Weathering the storms of climate change: Preparing persons with disabilities and the physiatrists who provide their care for extreme hurricanes.

Climate-driven disasters have disproportionate and often devastating consequences on individuals with disabilities. Warming ocean and air temperatures are fueling more extreme tropical cyclones, further endangering those living in at-risk regions. Although hurricane preparedness is particularly critical for those with functional impairments and/or special medical needs, studies show such persons are less ready for disasters than the general population. This review calls attention to the time-urgent need to improve hurricane readiness among persons with disabilities. It summarizes evidence that climate change is resulting in cyclonic storms that are increasingly jeopardizing the health and safety of affected persons and reflects on how this trend may compound the particular hardships those with disabilities experience during times of disaster. It identifies unique storm-related challenges faced by patient populations commonly cared for by physiatrists, including those with stroke, traumatic brain injury, multiple sclerosis, spinal cord injury, and limb loss. Available research pertaining to the gaps in emergency preparedness practices among persons with disabilities is reviewed as are potential strategies to mitigate barriers to achieving disaster readiness and resilience. Lastly, the review provides physiatrists with a comprehensive guide for optimally safeguarding their patients before, during, and after catastrophic hurricanes.

Treatment and Management of Work-Related Mild Traumatic Brain Injury in Physical Medicine and Rehabilitation.

ABSTRACT: The purpose of this narrative review was to assess work-related mild traumatic brain injury treatment approaches and outcomes. Literature indicates that incidence of work-related mild traumatic brain injury is high. Ability to return to work after injury is variable, with differences identified across industry sector, mechanisms of injury, sex, and timely treatment and referral. Additional challenges exist in the context of secondary gains (e.g., financial) and the potential for symptom exaggeration. Emerging evidence from studies outside the United States demonstrate the benefits of proactive assessment and treatment at the time of injury. These benefits can be further augmented by early referral to multidisciplinary treatment teams led by physical medicine and rehabilitation physicians. Opportunities for ongoing research and development of strategies to improve treatment, management, and more timely return to work for patients with occupational mild traumatic brain injury are discussed. It is concluded that challenges persist in treatment and management of patients with work-related mild traumatic brain injury as they present unique challenges not seen in those with nonwork-related mild traumatic brain injuries. The unique position of physical medicine and rehabilitation and the skills of physiatrists render them poised to lead multidisciplinary treatment teams for these patients and contribute to the development of a new guideline for return to work, with an emphasis on functional recovery.