spastic hypertonia. Soleus H-reflexes were serially recorded in 34 subjects (19 men, mean age 32 years, mean follow-up 1.7 years) during simple continuous mode of CITB delivery. Different fitting meth...
Article
Intrathecal baclofen (ITB) therapy has been increasingly employed for the management of poststroke spastic hypertonia, a complication that can lead to deformity, discomfort, and exacerbation of motor impairments. Because its use in stroke is not as established as other indications, ITB therapy has not been subjected to rigorous investigation. There...
Article
To examine the incidence and intercorrelation of early impaired self-awareness (ISA) and depression after traumatic brain injury (TBI), as well as their contributions to prediction of patients' subjective well-being at discharge from inpatient rehabilitation. Inception cohort. Inpatient rehabilitation. Subjects were 96 patients with TBI seen for in...
Article
Full-text available
To validate the Mississippi Aphasia Screening Test (MAST) which includes nine sub-scales measuring expressive and receptive language abilities. Evaluation of inpatients admitted to neurology, neurosurgery or rehabilitation units at two local hospitals and who were within 60 days of onset of a unilateral ischemic or haemorrhagic stroke (left hemisph...
Article
To compare clinical and neurophysiologic responses to intrathecal baclofen (ITB) bolus injection in subjects with spasticity after acquired brain injury. Prospective case series. Tertiary care rehabilitation center. Thirty consecutive ITB pump candidates with dysfunctional spasticity caused by traumatic brain injury, hypoxic encephalopathy, or stro...
Article
Impaired self-awareness (ISA) is common among patients with severe traumatic brain injury (TBI) and contributes to poorer functional outcome. There is keen interest in improving the understanding of this disorder as the neuroanatomic substrate of posttraumatic ISA is poorly understood. Determine whether (1) greater number of brain lesions, (2) grea...
Article
To evaluate changes in temporospatial gait parameters after intrathecal baclofen (ITB) bolus administration in patients with spasticity resulting from acquired brain injury by using computerized gait analysis. Case series; before-after intervention. Walking performance and spasticity in lower-extremity muscles were assessed before and at 2, 4, and...
Article
To describe the phenomenology of posttraumatic confusional state (PTCS) and to provide preliminary validation of a new procedure, the Confusion Assessment Protocol (CAP), for assessing PTCS. Criterion standard investigation. Inpatient traumatic brain injury (TBI) rehabilitation program. Two consecutive series of patients (n=62, n=93) with TBI admit...
Article
A number of techniques attempt to objectively quantify various clinical characteristics associated with spastic hypertonia and related motor disorders. These range in cost, complexity, physiologic basis of measured response, and invasiveness. With a greater range of treatment options for spasticity and an increase in the number of centers participa...
Article
To determine the prevalence and risk factors of deep vein thrombosis (DVT) among neurorehabilitation admissions with acquired brain injury (BI). In this prospective, sequential case series, 709 consecutive initial neurorehabilitation patients with BI < 120 days-including traumatic brain injury (TBI; n = 360), intracranial hemorrhage (ICH; n = 213),...
Article
Full-text available
To determine the incidence, duration and symptoms associated with acute confusion/delirium among traumatic brain injury (TBI) neuro-rehabilitation admissions. Prospective evaluation of neurobehavioural impairments following TBI among inpatient neurorehabilitation admissions. Eighty-five consecutive TBI model system patients were evaluated using mea...
Article
Objective: To provide preliminary validation of a new measure of posttraumatic confusional state (PTCS), the Confusion Assessment Protocol (CAP), that assesses 7 key symptoms of PTCS (disorientation, cognitive impairment, restlessness, fluctuation in presentation, nighttime sleep disturbance, decreased daytime arousal, psychotic-type symptoms). Des...
Article
Objective: To determine sensitivity of H-reflex in assessing spinal cord responsiveness before and after programming complex-continuous mode of intrathecal baclofen (ITB) delivery. Design: Prospective, consecutive sample. Setting: Traumatic Brain Injury Model Systems inpatient rehabilitation center. Participants: 7 patients with dysfunctional spast...
Article
Objective: To examine the relationship between P300 latency and amplitude and neuropsychologic test scores in persons with traumatic brain injury (TBI) during acute inpatient rehabilitation. Design: Prospective, consecutive sample. Setting: Traumatic Brain Injury Model Systems (TBIMS) acute inpatient rehabilitation center. Participants: 52 patients...
Article
Investigate the impact of race on productivity outcome after traumatic brain injury (TBI) and evaluate the influence of confounding factors on this relationship. Inception cohort of 1083 adults with TBI for whom 1-year productivity follow-up data were available. Univariable logistic regression indicated that race was a significant predictor of prod...