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Short-term effects of thoracic spinal manipulations and message conveyed by clinicians to patients with musculoskeletal shoulder symptoms: a randomized clinical trial. - The Journal of manual & manipulative therapy
Randomized clinical trial.To evaluate the effects of high-velocity, low-amplitude thrust manipulations (HVLATMs) and various messages on patients with musculoskeletal shoulder symptoms.Previous studies indicated that HVLATM directed at the thoracic spine and ribs resulted in improvements of shoulder range of motion, pain, and disability in patients with musculoskeletal shoulder symptoms. These studies did not explore if the outcome was dependent on thrust location, clinician communication with the patient, or if there were any lasting effects.A consecutive sample of 100 patients with shoulder pain was randomized into four groups. Patients received one intervention session including: six thoracic HVLATM (spine versus scapula), a message about HVLATM (neutral versus positive), and standardized home exercises. Outcome measures included shoulder Numeric Pain Rating Scale (NPRS), NPRS with impingement testing, and Shoulder Pain and Disability Index (SPADI). Measurements were recorded prior to intervention, immediately following intervention, and at short-term follow-up. Kruskal-Wallis statistics were used for between-group comparisons and Wilcoxon signed ranks for within-group comparisons.Eighty-eight patients (22 per group) completed the study. Statistically significant differences were found for within-group comparisons for most time points assessed. No statistical differences were found for between-group comparisons.Patients improved following the interventions. Neither the type of HVLATM nor the message conveyed to the patients had a significant effect on the patients' improvements.1b.
The Shoulder Pain and Disability Index: Is it sensitive and responsive to immediate change? - Manual therapy
The Shoulder Pain and Disability Index (SPADI) is designed to detect changes in shoulder pain and disability after a one-week interval. With the new Medicare guideline, the SPADI may have to be employed for time frames of less than one week.To determine if the SPADI or its subscales could detect immediate changes in pain and function after a thoracic manipulative intervention known to produce short-term improvement and by comparing it to changes on the numeric pain rating scale (NPRS).Subjects with primary complaints of non-post-surgical shoulder pain completed the NPRS and the SPADI prior to and immediately following interventions.The SPADI pain subscale detected statistically significant differences that were also detected using the NPRS. In addition, the SPADI pain score and the NPRS scores were moderately correlated between the pre-intervention SPADI and NPRS scores (r = 0.49-0.61, p < 0.001) and post-intervention SPADI and NPRS scores (r = 0.49-0.67, p < 0.001). These differences did not appear to be sensitive or responsive to immediate change.Since the SPADI may have to be employed in durations of less than one week secondary to third party payer requirements, it is valuable to validate the SPADI for this particular use.Although SPADI scores demonstrated low sensitivity and responsiveness to immediate changes, the SPADI pain scale was able to detect changes in durations of less than one week. This finding should be confirmed through further prospective experimentation.Copyright Â© 2014 Elsevier Ltd. All rights reserved.
Thoracic spinal manipulation for musculoskeletal shoulder pain: Can an instructional set change patient expectation and outcome? - Manual therapy
Planned secondary analysis of a randomized clinical trial.To examine: 1) patients' baseline expectations for treatment outcome of thoracic high velocity low amplitude thrust manipulations (HVLATM) to the thoracic spine for shoulder pain; 2) if the message conveyed by the clinician changed the patients' expectation; 3) any differences in outcome based on expectation independent of messaging.; and 4) any differences in outcome for those patients whose expectations significantly changed as a result of the messaging.Thoracic HVLATM may be an effective intervention for patients suffering from musculoskeletal shoulder pain. The role of expectation in the treatment effectiveness of this intervention has not been established.Subjects' expectations regarding the effectiveness of HVLATM on shoulder pain were recorded at baseline. This was reassessed immediately following the provision of positive or neutral instructional set. The subjects then received a thoracic or scapular HVLATM. The Shoulder Pain and Disability Index (SPADI) and the numeric pain rating scale (NPRS) were used as outcomes measures.There was a 10 subject change (23%) in positive expectation that was statistically significant (p = 0.019) following a positive message. There was no statistically significant difference in pain and function when these subjects were compared to all other subjects.Although patients' expectations of positive outcome significantly changed when providing a positive instructional set, these changes did not translate into clinically significant short term changes in shoulder pain and function.1b.Copyright Â© 2014 Elsevier Ltd. All rights reserved.
Upper extremity deep venous thromboembolism following arthroscopic labral repair of the shoulder and biceps tenodesis: a case report. - International journal of sports physical therapy
Case Report.Upper extremity deep vein thrombosis (UEDVT) is a rare complication following arthroscopic shoulder surgery. However, it is possible that a patient with an UEDVT will present to physical therapy as the first service to interact with the patient following surgery. As a result, proper screening in the physical therapy setting is essential.The purpose of this report is to present the case of a 37 year-old male who developed an upper extremity deep vein thrombosis (UEDVT) following arthroscopic glenohumeral labral repair and arthroscopically assisted biceps tenodesis. This patient presented with disproportionate pain and swelling of his involved upper extremity at his initial evaluation in physical therapy (8 days post-operatively), which raised the index of suspicion for an UEDVT.The patient was referred to the emergency department for immediate diagnostic testing and treatment. A Doppler scan provided a definitive diagnosis of UEDVT. Following successful medical treatment with anti-coagulant therapy, the patient went on to complete an otherwise uneventful course of rehabilitation.UEDVT events following arthroscopy are rare, and are often attributed to a systemic secondary stimulus. UEDVT following shoulder arthroscopy is a complication that occurs in the orthopaedic setting, but may present primarily to the physical therapist, and as such requires awareness of its clinical presentation and treatment. Care of UEDVT requires a systems-based approach when considering clinical manifestation, best treatment, and future research.
Tandem spinal stenosis: a case of stenotic cauda equina syndrome following cervical decompression and fusion for spondylotic cervical myelopathy. - The Journal of manual & manipulative therapy
Tandem spinal stenosis is a clinical phenomenon which may cause a functional loss related to neurologic compression in numerous areas of the spinal cord. In this phenomenon, the second area of symptomatic neurologic insult is not revealed until the primary symptomatic area has been treated. This case describes a 71-year-old male referred to physical therapy 4 weeks following a combined anterior/posterior C3/4 decompression and fusion for treatment of cervical spondylotic myelopathy. Approximately 8 weeks post-operatively (4 weeks after initiation of physical therapy), the patient began to complain of bilateral lower extremity weakness, primarily with climbing stairs. At 12 weeks post-operatively, the patient developed bowel incontinence and saddle paresthesia. Magnetic resonance imaging revealed multiple levels of critical stenosis of the lower thoracic and upper lumbar spine, which resulted in referral for surgical intervention. Following surgical decompression there was complete recovery of lower extremity strength, saddle area sensation and bowel function. This case highlights the need for the clinician to remain vigilant for concomitant pathology despite successful surgical intervention. A thorough knowledge of the presentation of various spinal disorders, as well as a thorough neurologic examination, is required to accurately recognize both candid and subtle red flags requiring immediate referral for surgical intervention.
The impact of psychotherapy, pharmacotherapy, and their combination on quality of life in depression. - Harvard review of psychiatry
Quality of life (QOL) is known to be negatively affected during the course of major depressive disorder. Various studies have documented the benefits of pharmacotherapy or psychotherapy alone on QOL in depression, with few studies examining combined treatment. This review will examine the evidence for the impact of each modality, as well as their combination, on QOL in depression.Using the key terms depression, depress*, major depress*, quality of life, antidepressant*, and psychotherapy, MEDLINE and PsycINFO searches were conducted to identify treatment-outcome studies that used known QOL measurements over the past twenty-six years (1984 to 2010).Significant improvements in depressive symptomatology and QOL measurements were found with pharmacotherapy, psychotherapy, and their combination, with some studies showing greater improvement following combined treatment than with either intervention alone.Substantial evidence suggests that psychotherapy, pharmacotherapy, and their combination have favorable effects on QOL in depression. While some studies have shown that combined therapy is superior than either of the two forms alone in improving QOL, additional research is needed to elucidate this effect. QOL measurement is an important dimension of treatment-outcome assessment in patients with depression.
Surface-enhanced Raman spectroscopy of soft-landed polyatomic ions and molecules. - Analytical chemistry
Surface-enhanced Raman spectroscopy (SERS) was used to detect and characterize polyatomic cations and molecules that were electrosprayed into the gas phase and soft-landed in vacuum on plasma-treated silver substrates. Organic dyes such as crystal violet and Rhodamine B, the nucleobase cytosine, and nucleosides cytidine and 2'-deoxycytidine were immobilized by soft landing on plasma-treated metal surfaces at kinetic energies ranging from near thermal to 200 eV. While enhancing Raman scattering 10(5)-10(6)-fold, the metal surface effectively quenches the fluorescence that does not interfere with the Raman spectra. SERS spectra from submonolayer amounts of soft-landed compounds were sufficiently intense and reproducible to allow identification of Raman active vibrational modes for structure assignment. Soft-landed species appear to be microsolvated on the surface and bound via ion pairing or pi-complexation to the Ag atoms and ions in the surface oxide layer. Comparison of spectra from soft-landed and solution samples indicates that the molecules survive soft landing without significant chemical damage even when they strike the surface at hyperthermal collision energies.
Bacterial incorporation of leucine into protein down to -20 degrees C with evidence for potential activity in sub-eutectic saline ice formations. - Cryobiology
Direct evidence for metabolism in a variety of frozen environments has pushed temperature limits for bacterial activity to increasingly lower temperatures, so far to -20 degrees C. To date, the metabolic activities of marine psychrophilic bacteria, important components of sea-ice communities, have not been studied in laboratory culture, not in ice and not below -12 degrees C. We measured [3H]-leucine incorporation into macromolecules (further fractionated biochemically) by the marine psychrophilic bacterium Colwellia psychrerythraea strain 34H over a range of anticipated activity-permissive temperatures, from +13 to -20 degrees C, including expected negative controls at -80 and -196 degrees C. For incubation temperatures below -1 degrees C, the cell suspensions [all in artificial seawater (ASW)] were first quick-frozen in liquid nitrogen. We also examined the effect of added extracellular polymeric substances (EPS) on [3H]-leucine incorporation. Results showed that live cells of strain 34H incorporated substantial amounts of [3H]-leucine into TCA-precipitable material (primarily protein) down to -20 degrees C. At temperatures from -1 to -20 degrees C, rates were enhanced by EPS. No activity was detected in the killed controls for strain 34H (or in Escherichia coli controls), which included TCA-killed, heat-killed, and sodium azide- and chloramphenicol-treated samples. Surprisingly, evidence for low but significant rates of intracellular incorporation of [3H]-leucine into protein was observed for both ASW-only and EPS-amended (and live only) samples incubated at -80 and -196 degrees C. Mechanisms that could explain the latter results require further study, but the process of vitrification promoted by rapid freezing and the presence of salts and organic polymers may be relevant. Overall, distinguishing between intracellular and extracellular aspects of bacterial activity appears important to understanding behavior at sub-freezing temperatures.
Experimental investigation of the homogeneous freezing of aqueous ammonium sulfate droplets. - The journal of physical chemistry. A
We have measured the light scattering intensity and homogeneous ice nucleation temperatures from water droplets containing 0-33 wt % ammonium sulfate. In these laboratory experiments, we used a free-fall freezing tube technique to determine the fraction of frozen droplets at a particular droplet temperature by measuring the depolarized light scattering intensity from the droplets in free-fall. Previously reported freezing temperatures for solution concentrations greater than 5 wt % display a larger spread than can be accounted for by the reported experimental errors. We find freezing temperatures in good agreement with the lowest temperature freezing results reported by previous experiments. Our ammonium sulfate freezing temperature data set with water activity less than 0.98 is consistent with a curve that deviates in activity shift by about 5% from the best-fit ice nucleation temperature versus water activity curve found by Koop et al. in 2000, but the significance of this deviation will only be known with further high-precision ice nucleation temperature measurements for other aqueous solutions.
Comparison of psychro-active arctic marine bacteria and common mesophillic bacteria using surface-enhanced Raman spectroscopy. - Applied spectroscopy
Psychro-active bacteria, important constituents of polar ecosystems, have a unique ability to remain active at temperatures below 0 degrees C, yet it is not known to what extent the composition of their outer cell surfaces aids in their low-temperature viability. In this study, aqueous suspensions of five strains of Arctic psychro-active marine bacteria (PAMB) (mostly sea-ice isolates), were characterized by surface-enhanced Raman spectroscopy (SERS) and compared with SERS spectra from E. coli and P. aerigunosa. We find the SERS spectra of the five psychro-active bacterial strains are similar within experimental reproducibility. However, these spectra are significantly different from the spectra of P. aeruginosa and E. coli. We find that the relative intensities of many of the common peaks show the largest differences reported so far for bacterial samples. An indication of a peak was found in the PAMB spectra that has been identified as characteristic of unsaturated fatty acids and suggests that the outer membranes of the PAMB may contain unsaturated fatty acids. We find that using suspensions of silver colloid particles greatly intensifies the Raman peaks and quenches the fluorescence from bacterial samples. This technique is useful for examination of specific biochemical differences among bacteria.
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